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Greenhawt M, Shaker M, Stukus DR, Fleischer DM, Hourihane J, Tang MLK, Abrams EM, Wang J, Bingemann TA, Chan ES, Lieberman J, Sampson HA, Bock SA, Young MC, Waserman S, Mack DP. Managing Food Allergy in Schools During the COVID-19 Pandemic. J Allergy Clin Immunol Pract 2020; 8:2845-2850. [PMID: 32711118 PMCID: PMC7375974 DOI: 10.1016/j.jaip.2020.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic and massive disruptions to daily life in the spring of 2020, in May 2020, the Centers for Disease Control (CDC) released guidance recommendations for schools regarding how to have students attend while adhering to principles of how to reduce the risk of contracting SARS-CoV-2. As part of physical distancing measures, the CDC is recommending that schools who traditionally have had students eat in a cafeteria or common large space instead have children eat their lunch or other meals in the classroom at already physically distanced desks. This has sparked concern for the safety of food-allergic children attending school, and some question of how the new CDC recommendations can coexist with recommendations in the 2013 CDC Voluntary Guidelines on Managing Food Allergy in Schools as well as accommodations that students may be afforded through disability law that may have previously prohibited eating in the classroom. This expert consensus explores the issues related to evidence-based management of food allergy at school, the issues of managing the health of children attending school that are acutely posed by the constraints of an infectious pandemic, and how to harmonize these needs so that all children can attend school with minimal risk from both an infectious and allergic standpoint.
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Affiliation(s)
- Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Department of Pediatrics, Dartmouth Children's Hospital, Dartmouth Geisel School of Medicine, Hanover, NH
| | - David R Stukus
- Department of Pediatrics, Division of Allergy and Immunology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | | | - Mimi L K Tang
- Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Theresa A Bingemann
- University of Rochester Division of Allergy, Immunology and Rheumatology, Rochester, NY
| | - Edmond S Chan
- BC Children's Hospital, Division of Allergy & Immunology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, TN
| | - Hugh A Sampson
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY; DBV Technologies, Montrouge, France
| | - S Allan Bock
- Deptartment of Pediatrics, University of Colorado School of Medicine (Emeritus), Aurora, Colo
| | - Michael C Young
- Division of Allergy & Immunology, Children's Hospital Boston, Harvard Medical School, Boston, Mass
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Douglas P Mack
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada; Halton Pediatric Allergy, Burlington, Ontario, Canada
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Abstract
OBJECTIVE To evaluate the prescribing trends of glaucoma drugs in six major cities of China from 2013 to 2017. METHODS A descriptive analysis using pharmacy prescription data was conducted. Outpatient prescription data was extracted from the Hospital Prescription Analysis Cooperative Project. Prescribing patterns, trends of visits, and corresponding expenditures for glaucoma medications were analyzed. RESULTS A total of 84297 ambulatory prescriptions were included in the current study. Visits by glaucoma patients increased from 13808 in 2013 to 20060 in 2017. Over the same period, the yearly expenditure for glaucoma drugs increased from 2.33 million to 3.95 million Chinese Yuan (CNY). Among all the six classes of glaucoma drugs (prostaglandin analogues, carbonic anhydrase inhibitors, α-receptor agonists, β-receptor antagonists, cholinergic agonists and fixed combinations), β-receptor antagonists were the most commonly prescribed in 2013, accounting for 34.3% of patients, but gradually decreased to 27.1% in 2017. Prostaglandin analogues became the most frequently prescribed drugs in 2017, accounting for 30.2% of the visits. Prostaglandin analogues are the most expensive and yielded a total expenditure of 2.34 million CNY in 2017, followed by carbonic anhydrase inhibitors, α-receptor agonists, β-receptor antagonists, fixed combinations, and cholinergic agonists. Combination therapy became increasingly prescribed in 2017. CONCLUSION Glaucoma prescribing practices exhibited substantial changes over the study period. The number of glaucoma prescriptions continuously increased from 2013 to 2017, leading to increased prescription costs. These findings implied a similar trend observed in previous studies, as well as recommendations in the appropriate guidelines.
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Affiliation(s)
- Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kai Ding
- Department of Pharmacy, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lifang Luo
- Department of Pharmacy, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- * E-mail:
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Bhatnagar S, Mishra S, Madhurima S, Gurjar M, Mondal AS. Clonidine as an Analgesic Adjuvant to Continuous Paravertebral Bupivacaine for Post-thoracotomy Pain. Anaesth Intensive Care 2019; 34:586-91. [PMID: 17061632 DOI: 10.1177/0310057x0603400507] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We prospectively evaluated the effect of Clonidine as an adjuvant to bupivacaine for continuous paravertebral intercostal nerve block, measuring pain and sedation scores and pulmonary function tests. Thirty patients scheduled to undergo thoracotomy were randomized to receive either a bolus of 0.125% bupivacaine 2 mg/kg (group BUP) or 0.125% bupivacaine 2 mg/kg with Clonidine 2 μg/kg (group BUP+CLO), followed by an infusion of 0.125% bupivacaine at 0.5 mg/kg/h, or 0.125% bupivacaine at 0.5 mg/kg/h with Clonidine at 2 μg/kg/h, in respective groups, through a paravertebral intercostal catheter. Haemodynamic parameters, pain and sedation scores and pulmonary function tests were recorded at 6, 12, 24 and 48 hours after arrival in postoperative care unit. There were significantly lower pain scores at rest and on coughing in group BUP+CLO compared with group BUP (P<0.01). Multiple comparisons revealed a significant reduction in pain score at each time point (P<0.01), except at 12h to 24h, in group BUP+CLO. Sedation scores were significantly higher in group BUP+CLO compared with group BUP at each time point (all P<0.01). There was a linear effect of time on sedation score in group BUP whereas in group BUP+CLO, the effect was quadratic. Patients in the Clonidine group had a higher incidence of hypotension (P<0.01). There was no significant difference in pulmonary function between the groups. We conclude that using Clonidine as an adjunct to bupivacaine for continuous paravertebral intercostal nerve block improves pain relief after thoracotomy, but hypotension and sedation are adverse effects interfering with its clinical application.
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Affiliation(s)
- S Bhatnagar
- Department of Anaesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi
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Kurysheva NI. [Selective α2-agonists in the treatment of glaucoma: pharmacology, efficacy and safety]. Vestn Oftalmol 2019; 135:144-150. [PMID: 31215546 DOI: 10.17116/oftalma2019135021144] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Glaucoma is the main cause of irreversible blindness in the world. Among the hypotensive eye drops, an important place belongs to the selective α2-adrenergic receptor antagonist brimonidine. This part of the review focuses on key pharmacological and therapeutic characteristics of brimonidine and its mode of action. The article also discusses the side effects of brimonidine and the methods of their prevention.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation State Research Center ,Burnasyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Department of Opthalmology, 15 Gamalei St., Moscow, Russian Federation, 123098
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Abstract
To determine whether cataract or glaucoma and combined cataract and glaucoma surgery (CGS) affect glaucoma medication usage.We recruited patients who received new diagnoses of glaucoma, either primary open-angle glaucoma (POAG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 365.1) or primary angle-closure glaucoma (PACG) (ICD-9-CM code 365.2), between 1998 and 2011 and had undergone cataract surgery alone (CS), glaucoma surgery alone (GS), or CGS under the National Health Insurance program in Taiwan. CS, GS, and CGS in all the patients were performed after the glaucoma diagnosis date. The patients were subdivided into CS, CGS, and GS groups. The number of glaucoma medications, including prostaglandin analogs, β-blockers, carbonic anhydrase inhibitors, α-agonists, pilocarpine, and a combination of drugs, in each prescription, were compared before and after surgery.The mean number of glaucoma medications in each prescription before the surgery increased from approximately 0.5/1 (CS/CGS + GS) to a peak of 1.75/3 within 3 months before the index date. The mean number of glaucoma medications in each prescription reduced to 0 (CS group) and to approximately 0.5 (CGS and GS) at the end of the 3-year follow-up period. The mean number of glaucoma medications in each prescription significantly reduced at the time points within 6 months, between 6 months and 2 years, and during 2 to 3 years after surgery in each group. At the end of the 3-year period, the reduction effect was most evident in the CS group. Similar trends were also observed in the POAG and PACG group.CS, GS, and CGS significantly reduced the number of glaucoma medications used by the glaucoma patients.
