Use of continuous epidural infusion of ropivacaine as a component of an anesthesiological appliance and postoperative analgesia in elderly patients in cancer surgery

The study was undertaken to evaluate the effectiveness and safety of ropivacaine used via long-term epidural infusion and to define the optimum doses of the agent in the intra- and postoperative period. The parameters of hemodynamics, the adequacy of anesthesia, and the consumption of the agent were explored in 53 patients (ASA III-IV) aged 68 +/- 1.4 years operated on for abdominal cancer. Following 15 and 25 min of the injection of a bolus dose of ropivacaine, the occurrence of sensory block II was observed in 60 and 95% of the patients, respectively. After injection of ropivacaine in a bolus dose (56 +/- 3.4 mg), there was a 20% lowering of mean blood pressure and a 17% reduction in heart rate as compared with the baseline values. Maintenance infusion was made at a rate of 15-25 (20 +/- 1.9) mg/h. The total consumption was 126 +/- 13 mg. Bradycardia was noted in 4 (7.5%) cases; 7 (13%) patients required additional administration of phentanyl. The latter was used in a dose of 100 microg in 87% of the patients only prior to tracheal intubation. For postoperative analgesia, 0.2% ropivacaine was infused at a rate of 6-10 ml/h. Increasing its dose up to 12-14 ml/h resulted in hypotension and the occurrence of the signs of motor block. Postoperative analgesia was effective in 89% of cases when the agent was infused at rate of 8.8 +/- 0.9 ml/h and the hemodynamic parameters were stable. Postoperative intestinal paresis was abolished in 85.8% of patients after an average of 52 +/- 2.7 hours. Long-term epidural infusion of ropivacaine may be regarded as an effective component of anesthesia at abdominal surgery in elderly patients with severe comorbidity. The method allows one to completely refuse the use of narcotic analgesics in most cases both during a surgical intervention and in the postoperative period, which creates good conditions for an early activation of patients and for a reduction of postoperative complications.     

Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood

BACKGROUND: The "hygiene hypothesis" postulates that infections during infancy may protect against asthma and atopy. There is also some evidence that antibiotic and/or paracetamol use may increase the risk of asthma. METHODS: The study measured the association between infections, and medication use early in life and the risk of asthma at age 6-7 years. It involved 1584 children who had been notified to public health services with serious infections at age 0-4 years, and 2539 children sampled from the general population. For both groups, postal questionnaires were completed by parents. RESULTS: There was little difference in the prevalence of current wheezing between the childhood infections group (prevalence = 23.5%) and the general population group (prevalence = 24.3%). There was also little difference whether the major site of infection was gastrointestinal (prevalence = 24.1%), invasive (prevalence = 24.6%) or respiratory (prevalence = 21.1%). However, in both groups, there were associations with antibiotic (OR = 1.78, 95% CI 1.49 to 2.14) or paracetamol (OR = 1.38, 95% CI 1.04 to 1.83) use in the first year of life or recent paracetamol use (OR = 2.10, 95% CI 1.78 to 2.49) and current wheezing. There was a weak protective effect of childhood infections in children who had not used antibiotics in the first year of life (OR = 0.78, 95% CI 0.55 to 1.10). CONCLUSIONS: These findings are consistent with other evidence that antibiotic use early in life may increase the risk of asthma. They are also consistent with some preliminary evidence associating paracetamol use with an increased risk of asthma. Any protective effect of notifiable childhood infections was weak.     

Antibiotic sales and the prevalence of symptoms of asthma, rhinitis, and eczema: The International Study of Asthma and Allergies in Childhood (ISAAC)

BACKGROUND: It has been hypothesized that antibiotic use early in life may increase the subsequent risk of asthma. We have conducted an ecologic analysis of the relationship between antibiotics sales and the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 99 centres from 28 countries. METHODS: Data for antibiotics sales for 28 countries were obtained from the Institute for Medical Statistics (IMS), Health Global Services, UK and converted to defined daily doses (DDD). Data on the prevalence of symptoms of asthma, rhinitis, and eczema in 13-14 year olds were based on the responses to the written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). The analysis was adjusted for gross national product (GNP) as an estimate of the level of affluence. RESULTS: In general, there was a positive association between per capita antibiotics sales and the prevalence of symptoms for asthma, rhinitis, and eczema, but the associations generally became negative once the analyses had been adjusted for GNP. In particular, there were non-significant negative associations between total antibiotics sales and the prevalence of wheeze ever, wheeze in the last 12 months, nose problems with itchy-watery eyes, itchy rash in the last 12 months, and eczema ever. On the other hand there were weak non-significant positive associations for asthma ever, nose problems ever, nose problems in the last 12 months, and itchy rash ever. There was a statistically significant positive association with wheeze at rest as measured by the asthma video questionnaire; however, even this association was weak and would not account for more than a 1% difference in asthma prevalence between countries. CONCLUSIONS: These findings are generally not consistent with the hypothesis that antibiotic use increases the risk of asthma, rhinitis, or eczema. If there is a causal association of antibiotic use with asthma risk, it does not appear to explain the international differences in asthma prevalence.     

