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1.
J Vet Pharmacol Ther ; 47(3): 157-167, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38151755

RESUMO

Alfaxalone is a commonly employed veterinary anaesthetic induction and sedation agent. A 4% w/v preserved, aqueous formulation of alfaxalone 'RD0387' (A4%) has recently been developed. To evaluate the sedative effects of A4%, three doses, 5 mg kg-1 (A5); 7.5 mg kg-1 (A7.5) and 10 mg kg-1 (A10) were administered intramuscularly into the epaxial musculature of six healthy adult mixed-breed dogs in an experimental, randomized, blinded, crossover study. Sedation time variables, quality of sedation (including onset of sedation and recovery), physiological variables, response to cephalic vein catheterization and frequency of undesirable events were recorded. Continuous variables were analysed between treatments (one-way ANOVA or restricted maximum likelihood modelling) and within treatments compared with baseline (Tukey's test). Categorical data were analysed between treatments (Kruskal-Wallis' test) and within treatments from baseline (Dunn's test). Significance was set at p < .05. All dogs became sedated (laterally recumbent) and sedation onset was significantly faster in groups A7.5 (9.8 ± 5.3 min) and A10 (9.1 ± 5.6 min) compared to A5 (25.6 ± 16.1 min) (p = .033, p = .027, respectively). Duration of sedation was significantly longer in A10 (168.5 ± 70.6 min) and A7.5 (143.8 ± 58 min) compared to A5 (63.8 ± 28.2 min) (p = .005 and p = .003, respectively). Dogs in A10 had a superior quality of onset of sedation compared to A5 (p = .028). Sedation scores and quality of recovery from sedation were not significantly different between doses. Two dogs (2/6) in A5 were insufficiently sedated for cephalic catheterization. Ataxia was the most frequently observed undesirable event with an overall frequency of 78% (14/18) and 89% (16/18) during sedation onset and recovery, respectively. Overall, A4% administered IM in dogs at 7.5 and 10 mg kg-1 resulted in sufficient sedation for IV catheterization in dogs. To improve the speed and quality of the sedation, it is recommended that future research focuses on combining A4% with other sedative or analgesic drugs.


Assuntos
Estudos Cross-Over , Hipnóticos e Sedativos , Pregnanodionas , Animais , Cães , Pregnanodionas/administração & dosagem , Pregnanodionas/farmacologia , Injeções Intramusculares/veterinária , Masculino , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Feminino , Relação Dose-Resposta a Droga
2.
Orbit ; 43(2): 222-230, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37978819

RESUMO

PURPOSE: To explore if orbital fat-to-muscle ratio (FMR) is predictive of whether surgical decompression or teprotumumab leads to greater proptosis reduction in thyroid eye disease (TED). METHODS: A single-center retrospective cohort study comparing surgical decompression with teprotumumab according to FMR. All TED patients completing an 8-dose course of teprotumumab between January 2020 and September 2022 and all patients undergoing bony orbital decompression from January 2017 to December 2019 were included. Subjects were excluded if they were <18 years, received both surgical decompression and teprotumumab, or lacked orbital imaging. The primary exposure variable was teprotumumab or surgical decompression. The secondary exposure variable was baseline FMR. The primary outcome measure was change in proptosis (mm). RESULTS: Thirty-eight patients, mean age 53.5 years (±11.4), were included in the teprotumumab group and 160 patients, mean age 48 years (±11.1), in the surgical group. Average proptosis reduction after teprotumumab and surgical decompression was 3 mm (±1.44) and 5 mm (±1.75), respectively. The FMR was stratified at the median of 1.80. In subjects with FMR < 1.80, teprotumumab showed equivalent proptosis reduction compared to surgical decompression, -0.33 mm (SE 1.32) p = .802. In subjects with FMR ≥ 1.80, surgical decompression led to significantly more proptosis reduction than teprotumumab, 3.01 mm (SE 0.54), p < .001. CONCLUSIONS: Baseline FMR can be used to counsel patients as to proptosis reduction with teprotumumab versus surgery. Subjects with low FMR obtain comparable proptosis reduction with teprotumumab or surgery, whereas high FMR is associated with more significant proptosis reduction following surgery over teprotumumab.


