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1.
Med Arch ; 78(2): 127-130, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38566870

RESUMO

Background: Where routine prophylactic antibiotics have been adopted following cataract surgery, rates of endophthalmitis have been decreasing. Intracameral and topical antibiotics are currently used to prevent endophthalmitis after cataract surgery. When applying topical antibiotics, there are different recommendations on the frequency and duration of therapy. The development of bacterial resistance to the excessive and long-term use of antibiotics is a growing problem worldwide. The goal is to achieve a good antibiotic effect with the shortest possible use of antibiotics. Objective: The aim of this study was to compare the effectiveness of a new combination therapy of dexamethasone and levofloxacin for seven days after cataract surgery with the previous regimen of dexamethasone, neomycin sulfate, and polymyxin B, which was given for 21 days. Methods: A retrospective analysis of medical records and administered a questionnaire was conducted to assess the effectiveness of postoperative therapy in our cataract surgery patients. The study involved 52 patients who underwent surgery within the last year, performed by a single surgeon at our institution. The findings can help us improve the quality of care we provide and optimize our patients' overall quality of life. Results: We conducted an in-depth study on 52 individuals who underwent cataract surgery at our institution. The prescribed therapeutic regimen for the participants included administering Ducressa solution four times daily for the first seven days and Maxidex solution three times daily for the subsequent 14 days. The study found that none of the participants experienced complications after surgery, and all found it easy to instill the medication. The prescribed regimen effectively managed the postoperative recovery of the participants, and the medication was well-tolerated. Conclusion: Our research found that a new combination of levofloxacin and dexamethasone, when used topically, may require a shorter treatment period, reducing the risk of antibiotic resistance and providing a safe alternative for endophthalmitis prevention.


Assuntos
Extração de Catarata , Catarata , Endoftalmite , Humanos , Levofloxacino/uso terapêutico , Estudos Retrospectivos , Qualidade de Vida , Complicações Pós-Operatórias/etiologia , Antibacterianos/uso terapêutico , Extração de Catarata/efeitos adversos , Dexametasona/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/etiologia , Endoftalmite/prevenção & controle , Catarata/etiologia
2.
Zhonghua Nei Ke Za Zhi ; 63(4): 378-385, 2024 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-38561283

RESUMO

Objective: To analyze the clinical characteristics and prognosis of patients with primary aldosteronism (PA) associated with subclinical Cushing syndrome (SCS). Methods: This retrospective cohort study was conducted at the First Affiliated Hospital of Chongqing Medical University in China. Patients with PA were included between January 2014 and December 2022. According to the results of 1-mg overnight dexamethasone suppression test, the patients were divided into the PA group and PA associated with SCS (PA/SCS) group. The demographic information, hormone levels, and follow-up results were analyzed. Independent sample t-test, chi-square test and Mann-Whitney U test were used for data comparison. Results: A total of 489 PA patients were enrolled in this study, of which 109 had PA/SCS (22.3%). Patients with SCS were on average older (54.4±10.7 vs. 47.4±11.0, P<0.001); had a larger proportion of women (69.7%, 76/109 vs. 57.4%, 218/380; P=0.020); and a longer duration of hypertension [96 (36, 180) vs. 60 (12, 120) months, P=0.001] than patients without SCS. There were 215 and 51 patients in the PA group and PA/SCS group, who completed adrenalectomy and follow-up, respectively. The remission rate of autonomous cortisol secretion in the PA/SCS group was 85.3% (29/34). There was no significant difference in the remission rate of autonomous aldosterone secretion among patients between the PA/SCS and PA group (94.1%, 48/51 vs. 94.4%, 203/215; P=1.000), while the clinical remission rate in the PA/SCS group was lower than that in the PA group (39.2%, 20/51 vs. 61.9%, 133/215; P=0.003). Conclusions: SCS is common in PA patients (22.3%), and the clinical remission rate is low. Screening using the 1-mg overnight dexamethasone suppression test is recommended for all patients with PA.


