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Platelet diseases and dysfunction are taught early in medical school to all future physicians. Understanding of the coagulation cascade and hemostatic mechanisms has allowed for targeted pharmacological therapies that have been significantly impactful in clinical practice. Platelets are an early participant in hemostasis physiologically and under pathophysiological states. A review of literature involving platelet disfunction. Various presentations of platelet diseases and dysfunction challenge clinicians and require a firm understanding of normal platelet function, drugs that mediate or modulate platelet effectiveness, and nonpharmacologic etiologies of platelet diseases and dysfunction with corresponding best practice treatment approaches. This review summarizes normal and abnormal states associated with platelets and treatment strategies.

Novel preparations allowing for the extended duration of action of local anesthetics have many clinically relevant benefits. With regard to this, the development of liposomal bupivacaine has the potential to significantly impact patient care by improving perioperative pain control. The unique liposomal bilayer that encapsulates bupivacaine allows for a sustained release of local anesthetic for up to 72 h after a single use and can significantly decrease postoperative opioid consumption. SABER-bupivacaine is another depot formulation that helps in sustained release of bupivacaine from an encapsulated bupivacaine in a biodegradable sucrose acetate isobutyrate biolayer. HTX-011 is an investigational extended-release local anesthetic formulation currently undergoing Phase 3 clinical trials. HTX-011 is composed of a bioerodible polymer with bupivacaine and low-dose meloxicam in which the polymer undergoes hydrolysis and allows for sustained release of bupivacaine and meloxicam for 3 days. The present investigation reviews pharmacologic considerations related to the formulation of liposomal bupivacaine, current FDA-approved indications for its use, and future extended-release local anesthetic formulations currently under investigation.

Platelet diseases and dysfunction are taught early in medical school to all future physicians. Understanding of the coagulation cascade and hemostatic mechanisms has allowed for targeted pharmacological therapies that have been significantly impactful in clinical practice. Platelets are an early participant in hemostasis physiologically and under pathophysiological states.A review of literature involving platelet disfunction.Various presentations of platelet diseases and dysfunction challenge clinicians and require a firm understanding of normal platelet function, drugs that mediate or modulate platelet effectiveness, and nonpharmacologic etiologies of platelet diseases and dysfunction with corresponding best practice treatment approaches.This review summarizes normal and abnormal states associated with platelets and treatment strategies.

Fluoroquinolones are commonly prescribed antimicrobials that have been implicated in alterations of glucose metabolism. We report a case of refractory fluoroquinolone-induced hypoglycemia in a patient with type-2 diabetes mellitus on glipizide that was successfully treated with octreotide. A patient was admitted with hypoglycemia after having been initiated on levofloxacin therapy. Despite treating the hypoglycemia supportively with multiple boluses of 25 g of dextrose, a continuous dextrose infusion, and glucagon, the patient experienced repeated episodes of rebound hypoglycemia. The persistent hypoglycemia was eventually reversed with the administration of subcutaneous octreotide. Clinicians should be cognizant of this adverse effect of fluoroquinolones, as well as predisposing risk factors, and consider octreotide as an adjunctive therapy for refractory hypoglycemia cases.

This is a review of current literature published between January 2018 and January 2019 including any publications regarding adverse effects related to corticotrophins, corticosteroids, and prostaglandins. The following medications are included: corticotrophins, glucocorticoids, and the following prostaglandins alprostadil (PGE1), epoprostenol (PGI1 analogue), iloprost (PGI2 analogue), misoprostol (PGE1 analogue), and treprostinil (PGI2 analogue).

Procedural and 30-day outcomes with MitraClip are associated with center volumes. FDA approval of MitraClip led to greater volumes and trends toward improved outcomes. Possible extension of indications for MitraClip may further increase volumes.

Objectives Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. Methods In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. Results The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P = .015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P = .001), bradycardia (8.2% vs 0.0%; P = .002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤ .0001) were significantly higher in the amiodarone group. Conclusions Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.

Isoprene emission is an important mechanism for improving the thermotolerance of plant photosystems as temperatures increase. In this study, we measured photosynthesis and isoprene emission in trees along an urban-rural gradient that serves as a proxy for climate change, to understand daily and seasonal responses to changes in temperature and other environmental variables. Leaf-level gas exchange and basal isoprene emission of post oak (Quercus stellata) and sweet gum (Liquidambar styraciflua) were recorded at regular intervals over an entire growing season at urban, suburban, and rural sites in eastern Texas. In addition, the temperature and atmospheric carbon dioxide concentration experienced by leaves were experimentally manipulated in spring, early summer, and late summer. We found that trees experienced lower stomatal conductance and photosynthesis and higher isoprene emission, at the urban and suburban sites compared to the rural site. Path analysis indicated a daily positive effect of isoprene emission on photosynthesis, but unexpectedly, higher isoprene emission from urban trees was not associated with improved photosynthesis as temperatures increased during the growing season. Furthermore, urban trees experienced relatively higher isoprene emission at high CO2 concentrations, while isoprene emission was suppressed at the other sites. These results suggest that isoprene emission may be less beneficial in urban, and potentially future, environmental conditions, particularly if higher temperatures override the suppressive effects of high CO2 on isoprene emission. These are important considerations for modeling future biosphere-atmosphere interactions and for understanding tree physiological responses to climate change.

In the summer of 2012, Poland and Ukraine co-hosted the 2012 UEFA European Football Championship. A week before the tournament began, the BBC’s investigative journalism program, Panorama, aired its documentary highlighting pervasive violence, racism and anti-Semitism in the football stadiums in both these nations. Violent and racist football hooliganism is not a new phenomenon in Europe, but the images and interviews shown in the documentary shocked Europe as hundreds of thousands fans from all over the continent prepared to travel to Eastern Europe for the Euro 2012 tournament.During Euro 2012, media scrutiny of any incidences of racist and violent fan behavior was intensified, putting the governments of Poland and Ukraine on the defensive. The Polish and Ukrainian hooligan problem closely mirrors Britain’s history of football-related violence, reaching its peak in the 1970’s and 1980’s and known throughout Europe as ‘the English Disease.’ This article explores the history of European football hooliganism and its proliferation in Eastern Europe. Using the British response to hooliganism as a model, this article proposes that Poland and Ukraine should adopt similar measures to curb its growing problem of violent and racist football fans. Specifically this article argues that Poland and Ukraine should institute: (1) travel bans and banning orders for fans convicted of football-related criminal offenses; (2) strict speech restrictions to criminalize hate speech and speech that incites violence; and (3) modern policing tactics to lessen tensions between law enforcement and football supporters and better control large crowds. By implementing these three measures, the Polish and Ukrainian governments would be better equipped to handle instances of crowd disturbances and punish individuals convicted of football-related violence and racism.Part I of the article lays the foundation for the three proposals and presents: (1) a brief history of hooliganism in Britain and Eastern Europe; (2) the current governing structure in European football responsible for policing and monitoring football-related violence; (3) the relevant penal code provisions applicable to football-related violence and racism in Poland and Ukraine; and (4) the British legal framework established in response to organized and violent hooligan groups. In Part II, the article explains the use of travel bans and banning orders for individuals convicted of football-related violence and argues that implementing bans would be beneficial to prevent offenders from attending football matches and causing disorder in Poland and Ukraine. Part III discusses the regulation of hate speech and speech intended to incite violence at football matches and argues for implementation of statutes based on Scottish legislation to fight the increasing presence of racism and anti-Semitism at football grounds. Finally, in Part IV, the article argues for developing modern policing tactics concentrated on relieving tensions and conflict between police and supporters would be effective in Poland and Ukraine.