Medicina
-
Randomized Controlled Trial Comparative Study
[Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study].
The aim of the study was to find minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery. ⋯ Groups were comparable in demographics. No case of failure was registered but 4 patients (10.5%) in the group 3 received supplemental i/v fentanyl to treat tension in the abdomen intraoperatively. Level of sensory block in groups 1, 2, 3 was 10.4+/-1.7, 7.013+/-2.2, 6.7+/-1.9 dermatomes, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=1.0 group 2 vs 3, Bonferroni). Extent of motor block was 2-3 scores according to the Bromage scale in 70.5% of group 1 cases, compared to 0-1 score in 97.3% of group 2 and 92.1% of group 3 cases. Median (range) duration of motor block in groups 1, 2, 3 was 90 (0-120), 0 (0-90), and 0 (0-60) min, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=0.13 group 2 vs 3, Bonferroni). Time of ambulation was 181.5+/-41.5, 136.6+/-32.2 and 123.0+/-45.9 min, respectively (p<0.0001 ANOVA; p<0.001 group 1 vs 2, p<0.00001 group 1 vs 3, p=0.43 group 2 vs 3, Bonferroni). There was no significant intergroup difference in time to urinate; retention developed in 20.4% of total cases. No difference was found in morphine consumption, 64.5% of cases did not require rescue analgesics. Quality of anesthesia was stated as excellent by the anesthesiologist and surgeon in all groups. However, quality was rated as excellent by patient in the operating room in groups 1, 2, 3: 58.8, 94.7, and 86.8%, respectively (p=0.003), on day 1 postoperatively: 76.5, 92.1, and 97.4%, respectively (p=0.023); by nursing staff: 82.4, 100, and 97.4%, respectively (p=0.019). Lower rates in group 1 were due to extensive motor block. In conclusion, a minimal recommended dose of spinal hyperbaric bupivacaine for anorectal surgery is 4-5 mg; a dose of 7.5 mg is excessive due to prolonged sensory and motor block.
-
Hypertension is one of the most common medical problems affecting approximately 1 billion individuals worldwide. Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis. Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies. ⋯ Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury. Blood pressure can be lowered less rapidly in this condition. In this review article it is discussed about clinical assessment of patients under these conditions, evaluating neurological, cardiovascular, renal end-organ damage; how much blood pressure should be lowered, which medication should be used to lower blood pressure, treating hypertensive emergencies and urgencies; and management of specific conditions (acute intracranial events, acute left ventricular dysfunction etc).
-
Health education encompasses opportunities for learning designed to improve health literacy, including increased knowledge and the development of life skills that lead to the improvement of individual and community health. Health literacy represents the cognitive and social skills, which determine the motivation and ability of individuals to gain access, to understand and use information in ways, which promote and maintain good health. There are three types of health literacy: basic, functional and critical. ⋯ It implies a significant level of knowledge, personal skills and confidence to manage one's health, and the ability to take action to change the determinants of health in the environment. Although these levels of health literacy are widely examined but systematic point of view is missing. The goal of this article is to report the peculiarities of the health literacy education system.
-
Comparative Study
[Influence of sensitization to pollen and food allergens on pollinosis clinical symptoms].
Geographic position and local plants of the country influence the profile of sensitization of the population to airborne allergens. The aim of this study was to evaluate the sensitization pattern to pollen and food allergens in adult patients with pollinosis in Lithuania. 101 patients (age 16-63 years) suffering from seasonal allergic rhinitis and 23.8% of them also diagnosed with concomitant seasonal asthma were investigated. Oral allergy syndrome (OAS) was diagnosed in 29.7% of cases. The sensitization to 21 species of tree-, grass- and weed-pollen and plant food allergens was determined by positive skin prick and prick-prick test. In serum levels of total IgE and timothy and orchard grass specific IgE were determined by immunoenzyme assay. 52.5% of patients suffered from spring-summer pollinosis. 91.2% of patients were sensitized to grass-pollen allergens, 79.3% -to tree pollen-allergens. 74.7% of patients were allergic to weeds. Pollinosis starting in the spring and lasting more than sixteen weeks was associated with increased probability of OAS (OR=7.1, p<0.001 and OR=3.1, p=0.01). Sensitization to hazelnut (OR=8.6, p=0.009), birch (OR=9.6, p=0.07), lamb's quarters (OR=5.2, p=0.04) allergens and twofold and more increase in serum IgE (OR=4.8, p=0.03) were considered the significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma (OR=3.4, p=0.03). Sensitization to ragweed was associated with decreased risk for asthma (OR=0.26, p=0.03). ⋯ Our data indicate that more than a half of patients (52.5%) had pollinosis symptoms during spring and summer seasons because of multiple sensitivity to pollen allergens. Sensitization to hazelnut, birch, lamb's quarters allergens, more than two times elevated serum IgE are significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma, but sensitization to ragweed was associated with decreased risk for pollinosis with asthma.
-
Randomized Controlled Trial Comparative Study
[Postoperative analgesia with intraarticular local anesthetic bupivacaine and alpha2-agonist clonidine after arthroscopic knee surgery].
To evaluate the efficacy of intraarticular 0.5% 20 ml bupivacaine and compound of bupivacaine with alpha2-agonist clonidine for postoperative analgesia after arthroscopic knee surgery. A total of 48 patients, scheduled for knee arthroscopy, were enrolled in the study. Patients were randomly assigned to three different groups: placebo (group C), and two experimental groups that received one of the following double-blinded intraarticular solutions: 0.5% 20 ml of bupivacaine (group B) and 0.5% 20 ml of bupivacaine with l microg/kg of clonidine (group B+C). Patients were asked to evaluate on a visual analogy scale (VAS) the intensity of pain at rest and during motion, satisfaction with postoperative analgesia. Side effects and requirements for supplemental analgetics were recorded at the same time. ⋯ The compound of intraarticular bupivacaine and clonidine suppresses pain better than intraarticular injection of bupivacaine or use of usual systemic analgetics (p<0.05). Intraarticular analgesia assures satisfaction with anesthesiologic procedure.