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https://www.readbyqxmd.com/read/29196879/the-feasibility-of-physiologically-based-pharmacokinetic-modeling-in-forensic-medicine-illustrated-by-the-example-of-morphine
#1
Nadine Schaefer, Daniel Moj, Thorsten Lehr, Peter H Schmidt, Frank Ramsthaler
In forensic medicine, expert opinion is often required concerning dose and time of intake of a substance, especially in the context of fatal intoxications. In the present case, a 98-year-old man died 4 days after admission to a hospital due to a femur neck fracture following a domestic fall in his retirement home. As he had obtained high morphine doses in the context of palliative therapy and a confusion of his supplemental magnesium tablets with a diuretic by the care retirement home was suspected by the relatives, a comprehensive postmortem examination was performed...
December 1, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29186909/ketamine-a-clinically-used-anesthetic-inhibits-vascular-smooth-muscle-cell-proliferation-via-pp2a-activated-pi3k-akt-erk-inhibition
#2
Yi Chang, Jiun-Yi Li, Thanasekaran Jayakumar, Shou-Huang Hung, Wei-Cheng Lee, Manjunath Manubolu, Joen-Rong Sheu, Ming-Jen Hsu
Abnormal proliferation of vascular smooth muscle cells (VSMCs) gives rise to major pathological processes involved in the development of cardiovascular diseases. The use of anti-proliferative agents for VSMCs offers potential for the treatment of vascular disorders. Intravenous anesthetics are firmly established to have direct effects on VSMCs, resulting in modulation of blood pressure. Ketamine has been used for many years in the intensive care unit (ICU) for sedation, and has recently been considered for adjunctive therapy...
November 27, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29170340/43%C3%A2-management-of-acute-low-back-pain-in-the-ed-a-systematic-review
#3
Jane Ashbrook, Nikos Rodgdakis, Peter Goodwin, Gill Yeowell, Michael Callaghan
STUDY OBJECTIVE: There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of acute low back pain in the ED. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were observed during this review...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29151192/impact-of-oral-ketamine-augmentation-on-hospital-admissions-in-treatment-resistant-depression-and-ptsd-a-retrospective-study
#4
John Hartberg, Simone Garrett-Walcott, Angelo De Gioannis
RATIONALE: Depressive episodes are the leading cause of mental health-related hospital admissions in Australia, and 44% of those admitted have a previous history of hospitalisations for depression (Admitted patient mental health-related care: (Australian Institute of Health and Welfare Aust Hospital Stat 2011-12, 2013). Despite numerous available antidepressant treatments, many patients do not respond to conventional therapy, having what is called 'treatment resistance' (Fava Biol Psychiatry 53:649-659, 2003)...
November 18, 2017: Psychopharmacology
https://www.readbyqxmd.com/read/29149755/a-randomized-clinical-trial-of-adjunctive-ketamine-anesthesia-in-electro-convulsive-therapy-for-depression
#5
Minling Zhang, Robert Rosenheck, Xiaoming Lin, Qirong Li, Yanling Zhou, Yunshan Xiao, Xiong Huang, Ni Fan, Hongbo He
BACKGROUND: Electroconvulsive therapy (ECT) is a rapid acting and effective treatment for both major depressive disorder (MDD) and bipolar disorder (BP). Both propofol and ketamine are commonly used anesthetic agents but recent clinical studies suggest that ketamine has rapid-acting antidepressant properties, itself, at sub-anesthetic doses. METHODS: A total of 77 inpatients (41 MDD and 36 BP) were randomly assigned to receive ECT with propofol (1mg/kg) anesthesia or with ketamine (0...
November 10, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/29138992/use-of-ketamine-in-elderly-patients-with-treatment-resistant-depression
#6
REVIEW
Carolina Medeiros da Frota Ribeiro, Patricio Riva-Posse
PURPOSE OF REVIEW: The purpose of this paper is to provide a review of the use of ketamine as an antidepressant for treatment-resistant depression (TRD) in the geriatric population. Available treatment options for late-life treatment-resistant depression are limited and include electroconvulsive therapy and transcranial magnetic stimulation as well as possible pharmacologic augmentation. Ketamine has been shown to be a promising treatment in TRD; however, data regarding the use of ketamine in the elderly includes only five case reports...
