Chemotherapy-Associated nausea and vomiting: A cross-sectional survey of occurrence and management patterns at jos university teaching hospital, Nigeria.

Background: The management patterns for chemotherapy-associated nausea and vomiting (CANV) in Sub-Saharan African settings have not been previously reported. The objectives of this study were to describe the prescribing pattern of antiemetics for CANV, to assess their adherence to guidelines, and to determine the occurrence of CANV. Subjects and Methods: This was a cross-sectional study, with data extracted from the records of adult patients who received chemotherapy from 2015 to 2018 at Jos University Teaching Hospital, Nigeria. The National Comprehensive Cancer Network Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis Version 3.2018 was used to determine the extent of guideline adherence. Results: Records of 165 patients were analyzed. Majority of the patients (76.4%, n = 126) received moderate-to-high emetic risk intravenous (IV) chemotherapy. Out of 129 antiemetic prescriptions for acute-phase prophylaxis, ondansetron (75.2%), corticosteroids (61.2%), and promethazine (24.8%) were the most prescribed agents. In the delayed phase, 50 patients received prophylactic antiemetics in the order of corticosteroids, ondansetron, and promethazine at 74%, 34%, and 26%, respectively. Guideline adherence was low for the acute-phase (23.6%), delayed-phase (20.6%), and overall period (17.6%). Among inpatients (n = 85), occurrences of nausea were negligible, whereas acute vomiting (9%) and delayed vomiting (15%) levels were considerable. Not receiving highly emetogenic IV chemotherapy was associated with significantly lower odds for nausea or vomiting occurrence, odds ratio 0.228 (95% confidence interval 0.054-0.967). Conclusions: Antiemetic guideline adherence was low due to antiemetic under-prescribing. A few nausea and vomiting events were recorded predominantly among patients who received highly emetogenic IV chemotherapy.

RésuméContexte: Les schémas de prise en charge des nausées et vomissements associés à la chimiothérapie (CANV) en Afrique subsaharienne n'ont pas Été signalée précédemment. Les objectifs de cette étude étaient de décrire le schéma de prescription des antiémétiques pour le CANV, d'évaluer leur adhésion Aux lignes directrices et pour déterminer l'occurrence du CANV. Subjets et méthodes: Il s'agissait d'une étude transversale, avec des données extraites de Les dossiers des patients adultes ayant reçu une chimiothérapie de 2015 à 2018 à l'hôpital universitaire de Jos, au Nigéria. Le global national Cancer Network Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis Version 3.2018 a été utilisé pour déterminer l'étendue de la directive Adhérence. Résultats: Les dossiers de 165 patients ont été analysés. La majorité des patients (76,4 %, n = 126) ont présenté un risque émétique modéré à élevé Chimiothérapie intraveineuse (IV). Sur 129 prescriptions d'antiémétiques en prophylaxie de phase aiguë, ondansétron (75,2 %), corticoïdes (61,2 %), Et la prométhazine (24,8 %) étaient les agents les plus prescrits. Dans la phase retardée, 50 patients ont reçu des antiémétiques prophylactiques de l'ordre de Corticostéroïdes, ondansétron et prométhazine à 74 %, 34 % et 26 %, respectivement. Le respect des lignes directrices était faible pour la phase aiguë (23,6 %), Phase retardée (20,6 %) et période globale (17,6 %). Parmi les patients hospitalisés (n = 85), les occurrences de nausées étaient négligeables, alors que Les taux de vomissements (9 %) et de vomissements retardés (15 %) étaient considérables. Le fait de ne pas recevoir de chimiothérapie IV hautement émétisante était associé àProbabilités significativement plus faibles de survenue de nausées ou de vomissements, rapport de cotes 0,228 (intervalle de confiance à 95 % 0,054-0,967). Conclusions : Antiémétique Le respect des lignes directrices était faible en raison de la sous-prescription des antiémétiques. Quelques nausées et vomissements ont été enregistrés principalement chez les Patients ayant reçu une chimiothérapie IV hautement émétisante. Mots-clés: Antiémétique, chimiothérapie, nausées, Nigéria, vomissements.

Paracervical blocks facilitate timely brachytherapy amidst COVID-19.

