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1.
Autoimmun Rev ; 19(4): 102493, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32062034

RESUMO

Chronic graft-versus-host disease (cGVHD) remains the main complication of allogeneic hematopoietic stem cell transplantation, limiting its chances for a successful outcome. The over-activity of CD4+ effector T cells and the excessive production of pro-inflammatory cytokines are followed by the development of immune-mediated inflammation and fibrosis of multiple organs. This is the reason for adopting T cell targeting therapies such as cyclosporine A, tacrolimus and mycophenolate mofetil. However, 40% of treated cGVHD patients remain unresponsive, which results in increased morbidity and mortality. Given the complexity of cGVHD pathogenesis, the involvement of B cells as an important player also needs to be explored. Function of aberrant B cells and secretion of relevant cytokines such as B cell activating factor (BAFF) have been found to correlate with cGVHD severity and have therefore become therapeutic targets. Better understanding of the role of B cells and their efficient targeting could improve the outcome of cGVHD.


Assuntos
Autoimunidade/efeitos dos fármacos , Autoimunidade/imunologia , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/imunologia , Doença Crônica/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Humanos
2.
Am Fam Physician ; 101(2): 89-94, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31939645

RESUMO

Short-term systemic corticosteroids, also known as steroids, are frequently prescribed for adults in the outpatient setting by primary care physicians. There is a lack of supporting evidence for most diagnoses for which steroids are prescribed, and there is evidence against steroid use for patients with acute bronchitis, acute sinusitis, carpal tunnel, and allergic rhinitis. There is insufficient evidence supporting routine use of steroids for patients with acute pharyngitis, lumbar radiculopathy, carpal tunnel, and herpes zoster. There is evidence supporting use of short-term steroids for Bell palsy and acute gout. Physicians might assume that short-term steroids are harmless and free from the widely known long-term effects of steroids; however, even short courses of systemic corticosteroids are associated with many possible adverse effects, including hyperglycemia, elevated blood pressure, mood and sleep disturbance, sepsis, fracture, and venous thromboembolism. This review considers the evidence for short-term steroid use for common conditions seen by primary care physicians.


Assuntos
Doença Crônica/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Esteroides/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Humanos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
3.
J Med Microbiol ; 69(1): 104-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31846412

RESUMO

Introduction. Nanoparticles (NPs) have numerous biological benefits due to their large surface-volume ratio and convenient entry into cells compared to other particles. Previous research has shown the antimicrobial properties of biogenic selenium NPs (SeNps) and their effects on cellular immunomodulatory cytokines that play a key role in controlling infections.Aim. This study aimed to evaluate the therapeutic effects of SeNPs against chronic toxoplasmosis in mice.Methodology. Infected mice with Toxoplasma gondii (Tehran strain) were orally treated with SeNPs at doses of 2.5, 5 and 10 mg kg-1 once a day for 14 days. On the fifthteenth day, the mean number of brain-tissue cysts and the mRNA levels of TNF-α, IL-12, IL-10, IFN-γ and inducible nitric oxide synthase (iNOS) in the mice of each group were recorded. Moreover, serum clinical chemistry factors in the treated mice were examined to determine the safety of SeNPs.Results. The mean number of tissue cysts was significantly (P<0.001) decreased in mice treated with SeNPs in a dose-dependent manner compared with the control group. The mRNA levels of inflammatory cytokines were significantly increased in mice treated with SeNPs at a dose of 10 mg kg-1 compared with the control subgroup (P<0.05). No significant variation (P>0.05) observed in clinical chemistry parameters among the mice in the control subgroup compared with those treated with SeNPs.Conclusion. The findings demonstrated the therapeutic effects of SeNPs with no considerable toxicity against latent toxoplasmosis in the mouse model. Nevertheless, further studies are obligatory to reveal the exact anti-Toxoplasma mechanisms of SeNPs.


