Pub Date : 2021-09-17DOI: 10.22514/10.22514/sv.2021.209
H. Lo, S. Hung, C. Ng, Shou-Yen Chen
Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.
{"title":"Qualitative and quantitative analysis of emergency department cardiac arrest publications","authors":"H. Lo, S. Hung, C. Ng, Shou-Yen Chen","doi":"10.22514/10.22514/sv.2021.209","DOIUrl":"https://doi.org/10.22514/10.22514/sv.2021.209","url":null,"abstract":"Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47283941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Chronakis, I. Ktistakis, K. Mastrantonakis, Evaggelia Vrontaki, E. Daskalogiannakis, Vassiliki Zotou, Anastasia K. Garmpi, Charalambos Christogiannis, Georgios Velivasakis
Introduction: Buprenorfine is a semisynthetic opioid which is used as a therapeutic substitute of opioid drugs and as medium to strong painkiller in smaller doses for the management of chronic pain. It’s first use goes back in 80’s. The use of buprenorphine as therapeutic substitute was approved in 2002 in USA and 2006 in Europe. The administration of buprenorphrine, in contrast to other opioids, does not provoke euphoria. It binds as an agonist/antagonist to μ and κ receptors of the brain and last up to 72 hours. Compartment syndrome is a serious pathological situation where we have increased pressures within a compartment. Compartment is a group of muscles, blood vessels and nerves which are surrounded by a strong membrane called fascia attached to bone. Fascia cannot be expanded therefore the oedema within a compartment can lead to increased pressures. As a result, it can create muscle, vessel and nerve damage. The increased compartment pressure can block the blood flow in the compartment and lead to lack of oxygen in tissue (ischemia) and cellular death. Patient feels an acute pain, unbearable as described and strong opioids provide moderate pain relief. Purpose of the current study is to evaluate the analgesia and efficiency of buprenorphine patch not only in patients with chronic pain but as post surgical analgesia in patients who suffered compartment syndrome and need multiple operation before the end of the rehabilitation. Case presentation: A male patient, 36 y.o. with no past medical history attend A/E department after a fall from height and intense knee and proximal tibia pain. He suffered from a tibia plateau fracture. Neurovascularly was compromised with absence of pulses in posterior tibial artery, reduced sensation in the anterior compartment of the tibia and the passive movement of the toes triggered excruciating pain. Lower limb vein triplex was performed to exclude DVT. Clinical diagnosis of compartment syndrome was done and the patient was taken to OR where fasciotomy both sides was performed and all four compartments were released. Copious haematoma was evacuated[1] Breivik H, Ljosaa TM, Stengaard-Pedersen K, Persson J, Aro H, Villumsen J, et al. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naive to potent opioids., a bridging femur tibia ex fix was applied and the wound left open. The phased closure of the trauma was achieved in four stages within the next 30 days. Outcome and follow-up: Spinal anaesthesia was the preferred method and for the post-op pain management was applied transdermic buprenorphine patch 70mcg in combination with 1 gr three times a day of IV paracetamol. Gradual decrease of buprenorphine dose lasted for the period the wound was open until the final closure and the reduction of the fracture. Acute and continuous pain is constant in the post op period in patients with long bone fractures com
{"title":"Post-surgical analgesia management with transdermal buprenorphine patch on a patient with compartment syndrome after tibia plateau fracture with multiple operations before the end of his rehabilitation","authors":"I. Chronakis, I. Ktistakis, K. Mastrantonakis, Evaggelia Vrontaki, E. Daskalogiannakis, Vassiliki Zotou, Anastasia K. Garmpi, Charalambos Christogiannis, Georgios Velivasakis","doi":"10.22514/sv.2021.180","DOIUrl":"https://doi.org/10.22514/sv.2021.180","url":null,"abstract":"Introduction: Buprenorfine is a semisynthetic opioid which is used as a therapeutic substitute of opioid drugs and as medium to strong painkiller