Detección de efectos secundarios asociados con la administración de tramadol y dipirona en un hospital de alta complejidad

Detección de efectos secundarios asociados con la administración de tramadol y dipirona en un hospital de alta complejidad. Adverse events associated with tramadol and dipirona administration in a level III hospital. Montoya GA, Vaca C, Parra MF. Departamento de Farmacia, Hospital Universitario de La Samaritana, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.gamontoyapi@unal.edu.co <gamontoyapi@unal.edu.co> Biomedica. 2009 Sep;29(3):369-81. Abstract INTRODUCTION: The efficacy and safety of pharmaceutical drugs such as dipirone and tramadol must be a primary objective in the post-marketing period and as they are used in specific population groups. OBJECTIVES: The frequency of adverse effects (including therapeutic failure) with the medications tramadol and dipirona were described and estimated. MATERIAL AND METHODS: At the Hospital Universitario de la Samaritana, Bogotá, D.C., Colombia, adverse events associated with dipirone and tramadol were rigorously tracked in patients hospitalized in the internal medicine, as well as the orthopedics and surgery departments. For a period of six months, data were collected by means of the Instituto Nacional de Vigilancia Médica y Alimentos (INVIMA) standard report form. Direct costs of adverse event treatment to the patient were calculated. RESULTS: Adverse reactions were detected 213 times in 171 (8.4%) of the 2,547 patients admitted to the services (incidence rate. Of these instances, 53.4% were rated as possible for dipirone and 46.82% for tramadol. Of the total, 0.6% (16 cases) were classes as serious adverse events. The gastrointestinal system was the most affected, with the incidences of adverse events for dipirone of 27%) and tramadol of 42.9%. The total cost generated by the medical response to the 213 adverse events was estimated to be US$14,346.53. CONCLUSIONS: An unacceptable level of preventable adverse events was described that impacted the well-being of patients, as well as the costs associated with remedial treatment. These data recommend that institutional pharmacovigilance programs be required. http://www.scielo.org.co/pdf/bio/v29n3/v29n3a06.pdf  Manejo de la sedoanalgesia y de los relajantes musculares en las unidades de cuidados intensivos pediátricos españolas. Sedative, analgesic and muscle relaxant management in Spanish paediatric intensive care units. Mencía S, Botrán M, López-Herce J, Del Castillo J; Grupo de Estudio de Sedoanalgesia de la SECIP. Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España. An Pediatr (Barc). 2011 Feb 23 Abstract OBJECTIVE: The aim of the study was to define the strategies for the use and monitoring of sedative, analgesic, and muscle relaxant medication in Spanish paediatric intensive care units (PICU). MATERIAL AND METHODS: A questionnaire with 102 questions was sent by e-mail to all Spanish PICUs. RESULTS: Replies were received from 36 of the 45 PICUs (80%). A written protocol for sedation and analgesia was used in 64%; this medication was adjusted according to the diagnosis and clinical status of the patient in 30% of the units. Midazolam was the most widely used drug for sedation, followed by ketamine and propofol. Fentanyl was the most widely used drug for analgesia, followed by paracetamol and metamizole. The combination of midazolam and fentanyl in continuous infusion was used most frequently in patients on mechanical ventilation (MV), followed by propofol. Scales to monitor sedation and analgesia were employed in 45% of PICUs, most used the Ramsay scale. The bispectral index (BIS) was used in 50% of PICUs. Muscle relaxants were administered to 26% of patients on MV; the most common indications for MV were head injury and severe respiratory disease. The principal methods for avoiding withdrawal syndrome were a progressive withdrawal of the drugs and morphine chloride. CONCLUSIONS: Although there is insufficient scientific evidence to determine the ideal drugs for sedation and analgesia in the critically ill child and the methods for monitoring and control, the production of guidelines and written treatment and monitoring protocols could help to improve the management and control of sedation and analgesia. http://www.elsevier.es/sites/default/files/elsevier/eop/S1695-4033(10)00581-3.pdf   La adición de metimazol a la morfina y paracetamol mejora la analgesia postoperatoria temprana y la satisfacción del paciente después de cirugía de discos lumbares The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery. Uzun S, Aycan IO, Erden IA, Sahin A, Aypar U. Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey. sennuruzun@superonline.com Turk Neurosurg. 2010 Jul;20(3):341-7. doi: 10.5137/1019-5149.JTN.3081-10.3. Abstract AIM: Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery. MATERIAL AND METHODS: After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated. RESULTS: NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups. CONCLUSION: Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction http://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_765.pdf  Metamisol no es tan seguro como pensamos o asumimos Metamizole is not as safe as we think or assume. Tekkok IH Turk Neurosurg. 2011 Jan;21(1):116-7. I have read the article by Uzun et al with great interest (Turkish Neurosurgery 20:341-347, 2010). The authors have designed a double-blind randomized clinical research with 63 patients undergoing surgery for lumbar disc disease. The patients were allocated into 3 groups. Group I patients received 1 gm of intravenous paracetamol and 1 gm of intravenous metamizole at the end of the operation whereas patients in Group II received only 1 gm of paracetamol at the end of the operation. Group III was the placebo group and did not receive paracetamol or metamizole. All three groups of patients were also given morphine through patient controlled analgesia (PCA) pumps. All patients were evaluated in terms of pain (evaluated using the Numeric Pain Rating Scale [0-3]), morphine consumption and patient satisfaction at postoperative 15 and 30 minutes and 1st, 2nd, 6th and 24th hours. The graphs depicting morphine consumption showed that Group III patients consumed more than those who were given paracetamol plus metamizole or paracetamol alone. The authors concluded that addition of metamizole to paracetamol along with morphine PCA offered an advantage over single morphine PCA and paracetamol with respect to early postoperative pain treatment and patient satisfaction...... http://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_830.pdf   Consenso de un grupo de expertos mexicanos. Eficacia y seguridad del Metamizol (Dipirona). Heriberto Arcila-Herrera, Sergio Barragán-Padilla, José Rafael Borbolla-Escoboza, Antonio Canto-Solís, Gilberto Castañeda-Hernández, Maximiliano de León-González, Miguel Ángel Genis-Rondero, Vinicio Granados-Soto, José Luis Gutiérrez-García,  Sonia Hernández-Hernández, Alicia Kassian-Rank, Víctor Lara-Perera, Jorge Bernardo Vargas-Correa. Gac Méd Méx 2004;140:99-101 Antecedentes El metamizol, también conocido como dipirona, es un agente analgésico y antipirético utilizado en México y otros países desde hace más de siete décadas. Una de las principales ventajas del metamizol es que permite un adecuado control del dolor y/o la fiebre a un costo reducido. Sin embargo, en países como los Estados Unidos, el metamizol no está disponible debido a algunos reportes que sobre su seguridad se publicaron en el pasado. En algunas ocasiones los medios masivos de comunicación han retomado estos reportes dando información, frecuentemente anecdótica y sin el debido apoyo científico, que puede inducir a confusiones. Por lo tanto, se formó un grupo de trabajo, con médicos de distintas especialidades e investigadores básicos de diversas ciudades del país, cuyo propósito fue generar y difundir información científicamente válida sobre el metamizol en México. El grupo se ha reunido en varias ocasiones, la última en agosto de 2002, cuando llegó al consenso, que se presenta a continuación. http://www.medigraphic.com/pdfs/gaceta/gm-2004/gm041p.pdf

