Different Modes Of Administration Research Articles

CHARAKOKTA SNEHOPAGA MAHAKASHAYA AND ITS UTILITY IN CLINICAL PRACTICE: AN ANALYTICAL REVIEW

Panchakarma therapy detoxifies cells and body tissues, is beneficial in health and diseases and is a part of daily and seasonal regimens. Before subjecting a patient to Panchakarma, Snehana and Swedana are essential. Snehana and Swedana are also curative methods in certain diseases and prolong vitality and life. The human being is considered the essence of Sneha. It is also believed that the Prana or life is dependent on this Sneha Tattva in our body. Snehana, or Oleation Therapy, is an essential treatment procedure that prepares the body to receive specialised Panchakarma treatment. The fourth chapter of Charaka Samhita Sutra Sthana (Shadvirechanashatashritiya Adhyaya) details fifty Mahakashaya used in various diseases for external or external or internal use according to the need. Snehopaga is a group of drugs that help promote unctuousness or aid the oleation therapy. This work is intended to throw limelight on the Ayurvedic and pharmacological properties of Snehopaga Mahakashaya and its possible clinical use in different modes of administration.

Model-based meta-analysis of salbutamol pharmacokinetics and practical implications for doping control.

Salbutamol was included in the prohibited list of the World Anti‐Doping Agency (WADA) in 2004. Although systemic intake is banned, inhalation for asthma is permitted but with dosage restrictions. The WADA established a urinary concentration threshold to distinguish accordingly prohibited systemic self‐administration from therapeutic prescription by inhalation. This study aimed at evaluating the ability of the WADA threshold to differentiate salbutamol therapeutic use from violation of antidoping rules. Concentration‐time profile of salbutamol in plasma and its excretion in urine was characterized through a model‐based meta‐analysis of individual and aggregate data collected after administration of a large range of doses following different modes of administration and under a variety of conditions. The developed model adequately fitted salbutamol plasma and urine concentration‐time profiles of the 13 selected studies. Model‐based simulations confirmed that a wide range of salbutamol urine concentrations might be measured after drug intake. Although violation of the WADA Code can be strongly suspected in individuals showing very high salbutamol urine concentrations, uncertainty remains for values close to the WADA threshold as they can be compatible with both permitted therapeutic use and violation. Although not entirely discriminant, the current WADA rule is globally supported by our appraisal. It could be further improved by a slight and reasonable adjustment of inhaled daily dosages allowed for therapeutic use. Our model might help antidoping experts in the evaluation of suspected doping cases through confronting the athlete's urine measurements with their allegations about salbutamol treatment.

Validation and Normative Data of the Spanish Version of the Rey Auditory Verbal Learning Test and Associated Long-Term Forgetting Measures in Middle-Aged Adults

Rey Auditory Verbal Learning Test (RAVLT) is an episodic memory helpful measure to detect changes associated with abnormal aging. There is a lack of RAVLT validation and normalization studies in Spain. The aim was to determine its psychometric properties and explore long-term forgetting (LTF) performance through 1-week delayed recall under three different modes of administration. The RAVLT was administered to 602 cognitively healthy volunteers, aged between 41 and 65 years, of whom 251 completed the LTF assessment. Findings reveal a factorial structure of four components, with satisfactory goodness of fit, and adequate convergent and divergent validity. We also demonstrated the differential effect of three methodologies used in LTF assessment, supporting that test expectancy positively influences long-term storage. Finally, normative data were generated according to age, sex, and education. The test, including the LTF measure, is a promising tool to estimate memory in middle-aged adults and develop predictive brain aging models.

Associations of mode of administration on cannabis consumption and subjective intoxication in daily life.