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Affiliation(s)
| | - Cheng-Li Lin
- College of Medicine
- Management Office for Health Data
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Chen YY, Lai YJ, Yen YF, Shen YC, Wang CY, Liang CY, Lin KH, Fan LW. Association between normal tension glaucoma and the risk of Alzheimer's disease: a nationwide population-based cohort study in Taiwan. BMJ Open 2018; 8:e022987. [PMID: 30397009 PMCID: PMC6231573 DOI: 10.1136/bmjopen-2018-022987] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate a possible association between normal tension glaucoma (NTG) and an increased risk of developing Alzheimer's disease (AD). DESIGN Retrospective cohort study. SETTING NTG group and the comparison group were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013. PARTICIPANTS A total of 15 317 subjects with NTG were enrolled in the NTG group, and 61 268 age-matched and gender-matched subjects without glaucoma were enrolled in the comparison group. PRIMARY AND SECONDARY OUTCOME MEASURES Kaplan-Meier curves were generated to compare the cumulative hazard of AD between the two groups. A multivariable Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) of AD, adjusted for diabetes, hypertension, hyperlipidaemia, coronary artery disease and stroke. Furthermore, risk factors for developing AD among the NTG group were investigated. RESULTS The mean age of the cohort was 62.1±12.5 years. Patients with NTG had significantly higher proportions of diabetes, hypertension, hyperlipidaemia, coronary artery disease and stroke than the comparisons. Patients with NTG had a significantly higher cumulative hazard for AD than the comparisons (p<0.0001). In the multivariable Cox regression after adjustment for confounders, the NTG group had a significantly higher risk of AD (adjusted HR 1.52; 95% CI 1.41 to 1.63). Moreover, in the NTG group, when we compared the effects of different types of glaucoma eye drops, none of the eye drops used were significant risk factors or protective factors for AD. CONCLUSIONS People with NTG are at a significantly greater risk of developing AD compared with individuals without glaucoma. Among patients with NTG, none of the glaucoma eye drops used significantly changed the risk of subsequent AD.
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Affiliation(s)
- Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Yung-Feng Yen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Ying-Cheng Shen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiao-Ying Liang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Keng-Hung Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lir-Wan Fan
- Department of Pediatrics; Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Simsek S, Ertürk H, Demirok A, Cinal A, Yasar T, Karadenizli C. The Effect of 0.25% Apraclonidine in Preventing Intraocular Pressure Elevation after Nd: Yag Laser Posterior Capsulotomy. Eur J Ophthalmol 2018; 8:167-72. [PMID: 9793771 DOI: 10.1177/112067219800800309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The efficacy and adverse effects of 0.25% apraclonidine on intraocular pressure (IOP) after Nd: YAG laser posterior capsulotomy were investigated, and the results were compared with placebo, 0.50% timolol maleate and 1% apraclonidine. Methods Eighty eyes were randomly assigned to four groups of 20 eyes. In a double-masked design, the groups were treated with placebo (group I), 0.50% timolol maleate (group 2), 1% apraclonidine (group 3), 0.25% apraclonidine (group 4) one hour before and five minutes after Nd:YAG laser posterior capsulotomy. IOP was measured by applanation tonometry 1 hour before (baseline IOP) and 1,3, 24 hours after capsulotomy. Results The average baseline IOP increased respectively 3.90 ± 5.35, 5.95 ± 5.32, 1.15 ± 3.20 mmHg in the first group 1, 3 and 24 hours post-treatment. There were significant differences between baseline IOP and 1 and 3 hours but not at 24 hours (p=0.004, p=0.001, p=0.13). IOP increased 0.40 ± 4.08, 0.75 ± 5.33, 0.80 ± 6.03 mmHg in the second group at the same times. The differences between the average baseline IOP and the 1, 3 and 24h measurement were not significant (p=0.83, p=0.65, p=0.93). In the third group, IOP decreased 3.70 ± 2.40, 3.30 ± 2.47, 2.65 ± 1.56 mmHg at the measurement times, with significant differences between the average baseline IOP and the 1, 3 and 24 hour measurements (p=0.001, p=0.0001, p=0.01). In the fourth group IOP increased 0.35 ± 3.32 mmHg at 1 hour, but decreased 1.25 ± 3.41, 0.90 ± 2.07 mmHg at 3 and 24 hours. The differences were not significant (p=0.94, p=0.16, p=0.08). When the 0.25% and 1% apraclonidine groups were compared, there were significant differences between the average IOP at 1 hour in both groups but not at 3 and 24 hours (p=0.01, p=0.17, p=0.21). Similarly, there were no significant differences between the average IOP at the same times when the 0.25% apraclonidine group was compared with the timolol group (p=0.30, p=0.08, p=0.16). Some systemic and local side effects were seen in the timolol and 1% apraclonidine groups, but none with 0.25% apraclonidine. Conclusions It was concluded that 0.25% apraclonidine is effective in preventing the early elevation of IOP after Nd:YAG laser posterior capsulotomy and may offer an alternative to 0.50% timolol maleate and 1% apraclonidine.
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Affiliation(s)
- S Simsek
- Department of Ophthalmology Medical Faculty, Yüzüncü Yil University, Van, Turkey
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Abstract
BACKGROUND The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. OBJECTIVES To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. SEARCH METHODS We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. SELECTION CRITERIA We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied was clonidine in 21 trials, dexmedetomidine in 24 trials and mivazerol in two trials.In non-cardiac surgery, there was high quality evidence that α-2 adrenergic agonists led to a similar risk of all-cause mortality compared with control groups (1.3% with α-2 adrenergic agonists versus 1.7% with control; RR 0.80, 95% CI 0.61 to 1.04; participants = 14,081; studies = 16). Additionally, the risk of cardiac mortality was similar between treatment groups (0.8% with α-2 adrenergic agonists versus 1.0% with control; RR 0.86, 95% CI 0.60 to 1.23; participants = 12,525; studies = 5, high quality evidence). The risk of myocardial infarction was probably similar between treatment groups (RR 0.94, 95% CI 0.69 to 1.27; participants = 13,907; studies = 12, moderate quality evidence). There was no associated effect on the risk of stroke (RR 0.93, 95% CI 0.55 to 1.56; participants = 11,542; studies = 7; high quality evidence). Conversely, α-2 adrenergic agonists probably increase the risks of clinically significant bradycardia (RR 1.59, 95% CI 1.18 to 2.13; participants = 14,035; studies = 16) and hypotension (RR 1.24, 95% CI 1.03 to 1.48; participants = 13,738; studies = 15), based on moderate quality evidence.There was insufficient evidence to determine the effect of α-2 adrenergic agonists on all-cause mortality in cardiac surgery (RR 0.52, 95% CI 0.26 to 1.04; participants = 1947; studies = 16) and myocardial infarction (RR 1.01, 95% CI 0.43 to 2.40; participants = 782; studies = 8), based on moderate quality evidence. There was one cardiac death in the clonidine arm of a study of 22 participants. Based on very limited data, α-2 adrenergic agonists may have reduced the risk of stroke (RR 0.37, 95% CI 0.15 to 0.93; participants = 1175; studies = 7; outcome events = 18; low quality evidence). Conversely, α-2 adrenergic agonists increased the risk of bradycardia from 6.4% to 12.0% (RR 1.88, 95% CI 1.35 to 2.62; participants = 1477; studies = 10; moderate quality evidence), but their effect on hypotension was uncertain (RR 1.19, 95% CI 0.87 to 1.64; participants = 1413; studies = 9; low quality evidence).These results were qualitatively unchanged in subgroup analyses and sensitivity analyses. AUTHORS' CONCLUSIONS Our review concludes that prophylactic α-2 adrenergic agonists generally do not prevent perioperative death or major cardiac complications. For non-cardiac surgery, there is moderate-to-high quality evidence that these agents do not prevent death, myocardial infarction or stroke. Conversely, there is moderate quality evidence that these agents have important adverse effects, namely increased risks of hypotension and bradycardia. For cardiac surgery, there is moderate quality evidence that α-2 adrenergic agonists have no effect on the risk of mortality or myocardial infarction, and that they increase the risk of bradycardia. The quality of evidence was inadequate to draw conclusions regarding the effects of alpha-2 agonists on stroke or hypotension during cardiac surgery.
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Affiliation(s)
- Dallas Duncan
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - Ashwin Sankar
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - W Scott Beattie
- Toronto General Hospital, University Health NetworkDepartment of AnaesthesiaEN 3‐453 Toronto General Hospital, University Health Network200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Duminda N Wijeysundera
- St. Michael's HospitalLi Ka Shing Knowledge Institute30 Bond StreetTorontoOntarioCanadaM5B 1W8
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Abstract
Purpose To evaluate the effect of prophylactic brimonidine on bleeding complications after cataract surgery. Methods The authors performed a prospective, double-masked, two-surgeon study of 137 patients (137 eyes) who underwent phacoemulsification and intraocular lens implantation with or without prophylactic brimonidine before cataract surgery. The authors also compared the effect of brimonidine among patients with systemic diseases such as diabetes mellitus (types I and II), hypertension, and anticoagulant or antiplatelet treatment. Results Subconjunctival hemorrhage was observed in 73.70% of the patients not treated with brimonidine before surgery and in only 23.75% of the patients who were given prophylactic brimonidine (p<0.001, χ2). The grade of hemorrhage was also statistically significant (p<0.001, Mann-Whitney). No statistically significant difference with regard to the presence of hemorrhage in diabetic patients or in the anticoagulant or antiplatelet treatment group was observed. However, a statistically significant difference (p<0.027, χ2) was found between hypertensive patients treated and not treated with prophylactic brimonidine before cataract surgery. Conclusions This study suggests that brimonidine administered before cataract surgery may significantly reduce subconjunctival hemorrhage in the general population. It has been shown to be beneficial in hypertensive patients. A strong statistical trend, but not significance has been found in diabetic patients or in patients treated with antiplatelet or anticoagulant drugs, but further studies are needed to reach conclusive results.
