Prophylactic Drugs Research Articles

Cyproheptadine Treatment in Children and Adolescents with Migraine: A Retrospective Study in Japan

Objective: Evidence on prophylactic drugs for pediatric migraine is limited, especially when comorbid conditions contribute to treatment resistance. This study evaluated the efficacy of cyproheptadine in children with migraine and explored the impact of comorbid neurodevelopmental disorders and orthostatic intolerance (OI). Methods: We retrospectively analyzed pediatric migraine patients treated with cyproheptadine. Efficacy was assessed based on the reduction in headache frequency, with responders defined as patients experiencing at least a 50% reduction in headache episodes. Fisher’s exact test analyzed the relationship between efficacy and comorbid conditions or treatment sequence. Multiple logistic regression was performed to identify factors associated with adverse events. Results: In total, 155 children (71 males, 84 females) aged 3–15 years were included. Comorbid neurodevelopmental disorders and OI were present in 27 (17.4%) and 22 (14.2%) patients, respectively. Efficacy was evaluated in 148 patients, with 68.9% classified as responders. Patients with comorbid conditions showed lower efficacy. Responders required a lower dose of cyproheptadine (p = 0.039). Multiple logistic regression identified headache frequency, cyproheptadine dose, and comorbid OI and neurodevelopmental disorders as factors influencing treatment efficacy. Conclusions: Cyproheptadine is effective in treating pediatric migraine, though patients with neurodevelopmental disorders and OI demonstrated reduced efficacy.

Preventive and therapeutic effects of ephedrine alkaloids-free Ephedra Herb extract on paclitaxel-induced neuropathic pain.

Currently, there are no effective prophylactic or therapeutic drugs for the treatment of paclitaxel (PTX)-induced peripheral neuropathic pain (PTX-PNP), highlighting the urgent need for the development of effective prophylactic and therapeutic drugs. In this study, we initially compared the efficacy of Ephedra Herb extract (EHE) with that of ephedrine alkaloids-free Ephedra Herb extract (EFE), which lacked ephedrine alkaloids (EAs)-associated side effects, against the onset of PTX-induced mechanical allodynia, thermal hyperalgesia, and cold allodynia in mice. EHE and EFE demonstrated comparable preventive effects on the PTX-PNP in a dose-dependent manner. These results indicated that the preventive properties of EHE were independent of the EAs. Since elderly people are overwhelmingly more susceptible to developing cancer, we considered that EFE has greater benefits than EHE, so we conducted a study focused on the effects of EFE. EFE showed dose-dependent preventive effects on the onset of PTX-PNP. As a result of detailed investigation, coadministration of PTX and EFE (Co-EFE) was more effective than preadministration of EFE alone (Pre-EFE). And the effects of Co-EFE was same with the effect of preadministrationof EFE and then coadministration of PTX and EFE (P&C-EFE). Additionally, Co-EFE after the onset of PTX-PNP improved PTX-induced mechanical allodynia, thermal hyperalgesia, and cold allodynia, confirming the therapeutic efficacy of EFE on PTX-PNP. In contrast, goshajinkigan, a Kampo medicine, and diclofenac, a non-steroidal anti-inflammatory drug, showed minimal therapeutic effects on PTX-PNP. These findings demonstrate the significant potential of EFE as a novel, safe prophylactic and therapeutic agent against PTX-PNP.

The safety and feasibility of colchicine uptitration in the management of idiopathic recurrent pericarditis