As cannabis products are becoming increasingly available and young adults are increasingly using vaporizers to consume cannabis, there is a need to understand how this population is using different modes of administration and the extent to which specific modes are associated with differential cannabis use outcomes. Toward this end, the current study characterized predictors of cannabis mode of administration and examined how consumption levels and subjective intoxication vary as a function of mode of administration in daily life. Participants were 106 young adult cannabis and heavy alcohol users (51% female) who completed up to 14 daily diaries (n = 1,405 person days). Each day, participants reported whether they used any cannabis and, if any, which mode(s) were used, number of hits used per mode, overall subjective intoxication, and the socio-environmental context in which they used cannabis. Across all cannabis use days, Bong-Only and Vape-Only days were the most common, followed by Multimode, Joint-, Pipe-, and Blunt-Only days. Participants reporting a greater proportion of cannabis use days were more likely to report Bong-Only and Multimode days than Vape-Only days. Compared to Vape-Only days, participants reported fewer hits on Bong-Only days and more hits on Blunt-Only, Pipe-Only, and Multimode days. Participants felt more intoxicated on Bong-Only days than Vape-Only days. Mode-specific associations with cannabis consumption and subjective intoxication levels suggest assessing modes of administration may be a meaningful way to guide individual and public health intervention efforts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany.

Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods.

The importance of terminal complement inhibition in paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, chronic hematologic disorder associated with inappropriate terminal complement activity on blood cells that can result in intravascular hemolysis (IVH), thromboembolic events (TEs), and organ damage. Untreated individuals with PNH have an increased risk of morbidity and mortality. Patients with PNH experiencing IVH often present with an elevated lactate dehydrogenase (LDH; ⩾ 1.5 × the upper limit of normal) level which is associated with a significantly higher risk of TEs, one of the leading causes of death in PNH. LDH is therefore used as a biomarker for IVH in PNH. The main objective of PNH treatment should therefore be prevention of morbidity and mortality due to terminal complement activation, with the aim of improving patient outcomes. Approval of the first terminal complement inhibitor, eculizumab, greatly changed the treatment landscape of PNH by giving patients an effective therapy and demonstrated the critical role of terminal complement and the possibility of modulating it therapeutically. The current mainstays of treatment for PNH are the terminal complement component 5 (C5) inhibitors, eculizumab and ravulizumab, which have shown efficacy in controlling terminal complement-mediated IVH, reducing TEs and organ damage, and improving health-related quality of life in patients with PNH since their approval by the United States Food and Drug Administration in 2007 and 2018, respectively. Moreover, the use of eculizumab has been shown to reduce mortality due to PNH. More recently, interest has arisen in developing additional complement inhibitors with different modes of administration and therapeutics targeting other components of the complement cascade. This review focuses on the pathophysiology of clinical complications in PNH and explores why sustained inhibition of terminal complement activity through the use of complement inhibitors is essential for the management of patients with this chronic and debilitating disease.

Methotrexate(MTX) Induced Leukoencephalopathy(LE) and Relation of Vitamin B12, Folate and / or Homocysteine Levels with MTX Toxicity: A Prospective Study

