Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery

Background

Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.

Methods

After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.

Results

Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3 %) compared to group P (15 %; p?=?0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan–Meier plot, time to first vomiting was also significantly delayed in group A (p?=?0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67 %). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.

Conclusions

In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.     

A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options

IntroductionSeveral forms of cannabinoids are currently being used to manage nausea and vomiting (N/V). Emerging cases of refractory N/V associated with chronic cannabis use among adults and older patients have been reported named cannabis hyperemesis syndrome (CHS). CHS is a condition that leads to repeated and severe N/V in long-term users of cannabinoids.ObjectiveThe aim of this study was to outline current treatments for the management of CHS.MethodsA systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers.ResultsThe duration of cannabis administration ranged between 6 months to 11 years may precipitate symptoms of CHS. The Rome IV diagnostic criteria of CHS require cannabinoid use and persistence of N/V symptoms for at least the past 6 months. Cannabis cessation is noted to be the most successful management, but other treatments also demonstrated symptom relief; these include hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant administration.ConclusionMore research on CHS is needed to enhance knowledge translation, education, and create awareness in the medical community on the side effects of cannabinoids and to propose the best treatment options.     

Oral disorders,saliva secretion,and oral health‐related quality of life in patients with primary Sjögren's syndrome

Chemosensory function, burning sensations in the tongue (BST), halitosis, saliva secretion, and oral health‐related quality of life (OHRQoL) were investigated in patients with primary Sjögren's syndrome (pSS). In 31 patients with pSS and 33 controls, olfactory and gustatory functions were evaluated. Self‐reported complaints of dysgeusia, BST, and halitosis were recorded. Saliva secretion rates were measured and OHRQoL was assessed using the short‐form Oral Health Impact Profile (OHIP‐14). Patients had significantly lower olfactory (8.8 ± 3.5 vs. 10.7 ± 1.2) and gustatory (18.9 ± 7.1 vs. 25.4 ± 4.3) scores than controls, and significantly more patients complained of dysgeusia (58.1% vs. 0%), BST (54.8% vs. 6.1%), and halitosis (41.9% vs. 0%). A significantly greater proportion of patients with pSS had ageusia (19% vs. 0%), hypogeusia (32% vs. 12%), anosmia (13% vs. 0%), or hyposmia (29% vs. 9%). Significantly lower saliva secretion rates (ml min^?1) were observed in patients with pSS for stimulated (0.62 ± 0.40 vs. 1.57 ± 0.71) and unstimulated (0.08 ± 0.07 vs. 0.29 ± 0.17) saliva. The mean OHIP‐14 score was significantly higher in patients with pSS (16.2 ± 10.8 vs. 2.7 ± 3.1) and was positively correlated with dysgeusia, BST, and halitosis. In conclusion, patients with pSS reported higher occurrence of dysgeusia, BST, and halitosis, and demonstrated relatively impaired chemosensory and salivary functions. The patients’ poorer OHRQoL was associated with dysgeusia, BST, and halitosis.     

A facile and new approach to synthesize 2-amino-4-(4-amoinophenyl)-1<Emphasis Type="Italic">H</Emphasis>-1,3-diazol-1-yl-alkylaminomethanethiones

An “intellectual connection” approach to design a facile and new synthesis of suitably substituted 2-aminoimidazole-based precursors of expected antiasthmatic agents through a benzidine type of rearrangement of 2-phenylazoimidazole and subsequent coupling of the product thus obtained with alkylisothiocyanates involving a degenerative operation, thereby improving the time frame of the overall synthetic sequence, is reported. The alkylisothiocyanates required in this synthetic sequence are prepared using a best combination of reported methods. The compounds reported here can be used to produce derivatives of other biological agents.     

Impact of universal immunization programme on the incidence of tetanus neonatorum.

The standard WHO cluster sampling technique was applied to 30 randomly selected villages covering a population of 89,470 and 2010 live births in Jasra Community Development Block with a population of 123,000 distributed in 123 villages and 27 subcenters. In each cluster, 67 mothers were interviewed who gave birth between March 1989 and April 1990. Immunization history of tetanus toxoid given during the antenatal period and the delivery was recorded by 2 teams. There were 49 neonatal deaths: 30 (61.2%) were caused by tetanus neonatorum, 10 (30.4%) died of high fever of undetermined etiology, 5 (10.2%) of pneumonia, 3 (6.1%) of diarrhea, and there was 1 case of death of undetermined cause. The tetanus neonatorum rate was 18.7/1000 live births. 93% of the births were assisted by family members and untrained dais, and 2.4% by trained traditional birth attendants. In 69 deliveries (3.4%), a doctor was called, while in 24 cases a multipurpose female worker assisted. 46.7% of neonates with tetanus were brought to the district hospital for treatment, the rest were either taken to private practitioners or to traditional healers. 1336 (66.5%) of 2010 mothers interviewed had not received tetanus toxoid, 359 (17.8%) had received only 1 dose of toxoid, and 315 (15.7%) had been immunized with 2 doses. The mothers of 27 (90.0%) of those 30 neonates who died of tetanus had not received a dose of toxoid during the antenatal period, whereas 3 mothers obtained only 1 dose. None of the newborn of mothers immunized with 2 doses during pregnancy contracted tetanus. 61% of the neonatal deaths were attributed to tetanus. The causes of neonatal tetanus include unhygienic cutting of the cord and lack of immunization of mothers with tetanus toxoid during pregnancy. The administration of 2 doses of antenatal tetanus toxoid and health education regarding the importance of conducting hygienic deliveries could eliminate this disease.