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https://www.readbyqxmd.com/read/28922579/evaluating-real-time-effects-of-topical-1-1000-epinephrine-in-endoscopic-sinus-and-skull-base-surgery-on-hemodynamic-parameters-through-intraoperative-arterial-line-monitoring
#1
Michael T Yim, Omar G Ahmed, Masayoshi Takashima
BACKGROUND: Administration of topical 1:1000 epinephrine is commonly used in practice to achieve vasoconstriction during endoscopic sinus surgery and skull-base surgery; however, real-time effects on cardiovascular changes from systemic absorption have not been well studied. METHODS: Twenty-six patients undergoing endoscopic transsphenoidal resection of a pituitary lesion at a single institution were included into the study. Following arterial line placement by anesthesiology, 6 cottonoid pledgets soaked in 1:1000 epinephrine were placed into the bilateral nasal passages...
September 18, 2017: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/28873505/enhanced-recovery-after-surgery-pain-management
#2
REVIEW
Susan M Nimmo, Irwin T H Foo, Hugh M Paterson
Effective pain management is fundamental to enhanced recovery after surgery. Selection of strategies should be tailored to patient and operation. As well as improving the quality of recovery, effective analgesia reduces the host stress response, facilitates mobilization and allows resumption of oral intake. Multi-modal regimens combining paracetamol, non-steroidal anti-inflammatory agents where indicated, a potent opioid and a local anaesthetic technique achieve effective analgesia while limiting the dose and thereby side effects of any one agent...
September 5, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28853293/predictors-of-vasopressin-responsiveness-in-critically-ill-adults
#3
Brittainy Allen, Bridgette Kram, Shawn Kram, Jennifer Schultheis, Steven Wolf, Daniel Gilstrap, Mark Shapiro
BACKGROUND: Vasopressin is commonly used as an adjunct vasopressor in shock. However, response to vasopressin varies among critically ill patients. OBJECTIVE: To identify patient-specific factors that are associated with vasopressin responsiveness in critically ill adults. METHODS: This retrospective, multicenter study included adult patients who were admitted to an intensive care unit (ICU) and received vasopressin for shock. Patients were excluded if they received vasopressin for less than 30 minutes, if vasopressin was initiated prior to ICU arrival, or if an additional vasopressor was initiated within 30 minutes of starting vasopressin...
August 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28843114/clinical-and-radiological-predictors-of-outcome-in-tubercular-meningitis-a-prospective-study-of-209-patients
#4
M Modi, K Sharma, S Prabhakar, M K Goyal, A Takkar, N Sharma, A Garg, S Faisal, N Khandelwal, P Singh, J Sachdeva, R Shree, V Rishi, V Lal
OBJECTIVES: The predictors of poor outcome in tuberculous meningitis (TBM) remain to be delineated. We determined role of various clinical, radiological and cerebrospinal fluid (CSF) parameters in prediction of outcome in TBM. PATIENTS AND METHODS: Current study was a prospective observational study including 209 patients of TBM. All patients underwent detailed evaluation including Gadolinium enhanced Magnetic resonance imaging (GdMRI) of brain as well as tests to detect evidence of tuberculosis elsewhere in body...
August 18, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28822384/clinical-characteristics-of-trauma-patients-requiring-hydrocortisone-treatment-for-refractory-hypotension
#5
Gina Kim, Jeffrey Young
Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28808397/genistein-attenuated-gastric-injury-on-indomethacin-induced-gastropathy-in-rats
#6
Sarocha Vivatvakin, Duangporn Werawatganon, Kanjana Somanawat, Naruemon Klaikeaw, Prasong Siriviriyakul
OBJECTIVES: To investigates the mucoprotective effect of genistein on gastric injury in rats with indomethacin (IMN)-induced gastropathy. METHODS: Male Sprague-Dawley rats were randomly divided into three groups. Group 1 (control; n = 6) was given distilled water (DW). Group 2 (IMN; n = 6) was given indomethacin (IMN) 150 mg/kg dissolved in 5% sodium bicarbonate (NaHCO3(-)) 1 mL/rat via intragastric tube at time 0 and 4 h. Group 3 (genistein; n = 6) was given genistein 100 mg/kg dissolved in 0...
