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Background: Chemotherapy-induced nausea and/or vomiting (CINV) is an intractable adverse effect of anticancer drugs. Although prophylactic use of fosaprepitant may be effective in reducing CINV, there is a lack of studies evaluating the application of fosaprepitant in real world. Aims and methods: This study prospectively observed the effectiveness and safety for the prophylaxis of CINV in a real-world clinical setting. A single dose fosaprepitant 150 mg was intravenously administered to enrolled patients 30 min prior to the chemotherapy drug. Initial data were recorded and patients were followed for 120 h (5 days). The primary endpoint is the complete response (CR) rate and the incidence of serious adverse events (SAEs). The second endpoint is the use of rescue therapy. We also performed stratified analyses to investigate the impact of different factors on fosaprepitant for the prevention of CINV in the acute phase. Results: Between March 2021 to August 2021, 1001 patients were enrolled in this study. CR was 77.32%, 93.61%, and 76.72% for vomiting control in 0–24 h, 24–120 h, and 0–120 h respectively, and 97.4%, 99.1%, and 96.9% for nausea control. No SAEs were recorded. 23.48% or 3.1% of patients needed rescue therapy for vomiting or nausea control respectively, most of which occurred in the acute phase. CR rate decreased with increasing emetogenicity of chemotherapeutic agents. Conclusions: Single-dose fosaprepitant has shown good performance in real-world clinical practice. This study is the first to prospectively evaluate the efficacy and safety of fosaprepitant for the prevention of CINV in a real-world clinical setting and may be a good complement to the clinical data. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite progress made in antiemetic control, most cancer patients still experience chemotherapy-induced nausea and vomiting. In oncology departments, nurses can evaluate the effects of complementary therapies such as use of essential oil on reducing nausea and vomiting of patients undergoing chemotherapy. Therefore, this study was conducted to explore the effect of cinnamon essential oil on the chemotherapy-induced nausea and vomiting of cancer patients. Materials and Methods: This is a two-group experimental study with a pretest-posttest design that was conducted between January 20 and March 15 of the year 2020. Through convenience sampling, 70 patients experiencing chemotherapy-induced nausea and vomiting were recruited to participate in this study. The participants were randomly allocated to two control and intervention groups. A pad moistened with 2 ml of isotonic saline and 0.2 ml of cinnamon essential oil was first placed inside a plastic bag, and then patients in the intervention group were asked to take three deep breaths while their face was towards the bag for two times at five-minute intervals. Patients in the control group used a placebo (a pad moistened with 2 ml of isotonic saline) instead of cinnamon essential oil during the intervention period. Participants in the two groups received routine antiemetic treatment. Using Visual Analog Scale (VAS), the severity of nausea and vomiting was measured in both groups before the intervention. For this reason, the severity of nausea and vomiting was measured after the first three breaths, and then after the second three breaths. Data were analyzed by SPSS software, using independent t -test, Chi-squared test, and Fisher's exact test. Repeated measures ANOVA were also used to evaluate nausea and vomiting between the two groups across times. The significant level of 0.05 was considered for all tests. Results: There were no significant differences between the two groups in terms of demographic characteristics and the severity of chemotherapy-induced nausea and vomiting before the intervention. The severity of chemotherapy-induced nausea and vomiting was significantly lower in the cinnamon group than the control group after the first 3.08 (0.55), (F2 = 13.27, p < 0.001) and second breaths 1.91 (0.33) (F2 = 11.39, p < 0.001). Conclusions: Nurses can educate patients and their families to use of cinnamon essential oil. Nursing managers can also emphasize on the use of cinnamon essential oil, which is one of the non-pharmacological, low-cost, and effective methods of reducing chemotherapy-induced nausea and vomiting, by holding in-service training classes. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in preventing PONV in patients undergoing non-laparoscopic surgeries. Methods: A PRISMA-guided systematic review and meta-analysis was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at postoperative time points, namely T1 (0–2 hours), T2 (0–6 hours), T3 (12–24 hours), T4 (24–48 hours), and T5 (24–72 hours), as well as safety (number of incidence of adverse effects). A meta-analysis of the efficacy and safety groups was performed using a random-effects model. Results: Nineteen randomised controlled trials were included. Pooled risk ratio (RR) revealed that patients receiving palonosetron were significantly less likely to develop nausea [0–2 h, RR = 0.82 (95% confidence interval (CI): 0.50, 1.34), P = 0.317, I2 = 15.3%], [0–6 h, RR = 0.76 (95% CI: 0.44, 1.29), P = 0.137, I2 = 45.7%], [12–24 h, RR = 0.39 (95%CI: 0.16, 0.96), P = 0.088, I2 = 54.2%], [24–48 h, RR = 0.44 (95% CI: 0.20, 0.96), P = 0.598, I2 = 0%], [24–72 h, RR 0.22 (95% CI: 0.08, 0.57), P = 0.119, I2 = 53.0%] and vomiting [0–2 h, RR = 0.59 (95% CI: 0.29, 1.23), P = 0.868, I2 = 0%], [0–6 h, RR = 1.42 (95% CI: 0.74, 2.72), P = 0.790, I2 = 0%], [12–24 h, RR = 0.14 (95% CI: 0.04, 0.51), P = 0.749, I2 = 0.0%], [24–48 h, RR = 0.24 (95%CI: 0.09, 0.62), P = 0.561, I2 = 0%], [24–72 h, RR = 0.11 (95% CI: 0.02, 0.58), P = 0.859, I2 = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), P = 0.940, I2 = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), P = 0.870, I2 = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), P = 0.650, I2 = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), P = 0.644, I2 = 0%]. Conclusion: Palonosetron and ondansetron exhibited comparable efficacy in the early hours (0–6 h). Palonosetron showed superior efficacy beyond 6 hours, providing sustained PONV prophylaxis in patients undergoing various surgeries, excluding laparoscopic procedures. [ABSTRACT FROM AUTHOR]

This case report presents a 34-year-old Middle Eastern woman with atypical symptoms of Type II Necrotizing Soft Tissue Infection (NSTI). Due to the difficulty in diagnosing Type II NSTI, the patient experienced protracted illness. Once diagnosed, the patient underwent multiple surgical debridement procedures requiring antibiotic and pain management therapy before being successfully discharged home. Initial diagnosis of Type II NSTI is challenging to the provider due to vague symptoms and late occurrence of cutaneous changes. When cutaneous lesions are identified, rapid surgical evaluation is imperative to minimize morbidity and mortality. This paper emphasizes the complexity of diagnosing Type II NSTI and the need for a comprehensive history and frequent physical examinations. [ABSTRACT FROM AUTHOR]

Introduction Varenicline helps people who smoke quit at rates 2–3 times greater than placebo. Currently, in the United States, varenicline is not available over the counter (OTC). Aims and Methods In this study, we assessed the safety and efficacy of 1 mg and 0.5 mg varenicline as an OTC medication for smoking cessation in comparison to placebo. This randomized, double-blind, placebo-controlled study was performed at two clinical sites in the United States of n  = 313 people. The treatment period was 12 weeks. During the COVID pandemic, the protocol was modified to allow remote participation; verification of smoking status was via breath carbon monoxide levels for in-person visits and mailed urine cotinine kits for the remote participants. Results There was no difference in biologically confirmed continuous abstinence by condition between weeks 8 and 12; however, the odds of biologically confirmed point prevalence abstinence were higher for those in the 1 mg b.i.d. condition than for those in the placebo condition at week 12 (OR 3.39; 95% CI 1.49, 7.71), and were higher for those assigned to the 1.0 mg b.i.d. condition than the 0.5 mg b.i.d. condition at week 12 (OR 2.37; 95% CI 1.11, 5.05). Adverse events were modest, and as expected (vivid dreams and nausea in the medication conditions). Conclusions The results are suggestive that varenicline is safe and effective as an OTC medication. [ABSTRACT FROM AUTHOR]