in smaller doses for the management of chronic pain. It’s first use goes back in 80’s. The use of buprenorphine as therapeutic substitute was approved in 2002 in USA and 2006 in Europe. The administration of buprenorphrine, in contrast to other opioids, does not provoke euphoria. It binds as an agonist/antagonist to μ and κ receptors of the brain and last up to 72 hours. Compartment syndrome is a serious pathological situation where we have increased pressures within a compartment. Compartment is a group of muscles, blood vessels and nerves which are surrounded by a strong membrane called fascia attached to bone. Fascia cannot be expanded therefore the oedema within a compartment can lead to increased pressures. As a result, it can create muscle, vessel and nerve damage. The increased compartment pressure can block the blood flow in the compartment and lead to lack of oxygen in tissue (ischemia) and cellular death. Patient feels an acute pain, unbearable as described and strong opioids provide moderate pain relief. Purpose of the current study is to evaluate the analgesia and efficiency of buprenorphine patch not only in patients with chronic pain but as post surgical analgesia in patients who suffered compartment syndrome and need multiple operation before the end of the rehabilitation. Case presentation: A male patient, 36 y.o. with no past medical history attend A/E department after a fall from height and intense knee and proximal tibia pain. He suffered from a tibia plateau fracture. Neurovascularly was compromised with absence of pulses in posterior tibial artery, reduced sensation in the anterior compartment of the tibia and the passive movement of the toes triggered excruciating pain. Lower limb vein triplex was performed to exclude DVT. Clinical diagnosis of compartment syndrome was done and the patient was taken to OR where fasciotomy both sides was performed and all four compartments were released. Copious haematoma was evacuated[1] Breivik H, Ljosaa TM, Stengaard-Pedersen K, Persson J, Aro H, Villumsen J, et al. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naive to potent opioids., a bridging femur tibia ex fix was applied and the wound left open. The phased closure of the trauma was achieved in four stages within the next 30 days. Outcome and follow-up: Spinal anaesthesia was the preferred method and for the post-op pain management was applied transdermic buprenorphine patch 70mcg in combination with 1 gr three times a day of IV paracetamol. Gradual decrease of buprenorphine dose lasted for the period the wound was open until the final closure and the reduction of the fracture. Acute and continuous pain is constant in the post op period in patients with long bone fractures com","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45433948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients admitted to Intensive Care Units (ICU) suffer from critical illness and have the highest mortality rates among hospitalized patients. For those who survive, recovery is often a prolonged rehabilitation period with physical, cognitive and psychological dysfunction. Pre-existing chronic pain, previous impairment in quality of life due to health problems, but also the critical illness itself and organ support with multiple interventions, predispose to the development of chronic pain in the post-critical period, making it difficult to return to the pre-disease functional status. Opioid administration during mechanical ventilation is a common practice, frequently without reliable or systematic assessment of pain and individualized titration of dosage. Multimodal analgesia, including dexmedetomidine, ketamine, adjuvant medication and regional analgesia techniques can prevent chronic pain and treat withdrawal symptoms during opioid weaning. Early mobilization and physiotherapy as soon as the patient’s condition becomes stable, continuous assessment of pain and its corresponding treatment during hospitalization and the following period, individualized titration of opioids and follow-up by a team of specialists during rehabilitation, comprise a successful management plan for early recognition of complications and effective aftercare treatment of these patients.
