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1.
Medicine (Baltimore) ; 99(7): e19266, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049868

RESUMEN

Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.


Asunto(s)
Vértebras Cervicales , Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Degeneración del Disco Intervertebral/tratamiento farmacológico , Femenino , Humanos , Inyecciones Epidurales , Degeneración del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
2.
Artículo en Chino | MEDLINE | ID: mdl-32086915

RESUMEN

Objective:The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. Method:242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines(2015), the patients were divided into low frequency descending type (49 cases), high frequency descending type (66 cases), flat descending type (71 cases) and total deafness (56 cases). Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. Result:In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type (P<0.05). In 66 cases of high frequency descending type, there was no significant difference among the three treatments (P>0.05). In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type (P<0.05). In the other three types of deafness, there was no significant difference among the three treatment methods (P>0.05). There was no significant difference in the effective rate between men and women (P>0.05) in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset (P<0.05). Conclusion:Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.


Asunto(s)
Dexametasona/administración & dosificación , Inyección Intratimpánica , Audiometría de Tonos Puros , Femenino , Pérdida Auditiva Súbita , Humanos , Masculino , Resultado del Tratamiento
3.
Mymensingh Med J ; 29(1): 60-65, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915337

RESUMEN

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this retrospective study was to determine the effects of the interval between a single ACS (Dexamethasone) course and delivery on the incidence of respiratory distress syndrome (RDS) in neonates at Mymensingh Medical College Hospital Center from 1st January 2017 to 30th June 2017. Injection Dexamethasone 2 doses (12.5mg IM 12 hourly for 2 doses) or 4 doses (6mg IM every 12 hours for 4 doses) use to arrest preterm labor as well as to prevent RDS delivered beyond 48 hours after ACS administration between 24 and 34 weeks gestation. The risk of RDS was compared between patients who delivered within seven days (Group I) and 7-14 days (Group II) after ACS administration. We included 140 and 60 patients in Group I and Group II respectively. After adjusting for confounders, the ACS delivery interval was significantly associated with RDS in Group II (adjusted odds ratio 12.8, 95% confidence interval 1.31-164.7). A longer ACS delivery interval is associated with a higher risk of RDS. Thus, the use of a rescue course could be expected to reduce the incidence of RDS in patients beyond seven days after ACS administration who remain at risk for preterm delivery within seven days, especially in cases of placenta previa and/or women bearing a male fetus.


Asunto(s)
Corticoesteroides/administración & dosificación , Dexametasona/administración & dosificación , Nacimiento Prematuro/prevención & control , Atención Prenatal/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Corticoesteroides/efectos adversos , Bangladesh/epidemiología , Dexametasona/efectos adversos , Femenino , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro , Masculino , Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
4.
J Cancer Res Clin Oncol ; 146(2): 357-365, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31938902

RESUMEN

BACKGROUND: Castleman disease (CD) is a rare polyclonal lymphoproliferative disorder with unknown etiology. TAFRO syndrome is now regarded as a specific subtype of CD, and is still a huge challenge for clinicians. METHODS: To clarify the clinical features and management of TAFRO syndrome in China, we retrospectively analyzed 96 patients with HIV-negative CD (52 with unicentric CD and 44 with multicentric CD), who were diagnosed and treated at our center between 2008 and 2017. Specially, we systematically reviewed the 7 TAFRO syndrome cases based on the 2015 criteria proposed by Masaki. RESULTS: Among the 7 cases, there were 3 men and 4 women, and the median age was 53 years. The main symptoms included thrombocytopenia (7/7), anasarca (7/7), fever (4/7), renal dysfunction (7/7), and organomegaly (6/7). One patient was treated with corticosteroid monotherapy, one received RD (Rituximab, dexamethasone), and 5 received CHOP/COP like chemotherapy as first-line treatment, 2 of the 5 combined with Rituximab. Four patients needed hemodialysis or CRRT because of progressive renal failure. The outcome for TAFRO syndrome was significantly worse compared to other types of CD. Although 3 patients improved after early treatment, 4 patients died due to disease progression, and only one patient achieved complete resolution of all the symptoms after changing to lenalidomide based regimen. CONCLUSIONS: This study reveals that TAFRO syndrome is more severe and has more systemic symptoms than other iMCD, most cases need active treatment, and their prognoses are poor. Lenalidomide based regimen may be as a promising new therapy for TAFRO syndrome.


