Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 140.570
Filtrar
1.
Medicine (Baltimore) ; 99(9): e19232, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118725

RESUMEN

The aim of the study was to systematically characterize the interference of biotin on thyroid function tests and biotin washout periods.Ten healthy adults were recruited with administration of 5 and 10 mg/d biotin for 7 days. Analyte concentrations of thyroid function tests were measured at baseline prior to starting biotin and from 2 hours to 2 days after withdrawal of 5 and 10 mg/d biotin. The outcomes were compared the baseline with the several points after taking biotin at Roche cobas e602, Beckman UniCel DxI 800, and Abbott Architect 2000 immunoassay platforms, respectively.Ingesting 5 or 10 mg/d of biotin for 7 days could produce positive or negative interference among the thyroid function tests at Roche cobas e602 and Beckman UniCel DxI 800 systems, but no interference on Abbott Architect 2000. Interference duration of 5 mg/d biotin for Roche cobas e602 and Beckman UniCel DxI 800 of thyroid function tests lasted for 8 hours, while 10 mg/d biotin interfered with Roche cobas e602 or Beckman UniCel DxI 800 for 1 day or 2 days.This study provides valuable guidance on biotin washout periods at doses common in over-the-counter supplements necessary to avoid false assay results.Trial registration: ChiCTR1800020472.


Asunto(s)
Biotina/farmacología , Pruebas de Función de la Tiroides/normas , Complejo Vitamínico B/farmacología , Administración Oral , Adulto , Biotina/administración & dosificación , Femenino , Voluntarios Sanos , Humanos , Masculino , Tiroxina/sangre , Tiroxina/efectos de los fármacos , Triyodotironina/sangre , Triyodotironina/efectos de los fármacos , Complejo Vitamínico B/administración & dosificación , Adulto Joven
2.
Hautarzt ; 71(3): 227-243, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32130433

RESUMEN

In Germany, approximately 2% of the population suffers from psoriasis, which is no longer considered only a cutaneous, but rather a systemic disease. Accordingly, common comorbidities and potential joint involvement in psoriasis must be recorded. If necessary, interdisciplinary patient care has to be organized. The use of validated scores is recommended to complete the patient's medical history. The individual treatment should include intensified topical therapies as well as short-term phototherapy in case of an acute phase. In addition to conventional systemic therapies (e.g., fumarates, methotrexate), a number of new therapeutics for psoriasis are in development. Apart from the PDE­4 inhibitor apremilast, targeted therapies are currently available to block TNF-alpha, IL-17A, the IL-17 receptor and IL-23. Decisions on individualized, patient-centered psoriasis management should be based on assessment of disease severity and the existence of comorbidities. Furthermore, economic aspects should be taken into account.


Asunto(s)
Terapia Biológica/métodos , Terapia Molecular Dirigida , Fototerapia/métodos , Psoriasis/diagnóstico , Psoriasis/terapia , Administración Oral , Administración Tópica , Adulto , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/terapia , Fármacos Dermatológicos/uso terapéutico , Alemania , Humanos , Metotrexato/uso terapéutico , Inhibidores de Fosfodiesterasa 4/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(9): e19001, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118711

