Search Results (122)

Cannabinoid hyperemesis syndrome (CHS) is characterized by a pattern of cyclic vomiting and abdominal pain despite an absence of an organic cause, occurring in regular cannabis users. This syndrome was first described in 2004. Initially considered rare, with the increased use and legalization of cannabis, a growing incidence of diagnoses has been observed. Data on the pediatric population are still scant despite the high rate of cannabis consumption in young people. In this narrative review, we aim to synthesize the growing knowledge about CHS and its epidemiology, pathophysiology, diagnosis, and management in the pediatric population. Findings in this review highlight the diagnostic challenges in pediatric patients, the limited efficacy of standard anti-emetic therapies, and the central role of cannabis cessation in treatment. This review underscores the need for increased awareness of CHS in pediatric practice to ensure timely diagnosis and avoid unnecessary investigations and interventions. Full article

The area postrema (AP) is a circumventricular organ (CVO) at the base of the fourth ventricle. It has a crucial role in regulating nausea and vomiting due to its unique blood–brain barrier (BBB)-permeability and extensive neural connectivity. Here, we present two cases of area postrema syndrome (APS), a rare condition of intractable nausea and vomiting resulting from direct AP injury. Our cases each occurred in the context of infratentorial neoplasms or their treatment. Using these cases as a framework, we review the literature on central emetic pathways and propose a treatment algorithm for managing refractory nausea and vomiting of central origin. We also highlight other targets beyond conventional serotonergic, dopaminergic, or histaminergic blockade and their roles in central hyperemesis. Our literature review suggests that APS is due to the disruption of the baseline inhibitory tone of outgoing AP signals. When other options fail, our algorithm culminates in the off-label use of combined serotonergic and neurokinin-1 blockade, which is otherwise used to manage chemotherapy-induced nausea and vomiting (CINV). We believe multimodal CNS receptor blockade is efficacious in APS because it addresses the underlying central neural dysregulation, rather than solely targeting peripheral emetic triggers. Full article

Objective: This study examines the incidence and predictors of complications following intravenous (IV) sedation in children and adults. Methods: A retrospective analysis of 1463 surgical procedures under IV sedation was conducted at the University Hospitals of Leuven (2018–2022). Patients aged 10–91 years were divided into pediatric (10–16 years, n = 731) and adult (17–91 years, n = 732) groups. Data were analyzed using multiple regression models (p < 0.05). Results: Side effects occurred more often during recovery (children: 20.1%, adults: 9.4%) than intraoperatively (children: 4.8%, adults: 2.7%). The most common side effects were nausea (children: 10.5%, adults: 8.4%) and prolonged sedation (children: 6.0%, adults: 1.8%). Younger children had higher risks of intraoperative side effects (p = 0.02), hypotension (p < 0.001), and longer recovery (p < 0.001). Ketamine increased nausea risk in children (p = 0.02). Females had a higher risk of prolonged sedation (p = 0.03) and nausea (p = 0.01). Older adults had fewer recovery-related side effects (p = 0.03) and shorter recovery times (p = 0.05). Conclusions: IV sedation is a safe alternative to general anesthesia in oral surgery when properly monitored. However, nausea and prolonged sedation remain concerns, particularly in younger children and females. Prophylactic anti-emetics and cautious Ketamine use may help mitigate risks. Full article

Objective: This study aimed to explore the unmet palliative care needs among young and middle-aged (YMA) Chinese patients with advanced cancer. Methods: We used the principle of maximum difference. A total of 16 YMA patients with advanced cancer from cancer hospital were recruited. Semi-structured, in-depth, and face-to-face interviews were conducted from 28 August 2023 to 23 October 2023. The recorded audio of each interview was typed into Word software with each personal code. The interview transcripts were coded using the method of inductive content analysis. Results: Four themes and 14 sub-themes were identified in participants’ descriptions of care needs: (1) symptom management needs: need for pain relief, need for anti-emetics, and need for aid in managing fatigue; (2) psychological support needs: help reducing fear of pain, help achieving a better death, and help with parents’ negative reactions; (3) social support needs: taking care of children, emotional support from family members, consultation and emotional support from other cancer patients, and company and guidance of healthcare personnel; (4) information needs: better understanding of disease trajectory and future care needs, better access to palliative care information, and more participation in medical decision-making. Conclusions: According to the results of this study, the unmet palliative care needs of YMA patients with advanced cancer are diverse, but they have not been fully recognized and met. Therefore, medical staff should develop effective management strategies and explore patients’ needs in an all-around way. Future studies will further develop the scale of unmet needs for palliative care to accurately identify needs and improve patients’ quality of life. Full article