Assuntos
Fatores Imunológicos/administração & dosagem , Nanopartículas Metálicas , Selênio/administração & dosagem , Toxoplasma/efeitos dos fármacos , Toxoplasmose/tratamento farmacológico , Administração Oral , Animais , Encéfalo/parasitologia , Encéfalo/patologia , Doença Crônica/tratamento farmacológico , Modelos Animais de Doenças , Fatores Imunológicos/efeitos adversos , Camundongos , Selênio/efeitos adversos , Resultado do Tratamento
4.
Rev Lat Am Enfermagem ; 27: e3217, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31826159

RESUMO

OBJECTIVE: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. METHODS: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. RESULTS: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). CONCLUSION: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.


Assuntos
Doença Crônica/tratamento farmacológico , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil , Doença Crônica/classificação , Comorbidade , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
6.
Healthc Q ; 22(2): 21-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556375

RESUMO

Pharmacare, a recently proposed addition to Canada's universal medicare program, has become a prominent topic in the public discourse, but funding and leadership have not been established. Repeated Health Care in Canada (HCIC) surveys of the adult public and a broad spectrum of health professionals reveal very strong support for a national system that is easy to access and covers all prescribed pharmaceuticals. Although the practical details of universal pharmacare remain to be established, there is strong support among the public and professionals as well as increasing federal government interest in moving forward and ultimately implementing pharmacare. At the same time, HCIC surveys indicate that a high percentage of patients do not take their medications as directed, both for acute and chronic illnesses. The data suggest that pharmacare's success will be severely challenged by this. Of the four major challenges preventing usual care from being the best care - suboptimal access, non-diagnosis, non-prescription and non-adherence - risk from some form of non-adherence is often ranked first by care professionals. The most commonly reported reasons for non-adherence in clinical settings are patients' forgetfulness and how they feel in the moment on any given day. Costs of therapy, lack of understanding or poor knowledge transfer between prescribers and patients regarding therapeutic risks and benefits are rarely cited causes for poor adherence. These findings from the 2018 HCIC survey are not new. They are very consistent with measurements in the 2016 and other previous HCIC surveys. They do, however, raise practical challenges for the creation and ongoing management of universal pharmacare. Specifically, a patient-centred care component designed to improve non-adherence to prescribed therapies is needed. Ideally, it should include a measurement and feedback component on adherence that shares data with and between patients, health professionals and payers. Things can be better.


Assuntos
Seguro de Serviços Farmacêuticos , Adesão à Medicação/estatística & dados numéricos , Adulto , Canadá , Doença Crônica/tratamento farmacológico , Humanos , Adesão à Medicação/psicologia , Programas Nacionais de Saúde/organização & administração , Assistência Centrada no Paciente
7.
BMC Complement Altern Med ; 19(1): 258, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533697

RESUMO

BACKGROUND: Herbal and traditional medicines (HTM) are widely used in Asian countries. Specific data on prevalent of HTM usage and association with chronic diseases in the Thai population is currently lacking. We examined the prevalence and factors associated with HTM use in a Thai worker population. In addition, we explored the relationship between HTM use and therapeutic control of cardiovascular risk factors and documented the most common types of HTM used in various chronic diseases. METHODS: Employees of EGAT (The Electric Generating Authority of Thailand) who had participated in a health examination were studied. Each participant documented their HTM consumption and self-reported chronic diseases in a questionnaire. Clinical disease and therapeutic control were also defined by concomitant laboratory tests. RESULTS: Of a total of 6592 subjects, 32.6% were HTM-users. Age < 50 years, female gender, self-reported history of diabetes, liver disease, cancer, dyslipidemia, and alcohol use were independently associated with HTM use. HTM consumption increased in proportion to the numbers of self-reported chronic diseases. There were no differences in the therapeutic control of cardiovascular risk factors between HTM users and non-users. Liver and kidney function were not different. The most commonly used HTM was turmeric. CONCLUSIONS: HTM consumption is common in community-based Thai subjects, with higher use among those with chronic diseases. Although there were no differences in control of cardiovascular risk factors between HTM users and non-users, many of the commonly used herbs have relevant biological activities for chronic disease prevention or treatment.