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

"Actualización en Lactancia Materna"

Curso VIRTUAL "Actualización en Lactancia Materna" Facilitadores:  IBCLCs, Consultoras Internacionales de Lactancia Materna Certificados INICIO : * LUNES, 25 DE ABRIL DEL 2011 www.lactared.com.pe www.lactared.org

¿Por qué hacemos el Curso en Modalidad Virtual?

Porque, tú que eres un/una profesional con diversas responsabilidades podrás tener la oportunidad de acceder a un curso de excelente calidad y adaptando tu tiempo disponible, con horarios flexibles. Porque utilizaremos tecnología informática de avanzada, para brindarte conceptos y herramientas actuales y modernas, útiles para que la orientación  que se ofrezca a las mujeres gestantes y que dan de lactar sea eficiente. También para mejorar tus habilidades y tener mejor competencia en el manejo práctico de casos, para el logro de una lactancia materna exitosa.   Este  curso a distancia asistido por entornos virtuales de enseñanza - aprendizaje  vía internet se  desarrollará  a través  de recursos y actividades informáticas. La dinámica de tutorías que nuestros facilitadores (Tutor Docente y    Tutor tecnológico motivacional) llevarán a cabo para brindarte un curso personalizado, tendrá como herramientas: Uso de Portal Web Institucional: www.lactared.com.pe Uso de plataformas Virtuales de educación a distancia por Internet Asesoramiento permanente online Tutoría Virtual Telemática (evaluación y seguimiento online) Foros de discusión Diarios personales, encuestas online, consultas online Talleres online Actividades sincrónicas / asincrónicas online con evaluación virtual permanente

¿A quién  está dirigido?

A tí, que eres un profesional de la salud, atento a perfeccionar y fortalecer tus conocimientos para ejercer tu profesión con excelencia. A tí, que eres un profesional de la salud comprometido con la lactancia materna y el apoyo a madres gestantes y lactantes, pero que quieres profundizar tus conocimientos y habilidades, para postular al examen que te acreditará internacionalmente como IBCLC/International Board Certified Lactation Consultant (Consultor Internacional Certificado en Lactancia Materna) una nueva profesión en los países desarrollados del mundo globalizado en que vivimos. Puedes ser médico, enfermera, nutricionista, obstetriz, psicóloga u otro profesional de la salud, que labore en las áreas de atención y consejería a mujeres en  edad fértil, gestantes y/o que dan de lactar, tanto en los servicios de salud públicos como privados. También puedes ser un promotor o promotora de un organismos no gubernamental (ONG) que desarrolle actividades  de  salud y nutrición en la comunidad.

Temas que se desarrollarán en el Curso y la Metodología a utilizarse

MODULO I : LOS CIMIENTOS DE UNA LACTANCIA EXITOSA 1. Epidemiología y supervivencia infantil. 2. Nutrición de la madre durante la gestación y la lactancia. 3. Anatomía, fisiología y endocrinología de la lactancia materna. Anticoncepción y lactancia.       4. Técnicas exitosas para el inicio y mantenimiento de la lactancia materna.    MODULO II : SITUACIONES ESPECIALES Y ASPECTOS SOCIOCULTURALES DE LA LACTANCIA 1. El manejo de problemas de la madre y el niño durante la lactancia materna. 2. Amamantamiento en situaciones especiales (Prematuridad, ictericia, pobre ganancia de peso del     bebé, Inducción y Relactación). 3. Aspectos prácticos para el apoyo de la madre que trabaja. 4. Aspectos Socioculturales  de la lactancia materna. MODULO III: LO QUE HAY QUE SABER Y HACER PARA EL APOYO EFECTIVO A LA LACTANCIA OPTIMA 1. Enfermedades de la madre y el niño que pueden interferir con la lactancia materna. 2. Hospital Amigo de la Madre y el Niño. 3. Ética y lactancia. La importancia del Código de Comercialización de Sucedáneos de la Leche Materna. 4. Fármacos y lactancia materna. 5. Alimentación complementaria. Las nuevas curvas de crecimiento infantil (OMS-2006). El curso se desarrollará íntegramente por Internet, utilizando las herramientas del Centro Virtual de Formación en Lactancia Materna de LACTARED/ CEPREN/Red Peruana de Lactancia Materna.  El horario de actividades es asincrónico y sincrónico. Ud. podrá acceder desde cualquier cabina de Internet de LIMA ó PROVINCIAS o desde vuestra casa. Y algunas tareas se desarrollarán en horarios exactos (sincrónicos), mientras que la mayoría de tareas se pueden desarrollar en cualquier horario(asincrónicos). Duración del Curso Taller y Certificación:   Un mes por Módulo CERTIFICADO AL TERMINO DE CADA MODULO A LOS PARTICIPANTES CON NOTA DE EXAMEN APROBATORIA   Horario: El horario es administrado por LACTARED/CEPREN/Red Peruana de Lactancia Materna, estableciendo encuentros sincronizados así como también algunas sesiones serán coordinadas por grupos de acuerdo al horario en el que puedan asistir (mañana, tarde o noche), siendo el eje del curso, el desarrollo de las herramientas de nuestro Centro Virtual de Formación en Lactancia Materna Informes: CEPREN/ Red Peruana de Lactancia Materna  Dirección:   Av. José Pardo # 1335-302 Miraflores Teléfonos:  445 1978 /  241 6205 E-mail:     cepren.direccion@gmail.com                 cepren.cursos@gmail.com

