Azimilide dihydrochloride

Azimilide dihydrochloride is an antiarrhythmic drug with Vaughn Williams class III properties, which blocks both fast (IK_r) and slow (IK_s) components of the delayed rectifier cardiac potassium channel. The drug slows the heart rate slightly and, like other class III antiarrhythmic drugs, prolongs ventricular repolarization and thus, the QT interval. Unlike sotalol, another class III antiarrhythmic drug, azimilide does not exhibit reverse-use dependence, that is, its binding characteristics and effectiveness are not related to the heart rate. Azimilide is 85% bioavailable, reaches peak blood concentrations in 6–8 h and has a long elimination half-life of 114 h. Clinical trials have utilized once-daily dosing. These trials have tested the use of the drug for patients with supraventricular and ventricular arrhythmias.     

Blood pressure-lowering drugs: essential therapy for some patients with normal blood pressure

The risk of increasing blood pressure on the incidence of cardiovascular disease starts at 115/75 mmHg and roughly doubles for every 10 years increase in age, 20 mmHg increase in systolic blood pressure, 10 mmHg increase in diastolic blood pressure, or in the presence of comorbidities, such as diabetes or any evidence of cardiovascular disease. To lower blood pressure in patients with normal blood pressure and diabetes, or heart failure, or with any evidence of atherosclerotic disease in the coronary, cerebral and peripheral territories, reduces the incidence of major cardiovascular events by 18 to 42%. The diagnosis of hypertension in patients with these conditions is therefore irrelevant. The drugs that have mainly been tested in such conditions are the angiotensin-converting enzyme inhibitors, but their efficacy probably derives from their blood pressure-lowering effect, instead of a primary antiatherosclerotic effect.     

Expert Knowledge in Palliative Care on the World Wide Web: Palliativedrugs.Org

ABSTRACT.?

In my last Internet-related article, I speculated that social networking would be the coming wave in the effort to share knowledge among experts in various disciplines. At the time I did not know that a palliative care site on the World Wide Web (WWW), palliativedrugs.com, already provided the infrastructure for sharing expert knowledge in the field. The Web site is an excellent traditional formulary but it is primarily devoted to “unlicensed” (“off-label”) use of medications in palliative care, something we in the specialty often do with little to support our interventions except shared knowledge and experience. There is nothing fancy about this Web site. In a good way, its format is a throwback to Web sites of the 1990s. In only the loosest sense can one describe it as “multimedia.” Yet, it provides the perfect forum for expert knowledge and is a “must see” resource. Its existing content is voluminous and reliable, filtered and reviewed by renowned clinicians and educators in the field. Although its origin and structure were not specifically designed for social or professional networking, the Web site's format makes it a natural way for practitioners around the world to contribute to an ever-growing body of expertise in palliative care.     

渗透性缓泻药物早期干预对老年股骨 转子间骨折患者排便功能的影响

〔摘 要〕 目的：探讨渗透性缓泻药物早期干预大便管理对卧床的老年股骨转子间骨折患者排便功能的影响。 方法：选取南通市第四人民医院 2016 年 1 月至 2020 年 12 月收治的 86 例股骨转子间骨折老年患者,在入院时随机抽 签选入对照组及观察组,每组 43 例。对照组入院后按常规排便管理,观察组在常规排便管理的同时,入院后即口服 渗透性缓泻药物早期干预排便,比较两组患者排便情况。结果：观察组入院后首次排便时间早于对照组,首次排便消 耗时间短于对照组,入院后首周内排便次数多于对照组,差异具有统计学意义（P ＜ 0.05）;观察组首次大便的性状 更合理于对照组,差异具有统计学意义（Z = –6.126,P ＜ 0.05）。结论：渗透性缓泻药物的应用能够有效预防便秘 的发生,早期预防性口服渗透性缓泻药物能更好对排便功能进行管理。     

吴玉生教授辨治肝癌经验介绍

[目的]总结吴玉生教授治疗肝癌的学术观点及临证经验,并在临床中进一步推广。     

基于数据挖掘对颜红教授治疗抑郁发作用药经验初探

[目的]初探颜红教授治疗抑郁发作患者的中医用药规律.收集2019—2020年于天津中医药大学第一附属医院心身科住院治疗确诊抑郁发作且出院后于颜红教授门诊规律就诊至少6个月的患者,通过数据筛选、规范化处理后提取中药处方相关信息,建立相关数据库.通过描述统计法、Apriori算法进行关联规则分析、聚类分析对处方进行数据挖掘...     

Effects of pretreatment with cisatracurium, rocuronium, and d-tubocurarine on succinylcholine-induced fasciculations and myalgia: a comparison with placebo

Study Objective: To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery.

Design: Randomized, prospective, placebo-controlled trial

Setting: Teaching hospital.

Subjects: 80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia.

Intervention: A standardized balanced anesthetic technique was used for all patients.

Measurements and Main Results: Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (IV) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia was assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) in the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative myalgia.

Conclusion: Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery.     

The effect of rectal diclofenac on pruritus in patients receiving intrathecal morphine

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery in which intrathecal morphine was administered. Each patient received intrathecal morphine 0.3 mg prior to induction, followed by a standard anaesthetic. The patients were randomly allocated to one of two groups. One group received 100 mg of rectal diclofenac immediately post-induction. Patients receiving diclofenac had significantly lower pruritus scores at 30 min (p = 0.0076), 2, 4, 8 and 24 h postoperatively, as well as significantly reduced pain scores at each time point (p < 0.0001 at each study interval). Morphine consumption in the first 24 h was also significantly lower in this group. In conclusion, rectal administration of diclofenac significantly reduces the incidence and severity of postoperative pruritus. It also significantly reduces pain and further analgesic requirements postoperatively.     

Ventricular fibrillation related to reversal of the neuromuscular blockade in a patient with long QT syndrome

The long QT syndrome (LQTS) is associated with syncopal attacks or even sudden death at a young age due to ventricular fibrillation. We report a patient with an undiagnosed LQTS who had an episode of cardiac arrest during the final part of general anesthesia, immediately after the drugs for reversal of the neuromuscular blockade were given. We suggest that the administration of glycopyrronium might have been the provoking factor in this patient.     

Epidemiology,pathophysiology and putative genetic basis of carbamazepine‐ and oxcarbazepine‐induced hyponatremia

The use of carbamazepine (CBZ) and oxcarbazepine (OXC) as first‐line antiepileptic drugs in the treatment of focal epilepsy is limited by hyponatremia, a known adverse effect. Hyponatremia occurs in up to half of people taking CBZ or OXC and, although often assumed to be asymptomatic, it can lead to symptoms ranging from unsteadiness and mild confusion to seizures and coma. Hyponatremia is probably due to the antidiuretic properties of CBZ and OXC that are, at least partly, explained by stimulation of the vasopressin 2 receptor/aquaporin 2 pathway. No known genetic risk variants for CBZ‐ and OXC‐induced hyponatremia exist, but likely candidate genes are part of the vasopressin water reabsorption pathway.