RESUMEN
Shivering is a frequently encountered perioperative complication in patients undergoing spinal anesthesia. Numerous different pharmacological agents have been employed to mitigate this issue. This scoping review aims to evaluate the efficacy of ketamine in mitigating the incidence of shivering. This review process utilized PubMed, JAMA, and Cochrane as primary databases. Searches were performed using combinations of key terms: "Ketamine," "Shivering," "Spinal Anesthesia," and "Hypothermia." Reviews of reference lists for additional pertinent data were performed. When ketamine was compared against a saline control, three out of five studies found ketamine to be more effective (p < 0.05, p < 0.001, p < 0.001) in the prevention of shivering. When compared with tramadol, two studies found ketamine to be more effective (p < 0.001, p < 0.001), one found no difference (p = 0.261), and one found tramadol to be more effective (p < 0.001). Two studies found dexmedetomidine more effective (p < 0.022, p < 0.027) than ketamine and tramadol. When comparing ketamine, ondansetron, and meperidine, all three were effective (p < 0.001) versus saline, with no significant difference between the three. Meperidine demonstrated more efficacy (p < 0.05) in reducing the intensity of shivering than ketamine. Ketamine's effects on hemodynamics were shown to be equivocal or more favorable across several studies. While there is mixed evidence on whether it is better than other treatments, ketamine may have advantages from a hemodynamic standpoint. Dosages of 0.2-0.5 mg/kg with or without a subsequent infusion of 0.1 mg/kg per hour may aid in the prevention of perioperative shivering. Overall, ketamine is a safe and effective drug for the prevention of perioperative shivering. However, other drugs may be equally or more effective; therefore, patient population, hemodynamic status, patient preferences, and provider familiarity with different agents should be considered.
RESUMEN
Psychogenic polydipsia (PPD) may be commonly seen in patients suffering from schizophrenia. It remains unknown how often psychiatric illness can mask other more serious conditions. The patient is a 58-year-old female with chronic schizophrenia and PPD presenting to the emergency department (ED) with abdominal pain over a seven-year period from 2016 to 2022 with her symptoms attributed to a schizophrenia exacerbation with minimal to no diagnostic follow-up. After several ED admissions, in 2022, tumor marker tests were collected yielding concerning results for underlying cancer including CA125 85.9/50.1, CA19-9 >10, and CEA 0.3. A pelvic ultrasound was completed in 2022 after another three ED visits, revealing an infiltrative uterine mass measuring up to 5.6 cm, which was confirmed by CT abdomen and pelvis to be stage IV uterine adenocarcinoma. Several potential opportunities for intervention were missed in this patient including (1) primary prevention, (2) inadequate physical exam and history acquisition, and (3) delayed diagnostic imaging from the onset of abdominal pain to diagnosis. This case highlights the shortcomings across disciplines in providing early intervention and the disparities of basic patient care in psychiatric patients.
RESUMEN
Fecalomas are a rare potential etiology for constipation experienced in children and the elderly. Large bowel obstructions due to fecalomas are preferably treated conservatively with laxatives and bowel rest. However, in the setting of severe corporostasis, more invasive procedures are required to prevent bowel ischemia and perforation. This case report describes a patient who presented to the emergency department with symptoms of large bowel obstruction and constipation, and she was found to have a fecaloma. Conservative interventions, including bowel rest and the administration of laxatives failed, prompting the need for more invasive therapies. During her admission, multiple flexible sigmoidoscopies were required to alleviate the obstruction. Ultimately, this case demonstrates an encounter of a patient with a sigmoid fecaloma from an unlikely demographic with few risk factors that required endoscopic intervention for treatment.
RESUMEN
Redox-active metal-organic nanocages are of interest for many applications, but the development of cages with extensive redox activity is often hindered by their limited stability and solubility across multiple charge states. This report reveals that these properties can be tuned for cages with redox-active walls by incorporating additional redox activity into the linkers. In particular, new +12 charged triangular nanoprisms 1a,b were formed from three electroactive tetrakis(3-pyridyl)porphyrin walls linked by six [(TMEDA)Pt]2+ (for 1a) or [(2,2'-bipy)Pt]2+ (for 1b) vertices, the latter of which are also electroactive. Thus, 1b exhibits extensive redox activity, consisting of two porphyrin-centered (x3) and two 2,2'-bipy-centered (x6) reductions that provide reversible access to +12, +9, +3, 0, and -6 charge states, whereas 1a undergoes only two, porphyrin-centered (x3) reversible reductions. Comparisons of 1a and 1b (and monomeric control compounds) by cyclic voltammetry and UV-vis-NIR spectroelectrochemistry show that the redox-activity of the linkers in 1b lowers the second reduction potential of the porphyrins by 100 mV and improves the stability and solubility of this structure under highly reducing conditions (e.g., -2.25 V vs Fc+/0 in MeCN). These findings reveal new principles for controlling the properties of highly electroactive molecular nanostructures. Anion exchange rates (â«103 s-1) were also probed, showing that the narrow apertures (≤3 Å van der Waals width) of 1a,b do not impede the loss/gain of PF6- anions during redox processes.