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Affiliation(s)
- M C Desco
- Service of Ophthalmology, La Fe University Hospital, Valencia--Spain.
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Kircik LH, DuBois J, Draelos ZD, Werschler P, Grande K, Cook-Bolden FE, Weng E, Berk DR, Ahluwalia G. Pivotal Trial of the Efficacy and Safety of Oxymetazoline Cream 1.0% for the Treatment of Persistent Facial Erythema Associated With Rosacea: Findings from the First REVEAL Trial. J Drugs Dermatol 2018; 17:97-105. [PMID: 29320594] [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: 06/07/2023]
Abstract
An unmet need exists for a safe, tolerable, effective treatment for moderate to severe persistent facial erythema in patients with rosacea. This pivotal phase 3, multicenter, double-blind study evaluated the efficacy and safety of topical oxymetazoline in patients with facial erythema associated with moderate to severe rosacea. Patients were randomly assigned to treatment with oxymetazoline hydrochloride cream 1.0% or vehicle applied once daily for 29 days, and were followed for 28 days posttreatment. The primary efficacy outcome was having at least a 2-grade decrease from baseline on both the Clinician Erythema Assessment (CEA) and the Subject Self-Assessment for rosacea facial redness (SSA) scales (composite success) at 3, 6, 9, and 12 hours postdose on day 29. Safety assessments included treatment-emergent adverse events (TEAEs) and posttreatment worsening of erythema (composite CEA/SSA increase of 1-grade severity from baseline; rebound effect). A total of 440 patients (mean age, 49.5 years; 78.9% females) were randomized (oxymetazoline, n=222; vehicle, n=218); most had moderate erythema. On day 29, significantly greater proportions of oxymetazoline recipients achieved the primary efficacy outcome at each time point (P less than 0.02) and overall (P less than 0.001) compared with vehicle recipients. The incidence of discontinuation due to TEAEs was low in both groups (oxymetazoline group, 1.8%; vehicle group, 0.5%). The most common TEAEs reported during the entire study period were application-site dermatitis, application-site erythema, and headache in the oxymetazoline group (1.4% each), and headache (0.9%) in the vehicle group. Following cessation of treatment, low proportions of patients experienced rebound effect (oxymetazoline group, 2.2%; vehicle group, 1.1%). Oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in patients with moderate to severe persistent facial erythema of rosacea. <p><em>J Drugs Dermatol. 2018;17(1):97-105.</em></p>.
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Underwood BR, Green-Thompson ZW, Pugh PJ, Lazic SE, Mason SL, Griffin J, Jones PS, Rowe JB, Rubinsztein DC, Barker RA. An open-label study to assess the feasibility and tolerability of rilmenidine for the treatment of Huntington's disease. J Neurol 2017; 264:2457-2463. [PMID: 29075837 PMCID: PMC5688221 DOI: 10.1007/s00415-017-8647-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 01/07/2023]
Abstract
Preclinical data have shown that rilmenidine can regulate autophagy in models of Huntington's disease (HD), providing a potential route to alter the disease course in patients. Consequently, a 2-year open-label study examining the tolerability and feasibility of rilmenidine in mild-moderate HD was undertaken. 18 non-demented patients with mild to moderate HD took daily doses of 1 mg Rilmenidine for 6 months and 2 mg for a further 18 months followed by a 3-month washout period. The primary outcome was the number of withdrawals and serious adverse events. Secondary outcomes included safety parameters and changes in disease-specific variables, such as motor, cognitive and functional performance, structural MRI and serum metabolomic analysis. 12 patients completed the study; reasons for withdrawal included problems tolerating study procedures (MRI, and venepuncture), depression requiring hospital admission and logistical reasons. Three serious adverse events were recorded, including hospitalisation for depression, but none were thought to be drug-related. Changes in secondary outcomes were analysed as the annual rate of change in the study group. The overall change was comparable to changes seen in recent large observational studies in HD patients, though direct statistical comparisons to these studies were not made. Chronic oral administration of rilmenidine is feasible and well-tolerated and future, larger, placebo-controlled, studies in HD are warranted. TRIAL REGISTRATION EudraCT number 2009-018119-14.
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Affiliation(s)
| | | | - Peter J Pugh
- Addenbrooke's Hospital, Hills Road, Cambridge, CB21 2QQ, UK
| | - Stanley E Lazic
- Quantitative Biology, Discovery Sciences, IMED Biotech Unit, AstraZeneca, Cambridge, CB4 0WG, UK
| | - Sarah L Mason
- UK Dementia Research Institute, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
| | - Jules Griffin
- Department of Biochemistry, University of Cambridge, Cambridge, CB2 1GA, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, and MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - James B Rowe
- Department of Clinical Neurosciences, and MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - David C Rubinsztein
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0XY, UK
- UK Dementia Research Institute, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
| | - Roger A Barker
- Addenbrooke's Hospital, Hills Road, Cambridge, CB21 2QQ, UK.
- Department of Clinical Neurosciences, and MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.
- John Van Geest Centre for Brain Repair, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK.
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Abstract
BACKGROUND Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment. OBJECTIVES To assess the effects of opioid antagonists plus minimal sedation for opioid withdrawal. Comparators were placebo as well as more established approaches to detoxification, such as tapered doses of methadone, adrenergic agonists, buprenorphine and symptomatic medications. SEARCH METHODS We updated our searches of the following databases to December 2016: CENTRAL, MEDLINE, Embase, PsycINFO and Web of Science. We also searched two trials registers and checked the reference lists of included studies for further references to relevant studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled clinical trials along with prospective controlled cohort studies comparing opioid antagonists plus minimal sedation versus other approaches or different opioid antagonist regimens for withdrawal in opioid-dependent participants. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Ten studies (6 randomised controlled trials and 4 prospective cohort studies, involving 955 participants) met the inclusion criteria for the review. We considered 7 of the 10 studies to be at high risk of bias in at least one of the domains we assessed.Nine studies compared an opioid antagonist-adrenergic agonist combination versus a treatment regimen based primarily on an alpha2-adrenergic agonist (clonidine or lofexidine). Other comparisons (placebo, tapered doses of methadone, buprenorphine) made by included studies were too diverse for any meaningful analysis. This review therefore focuses on the nine studies comparing an opioid antagonist (naltrexone or naloxone) plus clonidine or lofexidine versus treatment primarily based on clonidine or lofexidine.Five studies took place in an inpatient setting, two studies were in outpatients with day care, two used day care only for the first day of opioid antagonist administration, and one study described the setting as outpatient without indicating the level of care provided.The included studies were heterogeneous in terms of the type of opioid antagonist treatment regimen, the comparator, the outcome measures assessed, and the means of assessing outcomes. As a result, the validity of any estimates of overall effect is doubtful, therefore we did not calculate pooled results for any of the analyses.The quality of the evidence for treatment with an opioid antagonist-adrenergic agonist combination versus an alpha2-adrenergic agonist is very low. Two studies reported data on peak withdrawal severity, and four studies reported data on the average severity over the period of withdrawal. Peak withdrawal induced by opioid antagonists in combination with an adrenergic agonist appears to be more severe than withdrawal managed with clonidine or lofexidine alone, but the average severity over the withdrawal period is less. In some situations antagonist-induced withdrawal may be associated with significantly higher rates of treatment completion compared to withdrawal managed with adrenergic agonists. However, this result was not consistent across studies, and the extent of any benefit is highly uncertain.We could not extract any data on the occurrence of adverse events, but two studies reported delirium or confusion following the first dose of naltrexone. Delirium may be more likely with higher initial doses and with naltrexone rather than naloxone (which has a shorter half-life), but we could not confirm this from the available evidence.Insufficient data were available to make any conclusions on the best duration of treatment. AUTHORS' CONCLUSIONS Using opioid antagonists plus alpha2-adrenergic agonists is a feasible approach for managing opioid withdrawal. However, it is unclear whether this approach reduces the duration of withdrawal or facilitates transfer to naltrexone treatment to a greater extent than withdrawal managed primarily with an adrenergic agonist.A high level of monitoring and support is desirable for several hours following administration of opioid antagonists because of the possibility of vomiting, diarrhoea and delirium.Using opioid antagonists to induce and accelerate opioid withdrawal is not currently an active area of research or clinical practice, and the research community should give greater priority to investigating approaches, such as those based on buprenorphine, that facilitate the transition to sustained-release preparations of naltrexone.
