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  • ISSN: 2333-7079
    Early Online
    Volume 6, Issue 4
    Review Article
    Kelly Michienzi, Ramiro Mireles, Carrie Wanamaker, James Zemer*, Paul Creighton, and Christopher Heard
    Purpose: Intranasal medications have become increasingly used for moderate sedation. Intranasal sedation can facilitate procedures without intravenous line access or general anesthesia.
    Methods: Pediatric patients age four to seven years old requiring moderate sedation for dental procedures were randomized to intranasal sufentanil and intranasal dexmedetomidine combination (DEX/SUF) or oral midazolam (MID). Treatment was blinded to the dentist and nurse evaluator. Efficacy outcomes included mean room noise level, Ohio State Behavior Rating Score (OSBRS) and University of Michigan Sedation Score (UMSS). Safety outcomes included pain assessment during treatment administration, oxygen desaturation, bradycardia, hypertension, nausea and olfactory function.
    Results: Twenty-one patients were randomized. Baseline characteristics, median procedure times, discharge times, and pain on treatment administration did not vary. Mean room noise levels were significantly reduced in the DEX/SUF group as was median percent of time room noise level was over 80dB. DEX/SUF (n=10) behavior scores were significantly better than the MID group (n=11). UMSS values were greater in the DEX/SUF group during and post-procedure. Hemoglobin desaturation occurred more frequently with DEX/SUF. Hypertension or tachycardia occurred in five MID patients.
    Conclusions: Intranasal dexmedetomidine / sufentanil combination provides greater sedation than oral midazolam, with potential over-sedation. Studies with greater patient enrollment are warranted.
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    • Klaus W. Lange*
      Attention deficit/hyperactivity disorder (ADHD) is a frequent diagnosis in children and adolescents and is also diagnosed in adults. The ADHD core symptoms of inattention, hyperactivity and impulsivity frequently cause significant impairments in behavioral, social and academic functioning in children, adolescents and adults. The goals in ADHD therapy should consider the chronicity and long-term impact of the disorder. This review provides an overview of the current debate regarding benefits and harms of methylphenidate in ADHD. Short-term benefits of pharmacotherapy, including the use of psychostimulants such as methylphenidate, have consistently been demonstrated in many studies. However, the recommendation of methylphenidate as first-line treatment for children and adolescents with ADHD has been questioned on the basis of two recent Cochrane reviews, which have raised questions concerning the overall quality of the available methylphenidate trials. The extent of the efficacy of methylphenidate in the treatment of ADHD remains a matter of debate in view of low quality of outcome measures and of possible bias of research studies. Extended use of stimulant medication has been shown to offer no benefits in regard to reduction of symptom severity but to be associated with suppression of adult height. Other adverse effects of methylphenidate may include serious cardiovascular events. The findings of trials assessing efficacy and safety of methylphenidate over short time periods need to be interpreted with caution and cannot be extrapolated to long-term effects. The long-term administration of methylphenidate for ADHD has not been shown to have proven efficacy and may be associated with various adverse effects. Scant research has adequately evaluated the long-term safety of methylphenidate, especially in elderly adults. Given the limited or absent long-term benefits of methylphenidate, the therapeutic value of this compound may be outweighed by its adverse effects. In clinical practice, careful weighting of risks and benefits of methylphenidate is important.
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      • Case Series
        Ignacio Sandia S*, Jorge Ramirez V, Javier Pinero A, and Trino Baptista T
        We here report a series of six patients who were admitted at a hospital's emergency room because of voluntary or involuntary intoxication with non-pharmaceutical scopolamine preparations known as '"Devil's Breath. Physostigmine, the antidote of choice in such cases, was not available at that institution. In four of these cases, psychotic symptoms did not improve after four days of treatment with appropriate doses of atypical antipsychotics (risperidone, olanzapine or quetiapine). The antipsychotic medication was then suspended in each case, and a transdermal patch of 10 cm2 of rivastigmine (equivalent to 9.5 mg of the drug) was indicated as monotherapy. The remaining two subjects did not receive any antipsychotic treatment but were administered rivastigmine immediately upon their arrival at the emergency room. Mental status was assessed with the Brief Psychiatric Rating Scale (BPRS) at baseline and on the third and fifth day. The BPRS scores significantly decreased when assessed on days 3 and 5 (p = 0.012). We argue that rivastigmine was pivotal in the fast and efficient resolution of these cases of intoxication with non-pharmaceutical scopolamine preparations.
        Letter to the Editor
        Olalla Martinez-Macias*, Vicente Palop-Larrea, Miguel Murcia-Soler, Virginia Perez-Donate
        For some time, different institutions in countries such as France, the United Kingdom or the United States have published alerts reminding of the precautions that apply to the use of nitrofurantoinan antimicrobial commonly used for the treatment of urinary infections.
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        • Research Article
          Marina Tusup, Lars E French, Emmanuella Guenova, Thomas Kundig, and Steve Pascolo*
          The transient expression of a protein in vitro or in vivo can be obtained by transfection of the in vitro transcribed messenger RNA (ivt mRNA). Delivery of ivt mRNA for therapies is typically based on liposomal formulations. The trapping and possible metabolic degradation of the liposomes payload within acidic/digestive compartments can limit the efficacy of this transfection method. By raising the pH in acidic vesicles, chloroquine inhibits endosome and lysosome activities. Thus, we tested whether chloroquine can enhance the expression of ivt mRNA delivered by lipofection. Using luciferase coding ivt mRNA, we found that at an optimal dose and schedule, chloroquine could increase the amount of protein produced from ivt mRNA formulated in liposomes. This method could be used as a generic way to potentiate the efficacy of therapeutic ivt mRNA formulations in development.
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