RESUMEN

BACKGROUND: Intranasal dexmedetomidine is a relatively new way to sedate young children undergoing nonpainful diagnostic procedures. We performed a meta-analysis to compare the efficacy and safety of intranasal dexmedetomidine in young children with those of oral chloral hydrate, which has been a commonly used method for decades. METHODS: We searched PubMed, Embase, and the Cochrane Library for all randomized controlled trials that compared intranasal dexmedetomidine with oral chloral hydrate in children undergoing diagnostic procedures. Data on success rate of sedation, onset time, recovery time, and adverse effects were extracted and respectively analyzed. RESULTS: Five studies with a total of 720 patients met the inclusion criteria. Intranasal dexmedetomidine provided significant higher success rate of sedation (relative risk [RR], 1.12; 95% confidence interval [CI], 1.02 to 1.24; P = .02; I = 74%) than oral chloral hydrate. Furthermore, it experienced significantly shorter onset time (weight mean difference [WMD], -1.79; 95% CI, -3.23 to -0.34; P = .02; I = 69%). Nevertheless, there were no statistically differences in recovery time (WMD, -10.53; 95% CI, -24.17 to 3.11; P = .13; I = 92%) and the proportion of patients back to normal activities (RR, 1.11; 95% CI, 0.77-1.60; P = .57; I = 0%). Intranasal dexmedetomidine was associated with a significantly lower incidence of nausea and vomiting (RR, 0.05; 95% CI, 0.01-0.22; P < .0001; I = 0%) than oral chloral hydrate. Although adverse events such as bradycardia, hypotension and hypoxia were not synthetized due to lack of data, no clinical interventions except oxygen supplementation were required in any patients. CONCLUSION: Our meta-analysis revealed that intranasal dexmedetomidine is possibly a more effective and acceptable sedation method for infants and toddlers undergoing diagnostic procedures than oral chloral hydrate. Additionally, it shows similar safety profile and could be a potential alternative to oral chloral hydrate.


Asunto(s)
Hidrato de Cloral/administración & dosificación , Sedación Profunda/métodos , Dexmedetomidina/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Administración Intranasal , Administración Oral , Preescolar , Hidrato de Cloral/efectos adversos , Dexmedetomidina/efectos adversos , Humanos , Hipnóticos y Sedantes/efectos adversos , Lactante
4.
Medicine (Baltimore) ; 99(10): e19301, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150064

RESUMEN

We treated skin sclerosis with triple therapy consisting of a glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis. The objective of this study was to analyze its effectiveness in a case series of patients who received triple therapy.We enrolled 8 patients with diffuse cutaneous systemic sclerosis (dcSSc) who received triple therapy at our hospital from 2008 to 2016. We analyzed the mean change in the modified Rodnan skin score (mRSS), percentage of the predicted forced vital capacity (%FVC), percentage of the predicted carbon monoxide diffusing capacity (%DLCO), and serum KL-6 levels from baseline to follow-up.All patients were treated with an intermediate dose of oral prednisolone (30.6 ±â€Š2.1 mg/day) initially. The mean cumulative dose of intravenous cyclophosphamide was 1.4 ±â€Š0.2 g. The mean mRSS decreased significantly at follow-up compared with that at baseline (27.0 ±â€Š3.3 vs 15.8 ±â€Š3.5; P = .03). At the end of the treatment, the mean %FVC and %DLCO were improved moderately, although the differences were not significant. The serum KL-6 levels decreased from 578.9 ±â€Š146.5 to 205.3 ±â€Š43.1 U/ml (P = .02). No significant correlation was found between the change in mRSS or disease duration and the initial skin score severity.Triple therapy may improve skin sclerosis, with effectiveness equal or superior to other reported treatments. This preliminary case series demonstrates the potential of triple therapy for treating dcSSc. However, prospective studies with long-term follow-up should be performed to assess its role.


Asunto(s)
Ciclofosfamida/uso terapéutico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Plasmaféresis , Prednisolona/uso terapéutico , Esclerodermia Difusa/terapia , Administración Oral , Anciano , Terapia Combinada , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Mucina-1/sangre , Capacidad de Difusión Pulmonar , Estudios Retrospectivos , Esclerodermia Difusa/tratamiento farmacológico , Esclerodermia Difusa/fisiopatología , Resultado del Tratamiento , Capacidad Vital
5.
Biomed Khim ; 66(1): 71-76, 2020 Jan.
Artículo en Ruso | MEDLINE | ID: mdl-32116228

RESUMEN

The pharmacokinetics and bioavailability of a derivative of 3,7-diazabicyclo[3.3.1]nonane exhibiting a nootropic effect, were studied after a single dose to rats. The pharmacokinetics of the compound was studied after oral and intravenous administration to 270 male rats Sprague Dawley at doses of 2.5 mg/kg, 13 mg/kg and 25 mg/kg. Its distribution in organs and tissues (brain, thymus, heart, lungs, liver, kidneys, and spleen) was also investigated. It was found that after a single intravenous administration, the investigated substance was determined in the blood of animals for 24 h; the half-life was 4.69 h. The relative bioavailability of the 3,7-diazabicyclo[3.3.1]nonane derivative after oral administration was 42.3%, thus suggesting the prospect of creating dosage forms for oral administration. After a single oral administration, the dose dependence of AUC0-t was exponential. The substance is characterized by heterogeneous distribution in the body with preferential accumulation mainly in well-vascularized tissues.