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Affiliation(s)
- Linda Gowing
- University of AdelaideDiscipline of PharmacologyFrome RoadAdelaideSouth AustraliaAustralia5005
| | - Robert Ali
- University of AdelaideDiscipline of PharmacologyFrome RoadAdelaideSouth AustraliaAustralia5005
| | - Jason M White
- University of South AustraliaSchool of Pharmacy and Medical SciencesGPO Box 2471AdelaideAustraliaSA 5001
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13
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Fantasia HC. A Nonhormonal Treatment for Moderate to Severe Vasomotor Symptoms of Menopause. Nurs Womens Health 2016; 20:511-518. [PMID: 27719781 DOI: 10.1016/j.nwh.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/04/2016] [Indexed: 11/18/2022]
Abstract
It is estimated that up to 80% of women experience symptoms related to declining estrogen levels that occur with menopause. The most common bothersome symptoms reported by women during and after this transition are vasomotor symptoms, which can include hot flashes, flushing, night sweats, and sleep disturbances. These symptoms are the most common reason women seek care during menopause. Until recently, the mainstay of treatment and symptom relief has been estrogen supplementation. In 2013, the U.S. Food and Drug Administration approved paroxetine, a low-dose selective serotonin reuptake inhibitor, as the first nonhormonal treatment for moderate to severe vasomotor symptoms of menopause. This article provides an overview of the use of paroxetine to treat vasomotor symptoms of menopause, including potential adverse reactions, special considerations for use, and implications for nursing practice.
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14
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Abstract
This study reports 2 cases of severe coronary artery spasm with anaphylactoid shock caused by contrast medium. The first patient had anaphylactoid shock in response to contrast medium and severe coronary spasms of both the left anterior descending coronary artery and the left circumflex coronary artery. The patient developed ventricular arrhythmia and complete atrioventricular block following the severe coronary spasm. The second patient had a totally occluded right coronary artery, owing to a spasm after anaphylactoid shock. Anaphylactoid shock should always be considered when persistent shock is noted after the coronary artery spasm has been relieved.
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Affiliation(s)
- Charles Chao-Yung Wang
- Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
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15
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Goyal O, Sidhu SS, Sehgal N, Puri S. Noradrenaline is as Effective as Terlipressin in Hepatorenal Syndrome Type 1: A Prospective, Randomized Trial. J Assoc Physicians India 2016; 64:30-35. [PMID: 27762512] [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: 06/06/2023]
Abstract
OBJECTIVES Hepatorenal syndrome (HRS) is a functional renal failure occurring in end stage liver disease, which is associated with poor prognosis. Terlipressin has been shown to be effective in treatment of HRS. More recently, it was suggested that noradrenaline, an alpha-adrenergic drug may be also effective in HRS. We aimed to compare the efficacy of noradrenaline versus terlipressin in treatment of HRS type 1. METHODS Consecutive patients with cirrhosis and HRS type 1 were enrolled and randomised into 2 groups- Group A received intravenous noradrenaline infusion (0.5-3 mg/h) and group B received intravenous terlipressin (0.5-2 mg/6h) for 2 weeks. Intravenous albumin (20 g/day) was given to both groups. RESULTS Out of 55 cirrhotics screened, 41 were randomised into group A (n=21) or group B (n=20). Baseline characteristics of the two groups were similar. HRS reversal was seen in 47.6%(10/21) patients in group A, and 45% (9/20) patients in group B (p=1.00). In both groups, there was a significant decrease in serum creatinine from baseline (group A- 3.1±1.4 mg/dl to 2.2±1.3 mg/dl, p=0.028; group B- 3.4±1.6 mg/dl to 2.3±1.3 mg/dl, p=0.035). Both the groups showed a significant increase in mean arterial pressure (group A- 77.3±8.6 mmHg to 103.4±8.3 mmHg, p=0.0001; group B- 76.8±11.6 mmHg to 100±9.4 mmHg, p=0.0001). Noradrenaline was associated with fewer adverse events and was significantly cheaper than terlipressin. Lower baseline MELD score was an independent predictor of response to treatment. CONCLUSIONS Noradrenaline is as effective and safe as terlipressin in the treatment of HRS type 1.
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Affiliation(s)
| | | | | | - Sandeep Puri
- Professor of Medicine and Principal, Dayanand Medical College & Hospital, Ludhiana, Punjab
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16
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Abstract
Epinephrine is the most important treatment for severe allergic-like contrast reactions. The signs and symptoms of a severe reaction and the dose and methods of epinephrine administration are important for all radiologists to master. In this review article, we review the epidemiology of severe allergic-like contrast reactions, their common clinical manifestations, and their appropriate treatment, with a focus on correct epinephrine administration. We also discuss systematic limitations in the training of current and future radiologists, and recommend strategies for improvement.
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Affiliation(s)
- William R Masch
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Carolyn L Wang
- Department of Radiology, Division of Abdominal Imaging, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Matthew S Davenport
- Department of Radiology, Division of Abdominal Imaging, and Michigan Radiology Quality Collaborative, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48108, USA
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17
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Affiliation(s)
- Marc A Schuckit
- From the Department of Psychiatry, University of California, San Diego, La Jolla
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18
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Martin E, Ramsay G, Mantz J, Sum-Ping STJ. The Role of the α2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit. J Intensive Care Med 2016; 18:29-41. [PMID: 15189665 DOI: 10.1177/0885066602239122] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dexmedetomidine was evaluated for sedation of 401 postsurgical patients in this double-blind, randomized, placebocontrolled, multicenter trial. Dexmedetomidine or saline was started on arrival in the intensive care unit (ICU) (1.0 mcg/kg for 10 minutes), then titrated at 0.2 to 0.7 mcg/kg/h to effect. Patients could be given propofol if necessary. Morphine was administered for pain. Sixty percent of the dexmedetomidine patients required no other sedative to maintain an RSS ≥ 3; 21% required < 50 mg propofol. In contrast, 76% of the control group received propofol; 59% required ≥ 50 mg. Dexmedetomidine patients required significantly less morphine for pain relief (P < .001). Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation. Nurses judged the dexmedetomidine patients were easier to manage. Later, fewer dexmedetomidine patients remembered pain or discomfort. The majority of dexmedetomidine patients maintained blood pressures within normal range, without rebound. Hypertension, atelectasis, and rigors occurred more frequently in the control group, while hypotension and bradycardia occurred more frequently in the dexmedetomidine group. Preoperative cardiovascular conditions were not risk factors for dexmedetomidine patients.
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Affiliation(s)
- Eike Martin
- Klinik für Anaesthesiologie Universitatskliniken, Heidelberg, Germany
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19
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Gupta D, Chen PP. Glaucoma. Am Fam Physician 2016; 93:668-674. [PMID: 27175839] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.
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Affiliation(s)
| | - Philip P Chen
- University of Washington Medical Center, Seattle, WA, USA
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20
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Saba G, Nieto I, Bation R, Allaïli N, Bennabi D, Moliere F, Richieri R, Holtzmann J, Bubrovszky M, Camus V, Charpeaud T, Courtet P, Courvoisier P, Haesebaert F, Doumy O, El-Hage W, Garnier M, d'Amato T, Bougerol T, Lançon C, Haffen E, Llorca PM, Vaiva G, Bellivier F, Leboyer M, Aouizerate B. [Other therapeutic strategies]. Presse Med 2016; 45:350-9. [PMID: 26995510 DOI: 10.1016/j.lpm.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.
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Affiliation(s)
- Ghassen Saba
- Henri-Mondor, hôpital Chenevier, pôle de psychiatrie des hôpitaux universitaires, centre expert dépression résistante FondaMental, 94000 Créteil, France.