PURPOSE: The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer, the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of locally advanced cervical cancer in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based intracavitary brachytherapy (ICBT). METHODS AND MATERIALS: This technical report will highlight our experience with the use of paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment. RESULTS: 18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCBs and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D2cc for rectum and bladder were 64.8 (58.6-70.2) Gy and 84.1 (70.9-89.4) Gy, respectively. Median (IQR) CTV high-risk D90 was 88.0 (85.6-89.8) Gy. CONCLUSIONS: In a multidisciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.

Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea.

BACKGROUND: Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse. AIMS: To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments. METHODS: Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression. RESULTS: One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI. CONCLUSIONS: When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.

Antifungal activity of promethazine and chlorpromazine against planktonic cells and biofilms of Cryptococcus neoformans/Cryptococcus gattii complex species.

Cryptococcus neoformans/Cryptococcus gattii are fungal pathogens that affect the central nervous system, mainly in immunocompromised individuals. Due to the limited pharmacological arsenal available for the treatment of cryptococcosis associated with cases of antifungal resistance of Cryptococcus spp. reported in some studies, the search for new compounds with antifungal potential becomes relevant. Thus, the objective of this study was to evaluate the inhibitory effect of phenothiazines (promethazine and chlorpromazine) on C. neoformans/C. gattii planktonic cells and biofilms. In vitro planktonic susceptibility testing was performed using the broth microdilution assay. The effect of phenothiazines was evaluated against biofilm formation and mature Cryptococcus biofilms. Biofilm morphology and ultrastructure were also evaluated by scanning electron microscopy. Promethazine and chlorpromazine showed antifungal activity against planktonic cells, with minimum inhibitory concentrations of 8-32 µg/ml and 4-16 µg/ml, respectively. As for biofilm formation, phenothiazines reduced biomass by 60% and metabolic activity by 90% at 64 µg/ml; while in mature biofilms, reductions of 85% and 90% in biomass and metabolic activity, respectively, were observed at 1024 µg/ml. Promethazine and chlorpromazine were also able to disrupt and fragment biofilms. In conclusion, promethazine and chlorpromazine have antifungal activity against planktonic cells and biofilms of Cryptococcus spp. These data show the potential of promethazine and chlorpromazine as antibiofilm drugs.

Sea State Green.

The series objective is to review various clinical conditions/ presentations, including the latest evidence on management, and to dispel common myths. In the process, core knowledge and management principles are enhanced. A clinical case will be presented. Cases will be drawn from real life but phrased in a context that is applicable to the Special Operations Forces (SOF) or tactical emergency medical support (TEMS) environment. Details will be presented in such a way that the reader can follow along and identify how they would manage the case clinically depending on their experience and environment situation. Commentary will be provided by currently serving military medical technicians. The medics and author will draw on their SOF experience to communicate relevant clinical concepts pertinent to different operational environments including SOF and TEMS. Commentary and input from active special op.