Assuntos
Doença Crônica/tratamento farmacológico , Medicina Tradicional/estatística & dados numéricos , Extratos Vegetais/uso terapêutico , Adulto , Idoso , Estudos de Coortes , Feminino , Medicina Herbária/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Centrais Elétricas , Tailândia
10.
Med Care ; 57(9): 667-672, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31404013

RESUMO

BACKGROUND: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), it is unknown whether buprenorphine use may affect patients' adherence to treatments for chronic, unrelated conditions. OBJECTIVES: To quantify the effect of buprenorphine treatment on patient adherence to 5 therapeutic classes: (1) antilipids; (2) antipsychotics; (3) antiepileptics; (4) antidiabetics; and (5) antidepressants. RESEARCH DESIGN: This was a retrospective cohort study. SUBJECTS: We started with 12,719 commercially ensured individuals with a diagnosis of OUD and the buprenorphine initiation between January 2011 and June 2015 using Truven Health's MarketScan data. Individuals using any of the 5 therapeutic classes of interest were included. MEASURES: Within the 180-day period post buprenorphine initiation, we derived 2 daily indicators: having buprenorphine and having chronic medication on hand for each therapeutic class of interest. We applied logistic regression to assess the association between these 2 daily indicators, adjusting for demographics, morbidity, and baseline adherence. RESULTS: Across the 5 therapeutic classes, the probability with a given treatment on hand was always higher on days when buprenorphine was on hand. After adjustment for demographics, morbidity, and baseline adherence, buprenorphine was associated with a greater odds of adherence to antilipids [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.04-1.54], antiepileptics (OR, 1.22; CI, 1.10-1.36) and antidepressants (OR, 1.42; CI, 1.32-1.60). CONCLUSIONS: Using buprenorphine to treat OUD may increase adherence to treatments for chronic unrelated conditions, a finding of particular importance given high rates of mental illness and other comorbidities among many individuals with OUD.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Doença Crônica/psicologia , Adesão à Medicação/psicologia , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Adulto , Doença Crônica/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos
11.
Int J Immunopathol Pharmacol ; 33: 2058738419872120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31438744

RESUMO

The treatment of severe chronic immune thrombocytopenia (SCITP) in pediatric patients is challenging. We evaluated the clinical efficacy and safety of eltrombopag in children with SCITP in China. This observational study was carried out at the Hematology Oncology Center, Beijing Children's Hospital between April 2017 and July 2018. Patients with SCITP who had at least 12 weeks of eltrombopag treatment and follow-up data were included. Baseline data, such as age, drug dosage, pre-study platelet count, concomitant medications, and bleeding severity, were collected. Treatment response rates, durable response rates, bleeding events, and adverse events were assessed during eltrombopag therapy for at least 12 weeks. The median duration of eltrombopag therapy was 16 (12-48) weeks. The overall, complete, and partial response rates were 75% (15/20), 35% (7/20), and 40% (8/20), respectively. The durable response rate was 70% (14/20). No serious bleeding events or serious adverse events occurred during the study period. Eltrombopag appears to be effective and safe in children with SCITP, although additional research is needed to confirm this.


Assuntos
Benzoatos/efeitos adversos , Benzoatos/uso terapêutico , Doença Crônica/tratamento farmacológico , Hidrazinas/efeitos adversos , Hidrazinas/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Adolescente , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Masculino , Contagem de Plaquetas/métodos , Resultado do Tratamento
12.
Int J Mol Sci ; 20(17)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31443458

RESUMO

Natural compounds, in recent years, have attracted significant attention for their use in the prevention and treatment of diverse chronic diseases as they are devoid of major toxicities. Boswellic acid (BA), a series of pentacyclic triterpene molecules, is isolated from the gum resin of Boswellia serrata and Boswellia carteri. It proved to be one such agent that has exhibited efficacy against various chronic diseases like arthritis, diabetes, asthma, cancer, inflammatory bowel disease, Parkinson's disease, Alzheimer's, etc. The molecular targets attributed to its wide range of biological activities include transcription factors, kinases, enzymes, receptors, growth factors, etc. The present review is an attempt to demonstrate the diverse pharmacological uses of BA, along with its underlying molecular mechanism of action against different ailments. Further, this review also discusses the roadblocks associated with the pharmacokinetics and bioavailability of this promising compound and strategies to overcome those limitations for developing it as an effective drug for the clinical management of chronic diseases.


