Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

Background

Patients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents.

Objective

To compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy.

Methods

A systematic review was conducted by two independent reviewers based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the “gray” literature (Google Scholar). The end search date was May 8, 2015, across all databases.

Results

Five studies met the eligibility criteria. In three studies, individual risk of bias was low, and in two of them, moderate. In all studies, no differences regarding mild to moderate incidence of hemorrhagic complications were found between patients using antithrombotics (aspirin, clopidogrel, and warfarin) and those not using them. Rates of severe hemorrhagic complication were very low (0.04%) in both groups, supporting the safety of needle blocks, even in patients using antithrombotics. High heterogeneity across studies prevented meta-analysis. Limitations to these results include low statistical power in three experimental studies and a large 95% confidence interval in the two retrospective cohorts.

Conclusion

In this review, none of the selected studies showed significant bleeding related to needle-based ophthalmic regional anesthesia in association with the use of aspirin, clopidogrel, or vitamin K inhibitors. Since the available data is not powerful enough to provide a reliable evaluation of the true effect of antithrombotics in this setting, new studies to address these limitations are necessary.     

Creatine nanoliposome reverts the HPA-induced damage in complex II–III activity of the rats’ cerebral cortex

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Reversal of haloperidol-induced orofacial dyskinesia and neuroinflammation by isoflavones

Molecular Biology Reports - Schizophrenia is a mental illness and its pharmacological treatment consists in the administration of antipsychotics like haloperidol. However, haloperidol often causes...     

Phytosociology as a tool for forest restoration: a study case in the extreme South of Atlantic Forest Biome

The biodiversity loss, due to anthropic activities, has generated the necessity of studies that enable the ecosystem conservation. Nevertheless, the majority of studies restrict themselves to the floristic composition and phytosociological structure from determined pre-established diameter, neglecting attributes of the species, such as its (their) niche (s) of occurrence in the forest, thus, making it difficult to identify potential species for restoration. In this way, the present study aimed to evaluate the structure of a forest fragment in the extreme South of Atlantic Forest Biome, through identification of species in the different layers. There were used 18 parcels of 10 m × 20 m, distributed systematically, where the vegetation was evaluated in four size classes. The characterization of the structure of the arboreal-shrub of the forest was performed by the data comparison of the floristic composition and phytosociological structure. In the fragment of forest studied, there were sampled a total of 2.176 individuals. The floristic composition of the area includes 74 species, belonging to 58 genera and 28 botanical families. We observed differences in relation of richness and diversity of species among the analyzed layers, the intermediate layer presented the lowest richness of species, being the pioneers and initial secondaries the least representatives. Trichilia claussenii, Sorocea bonplandii, Actinostemon concolor, Apuleia leiocarpa and Nectandra megapotamica were the most abundant species and well distributed in the different size classes, and they can be used in the enrichment of areas in process of restoration in the scope of the Deciduous Seasonal Forest in the extreme South of Atlantic Forest Biome. Ocotea puberula, Allophylus edulis, Cedrela fissillis and Machaerium paraguariense formed a group of species with expressive representativeness in the arboreal layer, thus they can be used in the moment of planting as species to the fast covering of the area.     

The protective effects of nutritional antioxidant therapy on Ehrlich solid tumor-bearing mice depend on the type of antioxidant therapy chosen: histology, genotoxicity and hematology evaluations

Strong evidence indicates that reactive oxygen species (ROS) play an important role in the initiation as well as the promotion phase of carcinogenesis. Studies support the role of ROS in cancer, in part, by showing that dietary antioxidants act as cancer-preventive agents. Although results are promising, the research on this topic is still controversial. Thus, the aim of this study was to investigate whether vitamins C, E and pequi oil can, individually, provide prevention and/or be used afterward as an adjuvant in cancer therapy. Ehrlich solid tumor-bearing mice received antioxidant as follows: before tumor inoculation, before and after tumor inoculation (continuous administration), and after tumor inoculation; morphometric analyses of tumor, genotoxicity and hematology were then carried out. Antioxidant administrations before tumor inoculation effectively inhibited its growth in the three experimental protocols, but administrations after the tumor's appearance accelerated tumor growth and favored metastases. Continuous administration of pequi oil inhibited the tumor's growth, while the same protocol with vitamins E and C accelerated it, favoring metastasis and increasing oxidative stress on erythrocytes. Except for continuous administration with vitamin E, the development of ascites tumor metastases was linked with increased inflammation. Results suggest that the efficiency and applicability of antioxidants in the medical clinic can depend not only on the nature of the antioxidant, the type and stage of cancer being treated and the prevailing oxygen partial pressure in the tissues, but also on the type of antioxidant therapy chosen.     

Molecular inferences about the genus Hypostomus Lacépède, 1803 (Siluriformes: Loricariidae): a review

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Antimicrobial activity of [2-(methacryloyloxy)ethyl]trimethylammonium chloride against Candida spp

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Antifungal Properties of Essential Oils Derived from the Genus Cymbopogon: A Systematic Review

Essential oils (EOs) are products of secondary metabolism with recognized organoleptic characteristics and biological properties. Recently, there has been a growing demand for EOs in the national and international market, mainly due to the recognition of their use as complementary medicine practices, and the increased use in the industries of pharmaceutics, cosmetics, well-being, veterinary and agroecology, boosting the productive sector. In this context, EOs from grasses of the Cymbopogon (Poaceae) are promising sources of bioactive compounds, due to their recognized biological properties, such as anti-inflammatory, antibacterial, antifungal, antidiabetic, repellent, and larvicide. Thus, the present study aims to carry out a review of the scientific literature of the main works related to the evaluation of the antifungal action of essential oils extracted from plants of the Cymbopogon genus, compiling the species that showed the best results and relating them to their main chemical constituents. This review covers the following species: C. citratus, C. flexuosus, C. winterianus, C. martinii, C. nardus, C. giganteus, C. schoenanthus, C. khasans, and C. proximus. Among them, C. citratus was the most assessed, being associated with the vast majority of studies (61.9 %), and it was also the species that showed the best results in terms of MIC.     

Assessment of the Functional Activities of Casein Phosphopeptides on Circulating Blood Leukocytes

International Journal of Peptide Research and Therapeutics - One of the beneficial effects of peptide-rich protein hydrolysates on diverse pathological conditions has emerged from the concept that...