The Role of Ketamine in Trauma

Early and effective pain control in trauma patients improves outcomes and limits disability, but analgesia is often missed in the unstable patient, or hemodynamically depressing medications are avoided for fear of losing stability. This chapter outlines the role of ketamine in managing traumatic emergencies in both out-of-hospital and hospital environment, and beyond. Low-dose ketamine also called a sub-dissociative dose is safe, efficient and effective analgesic that can be considered for trauma patients, pediatric or adults, as an alternative to opioids or in combination with opioids for on additive or synergistic effect, with minimal impact on hemodynamic stability. Ketamine at higher doses is also an excellent drug for induction of anesthesia in rapid sequence induction (RSI), post-intubation sedation maintenance or procedural sedation in the trauma patient. Also, can be used for acute agitation and excited delirium. In this chapter, we are describing this drug focusing on a deeper understanding of the safety and efficacy of this agent and, if supported, to encourage physicians to consider ketamine for pain control in trauma and beyond. Also, we are presenting the current literature surrounding ketamine’s evidences in the trauma condition to establish its utility and profile of safety for these patients

Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients

Autoimmune thyroiditis (AIT) is on the rise among the population, and is frequently associated with patients with acne vulgaris, especially females aged between 18–55 years old. The connection between the two is not fully elucidated. In this study, 236 patients diagnosed with acne in the dermatological office of the private Pelican Hospital and in few private dermatological offices from Oradea, Romania, during January 2018–December 2020, aged between 12 and 55 years old, were endocrinologically investigated to determine AIT and its influence on the severity of the acne. The values for the thyroid antibodies and thyroid-stimulating hormone (TSH) were determined for all of the subjects. The frequency of AIT in the study group was 72% and was associated with severe acne (p < 0.001). Patients with AIT with normal or hypofunction had more frequent severe acne than those with hyperfunction (p < 0.001, p = 0.002). The TSH and anti thyroidperoxidase (TPO) values did not influence the severity of the acne (p = 0.494; p = 0.111), while the anti-TG values were associated with severe acne (p = 0.007). The risk analysis indicated that raised values of anti-TPO (2.91 times greater) correlated with high anti-thyroglobulin (TG) values (4.36 times greater) doubled the risk of developing severe acne in patients. In acne evolution, the existence of AIT involves significant modifications

Evaluation of Geriatric Sarcopenia and Nutrition in the Case of Cachexia before Exitus: An Observational Study for Health Professionals

It is important to assess the physical and nutritional status of the body using a bioelectrical impedance analyzer (BIA) in patients with cachexia; however, the correlation between cachexia and nutritional evaluations remains unclear. The objective of this study is to follow the effects of diet therapy in patients with cachexia/sarcopenia, using parameters measured by BIA, clinical parameters, and other nutrition-related assessments in patients with osteoporosis. This study aims to clarify the correlation between BIA-measured parameters, clinical parameters, and other nutrition-related assessments. Methods: Measurements of body composition, a clinical assessment of the sarcopenia/cachexia, and nutritional goal setting/a nutrition care process were performed. Results: The number of subjects was 200, of which 15 people (7.5%) were diagnosed with sarcopenia/cachexia. Univariate analyses showed that participants with a high body-fat mass tend to develop sarcopenic obesity (p = 0.029), those who lost a significant and progressive amount of muscle mass tend to develop sarcopenia (p = 0.001), as well as those with malnutrition (p < 0.001). The regression study shows not only the correlation but also the cause of the correlation, as is the case with obesity. As obesity increases, so does the sarcopenic index (this can explain sarcopenic obesity), and as fat mass decreases it leads to muscle mass loss, increasing the risk of cachexia with age. Conclusions: There was an improvement, but statistically insignificant, in cachexia and the nutritional objectives (p > 0.05); at the same time, correlations were established between the independent parameters (sex, age) and malnutrition parameters (hemoglobin and amylase) with the parameters of the research

The Antimicrobial Activity of <i>Origanum vulgare</i> L. Correlated with the Gastrointestinal Perturbation in Patients with Metabolic Syndrome

(1) The metabolic syndrome (MS) promotes acute and chronic infections, due to the pro-inflammatory condition given by TNFα and IL6 or by affecting the microbiota. MS is also correlated with insulin resistance, causing inflammation and infections throughout the organism. (2) The purpose of this study was to track the effect of using the essential oil of Origanum vulgare L. (EOO) as an antibacterial treatment, compared to allopathic treatment with antibiotics in MS patients. A group of 106 people with MS was divided into four subgroups: L1—staphylococcal infection group, L2—Escherichia coli infection group, L3—streptococcal infection group with EOO treatment, and CG—control group without infection or treatment. (3) EOO is responsible for the antibacterial effect, and reduced minor uncomplicated infections. After a 10-day treatment, intestinal side effects were absent, improving the phase angle. (4) The results suggest that EOO may exhibit an antibacterial effect, similar to the antibiotic treatment, without promoting MS-specific dysbiosis, and it also improves the phase angle in patients, which is used as an index of health and cellular function

Laser Therapy in Perianal Fistulas

(1) Background: Perianal fistula represents a chronic local suppuration, and recurrent or incorrectly treated, this pathology has a negative effect on the life of patients. (2) Methods: A 12-month prospective study was conducted with a study group (patients at the second presentation) and a control group (patients at the first presentation). The BTL-6000 brand laser has 50 times the maximum power of conventional laser devices with an unmatched wavelength of 1064 nm and a tissue penetration power of up to 10 cm. It is highly effective in speeding up healing and pain management (3) Results: Transcutaneous high-intensity laser therapy of perianal fistulas proved effective with a promising positive impact on both symptomatology and local signs in the study group. As for the patients in the control group, 37 of them required a second hospitalization due to the recurrence of symptoms and to whom the same laser therapy was applied. (4) Conclusions: A beneficial and positive effect was observed in our study, mainly on the symptoms determined by the appearance of the perianal fistula, both in the short- and long-term. High-frequency laser therapy is of major importance, considering the lower costs compared to surgery as well as the discomfort created during local treatments

Laser Therapy in Perianal Fistulas

(1) Background: Perianal fistula represents a chronic local suppuration, and recurrent or incorrectly treated, this pathology has a negative effect on the life of patients. (2) Methods: A 12-month prospective study was conducted with a study group (patients at the second presentation) and a control group (patients at the first presentation). The BTL-6000 brand laser has 50 times the maximum power of conventional laser devices with an unmatched wavelength of 1064 nm and a tissue penetration power of up to 10 cm. It is highly effective in speeding up healing and pain management (3) Results: Transcutaneous high-intensity laser therapy of perianal fistulas proved effective with a promising positive impact on both symptomatology and local signs in the study group. As for the patients in the control group, 37 of them required a second hospitalization due to the recurrence of symptoms and to whom the same laser therapy was applied. (4) Conclusions: A beneficial and positive effect was observed in our study, mainly on the symptoms determined by the appearance of the perianal fistula, both in the short- and long-term. High-frequency laser therapy is of major importance, considering the lower costs compared to surgery as well as the discomfort created during local treatments