Assuntos
Triterpenos/farmacologia , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/farmacocinética , Anti-Inflamatórios não Esteroides/farmacologia , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/farmacocinética , Antineoplásicos Fitogênicos/farmacologia , Doença Crônica/tratamento farmacológico , Humanos , Camundongos , Extratos Vegetais/administração & dosagem , Extratos Vegetais/química , Extratos Vegetais/farmacocinética , Extratos Vegetais/farmacologia , Relação Estrutura-Atividade , Triterpenos/administração & dosagem , Triterpenos/química , Triterpenos/farmacocinética
13.
Nat Rev Drug Discov ; 18(9): 707-729, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31324874

RESUMO

The complement system plays a key role in pathogen immunosurveillance and tissue homeostasis. However, subversion of its tight regulatory control can fuel a vicious cycle of inflammatory damage that exacerbates pathology. The clinical merit of targeting the complement system has been established for rare clinical disorders such as paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome. Evidence from preclinical studies and human genome-wide analyses, supported by new molecular and structural insights, has revealed new pathomechanisms and unmet clinical needs that have thrust a new generation of complement inhibitors into clinical development for a variety of indications. This review critically discusses recent clinical milestones in complement drug discovery, providing an updated translational perspective that may guide optimal target selection and disease-tailored complement intervention.


Assuntos
Ativação do Complemento/efeitos dos fármacos , Inativadores do Complemento/farmacologia , Inativadores do Complemento/uso terapêutico , Proteínas do Sistema Complemento/efeitos dos fármacos , Proteínas do Sistema Complemento/imunologia , Doença Crônica/tratamento farmacológico , Inativadores do Complemento/efeitos adversos , Descoberta de Drogas/métodos , Humanos , Inflamação/tratamento farmacológico , Modelos Biológicos
14.
Med. clín (Ed. impr.) ; 153(1): 1-5, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183350

RESUMO

Antecedentes y objetivo: Varios estudios han puesto de manifiesto un cumplimiento terapéutico subóptimo en la población general, sobre todo en ancianos y en enfermos crónicos. El objetivo de este estudio es describir la adherencia al tratamiento de diabetes mellitus, dislipidemia e hipertensión arterial, e identificar los factores que la influencian. Material y métodos: Estudio observacional transversal retrospectivo sobre 16.208 pacientes mayores de 65 años de la Cohorte EpiChron, que iniciaron tratamiento en monoterapia de un antidiabético, un hipolipidemiante o un antihipertensivo en 2010. La adherencia se midió mediante el cálculo de la relación de posesión de medicación durante un año de seguimiento, considerándose adherentes los casos con posesión de medicación ≥80%. Se realizó un estudio descriptivo y un modelo de regresión logística para identificar los factores predictores de baja adherencia. Resultados: La adherencia a los antidiabéticos, antihipertensivos e hipolipidemiantes fue del 72,4; 50,7 y 44,3%, respectivamente. Se observó un aumento en la adherencia del 3-8% por cada enfermedad crónica adicional del paciente. La presencia de enfermedad mental no afectó a la adherencia, y el sexo, edad y número de fármacos prescritos no presentaron efectos consistentes. Conclusiones: Los resultados obtenidos ponen de manifiesto una adherencia al tratamiento subóptima en las enfermedades crónicas estudiadas. La adherencia aumentó con el número de enfermedades crónicas, mientras que sexo, edad y número de fármacos no presentaron un efecto consistente. Es necesario investigar si existen otros factores que puedan influir en la adherencia terapéutica, ya que su mejora puede tener mayor impacto en la salud que cualquier avance en las terapias


