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SONG H, LI C, QU C, ZHANG Y, MIAO S. Clinical research for dose effects of ketorolac tromethamine on PCIA after hip arthroplasty. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.70520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hailong SONG
- Heze Municipal Hospital, China; Caoxian people’s Hospital, China
| | - Cong LI
- Heze Municipal Hospital, China; Taishan Medical University, China
| | | | - Yan ZHANG
- Heze Municipal Hospital, China; Taishan Medical University, China
| | - Shaohua MIAO
- Heze Municipal Hospital, China; Taishan Medical University, China
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Feola A, Carfora A, Mascolo P, Petrella R, Della Pietra B, Campobasso CP. Alprazolam-associated death: suicide or unintentional overdose? AUST J FORENSIC SCI 2021. [DOI: 10.1080/00450618.2021.1892190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alessandro Feola
- Department of Experimental Medicine – Institute of Legal Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Anna Carfora
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Pasquale Mascolo
- Department of Experimental Medicine – Institute of Legal Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Raffaella Petrella
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Bruno Della Pietra
- Department of Experimental Medicine – Institute of Legal Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine – Institute of Legal Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Naples, Italy
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Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review. Toxins (Basel) 2020; 12:toxins12110699. [PMID: 33153179 PMCID: PMC7693695 DOI: 10.3390/toxins12110699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake's size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake's mouth and victim's skin, age of the victim, weight, health status, and victim's activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.
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Affiliation(s)
- Andrew A White
- From the Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA
| | - Donald D Stevenson
- From the Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA
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Fernandes V, Alfaro TM, Baptista JP, Regateiro FS, Fradinho F, Cordeiro CR. Severe ketorolac-induced asthma diagnosed by chest computed tomography. J Thorac Dis 2017; 9:S1567-S1569. [PMID: 29255644 DOI: 10.21037/jtd.2017.11.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aspirin-exacerbated respiratory disease (AERD) affects 15% of severe asthmatics and drug reactions cause 200,000 annual deaths in Europe. A 65-year-old lady presented to emergency for progressive abdominal pain. Her medical history included gallstones, asthma, rhinosinusitis and hypertension. She was regularly medicated with inhaled fluticasone, vilanterol and tiotropium, nasal budesonide, pantoprazole, oxazepam and perindopril. She reported partial asthma control and an exacerbation requiring admission to a respiratory ward 6 weeks before. On examination, there was right upper quadrant tenderness and no other changes. Blood tests were normal, and an ultrasound showed gallbladder stones with normal wall. Intravenous ketorolac led to prompt pain resolution. After 30 minutes she became severely dyspnoeic, with an O2 saturation of 85% on high flow O2. She had no breath sounds on the left lung, and there was no wheezing or prolonged expiration. A chest X-ray showed no pneumothorax and a computed tomography (CT) angiography was performed showing bilateral mucoid impaction and sub-segmental atelectasis. Continuous bronchodilation and systemic steroids led to gradual improving in the following 6 hours. After 9 days of admission on a respiratory ward she was discharged home with no symptoms and normal oxygenation. Importantly, she denied previous allergies to nonsteroidal anti-inflammatory drugs (NSAIDs) and had actually taken diclofenac and nimesulid before with no reactions. This report illustrates both an intravenous NSAID causing severe AERD, and how a chest CT may be instrumental for the diagnosis of life-threatening asthma.
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Affiliation(s)
- Vânia Fernandes
- Pneumology Unit A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Tiago M Alfaro
- Pneumology Unit A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João P Baptista
- Intensive Care Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Frederico S Regateiro
- Immunoallergology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Fradinho
- Pneumology Unit A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Scarpelli MP, Keller S, Tran L, Palmiere C. Postmortem serum levels of IgE and mast cell tryptase in fatal asthma. Forensic Sci Int 2016; 269:113-118. [PMID: 27888720 DOI: 10.1016/j.forsciint.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022]
Abstract
The aim of this study was to characterize the concentrations of total and specific IgE as well as mast cell-derived tryptase in postmortem serum from femoral blood and evaluate the usefulness of their determination for diagnostic purposes in cases of fatal asthma attacks. 36 autopsy cases were retrospectively selected including cases of witnessed death in asthmatic subjects, deaths in asthmatics and atopic subjects with causes of death unrelated to asthma or allergic anaphylaxis as well as deaths in non-atopic, non-allergic individuals with causes of death unrelated to asthma or allergic anaphylaxis. Initial results indicated increased postmortem serum total IgE in atopic and asthmatic individuals, irrespective of the cause of death. Conversely, increased mast cell tryptase levels were noted exclusively in fatal asthma attacks. This suggests that mast cell tryptase measurement in cases of death potentially caused by severe acute bronchial asthma may be useful for diagnostic purposes.
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Affiliation(s)
- Maria Pia Scarpelli
- Dipartimento di Sanità Pubblica e Medicina di Comunità, Università degli Studi di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Sanjiv Keller
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Lara Tran
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland.
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Corbi G, Gambassi G, Pagano G, Russomanno G, Conti V, Rengo G, Leosco D, Bernabei R, Filippelli A, Ferrara N. Impact of an Innovative Educational Strategy on Medication Appropriate Use and Length of Stay in Elderly Patients. Medicine (Baltimore) 2015; 94:e918. [PMID: 26091456 PMCID: PMC4616548 DOI: 10.1097/md.0000000000000918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
UNLABELLED To evaluate the impact of an educational strategy on potentially inappropriate medications (PIMs) and length of stay in hospitalized elderly patients. DESIGN An open study, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase), has been performed in order to compare the PIMs number before and after the introduction of an educational strategy. The study included 2 phases: PRE, in which patients were enrolled as control group; POST, in which an educational strategy on the PIMs use was introduced among physicians, and patients were enrolled as intervention group. SETTING Italian residential rehabilitation Centre. Inclusion criteria were ≥ 2 active chronic diseases and the current use of ≥ 4 medications. The educational strategy consisted of a 3-day course on strategies to prevent PIMs and a computerized tool running on a Personal Digital Assistant (PDA) device to check for PIMs. OUTCOMES The primary was the PIMs number, the secondary the length of stay. RESULTS A total of 790 patients, 450 controls and 340 cases, were enrolled. According to the Beers criteria, 52.3% of the study population received ≥ 1 PIMs, 18.73% ≥ 2, and 2.4% ≥ 4 PIMs. A significant reduction of PIMs (P = 0.020) and length of stay (P < 0.0001) were seen in the intervention group. At multivariate analysis, PIMs significantly correlated with age, drugs number, and the intervention, and the length of stay significantly correlated with disease count, comorbidities, and intervention. These data suggest that our educative instrument may be useful in reducing the PIMs number and length of hospitalization in elderly with a high number of drugs and comorbidities.
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Affiliation(s)
- Graziamaria Corbi
- From Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy (GC, GP); Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy (GG, RB); Division of Brain Sciences, Imperial College London, UK (GP); Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy (GR, VC, AF); Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy (GR, DL, NF); and Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy (GR, NF)
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Hsiao FY, Chou HC, Chen WW. Impact of safety-related regulation on use of parenteral ketorolac in a nationally representative population. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2014. [DOI: 10.1111/jphs.12054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy; National Taiwan University; Taipei Taiwan
- School of Pharmacy; College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Pharmacy; National Taiwan University Hospital; Taipei Taiwan
| | - Hsin-Chun Chou
- Graduate Institute of Clinical Pharmacy; National Taiwan University; Taipei Taiwan
| | - Wen-Wen Chen
- Taiwan National Adverse Drug Reaction Reporting Center; Taipei Taiwan
- Drug Safety Division; Taiwan Drug Relief Foundation; Taipei Taiwan
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Lauretti GR, Righeti CCF, Mattos AL. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty. J Anaesthesiol Clin Pharmacol 2013; 29:503-8. [PMID: 24249988 PMCID: PMC3819845 DOI: 10.4103/0970-9185.119155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT) ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml). The control group (CG) received saline as IT test drug. The morphine group (MG) received IT 200 g morphine, the ketorolac group (KG) IT 2 mg ketorolac and the morphine-ketorolac group (MKG) 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P > 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively). Both groups were longer when compared to the CG (170 ± 13 min) (P > 0.01). The MG and KG had lesser ketoprofen consumption compared to the CG (P > 0.05). The time to first rescue analgesic was longer to the MKG (926 ± 222 min) (15 h) compared to CG (P > 0.001) and to the MG and the KG (P > 0.01). MKG displayed lesser ketoprofen consumption compared to MG and KG (P > 0.05) and to the CG (P > 0.02). Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.
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Affiliation(s)
- Gabriela R Lauretti
- Department of Biomechanics, Medicine and Rehabilitation of Members, Teaching Hospital, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Potential mechanisms linking atherosclerosis and increased cardiovascular risk in COPD: focus on Sirtuins. Int J Mol Sci 2013; 14:12696-713. [PMID: 23774840 PMCID: PMC3709808 DOI: 10.3390/ijms140612696] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/11/2013] [Accepted: 06/05/2013] [Indexed: 11/17/2022] Open
Abstract
The development of atherosclerosis is a multi-step process, at least in part controlled by the vascular endothelium function. Observations in humans and experimental models of atherosclerosis have identified monocyte recruitment as an early event in atherogenesis. Chronic inflammation is associated with ageing and its related diseases (e.g., atherosclerosis and chronic obstructive pulmonary disease). Recently it has been discovered that Sirtuins (NAD+-dependent deacetylases) represent a pivotal regulator of longevity and health. They appear to have a prominent role in vascular biology and regulate aspects of age-dependent atherosclerosis. Many studies demonstrate that SIRT1 exhibits anti-inflammatory properties in vitro (e.g., fatty acid-induced inflammation), in vivo (e.g., atherosclerosis, sustainment of normal immune function in knock-out mice) and in clinical studies (e.g., patients with chronic obstructive pulmonary disease). Because of a significant reduction of SIRT1 in rodent lungs exposed to cigarette smoke and in lungs of patients with chronic obstructive pulmonary disease (COPD), activation of SIRT1 may be a potential target for chronic obstructive pulmonary disease therapy. We review the inflammatory mechanisms involved in COPD-CVD coexistence and the potential role of SIRT1 in the regulation of these systems.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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