Administration Of Suppositories Research Articles

Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository.

The vaginal microbiota can be altered by uropathogenic bacteria associated with recurrent cystitis (RC), and the vaginal administration of Lactobacillus have suggested certain effects to prevent RC. The relationship between vaginal microbiota and the development of RC has not been elucidated. We aimed to clarify the etiology of RC from vaginal microbiota and importance of vaginal Lactobacillus. Vaginal samples obtained from 39 postmenopausal women were classified into four groups: healthy controls; uncomplicated cystitis; RC; and prevention (prevented RC by Lactobacillus crispatus-containing vaginal suppositories). Principal coordinate analysis and beta-diversity analysis was used to assess 16S rRNA gene sequencing data from the vaginal microbiome. Cluster analysis divided the vaginal bacterial communities among 129 vaginal samples into three clusters (A, B, and C). Fourteen of 14 (100%) samples from the RC group and 51 of 53 (96%) samples from the prevention group were in clusters B and C, while 29 of 38 (76%) samples from the healthy group and 14 of 24 (58%) samples from the uncomplicated cystitis group were in cluster A. The principal coordinate analysis showed that plots in the uncomplicated cystitis group were similar to the healthy group, indicating a large separation between the RC group and the uncomplicated cystitis group. On beta-diversity analysis, there were significant differences between the healthy group and the uncomplicated cystitis group (p = 0.045), and between the RC group and the uncomplicated cystitis group or the healthy group (p = 0.001, p = 0.001, respectively). There were no significant differences between the RC group and the prevention group (p = 0.446). The top six taxa were as follows: Prevotella, Lactobacillus, Streptococcus, Enterobacteriaceae, Anaerococcus, and Bifidobacterium. Among patients with RC, Lactobacillus was undetectable before administration of suppositories, while the median relative abundance of Lactobacillus was 19% during administration of suppositories (p = 0.0211), reducing the average cystitis episodes per year (6.3 vs. 2.4, p = 0.0015). The vaginal microbiota of postmenopausal women with RC is differed from healthy controls and uncomplicated cystitis in terms of lack of Lactobacillus and relatively dominant of Enterobacteriaceae. Vaginal administration of Lactobacillus-containing suppositories can prevent RC by stabilizing vaginal dysbiosis and causing a loss of pathogenic bacteria virulence.

MP34-08 ETIOLOGY OF RECURRENT CYSTITIS BASED ON VAGINAL MICROBIOME: THINKING BEYOND THE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP34-08 ETIOLOGY OF RECURRENT CYSTITIS BASED ON VAGINAL MICROBIOME: THINKING BEYOND THE BLADDER Takuya Sadahira, Takanori Sekito, Takehiro Iwata, Yuki Maruyama, and Motoo Araki Takuya SadahiraTakuya Sadahira More articles by this author , Takanori SekitoTakanori Sekito More articles by this author , Takehiro IwataTakehiro Iwata More articles by this author , Yuki MaruyamaYuki Maruyama More articles by this author , and Motoo ArakiMotoo Araki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to determine the etiology of recurrent cystitis from vaginal microbiome and to evaluate the importance of the presence of Lactobacillus in the vagina. METHODS: Vaginal samples were obtained from postmenopausal women classified into four groups: healthy controls (“Healthy”) group, patients with uncomplicated cystitis (“Uncomplicated Cystitis”) group, patients with recurrent cystitis (“RC”) group, and patients with recurrent cystitis prevented by administration of Lactobacillus crispatus-containing vaginal suppositories (“Prevention”) group. 16S rRNA gene sequencing data from vaginal microbiome was analyzed among four groups by principal coordinate analysis. RESULTS: A total of 129 vaginal samples from 39 women were studied. The vaginal bacterial communities could be divided into three clusters (A, B, C), based on differences in relative abundances of bacterial taxa among samples (Figure 1A). Among the four groups of postmenopausal women, 39/39 (100%) samples from "Healthy" group were in Cluster A and B, 24/24 (100%) samples from "Uncomplicated Cystitis" group were in Cluster A and B, 3/4 (75%%) samples from "RC" group were in Cluster C, and 61/63 (97%) samples from "Prevention" group were in Cluster B and C. In principal coordinate analysis, the plots in the “Uncomplicated cystitis” group was similar to those of "Healthy" group (Figure 1A). In addition, principal coordinate analysis indicated a large separation between the plots in the “RC” group and "Uncomplicated cystitis" group. Among four patients in "RC" group, the median (range) relative abundance of Lactobacillus was not detected before administration of Lactobacillus crispatus-containing vaginal suppositories, while Lactobacillus was 18% (12%-25%) during administration on average reducing the onset of cystitis per year (7.8 vs 2.5, p=0.0061) (Figure 1B). CONCLUSIONS: The vaginal microbiome of recurrent cystitis is essentially different from that of uncomplicated cystitis. Moreover, lack of Lactobacillus in postmenopausal vaginal microbiome is associated with the development of recurrent cystitis. Vaginal administration of Lactobacillus prevents recurrent cystitis by improving vaginal dysbiosis. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e462 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takuya Sadahira More articles by this author Takanori Sekito More articles by this author Takehiro Iwata More articles by this author Yuki Maruyama More articles by this author Motoo Araki More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of formulation and route of administration on the distribution of 17-hydroxyprogesterone caproate in rats