Background and objective: Sub-optimal adherence to treatment in the general population has been highlighted in several studies, especially in the elderly and/or chronic patients. This study aims to describe the adherence to treatment of diabetes mellitus, dyslipidaemia and hypertension, and to identify the factors that influence adherence. Material and method: Retrospective, cross-sectional observational study on 16,208 patients aged ≥65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic, a lipid-lowering or an antihypertensive medication in 2010. Adherence was measured by calculating the medication possession ratio during one year, considering those cases with medication possession ratio ≥80% to be adherent. We performed a descriptive study, and a logistic regression model was used to identify the predictors of low adherence. Results: Adherence to antidiabetics, antihypertensive and lipid-lowering drugs was 72.4%, 50.7% and 44.3%, respectively. An increase in adherence of 3-8% was observed for each additional chronic disease suffered by the patient. The presence of mental illness did not affect adherence, and sex, age and number of prescribed drugs did not present consistent effects. Conclusion: The results obtained show a sub-optimal adherence to treatment for the 3chronic diseases studied. Adherence increased with the number of chronic diseases, while sex, age and number of drugs did not show a consistent effect. It is necessary to investigate if there are other factors that may influence therapeutic adherence, since improving adherence may have a greater impact on health than any progress in therapies


Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cooperação e Adesão ao Tratamento , Hipertensão/terapia , Hipercolesterolemia/terapia , Diabetes Mellitus/terapia , Estudos de Coortes , Estudos Transversais , Estudos Retrospectivos , Modelos Logísticos , Doença Crônica/tratamento farmacológico , Doença Crônica/epidemiologia
15.
J Dermatol ; 46(8): 680-685, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187925

RESUMO

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI-75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient-reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty-seven patients were included (32 males; mean age, 45 years). HECSI-75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0-164; 95% within-subject confidence interval, 46.4-52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI-75 and HECSI-75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Doença Crônica/tratamento farmacológico , Dermatite Atópica/complicações , Método Duplo-Cego , Esquema de Medicação , Eczema/complicações , Eczema/diagnóstico por imagem , Eczema/imunologia , Feminino , Mãos , Humanos , Injeções Subcutâneas , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Subunidade alfa de Receptor de Interleucina-4/imunologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Fotografação , Estudos Prospectivos , Qualidade de Vida , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
16.
Int J Clin Pharm ; 41(4): 1004-1011, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31168762

RESUMO

Background Little was known about patient's pharmacotherapy related quality of life (PTRQoL) and its differences between disease groups. Objective First, to assess PTRQoL in Thai patients with chronic diseases using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL). Second, to determine the differences in PROMPT-QoL domain scores and total scores between disease groups. Setting Three public university hospitals in Bangkok, Thailand. Method Eleven hundred and fifty-six adult outpatients continuously taking medicines to treat their diseases for at least 3 months were conveniently sampled. Bonferroni post hoc tests were used to determine the differences in eight PROMPT-QoL domain scores and total scores between 14 disease groups. Main outcome measure The descriptive statistics of PROMPT-QoL domains and the total score. Results Approximately two-thirds of all patients preferred to use only medicines for treating their diseases. Impacts of Medicines and Side-Effects and Medicine and Disease Information yielded the highest (87.3) and lowest (55.4) mean domain scores, respectively. The other domains and the total score provided the average scores between 65 and 75, which were interpreted as moderate-to-good. Bonferroni post hoc tests showed that there were five domains providing significantly different scores between disease groups. They included Medicine and Disease Information, Satisfaction with Medicine Effectiveness, Impacts of Medicines and Side-effects, Convenience, and Therapeutic Relationships with Healthcare Providers domains. Conclusion Pharmacotherapy related quality of life in Thai patients is moderate-to-good. Five of eight pharmacotherapy related quality of life domain scores differed by disease groups.


Assuntos
Doença Crônica/psicologia , Tratamento Farmacológico/psicologia , Pacientes Ambulatoriais/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Doença Crônica/tratamento farmacológico , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Tailândia
17.
BMC Vet Res ; 15(1): 213, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238912

RESUMO

BACKGROUND: This study aimed to evaluate the safety and efficacy of reduced-dosage ketoprofen with or without tramadol in dogs. Five healthy dogs receiving standard-dosage ketoprofen (2 mg/kg SC, then 1 mg/kg PO daily) comprised Group A. Twenty dogs with osteoarthritis were randomized to receive reduced-dosage ketoprofen (0.5 mg/kg SC once; 0.25 mg/kg PO daily) alone (Group B) or in combination with tramadol (5 mg/kg/day PO) (Group C). Treatments were administered for 28 days. Platelet aggregation time (PAT), gastrointestinal (GI) endoscopy and glomerular filtration rate (GFR) were performed up to 60 days after treatment initiation. Pain was scored using a validated clinical metrology instrument up to D120. Data were analyzed with general linear mixed model for repeated measures (α = 0.05). RESULTS: PAT was not different between groups but was increased with time for all groups. GI lesion scores were higher in Group A than Groups B and C (day 28; P = 0.005) and were increased with time for Group A (P = 0.005). GFR was lower in Group A than Groups B and C (day 28; P < 0.01) and were decreased with time for group A (P < 0.001). Standard-dosage ketoprofen administration resulted in clinically relevant adverse effects. Pain score decreased in both treated groups (B and C) from D0 to D28. Need of rescue analgesia from D29 to D120 was higher in Group B than in Group C (P = 0.039). CONCLUSIONS: The long-term safety profile of reduced-dosage ketoprofen is similar whether the drug is administered alone or in combination with tramadol to dogs with osteoarthritis. Analgesic efficacy of the combination looks attractive.


Assuntos
Analgésicos Opioides/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Doenças do Cão/tratamento farmacológico , Cetoprofeno/uso terapêutico , Tramadol/uso terapêutico , Analgésicos Opioides/administração & dosagem , Animais , Doença Crônica/tratamento farmacológico , Doença Crônica/veterinária , Inibidores de Ciclo-Oxigenase/administração & dosagem , Cães , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Cetoprofeno/administração & dosagem , Cetoprofeno/efeitos adversos , Masculino , Osteoartrite/tratamento farmacológico , Agregação Plaquetária/efeitos dos fármacos , Distribuição Aleatória , Tramadol/administração & dosagem , Tramadol/efeitos adversos
18.
Medicine (Baltimore) ; 98(25): e16127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232963

RESUMO

BACKGROUND: Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU. METHODS: Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy. CONCLUSION: This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval. PROSPERO REGISTRATION NUMBER: CRD42019128364.


Assuntos
Pontos de Acupuntura , Autoenxertos , Urticária/tratamento farmacológico , China , Doença Crônica/tratamento farmacológico , Protocolos Clínicos , Humanos , Injeções/métodos , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Inquéritos e Questionários , Resultado do Tratamento
19.
Pharm. pract. (Granada, Internet) ; 17(2): 0-0, abr.-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184679

RESUMO

Background: Due to aging, along with its associated physiological changes, older adults are extremely vulnerable to be afflicted with multiple chronic conditions (multimorbidity). Accordingly, prescribing a large number of drugs to older adults would be inevitable. Resulted complex drug regimens can lead to prescribing of Potentially Inappropriate Medications (PIMs) with subsequent negative health and economic outcomes. Objectives: The main objective of this study is to investigate the prevalence and predictors of PIMs prescribing among Jordanian elderly outpatients, using the last updated version of the American Geriatrics Society (AGS) Beers Criteria (2015 version). Methods: A Unicenter, cross-sectional study were data was assessed using medical records of included study subjects conducted over three months period from beginning of October to the end of December 2016 at King Abdullah University Hospital, Al Ramtha, Jordan. Our study included patients aged 65 years or above who visited the outpatient clinics at King Abdullah University hospital (KAUH) and were prescribed at least one oral medication during the study period. PIMs were identified for these patients and further classified according to the 2015 AGS Beers Criteria. We measured the prevalence of PIMs prescribed among elderly outpatients in Jordan. Results: A total of 4622 eligible older adults were evaluated in this study, of whom 62.5% (n=2891) were found to have at least one PIM prescribed during the three months study period. 69% of identified PIMs were medications to be used with caution in elderly, 22% were medications to avoid in many or most older adults, 6.3% were medications to be avoided or have their dosage adjusted based on kidney function in older adults, 2.04% medications were to avoid in older adults with specific diseases/syndromes, and 1.6% were potentially clinically important non-anti-infective drug-drug interactions to be avoided in older adults. Female gender and polypharmacy were found to be significant predictors of PIMs use among elderly. Conclusions: Potentially Inappropriate Medication prescribing is common among Jordanian elderly outpatients. Female gender and polypharmacy are associated with more PIMs prescribing and so need further attention


