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Postoperative nausea and vomiting (PONV) represent significant concerns for patients undergoing surgical procedures, as these symptoms greatly impact their postoperative experience. Among female patients undergoing laparoscopic surgery, the incidence of PONV is estimated to be approximately 45%. Moreover, for those individuals who have not undergone preventive treatment, the risk of experiencing PONV can be as high as 80%.Regrettably, despite ongoing efforts, there is still a lack of a fully effective and comprehensive solution to effectively manage and prevent PONV in these patient populations. The pursuit of an ideal strategy for the prevention and management of PONV remains an active area of research and clinical investigation. This prospective, single-center, randomized, double-blind study was conducted at Gansu Provincial Hospital from June 2021 to March 2022, involving a cohort of 100 subjects aged 18–65 years undergoing non-emergent gynaecological laparoscopic surgery. Prior to anesthesia induction, subjects were intravenously administered either 6.25 mg of promethazine or 1 mL of saline. Postoperatively, all subjects received patient-controlled intravenous analgesia and a continuous infusion of metoclopramide at a rate of 50 mg. The primary outcome measures included assessing the incidence of postoperative nausea and vomiting at 72 h following the surgical procedure. The results of this study show that the overall incidence of postoperative nausea and vomiting within 72 h after operation is significantly different between the two groups before. ( P  = 0.026, P  = 0.012). The incidence and severity of nausea during the early period (the first 6 h postoperatively) was significantly different between groups ( P  = 0.043, 95%CI(-0.273,-0.019), P  = 0.048). A statistically significant difference was found in the incidence and severity within 24 h postoperatively ( P  = 0.026,95%CI (-0.348,-0.042), P  = 0.003). Vomiting incidence and severity were lower than in the control group at the 6 h postoperatively but without statistical difference between the two groups ( P  = 0.166, 95%CI(-0.164,0.016) P  = 0.180). Vomiting incidence and severity were statistically different during the 24 h postoperatively ( P  = 0.011, 95%CI(-0.342,-0.048), P  = 0.004). A significant statistical difference was found in the satisfaction between the two groups during the postoperative observation period ( P  = 0.002). The administration of preoperative prophylactic promethazine proved to be notably effective in diminishing both the incidence and severity of postoperative nausea and vomiting within the initial 72 h postoperatively. This intervention demonstrated a favorable safety profile, characterized by a minimal occurrence of adverse effects and an absence of serious adverse reactions. Furthermore, the satisfaction levels of patients undergoing this prophylactic approach were observed to be improved. These findings highlight the potential benefits of preoperative prophylactic promethazine in enhancing the postoperative experience for patients, with positive implications for their overall satisfaction with the surgical procedure.  Clinical Trials Registration Number : (18/12/2021) ChiCTR2100054495.

Envenoming from snakebites is most effectively treated by antivenom. However, the antivenom available in South Asian countries commonly causes acute allergic reactions, anaphylactic reactions being particularly serious. We investigated whether adrenaline, promethazine, and hydrocortisone prevent such reactions in secondary referral hospitals in Sri Lanka by conducting a randomised, double-blind placebo-controlled trial. In total, 1,007 patients were randomized, using a 2 × 2 × 2 factorial design, in a double-blind, placebo-controlled trial of adrenaline (0.25 ml of a 1∶1,000 solution subcutaneously), promethazine (25 mg intravenously), and hydrocortisone (200 mg intravenously), each alone and in all possible combinations. The interventions, or matching placebo, were given immediately before infusion of antivenom. Patients were monitored for mild, moderate, or severe adverse reactions for at least 96 h. The prespecified primary end point was the effect of the interventions on the incidence of severe reactions up to and including 48 h after antivenom administration. In total, 752 (75%) patients had acute reactions to antivenom: 9% mild, 48% moderate, and 43% severe; 89% of the reactions occurred within 1 h; and 40% of all patients were given rescue medication (adrenaline, promethazine, and hydrocortisone) during the first hour. Compared with placebo, adrenaline significantly reduced severe reactions to antivenom by 43% (95% CI 25-67) at 1 h and by 38% (95% CI 26-49) up to and including 48 h after antivenom administration; hydrocortisone and promethazine did not. Adding hydrocortisone negated the benefit of adrenaline. Pretreatment with low-dose adrenaline was safe and reduced the risk of acute severe reactions to snake antivenom. This may be of particular importance in countries where adverse reactions to antivenom are common, although the need to improve the quality of available antivenom cannot be overemphasized.

