Visit Blog
Explore Tumblr blogs with no restrictions, modern design and the best experience.
#emergency medicine
Juniper Publishers- Open Access Journal of Case Studies
Tumblr media
Kambô: A Shamanic Medicine - Personal Testimonies
Authored by Jan M Keppel Hesselink
Since the beginning of this century more and more people in Europe and USA make use of a shamanic product based on the secretion of an Amazonian frog, the Phyllomedusa bicolor. This secretion contains a great number of bio-active peptides and is administered in a ritual via a fresh burn created on the skin of forearm or leg. The desired effects are related to acute intoxication and consist amongst others of nausea and vomiting, diarrhea and swelling of the face as in Quinke’s edema. These effects occur within minutes after the inoculation with the secretion and last mostly for few hours. After this intense period people feel rejuvenated and many participants of the cleansing ritual claim long lasting positive effects for their health. We present the history and context of Kambô use and some case-studies based on personal testimonies. Clearly the increasing use of a shamanic intervention as Kambô is also an expression and a signal of the dissatisfaction of consumers with the results of Western medicine.
Keywords: Phyllomedusa bicolor; Shaman; Healing; Target; Side-effects
Phyllomedusa bicolor is an Amazonian frog and the source of Kambô. Kambô is the dried secretion from the frog’s skin, a concoction containing many bio-active peptides. These peptides have a broad range of activities related to many potential interesting indications, such as hypertension, chronic pain, anxiety, depression and endocrinology disorders. Frequently new targets are discovered. In in vitro and in vivo models for a number of disorders, many of these peptides have been found to be quite potent, much more potent than the golden standard. However, the bioavailability is not optimal, due to the peptide nature of the compounds.
During the Kambô-ritual the bioactive compounds are introduced in the bloodstream via a fresh burn; the secretion is subsequently rubbed into the wound and thus will quickly enter the blood. This induces a fast action of onset. One can recognize the past experience of a Kambo ritual based on discoloration on the skin due to the healed burns, see Figure 1.
The exact mechanism of action of many peptides is still a matter of debate, as new targets are continuously identified. It is therefore of interest to study the personal experiences of Kambô-users, in order to understand why consumers increasingly turn to this exotic shamanistic intervention.
Original use of Kambô
The early and mythological use of Kambô is suggested to be related to a shaman from the the Kaxinawa tribe in Brazil [1]. This tribe also is known for its use of the strong psychedelic tea Ayahuasca [2]. Kambô was and is used by native Indians from the tribes around the Amazon in various rites, in order to increase their hunting powers [3].
The use of Kambô as a stimulant by indigenous populations of the upper and middle Juruá river was documented in 1925 by the missionary Constantin Tastevin [4]. He is supposed to be the first author describing the ritual and the purpose of administering Kambô, which he referred to as ‘Kachinaua campon’. As his first description contains some important pointers for its current use, we quote Tastevin verbatim:
‘When an Indian becomes ill, he becomes thin, pale and swollen; when he is unlucky in hunting, it is because he has in his body a bad principle which must be expelled. At dawn, before dawn, while still fasting, for the sick and unlucky hunter, small scars are produced on the arm or belly with the tip of a burning stick, then they are vaccinated with the “milk” of frog, as they say. Soon violent nausea and diarrhea starts; the bad principle leaves its body by all the exits. As a result, the patient returns from being big and fat and recovers its colors and finds more hunting than he can bring back. No animal escapes from his sharp sight, his ear perceives the smallest noises, and his weapon does not miss its mark [4].
In this first description, the most frequent side effects of Kambô are described: nausea, vomiting, diarrhea, and edema forming as in Quicke’s edema. The vomiting and diarrhea are supposed to cleanse the body and the ‘bad principle’ thus leaves the body and a more vigorous state appears.
In a recent ethnography (2008) the authors describe the diffusion of the use and knowledge of Kampo, due to the members of the Katukina tribe. It is based on their discourse that the use of the secretion as perceived as an ‘indigenous remedy’, and a very special remedy as it is that the substance is used ‘traditionally’ both to eliminate ‘bad luck’, ‘panema’ (negative energy), and ‘weakness and lack in harmony with nature’ [5].
In some recent sources in the internet Kambô is claimed to be ‘one of the strongest, anti-inflammatory, antibiotic, antimicrobial and anesthetic substances on the planet’ [2].
The above context makes it understandable that Kambô is perceived as a therapy for many different disorders. Within shamanic and healing contexts Kambô is often explicitly referred to as ‘medicine’.
Katherine Milton, an anthropologist, described Kambô use among the Mayoruna tribe in Brazil in the 1980s and Peter Gorman recorded the use of Kambô within the Matse Tribe in Peru in the same period [6]. Since this century Kambô use has spread to the West, and meanwhile many people are looking for medical solutions via the use of Kambô.
Bio-Active Peptides
There are a number of different bio-active peptides in the secretion of frogs from the Phyllomedusinae subfamily, and fundamental work on these peptides has been conducted by the group of Erspamer, starting around 50 years ago in the 60s of last century [7-10]. Instead of the expected bioactive tryptamines and alkaloids, high amounts of different bio-active peptides were found, belonging to the groups of caeruleins, tachykinins, bradykinins, bombesins, sauvagine (a corticotropinreleasing- hormone-like peptide), tryptophyllins and opioid peptides such as dermorphin. These peptides extracted via methanol from the frog skin have a small molecular mass (700- 4600 Da). Dermorphin for instance was the first peptide found in high concentrations in the skin, of the Phyllomedusinae, about 50-80 ug per g of fresh skin. Dermorphin is a very potent analgesic, in vitro models centrally administered, it is 500- 1000fold more potent than morphine [11,12]. However, due to its suboptimal pharmacokinetic properties, its potency after peripheral administration is comparable to morphine. In the lay press so called scientific facts on Kambô are presented without the context outlined above, leading to absurd claims such as: ‘Dermorphin and Deltorphin are potent opioid peptides 4000 times stronger than morphine and 40 times stronger than endogenic b-endorphines [3].’
