Dose-independent occurrence of seizure with tramadol

Introduction

Tramadol, as a centrally-acting, opioid-like analgesic with serotonin reuptake inhibition property, is one of the most prescribed analgesics in the world. We assessed the incidence of seizure, as it is one of the most important adverse effects.

Methods

In a cross-sectional study, 215 cases of tramadol users or abusers who were admitted to Loghman-Hakim Hospital Poisoning Center (LHHPC) in Tehran during a 5-month period, from April 2007 to September 2007, were assessed to evaluate the occurrence of seizure. Patients with positive history of co-ingestion of other drugs, addiction, convulsive disorders, renal diseases, or head trauma with abnormal electroencephalography (EEG) or computerized tomography (CT) scan of the brain were excluded, thus 132 patients were included in the study. For patients who had seizure, CT scan of the brain and EEG were performed, and frequency and type of seizure were identified. Mean tramadol dose was compared between patients with and without seizure.

Results

Among the patients, 97 (73.5%) were male. Seizure occurred in 61 patients (46.2%) within 24 hours after tramadol ingestion. The majority of patients who had seizure were male (male, 83.6% vs. female, 16.4%). Mean tramadol dose was lower among females than males (males, 2413 mg vs. females, 1706 mg), but the difference was not statistically significant. Of 35 patients with documented seizure type, all showed generalized tonic-clonic seizure and 12 patients had abnormal EEG (35.3%). No statistically significant difference was observed in mean tramadol intake between patients with or without seizure. Analysis of patients with seizure, according to tramadol intake, indicated that most patients used tramadol in the dose range of 500–1000 mg followed in occurrence by 1500–2000 mg, then 100–500 mg, 2500–3000 mg, and 3500–4000 mg.

Conclusions

Mean tramadol intake does not differ between patients with and without seizure, and the most common dose range in those with seizure is 500–1000 mg. We thus conclude that the incidence of seizure with tramadol is not dose dependent.     

Randomized Study of the Effect of Dietary Counseling During Adjuvant Chemotherapy on Chemotherapy Induced Nausea and Vomiting,and Quality of Life in Patients With Breast Cancer

Patients with breast cancer (PsBC) usually face with chemotherapy induced nausea and vomiting (CINV). The aim of this study was to assess the impact of nutritional counseling on CINV and quality of life (QoL) of PsBC. 150 PsBC were randomly assigned for receiving a personalized diet, which contained 1.2–1.5?g/kg of protein, 30% of energy from fat and 55–60% of energy from carbohydrate, a face to face nutrition education, and a pamphlet which contained beneficial nutrition information to reduce the severity of CINV before each chemotherapy session for three times (n?=?75) or regular care (n?=?75). CINV, QoL, and dietary intake were evaluated after each chemotherapy session. Nausea rating index, overall nausea index, and visual analog scale (P?<?0.001) were dramatically lower in the intervention group. Global health status/QoL as well as physical functioning, role functioning, emotional functioning, and cognitive functioning (P?<?0.001) were significantly better in the intervention group. Patients in the control group experienced more fatigue, nausea and vomiting, pain, dyspnea, loss of appetite, constipation, and diarrhea (P?<?0.001). Nutrition counseling during adjuvant chemotherapy among PsBC reduced the occurrence of CINV and led to significant improvements in the QoL.     

Correction to: Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals

Emergency Radiology - A correction to this paper has been published: https://doi.org/10.1007/s10140-021-01943-0     

Response of salivary peroxidase to exercise intensity

Oral peroxidase, one of the most important salivary antioxidant enzymes, is subjected to alternation due to various body conditions. The aim of this study was to assess the effect of exercise intensity on salivary peroxidase activity. Using a randomized design, ten healthy male university students (mean age, 23.22; s _x = 2.34 years) completed treadmill runs with initial velocity 6.73 km/h at the rate of 1.58 km/h increase every 3 min until exhaustion. Unstimulated whole saliva collected over a 5-min period in pre-weighed tubes before, immediately after exercise, and 1 h after exercise was analyzed for total protein and saliva peroxidase activity. The saliva flow rate ranged from 0.08 to 1.40 ml min⁻¹ at rest and was not significantly affected by the exercise. Peroxidase activity in each sample was measured using 4-amino antipyrine as substrate. In the incremental exhaustion run and also at 75% VO_2max, the secretion rates of peroxidase increased. No significant changes in saliva flow rate were observed in any treadmill run. Treadmill runs at 75% VO_2max and to exhaustion increased the activity of peroxidase immediately after exercise which decreased after 1 h. It was concluded that short-duration, high-intensity exercise increases the activity rate of peroxidase despite no change in the saliva flow rate. These effects appear to be associated with changes in sympathetic activity and not the hypothalamic pituitary adrenal axis.     