Weekly intramuscular (250 mg/week) or subcutaneous (275 mg/week) injections of 17-hydroxyprogesterone caproate (17-OHPC) is the only treatment option for the prevention of preterm birth in women with a prior history of preterm delivery. The objective of the current study was to determine the relative distribution of 17-OHPC in selected tissues in adult female SD rats after IM (oily formulation or solution), IV (solution), PO (solution), or intravaginal (suppository) administration. Plasma, uterus, adipose, and liver samples were collected at various times and analysed by LC-MS-MS. The highest concentrations of 17-OHPC were observed in the adipose tissue, after IM (oily formulation), and intravaginal administration. Substantial concentrations of 17-OHPC were also observed in the uterus after IM, intravaginal and IV administration. 17-OHPC was not detected in the liver and in any of the tissues tested after PO administration. 17-OHPC levels in plasma after intravaginal suppository administration were low despite substantial concentrations in the adipose and the uterus. The distribution of 17-OHPC depends on the formulation, the route of administration, and the sampling time. Low systemic concentrations and substantial distribution in the tissues of interest after intravaginal administration warrants future studies to evaluate the potential of the daily intravaginal route of administration of 17-OHPC.

COMPARATIVE STUDY OF THE USAGE OF RECTAL TRAMADOL SUPPOSITORY VERSUS WITHOUT SUPPOSITORY FOR POST-OPERATIVE PAIN MANAGEMENT IN CASES OPERATED UNDER SPINALANESTHESIA

Introduction: Various techniques and medications are employed to lessen postoperative discomfort. Present study aimed to assess the efcacy of pre-operative tramadol suppository administration for the management of post-operative pain in patients undergoing surgery under spinal anaesthesia, requirement of analgesia and duration of hospital stay. Material & Method: The present comparative study with patients presenting to the department of General Surgery, AVMCH who were posted for elective surgeries & with no evidence/signs of inammation/infection consenting were included in the study. Patients were grouped based on utility of tramadol suppository, cases were with administration of rectal suppository and control group was with no pre-operative administration of rectal suppository. The patients were assessed for the post-operative pain at different point of time, mean duration of hospital stay and any side effects like nausea, vomiting between the groups. Results: Total 152 patients included in the study, with mean age of 47.57yrs. The pain score was signicantly lower among the cases compared to control at 1st hr, 6th hr, 12th hr and 24th hr post-operative period. (p<0.05) There was signicant shorter duration of hospital stay among the cases (2.3days) compared to controls (3.2days).(p<0.05) Conclusion: A signicant pain management in post-operative period with the utility of tramadol suppository administration compared to the patients without suppository

