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1.
Medicine (Baltimore) ; 100(14): e25360, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832116

RESUMO

INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, and most patients in China are diagnosed at the intermediate or later stages, which is not suitable for the first line therapies. Transarterial chemoembolization (TACE) is a commonly selected therapeutic option for intermediate and later stage HCC in China, but patients often suffer from postembolization syndrome (PES), manifesting as fever, liver area pain, nausea, vomiting, paralyzed intestinal obstruction, and abdominal pain after TACE. We try to conduct a double blinded, randomized, placebo-controlled clinical trial to observe whether Chaihu Guizhi decoction (CGD), a classic traditional Chinese formula, could prophylactically alleviate the incidence of PES in HCC patients after TACE. METHODS: Patients will be randomly assigned sequentially in a 1:1 ratio by using preformed randomization envelopes. After TACE procedures, patients in the treatment group will be administrated with Chinese herbal formula CGD, and patients in the control group with CGD simulations, twice a day, continuously for 7 days. The outcomes are the incidence of PES hospitalization and, complications. SPSS version 22 (IBM, Chicago, IL) will be used for the data, and a P < .05 will be considered statistically significant. CONCLUSIONS: The findings will explore the prophylactic effect of CGD in alleviating the incidence of PES following TACE in HCC patients. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/FKRSN.


Assuntos
Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/métodos , Medicamentos de Ervas Chinesas/administração & dosagem , Febre/prevenção & controle , Neoplasias Hepáticas/terapia , Náusea/prevenção & controle , Vômito/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Projetos de Pesquisa , Síndrome , Vômito/etiologia , Adulto Jovem
2.
Nat Commun ; 12(1): 814, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547300

RESUMO

On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100 mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO2/FiO2 ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted.


Assuntos
Bevacizumab/uso terapêutico , /efeitos dos fármacos , Idoso , Inibidores da Angiogênese/uso terapêutico , Temperatura Corporal/efeitos dos fármacos , China , Feminino , Febre/prevenção & controle , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Nat Commun ; 11(1): 6385, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318491

RESUMO

The response to the coronavirus disease 2019 (COVID-19) pandemic has been hampered by lack of an effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antiviral therapy. Here we report the use of remdesivir in a patient with COVID-19 and the prototypic genetic antibody deficiency X-linked agammaglobulinaemia (XLA). Despite evidence of complement activation and a robust T cell response, the patient developed persistent SARS-CoV-2 pneumonitis, without progressing to multi-organ involvement. This unusual clinical course is consistent with a contribution of antibodies to both viral clearance and progression to severe disease. In the absence of these confounders, we take an experimental medicine approach to examine the in vivo utility of remdesivir. Over two independent courses of treatment, we observe a temporally correlated clinical and virological response, leading to clinical resolution and viral clearance, with no evidence of acquired drug resistance. We therefore provide evidence for the antiviral efficacy of remdesivir in vivo, and its potential benefit in selected patients.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Imunidade Humoral/efeitos dos fármacos , /efeitos dos fármacos , Monofosfato de Adenosina/uso terapêutico , Adulto , Alanina/uso terapêutico , Antivirais/uso terapêutico , Febre/prevenção & controle , Humanos , Imunidade Humoral/imunologia , Contagem de Linfócitos , Masculino , /fisiologia , Resultado do Tratamento
4.
Rev Med Suisse ; 16(711): 1995-2000, 2020 Oct 21.
Artigo em Francês | MEDLINE | ID: mdl-33085256

RESUMO

Chemotherapy induced neutropenic fever requires a hospitalization in 20-30 % of cases and is then associated with a mortality above 10 %. Hospitalized patients require strict isolation, which sometimes results in a substantial physical and psychological burden. Granulocyte-colony stimulating factors (G-CSF) are established in the primary and secondary prevention of chemotherapy-induced neutropenia. However, their role as adjunctive therapy in patients with neutropenic fever is less clear. This review resumes current best evidence in this area and discusses current recommendations.


