Base de dados : MEDLINE
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[PMID]:29241237
[Au] Autor:Perez MF; Ongkeko Perez JV; Serrano AR; Andal MP; Aldover MC
[Ad] Endereço:Saint Patrick's Hospital Medical Centre, SPHMC-HH, Lopez Jaena Street, Batangas City, Philippines, mikeperezmd@yahoo.com.
[Ti] Título:Delayed hyperbaric intervention in life-threatening decompression illness.
[So] Source:Diving Hyperb Med;47(4):257-259, 2017 Dec.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Arterial gas embolism is a catastrophic event. Bubbles in the arterial circulation may lodge in the brain and cause infarction in the affected area and/or in a coronary vessel causing acute myocardial ischaemia. There is no well-defined window of time beyond which a response to hyperbaric oxygen is not expected. Major improvement may occur if the patient is treated as soon as possible, but is less likely in divers with severe decompression illness who have delayed intervention. We report on a 51-year-old, male rebreather diver who suffered loss of consciousness and cardiovascular collapse within minutes of a 30-metre deep dive at a remote Micronesian dive site. Recompression treatment did not start for six days for reasons to be presented, during which time he remained deeply comatose, cardiovascularly unstable and intubated on ventilator support. Despite this, following aggressive hyperbaric treatment over many days he made a functional recovery. At one year post injury, he is leading a functional life but has not returned to his previous occupation as a diver and suffers from moderately severe tinnitus and impaired right ear hearing and occasional mild speech problems. He is undertaking a number of on-line courses with a view to re-employment.
[Mh] Termos MeSH primário: Doença da Descompressão/terapia
Oxigenação Hiperbárica
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Doença da Descompressão/complicações
Seres Humanos
Masculino
Meia-Idade
Recuperação de Função Fisiológica
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.28920/dhm47.4.257-259


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[PMID]:29241236
[Au] Autor:Querido AL
[Ad] Endereço:Larenseweg 14, Hilversum, The Netherlands, bram@praktijkquerido.nl.
[Ti] Título:Diving and antidepressants.
[So] Source:Diving Hyperb Med;47(4):253-256, 2017 Dec.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Psychoactive drugs pose a risk to both the diver and his or her buddy. Little is known about the safety of diving with antidepressants. Amongst the potential interactions with the diving environment are: somnolence; convulsions; a bleeding tendency (potentially worsening decompression illness, DCI), alterations to glucose metabolism and psychiatric side effects. Fluoxetine may potentially reduce the inflammatory process associated with DCI. This article presents guidelines for recreational diving in combination with antidepressants. These guidelines were endorsed at a meeting of the Dutch Association for Diving Medicine in 2015 and are solely based on 'expert' opinion.
[Mh] Termos MeSH primário: Antidepressivos/efeitos adversos
Mergulho/psicologia
Fluoxetina/efeitos adversos
[Mh] Termos MeSH secundário: Glicemia/efeitos dos fármacos
Glicemia/metabolismo
Doença da Descompressão/etiologia
Mergulho/efeitos adversos
Hemorragia/induzido quimicamente
Seres Humanos
Convulsões/induzido quimicamente
Transtornos do Sono-Vigília/induzido quimicamente
[Pt] Tipo de publicação:GUIDELINE; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antidepressive Agents); 0 (Blood Glucose); 01K63SUP8D (Fluoxetine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.28920/dhm47.4.253-256


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[PMID]:29045210
[Au] Autor:Sun Q; Gao G
[Ad] Endereço:No. 401 Hospital of the People's Liberation Army, Qingdao, China guangkaigao@gmail.com.
[Ti] Título:Decompression Sickness.
