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https://www.readbyqxmd.com/read/28436927/looking-at-the-positive-side-of-moral-distress-why-it-s-a-problem
#1
Elizabeth G Epstein, Ashley R Hurst
Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#2
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
April 20, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28426914/recommended-dose-of-idarucizumab-may-not-always-be-sufficient-for-sustained-reversal-of-dabigatran
#3
Alexander Simon, Hans Domanovits, Cihan Ay, Gürkan Sengölge, Jerrold H Lewy, Alexander O Spiel
Idarucizumab is a monoclonal antibody fragment designed for reversing the anticoagulant effects of dabigatran. Administration is recommended as two intravenous boluses of 2.5 g within 15 minutes of each other or as a single 5 g bolus. However, in certain situations a second dose of the drug could be necessary. We report the case of a 77-year old man, treated with dabigatran for paroxysmal atrial fibrillation. He presented at our department with acute renal failure, concomitant massive dabigatran accumulation, and subsequent acute gastrointestinal bleeding...
April 20, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28426589/open-access-crowd-sourced-repository-of-anesthesia-information-wiki-anesthesia-as-antidote-to-inaccurate-internet-based-resources
#4
André A J Van Zundert, Stephen P Gatt, Ravi P Mahajan
No abstract text is available yet for this article.
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28425821/l-carnitine-supplementation-to-reverse-hyperammonemia-in-a-patient-undergoing-chronic-valproic-acid-treatment-a-case-report
#5
Cecilia Maldonado, Natalia Guevara, Alicia Silveira, Pietro Fagiolino, Marta Vázquez
Valproic acid is a broad-spectrum anticonvulsant that has also gained attention in the psychiatric setting. With respect to safety, valproic acid may induce a seemingly rare condition, hyperammonemia, which can induce a wide variety of symptoms ranging from irritability to coma. The proposed mechanism of hyperammonemia involves depletion of carnitine and overproduction of a toxic metabolite, 4-en-valproic acid, both of which impair the urea cycle and thus ammonia elimination. Carnitine is a commonly used antidote for acute intoxication of valproic acid, but is not a therapeutic option for management of chronic adults with adverse effects related to valproic acid...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28421841/adolescent-with-prolonged-toxidrome
#6
Jami Johnson, Kristie Williams, William Banner
A 13-year-old female was presented to the emergency department following an intentional ingestion. The patient developed significant toxicity including multiple, discreet tonic-clonic seizures. Despite appropriate resuscitation and antidotal management, the patient's symptoms persisted for more than 36 hours post-ingestion. An upright abdominal radiograph was performed revealing a radiopacity suggesting a pharmacobezoar. An esophagogastroduodenoscopy was performed with successful removal of a tennis ball-sized pharmacobezoar...
June 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28418831/the-evaluation-of-benefit-of-newly-prepared-reversible-inhibitors-of-acetylcholinesterase-and-commonly-used-pyridostigmine-as-pharmacological-pretreatment-of-soman-poisoned-mice
#7
Jiří Kassa, Jan Korábečný, Eugenie Nepovimová
AIM: The ability of four newly prepared reversible inhibitors of acetylcholinesterase (6-chlorotacrine, 7-phenoxytacrine, compounds 1 and 2) and currently used carbamate pyridostigmine to increase the resistance of mice against soman and the efficacy of antidotal treatment of soman-poisoned mice was evaluated. METHODS: The evaluation of the effect of pharmacological pretreatment is based on the identification of changes of soman-induced toxicity that was evaluated by the assessment of its LD50 value and its 95% confidence limit using probitlogarithmical analysis of death occurring within 24 h after administration of soman...
April 18, 2017: Acta Medica (Hradec Králové)
https://www.readbyqxmd.com/read/28416275/cisplatin-analogs-confer-protection-against-cyanide-poisoning
#8
Anjali K Nath, Xu Shi, Devin L Harrison, Jordan E Morningstar, Sari Mahon, Adriano Chan, Patrick Sips, Jangwoen Lee, Calum A MacRae, Gerry R Boss, Matthew Brenner, Robert E Gerszten, Randall T Peterson
Cisplatin holds an illustrious position in the history of chemistry most notably for its role in the virtual cure of testicular cancer. Here we describe a role for this small molecule in cyanide detoxification in vivo. Cyanide kills organisms as diverse as insects, fish, and humans within seconds to hours. Current antidotes exhibit limited efficacy and are not amenable to mass distribution requiring the development of new classes of antidotes. The binding affinity of the cyanide anion for the positively charged metal platinum is known to create an extremely stable complex in vitro...
