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O aplicativo móvel CalcVAN foi desenvolvido para auxiliar os profissionais de saúde para otimizar as doses de vancomicina em pacientes hospitalizados. Porém, é imprescindível avaliar a sua usabilidade antes de disponibilizá-lo para prática clínica. Assim, o objetivo do estudo é avaliar a usabilidade do aplicativo móvel na perspectiva dos profissionais de saúde. Trata-se de um estudo descritivo, de avaliação heurística da usabilidade de um aplicativo móvel. Foram convidados profissionais da área de saúde com expertise no tema de gerenciamento de antimicrobianos e vancomicina. O instrumento validado Smartphone Usability questionnaiRE (SURE) foi utilizado para mensuração da usabilidade por meio de um questionário on-line. Vinte e um especialistas participaram do estudo, com média de idade de 32,6 anos, sendo a maioria de mulheres (n = 14, 66,7%), profissionais farmacêuticos (n = 13, 61,9%), com pós-graduação lato sensu (n = 10, 47,6%), que trabalhavam em hospitais públicos ou privados (n = 15, 71,4%) e com média de experiência em 9,7 anos. Com base na interpretação dos resultados obtidos pelo instrumento SURE, a média de usabilidade geral do CalcVAN foi de 83 pontos, com escore menor de 78 e maior de 90 pontos. O teste de usabilidade foi enquadrado nos dois últimos níveis, 70 e 80, onde os profissionais de saúde passaram a concordar fortemente e totalmente, indicando que o aplicativo móvel apresenta uma usabilidade satisfatória. O CalcVAN atingiu uma usabilidade satisfatória e atende as necessidades e exigências dos profissionais de saúde, mostrando--se eficiente para realizar as funções propostas.
The CalcVAN app was developed to assist healthcare professionals in optimizing vancomycin doses for hospitalized patients. However, the usability test before making it available for clinical practice is essential. Therefore, the study aims to evaluate the usability of the app from the perspective of health professionals. A descriptive study, a heuristic evaluation of the usability of a mobile application was conducted. Healthcare professionals with expertise in antimicrobial management and vancomycin were invited to participate. The validated Smartphone Usability questionnaiRE (SURE) was used to measure usability through an online questionnaire. Twenty-one experts participated in the study, with a mean age of 32.6 years, mostly of them women (n = 14, 66.7%), pharmacists (n = 13, 61.9%), with postgraduate education (n = 10, 47.6%), working in private or public hospitals (n = 15, 71.4%), and a mean experience of 9.7 years. Overall usability score for CalcVAN was 83 points, ranging from a minimum of 78 to a maximum of 90 points. The usability test registered within the last two levels, 70 and 80, with users expressing strongly and fully agreed, indicating that the app demonstrates satisfactory usability. CalcVAN achieved satisfactory usability, fulfilling the needs and requirements of health professionals, proving to be efficient in performing the intended functions.
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Humans , Male , Female , Adultالملخص
Objective:To evaluate the feasibility of low radiation dose and low contrast dosage in coronary CT angiography (CCTA) of class I obese patients.Methods:This prospective study enrolled 57 patients (male/female, 50/7, age, 25-77 years) with body mass index (BMI) of 30-38 kg/m 2 and body weight of 85-119 kg scheduled for CCTA from August 2022 to March 2023 in our hospital. The patients were divided into two groups: control group (group A, n = 20) and low-dose group (group B, n = 37). Group A employed a standard-dose protocol: tube voltage 120 kVp and IDR 2.2 g I/s, while group B were scanned using the low-dose protocol: tube voltage 100 kVp and IDR 1.5 g I/s. Images in Group A and Group B were reconstructed with hybrid iterative reconstruction (HIR) at strength 4 and 8, respectively. Other scanning and reconstruction parameters were the same in two groups. Methods:The image quality was assessed by measuring the CT values and noise in the aortic root, left anterior descending artery and right coronary artery, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated for vessels according to the 18-segment classification system using a 4-point scale (1. poor, 4. excellent). The effective dose E and contrast dosage were compared. Statistical analysis was performed using independent samples t-test, Mann-Whitney U test or χ 2 test. Results:The BMI of groups A and B were 31.89 (30.77, 33.81) and 31.22 (30.46, 32.83) kg/m 2, respectively ( P>0.05). No statistically significant differences in CT values, noise, SNR, CNR were noticed between the two groups (all P>0.05). The mean subjective score of all coronary artery segments in the two groups were not less than 3, meeting the requirement of clinical diagnosis. There was no statistically significant difference in the overall subjective image quality between the two groups ( P>0.05). The radiation dose E in groups A and B were 7.58 and 4.49 mSv, respectively ( Z=-5.46, P<0.05). The contrast dosage in groups A and B were 66 and 45 ml, respectively. The radiation dose E and contrast dosage in group B were 41% and 32% lower than that in group A, respectively. Conclusions:For class I obese patients, it was feasible to use a low tube voltage (100 kVp) and low IDR (1.5 gI/s) protocol in CCTA. Radiation dose and contrast dosage can be reduced reasonably without compromising the CCTA image quality.
