Day: 03/06/2022

Impact of obesity on uterine contractile activity during labour: a blinded analysis of a randomised controlled trial cohort

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Abstract

Objective

To investigate the impact of severe obesity (BMI ≥35 kg/m2) on uterine contractile activity. The hypothesis was that obese parturients might have weaker uterine activity and need more oxytocin than leaner parturients.

Design

Exploratory, blinded analysis of a randomised controlled trial cohort.

Setting:

Two labour wards, in a university tertiary hospital and a central hospital.

Population

686 parturients with singleton pregnancies, gestational age ≥ 37 weeks, foetus in cephalic presentation, and intrauterine tocodynamometry during labour.

Methods

Uterine contractile activity was assessed as intrauterine pressure, frequency of contractions and basal tonus of uterine muscle. The use of oxytocin and cervical dilatation were recorded simultaneously.

Main Outcome Measures

Primary Outcome: uterine contractile activity. Secondary outcomes: use of oxytocin, labour outcomes.

Results

Obese parturients reached intrauterine pressure ≥ 200 MVUs during the first stage of labour more often than leaner parturients; 62% vs. 49%; OR 1.67 (95%CI 1.05–2.67) and had higher basal tone of uterine muscle. However, obese parturients without previous vaginal delivery were not able to reach the active stage of labour as often as leaner ones, and their vaginal delivery success rate was lower. If a parturient had had previous vaginal delivery, obesity did not influence uterine activity, nor was it a risk of caesarean section. Doses and total consumption of oxytocin did not differ between BMI groups.

Conclusions

Obese nulliparas have stronger uterine contractile activity than leaner ones, but they more often fail to reach the active phase of labour and their vaginal delivery success rate is lower.

Barbiturate‐related hospitalisations, drug treatment episodes, and deaths in Australia, 2000‒2018

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Abstract

Objectives: To determine the characteristics and population rates of barbiturate‐related hospitalisations, treatment episodes, and deaths in Australia, 2000–2018.

Design, setting: Analysis of national data on barbiturate‐related hospitalisations (National Hospital Morbidity Database, 1999‒2000 to 2017‒18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002–03 to 2017–18), and deaths (National Coronial Information System, 2000–01 to 2016–17).

Main outcome measures: Population rates directly age‐standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression.

Results: We identified 1250 barbiturate‐related hospitalisations (791 cases of deliberate self‐harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate‐related hospitalisation rate declined from 0.56 in 1999‒2000 to 0.14 per 100 000 population in 2017‒18 (AAPC, ‒6.0%; 95% CI, ‒7.2% to ‒4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, ‒5.8%; 95% CI, ‒9.1% to ‒2.4%) and intentional self‐harm (AAPC, ‒5.6%; 95% CI, ‒6.9% to ‒4.2%) were each statistically significant. Despite a drop from 0.67 in 2002‒03 to 0.23 per 100 000 in 2003–04, the drug treatment episode rate did not decline significantly (AAPC, ‒6.7%; 95% CI, ‒16% to +4.0%). The population rate of barbiturate‐related deaths increased from 0.07 in 2000–01 to 0.19 per 100 000 population in 2016–17 (AAPC, +9.3%; 95% CI, +6.2–12%); the rate of intentional self‐harm deaths increased (AAPC, +11%; 95% CI, +7.4–15%), but not that of accidental deaths (AAPC, ‒0.3%; 95% CI, ‒4.1% to +3.8%).

Conclusions: While prescribing and community use of barbiturates has declined, the population rate of intentional self‐harm using barbiturates has increased. The major harm associated with these drugs is now suicide.

The known: Barbiturates are no longer routinely prescribed in Australia because of the considerable risks of dependence and toxicity.

The new: The rate of barbiturate‐related hospitalisations (but not that of drug treatment episodes) has declined significantly in Australia since 2000. However, the number of barbiturate‐related deaths has risen significantly because of increased use for intentional self‐harm.

The implications: With the declines in prescribing and community use of barbiturates, the major concern regarding barbiturate‐related harm has shifted from accidental overdoses to their use in suicide.