Abstract Introduction Colchicine is recommended first line in the management of idiopathic recurrent pericarditis (IRP) at low doses (0.5 - 1 mg/24h). In cases refractory to low dose colchicine, corticosteroid use is common, despite an increased risk of disease recurrence and the risk of complications resulting from corticosteroid dependence. Biologic agents that block interleukin-1, anakinra and rilonacept, are highly effective in IRP, but their use is limited by expertise and cost. Colchicine uptitration is recommended by consensus international guidance in familial Mediterranean fever, a disease characterised by recurrent serositis, and, hence, offers an accessible steroid sparing approach to the management of treatment-refractory idiopathic recurrent pericarditis Purpose To explore the safety and feasibility of colchicine uptitration in patients with IRP refractory to low dose colchicine (0.5-1 mg/24h). Methods Retrospective review of electronic medical records of all patients with IRP and familial Mediterranean fever reviewed at a tertiary centre 2013-2023. Treatment-refractory IRP cases were defined as active disease despite colchicine 1mg/24h or disease requiring other prophylactic drugs, and corticosteroid dependence as daily corticosteroid use for 6 months. Results Of 121 IRP cases, 77 (63.6%) were treatment refractory at first review. Median follow up was 24 months (IQR 6 – 36). Corticosteroid dependence complicated 34/77 (44.2%) cases. Of treatment-refractory cases without corticosteroid dependence, 42/43 (97.7%) were treated with colchicine uptitration and 4/43 (9.3%) with anti-interleukin-1 biologic(s); none became corticosteroid dependent. Of corticosteroid dependent cases, 30/34 (88.2%) were treated with colchicine uptitration and 13/34 (38.2%) with anti-interleukin-1 biologic(s). Corticosteroids were fully discontinued in 25/34 (73.5%): 8/25 (32.0%) weaned with colchicine uptitration alone, 14/25 (56.0%) with anti-interleukin-1 biologic(s) and 3/21 (14.3%) with azathioprine. Median corticosteroid duration was 17.5 months (IQR 13 - 44.25) and corticosteroid toxicity occurred in 8/34 (23.5%). Among the 76/77 cases (98.7%) treated with colchicine (median maintenance dose 2 mg/24h (IQR 1.5-2)), permanent discontinuation was uncommon (3/76, 3.9%) and due to gastrointestinal symptoms. Self-limiting liver transaminase elevation was common (29/76, 38.2%) but did not lead to discontinuation in any case. The prevalence of liver transaminase elevation among patients with familial Mediterranean fever on life long colchicine was 181/568 (31.9%). Conclusions In this treatment-refractory pericarditis cohort, colchicine uptitration enabled avoidance of new corticosteroid dependence, facilitated corticosteroid discontinuation and was well tolerated. This contrasts with the frequent toxicity seen with prolonged corticosteroid use and offers an accessible steroid sparing approach to IRP management that warrants prospective investigation.

Beyond Pain: Innovative Approaches to Tension-Type Headache Management and Treatment

Introduction: Tension-type headache (TTH) is a common neurological disorder characterized by bilateral head pain and muscle tension, affecting up to 78% of the population. Despite its prevalence, TTH has historically received less attention than migraines. However, recent years have seen increased interest in understanding its pathophysiology and treatment options. This review comprehensively analyzes TTH management, covering non-pharmacological and pharmacological approaches to guide clinical practice and future research effectively. State of Knowledge: TTHs manifest as bilateral, pressing, encircling head pain, profoundly affecting individuals' quality of life. Recent years have witnessed increased interest in TTH understanding and treatment. Non-pharmacological interventions, including behavioral modifications, exercise, dietary adjustments, sleep hygiene, physical therapy, psychotherapy, and pharmacological treatments like over-the-counter medications, prophylactic drugs, psychedelics, and botulinum toxin A, have shown promise in alleviating symptoms. Conclusion: This review highlights the multifaceted management of TTH. Non-pharmacological interventions, including behavioral modifications and psychotherapy, offer symptom relief. Body awareness therapy, exercise, and psychotherapy benefit TTH symptoms and quality of life. Paracetamol, ibuprofen, and amitriptyline are standard treatments, with emerging options like psychedelics and botulinum toxin A. Personalizing treatment and understanding TTH mechanisms pose challenges. A multidisciplinary approach is essential for enhancing management and outcomes. More research is required to identify optimal treatments and long-term efficacy. Despite challenges, progress in TTH management brings hope for better patient care.

