Evaluation of prophylactic Effect of Remifentanil on Succinylcholine-Induced Myalgia in Humans

Purpose: To assess the efficacy of remifentanil in preventing succinylcholine-induced myalgia in humans.Methods: Sixty healthy adults scheduled for elective surgery under general anesthesia were enrolled in a double-blind study and randomly allocated to two groups of thirty patients. Patients in Group I (remifentanil group) were pretreated with remifentanil 1 ìg/kg one minute prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline. Anesthesia was induced in both groups with fentanyl 1 µg/kg, propofol 2.0 mg/kg and succinylcholine 1.5 mg/kg. Postoperative myalgia was assessed 12, 24, and 48 h after induction and graded as nil, mild, moderate, or severe.Results: Fifty nine patients completed the study. The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia at 12, 24, and 48 h after induction were 34.5, 34.5 and 14.1 % in group I, and 60, 53.4 and 30 % in group II, respectively (p > 0.05).Conclusion: Prophylactic use of remifentanil 1 µg/kg intravenously is ineffective in the prevention of postoperative myalgiaKeywords: Remifentanil, Succinylcholine, Myalgia, Propofol, Prophylaxi

Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia

<p>Abstract</p> <p>Background</p> <p>To date, the great majority of Russian HIV infections have been diagnosed among IDUs and concerns about the potential for a sexual transmission of HIV beyond the IDU population have increased. This study investigated differences in the prevalence of sexual risk behaviors between IDUs and non-IDUs in St. Petersburg, Russia and assessed associations between substance use patterns and sexual risks within and between those two groups.</p> <p>Methods</p> <p>Cross-sectional survey data and biological test results from 331 IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate regression was employed to calculate measures of associations.</p> <p>Results</p> <p>IDUs were less likely than non-IDUs to report multiple sexual partners and unprotected sex with casual partners. The quantity, frequency and intensity of alcohol use did not differ between IDUs and non-IDUs, but non-IDUs were more likely to engage in alcohol use categorized as risky per the alcohol use disorders identification test (AUDIT-C). Risky sexual practices were independently associated with monthly methamphetamine injection among IDUs and with risky alcohol use among non-IDUs. Having sex when high on alcohol or drugs was associated with unprotected sex only among IDUs.</p> <p>Conclusions</p> <p>Greater prevalence of sexual risk among non-IDUs who have IDU sex partners compared to IDUs suggests the potential for sexual transmission of HIV from the high-prevalence IDU population into the general population. HIV prevention programs among IDUs in St. Petersburg owe special attention to risky alcohol use among non-IDUs who have IDU sex partners and the propensity of IDUs to have sex when high on alcohol or drugs and forgo condoms.</p

Subgroup analyses of maraviroc in previously treated R5 HIV-1 infection.

BACKGROUND: We conducted subanalyses of the combined results of the Maraviroc versus Optimized Therapy in Viremic Antiretroviral Treatment-Experienced Patients (MOTIVATE) 1 and MOTIVATE 2 studies to better characterize the efficacy and safety of maraviroc in key subgroups of patients. METHODS: We analyzed pooled data from week 48 from the two studies according to sex, race or ethnic group, clade, CC chemokine receptor 5 (CCR5) delta32 genotype, viral load at the time of screening, the use or nonuse of enfuvirtide in optimized background therapy (OBT), the baseline CD4 cell count, the number of active antiretroviral drugs coadministered, the first use of selected background agents, and tropism at baseline. Changes in viral tropism and the CD4 count at treatment failure were evaluated. Data on aminotransferase levels in patients coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) were also analyzed. RESULTS: A treatment benefit of maraviroc plus OBT over placebo plus OBT was shown in all subgroups, including patients with a low CD4 cell count at baseline, those with a high viral load at screening, and those who had not received active agents in OBT. Analyses of the virologic response according to the first use of selected background drugs showed the additional benefit of adding a potent new drug to maraviroc at the initiation of maraviroc therapy. More patients in whom maraviroc failed had a virus binding to the CXC chemokine receptor 4 (CXCR4) at failure, but there was no evidence of a decrease in the CD4 cell count at failure in such patients as compared with those in whom placebo failed. Subanalyses involving patients coinfected with HBV or HCV revealed no evidence of excess hepatotoxic effects as compared with baseline. CONCLUSIONS: Subanalyses of pooled data from week 48 indicate that maraviroc provides a valuable treatment option for a wide spectrum of patients with R5 HIV-1 infection who have been treated previously. (ClinicalTrials.gov numbers, NCT00098306 and NCT00098722.