There is tentative evidence that children with recurrent acute otitis media (AOM) who receive tubes have a modest improvement in the number of further AOM episodes (around one fewer episode at six months and less of an improvement at 12 months following the tubes being inserted). Evidence does not support an effect on long-term hearing or language development. A common complication of having a tympanostomy tube is otorrhea, which is a discharge from the ear. The risk of persistent tympanic membrane perforation after children have grommets inserted may be low. It is still uncertain whether or not grommets are more effective than a course of antibiotics.Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea. They are not sufficient for the bacteria that cause this condition and have side effects including increased risk of opportunistic infection. In contrast, topical antibiotic eardrops are useful. Otitis media with effusion
The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including audiometry, tympanogram, temporal bone CT and MRI. Decongestants, glucocorticoids, and topical antibiotics are generally not effective as treatment for non-infectious, or serous, causes of mastoid effusion. Moreover, it is recommended against using antihistamines and decongestants in children with OME. In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as autoinflation.
Its unclear how the plant first arrived in Paris and the details of its origins in Madagascar beyond reports of its transport from Madagascar by early European explorers. Vincristine was initially distributed at cost to increase accessibility, though later switched to a for-profit model to recover the costs of production and development. According to Michael Brown, vincristine may not be a tidy example of pharmaceutical bioprospecting, but it demonstrates how pharmaceuticals with a history of use in folk medicine have intellectual property claims which are difficult to untangle.Since ethnobotanical studies and pharmaceutical bioprospecting depend on traditional knowledge from indigenous communities, the process of sourcing botanical and biological knowledge raises issues of the proper representation of the indigenous and local knowledge. Vincristine and confusion with other drugs in administration
Vincristine has been involved in a number of medical errors. If given into the spine (intrathecal) it causes paralysis and usually death. Multiple instances of it being given wrongly, having been confused with other drugs, have occurred. Research
In 2012, the FDA approved a liposomal formulation of vincristine branded as Marqibo. Marqibo was voluntarily withdrawn from the US market in November, 2021.A nano-particle bound version of vincristine was under development as of 2014. References
External links
"Vincristine". Drug Information Portal. U.S. National Library of Medicine. Vincristine and vinblastine
Description and Natural History of the Periwinkle
The Boger Route to (−)-Vindoline