This study aimed to assess the incidence of post‐discharge nausea and vomiting (PDNV) following sedation with nalbuphine and etomidate and to evaluate the prophylactic effects of scopolamine in reducing PDNV. A two‐stage prospective clinical trial was conducted. The first part involved an observational study of 77 subjects to assess the PDNV incidence post‐sedation with nalbuphine, etomidate, and propofol. The second part compared the effectiveness of palonosetron 0.075 mg (P group), scopolamine 0.1 mg (S group), and their combination (PS group) in reducing PDNV. The primary endpoint was the incidence of PDNV within 8 h post‐sedation. Secondary outcomes included PDNV frequency and severity at 8–24, 0–24, and 24–48 h and side effects of medications. The incidence of PDNV within 8 h post‐sedation was 37.66% (29/77). The PS group showed a significantly lower PDNV rate of 2.56% within 8 h, compared to the P group (35.71%, P <.001), S group (19.64%, P <.001), and control group (38.39%, P <.001), respectively. The S group (19.64%) also had a lower rate than the P group (35.71%, P =.007) and the control group (38.39%, P =.002). Subgroup analysis suggested a potential differential effect of palonosetron in reducing vomiting among male patients undergoing gastrointestinal procedures. The combination therapy was also associated with fewer cases of mild or no nausea and vomiting. In summary, the incidence of PDNV following sedation with nalbuphine and etomidate was notably high. The combination of scopolamine and palonosetron was more effective in preventing PDNV, with implications for improved post‐sedation care. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to investigate the prevalence of sexual harassment among operating room nurses, and to analyze the influencing factors. Background: Sexual harassment in the healthcare field has a high incidence and nurses are the main victims; sexual harassment not only leads to physical and mental problems, but also undermines nurses' performance and affects the quality of medical care. Methods: A multi-center cross-sectional study was conducted using an online survey to investigate the sexual harassment experiences of 483 operating room nurses. The survey included demographic information, personality traits (Ten-Item Personality Inventory), sexual harassment experiences (Workplace Sexual Harassment Questionnaire), negative consequences, coping strategies, and social support status. Results: 63% of operating room nurses experienced sexual harassment in the past 12 months, with gender harassment predominating (56.7%), followed by unwanted sexual attention (28.6%) and sexual coercion (13.6%). Surgeons (81.20%) and married ones (66.7%) were the most common perpetrators. Most victims possess limited knowledge regarding sexual harassment laws and exhibit weak awareness of their rights protection. 47.8% remained silent after being sexually harassed; most of nurse employed passive coping strategies. Sexual harassment had the most prominent impact on the work of operating room nurses, mainly in the form of decreased work quality and efficiency (87.3%), as well as decreased work engagement (77.0%) and negative workplace pressure experience (72.2%); emotional disturbances, such as anxiety (76.6%), stigma (71.8%), and fear (71.5%); and was accompanied by sleep disorders (74.9%), headaches (56.0%) and nausea and vomiting (54.3%); as well as reduced trust in the opposite sex (83.8%) and disruption of family life (82.1%).Only 39.2% of the hospitals had sexual harassment reporting channels or methods, 30.7% had departments to deal with sexual harassment in the workplace, and 46.8% had communication discussions about psychological safety after sexual harassment. Personality traits, drinking behaviour, age, marriage, and social support were associated with sexual harassment behavior in the operating room. Conclusion: The high incidence of sexual harassment in the operating room affects nurses' productivity and physical and mental health. Operating room nurses had insufficient legal knowledge about sexual harassment and lacked hospital organizational support. agreeableness and openness personality traits, alcohol consumption, age, being married, and lack of social support were influential factors of sexual harassment in the operating room. Implications for nursing management: Healthcare organizations should encourage reporting, care for victims, and join with the police department, judiciary, and women's federation to develop reporting procedures and training programs on sexual harassment knowledge to create a safe and comfortable professional environment. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain usually occur in patients who have undergone functional endoscopic sinus surgery (FESS). Remimazolam and dexmedetomidine could enhance the quality of recovery (QoR) after surgery. The aim of this study was to compare the effects of remimazolam and dexmedetomidine with respect to the QoR-40 score of patients who have undergone FESS. Methods: A total of 120 patients (18–65 years) scheduled for FESS were randomly allocated to Group R, Group D or Group C. Group R received 0.075 mg/kg remimazolam loading and 0.1 mg/kg/h infusion. Group D received dexmedetomidine (1.0 µg/kg loading, 0.5 µg/kg/h infusion). Group C received a placebo equal to dexmedetomidine. Anaesthesia was induced with propofol, sufentanil and cisatracurium. Anaesthesia maintenance was performed via target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome was the QoR-40 score on the day before surgery and postoperative Day 1 (POD1). The secondary outcomes were the time to return to consciousness, length of stay in the PACU, sedation score upon PACU arrival, pain, postoperative nausea and vomiting (PONV) and cumulative consumption of propofol and remifentanil. Adverse effects were recorded. Results: The total QoR-40 scores (median, IQR) on POD1 decreased less (154.5, 152.0 -159.0) in Groups R and D (155.0, 154.8 -159.3) than in Group C (139.0, 136.8 -142.0) (P < 0.001). The time to return of consciousness and the length of stay in the PACU were significantly shorter in Groups R and C than in Group D (P < 0.001). The level of sedation upon PACU arrival (median, IQR) in Groups R (-2.0, -2.0—-1.0) and D (-2.0, -3.0—-2.0) was greater than that in Group C (1.0, 0.0 -1.0) (P < 0.001). The cumulative consumption rates of propofol and remifentanil in Groups R and D were lower than that in Group C (P < 0.001). Compared with that in Group C, the pain intensity was lower in Groups R and D (P < 0.001).The number of patients occurring PONV was less in Groups R (3/40) and D (4/40) than in Group C (11/40) (P = 0.024). Fifteen patients had bradycardia in Group D, whereas no bradycardia was noted in Groups R or C (P < 0.001). Conclusion: Administration of remimazolam could provide a similar QoR to that of dexmedetomidine. In addition, remimazolam may be a promising option for improving the QoR of patients who have undergone FESS. Trial registration: ChiCTR2300076209. (Prospectively registered). The initial registration date was 27/9/2023. [ABSTRACT FROM AUTHOR]

Background: Migraine is a painful neurological syndrome characterized by attacks of throbbing headache, of moderate to severe intensity, which is associated with photo- and phono- sensitivity as well as nausea and vomiting. It affects about 15% of the world's population being 2–3 times more prevalent in females. The calcitonin gene-related peptide (CGRP) is a key mediator in the pathophysiology of migraine, and a significant advance in the field has been the development of anti-CGRP therapies. The trigeminal ganglion (TG) is thought to be an important site of action for these drugs. Moreover, experimental migraine can be induced by CGRP injection in the TG. The signaling pathway induced by CGRP in the TG is not fully understood, but studies suggest that voltage-gated calcium channels contribute to CGRP effects relevant to migraine. Objective: We hypothesised that CGRP injection in the TG enhances CaV3.2 T-type calcium channel currents to contribute to the development of periorbital mechanical allodynia. Results: A Co-Immunoprecipitation assay in tsA-201 cells revealed that CaV3.2 channels form a complex with RAMP-1, a component of the CGRP receptor. Constitutive CGRPR activity was able to inhibit CaV3.2 channels and induce a depolarizing shift in both activation and inactivation curves. Incubation of TG neurons with CGRP increased T-type current density by ~ 3.6 fold, an effect that was not observed in TG neurons from CaV3.2 knockout mice. Incubation of TG neurons with Z944, a pan T-type channel blocker, resulted in an approximately 80% inhibition of T-type currents. In vivo, this treatment abolished the development of periorbital mechanical allodynia induced by CGRP in male and female mice. Likewise, CaV3.2 knockout mice did not develop periorbital mechanical allodynia after intraganglionic CGRP injection. Finally, we demonstrated that the CGRP effect depends on the activation of its canonical GPCR, followed by protein kinase A activation. Conclusion: The present study suggests that CGRP modulates CaV3.2 in the TG, an effect possibly mediated by the canonical CGRP receptor and PKA activation. The increase in T-type currents in the TG may represent a contributing factor for the initiation and maintenance of the headache pain during migraine. [ABSTRACT FROM AUTHOR]

