Toward personalized medicine for pharmacological interventions in neonates using vital signs

Oral nitroglycerin solution for oesophageal food impaction: a prospective single-arm pilot study

Emergency Medicine Journal ◽

10.1136/emermed-2019-209320 ◽

2020 ◽

Vol 37 (7) ◽

pp. 434-436

Author(s):

Benjamin Aaron Willenbring ◽

Callie Korliss Schnitker ◽

Samuel J Stellpflug

Keyword(s):

Average Duration ◽

Vital Signs ◽

Oesophageal Perforation ◽

Haemodynamic Instability ◽

Medical Setting ◽

Food Impaction ◽

Food Bolus ◽

Pharmacological Interventions ◽

Duration Of Symptoms ◽

Symptom Resolution

BackgroundThirteen episodes of oesophageal food impaction (EFI) per 100 000 people present to a medical setting each year. Several pharmacological interventions meant to relieve such impactions have been explored; none have proven superior.ObjectivesPerform a single-arm feasibility study of oral nitroglycerin solution for EFI.MethodsTwenty adult patients presenting to a single urban tertiary medical centre thought to have EFI were given up to three doses of 0.4 mg nitroglycerin solution orally and evaluated for resolution of symptoms, new symptoms and vital signs. Patients with intractable vomiting, haemodynamic instability, airway compromise, oesophageal perforation, coronary ischaemia or presentation delayed greater than 12 hours were excluded.Results17 of 20 enrolled subjects received the intervention. The average duration of symptoms prior to intervention was 285 min (SD=187). Four subjects did not tolerate the intervention (inability to swallow or headache). Two of 17 (11.8%) subjects obtained temporally proximal symptom resolution: 11 min after the second dose, and 7 min after the third dose. Seven also received glucagon during their visit, with 0% temporally proximal symptom resolution. Fifteen underwent endoscopy, with food bolus identified in 12. One subject had brief and mild hypotension with spontaneous resolution. Two subjects developed a headache after nitroglycerin administration. The median length of stay for those who found relief without endoscopy was 195 min (range 129–261) vs 374 min (range 122–525) among those with endoscopy.ConclusionThe observed rate of relief after oral nitroglycerin solution for EFI is disappointing but comparable to previous glucagon, benzodiazepines and effervescent beverage studies, and that of placebo. Oral nitroglycerin solution appears to be well tolerated among those able to swallow, although in our sample several subjects were unable to tolerate swallowing entirely.

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Personalized Medicine

Genomics and Personalized Medicine ◽

10.1093/wentk/9780190234775.003.0001 ◽

2016 ◽

Author(s):

Michael Snyder

Keyword(s):

Family History ◽

Personalized Medicine ◽

Medical History ◽

Personal Information ◽

Vital Signs ◽

Physical Exam ◽

Practice Of Medicine ◽

Laboratory Measures

What is personalized medicine? The practice of medicine has always been personal. Doctors use extensive personal information about a patient—including medical history, physical exam, vital signs, family history, laboratory measures, and imaging tests—to determine a patient’s risk for certain diseases and to make diagnoses....

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Sepsis: Personalized Medicine Utilizing ‘Omic’ Technologies—A Paradigm Shift?

Healthcare ◽

10.3390/healthcare6030111 ◽

2018 ◽

Vol 6 (3) ◽

pp. 111 ◽

Cited By ~ 2

Author(s):

Theis Itenov ◽

Daniel Murray ◽

Jens Jensen

Keyword(s):

Personalized Medicine ◽

Paradigm Shift ◽

Clinical Syndrome ◽

Pharmacological Interventions ◽

Omics Technologies ◽

Pathophysiological Mechanisms ◽

Advanced Technologies ◽

Biochemical Characterisation ◽

Biochemical Analyses ◽

Large Groups

Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may be too heterogeneous to be targeted with the traditional one treatment suits all’ approach. Recent advances in genetic and biochemical analyses now allow genotyping and biochemical characterisation of large groups of patients via the ‘omics’ technologies. These new opportunities could lead to a paradigm shift in the approach to sepsis towards personalised treatments with interventions targeted towards specific pathophysiological mechanisms activated in the patient. In this article, we review the potentials and pitfalls of using new advanced technologies to deepen our understanding of the clinical syndrome of sepsis.

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