scholarly journals Ultrasound to the Rescue: Axillary Clearance under Complete Regional Blockade

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
B. M Munasinghe ◽  
N. Subramaniam ◽  
S. Nimalan ◽  
P. Sivamayuran
Keyword(s):  
Breast Carcinoma ◽  
Adverse Effects ◽  
General Anaesthesia ◽  
Ultrasound Guidance ◽  
Current Evidence ◽  
Axillary Clearance ◽  
Asthma Exacerbations ◽  
Axillary Region ◽  
Intercostobrachial Nerve ◽  
Regional Anaesthetic Technique

No single regional anaesthetic technique is capable of complete anaesthesia of the axillary region. Regional or interfascial nerve blockade could be an effective alternative where administering general anaesthesia is not feasible, with superior analgesia, favourable haemodynamics, and reduced opiate related adverse effects. Ultrasound guidance improves effectiveness and safety profile. We report a case of a successful axillary clearance conducted under combined regional blocks for an axillary nodal recurrence following mastectomy for a breast carcinoma, in a patient who was not fit for general anaesthesia due to a persistent lobar pneumonia and recurrent asthma exacerbations. Our experience and current evidence supersede the initial conceptions of difficult ultrasonic intercostobrachial nerve (ICBN) visualization.

scholarly journals Hormones in international meat production: biological, sociological and consumer issues

2002 ◽  
Vol 15 (2) ◽  
pp. 293-314 ◽  
Author(s):  
Hugh Galbraith
Keyword(s):  
Biological Activity ◽  
Adverse Effects ◽  
Good Practice ◽  
Current Status ◽  
Current Evidence ◽  
Meat Production ◽  
International Consensus ◽  
Free Radical Damage ◽  
Endogenous Production ◽  
Human Pathology

AbstractBeef and its products are an important source of nutrition in many human societies. Methods of production vary and include the use of hormonal compounds (‘hormones’) to increase growth and lean tissue with reduced fat deposition in cattle. The hormonal compounds are naturally occurring in animals or are synthetically produced xenobiotics and have oestrogenic (oestradiol-17β and its esters; zeranol), androgenic (testosterone and esters; trenbolone acetate) or progestogenic (progesterone; melengestrol acetate) activity. The use of hormones as production aids is permitted in North American countries but is no longer allowed in the European Union (EU), which also prohibits the importation of beef and its products derived from hormone-treated cattle. These actions have resulted in a trade dispute between the two trading blocs. The major concern for EU authorities is the possibility of adverse effects on human consumers of residues of hormones and metabolites. Methods used to assess possible adverse effects are typical of those used by international agencies to assess acceptability of chemicals in human food. These include analysis of quantities present in the context of known biological activity and digestive, absorptive, post-absorptive and excretory processes. Particular considerations include the low quantities of hormonal compounds consumed in meat products and their relationships to endogenous production particularly in prepubertal children, enterohepatic inactivation, cellular receptor- and non-receptor-mediated effects and potential for interference with growth, development and physiological function in consumers. There is particular concern about the role of oestradiol-17β as a carcinogen in certain tissues. Now subject to a ‘permanent’ EU ban, current evidence suggests that certain catechol metabolites may induce free-radical damage of DNA in cell and laboratory animal test systems. Classical oestrogen-receptor mediation is considered to stimulate proliferation in cells maintaining receptivity. Mathematical models describing quantitative relationships between consumption of small amounts of oestrogens in meat in addition to greater concentrations from endogenous production, chemical stoichiometry at cellular level and human pathology have not been developed. Such an approach will be necessary to establish ‘molecular materiality’ of the additional hormone intake as a component of relative risk assessment. The other hormones, although generally less well researched, are similarly subject to a range of tests to determine potentially adverse effects. The resulting limited international consensus relates to the application of the ‘precautionary principle’ and non-acceptance by the European Commission of the recommendations of the Codex Alimentarius Commission, which determined that meat from cattle, hormone-treated according to good practice, was safe for human consumers. The present review considers the hormone issue in the context of current international social methodology and regulation, recent advances in knowledge of biological activity of hormones and current status of science-based evaluation of food safety and risk for human consumers.