▪Background: MTX-induced neurotoxicity is often associated with leukoencephalopathy, and the diagnostic radiological feature in magnetic resonance imaging (MRI) is white matter hyper intensities. The clinical significance of these white matter changes is unknown. The risk factors of MTX-induced acute leukoencephalopathy are not well established. Few authors have suggested increased homocysteine or alteration of Central Nervous System (CNS) folate, vitamin b12 homeostasis may be associated with CNS toxicity. It is a usual clinical practice to withhold methotrexate during further duration of chemotherapy after an episode of leukoencephalopathy but the risk of neurotoxicity must be weighed against the risk of relapse of leukemia. Moreover, there is limited data on continued treatment with High-dose methotrexate (HD-MTX) or Intrathecal Methotrexate (IT-MTX) or Oral-MTX in patients who developed leukoencephalopathy.Objective: The study aims to 1) identify the risk and prevalence of leukoencephalopathy in patients of Acute Lymphoblastic Leukemia (ALL) receiving intrathecal or high dose or oral methotrexate therapy through sequential MRI Brain study. 2) Safety of re-administration of methotrexate in patients with documented toxic leukoencephalopathy 3) The relationship of serum homocysteine, vitamin b12 and folate levels with methotrexate induced leukoencephalopathyMethods: Our study enrolled 34 newly diagnosed pediatric ALL / Lymphoblastic Lymphoma (LBL) patients (age ≤18 years) between June 2019 & June 2020. Induction chemotherapy was initiated as per modified ALL IC BFM 2002 protocol after obtaining informed consent. Apart from the Hematological investigations, Bone Marrow Aspiration and Biopsy, Flow Cytometry/Immunohistochemistry (IHC), Cytogenetics, Molecular study were done. All the patients underwent MRI Brain and Serum homocysteine, Vitamin B12, Folate level measurement (sequentially as per protocol at 4 different time points). 1st time point - AT DIAGNOSIS, i.e. before starting methotrexate, 2nd time point - POST CONSOLIDATION, 3rd time point - POST EXTRACOMPARTMENT THERAPY, 4th time point - IN MAINTENANCE, thus analyzing leukoencephalopathy secondary to different modes of administration of methotrexate therapy. At all-time points serum folate, vitamin b12 or homocysteine level were done before administering methotrexate and any association with development of leukoencephalopathy was analyzed.Results: We identified Leukoencephalopathy secondary to methotrexate in 6.03% (7/116) on MRI brain in 5 of 33 (15.15%) patients of which 1 (3.03%) had symptomatic LE and 4 (12.12%) were clinically asymptomatic. All our LE patients were in the age group more than or equal to 10 years. We found no increase in the incidence of leukoencephalopathy secondary to methotrexate: leucovorin ratio, also there was no difference in the incidence with respect to mode of administration of MTX (IT/HD/ORAL), even there was no increase in incidence after 4 courses of high dose methotrexate. MRI at baseline was not a predictor of development of leukoencephalopathy. 3 out of 5 patients with LE had abnormal b12/folate/homocysteine with corresponding abnormal MRI Brain at pre-specified time point. Also 4 patients with abnormal b12/folate/homocysteine levels had intractable cytopenias while on chemotherapy and more after HD MTX therapy which got corrected after supplementation with vitamin b12 and folic acid.Conclusion: MTX-induced clinical leukoencephalopathy is transient, and most patients can be re-challenged with subsequent MTX without recurrence of acute or subacute symptoms. MRI at baseline was not a predictor of development of leukoencephalopathy. More multi institutional prospective studies of large number of patients are needed to study the incidence of MTX-induced leukoencephalopathy and its relation with folic acid, vitamin b12 and homocysteine level. DisclosuresNo relevant conflicts of interest to declare.

Effects of biologically active substances from brown algae on the resistance of erythrocyte membranes

A study of different modes of administration of bioactive substances (BAS) of algae F. vesiculosus and S. latissima to laboratory animals allowed the authors to establish the doses and duration of administration, at which the complexes under study show moderate cytoprotective activity (15 and 30 mg/kg for S. latissima, 60 and 120 mg/kg for F. vesiculosus; three-day administration). It was found that the complex of BAS F. vesiculosus is characterized by a higher activity with respect to erythrocyte osmotic resistance compared to the complex of BAS S. latissima. At the same time, the complex of BAS laminaria is characterized by a higher activity with respect to erythrocyte peroxide resistance. The above features emphasize the feasibility of combined use of these extracts. At three-day combined administration of complexes of BAS F. vesiculosus and S. latissima at doses of 60 and 15 mg/kg, respectively, their high membrane-protective and antioxidant activity was determined. However, a higher dose or longer administration of the BAS complexes negatively affects the resistance of erythrocyte membranes.

Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder.

Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder.

Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty.