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Objective:To compare the differences of actual absorbed doses of liver malignant tumors after 90Y-selective internal radiation therapy (SIRT) evaluated by 90Y PET/CT and 90Y bremsstrahlung (BRS) SPECT/CT imaging, and to compare the image quality of the 2 imaging methods. Methods:Twenty-one patients (15 males and 6 females; age: (52.4±15.4) years) with liver malignant tumors (15 cases of primary liver cancer, 6 cases of liver metastases; 39 lesions) between September 2021 and August 2022 were retrospectively analyzed. All patients underwent both 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging in the Department of Nuclear Medicine, Hainan Cancer Hospital. The ratios of the actual absorbed doses based on 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging to the lowest standard absorbed dose(100 Gy) for tumor response were calculated. The image contrast and distinguishability of the two imaging methods were scored. Wilcoxon signed rank test and Wilcoxon rank sum test were used for data analysis. Results:The tumor absorbed doses evaluated by 90Y PET/CT and 90Y BRS SPECT/CT were 143.94(55.91, 233.48) Gy and 107.82(53.59, 157.53) Gy respectively. The doses evaluated by 90Y PET/CT were higher than the standard threshold in 24 lesions, while 19 lesions showed higher evaluated doses by 90Y BRS SPECT/CT than the standard threshold. Compared with 90Y PET/CT, 90Y BRS SPECT/CT underestimated the tumor absorbed dose of -24.25%(-32.32%, -12.14%). The ratio of dose evaluated by 90Y PET/CT to the lowest standard threshold was 1.33(0.56, 1.91), which was higher than that of dose evaluated by 90Y BRS SPECT/CT to the lowest standard threshold (0.97(0.47, 1.25); z=0.04, P<0.001). PET/CT image contrast was scored 0, 1, 2, 3 in 2, 2, 12, 23 lesions respectively, and SPECT/CT image contrast was scored 0, 1, 2, 3 in 2, 3, 16, 18 lesions respectively ( z=-1.29, P=0.199). The distinguishability scores of 0, 1, 2 based on PET/CT images were found in 3, 15, 21 lesions, while those based on SPECT/CT images were found in 4, 32, 3 lesions respectively ( z=-2.79, P=0.005). Conclusion:90Y PET/CT imaging is superior to 90Y BRS SPECT/CT imaging in radiation dose evaluation and tumor focus differentiation in patients with liver malignant tumors after 90Y-SIRT.
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As a glucocorticoid drug with wide clinical application， triamcinolone acetonide can be administered by multiple routes， such as eye， nose， joint cavity， and skin， for the treatment of various local diseases such as arthritis， macular edema， rhinitis， and urticaria. As a drug with extremely low solubility in water， the dose form of triamcinolone acetonide is closely correlated with administration route and site. The dosage form of triamcinolone acetonide administered via injection（including joint cavity injection， vitreous injection， suprachoroidal injection， intramuscular injection） is mainly suspension， and the representative drugs include Kenalog-40®， Zilretta®， Triesence®， Xipere®， etc.； the dosage forms of nasal mucosal administration are mostly sprays， and the representative drug is Nasacort®； the dosage forms of oral mucosal administration are mostly patches， ointments and creams， and the representative drug is Oracort®； the dosage forms for transdermal administration are mostly ointments， creams and lotions， and the representative drugs include Trianex®， Teva-Triacomb®， etc. At present， the research on dosage forms of triamcinolone acetonide by various administration routes mainly focuses on the construction of delivery carriers， the addition of cosolvents or the use of new delivery tools.
