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Nazarali S, Sajic D. Cryosurgery and 5-Fluorouracil Combination Therapy for Treatment of Bowen's Disease and Superficial Basal Cell Carcinoma. J Drugs Dermatol 2023; 22:1166-1171. [PMID: 38051856 DOI: 10.36849/jdd.7378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC), which includes both Bowen's disease (BD) and superficial basal cell carcinoma (sBCC), is the most commonly diagnosed cancer in Canada. BD and sBCC are amenable to minimally invasive treatments however, large-scale studies assessing long-term outcomes are lacking, particularly regarding the timing and duration of non-invasive combination treatments. OBJECTIVE Examine the clinical cure rate of BD and sBCC using a combination treatment consisting of a single cycle of cryotherapy followed by a three to four-week course of topical 5-fluorouracil (5-FU). METHODS Retrospective chart review at a single center. Inclusion criteria included histology-proven sBCC or BD treated with either a combination protocol, cryosurgery, or 5-FU alone. RESULTS 310 biopsy-confirmed cases of BD and 176 biopsy-confirmed cases of sBCC were analyzed. Of these, 229 cases of BD and 61 cases of sBCC were treated with cryosurgery and immediate 5-FU application, yielding a clearance rate of 90% and 86.9% at 6 months from initial treatment. CONCLUSION Cryosurgery followed by immediate 5-FU use may be an effective mode of treatment for BD and sBCC, negating the need for invasive procedures and allowing for increased accessibility. Further studies with longer follow-up intervals, comparisons with other non-invasive treatments, and evidence of histologic cure are required. J Drugs Dermatol. 2023;22(12):1166-1171. doi:10.36849/JDD.7378.
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Lucaciu SA, Figliuzzi R, Neumann R, Nazarali S, Del Sordo L, Leighton SE, Hauser A, Shao Q, Johnston D, Bai D, Laird DW. GJB4 variants linked to skin disease exhibit a trafficking deficiency en route to gap junction formation that can be restored by co-expression of select connexins. Front Cell Dev Biol 2023; 11:1073805. [PMID: 36861039 PMCID: PMC9968944 DOI: 10.3389/fcell.2023.1073805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
Epidermal keratinocytes are enriched with at least nine connexins that are key regulators of epidermal homeostasis. The role of Cx30.3 in keratinocytes and epidermal health became evident when fourteen autosomal dominant mutations in the Cx30.3-encoding GJB4 gene were linked to a rare and incurable skin disorder called erythrokeratodermia variabilis et progressiva (EKVP). While these variants are linked to EKVP, they remain largely uncharacterized hindering therapeutic options. In this study, we characterize the expression and functional status of three EKVP-linked Cx30.3 mutants (G12D, T85P, and F189Y) in tissue-relevant and differentiation-competent rat epidermal keratinocytes. We found that GFP-tagged Cx30.3 mutants were non-functional likely due to their impaired trafficking and primary entrapment within the endoplasmic reticulum (ER). However, all mutants failed to increase BiP/GRP78 levels suggesting they were not inducing an unfolded protein response. FLAG-tagged Cx30.3 mutants were also trafficking impaired yet occasionally exhibited some capacity to assemble into gap junctions. The pathological impact of these mutants may extend beyond their trafficking deficiencies as keratinocytes expressing FLAG-tagged Cx30.3 mutants exhibited increased propidium iodide uptake in the absence of divalent cations. Attempts to rescue the delivery of trafficking impaired GFP-tagged Cx30.3 mutants into gap junctions by chemical chaperone treatment were ineffective. However, co-expression of wild type Cx30.3 greatly enhanced the assembly of Cx30.3 mutants into gap junctions, although endogenous levels of Cx30.3 do not appear to prevent the skin pathology found in patients harboring these autosomal dominant mutations. In addition, a spectrum of connexin isoforms (Cx26, Cx30, and Cx43) exhibited the differential ability to trans-dominantly rescue the assembly of GFP-tagged Cx30.3 mutants into gap junctions suggesting a broad range of connexins found in keratinocytes may favourably interact with Cx30.3 mutants. We conclude that selective upregulation of compatible wild type connexins in keratinocytes may have potential therapeutic value in rescuing epidermal defects invoked by Cx30.3 EKVP-linked mutants.
