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BJOG : An International Journal of... Jan 2023The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in...
The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in the care of women with postpartum hemorrhage has come at a price. For the anesthetist, having tranexamic acid ampoules close at hand would seem an obvious strategy to facilitate its use during cesarean delivery, an important setting for severe hemorrhage. Tragically, we have identified a number of recent instances of inadvertent intrathecal administration of tranexamic acid instead of local anesthetic for spinal anesthesia. Reported cases of this catastrophic error seem to be increasing. The profound neurotoxicity of tranexamic acid causes rapid-onset convulsions, with mortality of 50%. How can these tragic errors be averted? Drug safety alerts have been issued by the US Food and Drug Administration and the World Health Organization, but that is not enough. We recommend extensive dissemination of information to raise awareness of this potential hazard, and local hospital protocols to ensure that tranexamic acid is stored separately from anesthetic drugs, preferably outside the operating room and with an auxiliary warning label. Implementation of safety strategies on a very large scale will be needed to ensure that the life-saving potential of tranexamic acid is not eclipsed by drug-error mortality.
Topics: Pregnancy; Female; Humans; Tranexamic Acid; Antifibrinolytic Agents; Postpartum Hemorrhage; Cesarean Section; Medication Errors
PubMed: 36300729
DOI: 10.1111/1471-0528.17292 -
International Journal of Gynaecology... Jan 2023The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in...
The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in the care of women with postpartum hemorrhage has come at a price. For the anesthetist, having tranexamic acid ampoules close at hand would seem an obvious strategy to facilitate its use during cesarean delivery, an important setting for severe hemorrhage. Tragically, we have identified a number of recent instances of inadvertent intrathecal administration of tranexamic acid instead of local anesthetic for spinal anesthesia. Reported cases of this catastrophic error seem to be increasing. The profound neurotoxicity of tranexamic acid causes rapid-onset convulsions, with mortality of 50%. How can these tragic errors be averted? Drug safety alerts have been issued by the US Food and Drug Administration and the World Health Organization, but that is not enough. We recommend extensive dissemination of information to raise awareness of this potential hazard, and local hospital protocols to ensure that tranexamic acid is stored separately from anesthetic drugs, preferably outside the operating room and with an auxiliary warning label. Implementation of safety strategies on a very large scale will be needed to ensure that the life-saving potential of tranexamic acid is not eclipsed by drug-error mortality.
Topics: Pregnancy; Female; Humans; Tranexamic Acid; Antifibrinolytic Agents; Postpartum Hemorrhage; Cesarean Section; Anesthesia, Spinal
PubMed: 36300721
DOI: 10.1002/ijgo.14462 -
Rhinology Feb 2023Chemosensory dysfunction (CD) has been reported as a common symptom of SARS-CoV-2 infection, but it is not well understood whether and for how long changes of smell,...
BACKGROUND
Chemosensory dysfunction (CD) has been reported as a common symptom of SARS-CoV-2 infection, but it is not well understood whether and for how long changes of smell, taste and chemesthesis persist in infected individuals.
METHODOLOGY
Unselected adult residents of the German federal state of Schleswig-Holstein with Polymerase Chain Reaction (PCR)-test-confirmed SARS-CoV-2 infection were invited to participate in this large cross-sectional study. Data on the medical history and subjective chemosensory function of participants were obtained through questionnaires and visual analogue scales (VAS). Olfactory function (OF) was objectified with the Sniffin Sticks test (SST), including threshold (T), discrimination (D) and identification (I) test as well as summarized TDI score, and compared to that in healthy controls. Gustatory function (GF) was evaluated with the suprathreshold taste strips (TS) test, and trigeminal function was tested with an ampoule containing ammonia.
RESULTS
Between November 2020 and June 2021, 667 infected individuals (mean age: 48.2 years) were examined 9.1 months, on average, after positive PCR testing. Of these, 45.6% had persisting subjective olfactory dysfunction (OD), 36.2% had subjective gustatory dysfunction (GD). Tested OD, tested GD and impaired trigeminal function were observed in 34.6%, 7.3% and 1.8% of participants, respectively. The mean TDI score of participants was significantly lower compared to healthy subjects. Significant associations were observed between subjective OD and GD, and between tested OD and GD.
CONCLUSION
Nine months after SARS-CoV-2 infection, OD prevalence is significantly increased among infected members of the general population. Therefore, OD should be included in the list of symptoms collectively defining Long-COVID.