Vomitoxin is a member of the monotrichous mycotoxin family with a complex chemical structure and significant biological activity. This toxin has strong immunosuppressive toxic effects and can cause serious damage to human and animal health. In this study, an on-site immune detection method based on an immune SiO₂@QD fluorescent probe was developed, which realized the rapid and quantitative detection of emetic toxins in grains. Polyethyleneimine (PEI) is a polymer containing a large number of amino groups, and the binding of PEI to the surface of quantum dots can serve to regulate growth and provide functionalized groups. A SiO₂@QD nanotag with good dispersibility and a high fluorescence intensity was synthesized by combining a PEI interlayer on the surface of SiO₂ nanospheres. Utilizing the electrostatic adsorption of the amino group in PEI, CdSe/ZnS QDs were self-assembled on the surface of SiO₂ nanospheres. In the stability test, the SiO₂@QDs could maintain basically the same fluorescence intensity for 90 consecutive days in the dark at 4 °C, showing a high fluorescence stability. The fluorescence-enhanced QD immune probe was formed by coupling with anti-DON monoclonal antibodies through carbodiimide chemical synthesis. For the detection of spiked wheat flour samples, the immuno-SiO₂@QD fluorescent probe showed excellent sensitivity and stability, the detection limit reached 0.25 ng/mL, and the average recovery rate was 92.2–101.6%. At the same time, the immuno-SiO₂@QD fluorescent probe is simple to operate, is capable of rapid responses, and has great potential in the rapid detection of vomitoxins in grains. Full article

This study aimed to assess the efficacy of a veterinary enhanced recovery after surgery (Vet-ERAS) protocol in dogs undergoing emergency laparotomy (EL). The protocol, adapted from human medicine, encompassed a multidisciplinary approach and interventions such as early goal-directed fluid resuscitation, antibiotic prophylaxis, anti-emetic therapy, multimodal analgesia, and early enteral nutrition. A prospective observational study compared outcomes between dogs managed with the Vet-ERAS protocol (n = 59) and historical controls (n = 82). Implementation of the Vet-ERAS protocol resulted in a significant reduction in perioperative complication rates (p = 0.003) and 15-day mortality (5% vs. 20.7%). Intraoperative complications, including tachycardia and hypothermia, were significantly lower in the Vet-ERAS group. Compliance with the protocol improved over time (p = 0.01). These findings suggest that integrating the Vet-ERAS protocol into perioperative management can improve outcomes in dogs undergoing EL. Full article

Background: Helicobacter pylori is a globally prevalent pathogen and a major contributor to gastric diseases, including chronic gastritis, peptic ulcer disease, and gastric cancer. This study investigates the prevalence, distribution, and clinical relevance of its key virulence genes, vacA and cagA, in a Peruvian patient cohort. Materials and Methods: Fifty-one gastric biopsies were collected from patients with a presumptive diagnosis of H. pylori-induced gastritis at Hospital Carlos Alberto Seguín Escobedo in Arequipa, Peru, in March 2024. Two biopsies per patient—one from the antrum and one from the gastric body—were obtained during endoscopy. DNA extraction was performed using the Quick-DNA Fungal/Bacterial Kit (Zymo Research, USA). Molecular identification of H. pylori was conducted via PCR targeting the glmM gene, while the vacA and cagA virulence genes were detected using specific primers. Statistical analyses, including Pearson’s chi-square and Mann–Whitney tests, were applied to assess associations between virulence gene presence and clinical or histopathological variables. Results: Among the gastric biopsies, the vacA gene was detected in 37.3% of samples, while cagA was present in 17.6%. Statistical analysis revealed significant associations between vacA and specific clinical and endoscopic features, including erythematous gastropathy, nodular gastritis, and emetic syndrome, suggesting its localized role in disease pathogenesis. Additionally, the presence of cagA was significantly linked to moderate inflammatory intensity in gastric body biopsies, indicating its association with more severe histopathological outcomes. Chronic gastritis was the most common histopathological finding, with moderate intensity correlating strongly with the presence of virulence genes. Conclusions: These findings highlight substantial regional variability in the distribution and pathogenicity of H. pylori genotypes. This study underscores the importance of incorporating molecular diagnostics into routine clinical practice to improve diagnostic accuracy and inform region-specific therapeutic strategies. This is particularly crucial in endemic regions like Peru, where unique environmental and genetic factors may influence infection dynamics and disease outcomes. Full article