P18.39.A SEIZURE PROPHYLAXIS IN GLIOMA SURGERY (SPRING): A MULTI-CENTRE, UNBLINDED, RANDOMISED TRIAL

Abstract BACKGROUND 50-80% of all glioma patients will suffer from seizures during their lifetime. Over half of these patients will have drug resistant seizures. Seizure risk is increased peri-operatively, at tumour progression, and shortly before death. Current guidelines do not support routine use of prophylactic peri-operative anti-epileptic drugs (AED) in seizure naïve patients; despite this, levetiracetam is frequently prescribed for this indication. The aim of this trial was to determine the clinical and cost effectiveness of prophylactic levetiracetam in seizure naïve patients undergoing surgery for a glioma at reducing the risk of seizures. MATERIAL AND METHODS Seizure naïve patients with newly diagnosed glioma undergoing surgery (biopsy or resection) were randomised (1:1) to receive 12 months prophylactic levetiracetam or no prophylaxis at 14 neurosurgery and neuro-oncology units in the UK. Participants received standard of care neurosurgery and neuro-oncology treatment and were followed until death or for a maximum of one year. The primary outcome was one year risk of first seizure analyzed using a logistic regression model and intention to treat analysis. Outcomes were analyzed by intention-to-treat. The target accrual was 804 participants. This trial was registered with ISRCTN 49474281. RESULTS Between Oct 10, 2019 and Aug 30, 2022, we randomised 96 patients, from 24 to 79 years of age, to levetiracetam (n=49) or no prophylaxis (n=47). Due to slow accrual during the Covid-19 pandemic the trial closed early. In the levetiracetam group there were 43 high grade glioma (HGG) and 6 low grade glioma (LGG), and in the no prophylaxis group there were 43 HGG and 4 LGG. Seventeen (35%) of 49 patients randomised to levetiracetam had a seizure, compared to 15 (32%) of 47 patients randomised to no prophylaxis (OR 1.25, 95%CI 0.49-3.21, p=0.64). Median time to first seizure was 4.8 months in the levetiracetam group and 3.0 months in the no prophylaxis group. In the levetiracetam group 20 (41%) of 49 patients died within 12 months (median overall survival 6.8 months; range 0.2-11.9), and in the no prophylaxis group 15 (32%) of 47 patients died within 12 months (median 4.7 months; range 0.1-12.0). There were no serious adverse events or suspected unexpected serious adverse events related to levetiracetam. CONCLUSION Due to poor accrual caused by the Covid-19 pandemic the SPRING trial closed early and is therefore underpowered. Based on the limited data there was no difference in the 12 month seizure risk in the prophylaxis and no prophylaxis patients undergoing surgery for newly diagnosed glioma. The role of prophylactic anti-epileptic drugs remains undefined.

Chinese expert consensus on diagnosis, treatment and prevention of pulmonary infection in patients with solid tumors (2024 edition)

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia and the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, differential diagnosis from anti-tumor treatment associated pulmonary conditions, and consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physician, and general practice healthcare professionals involved in the management of solid tumors in adults.

Incidence of drug dependence and epilepsy in patients with PTC (Post Traumatic Contusions) manage conservatively. A prospective study.

Objective: To explore the presence of drug dependence and Epilepsy in patients with PTC (Post Truamatic Contusions) balanced cautiously. Study Design: Proposed Reviewed Research study. Setting: Hayatabad Medical Complex, Peshawar. Period: July 2020 to December 2020. Methods: About 90% of patients aged between fifteen to sixty-five years old identified with cerebral lesion and balanced cautiously were applied. Follow up sessions was provided to patients for 12to 18 months. Results: Among the enrolled patients, 23% established early PTS (Post Traumatic Seizures) and approximately established late PTS (Post Traumatic Seizures) from mild to moderate level of cerebral lesion. Patients having early signs of Post traumatic Seizure, about 6% utilized AEDs (Anti-epileptic Drugs) for about 3 months throughout the treatment period and about 7% of patients along with late Post Traumatic Seizures utilized AEDs. Moreover, approximately 8 percent patients established late post traumatic Seizure without considering any early signs of condition. Research findings indicated that only 3% of patients with early and late PTS actually required AEDs for at least 6 months. Although, about 44 percent of patients were utilizing Anti-epileptic drugs to control seizures. Sensible usage of Anti-epileptic drugs is familiar in our region, contributing to enhanced danger of medicine opposition and acquiring financial pressure on low-paid people in well-established state. Additionally, extreme usage of anti-epileptic and prophylactic drugs doesn’t impact the occurrence of PTE (Post Traumatic Epilepsy). Conclusion: The presence of late and early post-traumatic epilepsy observed within our study is contrast to that explored in another research. Sensible production of AEDs is occured in our state, that increases the danger of medicine opposition and attain financial issues for economically destruct people in well-established states. Extreme usage of AEDs and prophylactic drugs doesn’t have an important influence on stopping PTE.