Asunto(s)
Compuestos Aza/farmacocinética , Nootrópicos/farmacocinética , Administración Oral , Animales , Disponibilidad Biológica , Semivida , Inyecciones Intravenosas , Masculino , Ratas , Ratas Sprague-Dawley , Distribución Tisular
6.
N Engl J Med ; 382(12): 1124-1135, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130806

RESUMEN

BACKGROUND: Long-acting injectable regimens may simplify therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection. METHODS: We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm). RESULTS: At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found in 6 of 283 participants (2.1%) who received long-acting therapy and in 7 of 283 (2.5%) who received oral therapy (adjusted difference, -0.4 percentage points; 95% confidence interval [CI], -2.8 to 2.1), a result that met the criterion for noninferiority for the primary end point (margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 93.6% who received long-acting therapy and in 93.3% who received oral therapy (adjusted difference, 0.4 percentage points; 95% CI, -3.7 to 4.5), a result that met the criterion for noninferiority for this end point (margin, -10 percentage points). Of the participants who received long-acting therapy, 86% reported injection-site reactions (median duration, 3 days; mild or moderate severity, 99% of cases); 4 participants withdrew from the trial for injection-related reasons. Grade 3 or higher adverse events and events that met liver-related stopping criteria occurred in 11% and 2%, respectively, who received long-acting therapy and in 4% and 1% who received oral therapy. Treatment satisfaction increased after participants switched to long-acting therapy; 91% preferred long-acting therapy at week 48. CONCLUSIONS: Therapy with long-acting cabotegravir plus rilpivirine was noninferior to oral therapy with dolutegravir-abacavir-lamivudine with regard to maintaining HIV-1 suppression. Injection-site reactions were common. (Funded by ViiV Healthcare and Janssen; FLAIR ClinicalTrials.gov number, NCT02938520.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Quimioterapia de Inducción , Inyecciones Intramusculares , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
7.
N Engl J Med ; 382(12): 1112-1123, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130809

RESUMEN

BACKGROUND: Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS: In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS: Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS: Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Inyecciones Intramusculares/efectos adversos , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
8.
Medicine (Baltimore) ; 99(12): e19540, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195959

RESUMEN

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urinary system disease in men. As part of traditional Traditional Chinese medicine, acupuncture has been widely used in clinical practice. In order to evaluate the exact effect of acupuncture on the clinical efficacy of CP/CPPS, this experiment uses randomized controlled experiments. METHODS/DESIGN: This pragmatic randomized controlled trial will recruit 166 patients who are diagnosed with CP/CPPS. Simple randomization to conventional drug treatment with a 1:1 allocation ratio will be used. Ten 30-minute acupuncture sessions will be provided to patients assigned to the Intervention group. All participants will continue to receive conventional drug treatment. The selection of outcomes will be evaluated by Health's Symptom Score Index (NIH-CPSI) score at week 4. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with CP/CPPS. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR1900021132, Registered on 29 January 2019.


Asunto(s)
Terapia por Acupuntura/métodos , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Dolor Pélvico/terapia , Prostatitis/terapia , Tamsulosina/uso terapéutico , Terapia por Acupuntura/economía , Administración Oral , Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , China/epidemiología , Enfermedad Crónica , Terapia Combinada , Análisis Costo-Beneficio , Preparaciones de Acción Retardada , Estudios de Factibilidad , Humanos , Masculino , Dolor Pélvico/diagnóstico , Prostatitis/diagnóstico , Síndrome , Tamsulosina/administración & dosificación , Resultado del Tratamiento
9.
N Engl J Med ; 382(10): 893-902, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-32130813