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Due to the difference between the system of weights and measures， and the dosage of clinical prescriptions of traditional Chinese medicine in various historical periods， the dosage and conversion standard of prescriptions in past dynasties are different. Therefore， when discounting the dosage of famous classical formulas， the principles of inheriting the essence， making the past serve the present， linking the past and the present， and forming a consensus should be followed， firstly， the dosage of the prescription was converted according to the weights and measures system of the past dynasties. If the converted dosage significantly exceeds the provisions of the 2020 edition of Chinese Pharmacopoeia， then on the premise of ensuring that the proportion of the original prescription drug dosage remains unchanged， the conversion shall be based on expert consensus and drug safety evaluation. For drugs measured in non-standard units， a conversion range is provided based on comprehensive literature analysis and physical measurements. For the conversion of service volume， the original text was used as the basis for the conversion with reference to the measurement standards of different eras. If the original dosage is not clear， the converted dosage will be determined based on the historical evolution of the formula， referring to relevant ancient books， and combining modern applications. Eventually， the converting standard for famous classical formulas was determined as follows：during the Han and Tang dynasties， one Liang（两） was equivalent to 13.8 g and one Sheng（升） was equivalent to 200 mL， in the Tang dynasty， one Fen（分） was equivalent to 3.45 g， during the Song， Jin and Yuan dynasties， one Qian（钱） was equivalent to 4.13 g and one Zhan（盏） was equivalent to 300 mL， during the Ming and Qing dynasties， one Qian（钱） was equivalent to 3.73 g， and one Bei（杯） and one Zhong（盅） were equivalent to 200 mL. For drugs recorded in non-standard units of measurement， it is necessary to conduct actual measurements to determine their conversion standards based on comprehensive analysis to determine their origin. If necessary， different records of the dosage of drugs with the same or similar efficacy and indications in medical books of similar ages can be used to assist in determining the conversion standards. The analysis of the principle of dosage conversion for Chinese medicine is helpful for the clinical application and development of famous classical formulas.
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Objective To compare patient radiation dose during implantation of the second generation wireless pacemaker(Micra AV)and traditional dual-chamber pacemaker.Methods Data of 74 patients who received pacemaker implantation for bradycardia were retrospectively analyzed.According to the kind of pacemaker,the patients were divided into AV group(n=30)and traditional group(n=44).The perspective time,air kerma(AK),dose area product(DAP),number of movie sequences and total movie frames were compared between groups.Results AK,movie DAP,number of movie sequence and total movie frames in AV group were all higher than those in traditional group(all P＜0.05).No significant difference of the perspective time nor perspective DAP was found between groups(both P＞0.05).Patients'X-ray radiation projection range were essentially the same in both groups,most distributing on the left side of the bodies.Conclusion Compared with implantation of traditional dual-chamber pacemaker,implantation of Micra AV brought patient greater radiation dose from movie acquisition,while radiation dose from fluoroscopy were not significantly different.
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Prostate cancer is a common malignant tumor in male genitourinary system, and radical prostatectomy is one of the important methods to treat prostate cancer. Indocyanine green is a non-radioactive, water-soluble compound, which can help identify anatomical structures and visualize blood vessels through near-infrared fluorescence. The role and injection techniques of Indocyanine green in radical prostatectomy in sentinel lymph node identification, pelvic lymph node dissection and neurovascular bundle preservation are reviewed, so as to provide a reference for improving the surgical effect, reducing the difficulty of surgery, and prolonging the survival period of patients, and evaluate the potential research field of this technology in the future.
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Objective To analyze the effect of different retained dosage of lauromacrogol within the thyroid cyst in the sclerotherapy of thyroid cysts.Methods A total of 200 patients with thyroid cysts,who were admitted to the Longyan Municipal First Hospital of China between August 2020 and August 2021,were enrolled in this study.The patients were randomly and equally divided into group zero(suctioning out all the amount of the injected lauromacrogol),and,according to the percentage of the retained lauromacrogol dosage to the total cystic fluid,group 10%,group 20%,group 30%and group 50%,with 40 patients in each group.Thyroid color ultrasound was reviewed at 1,3,6,and 12 months after treatment.The changes of capsule volume,curative efficacy,influencing factors,and adverse reactions after the cyst became sclerosis were analyzed.Logistic regression analysis was used to