Background: Even with the great advancements in recent years in total knee arthroplasty (TKA), some patients continue to have persistent postsurgical pain (PPSP). The advantages of systemic corticosteroids in the perioperative context have been further supported by previously published trials. However, the impact of dexamethasone on the intensity of post-TKA PPSP is still unclear. We aimed to investigate its effect on the degree of PPSP and compare that with a placebo. Methods: In this randomized, double-blind, placebo-controlled study, 48 patients undergoing unilateral TKA were given intravenous dexamethasone 10 mg or saline just before spinal anesthesia was induced, and they also received two additional doses of dexamethasone 10 mg or saline 24 and 48 h after surgery. A standardized, multimodal analgesic regimen was administered to each patient. The modified WOMAC pain scores at 12 weeks postoperative were the main outcome. The secondary outcomes included pain during a walk of five meters, pain during active knee flexion at 45 degrees, maximum pain at rest during the previous 24 h, nausea visual analogue scale values, and use of rescue opioid and antiemetic medications. Results: There was no difference in modified WOMAC pain scores 12 weeks after surgery between patients who received and did not receive perioperative dexamethasone. At 24, 30, 48, 54, and 72 h following surgery, the dexamethasone group experienced considerably less pain during a five-meter walk and during 45 degrees active knee flexion (p < 0.01). At postoperative 0–24, 24–48, and 48–72 h, the dexamethasone group experienced less maximal pain at rest (p < 0.01). The dexamethasone group also had less visual analogue scale scores for nausea at 6, 24, 30, 48, and 54 h after surgery (p < 0.02). During the first 0–24 and 24–48 h, the dexamethasone group consumed fewer opioids and antiemetic medications (p < 0.01). All patients showed no signs of wound complications. Conclusions: When compared to a placebo at 12 weeks after TKA, intravenous dexamethasone did not reduce PPSP. Nevertheless, early postoperative pain was relieved by perioperative intravenous dexamethasone, which also decreased the need for opioid and antiemetic medications and decreased postoperative nausea and vomiting. Trial registration: NCT02760459. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI), especially Machine Learning (ML), has developed systems capable of performing tasks that require human intelligence. In anesthesiology and other medical fields, AI applications can improve the precision and efficiency of daily clinical practice, and can also facilitate a personalized approach to patient care, which can lead to improved outcomes and quality of care. ML has been successfully applied in various settings of daily anesthesiology practice, such as predicting acute kidney injury, optimizing anesthetic doses, and managing postoperative nausea and vomiting. The critical evaluation of ML models in healthcare is crucial to assess their validity, safety, and clinical applicability. Evaluation metrics allow an objective statistical assessment of model performance. Tools such as Shapley Values (SHAP) help interpret how individual variables contribute to model predictions. Transparency in reporting is key in maintaining trust in these technologies and to ensure their use follows ethical principles, aiming to reduce safety concerns while also benefiting patients. Understanding evaluation metrics is essential, as they provide detailed information on model performance and their ability to discriminate between individual class rates. This article offers a comprehensive framework in assessing the validity, applicability, and limitations of models, guiding responsible and effective integration of ML technologies into clinical practice. A balance between innovation, patient safety and ethical considerations must be pursued. [ABSTRACT FROM AUTHOR]

Introduction: Chenopodium album, commonly known as "lambsquarters," is a plant consumed as food and used in traditional medicine. Its popularity is increasing due to the belief that it has fewer side effects compared to synthetic drugs. However, its use can lead to acute or chronic poisoning. The growing interest in herbal remedies, along with uncontrolled usage and disregard for expert recommendations, contributes to adverse effects. Case Presentation: : A 68-year-old female patient presented to the emergency department with nausea, vomiting, and flank pain following the use of lambsquarters. Impaired kidney function was detected in the patient. A biopsy performed after Chenopodium album usage led to the diagnosis of tubulointerstitial nephritis (TIN). The patient responded positively to corticosteroid and hemodialysis treatment. Discussion: Caution is necessary in the use of herbal medicines and traditional treatments. A thorough evaluation of factors such as patients' nutritional status, herbal product usage, medication history, and genetic background is crucial. Chenopodium album can cause tubulointerstitial nephritis, resulting in kidney damage. Similarly, heavy metal poisoning through herbal products can lead to kidney damage. Adopting a multidisciplinary approach in the diagnosis and treatment process can contribute to better patient management. Conclusion: This case presents a rare instance of tubulointerstitial nephritis developed due to the use of herbal products. Physicians should inquire about patients' history of exogenous substance use and conduct a comprehensive assessment, keeping such situations in mind. Conscious use of herbal medicines and traditional treatments can help prevent serious complications like kidney damage. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Medicine & Health is the property of Journal of Modern Medicine & Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: This systematic review examined 42 adult cerebellopontine angle (CPA) medulloblastoma (CPAMB) patients with individual patient data from 27 studies. The median age was 32 years. Patients commonly presented with headaches (81%), cranial neuropathy (90%), cerebellar dysfunction (79%), and nausea/vomiting (50%). Maximal safe resection was pursued, and a gross total resection was performed in 60% of cases. Most patients (93%) received adjuvant therapy, typically both radiotherapy and chemotherapy. Outcomes were promising, with median survival rates of 96%, 85%, and 85% at 1, 3, and 5 years, respectively. The recurrence rate was low (11%) at a median of 18 months' follow-up. The receipt of adjuvant therapy was significantly associated with better recurrence and survival outcomes. Medulloblastoma should be considered in the differential diagnosis of young adult patients with CPA lesions with radiographical features suggesting hypercellularity. Maximal safe resection and adjuvant craniospinal radiotherapy plus systemic therapy is an optimal management strategy. Objective: The aim of this study was to systematically review the existing individual patient data in the literature on adult cerebellopontine angle (CPA) medulloblastoma (MB) and characterize the patient presentation, management strategies used, and oncological outcomes of this rare entity to guide future clinical practice. Methods: Following PRISMA guidelines, a systematic review was conducted by searching PubMed, EMBASE, Web of Science, and Cochrane databases from inception to 19 June 2024. Studies regarding adult patients with histologically confirmed MB radiographically confirmed to be located in the CPA were included. Clinical data were synthesized, and predictors of outcomes were evaluated. Results: Twenty-seven studies with 42 adult CPAMB patients were included. The median age was 32 years (range: 19–56). Headaches (81%), cranial neuropathy (90%), cerebellar dysfunction (79%), and nausea/vomiting (50%) were typical presenting features. The predominant histological subtype was the classic variant. Maximal safe surgical resection was performed, most commonly using a retrosigmoid approach, and 60% of cases received a gross total resection. Most patients received adjuvant treatment (93%), typically chemoradiotherapy. The recurrence rate was 11% after a median of 18 months of follow-up. Relatively high survival rates of 96%, 85%, and 85% were observed at 1, 3, and 5 years, respectively. Patients who received adjuvant therapy had significantly better recurrence and greater overall survival outcomes. Conclusions: These results support the consideration of MB in young adult patients presenting with CPA tumors with radiographical features suggestive of hypercellularity and the utilization of a management strategy of maximal safe resection plus post-operative craniospinal irradiation along with chemotherapy to optimally treat these rare patients. [ABSTRACT FROM AUTHOR]

Both enhanced motion-induced nausea and increased static imbalance are observed symptoms in migraine and especially vestibular migraine (VM). Motion-induced nausea and static imbalance were investigated in a mouse model, nestin/hRAMP1, expressing elevated levels of human RAMP1 which enhances CGRP signaling in the nervous system, and compared to non-affected littermate controls. Behavioral surrogates such as the motion-induced thermoregulation and postural sway center of pressure (CoP) assays were used to assess motion sensitivity. Nausea readouts revealed that the nestin/hRAMP1 mouse exhibit an increased sensitivity to CGRP's effects at lower doses compared to unaffected controls. In addition, the nestin/hRAMP1 mice exhibit a higher dynamic range in postural sway than their wildtype counterparts, along with increased sway observed in nestin/hRAMP1 male mice that was not present in male unaffected controls. Results from migraine blocker experiments were challenging to interpret, but the data suggests that olcegepant is incapable of reversing CGRP-induced or endogenous alterations in the nestin/hRAMP1 mice, while rizatriptan was ineffective in both the nestin/hRAMP1 and control mice. The results indicate that overexpression of hRAMP1 leads to heightened endogenous CGRP signaling. Results also suggest that both olcegepant and rizatriptan are ineffective in reducing nausea and sway in this hypersensitive CGRP mouse model. This study suggests that the hypersensitive nestin/hRAMP1 mouse may serve as a model for difficult to treat cases of migraine that exhibit increased motion sensitivity. [ABSTRACT FROM AUTHOR]

COVID-19 symptoms are often perceived as respiratory only. However, recent findings have shown that gastrointestinal symptoms are being reported in a significant number of patients, ranging from 17% to more than 50%, with some studies speculating that the figure may be even higher, but that it is under-reported and overlooked. Therefore, a hypothesis was put forward that gastrointestinal symptoms related to COVID-19 may make pouch or stoma function deteriorate or even mimic pouchitis symptoms in ileoanal pouches and gastroenteritis in stoma patients; the intention was to investigate this further and to test the hypothesis. A retrospective analysis of patients with a stoma or ileoanal pouch was conducted, including those who reported having gastrointestinal symptoms following a positive COVID-19 test in the preceding 4 years (2020–2024). It was anticipated that gaining insight into this topic can help improve care for this patient group. [ABSTRACT FROM AUTHOR]

Background: Prior meta-analyses have established the potential of intravenous ketamine in safeguarding against neurocognitive impairment, but the efficacy of intravenous esketamine for the prevention of perioperative neurocognitive disorders (PND) remains uncertain. The primary aim of this meta-analysis was to conduct a comprehensive evaluation of the effects of esketamine on PND in adult surgical patients undergoing general anesthesia. Methods: We searched several electronic databases and clinical trial registries to find relevant trials. Randomized controlled trials of perioperative use of esketamine adjuvant were included in the analysis. The main outcome measured was the risk of postoperative delirium(POD) and postoperative cognitive dysfunction (POCD). Secondary outcomes included the assessment of postoperative cognitive status, pain scores (VAS/NRS), remifentanil consumption and the occurrence of postoperative nausea and vomiting (PONV). Results: Thirteen studies encompassing procedures such as abdominal, thoracoscopic lung, gastrointestinal, laparoscopic gynecological, spinal surgery, and modified radical mastectomy, were included in the analysis. A cohort comprising 1068 adult patients underwent general anesthesia, with 584 patients assigned to the esketamine group and 484 patients designated to the placebo group. The administration of general anesthesia was augmented by intravenous infusion of esketamine, and a comparative analysis was conducted in relation to alternative pharmacological interventions or a placebo. The application of esketamine during the perioperative period was observed to decrease the risk of POD (RR 0.46; 95% CI: 0.32, 0.66, p < 0.0001, GRADE = High) and exhibited a protective influence on POCD (RR = 0.50; 95%CI: 0.30, 0.84, p = 0.009, I2 = 0%, GRADE = Moderate). Significant improvements were observed at 4, 24 and 48 h post-surgery when comparing esketamine to a placebo (4 h: SMD -0.78, 95% CI: -1.24, -0.32, p = 0.0009, I2 = 58%, GRADE = Low; 24 h: SMD -0.92, 95% CI: -1.40, -0.44, p = 0.0002, I2 = 86%, GRADE = Low; 48 h: SMD -0.9, 95% CI: -1.68, -0.12, p = 0.02, I2 = 89%, GRADE = Low), and intraoperative remifentanil consumption was significantly reduced in the esketamine group (SMD -0.56; 95%CI: − 0.86, − 0.27, p = 0.0002, I2 = 62%, GRADE = moderate). A notable reduction in the risk of PONV was observed in the esketamine group(RR = 0.64; 95%CI: 0.49, 0.84, p = 0.001, I2 = 0%, GRADE = High). Conclusion: The use of intravenous esketamine as an adjuvant in general anesthesia may represent a potentially beneficial strategy for reducing susceptibility to PND, with potential benefits for preventing POD and POCD. Furthermore, it can decrease intraoperative opioid consumption and alleviate postoperative pain intensity without increasing the incidence of PONV. Trial registration: This meta-analysis was registered on PROSPERO (CRD42023453714). [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the effects of combining esketamine with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) in patients undergoing elective impacted tooth surgery or open reduction and internal fixation. Methods: In this single-center, prospective, double-blinded, randomized, parallel-controlled trial, 91 patients were randomly divided into two groups. The experimental group (group ES, n = 46) received a combination of sufentanil 1.5 µg/kg and esketamine 1.0 mg/kg, while the control group (group S, n = 45) received sufentanil 2 µg/kg alone for PCIA after surgery. Primary outcome was assessed using the Visual Analogue Scale (VAS) for patients at rest and during mouth opening at 6 h, 12 h, 24 h, and 48 h post-surgery. Secondary outcomes included the Ramsay Sedation Scale (RSS) scores, the Quality of Recovery-15 (QoR-15) scores, patient satisfaction with analgesia, and the occurrence of adverse events within 48 h post-surgery. The frequency of PCIA button presses and the number of patients requiring rescue analgesia were also recorded. Results: The resting VAS scores and the mouth-opening VAS scores at 6 h, 12 h, 24 h, and 48 h post-surgery were significantly lower in Group ES than in Group S (P < 0.05). Additionally, the RSS scores were significantly higher at 6 h (P = 0.032) and 12 h (P = 0.021) post-surgery in Group ES. The frequency of PCIA postoperative use within 48 h post-surgery decreased (P = 0.021) in Group ES, while satisfaction with analgesia and QoR-15 scores increased (P = 0.001 and P < 0.001, respectively). The incidences of postoperative dizziness and nausea/vomiting reduced (P = 0.045 and P = 0.036, respectively) in Group ES, but one adverse event of nightmare was observed. There was no significant difference in rescue analgesia between the two groups. Conclusion: The use of esketamine combined with sufentanil in patients undergoing third molar surgery and maxillofacial trauma can alleviate short-term postoperative pain, and improve the quality of postoperative recovery. Esketamine is worth promoting in the clinical application of oral and maxillofacial surgery. Trial registration: The study was retrospectively registered in chictr.org.cn with the identifier: ChiCTR2400086662 on 08/07/2024. [ABSTRACT FROM AUTHOR]

Background: Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation. Methods: We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models. Results: We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable. Conclusions: Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery. Trial registration: This systematic review was registered at PROSPERO (CRD42023397259). [ABSTRACT FROM AUTHOR]

This case report describes a rare occurrence of neurosarcoidosis presenting as area postrema syndrome, marked by severe nausea and vomiting. A woman in her 30s developed persistent symptoms following a cesarean section. Diagnostic investigations, including magnetic resonance imaging and cerebrospinal fluid analysis, confirmed the diagnosis of neurosarcoidosis. Treatment with prednisolone resulted in substantial symptom relief. This case emphasizes the need to consider neurosarcoidosis in the differential diagnosis of unexplained gastrointestinal symptoms and highlights the diagnostic challenges associated with such atypical presentations. [ABSTRACT FROM AUTHOR]

Background Monitoring toxicities among patients receiving immune checkpoint inhibitors using patient-reported outcome measures (PROMs) is relatively recent. This scoping review aims to guide decision making in the development of PROMs programs for patients receiving immune checkpoint inhibitor therapy. Methods Four electronic databases were searched from inception to January 2024. Data on PROM programs for patients receiving immune checkpoint inhibitors (eg, PROMs used, frequency) were extracted. Two authors with established interrater reliability screened titles, abstracts, and full texts. A narrative synthesis identified patterns in the data. Results A total of 22 articles described 16 unique multicomponent, electronic PROM programs for patients receiving immune checkpoint inhibitor therapy, mainly developed for remote monitoring of toxicities between appointments. Patients typically completed 18-26 items from the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) or Common Terminology Criteria for Adverse Events (CTCAE) weekly, with high adherence and satisfaction. Commonly monitored symptoms were diarrhea, fatigue, shortness of breath, cough, nausea, decreased appetite, rash, joint pain, pain, and mood. Other features of PROMs programs included clinician alerts, with some programs only flagging symptoms that had an impact on treatment. Some programs also or only sent alerts to patients to contact their clinicians and gave access to symptom management information. In terms of efficacy, the only consistent finding was an increase in quality of life. Conclusions The findings of this scoping review provide some indication as to which components of a PROM program are promising. However, as the evidence base for using PROMs among patients receiving immune checkpoint inhibitors is growing, many questions remain, including which symptoms to monitor, using which PROM, and at what frequency. More trials are needed to answer these questions and to determine how best to implement PROMs among patients receiving immune checkpoint inhibitor in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Transcatheter Arterial Chemoembolization (TACE) is administered repeatedly throughout all stages of liver cancer, often leading to side effects like nausea, vomiting, and retching. This study aimed to evaluate the clinical impact of P6 acupressure using Sea-Band® wristbands on these symptoms following TACE. Methods: From October 2017 to March 2018, 90 liver cancer patients were recruited from a tertiary hospital and divided into three groups: control, placebo, and P6 acupressure. The control group received standard nursing care, while the placebo group underwent SI3 acupressure on the lateral hand, and the P6 acupressure group used Sea-Band® wristbands for four days. Symptoms were measured at seven time points using Rhodes' INVR tool. Results: Data analysis with SPSS revealed that the P6 acupressure group had significantly lower total INVR scores, as well as reduced vomiting (F=5.53, p<.001) and retching (F=3.35, p<.032) compared to the placebo and control groups. Nausea scores, however, did not show a significant difference across the groups (F=1.78, p<.090). Conclusion: This study highlights that P6 acupressure is a safe, non-invasive, and cost-effective intervention that effectively reduces vomiting and retching in liver cancer patients post-TACE. It recommends incorporating this intervention into clinical practice, alongside comprehensive nursing education on symptom management. [ABSTRACT FROM AUTHOR]