RESUMEN

BACKGROUND: Patients with highly drug-resistant forms of tuberculosis have limited treatment options and historically have had poor outcomes. METHODS: In an open-label, single-group study in which follow-up is ongoing at three South African sites, we investigated treatment with three oral drugs - bedaquiline, pretomanid, and linezolid - that have bactericidal activity against tuberculosis and to which there is little preexisting resistance. We evaluated the safety and efficacy of the drug combination for 26 weeks in patients with extensively drug-resistant tuberculosis and patients with multidrug-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. The primary end point was the incidence of an unfavorable outcome, defined as treatment failure (bacteriologic or clinical) or relapse during follow-up, which continued until 6 months after the end of treatment. Patients were classified as having a favorable outcome at 6 months if they had resolution of clinical disease, a negative culture status, and had not already been classified as having had an unfavorable outcome. Other efficacy end points and safety were also evaluated. RESULTS: A total of 109 patients were enrolled in the study and were included in the evaluation of efficacy and safety end points. At 6 months after the end of treatment in the intention-to-treat analysis, 11 patients (10%) had an unfavorable outcome and 98 patients (90%; 95% confidence interval, 83 to 95) had a favorable outcome. The 11 unfavorable outcomes were 7 deaths (6 during treatment and 1 from an unknown cause during follow-up), 1 withdrawal of consent during treatment, 2 relapses during follow-up, and 1 loss to follow-up. The expected linezolid toxic effects of peripheral neuropathy (occurring in 81% of patients) and myelosuppression (48%), although common, were manageable, often leading to dose reductions or interruptions in treatment with linezolid. CONCLUSIONS: The combination of bedaquiline, pretomanid, and linezolid led to a favorable outcome at 6 months after the end of therapy in a high percentage of patients with highly drug-resistant forms of tuberculosis; some associated toxic effects were observed. (Funded by the TB Alliance and others; ClinicalTrials.gov number, NCT02333799.).


Asunto(s)
Antituberculosos/administración & dosificación , Diarilquinolinas/administración & dosificación , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Linezolid/administración & dosificación , Nitroimidazoles/administración & dosificación , Administración Oral , Adolescente , Adulto , Antituberculosos/efectos adversos , Carga Bacteriana , Diarilquinolinas/efectos adversos , Quimioterapia Combinada , Tuberculosis Extensivamente Resistente a Drogas/mortalidad , Femenino , Humanos , Análisis de Intención de Tratar , Linezolid/efectos adversos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Nitroimidazoles/efectos adversos , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto Joven
10.
Isr Med Assoc J ; 22(3): 154-159, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147979

RESUMEN

BACKGROUND: Guidelines recommend initiation of parenteral biologic or oral target-specific disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) in rheumatoid arthritis (RA) patients who do not adequately respond to conventional DMARDs. OBJECTIVES: To compare the preferred route of administration of bDMARDs or tsDMARDs in RA patients who were previously treated with at least one type. METHODS: A cross-sectional survey was conducted of consecutive RA patients previously prescribed bDMARDs or tsDMARDs. We analyzed the factors associated with patients' preferred route of administration. RESULTS: The cohort included 95 patients, mostly female (72.6%), seropositive (81.05%), mean age 63.4 ± 11.9 years. The oral route was preferred by 39 patients (41%) and 56 (59%) preferred the parenteral route. Most patients (65.9%) preferred to continue with their current route (P < 0.001). Switching from a current route was less common with patients who were currently using the oral route (13.3% vs. 38.2%, P = 0.04). Many patients (53.8%) who preferred the oral route had never experienced it before, while this was rare (3.6%) regarding the parenteral route (P = 0.0001). Employment status was associated with preference of the subcutaneous route over the intravenous route of bDMARDs (P = 0.01). Of the 21 patients who had previously experienced both parenteral and oral treatment, 16 (76.2%) preferred the oral route. CONCLUSIONS: RA patients preferred to continue treatment with an administration route they have already experienced. However, when choosing an unexperienced route, significantly more patients preferred the oral route. Our results strengthen the understanding of patient preferences, which could improve drug adherence, compliance, and disease outcome.