The Bacillus cereus group frequently contaminates milk and dairy products. Some members of this group can produce the heat-stable pre-formed toxin cereulide, which causes emetic foodborne intoxication. This study characterised emetic B. cereus group isolates from raw cow’s milk in the biochemical, genetic, and toxigenic aspects. Of the 158 B. cereus group isolates derived from 99 raw milk samples, 7 (4.43%) harboured cereulide synthetase A (cesA), which encodes a cereulide synthetase associated with the emetic phenotype. Heat-treated culture filtrates from the cesA-positive isolates demonstrated cytotoxicity to HepG2 and Caco-2 cells, resulting in cell viabilities of 32.22–36.57% and 44.41–47.08%, respectively. The cytotoxicity levels were comparable to those of the reference emetic strain, F4810/72 (alternately termed AH187). Genome analysis of a representative isolate, CSB98, revealed the complete ces gene cluster with additional virulence factors such as non-haemolytic enterotoxin, haemolysins and phospholipases, suggesting that the isolate could be both emetic and diarrhoeagenic. CSB98 exhibited a closer relationship to the type strain of B. paranthracis than to that of B. cereus sensu stricto (ATCC 14579). The genomes of CSB98 and AH187 were indistinguishable through OrthoANI analysis, but 13 variants were identified via SNP calling. These results affirm genetic conservation among the emetic traits. Full article

Bacillus cereus is a Gram-positive pathogen associated with foodborne illnesses and severe non-gastrointestinal infections. Robust tools for accurate gene transcription analysis are essential for studying toxin gene expression dynamics and deciphering the complex regulatory networks orchestrating the expression of toxin and virulence factors. This study aimed to identify reliable reference genes for normalizing reverse transcription quantitative PCR (RT-qPCR) data in toxigenic B. cereus. An emetic and an enteropathogenic strain were used as model organisms to establish a suitable reference gene set to monitor the dynamics of toxin gene transcription. Ten candidate reference genes were evaluated for their expression stability using geNorm, NormFinder, BestKeeper and the ΔCq method, with the final rankings integrated via RefFinder. Among the tested genes, rho, rpoD and recA were identified as the most stable expressed reference genes across all tested conditions. As shown in this proof-of-principle study, the established reference gene set provides a suitable tool to investigate the influence of extrinsic and intrinsic factors on toxin gene transcription. In conclusion, our newly established reference gene set provides a robust basis for studying toxin gene expression in B. cereus and contributes to a better understanding of its pathogenicity and potential strategies to mitigate its harmful effects. Full article

Background/Objectives: Lutathera^® ([¹⁷⁷Lu]Lu-DOTA-TATE) is the first radiolabelled somatostatin (SST) analog approved for the treatment of patients with well-differentiated (G1 and G2) unresectable or metastatic gastro-entero-pancreatic neuro-endocrine-neoplasms (GEP-NENs). The bone marrow and kidneys are critical organs for RLT with [¹⁷⁷Lu]Lu-DOTA-TATE. Our purpose was to evaluate hematological and renal toxicity in 29 patients (18 males, 11 females) treated with Lutathera^®. Methods: According to standard protocols, four cycles of (¹⁷⁷Lu)Lu-DOTA-TATE were administered every eight/nine weeks. Patients received pre-medication with anti-emetic and anti-acid drugs and a slow amino acid infusion for renal protection. Blood count and serum creatinine data were collected at three time points: before the first cycle, after the second cycle, and at the end of treatment. Results: We found that almost all hematological parameters significantly decreased between the baseline and/or interim and post-therapy evaluation, although without a clinical impact. The presence of total tumor load or bone metastases had no influence on these findings, while male patients showed less hematological toxicity than females. Conversely, creatinine levels did not vary during treatment. Conclusions: Our study confirms that [¹⁷⁷Lu]Lu-DOTATATE RLT is safe and well tolerated despite some minor (grade 1) hematological toxicity. Full article

Background: Postoperative nausea and vomiting (PONV) remains a frequent and uncomfortable complication in women undergoing robotic gynecological procedures. Despite the use of various preventive strategies, PONV continues to negatively impact recovery and increase healthcare expenses. This study aimed to evaluate whether the preoperative use of sugar-free chewing gum could effectively minimize the dependence on anti-emetic drugs in women undergoing robot-assisted laparoscopic surgery for uterine myomas. Methods: In this randomized, single-blind study, 92 adult women scheduled for robot-assisted laparoscopic surgery were enrolled. The participants were randomly assigned to one of two groups: a gum-chewing group, which was instructed to chew sugar-free gum for 15 min in the preoperative holding area, or a control group that did not chew gum. The primary outcome was the requirement for anti-emetic medication within the first hour after surgery, when the patient was in the post-anesthesia care unit (PACU). Secondary outcomes included the overall frequency of anti-emetic use. To assess the intervention’s effectiveness independent of any other factors, no prophylactic anti-emetics were administered during surgery. Results: Of the 92 participants, 89 completed the study, with 44 assigned to the gum-chewing group and 45 to the control group. The gum-chewing group showed a significantly lower rate of PONV, requiring anti-emetic treatment (79.5%), compared to the control group (95.6%). Additionally, the control group demonstrated a higher overall need for anti-emetic medications. Notably, there were no reported adverse effects, such as jaw discomfort, dental injuries, or gastric regurgitation, in either group. Conclusions: Chewing sugar-free gum for 15 min prior to surgery was found to be a safe, simple, and effective method to reduce the occurrence of PONV in women undergoing robot-assisted laparoscopic surgery for benign uterine tumors. This non-invasive intervention reduced the reliance on anti-emetic drugs and improved patient comfort, without introducing risks. These findings suggest that preoperative gum chewing could be routinely implemented in clinical settings to enhance surgical outcomes. Full article

