Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Introducción : El ondasentrón es un agente farmacológico de uso frecuente para el tratamiento sintomático de los vómitos originados por gastroenteritis. Sin embargo, podría enmascarar patologías más graves que ameriten reconsultas y hospitalización. Objetivo: Indagar si la administración del ondansetrón como tratamiento sintomático de los vómitos en el departamento de emergencias pediátricas (DEP) retrasó el diagnóstico de patologías graves. Materiales y métodos: Estudio observacional, descriptivo de corte transverso retrospectivo. Fueron elegibles pacientes que consultaron en el DEP, recibieron tratamiento con ondansetron, y reconsultaron dentro de las 24 horas. Los datos fueron recolectados de la base de datos de consultas del DEP, el comando reconsultas y entrevista telefónica a los padres. Las variables fueron edad, sexo, procedencia, motivo de la segunda consulta, diagnósticos finales en la segunda consulta. Los datos fueron analizados en SPSS utilizando estadística descriptiva. Resultados En el periodo de estudio consultaron por vómitos y recibieron ondasentrón 2018 pacientes. Reconsultaron dentro de las 24 horas 212, cumpliendo con los criterios de inclusión 205 pacientes. Se constató un 24,8% nuevos diagnósticos durante la reconsulta, de los cuales 35% requirieron hospitalización. Los diagnósticos fueron fiebre sin foco 2,9%, neumonía 2,4%, infección de vías urinarias 1%, sospecha de chikunguya 1,5%, adenitis mesentérica 0,5%, abdomen agudo quirúrgico 0,5%. Conclusión: Se identificó diagnósticos diferentes a la primera consulta en pacientes que recibieron ondansetrón como tratamiento sintomático de los vómitos en urgencias pediátricas, requiriendo hospitalización el 35% de los mismos.

Introduction: Ondansetron is a pharmacological agent frequently used for the symptomatic treatment of vomiting caused by gastroenteritis. However, it could mask more serious pathologies that require repeat consultations and hospitalization. Objective: To investigate whether the administration of ondansetron as a symptomatic treatment of vomiting in the pediatric emergency department (PED) delayed the diagnosis of serious pathologies. Materials and methods: This was an observational, descriptive, retrospective and cross-sectional study. Patients who consulted at the PED, received treatment with ondansetron, and returned for consultation within 24 hours were eligible. Data were collected from the PED consultation database, the follow-up consultation request, and a telephone interview with parents. The variables were age, sex, origin, reason for the second consultation, and final diagnoses in the second consultation. The data were analyzed in SPSS using descriptive statistics. Results: During the study period, 2018 patients consulted for vomiting and received ondansetron. 212 were consulted again within 24 hours, with 205 patients meeting the inclusion criteria. There were 24.8% new diagnoses during the follow-up consultation, of which 35% required hospitalization. The diagnoses were fever without source 2.9%, pneumonia 2.4%, urinary tract infection 1%, suspected chikunguya 1.5%, mesenteric adenitis 0.5%, and surgical acute abdomen 0.5%. Conclusion: Diagnoses different from the first consultation were identified in patients who received ondansetron for symptomatic treatment of vomiting in pediatric emergencies, with 35% requiring hospitalization.

Network meta-analysis of triple therapy for the prevention and treatment of acute nausea and vomiting caused by emetogenic chemotherapy drugs with moderate and high risk / 中国药房

OBJECTIVE To evaluate the efficacy of the triple therapy of 5-HT3 receptor antagonists， neurokinin-1 receptor antagonists and dexamethasone （referred to as “triple therapy”） in the prevention and treatment of acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） about triple therapy or 5-HT3 receptor antagonist combined with dexamethasone （referred to as “dual therapy”） were collected during the inception to May 2023. After literature screening， data extraction and literature evaluation， network meta-analysis was performed by using Stata 16.0 software. RESULTS A total of 59 RCTs were included， involving 23 418 patients and 15 interventions. Results of network meta-analysis showed that fosaprepitant + palonosetron + dexamethasone （FPD） was most effective in terms of acute nausea and vomiting control rate， followed by fosaprepitant + granisetron + dexamethasone （FGD） and aprepitant + ramosetron + dexamethasone （AMD）. In terms of acute nausea control rate， FPD was the most effective， followed by aprepitant + palonosetron + dexamethasone （APD） and FGD. In terms of acute vomiting control rate， FPD was the most effective， followed by FGD and APD. CONCLUSIONS Fosaprepitant + palonosetron + dexamethasone is better than other triple therapy or dual therapy in preventing acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.

