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[PMID]:29443669
[Au] Autor:El-Jawahri AR; Schaefer PW; El Khoury JB; Martinez-Lage M
[Ad] Endereço:From the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Massachusetts General Hospital, and the Departments of Medicine (A.R.E.-J., J.B.E.K.), Radiology (P.W.S.), and Pathology (M.M.-L.), Harvard Medical School - both in Boston.
[Ti] Título:Case 5-2018: A 63-Year-Old Man with Confusion after Stem-Cell Transplantation.
[So] Source:N Engl J Med;378(7):659-669, 2018 Feb 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Confusão/etiologia
Transplante de Células-Tronco Hematopoéticas/efeitos adversos
Herpesvirus Humano 6/isolamento & purificação
Hospedeiro Imunocomprometido
Meningoencefalite/diagnóstico
Infecções por Roseolovirus/diagnóstico
[Mh] Termos MeSH secundário: Antivirais/uso terapêutico
Autopsia
Diagnóstico Diferencial
Evolução Fatal
Foscarnet/uso terapêutico
Reação Enxerto-Hospedeiro
Seres Humanos
Leucemia Linfocítica Crônica de Células B/terapia
Masculino
Meningoencefalite/complicações
Meningoencefalite/virologia
Meia-Idade
Infecções por Roseolovirus/complicações
Infecções por Roseolovirus/tratamento farmacológico
Transplante Homólogo
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiviral Agents); 364P9RVW4X (Foscarnet)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1707556


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[PMID]:29254496
[Au] Autor:Villalobos-Vindas JM; Amuy E; Barquero-Calvo E; Rojas N; Chacón-Díaz C; Chaves-Olarte E; Guzman-Verri C; Moreno E
[Ad] Endereço:Caja Costarricense de Seguro Social, San José, Costa Rica.
[Ti] Título:Brucellosis caused by the wood rat pathogen Brucella neotomae: two case reports.
[So] Source:J Med Case Rep;11(1):352, 2017 Dec 19.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Brucellosis is a chronic bacterial disease caused by members of the genus Brucella. Among the classical species stands Brucella neotomae, until now, a pathogen limited to wood rats. However, we have identified two brucellosis human cases caused by B. neotomae, demonstrating that this species has zoonotic potential. CASES PRESENTATION: Within almost 4 years of each other, a 64-year-old Costa Rican white Hispanic man and a 51-year-old Costa Rican white Hispanic man required medical care at public hospitals of Costa Rica. Their hematological and biochemical parameters were within normal limits. No adenopathies or visceral abnormalities were found. Both patients showed intermittent fever, disorientation, and general malaise and a positive Rose Bengal test compatible with Brucella infection. Blood and cerebrospinal fluid cultures rendered Gram-negative coccobacilli identified by genomic analysis as B. neotomae. After antibiotic treatment, the patients recovered with normal mental activities. CONCLUSIONS: This is the first report describing in detail the clinical disease caused by B. neotomae in two unrelated patients. In spite of previous claims, this bacterium keeps zoonotic potential. Proposals to generate vaccines by using B. neotomae as an immunogen must be reexamined and countries housing the natural reservoir must consider the zoonotic risk.
[Mh] Termos MeSH primário: Brucelose/diagnóstico
Infecções do Sistema Nervoso Central/diagnóstico
[Mh] Termos MeSH secundário: Brucella
Confusão/etiologia
Costa Rica
Febre/etiologia
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1496-8


