Perioperative control of paroxysmal hypertension using esmolol with alpha-blockade in a child with a germline mutated paraganglioma

Summary The use of antihypertensive medications in patients with pheochromocytomas and paragangliomas (PCC/PG) is usually a challenge. We report a case of familial paraganglioma that was successfully treated by esmolol and other antihypertensive medications without associated perioperative complications. Our patient was an 11-year-old girl who presented with classic symptoms and signs of PCC/PG and a CT scan of the abdomen that showed a right-sided paravertebral mass. Her father was diagnosed with paraganglioma a few years ago. Prazosin had been started but she continued to experience uncontrolled paroxysms of blood pressure (BP). She was known to have asthma; hence, she developed serious bronchospasm with atenolol. She was, therefore, switched to esmolol that successfully controlled her BP in addition to prazosin and intermittent doses of hydralazine prior to laparoscopic surgery with no side effects of medications or postoperative complications. Esmolol could be a good alternative to routinely used beta-blockers in children with PCC/PG with labile hypertension and related symptoms in the pre and intra-operative periods. It is titrable, effective, and can be weaned rapidly helping to avoid postoperative complications. Further larger studies on the use of esmolol in children with PCC/PG are needed to confirm our observation. Learning points In addition to alpha-blockers, esmolol could be a good alternative for routinely used beta-blockers to control paroxysmal hypertension and tachycardia in the pre- and intra-operative periods. Esmolol is titrable and an effective beta-blocker. It can be weaned rapidly helping to avoid postoperative complications in children with PCC/PG. Children with PCC/PG and other comorbidity like asthma may particularly benefit from the use of esmolol due to no or less side effects on airway resistance and the advantage of rapid titration of the medication compared to other beta-blockers.

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Carbon dioxide levels in neonates: what are safe parameters?

Pediatric Research ◽

10.1038/s41390-021-01473-y ◽

2021 ◽

Author(s):

Sie Kei Wong ◽

M. Chim ◽

J. Allen ◽

A. Butler ◽

J. Tyrrell ◽

...

Keyword(s):

Carbon Dioxide ◽

Systematic Review ◽

Side Effects ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

List Type ◽

Permissive Hypercapnia ◽

Prisma Statement ◽

Carbon Dioxide Levels ◽

Online Software

Abstract There is no consensus on the optimal pCO2 levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO2 ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO2 levels that were found to increase the risk of neonatal disease. Although PaCO2 ranges were reported from 2.6 to 8.7 kPa (19.5–64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO2 6.0–7.3 kPa: 45.0–54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO2 ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO2 parameters and correlation with outcomes. Impact There is no consensus on the optimal pCO2 levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO2 of 5–7 kPa was inferred following systematic review.

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Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10040771 ◽

2021 ◽

Vol 10 (4) ◽

pp. 771

Author(s):

In-Jeong Cho ◽

Jeong-Hun Shin ◽

Mi-Hyang Jung ◽

Chae Young Kang ◽

Jinseub Hwang ◽

...

Keyword(s):

Antihypertensive Drugs ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Incident Cancer ◽

Increased Risk ◽

Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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Systematic review of genuine versus spurious side-effects of beta-blockers in heart failure using placebo control: Recommendations for patient information

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.05.068 ◽

2013 ◽

Vol 168 (4) ◽

pp. 3572-3579 ◽

Cited By ~ 52

Author(s):

Anthony J. Barron ◽

Nabeela Zaman ◽

Graham D. Cole ◽

Roland Wensel ◽

Darlington O. Okonko ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Side Effects ◽

Patient Information ◽

Beta Blockers ◽

Placebo Control

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EEG Synchronized TMS for Individualized Therapy in Major Depressive Disorder

European Psychiatry ◽

10.1016/s0924-9338(11)72849-8 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1144-1144

Author(s):

Y. Jin ◽

J. Phillips ◽

Yueqin Huang ◽

Steven Heurta

Keyword(s):

Major Depressive Disorder ◽

Side Effects ◽

Depressive Disorder ◽

Active Treatment ◽

Rating Scale ◽

Repetitive Transcranial Magnetic Stimulation ◽

Stimulus Frequency ◽

List Type ◽

Major Depressive ◽

Double Blind

IntroductionEfficacy of conventional repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD) is limited. The authors report here on an alternative treatment using low energy synchronized TMS (sTMS) at the intrinsic frequency of subjects’ alpha electroencephalogram (EEG).ObjectivesEstablish efficacy and safety profile of sTMS in MDD.Aim(1)Examine the clinical effectiveness of sTMS.(2)Identify adverse effects associated with sTMS.MethodsFifty-two MDD subjects with 17-item Hamilton Depression Rating Scale (HAMD17) scores >17 were enrolled into a randomized, sham controlled, double-blind trial. Current medication remained unchanged during the trial. Depressive symptoms were evaluated by HAMD17 administered weekly.EEGs were recorded at baseline to determine the stimulus frequency and at week 4 to evaluate the physiological effect. sTMS was delivered through three 6000-G cylindrical neodymium magnets synchronously rotating at a rate equal to the subject's intrinsic alpha frequency.ResultsForty-five subjects completed at least 1 week of treatment and were evaluable. Those who received active treatment had superior clinical response to sham (t = 2.54, P = 0.01), where 55.2% in the active treatment group were clinical responders versus 12.5% in sham (X2 = 7.82, P = 0.005). No significant side effects were reported. The clinical improvement was correlated with the degree of EEG improvement (r = .46, P = 0.009).ConclusionsA therapeutic effect in MDD subjects can be achieved through administration of sTMS at the subject's alpha EEG frequency. Because of minimal side effects, this appears to be a safe and effective treatment option.

