When Columbus landed in the New World in 1492, he and his men were astonished to find the native Indians smoking rolled-up tobacco leaves, the forerunners of present-day cigars. In the 16th century, Sir Walter Raleigh set London on its ear by puffing away on an elaborate pipe that he brought back from America. Soon tabacco smoking spread to Europe, and the craze was on. Doctors, noting its soothing effects, prescribed tobacco for all sorts of ailments, including lockjaw. In time, the craze was taken up by America’s new settlers. By the 1800s, cigarettes, which were really tiny cigars wrapped in paper, were a major industry, with billions being sold each year.Continue reading “When the Movies Promoted Smoking (Piece of History – Reading & Sharing)”
Pathophysiology of COVID-19 Infection:
SARS-CoV-2 is a single-stranded RNA virus that belongs to the Orthocoronavirinae subfamily. It consists of 16 nonstructural proteins and 4 structural components: spike glycoprotein (S), envelope protein, membrane glycoprotein, and nucleocapsid phosphoprotein (N). However, the viral types can differ across infections at different times and at least 116 mutations have been identified. The S proteins are chritical for binding to the host cell surface receptors, whereas the N proteins are essential for viral survival and expansion.
SARS-CoV-2 is transmitted through exposure to respiratory droplets from a person with COVID-19 that are inhaled or deposited on the host’s mucous membranes. Respiratory droplets may be airbone or can land on surfaces and objects, which when exposed to a host cell with the entry receptor ACE2 (angiotensin-converting enzyme 2) in the presence of TMPRSS2 (transmembrane protease serine 2) interacting with its spike protein to gain entry. Upon binding to the ACE2 receptor, the SARS-CoV-2 spike protein is activated through proteolytic cleavage by TMPRSS2, inserted into the cell membrane, and fuses the viral and cellular membranes so that transfer of the viral RNA into the host cell cytoplasm can occur, followed by viral replication. In addition to varying entry routes into host cells, questions remain regarding how SARS-CoV-2 gains access into the central nervous system (CNS), referred to as neurotropism or the ability to infect nerve tissue. The nasal-olfactory nerve route, blood-nervous stem barrier breakdown, blood-nerve barrier or blood-cerebrospinal fluid barrier permeability, lymphatic drainage system of the brain, retrograde transmission from the enteric, lung, or kidney nerve routes, or macrophage/ monocyte cargo routes have all been suggested pathways by which the SARS-CoV-2 virus reaches the CNS.
For now, general precautions (masks, social distancing, and frequent handwashing) remain in place to control the virus, as COVID-19 vaccinations are taking place worldwide. Testing for COVID-19 infection remains a critcal component of the COVID-19 detection and surveillance efforts.Continue reading “COVID-19 (Reading & Sharing)”
Venlafaxine is a selective serotonin-norepinephrine reuptake inhibitor (SNRI) used in the palliative care setting for concurrent treatment of depressive disorders and neuropathic pain. (Neuropathic chronic pain is often resistance to standard opioid therapy and is best treated with a secondary amine tricyclic antidepressant (nortriptyline, desipramine), a selective serotonin or norepinephrine reuptake inhibitor (SSNRI) (venlafaxine, duloxetine), or a calcium channel alpha2 delta lignd (anticonvulsants) (gabapentin or pregabalin).
In the United States, there are three SNRIs that have been approved by the FDA: venlafaxine (Effexor and Effexor XR), desvenlafaxine (Pristiq), and duloxetine (Symbalta). Venlafaxine and duloxetine both block the serotonin and norepinephrine transporters, thereby inhibiting and availability to bind with the postsynaptic receptors. At lower doses, venlafazine predominantly affects serotonin reuptak, contributing to greater anxiety reduction more so than depressive symptom reduction. Duloxetine, however, appears to be a more potent and equal serotonin and norepinephrine reuptake inhibitor than venlafaxine is. These drugs are rapidly absorbed after oral intake and metabolized extensively in the liver. Time needed to reach maximum plasma concentration is 2 hours for both venlafaxine and duloxetine. Venlafaxine has a half-life of 5 hours and the active metabolite is 11 hours. Steady state is achieve in 3 to 4 days. Duloxetine has a half-life of 12 hours, reaching steady state in 3 days. Both drugs are excreted mostly in urine.Continue reading “Venlafaxine – Effexor (Selective Serotonin-Norepinephrine Reuptake Inhibitor /SNRI)”
The original six activities, defined by Katz in the 1960s were bathing, dressing, toileting, transfer, continence, and feeding.
A patient’s ability to perform each of these activities, the evaluation of ADLs on a serial basis has been found to be an important indicator of patient prognosis.
The Palliative Performance Scale (PPS) is a modification of the KPS and aims to help overcome the limitation of the KPS. In addition to the activities already measured in the KPS, the PPS assesses the patient characteristics of food/fluid intake and level of consciousness. PPS ratings directly correlated with short-term prognosis for terminally ill patients with or without cancer. It is generally accepted that a KPS or PPS score of 50 or less is predictive that the patient may have a prognosis of 6 months or less.
The PPS assessing ambulation, self care ability, intake, level of consciousness, activity level, and evidence of disease, is described as follows: