Assuntos
Infecções por Helicobacter/diagnóstico por imagem , Infecções por Helicobacter/terapia , Helicobacter pylori , Úlcera Péptica/diagnóstico por imagem , Úlcera Péptica/terapia , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Gastroenterologia/normas , Alemanha , Infecções por Helicobacter/virologia , Humanos , Resultado do TratamentoAssuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Inibidores de Ciclo-Oxigenase/administração & dosagem , Inibidores de Ciclo-Oxigenase/efeitos adversos , Gastroenteropatias/induzido quimicamente , Doenças Reumáticas/tratamento farmacológico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Medicina Baseada em Evidências , Gastroenteropatias/imunologia , Gastroenteropatias/prevenção & controle , Humanos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/imunologia , Resultado do TratamentoRESUMO
In the line "bismuth-containing quadruple therapy" of Table 7 (p 342), in the column "dosage" incorrectly at the three antibiotics respectively 1-1-1-1. The correct is: 3-3-3-3.
RESUMO
NSAIDs exert their anti-inflammatory and analgesic effects by inhibition of COX2, a key enzyme for proinflammatory prostanoid synthesis. Therapy with NSAIDs is limited by their typical gastrointestinal, cardiovascular and renal side effects, which are caused by inhibition of COX1 (gastrointestinal toxicity), COX2 (cardiovascular side effects) or both COX-isoenzymes (renal side effects). Appropriate prevention strategies should be employed in patients at risk. If gastrointestinal risk factors are present, co-administration of a proton pump inhibitor or misoprostol is recommended; in patients with cardiovascular risk, coxibs, diclofenac and high-dose ibuprofen should be avoided. Furthermore, drug interactions and contraindications should be considered. In patients with renal impairment (GFR < 30 ml/min) all NSAIDs must be avoided. Ulcer anamnesis is a contraindication for traditional NSAIDs. Preexisting cardio- or cerebrovascular diseases are contraindications for coxibs. Treatment decisions should be individually based with a continuous monitoring of the risk - benefit ratio and exploitation of non-pharmacological treatment options.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Hemorragia Gastrointestinal/prevenção & controle , Guias de Prática Clínica como Assunto , Reumatologia/normas , Anti-Inflamatórios não Esteroides/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Hemorragia Gastrointestinal/induzido quimicamente , Alemanha , Humanos , Medição da Dor/efeitos dos fármacos , Medição da Dor/normas , Resultado do TratamentoRESUMO
The irradiation facility at an old medical cyclotron (Ep=17 MeV; Ed=10 MeV) was upgraded by extending the beam line and incorporation of solid state targetry. Tests performed to check the quality of the available beam are outlined. Results on nuclear data measurements and improvement of radiochemical separations are described. Using solid targets, with the proton beam falling at a slanting angle of 20°, a few radionuclides, e.g. (75)Se, (120)I, (124)I, etc. were produced with medium currents (up to 20 µA) in no-carrier-added form in quantities sufficient for local use. The extended irradiation facility has considerably enhanced the utility of the medical cyclotron.
Assuntos
Ciclotrons/instrumentação , Marcação por Isótopo/instrumentação , Compostos Radiofarmacêuticos/síntese química , Desenho de Equipamento , Análise de Falha de Equipamento , Marcação por Isótopo/métodos , Doses de RadiaçãoRESUMO
BACKGROUND: This prospective study evaluated the relationship between arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer. PATIENTS AND METHODS: COMPliance and Arthralgia in Clinical Therapy (COMPACT) was an open-label, multicenter, noninterventional study conducted in Germany. Patients had started adjuvant anastrozole 3-6 months before the study start. The primary end points were arthralgia, compliance, and the relationship between compliance and arthralgia, assessed at specific time points. RESULTS: Overall, 1916 patients received upfront anastrozole. Mean arthralgia scores were increased from baseline at each visit up to 9 months. Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months (P<0.001). At 9 months, investigators estimated that >95% of patients were compliant versus patient reports of <70%. There was a significant association between arthralgia mean scores and noncompliance at 6 months (P<0.0001), 9 months (P<0.0001), and overall (P<0.0001). Over time, new events or impairment of existing arthralgias were reported in 14% (3 months), 11% (6 months), and 9% (9 months) of patients. CONCLUSION: Arthralgia is important in the clinical management of women with early breast cancer and may contribute to noncompliance and clinical outcomes. CLINICALTRIALSGOV IDENTIFIER: NCT00857012.