Acalasia esofágica de presentación inespecífica. A propósito de un caso clínico

Introducción: la acalasia es una entidad poco frecuente en pediatría. Es un desorden de la motilidad esofágica de tipo neurovegetativo, idiopático; aunque también puede ser secundario a infecciones, neoplasias y enfermedades autoinmunes. Se caracteriza por síntomas como disfagia, regurgitaciones, dolor y descenso ponderal. En adultos la manometría de alta resolución es el gold standard. En niños las dificultades técnicas complejizan su realización. En la actualidad la asociación de la impedanciometría intraesofágica con la manometría es el método diagnóstico más eficaz. El objetivo del tratamiento es mejorar el vaciamiento esofágico mediante la disminución del tono del esfínter esofágico inferior por métodos farmacológicos, endoscópicos o quirúrgicos. Actualmente la miotomía de Heller es de elección. Caso clínico: escolar de 6 años, previamente sano, ingresado por regurgitaciones, dolor abdominal y adelgazamiento. Estudio radiográfico con bario con hallazgos compatibles con acalasia esofágica. Se descartaron causas secundarias. El tratamiento definitivo fue la miotomía de Heller con funduplicatura anterior de Dorr, presentando buena evolución clínica. Discusión: si bien la disfagia es el síntoma clave y en general guía el diagnóstico, es importante estar alertas a las formas clínicas atípicas con presentaciones inespecíficas, como en el caso clínico presentado, esto permite establecer un diagnóstico oportuno, evitando el impacto nutricional y psicosocial del niño y su familia.

Summary: Introduction: achalasia is a rare entity in pe-diatrics. It is an idiopathic neurovegetative esophageal motility disorder; although it can also be secondary to infections, neoplasias and autoimmune diseases. It is characterized by symptoms such as dysphagia, regurgitation, pain, and weight loss. In adults, high-resolution manometry is the gold standard. In children, technical difficulties complicate its realization. Currently, the association of intraesophageal impedance measurement with manometry is the most effective diagnostic method. The goal of treatment is to improve esophageal emptying by reducing the tone of the lower esophageal sphincter by pharmacological, en-doscopic, or surgical methods. Heller's myotomy is currently the treatment of choice. Clinical case: a 6-year-old schoolboy, previous-ly healthy, admitted for regurgitation, abdomi-nal pain, and weight loss. Barium radiographic study with findings compatible with esopha-geal achalasia. Secondary causes were ruled out. The definitive treatment was Heller's myotomy with Dorr's anterior fundoplication, presenting good clinical evolution. Discussion: although dysphagia is the key symptom and in general it leads the diagnosis, it is important to be aware of atypical clinical forms with non-specific presentations as in the clinical case presented, which allows timely diagnosis, preventing the nutritional and psychosocial impact of the child and his family.

Introdução: a acalasia é uma entidade rara em pediatria. É um distúrbio neurovegetativo da motilidade esofágica idiopática; embora também possa ser secundária a infecções, neoplasias e doenças autoimunes. É caracterizada por sintomas como disfagia, regurgitação, dor e perda de peso. Em adultos, a manometria de alta resolução é o padrão ouro. Nas crianças, as dificuldades técnicas tornam a sua implementação mais complexa. Atualmente, a associação da impedanciometria intraesofágica com a manometria é o método diagnóstico mais eficaz. O objetivo do tratamento é melhorar o esvaziamento esofágico, reduzindo o tônus do esfíncter esofágico inferior por métodos farmacológicos, endoscópicos ou cirúrgicos. Atualmente a miotomia de Heller é de escolha. Caso clínico: escolar de 6 anos, previamente hígido, internado por regurgitação, dor abdominal e emagrecimento. Estudo radiográfico com bário com achados compatíveis com acalasia esofágica. As causas secundárias foram descartadas. O tratamento definitivo foi miotomia de Heller com fundoplicatura anterior de Dorr, com boa evolução clínica. Discussão: embora a disfagia seja o sintoma chave e geralmente oriente o diagnóstico, é importante estar atento às formas clínicas atípicas e com apresentações inespecíficas, como no caso clínico apresentado, isso permite estabelecer um diagnóstico oportuno, evitando o impacto nutricional e psicossocial da criança e de sua família.