Postoperative nausea and vomiting (PONV) are undesirable postoperative problems in patients undergoing surgery. However, there is currently no satisfactory solution to this problem. This prospective, single-center, randomized, double-blind, pilot study was conducted at Gansu Provincial Hospital in China. Patients aged 18-65 years who underwent elective colorectal tumor resection were randomly assigned to receive 6.25 mg promethazine or 1 mL saline intravenously before induction of anesthesia. All patients then received postoperative patient-controlled intravenous analgesia and a continuous metoclopramide infusion at 50 mg. The primary endpoint was the incidence and severity of PONV at 6 h, 24 h, 48 h, and 72 h postoperatively. Between June 2021 and March 2022, 96 eligible patients were included in the final analysis, with 48 patients in the promethazine group and 46 in the saline group. The incidence and severity of nausea during the early period (the first 6 hours postoperatively) were significantly different between groups ( = 0.031 and = 0.036). A statistically significant difference was found in the incidence and severity within 24 hours postoperatively ( = 0.023 and = 0.020). The incidence and severity of vomiting were significantly different between groups at 6 h postoperatively ( = 0.043 and = 0.048). Vomiting incidence and severity were statistically different during the 24 hours postoperatively ( = 0.012 and = 0.046). A significant statistical difference was found in the satisfaction between the two groups during the postoperative observation period ( = 0.004). Preoperative prophylactic promethazine significantly reduced the incidence and severity of PONV within 24 hours postoperatively, with few adverse effects and no serious adverse reactions. Additionally, patient satisfaction was also improved.

Promethazine, an antihistamine drug used in the clinical treatment of nausea, has been demonstrated the ability to bind Abeta in a transgenic mouse model of Alzheimer’s disease. However, so far, all of the studies were performed in vitro using extracted tissues. In this work, we report the design and synthesis of a novel [11C]promethazine PET radioligand for future in vivo studies. The [11C]promethazine was isolated by RP-HPLC with radiochemical purity >95% and molar activity of 48 TBq/mmol. The specificity of the probe was demonstrated using human hippocampal tissues via autoradiography.

Promethazine hydrochloride (PMH) is a first-generation antipsychotic drug created from phenothiazine derivatives that is widely employed to treat psychiatric disorders in human healthcare systems. However, an overdose or long-term intake of PMH can lead to severe health issues in humans. Hence, establishing a sensitive, accurate, and efficient detection approach to detect PMH in human samples is imperative. In this study, we designed orthorhombic copper molybdate microspheres decorated on reduced graphene oxide (Cu3Mo2O9/RGO) composite via the effective one-pot hydrothermal method. The structural and morphological features of the designed hybrid were studied using various spectroscopic methods. Subsequently, the electrochemical activity of the composite-modified screen-printed carbon electrode (Cu3Mo2O9/RGO/SPCE) was assessed by employing voltammetric methods for PMH sensing. Owing to the uniform composition and structural benefits, the combination of Cu3Mo2O9 and RGO has not only improved electrochemical properties but also enhanced the electron transport between PMH and Cu3Mo2O9/RGO. As a result, the Cu3Mo2O9/RGO/SPCE exhibited a broad linear range of 0.4–420.8 µM with a low limit of detection (LoD) of 0.015 µM, highlighting excellent electrocatalytic performance to PMH. It also demonstrated good cyclic stability, reproducibility, and selectivity in the presence of chlorpromazine and biological and metal compounds. Furthermore, the Cu3Mo2O9/RGO/SPCE sensor displayed satisfactory recoveries for real-time monitoring of PMH in human urine and serum samples. This study delivers a promising electrochemical sensor for the efficient analysis of antipsychotic drug molecules.

Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD. Meniere's disease is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. In this Primer, Nakashima et al . give an overview of the complex aetiology, classification systems, diagnostic tools and management strategies.

Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists. A pragmatic randomised open trial (September 2018-July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg. Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47-1.50]. Neither intervention consistently impacted the outcome of 'calm', or 'asleep' and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.