IntroductionDexmedetomidine (DEX) as a nerve block adjuvant can significantly prolong analgesia. However, whether perineural or systemic administration of DEX is more beneficial in patients undergoing total knee arthroplasty (TKA) has not been thoroughly investigated. To this end, we evaluated the effects of perineural and systemic DEX administration on postoperative analgesia in patients undergoing TKA surgery.MethodsWe randomly assigned patients undergoing TKA under general anesthesia combined with femoral nerve block and sciatic nerve block to one of three groups: (1) ropivacaine plus perineural dexmedetomidine (DP): 0.25% ropivacaine 40 mL plus 0.5 μg/kg dexmedetomidine; (2) ropivacaine plus systemic dexmedetomidine (DS): 0.25% ropivacaine 40 mL plus systemic 0.5 μg/kg dexmedetomidine; (3) control group (C): 0.25% ropivacaine 40 mL.ResultsThe average length of time until patients first experienced postoperative pain was significantly longer in the DP group (26.0 h [22.0–30.0 h]) than in the DS group (22.4 h [18–26.8 h]) and the control group (22.9 h [19.5–26.3 h], P = 0.001). For this result there was no significant difference between the DS and the control group. Compared with the DS and control groups, patients in the DP group had lower resting visual analogue scale (VAS) scores at 24, 48, and 72 h after surgery (P < 0.05). VAS activity scores at 12, 24, and 48 h after surgery in the DP group were lower than those in the DS and control groups, with a statistically significant difference (P < 0.05). Compared with the DS and control groups, the amount of postoperative opioids in the DP group was also significantly reduced, and the number of people needing postoperative rescue analgesia was significantly lower, with a statistical difference (P < 0.05). Meanwhile, the sleep satisfaction of patients in the DP group on the first night after surgery and the satisfaction with pain control at 72 h after surgery were both higher than those in the DS group and control group (P < 0.05).ConclusionsPerineural administration of DEX can significantly prolong the interval until patients report pain for the first time after TKA, relieve postoperative pain, reduce postoperative opioid dosage, and improve postoperative sleep quality and satisfaction with pain control.Trial RegistrationThe trial was registered at the Chinese Clinical Trial Registry, identifier ChiCTR1900025808.

Comparative study of intravenous diuretics therapy-bolus versus infusion regimen in acute decompensated heart failure

Background: Heart failure (HF) is a growing problem worldwide; more than 20 million people around the world are affected. The objective of the study was to compare the effect of different modes of administration of intravenous diuretic –bolus versus infusion, in acute decompensated heart failure in relation to diuresis and electrolyte balance.Methods: This prospective study was conducted in Darbhanga Medical College and hospital, Laheria sarai between October 2014 to November 2016. Patients of acute decompensated heart failure attending medical emergency ward and Intensive care unit of medicine department of Darbhanga Medical College and hospital, Laheria sarai were selected and grouped randomly as per inclusion and exclusion criteria.Results: The main findings of our study were greater diuresis in the first 24 h of admission with bolus dose. No difference in serum sodium or serum potassium levels between the groups.Conclusions: All three modes of diuretic therapies can be practiced with no difference in worsening of electrolyte levels. Bolus dose administration with its rapid volume loss might be a more effective diuretic strategy in our country with limited health resources.

Dhoopana-A Concept of Fumigation in Ayurveda

Concept of disinfection or fumigation is very important as every host has not optimum level of immunity to defence himself against pathogens causing diseases and so it is commonly practised in many developed nations to prevent transmission of viral diseases which are airborne in nature such as COVID -19. However various review of modern fumigating physical &amp; chemical agents e.g. Formalin which are expensive, having crumblesome technique &amp; toxic nature are generally used for this purpose.Therefore, current situation of COVID pandemic demands for the replacement in Ayurveda e.g. Dhoopana Karma for such techniques.As it is cost effective, safe, convenient, effective, and lucrative method of sterilizaion. Main aim of this paper is to compile all scattered information regarding Dhoopana Karma from different Ayurvedic sculptures. All information of these karma which is in dispursed form is complied &amp; described under different heads such as history pf Dhoopana Karma, synonyms, classification, indications (general &amp; specific), various drugs useful for Dhoopana, their period for collection, different formulations for Dhoopana, instruments for Dhoopana, different modes of administration / procedure, method of storing and preservation of Dhoopana Dravya &amp; duration of procedure in descriptive manner &amp; tabular form. Extensive review related with Dhoopana Karma shows that that Dhoopan Karma which is a most common method of sterilization described in an ayurveda &amp; it is categorised under topical (Bahiparimarjana) treatment.Broad spectrum utility of these different formulations of Dhoopana suggests demands for researches in future to study their various pharmacological properties &amp; actions such as bacteriostatic or bactericidal, wormicidal, anti-inflammatory ,antiseptic, antimicrobial, antifungal, antiviral, insecticidal anti –pyretic. Suchpe of vivid research may become helpful to prevent the need for medical intervention in entities such as COVID-19. On the basis of this review, it can be concluded that Dhoopana Karma can be used as a type of fumigation for massive &amp; local sterilization in current dreadful outbreak of COVID-19.