Palonosetron versus ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic cholecystectomy: a non-inferiority randomized controlled trial

Abstract Background: We tested the hypothesis that, within the margin of 15% of risk difference, palonosetron is not inferior to ondansetron in reducing the incidence of postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy. Methods: We conducted a double-blind, non-inferiority, randomized, controlled trial of 212 patients aged 18 to 65 years undergoing laparoscopic cholecystectomy under general anesthesia in two secondary care hospitals. Patients were randomly assigned to receive either palonosetron (0.075 mg) or ondansetron (8 mg) intravenously at induction of anesthesia. Ondansetron (8 mg) was also administered 8 and 16 hours postoperatively. All anesthetic and surgical procedures were standardized. Patients were evaluated for 24 hours postoperatively for the occurrence of PONV. Results: A high incidence of PONV was observed at 2-6 hours postoperatively, with a rate of 36.8% (95% confidence interval [CI] 28.2-46.3) in the palonosetron group, as compared to 43.4% (95% CI 34.4-52.9) in the ondansetron group. The risk difference (95% CI) between palonosetron and ondansetron for PONV was 0 (-10.9 to 10.9) at 0-2 hours, -6.6 (-19.4 to 6.5) at 2-6 hours, -0.9 (-11.0 to 9.2) at 6-12 hours, and -2.8 (-9.6 to 3.6) at 12-24 hours. There was no statistically significant difference between the palonosetron and ondansetron groups in the use of rescue medication (dimenhydrinate). There were no adverse events associated with the medications under study. Conclusion: Palonosetron is not inferior to ondansetron in patients at risk of PONV undergoing laparoscopic cholecystectomy, providing a good option for PONV prophylaxis, as it can be administered in a single dose.

Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

Abstract Objective We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p> 0.05) All VAS values were statistically lower in Group S than in Group C (p< 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p< 0.05). Conclusion Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.

Olanzapine as a prophylactic antiemetic for preventing postoperative nausea and vomiting after general anesthesia: A systematic review and metaanalysis

Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.

Prevalence of anticipatory nausea and vomiting in breast cancer patients undergoing highly emetogenic chemotherapy

SUMMARY OBJECTIVE: Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS: This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS: From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION: The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.

Estenosis hipertrófica del píloro en la Orinoquía colombiana (2010-2020)

Introducción: La hipertrofia del esfínter pilórico (EHP) es una condición que se caracteriza por la obstrucción del vaciamiento gástrico fisiológico y se considera una patología de resolución quirúrgica. Objetivo: Realizar la caracterización de los pacientes con hipertrofia congenita del píloro atendidos en el Hospital Regional de la Orinoquía entre 2010 y 2020. Metodología: Estudio observacional, descriptivo y retrospectivo en el cual se incluyeron los pacientes que consultaron al Hospital Regional de la Orinoquía entre el 01 de enero del 2010 y el 31 de diciembre del 2020 y que presentaron diagnóstico de hipertrofia congenita del píloro, identificados mediante los códigos CIE 10. Resultados: En total, se incluyeron 18 pacientes que cumplían con los criterios de selección. El promedio de edad de los participantes fue de 24,3 días de edad. La mayoría eran varones, asimismo, dos pacientes presentaban sobrepeso al nacer. El síntoma predominante fue la emesis posprandial en un 100 %. El diagnóstico se realizó mediante las medidas del píloro con ecografía abdominal y a la totalidad de los pacientes se les realizó piloromiotomía, de los cuales uno solo requirió una reintervención, sin embargo, ningún paciente falleció. Conclusiones: La hipertrofia congenita del píloro es una entidad patológica poco común, su síntoma clínico cardinal es la emesis postprandial. El método diagnóstico por excelencia es el estudio ecográfico. A pesar de su complejidad, esta entidad patológica tiene un buen pronóstico a corto y largo plazo.