| | - Isabel Nieto
- Hôpital Fernand-Widal, service de psychiatrie adulte, centre expert dépression résistante FondaMental, 75010 Paris, France
| | - Rémy Bation
- Centre hospitalier Le Vinatier, service universitaire de psychiatrie adulte, centre expert dépression résistante FondaMental, BP 300 39, 69678 Bron cedex, France
| | - Najib Allaïli
- Hôpital Fernand-Widal, service de psychiatrie adulte, centre expert dépression résistante FondaMental, 75010 Paris, France
| | - Djamila Bennabi
- CHU de Besançon, service de psychiatrie de l'adulte, centre expert dépression résistante FondaMental, 25030 Besançon cedex, France
| | - Fanny Moliere
- CHRU Lapeyronie, département des urgences et post-urgences psychiatrique, centre expert dépression résistante FondaMental, 34295 Montpellier cedex 5, France
| | - Raphaëlle Richieri
- CHU La Conception, pôle psychiatrie centre, centre expert dépression résistante FondaMental, 13005 Marseille, France
| | - Jérôme Holtzmann
- CHU de Grenoble, hôpital Nord, service de psychiatrie de l'adulte, centre expert dépression résistante FondaMental, CS 10217, 38043 Grenoble cedex 9, France
| | - Maxime Bubrovszky
- CHRU de Lille, hôpital Fontan 1, service de psychiatrie adulte, centre expert dépression résistante FondaMental, 59037 Lille cedex, France
| | - Vincent Camus
- CHU de Tours, clinique psychiatrique universitaire, centre expert dépression résistante FondaMental, 37044 Tours cedex 9, France
| | - Thomas Charpeaud
- CHU de Clermont-Ferrand, service de psychiatrie de l'adulte B, centre expert dépression résistante FondaMental, 63003 Clermont-Ferrand, France
| | - Philippe Courtet
- CHRU Lapeyronie, département des urgences et post-urgences psychiatrique, centre expert dépression résistante FondaMental, 34295 Montpellier cedex 5, France
| | - Pierre Courvoisier
- CHU de Grenoble, hôpital Nord, service de psychiatrie de l'adulte, centre expert dépression résistante FondaMental, CS 10217, 38043 Grenoble cedex 9, France
| | - Frédéric Haesebaert
- Centre hospitalier Le Vinatier, service universitaire de psychiatrie adulte, centre expert dépression résistante FondaMental, BP 300 39, 69678 Bron cedex, France
| | - Olivier Doumy
- CH Charles-Perrens, pôle de psychiatrie générale et universitaire, centre expert dépression résistante FondaMental, 33076 Bordeaux cedex, France
| | - Wissam El-Hage
- CHU de Tours, clinique psychiatrique universitaire, centre expert dépression résistante FondaMental, 37044 Tours cedex 9, France
| | - Marion Garnier
- CHU de Clermont-Ferrand, service de psychiatrie de l'adulte B, centre expert dépression résistante FondaMental, 63003 Clermont-Ferrand, France
| | - Thierry d'Amato
- Centre hospitalier Le Vinatier, service universitaire de psychiatrie adulte, centre expert dépression résistante FondaMental, BP 300 39, 69678 Bron cedex, France
| | - Thierry Bougerol
- CHU de Grenoble, hôpital Nord, service de psychiatrie de l'adulte, centre expert dépression résistante FondaMental, CS 10217, 38043 Grenoble cedex 9, France
| | - Christophe Lançon
- CHU La Conception, pôle psychiatrie centre, centre expert dépression résistante FondaMental, 13005 Marseille, France
| | - Emmanuel Haffen
- CHU de Besançon, service de psychiatrie de l'adulte, centre expert dépression résistante FondaMental, 25030 Besançon cedex, France
| | - Pierre-Michel Llorca
- CHU de Clermont-Ferrand, service de psychiatrie de l'adulte B, centre expert dépression résistante FondaMental, 63003 Clermont-Ferrand, France
| | - Guillaume Vaiva
- CHRU de Lille, hôpital Fontan 1, service de psychiatrie adulte, centre expert dépression résistante FondaMental, 59037 Lille cedex, France
| | - Frank Bellivier
- Hôpital Fernand-Widal, service de psychiatrie adulte, centre expert dépression résistante FondaMental, 75010 Paris, France
| | - Marion Leboyer
- Henri-Mondor, hôpital Chenevier, pôle de psychiatrie des hôpitaux universitaires, centre expert dépression résistante FondaMental, 94000 Créteil, France
| | - Bruno Aouizerate
- CH Charles-Perrens, pôle de psychiatrie générale et universitaire, centre expert dépression résistante FondaMental, 33076 Bordeaux cedex, France
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Hansen M, Meckler G, Lambert W, Dickinson C, Dickinson K, Guise JM. Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services. Am J Emerg Med 2016; 34:599-601. [PMID: 26818155 PMCID: PMC4799729 DOI: 10.1016/j.ajem.2015.12.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/01/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Matthew Hansen
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Garth Meckler
- Division of Pediatric Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William Lambert
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Caitlin Dickinson
- Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA
| | - Kathryn Dickinson
- Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA
| | - Jeanne-Marie Guise
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA; Department of Medical Informatics & Clinical Epidemiology, Oregon Heath & Science University, Portland, OR, USA
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22
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23
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Andersen LW, Berg KM, Donnino MW. Epinephrine Administration and Pediatric In-Hospital Cardiac Arrest--Reply. JAMA 2016; 315:417. [PMID: 26813221 DOI: 10.1001/jama.2015.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lars W Andersen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Katherine M Berg
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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Poulton A, Chen F, Nanan R. Epinephrine Administration and Pediatric In-Hospital Cardiac Arrest. JAMA 2016; 315:416-7. [PMID: 26813218 DOI: 10.1001/jama.2015.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alison Poulton
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
| | | | - Ralph Nanan
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
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25
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Abstract
Glaucoma comprises a group of progressive, neurodegenerative disorders characterized by retinal ganglion cell death and nerve fiber layer atrophy. Several randomized controlled trials have consistently demonstrated the efficacy of intraocular pressure lowering to slow or halt the measurable progression of the disease. Medical therapy, in places where it is easily accessible, is often the primary method to lower intraocular pressure. We review the medical options currently available and possible future options currently in development. The 5 contemporary classes of topical agents in use include prostaglandin analogs, beta blockers, carbonic anhydrase inhibitors, alpha agonists, and cholinergics. In addition, several fixed combination agents are commercially available. Agents from each of these classes have unique mechanisms of action, adverse effects, and other characteristics that impact how they are used in clinical practice. Despite the plethora of medical options available, there are limitations to topical ophthalmic therapy such as the high rate of noncompliance and local and systemic adverse effects. Alternate and sustained drug delivery models, such as injectable agents and punctal plug delivery systems, may in the future alleviate some such concerns and lead to increased efficacy of treatment while minimizing adverse effects.
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Affiliation(s)
- Anjum Cheema
- From the *Department of Ophthalmology, Kaiser Permanente, Atlanta, GA; †Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA; and ‡Department of Ophthalmology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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26
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Tasker RC, Randolph AG. Pediatric Pulseless Arrest With "Nonshockable" Rhythm: Does Faster Time to Epinephrine Improve Outcome? JAMA 2015; 314:776-7. [PMID: 26305646 DOI: 10.1001/jama.2015.9527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robert C Tasker
- Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts2Department of Neurology, Boston Children's Hospital, Boston, Massachusetts3Department of Anesthesia, Harvard M
| | - Adrienne G Randolph
- Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts3Department of Anesthesia, Harvard Medical School, Boston, Massachusetts5Department of Pediatrics, Harvard Medi
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Abstract
IMPORTANCE Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remains unknown. OBJECTIVE To determine whether time to first epinephrine dose is associated with outcomes in pediatric in-hospital cardiac arrest. DESIGN, SETTING AND PARTICIPANTS We performed an analysis of data from the Get With the Guidelines-Resuscitation registry. We included US pediatric patients (age <18 years) with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least 1 dose of epinephrine. A total of 1558 patients (median age, 9 months [interquartile range [IQR], 13 days-5 years]) were included in the final cohort. EXPOSURE Time to epinephrine, defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome. A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale. RESULTS Among the 1558 patients, 487 (31.3%) survived to hospital discharge. The median time to first epinephrine dose was 1 minute (IQR, 0-4; range, 0-20; mean [SD], 2.6 [3.4] minutes). Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (multivariable-adjusted risk ratio [RR] per minute delay, 0.95 [95% CI, 0.93-0.98]). Longer time to epinephrine administration was also associated with decreased risk of ROSC (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.96-0.99]), decreased risk of survival at 24 hours (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.95-0.99]), and decreased risk of survival with favorable neurological outcome (multivariable-adjusted RR per minute delay, 0.95 [95% CI, 0.91-0.99]). Patients with time to epinephrine administration of longer than 5 minutes (233/1558) compared with those with time to epinephrine of 5 minutes or less (1325/1558) had lower risk of in-hospital survival to discharge (21.0% [49/233] vs 33.1% [438/1325]; multivariable-adjusted RR, 0.75 [95% CI, 0.60-0.93]; P = .01). CONCLUSIONS AND RELEVANCE Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, delay in administration of epinephrine was associated with decreased chance of survival to hospital discharge, ROSC, 24-hour survival, and survival to hospital discharge with a favorable neurological outcome.