Dexamethasone as an Adjuvant to 0.5 % Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block

2021 ◽  
Vol 8 (14) ◽  
pp. 849-853
Author(s):  
Shweta Saurin Mehta ◽  
Nidhiben Sureshbhai Patel
Keyword(s):  
Adverse Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Supraclavicular Approach ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Regional Anaesthetic Technique ◽  
Plexus Block

BACKGROUND Supraclavicular brachial plexus block is a reliable, regional anaesthetic technique for upper limb surgeries. Also known as “spinal of upper limb”.1 The present study was conducted to assess the analgesic efficacy of dexamethasone as an adjuvant to 0.5 % ropivacaine for ultrasound sonography (USG) guided brachial plexus block. METHODS 50 adult patients of American Society of Anaesthesiologists (ASA) physical status I and II of both genders, aged 18 - 50 years scheduled for elective upper limb surgeries under brachial plexus block via supraclavicular approach were randomised into 2 groups of 25 patients each to receive either 20 ml of 0.5 % ropivacaine with 2 ml of normal saline (group A) or 20 ml of 0.5 % ropivacaine with 2 ml of dexamethasone (8 mg) (group B). RESULTS Use of ultrasound helps in better visualisation of nerves, needle & spread of local anaesthetic at brachial plexus block site. So, less amount of drug volume is required for the block. Time of onset of sensory and motor block was significantly lower in group B compared to group A. Mean duration of motor and sensory block was significantly longer in group B than group A. The duration of postoperative analgesia was 18.79 ± 2.31 hours in group B & 9.06 ± 0.35 hours in group A, with statistically highly significant difference (P < 0.05). There were no perioperative haemodynamic variations between the two groups and no complication of technique or adverse effects due to dexamethasone occurred. CONCLUSIONS Dexamethasone 8 mg has significantly extended duration of analgesia of brachial plexus block with no adverse effects. KEYWORDS Brachial Plexus Block, Ropivacaine, Dexamethasone, Supraclavicular Approach, Ultrasound Guidance

scholarly journals Asenapine for the Treatment of Psychotic Disorders

2016 ◽  
Vol 62 (2) ◽  
pp. 123-137 ◽  
Author(s):  
Catherine Orr ◽  
Santosh Deshpande ◽  
Sonja Sawh ◽  
Philip M. Jones ◽  
Kamini Vasudev
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Psychotic Disorders ◽  
Randomized Clinical Trials ◽  
Current Evidence ◽  
Metabolic Outcomes ◽  
Syndrome Scale ◽  
Efficacy Measures ◽  
Clinically Significant ◽  
Negative Syndrome

Objective: A systematic review was conducted to examine the efficacy, tolerability, and acceptability of asenapine compared with other antipsychotics in the treatment of psychotic disorders. Methods: Four databases, 8 trial registries, and conference presentations were searched for randomized clinical trials of asenapine versus any comparator for the treatment of any psychotic illness. Primary outcome measures were changes in the Positive and Negative Syndrome Scale (PANSS) total score and the incidence of withdrawal due to adverse effects. Results: Eight randomized clinical trials, encompassing 3765 patients, that compared asenapine with placebo ( n = 5) and olanzapine ( n = 3) were included. No differences were found between asenapine and olanzapine in terms of changes to PANSS total or PANSS negative subscale scores. Patients taking asenapine were more likely to experience worsening schizophrenia and/or psychosis than were those taking olanzapine. No differences were found between asenapine and olanzapine in rates of discontinuation due to adverse drug reactions or lack of efficacy, but those taking asenapine had higher rates of withdrawal for any reason than those taking olanzapine. Asenapine caused less clinically significant weight gain or increases in triglycerides than olanzapine and was more likely to cause extrapyramidal symptoms than olanzapine. In comparison to placebo, either no difference or superiority was demonstrated in favour of asenapine on all efficacy measures. Conclusion: The current evidence is limited, as asenapine has been compared only with placebo or olanzapine. In the randomized clinical trials analysed, asenapine was similar or superior to placebo and similar or inferior to olanzapine on most efficacy outcomes. While asenapine demonstrated fewer adverse metabolic outcomes than olanzapine, rates of extrapyramidal symptom–related adverse effects were higher.

scholarly journals Plasticizers and Cardiovascular Health: Role of Adipose Tissue Dysfunction

2021 ◽  
Vol 11 ◽  
Author(s):  
Mikyla A. Callaghan ◽  
Samuel Alatorre-Hinojosa ◽  
Liam T. Connors ◽  
Radha D. Singh ◽  
Jennifer A. Thompson
Keyword(s):  
Cardiovascular Disease ◽  
Adipose Tissue ◽  
Adverse Effects ◽  
Cardiovascular Health ◽  
The United States ◽  
Current Evidence ◽  
Endocrine Disrupting ◽  
And Function