Introduction: Hypertrophic pyloric stenosis (HPS) is a condition that is characterized by the obstruction of physiological gastric emptying and is considered a surgically-resolved pathology. Objective: To characterize patients with congenital hypertrophy of the pylorus treated at the Regional Hospital of Orinoquía between 2010 and 2020. Methods: Observational, descriptive and retrospective study of patients who were admitted at the Orinoquía Regional Hospital between January of 2010 and December of 2020. The patients that were included had a diagnosis of hypertrophic pyloric stenosis identified by the ICD-10 codes. Results: A total of patients were included by selection criteria. The average age of participants was 24.3 days old. Most of them were males and 2 patients were overweight at birth. The most common symptom was postprandial emesis in 100%. The diagnosis was made through measurements of pylorus measured with abdominal ultrasound. All the patients performed pyloromyotomy, and only one required a surgical reintervention, however, the mortality was 0. Conclusions: Congenital hypertrophy of pylorus is an uncommon pathology, whose cardinal symptom is postprandial emesis. The ideal diagnostic method is an ultrasound study. Despite its complexity, this pathology has a good short and long-term prognosis.

Post-operative nausea and vomiting prophylaxis: A meta-review on systematic reviews and meta-analyses

Introduction: Postoperative nausea and vomiting (PONV) are common complications in surgical patients undergoing general anesthesia, and multiple strategies have been suggested to prevent them. Objective: To describe the available evidence on the effectiveness of pharmacological and non-pharmacological strategies for preventing PONV in adults undergoing surgery under general anesthesia, as reported in previous meta-analyses and systematic reviews. Methodology: An overview of systematic reviews and meta-analyses was conducted. Searches were performed in PubMed, EBSCO, EMBASE, Cochrane Database, Science Direct, and Scopus, without restrictions as to gender, clinical condition, or date of publication, including articles in Spanish, French, and English only. Two reviewers independently and in duplicate did the screening, data extraction, quality evaluation, and risk of bias assessment according to AMSTAR-2. The PRISMA and PRIOR statements were followed for reporting. PROSPERO registration number CRD42021251999. Results: Out of 80 candidate articles, three were viable for meta-analysis. 1.5 mg to 18 mg doses of Dexamethasone showed a significant reduction in the risk of PONV, with a RR of 0.48 (95 % CI 0.41-0.57; p<0.001), I2=63 % (p=0.07), and a NNTc of 5 and 7. Other effective strategies included the use of acoustic stimulation/acupuncture/acupressure, 5HT3 antagonists, NK1 antagonists, gabapentinoids, haloperidol, droperidol, metoclopramide, midazolam, mirtazapine, among others. The risk of publication bias was low. Conclusion: Different strategies are effective for PONV prophylaxis in surgeries under general anesthesia. Dexamethasone shows the best available evidence at the moment. The documented methodological quality suggests the need for better studies to establish the effectiveness of the strategies.

Introducción: Las náuseas y el vómito posoperatorios (NVPO) son comunes en pacientes quirúrgicos bajo anestesia general y se han planteado múltiples estrategias para prevenirlos. Objetivo: Describir la evidencia disponible sobre la efectividad de las estrategias farmacológicas y no farmacológicas para prevenir las NVPO en adultos sometidos a cirugía bajo anestesia general, según lo descrito en metaanálisis y revisiones sistemáticas previas. Metodología: Se realizó una metarrevisión de revisiones sistemáticas y metaanálisis. Se ejecutaron búsquedas en PubMed, EBSCO, Embase, Cochrane Database, ScienceDirect y Scopus, sin restricción por sexo, condición clínica ni fecha de publicación, solo de artículos en español, francés e inglés. Dos revisores llevaron a cabo tamizaje, extracción de datos, evaluación de calidad y riesgo de sesgo según AMSTAR-2, de manera independiente y en duplicado. Se siguieron las declaraciones PRISMA y PRIOR para el reporte, previo registro en Prospero CRD42021251999. Resultados: De 80 artículos candidatos, se seleccionaron tres viables para realización de metaanálisis. La dexametasona entre 1,5 mg y 18 mg mostró un RR=0,48 (IC95 % [0,41-0,57]; p<0,001), I2=63 % (p=0,07) y un NNTc 5 y 7. Otras estrategias efectivas incluyen el uso de acuestimulación/acupuntura/acupresión, antagonistas 5HT3, antagonistas NK1, gabapentinoides, haloperidol, droperidol, metoclopramida, midazolam, mirtazapina, entre otras. El riesgo de sesgo de las publicaciones fue bajo. Conclusión: Diferentes estrategias son efectivas para profilaxis NVPO en cirugías con anestesia general. Dexametasona presenta la mejor evidencia disponible al momento. La calidad metodológica documentada sugiere la necesidad de realizar mejores trabajos para determinar la efectividad de las estrategias.