Repeated episodes of seizures in an infant following accidental administration of tramadol suppository: a case report

Tramadol has become a popular analgesic in last few years. Number of studies has reported tramadol poisoning in children. Here, we report a case of tramadol poisoning in a one and half month old infant who presented with repeated seizures and apnea following accidental administration of tramadol suppository. IMC J Med Sci. 2023; 17(1): 010. DOI: https://doi.org/10.55010/imcjms.17.010 *Correspondence: Israt Zahan Ima, Department of Pediatrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), 1/A Ibrahim Sarani, Segunbagicha, Dhaka, Bangladesh. Email: imaisratzahan@gmail.com

Pre-referral intranasal artesunate powder for cerebral malaria: a proof-of-concept study

BackgroundMalaria still kills young children in rural endemic areas because early treatment is not available. Thus, the World Health Organization recommends the administration of artesunate suppositories as pre-referral treatment before transportation to the hospital in case of severe symptoms with an unavailable parenteral and oral treatment. However, negative cultural perception of the rectal route, and limited access to artesunate suppositories, could limit the use of artesunate suppositories. There is, therefore, a need for an alternative route for malaria pre-referral treatment. The aim of this study was to assess the potential of intranasal route for malaria pre-referral treatment.MethodsThe permeability of artesunate through human nasal mucosa was tested in vitro. The Transepithelial Electrical Resistance (TEER) of the nasal mucosa was followed during the permeation tests. Beside, regional deposition of artesunate powder was assessed with an unidose drug delivery device in each nostril of a nasal cast. Artesunate quantification was performed using Liquid Chromatography coupled to tandem Mass Spectrometry.ResultsThe experimental model of human nasal mucosa was successfully implemented. Using this model, artesunate powder showed a much better passage rate through human nasal mucosa than solution (26.8 ± 6.6% versus 2.1 ± 0.3%). More than half (62.3%) of the artesunate dose sprayed in the nostrils of the nasal cast was recovered in the olfactory areas (44.7 ± 8.6%) and turbinates (17.6 ± 3.3%) allowing nose-to-brain and systemic drug diffusion, respectively.ConclusionArtesunate powder showed a good permeation efficiency on human nasal mucosa. Moreover it can be efficiently sprayed in the nostrils using unidose device to reach the olfactory area leading to a fast nose-to-brain delivery as well as a systemic effect. Taken together, those results are part of the proof-of-concept for the use of intranasal artesunate as a malaria pre-referral treatment.

Urinary excretion profile of prednisolone and prednisone after rectal administration: Significance in antidoping analysis.

The rectal administration of glucocorticoids, as well as any injectable, and oral ones, is currently prohibited by the World Anti-Doping Agency when occurs "in competition." A reporting level of 100 ng/ml for prednisolone and 300 ng/ml for prednisone was established to discriminate the allowed and the prohibited administration. Here, the urinary excretion profiles of prednisone and prednisolone were evaluated in five volunteers in therapy with glucocorticoid-based rectal formulations containing prednisone or prednisolone caproate. The urinary levels of the excreted target compounds were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) following the procedure validated and currently in use in our laboratory to detect and quantitate glucocorticoids in urine. Predictably, the excretion trend of the analytes of interest were generally comparable with those obtained after oral administration, even if the excretion profile showed a broad interindividual variability, with the absorption rate and the systemic bioavailability after rectal administration being strongly influenced by the type of formulations (suppository or rectal cream, in our case) as well as the physiological conditions of the absorption area. Results showed that the target compounds were detectable for at least 30 h after drug administration. After suppository administration, prednisolone levels reached the maximum after 3h from drug administration and then dropped below the reporting level after 15-21 h; prednisone reached the maximum after 3h from drug administration, and then dropped below the reporting level after 12-15 h. After cream administration, both prednisone and prednisolone levels remained in a concentration below the reporting level throughout the entire monitored period.