{"title":"Chronic Pain after hospitalization in intensive care unit","authors":"D. Maliamanis","doi":"10.22514/sv.2021.205","DOIUrl":"https://doi.org/10.22514/sv.2021.205","url":null,"abstract":"Patients admitted to Intensive Care Units (ICU) suffer from critical illness and have the highest mortality rates among hospitalized patients. For those who survive, recovery is often a prolonged rehabilitation period with physical, cognitive and psychological dysfunction. Pre-existing chronic pain, previous impairment in quality of life due to health problems, but also the critical illness itself and organ support with multiple interventions, predispose to the development of chronic pain in the post-critical period, making it difficult to return to the pre-disease functional status. Opioid administration during mechanical ventilation is a common practice, frequently without reliable or systematic assessment of pain and individualized titration of dosage. Multimodal analgesia, including dexmedetomidine, ketamine, adjuvant medication and regional analgesia techniques can prevent chronic pain and treat withdrawal symptoms during opioid weaning. Early mobilization and physiotherapy as soon as the patient’s condition becomes stable, continuous assessment of pain and its corresponding treatment during hospitalization and the following period, individualized titration of opioids and follow-up by a team of specialists during rehabilitation, comprise a successful management plan for early recognition of complications and effective aftercare treatment of these patients.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46444578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: As nurses come into daily contact with terminal patients, the management of palliative care, and the attitude of the nursing staff towards death is an issue that is of great concern. In Greece, in contrast to countries abroad, the management of palliative care and the attitude of the nurses towards death have not been adequately researched. Purpose: The purpose of this study is to investigate the management of palliative care for oncology patients in the ICU, as well as the attitude, perception and behavior of nursing staff towards death. Material-method: The study population consisted of 100 nurses working at Theagenio (Cancer Hospital of Thessaloniki). Two questionnaires were used in the study: The DAP-R questionnaire on the perception and behavior of nursing staff towards death and the Frommelt questionnaire (FATCOD) on end-stage patient care. A study was also conducted on 30 end-stage oncology patients at the ICU of Theagenio, in order to investigate their management of palliative care. Results: The results of the study show that the duration of hospitalization of patients in the ICU is significantly related to protein intake and GCS. Patients who received a low protein content in the ICU survived less than those who received a higher protein content, while patients with low GCS at the time of admission to the ICU died in a shorter period of time. Regarding the attitude of nurses towards death, Greek nurses generally seem to have a less positive attitude compared to the international research. In addition, a statistically significant difference was found in the attitude of nurses towards death, in the acceptance but also in the avoidance of death, linked to the level of their education. Conclusions: Intensive care can prolong the death process of end-stage patients, as the chance of survival or return to a life of tolerable quality is minimal to zero. For this reason, it may be preferable for these patients to spend the last days of their lives in a familiar environment. The attitude of the nursing staff towards death and palliative care could be improved not only with specialized knowledge and training, but also by preparing the nurses to face death.
{"title":"Management of palliative care for oncology patients and ICU nursing staff attitude towards death","authors":"Savvopoulos Georgios, Kaimakamis Evangelos","doi":"10.22514/sv.2021.153","DOIUrl":"https://doi.org/10.22514/sv.2021.153","url":null,"abstract":"Introduction: As nurses come into daily contact with terminal patients, the management of palliative care, and the attitude of the nursing staff towards death is an issue that is of great concern. In Greece, in contrast to countries abroad, the management of palliative care and the attitude of the nurses towards death have not been adequately researched. Purpose: The purpose of this study is to investigate the management of palliative care for oncology patients in the ICU, as well as the attitude, perception and behavior of nursing staff towards death. Material-method: The study population consisted of 100 nurses working at Theagenio (Cancer Hospital of Thessaloniki). Two questionnaires were used in the study: The DAP-R questionnaire on the perception and behavior of nursing staff towards death and the Frommelt questionnaire (FATCOD) on end-stage patient care. A