Interventions for treating hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy affecting 0.3% to 1.0% of pregnancies, and is one of the most common indications for hospitalization during pregnancy. While a previous Cochrane review examined interventions for nausea and vomiting in pregnancy, there has not yet been a review examining the interventions for the more severe condition of hyperemesis gravidarum. OBJECTIVES: To assess the effectiveness and safety, of all interventions for hyperemesis gravidarum in pregnancy up to 20 weeks' gestation. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and the Cochrane Complementary Medicine Field's Trials Register (20 December 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials of any intervention for hyperemesis gravidarum. Quasi-randomized trials and trials using a cross-over design were not eligible for inclusion.We excluded trials on nausea and vomiting of pregnancy that were not specifically studying the more severe condition of hyperemesis gravidarum. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed the eligibility of trials, extracted data and evaluated the risk of bias. Data were checked for accuracy. MAIN RESULTS: Twenty-five trials (involving 2052 women) met the inclusion criteria but the majority of 18 different comparisons described in the review include data from single studies with small numbers of participants. The comparisons covered a range of interventions including acupressure/acupuncture, outpatient care, intravenous fluids, and various pharmaceutical interventions. The methodological quality of included studies was mixed. For selected important comparisons and outcomes, we graded the quality of the evidence and created 'Summary of findings' tables. For most outcomes the evidence was graded as low or very low quality mainly due to the imprecision of effect estimates. Comparisons included in the 'Summary of findings' tables are described below, the remaining comparisons are described in detail in the main text.No primary outcome data were available when acupuncture was compared with placebo, There was no clear evidence of differences between groups for anxiodepressive symptoms (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.73 to 1.40; one study, 36 women, very low-quality evidence), spontaneous abortion (RR 0.48, 95% CI 0.05 to 5.03; one study, 57 women, low-quality evidence), preterm birth (RR 0.12, 95% CI 0.01 to 2.26; one study, 36 women, low-quality evidence), or perinatal death (RR 0.57, 95% CI 0.04 to 8.30; one study, 36 women, low-quality evidence).There was insufficient evidence to identify clear differences between acupuncture and metoclopramide in a study with 81 participants regarding reduction/cessation in nausea or vomiting (RR 1.40, 95% CI 0.79 to 2.49 and RR 1.51, 95% CI 0.92 to 2.48, respectively; very low-quality evidence).In a study with 92 participants, women taking vitamin B6 had a slightly longer hospital stay compared with placebo (mean difference (MD) 0.80 days, 95% CI 0.08 to 1.52, moderate-quality evidence). There was insufficient evidence to demonstrate a difference in other outcomes including mean number of episodes of emesis (MD 0.50, 95% CI -0.40 to 1.40, low-quality evidence) or side effects.A comparison between metoclopramide and ondansetron identified no clear difference in the severity of nausea or vomiting (MD 1.70, 95% CI -0.15 to 3.55, and MD -0.10, 95% CI -1.63 to 1.43; one study, 83 women, respectively, very low-quality evidence). However, more women taking metoclopramide complained of drowsiness and dry mouth (RR 2.40, 95% CI 1.23 to 4.69, and RR 2.38, 95% CI 1.10 to 5.11, respectively; moderate-quality evidence). There were no clear differences between groups for other side effects.In a single study with 146 participants comparing metoclopramide with promethazine, more women taking promethazine reported drowsiness, dizziness, and dystonia (RR 0.70, 95% CI 0.56 to 0.87, RR 0.48, 95% CI 0.34 to 0.69, and RR 0.31, 95% CI 0.11 to 0.90, respectively, moderate-quality evidence). There were no clear differences between groups for other important outcomes including quality of life and other side effects.In a single trial with 30 women, those receiving ondansetron had no difference in duration of hospital admission compared to those receiving promethazine (MD 0.00, 95% CI -1.39 to 1.39, very low-quality evidence), although there was increased sedation with promethazine (RR 0.06, 95% CI 0.00 to 0.94, low-quality evidence) .Regarding corticosteroids, in a study with 110 participants there was no difference in days of hospital admission compared to placebo (MD -0.30, 95% CI -0.70 to 0.10; very low-quality evidence), but there was a decreased readmission rate (RR 0.69, 95% CI 0.50 to 0.94; four studies, 269 women). For other important outcomes including pregnancy complications, spontaneous abortion, stillbirth and congenital abnormalities, there was insufficient evidence to identify differences between groups (very low-quality evidence for all outcomes). In other single studies there were no clear differences between groups for preterm birth or side effects (very low-quality evidence).For hydrocortisone compared with metoclopramide, no data were available for primary outcomes and there was no difference in the readmission rate (RR 0.08, 95% CI 0.00 to 1.28;one study, 40 women).In a study with 80 women, compared to promethazine, those receiving prednisolone had increased nausea at 48 hours (RR 2.00, 95% CI 1.08 to 3.72; low-quality evidence), but not at 17 days (RR 0.81, 95% CI 0.58 to 1.15, very low-quality evidence). There was no clear difference in the number of episodes of emesis or subjective improvement in nausea/vomiting. There was insufficient evidence to identify differences between groups for stillbirth and neonatal death and preterm birth. AUTHORS' CONCLUSIONS: On the basis of this review, there is little high-quality and consistent evidence supporting any one intervention, which should be taken into account when making management decisions. There was also very limited reporting on the economic impact of hyperemesis gravidarum and the impact that interventions may have.The limitations in interpreting the results of the included studies highlights the importance of consistency in the definition of hyperemesis gravidarum, the use of validated outcome measures, and the need for larger placebo-controlled trials.

