The difficult patient: Drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism [O paciente difícil: Interação entre drogas e influência de doenças concomitantes no tratamento do hipotiroidismo]
Ward L.S.,University of Medical Sciences of Costa Rica
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2010
Although most hypothyroid patients do well with one single tablet of thyroxine daily, approximately 10% are dissatisfied and another important group of patients is difficult to control. We reviewed the most common causes for frequent-dose adjustment or high-dose requirement, including poor compliance with therapy and inadequate medication. Since these two causes have been ruled out, drug interaction and other concomitant diseases need to be investigated. Requirements of thyroxine increase in all conditions characterized by impaired gastric acid secretion. Proton-pump inhibitors, antacids and a long list of drugs may decrease thyroxine absorption. In addition, a series of diseases including celiac disease and chronic inflammatory intestinal diseases, as well as nutritional habits may be important in patient control. Finally, we mention the effects of a growing list of drugs and thyroid disruptors that may also affect thyroid hormone metabolism at many levels. Copyright© ABE&M todos os direitos reservados.
Barragan-Garfias J.A.,University of Medical Sciences of Costa Rica
Revista médica del Instituto Mexicano del Seguro Social | Year: 2013
The main physiological function of the immune system consists in the defense against infectious micro-organisms. Sometimes there is a loss of immunological tolerance with the consequence of ignorance of self-antibodies. Some thyroid diseases are related to autoimmune diseases associated with the most common exocrine glands between them. There are also the autoimmune thyroid organ specific diseases, such as Graves-Basedow and the Hashimoto thyroiditis. It has been shown that there is a higher prevalence of autoimmune thyroid diseases in patients with connective tissue diseases (systemic autoimmune) such as Sjögren syndrome, rheumatoid arthritis, systemic lupus erithmatosis and systemic myopathic diseases. In the same way a higher prevalence of antinuclear antibodies against antigens extracted from the nucleus in patients with a thyroid autoimmune disease has been identified. There is a high percentage of patients with subclinical thyroid diseases, and it is recommended for patients with connective tissue diseases with hypo- or hyperthyroidism to have thyroid globulin and peroxide antibodies measured.
Saito A.,University of Medical Sciences of Costa Rica |
Castilho R.F.,University of Medical Sciences of Costa Rica
Neurochemical Research | Year: 2010
The adenine nucleotides ADP and ATP are probably the most important endogenous inhibitors of the mitochondrial permeability transition (MPT). We studied the inhibitory effects of adenine nucleotides on brain MPT by measuring mitochondrial swelling and Ca2+ and cytochrome c release. We observed that in the presence of either ADP or ATP, at 250 μM, brain mitochondria accumulated more than 1 μmol Ca2+ × mg protein-1. ADP or ATP also prevented Ca2+-induced mitochondrial swelling and cytochrome c release. Interestingly, ATP lost most of its inhibitory effects on MPT when the experiments were carried out in the presence of ATP-regenerating systems. These results indicate that MPT inhibition observed in the presence of added ATP could be mainly due to hydrolysis of ATP to ADP. From mitochondrial swelling measurements, half-maximal inhibitory values (K i) of 4.5 and 98 μM were obtained for ADP and ATP, respectively. In addition, a delayed mitochondrial swelling sensitive to higher ADP concentrations was observed. Mitochondrial anoxia/reoxygenation did not interfere with the inhibitory effect of ADP on Ca2+-induced MPT, but oxidative phosphorylation markedly decreased this effect. We conclude that ADP is a potent inhibitor of brain MPT whereas ATP is a weaker inhibitor of this phenomenon. Our results suggest that ADP can have an important protective role against MPT-mediated tissue damage under conditions of brain ischemia and hypoglycemia. © 2010 Springer Science+Business Media, LLC.
Canesqui A.M.,University of Medical Sciences of Costa Rica
Ciencia e Saude Coletiva | Year: 2010
This article is a summary on the intellectual production of Social and Human Science in Health concerned to the Public Health area in Brazil. It includes 498 articles and books reviews, from eight Public Heath journals consulted in the electronic database SciELO. A theoretical and methodological analysis was performed on the main and secondary's themes, the changes in the previous decades, considering also the literature reviews (1997-2007). The themes and its perceptual distributions are: health policies and institutions 32.5%; health and illness 18.5%; gender and health 16.5%; violence and health 9.0%; old age and aging 4.0%; human resources, health professions and education 7.5%; social studies on sciences production and techniques 7.0% as well as health education and communication 4.0%. The results show an academic production growth; the use of combined theories, approaches and methodologies; the residual interdisciplinary between live science and social science and the guarantee of the disciplinarian's approaches. A multi-institutional research agenda is recommended to refine the investigations on health conditions and social transformations; health policies and services; professional training; knowledge and technologies.