Assuntos
Neoplasias das Glândulas Suprarrenais , Síndrome de Cushing , Hiperaldosteronismo , Humanos , Feminino , Síndrome de Cushing/complicações , Síndrome de Cushing/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Estudos Retrospectivos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Prognóstico , Dexametasona/uso terapêutico , Aldosterona
6.
BMJ Case Rep ; 17(4)2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38627054

RESUMO

Extramedullary relapse in patients with multiple myeloma (MM) is often associated with loss of biochemical response and the appearance of measurable residual disease in the bone marrow. Fever is an unusual presenting manifestation of MM. Treatment of extramedullary relapse in patients progressing on proteasome inhibitors, anti-CD38 monoclonal antibodies and immunomodulatory drugs is challenging, as access to chimeric antigen receptor T-cells and bispecific antibodies is limited. We report a case of relapsed MM who presented with fever and hepatic space-occupying lesion mimicking hepatocellular carcinoma. In this case report, we also present our experience of using a novel combination regimen comprising Dara-Pom-Benda-Dexa (daratumumab, pomalidomide, dexamethasone and bendamustine) for relapsed MM.


Assuntos
Mieloma Múltiplo , Talidomida/análogos & derivados , Humanos , Mieloma Múltiplo/patologia , Cloridrato de Bendamustina/uso terapêutico , Dexametasona/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Fígado/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
7.
J Coll Physicians Surg Pak ; 34(4): 390-393, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38576278

RESUMO

OBJECTIVE: To evaluate the efficacy of dexamethasone as a final intracanal rinse in relieving postoperative pain of teeth with symptomatic irreversible pulpitis. STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Operative Dentistry, PIMS, Islamabad, Pakistan, from June 2019 to December 2020. METHODOLOGY: Sixty patients aged 18- 50 years diagnosed with symptomatic irreversible pulpitis were selected according to the inclusion criterion. After obtaining informed consent, root canal therapy (RCT) was initiated under rubber dam. Pulpectomy was done followed by canal preparation. The lottery method was utilised for the division of patients. Group A (experimental) received dexamethasone (4mg/ml in 5ml syringe) as a final rinse, while Group B (control group) recalled after 1 week and asked whether their pain had relieved or not as a yes/no question. After data collection teeth were obturated and permanent restoration was placed. Data were analysed using Chi-square test. RESULTS: The efficacy of dexamethasone as a final intracanal rinse was greater than saline 86.67% and 20.0%, respectively (p < 0.05) in relieving postoperative pain in teeth with symptomatic irreversible pulpitis. CONCLUSION: Dexamethasone was proved to be more efficacious than saline in alleviating postoperative pain when used as a final intracanal rinse after canal instrumentation. KEY WORDS: Irreversible pulpitis, Dexamethasone, Postoperative pain, Pulpectomy.


Assuntos
Pulpite , Humanos , Pulpite/cirurgia , Tratamento do Canal Radicular/métodos , Dor Pós-Operatória/tratamento farmacológico , Preparo de Canal Radicular , Dexametasona/uso terapêutico
8.
Medicine (Baltimore) ; 103(14): e37624, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38579060

RESUMO

INTRODUCTION: Megalosplenia in newly diagnosed multiple myeloma (MM) is extremely rare, posing diagnostic and therapeutic challenges due to its unusual location and clinical manifestations and lack of optimal therapeutic strategies. CASE PRESENTATION: A 65-year-old female who was previously healthy presented with a history of ecchymosis on her right leg accompanied by progressive fatigue for 2 weeks. She was admitted to our center in July 2019 due to thrombocytopenia. The patient presented with megalosplenia, anemia, monoclonal protein (λ-light chain type) in the serum and urine, and 45.6% malignant plasma cells in the bone marrow. Splenectomy was performed due to persistent splenomegaly after 3 cycles of the bortezomib plus dexamethasone regimen, and immunohistochemistry results indicated λ-plasmacytoma of the spleen. The same cytogenetic and molecular abnormalities, including t(14;16), 14q32 amplification, 16q32 amplification, 20q12 amplification, and a novel CYLD gene mutation, were identified using fluorescence in situ hybridization and next-generation sequencing in both bone marrow and spleen samples. Therefore, a diagnosis of MM (λ-light chain type, DS III, ISS III, R-ISS III, high-risk) with spleen infiltration was proposed. The patient did not achieve remission after induction treatment with bortezomib plus lenalidomide and dexamethasone or salvage therapy with daratumumab plus ixazomib and dexamethasone. However, she ultimately did achieve very good partial remission with a regimen of bendamustine plus lenalidomide and dexamethasone. Unfortunately, she died of pneumonia associated with chemotherapy. CONCLUSION: To our knowledge, only 8 cases of spleen plasmacytoma at MM diagnosis have been described previously. Extramedullary myeloma patients with spleen involvement at diagnosis are younger and that the condition is usually accompanied by splenic rupture with aggressive clinical features and poor prognosis. Further studies are needed to explore pathogenesis and effective therapies to prolong the survival of such patients.