analyze the factors affecting the postoperative efficacy.Results In all the 5 groups,the suctioned fluid was dark red in colour,and the patients had cystic nodules.The preoperative mean cyst volume was(20.43±5.86)cm3.In all the 5 groups,the postoperative changes in cyst volume indicated that the postoperative one-month cyst volume significantly shrank when compared with the preoperative volume,the postoperative 3-month cyst volume remarkably shrank when compared with the postoperative one-month volume,and the postoperative 6-month cyst volume strikingly shrank when compared with the postoperative 3-month volume(all P＜0.05),while no statistically significant difference in the cyst volume existed between the postoperative 12-month value and the postoperative 6-month value(P＞0.05).The postoperative 6-month total effective rate of all the five groups was 87%(174/200),and no statistically significant differences in the postoperative 6-month curative effect existed between each other among the 5 groups(P＞0.05).Taking the postoperative 6-month curative effect as the dependent variable,and the age,sex,thick cystic wall,cystic septum,and preoperative cyst volume as independent variables,the binary logistic regression analysis was conducted,which revealed that the thick cystic wall(OR=0.24,95%CI=0.08-0.72,P=0.01)and the cystic septum(OR=0.21,95%CI=0.07-0.67,P=0.01)were the factors affecting the postoperative 6-month curative effect.The main side reaction was pain,which was tolerable by patients.There was no significant difference in the incidence of adverse reactions between each other among the five groups(all P＞0.05).Conclusion In treating thyroid cysts by using ultrasound-guided lauromacrogol sclerotherapy,there is no relationship between the curative effect and the percentage of the retained lauromacrogol dosage to the total cystic fluid.The best curative effect can be achieved at 6 months after injection of lauromacrogol,which can be used as the optimal time for follow-up check.The thick cystic wall and the cystic septum are the main factors that affect the curative effect of lauromacrogol sclerotherapy.For the treatment of thyroid cyst,lauromacrogol sclerotherapy carries reliable curative effect with few adverse reactions,therefore,this therapy is worthy of clinical application.(J Intervent Radiol,2024,32:69-73)
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AIM: To explore the variance in efficacy between botulinum toxin A(BTA)injection and extraocular muscle surgery in managing large-angle(≥+60 PD)acute acquired concomitant esotropia(AACE).METHODS: A retrospective analysis was conducted on clinical data of 60 patients with AACE treated at our hospital from June 2020 to December 2022. Patients were divided into three groups based on different treatments: 2.5 IU BTA injection group(14 cases), 5.0 IU BTA injection group(29 cases), and surgical group(17 cases). Follow-up was conducted for 6 mo after treatment to observe the degree of strabismus after the correction of refractive error, visual function, treatment effectiveness, and occurrence of complications after BTA injection.RESULTS: At 6 mo post-treatment, the degree of strabismus in the surgical group and the 5.0 IU BTA injection group was lower than that in the 2.5 IU BTA injection group(P<0.017). However, there was no significant difference in the degree of strabismus between the surgical group and the 5.0 IU BTA injection group(P>0.017). The effective rate of the 5.0 IU BTA injection group was higher than that of the 2.5 IU BTA injection group(86% vs 43%, P<0.017). There was no difference in visual function among the three groups(P>0.05). The incidence of complications after treatment was not significantly different between the 2.5 IU BTA injection group and the 5.0 IU BTA injection group(43% vs 52%, P>0.05).CONCLUSION: For AACE patients with esotropia degree ≥+60 PD, bilateral medial rectus injection of 5.0 IU BTA can yield outcomes comparable to traditional extraocular muscle surgery, with the advantages of minimal trauma and simple and convenient operation.
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The dosage， dose and administration method of decoctions are important factors affecting the efficacy of prescriptions. By analyzing 35 decoction formulas from the Ming and Qing dynasties within the Catalogue of Ancient Classic Famous Formulas （First Batch）， it was found that the average dosage was equivalent to about 65 g， of which 71.4% （25/35） of the prescriptions had a dosage ≤60 g. And among them， the dosage of decoctions in the Ming dynasty was significantly smaller than that in the Qing dynasty. Considering the characteristics of formulas in Song dynasty， it is believed that decoctions in Ming and Qing dynasties were influenced by the popular use of decoctions during the Song， Jin， and Yuan dynasties. Some decoctions recorded a dosage of one dose instead of one day， which was more evident in the Ming dynasty. However， by the Qing dynasty， the usage of prescriptions with a dosage of one day gradually became more common. Therefore， in the practical research and application of classic famous formulas from the Ming and Qing dynasties， it is advised to pay attention to the difference between the dosage， one dose and the daily dosage. It is necessary to determine whether to double the dosage of the original formula based on the actual use， in order to ensure the clinical efficacy.