Barbiturates are central nervous system depressants that were widely prescribed during the 20th century as anxiolytics, hypno‐sedatives, and anticonvulsants.1,2 Recognition of the risks of barbiturate dependence and toxicity and the high incidence of poisoning led to supply restrictions (eg, reductions in pack sizes and number of permitted repeat dispensings) and to barbiturates being supplanted by benzodiazepine and Z‐drug hypnotics.1,2,3,4,5,6 Barbiturates are no longer routinely prescribed for humans, except for rare indications such as induction anaesthesia and refractory epilepsy;1 during the period 2001‒2015, the annual number of prescriptions in Australia declined from 50 000 to 27 000.7

Nevertheless, barbiturate toxicity remains a problem, particularly when used for suicide.8,10,11,12,13,14,15,16,17 We recently characterised the 511 barbiturate‐related deaths in Australia during 2000‒2019, three‐quarters of which involved pentobarbital.9 Among those who died, we distinguished two profiles: younger people with mental health problems and low levels of physical disease, and older people with higher levels of physical disease but low levels of mental health problems. About 90% of the deaths were caused by intentional overdoses, and the proportion of barbiturates purchased online increased across the study period; in 8% of cases, the drugs had been obtained from veterinary practices. Evidence of a prior suicide attempt was documented for only 15% of deaths,9 reflecting the lethality of deliberate barbiturate overdose, and possibly also the increased availability of online materials on euthanasia.

While barbiturate‐related deaths in Australia over the past two decades have been characterised, barbiturate‐related hospitalisations and drug treatment episodes have not. Moreover, national population rates of hospitalisations, treatment episodes, and deaths have not been reported.

We therefore examined the characteristics and population rates in Australia of barbiturate‐related hospitalisations (1999–2000 to 2017–18), treatment episodes (2002–03 to 2017–18), and deaths (2000–01 to 2016–17).

Methods

Barbiturate‐related hospitalisations

We analysed National Hospital Morbidity Database (NHMD) hospital separations (hospitalisations) data. The NHMD comprises episode‐level records from all Australian public and private hospitals. The principal diagnosis and up to 99 additional diagnoses are coded at separation (since June 1999) according to the International Statistical Classification of Diseases and Related Health Problems, tenth revision, Australian modification (ICD‐10‐AM).18 We extracted records for the period 1999‒2000 to 2017‒18 in which the ICD‐10‐AM code T42.3 (poisoning by barbiturates) was included in the principal diagnosis field or any additional diagnosis field (the barbiturates involved are not specified). Several hospitalisations could be recorded for an individual in a single year. We excluded records for hospitalisations with the care type “newborn without qualified days” and those for “posthumous organ procurement” or “hospital boarders”. External cause of injury and poisoning coded as “intentional self‐harm” (X60–X84) was deemed to indicate attempted suicide, and “accidental injury and poisoning” (V01–X59) accidental poisonings (Supporting Information, table 1).

Treatment episodes

Drug treatment episodes data were extracted from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS), which compiles data from publicly funded government and non‐government agencies that provide specialist alcohol and other drug treatment services.19 A treatment episode is deemed closed when treatment is completed, there has been no contact between client and provider for three months, there has been a change in the main treatment, principal drug of concern or delivery setting, or treatment has ended. Data include self‐reported information for people assessed or accepted for treatment. Standardised treatment data collection commenced in 2000–01; we had access to unit record data from 2002–03 (data extracted to 2017–18) for episodes in which the client identified barbiturates as their principal or other drug of concern (Australian Standard Classification of Drugs of Concern [ASCDC20] codes 2300, 2301, 2302, 2303, 2399; in this study, we did not distinguish between the barbiturates involved) (Supporting Information, table 1). Several treatment episodes could be recorded for an individual in a single year.

Barbiturate‐related deaths

Deaths data for 2000–19 were retrieved from the National Coronial Information System (NCIS; https://www.ncis.org.au), a database of medico‐legal death investigation records provided by the coroners’ courts in each jurisdiction in Australia (from July 2000) and New Zealand (from July 2007). We retrieved all closed Australian cases between 1 July 2000 and our data extraction date (30 June 2019) in which barbiturates were recorded in the NCIS pharmaceutical substance code set as contributing to death. The characteristics of this case series have been reported in detail elsewhere.9 At the time of data extraction, we had access to data for 2000–2006 (99% of cases closed), 2007–2012 (97%), 2013–2016 (92%), 2017 (58%), 2018 (32%), and 2019 (3.6%). Our analysis of fatal cases was restricted to the period July 2000 – June 2017, as most subsequent cases were still open.

Statistical analyses

We summarise demographic and other characteristics as descriptive statistics. We analysed and report data by financial year (1 July – 30 June), reflecting hospital and treatment episode record practice. Population rates were calculated using the Australian Bureau of Statistics resident population at June of the corresponding year, directly age‐standardised to the 2001 Australian standard population.21 Changes in population rates were analysed by Joinpoint (version 4.9.0.0) regression (National Cancer Institute [US]; https://surveillance.cancer.gov/joinpoint). We fitted a maximum of two joinpoints, with a minimum of three data points between joinpoints; model fit was assessed by permutation testing. The estimated average annual percentage change (AAPC) in rate was determined for each segment as a weighted mean of the annual percentage change in the fitted model; an AAPC with a 95% confidence interval (CI) not including zero was deemed statistically significant. We also undertook a sensitivity analysis restricted to data for 2002–03 to 2016–17 (ie, the period for which data on hospitalisations, treatment episodes, and deaths were all available).