Asunto(s)
Enfermedad de Castleman/diagnóstico , Enfermedad de Castleman/tratamiento farmacológico , Adolescente , Corticoesteroides/administración & dosificación , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciclofosfamida/administración & dosificación , Dexametasona/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Rituximab/administración & dosificación , Vincristina/administración & dosificación , Adulto Joven
5.
Infection ; 48(2): 289-293, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31900872

RESUMEN

INTRODUCTION: Central nervous system (CNS) tuberculomas are a challenging manifestation of extrapulmonary tuberculosis often leading to neurological complications and post-treatment sequelae. The role of adjunctive corticosteroid treatment is not fully understood. Most guidelines on management of tuberculosis do not distinguish between tuberculous meningitis and CNS tuberculomas in terms of corticosteroid therapy. METHODS: We describe five patients with CNS tuberculomas who required intensified dexamethasone treatment for several months, in two cases up to 18 months. RESULTS: These patients were initially treated with the standard four-drug tuberculosis regimen and adjuvant dexamethasone. Neurological symptoms improved rapidly. However, multiple attempts to reduce or discontinue corticosteroids according to guideline recommendations led to clinical deterioration with generalized seizures or new CNS lesions. Thus, duration of adjunctive corticosteroid therapy was extended eventually leading to clinical cure and resolution of lesions. CONCLUSION: In contrast to tuberculous meningitis, the treatment for CNS tuberculomas appears to require a prolonged administration of corticosteroids. These findings need to be verified in controlled clinical studies.


Asunto(s)
Antibióticos Antituberculosos/administración & dosificación , Dexametasona/administración & dosificación , Tuberculoma/tratamiento farmacológico , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Adulto , Anciano , Terapia Combinada , Alemania , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Tuberculoma/diagnóstico por imagen , Tuberculoma/patología , Tuberculosis del Sistema Nervioso Central/diagnóstico por imagen , Tuberculosis del Sistema Nervioso Central/patología
6.
Expert Opin Drug Saf ; 19(2): 205-210, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31709853

RESUMEN

Objectives: HTX-019 (Cinvanti®) is a novel injectable emulsion formulation of the neurokinin 1 receptor antagonist (RA) aprepitant, approved (as 30-min infusion and 2-min injection) for preventing acute and delayed chemotherapy-induced nausea and vomiting (CINV). This retrospective analysis evaluated the safety of HTX-019 administered by 2-min injection in patients with cancer.Methods: At a single center, HTX-019 was evaluated as a 2-min injection within a guideline-recommended three-drug regimen for CINV prophylaxis in patients receiving highly (HEC) or moderately emetogenic chemotherapy (MEC). Treatment-emergent adverse events (TEAEs) were assessed 0-60 minutes following initiation of HTX-019 administration, focusing on infusion-site adverse events and hypersensitivity reactions.Results: Among 600 patients (78 MEC, 522 HEC), the most common diagnoses were lung (172) and breast (129) cancer. Patients received a 2-min injection of HTX-019, followed by a 5-hydroxytryptamine type 3 RA intravenously (IV) (palonosetron or ondansetron), dexamethasone IV, and chemotherapy regimen (most common was cisplatin-containing) via a central (76%) and peripheral line (24%). No TEAEs occurred within 60 min after start of HTX-019 administration.Conclusion: HTX-019 administered by 2-min injection has a tolerable safety profile in patients with cancer, representing a viable method of HTX-019 administration for CINV prevention.


Asunto(s)
Antieméticos/administración & dosificación , Aprepitant/administración & dosificación , Antagonistas del Receptor de Neuroquinina-1/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Antieméticos/efectos adversos , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Aprepitant/efectos adversos , Dexametasona/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/prevención & control , Neoplasias/tratamiento farmacológico , Antagonistas del Receptor de Neuroquinina-1/efectos adversos , Ondansetrón/administración & dosificación , Palonosetrón/administración & dosificación , Estudios Retrospectivos , Vómitos/inducido químicamente , Vómitos/prevención & control
7.
Br J Anaesth ; 124(1): 92-100, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31711605

RESUMEN

BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block. METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).