Assuntos
Anticorpos Monoclonais Humanizados , Exoftalmia , Oftalmopatia de Graves , Humanos , Pessoa de Meia-Idade , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/cirurgia , Estudos Retrospectivos , Exoftalmia/cirurgia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Músculos Oculomotores/cirurgia , Descompressão Cirúrgica/métodos
3.
Clin Infect Dis ; 76(4): 741-744, 2023 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-35684960

RESUMO

We describe a case of relapsing babesiosis in an immunocompromised patient. A point mutation in the Babesia microti 23S rRNA gene predicted resistance to azithromycin and clindamycin, whereas an amino acid change in the parasite cytochrome b predicted resistance to atovaquone. Following initiation of tafenoquine, symptoms and parasitemia resolved.


Assuntos
Aminoquinolinas , Babesiose , Humanos , Atovaquona , Babesiose/tratamento farmacológico , Recidiva , Aminoquinolinas/uso terapêutico , Resistência a Medicamentos/genética , RNA Ribossômico 23S/genética
4.
J Neuroophthalmol ; 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38117577

RESUMO

BACKGROUND: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for patients with motor symptoms of Parkinson disease but can be complicated by disabling blepharospasm and apraxia of eyelid opening (ALO). Currently, there is no clear consensus on optimal management, and addressing these issues is further hindered by systemic morbidity and resistance to treatments. We aim to describe the different phenotypes of these eyelid movement disorders, to report our management approach and patient responses to treatment. METHODS: A retrospective case series of all patients with blepharospasm/ALO secondary to STN-DBS that were treated at a tertiary center between 2011 and 2020. Data collected included date of Parkinson diagnosis, date of DBS surgery, date of development of blepharospasm/ALO symptoms, STN-DBS stimulation settings, and treatment given. Patients' symptoms before and after treatment were measured using the blepharospasm disability index and Jankovic Rating Scale. RESULTS: Five patients were identified with eyelid movement disorders secondary to STN-DBS. All patients had moderate-to-severe symptoms at presentation. Four patients received periocular botulinum toxin injections. Three patients underwent surgery in the form of frontalis suspension or direct brow lift with or without upper lid blepharoplasty. All reported an improvement in symptoms following treatment. CONCLUSIONS: A multimodality, patient-specific approach is required in the treatment of blepharospasm/ALO secondary to STN-DBS. Botulinum toxin injections can be effective, but patients may require surgery if toxin treatment alone becomes ineffective. Tailoring treatment to individual needs can result in a measurable improvement in symptoms.

5.
Ophthalmic Plast Reconstr Surg ; 39(6): e208-e210, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37656913

RESUMO

The authors report 4 cases of cutaneous hypersensitivity reactions developing in the course of teprotumumab treatment for thyroid eye disease. The onset of the cutaneous hypersensitivity reaction was also observed during the treatment course in all cases, between the second and fifth infusions. Teprotumumab-related cutaneous reactions suggest a possible immunogenic component of the monoclonal antibody and highlight the importance of close monitoring during treatment.


Assuntos
Anticorpos Monoclonais Humanizados , Oftalmopatia de Graves , Humanos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais
6.
Ophthalmic Plast Reconstr Surg ; 39(1): e15-e17, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36095845

RESUMO

Subconjunctival hemorrhages commonly present to eye care professionals and are frequently regarded as benign self-limited conditions. In selected cases, subconjunctival hemorrhages can be a harbinger of more severe disease. Perivascular epithelioid cell tumors, or PEComas, are rare mesenchymal neoplasms believed to originate from perivascular myoid cells and are rarely present in ocular structures. We present a rare case of a conjunctival perivascular epithelioid cell tumor that initially presented with recurrent subconjunctival hemorrhage. To our knowledge, this is the first description of a PEComa with a RBM10-TFE3 gene fusion, only previously seen with renal cell carcinoma. Physicians should be aware of this rare condition, its location in the fornix and its presentation as a recurrent subconjunctival hemorrhage.