The Physiological Effects, Including Risks and Potential Benefits, of Cannabis for Patients Undergoing Elective Orthopedic Procedures.

Given the evolving regulations regarding and availability of cannabis in the United States, physicians should understand the risks and benefits associated with its use. Patients are interested in learning about the use of cannabis for the management of orthopedic pain and any potential risks associated with it when undergoing elective surgery. Edible and topical cannabis products appear to have fewer side effects than inhaled cannabis products. A review of the literature was performed regarding different modes of administration and their related risks and potential benefits specifically regarding perioperative concerns for elective orthopedic procedures. Larger studies are necessary to further determine the efficacy, safety, and side effect profile of cannabis. [Orthopedics. 2021;44(3):e314-e319.].

Ethnobotanicals and commercial trends of herbal markets in Punjab, Pakistan

The objective of the present study was to evaluate commercially important herbal medicinal plant products present in herbal markets of the province of Punjab, Pakistan. Herbal medicine is undoubtedly a reliable alternative approach to healthcare delivery in this metropolis because it is economical, accessible and efficacious. Ethnobotanical information was collected from approximately 300 informants including certified and uncertified herbalists. The sample size was determined by statistical formulation. The informative data was based on semi structured interviews, group discussions, questionnaires and field visits. The data were analyzed by different quantitative indices, such as informant consent factor (ICF) and frequency of citation (FC). Availability of almost 96 plants belonging to 51 families was reported in commercial markets. The most frequently traded plant species were from the family Fabaceae (11 species). Herbs (30.20 %) are sold more frequently than shrubs and trees. Leaves (22.11 %) and seeds (17.58 %) are being commonly sold in herbal markets as traditional medicines. The mode of administration for the majority of medicinal plants was through extraction (25.57 %) and paste. Almost 12 species were found with different modes of administration as mentioned previously in the literature. Ten species were uncovered for new medicinal uses. Generally, herbal medicines were acquired from dried plant material, and their price per kg of plant species varied from Rs 20/- to 2000/- PKR. The species reported with the highest price was Buchanania lanzan Spreng, and the species with the lowest price was Prosopis juliflora (Sw.) DC). Papar Mandi (Lahore) is the largest trade center of herbal medicine in Punjab. Different symptoms of diseases and their traditional diagnostic methods were also explored.

PNS219 National and Regional Representativeness of the National Health and Wellness Survey Compared to the Behavioral Risk Factor Surveillance System