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Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prescrição Inadequada/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Doença Crônica/tratamento farmacológico , Líbano/epidemiologia , Múltiplas Afecções Crônicas/tratamento farmacológico , Polimedicação , Fatores de Risco , Saúde do Idoso
20.
An Real Acad Farm ; 85(2): 182-188, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186175

RESUMO

Los errores de medicación constituyen tema prioritario dentro de la estrategia de seguridad del paciente, por lo que es fundamental analizar discrepancias que ocurren entre los medicamentos que se administra el paciente antes de ingresar a la unidad de salud y la prescripción que se le indica durante su hospitalización y al alta. El objetivo del trabajo fue identificar los errores de medicación en pacientes con enfermedades crónicas no transmisibles (ECNT), en un hospital de Tungurahua, Ecuador. Se evaluaron, en un período de tres meses, las anamnesis presentes en historias clínicas de pacientes con ECNT, al ingreso al servicio de emergencia y durante la estancia, traslados intra hospitalarios y el alta; a fin de identificar y clasificar errores encontrados como discrepancias o errores de conciliación. Se encontraron que, de 154 historias clínicas analizadas, en 57 (34,1%) no existía anamnesis, siendo ésta última realizada de manera correcta en 58 (42,5%) y de manera incorrecta en 39(23,4%). Se determinaron 327 discrepancias, 218 durante la estancia hospitalaria y 109 en el momento del alta de los pacientes, siendo la hipertensión arterial en ambos casos la ECNT, con mayor número de discrepancias. Fueron encontradas discrepancias justificadas y discrepancias que requirieron aclaración durante la estancia y alta hospitalaria, identificándose en las primeras una mayor prevalencia de gravedad tipo A, mientras que, las discrepancias de gravedad tipo D correspondieron a las de mayor presencia al momento del alta


Medication errors are a priority issue within the strategy of patient safety, so it is essential to analyze discrepancies that occur between the medications administered by the patient before entering the health unit and the prescription that is indicated during their hospitalization and discharge. The objective of the work was to identify medication errors in patients with noncommunicable chronic diseases (NCD), in a hospital in Tungurahua, Ecuador. The anamnesis present in clinical histories of patients with NCD, on admission to the emergency service and during the stay, intrahospital transfers and discharge were evaluated over a period of three months; in order to identify and classify errors found as discrepancies or reconciliation errors. We found that out of 154 clinical histories analyzed, in 57 (34,1 %) there was no anamnesis, the latter being performed correctly in 58 (42,5 %) and incorrectly in 39 (23,4 %). 327 discrepancies were determined, 218 during the hospital stay and 109 at the time of discharge of the patients, with arterial hypertension in both cases being the ECNT, with the greatest number of discrepancies. We found justified discrepancies and discrepancies that required clarification during the hospital stay and discharge, identifying in the former a higher prevalence of type A severity, while the discrepancies of type D severity corresponded to those of greater presence at discharge


Assuntos
Humanos , Erros de Medicação/estatística & dados numéricos , Serviço de Farmácia Hospitalar , Doença Crônica/tratamento farmacológico , Equador
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