Heidi Prather, DO, on Low Back Pain- Washington University Orthopedics

En este día...

ON THIS DAY

April 5

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On April 5, 1951, Julius and Ethel Rosenberg were sentenced to death for conspiring to commit espionage for the Soviet Union.

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On April 5, 1856, Booker T. Washington, the educator and reformer who became an important spokesperson for black Americans at the turn of the 20th century, was born. Following his death on Nov. 14, 1915, his obituary appeared in The Times.

Go to obituary » | Other birthdays »

On This Date

1614	Pocahontas, daughter of the leader of the Powhatan tribe, married English colonist John Rolfe in Virginia.
1649	Elihu Yale, the English philanthropist for whom Yale University is named, was born in Boston.
1792	George Washington cast the first presidential veto, rejecting a congressional measure for apportioning representatives among the states.
1856	Black educator Booker T. Washington was born in Franklin County, Va.
1887	British historian Lord Acton wrote in a letter, "All power tends to corrupt and absolute power corrupts absolutely."
1895	Playwright Oscar Wilde lost his criminal libel case against the Marquess of Queensberry, who had accused the writer of homosexual practices.
1908	Actress Bette Davis was born in Lowell, Mass.
1951	Julius and Ethel Rosenberg were sentenced to death for conspiring to commit espionage for the Soviet Union.
1964	Army Gen. Douglas MacArthur died at age 84.
1975	Nationalist Chinese leader Chiang Kai-shek died at age 87.
1976	Reclusive billionaire Howard Hughes died at age 72.
1984	Kareem Abdul-Jabbar became the highest-scoring player in NBA history with 31,421 career points. (He still holds the career record with with 38,387 points.)
1987	Fox Broadcasting Co. made its prime-time TV debut.
1992	Wal-Mart founder Sam Walton died at age 74.
1997	Beat poet Allen Ginsberg died at age 70.
2008	Actor Charlton Heston died at age 84.
2009	President Barack Obama, visiting Prague, launched an effort to rid the world of nuclear weapons, calling them "the most dangerous legacy of the Cold War."

Current Birthdays

Filmmaker Roger Corman turns 85 years old today.

AP Photo/Chris Pizzello

Country singer Troy Gentry (Montgomery-Gentry) turns 44 years old today.

AP Photo/Jae C. Hong

1922	Gale Storm, Actress, turns 89
1937	Colin Powell, Former secretary of state, turns 74
1941	Michael Moriarty, Actor, turns 70
1942	Allan Clarke, Rock singer (The Hollies), turns 69
1943	Max Gail, Actor ("Barney Miller"), turns 68
1950	Agnetha Faltskog, Singer (ABBA), turns 61
1968	Paula Cole, Rock singer, turns 43
1973	Pharrell Williams, Rapper, producer, turns 38

Historic Birthdays

Booker T. Washington4/5/1856 - 11/14/1915American educator and spokesman for black Americans.Go to obituary »