Topics: Adult; Humans; Middle Aged; COVID-19; Cross-Sectional Studies; Olfaction Disorders; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Smell; Taste Disorders
PubMed: 36323438
DOI: 10.4193/Rhin22.176 -
Materials (Basel, Switzerland) Oct 2022In recent years, interest in the liquid-phase exfoliation (LPE) of layered crystals has been growing due to the efficiency and scalability of the method, as well as the...
In recent years, interest in the liquid-phase exfoliation (LPE) of layered crystals has been growing due to the efficiency and scalability of the method, as well as the wide range of practical applications of the obtained dispersions based on two-dimensional flakes. In this paper, we present a comparative study of as-grown and liquid-phase exfoliated GaSeS flakes. Bulk GaSeS crystals with x ~ 0, 0.25, 0.5, 0.75, 1 were synthesized by melting stoichiometric amounts of gallium, selenium, and sulfur particles in evacuated ampoules. X-ray diffraction analysis showed that the crystal structure does not change considerably after LPE, while the analysis of the Raman spectra revealed that, after liquid-phase processing in IPA, an additional peak associated with amorphous selenium is observed in selenium-rich GaSeS compounds. Nevertheless, the direct and indirect transition energies determined from the Kubelka-Munk function for LPE crystals correlate with the band gap of the as-grown bulk GaSeS crystals. This finding is also confirmed by comparison with the data on the positions of the photoluminescence peak.
PubMed: 36295149
DOI: 10.3390/ma15207080 -
Journal of Pediatric Urology Aug 2019In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of...
INTRODUCTION
In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity.
OBJECTIVE
The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis.
STUDY DESIGN
In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment.
RESULTS
The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05).
DISCUSSION
This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed.
CONCLUSIONS
Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.
Topics: Animals; Biopsy, Needle; Disease Models, Animal; Fibrosis; Hypospadias; Immunohistochemistry; Inflammation; Injections, Intralesional; Male; Pantothenic Acid; Postoperative Complications; Rabbits; Random Allocation; Reference Values; Statistics, Nonparametric; Treatment Outcome; Urethra; Urologic Surgical Procedures; Wound Healing
PubMed: 31040076
DOI: 10.1016/j.jpurol.2019.04.003 -
International Journal of Pharmaceutics Jun 2021Needle-free jet injections are actuated by a pressure impulse that can be delivered by different mechanisms to generate high-speed jets (V~O10 m/s). During filling and...
Needle-free jet injections are actuated by a pressure impulse that can be delivered by different mechanisms to generate high-speed jets (V~O10 m/s). During filling and transportation of disposable cartridges and ampoules, bubbles can form, which can be problematic especially for viscous fluids. Here, we report on the effect of location and size of entrapped air pockets in cartridges used in spring-powered jet injections. As air bubbles pass through the orifice, they undergo depressurization, which results in intermittent atomization and spray formation, temporarily increasing the jet dispersion. Atomization and dispersion of the jet can lead to product loss during an injection. We find that the effect of bubble location on the jet exit speed, delivery efficiency, and the projected area of the blebs formed after the injection was statistically significant (p<0.05). The findings of this study have implications for the development of pre-filled cartridges for jet injection applications.
Topics: Drug Delivery Systems; Equipment Design; Injections, Jet; Pharmaceutical Preparations; Viscosity
PubMed: 33831488
DOI: 10.1016/j.ijpharm.2021.120547 -
Acta Crystallographica. Section E,... Jan 2022Single crystals of CsSnSiO, dicaesium tin(IV) hexa-silicate, were serendipitously obtained from a CsCl/NaCl flux at 923 K, starting from mixtures of CaO, SnO and TeO...
Single crystals of CsSnSiO, dicaesium tin(IV) hexa-silicate, were serendipitously obtained from a CsCl/NaCl flux at 923 K, starting from mixtures of CaO, SnO and TeO in a closed silica ampoule. The crystal structure of CsSnSiO is constructed from {SiO} layers extending parallel to (101), and Cs cations with a coordination number of eleven as well as isolated [SnO] octa-hedra situated between the silicate layers. Each of the nine different SiO tetra-hedra in the silicate layer has a connectedness of (three bridging and one terminal O atom), which leads to the formation of five- and eight-membered rings. The same type of silicate layer is found in the crystal structure of the mineral zeravshanite. Comparison with other silicates of the type Cs SiO ( = Ti, Zr, Th, U) revealed a group-subgroup relationship of index 2 between CsZrSiO ( = 6, space group 2/) and CsSnSiO ( = 12, space group 2/).