Since the 1950s, the production of plastics has increased 200-fold, reaching 360 million tonnes in 2019. Plasticizers, additives that modify the flexibility and rigidity of the product, are ingested as they migrate into food and beverages. Human exposure is continuous and widespread; between 75 and 97% of urine samples contain detectable levels of bisphenols and phthalates, the most common plasticizers. Concern over the toxicity of plasticizers arose in the late 1990s, largely focused around adverse developmental and reproductive effects. More recently, many studies have demonstrated that exposure to plasticizers increases the risk for obesity, type 2 diabetes, and cardiovascular disease (CVD). In the 2000s, many governments including Canada, the United States and European countries restricted the use of certain plasticizers in products targeted towards infants and children. Resultant consumer pressure motivated manufacturers to substitute plasticizers with analogues, which have been marketed as safe. However, data on the effects of these new substitutes are limited and data available to-date suggest that many exhibit similar properties to the chemicals they replaced. The adverse effects of plasticizers have largely been attributed to their endocrine disrupting properties, which modulate hormone signaling. Adipose tissue has been well-documented to be a target of the disrupting effects of both bisphenols and phthalates. Since adipose tissue function is a key determinant of cardiovascular health, adverse effects of plasticizers on adipocyte signaling and function may underlie their link to cardiovascular disease. Herein, we discuss the current evidence linking bisphenols and phthalates to obesity and CVD and consider how documented impacts of these plasticizers on adipocyte function may contribute to the development of CVD.

scholarly journals A Preliminary Investigation on the Effects of Atenolol for Treating Symptoms of Anxiety

2020 ◽  
Vol 185 (11-12) ◽  
pp. e1954-e1960 ◽  
Author(s):  
Cody Armstrong ◽  
Michelle R Kapolowicz
Keyword(s):  
Mental Health ◽  
Posttraumatic Stress Disorder ◽  
Adverse Effects ◽  
Anxiety Disorders ◽  
Posttraumatic Stress ◽  
Beta Blocker ◽  
Stress Disorder ◽  
Current Evidence ◽  
Patient Reported ◽  
Positive Effect

Abstract Introduction Anxiety disorders are among the most commonly diagnosed of psychiatric disorders. Many symptoms of posttraumatic stress disorder are also anxiety-related. Traditional medications used to treat these disorders, such as antidepressants and benzodiazepines, are often ineffective, not well-tolerated, and can be habit forming. An alternative agent is, therefore, needed. Beta-blockers are one class of medication with potential to treat anxiety-related disorders; however, current evidence remains limited and requires further characterization. To this end, this retrospective study aims to present a novel preliminary report on the use of the beta-blocker, atenolol, to potentially treat anxiety-related disorders. Materials and methods Ninety-two patients were identified from outpatient military mental health clinics in Okinawa, Japan, who had received atenolol for mental health-related symptoms. Primary measures collected were the rates of patient-reported (1) general beneficial/positive effect of atenolol, (2) adverse effects from atenolol, and (3) preference of atenolol to propranolol. Data were collected from patients who were given binary response options to report their perceived experiences for each primary measure. This study was approved by the Naval Medical Center San Diego Institutional Review Board. Results The results showed 86% of patients reporting a positive effect and continuing to take atenolol, including 87% with a diagnosis of posttraumatic stress disorder, 100% with diagnosis of other specified trauma- and stressor-related disorder, and 81% diagnosed with anxiety disorders. In total, 90% of patients denied adverse effects or found the adverse effects tolerable. Additionally, 100% of patients who had previously taken propranolol for anxiety reported that they preferred atenolol. Conclusions The present preliminary observational data suggests that atenolol may be well-tolerated and effective among persons with anxiety disorders. These data also suggest that atenolol may be more effective and better tolerated than propranolol, which is the most commonly prescribed beta-blocker for these conditions; however, more rigorously controlled empirical studies are needed to further substantiate this claim. Despite an overwhelmingly high rate of positive reports from patients’ self-evaluations of atenolol treatment for anxiety-related disorders, this early investigation was not placebo-controlled nor double-blinded, and formal outcome measures were not assessed due to a lack of availability. More detailed examinations are needed to further determine whether atenolol is a viable alternative or augmenting agent to propranolol, benzodiazepines, and antidepressants for anxiety disorders and trauma-related disorders.