study was also conducted on 30 end-stage oncology patients at the ICU of Theagenio, in order to investigate their management of palliative care. Results: The results of the study show that the duration of hospitalization of patients in the ICU is significantly related to protein intake and GCS. Patients who received a low protein content in the ICU survived less than those who received a higher protein content, while patients with low GCS at the time of admission to the ICU died in a shorter period of time. Regarding the attitude of nurses towards death, Greek nurses generally seem to have a less positive attitude compared to the international research. In addition, a statistically significant difference was found in the attitude of nurses towards death, in the acceptance but also in the avoidance of death, linked to the level of their education. Conclusions: Intensive care can prolong the death process of end-stage patients, as the chance of survival or return to a life of tolerable quality is minimal to zero. For this reason, it may be preferable for these patients to spend the last days of their lives in a familiar environment. The attitude of the nursing staff towards death and palliative care could be improved not only with specialized knowledge and training, but also by preparing the nurses to face death.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44239612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer patients are at high risk of thromboembolic complications (deep vein thrombosis, pulmonary embolism) which increase the morbidity and mortality rates. Τhe thromboembolic risk is further increased perioperatively in cancer surgery, rendering its prevention and management a clinical challenge. International Societies and Experts’ Panels have addressed this issue in an effort to fill in the existing gaps, since evidence is rather limited. Thromboprophylaxis should be given to all patients undergoing cancer surgery. It should include pharmacological agents and should be initiated preoperatively and/or as soon as possible postoperatively. Mechanical prophylaxis alone is not recommended, and should be reserved only for cases where pharmacological thromboprophylaxis is contraindicated. Combined pharmacological/mechanical thromboprophylaxis should be used in high risk patients. The patient risk factors, co-morbidities, procedure type/duration and the surgical bleeding risk should be carefully assessed before deciding the scheme, drugs, dosing and timing of thromboprophylaxis. Low Molecular Weight Heparin (is the preferred agent), Unfractionated Heparin (if creatinine clearance <30 mL/min) and possibly Fondaparinux can be used for thromboprophylaxis. There is no consensus on the use of inferior vena cava filters; they are not recommended as a routine thromboprophylactic measure, but their placement could be considered in patients with pulmonary embolism or lower limb proximal deep vein thrombosis (especially during the first 2–4 weeks), if anticoagulants are contraindicated. The risk of intervention-related adverse effects/complications should be taken into account. Postoperative pharmacological thromboprophylaxis should be maintained for at least 7–10 days. For high risk, major abdominal or pelvic surgery (laparotomy or laparoscopic), thromboprophylaxis should last longer (up to 4 weeks). Patients facing a high risk for both thrombosis and major bleeding should receive mechanical thromboprophylaxis first and pharmacological prophylaxis should be added as soon as possible. Early postoperative ambulation should be encouraged whenever possible.
{"title":"Thromboembolism in cancer patients. What should anaesthesiologists know","authors":"C. Staikou","doi":"10.22514/sv.2021.196","DOIUrl":"https://doi.org/10.22514/sv.2021.196","url":null,"abstract":"Cancer patients are at high risk of thromboembolic complications (deep vein thrombosis, pulmonary embolism) which increase the morbidity and mortality rates. Τhe thromboembolic risk is further increased perioperatively in cancer surgery, rendering its prevention and management a clinical challenge. International Societies and Experts’ Panels have addressed this issue in an effort to fill in the existing gaps, since evidence is rather limited. Thromboprophylaxis should be given to all patients undergoing cancer surgery. It should include pharmacological agents and should be initiated preoperatively and/or as soon as possible postoperatively. Mechanical prophylaxis alone is not recommended, and should be reserved only for cases where pharmacological thromboprophylaxis is contraindicated. Combined pharmacological/mechanical thromboprophylaxis should be used in high risk patients. The patient risk factors, co-morbidities, procedure type/duration and the surgical bleeding risk should be carefully assessed before deciding the scheme, drugs, dosing and timing of thromboprophylaxis. Low Molecular Weight Heparin (is the preferred agent), Unfractionated Heparin (if creatinine clearance <30 mL/min) and possibly Fondaparinux can be used for thromboprophylaxis. There is no consensus on the use of inferior vena cava filters; they are not recommended as a routine thromboprophylactic measure, but their placement could be considered in patients with pulmonary embolism or lower limb proximal deep vein thrombosis (especially during the first 2–4 weeks), if anticoagulants are contraindicated. The risk of intervention-related adverse effects/complications should be taken into account. Postoperative pharmacological thromboprophylaxis should be maintained for at least 7–10 days. For high risk, major abdominal or pelvic surgery (laparotomy or laparoscopic), thromboprophylaxis should last longer (up to 4 weeks). Patients facing a high risk for both thrombosis and major bleeding should receive mechanical thromboprophylaxis first and pharmacological prophylaxis should be added as soon as possible. Early postoperative ambulation should be encouraged whenever possible.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42829183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aikaterini Liossi, E. Papaioannou, E. Kalliontzi, Efthimios Mavrommatis, C. Koufopoulou, Aggeliki Maniati, C. Paloumbi, E. Papadopoulou, A. Lambadariou
Migraine is a common disorder that negatively affects a significant percentage of patients, with corresponding social and economic costs. It is a neurovascular disease whose pathophysiological mechanisms are still being examined. While cortical spreading depression (CSD) and dysfunction of the trigeminovascular system appear to play a key role in the onset of migraine aura and pain, the study of human genome has shown the involvement of several genes and neuropeptides in its pathogenesis. New data make it necessary to search for targeted methods in the diagnosis and treatment of the disease, as current therapeutic approaches in many cases show little effectiveness and significant side effects. Nowadays, the rapid development of genetics opens new horizons in the approach of migraine through the prism of Medical Precision. Precision Medicine (PM) is a new approach to the treatment and prevention of the disease, which combines the individualized approach of the patient with the design and implementation of appropriate treatment. It differs radically from the "one size fits all" approach, leading to a better understanding of the pathophysiological mechanisms of the disease and the development of innovative diagnostic and treatment options. It combines the expression of genome and the correlation of science of Biochemistry with the comorbidity of the patient, in order to achieve the optimal clinical result. The purpose of this essay is to present the current therapeutic approaches for migraine treatment and to investigate their applicability, according to the new data of Medical Precision. The investigation and identification of new genetic, epigenetic, biochemical and other biomarkers will enable the patient to be better approached, more targeted treatment and reduced disease’s management costs.
{"title":"Precision Medicine in migraine management","authors":"Theodora Barkoula","doi":"10.22514/sv.2021.206","DOIUrl":"https://doi.org/10.22514/sv.2021.206","url":null,"abstract":"Migraine is a common disorder that negatively affects a significant percentage of patients, with corresponding social and economic costs. It is a neurovascular disease whose pathophysiological mechanisms are still being examined. While cortical spreading depression (CSD) and dysfunction of the trigeminovascular system appear to play a key role in the onset of migraine aura and pain, the study of human genome has shown the involvement of several genes and neuropeptides in its pathogenesis. New data make it necessary to search for targeted methods in the diagnosis and treatment of the disease, as current therapeutic approaches in many cases show little effectiveness and significant side effects. Nowadays, the rapid development of genetics opens new horizons in the approach of migraine through the prism of Medical Precision. Precision Medicine (PM) is a new approach to the treatment and prevention of the disease, which combines the individualized approach of the patient with the design and implementation of appropriate treatment. It differs radically from the \"one size fits all\" approach, leading to a better understanding of the pathophysiological mechanisms of the disease and the development of innovative diagnostic and treatment options. It combines the expression of genome and the correlation of science of Biochemistry with the comorbidity of the patient, in order to achieve the optimal clinical result. The purpose of this essay is to present the current therapeutic approaches for migraine treatment and to investigate their applicability, according to the new data of Medical Precision. The investigation and identification of new genetic, epigenetic, biochemical and other biomarkers will enable the patient to be better approached, more targeted treatment and reduced disease’s management costs.