Ethics approval

The University of New South Wales Human Research Ethics Committee (UNSW HREC) approved our analysis of NHMD data (HC180004); the UNSW HREC (HC180004) and the Australian Institute of Health and Welfare Human Research Ethics Committee (EC2012‐4‐56) approved our analysis of AODTS NMDS data; the Victorian Department of Justice and Community Safety Human Research Ethics Committee (CF/18/22484), the Western Australia Coronial Ethics Committee (EC11/2018), and the UNSW HREC (HC180004) approved our analysis of NCIS data on barbiturate‐related deaths.

Results

Hospitalisations

We identified 1250 barbiturate‐related hospitalisations, including 663 of women (53%); 510 were of people aged 30–49 years (41%), and in 378 cases (30%) the patients were aged 50 years or more. For 749 separations (60%), the principal diagnosis was barbiturate toxicity; the most frequent other principal diagnoses were injuries and poisonings involving other substances (338 cases, 27%). A total of 791 hospitalisations (63%) were deemed to be results of attempted suicide using barbiturates (Box 1).

Box 1

Characteristics of barbiturate‐related hospitalisations, Australia, 1999–2000 to 2017–18

Mental health diagnoses were documented as other diagnoses in 719 cases (58%), the most frequent being mood (360 cases) and substance use disorders (249 cases). Physical health diagnoses were documented in 581 cases (46%); diseases of the nervous system were most frequent (213 cases), including 118 epilepsy diagnoses. Hospital length of stay was one day for 547 hospitalisations (44%), and longer than seven days for 276 (22%) (Box 1).

Treatment episodes

We identified 993 closed treatment episodes for drug dependence in which barbiturates were nominated as a principal or other drug of concern; in 611 episodes (67%), the clients were men. Most episodes were for people aged 20‒49 years (820 episodes, 82%). Clients nominated barbiturates as the principal and sole drug of concern in only 75 cases (8%). The most frequently nominated other principal substances of concern were opioids (231 episodes, 23%), alcohol (201 episodes, 20%), and psychostimulants (167 episodes, 17%); benzodiazepines were reported as the principal drug of concern in only 62 cases (6%) (Box 2).

Box 2

Drug treatment episodes in which barbiturates were noted as the principal or other drug of concern, Australia, 2002–03 to 2017–18

Barbiturate‐related hospitalisations, treatment episodes, and deaths

The annual rate of barbiturate‐related hospitalisations declined from 0.56 per 100 000 population (107 hospitalisations) in 1999‒2000 to 0.14 per 100 000 population (37 hospitalisations) in 2017‒18. This decline was statistically significant (AAPC, ‒6.0%; 95% CI, ‒7.2% to ‒4.8%) (Box 3, A), as were those for men (AAPC, ‒6.3%; 95% CI, ‒7.8% to ‒4.8%) and women separately (AAPC, 5.6%; 95% CI, ‒7.6% to ‒3.6%).

Box 3

Age‐standardised rates of barbiturate‐related hospitalisations, Australia, 1999–2000 to 2017–18, by intent; drug treatment episodes, 2002–03 to 2017–18, by sex; and deaths, 2000–01 to 2016–17, by intent

The annual rate of barbiturate‐related hospitalisations related to intentional self‐harm was consistently higher than that for accidental poisoning, but declined from 0.33 per 100 000 population in 1999‒2000 to 0.10 per 100 000 population in 2017‒18. This decline was statistically significant (AAPC, ‒5.6%; 95% CI, ‒6.9% to ‒4.2%), as was that for accident‐related hospitalisations (from 0.16 to 0.04 per 100 000 population; AAPC, ‒5.8%; 95% CI, ‒9.1% to ‒2.4%) (Box 3, A).

The annual rate of barbiturate‐related drug treatment episodes declined from 0.67 per 100 000 population (143 episodes) in 2002‒03 to 0.23 per 100 000 (52 episodes) in 2003‒04, then fluctuated between 0.15 and 0.44 per 100 000 population in subsequent years. The decline between 2002‒03 and 2017‒18 was statistically significant neither overall (AAPC, ‒6.7%; 95% CI, ‒16% to +4.0%) nor for men (AAPC, ‒2.7%; 95% CI, ‒6.5% to +1.3%) or women separately (AAPC, ‒9.1%; 95% CI, ‒22% to +6.4%) (Box 3, B).