All these Kambô peptides however have indeed impressive endocrine, cardiovascular and nervous system activities [13]. Frequently new targets of these peptides are described, for instance phyllomedusin, has been shown to be quite selective for the Neurokinin 1 receptor [14]. This all creates a whole chapter of various disorders where one or more of these peptides could bring meaningful effects in the treatment of a variety of diseases. The fact that the peptides from the frog’s skin are entering the bloodstream after subdermal application (application via a fresh burn), might indicate that plasma-levels after administration could become high. This is probably also the reason why the side-effects start very soon after administration Kambô, within minutes. In how far the effects on disorders can be achieved after a limited series of repeated Kambô-rituals is still unanswered. More detailed case-stories are needed to bring more light in this matter. In this paper, we present some qualitative testimonials, serving to indicate the perceived value of the ritual on a personal
Kambô Testimonials
Many of these experiences can be found on the net [15], for the purpose of this article we selected only a few and will quote these verbatim:
a) on alcohol addiction,
b) depression,
c) chronic pain,
d) chronic pain with alcohol craving and
e) Hashimoto’s thyroiditis and celiac’s disease.
i. My first Kambô session knocked me out - literally, I passed out briefly - but it also cleansed my liver and helped me heal a long-term toxic relationship with alcohol. A month after my first Kambô session with Simon, I decided to stop drinking and did so for two years. While I knew it likely wouldn’t be a forever thing, my relationship with alcohol and other substances is forever changed, and the break that my first experience with Kambô helped me to take gave me a chance to reassess my priorities and learn better selfcontrol.
ii. I feel different. I am different. My life has synchronistically altered to reflect all that has opened and continues to evolve inside me. The emptiness I have carried for so very long is now felt as space permeated by air thick with grace and possibility. The chronic, long-standing grief has been lifted. My heart is both full and light. I simply showed up with the cautious hope that perhaps some of the weight might be left behind. Little did I know that I would be given so much more. The initial euphoria was accompanied by a vision of my life in stunning clarity with a sense of urgency and direction. The beauty of all things whispering to me that it is not too late. It is not too late to live what matters most. I remember now and have been remembered. And that is the gift and the work of it.
iii. Besides having more strength and vitality then I have had since I first became sick 5 years ago, and the pain from my back nerve injury earlier this year completely gone, there is a focus and clarity, a lightness and spaciousness, an otherworldly heightened intuition and perception, a visceral, felt sense of my soul and energy body and its expansiveness, a quietness of the mind I have only ever previously achieved through hours of meditation, and so much more. You can feel the medicine scanning your body and building up intense pressures in certain areas that need healing. Kambô has an intelligence and plan, and each day, each experience, is completely unique. On the third and final day of the 3-day course, I was filled with childlike joy; hysterically laughing, clapping my hands and feet. Somewhere along the way, I learned to stay in line, be quiet, and fit in, so I couldn’t help apologizing for my laughter, then laughing even harder at my absurdity of apologizing for being joyful.
iv. After days two and three though I did start to notice some positive changes. I have had chronic lower back, hip and neck pain for the past several years and I noticed by day two that my back pain was almost gone. By the third day I noticed my neck started popping every time I turned it and it felt like it was loosening up and I noticed I could turn it farther to the left and the right. Those were things I was hoping for but not knowing if I would get those types of results or not. Having had problems with alcohol dependency for years was one of the main reasons I went for the treatment and after all three days I didn’t have any cravings for alcohol, nor did it even sound good to me, so I was quite amazed at that and very happy. Another big thing for me was I just felt good and in a very positive mood and with more energy than I have had in a long time. Those changes have continued to this day, as I just feel good and in a good mood and enjoy being around my family and friends much more than before.
v. Six years ago, I was diagnosed with Hashimoto’s thyroiditis and celiac’s disease, both of which are autoimmune diseases. Because I fundamentally disagreed with Western medicine’s treatment of Hashimoto’s (which is to put you on thyroid replacement hormone for the rest of your life, without actually treating the autoimmune system), I had been looking for a treatment that could get at the underlying cause. After years of research, I believed that Kambô might hold the answer. After my experience with Kambô in Peru I stopped taking my Western meds, because the shaman told me I needed to be off of my prescriptions medicines for the Kambô to work. After six weeks, blood work revealed that my thyroid markers had improved, but still indicated hypothyroidism.
Adverse Events
Because things were better, but not “normal,” I decided to go again. A three-day cleanse instead of a single session. Six weeks after the three-day inoculation, my blood work was perfect. Even though I hadn’t taken any thyroid medication for over 3 months, all of my thyroid numbers were well within the normal range. Just to be sure, I did another round of blood work just six weeks later and much to my delight, the markers were even better.
We will discuss the adverse events (and transpersonal experiences) in detail in a different paper
a) Den Brave et al. [16] only reported on some scars on the shoulder of a patient [16].
b) Leban et al. [17] dealt with the emergence of a transient syndrome of inappropriate antidiuretic hormone (SIADH) secretion, due to the combination of Kambô burns, and the drinking of six liters of water after the ritual [17].
c) Pogorzelska and Łapiński [18] dealt with a patient with signs of a transient hepatitis, a chronic history of alcohol and Cannabis use, who used Kambô to maintain abstinence of drinking and smoking [18].
d) Aquila et al. [19] described a sudden death of a 42-old overweight man with signs of coronary pathology [19]. It was suggested that in this case perhaps the hypotensive effects of Kambô could have resulted in reduced myocardial perfusion, tachycardia perhaps leading to a cardiac arrhythmia and sudden death.
e) Li et al. [20] described a 24-year-old woman, brought to the emergency department, due to nausea, vomiting, flushing, facial swelling, altered mental status, and agitation 22h after a Kambô ritual [20].
f) Kumachev et al. [21] described prolonged nausea, very frequent episodes of vomiting, (circa 50), and abdominal discomfort, up to 8 hours after a Kambô [21].
g) Roy et al. [22] described a labile woman who took multiple doses of the Kambô and developed a paranoid psychosis, responding well on risperidone [22]. The causality of this case seems questionable.