Prophylactic Administration of Perampanel for Post-Stroke Epilepsy (PROPELLER Study): A Trial Protocol.

Post-stroke epilepsy can reduce patients' abilities to carry out various activities of daily living. Despite their importance in preventing the onset of post-stroke epilepsy, the prophylactic administration of antiepileptic drugs is controversial due to a lack of high-level clinical research. In this study, we initiated a prospective interventional study of prophylactic antiepileptic drug administration in patients with a subcortical hemorrhage, who are at the highest risk of developing epilepsy after experiencing a stroke. The study was conducted in a single-center setting and was a single-arm study with no control group; the case entry period started in November 2023 and is due to end in March 2025. Only cases with a subcortical hemorrhage will be included. The treatment regimen used in this study is 2 mg of perampanel per day. Perampanel will be administered for one year, followed by two years of follow-up, for a total study period of three years. The primary endpoint will be the development of epilepsy. Perampanel administration is expected to reduce the incidence of post-stroke epilepsy in comparison to the results of previous reports on the use of alternative treatments. The results of this study will provide new insights into the prevention of post-stroke epilepsy. The relatively small size of this study makes it difficult to provide strong evidence of the efficacy of perampanel, but it may serve as a basis for larger clinical trials.

Modulation of liver metabolism and gut microbiota by Alhagi-honey alleviated heat stress-induced liver damage

Alhagi-honey (AH) is a well-established traditional ethnic medicine with advantageous effects against diarrhea and headaches. We aimed to explore the preventive effect of AH on liver damage induced by heat stress (HS) and its underlying mechanism. HS models were established by thermostat, and mice were treated at 39 ℃ for 10 h, lasting for 7 days. Hematoxylin–eosin (H&E) staining and Periodic Acid-Schiff (PAS) staining were used for histological observation, and transmission electron microscopy (TEM) was used for ultrastructure examination of hepatocytes. Gut microbiota (GM) composition and liver metabolites were respectively analyzed by 16S rRNA sequencing and non-targeted metabolome sequencing. AH pretreatment alleviated liver damage caused by heat stress in mice. The main manifestation was that AH alleviated serum aspartate transferase (AST) and aspartate transaminase (ALT). It was found that AH improved symptoms of hepatocyte damage. In addition, the relative abundance of f_Rikenellaceae, g_Incertae_Sedis and s_Staphylococcus_Orisratti, g_Lachnoclostridium, g_GCA-900066575, and s_Alistipes_inops were modified by AH and these bacterial genera showed association with 6 metabolites (2- (3,4-dihydroxyphenyl) acetamide, 3-hydroxy-3-methylpentanedioic acid, PC (17:0/17:1), Y-L-Glutamy-L-glutamic acid, L-Isoleucine, 5-Methyluridine, 8,8-dimethyl-2-phenyl-4H,8H-pyrano [2, 3-h] chromen-4-one). The Pearson analysis also showed a strong correlation between these microbes and 2 risk indicators (AST and ALT) of liver damage. AH alleviated HS-induced liver damage by regulating liver metabolism and maintaining normal GM. It demonstrated that AH held potential as a prophylactic drug for the prevention of HS-induced liver damage.

The crucial role of beta-catenin in the osteoprotective effect of semaglutide in an ovariectomized rat model of osteoporosis.

Postmenopausal osteoporosis is a common chronic medical illness resulting from an imbalance between bone resorption and bone formation along with microarchitecture degeneration attributed to estrogen deficiency and often accompanied by other medical conditions such as weight gain, depression, and insomnia. Semaglutide (SEM) is a recently introduced GLP-1 receptor agonist (GLP-1RA) for the treatment of obesity and type 2 diabetes mellitus by mitigating insulin resistance. It has been discovered that the beneficial effects of GLP-1 are associated with alterations in lipolysis, adipogenesis, and anti-inflammatory processes. GLP-1 analogs transmit signals directly to adipose tissue. Mesenchymal stem cells (MSCs) are multidisciplinary cells that originate from bone marrow, migrate to injury sites, and promote bone regeneration. MSCs can differentiate into osteoblasts, adipose cells, and cartilage cells. Our aim is to investigate the role of semaglutide on bone formation and the Wnt signaling pathway. Osteoporosis was induced in female rats by ovariectomy, and the ovariectomized rats were treated with alendronate as standard treatment with a dose of 3mg/kg orally and semaglutide with two doses (150 mcg/kg and 300 mcg/kg) S.C. for 10 successive weeks. Semaglutide ameliorates bone detrimental changes induced by ovariectomy. It improves bone microarchitecture and preserves bone mineral content. Semaglutide ameliorates ovariectomy-induced osteoporosis and increases the expression of β-catenin, leading to increased bone formation and halted receptor activator of nuclear factor kappa-Β ligand (RANKL's) activation. Semaglutide can be used as a potential prophylactic and therapeutic drug against osteoporosis, possibly by activating Wnt signaling and decreasing bone resorption.