Asunto(s)
Adyuvantes Anestésicos , Dexametasona , Bloqueo Nervioso/métodos , Nervios Periféricos , Adyuvantes Anestésicos/administración & dosificación , Adyuvantes Anestésicos/efectos adversos , Administración Intravenosa , Adulto , Estudios Cruzados , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Fuerza de la Mano , Voluntarios Sanos , Humanos , Masculino , Nervio Mediano , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Umbral del Dolor/efectos de los fármacos , Sensación/efectos de los fármacos , Sensación Térmica/efectos de los fármacos , Adulto Joven
8.
Ann Hematol ; 99(1): 137-145, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31768675

RESUMEN

The combinations of melphalan, bortezomib, and prednisolone (VMP) and of lenalidomide and dexamethasone (Rd) are standard treatment strategies for transplant-ineligible newly diagnosed multiple myeloma (NDMM). To make the most of these two strategies, we investigated the efficacy and feasibility of first-line treatment with 4 cycles of VMP followed by continuous Rd therapy in a multi-institutional phase 2 study in Japanese patients with transplant-ineligible NDMM. Thirty-six patients of median age 74 years old with NDMM initially received 35-day cycles of VMP: oral melphalan (6 mg/m2) and prednisolone (60 mg/m2) on days 1 to 4 and bortezomib (1.3 mg/m2) on days 1, 8, 15, and 22. After 4 cycles of VMP, treatment was switched to 28-day cycles of Rd, which was continued until disease progression or emergence of an unacceptable adverse event (AE) in 33 patients, while one patient who achieved CR after VMP continued VMP at the physician's discretion. The overall response rates after VMP and after Rd were 66.7% and 86.1%, including CR rates of 5.6% and 36.1%, respectively. In a median follow-up period of 34.3 months, the progression-free survival and overall survival rates at 3 years were 43.2% and 81.3%, respectively. Grade 3-4 hematological AEs included neutropenia (39% with VMP and 24% with Rd) and thrombocytopenia (11% with VMP and 3% with Rd). There was no death due to an AE. In conclusion, sequential therapy with VMP followed by Rd is effective and mostly feasible for transplant-ineligible NDMM. The study is registered as UMIN000034815.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/mortalidad , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bortezomib/administración & dosificación , Bortezomib/efectos adversos , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lenalidomida/administración & dosificación , Lenalidomida/efectos adversos , Masculino , Melfalán/administración & dosificación , Melfalán/efectos adversos , Mieloma Múltiple/diagnóstico , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Tasa de Supervivencia
9.
Br J Anaesth ; 124(1): 84-91, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31591018

RESUMEN

BACKGROUND: Efforts to prolong interscalene block (ISB) analgesia include the use of local anaesthetic adjuvants such as dexamethasone. Previous work showing prolonged block duration suggests that both perineural and intravenous (i.v.) routes can both prolong analgesia. The superiority of either route is controversial given the design of previous studies. As perineural dexamethasone is an off-label use, anaesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to test whether perineural vs i.v. dexamethasone administration are equivalent. METHODS: We randomised 182 eligible patients scheduled for arthroscopic shoulder surgery to receive low-dose ISB (0.5% ropivacaine 5 ml) with perineural or i.v. dexamethasone 4 mg. Subjects, anaesthesiologists, and research personnel were blinded. All subjects also received a standardised general anaesthetic and multimodal analgesia. The primary outcome was duration of analgesia analysed as an equivalence outcome (2 h equivalency margin) using the two one-sided test (TOST) method. RESULTS: For the primary outcome, duration of analgesia, and perineural and i.v. administration of dexamethasone were not equivalent. The upper and lower bounds of the 90% confidence interval were 1 h (P=0.12) and -2.5 h (P=0.01), respectively. The observed difference in mean block duration was not clinically relevant (0.75 h longer for i.v. dexamethasone). There were no other clinically significant differences between groups. CONCLUSION: In the context of low-volume ISB with ropivacaine, perineural and i.v. dexamethasone were not equivalent in terms of their effects on block duration. However, there were no clinically significant differences in outcomes, and there is no advantage of perineural over intravenous dexamethasone. WWW.CLINICALTRIALS. GOV REGISTRATION: NCT02322242.


Asunto(s)
Adyuvantes Anestésicos/administración & dosificación , Adyuvantes Anestésicos/farmacología , Bloqueo del Plexo Braquial/métodos , Plexo Braquial , Dexametasona/administración & dosificación , Dexametasona/farmacología , Bloqueo Nervioso/métodos , Administración Intravenosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroscopía/métodos , Método Doble Ciego , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Hombro/cirugía , Adulto Joven
13.
J Matern Fetal Neonatal Med ; 33(1): 1-4, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29804488