These reported side effects all were transient apart from the one reported by Aquila et al. [19] and should be a warning to be extremely cautious during a Kambô ritual. It is clear such rituals should and can only be guided by quite experienced moderators, who can differentiate early on between effects which are benign and transient versus life threatening adverse events. Based on case-reports it seems that it is wise to define contra-indications, such as severe cardiovascular conditions and hypotensive syndromes such as Shy-Drager, and to recommend not to drink too much water after a ritual, in order not to provoke a SIADH syndrome. Furthermore, as Kambô seems to be used by the tribes to terminate pregnancies, one would like to exclude pregnant women.
Kambô is used increasingly by Western consumers in order to achieve positive health effects, or to cure certain disorders. This use of a shamanic intervention such as Kambô might also be perceived as an expression and a signal of the dissatisfaction of consumers with the results of Western medicine. It seems a tendency, as more and more consumers also start using healing rituals based on other natural sources, such as the psychedelic tea Ayahuasca.
An increasing number of users report positive effects on a great variety of disorders, from auto-immune disorders up to chronic pain. Kambô contains many bio-active peptides in high concentrations. It is administered into the blood stream via rubbing it in a fresh burn. The effects are immediate and last mostly only for some hours. Many consumers report positive health effects, and effects related to healing. Adverse events have been reported in literature, mostly of transient nature. However, severe reactions can occur, and it is discouraged to use Kambô without the presence of a very experienced therapist. Kambô seems a rich source for new therapies.
For more articles in Juniper Publishers | Open Access Journal of Case Studies please click on:
0 notes
doctorspork · a day ago
Did my first pediatric LP! Cannot believe how much easier it is than in adults. But still got TWO RBCs so no champagne yet :(
15 notes · View notes
Juniper Publishers- Open Access Journal of Case Studies
Tumblr media
The Treatment of a Gummy Smile Patient with Laminate Veneers by Reverse Vestibuloplasty: A Case Study
Authored by Mustafa Özay Uslu
Aesthetically desirable smiles demonstrate a gingival appearance of up to 3mm. Gummy smile is a clinical condition with gingival display more than 3mm which is often unpleasant for the individual. Reverse vestibuloplasty is a traditional surgical approach for the treatment of excessive gingival appearance by repositioning downward of the lips. Reverse vestibuloplasty offers a easy approach for the correction of gummy smile. In this case report, the treatment of gummy smile with reverse vestibuloplasty operation in a female patient with abnormal gingival view, was presented. A systemically healthy female patient was admitted to our clinic with an unesthetic appearance of gingival tissue with anterior teeth. Reverse vestibuloplasty surgery was planned. A two parallel horizontal incisions was made after local anesthesia at the mucogingival junction to alveolar mucosa on the lip, extend from right first molar to the left first molar tooth and the distal parts of incisions was merged. Sharp tissue dissection was made and the tissue was removed. Two horizontal incision lines were connected using simple suttures. The sutures removed after one week. Clinical records was collected at first week, one month and six month later. No complications and no scar were observed after operation. The healing was uneventful. High-level patient satisfaction was achieved.
Keywords:Reverse vestibuloplasty; Gummy smile; Aesthetic periodontal surgery
Pleasant smile is the most important part of the beauty of facial aesthetics [1]. The condition of the oral tissues, the gingival outlines, the position of the lips and the symmetry of the teeth form appearing the basis of an aesthetic smile [2]. Ideal smile line is associated with the appearance of 1-2mm of gingival tissue with all coronal part of teeth [3]. A gummy smile usually appears when gingival visibility is greater than 3mm [4]. Gummy smile is more common in women. In addition, it has been reported that the grade of the gummy smile reduced with age due to decreased muscle tone in the lower and upper lips [5].
Gummy smile is associated with different etiologies. For this reason, it is necessary for the researcher to assess the patient’s smile design and to regard the relationship between the patient’s teeth, gingiva and lips in a smiling state. Depending on the etiology of the gummy smile treatment methods are crown lenghtening procedures, botulinum toxin injections, intrusion, orthognatic surgeries and reverse vestibuloplasty operation [6-8]. Reverse vestibuloplasty include the removal of a band of maxillary buccal mucosa and subsequently suturing the lip mucosa to the newly formed mucogingival line. The purpose of this approach is to reduce the retraction of the elevator smile muscles (e.g. levator anguli, levator labii superioris, zygomaticus minör and orbicularis oris).
In this case report we aimed to present the outcomes of a gummy smile treatment with reverse vestibuloplasty.
Case Report
Systematically healthy 30 years old female patient was admitted with a chief complaint of an abnormal excessive appearance more than 5mm of gingival tissues at anterior teeth (Figure 1). Reverse vestibuloplasty surgery was chosen instead of crown lenghtening procedure because of prosthetic laminate veneers.
A two parallel horizontal incisions was made after local anesthesia at the mucogingival junction to alveolar mucosa on the lip, extend from right first molar to the left first molar tooth and the distal parts of incisions was merged (Figure 2). Sharp dissection was made by scalpel and the reflected half-thickness flap between two incisions was removed (Figure 3).
Incision lines of newly formed shortened alveolar mucosa, were connected together with simple sutures (6-0 polyglycolideco- lactide, PGLA, Pegelak, Doğsan) and the tension was eliminated by sling sutures (3-0 PGLA, Doğsan) (Figure 4 & 5). The surgical area was covered by periodontal dressing (Coepak, GC).
