Emergency Pharmacological Treatment

Pharmacological treatment of the spinal cord injured patient is, at this time, limited to the use of steroids. The NASCIS II and III trials have established a definite benefit in outcome at 6 weeks, 6 months and 1 year in patients with both complete and incomplete injuries [7,8]. Intravenous infusion of methylprednisolone (MPSS) at 30 mg/kg over 1 hour as a loading dose, followed by a continuous infusion of 5.4 mg/kg/hour over 23 hours if this regimen is started within 3 hours of the injury or continued for 48 hours if it is started within 3 and 8 hours of the injury, is the recommended standard of care [9]. Of importance is the fact that steroids are contraindicated for patients whose loading dose would be administered 8 hours after the injury, since the NASCIS II study found worsening in outcome in both motor and sensory scores in this subgroup of patients [8]. Also, no evidence has been found that steroids benefit patients with spinal cord injuries due to penetrating trauma or nerve root injuries.

Although the neuroprotective effects of glu-cocorticoids like MPSS remain uncertain, their theoretical beneficial effects, such as suppression of vasogenic edema [10], enhancement of spinal cord blood flow, attenuation of the inflammatory response [8], stabilization of lysosomal membranes, inhibition of pituitary endorphin release and alteration of electrolyte concentrations in injured tissue, make them attractive as potential modulators of secondary injury. This is because it is believed that the antioxidant function which these agents seem to convey scavenges lipid peroxidation products from the cell membrane and attenuates the damage done by the production of oxygen, derived free radicals. Their iatrogenic complications, such as gastrointestinal hemorrhage and a higher incidence of wound infections, have prompted the search for compounds which minimize the glucocorticoid and miner-alocorticoid effects while preserving their ability to inhibit lipid peroxidation. Tirilizad mesylate, the best known and most extensively studied agent, is a 21-aminosteroid, which, in numerous animal models, has been shown to enhance recovery of motor function. In the NASCIS III study, a 48-hour infusion of tirilizad resulted in improved function similar to that obtained with an MPSS infusion. Since patients that received tirilizad also received a bolus of MPSS, conclusions cannot be reached about its use in acute spinal cord injury [9].

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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