American journal of therapeutics
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Methemoglobinemia can cause life-threatening hypoxia associated with cyanosis and dyspnea not responsive to oxygen. We present a case of recurrent methemoglobinemia because of occult use of topical benzocaine to the vulva. A 47-year-old female with medical history of vulvar cancer and HIV undergoing chemoradiation was sent by the oncology clinic to the emergency department for worsening dyspnea, fatigue, hypoxia to 78% on room air, and gradual onset of cyanosis over the past week. ⋯ Many patients do not consider over-the-counter medications to be potentially harmful. Methemoglobinemia from occult topical benzocaine administration to the vulva is an uncommon exposure route. Occult medication use can be a source of methemoglobinemia.
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Letter Case Reports
Intranasal Ketamine in Subdissociative Doses for a 2-Year-Old.
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β-blocker use in perioperative period of noncardiac surgeries has been a topic of debate since many years. Earlier studies conducted in the 90s showed decreased cardiac adverse events and improved postoperative outcomes with β-blocker use. Based on this, the ACCF and ESC published guidelines strongly supporting β-blocker use. But contemporaneous studies conducted revealed conflicting evidence and have also proven some of the earlier studies to be fraudulent. Although ACCF guidelines have been updated to partially reflect the changes, ESC guidelines continue to support β-blocker use. ⋯ Based on our review, we conclude that the use of β-blockers in perioperative period of noncardiac surgeries should be determined on an individual basis based on risk-benefit analysis. Guideline organizations should update their recommendations based on new evidence.
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Procalcitonin (PCT) is a quickly measurable marker, assumed to have high sensitivity and specificity for sepsis and infection. A literature search was conducted to evaluate PCT ability as a diagnostic and prognostic tool in infectious processes and its ability to monitor the antibiotic therapy. ⋯ Antibiotic treatment algorithms guided by PCT decreased the need for antibiotic treatment in approximately 50%. PCT is a promising test in clinical practice to decide the introduction of antibiotic therapy in addition to the existing tools, without neglecting the clinical assessment, with a significant decrease in costs.
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Meta Analysis Comparative Study
Epidural Injection With or Without Steroid in Managing Chronic Low-Back and Lower Extremity Pain: A Meta-Analysis of 10 Randomized Controlled Trials.
Chronic low-back and lower extremity pain is mainly caused by lumbar disc herniation and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat lumbar disc herniation or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the 2 interventions in managing various chronic low and lower extremity pain. ⋯ The average procedures per year in group 1 were 3.68 ± 1.17 and 3.68 ± 1.26 in group 2, with an average total relief per year of 31.67 ± 13.17 and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI, -12.24 to -5.38) and 16.92 mg (95% CI: -22.71 to -11.12) in the 2 groups, respectively. This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low-back and lower extremity pain.