Analgesic and chlorhexidine gluconate mouthrinse was prescribed and a post-op regimen was given. The sutures removed after one week. Clinical parameters was evaulated at 1st week, 1st and 6th month later (Figure 6-8).
No complications and no scar were observed after surgical operation. The healing was uneventful. The patient recruited an aesthetic smile and there was no relaps.
Excessive gingival appearance known as gummy smile is an aesthetic problem in smile line [3]. Gingivoplasty is usually performed for aesthetic and functional purposes, to increase the crown lengths in the correction of the gummy smile. However, botulinium toxin injections, orthognathic surgical interventions and reverse vestibuloplasty, are among the other treatment options when gingivoplasty is not sufficient [9].
When performing a reverse vestibuloplasty, attention should be paid to surrounding anatomical formations and damage should be avoided. Suturing procedures should be done considering the attached gingiva borderline. If attached gingiva aren’t sufficient, flap design, suturing and stabilization are difficulty. Patients with severe skeletal deformities, reverse vestibuloplasty is contraindicated and orthognathic surgery should be considered [7].
In this case, it was showned that the treatment of some suitable gummy smile cases with reverse vestibuloplasty was very effective treatment modality of and provides stable results.
For more articles in Open Access Journal of Case Studies please click on:
0 notes
nurmedics · 2 days ago
The Ultimate Emergency Medicine Guide: The only EM book you need to succeed 2021
The Ultimate Emergency Medicine Guide: The only EM book you need to succeed 2021
Emergency Medicine at your fingertips Written by clinicians in day-to-day practice of emergency medicine, this book provides a review of all topics relevant to practicing physicians. Contributions from current and recent emergency medicine residents ensures that it is the most up to date resource available for preparation for the ABEM written boards examination, the annual inservice examination,…
Tumblr media
View On WordPress
0 notes
nurmedics · 2 days ago
Strange and Schafermeyer's Pediatric Emergency Medicine, Fifth Edition
Strange and Schafermeyer’s Pediatric Emergency Medicine, Fifth Edition
Endorsed by the American College of Emergency Physicians  “…a comprehensive and current resource for anyone who cares for children in an acute setting, from the office to the emergency department. Its presentation is straightforward, and the information is easy to read and assimilate. It will be a valuable resource for those in the field of pediatric emergency medicine as well as other…
Tumblr media
View On WordPress
0 notes
nurmedics · 2 days ago
Atlas of Emergency Medicine 5th Edition
Atlas of Emergency Medicine 5th Edition
The Atlas of Emergency Medicine is your “look quick, act fast” guide to accurately diagnosing acute medical problems in emergency practice settings. Packed with the highest-quality images available and fully updated clinical information, this is the definitive resource to assessing, diagnosing, and treating patients quickly, safely, and effectively. Top experts in their field, the authors cover…
Tumblr media
View On WordPress
0 notes
thetinydocter · 2 days ago
Residency tips: life is too short for
1. A cheap bed
2. Mediocre coffee
3. An old apartment just to save money
0 notes
biomedres · 3 days ago
Free medical journal - BJSTR Journal
Tumblr media
A Cross-Sectional Assessment of Health Literacy among Hypertensive Community of Quetta City, Pakistan by  Mohammad Bashaar* in  Biomedical Journal of Scientific & Technical Research Background: We aimed to assess the Health Literacy (HL) among hypertensive community of Quetta city, Pakistan. Methods: A questionnaire based, cross sectional survey was conducted at Sandeman Provincial Hospital, Quetta. The Health Literacy Questionnaire (HLQ) was used to assess the health literacy level. The cutoff values of having adequate / poor HL were calculated by Receiver Operating Characteristic Curve. Where significant associations were reported, effect size was calculated by using Kendall tau correlation coefficient.Results: Two hundred and eight five patients responded to the survey with mean age of 45.22±10.13 years. Females dominated the cohort (159, 55.8%), and 78% of the respondents were married. The scores for the first five domains of HLQ ranged from 11.63 - 15.70. Domain 2 (having sufficient information to manage my health) was significantly associated with educational status (p = 0.005) and locality (p = 0.022). The appraisal of health information (domain 5) was also significantly associated with educational status (p = 0.003) and locality (p = 0.004). Urban respondents had sufficient information about health management and reported better appraisal of health information. Interpretation of significant association among educational status revealed positive moderate correlation (τ = 0.300 and 0.436 respectively for domain 2 and 5) whereby respondents with higher education were likely to have sufficient information to manage their health and had better judgment of assessing health-related information. The scores for the remaining four domains (6 - 9) ranged from 17.67 - 21.86. All domains (6-9) were significantly associated (p < 0.05) with locality whereas urban respondents having better HL when compared with their counterparts.Conclusion: Considering the lower HL, a reorientation of the health policy is recommended. Additionally, collaborative efforts must be undertaken by the government, the health care institutions, civil society and mass media to design and implement effectual interventions for improving HL. For more articles on Free medical journal  plese click here bjstr Follow on Twitter : Follow on Blogger : Like Our Pins On :
0 notes
nurmedics · 3 days ago
Oxford Handbook of Emergency Medicine (Oxford Medical Handbooks) 5th Edition
Oxford Handbook of Emergency Medicine (Oxford Medical Handbooks) 5th Edition
Now in its fifth edition, the Oxford Handbook of Emergency Medicine is the essential rapid-reference guide to emergency medicine for everyone from junior doctors to specialist registrars, nurse practitioners, and paramedics. New and improved, the Handbook has been thoroughly revised throughout, with 100 extra illustrations and the latest guidelines and treatment advice, completely overhauled…
Tumblr media
View On WordPress
0 notes
nurmedics · 3 days ago
Deja Review: Microbiology and Immunology
Deja Review: Microbiology and Immunology
This high-yield, rapid-fire Q&A book simulates flashcards in a book to help you review microbiology and immunology for your course exams as well as prepare for the USMLE Step 1. The convenient two-column “flashcard” Q&A format reinforces familiar material, while accelerating mastery of commonly tested topics. You’ll efficiently absorb a large amount of pertinent information and streamline study…
Tumblr media
View On WordPress
0 notes
surendra84 · 3 days ago
RENIL Travel Medicine Pouch Emergency First Aid Kit Box Organizer with Medicine-Pocket Empty Bag for Travelling Car, Home, Office
RENIL Travel Medicine Pouch Emergency First Aid Kit Box Organizer with Medicine-Pocket Empty Bag for Travelling Car, Home, Office
Price: (as of – Details) We always need to get prepared for emergency. This empty first aid bag, you can put the emergency supplies medicines that you need. Small and light weight, great for office, car, gym bag, backpack. Easy and convenient to use. Features: Made of 600D oxford fabric, waterproof with high durabilty. Empty first aid bag, you can put the emergency supplies medicines that you…
Tumblr media
View On WordPress
0 notes
Juniper Publishers- Open Access Journal of Case Studies
Tumblr media
Investigation on Therpeutic Efficacy of Teofilin in Calves with Respiratory Diseases
Authored by Bulent Elitok
This study was carried out in a total of 50 calf calves in the Uşak province that were found to have developed a clinical respiratory system problem. Twenty-five animals constituted the control group (KG) while 25 animals constituted the experimental group (DG). KG calves were treated under the classical treatment procedure. In addition to the routine clinical treatment procedure for DG animals, intravenous (iv) theophylline (TECAR® 240mg/10ml iv ampul) is administered in the form of slow infusion in a physiological saline 2 times daily at a dose of 6mg/kg for 3 days). Before and after starting work on all of the animals studied 1.2.3. Clinical, haematological and blood biochemical examinations were performed on days. With the application of theophylline, contraction of the muscles seen in some of the DG animals was formed, and no such symptom was observed in the control group animals. It has been observed that theophylline applications cause some significant changes in hematological parameters, especially in the number of RBCs. The most significant increases were obtained in terms of platelet (PLT). The mean levels of enzyme levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), sorbitol dehydrogenase (SDH), lactate dehydrogenase (LDH), glutamate dehydrogenase (GLDH), creatinine kinase (CK) decreased progressively in both groups on day 3 (p <0.05), which was statistically significant in terms of all time periods in DG animals compared to KG. As a result; it has been determined that theophylline investigated for the first time in the refrigerator can provide significant improvements in the clinical symptoms of the respiratory system and contribute to recovery.
Keywords:Theophylline; Calf; Clinical; Hematologic; Blood biochemistry
Abbrevations: PLT: Platelet, AST: Aspartate Aminotransferase; ALP: Alkaline Phosphatase; SDH: Sorbitol Dehydrogenase; LDH: Lactate Dehydrogenase; GLDH: Glutamate Dehydrogenase; CK: Creatinine Kinase, COPD: Chronic Obstructive Pulmonary Disease
Respiratory diseases in the calves cause economic losses in animal breeding [1-3]. This disease complex, which is of particular importance in feeder animals, especially on the ice, is formed by the combination of many factors [4-7]. Main specifications; cough, power breathing, stagnation, loss of appetite, nasal discharge, and abdominal solu- tion. Although the increase in body temperature may be at the beginning of the disease, it may subsequently fall to normal, but the pulse rate increases [5,8-10]
Theophylline is a methylxanthine group drug that is widely used as a bronchodilator in diseases such as asthma where respiratory tract constriction is severe [11-13]. The recommended therapeutic range for treatment efficacy is 10-20μg/ml and reported to occur when side effects are generally used above 20μg/ml [14].
The methylxanthine group of drugs, theophylline, is an effective bronchodilator for the treatment of airway obstruction diseases such as chronic obstructive pulmonary disease (COPD), asthma, neonatal apnea and bradycardia syndrome [15,16]. In addition to the bronchodilator effect of theophylline, diuretics and diuretic and respiratory muscle strengthening effects and antiinflammatory effects have been found to increase catecholamine release [17-19].
The aim of this study was to demonstrate the therapeutic efficacy of theophylline, a respiratory stimulant and bronchodilator, which was commonly used in the human medicine and less frequently used in the veterinary field, in respiratory system diseases.
Materials and Methods
Animal materials
The study was carried out in a total of 50 calves, 25 control groups (KG) and 25 experimental groups (DG), 0 to 6 months old, who were found to have developed a respiratory system problem clinically in Uşak city and according to the method [5]. KG calves were treated under the routine clinical treatment procedure (Clamoxy-LA®Pfizer, Injacom-C® Ceva, Nervit Kompoze® Vetaş, Fulimed®Alke).
In addition to the routine clinical treatment procedure for DG animals, intravenous (iv) theophylline (TECAR® 240mg /10ml iv ampul-Avicenna (iv) is administered intravenously in the form of slow infusion in a physiological saline at a dose of 6mg/kg for 2 days, Farma Foreign Trade Inc. and Istanbul-Turkey).
Respiratory quality (depth, superficiality), cough, nasal discharge, auscultation of pulmonary sounds were examined and recorded in addition to clinical examinations of KG and DG animals (body temperature, respiration and heart rates and rumen contractions at 5 minutes). Blood samples from V. jugularis were taken and examined for hematological and blood biochemical examinations on days of 1, 2, 3.
This study was supported by the reference number 490- 15 of Afyon Kocatepe University Animal Experiments Ethics Committee with the reference number of AKUHADYEK and supported by the Coordination Unit of Scientific Research Projects of Afyon Kocatepe University (BAPK) with the reference number of 17.SAGBIL.15.