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44764929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cannabis is a plant, native to Greece, the cultivation of which was under the protection of the State up until 1957. In 1961, due to pressure exercised mainly by the US, the UN proceed with a ban on all products from any part of the plant, under the pretext of its psychotropic effects. It does appear, however, that the real purpose behind America's actions was an attempt to consolidate the cotton fiber market at the time which, until then, had been mainly serviced by the durable fabrics derived from the hemp plant (ex. sails, sacks and ropes) - an unwelcome competitor. However, all across the globe people had learned to appreciate the cannabis plant as a source of fiber, of medicine, and as well as a recreational and spiritual medium, thus any attempt at isolation was bound to meet with failure - such as was witnessed during alcohol prohibition that led to similar consequences: the illicit domestic production and continued use of a commodity people simply did not want to part with. During this time, organic chemist Raphael Mechulam managed to isolate tetrahydrocannabinol as a molecule, while in the ‘80s he went on to discover that mammals produce substances that are chemically related to cannabinoids, called endocannabinoids, and more so; that there is a system of specific binding receptors for these substances. His discoveries rekindled the interest of the scientific community in the possible therapeutic uses of the cannabis plant. At the same time, there began to be reports from patients of a variety of benefits they were seeing from consuming cannabis in various forms. Unfortunately, the legal framework for conducting integrated research in this area is complex, due to the limitations and regulations put in place that continue, to a great extent, until today. An additional complication is that the plant produces more than 150 chemical molecules that are identified today as cannabinoids, the actions of which are interconnected and interdependent, with clinical results contributed to by the terpenes and flavonoids that are also abundant in the plant. Therefore, designing a prospective study is seemingly mathematically impossible as the potential combinations of active molecules are plausibly infinite. In an attempt to side step these difficulties, the industry created synthetic replicas/equivalents of tetrahydrocannabinol, which were marketed as pharmaceuticals and tested in numerous clinical situations. Unfortunately, the resulting effects were disappointing - proponents of the plant attribute this to the absence of other molecules of cannabinoids, as well as terpenes and flavonoids, which have been shown to contribute to the therapeutic effects of cannabis (commonly known as the ‘entourage effect’). Nonetheless, in countries such as Canada, with many states of Europe and the US following suit, patient appeals and the findings from various small-scale clinical trials were taken into consideration and a structured framework for prescribing and u
{"title":"Cannabinoids: A new friend or just another pandemic?","authors":"C. Karanastasi","doi":"10.22514/sv.2021.194","DOIUrl":"https://doi.org/10.22514/sv.2021.194","url":null,"abstract":"Cannabis is a plant, native to Greece, the cultivation of which was under the protection of the State up until 1957. In 1961, due to pressure exercised mainly by the US, the UN proceed with a ban on all products from any part of the plant, under the pretext of its psychotropic effects. It does appear, however, that the real purpose behind America's actions was an attempt to consolidate the cotton fiber market at the time which, until then, had been mainly serviced by the durable fabrics derived from the hemp plant (ex. sails, sacks and ropes) - an unwelcome competitor. However, all across the globe people had learned to appreciate the cannabis plant as a source of fiber, of medicine, and as well as a recreational and spiritual medium, thus any attempt at isolation was bound to meet with failure - such as was witnessed during alcohol prohibition that led to similar consequences: the illicit domestic production and continued use of a commodity people simply did not want to part with. During this time, organic chemist Raphael Mechulam managed to isolate tetrahydrocannabinol as a molecule, while in the ‘80s he went on to discover that mammals produce substances that are chemically related to cannabinoids, called endocannabinoids, and more so; that there is a system of specific binding receptors for these substances. His discoveries rekindled the interest of the scientific community in the possible therapeutic uses of the cannabis plant. At the same time, there began to be reports from patients of a variety of benefits they were seeing from consuming cannabis in various forms. Unfortunately, the legal framework for conducting integrated