Asunto(s)
Antirreumáticos/administración & dosificación , Artritis Reumatoide/tratamiento farmacológico , Productos Biológicos/administración & dosificación , Nutrición Parenteral/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Antirreumáticos/uso terapéutico , Productos Biológicos/uso terapéutico , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
11.
Medicine (Baltimore) ; 99(10): e18925, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150045

RESUMEN

There is little consensus on the optimal timing of anti-tumor necrosis factor (anti-TNF) therapy to decrease the rates of hospitalization and surgery in Crohn disease (CD). We aimed to assess the real-world outcomes of anti-TNF therapy and estimate the optimal timing of anti-TNF therapy in Korean patients with CD.Claims data were extracted from the Korean Health Insurance Review and Assessment Service database. Incident patients diagnosed with CD between 2009 and 2016, with at least 1 anti-TNF drug prescription, and with follow-up duration > 6 months were stratified according to the number of relapses prior to initiation of anti-TNF therapy: groups A (≤1 relapse), B (2 relapses), C (3 relapses), and D (≥4 relapses). The cumulative survival curves free from emergency hospitalization (EH) and surgery were compared across groups.Among the 2173 patients analyzed, the best and worst prognoses were noted in groups A and D, respectively. The incidences of EH and surgery decreased significantly as the use of anti-TNF agents increased. The 5-year rate of hospitalization was significantly lower in group A than in groups C and D (P = .004 and .020, respectively), but similar between groups A and B. The 5-year rate of surgery was lower in group A than in group C (P = .024), but similar among groups A, B, and D.In Asian patients with CD, anti-TNF therapy reduces the risk of EH and surgery and should be considered before three relapses, regardless of disease duration.


Asunto(s)
Enfermedad de Crohn/epidemiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/administración & dosificación , Adalimumab/uso terapéutico , Administración Oral , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Bases de Datos Factuales , Supervivencia sin Enfermedad , Femenino , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/uso terapéutico , Humanos , Incidencia , Infliximab/administración & dosificación , Infliximab/uso terapéutico , Revisión de Utilización de Seguros , Masculino , Recurrencia , República de Corea/epidemiología , Estudios Retrospectivos , Adulto Joven
12.
Rev Med Suisse ; 16(680): 264-267, 2020 Feb 05.
Artículo en Francés | MEDLINE | ID: mdl-32022491

RESUMEN

Considering the progressive nature of type 2 diabetes, glycated hemoglobin (HbA1c) goals and treatment plans should be regularly tailored to the patient's need to prevent hypoglycemia. There are individual HbA1c target levels that take into account factors such as age, comorbidity, and risks of treatment. The emergence of new therapeutic classes reducing hypoglycemia has changed ongoing practices. This article presents a potentially preventable case of a patient with hypoglycemia and reflects on the latest European and American recommendations for antidiabetic treatment in elderly patients.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Administración Oral , Anciano , Glucemia/efectos de los fármacos , Hemoglobina A Glucada/análisis , Humanos
13.
N Engl J Med ; 382(7): 622-631, 2020 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053298

RESUMEN

BACKGROUND: More effective and safer treatments are needed for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. METHODS: We conducted a randomized trial with a 2-by-2 factorial design to evaluate the use of plasma exchange and two regimens of oral glucocorticoids in patients with severe ANCA-associated vasculitis (defined by an estimated glomerular filtration rate of <50 ml per minute per 1.73 m2 of body-surface area or diffuse pulmonary hemorrhage). Patients were randomly assigned to undergo plasma exchange (seven plasma exchanges within 14 days after randomization) or no plasma exchange (control group). Patients were also randomly assigned to follow either a standard-dose regimen or a reduced-dose regimen of oral glucocorticoids. Patients were followed for up to 7 years for the primary composite outcome of death from any cause or end-stage kidney disease (ESKD). RESULTS: Death from any cause or ESKD occurred in 100 of 352 patients (28.4%) in the plasma-exchange group and in 109 of 352 patients (31.0%) in the control group (hazard ratio, 0.86; 95% confidence interval [CI], 0.65 to 1.13; P = 0.27). The results were similar in subgroup analyses and in analyses of secondary outcomes. We also assessed the noninferiority of a reduced-dose regimen of glucocorticoids to a standard-dose regimen, using a noninferiority margin of 11 percentage points. Death from any cause or ESKD occurred in 92 of 330 patients (27.9%) in the reduced-dose group and in 83 of 325 patients (25.5%) in the standard-dose group (absolute risk difference, 2.3 percentage points; 90% CI, -3.4 to 8.0), which met the criterion for noninferiority. Serious infections at 1 year were less common in the reduced-dose group than in the standard-dose group (incidence rate ratio, 0.69; 95% CI, 0.52 to 0.93), but other secondary outcomes were similar in the two groups. CONCLUSIONS: Among patients with severe ANCA-associated vasculitis, the use of plasma exchange did not reduce the incidence of death or ESKD. A reduced-dose regimen of glucocorticoids was noninferior to a standard-dose regimen with respect to death or ESKD. (Funded by the U.K. National Institute for Health Research and others; PEXIVAS Current Controlled Trials number, ISRCTN07757494; ClinicalTrials.gov number, NCT00987389.).


Asunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/tratamiento farmacológico , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Glucocorticoides/administración & dosificación , Fallo Renal Crónico/prevención & control , Intercambio Plasmático , Administración Oral , Adulto , Anciano , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/mortalidad , Terapia Combinada , Ciclofosfamida/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Glucocorticoides/efectos adversos , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Quimioterapia de Inducción , Enfermedades Renales/complicaciones , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Masculino , Persona de Mediana Edad , Intercambio Plasmático/efectos adversos , Rituximab/uso terapéutico
15.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 109-113, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32064843

RESUMEN

Control of bleeding after oral surgery is mandatory in patients taking anticoagulants. There are different haemostatic measures to prevent post-surgical bleeding. The aim of the present paper is to study the use of a haemostatic agent, calcium sulphate (CaS) (P30, Ghimas, Bologna, Italy) for controlling post-surgical bleeding in a group of patients treated with warfarin therapy for thromboembolic states. Twenty teeth (12 mandibular molars, 8 maxillary molars) in 20 patients (14 male and 6 females) with a mean age of 54.3 years (±10.3 years) were included in the study. The patients were divided into 2 groups; in the study group of 10 patients calcium sulphate was used in layers to fill the socket after extraction, while for the 10 patients in the control group put a gauze with tranexamic acid was put in the extraction site immediately after extraction, and half an hour after extraction. The outcome was bleeding in subsequent days. Bleeding at post-operative day 1 was significant in 5 patients of the control group, however, in the study group treated with calcium sulfate there was no bleeding in any patient (p value 0.0055). CaS demonstrated to be a good haemostatic agent for controlling bleeding after oral surgery in patients taking anticoagulants.


Asunto(s)
Sulfato de Calcio/uso terapéutico , Hemostáticos/uso terapéutico , Hemorragia Posoperatoria/tratamiento farmacológico , Extracción Dental , Administración Oral , Adulto , Anticoagulantes/uso terapéutico , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Int J Pharm Compd ; 24(1): 77-82, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023219

RESUMEN

This study reports on the stability of United States Pharmacopeia-grade metronidazole powder and commercially available metronidazole tablets in two dye-free oral suspending vehicles, namely Oral Mix and Oral Mix Sugar-Free. Metronidazole at 50 mg/mL was prepared individually in Oral Mix and Oral Mix Sugar-Free suspension vehicles and placed in 50-mL amber polyethyleneterephthalate bottles and 3-mL amber plastic syringes and stored at 4°C or 25°C/60% relative humidity for 90 days. The solutions were analyzed at the time of preparation and at 7 days, 14 days, 30 days, 45 days, 60 days, 75 days, and 90 days, with the concentration of metronidazole measured by high-performance liquid chromatography with photodiode array detection. The oral solutions were also monitored for pH, homogeneity, color, and odor. Except for the Oral Mix suspension of metronidazole prepared from the United States Pharmacopeia-grade powder and from the commercial tablet, when stored in pre-filled syringes, all the other preparations were stable at 4°C or 25°C/60% relative humidity for 90 days, with the metronidazole remaining within ± 10% of the initial concentration. The pH, color, odor, and resuspendability remained essentially unchanged. Metronidazole in Oral Mix and Oral Mix Sugar-Free oral suspensions, compounded from United States Pharmacopeia-grade powder or commercially available tablets, are a suitable alternative as an extemporaneously prepared medication.


