Successful management of a kitten with chlorpyrifos and cypermethrin toxicosis with pralidoxime and atropine

Case summary Organophosphates and pyrethroids have been widely used as agricultural and domestic insecticides. This case report describes a 3-month-old free-roaming female kitten, weighing 930 g, that developed hypersalivation, hypothermia, dyspnoea due to increased bronchial secretion, bradycardia, miosis and neurological signs, including restlessness, ataxia, disorientation, apparent hallucination, muscle twitching and seizures within 6 h of accidental ingestion of an insecticide containing chlorpyrifos (500 g/l) and cypermethrin (50 g/l). The kitten was treated empirically with intramuscular atropine and dexamethasone, and rectal diazepam. The history of insecticide exposure was obtained after 6 h of treatment and intramuscular 2-pyridine aldoxime methochloride (pralidoxime [2-PAM]) and atropine therapy was started 2 h later. Recovery was complicated by suspected aspiration, but there were no sequelae from the insecticide exposure and by 7 days post-ingestion the kitten was normal and playful. Relevance and novel information To the best of our knowledge, this is the first report of successful management of chlorpyrifos and cypermethrin toxicosis in a cat in Bangladesh. This case report suggests that 2-PAM followed by atropine and other supportive therapy may be an effective strategy to manage a cat poisoned by chlorpyrifos and cypermethrin; however, expanded clinical trials are needed.

ESTIMATION OF POSSIBILITY OF APPLICATION OF TIGERASE® (DORNASE ALFA) DRUG ON THE RESULTS OF A MULTICENTER SCIENTIFIC PROGRAM OF POST-MARKETING USE OF THE DRUG

The aim of the program was to study the tolerability of Tigerase® in patients with cystic fibrosis (CF) of all ages in rutine clinical practice. Study design: retrospective open uncontrolled comparative multicenter solid. Materials and methods of research: retrospective data of clinical observations were collected from medical records of patients with CF on the use of Tigerase®. Results: therapy with Tigerase® was well tolerated by 668 (93,4%) of 715 patients included in the study. In 47 (6,6%) patients, 127 adverse reactions (ADRs) associated with the use of Tigerase® were recorded. ADRs from the respiratory system were the most common. Of these, 24 (3,4%) were coughing and 10 (1,4%) had increased viscosity of bronchial secretion. Among all patients included in the study, the proportion of patients in whom ADRs were registered based on clinical manifestations (3,9%) did not differ statistically significantly from the proportion of patients in whom ADRs were recorded based on complaints only (2,8%) (p=0,30). The distribution of ADRs by the source of registration and place of residence of patients did not depend on their gender and age. Registration of ADRs in different regions of the country differed statistically significantly both in frequency and in the source of detection (p<0,001). ADRs were not recorded in several regions, and the largest number of ADRs were registered in patients living in Moscow, and most of them were based only on patient complaints. 22 patients (47% of the number of patients with ADR) had medical commissions for ADR, and only in 8 (17% of the number of patients with ADR) of them had expertise of specialists with experience in the treatment of patients with CF. In 29 patients (62% of the number of patients with ADR), the development of ADR did not require cessation of the Tigerase® therapy. Conclusion: in the majority of CF patients (93,4%) tolerated the Tigerase® therapy well.

EFFECTIVENESS OF FIXED COMBINATION OF FORMULATIONS FOR COUGHING

There are many respiratory diseases, which despite the difference in aetiology, pathogenesis, the peculiarities in progression may have some common features, resulting in the localization of the pathological process in the respiratory systems. These common signs include changes in bronchial secretion that ultimately leads to mucostasis and burdens the course of any respiratory disease. There are very few combined formulations capable of impacting several mechanisms of mucostasis at once. One of them is Ascoril possessing a double effect of bronchodilator and expectorant. The aim of this study was to evaluate the clinical efficacy and safety of Ascoril therapy for patients with acute respiratory diseases. The study included 105 patients aged 25 ± 0.5 to 55 ± 1.6 years with mild or moderate acute respiratory disease, who had acute respiratory diseases with cough due to laryngitis, pharyngitis, tracheitis, bronchitis. Patients of the 1st group (75 patients, the main group) received the treatment with Ascoril, the patients of the 2nd group (30 patients, the comparison group) received Bromhexine. The patients in both groups were comparable by age and sex. The patients treated with Ascoril showed the disappearance of cough symptoms 3 – 4 days earlier than the patients in the comparison group (p < 0.05). The total score assessment of clinical symptoms during the treatment demonstrated the administration of Ascoril promoted the effectiveness of therapy, which was found significantly higher than in the 2nd group (p < 0.05). We can conclude Ascoril reduces the duration of the disease, cut down the need in antibiotics, lowers the manifestations of bronchial hyper reactivity, and promotes faster clinical recovery, the last but not the least, it is safe.

Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern

ABSTRACT Objective: To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern". Method: Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results. Results: Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea. Conclusion: This diagnosis manifests differently according to the patients’ age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.

PREOPERATIVE PROTOCOL AND MORBIMORTALITY IN CERVICAL SURGERY WITH ANTERIOR APPROACH

ABSTRACT Objective: To determine the correlation between morbidity/mortality and the pre-surgical protocol in patients undergoing anterior cervical surgical approach. Methods: Retrospective, cross-sectional and descriptive study, in which 114 patients who underwent anterior cervical surgical approach were reviewed, divided into two groups: “Group A” Conventional Presurgical Protocol (CPP) and “Group B” Extended Presurgical Protocol (EPP). Statistical analysis used the IBM SPSS Statistics Base v.24 software. Results: We evaluated 114 patients, 35 from “Group A”, 79 from “Group B”, 83 (72.8%) with cervical myelopathy, 30 (26.3%) with cervicobrachialgia. “Group A” had 10 cases of respiratory failure, with 5 secondary to bronchial secretion, 2 secondary to cervical hematoma. “Group B” had 12 cases of respiratory failure, 3 secondary to bronchial secretion and 1 secondary to cervical hematoma. Conclusions: The extended presurgical protocol can be the answer to reduce complications by improving selection parameters of the candidate patient for a surgical procedure of the cervical spine. Level of Evidence III; Case-control studyg.

Sputum as a source of adipokines in bronchial asthma

Forty-four patients with allergic (ABA) and non-allergic (NABA) variants of bronchial asthma (BA) were examined to evaluate levels of key adipokines (leptin, resistin, adiponectin) in sputum in different variants of BA. Adipokines in sputum and blood plasma were measured by Enzyme-Linked Immunosorbent Assay (ELISA). The indices that reflect the percentage of adipokines in sputum regarding adipokines in plasma of the same patients were worked out to evaluate the ratio of levels of corresponding adipokines in plasma and sputum in patients with BA. Two regularities are clearly seen in the study: the first - levels of proinflammatory adipokines (leptin, resistin) in sputum in ABA correlate directly with indicators of respiratory function but levels of anti-inflammatory adipokines (adiponectin) in sputum correlate inversely with indicators of respiratory function; the second -correlation of levels of the studied adipokines with indicators of respiratory function are almost not revealed in NABA. The first regularity reflects the important fact that the content of adipokines in bronchial secretion is to a certain extent one of regulating local mechanisms in target organ controlled system levels of corresponding adipokines in exacerbation of BA.