The annual rate of barbiturate‐related deaths increased from 0.07 per 100 000 population (13 deaths) in 2000–01 to 0.19 per 100 000 population (51 deaths) in 2016–17. This increase was statistically significant, both overall (AAPC, +9.3%; 95% CI, +6.2% to +12%) and for men (AAPC, +10%; 95% CI, +6.8% to +14%) and women separately (AAPC, +7.4%; 95% CI, +3.3% to +12%). The annual rate of deaths caused by intentional self‐harm increased (AAPC, +11%; 95% CI, +7.4% to +15%), but the low rate of accidental barbiturate‐related deaths did not change significantly (AAPC, ‒0.3%; 95% CI, ‒4.1% to +3.8%) (Box 3, C).

The results of sensitivity analyses restricted to the period 2002–03 to 2016–17 were similar to those of the main analyses (Supporting Information, table 2).

Discussion

We have described disparate patterns of change in the national population rates of barbiturate‐related hospitalisations, treatment episodes, and deaths in Australia during 2000–2018, providing a complex picture of contemporary barbiturate‐related harm. Taken together, it appears that barbiturates are no longer frequently misused as drugs of dependence, and deaths are typically the result of deliberate self‐harm rather than accidental poisoning.

Consistent with reduced barbiturate prescribing in Australia, the rates of barbiturate‐related hospitalisation declined markedly for both intentional and accidental poisonings. These declines may reflect the generally lower community availability of these drugs. It is notable that almost two‐thirds of hospitalisations were linked with deliberate self‐harm, confirming the continued association of barbiturates with suicide. Further, mental health diagnoses (particularly mood disorders) were recorded in nearly three in five hospitalisations, and physical health diagnoses were also common. The frequency of epilepsy diagnoses is probably linked with the use of barbiturates to treat some patients with this condition. Overall, the burden of disease for people admitted to hospital with barbiturate‐related harms was considerable, and attempted suicide was the most frequent reason for their admission.

After its sharp, unexplained drop in 2003–04, the treatment episode rate subsequently fluctuated around the lower rate, consistent with limited community availability and misuse of barbiturates. Moreover, barbiturates were the principal drugs of concern in only one in five treatment episodes, and were rarely the sole drugs of concern. The other most frequently noted principal drugs of concern were also depressants, including opioids and alcohol. The low reported rate for benzodiazepines as drugs of concern was surprising, given their widespread use and misuse.22

In contrast to hospitalisations, treatment episodes, and prescribing, the population rate of barbiturate‐related deaths increased significantly; in particular, the number of hospitalisations linked with deliberate self‐harm declined, but the number of deaths increased. We have previously noted that one‐third of the people who died of barbiturate overdose during 2000‒2017 had access to materials regarding euthanasia, including more than half of those aged 65 years or more.9 In most cases, the drugs appear to have been procured for self‐harm rather than misuse, and evidence of a previous suicide attempt was available in only 78 cases (15%).9 It would therefore appear that a large proportion of people who attempt suicide using barbiturates succeed at their first attempt, reflecting well considered suicide planning and the lethality of barbiturates.

While the prescribing and community use of barbiturates has declined, their increased use for intentional self‐harm, particularly by people with mental health problems, is worrying. Clinicians should be aware of their association with suicide when prescribing these drugs. Access to barbiturates via the internet is a difficult public health and border control problem. Although their use for medically supervised euthanasia is now legal in some Australian states (but not during the period covered by our analysis), restricting access to these high lethality drugs remains important, particularly to people with mental health disorders. Whether the availability of medically supervised euthanasia reduces the online purchasing of these drugs will be a question of major public health interest.

Limitations

Barbiturate‐related clinical events are relatively uncommon, and chance fluctuations may have influenced our findings. However, the comparative rarity of these events does not diminish their clinical and public health significance. We could not determine with our analysis whether the same barbiturates were most frequently involved in hospital separations, treatment episodes, and deaths. As an individual could be hospitalised several times during a single year, our hospitalisation analysis was of events, not of unique patients. Comparison of diagnosis and external cause data over time must be cautious, as the classifications and coding standards used can change, and our data may not have captured all comorbid conditions. Identifying the drugs of concern for treatment episodes relied on reports by patients, and our analysis was again of events, not unique patients. Variations in treatment rates may also reflect changes in the number of treatment agencies and their capacity. Finally, barbiturate‐related deaths for which a medical practitioner signs the death certificate are unlikely to be referred to a coroner, and will therefore not be included in the NCIS. Deaths for which investigations had not yet been finalised were not included in our analysis, and barbiturates were not routinely examined for all toxicology reports. Consequently, our estimates, particularly for the most recent years of our analysis, are probably conservative.

Conclusion

The prescribing and community use of barbiturates has declined in Australia. The major harm associated with these drugs is now their use for suicide. In this changing environment, it is difficult to predict whether the changes we have described will continue, but ongoing surveillance is warranted. Specifying in administrative datasets the barbiturates implicated in hospitalisations, treatment episodes and deaths, rather than reporting aggregated data for all barbiturates, would help with the targeting of specific countermeasures.