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Affiliation(s)
- Lars W Andersen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Katherine M Berg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian Z Saindon
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts5Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Tia T Raymond
- Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, Texas
| | - Robert A Berg
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
BACKGROUND Shivering after general anaesthesia is common. It is unpleasant but can also have adverse physiological effects. Alpha-2 (α-2) adrenergic agonist receptors, which can lead to reduced sympathetic activity and central regulation of vasoconstrictor tone, are a group of drugs that have been used to try to prevent postoperative shivering. OBJECTIVES To assess the following: the effects of α-2 agonists on the prevention of shivering and subsequent complications after general anaesthesia in people undergoing surgery; the effects of α-2 agonists on the risk of inadvertent perioperative hypothermia; and whether any adverse effects are associated with these interventions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE on 13 June 2014. Our search terms were relevant to the review question and limited to studies that assessed shivering or hypothermia. We also carried out searches of clinical trials registers, and forward and backward citation tracking. SELECTION CRITERIA We considered all randomized controlled trials, quasi-randomized studies, and cluster-randomized studies with adult participants undergoing surgery with general anaesthesia in which an α-2 agonist was compared with another α-2 agonist or a placebo for the prevention of shivering. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting a third review author in the case of disagreements. We used standard Cochrane methodological procedures, including an assessment of risk of bias and use of GRADEpro software to interpret findings. MAIN RESULTS We included 20 studies with 1401 surgical participants comparing an α-2 agonist against a control. Thirteen studies compared clonidine with a control, whilst seven compared dexmedetomidine with a control. The doses, methods, and time of administration varied between studies: three studies gave the drug orally or as an intravenous bolus preoperatively and nine intraoperatively; one study gave the drug as an infusion starting preoperatively and seven started at varying points from anaesthetic induction to the end of surgery. Whilst all the studies were described as randomized, many provided insufficient detail on methods used. We had anticipated that attempts would be made to reduce performance bias by blinding of personnel and participants, however this was detailed in only six of the papers. Similarly, in some studies detail was lacking on methods to reduce the risk of detection bias. We therefore downgraded the quality of evidence in our 'Summary of findings' table by one level for risk of bias using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.All 20 included studies presented outcome data for postoperative shivering, and in meta-analysis α-2 agonists were shown to significantly reduce the risk of shivering (Mantel-Haenszel risk ratio 0.28, 95% confidence interval 0.18 to 0.43, P value < 0.0001). We found significant evidence of heterogeneity (I(2) = 80%) for this result that was not explained by sensitivity or subgroup analysis; we therefore downgraded the inconsistency of the evidence by one level. Although we did not feel that there were concerns with imprecision or indirectness of the data, we downgraded the quality of the evidence for the risk of publication bias following visual analysis of a funnel plot. Using GRADEpro, we rated the overall quality of the data for shivering as very low. Only one study reported the incidence of core hypothermia, whilst 12 studies measured core temperature. However, as the results for core temperature were reported in different styles, pooling the results was inappropriate. We found no studies with participant-reported outcomes such as experience of shivering or participant satisfaction. We found limited data for the outcomes of length of stay in the postanaesthetic care unit (three studies, 200 participants) and the following adverse effects: sedation (nine studies, 875 participants), bradycardia (eight studies, 716 participants), and hypotension (seven studies, 688 participants). Unpooled analysis suggested that sedation and bradycardia were significantly more common with dexmedetomidine than placebo, with all seven dexmedetomidine studies and none of the clonidine studies reporting statistically significantly higher levels of sedation as an adverse effect. AUTHORS' CONCLUSIONS There is evidence that clonidine and dexmedetomidine can reduce postoperative shivering, but patients given dexmedetomidine may be more sedated. However, our assessment of the quality of this evidence is very low.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryPatient Safety ResearchPointer Court 1, Ashton RoadLancasterUKLA1 1RP
| | - Amanda Nicholson
- University of LiverpoolLiverpool Reviews and Implementation GroupSecond FloorWhelan Building, The Quadrangle, Brownlow HillLiverpoolUKL69 3GB
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
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Kim KH, Yi J, Oh WS, Kim NH, Choi SJ, Choe PG, Kim NJ, Lee JK, Oh MD. Human granulocytic anaplasmosis, South Korea, 2013. Emerg Infect Dis 2015; 20:1708-11. [PMID: 25271737 PMCID: PMC4193166 DOI: 10.3201/eid2010.131680] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a patient with human granulocytic anaplasmosis in South Korea. The patient had fever and thrombocytopenia. Human granulocytic anaplasmosis was confirmed by seroconversion, PCR, and sequence analysis for Anaplasma phagocytophilum. Morulae were observed in the cultured HL-60 cells inoculated with blood from the patient.
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30
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. In part 1 of this article, information regarding primary care assessment of ADHD was presented. Part 2 focuses on best practice guidelines for treatment once the diagnosis has been established. For most children, successful treatment of ADHD requires a multicomponent approach comprised of patient and family psychoeducation, use of medications approved by the US Food and Drug Administration (eg, stimulants) and/or behavioral interventions, and management of any psychiatric comorbid conditions. Furthermore, as ADHD is a chronic illness, primary care physicians will need to frequently reassess their patients and make treatment adjustments as needed.
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de Miranda ML, Pereira SJ, Santos AOMT, Villela NR, Kraemer-Aguiar LG, Bouskela E. Milrinone attenuates arteriolar vasoconstriction and capillary perfusion deficits on endotoxemic hamsters. PLoS One 2015; 10:e0117004. [PMID: 25646813 PMCID: PMC4315607 DOI: 10.1371/journal.pone.0117004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/17/2014] [Indexed: 12/29/2022] Open
Abstract
Background and Objective Apart from its inotropic property, milrinone has vasodilator, anti-inflammatory and antithrombotic effects that could assist in the reversal of septic microcirculatory changes. This paper investigates the effects of milrinone on endotoxemia-related microcirculatory changes and compares them to those observed with the use of norepinephrine. Materials and Methods After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.kg-1), male golden Syrian hamsters were treated with two regimens of intravenous milrinone (0.25 or 0.5 μg.kg-1.min-1). Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables. Macro-hemodynamic, biochemical, and hematological parameters and survival rate were also analyzed. Endotoxemic non-treated animals, endotoxemic animals treated with norepinephrine (0.2 μg.kg-1.min-1), and non-endotoxemic hamsters served as controls. Results Milrinone (0.5 μg.kg-1.min-1) was effective in reducing lipopolysaccharide-induced arteriolar vasoconstriction, capillary perfusion deficits, and inflammatory response, and in increasing survival. Norepinephrine treated animals showed the best mean arterial pressure levels but the worst functional capillary density values among all endotoxemic groups. Conclusion Our data suggests that milrinone yielded protective effects on endotoxemic animals’ microcirculation, showed anti-inflammatory properties, and improved survival. Norepinephrine did not recruit the microcirculation nor demonstrated anti-inflammatory effects.
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Affiliation(s)
- Marcos Lopes de Miranda
- Department of Internal Medicine, Division of Critical Care, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Sandra J. Pereira
- Pediatric Cardiac Intensive Care Unit, Perinatal Barra, Rio de Janeiro, RJ, Brazil
| | - Ana O. M. T. Santos
- Institute Fernandes Figueira, Oswaldo Cruz Foundation—FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Nivaldo R. Villela
- Department of Surgery, Division of Anesthesiology, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Eliete Bouskela
- Laboratory for Clinical and Experimental Research in Vascular Biology—BioVasc, Biomedical Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
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Schaffer FM, Naples AR, Ebeling M, Hulsey TC, Garner LM. The safety of self-administered allergen immunotherapy during the buildup and maintenance phases. Int Forum Allergy Rhinol 2015; 5:149-56. [PMID: 25476041 PMCID: PMC4465093 DOI: 10.1002/alr.21443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/30/2014] [Accepted: 10/05/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Self-administered allergen immunotherapy is considered controversial. We believe the implementation of a self-administration protocol characterized by patient preselection and a slow buildup phase is safe. METHODS We analyzed 23,614 patient records and associated immunotherapy injections for systemic reactions (SR) during a 1-year period (2011 to 2012). SRs were graded in accordance with the World Allergy Organization (WAO) criteria. RESULTS Thirty-seven SRs were reported for 23,614 patients who self-administered 2,021,600 injections yielding an annual SR rate of 0.16% (per patient) or 0.002% (per injection). Only 9 of 4643 pediatric (0.19%) and 28 of 18,971 adult patients (0.15%) experienced 1 or more SRs. No deaths (grade V SR) occurred. From 2009 through early 2014, over 90,000 patients received more than 10 million injections in accordance with the United Allergy Services (UAS) protocol without fatalities. CONCLUSION We believe this safety profile is due to a preselection of patients to exclude those with a high risk for adverse reactions and a slow immunotherapy buildup phase. In contrast, previous studies documented office-based SRs ranging from approximately 3% to greater than 14%. Thus, the UAS home-immunotherapy SR rate is significantly lower than office-based immunotherapy SR rates (p < 0.0001). The enhanced safety of this protocol results in a decreased frequency and severity of SRs. This safety report, derived from analyses of one of the largest patient cohorts studied, corroborates and expands the observations of previous studies of self-administered subcutaneous immunotherapy in a low-risk patient population by assessing self-administered allergen immunotherapy during the buildup and maintenance phases.