April 7, 2017: Cell Chemical Biology
https://www.readbyqxmd.com/read/28412453/in-vitro-mercaptopyruvate-sulfurtransferase-species-comparison-in-humans-and-common-laboratory-animals
#9
Bryant M Moeller, Daune L Crankshaw, Jacquie Briggs, Herbert Nagasawa, Steven E Patterson
Cyanide is a metabolic poison that inhibits cytochrome c oxidase. Its broad applications in manufacturing and history as an agent of warfare/terror highlight the limitations in approved cyanide antidotes for mass casualties. Sulfanegen, a pre-clinical antidote for cyanide poisoning, exploits an endogenous detoxification pathway and should be amenable to mass-casualty scenarios. Because human studies are unethical, determination of appropriate animal species as models in translational studies for FDA approval under the "Animal Rule" are critical...
April 12, 2017: Toxicology Letters
https://www.readbyqxmd.com/read/28406883/characteristics-of-fentanyl-overdose-massachusetts-2014-2016
#10
Nicholas J Somerville, Julie O'Donnell, R Matthew Gladden, Jon E Zibbell, Traci C Green, Morgan Younkin, Sarah Ruiz, Hermik Babakhanlou-Chase, Miranda Chan, Barry P Callis, Janet Kuramoto-Crawford, Henry M Nields, Alexander Y Walley
Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015 (1). The proportion of opioid overdose deaths in the state involving fentanyl, a synthetic, short-acting opioid with 50-100 times the potency of morphine, increased from 32% during 2013-2014 to 74% in the first half of 2016 (1-3). In April 2015, the Drug Enforcement Agency (DEA) and CDC reported an increase in law enforcement fentanyl seizures in Massachusetts, much of which was believed to be illicitly manufactured fentanyl (IMF) (4)...
April 14, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28405068/hemodialysis-failure-secondary-to-hydroxocobalamin-exposure
#11
Kenneth Lim, Eliot Heher, David Steele, Andrew Z Fenves, John Kevin Tucker, Ravi Thadhani, Kenneth Christopher, Nina Tolkoff-Rubin
Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. Unfortunately, hemodialysis was confounded by a recurrent "blood leak" alarm. This unforeseen effect was secondary to interference from hydroxocobalamin. Hydroxocobalamin causes orange/red discoloration of bodily fluids and permeates the dialysate...
April 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28398746/sensitive-immunoassay-for-detection-and-quantification-of-the-neurotoxin-tetramethylenedisulfotetramine
#12
Natalia Vasylieva, Bogdan Barnych, Amy Rand, Bora Inceoglu, Shirley J Gee, Bruce D Hammock
Tetramethylenedisulfotetramine (TETS, tetramine) is a formerly used and highly neurotoxic rodenticide. Its lethality, recent history of intentional use for mass poisoning, and the absence of a known antidote raise public health concerns. Therefore, rapid, high throughput, and sensitive methods for detection and quantification of TETS are critical. Instrumental analysis method such as GC/MS is sensitive but not rapid or high throughput. Therefore, an immunoassay selective to TETS was developed. The assay shows an IC50 of 4...
April 24, 2017: Analytical Chemistry
https://www.readbyqxmd.com/read/28392512/direct-oral-anticoagulants-for-the-treatment-of-venous-thromboembolism-in-japan
#13
Mashio Nakamura, Norikazu Yamada, Masaaki Ito
Direct oral anticoagulants (DOACs) were developed to compensate for the demerits of warfarin. In Japan, three factor Xa inhibitors are used for the treatment of venous thromboembolism (VTE): edoxaban, rivaroxaban, and apixaban. Despite problems, such as the inability to monitor their effect and the lack of an antidote, these inhibitors have the same efficacy as conventional treatment with warfarin, and they are associated with a significantly high degree of safety in relation to hemorrhagic complications. East Asians, including Japanese, suffer from hemorrhage more frequently; therefore, DOACs are considered to be highly effective...
April 7, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28390791/edoxaban-defining-place-in-therapy-for-the-newest-direct-acting-oral-anticoagulant
#14
REVIEW
Caitlin M Gibson, Shannon W Finks
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the FDA for treatment of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug-drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis...