November 15, 2017: Current Psychiatry Reports
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#7
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29135596/general-anesthetics-to-treat-major-depressive-disorder-clinical-relevance-and-underlying-mechanisms
#8
Laszlo Vutskits
Major depressive disorder is a frequent and devastating psychological condition with tremendous public health impact. The underlying pathophysiological mechanisms involve abnormal neurotransmission and a relatedly impaired synaptic plasticity. Since general anesthetics are potent modulators of neuronal activity and, thereby, can exert long-term context-dependent impact on neural networks, an intriguing hypothesis is that these drugs could enhance impaired neural plasticity associated with certain psychiatric diseases...
November 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29127600/a-review-of-current-and-emerging-approaches-to-pain-management-in-the-emergency-department
#9
REVIEW
Knox H Todd
INTRODUCTION: Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches...
December 2017: Pain and Therapy
https://www.readbyqxmd.com/read/29107412/ketamine-infusion-for-refractory-status-epilepticus-a-case-report-of-cardiac-arrest
#10
Lauren Koffman, Ho Yan Yiu, Salia Farrokh, John Lewin, Romergryko Geocadin, Wendy Ziai
BACKGROUND: Refractory status epilepticus (RSE) has a high mortality rate and is often difficult to treat. When traditional therapies fail ketamine may be considered. There are limited reports of adverse cardiac events with the use of ketamine for RSE and no reports of cardiac arrest in this context. OBJECTIVE: Evaluate the occurrence of cardiac arrhythmias associated with the use of ketamine for RSE. METHODS: Retrospective chart review of nine patients who underwent ketamine infusion for RSE...
October 26, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29100629/metabotropic-glutamatergic-receptor-5-and-stress-disorders-knowledge-gained-from-receptor-imaging-studies
#11
REVIEW
Irina Esterlis, Sophie E Holmes, Priya Sharma, John H Krystal, Christine DeLorenzo
The metabotropic glutamatergic receptor subtype 5 (mGluR5) may represent a promising therapeutic target for stress-related psychiatric disorders. Here, we describe mGluR5 findings in stress disorders, particularly major depressive disorder (MDD), highlighting insights from positron emission tomography studies. Positron emission tomography studies report either no differences or lower mGluR5 in MDD, potentially reflecting MDD heterogeneity. Unlike the rapidly acting glutamatergic agent ketamine, mGluR5-specific modulation has not yet shown antidepressant efficacy in MDD and bipolar disorder...
September 19, 2017: Biological Psychiatry
https://www.readbyqxmd.com/read/29055748/sex-and-dose-dependent-abuse-liability-of-repeated-subanesthetic-ketamine-in-rats
#12
Kristin J Schoepfer, Caroline E Strong, Samantha K Saland, Katherine N Wright, Mohamed Kabbaj
RATIONALE: Subanesthetic ketamine (KET) elicits rapid, robust, but transient antidepressant effects. KET's antidepressant actions can be augmented and maintained for a longer duration when repeatedly delivered. However, KET is recreationally abused, raising long-term treatment safety concerns. Women are more likely than men to seek treatment for depression, escalate from casual to compulsive drug use, and are more sensitive to antidepressants. Similarly, female rodents are more sensitive than males to KET's rapid antidepressant-like behavioral effects; dose-response thresholds in these assays equal 2...
October 18, 2017: Physiology & Behavior
https://www.readbyqxmd.com/read/29033344/a-prospective-study-of-ketamine-as-primary-therapy-for-prehospital-profound-agitation
#13
Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, Jeffrey D Ho
OBJECTIVE: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. METHODS: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29028641/postoperative-care-after-tonsillectomy-what-s-the-evidence
#14
Patrick Carpenter, Daniel Hall, Jeremy D Meier
PURPOSE OF REVIEW: The purpose of this review is to evaluate the current literature regarding postoperative management after tonsillectomy in children. RECENT FINDINGS: Controversy remains regarding the ideal medication regimen to manage pain after tonsillectomy. Acetaminophen and ibuprofen are routinely used, although concerns of more severe postoperative hemorrhage with ibuprofen remain. Narcotics are prescribed commonly, but with extreme caution in children with severe obstructive sleep apnea...
December 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28946059/pregabalin-as-adjunct-in-a-multimodal-pain-therapy-after-traumatic-foot-amputation-a-case-report-of-a-4-year-old-girl
#15
Stephanie Wössner, Kirsten Weber, Anna C Steinbeck, Markus Oberhauser, Matthias Feuerecker
BACKGROUND AND PURPOSE: The purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation. Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70-75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin...