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Affiliation(s)
- Frederick M. Schaffer
- United Allergy Services (UAS), San Antonio, TX
- Division of Pediatric Pulmonary, Allergy and Immunology, Medical University of South Carolina, Charleston, SC
| | | | - Myla Ebeling
- Division of Pediatric Epidemiology, Medical University of South Carolina, Charleston, SC
| | - Thomas C. Hulsey
- Division of Pediatric Epidemiology, Medical University of South Carolina, Charleston, SC
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Lieberman P. An infant with atopic dermatitis and itching after ingestion of milk. J Allergy Clin Immunol Pract 2015; 3:146-147. [PMID: 25577643 DOI: 10.1016/j.jaip.2014.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/13/2014] [Indexed: 06/04/2023]
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34
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Abstract
Hypertension in pregnancy remains a significant public health problem. Pharmacological management of blood pressure in pregnancy is impacted by changes in maternal drug disposition and by the pharmacodynamic effects of specific agents. This article will review the impact of pregnancy on pathways of drug elimination and the associated clinical implications, the pharmacodynamic effects of specific drugs and classes of drugs in pregnancy, and the data to date on the impact of antihypertensive therapy on mothers and their fetuses.
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Affiliation(s)
- Thomas R Easterling
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195.
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Mansouri Y, Goldenberg G. Devices and topical agents for rosacea management. Cutis 2014; 94:21-25. [PMID: 25101340] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rosacea is a chronic inflammatory disease that predominantly affects facial skin in light-skinned individuals and can be divided into 4 subtypes. Patients can display signs of more than 1 subtype. Diffuse facial erythema is a common finding in rosacea patients and can lead to persistent erythema. Although there is no cure for rosacea, reduction of signs and symptoms can be achieved via various treatment modalities. This article reviews devices and topical agents currently available for the management of rosacea.
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Affiliation(s)
| | - Gary Goldenberg
- Department of Dermatology, Mount Sinai Hospital, 5 E 98th St, 5th Floor, New York, NY 10029-6574, USA.
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36
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Abstract
Critical congenital heart disease (CCHD) is defined as a ductal-dependent congenital heart defect requiring surgical or percutaneous intervention via cardiac catheterization before 1 year of age. Most cases of CCHD can be diagnosed with prenatal ultrasound or fetal echocardiogram. If not prenatally diagnosed, CCHD can be stable in the newborn nursery due to persistent ductal patency, and the patient may only be diagnosed after ductal closure and development of cardiac symptoms at home. In this case, a 6-day-old female presented to the emergency department (ED) floppy with agonal respirations, poor capillary refill, and absent femoral pulses. On the day of presentation, the patient became increasingly fussy, refused feeding, and began to gasp. The patient was transported to the ED for evaluation, where a bedside echocardiogram revealed interrupted aortic arch (IAA), ventricular septal defect, minimal flow through a thread-like ductus arteriosus, and severely depressed cardiac function. IAA is very rare, with an incidence of three cases per 1 million live births. Patients require neonatal supportive care, continuous prostaglandin E1 infusion, and urgent referral for neonatal surgical repair in the first days to weeks of life. To reduce the volume of undiagnosed CCHD in the immediate newborn period, the U.S. Department of Health and Human Services Secretary's Advisory Committee on Heritable Diseases in Newborns and Children (SACHDNC) recommended that CCHD screening via pulse oximetry be added to the recommended uniform screening panel. A positive screen results in an immediate referral for an echocardiogram. Fetal diagnosis, newborn screening, and/or careful clinical examination may have resulted in detection of IAA in our patient prior to ductal closure.
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Del Rosso JQ. Management of facial erythema of rosacea: what is the role of topical α-adrenergic receptor agonist therapy? J Am Acad Dermatol 2014; 69:S44-56. [PMID: 24229637 DOI: 10.1016/j.jaad.2013.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 12/19/2022]
Abstract
Several more recent advances have led to a better understanding of the pathophysiologic mechanisms involved in rosacea and therapeutic modalities used for treatment. Although the clinical features may vary among patients, there are some unifying mechanisms that appear to relate to the more common presentations of rosacea. Both neurovascular dysregulation and augmented immune detection and response appear to play central roles that lead to many of the signs and symptoms of rosacea. Diffuse central facial erythema is a very common finding that intensifies during flares and persists to varying degrees between flares. This background of facial redness occurs secondary to vasodilation and fixed vascular changes that develop over time. Physical modalities are commonly used to treat the erythema that persists as a result of fixed changes in superficial cutaneous vasculature that do not remit after treatment with agents whose mechanisms are active primarily against some of the inflammatory processes operative in rosacea (ie metronidazole, azelaic acid, tetracyclines). As enlarged superficial cutaneous vessels that contribute to the fixed background facial redness of rosacea remain vasoactive to sympathetic nervous system innervation, topical α-adrenergic receptor agonists, namely brimonidine and oxymetazoline, are currently under evaluation for the treatment of facial erythema of rosacea. This article focuses on the clinical differentiation of facial erythema of rosacea and its management.
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Affiliation(s)
- James Q Del Rosso
- Dermatology Residency Program, Valley Hospital Medical Center Las Vegas, Las Vegas, Nevada; Dermatology, Touro University College of Osteopathic Medicine, Henderson, Nevada; Dermatology and Cutaneous Surgery, Las Vegas Skin and Cancer Clinics, Las Vegas and Henderson, Nevada.
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Abstract
Vasovagal syncope is a common disorder that affects at least 20% of people at some time in their lives. Probably half of these patients faint recurrently; for many this causes physical trauma, a substantial reduction in quality of life, and difficulties with driving, employment and education. The last 15 years have seen striking advances in diagnostic approaches and prognostic understanding. A number of physiological, pharmacological and electrical therapies have been developed and tested to various degrees in patients. These include counterpressure manoeuvres, salt and fluid recommendations, and attempted treatment with fludrocortisone, midodrine, beta-blockers, serotonin reuptake inhibitors, and permanent pacemakers. This review highlights the most important of these advances and suggests strategies for managing this often difficult problem.
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Affiliation(s)
- Robert Sheldon
- University of Calgary, Libin Cardiovascular Institute of Alberta, Faculty of Medicine, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada.
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Abstract
Initiatives to develop better-tolerated, more efficacious pharmacological agents with improved drug delivery systems have driven recent research in attention-deficit hyperactivity disorder (ADHD). While stimulants are the primary pharmacotherapy for ADHD, these drugs have a limited duration of action and a subset of patients will either fail to respond to these medications or have side effects that preclude their use. The development of atomoxetine, the first nonstimulant approved for ADHD, has been followed by additional innovative research, such as the methylphenidate transdermal system, modafinil, NRP-104 and cholinergic agents. This review highlights some of the recent trends in ADHD treatment and the current status of promising treatment options that may help to shape the future of ADHD treatment.
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Affiliation(s)
- Vishal Madaan
- Child and Adolescent Psychiatry, Creighton University-University of Nebraska Medical Center, Omaha, NE, USA.
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40
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Sarnoff DS. Therapeutic update on Rosacea. J Drugs Dermatol 2014; 13:10-11. [PMID: 24385112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Moore A, Kempers S, Murakawa G, Weiss J, Tauscher A, Swinyer L, Liu H, Leoni M. Long-term safety and efficacy of once-daily topical brimonidine tartrate gel 0.5% for the treatment of moderate to severe facial erythema of rosacea: results of a 1-year open-label study. J Drugs Dermatol 2014; 13:56-61. [PMID: 24385120] [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: 06/03/2023]
Abstract
Once-daily topical brimonidine tartrate (BT) gel 0.5% was shown to be efficacious and safe for the treatment of erythema of rosacea in previous studies including a 4-week treatment phase. In the present 1-year study, we aimed to assess the long-term safety and efficacy of the treatment. Subjects with moderate to severe erythema of rosacea were instructed to apply topical BT gel 0.5% once daily for 12 months. Severity of erythema and adverse events (AEs) were evaluated. Approximately 345 subject years of exposure to BT gel 0.5% was achieved in the study. The incidence of AEs and AEs judged to be related to the study drug was higher at the beginning and decreased over the course of the study. Similar safety profiles were observed between the subjects who had received or not received concomitant therapies for the inflammatory lesions of rosacea. Effect of topical BT gel 0.5% on erythema severity was observed after the first application and the durability of the effect was maintained until the end of the study at month 12, with no tachyphylaxis observed. In conclusion, once-daily topical BT gel 0.5% is safe and consistently effective for the long-term treatment of moderate to severe erythema of rosacea, even in the presence of concomitant therapies for the inflammatory lesions of rosacea.
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Ruokonen E, Hovilehto S, Karlsson S, Loisa P, Pettilä V, Rintala E, Sirola J, Uusaro A. [Update on current care guideline: sepsis (adults]. Duodecim 2014; 130:516-517. [PMID: 24730203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The incidence of severe sepsis and septic shock requiring intensive care in Finnish adult population has increased to 0.60 11000 /y. Despite improved prognosis, hospital mortality related to severe sepsis and septic shock is high 24.1%. Key recommendations include prompt administration of antimicrobial therapy, optimally after blood cultures, quantitative fluid resuscitation and imaging studies to identify possible source of infection. Crystalloids are suitable for fluid resuscitation. Norepinephrine is the first-choice vasopressor in septic shock. Hydrocortisone should be considered only if fluid and vasopressor treatment does not restore hemodynamics.
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Zhang Q, Li C. Combination of epinephrine with esmolol attenuates post-resuscitation myocardial dysfunction in a porcine model of cardiac arrest. PLoS One 2013; 8:e82677. [PMID: 24367539 PMCID: PMC3867387 DOI: 10.1371/journal.pone.0082677] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/26/2013] [Indexed: 11/19/2022] Open
Abstract
Background Recent experimental and clinical studies have indicated that the β-adrenergic effect of epinephrine significantly increases the severity of post resuscitation myocardial dysfunction. The aim of the study was to investigate whether the short-acting β1-selective adrenergic blocking agent, esmolol, would attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac arrest. Methods and Results After 8 min of untreated ventricular fibrillation and 2 min of basic life support, 24 pigs were randomized to three groups (n = 8 per group), which received central venous injection of either epinephrine combined with esmolol (EE group), epinephrine (EP group), or saline (SA group). Hemodynamic status and blood samples were obtained at 0, 30, 60, 120, 240 and 360 min after return of spontaneous circulation (ROSC). Surviving pigs were euthanatized at 24 h after ROSC, and the hearts were removed for analysis by electron microscopy, Western blotting, quantitative real-time polymerase chain reaction, and terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling (TUNEL) assay. Compared with the EP and SA groups, EE group had a better outcome in hemodynamic function, (improved dp/dt maxima and minima and cardiac output) (P<0.05), and improved oxygen metabolism (oxygen delivery and oxygen consumption) (P<0.05), which suggesting that EE can protect myocardial tissue from injury and improve post-resuscitation myocardial dysfunction. The protective effect of EE also correlated with reducing cardiomyocyte apoptosis, evidenced by reducing TUNEL-positive cells, increasing anti-apoptotic Bcl-2/Bax ratio and suppression of caspase-3 activity in myocardium. Conclusions Esmolol, a short-acting β1-selective adrenergic blocking agent, given during CPR has significant effects on attenuating post resuscitation myocardial dysfunction. The current study provides a potential pharmacologic target for post resuscitation myocardial dysfunction.
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Affiliation(s)
- Qian Zhang
- Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - ChunSheng Li
- Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Chen Y, Palczewska G, Mustafi D, Golczak M, Dong Z, Sawada O, Maeda T, Maeda A, Palczewski K. Systems pharmacology identifies drug targets for Stargardt disease-associated retinal degeneration. J Clin Invest 2013; 123:5119-34. [PMID: 24231350 DOI: 10.1172/jci69076] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/12/2013] [Indexed: 12/22/2022] Open
Abstract
A systems pharmacological approach that capitalizes on the characterization of intracellular signaling networks can transform our understanding of human diseases and lead to therapy development. Here, we applied this strategy to identify pharmacological targets for the treatment of Stargardt disease, a severe juvenile form of macular degeneration. Diverse GPCRs have previously been implicated in neuronal cell survival, and crosstalk between GPCR signaling pathways represents an unexplored avenue for pharmacological intervention. We focused on this receptor family for potential therapeutic interventions in macular disease. Complete transcriptomes of mouse and human samples were analyzed to assess the expression of GPCRs in the retina. Focusing on adrenergic (AR) and serotonin (5-HT) receptors, we found that adrenoceptor α 2C (Adra2c) and serotonin receptor 2a (Htr2a) were the most highly expressed. Using a mouse model of Stargardt disease, we found that pharmacological interventions that targeted both GPCR signaling pathways and adenylate cyclases (ACs) improved photoreceptor cell survival, preserved photoreceptor function, and attenuated the accumulation of pathological fluorescent deposits in the retina. These findings demonstrate a strategy for the identification of new drug candidates and FDA-approved drugs for the treatment of monogenic and complex diseases.
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MESH Headings
- ATP-Binding Cassette Transporters/deficiency
- ATP-Binding Cassette Transporters/genetics
- Adenine/analogs & derivatives
- Adenine/pharmacology
- Adenine/therapeutic use
- Adenylyl Cyclase Inhibitors
- Adrenergic alpha-Agonists/pharmacology
- Adrenergic alpha-Agonists/therapeutic use
- Adrenergic alpha-Antagonists/pharmacology
- Adrenergic alpha-Antagonists/therapeutic use
- Alcohol Oxidoreductases/deficiency
- Alcohol Oxidoreductases/genetics
- Animals
- Cell Survival
- Disease Models, Animal
- Doxazosin/pharmacology
- Doxazosin/therapeutic use
- Drug Evaluation, Preclinical
- Guanabenz/pharmacology
- Guanabenz/therapeutic use
- Humans
- Light/adverse effects
- Macaca fascicularis
- Macular Degeneration/congenital
- Macular Degeneration/drug therapy
- Macular Degeneration/genetics
- Macular Degeneration/prevention & control
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Molecular Targeted Therapy
- Nerve Tissue Proteins/biosynthesis
- Nerve Tissue Proteins/genetics
- Photoreceptor Cells, Vertebrate/drug effects
- Photoreceptor Cells, Vertebrate/pathology
- Photoreceptor Cells, Vertebrate/physiology
- Photoreceptor Cells, Vertebrate/radiation effects
- Reactive Oxygen Species
- Receptor, Serotonin, 5-HT2A/biosynthesis
- Receptor, Serotonin, 5-HT2A/genetics
- Receptors, Adrenergic, alpha-2/biosynthesis
- Receptors, Adrenergic, alpha-2/genetics
- Receptors, G-Protein-Coupled/biosynthesis
- Receptors, G-Protein-Coupled/genetics
- Serotonin Antagonists/pharmacology
- Serotonin Antagonists/therapeutic use
- Signal Transduction
- Stargardt Disease
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Parsaik AK, Ahlskog JE, Singer W, Gelfman R, Sheldon SH, Seime RJ, Craft JM, Staab JP, Kantor B, Low PA. Central hyperadrenergic state after lightning strike. Clin Auton Res 2013; 23:169-73. [PMID: 23761114 DOI: 10.1007/s10286-013-0197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 04/25/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe and review autonomic complications of lightning strike. METHODS Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. RESULTS A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. INTERPRETATION The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.
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Affiliation(s)
- Ajay K Parsaik
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Subspecialty Group of Neurology, The Society of Pediatrics, Chinese Medical Association. [Diagnosis and treatment recommendations for tic disorders in children]. Zhonghua Er Ke Za Zhi 2013; 51:72-5. [PMID: 23527937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Giuliani E, Albertini G, Vaccari C, Manenti A, Barbieri A. Multi-organ failure following severe cocaine-tetramisole intoxication in a body-packer. Anaesth Intensive Care 2012; 40:562-564. [PMID: 22577932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Shi QQ, Wang H, Fang H. Dose-response and mechanism of protective functions of selective alpha-2 agonist dexmedetomidine on acute lung injury in rats. Saudi Med J 2012; 33:375-381. [PMID: 22485231] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To investigate the protective functions of dexmedetomidine on lipopolysaccharide-induced acute lung injury in the lung tissues of rats. METHODS The experiment was conducted from May 2008 to December 2009 in Zhongshan Hospital, Shanghai, China. Forty Sprague Dawley rats were randomized into a normal group (NS group), a lipopolysaccharide model group (LPS group), and dexmedetomidine groups in high dosages (HD), moderate dosages (MD), and low dosages (LD). After the acute lung injury model was duplicated by lipopolysaccharide, the rats in the LD, MD, and HD groups were injected with 0.5 ug/kg, 1.5 ug/kg, and 4.5 ug/kg of dexmedetomidine. The rats in the NS group were injected with normal saline. Immuno-histochemical and reverse transcription polymerase chain reaction techniques were used to assess the damage of lung tissue in each group. RESULTS The nuclear factor-KappaB and Toll-like receptor 4 messenger RNA expression in the lung tissues of the rats in the MD and HD groups were inhibited compared to the LPS group. The amount of tumor necrosis factor-beta, interleukin-1beta, and interleukin-6 as well as the lung tissue wet to dry weight ratio were also reduced in the MD and HD groups. CONCLUSION The inflammatory reactions in lung tissues can be effectively inhibited at doses ranging from 1.5-4.5 ug/kg, resulting in a protective effect on lung tissue.
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Affiliation(s)
- Qi-Qing Shi
- Department of Anesthesiology, Zhongshan Hospital of Fudan University, Shanghai, China
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Bharti N. Dexmedetomidine for the treatment of severe postoperative functional stridor. Anaesth Intensive Care 2012; 40:354-355. [PMID: 22417039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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