Assuntos
Terapia Combinada , Febre/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Neutropenia/tratamento farmacológico , Febre/prevenção & controle , Humanos , Neutropenia/prevenção & controle
6.
Int J Infect Dis ; 96: 408-415, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360942

RESUMO

OBJECTIVES: Children aged <5 years are the group most affected by infectious diseases, more specifically in underdeveloped countries. A study was performed to assess the effects of daily soap use on the incidence of diarrhoea, fever, respiratory infection, and the prevalence of pathogenic bacteria on the skin. METHODS: Soap was distributed to the population of the village of Ndiop (test) for use in their daily hygiene but not to the population of the village of Dielmo (control). Fieldworkers daily recorded the clinical events in the two villages and encouraged the use of soap in Ndiop. RESULTS: A total of 638 people participated in the study. The incidence rates of cough, runny nose and fever significantly decreased in 2016 compared with 2015, unlike that of diarrhoea. In 2016, significant reductions in the incidence rates of cough, runny nose and fever were observed in children aged <15 years in Ndiop. The prevalence of Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes in the palms of the hands significantly dropped in Ndiop. CONCLUSION: Using soap reduces the incidence of respiratory infections, fevers and the prevalence of pathogenic bacteria on the skin. However, for diarrhoea, additional strategies are needed to improve outcomes.


Assuntos
Febre/prevenção & controle , Microbiota , Infecções Respiratórias/prevenção & controle , Pele/microbiologia , Sabões/uso terapêutico , Adolescente , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/prevenção & controle , Feminino , Febre/epidemiologia , Febre/microbiologia , Humanos , Incidência , Lactente , Masculino , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , População Rural/estatística & dados numéricos , Senegal/epidemiologia
7.
Cochrane Database Syst Rev ; 4: CD007892, 2020 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-32335895

RESUMO

BACKGROUND: Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane Review first published in 2010 and subsequently updated in 2012, twice in 2014, in 2017 and 2018. OBJECTIVES: To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We also assessed the side effects of vaginal cleansing solutions to determine adverse events associated with the intervention. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (7 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. Cluster-RCTs were eligible for inclusion, but we did not identify any. We excluded trials that utilized vaginal preparation during labor or that did not use antibiotic surgical prophylaxis. We also excluded any trials using a cross-over design. We included trials published in abstract form only if sufficient information was present in the abstract on methods and outcomes to analyze. DATA COLLECTION AND ANALYSIS: At least three of the review authors independently assessed eligibility of the studies. Two review authors were assigned to extract study characteristics, quality assessments, and data from eligible studies. MAIN RESULTS: We included 21 trials, reporting results for 7038 women evaluating the effects of vaginal cleansing (17 using povidone-iodine, 3 chlorhexidine, 1 benzalkonium chloride) on post-cesarean infectious morbidity. Trials used vaginal preparations administered by sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (17 trials) or the use of a saline vaginal preparation (4 trials). One trial did not report on any outcomes of interest. Trials were performed in 10 different countries (Saudi Arabia, Pakistan, Iran, Thailand, Turkey, USA, Egypt, UK, Kenya and India). The overall risk of bias was low for areas of attrition, reporting, and other bias. About half of the trials had low risk of selection bias, with most of the remainder rated as unclear. Due to lack of blinding, we rated performance bias as high risk in nearly one-third of the trials, low risk in one-third, and unclear in one-third. Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence of post-cesarean endometritis from 7.1% in control groups to 3.1% in vaginal cleansing groups (average risk ratio (aRR) 0.41, 95% confidence interval (CI) 0.29 to 0.58; 20 trials, 6918 women; moderate-certainty evidence). This reduction in endometritis was seen for both iodine-based solutions and chlorhexidine-based solutions. Risks of postoperative fever and postoperative wound infection are also probably reduced by vaginal antiseptic preparation (fever: aRR 0.64, 0.50 to 0.82; 16 trials, 6163 women; and wound infection: RR 0.62, 95% CI 0.50 to 0.77; 18 trials, 6385 women; both moderate-certainty evidence). Two trials found that there may be a lower risk of a composite outcome of wound complication or endometritis in women receiving preoperative vaginal preparation (RR 0.46, 95% CI 0.26 to 0.82; 2 trials, 499 women; low-certainty evidence). No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing. Subgroup analysis suggested a greater effect with vaginal preparations for those women in labour versus those not in labour for four out of five outcomes examined (post-cesarean endometritis; postoperative fever; postoperative wound infection; composite wound complication or endometritis). This apparent difference needs to be investigated further in future trials. We did not observe any subgroup differences between women with ruptured membranes and women with intact membranes. AUTHORS' CONCLUSIONS: Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis, postoperative fever, and postoperative wound infection. Subgroup analysis found that these benefits were typically present whether iodine-based or chlorhexidine-based solutions were used and when women were in labor before the cesarean. The suggested benefit in women in labor needs further investigation in future trials. There was moderate-certainty evidence using GRADE for all reported outcomes, with downgrading decisions based on limitations in study design or imprecision. As a simple intervention, providers may consider implementing preoperative vaginal cleansing with povidone-iodine or chlorhexidine before performing cesarean deliveries. Future research on this intervention being incorporated into bundles of care plans for women receiving cesarean delivery will be needed.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Cesárea/efeitos adversos , Desinfecção/métodos , Endometrite/prevenção & controle , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Intravaginal , Compostos de Benzalcônio/administração & dosagem , Clorexidina/administração & dosagem , Feminino , Febre/prevenção & controle , Humanos , Povidona-Iodo/administração & dosagem , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Pediatr Blood Cancer ; 67(6): e28140, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32275120