Rationale: Paraquat, a highly toxic bipyridyl herbicide lacking a specific antidote, poses severe risks upon ingestion. However, the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms, particularly when a detailed exposure history is not provided. Patient's Concern: A 33-year-old man inadvertently ingested an unknown liquid and presented to medical services a day later with complaints of ongoing nausea, vomiting, and diarrhea. The assessment revealed elevated serum creatinine, signaling acute kidney injury, initially thought due to gastroenteritis and dehydration. Diagnosis: Acute renal insufficiency due to paraquat poisoning. Interventions: The treatment involved fluid resuscitation and antibiotics, but his decline led to intensive care unit transfer. Subsequent chest computed tomography scans indicated lung changes indicative of paraquat poisoning. A detailed history review and comprehensive blood and urine toxicology screens confirmed the diagnosis. Subsequently, aggressive interventions such as hemoperfusion and continuous renal replacement therapy were initiated, yet there was a further decline in respiratory function, necessitating mechanical ventilation. The prognosis was poor, and ultimately, the family chose to withdraw care. Outcomes: The patient succumbed to his illness. Lessons: This case underscores the importance of promptly and accurately diagnosing paraquat poisoning, as its vague early signs can lead to diagnostic delays, crucial due to the condition's rapid progression. Alertness to paraquat poisoning is essential in patients with sudden gastrointestinal and renal symptoms post-exposure. Additionally, it underscores the necessity for public health measures to avert paraquat ingestion and advance therapeutic approaches. [ABSTRACT FROM AUTHOR]

GLP-1 receptor agonist (GLP-1RA) have been developed to address the global burden of obesity and are renowned for their safety and efficacy. These medications influence hunger and satiety, reducing energy intake and promoting weight loss. Despite their benefits, GLP-1RAmay cause a slowed gastric emptying, leading to gastrointestinal symptoms. This study examines how food properties and meal composition affect these symptoms. Dietary recommendations are provided, particularly for evening meals, focusing on how different foods and nutrients can influence the rate of gastric emptying, to improve patient compliance and prevent interruption in weight loss. [ABSTRACT FROM AUTHOR]

The article focuses on comparing the preemptive and preventive effects of dexmedetomidine and ketorolac on postoperative pain in appendectomy patients through a randomized clinical trial. Topics include the assessment of pain reduction using the Visual Analogue Scale (VAS), the cumulative fentanyl dosage required for postoperative pain management, and secondary effects such as changes in vital signs and the incidence of postoperative nausea and shivering.

Introduction: Pembrolizumab is a humanized monoclonal antibody IgG4 programmed cell death protein 1 antagonist, and its use in oncology has been increasing in recent years, providing durable and favorable responses and tolerable toxicity profiles in various types of cancer. We describe a case of pembrolizumab related perforated appendicitis in a patient with stage 3C malignant melanoma (MM). Case report: A 70-year-old male patient who had no known disease was diagnosed with MM as a result of the excision of the mass on his right shoulder. The disease stage was stage 3C (pT4aN1bM0). Subsequently, adjuvant pembrolizumab treatment was started. A few days after the fourth maintenance course, he presented to the emergency department complaining of abdominal pain, nausea and vomiting. Emergency abdominal tomography showed a significant increase in the diameter of the appendix vermiformis, peritoneal thickening and appendiceal wall defects that could be significant in terms of perforation. Management and outcome: The mentioned finding and given the clinical presentation, was attributed to a perporating of the appendix, so the patient was hospitalized in the Department of Surgery and the patient underwent emergency appendectomy. Histological findings were consistent with appendicitis. After a day in the hospital, the abdominal pain subsided, C-reactive protein tended to decrease and the patient was discharged. Discussion: In patients who develop acute abdominal pain with or without diarrhea during immunotherapy, urgent imaging, endoscopic and clinical evaluation should be performed, and bowel perforation, although rare, should be considered as a potential complication of any immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Migraine is the fourth most common cause of disability in women and the eighth most common cause in men. Central sensitization phenomena predispose to chronic migraine and are generally more pronounced in women. Objective: The aim of this retrospective observational study was to look for sex differences in a population of migraine subjects attending a tertiary headache center, focusing on symptoms of central sensitization such as allodynia and pericranial tenderness. Methods: This study is based on data collected at a tertiary headache center between January 1, 2018, and December 31, 2022. The clinical interview included the main features of migraine, allodynia, a disability questionnaire, the pericranial tenderness score, and anxiety and depression scales. Results: We selected a total of 1,087 migraine subjects (233 men). Osmophobia predominated in women, as did nausea. Disability scores, headache intensity, allodynia, anxiety, and depression predominated in women, without menopausal age playing a role. The frequency of symptomatic medication use was similar in both sexes. Allodynia score was the largest discriminating factor between women and men. Conclusions: Women with migraine are more likely than men to report acute allodynia, nausea, and osmophobia and are also more likely to be anxious, depressed, and disabled. These features appear to be independent of fertile age and are probably related to sex-specific genetic characteristics. These symptoms represent a tendency toward sensory hypersensitivity and central sensitization that should be carefully assessed in both women and men with migraine with a view to possibly predicting chronic development. [ABSTRACT FROM AUTHOR]

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Summary: Olanzapine combined with the neurokinin-1 receptor antagonist, palonosetron and dexamethasone is the standard treatment for chemotherapy-induced nausea and vomiting (CINV) due to highly emetogenic chemotherapy (HEC). However, the use of olanzapine poses challenges in patients with diabetes mellitus (DM) due to the potential risk of hyperglycemia. ME2136, antipsychotic similar to olanzapine, is associated with a lower risk of hyperglycemia. This study investigated the antiemetic efficacy and safety of ME2136 for HEC. This single-arm phase 2 study examined the safety and efficacy of ME2136 5 mg for 4 days in combination with triplet-combination antiemetic therapy. Two cohorts were established for the safety assessment: DM and non-DM. Eligible patients had malignant tumors and were receiving cisplatin-based chemotherapy for the first time. The primary endpoint was the complete response (CR) rate, defined as the percentage of patients without vomiting and not requiring rescue medications in the delayed phase (24–120 h). Between December 2020 and January 2022, 40 patients were enrolled, with 20 in each cohort. All patients were included in the safety analysis and 35 in the efficacy analysis. The CR rate in the delayed phase was 71.4% [60% CI 63.1–78.6%] for all patients, 66.7% in the DM cohort, and 76.5% in the non-DM cohort. No treatment-related adverse events ≥ grade 3, including hyperglycemia, were reported. ME2136, when combined with standard triplet-combination antiemetic therapy, is expected to exert similar antiemetic effects to the standard treatment for CINV due to HEC. Currently, ME2136-02 trial is underway to examine the safety and efficacy of triplet-combination antiemetic therapy and a 5-day treatment with ME2136. This study was registered with the Japan Registry of Clinical Trials (jRCT2041200071) on 10 December 2020. Clinical trial registration: This study was registered with the Japan Registry of Clinical Trials (jRCT2041200071) on 10 December 2020. [ABSTRACT FROM AUTHOR]