Pink urine.

A 55-year-old man was admitted after a suspected hypnotic overdose of valerian extracts. In addition to altered consciousness, the first clinical symptoms included not only diffuse rash on the face, trunk, and limbs, but also an inspiratory dyspnea with a marked hypoxemia. A major laryngeal edema was noted during orotracheal intubation. After correction of hypoxemia, the patient became agitated and propofol was administered by continuous infusion. In addition, the patient passed pink urine staining the urine collection bag. The presence of an unidentified toxic substance was suspected.

Common variants in TGFBR2 and miR-518 genes are associated with hypertension in the Chinese population.

BACKGROUND: An animal study reported that TGF-ß1 maturation was linked to the homeostasis of blood pressure and elastogenesis of essential hypertension (EH). Recent advances require further research of TGF-ß1 receptor in EH. METHODS: A case-control study comprised of 2,012 adult hypertension case patients and 2,210 adult control subjects was conducted, and the association with blood pressure was further tested in children. Logistic regression and calculated genetic risk score were used to evaluate the effects of one single nucleotide polymorphism (SNP) and multiple SNPs on EH, respectively. RESULTS: The genetic risk score of 10 SNPs showed a significant association with hypertension; the odds ratio of the upper quartile vs. the lower quartile was 1.282 (P = 4.67 × 10(-3)). rs7256241 in miR-518 was significantly associated with diastolic blood pressure (DBP) change in control subjects (P = 0.002), and this association was also observed in children (P = 0.04). The systolic blood pressure (SBP) and DBP of female patients taking reserpine were higher with the C and G alleles of rs3773661 (P = 0.004) and rs7256241 (P = 0.002), respectively. In patients taking Zhen Ju Jiang Ya tablets, SBP and DBP decreased linearly with rs749794 (P = 0.004 and P = 0.048, respectively). SBP decreased linearly with rs1155705 (P = 0.007) and rs11709624 (P = 0.04), but increased with rs1036096 (P = 0.03) in male patients. In male patients taking Jiang Ya tablets, SBP increased linearly with rs11709624 (P = 0.007), DBP increased linearly with rs1155705 (P = 0.03) whereas decreased with rs7256241 (P = 0.04). CONCLUSIONS: Our results suggest that TGFBR2 and miR-518 harbor variants that increase the risk of EH and affect blood pressure homeostasis as well as efficacy of antihypertensive agents.

Percutaneous nephrolithotomy under local infiltration anesthesia: a single-center experience of 2000 Chinese cases.

OBJECTIVE: To determine the feasibility and safety of percutaneous nephrolithotomy (PCNL) in treating upper urinary calculi under local infiltration anesthesia. METHODS: A series of 2000 patients with upper urinary calculi underwent PCNL under local infiltration anesthesia. Of the 2000 patients, 536 had upper ureteral calculi, 805 patients had pelvic calculi, and 659 patients had complex renal calculi. Pethidine premedication (75-100 mg) and Phenergan (25 mg) were used half an hour preoperatively. The mean pain scores at 0, 6, 24, and 48 hours postoperatively, the demographic characteristics, and the stones characteristics were evaluated to determine the feasibility. The complications were evaluated to determine the safety, and stone-free rate was evaluated to determine effectivity. RESULTS: The mean American Society of Anesthesiologists score was 1.55 ± 0.54 (range, 1-3). The mean operative time was 48 minutes (range, 20-125). The mean Visual Analogue Scale scores at 0, 6, 24, and 48 hours postoperatively were 3.62, 3.02, 2.27, and 2.09, respectively. The mean hemoglobin drop was 1.06 g/dL (range, 0.2-6.8). Sixty-five patients (3.3%) received transfusions, 10 patients (0.5%) required selective renal angioembolism (Clavien grade II), and 1 patient (0.05%) received chest drainage therapy (Clavien grade II). The total stone-free rate was 85.8%. CONCLUSION: Local infiltration anesthesia is a well-tolerated alternative anesthesia technique that provides effective intraoperative and postoperative analgesia for PCNL. PCNL performed under local infiltration anesthesia in a selected group of patients is feasible and provides satisfactory clinical outcomes. Comparative studies should be performed to classify efficacy, safety, tract quantity, dilation method, and the best candidates.

