Effects of Dexmedetomidine on Postoperative Nausea and Vomiting in Adult Patients Undergoing Ambulatory Thyroidectomy: A Randomized Clinical Trial

Background: Postoperative nausea and vomiting (PONV) is a common and disturbing problem in patients undergoing ambulatory thyroidectomy. This prospective trial aimed to explore whether dexmedetomidine (DEX) combined with azasetron (AZA) can further drop the incidence of PONV in patients undergoing ambulatory thyroidectomy compared with AZA.Methods: This single-center, randomized, double-blind trial involved 172 adult patients undergoing ambulatory thyroidectomy. The individuals were randomized to DEX + AZA group and AZA group. In the DEX + AZA group, patients received dexmedetomidine 0.5 μg kg−1 for 10 min and then the infusion rate was held at 0.1 μg kg−1 h−1 until the completion of the operation, while the same amount of 0.9% saline in the AZA group. At the completion of the surgery, 10 mg azasetron was administered to every patient in both groups. The primary outcome was the incidence of 24 h PONV after ambulatory thyroidectomy. The secondary outcomes included residence time in recovery room, pain scores, severity of nausea, and adverse events.Results: No significant difference was found in the incidence of 24-h PONV between the DEX + AZA group and the AZA group [36% (30 of 84) vs. 38% (32 of 84); relative risk, 0.94; 95% confidence interval (CI), 0.63–1.40; P = 0.749]. The incidence of severe nausea was similar between the DEX + AZA group and the AZA group [57% (12 of 21) vs. 43% (9 of 21); relative risk, 1.33; 95% CI, 0.72–2.50; P = 0.355].Conclusions: Intraoperative dexmedetomidine combined with azasetron failed to drop the incidence of 24-h PONV compared with azasetron alone in patients undergoing ambulatory thyroidectomy.

A study to identify clinical and laboratory parameters in cases of excessive vomiting in early pregnancy

Background: Around half of all pregnant women experience vomiting, and more than 80% of women experience nausea in the first 12 weeks. Women with severe nausea and vomiting during pregnancy may have hyperemesis gravidarum (HG), an entity distinct from nausea and vomiting of pregnancy (NVP), which if left untreated may lead to significant maternal and foetal morbidity. In our study, we studied, clinical and laboratory parameters in patients presenting with excessive vomiting. The study may help in evaluating what is the major clinical problem encountered during treatment and how many days of care are needed in such cases.Methods: The study design was a prospective observational study. Patients attending the ANC clinic and emergency indoor cases at Peoples college of medical sciences, Bhopal were considered as study population. 100 patients who satisfied inclusion and exclusion criteria were included in the study. Patient’s sociodemographic variables, detailed obstetric history, clinical and laboratory parameters were recorded. Results obtained were analysed and tabulated.Results: Persistence of vomiting in the first trimester leading to dehydration and hospitalization was documented in 12% of patients. The 5% of then had metabolic acidosis and 1% required correction of starvation ketoacidosis, but there was not significant weight loss observed in any of the case. Liver function test were normal in almost in all cases except 9% had raised serum alkaline phosphatase levels.Conclusions: All cases with vomiting in early pregnancy should receive attention and exclusion of all emergency clinical conditions. Patient should be screened for urine tract infection and diabetes in all cases.

A Case Report on Chronic Digoxin Toxicity

Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of toxicity induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. Here, a 65-years-old patient who was hospitalized following chronic ingestion with acute renal impairment. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient’s blood was estimated at 8.5 ng/ml. During her stay on the ward, typical symptoms of severe toxicity were observed: from gastric symptoms (severe nausea, vomiting) to conduction disturbances. Type I, moitz type 1 and 2 AV blocks were detected, as well as some supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective. Bangladesh Heart Journal 2021; 36(2): 139-144

Migraine: features of pharmacotherapeutic and drug-free preventive treatment

Migraine is one of the most common forms of headache, which can lead to a significant reduction in quality of life. There is migraine with aura, migraine without aura, as well as chronic migraine, which significantly reduces the efficiency of patients and is often combined with mental disorders and drug-induced headaches. Complications of migraine include migraine status, persistent aura without a heart attack, migraine heart attack (stroke) and epileptic seizure caused by migraine aura. The diagnosis of migraine is established based on complaints, medical history, objective examination data, and diagnostic criteria of the International Headache Classification of the 3rd revision. Additional research methods are recommended only in the presence of “red flags” — symptoms that alert to the secondary nature of the headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks, reducing the number of pharmatherapeutical analgesics. It includes three main approaches: seizure relief therapy, preventive therapy, and non-drug methods. Non-steroidal anti-inflammatory drugs, simple and combined analgesics, triptans, as well as anti-nausea drugs (for severe nausea or vomiting) are recommended for seizures relief. In case of frequent or severe migraine attacks, as well as in case of chronic migraine, prophylactic therapy is indicated, which includes antidepressants, topiramate, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide receptors. Pharmacotherapy is recommended to be combined with non-drug methods, which include cognitive-behavioral therapy, the method of transcranial magnetic stimulation, the method of biological feedback, postsphygmic period, acupuncture, therapeutic exercises, block of greater occipital nerve, and stimulation of the first trigeminal nerve.

