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Victoria Louise Reid, Rachael McDonald, Amara Callistus Nwosu, Stephen R Mason, Chris Probert, John E Ellershaw, Séamus Coyle
BACKGROUND: The Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the current, limited understanding of the dying process and assist clinicians in recognising dying, in particular how to distinguish dying from reversible acute deterioration. OBJECTIVES: To critically appraise the literature on biological factors that may be used as prognostic indicators in advanced cancer patients and to identify candidate biomarkers of the dying process that can be measured serially in cancer patients' bodily fluids...
2017: PloS One
H N Vijayakumar, Sudheesh Kannan, C Tejasvi, Devika Rani Duggappa, K M Veeranna Gowda, S S Nethra
BACKGROUND: Organophosphorus compound poisoning (OPCP) is a major public health problem in developing countries like India. Atropine and oximes remain the main-stay of management. Magnesium sulfate (MgSO4) has shown benefit in the management of OPCP. AIMS: This study was designed to assess the effect of MgSO4 on outcome in OPCP patients admitted to Intensive Care Unit (ICU). SETTINGS AND DESIGN: Double-blind prospective randomized clinical trial in an ICU of tertiary care institution...
January 2017: Anesthesia, Essays and Researches
Billy K Tran, Stephen E O'Donnell, Agnes Balla, David C Adams, Lydia S Grondin, Mitchell H Tsai
As the transgender patient population continues to grow, health care providers will need to become aware of elements unique to the transgender community in order to provide the highest quality of care. Neuromuscular blockade with succinylcholine is routinely administered to patients undergoing electroconvulsive therapy (ECT). Decreased amounts or activity of pseudocholinesterase in serum can lead to prolonged duration of muscle paralysis. Causes of reduced action by pseudocholinesterase include genetically abnormal enzymes, reduced hepatic production, pregnancy, and various drug interactions...
December 21, 2016: Journal of ECT
H N Vijayakumar, K Ramya, Devika Rani Duggappa, Km Veeranna Gowda, K Sudheesh, S S Nethra, R S Raghavendra Rao
BACKGROUND AND AIMS: Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients. METHODS: Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied...
November 2016: Indian Journal of Anaesthesia
Pradeepkumar Hiremath, Pradeep Rangappa, Ipe Jacob, Karthik Rao
BACKGROUND: Organophosphorus (OP) pesticide poisoning is a major clinical and public health problem in India. Mortality rate remains high at 15%-30%. AIMS: This prospective, observational study examines the relationship between pseudocholinesterase (PChE) activity and morbidity and mortality in OP poisoning. SETTING AND DESIGN: OP poisoning cases admitted to a tertiary care center Intensive Care Unit (ICU) over 5 years from 2010 to 2014 were studied...
October 2016: Indian Journal of Critical Care Medicine
D Eschbach, T Kirchbichler, T Wiesmann, L Oberkircher, C Bliemel, S Ruchholtz, B Buecking
BACKGROUND: Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. PATIENTS AND METHODS: This prospective intervention study included cognitively impaired geriatric patients (Mini-Mental State Examination <25, age >65 years) with hip-related fractures...
2016: Clinical Interventions in Aging
Bo Zhang, Cheng Shen, Jie Jin, Yi Song, Zheng Zhao, Xiaochun Zhang, Gang Wang, Yu Fan, Yue Mi, Shuai Hu, Yun Cui, Liqun Zhou, Zhisong He, Wei Yu, Wenke Han
PURPOSE: Pretreatment serum pseudocholinesterase (PChE) has been reported to be a prognostic predictor in several cancers. However, the prognostic significance of serum PChE level in patients with upper tract urothelial carcinoma (UTUC) remains unknown. METHODS: A total of 180 patients who underwent radical nephroureterectomy (RNU) for UTUC were included in this retrospective analysis. The associations of pretreatment serum PChE levels with clinicopathological characteristics and clinical outcomes were assessed...
December 2016: International Urology and Nephrology
Candace Binkley
Pseudocholinesterase abnormalities are a genetic cause of aberrant metabolism of the depolarizing muscle relaxant succinylcholine. This article examines a case where succinylcholine was chosen to facilitate intubation due to its ultra short duration and the request of the surgeon to monitor motor evoked potentials. Following succinylcholine administration the neurophysiologist was unable to obtain motor evoked potentials. This case study highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency...
June 2016: AANA Journal
Christopher J LaRocca, Greg J Beilman, Martin Birch
Pseudocholinesterase deficiencies occur because of both genetic and acquired factors. We present the case of a patient with a history of bariatric surgery and severe malnutrition who subsequently developed prolonged neuromuscular blockade after succinylcholine administration. She had markedly decreased pseudocholinesterase levels at the time of the incident, but her motor function returned to normal with supportive care. After aggressive nutritional support over multiple weeks, her pseudocholinesterase levels drastically improved...
September 1, 2016: A & A Case Reports
Duran Özkök, Sibel Silici
Hydroxymethylfurfural (HMF) is a by-product of thermal degradation of glucose and fructose. In this study, the effects of high HMF content of honey on biochemical parameters of rats were investigated. Experiments were conducted with 40 Wistar albino male rats, each weighing 250-350 g and covered a period of 5 weeks. The animals were divided into five groups. The first group was served as control group. HMF was injected subcutaneously at a dose of 200 mg/kg rat b.w. to the animals in group 2. Group 3 was fed with honey that contains 10 mg HMF/kg honey...
