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Abstract: Suspected perioperative hypersensitivity reactions are rare but contribute significantly to the morbidity and mortality of surgical procedures. Recent publications have highlighted the differences between countries concerning the respective risk of different drugs, and changes in patterns of causal agents and the emergence of new allergens. This review summarises recent information on the epidemiology of perioperative hypersensitivity reactions, with specific consideration of differences between geographic areas for the most frequently involved offending agents.
Keywords: anaphylaxis, anti-bacterial agents, blood, chlorhexidine, latex, neuromuscular blocking agents, hypersensitivity, drug hypersensitivity, sugammadex, antibiotics, blood products, perioperative anaphylaxis, perioperative hypersensitivity
Published in DiRROS: 16.10.2020; Views: 1425; Downloads: 361
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Abstract: Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1-9) and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more) and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.
Keywords: alergy and immunology, anesthesia, anaphylaxis, drug hypersensitivity, drug-related side effects and adverse reactions, perioperative period, surgery, operative surgical procedures
Published in DiRROS: 09.10.2020; Views: 1770; Downloads: 334
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Abstract: Venom immunotherapy is the standard of care for people with severe reactions and has been proven to reduce risk of future anaphylactic events. There is a moral imperative to ensure production, supply and worldwide availability of locally relevant, registered, standardized commercial venom extracts for diagnosis and treatment. Insects causing severe immediate allergic reactions vary by region worldwide. The most common culprits include honeybees (Apis mellifera), social wasps including yellow jackets (Vespula and Dolichovespula), paper wasps (Polistes) and hornets (Vespa), stinging ants (Solenopsis, Myrmecia, Pachycondyla, and Pogonomyrmex), and bumblebees (Bombus). Insects with importance in specific areas of the world include the Australian tick (Ixodes holocyclus), the kissing bug (Triatoma spp), horseflies (Tabanus spp), and mosquitoes (Aedes, Culex, Anopheles). Reliable access to high quality venom immunotherapy to locally relevant allergens is not available throughout the world. Many current commercially available therapeutic vaccines have deficiencies, are not suitable for, or are unavailable in vast areas of the globe. New products are required to replace products that are unstandardized or inadequate, particularly whole-body extract products. New products are required for insects in which no current treatment options exist. Venom immunotherapy should be promoted throughout the world and the provision thereof be supported by health authorities, regulatory authorities and all sectors of the health care service.
Keywords: allergy and immunology, venoms, Hymenoptera, bee venoms, wasp venoms, insecta, ants hornet, bumblebee, mosquitoes, venom immunotherapy, immunologic desensitization
Published in DiRROS: 23.09.2020; Views: 1788; Downloads: 1065
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Keywords: medicinska konoplja, Slovenija, kanabinoidi, zakonodaja, medicina
Published in DiRROS: 15.06.2020; Views: 2066; Downloads: 600
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Abstract: In the presented research, we studied the forest edge structure of urban and peri-urban forests on the outskirts of Ljubljana (Slovenia) consisting of a number of patches covering the collective surface of 1884 ha. They differ from each other according to the degree of fragmentation and by the share of the interior forest area. On the basis of LiDAR data, we conducted an analysis of the edges of the persistent forest patches and estimated them with regard to the land use they bordered on. The horizontal estimation of forest edges and the changes of forest edges, in the last decades, were estimated using digital orthophoto images of cyclic aerial surveys of Slovenia, from 1975 to 2018. The data, provided by LiDAR, were used to obtain an accurate estimate of forest edges and the metrics of their vertical canopy structure. On the basis of the canopy height model (CHM), we determined the height classes, the heights of the tallest trees, and indices of canopy height diversity (CHD) as variables subjected to a k-means cluster analysis. To determine the forest edge and trees stability, their heights and diameters at breast height (DBH) were measured and their canopy length and h/d (height/diameter) dimension ratios were estimated. In the study area of the Golovec forest patch, more than half of the forest edge segments (56%) border on residential buildings. After the construction of buildings, 54% of the newly formed forest edges developed a high and steep structure. Unfavorable h/d dimension ratio was estimated for 16% of trees, more among the coniferous than among the deciduous trees. Similar characteristics of newly formed forest edges bordering on built-up areas were determined in other sub-urban forest patches, despite the smaller share of such forest edges (19% and 10%, respectively). Tools and methods presented in the research enable the implementation of concrete silvicultural practices in a realistic time period and extend to ensure that adequate forestry measures are taken to minimize possible disturbances.
Keywords: forest ecosystem services, forest edge stability, forest edge structure, LiDAR, urban forests
Published in DiRROS: 26.05.2020; Views: 1922; Downloads: 1042
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