National health surveys provide insight into population health behaviors and outcomes. To ensure generalizability of findings, surveys are often weighted against reputable sources such as the US Census Bureau (USCB). The purpose of this study is to determine national and regional representativeness of the National Health and Wellness Survey (NHWS) compared to the Behavioral Risk Factor Surveillance System (BRFSS). Data were obtained from 2018 NHWS (n=74,977) and 2018 BRFSS (n=429,836). NHWS is a self-administered, web-based survey of a representative sample of US adults aged 18+, weighted against age, sex, ethnicity, and education (USCB Current Population Survey 2017). BRFSS is a telephone-based survey of noninstitutionalized US adults, weighted against age, sex, race/ethnicity (Claritas, LLC), education, marital status, home-owner/renter-ship (USCB American Community Survey), and telephone wireless percentages (National Center for Health Statistics). National and Regional (Northeast, Midwest, South, West) weighted prevalence estimates were calculated for sex, age, race/ethnicity, education, employment, income, body mass index (BMI), smoking, and exercise status. Significance testing was performed on weighted estimates for continuous (student’s t-test) and categorical (chi-squared test) variables. Most national and regional demographic variables and prevalence estimates differed by <2% between surveys. The following variables were not significantly different: sex (female: 51.8% (NHWS), 51.3% (BRFSS); p=0.0967), Midwestern smoking status (smoker: 17.7% (NHWS), 17.4% (BRFSS); p=0.4981), Southern BMI (28.4±0.053 (NHWS), 28.5±0.041 (BRFSS); p=0.3272), Southern smoking status (smoker: 16.1% (NHWS), 15.9% (BRFSS); p=0.4638), Western sex (female: 49.6% (NHWS), 50.6% (BRFSS); p=0.0944), and Western BMI (27.5±0.067 (NHWS), 27.5±0.043 (BRFSS); p=0.6241). Despite applying weighting estimates from different sources and having different modes of administration (online versus telephone), prevalence estimates were comparable between NHWS and BRFSS. Thus, NHWS is nationally and regionally representative for population demographics and health behaviors. Comparison of prevalence estimates for self-reported physician-diagnoses and healthcare resource utilization will be explored in follow-up analyses.

The ethicolegal framework relevant to human faecal microbiota transplants in South Africa: Part 2. Human stool as tissue?

Faecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infection. The purpose of this article, the second of a series of three articles, is to explore the legal framework governing human FMT in South Africa (SA). FMT involves different modes of administration that require different regulatory considerations. The focus of this article is to explore the legal classification of human stool as tissue in terms of the National Health Act 61 of 2003, as well as the regulation of human stool banks as tissue banks. The article concludes with specific recommendations aimed at improving the current regulatory vacuum relating to the regulation of FMT in SA.

Insights into the choice between intravenous infusion and subcutaneous injection: physician and patient characteristics driving treatment in SLE

Introduction/objectivesMultiple modes of administration are available for systemic lupus erythematosus (SLE) treatments. This study examined patient and physician characteristics associated with the choice of weekly subcutaneous (SC) injection or monthly intravenous (IV) infusion for an unspecified SLE treatment.MethodsThis was a cross-sectional, US web-based survey using a direct elicitation, stated-preference methodology (HO-16-16706). Two hundred patients and 200 physicians were asked to choose between IV or SC administration in a hypothetical scenario. Pairwise and multivariate analyses estimated the odds ratio (OR) for the likelihood of choosing SC over IV for respondent characteristics.ResultsAmong patients, taking non-steroidal anti-inflammatory drugs increased the likelihood of choosing SC injection (OR 3.884), whilst having SLE-related skin problems, a fear of needles or self-injection, and never needing help around the house decreased the likelihood (OR 0.28, 0.13, 0.12, respectively; all p ≤ 0.05). Among physicians, > 95% recommended SC injection for patients who live or work far from an infusion center, prefer SC administration, and never or rarely miss medication doses. Physician characteristics including age and treatment practice also influenced choice.ConclusionsPatient and physician characteristics influence choice of SC versus IV therapy for SLE. These findings might inform shared decision-making, which could lead to improved patient outcomes.Key Points• Data regarding patient and physician preference for different modes of administration of SLE therapy are sparse.• This cross-sectional, US web-based study showed that patient and physician characteristics influence choice of SC versus IV therapy for SLE.• A degree of disconnect exists between how factors influence patients’ choice and how those characteristics influence physicians’ choice of SLE treatment mode of administration.• The findings from this study might inform shared decision-making, which could improve alignment between treatment choice and patient preferences, treatment satisfaction, adherence, and improved patient outcomes.

Standard tetrahydrocannabinol units: an idea whose time has come.