Assuntos
Antineoplásicos Hormonais/efeitos adversos , Artralgia/epidemiologia , Neoplasias da Mama/tratamento farmacológico , Nitrilas/efeitos adversos , Triazóis/efeitos adversos , Idoso , Anastrozol , Antineoplásicos Hormonais/uso terapêutico , Artralgia/induzido quimicamente , Quimioterapia Adjuvante , Substituição de Medicamentos , Feminino , Humanos , Incidência , Adesão à Medicação , Pessoa de Meia-Idade , Nitrilas/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento , Triazóis/uso terapêuticoRESUMO
The treatment of musculoskeletal pain is often difficult. For this reason opioids are increasingly being used for chronic musculoskeletal complaints despite poor or lacking evidence for their pain relieving and function improving effects. However, side effects are common and can be severe. Opioid-induced hyperalgesia can lead to higher doses and stronger pain and increase the risk of side effects. Long-term treatment of rheumatic pain with opioids should be carried out with caution.
Assuntos
Analgésicos Opioides/uso terapêutico , Artralgia/etiologia , Artralgia/prevenção & controle , Cuidados Paliativos/normas , Febre Reumática/complicações , Febre Reumática/tratamento farmacológico , Reumatologia/normas , Analgésicos Opioides/efeitos adversos , Alemanha , HumanosRESUMO
Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3-6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.
Assuntos
Algoritmos , Antirreumáticos/administração & dosagem , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Guias de Prática Clínica como Assunto , Reumatologia/normas , Antirreumáticos/efeitos adversos , Europa (Continente) , HumanosRESUMO
This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.
Assuntos
Gastroenterite/diagnóstico , Gastroenterite/terapia , Gastroenterologia/normas , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/terapia , Helicobacter pylori , Úlcera Péptica/diagnóstico , Úlcera Péptica/terapia , Alemanha , HumanosRESUMO
This guideline updates a prior concensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE) and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based consensus guideline of S 3 level and has also implemented grading criteria according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics and therapy were taken into account.
Assuntos
Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Medicina Baseada em Evidências , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Úlcera Péptica/tratamento farmacológico , Adolescente , Adulto , Criança , Estudos Transversais , Quimioterapia Combinada , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastroscopia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , Linfoma de Células B/patologia , Linfoma de Células B/prevenção & controle , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/prevenção & controle , Estadiamento de Neoplasias , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/patologia , Neoplasias Gástricas/prevenção & controleAssuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Artrite Reumatoide/etiologia , Quimioterapia Combinada , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
It is well documented that the aromatase inhibitors (AIs) are superior to tamoxifen as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia has been observed during AI treatment. Concerns have been raised that AI-induced arthralgia may dissuade patients from completing their full AI treatment course, and may also deter physicians from prescribing an AI if they feel that patients may be at risk of permanent joint damage. Patient education about the possibility of experiencing arthralgia, and effective management of symptoms if they appear, are important in helping patients adhere to AI treatment, and consequently improving breast cancer outcomes. In this paper, we discuss the potential mechanisms behind AI-induced arthralgia, review the frequency with which arthralgia occurs, and propose for the first time an algorithm specifically for the treatment of AI-induced arthralgia. As with joint pain in non-breast cancer patients, a sequential approach to disease management is recommended, involving modifying the patient's lifestyle in addition to taking a stratified approach to pharmacological intervention with analgesia and anti-inflammatory medication. Knowing that joint symptoms can be managed in most patients may encourage patient-physician communication and treatment compliance.
Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Artralgia/induzido quimicamente , Neoplasias da Mama/tratamento farmacológico , Algoritmos , Anti-Inflamatórios não Esteroides/uso terapêutico , Artralgia/tratamento farmacológico , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Feminino , Humanos , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Educação de Pacientes como AssuntoAssuntos
Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Osteoartrite/tratamento farmacológico , Osteoartrite/fisiopatologia , Dor/tratamento farmacológico , Dor/etiologia , Administração Cutânea , Administração Oral , Anti-Inflamatórios não Esteroides/administração & dosagem , Buprenorfina/administração & dosagem , Buprenorfina/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Humanos , Naloxona/uso terapêutico , Fatores de Risco , Tilidina/administração & dosagem , Tilidina/uso terapêutico , Tramadol/administração & dosagem , Tramadol/uso terapêuticoRESUMO
Treatment of pain in rheumatoid arthritis must take into account the gastrointestinal and cardiovascular risk of individual patients. Adequate results are not yet available, and until they are, treatment recommendations must take into account, not only the more favourable gastrointestinal risk profile of selective COX-2 inhibitors, but also the potential atherothrombotic risk of any NSAID or selective COX-2 inhibitor treatment.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aterosclerose/induzido quimicamente , Trombose/induzido quimicamente , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Inibidores de Ciclo-Oxigenase/efeitos adversos , Humanos , Tromboxano A2/metabolismoRESUMO
Recommendations for treatment with NSAIDs that take into account the latest study results must note that both the duration of treatment and the NSAID dose must be kept as small as possible. Elevated gastrointestinal risk is the rationale for the use of selective COX-2 inhibitors in place of conventional NSAIDs, or, where indicated, co-medication with a proton pump inhibitor. A manifest cardiovascular risk is aggravated by the use of coxibs, but probably also by the administration of traditional NSAIDs. Cardioprotective medication in the form of low-dose acetyl salicylic acid can probably reduce the cardiovascular risk, but at the same time increases the gastrointestinal risk. In such cases, proton pump inhibitors can offer some relief. However, the latter have no effect on the situation in the lower gastrointestinal tract. In patients with an elevated cardiovascular risk, the use of coxibs, and probably also NSAIDs for the treatment of pain, is problematical. The decision on what treatment to apply should be made on the basis of a benefit/risk assessment, and consideration should be given to alternative therapeutic strategies.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Antirreumáticos/efeitos adversos , Aspirina/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Ensaios Clínicos como Assunto , Inibidores de Ciclo-Oxigenase/efeitos adversos , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/prevenção & controle , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Inibidores da Bomba de Prótons , Medição de Risco , Fatores de RiscoAssuntos
Inibidores de Ciclo-Oxigenase/normas , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/economia , Arteriosclerose/prevenção & controle , Inibidores de Ciclo-Oxigenase/efeitos adversos , Inibidores de Ciclo-Oxigenase/economia , Trato Gastrointestinal/efeitos dos fármacos , Humanos , Inibidores da Bomba de Prótons , Fatores de RiscoAssuntos
Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Isoxazóis/efeitos adversos , Lactonas/efeitos adversos , Doenças Reumáticas/tratamento farmacológico , Sulfonamidas/efeitos adversos , Sulfonas/efeitos adversos , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Qualidade de Produtos para o Consumidor , Inibidores de Ciclo-Oxigenase/efeitos adversos , Inibidores de Ciclo-Oxigenase/uso terapêutico , Aprovação de Drogas , Alemanha , Humanos , Isoxazóis/uso terapêutico , Lactonas/uso terapêutico , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Sulfonamidas/uso terapêutico , Sulfonas/uso terapêuticoAssuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Isoxazóis/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/efeitos adversos , Europa (Continente) , Humanos , Isoxazóis/efeitos adversos , Leflunomida , Metotrexato/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sulfassalazina/uso terapêutico , Resultado do TratamentoRESUMO
The leading symptom of arthrosis and arthritis is pain. As in the case of pharmacotherapy fortumor pain, a stepped approach is also recommended for rheumatic complaints. Mild-to-moderate pain in noninflammatory arthrosis can be ameliorated by paracetamol or low-dose ibuprofen. If inflammation is present, nonsteroidal anti-inflammatory drugs (NSAIDs) must be employed. If this treatment does not suffice to manage systemic arthritis, oral short-acting corticosteroids are applied. Intra-articular corticosteroid injections can be used to individual inflamed active joints. For chronic pain, opioids may be necessary in addition to NSAID treatment. The use of NSAIDs is limited by gastrointestinal side effects. In the case of risk patients, therefore, preventive measures must be taken, and PPI or, instead of NSAIDs, coxibs employed in addition.