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While debates are taking place on the medical use of cannabis, debates about ketamine have heated the global medical community in recent months.
Many of us might be aware of China’s long push to make this substance a List IV substance through the United Nations Commission on Narcotic Drugs (UNCND). This, after failing to place it as a List I (even more restrictive) under the 1971 Convention on Psychotropic Substances. Such a move would leave it with very limited access, especially in developing countries with vulnerable access to anaesthetics.
The country made the request in the context of the drug being used as a recreational drug in China and more widely across the East Asian region, where trafficking and misuse is increasing exponentially. However Ketamine is currently the most common and essential anesthetic substance in low-income countries. Since morphine and morphine related anaesthetics are more regulated, morphine use is often impossible in those countries with limited financial, legal, bureaucratic and logistical resources.
Now, with a toughened regulation of ketamine, the implications are:
- Annual estimates of scientific and medical needs must be submitted to the INCB (International Narcotics Control Board) for their validation.
- Limitation on estimates for production, exports and imports.
- Securitization of the supply chain through a system of authorized handling personnel.
- Medical prescription for its issuance for scientific/medical use.
- Report to the INCB all quantities imported, exported, produced and consumed.
- Build, maintain and monitor an inspection system for stocks and supply chains.
- Strategic planning, application and monitoring for tackling misuse.
However, in countries where electricity access remains difficult, stocks can not be regulated down to the nearest milligram, which would create a access barrier of the substance. In situations in which because of the already limited resource, ketamine is the most common (if not the only) method of anesthesia, the establishment of these regulations and maintenance of such control systems are massively disrupting. Furthermore, without Ketamine, surgeries in such low-income settings may stop being performed, or if so, it will push doctors in their health systems to perform risky and painful surgeries necessary.
Although the WHO has rejected this restriction requests through vetos, and the work done within WHO and UNDC by doctors to prevent any damaging ruling continues (in particular I can refer to the work of international researchers, especially J. Nickerson of the Bruyère Research Institute in Ottawa) China withdrew its proposals for further analysis, but this attempts are far from settled. The debate is still active, and any attempts that are not met by a mobilized medical community could jeopardize access to anesthesia to 5.5 billion people… Can any of you share (especially those in anesthesiology) how you´re keeping connected and active to deter this process in your local/national/international networks? Thanks to all.
Hi everyone, this is more of an open question and reflexion.
After a few exchanges with patients, it has come to my attention again a 2013 study titled “Effect of increased potassium intake on cardiovascular risk and disease factors: a systematic review and meta-analyzes”. Here the link:
While our ancestors’ arguably included in their eating habits about a daily potassium intake of 200ml, present day societies to my knowledge are seeing a surge in hypokalemia cases. This deficiency could be due to the massification of processed foods, with people tending to go for the chocolate bar over the fruit. I have come across a wave of new studies on the role of potassium in lowering blood pressure values. Potassium is hence an effective component in the prevention and treatment of hypertension. Stroke, kidney failure, cardiovascular risks .... We all know the dramatic consequences from these conditions but I think we often underestimate how this awareness is not necessarily still widespread amongst patients. Hypertensive subjects who are more comfortable coping and living their everyday lives with their hypertension tend to abandon their treatment but are also more likely to change their diets, if given specific “hacks” of what to eat. If they are advised to consume more potassium with clear food examples, there is a good chance that they prefer to follow this rather than following their (pharmacological) treatment. I guess potassium intake in this way, has an insidious effect on high blood pressure and it does not overwhelm patients too much. So do not hesitate to “prescribe” and encourage patients to eat a banana or a fruit of their choice more frequently and on a daily basis!
Whats your experience with this? Should we at least keep our patients informed on fruits and vegetables as a form of prevention and solution to certain conditions? Have you found this to be effective in cases where treatment compliance fails or is intermittent? Has this been effective in their control readings for their pathologies.
Thanks all for any reflections!
I have been treating a 28-year-old patient, male, with severe allergic asthma for a while. The patient has many food allergies, plus allergic reaction to dust mites, mold and almost all types of pollen. It is almost impossible for him to avoid allergens. Even with long-acting beta-adrenoceptor agonist (LABA) or glucocorticoid therapy, severe asthma attacks are common, and day-to-day life is severely disrupted.
I am studying the possibility of prescribing Omalizumab, a monoclonal antibody targeted at immunoglobulin E. However, I have no experience with this treatment and am at the moment somewhat reserved. I read that this treatment poses a risk of developing malignant tumors and that the drug could cause anaphylactic adverse reactions. Treatment costs are also of concern.
Are you in favor of prescribing this medicine?
Thanks for your help.
In February 2014, the journal "Neuropsychopharmacology" published results from a research conducted at the Charité University Hospital in Berlin about cortisol’s capacity to influence feelings of compassion.
We know that cortisol activates the mineralocorticoid and glucocorticoid receptors in the brain. For the study, the participants' mineralocorticoid receptors were stimulated with fludrocortisone. Stimulated participants reacted with significantly more empathy than the control group.
The pharmacological effect of feeling more compassion could be used for the treatment of psychiatric disorders. My questions to colleagues is, which pathologies do you believe may be relevant from a therapeutic perspective for the application of cortisol treatment given this finding?+
Could people in non-pathological or asymptomatic mental health also benefit from this potential?
Thanks for any opinions. Here's the link to the article in question
Hi am looking for a scientific article that addresses the topic of aortic disease, in particular references for thoracic/thoracic abdominal aneurysms are greatly appreciated. Especially articles that address these subjects with in-depth focus on its development and studies based on ultrasound methods.
Thank you for your help.
Hi, I’m a general practitioner and need an opinion on one of my patients.
She is a 55-year-old morbidly obese female, with a BMI of 42 in need of bariatric care. The patient has already undergone LAGB with a therapeutic failure event 10 years ago. Her dietary history includes multiple regimes and the patient has had several cycles of weight loss and gain. Comorbidities include hypertension and type 2 diabetes (insulin independent), both treated and evolving within normal values.
My question to colleagues is if this patient would benefit from a new bariatric surgery intervention despite the previous incidence of LAGB failure? If so, what type could she have as the best option? Or would any of you recommend a trial of psychological treatment associated with dietary management before a surgical intervention?
Thank you in advance for your comments!
Yours sincerely, AP
Could any of you provide feedback on your experience with Tramadol ODs? In particular, instances of management with naloxone, and without association to alcohol intake.