Does dipyrone have any effect on respiratory function in COPD patients?

OBJECTIVE: Dipyrone (Novalgin) is an effective analgesic, antipyretic agent also with spasmolytic effects on various types of smooth muscles. It has recently been reported that dipyrone relaxes tracheal smooth muscle of guinea pig. In this present study, we aimed to investigate whether this and previously reported in vitro results have any consequences on the respiratory function of normal healthy volunteers and chronic obstructive pulmonary disease (COPD) patients. METHODS: In this one-centered, non-randomized, non-comparative, open labelled study, 15 normal healthy volunteers and 15 stable COPD patients, with partially reversible bronchospasm, diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were enrolled in the study at the time they had any indication of dipyrone use. The spirometric tests were performed by a portable notebook and Medikro Spiro2000 spirometry programme-software 1.6 version, before 30, 60, 90, and 120 min after 20 mg/kg of orally dipyrone intake. Groups were compared with the General Linear Model Repeated Measures analysis of variance. RESULTS: None of the spirometric parameters evaluated showed any significant differences when compared with the baseline values in both groups. CONCLUSION: While dipyrone had no bronchodilator effects on either COPD patients or normal volunteers, it also did not impair the spirometric parameters. Since COPD is a disease characterized by a progressive and largely irreversible airflow limitation, dipyrone has no observable bronchodilator effect. However, since dipyrone does not impair the pulmonary function, it can be used safely in COPD patients when there is an indication.     

Case Formulation and the Therapeutic Relationship: The Role of Therapist Self‐Reflection and Self‐Revelation

This article examines the role of the therapist's self‐reflection and self‐revelation in case formulation. We believe that a collaboratively constructed case formulation must always be considered in the context of an evolving therapeutic relationship. Further, self‐reflection and self‐revelation on the part of the therapist are critical for a more elaborate and nuanced case formulation and for understanding the patient. This highlights the importance of attunement to the here and now and the evolving therapeutic relationship. From this attunement, the therapist's self‐reflection and self‐revelation can emerge further, which can lead to the patient's personal growth and increased self–other awareness. To illustrate our point, we present an integrative, relational model in the case of a patient who has been in treatment.     

Incidence and risk factors of postnatal growth restriction in preterm infants

Aim: Preterm infants are often significantly underweight at the time of hospital discharge. Growth impairment during early infancy can have permanent detrimental effects. We aimed to evaluate the incidence and risk factors of postnatal growth restriction (PNGR) in preterm infants.

Methods: This prospective study included 124 preterm infants in neonatal intensive care unit between January 2015 and June 2016.

Results: Of 140 preterm infants screened, postnatal growth retardation was detected in 46 babies (37%). Low gestational age was independent risk factors for PNGR.

Conclusion: Clinicians should be aware of the presence of this morbidity when caring for preterm infants and to provide optimal enteral nutrition.     

Body Temperature Changes of Newborns Under Fluorescent Versus LED Phototherapy

Objective

To determine changes in body temperature (BT) of hyperbilirubinemic newborns under conventional phototherapy with fluorescent lamps and light emitting diodes (LED) at different irradiances.

Methods

Otherwise healthy newborn infants >34 wk gestational age (GA) hospitalized for indirect hyperbilirubinemia, requiring phototherapy in the first 10 d of life were enroled. Infants who received conventional phototherapy with fluorescent lamps (10–15 μW/cm²/nm irradiance) were defined as group 1, LED phototherapy of 26–60 μW/cm²/nm irradiance as group 2, and LED phototherapy of 60–120 μW/cm²/nm irradiance as group 3. Primary outcome measure was mean BT which was defined as arithmetical mean of axillary BT measured at 2 h intervals during the first day of phototherapy.

Results

Thirty patients were enroled in each group. Mean birth weight and GA of the total cohort was 2800?±?530 g and 36.6?±?2 wk, respectively. Baseline demographic variables and serum total bilirubin levels were similar among groups. Mean BT was 36.7?±?0.1 °C in group 1, 36.6?±?0.2 °C in group 2, 37.7?±?0.2 °C in group 3. Mean BT was higher in group 3 compared to group 1 (p?<?0.001) and group 2 (p?<?0.001). Group 1 and group 2 had similar mean BT measurements (p?=?0.09). During phototherapy all the patients in group 3 had at least one BT measurement ≥37.5 °C and 77 % had BT ≥38 °C. Only one patient in group 2 had BT?≥?37.5 °C which was also ≥38 °C. During phototherapy all BT measurements were <37.5 °C in group 1.

Conclusions

LED phototherapy of ≥60 μW/cm²/nm intensity significantly increases BT in hyperbilirubinemic newborns.     

Adjustable suture surgery for correction of various types of strabismus.

BACKGROUND AND OBJECTIVE: This study was conducted to analyze the efficacy of the adjustable suture technique for correction of strabismus in patients with different types of strabismus. PATIENTS AND METHODS: This was an observational case series of patients who underwent the adjustable suture technique for correction of strabismus. A total of 33 adult patients (16 males and 17 females) with a minimum postoperative follow-up period of 6 months were included in the study. Patients were analyzed in three groups (patients with exotropia, esotropia, and vertical deviations). Success criteria determined were percentage change in the angle of deviation for far and near fixation, need for reoperation, and relief of diplopia. RESULTS: The median percentage change in the angle of deviation for far and near fixation was 86.60% and 84%, 92.50% and 94.44%, and 100% and 100% in the exotropia, esotropia, and vertical deviation groups, respectively. There was no need for reoperation, and postoperative adjustment performed 24 hours after surgery was needed in 30.3% of patients due to diplopia. CONCLUSIONS: The adjustable suture technique seems to be an effective method in the correction of various types of strabismus.     

Personality disorder and early therapeutic alliance in two time-limited therapies

Abstract

This study examined the relationship of pre-treatment personality disorder diagnosis to the quality of early therapeutic alliance in 145 patients randomly assigned to either cognitive behavioral therapy or brief relational therapy. The pre-treatment diagnosis was established by DSM-IV (SCID) and Wisconsin Personality Inventory. Quality of the alliance was assessed by patient and therapist reports using the 12-item Working Alliance Inventory, Session Evaluation Questionnaire, and direct questions of ruptures. Results indicated that pre-treatment personality disorder as determined by SCID predicted no variables of early psychotherapy process. Factor scores yielded from a PCA of the WISPI indicated that high impulsivity, dysregulation, and lability were associated with lower patient and therapist ratings of session depth of exploration and higher patient ratings of rupture intensity.