Assuntos
Hemorragia Ocular , Neoplasias de Células Epitelioides Perivasculares , Humanos , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/genética , Hibridização in Situ Fluorescente , Neoplasias de Células Epitelioides Perivasculares/genética , Neoplasias de Células Epitelioides Perivasculares/patologia , Hemorragia Ocular/diagnóstico , Hemorragia Ocular/etiologia , Hemorragia , Biomarcadores Tumorais , Proteínas de Ligação a RNA/genética
7.
Ophthalmic Plast Reconstr Surg ; 39(2): e40-e43, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36700847

RESUMO

The authors present the case of a middle-aged woman with subacute progressive swelling of the OD associated with pain and severely limited duction in all gazes. MRI demonstrated a ~3 cm circumscribed mass in the extraconal space, which displaced and distorted the globe and impinged upon ocular adnexa. She underwent lateral orbitotomy with bone osteotomy to remove the mass, and subsequent histopathologic examination showed woven bone set within a fibrotic background, microscopic features of fibrous dysplasia. Fibrous dysplasia is characterized by abnormal scar-like bony proliferation, typically within a preexisting structure of the skeletal system. To the authors' knowledge, this represents the first example of fibrous dysplasia presenting as an orbital mass unconnected to the craniofacial skeleton.


Assuntos
Displasia Fibrosa Óssea , Doenças Orbitárias , Pessoa de Meia-Idade , Feminino , Humanos , Doenças Orbitárias/cirurgia , Órbita/cirurgia , Osteotomia , Imageamento por Ressonância Magnética
8.
Ophthalmic Plast Reconstr Surg ; 39(3): 281-287, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36727790

RESUMO

PURPOSE: To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database. METHODS: Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety. RESULTS: Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08-3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16-3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00-5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25-3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03-2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79-0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57-0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02-0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64-0.94, p = 0.009). CONCLUSIONS: Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.


Assuntos
Oftalmopatia de Graves , Saúde da População , Humanos , Feminino , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia , Fatores de Risco
9.
Ophthalmic Plast Reconstr Surg ; 39(4): 336-340, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36394556

RESUMO

PURPOSE: To assess the association between thyroid eye disease (TED) and glaucoma. METHODS: Patients 18 years of age and over enrolled in the NIH All of Us Research Program, a nationwide cohort, were extracted. Those with conditions relating to TED were identified and compared with 2020 US Census-matched controls without a diagnosis of TED in a 1:4 ratio. The authors used Pearson's χ 2 tests to study demographics by TED status, and logistic regression to generate odds ratios and 95% confidence intervals to evaluate the association between TED and glaucoma (any type, including glaucoma suspect), using those without TED as the reference group. Multivariable models were adjusted for age, gender, race/ethnicity, eye doctor visits, and smoking status. RESULTS: A total of 393 cases of TED and 1,572 US Census-matched controls were identified. The median age of the cohort was 63 years (interquartile range: 48-73 years). Age, gender, and race/ethnicity varied by TED status ( p < 0.001). Overall, 114 (29.0%) of TED cases had a diagnosis of glaucoma, compared with 94 (6.0%) of non-TED controls. On bivariate logistic regression models, those diagnosed with TED were significantly more likely to be diagnosed with glaucoma compared with controls (odds ratio: 6.42; 95% confidence interval: 4.76-8.70; p < 0.001). This trend persisted on multivariable logistic regression controlling for confounding factors (odds ratio: 3.37; 95% confidence interval: 1.85-6.20 p < 0.001). CONCLUSIONS: Individuals with TED were significantly more likely to be diagnosed with glaucoma. Clinicians caring for patients with TED should be aware of this elevated risk and arrange glaucoma evaluation, accordingly.


Assuntos
Glaucoma , Oftalmopatia de Graves , Hipertensão Ocular , Saúde da População , Humanos , Pessoa de Meia-Idade , Idoso , Estados Unidos/epidemiologia , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/epidemiologia , Glaucoma/diagnóstico , Glaucoma/epidemiologia , National Institutes of Health (U.S.)
10.
Orbit ; 42(4): 455-458, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35576315

RESUMO

Skin rejuvenation procedures have increasingly flooded the aesthetic market, one of which includes microneedling. In microneedling, multiple fine punctures of the skin are performed with a needle to induce neocollagenesis. Microneedling has increasingly been used to treat inflammatory acne, acne scarring, photodamaged skin, and even radiation dermatitis. We present a patient with a stable history of liquid injectable silicone (LIS) given 20 years prior who developed chronic periocular and facial hypersensitivity after undergoing microneedling at a medi-spa. Long-term steroids and immunosuppressants were needed for control. The patient's severe reaction and resistance to treatment highlights the potential complications of microneedling administered by a non-medical professional in the setting of prior injectable silicone.