[So] Source:N Engl J Med;377(16):1568, 2017 Oct 19.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Doença da Descompressão/diagnóstico por imagem
Embolia Aérea/diagnóstico por imagem
Veia Porta/diagnóstico por imagem
Radiografia Abdominal
Pele/patologia
[Mh] Termos MeSH secundário: Adulto
Doença da Descompressão/complicações
Doença da Descompressão/patologia
Embolia Aérea/etiologia
Seres Humanos
Masculino
Tomografia Computadorizada por Raios X
Vômito/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMicm1615505


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[PMID]:28868599
[Au] Autor:Lippmann J; McD Taylor D; Stevenson C; Williams J; Mitchell SJ
[Ad] Endereço:Divers Alert Network Asia-Pacific, Ashburton, Victoria, Australia.
[Ti] Título:Diving with pre-existing medical conditions.
[So] Source:Diving Hyperb Med;47(3):180-190, 2017 Sep.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: This is the second report based on a survey of Divers Alert Network Asia-Pacific (DAN AP) members who dive with cardiovascular and respiratory conditions and diabetes. It examines the medical management of the divers' conditions, any diving modifications used to mitigate the risk and outcomes. METHODOLOGY: An online cross-sectional survey was sent to 833 divers who had declared a targeted medical condition when applying for DAN AP membership between July 2009 and August 2013. RESULTS: Two-hundred-and-sixty-eight respondents (32%) provided sufficient information on their conditions to be included in the analyses. These included ischaemic heart disease (31), arrhythmias (20), cardiac septal defects (31), other cardiac conditions (10), hypertension (127), diabetes (25), asthma (40) and pneumothorax (5). Forty-nine per cent had sought specialist diving medical advice about their condition and 23% reported modifying their diving practices to mitigate their risk. The cohort had completed 183,069 career dives, 57,822 of these since being diagnosed with their medical condition. There were 27 individuals who reported having decompression illness (25 of whom were subsequently diagnosed with a persistent foramen ovale), and two individuals who experienced an arrhythmia during diving. CONCLUSIONS: Some DAN AP members are diving with medical conditions which could potentially impact the safety of their diving. A minority modified their diving practices to mitigate the risk of their condition and approximately half sought specialist diving medical advice. The incidence of diving-related problems precipitated by known and managed pre-existing health conditions seems low but further studies of larger cohorts and incorporating fatality data would be necessary to confirm this. These results are limited by the 32% response rate and potential for bias towards selection of those most careful with their health.
[Mh] Termos MeSH primário: Asma/epidemiologia
Diabetes Mellitus/epidemiologia
Mergulho/estatística & dados numéricos
Cardiopatias/epidemiologia
Hipertensão/epidemiologia
Pneumotórax/epidemiologia
[Mh] Termos MeSH secundário: Arritmias Cardíacas/epidemiologia
Doença da Descompressão/epidemiologia
Feminino
Defeitos dos Septos Cardíacos/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Isquemia Miocárdica/epidemiologia
Medicamentos sob Prescrição/uso terapêutico
Distribuição por Sexo
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Prescription Drugs)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28868598
[Au] Autor:Mirasoglu B; Aktas S
[Ad] Endereço:Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department.
[Ti] Título:Turkish recreational divers: a comparative study of their demographics, diving habits, health and attitudes towards safety.
[So] Source:Diving Hyperb Med;47(3):173-179, 2017 Sep.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In Turkey, scuba diving has become more popular and accessible in the past decade and there has been a commensurate rise in the number of certified divers. This new generation of recreational divers has not been described in detail previously. The aim of this study was to profile this group, while investigating any gender differences and making comparisons with the global diving community. METHODS: Turkish dive club members and diving forum/blog readers were invited to complete an online questionnaire investigating their demography, medical issues and diving history and habits. RESULTS: The questionnaire was completed by 303 female and 363 male divers. Significant differences were found between the sexes in terms of demographics, diving experience and attitudes toward safety. Previous or ongoing medical conditions were reported by 100 female divers and 141 males. Only 29% of females and 22% of males had been examined by a physician trained to conduct assessments of fitness to dive. Female divers did not report problems while diving during menstruation or while taking oral contraceptives. There was no significant difference in the occurrence of decompression sickness (DCS) and DCS-like symptoms between the sexes. CONCLUSION: This is the largest study to date conducted on recreational divers in Turkey and so carries some value. It profiles their physical and behavioral attributes as well as differences in diving practices between the sexes in Turkey. Our findings should have implications for medical screening and dive training standards.
