Eur Rev Med Pharmaco
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Eur Rev Med Pharmaco · Feb 2013
ReviewPsychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases.
In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. ⋯ Substance induced mood disorders and psychotic symptoms are as much frequent conditions in ED, and the recognition of associated organic symptoms may allow to achieve diagnosis. Finally, psychiatric and organic symptoms may be caused by prescription and doping medications, either as a direct effect or after withdrawal. Adverse drug reactions can be divided in type A, dose dependent and predictable, including psychotropic drugs and hormones; and type B, dose independent and unpredictable, usually including non psychotropic drugs, more commonly included being cardiovascular, antibiotics, anti-inflammatory and antineoplastic medications.
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Eur Rev Med Pharmaco · Feb 2013
Comparative StudyPrevention of acute renal failure post-contrast imaging in cardiology: a randomized study.
The contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure (ARF) and the worsening in a pre-existing chronic renal failure (CRF), with a foreseeable increase of morbidity, mortality, length of the stay in hospital and, as a consequence, of the health costs. We studied the effectiveness of N-acetylcysteine (NAC) associated with sodium bicarbonate (Na2HCO3) infusion in order to prevent CIN in patients undergoing coronary angiography with administration of contrast medium. ⋯ In patients affected by severe CRF who are undergoing investigations with contrast medium administration, such as coronary angiography, the combined use of NAC + Na2HCO3 infusion significantly reduces the risk of developing CIN. In other circumstances the final result is related to the degree of previous GFR or creatinine values alteration or to gender. In such situations the combined use of both substances is more questionable and sometimes ineffective.
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Eur Rev Med Pharmaco · Feb 2013
Clinical TrialInfluence of sepsis on higher daily dose of amikacin pharmacokinetics in critically ill patients.
Severe sepsis is a major problem as cause of high rates morbidity and mortality in intensive care units (ICU). Aminoglycosides are an important group of antimicrobials used for severe sepsis. However, aminoglycoside pharmacokinetics in ICU patients may be altered during sepsis, which can affect the drug concentrations. Therefore, this study was undertaken to examine the relationship between amikacin disposition kinetics after a 25 mg/kg loading dose and hemodynamic response to sepsis, as well as clinical parameters, in a population of critically ill patients. ⋯ It appears necessary to use higher amikacin dosage (≥ 25 mg/kg) considering hemodynamic response of patients to sepsis. To achieve therapeutic drug concentration a close drug monitoring and a shift from the population mean toward a value more representative of the critically ill patient subpopulation is crucial.
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Eur Rev Med Pharmaco · Feb 2013
Recurrent use of the Emergency Department in patients with anxiety disorder.
Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks. During panic attacks, patients (pts) refer to the Emergency Department (ED). The diagnostic work-up for any panic attack is expensive since symptoms at presentation mimic other diseases such acute coronary syndrome or neurological emergencies. The aim of the present study was to describe a 10 years cohort of pts diagnosed with panic disorder in the ED in terms of ED visit recurrence. ⋯ Male under 40 years old with palpitations or cardiovascular risk and other psychiatric diseases, have a higher recurrence of panic attacks. General psychiatric evaluation and treatment with benzodiazepine in ED is not useful to prevent recurrences. Identifying those patients at high risk of panic attack and ED visit recurrence might be useful to establish ad-hoc interventions, improve patients' morbidity and save precious resources.
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Eur Rev Med Pharmaco · Feb 2013
Chronic utilization of agents acting on the renin-angiotensin system and intraoperative arterial pressure.
There has been concern that taking agents acting on the renin-angiotensin system (ARAS) in surgery day, may predispose patients to higher risk of intraoperative hypotension during surgery. Therefore, the European Society of Cardiology and the European Society of Anesthesiology recommend transient discontinuation of ARAS before non-cardiac surgery in hypertensive patients. As the existent evidence is limited, this recommendation remains debated. ⋯ In our study hypotension episodes during non-cardiac surgery could not be attributed to ARAS chronic utilization and taking ARAS on surgery morning when compared with withdrawal was not associated with hypotension episodes.