RESUMO

BACKGROUND: Children with cancer experience a wide range of conditions that require urgent evaluation in the emergency department (ED), yet variation in admission rates is poorly documented. PROCEDURE: We performed a retrospective cohort study using the Pediatric Health Information System of ED encounters by children with cancer between July 2012 and June 2015. We compared demographics for admitted versus discharged using univariate statistics, and calculated admission rates by hospital, diagnosis, day of the week, and weekend versus weekday. We assessed the degree of interhospital admission rates using the index of dispersion (ID). RESULTS: Children with cancer had 60 054 ED encounters at 37 hospitals. Overall, 62.5% were admitted (range 43.2%-92.1%, ID 2.6) indicating overdispersed admission rates with high variability. Children with cancer that visited the ED for a primary diagnosis of fever experienced the largest amount of variability in admission with rates ranging from 10.4% to 74.1% (ID 8.1). Less variability existed among hospital admission rates for both neutropenia (range 60%-100%, ID 1.0) and febrile neutropenia (FN) (range 66.7%-100%, ID 0.83). Admission rates by day of the week did not demonstrate significant variability for any of the scenarios examined (overall P = 0.91). There were no differences by weekend versus weekday either (overall P = 0.52). CONCLUSION: The percentage of children with cancer admitted through the ED varies widely by institution and diagnosis. Standardization of best practices for children with cancer admitted through the ED should be an area of continued improvement.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/diagnóstico , Sistemas de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Neoplasias/complicações , Neutropenia/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Febre/etiologia , Febre/prevenção & controle , Seguimentos , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Masculino , Neutropenia/etiologia , Neutropenia/prevenção & controle , Prognóstico , Estudos Retrospectivos , Adulto Jovem
9.
JAMA Netw Open ; 3(1): e1918565, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31899532

RESUMO

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Febre/prevenção & controle , Imunoglobulinas Intravenosas/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/prevenção & controle , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Pediatr Infect Dis J ; 39(1): 78-80, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31815841

RESUMO

BACKGROUND: Following the introduction of the 4CMenB (Bexsero, GlaxoSmithKline, Rixensart, Belgium) vaccine against Meningococcal B into the UK vaccination schedule, Public Health England advised paracetamol to be given prophylactically with the vaccine. This was based on observations of increased postvaccination febrile reactions in term infants. Evidence in preterm infants was lacking. We aimed to evaluate whether (i) 4CmenB is associated with an increase in adverse events (AEs) in the 48 hours after vaccination in preterm infants and (ii) the impact of prophylactic paracetamol on AEs. METHODS: Retrospective case-note review of preterm infants, within a UK level 3 neonatal unit, receiving first or second 4CMenB vaccination, within 3 periods; (i) period 1 (pre-4CMenB): September 2014-September 2015; (ii) period 2 (4CMenB without prophylactic paracetamol): September 2015-March 2016 and (iii) period 3 (4CMenB with prophylactic paracetamol): June 2016-May 2018. Data were collected on a predefined list of postvaccination AEs within 48 hours of vaccination: (i) number (%) of infants with temperature >37.5°C; (ii) highest temperature (°C); (iii) number (%) of infants receiving evaluation for sepsis and (iv) number (%) of infants receiving intravenous antibiotics. RESULTS: Ninety-five vaccination episodes were included. Compared with the pre-4CMenB (period 1), more infants developed temperature >37.5°C, needed partial septic screens and had intravenous antibiotics when 4CMenB was introduced without paracetamol prophylaxis (period 2). Paracetamol prophylaxis (period 3) with 4CMenB resulted in fewer infants experiencing postvaccination fever and antibiotic administration comparable to period 1. CONCLUSIONS: 4CMenB is associated with AEs in hospitalized preterm infants. Prophylactic paracetamol administration attenuates this.