Assuntos
Mieloma Múltiplo , Plasmocitoma , Humanos , Feminino , Idoso , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/genética , Lenalidomida , Bortezomib/uso terapêutico , Plasmocitoma/patologia , Hibridização in Situ Fluorescente , Dexametasona/uso terapêutico , Mutação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Enzima Desubiquitinante CYLD
10.
Am J Sports Med ; 52(5): 1165-1172, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38456291

RESUMO

BACKGROUND: Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea, and vomiting and length of hospital stay after arthroplasty surgery. PURPOSE/HYPOTHESIS: The purpose of this study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 am on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9%). The patient, the surgeons, the treating anesthesiologist, and the involved nursing and physical therapy personnel were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores-assessed using a translated revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2-and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events. RESULTS: The mean age at inclusion was 29 years in both groups. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were significantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P = .014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P = .034). Descriptive data and surgical parameters did not differ significantly. CONCLUSION: Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40% without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. REGISTRATION: NCT04610398 (ClinicalTrials.gov identifier).


Assuntos
Analgésicos Opioides , Artroscopia , Adulto , Humanos , Analgésicos Opioides/uso terapêutico , Artroscopia/efeitos adversos , Dexametasona/uso terapêutico , Método Duplo-Cego , Náusea/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Vômito/tratamento farmacológico
11.
PLoS One ; 19(3): e0294892, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38512832

RESUMO

BACKGROUND: Dexamethasone was approved for use in hospitalized COVID-19 patients early in the pandemic based on the RECOVERY trial, but evidence is still needed to support its real-world effectiveness in heterogeneous populations of patients with a wide range of comorbidities. METHODS: COVID-19 inpatients represented within the National COVID Cohort Collaborative (N3C) Data Enclave, prior to vaccine availability, were studied. Primary outcome was in-hospital death; secondary outcome was combined in-hospital death and severe outcome defined by use of ECMO or mechanical ventilation. Missing data were imputed with single imputation. Dexamethasone-treated patients were propensity score (PS) matched to non-dexamethasone-treated controls, stratified by remdesivir treatment and based on demographics, baseline laboratory values, comorbidities, and amount of missing data before imputation. Treatment benefit was quantified using logistic regression. Further sensitivity analyses were performed using clinical adjusters in matched groups and in strata defined by quartiles of PS. RESULTS: Dexamethasone treatment was associated with reduced risk of in-hospital mortality for n = 1,263 treated, matched 1:3 to untreated, patients not receiving remdesivir (OR = 0.77, 95% CI: 0.62 to 0.95, p = 0.017), and for n = 804 treated, matched 1:1 to untreated, patients receiving remdesivir (OR = 0.74, 95% CI: 0.53 to 1.02, p = 0.054). Treatment showed secondary outcome benefit. In sensitivity analyses, treatment effect generally remained similar with some heterogeneity of benefit across quartiles of PS, possibly reflecting concentration of benefit among the more severely affected. CONCLUSIONS: We add evidence that dexamethasone provides benefit with respect to mortality and severe outcomes in a diverse, national hospitalized sample, prior to vaccine availability.