What are the effects of drugs for nausea and vomiting prevention following general anesthesia? Summary and comments regarding a Cochrane Collaboration network meta-analysis

The aim of this special article is to summarize and discuss, from an anesthesia perspective, the network meta-analysis on drugs used for the prevention of postoperative nausea and vomiting after general anesthesia, in agreement with the Cochrane Colombia collaboration and within the framework of the Cochrane Corners strategy. Through the combination of indirect comparisons and based on the evidence, the use of aprepitant, ramosetron, granisetron, dexamethasone and ondansetron is recommended with a high degree of certainty for the reduction of postoperative nausea and vomiting.

Este artículo especial tiene el objetivo de resumir y discutir desde la perspectiva de la anestesiología, el metaanálisis en red sobre fármacos para prevenir náuseas y vómito posoperatorio luego de anestesia general, en acuerdo con la colaboración Cochrane Colombia y en el marco de la estrategia Cochrane Corners. Mediante la combinación de la evidencia y el uso de comparaciones indirectas, se ha recomendado con alto grado de certeza el uso de aprepitant, ramosetrón, granisetrón, dexametasona y ondansetrón para la reducción de náuseas y vómito posoperatorio.

Prognostic predictive model for PONV in cesarean delivery

Introduction: Apfel simplified risk score for postoperative nausea and vomiting (PONV) has shown to be useful in anesthesia; however, since it has not been calibrated in regional anesthesia or in pregnant patients, its use in cesarean section is limited. Objective: To develop a prognostic predictive model for postoperative nausea and vomiting in pregnant patients undergoing cesarean section under spinal anesthesia. Methods: In a cohort of 703 term pregnant patients scheduled of cesarean section, 15 variables were prospectively assessed, to design a prognostic predictive model for the development of postoperative nausea and vomiting. A logistic regression analysis was used to construct the model and its calibration and discrimination were based on the Hosmer-Lemeshow test, the calibration curves, and C statistic. Additionally, the internal calibration was performed with the Bootstrap resampling method. Results: Postoperative nausea and vomiting were experienced by 27% of the patients during the first six hours after surgery. The model included as prognostic variables the development of intraoperative nausea and vomiting, age under 28 years, a history of PONV, the mother's BMI and the weight of the newborn baby. The model showed an adequate calibration (x2: 4.65 p: 0.5888), though a low discrimination (Statistic C = 0.68). Conclusions: A prognostic predictive model was created for the development of PONV in cesarean section. This model was used to build a prognostic scale for the classification of patients into risk groups.

Introducción: La escala de riesgo simplificada de Apfel para náuseas y vómito posoperatorio (NVPO) ha mostrado utilidad en anestesia; sin embargo, al no haber sido calibrada en anestesia regional o en pacientes embarazadas, su utilidad en cesárea es limitado. Objetivo: Desarrollar un modelo de predicción pronóstica para náuseas y vómito posoperatorios en pacientes embarazadas, llevadas a cesárea bajo anestesia espinal. Métodos: En una cohorte de 703 pacientes con embarazo a término programadas para cesárea, se evaluaron 15 variables de forma prospectiva para construir un modelo de predicción pronóstica para el desarrollo de náuseas y vómito posoperatorio. Se utilizó el análisis de regresión logística para la construcción del modelo y se calculó su calibración y discriminación con la prueba de Hosmer-Lemeshow, las curvas de calibración y el estadístico C. Además, se realizó la calibración interna con el método de remuestreo Bootstrap. Resultados: Las náuseas y vómito posoperatorio se presentaron en el 27% de las pacientes durante las primeras seis horas después de la cirugía. El modelo incluyó como variables pro-nósticas el desarrollo de náuseas y vómito en el intraoperatorio, edad menor de 28 años, antecedentes de NVPO, índice de masa corporal (IMC) de la madre y el peso del recién nacido. El modelo mostró una adecuada calibración (x2: 4,65 p: 0,5888), aunque una baja discriminación (Estadístico C = 0,68). Conclusiones: Se construyó un modelo de predicción pronóstica para el desarrollo de NVPO en cirugía cesárea, y con este se construyó una escala pronóstica que permite clasificar a las pacientes por grupos de riesgo.

