Neurolytic Celiac Plexus Blockade in Patients with Upper Intraabdominal Malignancies: An Evidence-Based Narrative Review

Background: Cancer-related abdominal pain is a common symptom associated with upper intra-abdominal carcinoma, especially in patients with advanced disease and it has posed a significant therapeutic challenge to medical practitioners. Typically, cancer pain can be managed by following the World Health Organization 3-step analgesic ladder. However, analgesic use of opioids, the mainstay treatment for moderate-to-severe cancer-related pain, may be ineffective in a subset of cancer patients. Escalation of dosage may be limited by opioid-induced side effects. The aim of this study was to review the literature addressing the effect of neurolytic celiac plexus block (NCPB) on the palliation of pain emanating from advanced upper intra-abdominal malignancies. Methods: Electronic databases including Medline/PubMed, EMBASE, and Cochrane Library were searched. Only studies with a high level of evidence were reviewed. These included prospective randomized control studies, systematic reviews and meta-analyses. Further, references from included articles were carefully reviewed for additional relevant trials. Results: A total of 13 prospective randomized trials, 5 systematic reviews and meta-analyses, and one Cochrane review article were found to meet eligibility criteria. Conclusion: Neurolysis of the celiac/splanchnic plexus is an effective and safe therapeutic modality that should be considered early for palliation of cancer-related pain in advanced upper intra-abdominal malignancies. This is especially true for patients with intolerable opioid-induced adverse events and painful symptoms resistant to oral analgesics

Neurolytic Celiac Plexus Blockade in Patients with Upper Intraabdominal Malignancies: An Evidence-Based Narrative Review

Background: Cancer-related abdominal pain is a common symptom associated with upper intra-abdominal carcinoma, especially in patients with advanced disease and it has posed a significant therapeutic challenge to medical practitioners. Typically, cancer pain can be managed by following the World Health Organization 3-step analgesic ladder. However, analgesic use of opioids, the mainstay treatment for moderate-to-severe cancer-related pain, may be ineffective in a subset of cancer patients. Escalation of dosage may be limited by opioid-induced side effects. The aim of this study was to review the literature addressing the effect of neurolytic celiac plexus block (NCPB) on the palliation of pain emanating from advanced upper intra-abdominal malignancies. Methods: Electronic databases including Medline/PubMed, EMBASE, and Cochrane Library were searched. Only studies with a high level of evidence were reviewed. These included prospective randomized control studies, systematic reviews and meta-analyses. Further, references from included articles were carefully reviewed for additional relevant trials. Results: A total of 13 prospective randomized trials, 5 systematic reviews and meta-analyses, and one Cochrane review article were found to meet eligibility criteria. Conclusion: Neurolysis of the celiac/splanchnic plexus is an effective and safe therapeutic modality that should be considered early for palliation of cancer-related pain in advanced upper intra-abdominal malignancies. This is especially true for patients with intolerable opioid-induced adverse events and painful symptoms resistant to oral analgesics

Generation of Atovaquone-Resistant Toxoplasma gondii via Chemical Mutagenesis

Toxoplasma gondii is a zoonotic protozoan parasite that is the causative agent of toxoplasmosis, a leading cause of neurological birth defects in the United States and around the world. Furthermore it is closely related to Plasmodium falciparum, the parasite that causes malaria. The research conducted was aimed at furthering understanding in drug development for these parasites through the generation of artificial drug-resistance via chemical mutagenesis of T. gondii with N-ethyl-N-nitrosurea. Through chemical mutagenesis, an atovaquone-resistant mutant strain of T. gondii was created which is now a viable positive control for further application of this technique