Assuntos
Acetaminofen/uso terapêutico , Febre/prevenção & controle , Hospitalização , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/efeitos adversos , Neisseria meningitidis Sorogrupo B/imunologia , Sepse/epidemiologia , Vacinação/efeitos adversos , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Vacinas Meningocócicas/imunologia , Pré-Medicação , Medição de Risco , Fatores de Risco , Sepse/etiologia , Sepse/prevenção & controle , Reino Unido/epidemiologia
11.
Pediatr Blood Cancer ; 67(6): e28067, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31724788

RESUMO

BACKGROUND: Universal newborn screening and improved treatment options have led to increased survival in sickle cell disease (SCD). However, patients with SCD still rely heavily on acute care services. OBJECTIVE: To determine the variation seen in hospitalizations for the top complaints for ED visits for children with SCD nationally. METHODS: We performed a retrospective review of the Pediatric Health Information Systems (PHIS) Database between October 2011 and September 2015. Emergency department (ED) encounters were selected by using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes for SCD with and without crisis, fever, and pain. Univariate analyses were performed, as well as index of dispersion (ID) to assess variation by day of the week and region. ANOVA and t-test were used to determine statistical significance. RESULTS: A total of 68 661 ED encounters at 36 hospitals met the criteria for inclusion. Of those encounters, 50.1% were admitted to the hospital. Pain and fever were the most common primary diagnoses among this population. Although variation in hospitalization was seen overall, as well as for a primary diagnosis of pain or fever, this variation was not explained by weekday/weekend designation. CONCLUSION: The results of our study confirm pain and fever as the most common primary diagnoses for children with SCD who seek acute care, as well as demonstrate that while significant variation in hospitalization exists, it is not associated with day of the week. Further studies to elucidate patient- and hospital-level factors that influence admission variation are necessary.


Assuntos
Anemia Falciforme/complicações , Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/diagnóstico , Sistemas de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Dor/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Febre/etiologia , Febre/prevenção & controle , Seguimentos , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Masculino , Dor/etiologia , Dor/prevenção & controle , Prognóstico , Estudos Retrospectivos , Adulto Jovem
12.
Pediatr Int ; 62(2): 158-168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31846519

RESUMO

BACKGROUND: Prophylactic antibiotics decrease mortality and morbidity in patients with hematological malignancies following intensive chemotherapy. However, the efficacy of prophylactic antibiotics for pediatric patients with solid tumors remains unclear. METHODS: We retrospectively assessed 103 neutropenic periods from 26 patients with neuroblastoma or brain tumors following three different intensity chemotherapy regimens (05A3, A, and B). While piperacillin was intravenously administered as prophylaxis (PIPC prophylaxis group), the historical control group received no prophylaxis. As patients exhibited a variable degree of myelosuppression based on the intensity of the chemotherapy regimen, we separately evaluated the frequency and severity of febrile neutropenia (FN) in each regimen. RESULTS: Following intensive chemotherapy, we observed a significantly lower frequency of FN in the PIPC prophylaxis group compared with the historical control group in both regimen 05A3 (20% vs 65%; P = 0.01) and regimen A (56% vs 93%; P = 0.02). We also observed a shorter duration of fever, lower maximum fever, and lower C-reactive protein levels in the PIPC prophylaxis group compared with the historical control group after regimens 05A3 and A. Conversely, the frequency and severity of FN were not different between the two groups after moderate-intensity chemotherapy (regimen B). However, a longitudinal routine surveillance study of Pseudomonas aeruginosa also indicated a reduction in the susceptibility to PIPC throughout the study period. CONCLUSIONS: Although PIPC prophylaxis might provide an advantage for severe neutropenia in pediatric patients with solid tumors, there is concern regarding bacterial resistance to antibiotics. Therefore, further careful examination is necessary for adaptation.