Clinical Experiments
The routine clinical examinations such as inspiration, body temperature, respiration and heart rates, number of ruminant contractions, strength before and after intravenous administration of theophylline, and the clinical laboratory examinations of the parameters described by Blood and Radostits (1989). The obtained data are recorded and maintained for statistical evaluation.
Hematological Meausrements
Blood was drawn into EDTA blood vessels on the 1st and 2nd day before and after starting the use of theophylline by i.v in the subsequent control group and study group animals, and blood samples were sent to the laboratory on the same day and as soon as possible. These blood samples were counted in the blood count using counting solutions. The obtained data were recorded and evaluated at later stages for comparison with the control group values. In blood samples taken for hematological examination; (RBC), total leukocyte (WBC), hematocrit (HCT), hemoglobin (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MHC), mean corpuscular hemoglobin concentration (MCHC), lymphocyte (LENF), neutrophil Hematological examinations such as NOTR, eosinophil (EOS), monocyte (MON) and basophil (BAZ) were measured using commercial test kits with a Chemray Brand blood count device.
Serum biochemical measurements
For this purpose, blood samples were taken from the V. jugularis before and after the administration of i.v theophylline and on the 2nd and 3rd days in the animals designated as control and study groups. Blood samples were taken from the laboratory, where the serum was removed and the extracted sera were stored at +4 degrees centigrade, taking gods if not measured immediately. In blood biochemical examinations; Serum glutamate dehydrogenase (SDH) (spectrophotometrically measured at a wavelength of 340nm in a Chemwell Mark apparatus), serum glutamate dehydrogenase (GLDH) (Chemwell Elisa (R)), serum aspartate aminotransferase (AST), serum gamma glutamyltransferase (GGT), serum lactate dehydrogenase (TP), Albumin (ALB), Glucose (GLU), Total and Direct Bilirubin (TB and DB) were measured using commercial kit in the Chemwell Brand autoanalyser with the levels of creatinine kinase (CK).
Statistical analyses
The measurements referred to in all of the animals that make up the study material were repeated on the 1st and 2nd days after the control and study. Statistical calculations of the groups were made according to the ANOVA method. The Duncan test was used to determine the intraparticular differences in the study group. Statistical analyzes were performed using the Windows-compatible SPSS 18.0 (Inc. Chicago, II, USA) package program. Data were presented as mean ± standard error and p <0.05 was considered significant.
A total of 50 calves (control n=25, study group n=25) aged between 68 and 82 days were used in this study. The mean age of the patients was 72 ± 2 days in DG and 70 ± 3 days in DG. There was no statistical difference between group mean age (p> 0.05). Of the 25 animals that make DG, 10 are female, 15 are male calves, and KG is 8 female and 17 male calves. Findings from repeated measurements on day 1 and day 2 before and after the start of the study, as shown below; clinical, hematological and biochemical findings.
Clinical findings
Body temperature decreased significantly (p <0.05) from the statistical point of view in the later time periods but there was no difference statistically between the two groups in terms of body temperature (p> 0.05). However, when compared to KG; respiratory and cardiac frequencies were statistically significant (p <0.05) higher in DG animals.
When Table 1 is examined; There was no statistically significant difference between the body temperature (T), respiratory (R) and heart (P) frequencies in 5minutes and 5minute ruminal movements (RH) in both groups (p> 0.05). However, in both groups it was concluded that the reference levels of VS were above the reference levels and that an infection situation was the case when other clinical findings were taken into consideration. When compared with UO; On the 1st day of US, VS averages decreased significantly (p <0.05) in DG and KG animals, but there was no statistically significant difference (p> 0.05) between DG and KG averages in terms of this parameter. (P <0.05). However, there was no statistically significant difference (p> 0.05) between the mean values at different time points of DG (p> 0.05). The differences between the groups in terms of time intervals and UO averages and US time intervals were statistically significant (p <.05), while the increase was not statistically significant 0.05).
a-d.The difference between the averages of the control groups carrying different letters in the same column is important in terms of statistics (p<0,05). KG: Control group, DG: Experiment group, UO: Before experiment, US: After experiment.
Hematological findings
The averages and comparisons of the haematological parameters of UO and US groups are given in Table 2. When this table is examined; it has been observed that theophylline applications lead to significant changes in hematological parameters, especially in the number of RBCs. According to the results obtained from the measurements made; Similarly, the decrease in the mean of RBC, HB, HTC and WBC levels in the US period was statistically significant in terms of time in the US period (p <0.05) (p & lt; 0.05). A similar situation was also found in terms of NOTR and EOS averages and the difference was statistically significant (p <0.05). On the contrary, when the average of the LENF and MON levels in the US period was significantly higher (p <0.05) in terms of statistical significance than that of the UH turnover, when this height was compared with KG, the highest levels were obtained in terms of statistics and gradually increased with time (p <0.05).
The most significant increases were obtained in terms of platelet (PLT). When Table 2 is examined; (P <0.05), the highest level was obtained on day 3, the last day of the study, and the difference between the time intervals and the groups was statistically significant (p <0.05), while the PLT average did not differ between the groups 0.05).
a-f The difference between the averages of the control groups carrying different letters in the same column is important in terms of statistics (p<0,05). KG: Control group, DG: Experiment group, UO: Before experiment, US: After experiment.
MCV and MCH levels were significantly higher (p <0.05) in terms of time in terms of statistical significance in both groups when compared to the NL average, but it was observed that this increase was higher in DG animals and statistically significant (p <0.05). On the contrary, it was found that the mean levels of MCHC were decreased in both groups according to NDP, and the lowest levels were obtained in DG animals, although this decrease was statistically significant (p <0.05).