July 2017: Pharmacognosy Magazine
https://www.readbyqxmd.com/read/28776498/methylprednisolone-prevents-bacterial-translocation-in-thioacetamide-induced-liver-failure-in-rats
#7
Murat Muhsin Muhip Harputluoğlu, İsmail Temel, Ulvi Demirel, Yüksel Seçkin, Murat Aladağ, Barış Otlu, Neşe Karadağ, Fatma Özyalın, Nilay Aydoğan, Engin Burak Selçuk
BACKGROUND/AIMS: Steroids have been shown to prevent intestinal oxidative stress. We investigated the effects of methylprednisolone on intestinal oxidative damage and bacterial translocation in thioacetamide-induced liver failure in rats. MATERIALS AND METHODS: Group 1 (n=8) was the control group. In group 2 (n=8), the thioacetamide group, rats received 300 mg/kg intraperitoneal thioacetamide daily for 2 days. In group 3 (n=8), the thioacetamide+methylprednisolone group, treatment with methylprednisolone (30 mg/kg intraperitoneal) was commenced 48 h before the first dose of thioacetamide...
August 4, 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/28764794/exploration-of-knowledge-and-understanding-in-patients-with-primary-adrenal-insufficiency-a-mixed-methods-study
#8
L M Shepherd, A A Tahrani, C Inman, W Arlt, D M Carrick-Sen
BACKGROUND: Primary adrenal insufficiency (PAI) is a rare and severe condition requiring lifelong steroid replacement. During acute illness or stressful events, it is important to appropriately adjust glucocorticoid dose; failure to do so may lead to an adrenal crisis. The aim of the study was to explore patients PAI knowledge and understanding of the condition, steroid replacement adjustment during acute illness or stress and provided education. METHODS: Ten adult patients with PAI were purposefully recruited from two hospitals in a tertiary NHS Trust in England, UK...
August 1, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28758231/re-defining-the-stress-cortisol-response-to-surgery
#9
Bernard Khoo, Piers R Boshier, Alexander Freethy, George Tharakan, Samerah Saeed, Neil Hill, Emma L Williams, Krishna Moorthy, Neil Tolley, Long R Jiao, Duncan Spalding, Fausto Palazzo, Karim Meeran, Tricia Tan
BACKGROUND: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity, or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. METHODS: Euadrenal patients undergoing elective surgery were enrolled prospectively. Serum samples were taken at 8 am on surgical day, induction and 1 hr, 2 hr, 4 hr and 8 hr after...
July 31, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28750356/combined-calcitriol-and-menadione-reduces-experimental-murine-triple-negative-breast-tumor
#10
Luciana Bohl, Solange Guizzardi, Valeria Rodríguez, Lucila Hinrichsen, Viviana Rozados, David Cremonezzi, Nori Tolosa de Talamoni, Gabriela Picotto
BACKGROUND: Calcitriol (D) or 1,25(OH)2D3 inhibits the growth of several tumor cells including breast cancer cells, by activating cell death pathways. Menadione (MEN), a glutathione-depleting compound, may be used to potentiate the antiproliferative actions of D on cancer cells. We have previously shown in vitro that MEN improved D-induced growth arrest on breast cancer cell lines, inducing oxidative stress and DNA damage via ROS generation. Treatment with MEN+D resulted more effective than D or MEN alone...
October 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28721596/central-adrenal-insufficiency-following-traumatic-brain-injury-a-missed-diagnosis-in-the-critically-injured
#11
Eileen Fan, Peter W Skippen, Michael A Sargent, David D Cochrane, Jean-Pierre Chanoine
BACKGROUND: High-dose steroid administration is no longer recommended in the treatment of acute traumatic brain injury (TBI) as it failed to prove beneficial in improving patients' outcome. However, a masked benefit of steroid administration in TBI management was that it provided corticosteroid replacement therapy in patients with TBI-related central adrenal insufficiency. CASE PRESENTATION: We report the case of a 12-year-old boy who suffered a severe TBI from a motor vehicle accident that resulted in complete deficiency of anterior pituitary function...