Background: Breast cancer patients experience various adverse symptoms during adjuvant chemotherapy. These adverse symptoms often form symptom clusters and have a negative impact on patients. Aims: To summarise common symptom clusters in different dimensions and their longitudinal changes among breast cancer patients receiving adjuvant chemotherapy. Design: A systematic review. Data Sources: Ten electronic databases were searched from 2001 to January 2024, and the search was last updated on 16 August 2024. Methods: Two reviewers independently assessed the eligibility of each study and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies. The findings were synthesised narratively. This systematic review has been registered (CRD42022370210). Results: Nine studies with a total of 1454 participants were included. The common symptom clusters in breast cancer patients receiving adjuvant chemotherapy were the gastrointestinal symptom cluster (nausea‐lack of appetite), the fatigue‐pain‐sleep disturbance symptom cluster and the psychological symptom cluster (worry‐sadness‐nervousness‐distress‐feeling irritable‐difficult concentrating). The severity dimension was the most frequently utilised in identifying symptom clusters, with the number and concurrence of symptom clusters showing variation over time. Conclusions: This study summarised common symptom clusters in breast cancer patients receiving adjuvant chemotherapy and revealed their changes from symptom dimensions and the chemotherapy process. These findings support further exploration of symptom cluster changes and underlying mechanisms, facilitating the design of targeted management strategies, including appropriate interventions and measurement dimensions in clinical nursing, to ultimately reduce patients' symptom burden. Impact: Common symptom clusters have been identified in breast cancer patients receiving adjuvant chemotherapy. Clinical nursing in oncology can prioritise these symptom clusters and provide patients with targeted management strategies. Reporting Methods: PRISMA guidelines and SWiM guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background Buprenorphine, a partial opioid agonist, has emerging evidence as an alternative to full agonist opioids for treatment of acute pain. This systematic review aimed to evaluate the safety and efficacy of buprenorphine for acute pain in older adults. Methods PubMed Medline, Embase, Cochrane Central Register of Controlled Trials, CINHAL, Web of Science database, and Google Scholar were searched. We included articles that reported buprenorphine as an intervention to treat acute pain among patients 60 years or older. Primary outcome was difference in pain scores for patients treated with buprenorphine compared to other analgesia. Secondary outcomes included adverse events, opioid consumption, and patient satisfaction. Meta-analysis was conducted on difference in pain scores and differences in nausea and vomiting. Results Twenty-two studies were included (n  = 2610). Buprenorphine was administered as nerve blocks in 6 studies, transdermal in eight, intravenous or intramuscular in 5, sublingual in 2 studies, and both intravenous and sublingual in one study. 10 out of 20 (50%) studies found improved pain control in buprenorphine groups. Meta-analysis found no significant difference in pain scores between buprenorphine and control analgesia at 24 hours [Cohen's d  = −0.29 (95% confidence interval (CI) −0.85 to 0.27)] and 7 days [Cohen's d  = −0.89 (95% CI −2.66 to 0.88)]. Six studies (54.5%) found reduced opioid consumption in patients receiving buprenorphine. There was no difference in adverse effects in most studies. Conclusions This review did not find buprenorphine to be superior to alternative analgesia; however, the mixed results provide scientific rationale for future studies testing buprenorphine in older populations. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 13-year-old boy diagnosed with metastatic embryonal rhabdomyosarcoma (RMS) of the prostate after presenting with urinary symptoms. Topics include the symptoms and initial findings, such as weakened urine stream, urinary frequency, and hematuria; the types and risk factors of RMS; and the age-related incidence pattern of RMS, which peaks in early childhood and adolescence.

Objective: We aimed to investigate the serum concentration of the spexin, which has been shown to have an anorexic effect in animal models, in pregnant women with hyperemesis gravidarum (HG). Methods: This case-control study was conducted with 80 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between April 2022 and September 2022. The HG group consisted of 40 pregnant women who were diagnosed with HG in the first 14 weeks of pregnancy, and the control group consisted of 40 healthy pregnant women matched with the HG group in terms of age, BMI, and gestational week. Results: Both groups were similar in terms of demographic characteristics and gestational age at blood sampling for spexin (p > 0.05). While maternal serum spexin concentration was 342.4 pg/ml in the HG group, it was 272.8 pg/ml in the control group (p = 0.003). ROC analysis was performed to determine the value of maternal serum spexin concentration in terms of predicting HG. AUC analysis of maternal serum spexin for HG estimation was 0.693 (p = 0.003, 95% CI =0.577 − 0.809). The optimal cutoff value for maternal serum spexin concentration was determined as 305.90 pg/ml with 65% sensitivity and 65% specificity. Conclusions: High serum spexin concentration is thought to play a role in the etiopathogenesis of HG, and this should be supported by demonstrating changes in serum spexin concentrations in pregnant women with HG whose symptoms alleviated and weight regain started after treatment. [ABSTRACT FROM AUTHOR]

Background/Objectives: Chronic nausea and vomiting (N/V) disorders are common in clinical practice. Our primary aim was to compare total and segmental gastrointestinal transit times as well as gastric contraction patterns in patients with chronic N/V syndrome to those of healthy volunteers (HVs). In the patient group, our secondary aim was to explore how symptoms and motility patterns were affected by a serotonin HT4 receptor agonist (Prucalopride). Methods: Patients with chronic N/V syndrome and HVs underwent baseline assessment of regional gastrointestinal (GI) motility/transit using the Motilis 3D-Transit system. Patients were then treated with Prucalopride 2 mg daily for 28 days, with the 3D-transit examination repeated within 10–20 days after treatment onset. Two self-administered questionnaires (the Gastrointestinal Symptom Rating Scale [GSRS] and Gastroparesis Cardinal Symptom Index [GCSI]) were used to assess patients' symptoms. Results: A total of 19 patients (13 F; median age 25 years (IQR 22–39) and 55 HVs (25 F; median age 28 (24–35) were included. At baseline, no differences in regional GI transit times were found between groups. However, patients had a significantly lower gastric contraction amplitude than HVs (9 mmHg (IQR 8–11) vs. 12 (10–15: p < 0.001). In response to Prucalopride treatment, gastric emptying time was reduced from a median of 3.1 h to 1.6 h (p < 0.005). Further, the GCSI was significantly reduced from GCSI 3.0 (IQR 2.3–3.7) at baseline to GCSI 1.9 (IQR 1.3–3.2) with Prucalopride. Conclusions: Patients with chronic N/V syndrome have significantly lower gastric contraction amplitude than HVs and may symptomatically benefit from prokinetics. They do not, however, have evidence of panenteric dysmotility. [ABSTRACT FROM AUTHOR]

Endometriosis is a common benign gynecologic disorder associated with infertility and pelvic pain, affecting 6–11% of reproductive-age females, and can frequently lead to the formation of ovarian endometriomas. Mature cystic teratomas are benign ovarian tumors comprising 10–25% of ovarian tumors. Both pathologies are common individually but rarely coexist. The case presented here describes a 49-year-old female presenting with a large composite endometrioma–mature cystic teratoma, a rare occurrence with few documented cases. The patient had a 24 cm × 17 cm × 15 cm adnexal mass identified via imaging, which was surgically removed. Pathology confirmed a composite tumor, with the teratoma encased within the endometrioma. This case underscores the importance of surgical management in complex adnexal masses to obtain tissue for definitive diagnosis and to exclude malignancy. Given the rarity of such coexistence and the challenges in preoperative diagnosis, surgical intervention is crucial for accurate diagnosis and effective management. [ABSTRACT FROM AUTHOR]