Assuntos
COVID-19 , Vacinas , Humanos , Estados Unidos/epidemiologia , Pandemias , Mortalidade Hospitalar , COVID-19/epidemiologia , Tratamento Farmacológico da COVID-19 , Pacientes Internados , Dexametasona/uso terapêutico
12.
J Ocul Pharmacol Ther ; 40(3): 189-196, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38502813

RESUMO

Purpose: The objective of the present study was to evaluate the effects of low concentrations of benzalkonium chloride (BAC) (10-7%, 10-6%, or 10-5%) on healthy and glaucomatous human trabecular meshwork (HTM) cells. For this purpose, we used in vitro models replicating a healthy HTM and HTM with primary open-angle glaucoma (POAG) or steroid-induced glaucoma (SG) using two-dimensional (2D) cultures of HTM cells not treated or treated with a 5 ng/mL solution of transforming growth factor-ß2 or 250 nM dexamethasone (DEX). Methods: Analyses were carried out for (1) the intercellular affinity function of 2D HTM monolayers, as determined by transepithelial electrical resistance (TEER) measurements; (2) cell viability; (3) cellular metabolism by using a Seahorse bioanalyzer; and (4) expression of extracellular matrix (ECM) molecules, an ECM modulator, and cell junction-related molecules. Results: In the absence and presence of BAC (10-7% or 10-5%), intercellular affinity function determined by TEER and cellular metabolic activities were significantly and dose dependently affected in both healthy and glaucomatous HTM cells despite the fact that there was no significant decrease in cell viabilities. However, the effects based on TEER values were significantly greater in the healthy HTM. The mRNA expression of several molecules that were tested was not substantially modulated by these concentrations of BAC. Conclusions: The findings reported herein suggest that low concentrations of BAC may have unfavorable adverse effects on cellular metabolic capacity by inducing increases in the intercellular affinity properties of the HTM, but those effects of BAC were different in healthy and glaucomatous HTM cells.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Humanos , Malha Trabecular/metabolismo , Compostos de Benzalcônio/farmacologia , Compostos de Benzalcônio/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/metabolismo , Células Cultivadas , Glaucoma/metabolismo , Fator de Crescimento Transformador beta2/metabolismo , Dexametasona/farmacologia , Dexametasona/uso terapêutico , Fatores de Crescimento Transformadores/metabolismo , Fatores de Crescimento Transformadores/farmacologia , Fatores de Crescimento Transformadores/uso terapêutico
13.
ACS Appl Mater Interfaces ; 16(10): 12217-12231, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38480984

RESUMO

Psoriasis, a prevalent chronic inflammatory skin ailment affecting approximately 2-3% of the global population, is characterized by persistent symptoms. Dexamethasone, a primary corticosteroid for treating psoriasis, demonstrates notable efficacy; however, its limited skin permeation results in documented adverse effects. To address this, the presented study employed a novel strategy to conjugate gold nanorod and dexamethasone and evaluate their potential for mitigating psoriatic inflammation using an imiquimod-induced mouse model and human skin cells. Our findings revealed enhanced cutaneous penetration of gold nanorod and dexamethasone conjugates compared with that of dexamethasone, owing to superior skin penetration. Gold nanorod and dexamethasone conjugates demonstrated an optimal pharmacological impact at minimal dosages without toxicity during extended use. To further enhance the effectiveness of gold nanorod and dexamethasone conjugates, 808 nm near-infrared laser irradiation, which reacts to gold, was additionally applied to achieve thermal elevation to expedite drug skin penetration. Supplementary laser irradiation at 808 nm significantly ameliorated psoriatic symptoms following deep gold nanorod and dexamethasone conjugates penetration. This corresponded with restored peroxisome proliferator-activated receptor-γ levels and accelerated dexamethasone release from the gold nanorod and dexamethasone conjugates complex. These findings highlight the potential of gold nanorod and dexamethasone conjugates to enhance drug penetration through dermal layers, thereby aiding psoriasis treatment. Moreover, its compatibility with photothermal therapy offers prospects for novel therapeutic interventions across various inflammatory skin disorders.