Prevalence of symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: the International Study of Asthma and Allergies in Childhood (ISAAC)

The International Study of Asthma and Allergies in Childhood (ISAAC) has provided valuable information regarding international prevalence patterns and potential risk factors for asthma, allergic rhinoconjunctivitis and eczema. However, the only Pacific countries that participated in ISAAC Phase I were Australia and New Zealand, and these included only a small number of Pacific children. Phase III has involved not only repeating the Phase I survey to examine time trends, but also to include centres and countries which are of interest but did not participate in Phase I. The ISAAC Phase III study was therefore conducted in the Pacific (in French Polynesia, New Caledonia, Tonga, Fiji Islands, Samoa, Cook Islands, Tokelau Islands and Niue). The overall prevalence rates of current symptoms (in the last 12 months) were 9.9% for asthma, 16.4% for allergic rhinoconjunctivitis and 10.7% for atopic eczema. The prevalence of current wheezing (9.9%) was generally much lower than that has been observed in Pacific children in New Zealand (31%), but there was considerable variation between the various Pacific centres: Tokelau Islands (19.7%), Tonga (16.2%), Niue (12.7%), French Polynesia (11.3%), Cook Islands (10.6%), Fiji Islands (10.4%), New Caledonia (8.2%) and Samoa (5.8%). The reasons for these differences in prevalence across the Pacific are unclear and require further research. The finding that prevalence levels are generally considerably lower than those in Pacific children in New Zealand adds to previous evidence that children who migrate experience an altered risk of asthma as a result of exposure to a new environment during childhood.     

Risk factors for symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: an ISAAC Phase III study

BACKGROUND AND METHODS: Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) was conducted in eight Pacific countries, five of which (Samoa, Fiji, Tokelau, French Polynesia and New Caledonia) collected environmental questionnaire (EQ) data. We report the findings of the EQ analyses below. RESULTS: The major factors associated with current wheeze were regular margarine consumption (prevalence odds ratio [POR] 1.19, 95%CI 1.01-1.40), paracetamol use (POR 1.35, 95%CI 1.11-1.64), electric cooking (POR 1.42, 95%CI 1.11-1.80), regular exercise (POR 1.44, 95%CI 1.18-1.75) and maternal smoking (POR 1.16, 95%CI 1.01-1.33). Protective factors included having older siblings (two or more POR 0.69, 95%CI 0.58-0.82; one POR 0.86, 95%CI 0.71-1.05), and being born in the country of the survey (POR 0.74, 95%CI 0.63-0.87). Risk factors for rhinoconjunctivitis included regular consumption of meat, butter, margarine and nuts, regular exercise, regular television viewing, paracetamol use and passive smoking. Eczema was associated with regular meat, pasta and butter consumption, regular television viewing, paracetamol use and passive smoking. CONCLUSIONS: Regular meat and margarine consumption, paracetamol use, electric cooking and passive smoking are risk factors for symptoms of asthma, rhinoconjunctivitis and eczema in the Pacific. However, most of these associations were weak, and account for only a small proportion of cases.     

Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury

Purpose: After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach. Key messages and implications: Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service. Conclusion: A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned. [Box: see text].     

Functional activity of peritoneal macrophages in acute destructive pancreatitis: evaluation, implication

According to the etiology of acute pancreatitis, the authors identified the most common phenotypes of superficial antigens of peritoneal macrophages: CD14(+) CD25(-)CD64(-)HLA-DR(-) in acute biliary pancreatitis, CD14(+) CD25(+)CD64(+)HLA-DR(+) in nonbiliary pancreatitis; moreover, all the patients were found to have increased expression of early (CD25+) and late (HLA-DR+) markers of cell activation. A comparative study was conducted and the most informative tools to evaluate the adhesive, cytokine-producing, phagocytic, and oxygen-dependent activities of peritoneal macrophages were recognized.     

Short communication: quantitative proteomic plasma profiling reveals activation of host defense to oxidative stress in chronic SIV and methamphetamine comorbidity

The double epidemic of substance abuse and HIV infection is a multifaceted problem To investigate mechanistic clues to the effects of substance abuse on infected individuals we preformed quantitative proteomic profiling of plasma in a methamphetamine treated nonhuman primate model for AIDS. A nontargeted quantitative approach identified extracellular superoxide dismutase to be significantly upregulated by SIV and methamphetamine treatment, and targeted studies revealed an increase in expression in the antioxidant glutathione S-transferase, thus pointing to a compensatory response to increased oxidative stress in methamphetamine-treated animals.