Assessment of the current state of pharmaceutical development of anti-staphylococcal prophylactic drugs

Infection caused by Staphylococcus aureus is the most common infection leading to the development of serious complications in humans. S. aureus is among the highly lethal bacteremia-associated pathogens with a mortality rate of approximately 18% in industrial countries; in developing countries, the rate is even higher, up to 27%. One of the most striking and challenging aspects of clinical manifestations caused by S. aureus is the ability of the bacterium to develop resistance to antibiotics. The development of alternative treatment options for staphylococcal infection is urgently needed. The use of immunotherapy and immunoprophylaxis to activate the anti-infection immune response in patients should be considered as a promising direction. Objective: to analyze the main trends in the development of vaccines aimed at the prevention of S. aureus infection and its virulence factors. The present review discusses vaccine development in recent years aimed at preventing infection caused by S. aureus. Particular attention is paid to pathogenicity factors (such as capsule, surface proteins and enzymes) that may be useful for the development of new candidate vaccines or immune therapeutics. In recent years, numerous clinical trials of candidate vaccines based on different antigens, taking into account particularly relevant S. aureus pathogenicity factors that influence morbidity, have not been successful due to their low efficacy or insufficiently substantiated safety (development of adverse events). One of the most important factors constraining vaccine development is the lack of successful translation of vaccine protective activity, which is observed in preclinical studies in experimental models but not confirmed in clinical trials. Therefore, according to numerous researchers, the use of multiple antigens in vaccine formulations should be considered with the focus on different mechanisms of S. aureus pathogenicity and the use of adjuvants.

Discovery of Thiophene Derivatives as Potent, Orally Bioavailable, and Blood-Brain Barrier-Permeable Ebola Virus Entry Inhibitors.

The endemic nature of the Ebola virus disease in Africa underscores the need for prophylactic and therapeutic drugs that are affordable and easy to administer. Through a phenotypic screening employing viral pseudotypes and our in-house chemical library, we identified a promising hit featuring a thiophene scaffold, exhibiting antiviral activity in the micromolar range. Following up on this thiophene hit, a new series of compounds that retain the five-membered heterocyclic scaffold while modifying several substituents was synthesized. Initial screening using a pseudotype viral system and validation assays employing authentic Ebola virus demonstrated the potential of this new chemical class as viral entry inhibitors. Subsequent investigations elucidated the mechanism of action through site-directed mutagenesis. Furthermore, we conducted studies to assess the pharmacokinetic profile of selected compounds to confirm its pharmacological and therapeutic potential.

Impact of an emergency department nurse training intervention on the adequacy of thromboprophylaxis for venous thromboembolism: the PROTESU III study.

Objectives. To assess the impact of training for emergency department (ED) nurses on adequate thromboprophylaxis for patients admitted to hospital from the ED for medical conditions. Methods. Multicenter quasiexperimental pre-post study of an ED nurse training intervention in 8 hospitals. Patients were recruited from January 2022 through May 2023 in 3 phases: before nurse training, in the first month after training, and in the sixth month after training. Included were patients attended in the ED for medical conditions. Adequate thromboprophylaxis was defined as 1) use of prophylactic drugs in patients at high risk for venousthromboembolism according to the Padua Prediction Score (PPS), and 2) nonuse in patients at low risk. We compared the percentage of adequate prophylaxis in the first phase to the percentages in the second and third phases. Results. A total of 928 patients were included (326 in phase 1, 295 in phase 2, and 307 in phase 3). PPS scores indicated that 238 (73%) of the patients were at high risk in phase 1 vs 189 (64.1%, P = .016) in phase 2 and 207 (67.4%, P = .125) in phase 3. A total of 187 patients (57.4%, 95% CI, 51.8%-62.8%) were adequatelythromboprophylaxed in phase 1 vs 178 (60.%, 95% CI, 54.5%-66%) in phase 2 (absolute difference in proportions, 3.0% (95% CI, -4.8% to 10.6%; P = .462)]. In phase 3, 166 patients (54.1%, 95% CI, 48.3%-59.7%) received adequate prophylaxis (difference, -3.3% (95% CI, -11.0% to 4.4%; P = .405). Conclusions. A training intervention for ED nurses, implemented as an isolated strategy, had no impact on the adequacy of thromboprophylaxis in patients admitted from the ED for medical conditions.