Melioidosis is a severe infectious disease caused by Burkholderia pseudomallei, an intracellular pathogen with a high mortality rate and significant antibiotic resistance. The high mortality rate and resistance to antibiotics have drawn considerable attention from researchers studying melioidosis. This study evaluated the effects of various concentrations (75, 50, and 25 µg/mL) of promethazine hydrochloride (PTZ), a potent antihistamine, on biofilm formation and lipase activity after 24 h of exposure to B. thailandensis E264. A concentration-dependent decrease in both biofilm biomass and lipase activity was observed. RT-PCR analysis revealed that PTZ treatment not only made the biofilm structure loose but also reduced the expression of btaR1, btaR2, btaR3, and scmR. Single gene knockouts of quorum sensing (QS) receptor proteins (∆btaR1, ∆btaR2, and ∆btaR3) were successfully constructed. Deletion of btaR1 affected biofilm formation in B. thailandensis, while deletion of btaR2 and btaR3 led to reduced lipase activity. Molecular docking and biological performance results demonstrated that PTZ inhibits biofilm formation and lipase activity by suppressing the expression of QS-regulated genes. This study found that repositioning PTZ reduced biofilm formation in B. thailandensis E264, suggesting a potential new approach for combating melioidosis.Key PointsRepurposing promethazine hydrochloride to inhibit biofilms formation.Promethazine hydrochloride suppressed the expression of QS-regulated genes.The deletion of btaR1 affected the biofilm formation of B. thailandensis.

A simple, sensitive, and effective adsorptive stripping voltammetric sensor for the detection of trace-level promethazine was created based on a gold nanoparticle-graphene nanoplatelet-modified glassy carbon electrode (AuNP-GrNP/GCE). AuNP-GrNP nanocomposites were synthesized using an electroless deposition process, and the morphology was characterized using UV-vis spectroscopy, Fourier transform infrared spectroscopy, field emission scanning electron microscopy, and energy-dispersive X-ray spectroscopy. The electrochemical behavior and detection of promethazine at the AuNP-GrNP/GCE were investigated utilizing cyclic voltammetry and adsorptive stripping voltammetry. The AuNP-GrNP/GCE showed outstanding synergistic electrochemical activity for promethazine oxidation, a highly active surface area, great adsorptivity, and outstanding catalytic properties. The electrolyte pH, amount of AuNP-GrNP nanocomposite, preconcentration potential (vs. Ag/AgCl), and time were optimized to obtain a high performance electrochemical sensor. Under optimal conditions, the proposed sensor displayed two linear concentration ranges from 1.0 nmol L −1 to 1.0 μmol L −1 and from 1.0 to 10 μmol L −1 . The limits of detection and quantitation were 0.40 and 1.4 nmol L −1 , respectively. This sensor displayed high sensitivity, a capability for rapid analysis, and excellent repeatability and reproducibility. The developed sensor was effective and practical for promethazine detection in biological fluids and forensic samples, and the obtained results exhibited excellent agreement with the results obtained using the method described in the British Pharmacopoeia. Graphical abstract

Since most first-generation antihistamines have undesirable sedative effects on the central nervous systems (CNS), newer (second-generation) antihistamines have been developed to improve patients’ quality of life. However, there are few reports that directly compare the antihistaminic efficacy and impairment of psychomotor functions. We designed a double-blind, placebo controlled, crossover study to concurrently compare the clinical effectiveness of promethazine, a first-generation antihistamine, and fexofenadine and olopatadine, second-generation antihistamines, by measuring their potency as peripheral inhibitors of histamine-induced wheal and flare. Further, we investigated their sedative effects on the CNS using a battery of psychomotor tests. When single therapeutic doses of fexofenadine (60 mg), olopatadine (5 mg) and promethazine (25 mg) were given in a double-blind manner to 24 healthy volunteers, all antihistamines produced a significant reduction in the wheal and flare responses induced by histamine. In the comparison among antihistamines, olopatadine showed a rapid inhibitory effect compared with fexofenadine and promethazine, and had a potent effect compared with promethazine. In a battery of psychomotor assessments using critical flicker fusion, choice reaction time, compensatory tracking, rapid visual information processing and a line analogue rating scale as a subjective assessment of sedation, promethazine significantly impaired psychomotor function. Fexofenadine and olopatadine had no significant effect in any of the psychomotor tests. Promethazine, fexofenadine and olopatadine did not affect behavioral activity, as measured by wrist actigraphy. These results suggest that olopatadine at a therapeutic dose has greater antihistaminergic activity than promethazine, and olopatadine and fexofenadine did not cause cognitive or psychomotor impairment.