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Acute pain management in children
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Nitrous oxide is a weak general anesthetic and will potentiate the effect of other sedatives and anesthetics. Frequent but usually minor side effects include dizziness, nausea, dry mouth, and disorientation. It is insoluble and readily diffuses into gas-filled enclosed spaces causing them to expand or increase in pressure, nitrous oxide is therefore contraindicated in the presence of pneumothorax. Excessive sedation can occur and is treated by discontinuation of the gas, airway management, and oxygen administration.158 Prolonged exposure may affect folate metabolism leading to megaloblastosis, anemia, and peripheral neuropathy. Bone marrow depression can occur. Exposure to prolonged high concentrations has been associated with reduced fertility in both men and women. Nitrous oxide should be used in well-ventilated areas which maintain ambient concentrations below national occupational exposure standards (100 ppm in the UK). Patients who are to receive N2O more frequently than twice every four days should have regular blood examinations for megaloblastic changes and neutrophil hypersegmentation.158
Appraisal of anti-gout potential of colchicine-loaded chitosan nanoparticle gel in uric acid-induced gout animal model
Published in Archives of Physiology and Biochemistry, 2022
Poonam Parashar, Ifrah Mazhar, Jovita Kanoujia, Abhishek Yadav, Pranesh Kumar, Shubhini A. Saraf, Sudipta Saha
Colchicine is a naturally occurring alkaloid extracted from the flowers of Autumn crocus Colchicum autumnale commonly known as meadow saffron. It is an anti-inflammatory drug which is widely used in the treatment of gouty arthritis (Dalbeth et al. 2014). Colchicine acts by reducing lactic acid production via leukocytes, which results in lowering uric acid deposition as well as decrease inflammatory response. In spite of being the most effective and fastest acting drug against gouty arthritis, colchicine is considered as last alternative in gout therapy due to its severe adverse effects associated with enteral and parenteral routes of administration (Wortmann 2002, Chilappa et al. 2010). The most dreadful effects comprises of bone marrow depression leading to anaemia, polyneuropathy subsequent to kidney failure and hallucinations (Khalil et al. 2014). In addition to that, a special consideration for dose adjustment is required among geriatric and paediatric patient. Oral administration further faces the problem of first pass hepatic metabolism resulting in reduced bioavailability (Nascimento et al. 2009, Shen et al. 2011). Intravenous administration of colchicine leads to problems like tissue necrosis, cytopenias etc. (Bonnel et al. 2002). Thus these drawbacks need to be addressed and nanoparticulate system could be one of the promising approach.
The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review
Published in Expert Review of Clinical Immunology, 2020
Saifuddin Kharawala, Amanda K. Golembesky, Rhonda L. Bohn, Dirk Esser
This is the first structured review of the clinical, humanistic, and economic burden in GPP, and yields several interesting results. A major finding is the high burden of GPP, not only during acute flares but also during the post-flare period. Acute flares, which are serious episodes with considerable morbidity and mortality, are a hallmark of GPP. The morphology and distribution of cutaneous lesions and systemic manifestations have been thoroughly described in the literature. During the post-flare period, patients continue to experience plaque or pustular lesions and still require treatment, either to manage the lesions or to prevent widespread flares. Unfortunately, many of the treatments are associated with considerable side effects or precautions, such as osteoarticular symptoms, teratogenicity risk, and bone marrow depression. Finally, although QoL appears to be severely impaired during the post-flare period (noting that data to support this were drawn from a single study in an exclusive GPP population), little is known about the impact on other humanistic burden parameters during this period.
Relation between dynamic changes of platelet counts and 30-day mortality in severely burned patients
Published in Platelets, 2019
Xiaoqin Huang, Feng Guo, Zengding Zhou, Mengling Chang, Fei Wang, Yi Dou, Zhiyong Wang, Jingning Huan
However, amelioration of the slight thrombocytopenia as soon as possible mainly depends on the recovery of PCs and nadir PCs. The pattern of average of platelet counts between days 3 and 10 was an approximately straight line, which is calculated as ΔPC/ΔT. The ΔPC/ΔT was approximately 2.5-fold increased in survivors than in nonsurvivors, which represented two distinct patterns of platelet recovery. The blunted increase in PCs implied a longer thrombocytopenic phase post burn. Dynamic changes in platelet counts predicted pathophysiological responses. If bone marrow depression or regulatory abnormalities are assumed to reduce platelet synthesis, this phenomenon is not reflected by an absolute platelet count. The diversity of PCs in a normal population may vary by 200 × 109/L, from 150 to 350 × 109/L [34]. The advantages of using ΔPC/ΔT include the removal of baseline interindividual differences and that disease progression and PC productivity could be taken into account in contrast to absolute PCs and various factors related to mortality during hospitalization. Time-response changes of PCs could carry greater prognostic significance compared with absolute counts [35].