Targeting dysfunctional endocannabinoid signaling in a mouse model of Gulf War illness

Gulf War Illness (GWI) is a chronic disorder characterized by a heterogeneous set of symptoms that include pain, fatigue, anxiety, and cognitive impairment. These are thought to stem from damage caused by exposure under unpredictable stress to toxic Gulf War (GW) chemicals, which include pesticides, nerve agents, and prophylactic drugs. We hypothesized that GWI pathogenesis might be rooted in long-lasting disruption of the endocannabinoid (ECB) system, a signaling complex that serves important protective functions in the brain. Using a mouse model of GWI, we found that tissue levels of the ECB messenger, anandamide, were significantly reduced in the brain of diseased mice, compared to healthy controls. In addition, transcription of the Faah gene, which encodes for fatty acid amide hydrolase (FAAH), the enzyme that deactivates anandamide, was significant elevated in prefrontal cortex of GWI mice and brain microglia. Behavioral deficits exhibited by these animals, including heightened anxiety-like and depression-like behaviors, and defective extinction of fearful memories, were corrected by administration of the FAAH inhibitor, URB597, which normalized brain anandamide levels. Furthermore, GWI mice displayed unexpected changes in the microglial transcriptome, implying persistent dampening of homeostatic surveillance genes and abnormal expression of pro-inflammatory genes upon immune stimulation. Together, these results suggest that exposure to GW chemicals produce a deficit in brain ECB signaling which is associated with persistent alterations in microglial function. Pharmacological normalization of anandamide-mediated ECB signaling may offer an effective therapeutic strategy for ameliorating GWI symptomology.

Nano-Bio Interfaces: Pioneering Targeted Approaches for Disease Treatment and Prevention

Nanotechnology has emerged as a pivotal force in biomedical research, offering groundbreaking solutions for disease treatment and prevention through the integration of nanoscience with biology. This review explores the multifaceted applications of nano-bio interfaces in revolutionizing therapeutic interventions and public health strategies. At the forefront of innovation, nanomaterial-based drug delivery systems demonstrate unparalleled precision and efficacy in targeted drug delivery, minimizing systemic toxicity and maximizing therapeutic outcomes. Furthermore, the development of multifunctional nanoparticles capable of simultaneous drug delivery and diagnostic imaging enables real-time monitoring of treatment responses, heralding a new era of personalized medicine. Nano-bio interfaces also play a crucial role in advancing vaccine development and immunotherapies, with nanoparticle-based vaccine platforms offering enhanced antigen delivery and immune stimulation for robust and durable immune responses against infectious diseases and cancer. In the realm of disease prevention, antimicrobial nanomaterials provide effective strategies for infection control, while nanovaccines and prophylactic drug delivery systems offer tailored solutions for mitigating the spread of infectious agents. Through a comprehensive exploration of these pioneering approaches, this review, we believe, highlights the transformative potential of nano-bio interfaces in reshaping the landscape of disease treatment and prevention.

An observational study to compare the efficacy of intravenous dexmedetomidine versus intravenous esmolol for attenuation of pressor response during laryngoscopy and endotracheal intubation