Asunto(s)
Metronidazol , Administración Oral , Cromatografía Líquida de Alta Presión , Composición de Medicamentos/métodos , Estabilidad de Medicamentos , Suspensiones , Comprimidos/administración & dosificación , Estados Unidos
17.
Medicine (Baltimore) ; 99(6): e18834, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028393

RESUMEN

INTRODUCTION: There is a lack of published studies about the combination of duloxetine and pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI). The aim of our work will be to evaluate the effect of this intervention by assessing whether there is a change in the incontinence episode frequency (IEF), Incontinence Quality of Life (I-QoL), Patient Global Impression of Improvement score (PGI-I) and mean time between voids (MTBV). Combined therapy with duloxetine and PFMT will be compared to duloxetine treatment alone with respect to its efficacy and side effects. METHODS: This study will be a randomized intervention, parallel, multicenter study in collaboration with 45 urological outpatient clinics at the national level. Patients will be assigned in a 1:1 ratio to the experimental and control groups using simple randomization according to odd and even numbers assigned sequentially to the patients at each clinic. The experimental intervention will be 12 weeks. The experimental group will receive oral treatment with duloxetine at a daily dose of 2 × 40 mg and will be required to perform innovative PFMT. The control group will receive the same oral duloxetine treatment (2 × 40 mg a day) but will not perform PMFT. Data will be collected from both groups before intervention and after the 12-week intervention is completed. DISCUSSION: The study protocol presents the starting points, design and randomization of an interventional multicenter study to monitor the effect of the combination of duloxetine with innovative PFMT compared to duloxetine treatment alone in women with SUI. This study may provide evidence of the efficacy of this combined treatment for SUI and highlight benefits associated with active approaches to treatment through exercise. REGISTRATION: This study was retrospectively registered in the ClinicalTrials.go NCT04140253. Protocol version 1.0. date 11.1.2019.


Asunto(s)
Clorhidrato de Duloxetina/uso terapéutico , Terapia por Ejercicio , Diafragma Pélvico , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéutico , Incontinencia Urinaria de Esfuerzo/terapia , Administración Oral , Adolescente , Adulto , Anciano , Terapia Combinada , Clorhidrato de Duloxetina/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Inhibidores de Captación de Serotonina y Norepinefrina/administración & dosificación , Eslovaquia , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto Joven
18.
Medicine (Baltimore) ; 99(5): e19000, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000440

RESUMEN

BACKGROUND: Patients with cancer are of a high level risk of venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is recommended as the normal treatment for cancer-associated venous thrombosis. Recently, some studies suggest that patients with cancer-associated venous thrombosis can get a good efficacy and safety profile from treating with direct oral anticoagulants (DOACs) compared with other anticoagulants. However, when it comes to the efficacy of DAOCs in preventing VTE in patient with cancer, the data are limited. Thus, we performed such a meta-analysis to determine the efficacy and safety of DOACs in preventing VTE in patient with cancer compared with LMWHs. METHODS: Medline/PubMed and CENTRAL (The Cochrane Central Register of Controlled Trials) were systematically searched for relevant studies. For each trial, data on VTE, major bleeding, or bleeding were extracted by 2 reviewers independently. Pooled risk ratios (RRs) were calculated by using Review Manager 5.3 software and the significance was determined by the Z test. RESULTS: A total of 6 studies with 7185 patients were included in our meta-analysis. DOACs (RR = 0.55, 95% confidence interval [95%CI]: 0.34-0.90, I = 31%) had a similar prevention effect of VTE to LMWH (RR = 0.59, 95% CI: 0.37-0.95, I = 59%). DOACs (RR = 1.52, 95% CI: 0.99-2.33, I = 0%) yielded a similar bleeding occurrence rate compared with LMWH (RR = 1.35, 95% CI: 1.07-1.70, I = 35%). DOACs (RR = 1.95, 95% CI: 0.88-4.30, I = 0%) showed a sight higher major bleeding occurrence rate than LMWH (RR = 1.38, 95% CI: 0.88-2.14, I = 0%). CONCLUSION: DOACs show comparable efficacy to LMWH in cancer patients without VTE with a slightly higher major bleeding occurrence rate. DOACs are inclined to be an alternative thromboprophylaxis strategy in cancer patients as they have superiorities compared to traditional anticoagulation agents. Further studies are still demanded as exiting relevant researches are limited.