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Affiliation(s)
- Sergiu A. Lucaciu
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Rhett Figliuzzi
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Ruth Neumann
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Samina Nazarali
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Luigi Del Sordo
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Stephanie E. Leighton
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Alexandra Hauser
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Qing Shao
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Danielle Johnston
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Donglin Bai
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Dale W. Laird
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada,*Correspondence: Dale W. Laird,
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Nazarali S, Pantaleon A, Sajic S, Sajic D. The safety and efficacy of a novel topical cosmeceutical compound combined with oral isotretinoin and laser treatments for active acne and acne scarring. Dermatol Ther 2022; 35:e15512. [DOI: 10.1111/dth.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Samina Nazarali
- Department of Medicine Dalhousie University Halifax Nova Scotia Canada
| | | | | | - Dusan Sajic
- Derma Skin Institute Guelph Ontario Canada
- Faculty of Health Sciences McMaster University Waterloo Ontario Canada
- Guelph Dermatology Research Guelph Ontario Canada
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Nazarali S, Robinson CH, Khan F, Pocsai T, Desai D, De Souza RJ, Bhatt G, Dart A, Dionne J, Elmansy S, Kandasamy S, Lear SA, Obeid J, Parekh R, Punthakee Z, Sinha R, Thabane L, Wahi G, Zappitelli M, Anand SS, Chanchlani R. Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol. Can J Kidney Health Dis 2022; 9:20543581211072329. [PMID: 35127105 PMCID: PMC8808039 DOI: 10.1177/20543581211072329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations. Objective: The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements. Design: Cross-sectional study, quasi-representative sample. Setting: Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia. Participants: We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives. Measurements: Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data. Methods: Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child’s habitual movement behaviors and ABPM measures. Limitations: Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias. Conclusions: Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.
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Affiliation(s)
- Samina Nazarali
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cal H. Robinson
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Farah Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Tayler Pocsai
- Population Health Research Institute, Hamilton, ON, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON, Canada
| | - Russell J. De Souza
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Girish Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Allison Dart
- Division of Nephrology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, BC Children’s Hospital, The University of British Columbia, Vancouver, Canada
| | - Salma Elmansy
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Joyce Obeid
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Rulan Parekh
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zubin Punthakee
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Rajiv Sinha
- Pediatric Nephrology, Department of Pediatrics, Institute of Child Health, Kolkata, India
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Michael Zappitelli
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rahul Chanchlani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton ON, Canada
- ICES McMaster, McMaster University, Hamilton, ON, Canada
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Nazarali S, Sajic D. The use of a novel low irritancy nutraceutical compound to treat moderately severe facial acne and acne scarring. J Cosmet Dermatol 2021; 21:405-406. [PMID: 33740839 DOI: 10.1111/jocd.14084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/27/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Samina Nazarali
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dusan Sajic
- Guelph Dermatology Research, Guelph, ON, Canada
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Dushnicky MJ, Nazarali S, Mir A, Portwine C, Samaan MC. Is There A Causal Relationship between Childhood Obesity and Acute Lymphoblastic Leukemia? A Review. Cancers (Basel) 2020; 12:cancers12113082. [PMID: 33105727 PMCID: PMC7690432 DOI: 10.3390/cancers12113082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary The childhood obesity epidemic is impacting tens of millions of children globally. While obesity causes several cancers in adults, its potential role in causing pediatric cancers remains unclear. In this review, we assess the potential contribution of obesity to the development of acute lymphoblastic leukemia (ALL), the most common pediatric cancer. We review the possible mechanisms by which the adipose tissue attracts and protects leukemia cells and how it interferes with the actions of chemotherapies used in ALL treatment. We also examine adipose tissue-secreted molecules and fuels that may support leukemia development. While there are no current definite causal links between obesity and ALL, there are plausible mechanisms that need further investigation to explore the impact of obesity on causing ALL and on impacting treatment outcomes. Abstract Childhood obesity is a growing epidemic with numerous global health implications. Over the past few years, novel insights have emerged about the contribution of adult obesity to cancer risk, but the evidence base is far more limited in children. While pediatric patients with acute lymphoblastic leukemia (ALL) are at risk of obesity, it is unclear if there are potential causal mechanisms by which obesity leads to ALL development. This review explores the endocrine, metabolic and immune dysregulation triggered by obesity and its potential role in pediatric ALL’s genesis. We describe possible mechanisms, including adipose tissue attraction and protection of lymphoblasts, and their impact on ALL chemotherapies’ pharmacokinetics. We also explore the potential contribution of cytokines, growth factors, natural killer cells and adipose stem cells to ALL initiation and propagation. While there are no current definite causal links between obesity and ALL, critical questions persist as to whether the adipose tissue microenvironment and endocrine actions can play a causal role in childhood ALL, and there is a need for more research to address these questions.