scholarly journals Axillary Brachial Plexus Block

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Ashish R. Satapathy ◽  
David M. Coventry
Keyword(s):  
Brachial Plexus ◽  
Ultrasound Guidance ◽  
Hand Surgery ◽  
Success Rates ◽  
Axillary Approach ◽  
Case Surgery ◽  
Brachial Plexus Blockade ◽  
Injection Techniques ◽  
Intercostobrachial Nerve ◽  
Plexus Block

The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other approaches. In addition, the axillary approach remains the safest of the four main options, as it does not risk blockade of the phrenic nerve, nor does it have the potential to cause pneumothorax, making it an ideal option for day case surgery. Historically, single-injection techniques have not provided reliable blockade in the musculocutaneous and radial nerve territories, but success rates have greatly improved with multiple-injection techniques whether using nerve stimulation or ultrasound guidance. Complete, reliable, rapid, and safe blockade of the arm is now achievable, and the paper summarizes the current position with particular reference to ultrasound guidance.

scholarly journals Safety and Efficacy of Armodafinil in the Treatment of Excessive Sleepiness

2011 ◽  
Vol 3 ◽  
pp. CMT.S5124
Author(s):  
Jamie N. Brown ◽  
Dustin T. Wilson
Keyword(s):  
Adverse Effects ◽  
Health Care Providers ◽  
English Language ◽  
Rating Scales ◽  
Data Extraction ◽  
Current Evidence ◽  
Care Providers ◽  
Sleep Study ◽  
Excessive Sleepiness ◽  
Obstructive Sleep

Objective To review the efficacy and safety of armodafinil for the treatment in patients with excessive sleepiness. Data sources Literature was accessed via MEDLINE (1966–February 2011) and EMBASE (1980–February 2011) using the medical subject heading terms armodafinil and sleep. Study selection and data extraction All English-language, peer-reviewed publications were analyzed for relevance. Studies appropriate to the objective were evaluated if they prospectively assessed the effectiveness of armodafinil in patients with excessive sleepiness in a multiple-dose, comparator trial. The literature search identified published reports of 7 randomized, placebo-controlled studies. Data synthesis Armodafinil is a wakefulness-promoting agent used in the treatment of patients with excessive sleepiness and is the R-enantiomer of modafinil. Studies have demonstrated that armodafinil may be effective and safe when used in patients with obstructive sleep apnea, circadian rhythm disorders, and narcolepsy. Although the studies identified had limited sample sizes, they consistently demonstrated improvement on various efficacy rating scales for sleep. Study durations ranged from 3 days to 12 weeks, with doses ranging from 50 mg to 250 mg daily. The most common adverse effects associated with armodafinil therapy were headache, nausea, diarrhea, dizziness, and anxiety, although increases in systolic blood pressure and pulse rate were also reported. Conclusion Current evidence suggests that armodafinil significantly improves wakefulness in patients with excessive sleepiness in studies up to 12 weeks. Long-term effectiveness and safety cannot be adequately determined at this time. Although armodafinil should be considered safe for use, health-care providers should monitor for adverse effects, particularly cardiovascular complications.

scholarly journals Postoperative Apnoea in Infants

1994 ◽  
Vol 22 (1) ◽  
pp. 40-45 ◽  
Author(s):  
C. Sims ◽  
C. M. Johnson
Keyword(s):  
General Anaesthesia ◽  
Risk Group ◽  
Elective Surgery ◽  
Past History ◽  
High Risk Group ◽  
Current Evidence ◽  
Term Infants ◽  
Increased Risk ◽  
Minor Surgery ◽  
History Of

Past studies concerning postoperative apnoea in infants were identified and reviewed. A total of only 200 former preterm infants having minor surgery under general anaesthesia have been prospectively studied. The incidence of apnoea after general anaesthesia is approximately 30%, and is inversely related to postconceptual age. A large number of term infants have been studied, and the incidence of postoperative apnoea is very low. The initial apnoea is always within 12 hours of surgery, though only one study has collected data beyond this length of time. Past history of apnoea episodes, bronchopulmonary dysplasia, anaemia or neurological disease may be associated with an increased risk, though current evidence is not strong. No patient characteristic apart from postconceptual age has enough sensitivity and specificity to identify a high-risk group. The use of spinal anaesthesia or methylxanthines may reduce the incidence of postoperative apnoea, but again the evidence is not strong. Recommendations concerning the timing of elective surgery and the use of postoperative respiratory monitoring in the former preterm infant can only be made cautiously in view of the paucity of data on which to base them.