Metabolic profiles
The mean values of the blood serum biochemical parameters obtained in UO and US days in KG and DG animals are shown in Table 3. When this table is examined; The mean levels of AST, ALP, SDH, LDH, GLDH and CK enzymes decreased gradually at 3 days, gradually decreasing with time in both groups. It was statistically significant (p <0.05) in terms of all time periods in DG animals levels were found to be low. When compared with UO, these enzymes were not statistically different between the groups (p> 0.05). From TP perspective; It was found that the highest levels were obtained from the measurements in this period but the TP concentration averages after the treatment decreased with time and the decrease in theophylline-treated DG was not statistically significant compared to the KG (p> 0.05). As the opposite situation; ALB concentration levels were lower in both groups and there was no difference in group mean (p> 0.05) in terms of group mean, but ALB concentration levels which were lower in UO gradually increased in the later time periods and reached the highest level on the third day, There was no statistically significant difference (p> 0.05) in terms of ALB concentration levels between day and day. Compared with UO, ALB levels were found to be higher in the later time periods and this height was statistically significant (p <0.05). The mean values of GLU concentrations reached to the highest level on day 3 with progressive increase in time in KG and DG animals (p <0.05) higher than the mean of the GL animals in the US over the entire time period of the US in terms of the GLU averages.
a-g The difference between the averages of the control groups carrying different letters in the same column is important in terms of statistics (p<0,05). KG: Control group, DG: Experiment group, UO: Before experiment, US: After experiment.
In terms of TB and DB concentrations, there was no statistically significant difference between the groups or time periods (p> 0.05), while the high TB and DB concentration levels decreased with time and reached to the lowest level in US 3 days and the UO and US concentration levels (p< 0.05).
Theophylline remains one of the widely prescribed drugs worldwide for the treatment of chronic obstructive pulmonary disease (COPD) due to its low cost and easy access, as well as its antiinflammatory effect, which relaxes the airway smooth muscles [20]. This includes the reduction of chemoreceptor response to hypoxia and hypercapnia, the active reflexes acting by stimulation of the posterior pharynx, and the role of ineffective ventilation due to the impaired coordination of the inspiratory muscles and upper respiratory muscles [21,22].
In our study, the effects of theophylline on the respiratory system were investigated in a 3-day trial, and in studies of the adequacy of the study period, some investigators noted that theophylline increased rapidly in clinical symptoms and increased ventilation in the presence of apnea and that theophylline did not differ from [23,24].
While theophylline is used as an adjunctive therapeutic agent to treat bovine respiratory disease, there may be risks associated with typhoid [25,26]. Some authors [16,27-29] reported that symptoms such as tachycardia, tachycardia, vomiting, diarrhea, reflux and muscle spasms could be formed. In our study, significant increases in respiratory and cardiac frequencies in DG animals following the application of theophylline (Table 1) were consistent with those reported by these investigators. In our study, in addition to the above-mentioned klinink symptoms, 5 animals in the group of theophylline-treated DG, which had no KG animals, apparently observed vibrations in the costoabdominal region and in the foot muscles. As a matter of fact, it has been reported that contractions in the intercostal and strenal muscles are formed in the ice of 100-400mg dose by oral route, and that the possible cause is related to the hypofolicity of theophylline [27,30,31].
As a result of extensive literature reviews, we could not find a direct study of the effect of theophylline on hematological parameters on the ice. However, theophylline has been reported to weaken erythropoietin production and reduce RBC levels in some normal subjects and in patients developing erythrocytosis [32,33]. Bakris et al. [32] reported that theophylline also caused a decrease in hematocrit levels [33], similarly reporting a decrease in blood erythrocyte levels following theophylline administration. Ohnuma et al. [34] reported that the use of theophylline resulted in an increase in the platelet count. Considering the averages of the haematological examination parameters measured in our study, the RBC, HB, and HTC averages were significantly lower after the theophylline administration in DG animals compared to KG, consistent with the reported findings of the investigators.
Ubbink et al. [33] reported that after the administration of theophylline, a significant reduction in the levels of enzymes such as AST and ALT was found. Findings similar to this study were also obtained in a study in rats given 20mg/kg /day theophylline [35]. Khidr et al. [37] found that catalase enzymes increased on day 4, while the study of snails showed a similar decrease in AST, ALT and LDH levels in the group of theophylline. For 3 days during the work we did i.v. The decrease in AST, ALP, LDH, GLDH, SDH and CK enzyme levels measured in the same manner in the animals treated with theophylline is parallel to that reported by the researchers mentioned.
In our study, the probable cause of high baseline TB and DB levels was due to maternal erythrocyte destruction, the decreasing levels were not related to theophylline, but the difference between TB and DB concentrations in BSE and BSE animals. Kato et al. [28] report that low and short-term use of theophylline may lead to an increase in blood enzyme levels of theophylline, which does not lead to a significant increase but reaches high plasma concentrations and / or is used for a long time.
In our study, we observed a decrease in TP levels following theophylline administration in DG animals. In a study of mice showing asthma-like respiratory problems [38], it was found that there was a significant decrease in the rate of theophylline administration while having a high TP rate in lavage fluids. Edmunds & Mayhew [16] also reported that theophylline use at high doses may lead to proteinuria. Bruguerolle & Dubus [39] claimed that high fever caused an increase in blood protein and albumin levels and that theophylline administration did not cause a change in TP and ALB levels in high-fever subjects [37], in their study of snails, causing them to decrease slightly.
In the study we did, KG and DG were observed to have increased levels of GLU in animals, which was higher in DG animals. This finding is consistent with the findings of researchers [40] who report that theophylline in hypoglycemic subjects leads to an increase in blood GLU levels by increasing the level of cAMP. Raguso et al. [29] reported that theophylline infusions lead to significant increases in blood GLU levels in normal subjects.
As a result; it has been determined that theophylline investigated for the first time in the calves can provide significant improvements in the clinical symptoms of the respiratory system and contribute to recovery.