Laryngoscopy and endotracheal intubation during general anaesthesia is an invasive stimulus associated with release of circulating catecholamine leading to hemodynamic and cardiovascular responses resulting in tachycardia, hypertension and arrhythmias. Many prophylactic drugs have been used to decrease cardiovascular response to laryngoscopy & intubation. Aim of this study is to compare effectiveness of Dexmedetomidine 1μg/kg and Esmolol 1 mg/kg intravenously in attenuating cardiovascular response during laryngoscopy and intubation during general anaesthesia.This randomised double blinded prospective study was conducted on 50 patients, of either gender between age group 18-60 years and American Society of Anaesthesiology (ASA) classification I & II, undergoing various surgeries under General anaesthesia requiring intubation. Patients were randomly divided into 2 groups of 25 patients each. Group D patients received intravenously Inj. Dexmedetomidine 1 mcg/kg as an infusion in 100ml Normal Saline over 20 minutes before induction of general anaesthesia. Group E patients received intravenously Inj. Esmolol 1 mg/kg diluted with normal saline to volume of 10ml given just before induction of general anaesthesia.Hemodynamic parameters such as Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline, after study drug administration, after induction, at laryngoscopy and intubation and 1, 3, 5 and 7 min after Endotracheal intubation.: Comparison of two groups reveals that dexmedetomidine shows less rise in heart rate (P-0.0003) and mean arterial pressure (P-0.0106) at the laryngoscopy and intubation. It also shows less rise in systolic and diastolic blood pressure after induction and after intubation (P< 0.05) than Esmolol. This study suggests that Dexmedetomidine 1µg/kg was more effective in attenuating the stress response to laryngoscopy and intubation as compared to Esmolol 1mg/kg.

Bovine trypanosomosis, vector distribution and infection rate in three districts of Gamo Zone, southwestern Ethiopia

African animal trypanosomosis is one of the main obstacles to the development of livestock and agricultural output in Ethiopia. It usually results in a severe, frequently fatal sickness, and the infected animals were more weakened as the disease progress and become unfit for work. A cross sectional study design was conducted from December 2021 to April 2022 with the aim of estimating the prevalence of trypanosome infection both in Glossina spp. and cattle, and to assess apparent density of Glossina spp. A total of 298 cattle were selected and examined for trypanosome by using buffy coat technique. The overall prevalence of bovine trypanosomosis was 19.1%; and two species of trypanosomes, T. congolense and T. vivax, were identified in the study area. The prevalence of T. congolense and T. vivax were 15.8% and 2.3%, respectively. The prevalence of trypanosomosis was significantly higher in adult animals (OR = 2.7; p < 0.05) than in younger cattle and poor body condition (OR = 3.18; p < 0.05) than medium body condition animals. The mean PCV value of infected animals was 14.3% (13.3–15.4) significantly lower than the non-infected animals 18.5% (17.8–19.2). Glossina pallidipes is the only tsetse species encountered in all the study areas. In total, 2992 flies were caught of which 90.8% belong to G. pallidipes and 9.2% were other biting flies. The overall apparent density of G. pallidipes was 20.1 F/T/D and other biting flies were 2.0 F/T/D. A total of 307 live Glossina pallidipes were dissected. The overall prevalence of Glossina pallidipes infection rate was 9.1% (95% CI = 5.9–12.4). The prevalence of G. pallidipes infection was significantly higher in Kucha district (OR = 3.2, χ2 = 2.6, p < 0.05) than the other two districts, Daramalo and Arba Minch Zuria. Also it was significantly higher in flies trapped from riverine forest areas (OR = 5.5, χ2 = 2.86, p < 0.05). Therefore, to reduce the impact of trypanosomosis and Glossina, vector control and treating infected cattle with prophylactic or chemotherapeutic drugs and active community participation can play a key role.

Successful treatment with traditional Japanese medicine (kampo medicine) Yokukansan as a migraine prophylactic drug: A case report.

The use of anti-CGRP antibody drugs as migraine preventive drugs is increasing worldwide, but there are still a certain number of cases where antibody drugs are ineffective or cannot be used due to high prices. Conventional prophylactic drugs or traditional Japanese medicine (kampo medicine) are still often used in such cases. However, to date, only limited evidence supports the efficacy of kampo medicine for headaches because these treatments have been used primarily empirically and traditionally. However, in recent years studies have begun to be published that describe the efficacy of kampo medicine for various types of headache. Here, we report the case of a patient who achieved a marked reduction in migraine frequency and severity by prophylactic therapy with the kampo drug yokukansan (TSUMURA Yokukansan Extract Granules). The patient was a 50-year-old woman. She began to experience headaches around high school age and was diagnosed with migraine without aura at 42 years of age. She started prophylactic therapy with amitriptyline and topiramate and this treatment reduced the frequency of migraines for several years. However, the frequency began to increase again around 47 years, which is when she presented at our hospital. We achieved a temporary reduction in migraine frequency by adjusting the dose of drugs in her prophylactic therapy regimen, but the frequency increased again around age 49. We then tried monotherapy with the kampo medicine yokukansan, and this markedly reduced migraine frequency and severity over the following year. This therapy has remained effective to date. We speculate that, in this case, migraine without aura was improved by prophylactic therapy with yokukansan due to its action on the glutamatergic system or serotonin system through suppression of orexin-A secretion or its anti-inflammatory effects as reported in previous animal studies. Yokukansan could be a usable kampo medicine for migraine prophylaxis in countries all over the world and should be investigated in a large clinical trial as soon as possible.

