American journal of therapeutics
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Patients rank postoperative nausea and vomiting (PONV) in the top five most undesirable outcomes of surgery. Thirty percent of all surgical patients experience PONV. We conducted an economic study to determine the financial implications of providing surgical patients with PONV prophylaxis to increase patient satisfaction and minimize postoperative complications. ⋯ The average hospital cost and charge per antiemetic drug dose was $0.304 and $3.66, respectively. Using these figures, we determined that our hospital's net profit increases linearly with increased PONV prophylaxis administration. Our economic analysis shows that PONV prophylaxis is economically beneficial for the hospital when weighed against the expenses generated by treating patients returning to the hospital with PONV.
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Dysrhythmias, although common in overdose situations, are not often seen after benzodiazepine exposures. We report two cases of transient atrioventricular block after benzodiazepine misuse. Case 1 is a 4-year-old boy who was found unresponsive after an ingestion of clonazepam. ⋯ Benzodiazepines have been shown to alter L-type Ca2+ channel function. This alteration in function may account for the dysrhythmias seen in our patients. Together, these cases serve to remind clinicians of this rare but potentially serious complication associated with benzodiazepine exposure.
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Aging is associated with a host of alterations in thyroid gland structure and function. Some of these changes have favorable effects on longevity, whereas others are maladaptive and contribute to a decline in health and quality of life. ⋯ The biochemical profile of subclinical hypothyroidism includes normal serum levels of thyroid hormones with mildly elevated serum thyrotropin concentrations in the range of 4.5 to 10 mIU/L. In this article, the epidemiology of subclinical hypothyroidism in the elderly is reviewed, the potential advantages of mild hypothyroidism in people over the age of 75 years are discussed, and some guidelines for screening and management of this common thyroid dysfunction are suggested.
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Globally, tobacco use is associated with 5 million deaths per annum and is regarded as one of the leading causes of premature death. Major chronic disorders associated with smoking include cardiovascular diseases, several types of cancer, and chronic obstructive pulmonary disease (lung problems). Cigarette smoking (CS) generates a cumulative oxidative stress, which may contribute to the pathogenesis of chronic diseases. ⋯ Telomere attrition (expressed in WBCs) can serve as a biomarker of the cumulative oxidative stress and inflammation induced by smoking and, consequently, show the pace of biologic aging. We originally propose that patented specific oral formulations of nonhydrolized carnosine and carcinine provide a powerful tool for targeted therapeutic inhibition of cumulative oxidative stress and inflammation and protection of telomere attrition associated with smoking. The longitudinal studies of the clinical population groups described in this study including elderly support the hypothesis that telomere length is a predictor of survival and therapeutic treatment requirement associated with smoking behavior.
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Review
50 years of thiazides: should thiazide diuretics be considered third-line hypertension treatment?
The purpose of this report is to review available and emerging antihypertensive treatment options in light of current guidelines and evidence from large clinical trials. The published literature was reviewed for evidence regarding first-line options for antihypertensive agents, including thiazide-type diuretics, as monotherapy or as part of combination therapy. Current guidelines recommend using thiazide-type diuretics as first-line therapy alone or in combination with another agent. ⋯ Thiazide diuretics are inexpensive and effective but may not be preferable to other classes of antihypertensives that reduce blood pressure to a similar extent with a better safety profile and superior reductions in cardiovascular event rates. However, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and direct renin inhibitors also show promise as initial monotherapy or as part of a combination therapy regimen. In patients requiring additional blood pressure reduction, add-on therapy with a diuretic could provide additional blood pressure-lowering efficacy.