What’s face yoga and why is it important?

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What's face yoga and why is it important?

The health benefits, both physical and mental, of practising yoga, are manifold. But can the same apply when practising yoga with your face? Face yoga has been attributed to yield face-lifting, tightening, and sculpting benefits without salon or dermatologists’ interventions. It involves working the facial muscles for improving blood circulation for a healthy glow.

What is face yoga?

Face yoga is kind of what it sounds like: Moving, stretching, and relaxing your facial muscles in an attempt to keep them more toned. It could be to keep your face looking more youthful (if that’s a goal) or that it just feels nice and is relaxing. There’s no standard way to practice face yoga, but there are some more popular methods and moves hitting the spa scene.

The benefits of face yoga

A more radiant complexion

Face yoga exercises stimulate microcirculation and bring more oxygen to cells. This makes the complexion look more balanced, even and radiant. The breathing exercises help you to better manage your emotions, so your face looks calm and serene, and your eyes and features look softer.

Softened wrinkles and plumped skin

With age, natural collagen levels decrease. As a result, the skin starts to sag and lose tone, and wrinkles become more pronounced. The advantage of face yoga exercises is that they don’t just stimulate muscles; they also stimulate the production of collagen and elastin. By practising face yoga regularly, you’ll tone up your skin, visibly reduce the depth of wrinkles, and make your face look smoother and less tired.

Gravity-fighting facial exercises

There are around fifty muscles in the face, but they don’t get a workout every day! This means that they may lose tone prematurely – and there is a direct correlation between this loss of tone and skin ageing. You can help your face to defy gravity by practising the following exercises every day for five minutes.

Smooth forehead lines

To soften and smooth forehead lines, begin by placing your palms on the top of your forehead. Breathe in deeply and push the skin of your forehead upward. Continue to hold the skin in this position as you breathe out and look down as far as possible. Repeat ten times.

Russia-Ukraine conflict: Europe will be on the wrong side of history if it chooses not to mediate

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Jacques Chirac was a flawed leader. His tenure as France’s president from 1995 to 2007 was marred by both personal and political scandals. In 2011, he was convicted of corruption. But today, three years after he passed away in 2019 it’s time Europe remembered him.

Chirac’s opposition to the Iraq War (2003-11) probably redeemed his legacy. Germany too had refused to join the US-led coalition against Iraq, but what distinguished Chirac was that he tried to convince the then US president George W Bush against the invasion.

On 24 February 2022, when Russia launched an attack on Ukraine, European leaders, just like the rest of the world, were shocked. A Russian military build-up at the Ukrainian border had been going on for months, but an invasion in the 21st Century seemed inconceivable. Yet, Europe’s subsequent reaction to the crisis reflected that a sustained war was in fact very much possible in this day and age.

European nations responded by imposing sanctions on Russia and by sending military aid to Ukraine. As a non-military alliance, in a rare move, the EU approved $500 million worth of arms supply to Ukraine. Germany, UK, Ireland, Greece and Denmark are among the nations which have confirmed military aid for Ukraine. Some countries have also encouraged their citizens to fight for Ukraine as foreign volunteers.

Ukrainian president Volodymyr Zelenskyy has urged foreigners to fight against Russia as part of an “international brigade”.

On 27 February, Denmark’s prime minister Mette Frederiksen said, “There is nothing at first sight that would legally prevent someone from going to Ukraine to participate in the conflict, on the Ukrainian side.”

British foreign secretary Liz Truss said that she supported individuals from the UK who wanted to fight for the besieged country. “Everyone who wants to join the defence of security in Europe and the world may come and stand shoulder to shoulder with Ukrainians against the invaders of the 21st century,” Truss told the BBC.

Interestingly, a British law dating back to 1870 makes it illegal for citizens to join foreign armies. In 2019, a Briton was sentenced to four years in jail by a London court for travelling to Syria to join the Kurdish forces in fight against the Islamic State. Not surprisingly, 10 Downing Street distanced itself from Truss’ remarks and said that it advised citizens against travelling to Ukraine.

Sweden, a country which had remained neutral during the two World Wars, broke with its age-old policy by announcing weapons supply to Ukraine.

The extent to which these weapons can help Ukraine gain an upper hand over the much stronger Russian Army remains doubtful. But one thing is certain: These will help prolong this war which has seen Ukrainian cities turn into battle zones and its citizens into combatants against an invading force.

The onus to bring peace to this region lies on Europe, not the United States. In 2008, Russia invaded Georgia which, like Ukraine, was a part of the Soviet Union. The prelude to the conflict was Georgia’s NATO membership bid. In an attempt to counter Russia, the US backed Ukraine’s decision to join NATO. Fourteen years down the line, both Georgia and Ukraine are not part of the Washington-led 30-member military alliance.