September 22, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28926735/ketamine-metabolites-with-antidepressant-effects-fast-economical-and-eco-friendly-enantioselective-separation-based-on-supercritical-fluid-chromatography-sfc-and-single-quadrupole-ms-detection
#16
Georg M Fassauer, Robert Hofstetter, Mahmoud Hasan, Stefan Oswald, Christina Modeß, Werner Siegmund, Andreas Link
Increasing evidence accumulates that metabolites of the dissociative anesthetic ketamine contribute considerably to the biological effects of this drug and could be developed as next generation antidepressants, especially for acute treatment of patients with therapy-refractory major depression. Analytical methods for the simultaneous determination of the plethora of hydroxylated, dehydrogenated and/or demethylated compounds formed after administration of ketamine hydrochloride are a prerequisite for future clinical investigations and a deeper understanding of the individual role of the isomers of these metabolites...
September 8, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28925030/drug-repurposing-may-generate-novel-approaches-to-treating-depression
#17
REVIEW
Mohamed Elsaed Ebada
OBJECTIVES: The breakthrough advancements in scientific medical research have greatly improved our understanding of the pathogenesis of depression, encouraging drug discoverers to take a shorter path than ever through drug repurposing to generate new antidepressant medications. In addition to reduced noradrenergic and serotonergic neurotransmission in the brain, other coincidence features such as glutamate neurotoxicity, inflammation and/or cerebrovascular insufficiency are implicated in the pathogenesis of major depressive disorder and late-life depression...
November 2017: Journal of Pharmacy and Pharmacology
https://www.readbyqxmd.com/read/28902622/functional-interaction-between-n-methyl-d-aspartate-receptor-and-ascorbic-acid-during-neuropathic-pain-induced-by-chronic-constriction-injury-of-the-sciatic-nerve
#18
Sepideh Saffarpour, Farinaz Nasirinezhad
BACKGROUND: Neuropathic pain is a chronic pain condition, which is resistant to therapy. Ascorbate was released because of the activation of glutaminergic neurons. Due to the important role of N-methyl-D-aspartate (NMDA) receptors in the pathophysiology of neuropathic pain, this study investigated the analgesic efficacy of ascorbic acid (AA) in neuropathic pain condition and the role of NMDA receptors in this effect. METHODS: For this purpose, adult male rats were randomly allocated to experimental groups (n=8 in each group)...
November 27, 2017: Journal of Basic and Clinical Physiology and Pharmacology
https://www.readbyqxmd.com/read/28888802/yamamoto-new-scalp-acupuncture-for-postoperative-pain-management-in-cats-undergoing-ovariohysterectomy
#19
Matheus R Ribeiro, Carolina B de Carvalho, Ricardo H Z Pereira, Gabriel M Nicácio, Rejane B Brinholi, Renata N Cassu
OBJECTIVE: To evaluate the analgesic efficacy of Yamamoto New Scalp Acupuncture (YNSA) as an adjuvant for postoperative pain management in cats. STUDY DESIGN: Prospective, randomized, blinded, clinical study. ANIMALS: Twenty cats aged (mean ± standard deviation) 25 ± 9 months and weighing 2.7 ± 0.6 kg undergoing ovariohysterectomy. METHODS: The cats were sedated with intramuscular (IM) ketamine (5 mg kg(-1)), midazolam (0...
April 13, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28870222/general-anesthetics-protects-against-cardiac-arrest-induced-brain-injury-by-inhibiting-calcium-wave-propagation-in-zebrafish
#20
Dao-Jie Xu, Bin Wang, Xuan Zhao, Yi Zheng, Jiu-Lin Du, Ying-Wei Wang
Cardiac arrest is a leading cause of death and disability worldwide. Although many victims are initially resuscitated, they often suffer from serious brain injury, even leading to a "persistent vegetative state". Therefore, it is need to explore therapies which restore and protect brain function after cardiac arrest. In the present study, using Tg (HuC:GCaMP5) zebrafish as a model, we found the zebrafish brain generated a burst of Ca(2+) wave after cardiac arrest by in vivo time-lapse confocal imaging. The Ca(2+) wave was firstly initiated at hindbrain and then sequentially propagated to midbrain and telencephalon, the neuron displayed Ca(2+) overload after Ca(2+) wave propagation...
September 4, 2017: Molecular Brain
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