Asunto(s)
Anticoagulantes/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Neoplasias/complicaciones , Tromboembolia Venosa/prevención & control , Administración Oral , Hemorragia/inducido químicamente , Humanos
19.
Medicine (Baltimore) ; 99(8): e18912, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080074

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) is the most common form of degenerative arthritis. We used Phellinus linteus (PL), which has been well-known anti-inflammatory function. In this study, we will evaluate if PL extract improves symptoms with KOA. METHODS: This study will be an 8-week single-center randomized controlled double-blind clinical trial. Total of 24 subjects with KOA will be enrolled and they will be divided into 3 groups, PL 1,000 mg, PL 1,500 mg and placebo. Subjects will be followed up every 4 weeks with efficacy and safety at the 2nd and 3rd visits. All subjects should maintain a dosage schedule for this protocol. The primary outcome will be assessed with the Korean version of the Western Ontario and McMasters Universities. And the secondary outcomes will be measured using the visual analog scale, quality of life scale (EQ-5D-3L), ESR, C-reactive protein, and C-telopeptide of type-II collagen. Statistical analysis will be performed on the principle of full analysis set. DISCUSSION: This study has inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is the first step to assess the efficacy and safety of PL in patients with KOA. This study will make an important contribution to the literature and aid follow-up research into the use of PL in KOA.


Asunto(s)
Cartílago Articular/efectos de los fármacos , Articulación de la Rodilla/efectos de los fármacos , Osteoartritis de la Rodilla/tratamiento farmacológico , Extractos Vegetales/administración & dosificación , Administración Oral , Adulto , Anciano , Sedimentación Sanguínea/efectos de los fármacos , Proteína C-Reactiva/efectos de los fármacos , Colágeno Tipo I/efectos de los fármacos , Humanos , Persona de Mediana Edad , Osteoartritis de la Rodilla/sangre , Osteoartritis de la Rodilla/patología , Péptidos/efectos de los fármacos , Placebos/administración & dosificación , Extractos Vegetales/uso terapéutico , Estudios Prospectivos , Calidad de Vida , República de Corea/epidemiología , Resultado del Tratamiento
20.
Arerugi ; 69(1): 34-39, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32051367

RESUMEN

OBJECTIVE: We aim to examine the characteristics of the symptoms induced by exercise provocation tests following allergen consumption in patients who have undergone oral immunotherapy (OIT). METHOD: Patients who were positive for exercise provocation tests in Miyagi Children's Hospital from April 2012 to January 2019 were retrospectively analyzed. Patients were classified into food-dependent exerciseinduced anaphylaxis (FDEIA) group and post-OIT-FDEIA group. RESULT: Six patients in the FDEIA group and 19 patients in the post-OIT-FDEIA group were analyzed. There were no significant differences in age, sex, and number of complications between the FDEIA and post-OIT-FDEIA groups, except for level of total serum immunoglobulin E. The median time from the start of exercise to onset of symptoms was 20 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. The rate of adrenaline administration in post-OIT-FDEIA group was significantly lower. The median time from exercise to onset of severe symptoms requiring adrenaline was 32.5 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. CONCLUSION: These data suggest that FDEIA and post-OIT-FDEIA patients can exhibit similar clinical symptoms, and all symptoms occurred in 60 minutes after exercise.


Asunto(s)
Anafilaxia/terapia , Asma Inducida por Ejercicio/terapia , Hipersensibilidad a los Alimentos/terapia , Inmunoterapia , Administración Oral , Alérgenos , Niño , Epinefrina/administración & dosificación , Humanos , Estudios Retrospectivos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA