ABSTRACT
BACKGROUND: Transition from intravenous (IV) epoprostenol to IV treprostinil in patients with pulmonary hypertension (PH) has traditionally been performed by gradually decreasing the epoprostenol dose while increasing the treprostinil dose. Preliminary data suggest that this transition can be performed more rapidly without the need for epoprostenol weaning. We conducted a single center, prospective clinical trial to assess the safety, efficacy, and treatment satisfaction of rapidly switching from epoprostenol to IV treprostinil. METHODS: This study included patients with PH who had rapidly transitioned from epoprostenol to IV treprostinil. Data collected included clinical status, adverse events, PH symptoms, and previously validated measures of quality of life and treatment satisfaction. RESULTS: Ten patients were enrolled in this study. Exercise capacity measured by mean 6-min walk distance was maintained from baseline throughout follow-up. Severity of disease as assessed by WHO functional class was maintained or improved for the majority of patients. Adverse events were minimal during the transition, and all patients remained on IV treprostinil throughout the follow-up period. A favorable impact on quality of life and treatment satisfaction measures was observed by eight weeks following the transition from epoprostenol to IV treprostinil. Specifically, time spent on drug preparation activities decreased by 39.5% with treprostinil compared to epoprostenol. CONCLUSIONS: Rapidly switching from epoprostenol to IV treprostinil can be achieved without safety concerns, with minimal patient monitoring and without the need for extended hospitalization, while favorably impacting on patients' quality of life.
Subject(s)
Antihypertensive Agents/therapeutic use , Epoprostenol/analogs & derivatives , Epoprostenol/therapeutic use , Hypertension, Pulmonary/drug therapy , Quality of Life , Adult , Aged , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Drug Administration Schedule , Drug Substitution/methods , Drug Substitution/psychology , Epoprostenol/administration & dosage , Epoprostenol/adverse effects , Female , Humans , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/psychology , Infusions, Intravenous , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Severity of Illness Index , Treatment Outcome , Walking/physiologyABSTRACT
We have previously shown that elevation of anticardiolipin antibodies (aCL) at the first prenatal visit is associated with increased fetal loss in normal pregnancy. The variation in aCL levels during normal pregnancy has not been established. To examine this question we measured IgG, IgM and IgA aCL levels five times during pregnancy at weeks 5-15, 16-25, 26-35, 36-37 and at delivery. Data were analyzed to determine: (a) the within and between subject variability of aCL during pregnancy; (2) the temporal trend of aCL; and (3) the relation of serial measures of aCL with maternal complications of pregnancy. We divided our cohort of 354 subjects into two groups. Group A included those subjects with consistently normal levels of aCL and group B those subjects with at least one elevated level of aCL. In group A the within subject variability was relatively low (28-34%). In group B we found wide fluctuations in aCL levels and a within subject variability of 88-91%. Subjects in group B had no increase in maternal complications of pregnancy. The present data suggest that aCL may fluctuate significantly during normal pregnancy and there is little clinical value in measuring aCL on a serial basis during pregnancy.
Subject(s)
Antibodies, Anticardiolipin/blood , Pregnancy Complications/immunology , Pregnancy/immunology , Adolescent , Adult , Female , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant, Newborn , Infant, Premature , Labor, Obstetric , Longitudinal Studies , Pregnancy/blood , Pregnancy Complications/blood , Pregnancy Trimester, First , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Prospective Studies , Reference ValuesSubject(s)
Bone Development , Hand , Wrist , Adolescent , Age Determination by Skeleton , Child , Child, Preschool , Female , Humans , Male , Radius , Ulna , Wrist/diagnostic imagingABSTRACT
Ciudad Juárez (Chihuahua) and El Paso (Texas), two cities on the U.S.-Mexico border, form a single environmental system in which the same natural resources, especially air and water, are shared. It also constitutes a single metropolitan area which is characterized by high rates of pipulation growth, economic development, and urban expansion, all these factors mitigating against air quality. Early in 1972 the health authorities in El Paso and Ciudad Juárez initiated a joint air pollution sampling program with assistance from the Pan American Health Organization. The nearby city of Las Cruces (New Mexico) was later included in the program as well. Activities are carried out in accordance with a document entitled "Bases of Cooperation." The guiding criteria of the program are: functional simplicity, operational economy, and complementarity with other sampling programs conducted by the participating services. An Air Pollution Control Subcommittee is responsible for execution coordination of the program. Three studies are currently underway to determine levels of dust pollution in the air. A fourth study is aimed at measuring sulfur dioxide levels through the use of sulfation plates. The results collected reveal concentrations of particulates in the ambient air levels higher than the U.S. Federal primary standards. The program should be expanded to include the study of other pollutants and a joint inventory of emissions. In this way criteria on air quality may be established and joint plans of action and strategies drawn up for the control of air pollution in this important area.