Focal seizures during adrenocorticotropic hormone therapy in a school-aged boy: a case report

BackgroundAdrenocorticotropic hormone therapy for infantile spasms, including West syndrome, has been previously reported to induce seizures. We present the findings for a school-aged child with epilepsy who developed new focal seizures during adrenocorticotropic hormone therapy.Case presentationThe Japanese patient had posttraumatic epilepsy and developed intractable focal seizures at the age of 13 years. Adrenocorticotropic hormone therapy was administered when the patient was 14 years of age. On day 10 of treatment, he developed new focal seizures, which were characterized by left arm contractions followed by movements of touching things with his right hand and writhing and rocking his body left and right and back and forth as automatisms. The focal seizures clustered for 40 minutes and disappeared after suppository administration of 10 mg diazepam. These focal seizures did not reoccur after more than 2 years of follow-up.ConclusionAdrenocorticotropic hormone-induced seizures can occur in children older than previously reported, and can occur in children with intractable seizures other than epileptic spasms.

Оценка эффективности методов профилактики COVID-19 у беременных

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12; 95% CI 1.28–13.27; χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71; 95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α; Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08; 95% CI 0.05–0.14; 19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58; 95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women. Key words: pregnancy, COVID-19, incidence rate, vaccination, recombinant interferon alpha-2b, Grippferon, prevention

Down There – Pediatric Nurses, Constipation, and Rectal Interventions

BackgroundPediatric nurses care for hospitalized children with constipation on a daily basis. However, very little is reported in the literature about the experiences of pediatric nurses when providing care to hospitalized children who are constipated. A rarely discussed aspect of pediatric care is that of sensitive touch which is required during rectal interventions such as enema and suppository administration. The purpose of this qualitative study was to investigate the experiences of pediatric nurses regarding the identification & management of constipation in hospitalized children. A theme, “down there,” emerged from the larger study and revealed pediatric nurses' experiences with sensitive touch in hospitalized children with constipation. MethodsThis phenomenological investigation utilized in depth interviews with 21 pediatric nurses to explore their experiences of caring for hospitalized children with constipation. ResultsThe concept sensitive touch, a touch that is applied to an intimate area of the body, emerged as a theme from the interviews. There were several subthemes. Nurses discussed assessment as “I would not automatically do a rectal check;” and incorporated development as “an infant is totally different from a 5 or 6-year-old; developing a “trustful rapport” during interventions; ensuring “comfort and privacy” as strategies during rectal interventions; and performing a “dress rehearsal” when teaching orientees about rectal interventions. ConclusionsPediatric nurses describe a variety of experiences when using sensitive touch in children. Although there is high awareness of the need for comfort and privacy, pediatric nurses' hesitation to intervene using rectal maneuvers could contribute to ongoing constipation in hospitalized children.

Tramadol intoxication in infants: experience at a tertiary care hospital in Dhaka, Bangladesh