Assuntos
Antibacterianos/uso terapêutico , Febre/prevenção & controle , Neutropenia/prevenção & controle , Piperacilina/uso terapêutico , Antibioticoprofilaxia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Carboplatina/uso terapêutico , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Fluoruracila/uso terapêutico , Humanos , Lactente , Leucovorina/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Neuroblastoma/tratamento farmacológico , Estudos Retrospectivos
13.
BMJ Open ; 9(11): e032389, 2019 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-31685514

RESUMO

INTRODUCTION: Fever is an integral part of the inflammatory response and has therefore likely a physiological role in fighting infections. Nevertheless, whether fever in itself is beneficial or harmful in adults is unknown. This protocol for a systematic review aims at identifying the beneficial and harmful effects of fever control interventions in adults. METHODS AND ANALYSIS: This protocol for a systematic review was conducted following the recommendations of Cochrane, GRADE and the eight-step assessment suggested by Jakobsen and colleagues for better validation of meta-analytical results in systematic reviews. We plan to include all relevant randomised clinical trials comparing any fever control intervention with placebo, sham or no intervention in adults. We plan to search CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, CINAHL, Scopus and Web of Science Core Collection to identify relevant trials. Any eligible trial will be assessed and classified as either at high risk of bias or low risk of bias, and our primary conclusions will be based on trials at low risk of bias. We will perform our meta-analyses of the extracted data using Review Manager 5.3 and Trial Sequential Analysis. For all our outcomes, we will create a 'Summary of Findings' table based on GRADE assessments of the certainty of the evidence. ETHICS AND DISSEMINATION: No formal approval or review of ethics is required for this systematic review as individual patient data will not be included. This systematic review has the potential to highlight (1) whether one should believe fever to be beneficial, harmful or neither in adults; (2) the existing knowledge gaps on this topic; and (3) whether the recommendations from guidelines and daily clinical practice are correct. These results will be disseminated through publication in a leading peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019134006.


Assuntos
Febre/prevenção & controle , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Adulto , Humanos , Projetos de Pesquisa
14.
Arch Gynecol Obstet ; 300(6): 1551-1557, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667606

RESUMO

PURPOSE: To evaluate whether programmed intermittent epidural bolus (PIEB) reduces the incidence of maternal intra-partum fever compared with continuous epidural infusion (CEI) during labor. METHODS: Parturients were randomized to receive CEI (CEI group) or PIEB (PIEB group) with 10 ml per hour for epidural labor analgesia with 1500 subjects in each group. The maintaining dose of two groups is 0.08% ropivacaine with 0.4 µg/ml sufentanil, with patient-controlled epidural analgesia (PCEA) dose of 5 ml and lockout interval of 30 min. The incidence of maternal fever, pain score, epidural sensory levels, the number and proportion of PCEA demand, anesthetics consumption, satisfaction score, neonatal Apgar scale, and maternal and neonatal side effects were recorded. RESULTS: It was significantly lower of the incidence of maternal fever beginning at 4 h post-analgesia and continuing until delivery in the PIEB group than the CEI group (4 h: 2.6% vs. 4.2%; 5 h: 7.3% vs. 10.2%; delivery: 5.6% vs. 7.9%; 1 h post-delivery: 3.9% vs. 6.2%; 2 h post-delivery: 2.1 vs. 3.5%; total: 5.8% vs. 8.4% in PIEB and CEI, respectively). Compared with CEI group, pain scores at 3, 4, 5 h post-analgesia and delivery (3 h: 2 [1, 2] vs. 2 [1-3]; 4 h: 2 [2, 3] vs. 3 [2-4]; 5 h: 2 [2, 3] vs. 3 [2-4]; delivery: 3 [2-4] vs. 4 [3, 4] in PIEB and CEI, respectively), the number and proportion of PCEA demand (number: 0.7 ± 0.9 vs. 2.2 ± 1.9; proportion: 42.0% vs. 80.3% in PIEB and CEI, respectively), and anesthetics consumption significantly decreased in the PIEB group (Ropivacaine: 60 ± 13 mg vs. 76 ± 17 mg; Sufentanil: 26 ± 4 mg vs. 32 ± 6 mg in PIEB and CEI, respectively), without severe maternal and neonatal side effects and any difference in neonatal Apgar scale. The epidural sensory levels 2 h post-analgesia (2 h: 8[8, 9] vs. 9[8, 9] in PIEB and CEI) and satisfaction score (9 [9, 10] vs. 7 [6, 7] in PIEB and CEI) were significantly higher in the PIEB group compared with those in the CEI group. CONCLUSIONS: PIEB with 10 ml of 0.08% ropivacaine and 0.4 µg/ml sufentanil hourly provided a lower incidence of intra-partum fever with a better analgesic effect compared with CEI, without any severe maternal and neonatal adverse reactions.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgésicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Febre/epidemiologia , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Método Duplo-Cego , Feminino , Febre/prevenção & controle , Humanos , Incidência , Trabalho de Parto , Paridade , Gravidez , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem
15.
Pancreas ; 48(9): 1148-1154, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31593014