Assuntos
Acne Vulgar , Técnicas Cosméticas , Hipersensibilidade Tardia , Humanos , Técnicas Cosméticas/efeitos adversos , Silicones/efeitos adversos , Cicatriz/etiologia , Acne Vulgar/terapia , Acne Vulgar/complicações , Hipersensibilidade Tardia/complicações , Resultado do Tratamento
11.
Orbit ; 42(4): 418-425, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36097675

RESUMO

PURPOSE: To characterize the distribution of fat-to-muscle ratio (FMR) across patients with thyroid eye disease (TED) and to assess the association between FMR and therapeutic response to teprotumumab. METHODS: A retrospective cohort study of patients completing a full course of teprotumumab for TED between January 2020 and March 2022 at a single tertiary referral center. Patients without baseline orbital imaging were excluded. Quantitative analysis of FMR was performed by manual segmentation of patients' imaging using OsiriX software. The primary outcome measure was change in clinical measurement of proptosis. Linear regression modelled change in proptosis against FMR. Statistical significance was set at p < .05. RESULTS: Twenty-two patients (3 M:19F) were included with a mean age of 49.4 ± 15.5 years. The FMR ranged from 1.11 to 6.54, mean 3.15 ± 1.30. The data did not deviate from a normal distribution (Shapiro-Wilk test for normality, p = .18). Pre- and post-treatment average proptosis measurements were 21.72 ± 3.56 mm and 18.81 ± 3.07 mm, respectively. Univariable linear regression demonstrated a 0.78 ± 0.36 mm greater reduction in proptosis for every 1 unit decrease in FMR (p = .038). CONCLUSIONS: Contrary to the traditional dichotomous characterization of TED into type 1 and type 2 phenotypes, orbital FMR may represent a continuum of disease manifestation, more closely following a normal rather than bimodal distribution. Furthermore, pre-treatment FMR is associated with response to teprotumumab; those with lower FMR experiencing a greater reduction in proptosis. This has implications for patient selection and counselling regarding the expected treatment outcome.


Assuntos
Exoftalmia , Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/complicações , Estudos Retrospectivos , Músculos Oculomotores
12.
J Pathol ; 255(1): 52-61, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34086347

RESUMO

The myogenic differentiation 1 gene (MYOD1) p.L122R somatic mutation was first discovered in a subset of clinically aggressive embryonal rhabdomyosarcomas and has since been described in both pediatric and adult spindle cell/sclerosing rhabdomyosarcomas. Relatively little is known about the clinical, molecular, and histopathological features of these tumors in children. In order to further characterize the genomic and clinical features of pediatric MYOD1-mutant sarcomas, we evaluated a cohort of soft-tissue sarcoma patients treated at Texas Children's Hospital. Tumor DNA was subjected to next-generation panel sequencing and/or Sanger sequencing of the MYOD1 hotspot mutation. The MYOD1 p.L122R mutation was identified in six tumors, with a variant allele fraction greater than 0.8 in three cases, suggestive of loss of heterozygosity. One sclerosing rhabdomyosarcoma lacking the MYOD1 hotspot mutation was observed to have a MYOD1 copy number gain, also with evidence of loss of heterozygosity. Cancer gene panel sequencing revealed potentially targetable alterations in six of seven (86%) patients with MYOD1 alterations, including four patients with an alteration in the PI3K-AKT pathway: two hotspot PIK3CA mutations and deletions in PTEN and TSC2. On histopathologic review, MYOD1-altered tumors exhibited spindle and/or round cells and varying degrees of hyaline sclerosis. At last follow-up, six patients had died of disease and the seventh progressed early and was subsequently lost to follow-up. Both pre- and post-therapy patient-derived xenograft models were generated from one patient's tumor. These models were confirmed to harbor the MYOD1 and PIK3CA mutations seen in the primary tumor and were shown to be sensitive to PI3K/mTOR inhibition in vitro and in vivo. In conclusion, this study adds to recent reports describing the clinicopathologic and genomic features of MYOD1-altered soft-tissue sarcomas in children, including dismal prognosis and potential molecular targets for therapy. The novel preclinical models developed will facilitate further biological and preclinical study of this rare and aggressive tumor. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.


Assuntos
Proteína MyoD/genética , Rabdomiossarcoma/genética , Neoplasias de Tecidos Moles/genética , Ensaios Antitumorais Modelo de Xenoenxerto , Adolescente , Animais , Antineoplásicos/farmacologia , Criança , Feminino , Genômica , Humanos , Imidazóis/farmacologia , Masculino , Camundongos , Mutação , Quinolinas/farmacologia , Rabdomiossarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Adulto Jovem
13.
J Craniofac Surg ; 33(8): 2670-2676, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35946827

RESUMO

The lower eyelid tear trough deformity is a common cosmetic concern which is the result of multiple anatomic changes in the lower eyelid, usually resulting from age. A sound understanding of the underlying anatomy is vital to inform surgeons about the ideal treatment options for rejuvenation of this region and to minimize the risk of complications. Cadaveric studies provide unique insight into underlying anatomic changes. Here we review the relevant published cadaveric studies relating to the tear trough deformity and its treatment.


Assuntos
Blefaroplastia , Doenças Palpebrais , Lacerações , Humanos , Pálpebras/cirurgia , Pálpebras/anatomia & histologia , Rejuvenescimento , Doenças Palpebrais/cirurgia , Lacerações/cirurgia , Cadáver , Blefaroplastia/métodos
14.
Palliat Support Care ; 20(6): 813-817, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34663485

RESUMO

OBJECTIVE: Providing good end-of-life (EOL) care for noncancer patients has been made a national priority in Singapore. A combined medical and nursing ward-based intervention known as the EOL care plan was piloted in a general medicine ward at our institution, aiming to guide key aspects of EOL care. The aim of this study is to assess the EOL care plan's effect on EOL care for general medicine patients. METHOD: We conducted a retrospective cohort study on inpatients who died in a general ward under the discipline "General Medicine" from May to October 2019. We collected data around symptom management, rationalization of care and communication with families. The primary analysis compared care received by patients who died in the pilot ward with that of a control group of patients who died in other wards. RESULTS: In total, 112 records were included in the analysis. Pain assessment was more common in the pilot ward compared with the control group (35.3% vs. 6.3%, p < 0.001), as were anti-psychotic prescriptions for delirium (64.7% vs. 24.4%, p = 0.001). Fewer patients received blood glucose monitoring in the last 48 h of life in the pilot ward (69.5% vs. 35.3%, p = 0.007). There were also less frequent parameters monitoring in the pilot ward (p < 0.004). SIGNIFICANCE OF RESULTS: The implementation of the EOL care plan was associated with process-level indicators of better EOL care, suggesting that it could have a significant positive impact when implemented on a wider scale.


Assuntos
Automonitorização da Glicemia , Assistência Terminal , Humanos , Estudos Retrospectivos , Glicemia , Cuidados Paliativos , Pacientes Internados
15.
Orbit ; 41(6): 739-744, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34969350

RESUMO

PURPOSE: To identify common factors associated with the loss of an eye using the NIH All of Us database. METHODS: In this case-controlled study, we extracted electronic health record and socio-demographic data for 231 cases of eye loss from All of Us enrollment sites. Controls (N = 924) matched the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression identified variables significantly associated with increased odds of eye loss. OUTCOME MEASURES: Medical and social determinants associated with increased odds of losing an eye. RESULTS: Among cases, the average age (standard deviation) was 60.1 (14.4) years. The majority (125, 54.1%) were male. 87 (37.7%) identified as African American, and 49 (21.2%) identified as Hispanic or Latino. Loss of eye was more likely in those with ocular tumor (odds ratio [OR] 421.73, 25 95% confidence interval [CI] 129.81-1959.80, p < .001), trauma (OR 13.38, 95% CI 6.64-27.43, p < .001), infection (OR 11.46, 95% CI 4.11-32.26, p = .001) or glaucoma (OR 8.33, 95% CI 4.43- 15.81, p < .001). African American (OR 2.39, 95% CI 1.39-4.09, p = .002) and Hispanic or Latino (OR 1.80, 95% CI 1.01-3.15, p = .04) participants were disproportionately affected. CONCLUSIONS: Racial and ethnic disparities exist among those with loss of an eye from underlying conditions. Addressing health inequities may mitigate the risk of this morbid outcome.


