articaine hydrochloride + epinephrine (Septocaine)

Oxaliplatin desensitization for gastrointestinal cancer patients with hypersensitivity reactions: real-world experience from Vietnam.

Nguyen Le Trang LT, Nguyen Van Thang VT, Nong Hong Thach HT, Doan Nguyen Thanh Dat NTD et al.

Oxaliplatin-induced hypersensitivity reactions (HSRs) can interrupt clinically indicated treatment for gastrointestinal malignancies. We evaluated the early implementation of a multidisciplinary oxaliplatin desensitization pathway at Vinmec Times City International Hospital. We conducted a retrospective case series of patients who underwent oxaliplatin desensitization between 2022 and 2025 following an index HSR. Clinical characteristics, skin testing results, desensitization procedures, breakthrough reactions (BTRs), and subsequent oxaliplatin treatment completion were reviewed. Ten patients underwent desensitization after index HSRs occurring at a median of six oxaliplatin cycles (range, 2-11); six index reactions were Brown grade 2. Skin prick testing was negative in all patients, whereas intradermal testing was positive in six, negative in three, and equivocal in one. Three patients initially underwent a three-bag desensitization procedure and seven a four-bag procedure. Eight BTRs occurred in six patients, none requiring epinephrine. Seven patients completed all additional oxaliplatin cycles planned by their oncology team, receiving a median of four additional cycles. Three patients discontinued oxaliplatin after BTRs: two because of recurrent reactions despite procedure modification and one because the patient declined further treatment after a single BTR in the metastatic setting. Multidisciplinary oxaliplatin desensitization enabled most patients in this early case series to continue and complete planned oxaliplatin treatment, although BTRs were common. Given the small, retrospective cohort, these findings are descriptive and require further study to establish comparative safety or efficacy, superiority of a specific desensitization procedure, or predictors of treatment completion.

Prognostic discrimination of SOFA-2 vs. SOFA-1 and incremental information from cardiovascular scoring and vasoactive support intensity in patients with sepsis receiving early vasoactive therapy.

Huang Tianci T, Pan Mingyuan M, Pan Lifan L, Liang Peng P et al.

Patients with sepsis who require vasoactive support during the first 24 h of intensive care represent a heterogeneous population. It is uncertain whether the Sequential Organ Failure Assessment (SOFA)-2 score improves mortality discrimination compared with the SOFA-1 score and whether observed circulatory support intensity provides complementary prognostic information. This multicohort observational study used Medical Information Mart for Intensive Care IV (MIMIC-IV) for a 24-h conditional landmark analysis. Patients alive and still in the ICU beyond 24 h were followed from ICU admission +24 h through ICU day 28 for reconstructed all-cause mortality. We compared SOFA-1 and SOFA-2, evaluated SOFA-2 total and cardiovascular scores, analyzed first-24-h five-agent norepinephrine-equivalent peak burden (norepinephrine, epinephrine, dopamine, phenylephrine, and vasopressin), and internally evaluated an exploratory drug-composition model. Fixed strata were assessed directionally in eICU Collaborative Research Database and an independent-center high-risk stress test cohort with cohort-specific endpoints. The MIMIC-IV 24-h landmark cohort included 11,892 patients and 2,687 post-landmark deaths. SOFA-2 showed no observed discrimination advantage over SOFA-1 (area under the receiver operating characteristic curve, AUROC, 0.731 vs. 0.732; difference, -0.0005; 95% confidence interval, -0.0086 to 0.0076; P = 0.908). The SOFA-2 cardiovascular score had lower discrimination than the SOFA-1 cardiovascular score (0.663 vs. 0.676; P = 0.006). Mortality was 51.94% for the exploratory SOFA-2 ≥12 group and 17.09% below 12, and increased from 11.30% to 47.45% across four study-defined peak burden categories. The SOFA-2-plus-drug-composition model had an apparent AUROC of 0.768 and a bootstrap-corrected AUROC of 0.767, but it was not externally validated. Fixed strata preserved the direction of risk ranking in both external cohorts, whereas absolute risk and calibration differed. SOFA-2 did not show an observed overall mortality discrimination advantage over SOFA-1 in this population. SOFA-2 total and cardiovascular scores, together with observed vasoactive support intensity, provided complementary prognostic description at 24 h. The ≥12 rule is exploratory, and drug-related associations do not establish causal treatment effects or clinical decision utility.

Management of breakthrough pain during advanced labor with epidural alkalinized lidocaine 0.3%-epinephrine: a single-center retrospective study (2022-2026).

Hyuga Shunsuke S, Okutomi Toshiyuki T, Fujita Tomoe T, Kondo Hiroaki H

Breakthrough pain during advanced labor requires rapid analgesia while limiting motor block. We describe responses to epidural alkalinized lidocaine 0.3% with epinephrine 10 µg/mL. This single-center retrospective cohort included women receiving epidural alkalinized lidocaine 0.3%-epinephrine for breakthrough pain at cervical dilation of at least 7 cm after satisfactory neuraxial analgesia. Women with recurrent epidural boluses suggesting catheter dysfunction were excluded. Median bolus volume was 3 mL [interquartile range, 3-5]. The primary outcome was contraction-pain visual analog scale change from baseline to 5-15 min. Secondary outcomes included sensory and motor changes. Brackets indicate interquartile ranges. Paired assessments preceded delivery. Of 153 women, 143 were analyzed. Median visual analog scale decreased from 50 [30-60] to 0 [0-0] mm (mean reduction, 45.2; 95% confidence interval, 41.9-48.4); 126 (88.1%) scored 10 mm or less. Median rescue-to-delivery interval was 52 min [31-88]. Median cephalad cold-loss extension was one dermatome [1-2]. Modified Bromage scores were unchanged in 138 (96.5%) and worsened in five (3.5%). Maternal hypotension and new fetal heart rate abnormalities each affected six women (4.2%). Among vaginal deliveries, operative delivery rates were 9.3 and 0.6 percentage points higher in nulliparous and parous women, respectively, than in same-period deliveries with neuraxial analgesia without the study rescue. Epidural alkalinized lidocaine 0.3%-epinephrine (3-8 mL) was followed by early pain reduction with infrequent motor block increase, supporting clinical application of prior laboratory findings. Prospective comparisons should assess motor function and delivery outcomes.

Correction to: In vitro comparative quality evaluation of different brands of metformin hydrochloride tablets available in Mekelle City, Tigray Regional State, Ethiopia.

Welegebrial Brhane Gebrehiwot BG, Gezae Zenawi Z, Gebrekidan Samrawit Kidanemariam SK, Gebrerufael Gebru Gebremeskel GG et al.