October 2016: Environmental Science and Pollution Research International
Ruslan Abdullayev, Ömer Burak Küçükebe, Recai Kaya, Bülent Çelik, Hatice Kuşderci, Mehmet Duran, Öznur Uludağ, Mesut Öterkuş, Aysel Buyrukcan, Ülkü Sabuncu, Abdullah Arpacı
OBJECTIVE: Pseudocholinesterase (PChE) is an enzyme responsible for the hydrolysis of succinylcholine. In case of its deficiency, the effect of succinylcholine that is approximately 5-10 min is prolonged up to few hours. The use of succinylcholine has been declined recently. However, it is still actively used in some special conditions and in developing countries. In this study, incidence of PChE enzyme deficiency around Adiyaman city was investigated and presented with the literature review...
December 2015: Turkish Journal of Anaesthesiology and Reanimation
A A Mauritz, Z Y Strouch, A J Olufolabi
We report the use of rotational thromboelastometry (ROTEM) to guide the management of a 29-year-old primigravida at 36weeks' gestation with portal hypertension, esophageal varices, suspected pseudocholinesterase deficiency, and steroid refractory thrombocytopenia presenting to labor and delivery with worsening peripheral edema and new-onset hypertension. A multidisciplinary decision for preoperative platelet transfusion and cesarean delivery under spinal anesthesia was made, guided by ROTEM. A successful cesarean delivery was performed with no bleeding complications...
August 2016: Journal of Clinical Anesthesia
Vinod Varghese, Sadanandavalli Retnaswami Chandra, Rita Christopher, Jamuna Rajeswaran, Chandrajit Prasad, R Subasree, Thomas Gregor Issac
INTRODUCTION: Neurocysticercosis (NCC) is the most common parasitic infection of man. In addition to a headache, seizures, and focal deficits, this is associated with significant cognitive dysfunction. Many studies revealed that the number and location of lesions are not always responsible for cognitive dysfunction. Cholinesterase and pseudocholinesterase are found in the walls of the cysticercus which could contribute to cholinergic depletion and thus cognitive dysfunction. PATIENTS AND METHODS: A total of 43 patients who presented with NCC were evaluated for cognitive deficits, as well as cholinesterase levels in cerebrospinal fluid (CSF) with control CSF from patients undergoing spinal anesthesia...
March 2016: Indian Journal of Psychological Medicine
Matthew Ellison, Brian Grose, Stephen Howell, Colin Wilson, Jackson Lenz, Richard Driver
Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome...
March 2016: West Virginia Medical Journal
Tojan B Rahhal, Catherine A Fromen, Erin M Wilson, Marc P Kai, Tammy W Shen, J Christopher Luft, Joseph M DeSimone
Pulmonary delivery has great potential for delivering biologics to the lung if the challenges of maintaining activity, stability, and ideal aerosol characteristics can be overcome. To study the interactions of a biologic in the lung, we chose butyrylcholinesterase (BuChE) as our model enzyme, which has application for use as a bioscavenger protecting against organophosphate exposure or for use with pseudocholinesterase deficient patients. In mice, orotracheal administration of free BuChE resulted in 72 h detection in the lungs and 48 h in the broncheoalveolar lavage fluid (BALF)...
May 2, 2016: Molecular Pharmaceutics
Gökhan Inangil, Suleyman Deniz, Yasemin Gulcan Kurt, Ugur Keskin, Omer Bakal, Huseyin Sen, Sezai Ozkan, Ercan Kurt
OBJECTIVES: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants. STUDY DESIGN: We designed a prospective, controlled, pilot single-center study...
January 2016: Pregnancy Hypertension
Arash Behrooz
Pharmacogenetics seeks to elucidate the variations in individual's genetic sequences in order to better understand the differences seen in pharmacokinetics, drug metabolism, and efficacy between patients. This area of research is rapidly accelerating, aided by the use of novel and more economical molecular technologies. A substantial evidence base is being generated with the hopes that in the future it may be used to generate personalised treatment regimens in order to improve patient comfort and safety and reduce incidences of morbidity and mortality...
December 2015: Annals of Medicine and Surgery
S Maes, M Laubach, J Poelaert
BACKGROUND: Neuraxial anaesthesia is the desired method for Caesarean section. Bupivacaine is a well-known local anaesthetic. It has a long duration of action and can cause unpredictable levels of anaesthesia with subsequent prolonged discharge time. 2-Chloroprocaine has a rapid onset of action, producing an excellent sensory and motor block and has a rapid hydrolysis in the bloodstream by pseudocholinesterase. We compared bupivacaine and 2-chloroprocaine for spinal anaesthesia during Caesarean section...
May 2016: Acta Anaesthesiologica Scandinavica
Matthew Wecksell, Demetri Koutsospyros
Pseudocholinesterase deficiency manifests as prolonged motor blockade after the administration of succinylcholine. A previously unknown homozygous form of the disease, became apparent during a lumbar laminectomy seriously limiting the ability to monitor motor evoked potentials and perform electromyelography (EMG). Moreover, concerns were raised as to how the enzyme deficiency would affect the metabolism of remifentanil and other esters during a total intravenous anesthetic. We present the perioperative management of the patient and a literature review of the syndrome...
June 2015: Middle East Journal of Anesthesiology
Peter Alter, Tobias Glück, Jens H Figiel, A Rembert Koczulla, Claus F Vogelmeier, Heinz Rupp
BACKGROUND: In several trials, beneficial prognostic effects of highly unsaturated fatty acids (HUFAs) in heart failure were shown. Because other studies showed no incremental benefit in nearly preserved cardiac function, the question arises, whether the degree of cardiac dysfunction is involved. It is hypothesized that increased left ventricular (LV) wall stress affects the endogenous hepatic HUFA metabolism, which in turn exhibits adverse cardiac consequences. METHODS: Cardiac magnetic resonance imaging was performed in 30 patients with suspected cardiomyopathy...
February 2016: Canadian Journal of Cardiology
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