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Dalle EN, De Cassai A, Geraldini F, Cipolletti GM, Bolzonello R, Calandra S, Melchioro S, Munari M. Feasibility of a Nurse-driven Protocol for Fever Management in Neurocritical Patients: A Retrospective Cohort Study. J Neurosurg Anesthesiol 2024; 36:85-87. [PMID: 36306190 DOI: 10.1097/ana.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | | | - Sabrina Calandra
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Marina Munari
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
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Caffeine and MDMA (Ecstasy) Exacerbate ER Stress Triggered by Hyperthermia. Int J Mol Sci 2022; 23:ijms23041974. [PMID: 35216090 PMCID: PMC8880705 DOI: 10.3390/ijms23041974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Drugs of abuse can cause local and systemic hyperthermia, a known trigger of endoplasmic reticulum (ER) stress and the unfolded protein response (UPR). Another trigger of ER stress and UPR is ER calcium depletion, which causes ER exodosis, the secretion of ER-resident proteins. In rodent models, club drugs such as 3,4-methylenedioxymethamphetamine (MDMA, ‘ecstasy’) can create hyperthermic conditions in the brain and cause toxicity that is affected by the environmental temperature and the presence of other drugs, such as caffeine. In human studies, MDMA stimulated an acute, dose-dependent increase in core body temperature, but an examination of caffeine and MDMA in combination remains a topic for clinical research. Here we examine the secretion of ER-resident proteins and activation of the UPR under combined exposure to MDMA and caffeine in a cellular model of hyperthermia. We show that hyperthermia triggers the secretion of normally ER-resident proteins, and that this aberrant protein secretion is potentiated by the presence of MDMA, caffeine, or a combination of the two drugs. Hyperthermia activates the UPR but the addition of MDMA or caffeine does not alter the canonical UPR gene expression despite the drug effects on ER exodosis of UPR-related proteins. One exception was increased BiP/GRP78 mRNA levels in MDMA-treated cells exposed to hyperthermia. These findings suggest that club drug use under hyperthermic conditions exacerbates disruption of ER proteostasis, contributing to cellular toxicity.
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Menezes PMN, Araújo TCDL, Pereira ECV, Neto JA, Silva DS, Brito MC, Lima KSB, Monte APOD, Matos MHTD, Lima RSD, Ribeiro LADA, Silva FS, Rolim LA. Investigation of antinociceptive, antipyretic, antiasthmatic, and spasmolytic activities of Brazilian Cannabis sativa L. roots in rodents. JOURNAL OF ETHNOPHARMACOLOGY 2021; 278:114259. [PMID: 34058314 DOI: 10.1016/j.jep.2021.114259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Many studies are performed with the aerial parts of Cannabis sativa L. (Cannabaceae). However, roots remain poorly studied, despite citations in the scientific literature. The C. sativa roots are indicated for the treatment of pain, inflammation, fever, among other health problems. AIM OF THE STUDY This study aimed to evaluate the antinociceptive, antipyretic, antiasthmatic, and spasmolytic activities of C. sativa roots in experimental models using mice and rats. MATERIAL AND METHODS The chemical composition of the aqueous extract of C. sativa roots (AECsR) was evaluated by LC-MS. The antinociceptive activity was assessed in mice by the induction of writhing with acetic acid, paw licking with formalin, and reactivity in the hot plate test. Fever was induced by the administration of a suspension of Saccharomyces cerevisiae in young rats. The asthmatic activity was performed with ovalbumin (OVA)-immunized mice with cellular and histological analysis. Finally, the spasmolytic activity was performed using mice isolated trachea. For in vivo studies, the doses were 12.5, 25, or 50 mg/kg whereas for in vitro, the concentration of AECsR was 729 μg/mL. RESULTS From the LC-MS data, we identified p-coumaroyltyramine, feruloyltyramine canabissativine in AECsR. The extract promoted a reduction of writhing in all tested doses (12.5, 25, or 50 mg/kg). Similarly, it reduced the pain in the formalin test at doses of 12.5 and 50 mg/kg (first phase) and 12.5 and 25 mg/kg (second phase). In the hot plate test, the doses of 12.5, 25, and 50 mg/kg promoted antinociceptive effect at different times, and the lowest dose maintained its action in the analyzes performed at 60, 90, and 120 min after administration. The anti-inflammatory activity of AECsR was observed in the mouse model of asthma, reducing the total leukocyte count in the bronchoalveolar fluid (BALF) at a dose of 25 mg/kg, as well as reducing eosinophilia in all tested doses (12.5, 25, and 50 mg/kg). Histological analysis of lungs stained with H&E and PAS showed a reduction in the number of inflammatory cells in the perivascular and peribronchial region, as well as reduced mucus production. CONCLUSION The results suggest that AECsR promotes pain control, either by a central or inflammatory mechanism, and has antiasthmatic activity. However, there was no antipyretic or spasmolytic effect.
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Affiliation(s)
| | | | | | - Janaine Almeida Neto
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil.
| | - David Souza Silva
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil.
| | - Mariana Coelho Brito
- Pós-graduação em Biotecnologia - PPGB, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana-BA, Brazil.
| | | | | | | | | | - Luciano Augusto de Araújo Ribeiro
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil; Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil.
| | - Fabrício Souza Silva
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil; Pós-graduação em Biotecnologia - PPGB, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana-BA, Brazil; Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil.
| | - Larissa Araújo Rolim
- Pós-graduação em Biotecnologia - RENORBIO, Universidade Federal Rural de Pernambuco- UFRPE, Recife/PE, Brazil; Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil; Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE, Brazil.
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Estimation of the time since death based on body cooling: a comparative study of four temperature-based methods. Int J Legal Med 2021; 135:2479-2487. [PMID: 34148133 DOI: 10.1007/s00414-021-02635-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
The estimation of the time since death is an important task in forensic medicine that mainly relies on body cooling in the early post-mortem period. The rectum has been traditionally used to determine the central core temperature after death, though the external auditory canal has been proposed as an alternative site by several authors. The objective of this study was to assess the ability of four body temperature-based methods (Henssge's rectal nomogram, Henssge's brain nomogram, and Baccino's both interval and global formulae based on ear temperature) to estimate the post-mortem interval (PMI). PMI calculations were carried out based on ear and rectal temperature measurements performed with a reference metal probe on 100 inpatient bodies with an average PMI of 4.5 ± 2.5 h. For practical purposes, ear temperature measurements were applied to Henssge's brain nomogram. All methods could be applied to 81 cases, since high body temperatures prevented the rectal nomogram method from being used in most of the remaining cases. The actual PMI was within the time interval (95% CI) provided by the rectal nomogram method in 72.8% of cases, and in 63.0% to 76.5% of cases when using ear temperature-based methods. The proportions of adequate estimates did not differ statistically between the different methods. When the methods failed to provide a reliable time interval, all except the brain nomogram tended to underestimate the PMI. Similar results were obtained in the subgroup of normothermic patients at the time of death (n = 63), confirming that the PMI calculations had not been biased by the inclusion of patients with thermoregulation disorders. Our findings are in accordance with the published literature which suggests that ear temperature-based methods are as reliable as those based on rectal temperature for estimating the early PMI and that they may be used as quick, simple, and non-invasive methods at the scene, although caution should be taken in interpreting their results given their high error rates. However, further research including field studies is recommended to confirm their practical relevance in forensic casework.
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Fermeli DD, Theofanopoulos A, Papadakos D, Boulieris S, Constantoyannis C. Hemorrhage of a Cavernous Hemangioma of the Brainstem Presenting with Fever of Unknown Origin: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930437. [PMID: 34031354 PMCID: PMC8165496 DOI: 10.12659/ajcr.930437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 42-year-old Final Diagnosis: Brainstem cavernoma Symptoms: Headache • fever Medication: — Clinical Procedure: — Specialty: Neurosurgery
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Affiliation(s)
- Dionysia D Fermeli
- Department of Neurosurgery, University Hospital of Patras, Patras, Greece
| | | | | | - Spiros Boulieris
- Department of Neurosurgery, University Hospital of Patras, Patras, Greece
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Mishra RK, Jain N, Goyal K, Kedia S. Non-infectious fever in cerebral arteriovenous malformation: Central fever or paroxysmal sympathetic hyperactivity. Indian J Anaesth 2021; 65:S55-S57. [PMID: 33814594 PMCID: PMC7993038 DOI: 10.4103/ija.ija_590_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/15/2020] [Accepted: 09/30/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajeeb K Mishra
- Department of Neuroanaesthesiology and Critical Care, NIMHANS, Bangalore, Karnataka, India
| | - Nitin Jain
- Department of Neuroanaesthesiology and Critical Care, Max Patparganj, New Delhi, India
| | - Keshav Goyal
- Department of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Shweta Kedia
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Goyal K, Garg N, Bithal P. Central fever: a challenging clinical entity in neurocritical care. JOURNAL OF NEUROCRITICAL CARE 2020. [DOI: 10.18700/jnc.190090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Onichimowski D, Nosek K, Goraj R, Jalali R, Wińska A, Pawlos A, Tuyakov B. Use of levosimendan in the treatment of cerebral vascular vasospasm: a case study. Drug Des Devel Ther 2018; 12:1777-1783. [PMID: 29950812 PMCID: PMC6018894 DOI: 10.2147/dddt.s158237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite the progress in the management of cerebral arterial aneurysms, subarachnoid hemorrhage (SAH) remains the major cause of neurological disability. While SAH-related deaths usually occur as a result of brain impairment due to hemorrhage, permanent neurological deficits are caused by cerebral ischemia due to edema and spasm of cerebral arteries. Additionally, ~20%-30% of patients with SAH develop secondary cardiomyopathy; this phenomenon is known as neurogenic stress cardiomyopathy (NSC), which is associated with increased mortality and poor long-term prognosis. Levosimendan is a new inotropic drug that causes calcium sensitization of troponin C, thus increasing contraction force of myofilaments. The drug also causes opening of ATP-dependent potassium channels in vascular smooth muscles, which results in dilatation of veins and arteries, including cerebral arteries. To date, there have been several reports of levosimendan application in patients with SAH and neurogenic stress cardiomyopathy, and the effect of the drug on vasospasm has been previously advocated. This paper presents a case report of a 57-year-old patient with massive SAH, where levosimendan was used for reducing vasospasm.
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Affiliation(s)
- Dariusz Onichimowski
- Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Krzysztof Nosek
- Department of Neurology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Radosław Goraj
- Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Rakesh Jalali
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aleksandra Wińska
- Department of Neurology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aleksandra Pawlos
- Department of Pharmacology and Toxicology, Center for Experimental Medicine, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Bułat Tuyakov
- Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Buchmann SJ, Penzlin AI, Kubasch ML, Illigens BMW, Siepmann T. Assessment of sudomotor function. Clin Auton Res 2018; 29:41-53. [PMID: 29737432 DOI: 10.1007/s10286-018-0530-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To review the currently available literature on clinical autonomic tests of sudomotor function. METHODS We searched PubMED/MEDLINE for articles on technical principles and clinical applications of sudomotor tests with a focus on their drawbacks and perspectives in order to provide a narrative review. RESULTS The quantitative sudomotor axon reflex sweat test (QSART) is the most widely used test of sudomotor function. The technique captures pathology with low intra- and inter-subject variability but is limited by technical demands. The thermoregulatory sweat test comprises topographic sweat pattern analysis of the ventral skin surface and allows differentiating preganglionic from postganglionic sudomotor damage when combined with a small fiber test such as QSART. The sympathetic skin response also belongs to the more established techniques and is used in lie detection systems due to its high sensitivity for sudomotor responses to emotional stimuli. However, its clinical utility is limited by high variability of measurements, both within and between subjects. Newer and, therefore, less widely established techniques include silicone impressions, quantitative direct and indirect axon reflex testing, sensitive sweat test, and measurement of electrochemical skin conductance. The spoon test does not allow a quantitative assessment of the sweat response but can be used as bedside-screening tool of sudomotor dysfunction. CONCLUSION While new autonomic sudomotor function testings have been developed and studied over the past decades, the most were well-studied and established techniques QSART and TST remain the gold standard of sudomotor assessment. Combining these techniques allows for sophisticated analysis of neurally mediated sudomotor impairment. However, newer techniques display potential to complement gold standard techniques to further improve their precision and diagnostic value.
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Affiliation(s)
- Sylvia J Buchmann
- Department of Neurology, Campus Virchow, Charite University Medicine Berlin, Berlin, Germany
| | | | - Marie Luise Kubasch
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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