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_675-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Lisa M Lewis

Keyword(s):

African American ◽

Medication Adherence ◽

Qualitative Study ◽

Antihypertensive Medication ◽

Demographic Data ◽

Patient Treatment ◽

List Type ◽

Medication Regimen ◽

Antihypertensive Medications ◽

The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

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Carbimazole induced rhabdomyolysis

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-21-0006 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Niamh O’Donnell ◽

Aisling McCarthy ◽

Ken Thong

Keyword(s):

Adverse Effect ◽

Creatine Kinase ◽

Side Effects ◽

Temporal Relationship ◽

Early Recognition ◽

Antithyroid Drug ◽

Graves Disease ◽

List Type ◽

Musculoskeletal Complaints ◽

Learning Points

Summary Carbimazole is a commonly used antithyroid drug (ATD), which is associated with several well-established side effects. However, Carbimazole-induced rhabdomyolysis is rarely reported in the literature. We report a 27-year-old male who presented with upper limb myalgia and significantly raised creatine kinase elevation, 1-month post commencement of Carbimazole for Graves’ disease. Carbimazole was ceased with subsequent clinical and biochemical improvement. Though the pathophysiology remains unclear, we hope to raise awareness regarding this rare adverse effect with a view to promote early recognition and prompt discontinuation of the offending medication caused by a commonly used medication in endocrinology. Learning points Musculoskeletal complaints can relate to unidentified and untreated hyperthyroidism. However one must be mindful that the treatment for these disorders can too induce myopathies. ATD-induced myopathy should be considered when there is a temporal relationship between introduction of ATDs and the onset of symptoms. If ATD-induced myopathy is being considered, other causes of myopathy should still be outruled. Prompt discontinuation of potentially offending medications may provide resolution of symptoms and avoid significant consequences.

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Essential Oil-Based Bioherbicides: Human Health Risks Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms22179396 ◽

2021 ◽

Vol 22 (17) ◽

pp. 9396

Author(s):

Chloë Maes ◽

Jeroen Meersmans ◽

Laurence Lins ◽

Sandrine Bouquillon ◽

Marie-Laure Fauconnier

Keyword(s):

Side Effects ◽

Essential Oil ◽

Essential Oils ◽

Health Risks ◽

Good Alternative ◽

Aquatic Systems ◽

Air Transport ◽

Human Health Risks ◽

Potential Risks ◽

Negative Side Effects

In recent years, the development of new bio-based products for biocontrol has been gaining importance as it contributes to reducing the use of synthetic herbicides in agriculture. Conventional herbicides (i.e., the ones with synthetic molecules) can lead to adverse effects such as human diseases (cancers, neurodegenerative diseases, reproductive perturbations, etc.) but also to disturbing the environment because of their drift in the air, transport throughout aquatic systems and persistence across different environments. The use of natural molecules seems to be a very good alternative for maintaining productive agriculture but without the negative side effects of synthetic herbicides. In this context, essential oils and their components are increasingly studied in order to produce several categories of biopesticides thanks to their well-known biocidal activities. However, these molecules can also be potentially hazardous to humans and the environment. This article reviews the state of the literature and regulations with regard to the potential risks related to the use of essential oils as bioherbicides in agricultural and horticultural applications.

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Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

The American Surgeon ◽

10.1177/000313481708300739 ◽

2017 ◽

Vol 83 (7) ◽

pp. 786-792

Author(s):

Nathan Belkin ◽

Liliana G. Bordeianou ◽

Paul C. Shellito ◽

Alexander T. Hawkins

Keyword(s):

Adjuvant Chemotherapy ◽

Postoperative Complications ◽

Anterior Resection ◽

Massachusetts General Hospital ◽

Perioperative Complications ◽

Primary Anastomosis ◽

Operation Time ◽

Emergency Department Visits ◽

Rectosigmoid Resection ◽

Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

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Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

Global Spine Journal ◽

10.1177/2192568219895225 ◽

2019 ◽

pp. 219256821989522

Author(s):

So Kato ◽

Taylor Dear ◽

Stephen J. Lewis

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Length Of Stay ◽

Pediatric Patients ◽

Perioperative Complications ◽

Intraoperative Complications ◽

Operation Time ◽

Fluid Administration ◽

Prolonged Stay ◽

Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

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