Araujo D.B.,University of Medical Sciences of Costa Rica
Acta reumatológica portuguesa | Year: 2010
Sexual function is closely related to satisfactory quality of life. The sexual activity has an impact in the sexual satisfaction of patient, several aspects of personal life and in their relationships. Systemic autoimmune diseases affect various organs and systems and they can determine sexual dysfunction in patients, particularly with: rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, vasculitis and idiopathic inflammatory myopathies. Manuscripts describing sexual function in these diseases, mainly with large population, are scarce. Sexual dysfunction in females and males with rheumatic diseases is multifactorial due to chronic disease aspects, disease activity and drugs. A multidisciplinary approach is essential in order to offer preventive measures for these patients. The authors did a literature review based on Medline, Lilacs and Pubmed data using the keywords: sexual function, sexuality, reproductive health and rheumatic diseases.
The Brazilian Unified Health System (SUS), State Public Policy: Its institutionalized and future development and the search for solutions [SUS, política pública de Estado: Seu desenvolvimento instituído e instituinte e a busca de saídas]
dos Santos N.R.,University of Medical Sciences of Costa Rica
Ciencia e Saude Coletiva | Year: 2013
This paper redeems the significance of the health reform movement and the municipal healthcare movement in the context of the 1970s and 1980s, and its social, politic and innovative power in the democratic reconstruction of the day. It then notes that the implementation of the constitutional guidelines, regulated in 1990 by Laws 8080/90 and 8142/90, has been characterized in the last 22 years by four major and mounting obstacles imposed by State policy on all governments: federal underfunding; federal subsidies to the private health plan market; resistance to reform of the State management structure of service provision; and the handing over of administration of public facilities to private entities. The Brazilian Unified Health System (SUS) included half the population that was once excluded in the public health system, though these obstacles keep the coverage of primary care focused below the poverty line and with poor resolution. The conclusion drawn is that the real policy of the state for healthcare in the past 22 years has prioritized the creation and expansion of the private health plan market for consumer rights, and relegated the effectiveness of constitutional guidelines for civic human rights to second place.
Dominguez-Rosado I.,University of Medical Sciences of Costa Rica
Annals of Surgery | Year: 2016
OBJECTIVE:: Our goal was to determine the optimal timing for repair of bile duct injuries sustained during cholecystectomy. BACKGROUND:: Bile duct injury during cholecystectomy is a serious complication that often requires surgical repair. There is heterogeneity in the literature regarding the optimal timing of surgical repair, and it remains unclear to what extent timing determines postoperative morbidity and long-term anastomotic function. METHODS:: A single institution prospective database was queried for all E1 to E4 injuries from 1989 to 2014 using a standardized tabular reporting format. Timing was stratified into 3 groups [early (<7 days), intermediate (8 days until 6 weeks), and late (>6 weeks) after injury]. Analysis was stratified between those who had a previous bile duct repair or not, including postoperative complications and anastomotic failure as outcome variables in 2 separate multivariate logistic regression models. RESULTS:: There were 614 patients included in the study. The mean age was 41 years (range, 15–85 yrs), and the majority were female (80%). The mean follow-up time was 40.5 months. Side-to-side hepaticojejunostomy was performed in 94% of repairs. Intermediate repair was associated with a higher risk of postoperative complications [odd ratio = 3.7, 95% confidence interval (1.3–10.2), P = 0.01] when compared with early and late in those with a previous repair attempt. Sepsis control and avoidance of biliary stents were protective factors against anastomotic failure. CONCLUSIONS:: Adequate sepsis control and delayed repair of biliary injuries should be considered for patients presenting between 8 days and 6 weeks after injury to prevent complications, if a previous bile duct repair was attempted. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Nunes E.D.,University of Medical Sciences of Costa Rica
Salud Colectiva | Year: 2014
The article discusses the possibility of applying Kuhn's concept of paradigm to collective health. The concept and its use in epidemiology, planning and the social sciences are reviewed briefly. The study stresses the multi-paradigmatic character of collective health, resulting from the convergence of multiple epistemologies and the involvement of diverse fields such as the biological sciences, philosophy, the social sciences and humanities.
Batista-Duharte A.,University of Medical Sciences of Costa Rica
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2012
The occurrence and significance of autoimmune manifestations after administration of vaccines remain controversial. Evidence for immunization triggered autoimmunity come from several sources including theoretical models, animal studies, single and multiple case reports. In contrast, several epidemiological studies don't report this association, which is reassuring and at least indicates that vaccines are not a major cause of autoimmune diseases. We analyzed current scientific data concluded that vaccines bring a positive impact on public health, so it is necessary to continue developing this technology. Evaluation methods should be improved to avoid or anticipate the possible autoimmune side effects that can be presented.
[Anthropometric measures for the introduction of the nasogastric tube for enteral nutrition employing the esophagogastroduodenoscopy]. [Medidas antropométricas na introdução da sonda nasogástrica para nutrição enteral empregando a esofagogastroduodenoscopia.]
Malta M.A.,University of Medical Sciences of Costa Rica
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery | Year: 2013
The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.