For more articles in Juniper Publishers | Open Access Journal of Case Studies please click on:
0 notes
nosfearatus · 3 days ago
Are you tired of a middle aged white bread manchild being foisted upon you constantly? Tired of the interesting love interests being sidelined? Super tired of the manchild stand crying about Dr. Mommy Issues being important to the plot? Then here's the open heart plot rewrite for you!
None of your friends are going into internal medicine and I'll explain why. Sienna is a hopeless optimist who would be a stereotypical pediatrics specialist pair that with numerous kids dying and you have her wanting to quit arc and her feeling undervalued by her boyfriend arc, plus she just seems like she'd be really good with kids and would even bring them baked goods. Landry hates dealing with people, he loves puzzles, and he's not gonna be the traitor so, he'd make a perfect pathology specialist. Elijah is someone who cares about improving the quality of life for his patients even if it seems hopeless and he hates pharma companies and their endless greed, so, he's an oncology specialist. Jackie is similar to Landry in that their bedside manner isn't the best but Jackie's all about high stakes situations and immediate action so infectious disease seems like a good specialty. Now MC, they're going to specialize in something that's high stakes, rewarding, and gets them close to all four love interests, Emergency Medicine. Now how do you all meet, in the Cafeteria on break you all happen to share a table and after lamenting their closet situation you make quick friends with the rest of the interns and can spend diamonds to bond with them. This scene also unlocks the penthouse apartment because you decide to live together then and spend the rest of your break apartment hunting on your phones, however if you don't spend the diamonds you still live together because Sienna gets the idea at Donahue's, it's just the garden view apartment.
Now. Let's meet the love interests all of whom you'll encounter in chapter 1! First off you meet Bryce and Jackie the same way as in the original. As an Emergency Medicine specialist you meet Rafael Aveiro rather early on as he's rushes a patient into the ER. Then you're checking up on a patient whose now under the internal medicine wing and I guess you have to meet Dr. Eth-Holy shit it's Dr. Zaid Mirani with a metal chair! Anyways you meet the superior gruff boss with a secret soft spot, Dr. Zaid Mirani when the senior resident takes on one of your now stabilized emergency patients and you've come to check up on them. Zaid is the final LI because I love him and this is my rewrite and he fills the same trope Mommy Issues man did but he's better at it.
So the plot? Well, since Landry isn't sabotaging you, someone else is. Could it be that jerk of an attending who criticized you on day one but is now trying to convince you to switch to Internal Medicine? He seems to be willing to risk anything to get you on his team, from your reputation to your patients' lives. One of his sabotage attempts ends up killing one of your patients which puts your career and future as a doctor in jeopardy, can you and your friends cobble together an argument that not only proves your innocence but shows how the hospital's golden boy was behind it all?
Please tell me if any of my info is incorrect, I'm basing most of my info on Wikipedia, sorry. But anyways here's a rewrite outline to how Open Heart could be without forcing an LI and sorry, Giraffe man is still important to the plot, as the antagonist of course. Please give me any suggestions you have.
And after book 1, said doctor is fired from Edenbrook but easily secures a job at Mass Kenmore and with it, so goes the reputation he brought which then kicks into gear the competition between the hospitals. And in this book, you get two more LIs, Aurora Emery and Kyra Santana. Aurora helps you out when you're feeling overwhelmed about the Dr. Manchild situation and reassures you that you did what's right and he needed to be taken down a peg. Kyra you meet when paying Elijah a visit on your break and she flirts with you in her typically morbid way. In this book you have to deal with conflicting feelings about dealing with your saboteur, increasing demands in Emergency Medicine, schedule conflicts with your friends/roommates, and strains on your romantic relationships.
3 notes · View notes
paramedicstrand · 4 days ago
It does look really cute :)
sjdbsj thank u!! i wish it was like,, good enough to submit but alas, its just for us <3
1 note · View note
beattygarner85 · 4 days ago
Urgent situation Medicine Jobs and Unexpected emergency Physician Jobs Are Abounding
Emergency medicine jobs and emergency physician jobs are abundant all over the world. You can find so many positions available that doctors will never be out of work. There will always be emergency medicine doctor for doctors around the world because folks are always getting injured. A long time ego the doctors began to specialize in different professions. Emergency medicine jobs began to become offered by hospitals and trauma focuses on the country. This led to more medical students selecting this as their specialty. Many emergency physician jobs may also be available around the world. There is such a shortage of doctors in undeveloped countries because almost no one wants to go work there. They receives a commission very little and the conditions are substandard and antiquated. Many emergency medicine jobs in america are available and pay very well. There are various emergency physician jobs available to seasoned doctors with a couple of years of experience. Additionally, there are jobs open to newer doctors who just completed their residency. Although a more experienced doctor will have higher pay and an improved chance of choosing their location, you may still find jobs everywhere. In case a doctor wishes to work in an inferior rural town, they are able to also find good experience. However, their pay may not be as much as should they were to work in a larger city. Many doctors would rather work in large cities because there is so much to do. No matter where you live, you can find plenty of jobs around the country and world.
1 note · View note
brooklynpa-c · 5 days ago
The hospital has decided to allow visitors back into the ED...
Tumblr media
The daughter who keeps dabbing at her mother’s Rhino Rocket because it’s oozing...
Tumblr media
The family member who comes out of the room every time the monitor beeps...
Tumblr media
The husband demanding we fill a 90 day supply of his wife’s Xanax from the ED...
Tumblr media
10 notes · View notes
b-is-for-borderline · 5 days ago
It says a lot about millennial culture that when I was hospitalised for a transient ischaemic attack (TIA) in October, facing potential death, my first reaction in the ER was to make a post of how much I did not want that big ass needle near me.
Also cannulas suck. They suck hard.
Tumblr media
2 notes · View notes