Evaluating Aprepitant single-dose plus granisetron and dexamethasone in children receiving highly emetogenic chemotherapy for the prevention of chemotherapy-induced nausea and vomiting: A triple-blinded randomized clinical trial

ABSTRACT Introduction: This study was performed to evaluate the degree of 3-day chemotherapy-induced nausea and vomiting (CINV) in children with cancer who received highly emetogenic chemotherapy (HEC) to ascertain the efficacy of aprepitant single-dose on dayL 1 plus granisetron and dexamethasone (DEX). Methods: This clinical trial study was conducted on 120 patients in the age range of 5 to 18 years old who received chemotherapy. Patients were divided into two groups; Group A received aprepitant at 125 mg/kg on day 1 orally, followed by 80 mg/kg daily on days 2 and 3 and Group B received a single dose of aprepitant 125 mg/kg on day 1 orally and placebo on days 2 and 3. All groups received granisetron 3 mg/m2 on day 1 and DEX on days 1 to 3. The primary and secondary endpoints were to evaluate the proportion of patients with acute, delayed and overall CINV within each group. Results: There were no significant differences between the two groups for vomiting, nausea or the use of rescue therapy. The number of patients without vomiting on day 1 was similar in both groups (96.5% vs. 98.3%, respectively; p = 0.848). Conclusion: According to the results of this study, a single dose of aprepitant 125 mg/kg was as effective as administering three doses of aprepitant on 3 days. Therefore, the use of a single dose of aprepitant in combination with other standard treatment regimens to prevent CINV in children who received HEC was safe and efficacious and can be beneficial.

Factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil: a hierarchical approach / Comportamentos extremos para perda de peso e fatores associados em adolescentes do Nordeste brasileiro: uma abordagem hierárquica

Abstract The objective of this article is to identify the prevalence and evaluate the factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil. Cross-sectional study with 2,439 adolescents from Sample 2 (2015) of the National School-based Health Survey. Extreme weight loss behaviors, such as self-induced vomiting, laxative use and use of medicines or formulas (outcome) and independent variables were evaluated using a self-administered electronic questionnaire. The statistical analysis was performed following a hierarchical conceptual model. The prevalence of extreme weight loss behaviors in the sample was 12.1%. Among the factors that showed significant association with the outcome, we emphasize the administration model of the private school (PR = 0.62; CI = 0.46-0.84), bullying related to body appearance and for other reasons (PR = 1.62; CI = 1.19-2.20), forced sexual intercourse (PR = 2.65; CI = 1.90-3.69), insomnia (PR = 1.84; CI = 1.43-2.37), and be perceived as fat or very fat (PR = 1.90; CI = 1.50-2.42). Moderate prevalence of extreme weight loss behaviors was identified among adolescents. Socioeconomic factors, exposure to violence, mental health, and body image were associated with the adoption of these behaviors.

