Head and Neck Medicine by Alexandros G.Sfakianakis

Asthma is a chronic inflammatory disease of the airways. In this study, we evaluated the anti-inflammatory effects of myrtenol on the inflammatory indices in the pulmonary parenchyma and airways and on the inflammatory and oxidative indices of the bronchoalveolar lavage fluid (BALF) of asthmatic rats.

Methods

The allergic asthma was induced by sensitization (two weeks) followed by the inhalation of ovalbumin (four weeks). Animals were divided into two main groups: (1) Histopathology, and (2) measurement of inflammatory and oxidative biomarkers in the BALF. Each main group was subdivided into four subgroups: Control, Asthma, Asthma + Dexamethasone and Asthma + Myrtenol. (−)-Myrtenol (50 mg/kg) or Dexamethasone (2.5 mg/kg) was administered intraperitoneally once a day for one week, at the end of the inhalation period. On day 50, lung histopathologic parameters and inflammatory indices in BALF including INF-γ, IL-10, IL-1β, and TNF-α and oxidative stress biomarkers (MDA, SOD, and GPX) were measured.

Result

In the Asthma group, leukocyte infiltration, the thickness of smooth muscle and epithelium of airways wall and the number of goblet cells increased. Myrtenol reduced all of the above-mentioned indices except the epithelium thickness. It also inhibited the increase in BALF IL-1β, TNF-α and MDA and increased the levels of INF-γ, IL-10 and SOD.

Conclusion

Our results suggest that myrtenol reduced damage caused by experimental asthma by reducing the inflammatory indices, normalizing the level of interleukins and balancing oxidative stress in the lungs. It also prevented airway remodeling. Myrtenol may be suggested as a potent herbal medicine for the treatment of allergic asthma.

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When is epinephrine prescribed for anaphylaxis?

Anaphylaxis represents a severe allergic reaction that is rapid in onset and can be fatal 1. Epinephrine is the first-choice medication in the treatment of anaphylaxis, both in the community and in the hospital setting 2. Nonetheless, epinephrine is largely underused 3. The purpose of this study was to examine the reasons that currently motivate professionals to treat anaphylaxis with epinephrine in the Emergency Department (ED) and the prescription of EAI for outpatient use after the allergy workup.

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Πέμπτη 6 Δεκεμβρίου 2018

Cheaper drugs and techniques to fulfill chief executive officer perspectives – any choices?

Purpose of review Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. Recent findings Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change – even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. Summary Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort. Correspondence to Professor Thomas Ledowski, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia. Tel: +61 8 92242244; e-mail: Thomas.ledowski@health.wa.gov.au Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Role of anesthesiologists in managing perioperative anemia

Purpose of review Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. Recent findings Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedure during surgery. Restrictive transfusion triggers in adult cardiac surgery have been shown to be beneficial in the majority of studies. Elderly patients and defined comorbidities might require higher transfusion triggers. Both, intravenous and oral iron increase hemoglobin values when given prior to surgery. Oral iron is effective when given several weeks prior to elective surgery. Erythropoietin is a treatment decision individualized to each patient. Summary Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide. Correspondence to Andrea U. Steinbicker, MD, MPH, Westfalische Wilhelms-Universitat Munster, Muenster; Muenster University Hospital, Albert-SChweitzer Campus 1, Building A1, 48149 Muenster, Germany. Tel: +0049 251 83 47898; e-mail: andrea.steinbicker@ukmuenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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