The increasing diversity of cannabis products represents a challenge for measuring and reporting potency. Freeman & Lorenzetti's proposal for a standard tetrahydrocannabinol (THC) unit has considerable potential as a tool for reporting potency with respect to market surveillance and sales data, as well as in research studies. Although no standard unit can fully capture the qualitative differences across modes of administration, a 5-mg THC unit represents an appropriate threshold for communicating the potency of cannabis products. This commentary discusses a proposal from Freeman & Lorenzetti on the use of standard units of tetrahydrocannabinol (THC) for cannabis products [1]. With the advent of legal cannabis markets, regulatory authorities and the industry have a shared responsibility to ensure that consumers have adequate information regarding the potency and appropriate dose of products [2]. Effective consumer guidance is particularly important, given the proliferation of cannabis products and the wide range of tetrahydrocannabinol (THC) levels, which range from less than 1% to more than 90% [3]. Within this context, there is a need to standardize how cannabis potency is reported. Freeman & Lorenzetti propose a ‘standard THC unit’ of 5 mg of THC for all cannabis products. The authors point to the use of standard alcohol units as a framework; however, the nicotine market provides a more appropriate reference point given the diverse modes of administration for both cannabis and nicotine products, which include transdermal, oral ingestion, vaporized aerosol and smoke inhalation. A key question raised by Freeman & Lorenzetti is whether a 5-mg THC unit has the same meaning among these modes of administration, given inherently different pharmacological effects. Ultimately, there may be no way of reconciling these differences within a standard quantitative unit: modes of cannabis use differ not only with respect to the onset and duration of ‘peak’ THC effects, but also in the qualitative effects of THC. Nevertheless, even an imperfect standard unit would represent a considerable improvement on the status quo, in which consumers typically depend upon word of mouth and references to cannabis ‘strains’, which are unreliable indicators of cannabis potency [4, 5]. Standard THC units have the potential to serve as a common metric for reporting market-based data among different product categories, such as sales volumes and prices paid per unit. Standard THC units could also be integrated into product labelling as a consumer information tool. Currently, few consumers understand the THC numbers that serve as the basis of potency labelling in legal cannabis markets, in part because THC numbers are communicated using different units among different products, including dried herb, oils and edibles [1]. Although these practices are technically sound, consumers have little idea of how to interpret and apply these numbers to guide consumption levels. Alternatively, regulators could label the number of standard THC units in a particular product, such as a joint, edible or unit of oil, which is likely to be more intuitive for consumers [6]. Standard units could also enhance the way cannabis consumption is reported in epidemiological and clinical studies, most of which rely upon crude measures of frequency of use, without an established means of comparing different modes of administration. Freeman & Lorenzetti pose the question of whether 5 mg is the appropriate threshold for a standard THC unit. As the authors note, there are regulatory precedents in several US states for using 5 mg of THC as a standard ‘serving size’ for cannabis edibles, while other states and Canada use 10 mg of THC as a standard unit for serving size and packaging regulations. There is a compelling argument for a standard THC unit to be at, or below, the point of intoxication for most consumers [2]. For example, the amount of alcohol in a ‘standard drink’ is below the level that would induce intoxication or impairment for most consumers. A standard of 5 mg rather than 10 mg THC is more consistent with this principle and allows consumers to ‘titrate’ up to their desired level of consumption. Overall, Freeman & Lorenzetti's proposal for a standard THC unit has considerable merit and represents an opportunity to harmonize the ways in which cannabis potency is reported across the increasing number of jurisdictions with legal cannabis markets None.

Surfactant replacement therapy: from biological basis to current clinical practice.

This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology.

Controversial Topics in Total Knee Arthroplasty: A Five-Year Update (Part 2).

Background:This review article examines updates to the literature during the past 5 years on numerous topics which were felt to have ongoing controversy. These topics include venous thromboprophylaxis, tranexamic acid usage, tourniquet usage, and wound closure techniques.Methods:For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials.Results:Tranexamic acid is a safe and effective treatment modality, and consideration should be given to use multiple doses and combine different modes of administration. Certain treatment modalities (skin sutures, limited or no tourniquet usage) can cause greater patient satisfaction at a cost of longer operating times. Postoperative anticoagulation is still a very controversial topic. There is however some evidence suggesting prolonging anticoagulation to 35 days postoperative.Conclusions:By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.