91	Thomas Hobbes 4/5/1588 - 12/4/1679 English philosopher and political theorist
72	Elihu Yale 4/5/1649 - 7/8/1721 American-born English merchant and benefactor of Yale University
74	Jean-Honore Fragonard 4/5/1732 - 8/22/1806 French rococo painter
51	Vincenzo Gioberti 4/5/1801 - 11/26/1852 Italian philosopher, politician and cleric
85	Baron Joseph Lister 4/5/1827 - 2/10/1912 English surgeon and scientist
72	Algernon Chas. Swinburne 4/5/1837 - 4/10/1909 English poet and critic
92	Lincoln Filene 4/5/1865 - 8/27/1957 American business executive and philanthropist; chairman of Federated Department Stores (1929-57)
85	Chester Bowles 4/5/1901 - 5/25/1986 American politician and advertising entrepreneur
81	Bette Davis 4/5/1908 - 10/6/1989 American motion-picture dramatic actress
78	Jagjivan Ram 4/5/1908 - 7/6/1986 Indian politician and spokesman for the untouchables
81	Herbert von Karajan 4/5/1908 - 7/16/1989 Austrian-born conductor
72	Chaim Grade 4/5/1910 - 6/26/1982 Russian-born Yiddish poet, short-story writer and novelist

Treatments Show Promise in Reducing Autism-related Behaviors, but Some Have Significant Side Effects

Press Release Date: April 4, 2011 Some medical and behavioral treatments show promise for reducing certain behaviors in children with autism spectrum disorders (ASDs), but more research is needed to assess the potential benefits and harms, according to a new report funded by HHS' Agency for Healthcare Research and Quality (AHRQ). The research results were published online in the journal Pediatrics. The comparative effectiveness report found that two commonly used medications—risperidone and aripiprazole—show benefit in reducing some behaviors, including emotional distress, aggression, hyperactivity and self-injury. However, these medicines are associated with significant side effects, such as rapid weight gain and drowsiness. The review found that no medications used for ASDs improved social behaviors or communication skills. The report also found that several medications show promise and should be studied further, but that secretin, which has been studied extensively, has shown no effectiveness. Children with ASDs have difficulty in social interaction, behavior, and communication. Some children with ASDs may also have impaired cognitive skills and sensory perception. Based on limited evidence, behavioral interventions also showed promise for improving some symptoms and behaviors, but their effects varied. For example, early intensive behavioral and developmental interventions seemed to improve cognitive performance, language skills, and adaptive behavior in some groups of children, the report found. Other interventions, which focused on parent training and cognitive behavioral therapy, may be useful for children with ASDs to improve social communication, language use and potentially symptom severity, researchers said. "Autism spectrum disorders are frustrating and challenging for patients, their families and caregivers," said AHRQ Director Carolyn M. Clancy, M.D. "This report will help parents and clinicians understand their options and design a course of treatment that is consistent with their goals and values." Researchers at the Vanderbilt Evidence-based Practice Center in Nashville, TN, who prepared the report for AHRQ, noted that further research is needed to identify which children are likely to benefit from particular interventions. The authors also were critical of the fact that current studies contain few comparisons of medical interventions with behavioral interventions as well as combinations of the two, despite the fact that most children undergo multiple treatments at the same time. Because of these limitations in the available evidence, researchers were not able to compare treatments and interventions to each other. In addition, they noted that every case of ASD is different and did not conclude that one type of treatment is superior. ASDs—which include autistic disorder, Asperger syndrome, and pervasive developmental disorder-not otherwise specified—affect an estimated 1 in every 110 children in the United States. Treatment goals for ASDs often focus on improving social communication and addressing certain behaviors. Other treatments also target anxiety, attention difficulties, and sensory difficulties. Goals for treatment often vary by child. The report, Comparative Effectiveness of Therapies for Children with Autism Spectrum Disorders, is the latest comparative effectiveness review from AHRQ's Effective Health Care program is available athttp://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct"productid=656. The Effective Health Care program sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The program, authorized by the Medicare Prescription Drug, Improvement and Modernization Act, represents an important Federal effort to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, doctors, nurses, pharmacists and others choose the most effective treatments. Information can be found at http://www.effectivehealthcare.ahrq.gov. For more information, please contact AHRQ Public Affairs: (301) 427-1892 or (301) 427-1855

Energía limpia

Intereses económicos obligan a los gobiernos a seguir empleando la energía nuclear.....

Twitter mexico Marzo 2011

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Twitter mexico Marzo 2011

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