July 18, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28720385/differences-of-lipid-membrane-modulation-and-oxidative-stress-by-digoxin-and-21-benzylidene-digoxin
#12
Lilian N D Silva, Marco Tulio C Pessoa, Silmara L G Alves, Jessica Venugopal, Vanessa F Cortes, Herica L Santos, José A F P Villar, Leandro A Barbosa
Cardiotonic steroids (CTS) are compounds which bind to the Na,K-ATPase, leading to its inhibition and in some cases initiating signaling cascades. Long utilized as a treatment for congestive heart disease, CTS have more recently been observed to inhibit proliferation and cause apoptosis in several cancer cell lines. A synthetic derivative of the CTS digoxin, called 21-benzylidene digoxin (21-BD), activates the Na,K-ATPase rather than cause its inhibition, as its parent compound does. Here, the mechanism behind the unique effects of 21-BD are further explored...
July 15, 2017: Experimental Cell Research
https://www.readbyqxmd.com/read/28719635/differential-protein-expression-profile-in-the-hypothalamic-gt1-7-cell-line-after-exposure-to-anabolic-androgenic-steroids
#13
Freddyson J Martínez-Rivera, Juliana Pérez-Laspiur, María E Santiago-Gascot, Abner G Alemán-Reyes, Emanuel García-Santiago, Yolanda Rodríguez-Pérez, Cristhian Calo-Guadalupe, Inelia Otero-Pagán, Roxsana N Ayala-Pagán, Magdiel Martínez, Yisel M Cantres-Rosario, Loyda M Meléndez, Jennifer L Barreto-Estrada
The abuse of anabolic androgenic steroids (AAS) has been considered a major public health problem during decades. Supraphysiological doses of AAS may lead to a variety of neuroendocrine problems. Precisely, the hypothalamic-pituitary-gonadal (HPG) axis is one of the body systems that is mainly influenced by steroidal hormones. Fluctuations of the hormonal milieu result in alterations of reproductive function, which are made through changes in hypothalamic neurons expressing gonadotropin-releasing hormone (GnRH)...
2017: PloS One
https://www.readbyqxmd.com/read/28700384/update-on-graves-disease-advances-in-treatment-of-mild-moderate-and-severe-thyroid-eye-disease
#14
REVIEW
Diego Strianese
PURPOSE OF REVIEW: To report the most recent therapeutic advances of thyroid eye disease (TED) and offer general recommendations for management of TED. RECENT FINDINGS: Treatment of Graves ophthalmopathy is traditionally based on the use of high doses of corticosteroids and/or radiotherapy (RT) to decrease the activity of the disease, with the subsequent proptosis, strabismus and eyelid deformites treated with different surgical procedures. In recent years, the evidence that oxidative stress plays a relevant role in exacerbating TED severity has encouraged the use of antioxydative agents such as selenium, which has shown a capacity in limiting the disease progression...
September 2017: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/28695270/maternal-use-of-prednisolone-is-unlikely-to-be-associated-with-neonatal-adrenal-suppression-a-single-center-study-of-16-cases
#15
Leanne de Vetten, Margriet van Stuijvenberg, Ido P Kema, Gianni Bocca
The use of supra-physiological, exogenous corticosteroids in pregnancy may lead to neonatal adrenal suppression. We report on a single-center, case series study carried out between 2006 and 2014, which included all newborns (n = 16) of mothers using prednisolone ≥10 mg/day during pregnancy. Newborns were routinely assessed according to hospital protocol, with follow-up until 6 weeks after birth. We investigated the clinical symptoms and biochemical findings of adrenal suppression occurring in the newborns...
August 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28685301/steroid-use-for-refractory-hypotension-in-congenital-diaphragmatic-hernia
#16
Jason O Robertson, Cory N Criss, Lily B Hsieh, Niki Matsuko, Josh S Gish, Rodrigo A Mon, Kevin N Johnson, Samir K Gadepalli
PURPOSE: Guidelines for diagnosis and treatment of adrenal insufficiency (AI) in newborns with congenital diaphragmatic hernia (CDH) are poorly defined. METHODS: From 2002 to 2016, 155 infants were treated for CDH at our institution. Patients with shock refractory to vasopressors (clinically diagnosed AI) were treated with hydrocortisone (HC). When available, random cortisol levels <10 μg/dL were considered low. Outcomes were compared between groups. RESULTS: Hydrocortisone was used to treat AI in 34% (53/155) of patients...
July 6, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28684161/vitamin-e-isoform-%C3%AE-tocotrienol-protects-against-emphysema-in-cigarette-smoke-induced-copd
#17
Hong Yong Peh, W S Daniel Tan, Tze Khee Chan, Chen Wei Pow, Paul S Foster, W S Fred Wong
Inflammation and oxidative stress contribute to emphysema in COPD. Although corticosteroids are the standard of care for COPD, they do not reduce oxidative stress, and a subset of patients is steroid-resistant. Vitamin E isoform γ-tocotrienol possesses both anti-inflammatory and anti-oxidative properties that may protect against emphysema. We aimed to establish the therapeutic potential of γ-tocotrienol in cigarette smoke-induced COPD models in comparison with prednisolone. BALB/c mice were exposed to cigarette smoke for 2 weeks or 2 months...
July 3, 2017: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/28667510/a-randomized-controlled-trial-of-ganaxolone-in-posttraumatic-stress-disorder
#18
Ann M Rasmusson, Christine E Marx, Sonia Jain, Gail M Farfel, Julia Tsai, Xiaoying Sun, Thomas D Geracioti, Mark B Hamner, James Lohr, Richard Rosse, Lanier Summerall, Jennifer C Naylor, Cristine Cusin, Ariel J Lang, Rema Raman, Murray B Stein
Preclinical and clinical research supports a role for neuroactive steroids in the pathophysiology of posttraumatic stress disorder (PTSD). We investigated ganaxolone (a synthetic 3β-methylated derivative of allopregnanolone, a GABAergic neuroactive steroid) for treatment of PTSD in a proof-of-concept, multisite, double-blind, placebo-controlled trial. Veteran and non-veteran participants (n = 112) were randomized to ganaxolone or placebo at biweekly escalating doses of 200, 400, and 600 mg twice daily for 6 weeks...
August 2017: Psychopharmacology
https://www.readbyqxmd.com/read/28660168/spontaneous-intraventricular-rupture-of-a-craniopharyngioma-cyst-a-case-report
#19
Kunal Vakharia, Ioannis Dimitrios Siasios, Alexander B Dorsch, Jody Leonardo
Intraventricular rupture of craniopharyngioma cysts is an unusual event which is associated with a high risk of loculated or communicating hydrocephalus. A 75-year-old woman presented at the Emergency Department of our hospital with mental status deterioration due to chemical ventriculitis and acute hydrocephalus following the intraventricular rupture of a craniopharyngioma cyst. The patient was treated with stress-dose steroid therapy. In addition, she underwent placement of an external ventricular drain and endoscopy-assisted intra-cystic placement of an Ommaya reservoir for the aspiration of the cystic fluid...
April 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28611376/allopregnanolone-mediates-the-exacerbation-of-tourette-like-responses-by-acute-stress-in-mouse-models
#20
Laura J Mosher, Sean C Godar, Marianela Nelson, Stephen C Fowler, Graziano Pinna, Marco Bortolato
Tourette syndrome (TS) is a neuropsychiatric disorder characterized by multiple tics and sensorimotor abnormalities, the severity of which is typically increased by stress. The neurobiological underpinnings of this exacerbation, however, remain elusive. We recently reported that spatial confinement (SC), a moderate environmental stressor, increases tic-like responses and elicits TS-like sensorimotor gating deficits in the D1CT-7 mouse, one of the best-validated models of TS. Here, we hypothesized that these adverse effects may be mediated by neurosteroids, given their well-documented role in stress-response orchestration...
June 13, 2017: Scientific Reports
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