April 5, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28386620/direct-oral-anticoagulants-doac-management-of-emergency-situations-rationale-and-design-of-the-radoa-registry
#15
Edelgard Lindhoff-Last
The worldwide increase in the aging population and the associated increase in the prevalence of atrial fibrillation and venous thromboembolism as well as the widespread use of direct oral anticoagulants (DOAC) have resulted in an increase of the need for the management of bleeding complications and emergency operations in frail, elderly patients, in clinical practice. When severe bleeding occurs, general assessment should include evaluation of the bleeding site, onset and severity of bleeding, renal function, and concurrent medications with focus on antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAID)...
April 6, 2017: Hämostaseologie
https://www.readbyqxmd.com/read/28384906/golden-hours-in-severe-paraquat-poisoning-the-role-of-early-haemoperfusion-therapy
#16
Raghavendra Rao, Rama Bhat, Swathi Pathadka, Sravan Kumar Chenji, Savio Dsouza
INTRODUCTION: Paraquat is a commonly ingested poison especially in Southern India. There is no antidote for paraquat poison and consumption is often fatal. The usual cause of death is either acute lung injury or multi-organ failure. AIM: To evaluate the role of early haemoperfusion as a therapy in paraquat poisoned patients. MATERIALS AND METHODS: This study was a retrospective analysis of patients admitted to a Tertiary Medical College Hospital between January 2012 and December 2015 with history of paraquat consumption, comparing outcomes in those who received only gastric lavage and symptomatic treatment with those who received haemoperfusion as a therapy...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28376373/mindfulness-and-mind-wandering-the-protective-effects-of-brief-meditation-in-anxious-individuals
#17
Mengran Xu, Christine Purdon, Paul Seli, Daniel Smilek
Mind wandering can be costly, especially when we are engaged in attentionally demanding tasks. Preliminary studies suggest that mindfulness can be a promising antidote for mind wandering, albeit the evidence is mixed. To better understand the exact impact of mindfulness on mind wandering, we had a sample of highly anxious undergraduate students complete a sustained-attention task during which off-task thoughts including mind wandering were assessed. Participants were randomly assigned to a meditation or control condition, after which the sustained-attention task was repeated...
April 1, 2017: Consciousness and Cognition
https://www.readbyqxmd.com/read/28364736/bleeding-complications-and-management-on-anticoagulant-therapy
#18
Sam Schulman
Patients treated with anticoagulants have an unavoidable risk of bleeding complications. There are, for all oral anticoagulants, several potential options for management of major bleeding. The first action is to assess the causative role of the anticoagulant in the current bleeding. Supportive measures have been assessed in several post hoc analyses of the phase III pivotal trials with the non-vitamin K antagonist oral anticoagulants (NOACs). Those results will be reviewed here together with emerging data on the efficacy and safety of the specific antidotes idarucizumab (for dabigatran) and andexanet-α (for factor Xa inhibitors)...
April 1, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28364684/biophysical-and-molecular-docking-approaches-for-the-investigation-of-biomolecular-interactions-between-amphotericin-b-and-bovine-serum-albumin
#19
Muslim Raza, Aftab Ahmad, Feng Yue, Zahid Khan, Yang Jiang, Yun Wei, Saleem Raza, Wang Wen He, Faheem Ullah Khan, Yuan Qipeng
Exogenous drug as an antidote to treat various infections get absorbed in the blood circulatory system of a human can directly contact with transporter proteins such as serum albumin. Therefore, for rational drug discovery, understanding the biomolecular interaction between drugs and protein is highly important. In this contribution, we describe the possible interactions between an antifungal drug Amphotericin B (AmB) and Bovine Serum Albumin (BSA) using multi-spectroscopic techniques and further confirmed through in-silico approaches...
March 23, 2017: Journal of Photochemistry and Photobiology. B, Biology
https://www.readbyqxmd.com/read/28362649/rapid-and-well-tolerated-action-of-idarucizumab-for-antagonizing-dabigatran-in-a-patient-needing-urgent-thrombolysis-a-case-report
#20
Roberto Facchinetti, Giulia DeGuidi, Federica Pitoni, Giorgio Ricci, Giuseppe Lippi
Dabigatran is a direct oral anticoagulant drug exhibiting clinical benefits over vitamin K antagonists. A procedure for reversing the anticoagulant effect of direct oral anticoagulants may be needed in emergency clinical settings, and is traditionally accomplished by using plasma products or hemostatic physical interventions. Idarucizumab, a specific antidote for dabigatran, has recently become available. This compound can be rapidly administered by intravenous injection and is effective in reversing anticoagulation in few minutes...
March 30, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
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