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In order to provide a reference basis for the development of relevant compound preparations， this article takes a comprehensive analysis of the usage and dosage of famous classical formulas in Han dynasty from various perspectives， and gives corresponding countermeasures on this basis. Through the comprehensive analysis of the classification and statistics of Zhongjing's medication characteristics， decoction methods， administration and dosage， and combining conversion methods of weights and measures by ancient medical practitioners， along with the dosage and administration of the listed Han dynasty famous classical formulas， it was found that the "Jiangxi method" served as a general guideline for administration according to Zhongjing's original text. This method allowed for flexible dosing based on the conversion of the ancient measurements to modern equivalents［13.8 g per Liang（两）］， ensuring the safe and effective medication of these formulas. After combing， it is found that although the dosage of single medicine is large in famous classical formulas from Han dynasty， the administration is flexible. The crude drug amount per administration serves as the foundational dose， with the frequency of administration adjusted flexibly according to the condition. This dosing approach becomes the key for the rational development of compound formulations of famous classical formulas. Based on the conclusions of the study， it is recommended that when developing compound formulations of famous classical formulas in Han dynasty， the original administration method and dosage should be respected. The original crude drug amount per administration should be considered as the daily foundational dose， with the frequency of administration described within a range（1 to N times per day， where N is the maximum number of administrations as per the original text）. The specific frequency of administration can be adjusted flexibly by clinical practitioners based on the individual condition. This approach should also be adopted in toxicological studies， where the dosage per administration serves as the basis for toxicity research， and the toxicity profile at the maximum administration frequency should be observed， providing guidance on the clinical safety range. Corresponding drug labels should provide information within a range to indicate toxicological risk intervals.
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ABSTRACT The great advances in using new devices and imaging systems in surgeries aim to reproduce an ideal and safe scenario for the surgeon, the team, and the patient. New systems and devices are constantly available to demonstrate and facilitate intraoperative navigation, thereby reducing errors and avoiding complications for the patient and staff. This study evaluates and compares using the O-arm® system and radioscopy in the freehand technique in spine surgeries. For this, searches were conducted in PubMed and Embase for randomized and non-randomized studies using the O-arm® system and radioscopy in spine surgery. Twenty-four studies were included and compared regarding procedure time, accuracy of implant positioning, effective radiation dose, safety, and efficacy. In one study, the O-arm® group showed a shorter surgical time when compared to the freehand technique (222.5 min. [SD=38.0] vs. 255.2 min. [SD=40.3], p=0.011, respectively). In two studies, the freehand technique resulted in a lower effective radiation dose for patients. In 12 studies, a higher incidence of complications was observed among patients undergoing surgery with the freehand technique. It was concluded that using the O-arm® is associated with a reduction in malposition of implants and more safety for instrumented procedures. Still, no evidence exists that its use can result in less surgical time. Level of Evidence I; Diagnostic Analysis and Studies, Investigation of a Diagnostic Test.
Resumo: O grande avanço do uso de novos dispositivos e sistemas de imagem nas cirurgias tem por objetivo reproduzir um cenário ideal e seguro para o cirurgião, a equipe e o paciente. Constantemente, novos sistemas e aparelhos estão disponíveis para demonstrar e facilitar a navegação intraoperatória, com isso procurando reduzir erros e evitar complicações para o paciente e para equipe. Este estudo tem como objetivo avaliar e comparar o uso do sistema O-arm® e a utilização de radioescopia na técnica de freehand em cirurgias de coluna. Para isso, foram realizadas buscas nas bases PubMed e Embase de estudos randomizados e não randomizados sobre o uso em cirurgias de coluna do sistema O-arm® e radioscopia. Foram incluídos 24 estudos que foram comparados quanto ao tempo de procedimento, acurácia do posicionamento dos implantes, dose efetiva de radiação, segurança e eficácia. Um estudo o grupo O-arm® apresentou menor tempo cirúrgico quando comparado à técnica freehand (222,5 min. [DP=38,0] vs. 255,2 min. [DP=40,3], p=0,011, respectivamente). Em dois estudos, a técnica freehand resultou em menor dose efetiva de radiação para pacientes. Em 12 estudos observou-se maior incidência de complicações entre pacientes submetidos à cirurgia com técnica freehand. Concluiu-se que o uso do O-arm® está associado a uma redução da ocorrência do mal posicionamento dos implantes e mais segurança para os procedimentos instrumentados, porém sem evidências que seu uso possa resultar em menor tempo cirúrgico. Nível de Evidência I; Análises e Estudos Diagnósticos, Investigação de um Exame para Diagnóstico.