Background: Community pharmacists are frequently approached by patients seeking health advice for minor ailments, particularly for common childhood diseases like diarrhea. Globally, approximately two million children under five years of age die each year due to diarrhea, which remains a significant health concern, especially in developing countries. Objectives: The purpose of this study was to assess the skills of community pharmacists in addressing and prescribing for simple viral diarrhea in children. Methods: A hundred community pharmacies were visited by simulated clients following a standard scenario of inquiring about simple childhood diarrhea. Subsequently, they filled out a standardized form after each visit to assess the skills of the community pharmacists. Results: It was found that 98% of the pharmacists were males. Approximately 80% of them inquired about the child’s age, while only 29% asked about the presence of fever. Around 2–6% of them only asked about the stool nature, child’s feeding behavior, and family symptoms. Around 10% of them suggested a potential bacterial origin, and 24% recommended the use of antibiotics. Only 43% of the community pharmacists suggested the use of oral rehydration solution, while 15–56% recommended using antidiarrheals, anti-emetics, and spasmolytics. The mean knowledge score of the pharmacists was 9.06 out of 17. Conclusions: The results indicated a relatively low level of knowledge about managing simple viral childhood diarrhea, which may reflect a similar level of knowledge about dealing with minor ailments in general. Full article

Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility. At the same time, the thermoregulatory function of endocannabinoids might explain compulsive hot bathing in CHS patients. The prevalence of cannabis CHS is expected to rise as legal restrictions on its recreational use decrease in several states. Education and awareness are vital in diagnosing and treating CHS as its prevalence increases. This comprehensive review explores the ECS’s involvement, CHS management approaches, and knowledge gaps to enhance understanding of this syndrome. Full article

This study aimed to evaluate the diagnostic accuracy of an Optical Pulp Scanning (OPS) device. A total of 421 teeth from 107 emergency patients were investigated. Pulp vitality was assessed using conventional diagnostic methods (ConvDia), cold pulp testing (CPT), and a final diagnosis (FinDia) based on the pulp chamber contents (PCCs) of teeth requiring endodontic treatment (EmeTe). Following ConvDia, OPS screening was performed, endodontic access was prepared, and the FinDia was established. The specificity, sensitivity, as well as positive and negative predictive values of ConvDia, CPT, and FinDia were calculated against the OPS results. The null hypothesis stated that specificity and sensitivity would be equal to or lower than 90% and 80%, respectively. OPS sensitivity was 66.2% and 72.2% (EmeTe) for ConvDia, 66.2% and 69.8% (EmeTe) for CPT, and 76.9% for FinDia. Specificity was 26.4% and 25.5% (EmeTe) for ConvDia, 26.9% and 21.7% (EmeTe) for CPT, and 31.5% for FinDia. These results suggest that, at its current stage of development, the OPS device does not provide an acceptable level of diagnostic accuracy, particularly in vital teeth. Full article

Members of the B. cereus group are spore-forming organisms commonly associated with spoilage of milk and dairy products. We have determined the genetic identity and growth characteristics of 57 B. cereus isolates collected from a Norwegian ice cream production plant. Our findings revealed persistence of B. cereus spp. strains for up to 19 months, suggesting the plant’s susceptibility to long-term colonization. One of the mesophilic isolates, NVH-YM303, carried a complete cereulide synthetase operon. To assess the potential food poisoning risk associated with the presence of cereulide-producing strains in the production line, we examined the production of cereulide in ice cream and milk at different temperatures by NVH-YM303 and by the emetic psychrotrophic B. weihenstephanensis strain BtB2-4. Our findings revealed that NVH-YM303 produced higher levels of cereulide in ice cream as compared to milk. Furthermore, it was observed that NVH-YM303 produced more cereulide in ice cream at 25 °C compared to 15 °C. Conversely, BtB2-4 produced more cereulide in ice cream at 15 °C than at 25 °C. The results obtained in this study contribute to knowledge important for risk assessment of the potential hazards posed by the presence of B. cereus within ice cream production facilities. Full article