PubMed: 35145734
DOI: 10.1107/S2056989021013554 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Sep 2021Ampoule bottles are common clinical containers forliquid medicine. After use, ampoules occupy a lot of space, which will not only consume a large number of sharp boxes,...
Ampoule bottles are common clinical containers forliquid medicine. After use, ampoules occupy a lot of space, which will not only consume a large number of sharp boxes, but also lead to low work efficiency and easy to scratch the hands of medical staff by changing the sharp boxes frequently. In order to overcome the problems mentioned above, the neurosurgery medical staff of Yuechi County People's Hospital designed a new type of ampoule bottle opening and crushing device, and won the national utility model patent. The device includes a bottle-opening structure and a crushing structure, and has both ampoule opening and crushing function, the device is convenient to use, has high safety performance, and is suitable for clinical promotion.
Topics: Drug Packaging; Humans
PubMed: 34839878
DOI: 10.3760/cma.j.cn121430-20210104-00001 -
Toxins Jul 2021Despite recent reviews of best practice for the treatment of Australian venomous bites and stings, there is controversy about some aspects of care, particularly the use...
Despite recent reviews of best practice for the treatment of Australian venomous bites and stings, there is controversy about some aspects of care, particularly the use of antivenom. Our aim was to understand current attitudes and practice in the management of suspected snake envenoming. A single-stage, cross-sectional survey of Australian emergency care physicians who had treated snake envenomation in the previous 36 months was conducted. Hospital pharmacists were also invited to complete a survey about antivenom availability, usage, and wastage in Australian hospitals. The survey was available between 5 March and 16 June 2019. A total of 121 snake envenoming cases were reported, and more than a third (44.6%) of patients were not treated with antivenom. For those treated with antivenom ( = 67), 29 patients (43%) received more than one ampoule. Nearly a quarter of respondents (21%) identified that antivenom availability was, or could be, a barrier to manage snake envenoming, while cost was identified as the least important factor. Adverse reactions following antivenom use were described in 11.9% of cases ( = 8). The majority of patients with suspected envenoming did not receive antivenom. We noted variation in dosage, sources of information, beliefs, and approaches to the care of the envenomed patient.
Topics: Animals; Antivenins; Attitude; Australia; Cross-Sectional Studies; Elapid Venoms; Elapidae; Humans; Snake Bites; Snake Venoms; Surveys and Questionnaires
PubMed: 34357954
DOI: 10.3390/toxins13070482 -
Prehospital and Disaster Medicine Dec 2021Paramedics commonly administer intravenous (IV) dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This... (Review)
Review
INTRODUCTION
Paramedics commonly administer intravenous (IV) dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may cause harm and lead to difficulties regulating blood glucose levels (BGLs) post-treatment. It is hypothesized that a lower concentration, such as 10% dextrose (D10), may improve symptoms while minimizing harm.
METHODS
PubMed, Embase, CINAHL, and Cochrane Central were systematically searched on September 15, 2020. The PRISMA guidelines were followed. GRADE and risk of bias were applied to determine the certainty of the evidence. Primary literature investigating the use of IV dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department was included. Outcomes of interest included safety, efficacy (symptom resolution), and BGL.
RESULTS
Of 680 abstracts screened, 51 full-text articles were reviewed, with eleven studies included. Data from three randomized controlled trials (RCTs) and eight observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies, there was greater symptom resolution in the D10 group (95.9%) compared to the D50 group (88.8%). However, the mean time to resolution was approximately four minutes longer in the D10 group (4.1 minutes [D50] versus 8.0 minutes [D10]). There was a greater need for subsequent doses with the use of D10 (19.5%) compared to D50 (8.1%). The post-treatment glycemic profile was lower in the D10 group at 6.2mmol/L versus 8.5mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia: 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/1057) compared to 13/310 adverse events in the D50 group.
CONCLUSION
Studies show D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer, there appear to be fewer adverse events. The post-D10-treatment BGL may result in fewer untoward hyperglycemic episodes.
Topics: Blood Glucose; Emergency Service, Hospital; Hospitals; Humans; Hypoglycemia
PubMed: 34605385
DOI: 10.1017/S1049023X21001047