Resumen: El gran avance en el uso de nuevos dispositivos y sistemas de imagen en las cirugías pretende reproducir un escenario ideal y seguro para el cirujano, equipo y paciente. Constantemente se encuentran disponibles nuevos sistemas y dispositivos para demostrar y facilitar la navegación intraoperatoria, buscando así reducir errores y evitar complicaciones al paciente y al personal. Este estudio tiene como objetivo evaluar y comparar el uso del sistema O-arm® y el uso de radioscopia en la técnica de manos libres en cirugías de columna. Para ello se realizaron búsquedas en PubMed y Embase de estudios aleatorizados y no aleatorizados sobre el uso del sistema O-arm® y radioscopia. en cirugía de coluna. Se incluyeron y compararon 24 estudios con respecto al tiempo del procedimiento, precisión del posicionamiento del implante, dosis de radiación efectiva, seguridad y eficacia. En un estudio, el grupo O-arm® mostró tiempo quirúrgico más corto en comparación con técnica de mano alzada(222,5min [DE=38,0]vs. 255,2min[DE=40,3], p=0,011, respectivamente). En dos estudios, la técnica de mano alzada dio como resultado dosis de radiación efectiva más baja para los pacientes. En 12 estudios se observó mayor incidencia de complicaciones entre pacientes sometidos a cirugía con la técnica de mano alzada. Se concluyó que el uso del O-arm® está asociado con reducción en la ocurrencia de mala posición de los implantes y más seguridad para procedimientos instrumentados, pero sin evidencia de que su uso pueda resultar en menor tiempo quirúrgico. Descriptores:
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Orthopedic Procedures , Radiation, Ionizing , Dosageالملخص
ABSTRACT Purpose: To compare the injection of small amounts of undiluted C3F8 with the traditional gas injection in vitrectomy for macular hole treatment. Methods: This clinical trial included 26 individuals divided into two groups. Group 1 received an intravitreal injection of 0.9-1.0 mL of 100% C3F8, and Group 2 received 15-20 mL of 20% C3F8. Results: The median intraocular gas duration was 31 days in Group 1 and 34 in Group 2. The median letter gains in corrected distance visual acuity for the 26th postoperative week were 20 letters in Group 1 and 12.5 in Group 2. The median intraocular pressure was normal in both groups. Primary anatomical success was 11/13 in both groups. Conclusions: The use of C3F8 gas in a small undiluted volume is an alternative that slightly reduces the duration of the gas without negatively affecting the anatomical and visual response.
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Abstract Objective: To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). Materials and Methods: This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested. Results: The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia. Conclusion: Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.
Resumo Objetivo: Estudar o efeito da administração antenatal de corticosteroides na hemodinâmica fetal mediante análise longitudinal do Doppler na artéria umbilical e artéria cerebral média (ACM). Materiais e Métodos: Este foi um estudo retrospectivo que incluiu 30 fetos com risco de nascimento pré-termo. Vinte e oito gestantes foram tratadas com betametasona para maturação pulmonar fetal. Os exames de Doppler da AU e da ACM foram realizados uma vez antes e depois da administração de corticosteroides, num total de três ou oito observações. Utilizamos o modelo linear hierárquico com abordagem Bayesiana. Foram construídos os intervalos de referência e testadas associações entre variáveis (idade gestacional e pré-eclâmpsia). Resultados: A média ± desvio-padrão da idade materna, idade gestacional na administração de betametasona e idade gestacional no parto foram 32,6 ± 5,89 anos, 30,2 ± 2,59 semanas e 32,9 ± 3,42 semanas, respectivamente. No Doppler da AU, verificou-se diminuição significativa do índice de pulsatilidade (IP) com a terapêutica com corticosteroides (média: 0,1147 [0,03687-0,191]; em três observações) (mediana: 0,1437 [0,02509-0,2627]; em oito observações). No entanto, não foi observada alteração significativa no IP do Doppler da ACM, independentemente da idade gestacional e do diagnóstico de pré-eclâmpsia. Conclusão: Os corticosteroides pré-natais induziram diminuição significativa no IP do Doppler da AU, mas não houve alteração na vasculatura cerebral.
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Abstract The last decade provided significant advances in the understanding of microbiota and its role in human health. Probiotics are live microorganisms with proven benefits for the host and were mostly studied in the context of gut health, but they can also confer significant benefits for oral health, mainly in the treatment of gingivitis. Postbiotics are cell-free extracts and metabolites of microorganisms which can provide additional preventive and therapeutic value for human health. This opens opportunities for new preventive or therapeutic formulations for oral administration. The microorganisms that colonize the oral cavity, their role in oral health and disease, as well as the probiotics and postbiotics which could have beneficial effects in this complex environment were discussed. The aim of this study was to review, analyse and discuss novel probiotic and postbiotic formulations intended for oral administration that could be of great preventive and therapeutic importance. A special attention has been put on the formulation of the pharmaceutical dosage forms that are expected to provide new benefits for the patients and technological advantages relevant for industry. An adequate dosage form could significantly enhance the efficiency of these products.