research in this area is complex, due to the limitations and regulations put in place that continue, to a great extent, until today. An additional complication is that the plant produces more than 150 chemical molecules that are identified today as cannabinoids, the actions of which are interconnected and interdependent, with clinical results contributed to by the terpenes and flavonoids that are also abundant in the plant. Therefore, designing a prospective study is seemingly mathematically impossible as the potential combinations of active molecules are plausibly infinite. In an attempt to side step these difficulties, the industry created synthetic replicas/equivalents of tetrahydrocannabinol, which were marketed as pharmaceuticals and tested in numerous clinical situations. Unfortunately, the resulting effects were disappointing - proponents of the plant attribute this to the absence of other molecules of cannabinoids, as well as terpenes and flavonoids, which have been shown to contribute to the therapeutic effects of cannabis (commonly known as the ‘entourage effect’). Nonetheless, in countries such as Canada, with many states of Europe and the US following suit, patient appeals and the findings from various small-scale clinical trials were taken into consideration and a structured framework for prescribing and u","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44848141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Diakomi, A. Makris, M. Tileli, Stella Potamianou, K. Konstantopoulos
Introduction: Takotsubo syndrome (TTS) is a type of acute reversible left ventricular dysfunction in the form of acute catecholaminergic myocardial stunning in the absence of occlusive coronary artery, with considerable patient morbidity and mortality1. The optimal anesthetic management of patients with TTS remains unclear. We would like to share our experience with a patient with TTS presenting for hip fracture repair. Methods: An 80-year old female complained of dyspnea and retrosternal chest pain after subcapital hip fracture. Her diagnostic workup revealed elevated markers of myocardial necrosis and pathologic findings from transthoracic echocardiogram. Left ventriculography imaging along with an unremarkable coronariography was suggestive of TTS. After the initial control of acute myocardial crisis, the patient was scheduled for hip fracture repair, under spinal anesthesia. Having obtained patient’s informed consent, we performed an ultrasound guided fascia iliaca compartment block (FICB) (30 mL ropivacaine 0.5%/8 mg dexamethasone). Twenty minutes after the FICB, the patient was placed in the lateral decubitus position and 3 mL levobupivacaine 0.5% were injected intrathecally. A bolus dose of dexmedetomidine 1 mcg/kg followed by a continuous intravenous infusion at a rate of 0.5 mcg/kg/hour was initiated 10 min before lumbar puncture. The infusion was reduced to 0.25 mcg/kg/hour 30 min later due to a drop in systolic blood pressure 40% below baseline, until the end of surgery. Results: No complications occurred in the postoperative period. The patient walked on the second day and one week later she was discharged from hospital. Conclusion: To our knowledge, there are no reports of intraoperative dexmetomidine administration in TTS patients. Avoidance of adrenergic agonists and initiation of antiadrenergic therapy is suggestive by the pathogenesis of the syndrome [1]. Our main goal was the control of stress response [2, 3], performing FICB to facilitate perioperative analgesia and administering dexmetomidine, an agent with sedative, anxiolytic and analgesic properties.
{"title":"Anesthetic management of a patient with Takotsubo syndrome undergoing hip fracture repair","authors":"M. Diakomi, A. Makris, M. Tileli, Stella Potamianou, K. Konstantopoulos","doi":"10.22514/sv.2021.179","DOIUrl":"https://doi.org/10.22514/sv.2021.179","url":null,"abstract":"Introduction: Takotsubo syndrome (TTS) is a type of acute reversible left ventricular dysfunction in the form of acute catecholaminergic myocardial stunning in the absence of occlusive coronary artery, with considerable patient morbidity and mortality1. The optimal anesthetic management of patients with TTS remains unclear. We would like to share our experience with a patient with TTS presenting for hip fracture repair. Methods: An 80-year old female complained of dyspnea and retrosternal chest pain after subcapital hip fracture. Her diagnostic workup revealed elevated markers of myocardial necrosis and pathologic findings from transthoracic echocardiogram. Left ventriculography imaging along with an unremarkable coronariography was suggestive of TTS. After the initial control of acute myocardial crisis, the patient was scheduled for hip fracture repair, under spinal anesthesia. Having obtained patient’s informed consent, we performed an ultrasound guided fascia iliaca compartment block (FICB) (30 mL ropivacaine 0.5%/8 mg dexamethasone). Twenty minutes after the FICB, the patient was