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[PMID]:28991942
[Au] Autor:Koneri N; Muck A; Adams BD
[Ad] Endereço:Kendall Regional Medical Center, Miami, FL, USA.
[Ti] Título:Confusion recurs 2 weeks after fall.
[So] Source:J Fam Pract;66(10):635-637, 2017 Oct.
[Is] ISSN:1533-7294
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 77-year-old woman presented to the emergency department complaining of a headache following a syncopal episode (while standing) earlier that day. She said that she'd lost consciousness for several minutes, and then experienced several minutes of mild confusion that resolved spontaneously. On physical exam, she was oriented to person and place, but not time. She had a contusion in her left occipitoparietal region without extensive bruising or deformity. The patient had normal cardiopulmonary, abdominal, and neurologic exams. Her past medical history included hypertension and normal pressure hydrocephalus, and her vital signs were within normal limits. She was taking aspirin once daily. The patient's initial head and neck computerized tomography (CT) scans were normal, but she was hospitalized because of her confusion. During her hospitalization, the patient had mild episodic headaches that resolved with acetaminophen. The next day, her confusion resolved, and repeat CT scans were unchanged. She was discharged within 24 hours. Two weeks later, the patient returned to the hospital after her daughter found her on the toilet, unable to stand up from the sitting position. She was confused and experienced a worsening of headache during transport to the hospital. No recurrent falls or additional episodes of trauma were reported. A CT scan was performed. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
[Mh] Termos MeSH primário: Acidentes por Quedas
Confusão/etiologia
Hematoma Subdural Agudo/diagnóstico por imagem
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Idoso
Feminino
Hematoma Subdural Agudo/etiologia
Hematoma Subdural Agudo/psicologia
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE


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[PMID]:28711275
[Au] Autor:Nguyen MT; Stoianovici R; Brunetti L
[Ad] Endereço:Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; Department of Pharmacy, Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA. Electronic address: may.nguyen@rwjbh.org.
[Ti] Título:Chemotherapy induced stroke mimic: 5-Fluorouracil encephalopathy fulfilling criteria for tissue plasminogen activator therapy.
[So] Source:Am J Emerg Med;35(9):1389-1390, 2017 Sep.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Stroke mimics, especially those involving chemotherapy related neurotoxicity, can confound the clinical diagnosis of acute stroke. Here we describe the case of a 63year-old male with a recent history of stage IIIC colon cancer who presented with confusion on the second day of modified FOLFOX6 (5-fluorouracil/oxaliplatin) chemotherapy and subsequently received alteplase, tissue plasminogen activator therapy (tPA), for presumed ischemic stroke. Magnetic resonance imaging scans after tPA administration did not reveal evidence of an infarction and the patients' neurological symptoms resolved completely after discontinuation of 5-fluorouracil (5-FU). Although this patient did not experience any side effects from tPA, fibrinolytic therapy may have been avoided with a better understanding of potential chemotherapy related adverse reactions. Our experience suggests that 5-FU induced reversible encephalopathy can present with acute stroke-like symptoms and emergency medicine personnel evaluating patients for tPA treatment should be aware of this differential diagnosis.
[Mh] Termos MeSH primário: Antimetabólitos Antineoplásicos/efeitos adversos
Encefalopatias/induzido quimicamente
Neoplasias do Colo/tratamento farmacológico
Fluoruracila/efeitos adversos
[Mh] Termos MeSH secundário: Antimetabólitos Antineoplásicos/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica
Afasia/induzido quimicamente
Encefalopatias/diagnóstico por imagem
Confusão/induzido quimicamente
Diagnóstico Diferencial
Fibrinolíticos/uso terapêutico
Fluoruracila/administração & dosagem
Cefaleia/induzido quimicamente
Seres Humanos
Leucovorina
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Compostos Organoplatínicos
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/tratamento farmacológico
Ativador de Plasminogênio Tecidual/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antimetabolites, Antineoplastic); 0 (Fibrinolytic Agents); 0 (Organoplatinum Compounds); EC 3.4.21.68 (Tissue Plasminogen Activator); Q573I9DVLP (Leucovorin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170717
[St] Status:MEDLINE