Assuntos
Nanotubos , Psoríase , Animais , Camundongos , Humanos , Terapia Fototérmica , Ouro/farmacologia , Ouro/uso terapêutico , Psoríase/tratamento farmacológico , Dexametasona/farmacologia , Dexametasona/uso terapêutico , Inflamação/tratamento farmacológico
14.
Support Care Cancer ; 32(3): 204, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38433125

RESUMO

PURPOSE: We investigated the intensity and duration of nausea as well as its impact on health-related quality of life among cisplatin-treated patients who participated in a study of dexamethasone (DEX)-sparing regimens based on NEPA (netupitant/palonosetron). METHODS: This retrospective analysis included chemo-naive patients from a trial evaluating non-inferiority of DEX on day 1 (DEX1 arm) combined with NEPA, compared with the same regimen with DEX administered on days 1-4 (DEX4; reference arm) following cisplatin (≥ 70 mg/m2) administration. Nausea intensity was self-rated using a four-point Likert scale. Extended nausea duration was considered ≥ 3 days within the 5 days post-chemotherapy. Patients completed the Functional Living Index-Emesis (FLIE) questionnaire on day 6. RESULTS: In the DEX1 arm, more patients (20/76) experienced acute nausea, influencing the outcome of delayed nausea (38/76). During days 1 to 5, 51.3% (39/76) and 39.5% (30/76) of patients experienced nausea in the DEX1 and DEX4 arms, respectively (P = 0.192). Of these, 43.6% and 60% reported moderate-to-severe nausea, respectively, in the DEX1 and DEX4 arms (P = 0.200), while 74.4% and 56.7% of patients experienced extended nausea duration (P = 0.122). Similar between-arm rates of nauseated patients reported an impact on daily life (79.5% vs. 70%; P = 0.408). In analyses stratified for antiemetic regimen, moderate-to-severe nausea or extended nausea duration was associated with an impact on daily life (P ≤ 0.001). CONCLUSION: Despite the higher incidence, there was no suggestion of any strong adverse effect of NEPA plus single-dose DEX on the characteristics of nausea as well as its impact on daily life in patients with cisplatin-induced nausea. Further prospective controlled study is warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04201769. Registration date: 17/12/2019.


Assuntos
Cisplatino , Qualidade de Vida , Humanos , Cisplatino/efeitos adversos , Estudos Retrospectivos , Náusea/induzido quimicamente , Náusea/epidemiologia , Náusea/prevenção & controle , Dexametasona/uso terapêutico , Pulmão
15.
Dan Med J ; 71(3)2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38445317

RESUMO

INTRODUCTION: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure. Despite being less invasive than thoracotomy, post-operative pain remains a significant clinical problem. The aim of this study was to investigate if perioperative intravenous (IV) dexamethasone improves pain management in VATS. METHODS: Thirty-seven patients undergoing VATS with confirmed or suspected lung cancer were enrolled. The first 20 patients received standard care (Group 1) and the following 17 patients received standard care with addition of IV dexamethasone 8 mg (Group 2). The primary outcome was total opioid consumption during the first 24 hours after surgery. RESULTS: The baseline characteristics between groups were comparable. After adjusting for gender and duration of surgery, the median difference of total equianalgesic dose of opioid was 23 mg (p = 0.005). Group 2 had a significantly lower median pain score at rest. The first opioid dose was administered earlier in Group 1: 1.5 hours compared with to 6.9 hours in Group 2 (p = 0.020). Time to full mobilisation was longer in Group 1, with a mean of 12 hours (p = 0.018). CONCLUSION: This study suggests that addition of IV dexamethasone in VATS may reduce the need for opioids and facilitate early mobilisation. FUNDING: The study was funded by the Department of Clinical Medicine, Aalborg University, Aalborg, Denmark TRIAL REGISTRATION. The study is registered with ClinicalTrials.gov (NCT04633850). The study was conducted in accordance with the Declaration of Helsinki and all participants provided written consent.