Impact of Bariatric Surgery on Carotid Intima-Media Thickness in Patients with Morbid Obesity: a Prospective Study and Review of the Literature

Obesity Surgery - One of the main causes of mortality among obese patients is cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is an independent predictor for atherosclerosis and...     

Effect of recombinant β-defensin 1 protein on human sperm motility and viability

The reduction of sperm motility and subsequently reduced ability to undergo capacitation and acrosome reaction are considered as common causes of male infertility. The β-defensin family is a group of well-known secretory proteins with antimicrobial activity that contribute to the process of “sperm maturation” during the passage of spermatozoa in the epididymis when spermatozoa attain its motility. One member of this family is “β-defensin 1” which is present in seminal plasma and spermatozoa. The aim of this study was the incubation of human processed spermatozoa with recombinant β-defensin 1 (500 ng/ml) for 1, 2 and 3 hr at 37°C under 5% CO₂ atmosphere and assessment of sperm viability and motility in 59 semen samples. The analysis of semen samples such as sperm concentration, motility, viability, morphology and semen volume was performed according to the World Health Organization (2010; World health organization laboratory manual for the examination and processing of human semen (p. 287). Geneva, Switzerland: World Health Organization) criteria. The result of the current study shows that the incubation of spermatozoa with recombinant β-defensin significantly maintained percentage of sperm viability and motility compared to processed spermatozoa incubate in the absence of β-defensin in the studied time intervals (p < .05). Therefore, we concluded that recombinant β-defensin 1 protein as an agent with antimicrobial activity can maintain sperm viability and motility in in vitro condition.     

The Potential Role of Combined Highly Sensitive Troponin and Coronary Computed Tomography Angiography in the Evaluation of Patients with Suspected Acute Coronary Syndrome in the Emergency Department

The evaluation and triage of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) remains to be challenging despite available guidelines and clinical evidence. The current guidelines in the USA recommend clinical risk assessment based on cardiovascular risk factors followed by serial electrocardiograms and conventional cardiac troponin measurements, which are supplemented by advanced non-invasive cardiac testing in the majority of patients. This approach is safe, but leads to a lengthy work-up and high cost of care. There is clinical need for diagnostic strategies that will lead to rapid and reliable triage of patients with suspected ACS. In this review, we will summarize the experience and evidence for the use of highly sensitive troponin (hsTn) in the rapid and efficient evaluation of patients with suspected ACS. We will also review the available literature on the use of coronary computed tomography angiography (CTA) in the rapid evaluation of patients with suspected ACS. We will discuss the opportunities for the combined use of hsTn and coronary CTA in this population. Finally, we will outline the possible implementation of combined use of hsTn and coronary CTA in the evaluation of patients with suspected ACS in the ED.     

The ameliorative effects of Lactobacillus coagulans and Lactobacillus casei probiotics on CCl4-induced testicular toxicity based on biochemical,histological and molecular analyses in rat

Probiotics are commonly present in foods and role as dietary adjuncts and alternatives to pharmacological products in many medical fields. The aim of this study was to investigate the effects of Lactobacillus coagulans and Lactobacillus casei probiotics on carbon tetrachloride (CCl₄)-induced reproductive injury and sperm toxicity in rats. Thirty-two Wistar rats were divided into four groups as follows: sham, CCl₄ (2 ml/kg), L. casei probiotic + 2 ml/kg CCl₄ and L. coagulans probiotic + 2 ml/kg CCl₄. On the 36th day after the intervention, serum levels of follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone (T), as well as catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, were measured. Testicular malondialdehyde (MDA) level, the expressions of apoptosis-related genes (Bcl-2 and Bax), Bax/Bcl-2 ratio, histomorphometric indices such as tubular differentiation index (TDI), repopulation index (RI), spermiogenesis index (SPI) and sperm parameters were evaluated. L. casei and L. coagulans probiotics improved the levels of reproductive hormones and antioxidant capacity in rats. Both the probiotics, especially L. casei, increased the rate spermatogenesis which accompanied with significant increments in testicular TDI, RI and SPI. Furthermore, both probiotics down-regulated Bax and up-regulated Bcl-2, following by decreased Bax/Bcl-2 ratio. Our key findings indicated that L. casei and L. coagulans have protective effects against CCl₄-induced testicular toxicity.