Resumo O objetivo deste artigo é identificar a prevalência e avaliar os fatores associados aos comportamentos extremos para perda de peso em adolescentes do Nordeste brasileiro. Estudo transversal com 2.439 adolescentes da Amostra 2 (2015) da Pesquisa Nacional de Saúde do Escolar. Os comportamentos extremos para perda de peso (desfecho) e as variáveis independentes foram avaliadas por meio de um questionário eletrônico autoaplicável. A análise estatística foi realizada seguindo um modelo conceitual hierárquico. A prevalência de comportamentos extremos para perda de peso na amostra foi de 12,1%. Entre os fatores que mostraram associação significativa com o desfecho, destacam-se a situação administrativa da escola privada (RP = 0,62; IC = 0,46-0,84), ser vítima bullying relacionado à aparência corporal e pelos demais motivos (RP = 1,62; IC = 1,19-2,20), ser forçado a ter relação sexual (RP = 2,65; IC = 1,90-3,69), ter insônia (RP = 1,84; IC = 1,43-2,37) e se autoperceber como gordo ou muito gordo (RP = 1,90; IC = 1,50-2,42). Prevalência moderada de comportamentos extremos para perda de peso foi identificada entre os adolescentes. Os fatores socioeconômicos, de exposição à violência, de saúde mental e da imagem corporal se associaram à adoção de tais comportamentos.

Can music and medicine be effective on anxiety, depression and chemotherapy?related nausea and vomiting? (PEGASUS study)

Background: Music and medicine can be used in patients with cancer as a palliative complementary therapy. It is aimed to show the effect of music therapy performed on anxiety, depression, and chemotherapy?related nausea/vomiting. Methods: A total of 62 patients with colon cancer who previously experienced grade 1 or 2 chemotherapy?related nausea and vomiting were divided into two groups as intervention and control group based on the addition of music and medicine to infusion chemotherapies and 1:1 randomized. The groups were compared in terms of the effect of music and medicine on anxiety, depression, heart rate, blood pressure, and chemotherapy?related nausea?vomiting. Statistical analysis was done using SPSS Statistics for Windows, Version 19.0. A value of P < 0.05 was found statistically significant. Results: The patients were evaluated in terms of study variables at the beginning and after the completion of a chemotherapy session. As a result, there was a significant decrease in systolic blood pressure (P = 0.042), diastolic blood pressure (P = 0.44), heart rate (P = 0.046), state and trait sections of the state?trait anxiety inventory scores (P = 0.047 and P = 0.046, respectively), as well as a significant decrease in anxiety degree (P = 0.036) and a significant improvement in chemotherapy?related nausea (P = 0.021) and vomiting (P = 0.038) experience in the intervention group. However, no significant effect of music and medicine on depression was detected (P = 0.218). Conclusion: Although it has not been shown to have an effect on depression, it was concluded that music and medicine with classical music integrated into the chemotherapy session can reduce the degree of nausea/vomiting and anxiety levels.

The effect of music therapy on chemotherapy-induced nausea and vomiting in women with breast cancer

Background: Chemotherapy-induced nausea and vomiting (CINV) is an unavoidable side effect that affects the quality of life (QoL) and treatment compliance in patients with cancer. While the positive effect of music therapy in many clinical settings has been published, little information is available on the relieving effect of music therapy on CINV. Aim: To evaluate the effect of music therapy on the frequency and severity of CINV in women with breast cancer. Methods: Sixty patients were equally randomized to experimental (music therapy) and control (routine care) groups. One hundred and forty-eight instrumental, relaxation, and religious records were provided to be delivered by a headphone connected to an MP3 player. The intervention consisted of five 25-minute sessions supervised by trained nurses to provide the patient抯 favorite music, volume, and timing arrangement. A 0� visual analog scale (VAS) and the 4-point Likert scale were used to measure the severity of nausea. Frequencies were also asked and recorded. The study endpoints were before, during, and after (8-hours, 16-hours, and 24-hours) chemotherapy. Results: The analysis of variance (ANOVA) showed that the frequency and severity of CINV increased significantly over the first 24 hours after chemotherapy in both groups. The difference between music therapy and control groups was statistically significant with regard to the median of the frequency of nausea (5.92 versus 12.34), frequency of vomiting (4.55 versus 9.95), the severity of nausea (1.26 versus 3.27), and severity of vomiting (1.06 versus 2.53). Conclusion: This study supports the idea of incorporating music therapy into the healing process after chemotherapy in women with breast cancer

Rachianesthésie en ambulatoire au Centre Hospitalier Universitaire Andrainjato Fianarantsoa, Madagascar: tolérance et efficacité / Ambulatory spinal anaesthesia at the Andrainjato University Hospital of Fianarantsoa, Madagascar: tolerance and effectiveness