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Affiliation(s)
- Molly J. Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Samina Nazarali
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
| | - Adhora Mir
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
| | - Carol Portwine
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Hematology/Oncology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Muder Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence:
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Nazarali S, Liu H, Syed M, Ter-Zakarian A, Karanjia R, Sadun A. Cabin pressure aboard commercial aircraft and non-arteritic ischemic optic neuropathy. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0t038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Nazarali
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - H. Liu
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - M. Syed
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | | | - R. Karanjia
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
- Ottawa Eye Institute; University of Ottawa; Ottawa ON Canada
- Ophthalmology; Doheny Eye Institute; Los Angeles CA USA
- The Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON Canada
- UCLA; Doheny Eye Center UCLA; Los Angeles CA USA
| | - A.A. Sadun
- Ophthalmology; Doheny Eye Institute; Los Angeles CA USA
- UCLA; Doheny Eye Center UCLA; Los Angeles CA USA
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8
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Liu H, La Morgia C, Di Vito L, Nazarali S, Gauthier I, Syed M, Chahal J, Ammar M, Carbonelli M, De Negri A, Sadun A, Carelli V, Karanjia R. Differences in onset between eyes in patients with Leber's hereditary optic neuropathy (LHON). Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0t039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. Liu
- Medicine; University of Ottawa; Ottawa Canada
| | - C. La Morgia
- Ophthalmology; IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Department of Biomedical and NeuroMotor Sciences, Ophthalmology; Bologna Italy
| | - L. Di Vito
- Ophthalmology; IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
| | - S. Nazarali
- Medicine; University of Ottawa; Ottawa Canada
| | - I. Gauthier
- Medicine; University of Ottawa; Ottawa Canada
| | - M. Syed
- Medicine; University of Ottawa; Ottawa Canada
| | - J. Chahal
- Ophthalmology; Doheny Eye Institute; Los Angeles United States
| | - M. Ammar
- Ophthalmology; Doheny Eye Institute; Los Angeles United States
| | - M. Carbonelli
- Ophthalmology; IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Ophthalmology; Studio Oculistico D'Azeglio; Bologna Italy
| | - A.M. De Negri
- Ophthalmology; S.Camillo-Forlanini Hospital; Rome Italy
| | - A. Sadun
- Ophthalmology; Doheny Eye Institute; Los Angeles United States
- Ophthalmology; David Geffen School of Medicine at UCLA; Los Angeles United States
| | - V. Carelli
- Ophthalmology; IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
| | - R. Karanjia
- Medicine; University of Ottawa; Ottawa Canada
- Ophthalmology; IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Ophthalmology; David Geffen School of Medicine at UCLA; Los Angeles United States
- Ophthalmology; Ottawa Hospital Research Institute; Ottawa Canada
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Nazarali S, Kuzel P. Vitamin B Derivative (Nicotinamide)Appears to Reduce Skin Cancer Risk. Skin Therapy Lett 2017; 22:1-4. [PMID: 28888216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nicotinamide, an amide form of vitamin B3, has shown the potential to treat a variety of dermatological conditions, including acne, rosacea, and atopic dermatitis. Recent studies have demonstrated the role of nicotinamide, in both topical and oral forms, as a chemopreventive agent against skin cancer. Its anti-carcinogenic role may be due to its ability to enhance DNA repair and prevent ultraviolet (UV)-induced immunosuppression, which is known to contribute to the progression of pre-malignant lesions. Furthermore, nicotinamide is a precursor of essential coenzymes for many important reactions in the body, including the production of nicotinamide adenine dinucleotide (NAD). NAD is a key coenzyme in the synthesis of adenosine triphosphate (ATP), which transports chemical energy within cells. Therefore, nicotinamide plays a significant role in supporting energy-dependent cellular processes, including DNA repair.