Antiemetic efficacy of promethazine on xylazine-induced emesis in cats.

The prophylactic antiemetic effect of 3 dosages of promethazine injected into cats 1 h before administration of xylazine was compared with that of a saline solution. Prior treatment with 2 and 4 mg/kg of promethazine significantly reduced the frequency of emetic episodes. Promethazine may be used as a prophylactic antiemetic in cats treated with xylazine.

Airsickness prevention in helicopter passengers.

INTRODUCTION: Despite many existing treatments, airsickness is an issue of concern for soldiers being transported by helicopter. This experiment examined the efficacy of four airsickness treatments and their effects on performance. This study replicated the transport of soldiers in the cabin of an UH-60 Black Hawk helicopter performing many of the flight maneuvers potentially experienced in a night troop transport during turbulent conditions. METHODS: A double-blinded, placebo-controlled design was used to compare the effectiveness of four airsickness countermeasures to their placebo controls. There were 64 male, non-aviator subjects (ages 18-34 yr) who were recruited for the study. Of these, 16 subjects were randomly assigned to each of 4 groups: (1) promethazine (25 mg) + caffeine (200 mg); (2) meclizine (25 mg); (3) Scopolamine patch (1.5 mg); and 4) acustimulation wristband. Each individual participated twice, once with the treatment and once with placebo. RESULTS: The findings indicated that only the combination of promethazine + caffeine showed a statistically significant reduction in nausea and motion sickness severity, and an improvement in reaction time when compared with its placebo control. DISCUSSION: Data from this study indicated that of the countermeasures tested, promethazine + caffeine was the most effective at reducing airsickness while producing the fewest side effects when compared with its placebo. In addition, this study demonstrated that over-the-counter caffeine can serve as an effective stimulant counterpart to promethazine. This may be a more appealing option than employing scheduled sympathomimetic drugs in a combat environment.

Preinsertion local anesthesia at the trocar site improves perioperative pain and decreases costs of laparoscopic cholecystectomy.

BACKGROUND: Local anesthesia at the trocar site in laparoscopic cholecystectomy is expected to decrease postoperative pain and hence expedite recovery. The aims of this prospective randomized study were to investigate the effect of local anesthesia and to discover whether it is cost effective. METHODS: For this study, 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. The 43 study patients were injected with 0.5% bupivacaine hydrochloride at the trocar site before the trocars were inserted. They then were compared with 41 control patients who received no local anesthesia. The remaining 16 patients were excluded from the study. The postoperative pain was evaluated at the standard four trocar sites at 4 h and 24 h after surgery on a scale 1 (the mildest pain the patient had ever experienced) to 10 (the most severe pain the patient had ever experienced). Postoperative pain medications and their cost were evaluated. RESULTS: There was no difference between the two groups with regard to gender, age, weight, operative time, estimated operative blood loss, and bile culture. The patients who received bupivacaine at the trocar site clinically had less pain (p < 0.001 for all four sites) both at 4 and 24 h after surgery. The treatment group patients used less mepiridine and promethzine than the control group (p = 0.001 and 0.002, respectively) postoperatively. Overall, the patients who had local anesthesia used less postoperative pain and antiemetic medication than the control patients (p = 0.02). This afforded a significant decrease in the costs and charges of these medications (p = 0.004 and 0.005, respectively). Three patients in the study group were discharged from the hospital the day of surgery. CONCLUSION: Preinsertion of local anesthesia at the trocar site in laparoscopic cholecystectomy significantly reduces postoperative pain and decreases medication usage costs.

Autogenic-feedback training exercise is superior to promethazine for control of motion sickness symptoms.