Objectives Patients with hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) experience a wide array of symptoms and system disorders. This study aimed to identify whether differences occurred in 115 self-reported symptoms and comorbidities in patients diagnosed with hEDS or HSD. Methods In this study we analysed self-reported data from an EDS Clinic intake questionnaire in patients diagnosed with hEDS, HSD or no hypermobile conditions. Results From 1 November 2019 to 7 March 2024, the EDS Clinic saw 2088 patients. Using the 2017 diagnostic criteria, 66.5% were diagnosed with HSD (n  = 1389), 20.3% with hEDS (n  = 423), 10.6% with historic HSD (H-HSD) or localized HSD (L-HSD) (n  = 256) (hypermobile controls) and 2.6% were not diagnosed with hEDS, HSD, H-HSD or L-HSD (n  = 55) (controls). Symptoms/comorbidities that occurred with high prevalence in both hEDS and HSD included joint pain (hEDS 82.0%, HSD 88.9%), allergy (hEDS 77.0%, HSD 77.0%), subluxations (hEDS 71.2%, HSD 72.6%), brain fog (hEDS 70.0%, HSD 74.7%), headache (hEDS 68.1%, HSD 69.1%), anxiety (hEDS 60.3%, HSD 69.3%), depression (hEDS 52.2%, HSD 58.0%), migraine (hEDS 53.7%, HSD 52.5%), nausea (hEDS 54.6%, HSD 59.5%) and constipation (hEDS 53.0%, HSD 57.2%). In contrast, 9/115 (8%) symptoms/comorbidities were self-reported significantly more often in hEDS but 42/115 (37%) in HSD. hEDS patients reported more symptoms that suggest a defect in collagen, such as dislocation, hernias and rectal prolapse, while HSD patients reported more joint, muscle, allergy, neurological, gastrointestinal, sleep and psychological symptoms/comorbidities. Conclusion Although we found an overlap in some symptoms and comorbidities self-reported by hEDS/HSD patients, such as allergy/atopy, headache/migraine and gastrointestinal symptoms, our findings suggest key differences exist between the two diagnoses, suggesting that hEDS and HSD may be distinct conditions. [ABSTRACT FROM AUTHOR]

Background/Objectives: The current trend in maternal health is to foster more natural and less medicalized therapies, with increasing interest in complementary therapies. This study has analyzed the benefits of complementary therapies during pregnancy, delivery and the postpartum period. Methods: A paired systematic review was carried out (PROSPERO: CRD42024543981). The following databases were consulted: PubMed, Scopus, Web of Science and CINAHL. Inclusion criteria were randomized clinical trials about complementary therapies in women during pregnancy, delivery and/or the postpartum period. The risk of bias of the clinical trials was evaluated using the revised Cochrane Risk of Bias tool for randomized trials version 2 (RoB-2). Results: A total of 1684 studies were found, with a final selection of 17. The most studied symptom was pain. Hydrotherapy, perinatal Swiss ball exercises, acupressure, virtual reality and foot reflexology provided a significant reduction in pain during labor. Similarly, aromatherapy, electroacupuncture and massage have shown significant benefits in pain management after Cesarean. Yoga, when practiced during pregnancy, effectively reduces anxiety and depression, with similar benefits observed when practiced during the postpartum period. Conclusions: Complementary therapies improve pain, anxiety and depression management across maternal health phases. [ABSTRACT FROM AUTHOR]

Background: Evidence based guidelines for treatment of physical symptoms during the last days of life in older people are not available. Aim: We wanted to synthesize the existing evidence on the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting during the last days of life in older people to develop recommendations that can help guide clinical practice. Design: A systematic review was conducted (PROSPERO #CRD42023406100) and reported in accordance with PRISMA guidelines. Data sources: MEDLINE and EMBASE were searched from inception till March 2023, together with national and international guideline databases. Results: Four predominantly descriptive studies on opioid use were included for the treatment of pain and four for dyspnea, without clear evidence for the choice of one specific opioid, nor a specific opioid dose. For death rattle, five randomized controlled trials and two retrospective studies were included. These provide evidence for the prophylactic treatment of death rattle with hyoscine butylbromide. For fever, nausea, and vomiting, no articles met the inclusion criteria. Conclusion: Limited evidence exists to guide the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting in the last days of life of older people. Other than the use of opioids for treatment of pain and dyspnea and prophylactic administration of hyoscine butylbromide to decrease the likelihood of developing death rattle, no specific recommendations can be formulated for use in clinical practice. This demonstrates the challenging nature of research in the last days of life of older people, despite its pressing need. [ABSTRACT FROM AUTHOR]

Background: Palonosetron, a second-generation 5-HT3 receptor antagonist (5-HT3RA), is more effective than first-generation 5-HT3RA. Several studies have investigated whether dexamethasone (DEX), when combined with palonosetron as a 5-HT3RA, can be spared in the delayed phase after moderately emetogenic chemotherapy (MEC). In this systematic review, we aimed to determine which between 1- and 3-day DEX administration, when combined with palonosetron, is more useful in patients receiving MEC. Methods: The PubMed, Cochrane Library, and Ichushi-Web databases were searched for relevant studies published between 1990 and 2020. We included studies that compared the efficacy of 1- and 3-day DEX administration in preventing nausea and vomiting associated with MEC. Outcomes were "prevention of vomiting (complete response rate and no vomiting rate)," "prevention of nausea" (complete control rate, total control rate, no nausea rate, and no clinically significant nausea rate)" in the delayed phase, "prevention of blood glucose level elevation," and "prevention of osteoporosis." Results: Eight studies were included in this systematic review. The no vomiting rate was significantly higher in the 3-day DEX group than in the 1-day DEX group. However, the other efficacy items did not significantly differ between the two groups. Meanwhile, insufficient evidence was obtained for "prevention of blood glucose level elevation" and "prevention of osteoporosis." Conclusions: No significant differences in most antiemetic effects were found between 1- and 3-day DEX administration. Thus, DEX administration could be shortened from 3 days to 1 day when used in combination with palonosetron. [ABSTRACT FROM AUTHOR]

PURPOSE: There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)–driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention. METHODS: This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations. RESULTS: We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P =.008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P =.008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P =.04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits. CONCLUSION: Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM. [ABSTRACT FROM AUTHOR]

Background: The expanding roles and popularity of glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists has created access barriers to medication use. We sought to describe an adverse drug event which occurred after reinitiation of a GLP-1 receptor agonist following a prolonged lapse in therapy due to poor medication access. Case Summary : Once-weekly injectable semaglutide was prescribed to an outpatient 33-year-old male for chronic weight management. After a delayed initiation due to global shortage, semaglutide was initiated and titrated over five months before a seven week lapse in therapy due to prior authorization interruption. Despite the extended treatment gap, the patient was directed to reinitiate semaglutide at the target dose rather than starting dose, which was followed by recurrent, symptomatic nausea and vomiting requiring medical intervention. Practice Implications: A prolonged lapse in GLP-1 receptor agonist therapy, typically defined as missing three or more doses of a once-weekly injectable, warrants consideration of reinitiation at a reduced dose, personalized to the patient's prior gastrointestinal tolerability, efficacy goals, and therapy lapse duration. Therapy lapses with GLP-1 receptor agonists may be prevented by utilizing a multi-modal approach including extended dosing intervals, intermediate doses, agent interchange, efficient prior authorization communication, and cautious initiation of GLP-1 recent agonists while supply cannot meet demand. [ABSTRACT FROM AUTHOR]

Bruton's tyrosine kinase inhibitors (BTKis) are the preferred treatment for chronic lymphocytic leukemia (CLL). Despite their therapeutic benefits, these targeted agents have been associated with an increased risk of invasive infections. We describe a 68-year-old male who developed multiple bacterial, fungal and viral infections while on treatment with acalabrutinib. To our knowledge, this is the first reported case of concomitant CNS infections with Cryptococcus neoformans and Aspergillus fumigatus, along with cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1) pneumonia while on acalabrutinib. This case adds to the scarce literature of fungal and bacterial infections associated with acalabrutinib, raising the suspicion that infection risk is a medication class effect for BTKis. [ABSTRACT FROM AUTHOR]

Objectives: The present open-label multicenter pilot study sought to prospectively evaluate the efficacy and safety of rimegepant in treating migraine attacks. Methods: The primary endpoint was pain freedom at two hours post-dose, while the co-primary efficacy endpoints included a reduction in the headache intensity and freedom from the most bothersome symptoms (MBS) associated with migraine at the same time point. To test the potential efficacy of rimegepant, patients were asked to record in a questionnaire all the relevant changes with each migraine attack treated with rimegepant at two hours post-dose vs. two hours before. The attending neurologists provided information on the basic demographics, medical anamnesis, and migraine history as well as the triptan use history. Results: A total of 54 patients (32 with episodic and 22 with chronic migraine) received rimegepant 75 mg at least once during a single migraine attack (overall, 140 dosage intakes). Pain freedom at 2 h was achieved in 45/140 (32.1%) intakes. Regarding the efficacy of the first rimegepant dose (n = 54), significant reductions in the headache intensity were observed between the pre- and 2 h post-treatment average VAS scores (−4.8 ± 2.8 mean; p < 0.001). Likewise, the same mean reductions in the average VAS scores occurred when the 2 h response to all 140 doses was analyzed (−5 ± 2.8; p < 0.001). Freedom from MBS at 2 h post-dose was achieved for photophobia in 43%, for phonophobia in 53%, and for nausea in 57%. The ability to fully return to everyday activities at 2 h post-dose was achieved in 83/140 instances (59%). We only recorded mild adverse events in 24/140 dosages. Conclusions: Our preliminary results demonstrate that rimegepant is effective, safe, and well tolerated in treating acute migraine attacks. [ABSTRACT FROM AUTHOR]