Assuntos
Saúde da População , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Hispânico ou Latino , Etnicidade , Negro ou Afro-Americano
16.
Antimicrob Agents Chemother ; 65(9): e0236620, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34125591

RESUMO

Liposomal amphotericin B (LAmB) is used for various fungal infections, but it is unclear which dosing weight to use in obese patients. The purpose of this study was to compare clinical outcomes of adjusted body weight (adjBW) versus total body weight (TBW) dosing of LAmB. This single-center, retrospective cohort study included patients who received LAmB for definitive therapy and whose TBW exceeded 120% of their ideal body weight (IBW). Analyses were conducted for 3 mg/kg for adjBW versus TBW and 5 mg/kg for adjBW versus TBW. A total of 238 patients were included. For the 68 patients who received LAmB at 3 mg/kg, there were no differences in safety or efficacy outcomes. For the 170 patients who received LAmB at 5 mg/kg, significantly more patients in the TBW group experienced the primary outcome of nephrotoxicity (57% versus 35% [P value of 0.016]) and had significantly higher rates of early discontinuation of LAmB due to toxicity (33% versus 17% [P = 0.030]). There was a trend toward increased 90-day mortality in the adjBW group (60% versus 45% [P = 0.079]); however, adjBW dosing was not associated with increased mortality in an adjusted model. Given the lower rates of nephrotoxicity but a possible trend toward increased mortality in patients whose TBW exceeds 120% of their IBW, dosing LAmB by adjBW may be reasonable in patients who are not critically ill and who have lower-risk infections. In critically ill patients or those with fungal pathogens or sites of infection associated with higher mortality risk, dosing by TBW can be considered.


Assuntos
Anfotericina B , Obesidade , Peso Corporal , Humanos , Obesidade/tratamento farmacológico , Estudos Retrospectivos
17.
J Craniofac Surg ; 32(8): e813-e814, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34238883

RESUMO

ABSTRACT: Orbital dermoid cysts are benign choristomas that are very common in children and occur most often as a lateral or medial mass associated with the frontozygomatic or frontoethmoidal suture line. The authors present an unusual case of an occult giant deep orbital dermoid cyst in infancy that initially presented with a small, benign appearance and central upper eyelid location on clinical exam. Orbitotomy with complete excision prevented further ocular sequelae in this 11-month-old.


Assuntos
Coristoma , Cisto Dermoide , Neoplasias Orbitárias , Criança , Suturas Cranianas , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Pálpebras , Humanos , Lactente , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia
18.
Br J Nurs ; 29(22): 1341-1347, 2020 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-33325281

RESUMO

This article provides the reader with an outline of the anatomy and physiology of the lacrimal system and illustrates how a variety of pathologies within this system can result in the development of a watery eye. It describes the role of the nurse consultant in the diagnosis and management of patients with watery eye in the lacrimal clinic, and how the training programme for the development of such skills was implemented. Following training, within the realms of an established pilot study, the nurse consultant began to implement her skills in a newly established nurse-led lacrimal clinic. Patients seen in the lacrimal clinic would previously have been assessed and managed by a doctor. To confirm the accuracy of this approach, an audit was undertaken comparing the nurse-led diagnosis and management plans with that of an oculoplastic doctor. In addition, patient waiting times in the clinic and patient satisfaction were assessed, as important indicators of quality of care.


Assuntos
Satisfação do Paciente , Médicos , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Projetos Piloto
19.
J Chem Inf Model ; 59(4): 1295-1300, 2019 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-30932490

RESUMO

Mass spectrometric data are copious and generate a processing burden that is best dealt with programmatically. PythoMS is a collection of tools based on the Python programming language that assist researchers in creating figures and video output that is informative, clear, and visually compelling. The PythoMS framework introduces a library of classes and a variety of scripts that quickly perform time-consuming tasks: making proprietary output readable; binning intensity vs time data to simulate longer scan times (and hence reduce noise); calculating theoretical isotope patterns and overlaying them in histogram form on experimental data (an approach that works even for overlapping signals); rendering videos that enable zooming into the baseline of intensity vs time plots (useful to make sense of data collected over a large dynamic range) or that depict the evolution of different species in a time-lapse format; calculating aggregates; and providing a quick first-pass at identifying fragments in MS/MS spectra. PythoMS is a living project that will continue to evolve as additional scripts are developed and deployed.


Assuntos
Quimioinformática/métodos , Análise de Dados , Espectrometria de Massas , Linguagens de Programação , Dimerização , Paládio/química
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