Ondasetron is More Likely Than Ketamine to Cause Ventricular Tachycardia

3noN/AreservedmixedMarzuillo, Pierluigi; Rabach, Ingrid; Barbi, EgidioMarzuillo, Pierluigi; Rabach, Ingrid; Barbi, Egidi

A curious rash.

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Adolescent with recurrent knee pain

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Is Treatment With Hydroxychloroquine Effective in Surfactant Protein C Deficiency?

We present the case of two twin brothers with surfactant protein C deficiency who were treated with hydroxychloroquine for three years, with apparent success. The exact physiopathology of this disease is not known and there is no specific treatment for it. There is merely news from a few previous descriptions in the literature about the use of hydroxychloroquine for surfactant protein C deficiency with satisfactory results. Two years after the treatment was withdrawn, the twins were evaluated once again: they presented no new infections, growth and general state were normal and chest CT showed a notable additional reduction in the interstitial pneumopathy. These data seem to cast some doubt on the efficacy of hydroxychloroquine, and they suggest that the clinical improvement was simply the natural evolution of the disease

Tramadol: An effective alternative to codeine?

In June 2013, the European Medicine Agency (EMA) prohibited the use of medicines containing codeine for patients under 12 years of age. The EMA recommendations impose a change in the management of moderate-severe pain in children. Tramadol, an opioid-related analgesic with an intermediate analgesic potency between NSAIDs and major opioids, is a possible substitute for codeine in children. It shows less respiratory depression and sedation as well as other adverse effects of opioids and also has no clinically relevant effects on heart rate and blood pressure. It acts like a weak or partial agonist with no affinity for opioid receptors and its central analgesic effects are partially reversed by naloxone. According to the available evidence, tramadol appears to be efficacious in the management of moderate-severe pain in children and safe both in inpatients and outpatients with no case of paediatric respiratory depression at therapeutic dosage being currently reported in the literature. Nevertheless, it may be appropriate to limit the use of tramadol to monitored settings for children with specific risk factors (adeno-tonsillectomy, sleep apnoea, obesity, renal impairments and the neonatal period), subject to further safety evidence. This review takes into consideration the available evidence on the pharmacokinetic and pharmacodynamic efficacy and safety profile of tramadol

Sedation and analgesia in children with cerebral palsy: a narrative review

Background: Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications. Data sources: We reviewed the available literature to highlight the specific risk factors and area of criticism, that should be further improved. We searched the Cochrane Library, Medline, Pubmed from 1987 to September 2018 using key words such as \u2018cerebral palsy and children and pain\u2019 or \u2018sedation and cerebral palsy and children\u2019. Results: While different pain scales are useful in recognizing pain expressions, anxiety scales are not available. Moreover, studies on non-pharmacological techniques do not always have comparable results. Several risk factors, from anatomic abnormalities to liver and kidney functioning, should be kept in mind before proceeding with sedation. Conclusions: Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy (pharmacological and non-pharmacological) should be used in different settings

Carbon Sequestration in Agroforestry Systems Between Conservation Agriculture and Conventional Practice in the Asal Area of Machakos County, Kenya

Dryland ecosystems have always been prone to relatively high vegetation and general environmental degradation; translating to changes in soil physical and chemical properties and massive carbon losses. Despite their vast surface area, Carbon sequestration therein still remains low. However, this low carbon means they are less saturated and therefore a tremendous potential therein to sequester more Carbon. Conservation agriculture with trees (CAWT) presents an opportunity to reduce the degradation and enhance the carbon stocks. This study was set to compare the biomass productivity and carbon sequestration potential of agroforestry between conventional and conservation agriculture practice. The  study was carried out as part of ongoing experimentation established in short rain (SR) season of 2012 by the World Agroforestry Centre in a trial site at the Agricultural Training Centre (ATC) in Machakos county, Kenya. The trials adopted a split plot arranged in a randomized complete block design with two farming systems (conventional and conservation agriculture) as the main blocks, 7 treatments and three replicates, summing to a total of 42 plots. In the fields, two shrub species (Calliandra calothyrsus Meissn. and Gliricidia sepium Jacq.) were planted in three different spacing (1.5x1 m, 3x1 m, 4.5x1 m) for maize-legume intercrops. Trees were harvested by coppicing, weighed and leaf/twig samples taken for determination of biomass, which was then converted to Carbon using a conversion factor 0.5. The data was statistically analyzed using ANOVA and means separated using LSD at p <0.05. Results showed significant increase in carbon sequestration under conservation agriculture (p <0.001), with a yearly sequestration potential of between 12.8 and 24 Mg C/ha/yr compared to 11.6-23 Mg C/ha/yr for conventional practice. Calliandra also sequestered more carbon than Gliricidia. CAWT is therefore concluded to be a feasible way of increasing carbon stocks in the drylands

Bcl-2–related protein A1 is an endogenous and cytokine-stimulated mediator of cytoprotection in hyperoxic acute lung injury

Hyperoxic acute lung injury (HALI) is characterized by a cell death response with features of apoptosis and necrosis that is inhibited by IL-11 and other interventions. We hypothesized that Bfl-1/A1, an antiapoptotic Bcl-2 protein, is a critical regulator of HALI and a mediator of IL-11–induced cytoprotection. To test this, we characterized the expression of A1 and the oxygen susceptibility of WT and IL-11 Tg(+) mice with normal and null A1 loci. In WT mice, 100% O(2) caused TUNEL(+) cell death, induction and activation of intrinsic and mitochondrial-death pathways, and alveolar protein leak. Bcl-2 and Bcl-xl were also induced as an apparent protective response. A1 was induced in hyperoxia, and in A1-null mice, the toxic effects of hyperoxia were exaggerated, Bcl-2 and Bcl-xl were not induced, and premature death was seen. In contrast, IL-11 stimulated A1, diminished the toxic effects of hyperoxia, stimulated Bcl-2 and Bcl-xl, and enhanced murine survival in 100% O(2). In A1-null mice, IL-11–induced protection, survival advantage, and Bcl-2 and Bcl-xl induction were significantly decreased. VEGF also conferred protection via an A1-dependent mechanism. In vitro hyperoxia also stimulated A1, and A1 overexpression inhibited oxidant-induced epithelial cell apoptosis and necrosis. A1 is an important regulator of oxidant-induced lung injury, apoptosis, necrosis, and Bcl-2 and Bcl-xl gene expression and a critical mediator of IL-11– and VEGF-induced cytoprotection

Closure of birth centers Latisana and Gorizia | Chiusura dei punti nascita di Latisana e Gorizia

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