Lack of understanding of regional geopolitics is part of the US playbook but Europe should know better.

It has higher bargaining power over Russia than the United States. EU nations like France and Germany have mostly enjoyed stable relations with Russia. Thus, it is surprising that none of the European leaders have seriously batted for negotiations between Kyiv and Moscow.

For all talks of a rules-based international order, it is also disappointing that European powers have not pushed for a ceasefire which, if nothing else, will help speed up the evacuation of civilians.

There’s no doubt that Russia is the aggressor here and that it should face consequences for this war. But Europe’s options are limited. Including Ukraine in NATO will lead to a direct confrontation between the alliance’s members and Russia. According to NATO’s Article 5, “an attack on one ally is considered an attack on all allies”. The alliance has already announced that it will not be sending troops to Ukraine.

Extended war risks destabilising Europe

For a region that is no stranger to war, Europe should understand that a prolonged conflict will only destabilise it in the coming years. The collapse of the Soviet Union in 1991 sparked bloodshed in many countries in Europe and beyond. It triggered border disputes which led to conflicts in the subsequent years. Notably, two former Soviet nations — Armenia and Azerbaijan — fought a war over the Nagorno Karabakh enclave in 2020.

An extended Ukraine crisis risks igniting unresolved regional tensions. There is no guarantee that Russia, which has been taking an increasingly belligerent stand, will honour the conditions made during talks. But Europe should still take the diplomatic path.

History will never forgive Russia for this war but it will also not be kind to those who did not try to stop it.

What should be the emergency treatment of anaphylaxis in adults?

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Drugs (e.g., Penicillin), foods (e.g., shellfish), insect stings, and chemicals can cause allergic reactions. There is a wide range of severity, from a minor rash (urticaria) to potentially fatal airway blockage (laryngeal oedema) and full-blown anaphylaxis (hypotension, bronchospasm). Adults are more likely to develop anaphylaxis than children.

Oxygen, Adrenaline, and intravenous (IV) fluid are used for emergency treatment. Steroids can help prevent relapse, and antihistamines can ameliorate the urticarial itch, but these drugs are not useful for acute severe anaphylaxis.

Treatment in adults

A. Airway and breathing

High flow oxygen should be delivered via a face mask. A bronchodilator should be administered as well.

  • Salbutamol: 5 mg via nebuliser

B. Adrenaline

If severe (hypotension or severe bronchospasm or stridor or hypoxia):

  • Adrenaline: 0.5 mg intramuscularly (IM) must be given, and it should be repeated in 5 minutes if required.

 Or

If less severe (systolic blood pressure >90 mm Hg, mild bronchospasm, no stridor and no hypoxia):

  • Adrenaline: 100 mcg IV each minute until symptoms subside.

C. Intravenous fluids

  • 0.9% saline 250 ml IV bolus should be administered, and it should be repeated if necessary.

In severe anaphylaxis, large amounts of IV fluid might be required to keep blood pressure stable.

D. Corticosteroids

  • Hydrocortisone succinate: 200 mg IV, followed by 100 mg 6 hourly

Or

  • Dexamethasone: 8 mg IM

Or

  • Prednisolone: 50 mg orally daily

All patients with severe anaphylaxis should be monitored for 24 hours because relapse is possible.

E. Anti-histamines

  • Promethazine: 25 mg IM, followed by either 25mg IM or 20 mg orally 3 times daily.

F. Other issues

  • All cases must be properly documented.
  • The patient and families should be trained to prevent future incidents 
  • The patient might be given a medic alert bracelet 

Some patients may require Adrenaline syringes for home use.

Petite scientist with a big mission.

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Petite scientist with a big mission-Xinhua http://www.xinhuanet.com/english/20220307/f3358dd629af477e99c556351f41926a/c.html

New Study Disputes that Moderate Drinking is Associated with Lower Mortality Risk in CVD Patients

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New Study Disputes that Moderate Drinking is Associated with Lower Mortality Risk in CVD Patients https://www.medscape.co.uk/viewarticle/new-study-disputes-moderate-drinking-associated-lower-2022a1000jzq?faf=1&src=soc_tw_220307_mscpedt_news_student_alcohol

Microbiome-Based Enema Effective for Recurrent C. difficile

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A stool-based enema composed of a broad variety of microbes (RBX2660, Rebiotix/Ferring) was up to 84% effective in reducing recurrent Clostridioides difficile infection (rCDI) in a study of more than 720 adults with rCDI. Most responders had no occurrence of diarrhea for up to two years after treatment.