Buddhist meditation practices, including Samadhi meditation, which forms the basis for mindfulness practice, are broadly promoted as pathways to wellbeing, but evidence of their adverse effects is emerging. In a single-group observational study with assessments of autonomic system before, during, and after Samadhi meditation, we explore the relationship between post-meditation nausea symptoms and the degree of change in autonomic system activity during meditation as compared to before and after in 57 university students (42 women; mean age = 22.6) without any previous experience in meditation or yoga practices. We hypothesize that nauseous feelings in meditation are connected to a rapid increase of activity in the sympathetic nervous system, as indicated by decreased heart-rate variability (HRV). We additionally explore links between meditation-induced nausea and two markers of parasympathetic activity: increased HRV and vasovagal syncope. Engaging in meditation and increased nausea during meditation were both associated with increased markers of HRV parasympathetic activity, but 12 individuals with markedly higher nausea demonstrated increased HRV markers of sympathetic activity during meditation. Vasovagal syncope was observed but found to be unrelated to nausea levels. Drivers of adverse effects of meditation in some individuals require further investigation. [ABSTRACT FROM AUTHOR]

Background: Migraine is a common neurological condition marked by unilateral recurrent pulsating headaches, often associated with systemic signs and symptoms. Recently, calcitonin gene-related peptide (CGRP) antagonists, including atogepant, an oral CGRP receptor antagonist, have emerged as effective and safe treatments. The current study sought to assess the efficacy and safety of atogepant for preventing episodic migraines in adults. Methods: A comprehensive search, following PRISMA guidelines, was conducted using PubMed, Web of Science, and Cochrane Library to identify randomized, double-blind, placebo-controlled trials published up to June 2024. Results: The studies included adult participants with episodic migraine treated with atogepant. The primary outcomes assessed were changes in mean monthly migraine days (MMDs) and monthly headache days (MHDs) over 12 weeks. Secondary outcomes included reduction in acute medication use, 50% responder rates, and adverse events. A meta-analysis using a random-effects model was performed to evaluate efficacy and safety. Six trials with 4569 participants were included. Atogepant significantly reduced mean monthly migraine days (MMDs) and monthly headache days (MHDs) compared to placebo at all doses (10 mg, 30 mg, 60 mg), with the 60 mg dose showing the greatest reduction (mean difference: −1.48 days, p < 0.001). Significant reductions in acute medication use and improved 50% responder rates were also observed for all doses. The safety profile of atogepant was favorable, with common adverse events being mild to moderate, such as constipation and nausea. There were no significant differences in serious adverse events between the atogepant and placebo groups. Conclusions: Atogepant is an effective and well-tolerated option for preventing episodic migraines, showing significant reductions in migraine frequency and acute medication use. However, further studies are necessary to assess its long-term safety and efficacy, especially at higher doses, and to investigate its potential role in personalized treatment strategies for migraine prevention. [ABSTRACT FROM AUTHOR]

Background: Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. Methods: This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. Results: A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36–37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). Conclusion: The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Etrasimod is an oral, once-daily (QD), selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis (UC). It is known that non-serious treatment-emergent adverse events (TEAEs) may not lead to UC drug discontinuation but can affect treatment tolerability. Objectives: This post hoc analysis evaluated the incidence of specific, common, non-serious TEAEs reported in the etrasimod UC clinical programme and the characteristics of affected patients. Design: Data included patients from the Placebo-controlled UC cohort (phase II OASIS, and phase III ELEVATE UC 52 and ELEVATE UC 12 trials) receiving QD etrasimod (2 or 1 mg) or placebo. Methods: Proportions and incidence rates (IRs; the number of patients with a TEAE divided by the total exposure in patient-years (PYs), per 100 PY) of Headache, Pyrexia, Nausea and Dizziness TEAEs were reported. Changes in heart rate among patients with Dizziness TEAEs were also evaluated. Results: Among 943 patients (etrasimod 2 mg, N = 577 (276.7 PY); etrasimod 1 mg, N = 52 (11.4 PY); placebo, N = 314 (115.1 PY)), 48, 34, 27 and 21 patients experienced events of Headache, Pyrexia, Nausea and Dizziness, respectively. All events were non-serious; one patient treated with etrasimod was discontinued due to a Pyrexia TEAE. Numerically, IRs of Headache and Dizziness TEAEs were higher, and Nausea slightly higher, with etrasimod versus placebo (13.45 vs 8.63 per 100 PY, 6.52 vs 1.69 and 7.18 vs 5.13 per 100 PY, respectively); IRs were similar for Pyrexia. The duration of most TEAEs was 1–10 days. Conclusion: In the etrasimod UC clinical programme, all Headache, Pyrexia, Nausea and Dizziness events were non-serious. Headache and Dizziness were more frequent, and Nausea slightly more frequent, among patients receiving etrasimod versus placebo. The post hoc nature of this analysis is a limitation. These results reiterate the favourable safety profile and tolerability of etrasimod. Trial registration: ClinicalTrials.gov: NCT02447302; NCT03945188; NCT03996369. [ABSTRACT FROM AUTHOR]

Cannabinoid hyperemesis syndrome presents as a complex of symptoms and signs encompassing nausea, vomiting, abdominal pain, and hot water bathing behavior, most typically in a heavy cannabis user. Its presentation is frequently associated with hypothalamic-pituitary-adrenal axis activation with stress and weight loss. Recent investigation has identified five statistically significant mutations in patients distinct from those of frequent cannabis users who lack the symptoms, affecting the TRPV1 receptor, two dopamine genes, the cytochrome P450 2C9 enzyme that metabolizes tetrahydrocannabinol, and the adenosine triphosphate-binding cassette transporter. The syndrome is associated with escalating intake of high potency cannabis, or alternatively, other agonists of the cannabinoid-1 receptor including synthetic cannabinoids. Some patients develop environmental triggers in scents or foods that suggest classical conditioned responses. Various alternative "causes" are addressed and refuted in the text, including exposure to pesticides, neem oil or azadirachtin. Nosological confusion of cannabinoid hyperemesis syndrome has arisen with cyclic vomiting syndrome, whose presentation and pathophysiology are clearly distinct. The possible utilization of non-intoxicating antiemetic cannabis components in cannabis for treatment of cannabinoid hyperemesis syndrome is addressed, along with future research suggestions in relation to its genetic foundation and possible metabolomic signatures. [ABSTRACT FROM AUTHOR]

Introduction: Nausea and vomiting are very common among pregnant women. The current systematic study was conducted with aim to investigate the effect of herbal medicines on the treatment of nausea and vomiting in pregnant mothers. Methods: In this systematic review, to find double- and triple-blind clinical trial studies with a placebo control group that did not study other treatments such as acupuncture, the international databases of PubMed, Web of Science, Scopus, Science Direct, Cochran Library, Google Scholar, and internal databases of SID, Magiran, Irandoc, and Iranmedex were investigated using the keywords including: Morning sickness, nausea, vomiting, pregnancy, herbal treatment, herba medicine, herbal remedy with Boolean operators AND and OR. Finally, two researchers independently examined the articles to evaluate the quality using Verhagen's checklist and extract their main data. Results: In this study, 19 articles with a total sample size of 1593 were evaluated. The year of publication of the articles was from 2001 to April 2023, and a placebo control group was used in all of them. Except for one study that was conducted as crosssectional, the design of the other studies was parallel and except for 2 articles, the other articles received a score of 3 or more from Verhagen's quality assessment checklist. In general, the results showed that ginger, lemon, mint, cardamom and the combination of mint and lemon can be effective in reducing the intensity and frequency of nausea and vomiting in most cases. Conclusion: According to the studies, medicinal plants can have a positive effect on reducing morning nausea and vomiting in pregnant mothers and can be used with minimal side effects. [ABSTRACT FROM AUTHOR]