Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie
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Biomed. Pharmacother. · Aug 2006
The impact of educational intervention programs on pain management in a pediatric emergency department.
Management of pain and anxiety is an important part of patient care in the pediatric emergency department (ED). Even though it has improved significantly over the past few years, it is still suboptimal. The objective of this study was to evaluate the effect of informal and formal education on pain and anxiety management in the pediatric ED. ⋯ Whereas, during period C, a significant increase in the use of ketamine and morphine was demonstrated (RR=24.56, CI 10.71-56.3 and RR=3.07, CI 2.12-4.44, respectively), while the use of meperidine (RR=0.68, CI 0.49-0.94) and N2O (RR=0.46, 95% CI 0.32-0.67) declined significantly. Educational interventions have a clear impact on pain and anxiety management demonstrated by the subsequent change in the use of sedatives and analgesics and should be provided to pediatric ED physicians. Informal teaching affected mainly the use of milder sedatives and analgesics, while formal structured training influenced the use of opioids and dissociative agents.
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Biomed. Pharmacother. · Aug 2006
Pre-emptive analgesia and protective premedication. What is the difference?
The management of postoperative pain has been greatly informed by an increasing understanding of the basic science of pain transmission. The idea that analgesia given before the injury would be more effective than the same analgesia given after the injury was named pre-emptive analgesia. The evidence for this phenomenon in postoperative pain management has been very mixed. ⋯ A recent meta-analysis of the existing literature shows reduction of postoperative morphine consumption but little reduction in reporting of opiate side effects. Pregabalin, which has a better pharmacokinetic profile, may be a better alternative, and is currently under study. Neither gabapentin nor pregabalin are licensed for use in postoperative pain, and it is unlike that the manufacturers will seek such a licence.
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Biomed. Pharmacother. · Dec 2005
Clinical TrialPlasma levels of adiponectin and soluble thrombomodulin in hypothyroid patients with normal thyroid function following levothyroxine replacement therapy.
Hypothyroidism is associated with increased morbidity from cardiovascular disease, and adiponectin (ApN) is a newly-identified adipocytokine, which is expressed in human adipose cells and may have a protective effect against the development of coronary artery disease. The aim of the study was to evaluate the involvement of ApN secretion in hypothyroid patients with normal thyroid function following levothyroxine (L-T(4)) replacement therapy, and to associate plasma ApN levels with intima-media thickness (IMT) in the common carotid artery (CCA), an indicator of early atherosclerosis, and cardiovascular parameters including soluble thrombomodulin (sTM), a plasma endothelial injury marker. The CCA IMT and plasma levels of ApN and sTM were measured in 52 hypothyroid patients and in age-, sex- and body mass index (BMI)-matched normal control subjects. ⋯ Hence, we provide evidence that ApN and sTM might not contribute to enhanced atherosclerosis, as reflected by increased CCA IMT in hypothyroid patients. However, this is the first report to demonstrate a positive and significant association of sTM with ApN. These data support the hypothesis that sTM is one of the determinant of ApN and thus suggest the presence of an sTM-associated regulatory mechanism for ApN secretion in hypothyroid patients.
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Angiogenesis is the process in which endothelial cells divide and migrate to form new capillaries, which support the continued growth of tumor through blood flow. Cancer-induced angiogenesis in general represents results of increased expression of angiogenic factors such as VEGF or decreased expression of anti-angiogenic factors, or a combination of both events. Numerous reported studies have demonstrated that angiogenesis plays an important role in tumor progression and metastasis of the great majority of human solid tumors. ⋯ Therefore, it is very important to assess the status of angiogenesis or cancer-induced vessels in resected tumor or surgical pathology specimens including those before and after the neoadjuvant therapy. It then becomes very important for pathologists involved in this evaluation to determine which methods to use in order to obtain accurate and reproducible results. In this short review, the status of an analysis of angiogenesis in surgical pathology specimens through analyzing vascular density or vasculatiry using immunohistochemical staining of CD34, a specific immunohistochemical marker for endothelial cells and subsequent evaluation of immunoreactivity in surgical pathology specimens will be summarized.
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Biomed. Pharmacother. · Oct 2005
Fluoroquinolone resistance in hematopoietic stem cell transplant recipients with infectious complications.
The infectious complications are an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Our retrospective study has the objective to evaluate the incidence, clinical and bacteriologic features of documented infections in these patients. The frequency of infectious complications was analysed in 42 patients with hematologic malignancies who received HSCT from January to December 2002 at Pisa General Hospital. ⋯ Pneumonia was a coexisting cause of death in 2 patient in the late period. We can conclude that most of infectious complications, that occurred in the early period post-HSCT were due to coagulase negative staphylococci and gram negative rods resistant to ciprofloxacin. For this reason, the usefulness of fluoroquinolone prophylaxis in HSCT recipients should be reevaluated.