Use of antiepileptic medications for seizures' prevention during subarachnoid hemorrhage: A retrospective observational study.

The use of prophylactic antiepileptic drugs (AEDs) post-subarachnoid hemorrhage (SAH), particularly aneurysmal SAH, is controversial, with limited data available. This has led the new American Heart Association/American Stroke Association (AHA/ASA) guidelines to recommend against using AEDs. This study is aimed at determining whether the use of AEDs for primary prophylaxis is effective in reducing the incidence of seizures post-SAH. A retrospective observational study was conducted utilizing a reviewing chart for the period starting from June 2015 to the end of 2021. The reviews were conducted in the acute care areas of 2 tertiary hospitals primarily to assess the efficacy of AEDs against seizures in patients with SAH (particularly aneurysmal SAH). This was done by comparing the occurrence of early, late, and overall incidence of seizures between patients who received AEDs versus those who did not. Of the 62 patients, who mostly presented with aneurysmal SAH (71%), 42 received AEDs and 20 did not. Mostly, the baseline characteristics between the 2 groups were comparable. A few patients on AEDs developed early (n = 4/38), late (n = 3/29), and overall seizures (n = 6/33), whereas no early, late, or overall incidence of seizures was presented in the group who did not receive AEDs. However, this difference showed no significance (P > .05). The subjects who were given AEDs showed significantly longer hospital stays (42.11 ± 51.43 vs 14.10 ± 7.17; P = .002) and higher mortality rates (7/11 vs 0/11; P = .026). For all patients who received AEDs for prophylaxis, the overall incidence of seizures was negatively associated with the Glasgow coma scale (OR: 0.798; 95% CI 0.657-0.978; P = .022). Our findings support the 2023 AHA/ASA guideline recommendation to avoid using routine AEDs for prophylaxis for all SAH patients. Proper and careful stratification methods should be implemented in each given scenario.

Comparison of Postoperative Seizures Between Burr-Hole Evacuation and Craniotomy in Patients With Nonacute Subdural Hematomas: A Bi-Institutional Propensity Score-Matched Analysis.

Postoperative seizures are a common complication after surgical drainage of nonacute chronic subdural hematomas (SDHs). The literature increasingly supports the use of prophylactic antiepileptic drugs for craniotomy, a procedure that is often associated with larger collections and worse clinical status at admission. This study aimed to compare the incidence of postoperative seizures in patients treated with burr-hole drainage and those treated with craniotomy through propensity score matching (PSM). A retrospective cohort analysis was conducted on patients with surgical drainage of nonacute SDHs (burr-holes and craniotomies) between January 2017 to December 2021 at 2 academic institutions in the United States. PSM was performed by controlling for age, subdural thickness, subacute component, and preoperative Glasgow Coma Scale. Seizure rates and accompanying abnormalities on electroencephalographic tracing were evaluated postmatching. A total of 467 patients with 510 nonacute SDHs underwent 474 procedures, with 242 burr-hole evacuations (51.0%) and 232 craniotomies (49.0%). PSM resulted in 62 matched pairs. After matching, univariate analysis revealed that burr-hole evacuations exhibited lower rates of seizures (1.6% vs 11.3%; P = .03) and abnormal electroencephalographic findings (0.0% vs 4.8%; P = .03) compared with craniotomies. No significant differences were observed in postoperative Glasgow Coma Scale (P = .77) and length of hospital stay (P = .61). Burr-hole evacuation demonstrated significantly lower seizure rates than craniotomy using a propensity score-matched analysis controlling for significant variables.