RESUMEN

Objective: To demonstrate the utility of dexamethasone, used according to the criteria of the attending physician, in patients with HELLP syndrome.Methods: This cross-sectional study was conducted in patients with HELLP syndrome and was based on the daily, real-life management of HELLP syndrome. Patients who received dexamethasone had it administered immediately after giving birth at a dosage of 8 mg every 8 hours for 72 hours, for a total of 72 mg. The analysis was conducted between patients who received corticosteroids and those who did not, with complete or partial HELLP.Results: There were 97 women who suffered complications from HELLP syndrome, there were 43 (44.3%) received dexamethasone. The groups were comparable except for the initial platelet count because this was the criterion used to divide the groups. In addition, the group without corticosteroids comprised more patients with partial HELLP. The platelet count shows that on the third day was similar in both groups, following a difference of more than 40,000 at the beginning of the study. The average platelet increase was 27,448 in the group without corticosteroids and 88,408 in the corticosteroid group; p = .001.Conclusions: This study demonstrates that the administration of postpartum dexamethasone at a dosage of 8 mg every 8 hours for 72 hours in HELLP syndrome is associated with a significant increase in platelet count.


Asunto(s)
Dexametasona/uso terapéutico , Síndrome HELLP/tratamiento farmacológico , Adulto , Plaquetas/efectos de los fármacos , Plaquetas/patología , Bolivia/epidemiología , Estudios Transversales , Dexametasona/administración & dosificación , Esquema de Medicación , Femenino , Síndrome HELLP/epidemiología , Humanos , Recuento de Plaquetas , Atención Posnatal/métodos , Periodo Posparto/sangre , Periodo Posparto/efectos de los fármacos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Resultado del Tratamiento , Adulto Joven
14.
Carbohydr Polym ; 227: 115356, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31590850

RESUMEN

Chitosan oligosaccharide-valylvaline-stearic acid (CSO-VV-SA) nanomicelles were designed for topical ocular drug delivery, based on peptide transporter-1 (PepT-1) active targeting. Hydrogenated castor oil-40/octoxynol-40 (HCO-40/OC-40) mixed nanomicelles were also prepared according to Cequa, just approved by FDA. Both nanomicelles produced no significant cytotoxicity and difference in human corneal epithelial cells (HCEpiC) and human conjunctival epithelial cells (HConEpiC). The active transport of CSO-VV-SA nanomicelles by PepT-1 was illustrated in the inhibitory test. Ex vivo fluorescence images of frozen sections indicated that the nanomicelles entered the posterior segment mainly through conjunctival route. In vivo precorneal retention study suggested dexamethasone from both nanomicelles could be detected for more than 3 h in rabbit tears. In vivo distribution evaluation of rabbits' eyes showed the delivering efficiency of CSO-VV-SA nanomicelles was not inferior to that of HCO-40/OC-40 mixed nanomicelles. These findings indicated that CSO-VV-SA nanomicelles could become promising candidates for further clinical application.


Asunto(s)
Antiinflamatorios/administración & dosificación , Quitosano/administración & dosificación , Dexametasona/administración & dosificación , Sistemas de Liberación de Medicamentos , Micelas , Nanopartículas/administración & dosificación , Oligosacáridos/administración & dosificación , Administración Oftálmica , Animales , Antiinflamatorios/química , Línea Celular , Supervivencia Celular/efectos de los fármacos , Quitosano/química , Dexametasona/química , Dipéptidos/administración & dosificación , Dipéptidos/química , Liberación de Fármacos , Células Epiteliales/efectos de los fármacos , Células Epiteliales/metabolismo , Ojo/citología , Ojo/metabolismo , Humanos , Masculino , Nanopartículas/química , Oligosacáridos/química , Transportador de Péptidos 1/metabolismo , Conejos , Ratas Sprague-Dawley , Ácidos Esteáricos/administración & dosificación , Ácidos Esteáricos/química
16.
Ann Hematol ; 99(2): 309-319, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31872360