Background: Tramadol is a widely used opioid analgesic for different types of pain. Very few cases of acute tramadol intoxication in infants have been reported where respiratory and central nervous system depression are frequent. The aim of this study was to evaluate the clinical manifestation, treatment and outcome of tramadol intoxication in infants.
 Methods: This was a retrospective observational study of hospitalized infants in the Department of Neonatology and Paediatrics in BIRDEM General Hospital, Dhaka, Bangladesh from February 2014 to November 2019. Ten infants with history of administration of tramadol suppository were included in this study. Data regarding clinical features, cause of the “incident dose and route of administration” of tramadol, effects of naloxone and outcomes were recorded and analyzed.
 Results: Of 10 infants, 6 were male and 4 were female. The mean age was 5.1±3.0 months and the mean weight was 6.1±1.8 kg. The mean time of onset of symptoms after drug administration was 2.6±1.0 hours with a mean dose of 17.9±6.4 mg/kg body weight. The main clinical features were decreased level of consciousness (100%), seizure (80%), meiosis (80%) and apnoea (50%). In each 50% (5) of cases, tramadol was given erroneously instead of glycerine and paracetamol suppository. Among them 2 (20%) infants received tramadol suppository as an over-the-counter (OTC) drug. All infants were treated with naloxone without any side effect. In addition, three infants needed mechanical ventilation. The average duration of hospital stay was 89.3±47.4 hours. Nine infants were discharged and one (10%) died.
 Conclusions: Our study suggested that tramadol intoxication among infants is predominantly accidental. Early identification and prompt initiation of treatment are essential. The creation of public awareness about the safe storage of drugs at home and avoidance of OTC drugs can prevent tramadol intoxication in children.
 BIRDEM Med J 2021; 11(3): 197-201

Dynamics of cellular factors of innate immunity and antioxidant protection in the patients with chronic recurrent vulvovaginal candidosis upon exposure to cavitated physiological solution

Dysfunction of colonization resistance factors at the mucous membranes of genitourinary system during adhesion of Candida fungi is a common pathogenic situation leading to impairment of the mucous membrane regeneration, unsuccessful attempts at in vitro fertilization (IVF), increased risk of complications during gestation. The aim of present study was to substantiate the opportunity of complex therapy for chronic vulvovaginal candidiasis using cavitated saline and usage suppositories with alpha-2b human recombinant interferon a (Viferon LLC, Russia). The study involved 90 women at the age of25.45±7.16 years, with clinically and laboratory confirmed recurrencies of chronic vulvovaginal candidiasis observed, on average, 5.55±0.45 times. Group 1 consisted of 30 women with C. albicans infection of urogenital tract, at the mean age of 27.11±1.52 years, who received therapy with fluconazole (150 mg once every 7 days). Group 2 consisted of 30 women with C. albicans infection of mucous membranes, mean age 27.31±1.99 years, treated with Fluconazole (150 mg 1 time in 7 days, and 5-min. irrigation of vagina with ultrasonicated saline solution, 7 days; Low-intensity ultrasound exposure was performed using the Fotek AK100-25 hardware complex, ultrasonic vibration frequency of 25 kHz (Yekaterinburg, Russia). Group 3 consisted of 30 women whose treatment included Fluconazole (150 mg once every 6 days), irrigation of mucous membranes with ultrasonicated cavitated solution and subsequent administration of suppositories containing Viferon® 500,000 IU (1 suppository daily for 7 days). Biochemical studies included determination of isopropanol- and heptane-soluble primary, secondary end products of lipid peroxidation. Activity of the antioxidant system was studied by determination of superoxide dismutase, glutathione peroxidase, ceruloplasmin, vitamin C. Qualitative and quantitative characteristics of neutrophilic granulocytes from vaginal secretions were evaluated by testing phagocytic activity, reduction of nitroblue tetrazolium compound to diformazan. The studies of IL-8, TNFα, IL-2, and IL-10 cytokines were carried out in cell-free supernates of vaginal secretions by ELISA test systems (LLC “Vector Best”, Novosibirsk). Results: upon therapeutic exposure to low-frequency ultrasonic cavitation combined with antioxidant drug, we have observed a decreased local concentration of pro-inflammatory cytokines, the balance of lipid peroxidationantioxidant defense system was restored, and functional metabolic status of the phagocytes in vaginal secretions was normalized.

Comparison of the Incidence of Nausea and Vomiting in the Administration of Tramadol 100 mg Suppositories with Intravenous Post-Spinal Anesthesia for Lower Extremity Surgery

Pendahuluan : Post operative nausea vomiting (PONV) pasca pemberian tramadol Postoperative nausea vomiting (PONV) after intravenous administration of tramadol has a high incidence rate, so it needs alternative drug administration to overcome this problem. This study aims to compare the incidence of postoperative nausea and vomiting in the intravenous administration of tramadol suppositories. A double-blind analytical experimental study, involving 36 subjects divided into tramadol suppositories and intravenous tramadol post-extremity surgery with spinal anesthesia at Haji Adam Malik Hospital and Network Hospital in 2013. The incidence of PONV in tramadol suppository subjects was much lower than in intravenous tramadol subjects.

Relationship between serum progesterone levels at the day before progesterone suppository administration and pregnancy rate in embryo transfer cycles

Introduction: Given the importance of assisted reproductive therapies and achieving a pregnancy leading to live birth, as well as the importance of the used treatments and the various studies which have been performed so far, this study was performed with aim to evaluate the relationship between endometrial pattern and serum progesterone levels at the day before the onset of progesterone suppository in embryo transfer cycles in women referred to Infertility Center of Zahedan. Methods: This cross-sectional study was performed on 50 women who had undergone IVF for any reason and their embryos were frozen in infertility center of Zahedan University of Medical Sciences in 2019. The patients were treated with progesterone suppository 400 mg at morning and 400 mg at evening intra rectally. Demographic data, endometrial pattern and thickness ultrasound, serum progesterone level at the day before the onset of progesterone suppository and serum BHCG levels 14 days after embryo transfer were recorded. Data were analyzed by SPSS statistical software (version 24) and Chi-square and Mann-Whitney tests. P<0.05 was considered statistically significant. Results: IVF outcome was positive in 13 cases (26%). 23 patients (46%) had homogenous endometrial pattern and 27 (54%) had three-line pattern. Serum progesterone level were significantly lower in patients who had positive BHCG than patients who had negative BHCG (p <0.001). Conclusion: Among women undergoing IVF, serum progesterone levels and also endometrial pattern (homogenous or three-line) was different. Serum progesterone level before the onset of treatment was related to the pregnancy outcome (positive or negative), as well as in women with lower progesterone levels in day before the start of progesterone suppositories, treatment with progesterone suppository could lead to better pregnancy outcomes following IVF, which is a novel and important finding.

Opioid-Induced Constipation and Acupuncture: A Case Discussion

BackgroundUse of acupuncture for treatment of functional constipation is well studied; however, studies examining use of acupuncture for opioid-induced constipation are limited. Case DescriptionA 70-year-old woman with newly diagnosed multiple myeloma discovered after presentation to the emergency room with severe back pain. Pain management required use of opioids, escalating to effect. Hospital course was complicated by opioid-induced constipation causing abdominal pain, nausea, and ileus despite aggressive titration of stimulant and osmotic laxatives as well as administration of suppositories and enemas on multiple occasions. Prior to nasogastric tube placement for the ileus, the patient requested acupuncture treatment in attempt to relieve constipation. Shortly after acupuncture session, patient passed multiple stools with improvement in abdominal pain and nausea and avoidance of nasogastric tube. ConclusionAcupuncture for opioid-induced constipation may provide symptom relief through use of nonpharmacologic interventions; however, further studies are needed to determine the optimal therapeutic approach.

Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial.

The study aimed to compare the combination of femoral nerve block (FNB) with interspace between the popliteal artery and the capsule of posterior knee (IPACK) block (IPACK group) with the combination of FNB with lateral femoral cutaneous nerve (LFCN) block (LFCN group) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction. We hypothesized that the lower pain scores and decreased suppository use would be noted in patients administered a combination of FNB and IPACK block. A non-randomized prospective controlled clinical trial was conducted. The IPACK and LFCN groups included 40 patients each. The patients received IPACK block and LFCN block alternately. Thirty minutes prior to the surgery and after administration of general anesthesia, patients received an ultrasound-guided FNB and IPACK block or LFCN block. After ACL reconstruction, the visual analog scale pain scores were recorded at 30min, 4h, 8h, 12h, 24h, 48h, and 72h after the surgery. The administration and use of analgesic suppositories were assessed. These measures were compared among the treatment types at each time-point using the Welch's t-test. Suppository use was significantly less in the LFCN group than in the IPACK group. The pain scores were significantly lower in the LFCN group at 30min, 4h, 48h, and 72h after the surgery. The combination of FNB with LFCN block during ACL reconstruction significantly reduces pain in the early postoperative period compared to a combination of FNB with IPACK block. Prospective control trial, Level II.