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Oral Health/classification , Probiotics/analysis , Microbiota/immunology , Pharmaceutical Preparations/administration & dosage , Ligilactobacillus salivarius/classification , Mouth/injuriesالملخص
Background: The fact that about 90 % of newly discovered API’s or new molecular entity(NME) have little or no aqueous solubility, causes a significant protest to the initialization of development and their scale up of dosage form in the Pharma Industry. Aqueous solubility of API’s has critical role in drug dissolution or availability of drug at the site of action or bioavailability, when a dosage form is administered orally.Objective: The object of this study is to formulate a modified release tablet dosage form of a poorly aqueous soluble drug, which not only have higher aqueous solubility or bioavailability but also have sustained release characteristics with high mechanical strength &their commercial viability. Numerous techniques are available for the solubility enhancement but all individual techniques have its own limitations for commercialization.Method: Aqueous solubility of drugs is improved by the known Solubility enhancement techniques like Micronization &Solid dispersions. After successful solubility enhancement, sustained release or modified release tablets of poorly aqueous soluble drug can be easily formulated into a suitable shape or size by using a known Polymer Matrix Sintering Technology with commercial feasibility. Micronization of poorly water-soluble drugs can be performed by Air Jet Mill or Ball Mill. Whereas Solid dispersion technique involves, molecular dispersion of poorly soluble drug in a suitable inert carrier, to form an amorphous and highly soluble compounds. Sintering Technology is defined as the bonding of adjacent particle surfaces in a mass of powder, or in compact, by the application of heat. Conventional sintering technique involves the heating of compact at a temperature below the melting point of the solid constituents in a controlled environment under atmospheric pressure.Results: Enhanced solubility of poorly soluble API’s by these proposed techniques is due to either conversion of crystalline compound in to amorphous form or reduction of particle size to its molecular level by the application of Micronization or solid dispersion techniques. The developed modified release tablets will show a sustained release characteristic due to Sintering aspect and provides enhanced solubility of BCS class II or IV drugs.Conclusion: Novel modified release tablets have been designed through consolidation of Solubility enhancement and Polymer Matrix Sintering technologies. Simultaneous exploitation of well-known and established approaches- Micronization (optimum particle size reduction) or solid dispersion, optional surfactant and Polymer Matrix Sintering Technique in the recent concept, produces significant enhancement of solubility of poorly water soluble API’s without compromising the content uniformity of dosage form and also provide a modified or sustained release characteristics with high mechanical strength. The release profile of drug can be easily tailored by using combination of both techniques where challenges of low solubility are prominent.
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Introducción. Las radiografías continúan usándose ampliamente, subestimando los riesgos. Esto sucede, especialmente, en las unidades de cuidado neonatal, lo que implica que los neonatos reciben una dosis de radiación ionizante mayor que los adultos. Objetivo. Cuantificar las dosis de radiación recibidas al tomar radiografías y evaluar los posibles factores asociados con el aumento de la dosis. Materiales y métodos. Se llevó a cabo un estudio observacional de 160 neonatos de la Unidad de Recién Nacidos del Hospital Universitario San Ignacio, Bogotá, Colombia. Se consideró como variable dependiente la dosis de entrada en piel por cada radiografía. Se hizo la caracterización de los pacientes, seguida de un análisis multivariado con regresión lineal múltiple para identificar factores asociados. Resultados. Se analizaron 160 pacientes y 492 radiografías en total. Entre los hallazgos más frecuentes, se encuentran: pacientes de sexo masculino (n=87; 54,4 %), nacimiento por cesárea (n=122; 76,3 %) e indicación de toma de radiografías por dificultad respiratoria (n=123; 24,9 %). El 1,8 % (n=9) de los pacientes no tenían una indicación para la toma de la radiografía. La radiografía más frecuente fue la de tórax (n=322; 65,4 %). La mayoría de las radiografías se tomaron con el equipo computarizado (n=352; 71,5 %) y no con el digital (n=140, 28,4 %). La mediana de la dosis de entrada en piel con el equipo computarizado fue de 0,112 mGy (0,022; 0,134 mGy) y, con el equipo digital, de 0,020 mGy (0,019, 0,022 mGy). Conclusiones. Se cuantificaron las dosis de radiación absorbida en neonatos, general y específica, con el equipo computarizado y el digital. Se identificaron mayores dosis con el equipo computarizado. Se reconoció la interacción entre el equipo computarizado con menores edades gestacionales corregidas como principal factor para el aumento de la dosis. Además, se reconoció la relación entre el equipo computarizado y una menor edad gestacional corregida, como principal factor para una mayor dosis.