Motion sickness symptoms affect approximately 50% of the crew during space travel and are commonly treated with intramuscular injections of promethazine. The purpose of this paper is to compare the effectiveness of three treatments for motion sickness: intramuscular injections (i.m.) of promethazine, a physiological training method (autogenic-feedback training exercise [AFTE]), and a no-treatment control. An earlier study tested the effects of promethazine on cognitive and psychomotor performance and motion sickness tolerance in a rotating chair. For the present paper, motion sickness tolerance, symptom reports, and physiological responses of these subjects were compared to matched subjects selected from an existing database who received either AFTE or no treatment. Three groups of 11 men, between the ages of 33 and 40 years, were matched on the number of rotations tolerated during their initial rotating-chair motion sickness test. The motion sickness test procedures and the 7-day interval between tests were the same for all subjects. The drug group was tested under four treatment conditions: baseline (no injections), a 25 mg dose of promethazine, a 50 mg dose of promethazine, and a placebo of sterile saline. AFTE subjects were given four 30-minute AFTE sessions before their second, third, and fourth motion sickness tests (6 hours total). The no-treatment control subjects were only given the four rotating-chair tests. Motion sickness tolerance was significantly increased after 4 hours of AFTE when compared to either 25 mg (p < 0.00003) or 50 mg (p < 0.00001) of promethazine. The control and promethazine groups did not differ. AFTE subjects reported fewer or no symptoms at higher rotational velocities than subjects in the control or promethazine groups. The primary physiological effect of promethazine was an inhibition of skin conductance level. The AFTE group showed significantly less heart rate and skin conductance variability during motion sickness tests administered after training.

A year's experience of Irukandji envenomation in far north Queensland.

Envenomation by the Irukandji jellyfish (Carukia barnesi) can result in an array of systemic symptoms known as Irukandji syndrome. In 1996, 62 people presented to Cairns emergency departments with Irukandji envenomation: 57 developed systemic symptoms, and 38 required parenteral narcotics. All patients were discharged home within 24.5 hours, except for two who required high-dependence care for pulmonary oedema. Patients were more likely to be stung on hotter days, with lower-than-average rainfall in the past seven days, and with winds from the north, but less-than-average wind speed. We offer a protocol for treating patients with Irukandji envenomation.

Cognitive-behavioral management of motion sickness.

This monograph is intended to provide health professionals with information on a cognitive-behavioral technique which was developed to teach individuals who are prone to motion sickness to better cope with motion environments. It includes an overview of motion sickness, describing the signs and symptoms, etiology and incidence of this malady. Prevention and treatment are then reviewed, including both pharmacological and non-pharmacological therapies. The historical background on the cognitive-behavioral technique is then discussed. This is followed by a review of supporting experimental work, and an account of how such counselling should be carried out. Finally, a number of current military desensitization programs are compared and contrasted with cognitive-behavioral therapy.

Comparison of efficacy of ginger with various antimotion sickness drugs.

UNLABELLED: Ginger and several other medications were compared with scopolamine and d-amphetamine for effectiveness in prevention of motion sickness. METHODS: Double-blind techniques were used. The subjects were given the medications two hours before they were rotated in a chair making head movements until a symptom total short of vomiting was reached. Standardized N.A.S.A. techniques were used for speed of rotation and end-point of motion sickness. RESULTS: The three doses of ginger were all at the placebo level of efficacy. Amitriptyline, ethopropazine and trihexyphenidyl increased the tolerated head movements but the increase was not statistically significant. Significant levels of protection were produced by dimenhydrinate, promethazine, scopolamine and d-amphetamine. Protection was further increased by combination of these latter drugs with d-amphetamine. Efficacy was greatest as the dose was increased. CONCLUSIONS: The medication of choice in this study was scopolamine 0.6 mg with d-amphetamine 10 mg. This combination provided good protection with acceptable side effects.

A therapeutic trial of caerulein to a long-term heavy marihuana user with amotivational syndrome.

A male marihuana user with amotivational syndrome who responded poorly to neuroleptic therapy was treated four times with weekly intramuscular injection of caerulein in a dose of 0.6 micrograms/kg. He was maintained on his previous neuroleptic medication during the study period. The BPRS was used to rate the patient's symptoms. There were remarkable improvements in the total scores and the psychosis subscale score, which consists of the following symptoms that do not respond well to neuroleptic therapy in chronic schizophrenia: emotional withdrawal, mannerisms and posturing, uncooperativeness, and blunted affect. These improvements persisted for two weeks after cessation of caerulein administration, after which the patient's condition gradually worsened. Nevertheless, the improvement recurred upon reinjection of caerulein. These findings indicate that the improvement observed seems to be due to caerulein, and suggest that caerulein may be a useful and effective therapeutic drug for marihuana user with amotivational syndrome.