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[PMID]:28670166
[Au] Autor:Park SE; Choi DS; Shin HS; Baek HJ; Choi HC; Kim JE; Choi HY; Park MJ
[Ad] Endereço:Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea.
[Ti] Título:Splenial Lesions of the Corpus Callosum: Disease Spectrum and MRI Findings.
[So] Source:Korean J Radiol;18(4):710-721, 2017 Jul-Aug.
[Is] ISSN:2005-8330
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:The corpus callosum (CC) is the largest white matter structure in the brain, consisting of more than 200-250 million axons that provide a large connection mainly between homologous cerebral cortical areas in mirror image sites. The posterior end of the CC is the thickest part, which is called the splenium. Various diseases including congenital to acquired lesions including congenital anomalies, traumatic lesions, ischemic diseases, tumors, metabolic, toxic, degenerative, and demyelinating diseases, can involve the splenium of the CC and their clinical symptoms and signs are also variable. Therefore, knowledge of the disease entities and the imaging findings of lesions involving the splenium is valuable in clinical practice. MR imaging is useful for the detection and differential diagnosis of splenial lesions of the CC. In this study, we classify the disease entities and describe imaging findings of lesions involving the splenium of the CC based on our experiences and a review of the literature.
[Mh] Termos MeSH primário: Corpo Caloso/diagnóstico por imagem
Imagem por Ressonância Magnética
[Mh] Termos MeSH secundário: Encefalopatias/diagnóstico por imagem
Confusão/diagnóstico por imagem
Confusão/patologia
Corpo Caloso/anatomia & histologia
Seres Humanos
Infarto/diagnóstico por imagem
Infarto/patologia
Lipoma/diagnóstico por imagem
Lipoma/patologia
Doenças Neurodegenerativas/diagnóstico por imagem
Doenças Neurodegenerativas/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.3348/kjr.2017.18.4.710


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[PMID]:28657866
[Au] Autor:Mukerji SS; Gonzalez RG; Gandhi RT; Kraft S
[Ad] Endereço:From the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Radiology (R.G.G.), Medicine (R.T.G.), and Pathology (S.K.), Harvard Medical School - both in Boston.
[Ti] Título:Case 20-2017 - A 48-Year-Old Man with Weight Loss, Confusion, Skin Lesions, and Pancytopenia.
[So] Source:N Engl J Med;376(26):2580-2589, 2017 06 29.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Complexo AIDS Demência/diagnóstico
Síndrome de Imunodeficiência Adquirida/diagnóstico
HIV-1
Dermatopatias/patologia
[Mh] Termos MeSH secundário: Síndrome de Imunodeficiência Adquirida/complicações
Carcinoma Basocelular/patologia
Confusão/etiologia
Diagnóstico Diferencial
Lobo Frontal/diagnóstico por imagem
HIV-1/isolamento & purificação
Seres Humanos
Leucoencefalopatia Multifocal Progressiva/diagnóstico
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Pancitopenia/etiologia
RNA Viral/sangue
RNA Viral/líquido cefalorraquidiano
Sarcoma de Kaposi/patologia
Dermatopatias/etiologia
Tomografia Computadorizada por Raios X
Perda de Peso
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (RNA, Viral)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1616401


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[PMID]:28539246
[Au] Autor:Dean RK; Subedi R; Gill D; Nat A
[Ad] Endereço:Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States. Electronic address: deanr@upstate.edu.
[Ti] Título:Consideration of alternative causes of lactic acidosis: Thiamine deficiency in malignancy.
[So] Source:Am J Emerg Med;35(8):1214.e5-1214.e6, 2017 Aug.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Lactic acidosis is a common metabolic acidosis characterized by increased serum lactate and is usually associated with a decreased blood pH. Lactic acidosis has many different causes but has been differentiated into type A, hypoxic causes, and type B, non-hypoxic causes. Tissue hypoxia, type A, is the most common cause, usually secondary to processes such as sepsis and multi-organ failure. Type A must be differentiated from type B in the correct clinical setting as treatments are vastly different. Type B causes may include drug side-effects, toxins, enzymatic defects, inherited or acquired, any of which may lead to overproduction or underutilization of lactate. However, as most clinicians are more familiar, and likely more initially concerned with hypoxic etiologies, evaluation is directed toward finding the source of hypoperfusion or hypoxia, and thus generally leading to a delay in discovering a type B cause (or mixed type A and type B). Here we describe a case of lactic acidosis in the setting of thiamine deficiency thought to be secondary to advanced lung cancer. The purpose of this paper is to bring awareness to the clinician to consider other causes of lactic acidosis when evaluating a patient.
[Mh] Termos MeSH primário: Acidose Láctica/diagnóstico
Neoplasias Ósseas/tratamento farmacológico
Neoplasias Encefálicas/tratamento farmacológico
Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico
Deficiência de Tiamina/complicações
Tiamina/uso terapêutico
Complexo Vitamínico B/uso terapêutico
[Mh] Termos MeSH secundário: Acidose Láctica/etiologia
Acidose Láctica/terapia
Idoso
Protocolos de Quimioterapia Combinada Antineoplásica
Neoplasias Ósseas/secundário
Neoplasias Encefálicas/secundário
Carboplatina/administração & dosagem
Confusão
Etoposídeo/administração & dosagem
Seres Humanos
Masculino
Agitação Psicomotora
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
12001-76-2 (Vitamin B Complex); 6PLQ3CP4P3 (Etoposide); BG3F62OND5 (Carboplatin); X66NSO3N35 (Thiamine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE


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[PMID]:28494088
[Au] Autor:Guay J; Parker MJ; Griffiths R; Kopp S
[Ad] Endereço:Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.
[Ti] Título:Peripheral nerve blocks for hip fractures.
[So] Source:Cochrane Database Syst Rev;5:CD001159, 2017 05 11.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017. OBJECTIVES: This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. SEARCH METHODS: For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles. SELECTION CRITERIA: We included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach. MAIN RESULTS: We included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P < 0.00001). Based on seven trials with 676 participants, we did not find a difference in the risk of acute confusional state (risk ratio (RR) 0.69, 95% CI 0.38 to 1.27; I = 48%; very low quality of evidence). Three trials with 131 participants reported decreased risk for pneumonia (RR 0.41, 95% CI 0.19 to 0.89; I = 3%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 72; moderate quality of evidence). We did not find a difference in risk of myocardial ischaemia or death within six months, but the number of participants included was well below the optimal information size for these two outcomes. Two trials with 155 participants reported that peripheral nerve blocks also reduced time to first mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I = 52%; moderate quality of evidence). One trial with 75 participants indicated that the cost of analgesic drugs was lower when they were given as a single shot block (SMD -3.48, 95% CI -4.23 to -2.74; moderate quality of evidence). AUTHORS' CONCLUSIONS: High-quality evidence shows that regional blockade reduces pain on movement within 30 minutes after block placement. Moderate-quality evidence shows reduced risk for pneumonia, decreased time to first mobilization and cost reduction of the analgesic regimen (single shot blocks).
[Mh] Termos MeSH primário: Fraturas do Quadril/cirurgia
Bloqueio Nervoso/métodos
Manejo da Dor
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Anestésicos Locais/administração & dosagem
Anestésicos Locais/efeitos adversos
Confusão/epidemiologia
Feminino
Fraturas do Quadril/mortalidade
Seres Humanos
Masculino
Movimento
Infarto do Miocárdio/epidemiologia
Bloqueio Nervoso/efeitos adversos
Medição da Dor
Dor Pós-Operatória/terapia
Nervos Periféricos
Pneumonia/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Anesthetics, Local)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD001159.pub2


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[PMID]:28411733
[Au] Autor:Valéry B; Scannella S; Peysakhovich V; Barone P; Causse M
[Ad] Endereço:Ecole Nationale de l'Aviation Civile, 7, Avenue Edouard-Belin, 31055, Toulouse, France; Institut Supérieur de L'Aéronautique et de L'Espace, DCAS, Human Factors, 10, Avenue Edouard-Belin, 31055 Toulouse Cedex 4, Midi-Pyrénées, France. Electronic address: benoit.valery@isae.fr.
[Ti] Título:Can an aircraft be piloted via sonification with an acceptable attentional cost? A comparison of blind and sighted pilots.
[So] Source:Appl Ergon;62:227-236, 2017 Jul.
[Is] ISSN:1872-9126
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:In the aeronautics field, some authors have suggested that an aircraft's attitude sonification could be used by pilots to cope with spatial disorientation situations. Such a system is currently used by blind pilots to control the attitude of their aircraft. However, given the suspected higher auditory attentional capacities of blind people, the possibility for sighted individuals to use this system remains an open question. For example, its introduction may overload the auditory channel, which may in turn alter the responsiveness of pilots to infrequent but critical auditory warnings. In this study, two groups of pilots (blind versus sighted) performed a simulated flight experiment consisting of successive aircraft maneuvers, on the sole basis of an aircraft sonification. Maneuver difficulty was varied while we assessed flight performance along with subjective and electroencephalographic (EEG) measures of workload. The results showed that both groups of participants reached target-attitudes with a good accuracy. However, more complex maneuvers increased subjective workload and impaired brain responsiveness toward unexpected auditory stimuli as demonstrated by lower N1 and P3 amplitudes. Despite that the EEG signal showed a clear reorganization of the brain in the blind participants (higher alpha power), the brain responsiveness to unexpected auditory stimuli was not significantly different between the two groups. The results suggest that an auditory display might provide useful additional information to spatially disoriented pilots with normal vision. However, its use should be restricted to critical situations and simple recovery or guidance maneuvers.
[Mh] Termos MeSH primário: Estimulação Acústica
Sinais (Psicologia)
Carga de Trabalho
[Mh] Termos MeSH secundário: Adulto
Aeronaves/instrumentação
Atenção
Simulação por Computador
Confusão/prevenção & controle
Eletroencefalografia
Seres Humanos
Meia-Idade
Tempo de Reação
Análise e Desempenho de Tarefas
Transtornos da Visão/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170417
[St] Status:MEDLINE


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[PMID]:28393558
[Au] Autor:Lam RPK; Tang MHY; Leung SC; Chong YK; Tsui MSH; Mak TWL
[Ad] Endereço:a Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Hong Kong Special Administrative Region , China.
[Ti] Título:Supraventricular tachycardia and acute confusion following ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA: a case report with quantitative analysis of serum drug concentrations.
[So] Source:Clin Toxicol (Phila);55(7):662-667, 2017 Aug.
[Is] ISSN:1556-9519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: AB-FUBINACA and ADB-FUBINACA are structurally similar synthetic cannabinoids with potent CB receptor agonistic effects. Very little is known about their pharmacology and toxicology. OBJECTIVE: To report a case of supraventricular tachycardia and acute confusion after ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA, with quantitative analysis of the serum drug concentrations. CASE REPORT: A healthy 24-year-old man ingested two drops of e-cigarette fluid which were later found to contain AB-FUBINACA and ADB-FUBINACA. Within 30 min of ingestion, he became somnolent, confused, and agitated, with palpitation and vomiting. On arrival to the emergency department, a short run of supraventricular tachycardia was noted, which resolved spontaneously. Bedside urine immunoassay failed to detect recreational drugs. Laboratory blood tests showed mild hypokalemia. Exposure to AB-FUBINACA and ADB-FUBINACA was confirmed analytically, with serum concentrations of 5.6 ng/mL and 15.6 ng/mL, respectively, in the blood sample collected on presentation. The patient recovered uneventfully with supportive treatment and was discharged 22 h after admission. DISCUSSION: AB-FUBINACA and ADB-FUBINACA are orally bioavailable with rapid onset of toxicity after ingestion. In this case, supraventricular tachycardia was likely the result of exposure to AB-FUBINACA and ADB-FUBINACA. The serum concentrations of AB-FUBINACA and ADB-FUBINACA were higher than those previously reported in fatal cases. CONCLUSION: In the context of acute poisoning, the presence of unexplained tachyarrhythmias, confusion, and a negative recreational drug screen should prompt clinicians to consider synthetic cannabinoid toxicity as a differential diagnosis.
[Mh] Termos MeSH primário: Confusão/induzido quimicamente
Overdose de Drogas
Sistemas Eletrônicos de Liberação de Nicotina/efeitos adversos
Indazóis/envenenamento
Transtornos Relacionados ao Uso de Substâncias/etiologia
Taquicardia Supraventricular/induzido quimicamente
[Mh] Termos MeSH secundário: Confusão/diagnóstico
Confusão/psicologia
Confusão/terapia
Diagnóstico Diferencial
Overdose de Drogas/sangue
Overdose de Drogas/diagnóstico
Seres Humanos
Indazóis/sangue
Masculino
Valor Preditivo dos Testes
Detecção do Abuso de Substâncias
Transtornos Relacionados ao Uso de Substâncias/diagnóstico
Transtornos Relacionados ao Uso de Substâncias/fisiopatologia
Transtornos Relacionados ao Uso de Substâncias/terapia
Taquicardia Supraventricular/diagnóstico
Taquicardia Supraventricular/fisiopatologia
Taquicardia Supraventricular/terapia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (AB-FUBINACA); 0 (ADB-FUBINACA); 0 (Indazoles)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170411
[St] Status:MEDLINE
[do] DOI:10.1080/15563650.2017.1307385



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