RESUMO

OBJECTIVES: The aim of this study was to evaluate the role of parecoxib in patients with different severities of acute pancreatitis (AP). METHODS: A total of 772 eligible patients with AP were divided into 4 groups: mild and moderately AP (MAP) treated with parecoxib (group A, n = 236), MAP without parecoxib treatment (group B, n = 453), severe AP (SAP) treated with parecoxib (group C, n = 28), and SAP without parecoxib treatment (group D, n = 55). Patients in group A were exactly matched with patients in group B by propensity score matching, similar to the matching between group C and group D. RESULTS: The morbidity of abdominal infection in group A was significantly lower as compared with that in group B (P < 0.050). The progression of MAP to SAP significantly decreased in group A than group B (P < 0.050). No significant differences were observed between group C and group D. The risk factors independently related to the progression of MAP included alcoholic/high-fat dietary (P = 0.028) and parecoxib administration (P = 0.011). CONCLUSIONS: Early administration of parecoxib could reduce the morbidity of complications among patients with MAP. Parecoxib may prevent the progression of MAP to SAP and improve its outcomes.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Isoxazóis/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Pancreatite/tratamento farmacológico , Índice de Gravidade de Doença , Doença Aguda , Adulto , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Estudos de Coortes , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Progressão da Doença , Feminino , Febre/etiologia , Febre/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Pancreatite/complicações , Pancreatite/patologia , Substâncias Protetoras/uso terapêutico
17.
Artigo em Inglês | MEDLINE | ID: mdl-31632709

RESUMO

Study design: Interventional crossover study. Objective: Spinal cord injury (SCI) disrupts afferent input to the hypothalamus and impairs efferent vaso- and sudomotor output, especially in lesions above the sympathetic chain (T1-L2). In consequence, persons with SCI under heat stress experience impairment in the ability to dissipate heat proportional to the lesion level. Thermoregulatory dysfunction places an individual at high risk of hyperthermia, which can be life threatening, especially for athletes with SCI during exercise. Current evidence on therapeutic cooling techniques in athletes with SCI is limited, but basic physiologic and research data suggest water spray (WS) might be efficacious, particularly in athletes with tetraplegia (TP), who are most impaired in thermoregulation. The aim of this study was to evaluate the effect of WS on core temperature (Tc) during exercise in athletes with SCI. Setting: Texas, USA. Methods: Eleven individuals with SCI: seven with TP, four with paraplegia (PP); and sixteen able-bodied (AB) controls underwent a wheelchair intermittent sprint exercise for 90 min under two conditions: (1) WS application every 15 min and (2) control (C), without WS. Tc was measured every 15 min and was analyzed for the effect of group (TP, PP, and AB) and time. Change in Tc (ΔTc) was also compared between groups. Results: ΔTc was significantly higher in TP vs. PP (p < 0.0001) and TP vs. AB (p < 0.0001) groups under C treatment. WS significantly attenuated ΔTc in TP (p = 0.001), but did not change ΔTc in PP or AB. Conclusion: WS effectively attenuated Tc elevation during exercise in athletes with TP. Sponsorship: Texas chapter of the Paralyzed Veterans of America.