placed in the lateral decubitus position and 3 mL levobupivacaine 0.5% were injected intrathecally. A bolus dose of dexmedetomidine 1 mcg/kg followed by a continuous intravenous infusion at a rate of 0.5 mcg/kg/hour was initiated 10 min before lumbar puncture. The infusion was reduced to 0.25 mcg/kg/hour 30 min later due to a drop in systolic blood pressure 40% below baseline, until the end of surgery. Results: No complications occurred in the postoperative period. The patient walked on the second day and one week later she was discharged from hospital. Conclusion: To our knowledge, there are no reports of intraoperative dexmetomidine administration in TTS patients. Avoidance of adrenergic agonists and initiation of antiadrenergic therapy is suggestive by the pathogenesis of the syndrome [1]. Our main goal was the control of stress response [2, 3], performing FICB to facilitate perioperative analgesia and administering dexmetomidine, an agent with sedative, anxiolytic and analgesic properties.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46647455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The direct costs of anesthesia and analgesia (including anesthesia fee) represents only 2–4% of the total cost of a surgical procedure. the type of surgical procedure or its duration can make regional anesthesia less expensive or more expensive than general anesthesia. However, optimization of the total time spent inside the OR represents the main factor of the total bill (50–60%). Such a reduction in the total OR time leads to a significant decrease in personnel costs which represents 70% of the cost. Thus, scheduling, organizing flow of patients through the OR is the first improving factor to control. In this field, regional anesthesia can significantly reduce this major cost factor through multiple mechanisms: (1) setting a “block room” to perform blocks in a dedicated space outside the OR for high output short surgical procedures (hand surgery cases) improves the efficiency of the OR by 56%. (2) Regional anesthesia techniques reduce the duration of stay in PACU compared to general anesthesia and even allows more easily to encourage PACU bypass (10–82% of patients). (3) Regional anesthesia and analgesia significantly increase the percentage of surgical procedures which are performed on an ambulatory basis, compared to general anesthesia. Such a shift towards ambulatory surgery leads to a major decrease in nursing budgets for the hospital. (4) Finally, all ERAS surgical procedures require somehow the administration of local anesthetics which can go from intravenous lidocaine (associated to general anesthesia), to infiltration techniques, to nerve blocks. In conclusion, Regional anesthesia techniques, when combined to a strict optimisation of the management of patients flow throughout the whole process, are 2 major factors that significantly improve hospital business.
{"title":"Is regional anaesthesia worthy with hospital business?","authors":"P. Narchi","doi":"10.22514/sv.2021.201","DOIUrl":"https://doi.org/10.22514/sv.2021.201","url":null,"abstract":"The direct costs of anesthesia and analgesia (including anesthesia fee) represents only 2–4% of the total cost of a surgical procedure. the type of surgical procedure or its duration can make regional anesthesia less expensive or more expensive than general anesthesia. However, optimization of the total time spent inside the OR represents the main factor of the total bill (50–60%). Such a reduction in the total OR time leads to a significant decrease in personnel costs which represents 70% of the cost. Thus, scheduling, organizing flow of patients through the OR is the first improving factor to control. In this field, regional anesthesia can significantly reduce this major cost factor through multiple mechanisms: (1) setting a “block room” to perform blocks in a dedicated space outside the OR for high output short surgical procedures (hand surgery cases) improves the efficiency of the OR by 56%. (2) Regional anesthesia techniques reduce the duration of stay in PACU compared to general anesthesia and even allows more easily to encourage PACU bypass (10–82% of patients). (3) Regional anesthesia and analgesia significantly increase the percentage of surgical procedures which are performed on an ambulatory basis, compared to general anesthesia. Such a shift towards ambulatory surgery leads to a major decrease in nursing budgets for the hospital. (4) Finally, all ERAS surgical procedures require somehow the administration of local anesthetics which can go from intravenous lidocaine (associated to general anesthesia), to infiltration techniques, to nerve blocks. In conclusion, Regional anesthesia techniques, when combined to a strict optimisation of the management of patients flow throughout the whole process, are 2 major factors that significantly improve hospital business.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43607580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：