“Collectively, these data demonstrate that RBX2660 is consistently and sustainably effective for the reduction of rCDI in adult patients, as early as first recurrence, after receiving standard-of-care antibiotic treatment,” said investigator Lindy Bancke, PharmD, the head of clinical development at Rebiotix, presenting the data at ID Week 2021.

Dr. Bancke’s analysis included data from five prospective studies of the treatment in patients with rCDI (abstract #167). One ongoing study includes patients with rCDI and underlying inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and immunocompromised status—individuals “that are more typical of standard rCDI clinical practice,” she noted.

Three of the studies were open-label while two were randomized and placebo-controlled, with a subsequent open-label phase for patients who did not respond to initial treatment and were provided with a second course of the treatment. The duration of follow-up was 24 months in two studies and six months in three studies. A total of 723 patients with rCDI were evaluable for efficacy and included in the analysis presented by Dr. Bancke.

image

She reported that 50% to 73% of study participants were successfully treated with one dose, compared with 43% to 58% of placebo recipients. Treatment success was defined as an absence of rCDI diarrhea through eight weeks after treatment.

Between 50% and 79% of those who did not respond to an initial dose of the agent achieved treatment success after a second dose, leading to overall treatment success rates of 75% to 84%, Dr. Bancke reported.

Between 82% and 92% of treatment responders remained free of CDI through six months after treatment in the phase 3 program, with “similar rates observed in the phase 2 program out to 24 months,” Dr. Bancke said.

“Additionally, our analyses indicated a consistent safety and efficacy profile for RBX2660 across the expanded populations of patients with IBD, IBS and immunocompromised status,” Dr. Bancke said.

The efficacy of RBX2660 is impressive and falls in line with that of fecal microbiota transplantation (FMT) in rCDI patients, noted Elizabeth Hohmann, MD, an infectious disease physician and the director of Massachusetts General Hospital’s FMT Core laboratory, in Boston, who was not involved the study.

Dr. Hohmann said she administers stool-based, in-house formulated oral capsules to treat her patients with rCDI; although such treatment is effective in most patients, she said a standardized product such as RBX2660 would be preferred.

“There have been some reports of serious adverse effects using stool that has not been properly screened for pathogens, so we need something that is reliably safe, and I look forward to the FDA’s approval of such a treatment,” she said.

Dr. Hohmann noted that infectious disease physicians might find it challenging to administer an enema because “we’re used to prescribing pills, but I hope gastroenterologists would be able to deliver this product.”

STUDY: Covid face masks contain dangerous levels of titanium dioxide that are easily inhaled

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Image: STUDY: Covid face masks contain dangerous levels of titanium dioxide that are easily inhaled

 New research published in the Nature journal Scientific Reports reveals that Wuhan coronavirus (Covid-19) “face masks” are loaded with toxic levels of titanium dioxide (TiO2) that “systematically [exceed] the acceptable exposure level” of what is considered “safe.”

A suspected human carcinogen, TiO2, when inhaled as fiber-grade nanoparticles, is not good for human health. And yet this is the kind of TiO2 that is abundantly present in your standard Fauci Flu nose-and-mouth veil.

“STEM-EDX analysis on sections of a variety of single use and reusable face masks visualised agglomerated near-spherical TiO2 particles in non-woven fabrics, polyester, polyamide and bi-component fibers,” the study found.

“Median sizes of constituent particles ranged from 89 to 184 nm, implying an important fraction of nano-sized particles (<?100 nm). The total TiO2 mass determined by ICP-OES ranged from 791 to 152,345 µg per mask.”

The “acceptable” level of TiO2 for inhalation is 3.6 µg. All of the face masks tested, however, contained far, far more than this, averaging between 17 to 4394 µg depending on the brand. (Related: Face masks also deprive a person of oxygen, which is especially harmful in developing children.)

Separate study found that face masks are loaded with heavy metals, plastics

An earlier study published in the journal Water Research found that Fauci face masks also contain other toxins such as lead, cadmium, mercury and all sorts of plastics.

“The toxicity of some of the chemicals found and the postulated risks of the rest of the present particles and molecules, raises the question of whether [disposable face masks] are safe to be used on a daily basis and what consequences are to be expected after their disposal into the environment,” that study reads.

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Sadly, the Nature study included an obligatory genuflection at the end subscribing to the notion that wearing a face mask is still important and beneficial, despite the presence of toxic substances.

The paper claims that the “science” behind wearing a face mask is “unquestionable,” even if breathing in all the poisons it contains damages your health.

In the comment section at the Daily Sceptic, someone explained that in order for the Nature study to even get published in the first place, the researchers had to include the caveat that wearing a face mask is still necessary despite the risks.

“However, it makes no difference to the outcome if the authors are paying lip-service or believe what they say: another scientific myth is perpetuated,” this same person added.

