Cranio-Mandibular Disorders after Whiplash Injury: A Mono-Institutional Clinical Study on 31 Patients

Background: Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain. Methods: The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari “Aldo Moro”: 20 patients with whiplash (age range: 20–39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20–33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside). Results: During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed. Conclusion: Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.

Sedation, Analgesia, and Muscle Relaxation During VV-ECMO Therapy in Patients With Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2): A Single-Center, Retrospective, Observational Study

Objective: The pharmacokinetics and pharmacodynamics of ECMO-supported sedative, analgesic, and muscle relaxants have changed, but there are insufficient data to determine the optimal dosing strategies for these agents. Sedation, analgesia and muscle relaxation therapy for patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) receiving ECMO support are more specific and have not been fully reported. This study observed and evaluated the use of sedative and analgesic drugs and muscle relaxants in SARS-CoV-2 patients treated with VV-ECMO.Methods: This study was a single-center, retrospective and observational study. Our study includes 8 SARS-CoV-2 patients treated with VV-ECMO in an intensive care unit at Shanghai Public Health Center from February to June 2020. We collected the demographic data from these patients and the dose and course of sedation, analgesia, and muscle relaxants administered during ECMO treatment.Results: The doses of sedative, analgesic and muscle relaxant drugs used in patients with VV-ECMO were significant. Over time, the doses of drugs that were used were increased, and the course of muscle relaxant treatment was extended.Conclusion: Sedation, analgesia, and muscle relaxant use require individualized titration in patients with SARS-CoV-2 who have respiratory failure and who are receiving VV-ECMO.

Central muscle relaxants in rheumatology practice

The article describes the general principles of the treatment of musculoskeletal pain, discusses modern approaches to the treatment of osteoarthritis (OA) and nonspecific back pain (NBS). The issues discussed are: the efficacy and tolerability of the combined use of non-steroidal anti-inflammatory drugs (NSAIDs) of predominantly selective action (aceclofenac) and a centrally acting muscle relaxant (tolperisone) in the treatment of OA and NBS. Two clinical observations are presented that confirm the benefits of combined administration of NSAIDs and muscle relaxants in the treatment of OA and NBS. The efficacy and favorable safety profile of aceclofenac has been demonstrated in patients with comorbid diseases. Tolperisone has shown its efficacy both as a mean of controlling pain associated with muscle tension, and as an element of combination therapy not only for NBS, but also for OA.

A Case of Nasal Mucosa Cautery With Reintubation Under Pharyngeal Suction for Massive Epistaxis After Extubation

We describe a case of massive epistaxis that occurred after removal of a nasal endotracheal tube, prompting emergent reintubation. Mask ventilation could not be performed because the nasal cavity was packed with gauze and the airway was being evacuated with a suction catheter. Therefore, instead of inhalational anesthetics and muscle relaxants, boluses of midazolam and remifentanil were administered, and reintubation was promptly performed. Sedation was maintained with dexmedetomidine infusion and midazolam. Nasal cautery was performed near the left sphenopalatine foramen. The patient was extubated without agitation or additional hemorrhage. Immediate recognition of the potential for airway loss, sufficient control of active bleeding, and drug selection in accordance with the emergent circumstances enabled prompt resecuring of the airway without pulmonary aspiration of blood.

The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing

Background Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Methods This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. Results Five high-risk medication patterns—a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster—were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. Conclusions This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy.

Evaluation of Selected Flavonoids for the Anthelmintic and Skeletal Muscle Relaxant Activity using Animal Models

Most fruits and vegetables contain flavonoids, a type of phytonutrient. As well as carotenoids, they're responsible for fruits and vegetable brilliant hues. Some other phytonutrients such as flavonoids are strong antioxidants with anti-inflammatory and immune properties. There are many flavonoids, including anthocyanins, flavones, flavonols, flavonoids, and isoflavonoids. Quercetin and chrysin were chosen for the investigation. Humans and other animals can contract Helminthiasis (helminthiases), sometimes known as worm infection. Tapeworms, roundworms, and flukes are only a few of the parasites that exist. Skeletal muscle relaxants are used to treat spasticity caused by upper motor neuron syndromes and muscle discomfort or musculoskeletal spasms created by peripheral disturbances. Samples of quercetin and chrysin were generated in the presence of 0.5% SCMC suspension at concentrations of 10, 20, 30, and 40 mg/ml, and then analyzed. To keep track of photocell beam disruptions, a six-digit counter was utilized (locomotor activity). It was time to turn on the actophotometer and examine the locomotor behavior of each rat for five minutes. The basal activity levels of all the animals were recorded. Keywords: Flavonoids, Anthelmintic, Skeletal Muscle relaxant, animal models

THE DYNAMICS OF LUNG HISTOPATHOLOGY IN ACUTE BACLOFEN POISONING

Baclofen (sold under the name Baclosan©, Lioresal©) is a muscle relaxant. This drug is chemically different from other muscle relaxants. Due to its pronounced psychotropic effect the drug is often a subject of abuse especially among young people. The article deals with the dynamics of lung histopathology in acute baclofen poisoning. Experimental studies were performed on 15 Wistar rats. The animals were divided into 3 groups (the controls and two experimental groups). The controls included 5 intact rats. Each experimental group included 5 animals. Both groups were treated with baclofen at a dosage of 85 mg/kg. The duration of the experiment was 3 and 24 hours, respectively. We revealed a complex of pathological changes in the lungs of the rats. There were circulatory disorders in all the elements of the microcirculatory bed, areas of emphysema, atelectasis and dystelectasis, WBC infiltration of intralveolar septa and their thickening due to edema. The changes were even more severe 24 hours after the drug administration. These results along with the results of chemical analysis will be useful in establishing the fact of baclofen intoxication and the exact moment of the intoxication.

Which medications can worsen thinking, memory, behavior, or function?

Many medications may cause memory impairment, drowsiness, and confusion. Make sure that you know and keep track of all the medications your loved one is taking, including prescriptions, over-the-counter medications, vitamins, herbs, and supplements. Review these medications with their doctor. When possible, stop or lower the dose of medications that are causing problems. There are a variety of medications that can produce impairments in thinking and memory, including anticholinergic medications; antidepressants; antihistamines; antipsychotics; anxiety medications (benzodiazepines); dizziness and vertigo medications; incontinence medications (antispasmodics); migraine medications; muscle relaxants; narcotics (opioids); nausea, stomach, and bowel medications; seizure medications (anticonvulsants); sleeping medications; tremor medications; and herbal remedies. Consider anesthesia and cancer treatments carefully. Lastly, note that cholesterol-lowering medications do not cause memory problems.