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Neurology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
Neuralgia, trigeminal Temporal: Attack duration = sudden, momentary pain, repeated in bursts: Triggered by touching trigger zone or action, e.g. chewing, swallowing, talkingCharacter: Lancinating (stabbing) pain, in distribution of V2 or V3 dermatome typically
Otalgia
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The International Headache Society defines glossopharyngeal neuralgia as a severe transient stabbing pain experienced in the ear, base of tongue, tonsillar fossa, or beneath the angle of the jaw.26 It is much less common than trigeminal neuralgia, the incidence being between 0.2 and 0.7 per 100 000 per year.27,28 Glossopharyngeal neuralgia has been described as two clinical types based on the distribution of the pain: a tympanic type which mainly affects the ear, and an oropharyngeal type which affects the throat.29 The onset of pain is commonly provoked by swallowing and on occasion by coughing, yawning or talking. A trigger zone may be present within the preauricular or postauricular area, the neck or external auditory canal. Symptoms are paroxysmal and last for seconds to minutes and remission periods occur. Because it is rare, glossopharyngeal neuralgia is often misdiagnosed.30
Professional Training and Research in the 2 × 4 Model Clinic
Published in R. Andrew Chambers, The 2 × 4 Model, 2017
Smart phones and wristwatch/wearable monitoring technologies are now available that can monitor, in real-time or in multi-day summaries, a number of biological and behavioral variables including heart rate, wake/sleep time, motor activity, and location. Further, these technologies can prompt and query patients multiple times a day/week about psychiatric symptom levels and craving, and even warn patients when they are entering a geographical ‘trigger zone’. Such bio-patterns downloaded and analyzed in the 2 × 4 Model clinic could provide new insights about patients’ diagnoses, particularly how their MI and SUDS are clinically intertwined over time. Treatment responses could be more objectively tracked outside the clinic with these technologies, complimenting regular in clinic interviews. If paired with noninvasive methods for drug and alcohol use monitoring, these technologies could be especially useful in the early stages of treatment including outpatient DWT.
PEGylated Tween 80-functionalized chitosan-lipidic nano-vesicular hybrids for heightening nose-to-brain delivery and bioavailability of metoclopramide
Published in Drug Delivery, 2023
Saeed A. S. Al-Zuhairy, Mahmoud H. Teaima, Nabil A. Shoman, Mohamed Elasaly, Mohamed A. El-Nabarawi, Hossam S. El-Sawy
MTC has been classified as Biopharmaceutics Classification System (BCS) Class III; a high water-soluble drug with poor permeability, which explains the wide variability and poor bioavailability of orally administered MTC (Stosik et al., 2008). MTC also suffers from extensive hepatic metabolism, which significantly limits its efficiency (Lee & Kuo, 2010; Shakhatreh et al., 2019). However, MTC is one of the most renowned medications that widely prescribed for the treatment of nausea and vomiting. Regarding MTC site of action, the chemoreceptor trigger zone (CTZ) in the postrema region of the brain is where MTC mainly inhibits the dopamine D2 and serotonin 5-HT3 receptors, which are responsible for the antiemetic actions (Lee & Kuo, 2010). MTC is the sole FDA-approved antiemetic drug for the management of diabetic gastroparesis (Pasricha et al., 2006). The FDA clearly states that MTC is recommended for relieving symptoms in adults with acute and recurring diabetic gastroparesis and treating adults with gastroesophageal reflux symptoms (Shakhatreh et al., 2019). MTC also helps chemotherapy patients who are experiencing nausea and vomiting (Herrstedt et al., 2022).
Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery
Published in Journal of Obstetrics and Gynaecology, 2021
The chemoreceptor trigger zone (CTZ), known as vomiting centre, is outside the blood–brain barrier and in contact with cerebrospinal fluid. Direct stimulation of CTZ does not always result in vomiting. Immunochemical studies have shown that nausea and vomiting are mediated by histamine, serotonin, cholinergic, neurokinin-1 and D2 dopamine receptors in this area (Chatterjee et al. 2011). The cause of nausea and vomiting developing due to the increase in ICP may be cerebellar oedema related ischaemia and impaired oxygen metabolism. The vestibular system is highly sensitive to ischaemia, which is eventually one of the causes of PONV arising after laparoscopic gynaecological surgery performed in TP. Increased CO2 concentration due to PP further aggravates this.
Recent advances in the opioid mu receptor based pharmacotherapy for rheumatoid arthritis
Published in Expert Opinion on Pharmacotherapy, 2020
Eleftherios Pelechas, Paraskevi V Voulgari, Alexandros A Drosos
Nausea and vomiting are common side effects resulting from activation of the chemoreceptor trigger zone in the medulla but also from changes in the vestibular system. These two side effects have a negative impact on treatment efficacy due to the fact that they limit the effective analgesic dose that is needed to control pain. Various strategies have been tried with several antiemetic agents but with no permanent results [80].