“It’s not only if you want to get published,” wrote someone else. “We are now in a world where many things are unquestionable – if you want to keep your job, your house and your freedom.”

Another quoted scientist Richard Feynman who said that “it isn’t the questions that cannot be answered that bother me; it is the answers that cannot be questioned.”

It should also be noted that the Nature journal has a reputation for pushing censorship and political correctness, so it is no surprise that the mask study was crafted the way it was.

“Nothing is ‘unquestionable’ in science, other than the basic axioms in mathematics and logic,” pointed out another person. “Newton’s laws are pretty good and for hundreds of years most people thought they were 100% true in all circumstances but it turns out they were not.”

Many others agreed with these sentiments, with one also suggesting that the communitarian idea of wearing a mask for the “greater good,” even if it harms you personally – the same is true about the “vaccines” – makes it a necessity.

“Chopping up one healthy person for parts can save many lives!” joked someone else.

More related news can be found at ChemicalViolence.com.

Sources for this article include:

DailySceptic.org

NaturalNews.com

Bombshell study: Pfizer’s covid jab contents enter the liver, alter human chromosomes and rewrite DNA

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Image: Bombshell study: Pfizer’s covid jab contents enter the liver, alter human chromosomes and rewrite DNA

(Natural News) Swedish researchers from Lund University have found that the contents of Pfizer’s Wuhan coronavirus (Covid-19) “vaccine” enter human liver cells and convert into DNA.

When the jab’s messenger RNA (mRNA) spike proteins are injected into the body, they travel to the liver and trigger DNA located inside the nuclei of liver cells. This increases the expression of the LINE-1 gene that makes mRNA.

After this is complete, the mRNA leaves the nuclei and enters the cytoplasm of cells, translating into LINE-1 protein. A segment of this protein called the open reading frame-1 or ORF-1 then goes back into the nuclei of liver cells where it attaches to the jab’s mRNA and reverse transcribes it into spike DNA.

Reverse transcription is when DNA is made from RNA, by the way. The normal transcription process, on the other hand, involves a portion of the DNA serving as a template to make an mRNA molecule inside the nuclei.

“In this study we present evidence that COVID-19 mRNA vaccine BNT162b2 is able to enter the human liver cell line Huh7 in vitro,” the researchers wrote in a paper that was published in the journal Current Issues of Molecular Biology.

“BNT162b2 mRNA is reverse transcribed intracellularly into DNA as fast as 6 [hours] after BNT162b2 exposure,” they added, BNT162b2 being another name for the Pfizer-BioNTech injection the two companies are calling a “vaccine” – another name for the jab is Comirnaty.

CDC lied about mRNA shots, claimed they would never enter cell nuclei

The entire process described above occurs in just six hours. The Pfizer-BioNTech mRNA injection converts into artificial DNA during this time, which contradicts what the U.S. Centers for Disease Control and Prevention (CDC) has long said about how the jabs supposedly work.

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“The genetic material delivered by mRNA vaccines never enters the nucleus of your cells,” still reads the CDC’s web page entitled, “Myths and Facts about COVID-19 Vaccines.”

This is the first time, by the way, that researchers have shown either in vitro or in a petri dish how mRNA injections convert into DNA on a human liver cell line. Again, the “experts” and “fact checkers” continue to falsely claim that this is not possible.

“COVID-19 vaccines do not change or interact with your DNA in any way,” the CDC still claims about both the mRNA injections and the viral vector alternatives from Johnson & Johnson (J&J) and AstraZeneca.

Ever since the shots were launched by Donald Trump under Operation Warp Speed, the “authorities” have insisted that the contents of the shots are quickly discarded by the body once antibodies are produced, which is a lie.

“These vaccines deliver genetic material that instructs cells to begin making spike proteins found on the surface of SARS-CoV-2 that causes COVID-19 to produce an immune response,” reports The Epoch Times.

A Pfizer spokesperson responded to the new study’s revelations by claiming falsely that its mRNA injection “does not alter the DNA sequence of a human cell.”

“It only presents the body with the instructions to build immunity,” this person still claims.

Another thing the Swedish study revealed is that mRNA spike proteins on the surface of liver cells could cause autoimmune hepatitis.

“[T]here [have] been case reports on individuals who developed autoimmune hepatitis after BNT162b2 vaccination,” the study authors wrote.

They also presented the first reported case of a healthy 35-year-old female who developed autoimmune hepatitis one week after her first “dose” of Pfizer’s mRNA injection.

There is a possibility, the authors further wrote, that “spike-directed antibodies induced by vaccination may also trigger autoimmune conditions in predisposed individuals.”

The latest news about Pfizer’s mRNA injection can be found at ChemicalViolence.com.

Sources for this article include:

TheEpochTimes.com

NaturalNews.com