Opioids are the mainstay of therapy for SCD-related pain. However, a subset of patients report continued pain despite escalating doses of opioids. Tolerance and opioid-induced hyperalgesia (OIH) have been considered as possible explanations for this phenomenon. The activation of the N-methyl-d-aspartate (NMDA) receptor has been implicated in both tolerance and OIH. As a NMDA receptor agonist, ketamine has been shown to modulate opioid tolerance and OIH in animal models and clinical settings. Low-dose ketamine,

by virtue of its NMDA receptor agonist activity, could be a useful adjuvant to opioid therapy in patients with refractory SCD-related pain. Based on limited studies of adjuvant ketamine use for pain management,

SBE-β-CD nmr low-dose ketamine continuous infusion appears safe. Further clinical investigations are warranted to fully support the use of low-dose ketamine infusion in patients with SCD-related pain.”
“Background: Since the GSK2126458 purchase introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, the need for additional serotype coverage has become clear. Our objective was to assess the potential serotype coverage of PCV7 and of the 2 experimental conjugate vaccines, 10-valent (PCV10) and 13-valent (PCV13), against invasive pneumococcal disease (IPD), acute otitis media (AOM), acute conjunctivitis (AC), and pneumococcal carriage in southern Israel, where PCV7 had not yet been introduced at the time of the study.

Methods: Data on isolates were obtained prospectively front children <36 months during 2000-2004. The potential coverage of the PCVs was calculated and analyzed separately for antibiotic-resistant strains.

Results: A total of 5497 isolates were collected: 189 from blood or cerebrospinal fluid, 3197 from middle ear fluid, 348 Go 6983 in vivo from the conjunctiva, and 1763 from the

nasopharynx of healthy children. The serotype coverage of PCV7 for IPD, AOM, AC, and carriage was 44%, 54%, 37%, and 46%, respectively. Serotypes included in PCV7 caused 47 IPD cases per 100,000 children <3 years (54 per 100,000 if serotype 6A is included). PCV10 extended mainly the coverage of IPD, while addition of serotypes 6A and 19A to PCV13 increased the coverage substantially in all entities (84%, 79%, 54%, and 67% in IPD, AOM, AC, and carriage, respectively). PCV13 could prevent >90% of penicillin-, macrolide-, and multidrug-resistant strains associated with IPD and AOM.

Conclusions: PCV7 can substantially decrease pneumococcal disease and carriage in Israel, but PCV 10 and PCV 13 have a significant added benefit. Moreover, PCV 13 has an important potential added benefit over PCV7 and PCV10 in reducing disease by drug-resistant Streptococcus pneumoniae.”
“The study in particular relates to a process for modifying surface of polymeric membrane and their biocidal activities.