Effects of Simulated Gastric Acid Exposure on Surface Topography, Mechanical and Optical Features of Commercial CAD/CAM Ceramic Blocks

Gastric acid exposure produces tooth structure demineralization and dental ceramic degradation. The most affected patients are those who suffer from gastroesophageal reflux disease, bulimia nervosa, and pregnant women with prolonged severe nausea. In order to protect this kind of patient, the purpose of this study was to determine whether simulated gastric acid exposure leads to microstructural changes in surface topography, hardness, color changes, and translucency of some ceramic materials, which are already on the market. Forty disks (Triluxe Forte, Cerasmart, Enamic and Empress CAD) were analyzed before and after immersion in simulated gastric acid juice, in terms of microhardness, surface roughness, translucency, and surface morphology using scanning electron microscopy. Color change was assessed by using a spectrophotometer based on CIELab parameters and the results showed that, after exposure, ∆Eab remained under the threshold of acceptability and perceptibility. In terms of microhardness, Cerasmart is the only material that did not undergo changes after immersion. SEM images illustrated observable changes surface topography after acid exposure for all the tested materials. In conclusion, Triluxe Forte suffered the most important changes after simulated gastric acid juice exposure, and Cerasmart proved to be the least affected material.

Acute poisoning with acetamiprid: a case report

Background Acetamiprid is a potent new first-generation neonicotinoid insecticide in agricultural practices. It is well described that it has low toxicity among animals and is lethal if consumed in large amounts. However, toxicity in humans is rarely reported in literature. Here, we describe acetamiprid toxicity complicated with severe lactic acidosis, myocardial ischemia, refractory hypotension, and severe hypokalemia in a middle-aged man who presented with deliberate self-harming with acetamiprid poisoning in Sri Lanka. Case presentation We describe a case of acute poisoning with an acetamiprid in a middle-aged Sri Lankan Tamil farmer for suicidal purposes following family conflicts with his wife. He presented with severe nausea, vomiting, and altered level of consciousness. He had electrocardiogram changes, hypoxia, and lactic acidosis. With intensive care management including ventilatory support, inotropic therapy along with intraarterial blood pressure monitoring, correction of acidosis, and administration of electrolytes, he made good clinical recovery. He was discharged without any further complications 6 days after ingestion of acetamiprid. Conclusions This case illustrates a rare, acute poisoning with acetamiprid in human, as well as its clinical manifestations and successful management with supportive therapy. This will be helpful for clinicians to identify clinical manifestations and to guide management of acute poisoning with acetamiprid in the future.

Incidence and risk factors for euthanasia or physician-assisted suicide in oncology patients: A systematic review.

12034 Background: In a growing number of jurisdictions, oncology patients may choose euthanasia or physician-assisted suicide (EPAS). A 2016 systematic review reported that 75% of U.S. and over 70% of Dutch and Belgian EPAS cases involved oncology patients. In the Netherlands and Belgium, the percentage of deaths among oncology patients via EPAS has been increasing. We investigated the incidence and risk factors for EPAS and EPAS requests in oncology patients. Methods: A systematic review was performed following PRISMA guidelines. PubMed, Embase and Cochrane databases were searched for articles from January 2000 to April 2020. Search terms were related to suicide, euthanasia, assisted dying, assisted death, right to die, mercy killing, and cancer. Eligible studies reported incidence and/or risk factors for EPAS/EPAS request based on at least 50 oncology patients. Eligibility for inclusion was independently reviewed by two authors, with discrepancies adjudicated by a third. Data obtained included: study type, country, cancer diagnosis, number of eligible patients, inclusion criteria, follow-up length, incidence of EPAS or EPAS request, and odds ratios (OR) for risk factors for EPAS and EPAS request. ORs and p values were extracted from studies whenever possible and were otherwise calculated based on the data provided using chi-squared test. Results: The search strategy identified 6519 results. 25 abstracts were selected for full-text review and 10 studies were included for analysis. All studies reported incidence of EPAS/EPAS request and 6 studies reported risk factors for EPAS/EPAS request. Six studies were from the Netherlands, 3 from Belgium, and 1 from Canada. Inclusion period for studies spanned from 1996 to 2018. Half of the included studies were prospectively conducted. Incidence of EPAS in cancer patients ranged from 7% to 15% and EPAS requests ranged from 8% to 27%. Factors significantly associated (p<0.05) with EPAS or EPAS request in any study are shown in the Table. Conclusions: Up to 15% of oncology patients choose euthanasia or physician-assisted suicide. Potentially modifiable symptoms including severe nausea, vomiting, and pain are significantly associated with EPAS in oncology patients.[Table: see text]

Poisoning with Soranjan (Colchicum): a case report

Introduction: Colchicine, which is derived from a herb called Colchicum is a medication used to treat gout. Colchicum itself can act as a deadly toxic herb in the case of over dose. This is a case report study which investigates a patient who was poisoned with Colchicum (Soranjan, what it is called in Iran). Description: The patient was a 44-year-old man who came to the emergency poisoning ward after a day of mountaineering and eating Soup. He had severe nausea and vomiting. The patient was admitted to the ICU two days later with a toxic general condition, complaining of chest pain, nausea, vomiting and shortness of breath. The patient lab tests showed elevated liver enzymes and pancytopenia. The patient respiratory distress developed and physician had to intubate the patient. The patient was treated with antibiotics, GCSF for pancytopenia and antioxidant to protect the liver. Conclusion: The patient responded to broad spectrum antibiotic, antifungal and GCSF. paying attention to the patient’s history was the key of success to diagnosis.