RESUMEN

Although lenalidomide plus dexamethasone (RD) is a therapeutic option for relapsed/refractory multiple myeloma (RRMM), limited real-world clinical data exist. The purpose of this study was to estimate efficacy and safety of RD in RRMM patients of the clinical practice. Data from patients at 25 university hospitals in South Korea between October 2009 and December 2016 were collected retrospectively. We report the effectiveness and safety of RD in 546 RRMM patients in routine clinical practice in South Korea. Patients (median age, 65 years) typically received median 7 cycles of RD, and 184 (33.7%) patients were treated with 10 or more cycles of RD. Patients with renal impairment (CLCr < 40 mL/min; 10.4%), comorbid conditions (≥ 2; 12.0%), and poor performance status (≥ 2; 25.1%) were included. The overall response rate was 64.2%: complete response (13.1%), very good partial response (VGPR 19.9%). With median follow-up duration of 18.6 months, median PFS and OS were 11.2 months and 25.2 months, respectively. In multivariate analysis, less than 2 comorbid conditions, normal LDH, failed one chemotherapy prior to RD, and ≥ 10 cycles of RD therapy had significantly prolonged PFS (P = 0.007, P = 0.011, P = 0.007, and P < 0.001, respectively). Adverse events were acceptable. RD is effective and safe in real-life clinical practice, including patients with comorbidities. RD is an effective and safe treatment in a real clinical setting which includes patients with comorbidities. Early and continual use of RD treatment may improve RRMM survival outcomes.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Dexametasona/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Humanos , Lenalidomida/administración & dosificación , Masculino , Persona de Mediana Edad , Recurrencia , República de Corea/epidemiología , Tasa de Supervivencia
17.
Curr Opin Ophthalmol ; 31(1): 3-9, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31688227

RESUMEN

PURPOSE OF REVIEW: This review aims to cover the preoperative planning, intraoperative considerations, and postoperative management that aids in successful outcomes of patients with cataract and uveitis. Disease-specific management and pediatric management will also be addressed. RECENT FINDINGS: Dexamethasone implants appear to be a safe and effective addition to standard steroid treatment in decreasing the incidence of postoperative cystoid macular edema (CME). Intravitreal steroids and topical difluprednate have shown utility in CME treatment. SUMMARY: Cataract surgery in eyes with uveitis is generally safe and effective if inflammation is well controlled; however, complication rates are still higher than in eyes without uveitis. Future investigations should delineate outcomes for eyes with different etiologies of uveitis, and further research is needed to adequately control inflammation and avoid postoperative complications.


Asunto(s)
Extracción de Catarata , Catarata/complicaciones , Uveítis/complicaciones , Administración Oftálmica , Dexametasona/administración & dosificación , Implantes de Medicamentos , Fluprednisolona/administración & dosificación , Fluprednisolona/análogos & derivados , Glucocorticoides/administración & dosificación , Humanos , Cuidados Intraoperatorios , Inyecciones Intravítreas , Edema Macular/prevención & control , Cuidados Posoperatorios , Cuidados Preoperatorios , Uveítis/tratamiento farmacológico , Agudeza Visual/fisiología
18.
Support Care Cancer ; 28(1): 221-227, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31016422

RESUMEN

PURPOSE: Paclitaxel-associated acute pain syndrome (P-APS) affects 80% of patients undergoing therapy. Although it has been shown that prednisone administration for 5 days relieves P-APS, detailed results have not been reported thus far. Therefore, in this study, we evaluated the preventive effect of dexamethasone (DEX) administration against P-APS. METHODS: A total of 60 patients who received carboplatin (area under the curve; AUC = 5-6) plus paclitaxel (200 mg/m2) (plus bevacizumab 15 mg/kg, if non-squamous carcinoma of lung) were enrolled. Eight milligrams of DEX was orally administered on days 2 and 3 to the DEX group patients, and the frequency, severity, duration of P-APS, and other adverse effects in the first cycle were retrospectively evaluated and compared to those observed in control group patients, who were not administered DEX on days 2 and 3. RESULTS: No difference in terms of patient characteristics, except for type of cancer, was observed between groups. The results showed that the frequency of all grade P-APS was approximately 70% and there was no difference between groups. Frequency of ≥ G2 P-APS was 40% in the control group and 14% in the DEX group, demonstrating a significant reduction. Duration of P-APS was 5.8 days in the control group and 4.3 days in the DEX group, which tended to become shorter following additional DEX administration, although this was not significant. Adverse effects other than P-APS induced by chemotherapy were similar between the two groups. CONCLUSION: Additional DEX administration is safe and useful for the attenuation of the severity of P-APS.


Asunto(s)
Dolor Agudo/inducido químicamente , Dolor Agudo/prevención & control , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Dexametasona/administración & dosificación , Neoplasias Pulmonares/tratamiento farmacológico , Paclitaxel/efectos adversos , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bevacizumab/administración & dosificación , Bevacizumab/efectos adversos , Carboplatino/administración & dosificación , Carboplatino/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioprevención/métodos , Dexametasona/efectos adversos , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Estudios Retrospectivos , Síndrome , Resultado del Tratamiento
19.
Clin Ter ; 170(1): e11-e14, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31850478

RESUMEN

PURPOSE: A commonly recognized complication of intravitreal steroids is ocular hypertension (OHT).The aim of this study was to investigate the effectiveness of pharmacotherapy in controlling this side effect, even in patients receiving sequential injections. METHODS: A total of 146 injections were performed on 78 patients over 3 years. 78 eyes were treated with 1 injection, 44 eyes were treated with 2 injections; 24 eyes were treated with 3 injections. The intravitreal corticosteroid used in this observational study is 0.7mg dexamethasone, commercially known as 0.7mg Ozurdex®. RESULTS: Following the first injection, mean intraocular pressure (IOP) increased by 1,90 mmHg. Following the second injection, mean IOP increased by 0.23 mmHg. Following the third injection, there was no statistically significant change. Patients with IOP >= 21mmHg (7% of all participants) were started on topical pressure-lowering medications. CONCLUSIONS: Intravitreal dexamethasone implants increased IOP of variable degrees in different patients. However, secondary OHT was effectively controlled with pharmacotherapy alone. This allowed for continuation of dexamethasone therapy.


Asunto(s)
Dexametasona/efectos adversos , Dexametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Presión Intraocular/efectos de los fármacos , Edema Macular/tratamiento farmacológico , Hipertensión Ocular/inducido químicamente , Hipertensión Ocular/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Dexametasona/administración & dosificación , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
20.
Int J Nanomedicine ; 14: 8819-8834, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31819410

RESUMEN

Purpose: Age-related macular degeneration is a multifactorial disease involving inflammation and choroidal neovascularization. Vascular endothelial growth factor (VEGF) has been regarded as a potential therapeutic target to treat choroidal neovascularization. Dexamethasone can interfere with the expression or action of VEGF while bevacizumab targets and combines with VEGF. We propose electrostatically-conjugated bevacizumab-bearing dexamethasone-loaded poly (D,L-lactide-co-glycolide)/polyethylenimine nanoparticles (eBev-DPPNs) for angiogenic combination treatment of ocular diseases. Methods: We prepared a novel nanoparticle composed of poly (D, L-lactide-co-glycolide) and polyethylenimine and loaded the nanoparticles with dexamethasone. Bevacizumab was adsorbed onto the surfaces of the nanoparticles by electrostatic interactions. The eBev-DPPNs were evaluated according to their size, polydispersity index, zeta potential, morphology, drug loading, release behavior, and stability. The structural stability of bevacizumab on the surface of the nanoparticles was also analyzed. Subsequently, angiogenesis was investigated in the presence of the eBev-DPPNs using cell apoptosis, wound healing, Transwell invasion, and tube formation assays on the human umbilical vein endothelial cells (HUVECs) in vitro and chick embryo chorioallantoic membrane assay in vivo. The eBev-DPPNs intravitreal injection was applied in the laser-induced rabbit choroidal neovascularization (CNV) model to confirm the role for potential intravitreal applications. Results: The eBev-DPPNs was about 200 nm in diameter, with a narrow diameter distribution, and the surface charge was neutral (0.85 ± 0.37mV), which made the eBev-DPPNs stable under physiological conditions. The apoptosis, migration, invasion, and tube formation assays showed that the eBev-DPPNs had a good anti-angiogenic effect on HUVECs. The eBev-DPPNs also provided a strong inhibitory effect on VEGF secretion from HUVECs. Moreover, in vivo chick embryo chorioallantoic membrane assay showed eBev-DPPNs greatly reduced the amount of blood vessels. The leakage area of CNV decreased in the eBev-DPPNs group on rabbit CNV model. Conclusion: The eBev-DPPNs are a promising novel anti-angiogenesis therapeutic for potential intravitreal applications such as age-related macular degeneration.


Asunto(s)
Inhibidores de la Angiogénesis/farmacología , Bevacizumab/farmacología , Dexametasona/farmacología , Nanopartículas/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/química , Inhibidores de la Angiogénesis/administración & dosificación , Animales , Apoptosis/efectos de los fármacos , Bevacizumab/administración & dosificación , Embrión de Pollo , Membrana Corioalantoides/efectos de los fármacos , Dexametasona/administración & dosificación , Liberación de Fármacos , Células Endoteliales de la Vena Umbilical Humana/efectos de los fármacos , Humanos , Inyecciones Intravítreas , Masculino , Nanopartículas/ultraestructura , Conejos , Factor A de Crecimiento Endotelial Vascular/metabolismo , Cicatrización de Heridas/efectos de los fármacos
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