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Affiliation(s)
- S Nazarali
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - P Kuzel
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
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Lander J, Brady-Fryer B, Metcalfe J, Nazarali S, Muttitt S. Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision. A Randomized Controlled Trial. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Lander
- Faculties of Medicine and Nursing, University of Alberta and Divisions of Research Administration and Pharmacy, University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - B. Brady-Fryer
- Faculties of Medicine and Nursing, University of Alberta and Divisions of Research Administration and Pharmacy, University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - J.B. Metcalfe
- Faculties of Medicine and Nursing, University of Alberta and Divisions of Research Administration and Pharmacy, University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - S. Nazarali
- Faculties of Medicine and Nursing, University of Alberta and Divisions of Research Administration and Pharmacy, University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - S. Muttitt
- Faculties of Medicine and Nursing, University of Alberta and Divisions of Research Administration and Pharmacy, University of Alberta Hospitals, Edmonton, Alberta, Canada
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Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA 1997; 278:2157-62. [PMID: 9417009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Beliefs about the safety and effectiveness of current anesthetics have resulted in many newborns being circumcised without the benefit of anesthesia. OBJECTIVE To compare ring block, dorsal penile nerve block, a topical eutectic mixture of local anesthetics (EMLA), and topical placebo when used for neonatal circumcision. The placebo represented current practice, with no anesthetic for neonatal circumcision. DESIGN A randomized controlled trial. SETTING Antenatal units in 2 tertiary care hospitals in Edmonton, Alberta. PARTICIPANTS A consecutive sample of 52 healthy, full-term, male newborns, aged 1 to 3 days. INTERVENTIONS Physiological and behavioral monitoring occurred in a series of trials: baseline, drug application, preparation, circumcision, and postcircumcision. Surgical procedures defined the following 4 stages of the circumcision: cleansing, separation, clamp on, and clamp off. Methemoglobin level was assessed 6 hours after surgery. MAIN OUTCOME MEASURES Heart rate, cry, and methemoglobin level. RESULTS Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high-pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). The 3 treatment groups all had significantly less crying and lower heart rates during and following circumcision compared with the untreated group. The ring block was equally effective through all stages of the circumcision, whereas the dorsal penile nerve block and EMLA were not effective during foreskin separation and incision. Methemoglobin levels were highest in the EMLA group, although no newborn required treatment. CONCLUSIONS The most effective anesthetic is the ring block; EMLA is the least effective. It is our recommendation that an anesthetic should be administered to newborns prior to undergoing circumcision.
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Affiliation(s)
- J Lander
- Faculty of Medicine, University of Alberta, Edmonton, Canada.
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Abstract
Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. A double-blind, placebo-controlled design was utilized. The sample included 258 children and adolescents aged 5-18 years who were having venipuncture or intravenous (i.v.) cannulation. After having their anxiety assessed, subjects were randomly assigned to have EMLA or placebo applied over the procedure site for 90 min. The visual analogue scale was used to assess pain caused by removal of the semi-permeable dressing and by the procedure. Other information that was collected included: duration of drug application, interval between drug removal and procedure, skin changes at bandage and drug sites and rated difficulty of the procedure. EMLA was successful 84% of the time for venipuncture and 51% of the time for i.v. cannulation. Factors which predicted success of EMLA included type of procedure, duration of drug application and anxiety. EMLA was less successful for i.v. cannulation compared to venipuncture even with duration of drug application controlled. Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.
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Affiliation(s)
- J Lander
- Clinical Sciences, University of Alberta, Edmonton, Alberta T6G 2G3 Canada
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13
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Affiliation(s)
- J Lander
- University of Alberta, Edmonton, Canada
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14
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Abstract
A child with respiratory distress was found to have been given an antibiotic which was reconstituted with methadone. A delay in standard emergency room management led to a delay in diagnosis and treatment.
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Affiliation(s)
- M O Gayle
- Pediatric Intensive Care Unit, University of Alberta Hospitals, Edmonton, Alberta
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