The crystal structure of ethyl-1-(N-(adamantan-1-yl)-carbamothioyl)piperidine-4-carboxylate, C19H30N2O2S

C19H30N2O2S, monoclinic, P21/n (no. 14), a = 6.4977(5) Å, b = 28.728(2) Å, c = 10.1806(8) Å, β = 101.549(3)°, V = 1861.9(2) Å3, Z = 4, Rgt(F) = 0.0460, wRref(F2) = 0.1213, T = 296 K

Nonsteroidal Anti-inflammatory Drug (NSAID) Toxicity in Emergency Room

Nonsteroidal anti-inflammatory medicines, collectively referred to as NSAIDs in academic context, exhibit chemical diversity while concurrently manifesting comparable therapeutic and harmful effects. All pharmaceutical substances under this particular category function by diminishing inflammation, alleviating pain, and reducing fever by means of inhibiting enzymes responsible for the creation of endoperoxides, often referred to as cyclooxygenase (COX) enzymes. The two cyclooxygenase isozymes, COX-1 and COX-2, are responsible for the conversion of arachidonic acid into its endoperoxide metabolites. These metabolites include prostacyclin, prostaglandins, and thromboxane, each exhibiting a wide range of biological activities such as inflammation, regulation of smooth muscle tone, and promotion of thrombosis. The COX-1 enzyme is consistently produced and is recognized as the main provider of prostanoids required for maintaining physiological balance, such as safeguarding the stomach epithelium. In contrast, the COX-2 enzyme is capable of being induced, leading to a substantial increase in the synthesis of prostanoids in circumstances characterized by stress and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) may induce toxicity via the same pharmacological mechanisms that contribute to their therapeutic efficacy. This review aims to discuss NSAIDs toxicity in details, its symptoms, and possible management in the emergency room

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population