Assuntos
Manejo da Dor , Cirurgia Torácica Vídeoassistida , Humanos , Analgésicos Opioides/uso terapêutico , Dexametasona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico
16.
Nan Fang Yi Ke Da Xue Xue Bao ; 44(2): 317-323, 2024 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-38501417

RESUMO

OBJECTIVE: To investigate the role of caspase-1-medicated canonical pyroptosis pathway in chlorogenic acid (CGA) treatment of acute kidney injury (AKI) in mice. METHOD: Twenty-four C57Bl/6J mice were randomized into sham-operated group, cecal ligation and puncture (CLP) group, CLP+dexamethasone group (CLP+DXM group), and CLP+CGA group (n=6) and subjected to either sham operation (laparotomy only) or CLP. After modeling the mice received intravenous infusion of 10 mg/kg normal saline (in sham and CLP groups), 1 µg/kg dexamethasone or 15 mg/kg of chlorogenic acid for 6 h delivered using an intravenous pump. Eight hours after the infusion, renal morphology and histology, renal cell apoptosis, and the renal function parameters such as urea nitrogen (BUN), creatinine (Scr), and kidney injury molecule 1 (KIM-1) were compared among the 4 groups; the 7-day survival rates of the mice were recorded, and the expressions of NLRP3 inflammasomes and key proteins of the caspase-1 pathway in the renal tissue were detected. RESULTS: CGA treatment significantly improved the 7-day survival rate, reduced renal pathologies of the septic mice (P < 0.05), and lowered the levels of BUN, Scr, KIM-1, NLRP3 inflammasome and expressions of key proteins of the caspase-1 pathway. CONCLUSION: CGA alleviates AKI in mice with CLP-induced sepsis by inhibiting NLRP3 inflammasomes and the caspase-1 signaling pathway.


Assuntos
Injúria Renal Aguda , Sepse , Camundongos , Animais , Inflamassomos/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR , Caspase 1/metabolismo , Piroptose , Ácido Clorogênico/uso terapêutico , Injúria Renal Aguda/metabolismo , Sepse/tratamento farmacológico , Sepse/metabolismo , Dexametasona/uso terapêutico , Camundongos Endogâmicos C57BL
17.
Sci Rep ; 14(1): 6122, 2024 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-38480837

RESUMO

To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) treated with dexamethasone implants (DEX) or anti-vascular endothelial growth factor (anti-VEGF) we performed a multi-centre, retrospective and observational study using Fight Retinal Blindness! Registry. Of 725 eligible eyes, 10% received DEX initially with very frequent adjunctive anti-VEGF (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and anti-VEGF initiated groups were not statistically significantly different (BRVO: DEX + 6.7, anti-VEGF + 10.6 letters; CRVO: DEX + 2.8, anti-VEGF + 6.8 letters). DEX initiated eyes had fewer injections and visits than anti-VEGF initiated eyes. The BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-anti-VEGF eyes. The mean CST after the first three months was above 350 µm in all but the BRVO-anti-VEGF group, suggesting undertreatment. In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO requiring supplemental anti-VEGF within the first year. The 12-month outcomes were similar, but DEX initiated eyes had fewer injections and visits but more episodes of raised IOP Vs those starting anti-VEGF.


Assuntos
Edema Macular , Oclusão da Veia Retiniana , Humanos , Oclusão da Veia Retiniana/tratamento farmacológico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Estudos Retrospectivos , Edema Macular/tratamento farmacológico , Resultado do Tratamento , Injeções Intravítreas , Fatores de Crescimento do Endotélio Vascular , Sistema de Registros , Inibidores da Angiogênese/uso terapêutico
18.
Blood Cancer J ; 14(1): 52, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38519476