Evaluation of the effect of excess and deficiency of serum hydrogen sulfide on the condition of the vaginal wall of intact rats

Various pathological conditions can be characterized not only by a decrease or increase in basal levels of hydrogen sulfide in the serum, but also the levels of hydrogen sulfide can modulate the course of the pathological process. The impact of serum hydrogen sulfide on the condition of the intact vaginal wall of rats was evaluated in this study. The aim of the study was to evaluate the effect of excess and deficiency of serum hydrogen sulfide on the condition of the vaginal wall of intact rats. The study was performed on 75 female Wistar rats under 1 year of age and weighing 160.0 to 200.0 grams. All animals were divided into 6 groups: control (intact rats); experimental 1 (H2S excess); experimental 2 (H2S deficiency); experimental 3 (intravaginal administration of suppositories with clindamycin); experimental 4 (H2S excess + suppositories with clindamycin); experimental 5 (H2S deficiency + suppositories with clindamycin). The levels of serum hydrogen sulfide were studied, as well as microscopic examination of the structure of the vaginal wall and determination of the levels of TNF-α and IL-1β in tissue homogenate were performed. In experimental groups 3, 4 and 5 all studies were performed in dynamics – 10 minutes, 4, 8 and 24 hours after a single intravaginal administration of clindamycin phosphate. The data were processed using the statistical software package SPSS 20.0 for Windows. Under conditions of both hydrogen sulfide deficiency and excess, no statistically significant changes in TNF-α and IL-1β levels in the vaginal wall of intact rats were observed. Also, no changes in the histological structure of the wall were found. Similar data were demonstrated in experimental groups 3, 4 and 5. This picture is explained by the fact that hydrogen sulfide affects various parts of the inflammatory process, while reducing the production of inflammatory mediators. In intact tissues, in the absence of an inflammatory process, there is no point of application of hydrogen sulfide, and therefore no significant changes are observed. Thus, both excess and deficiency of serum hydrogen sulfide do not affect the condition of the vaginal wall of intact rats.

Tramadol suppository poisoning in children of Bangladesh

Background: Tramadol is an analgesic agent utilized in the treatment of different types of pain. Recently it was found that a few cases of tramadol poisoning were observed in hospitalized children. In all cases, it happened due to accidental administration of tramadol suppository.&#x0D; Objective: The aim of this study was to determine the clinical manifestations of tramadol suppository poisoning in children and to create public awareness about the prevention of this suppository poisoning.&#x0D; Materials &amp; Methods: This was an observational, retrospective, single-center caseseries study of hospitalized children in Dhaka Shishu Hospital during the periods of July 2016 to March 2017. Eleven patients with history of accidental intake of tramadol suppositories were enrolled in this study. Data regarding risk factors and clinical features were recorded and analyzed.&#x0D; Results: In this study, 7/11(64%) cases were male and 4/11(36%) female. Mean age was 7.8 month and mean duration of hospital stay was 46.4 hours. Parecetamol in 2/11 (18%) cases and glycerin suppository in 9/11(82%) cases were main drugs that were supposed to be introduced instead of tramadol. Keeping drugs in same containers (11/11), similarities of suppository’s size, shape and color (11/11) were found as causes of mistakes in this study. Main clinical features were drowsiness in 4/11(36%) cases, tachycardia in 3/11(27%) cases and one case died.&#x0D; Conclusions: More cautiousness of parents, dissimilarity among different suppository in color size, shape and using of different containers of drugs may be the preventive way of this poisoning.&#x0D; Bangladesh J Child Health 2019; VOL 43 (3) :157-160

Emergency treatment of adrenal crisis with prednisone suppositories: a bioequivalence study in female patients with Addison's disease.