scholarly journals Unraveling the Relationship of Asthma and COVID-19

2021 ◽  
Vol 11 (12) ◽  
pp. 1374
Author(s):  
Agamemnon Bakakos ◽  
Petros Bakakos ◽  
Nikoletta Rovina
Keyword(s):  
Molecular Mechanisms ◽  
Viral Infections ◽  
Asthma Severity ◽  
Current Evidence ◽  
Asthma Exacerbations ◽  
Inflammatory Phenotypes ◽  
Relationship Of ◽  
The Impact ◽  
The Relationship

Viral infections are one of the main causes of asthma exacerbations. During the COVID-19 era, concerns regarding the relationship of SARS-CoV2 with asthma have been raised. The concerns are both for COVID severity and asthma exacerbations. Many studies on COVID-19 epidemiology and comorbidities have assessed whether asthma represents a risk factor for SARS-CoV2 infection and/or more severe course of the disease. This review covers the current evidence on the prevalence of asthma in COVID-19 and its association with susceptibility to and severity of SARS-CoV2 infection. It will examine the possible role of underlying asthma severity in COVID-19 related outcomes as well as the molecular mechanisms involved in the co-existence of these entities. The possible role of asthma inflammatory phenotypes will also be evaluated. Finally, the impact of asthma comorbidities and the implications of asthma medication on COVID-19 will be addressed.

scholarly journals Ultrasound Guided Intercostobrachial Nerve Blockade in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study

2016 ◽  
Vol 19 (2;2) ◽  
pp. E309-E317 ◽  
Author(s):  
Nelun Wijayasinghe
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
Ultrasound Guidance ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Sensory Function ◽  
Breast Cancer Surgery ◽  
Maximum Point ◽  
Ultrasound Guided ◽  
Intercostobrachial Nerve

Background: Persistent pain after breast cancer surgery (PPBCS) affects 25 – 60% of breast cancer survivors and damage to the intercostobrachial nerve (ICBN) has been implicated as the cause of this predominantly neuropathic pain. Local anesthetic blockade of the ICBN could provide clues to pathophysiological mechanisms as well as aiding diagnosis and treatment of PPBCS but has never been attempted. Objectives: To assess the feasibility of ICBN blockade and assess its effects on pain and sensory function in patients with PPBCS. Study Design: This prospective pilot study was performed in 2 parts: Part 1 determined the sonoanatomy of the ICBN and part 2 examined effects of the ultrasound-guided ICBN blockade in patients with PPBCS. Setting: Section for Surgical Pathophysiology at Rigshospitalet, Copenhagen, Denmark. Methods: Part 1: Sixteen unoperated, pain free breast cancer patients underwent systematic ultrasonography to establish the sonoanatomy of the ICBN. Part 2: Six patients with PPBCS who had pain in the axilla and upper arm were recruited for the study. Summed pain intensity (SPI) scores and sensory function were measured before and 30 minutes after the block was administered. SPI is a combined pain score of numerical rating scale (NRS) at rest, movement, and 100kPa pressure applied to the maximum point of pain using pressure algometry (max = 30). Sensory function was measured using quantitative sensory testing, which consisted of sensory mapping, thermal thresholds, suprathreshold heat pain perception as well as heat and pressure pain thresholds. The ICBN block was performed under ultrasound guidance and 10 mL 0.5% bupivacaine was injected. Outcome Assessment: The ability to perform the ICBN block and its analgesic and sensory effects. Results: Only the second intercostal space could be seen on ultrasound which was adequate to perform the ICBN block. The mean difference in SPI was -9 NRS points (95%CI: -14.1 to -3.9), P = 0.006. All patients had pre-existing areas of hypoesthesia which decreased in size in 4/6 patients after the block. Limitations: The main limitation of this pilot study is its small sample size, but despite this, a statistically significant effect was observed. Conclusion: We have successfully managed to block the ICBN using ultrasound guidance and demonstrated an analgesic effect in patients in PPBCS calling for placebo-controlled studies. Key words: Anesthesia, local; intercostobrachial nerve; mastectomy; nerve block; neuralgia

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