Introduction. Radiographs are still widely used, underestimating the risks. This situation is frequent in neonatal care units, generating radiation doses than in adults. Objective. To quantify the received radiation doses when performing radiographs on neonates and the possible factors associated with higher doses. Materials and methods. We performed an observational study of 160 neonates from the newborn unit of the Hospital Universitario San Ignacio, Bogotá, Colombia. We considered the input dose of each radiograph as the dependent variable. Patients were characterized and a multivariate analysis with multiple linear regression was performed to identify associated factors. Results. We analyzed 160 newborns and 492 radiographs. The most frequent findings were male patients (n=87, 54.4%), cesarean delivery (n=122, 76.3%), and radiograph indication for respiratory distress (n=123, 24.9%). One-point eight percent of the patients (n=9) did not have radiograph indication. The most frequently taken radiograph was chest (322, 65.4%). Most radiographs were taken with a computerized equipment (n=352, 71.5%), compared to a digital one (n=140, 28.4%). The median input dose with computerized equipment was 0.112 mGy (0.022, 0.134 mGy), and with the digital equipment was 0.020 mGy (0.019, 0.022 mGy). Conclusions. The general and specific absorbed radiation doses were measured in neonates with a computerized and a digital equipment. We identified higher doses with the computerized equipment. In addition, it was recognized the correlation between computerized radiography equipment with lower corrected gestational ages as the main factor for dose increase.
الموضوعات
Radiation Dosage , Infant, Newborn , Radiation , Radiography , Risk Factorsالملخص
ABSTRACT Purpose: To evaluate the effectiveness of intravitreal bevacizumab injections following a single dexamethasone implant in the treatment of macular edema secondary to branch and central retinal vein occlusion. Methods: This was a prospective interventional non-comparative study, 44 eyes of patients with naïve macular edema related to branch and central retinal vein occlusion were treated with a dexamethasone implant. Patients were followed-up at four-week intervals from the second to the sixth month. If persistent or recurrent macular edema occurred during this period, the patient was treated with intravitreal bevacizumab injections on an as-needed basis. The outcome measures were best-corrected visual acuity and central macular thickness changes. Results: The mean best-corrected visual acuity changed from 0.97 ± 0.33 LogMAR at baseline to 0.54 ± 0.40 at the six-month post-implant examination (p<0.00001). Improvement ≥3 Snellen lines were seen in 20 eyes (45.54%). The mean central macular thickness at baseline was 670.25 ± 209.9 microns. This had decreased to 317.43 ± 112.68 microns at the six-month follow-up (p<0.00001). The mean number of intravitreal bevacizumab injections received in the six months post-implant was 2.32. The mean time from dexamethasone implant to first anti-VEGF injection was 3.45 months. Conclusions: Intravitreal bevacizumab injections following a single dexamethasone implant were found to improve best-corrected visual acuity and central macular thickness in patients with macular edema due to branch and central retinal vein occlusion at six months, with few intravitreal injections required.
RESUMO Objetivo: Avaliar a eficácia da combinação de injeções intravítreas de bevacizumabe em olhos com edema macular secundário à oclusão de ramo e da veia central da retina após um único implante de dexametasona. Métodos: Foi realizado um estudo prospectivo intervencionista não comparativo com 44 olhos de pacientes com edema macular relacionado à oclusão de ramo e veia central da retina, sem tratamento prévio e tratados com um único implante de dexametasona, que foram acompanhados em intervalos de quatro semanas do segundo ao sexto mês. Se fosse constatado edema macular persistente ou recorrente durante esse período, os pacientes eram tratados com injeções intravítreas de bevacizumabe em um regime ajustado conforme a necessidade. Foram estudadas a melhor acuidade visual corrigida e alterações da espessura macular central. Resultados: A média da melhor acuidade visual corrigida mudou de 0,97 ± 0,33 LogMAR iniciais para 0,54 ± 0,40 no exame de 6 meses (p<0,00001). Vinte olhos (45,54%) melhoraram 3 linhas de Snellen ou mais. A média da espessura macular central inicial foi de 670,25 ± 209,9 μm e diminuiu para 317,43 ± 112,68 μm na visita de 6 meses (p<0,00001). O número médio de injeções intravítreas de bevacizumabe em 6 meses foi de 2,32 e o tempo médio entre o implante de dexametasona e a primeira injeção de anti-VEGF foi de 3,45 meses. Conclusão: Injeções intravítreas de bevacizumabe após um único implante de dexametasona podem proporcionar um aumento da melhor acuidade visual corrigida e diminuição da espessura macular central aos 6 meses em pacientes com edema macular devido à oclusão de ramo e da veia central da retina, com poucas injeções intravítreas.
الملخص
Buccal tablets
Diclofenac sodium
Drug release
Mucoadhesion
Mucoadhesive tablets
Release kinetics