ObjectivePatients with adrenal insufficiency (AI) need to adapt their glucocorticoid replacement under stressful conditions to prevent adrenal crisis (AC). Prednisone (PN) suppositories are used for emergency treatment. Pharmacokinetics of 100 mg PN suppositories after vaginal or rectal administration was evaluated.DesignSingle-center, open-label, sequence-randomized, cross-over, bioequivalence study.MethodsTwelve females with primary AI were included. Comparison of pharmacokinetics after vaginal and rectal administration of 100 mg PN suppositories. Main outcome measures: bioequivalence (Cmax: maximum plasma concentration of prednisolone; AUC0 –360: area under the plasma concentration curve of prednisolone from administration to 360 min), adrenocorticotropin (ACTH) levels, safety and tolerability. Comparison of ACTH-suppressive effect with subcutaneous and intramuscular administration of 100 mg hydrocortisone.ResultsVaginal administration of PN suppositories was not bioequivalent to rectal administration: Cmax and AUC0–360 were significantly lower after vaginal compared to rectal administration: 22 ng/mL (109%) vs 161 ng/mL (28%), P < 0.001; 4390 ng/mL * min (116%) vs 40,302 ng/mL * min (26%), P < 0.001; (mean (coefficient of variation), respectively). A suppression of ACTH by >50% of baseline values was observed 149 min (32%) after rectal PN administration; after vaginal PN administration, the maximum decrease within 360 min was only 44%. Adverse events were more frequent after vaginal administration and mainly attributable to the glucocorticoid deficit due to inadequate vaginal absorption. The ACTH-suppressive effect was more pronounced after parenteral hydrocortisone compared to rectal or vaginal PN.ConclusionVaginal administration of PN suppositories in the available form is not useful for prevention of AC. Pharmacokinetics after rectal use of PN show inferiority compared to available data on parenteral glucocorticoids. In adrenal emergencies, hydrocortisone injection should be the first choice.

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway

This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy hospital length of stay to 5 days without increasing complication or readmission rates. Pancreaticoduodenectomy patients (high-risk patients excluded) were enrolled in an IRB-approved, prospective, randomized controlled trial (NCT02517268) comparing a 5-day Whipple accelerated recovery pathway (WARP) with our traditional 7-day pathway (control). Whipple accelerated recovery pathway interventions included early discharge planning, shortened ICU stay, modified postoperative dietary and drain management algorithm, rigorous physical therapy with in-hospital gym visit, standardized rectal suppository administration, and close telehealth follow-up post discharge. The trial was powered to detect an increase in postoperative day 5 discharge from 10% to 30% (80% power, α= 0.05, 2-sided Fisher's exact test, target accrual: 142 patients). Seventy-six patients (37 WARP, 39 control) were randomized from June 2015 to September 2017. A planned interim analysis was conducted at 50% trial accrual resulting in mandatory early stoppage, as the predefined efficacy end point was met. Demographic variables between groups were similar. The WARP significantly increased the number of patients discharged to home by postoperative day 5 compared with controls (75.7% vs 12.8%; p < 0.001) without increasing readmission rates (8.1% vs 10.3%; p= 1.0). Overall complication rates did not differ between groups (29.7% vs 43.6%; p= 0.24), but the WARP significantly reduced the time from operation to adjuvant therapy initiation (51 days vs 66 days; p= 0.005) and hospital cost ($26,563 vs $31,845; p= 0.011). The WARP can safely reduce hospital length of stay, time to adjuvant therapy, and cost in selected pancreaticoduodenectomy patients without increasing readmission risk.