RESUMO

Induction regimens for multiple myeloma (MM) commonly include bortezomib, which has typically been administered twice weekly despite studies demonstrating comparable efficacy and less peripheral neuropathy (PN) with once-weekly bortezomib. We aimed to analyze the real-world prevalence and efficacy of once-weekly versus twice-weekly bortezomib regimens in newly diagnosed MM. We analyzed 2497 US patients aged 18-70 years treated with commercial first-line bortezomib using nationwide Flatiron Health electronic health record-derived data, including 910 (36.4%) patients who received twice-weekly and 1522 (63.2%) who received once-weekly bortezomib. Once-weekly bortezomib use increased over time, from 57.7% in 2017 to 73.1% in 2022. Multivariate analysis identified worsened performance status and more recent year of diagnosis with higher odds of receiving once-weekly bortezomib. Real-world progression-free survival (median 37.2 months with once-weekly versus 39.6 months with twice-weekly, p = 0.906) and overall survival (medians not reached in either cohort, p = 0.800) were comparable. PN rates were higher in patients receiving twice-weekly bortezomib (34.7% versus 18.5%, p < 0.001). In conclusion, once-weekly bortezomib is clearly associated with similar efficacy and fewer toxicities compared to twice-weekly bortezomib. Our findings support once-weekly bortezomib as a standard-of-care regimen for newly diagnosed patients with MM.


Assuntos
Mieloma Múltiplo , Humanos , Bortezomib/efeitos adversos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/etiologia , Esquema de Medicação , Resultado do Tratamento , Intervalo Livre de Doença , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Dexametasona/uso terapêutico
19.
Zhonghua Yan Ke Za Zhi ; 60(3): 272-274, 2024 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-38462376

RESUMO

A 61-year-old male patient presented with blurred vision in the right eye for 1 day. The patient had previously undergone phacoemulsification with intraocular lens implantation (10 years ago) and intravitreal implantation of dexamethasone (due to uveitis) in the eye. There was edema in the inferior cornea, along with Descemet membrane folds. The rod-shaped dexamethasone implant was visible in the inferior anterior chamber. Without pupil dilation, the patient was asked to keep a supine position and avoid head tilting for 1 day. The implant spontaneously relocated into the vitreous cavity, resulting in a reduction of corneal edema. This suggests that the dislocation of the intravitreal implant into the anterior chamber may be caused by a local zonular abnormality, and the dislocated implant has the potential to reposition itself spontaneously.


Assuntos
Dexametasona , Glucocorticoides , Masculino , Humanos , Pessoa de Meia-Idade , Dexametasona/uso terapêutico , Reposicionamento de Medicamentos , Câmara Anterior , Implante de Lente Intraocular , Injeções Intravítreas
20.
Obes Surg ; 34(5): 1528-1535, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38472704

RESUMO

INTRODUCTION: Recovery from anesthesia is complex and affected by multiple factors. In patient with obesity, the increased prevalence of anxiety and depressive disorders poses a challenge in achieving optimal patient satisfaction. Therefore, strategies to enhance the quality of recovery are crucial for this population. This study aimed to investigate whether administration of dexamethasone to patients undergoing laparoscopic sleeve gastrectomy (LSG) could improve recovery outcomes. METHODS: This prospective observational study was conducted at a tertiary university hospital in Samsun, Turkey. Thirty patients who received dexamethasone prior to LSG (group D) and 30 patients who did not (group C) were included with convenience sampling method. The quality of recovery was assessed using the Quality of Recovery 40 questionnaire (QoR-40). The primary outcome measure was the QoR-40 score at 24 h postoperatively. RESULTS: The dexamethasone group showed a significant improvement in QoR-40 scores (185.4 ± 6.0 vs. 172.0 ± 8.4, p < 0.001), exhibited reduced morphine consumption (11.8 ± 7.8 vs. 21.8 ± 10.9 mg, p < 0.001), opioid demand count (21.50 [9.50-49.00], p = 0.001), the number of patient used antiemetic drug (1 vs. 22, p < 0.001), and achieved earlier mobilization (3 [3-4] vs. 3 [3-4] h, p < 0.0001). However, no significant differences were observed between the two groups concerning intraoperative complications, postoperative wound infections, or time to discharge. CONCLUSIONS: In patients undergoing laparoscopic sleeve gastrectomy, preoperative dexamethasone administration was associated with improved the recovery quality after discharge and reduced early postoperative need for antiemetic medications.


Assuntos
Antieméticos , Laparoscopia , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Laparoscopia/métodos , Antieméticos/uso terapêutico , Dexametasona/uso terapêutico , Gastrectomia/métodos
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