[Mh] Termos MeSH primário: Atitude
Mergulho
Nível de Saúde
Segurança
Fatores Sexuais
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Índice de Massa Corporal
Certificação/estatística & dados numéricos
Descompressão/estatística & dados numéricos
Doença da Descompressão/epidemiologia
Mergulho/psicologia
Mergulho/normas
Mergulho/estatística & dados numéricos
Feminino
Síndrome Neurológica de Alta Pressão/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Medicamentos sob Prescrição/uso terapêutico
Recreação
Razão de Masculinidade
Inquéritos e Questionários
Turquia/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Prescription Drugs)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28868597
[Au] Autor:Reid MP; Fock A; Doolette DJ
[Ad] Endereço:Submarine Underwater Medicine Unit, Royal Australian Navy, Sydney, Australia.
[Ti] Título:Decompressing recompression chamber attendants during Australian submarine rescue operations.
[So] Source:Diving Hyperb Med;47(3):168-172, 2017 Sep.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Inside chamber attendants rescuing survivors from a pressurised, distressed submarine may themselves accumulate a decompression obligation which may exceed the limits of Defense and Civil Institute of Environmental Medicine tables presently used by the Royal Australian Navy. This study assessed the probability of decompression sickness (P ) for medical attendants supervising survivors undergoing oxygen-accelerated saturation decompression according to the National Oceanic and Atmospheric Administration (NOAA) 17.11 table. METHODS: Estimated probability of decompression sickness (P ), the units pulmonary oxygen toxicity dose (UPTD) and the volume of oxygen required were calculated for attendants breathing air during the NOAA table compared with the introduction of various periods of oxygen breathing. RESULTS: The P in medical attendants breathing air whilst supervising survivors receiving NOAA decompression is up to 4.5%. For the longest predicted profile (830 minutes at 253 kPa) oxygen breathing at 30, 60 and 90 minutes at 132 kPa partial pressure of oxygen reduced the air-breathing-associated P to less than 3.1 %, 2.1% and 1.4% respectively. CONCLUSIONS: The probability of at least one incident of DCS among attendants, with consequent strain on resources, is high if attendants breathe air throughout their exposure. The introduction of 90 minutes of oxygen breathing greatly reduces the probability of this interruption to rescue operations.
[Mh] Termos MeSH primário: Doença da Descompressão/terapia
Descompressão/normas
Pessoal de Saúde
Doenças Profissionais/terapia
Oxigenoterapia
Trabalho de Resgate
Navios
Medicina Submarina
[Mh] Termos MeSH secundário: Austrália
Descompressão/métodos
Seres Humanos
Consumo de Oxigênio
Oxigenoterapia/estatística & dados numéricos
Pressão
Valores de Referência
Água do Mar
Sobreviventes
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28868596
[Au] Autor:Reid MP; Fock A; Doolette DJ
[Ad] Endereço:Submarine Underwater Medicine Unit, Royal Australian Navy, Sydney, Australia.
[Ti] Título:Decompressing rescue personnel during Australian submarine rescue operations.
[So] Source:Diving Hyperb Med;47(3):159-167, 2017 Sep.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Personnel rescuing survivors from a pressurized, distressed Royal Australian Navy (RAN) submarine may themselves accumulate a decompression obligation, which may exceed the bottom time limits of the Defense and Civil Institute of Environmental Medicine (DCIEM) Air and In-Water Oxygen Decompression tables (DCIEM Table 1 and 2) presently used by the RAN. This study compared DCIEM Table 2 with alternative decompression tables with longer bottom times: United States Navy XVALSS_DISSUB 7, VVAL-18M and Royal Navy 14 Modified tables. METHODS: Estimated probability of decompression sickness (P ), the units pulmonary oxygen toxicity dose (UPTD), the volume of oxygen required and the total decompression time were calculated for hypothetical single and repetitive exposures to 253 kPa air pressure for various bottom times and prescribed decompression schedules. RESULTS: Compared to DCIEM Table 2, XVALSS_DISSUB 7 single and repetitive schedules had lower estimated P , which came at the cost of longer oxygen decompressions. For single exposures, DCIEM schedules had P estimates ranging from 1.8% to 6.4% with 0 to 101 UPTD and XVALSS_DISSUB 7 schedules had P of less than 3.1%, with 36 to 350 UPTD. CONCLUSIONS: The XVALSS_DISSUB 7 table was specifically designed for submarine rescue and, unlike DCIEM Table 2, has schedules for the estimated maximum required bottom times at 253 kPa. Adopting these tables may negate the requirement for saturation decompression of rescue personnel exceeding DCIEM limits.
[Mh] Termos MeSH primário: Doença da Descompressão/terapia
Descompressão/normas
Socorristas
Doenças Profissionais/terapia
Trabalho de Resgate/métodos
Navios
Medicina Submarina/métodos
[Mh] Termos MeSH secundário: Austrália
Descompressão/métodos
Descompressão/estatística & dados numéricos
Mergulho/fisiologia
Mergulho/estatística & dados numéricos
Seres Humanos
Oxigenoterapia
Valores de Referência
Medicina Submarina/normas
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28656350
[Au] Autor:Carlsen AW
[Ad] Endereço:The Natural History Museum of Denmark, Øster Voldgade 5-7, DK-1350, Copenhagen K, Denmark. agnetecarlsen@mail.dk.
[Ti] Título:Frequency of decompression illness among recent and extinct mammals and "reptiles": a review.
[So] Source:Naturwissenschaften;104(7-8):56, 2017 Aug.
[Is] ISSN:1432-1904
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The frequency of decompression illness was high among the extinct marine "reptiles" and very low among the marine mammals. Signs of decompression illness are still found among turtles but whales and seals are unaffected. In humans, the risk of decompression illness is five times increased in individuals with Patent Foramen Ovale; this condition allows blood shunting from the venous circuit to the systemic circuit. This right-left shunt is characteristic of the "reptile" heart, and it is suggested that this could contribute to the high frequency of decompression illness in the extinct reptiles.
[Mh] Termos MeSH primário: Doença da Descompressão
[Mh] Termos MeSH secundário: Animais
Mergulho
Forame Oval Patente
Seres Humanos
Mamíferos
Répteis
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1007/s00114-017-1477-1


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[PMID]:28641328
[Au] Autor:Sherlock S
[Ad] Endereço:Department of Anaesthesia and Department of Hyperbaric Services, Royal Brisbane and Women's Hospital and University of Queensland, susannah.sherlock@health.qld.gov.au.
[Ti] Título:ECHM Consensus Conference and levels of evidence.
