Ultrasound-guided transmuscular quadratus lumborum block reduced postoperative opioids consumptions in patients after laparoscopic hepatectomy: a three-arm randomized controlled trial

Background To investigate whether transmuscular quadratus lumborum block (TQLB) combined with oxycodone-based patient-controlled intravenous analgesia (PCIA) compared with sufentanil-based patient-controlled intravenous analgesia could reduce postoperative pain and opioid consumption in patients undergoing laparoscopic hepatectomy. Methods Eighty patients undergoing laparoscopic hepatectomy surgery were randomly divided into Group S (Sufentanil for PCIA group), Group O (Oxycodone for PCIA group) and Group QO (transmuscular quadratus lumborum block + oxycodone for PCIA group). Primary outcome was Numerical Rating Scale (NRS) pain score when coughing at 6th hour after the operation. We summarized opioid consumption and recorded complications, opioid drug adverse reaction and analgesia satisfaction. Results NRS pain scores were significantly lower in Group QO while patients coughing at 6th hour after the operation compared with Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 4.0 [3.0, 5.0] vs. 4.0[3.0,5.0]vs.3.0 [2.0, 3.0], p < 0.05). Within 24 h after surgery, the bolus times of PCIA (patient controlled intravenous analgesia) in the QO group was reduced which was compared with the Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 13.0 [10.3, 19.5] vs. 11.5 [7.8, 18.3]vs.6.5[3.5,12.0], p < 0.05). The proportion of patients in the three groups who required additional analgesia was ranked as Group QO < Group O < Group S(p < 0.05). The analgesic satisfaction of patients in Group QO was higher than the Group S (p = 0.001) and Group O (p = 0.012). Conclusions TQLB combined with oxycodone-based PCIA provided satisfactory postoperative analgesia and reduced oxycodone consumption in patients following laparoscopic hepatectomy. Trial registration ChiCTR1900028467 (22/12/2019).

DRUG INDUCED DERMATOLOGICAL REACTION OF THE 100 MOST COMMONLY PRESCRIBED MEDICATIONS IN UK HOSPITALS

Objective: It is commonly reported that medicines have side effects related to dermatological practice. However, it is extremely difficult to establish how commonly, or rarely skin-related medication side effects occur. Common dermatological side effects include rash, pruritus, and photosensitivity. Objective: To demonstrate the dermatological side-effects of the most commonly prescribed medications in the United Kingdom. Methods: This paper discusses dermatological side-effects of the commonly prescribed medications, including uncommon or rare manifestations such as angioedema and Stevens - Johnson syndrome (SJS). The list used for the most frequently prescribed drugs in the United Kingdom was created by nurses. This list was compared to the British National Formulary to demonstrate the reported frequency of occurrence of dermatological side-effects or complications. Conclusion: The top 100 prescribed medication cause a number of dermatological side effects that need to be considered when they are prescribed to patients who have pre-existing skin conditions. Additionally, when confronted with a common dermatological problem in any patient, clinicians should always consider the possibility of a drug adverse reaction.

Formulation of gel containing clotrimazole-loaded nanoparticles

Background: Clotrimazole (CLO) is an imidazole derivative with antifungal activities. The conventional dosage forms for oral or topical administration have some disadvantages such as drug adverse reaction for long-term use, repeated doses daily due to short half-life. The aim of this study was to prepare gel containing CLO-loaded nanoparticles to increase drug solubility, enhance bioavailability, especially for a sustained drug release. Materials and methods: Eudragit RS 100 nanoparticles were prepared by the nanoprecipitation method, then was mixed with gel forming excipient. Gel containing CLO-loaded nanoparticles was characterized in terms of appearance, pH, particle size, PDI, encapsulation efficiency (EE), in vitro drug release. Results: The best formulation of gel containing 1% of CLO-loaded nanoparticles with 0.3% of Carbopol 934P, 5% of glycerin was smooth, homogenous, and particle size, PDI, EE, drug release of 154.6 ± 3.6 nm, 0.153 ± 0.011, 67.62 ± 0.89%, 51.46 ± 1.10% (after 24 hours). Conclusion: Gel containing CLO-loaded nanoparticles is a promising drug delivery system for the topical treatment of fungal infections. Key words: clotrimazole, Eudragit RS 100, fungal infection, nanoparticle, topical treatment

Adverse drug reaction early warning using user search data

Purpose The purpose of this paper is to propose a framework to detect adverse drug reactions (ADRs) using internet user search data, so that ADR events can be identified early. Empirical investigation of Avandia, a type II diabetes treatment, is conducted to illustrate how to implement the proposed framework. Design/methodology/approach Typical ADR identification measures and time series processing techniques are used in the proposed framework. Google Trends Data are employed to represent user searches. The baseline model is a disproportionality analysis using official drug reaction reporting data from the US Food and Drug Administration’s Adverse Event Reporting System. Findings Results show that Google Trends series of Avandia side effects search reveal a significant early warning signal for the side effect emergence of Avandia. The proposed approach of using user search data to detect ADRs is proved to have a longer leading time than traditional drug reaction discovery methods. Three more drugs with known adverse reactions are investigated using the selected approach, and two are successfully identified. Research limitations/implications Validation of Google Trends data’s representativeness of user search is yet to be explored. In future research, user search in other search engines and in healthcare web forums can be incorporated to obtain a more comprehensive ADR early warning mechanism. Practical implications Using internet data in drug safety management with a proper early warning mechanism may serve as an earlier signal than traditional drug adverse reaction. This has great potential in public health emergency management. Originality/value The research work proposes a novel framework of using user search data in ADR identification. User search is a voluntary drug adverse reaction exploration behavior. Furthermore, user search data series are more concise and accurate than text mining in forums. The proposed methods as well as the empirical results will shed some light on incorporating user search data as a new source in pharmacovigilance.