La rachianesthésie ambulatoire est une des méthodes d'anesthésies loco- régionales de plus en plus utilisées car permet une réhabilitation précoce. L'objectif de l'étude est d'évaluer la tolérance et l'efficacité de la rachianesthésie réalisée en ambulatoire. Méthodes : Il s'agit d'une étude rétrospective, analytique réalisée au Centre Hospitalier Universitaire Andrainjato Fianarantsoa pendant cinq ans (du mois de janvier 2016 au mois de décembre 2020). La tolérance de la rachianesthésie était évaluée par la fréquence et la gravité des incidents peropératoires et complications postopératoires. Son efficacité était estimée par le taux de sortie le jour de l'intervention et la ré-hospitalisation. Résultats : Soixante-quatre patients âgés de 44 [14-85] ans ont bénéficié d'une chirurgie viscérale, gynécologique, traumatologique ou vasculaire sous rachianesthésie. L'hypotension artérielle (n=04) et les nausées et vomissements peropératoires (n = 01) étaient les incidents retrouvés. Les complications postopératoires étaient la céphalée (n = 13), la douleur postopératoire d'intensité modérée à intense (n = 05) et les nausées et vomissements (n = 02). L'âge supérieur à 50 ans (p = 0,012) et une dose supérieure à 12 mg de bupivacaïne (p = 0,011) étaient corrélés à l'hypotension artérielle peropératoire. Le genre féminin (p = 0,004) et l'utilisation de la bupivacaïne hyperbare (p = 0,027) étaient associés aux complications postopératoires. Tous ces patients étaient sortis le jour même de l'intervention sans ré-hospitalisation. Conclusion : La rachianesthésie ambulatoire connaît actuellement un grand essor dans la pratique anesthésique. La prévention de certaines complications devrait être systématique afin d'optimiser sa tolérance et son efficacité

Analysis of influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on two models / 中国实用护理杂志

Objective:To analyze the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on Logistic regression model and decision tree model.Methods:This was a cross-sectional study. A total of 236 patients with primary liver cancer after transarterial chemoembolization in The Second Affiliated Hospital of Air Force Military Medical University from March 2021 to June 2022 were conveniently selected as the research subjects. The factors related to delayed nausea and vomiting were collected, and Logistic regression and decision tree models were established, respectively, and the differences between the two models were compared.Results:The incidence of delayed nausea and vomiting of patients with primary liver cancer after transarterial chemoembolization was 45.34% (107/236). Logistic regression model showed that age, anxiety, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization(all P<0.05). Decision tree model showed that age, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization (all P<0.05). The classification accuracy rates of Logistic regression, decision tree model and combined diagnosis of two models were 72.9%, 71.2% and 72.0% respectively; the areas under the ROC curve were 0.778, 0.781 and 0.806 respectively, with no significant difference (all P>0.05). Conclusions:The analysis results of Logistic regression and decision tree model on the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization are highly consistent, which can be combined to provide a more comprehensive reference for the evaluation and intervention of medical staff.

Episodic syndromes that may be associated with migraine / 中风与神经疾病杂志

Episodic syndromes that may be associated with migraine@#Episodic syndromes that may be associated with migraine are commonly seen in children and are likely to evolve into migraine in the subsequent course of the disease， including several subtypes such as benign paroxysmal torticollis， benign paroxysmal vertigo， and recurrent gastrointestinal disturbance. Understanding the above syndromes has an important clinical significance in the diagnosis of migraine in children.

A Case of Recurrent Nausea with Vomiting for Past Sixteen Years Successfully Treated with a Kampo Formulation Shimbuto / 日本東洋医学雑誌

We herein report a 36-year-old male patient, who complained of persistent and recurrent nausea with vomiting for 16 years in spite of various standard treatments, was successfully treated with Kampo formulation Shimbuto, which selected based on the left para-navel tender point. We speculated that the clinical disorder in this case was related to suitai i.e. water imbalance syndrome in Kampo medicine. However, there has never been such a case report in the field of Kampo, and no related papers have been found in the standard database Medline. We believe this report is valuable from the viewpoint of therapeutics in both Western and Kampo medicine.