[So] Source:Diving Hyperb Med;47(2):133, 2017 06.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:The ECHM Consensus Conference on indications for hyperbaric oxygen treatment (HBOT) was a welcome update of the evidence for HBOT use. However, clarification is requested in relation to how the GRADE system (Grades of Recommendation, Assessment, Development and Evaluation) was modified and how levels of evidence were applied in the case of idiopathic sudden sensorineural hearing loss (ISSHL). GRADE has a low kappa value for inter-observer agreement, so is modification valid? The original GRADE criteria, using consensus, grades evidence (defined as high, low and very low) and uses this to adjust the strength of recommendations. Randomised controlled trials (RCTs) score highly. The ECHM have modified the GRADE system without explanation, assigning grades as levels 1 to 4 and have asserted that RCTs which are double-blinded constitute level 1 or 2 evidence. This has important implications for HBOT research. The term double-blinded is not used in the abstract, which leads the reader to wonder; where do RCTs which are not double-blinded fit in? The ECHM, by including the term double blinded as a requirement for level 1 or 2, has lifted the evidence bar. Does this constitute a form of research "bracket creep"? Double-blinding is viewed by many to require a 'sham' treatment in hyperbaric research. Many conditions require multiple doses requiring daily hospital attendance with associated costs of lost time from work and daily transport costs. Even with a crossover after the sham, a requirement of many ethics committees, the lost time for a patient is a considerable burden. Delaying HBOT until crossover in those randomised to the control group in a disease that has a narrow therapeutic temporal window, such as idiopathic sudden sensorineural hearing loss (ISSHL), may affect the chance of recovery. Double blinding is logistically difficult with HBOT. A sham treatment may be achieved by using air instead of oxygen; however, this exposes the non-intervention group to a risk that the intervention group does not have, that of decompression sickness (DCS). This may be considered to be unethical. Researchers have used hypoxic air mixtures to compensate for the higher oxygen partial pressure at depth as the control, but this is complex and increases the nitrogen load (and thus the risk of DCS). RCTs which control by other methods should still be considered high level evidence (as the original GRADE system recognised). Many indications for HBOT have multiple therapies against which to compare, which could act as a control. The requirement for double-blinding to achieve level 1 or 2 evidence may hamper research; an unintended negative consequence. There is lack of consistency of definitions in relation to levels of evidence used by the ECHM. The authors state that for clinical research the levels of evidence are; levels A to F, which they defined. The ECHM jury used a grading scale of level 1 to 4. For ISSHL, this results in a recommendation to treat based on level B evidence. Is this the same as level 2 in their modified system? This is confusing. The authors have not explained why they modified the GRADE system which is itself non-validated. The lack of references to the publications which provide the foundation for the strength of the recommendations leaves the reader unable to determine the true strength of the evidence. The GRADE system has been criticised as it dissociates recommendations from the evidence that the recommendation is founded upon. Further, the application of the GRADE system has been questioned when strong recommendations are made with it as this may cause ethics committees to question whether equipoise exists, further hampering research. How do we present a well-designed trial for ISSHL to an ethics committee when a strong recommendation has already been made despite the Cochrane review on ISSHL concluding there is a need for large, well designed RCTs in this area?
[Mh] Termos MeSH primário: Doença da Descompressão
Oxigenação Hiperbárica
[Mh] Termos MeSH secundário: Pesquisa Biomédica
Método Duplo-Cego
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE


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[PMID]:28641324
[Au] Autor:Tan VH; Chin K; Kumar A; Chng J; Soh CRSR
[Ad] Endereço:Hyperbaric and Diving Medicine Centre, 16 College Road, Block 4, Level 1, Singapore General Hospital, Singapore 169854, rick.soh.chai@sgh.com.sg.
[Ti] Título:Treatment preferences for decompression illness amongst Singapore dive physicians.
[So] Source:Diving Hyperb Med;47(2):118-122, 2017 Jun.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Owing to the scarcity of randomized controlled trials to guide treatment for decompression illness (DCI), there are many unanswered questions about its management. Apart from reviews and expert opinion, surveys that report practice patterns provide information about useful management strategies. Hence, this study aimed to identify current treatment preferences for DCI amongst diving physicians in Singapore. METHODS: An anonymous web-based questionnaire was sent to known diving physicians in Singapore. The demographics of the respondents were captured. Respondents were asked about their preferred management for five different DCI scenarios. RESULTS: The response rate was 74% (17 of 23 responses). All respondents chose to recompress patients described in the five scenarios. Regarding the number of recompression sessions, "one additional session after no further improvement in signs and symptoms" was the most common end point of treatment across all the scenarios (47 of 85 responses). Analgesics would be used by five physicians, three would use lidocaine and two steroids as adjuvant therapies. CONCLUSIONS: Apart from the general agreement that recompression is indicated for DCI, there was no strong consensus regarding other aspects of management. This survey reinforces the need for robust RCTs to validate the existing recommendations for DCI treatment.
[Mh] Termos MeSH primário: Doença da Descompressão/terapia
Oxigenação Hiperbárica
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Analgésicos/uso terapêutico
Seres Humanos
Retratamento
Singapura
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE



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