Assuntos
Febre/prevenção & controle , Paratletas , Traumatismos da Medula Espinal/complicações , Água/administração & dosagem , Adulto , Temperatura Corporal , Febre/etiologia , Resposta ao Choque Térmico , Humanos , Masculino
18.
Emerg Med Clin North Am ; 37(3): 365-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262409

RESUMO

Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Encéfalo/diagnóstico por imagem , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Medicina de Emergência , Procedimentos Endovasculares , Febre/prevenção & controle , Fibrinolíticos/uso terapêutico , Humanos , Hipertensão/terapia , Oxigenoterapia , Transferência de Pacientes , Telemedicina , Tenecteplase/uso terapêutico , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico
19.
Neurotoxicology ; 74: 91-99, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31163210

RESUMO

There are no Food and Drug Administration approved pharmacotherapies for methamphetamine (METH) overdose, thus identifying novel drug targets to prevent this devastating adverse event is a public-health imperative. Previous research suggests that serotonin and sigma receptors may contribute to the adverse effects of METH. The present study assessed whether pretreatment with the 5-HT2A receptor antagonist M100907 or the sigma 1 (σ1) receptor antagonist BD 1047 attenuated METH-induced lethality, hyperthermia, convulsions, and seizures. Male, Swiss-Webster mice received intraperitoneal injections of M100907 (1 and 10 mg/kg), BD 1047 (10 mg/kg), or a combination of M100907 (1 mg/kg) and BD 1047 (10 mg/kg) prior to treatment with METH (78 mg/kg). Convulsions and lethality were assessed by observation, core body temperature was assessed by surgically implanted telemetric probes, and seizures were assessed by electroencephalography. M100907 reduced METH-elicited lethality from 67% to 33%, BD1047 reduced METH-elicited lethality from 67% to 50%, and combined administration of both agents eliminated lethality in all mice tested. Similarly, both agents and their combination reduced METH-elicited seizures and convulsions. None of the treatments decreased METH-induced hyperthermia. This research suggests that reducing METH-induced seizures is an important factor in reducing lethality associated with METH overdose. However, future studies should examine whether M100907 and BD 1047 modulate METH-induced hypertension and other adverse effects that may also contribute to METH overdose. Our data support the continued investigation of compounds that target 5-HT2A and σ1 receptors in METH-induced overdose, including their potential to yield emergency reversal agents.


Assuntos
Estimulantes do Sistema Nervoso Central/antagonistas & inibidores , Estimulantes do Sistema Nervoso Central/toxicidade , Etilenodiaminas/farmacologia , Fluorbenzenos/farmacologia , Metanfetamina/antagonistas & inibidores , Metanfetamina/toxicidade , Piperidinas/farmacologia , Receptores sigma/antagonistas & inibidores , Antagonistas do Receptor 5-HT2 de Serotonina/farmacologia , Animais , Temperatura Corporal/efeitos dos fármacos , Eletroencefalografia/efeitos dos fármacos , Febre/induzido quimicamente , Febre/prevenção & controle , Dose Letal Mediana , Masculino , Camundongos , Convulsões/induzido quimicamente , Convulsões/prevenção & controle
20.
Pediatr Blood Cancer ; 66(9): e27816, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31157521

RESUMO

BACKGROUND: Hydroxyurea (HU) increases fetal hemoglobin (HgbF) and ameliorates sickle cell disease (SCD) symptoms. Studies have demonstrated the safety and efficacy of HU in infants and children. Initiation of HU in infancy for children with SCD needs to be implemented in community practice. PROCEDURE: Starting in 2011, the Pediatric Sickle Cell Program of Northern Virginia initiated HU in infants with SCD. A prospective longitudinal database tracked the clinical course and outcomes. RESULTS: Twenty-four children with HgbSS who started HU by age 1 were continuously followed for a total of 95 person-years. Age at the time of analysis ranged from 2 to 7 years. Average hemoglobin at 6-month intervals ranged from 9.5 + 1.9 to 10.7 + 0.8 g/dL, and average HgbF ranged from 27.8 + 5.0% to 34.1 + 6.6%. Twenty-seven hospitalizations occurred (0.28/person-year), all before age 3, including 19 (70%) for fever or infection, five (19%) for splenic sequestration, and one (4%) for pain in an infant prior to starting HU. The treat-and-release emergency department visits totaled 68 (0.72/person-year), including 62 visits (91%) for fever, infection, or viral illness, and two visits (3%) for pain/dactylitis in infants before HU initiation. Splenic sequestration accounted for all five transfusions. No pain episodes requiring medical attention were documented after HU initiation. No complicated acute chest syndrome, no abnormal or conditional transcranial Doppler ultrasound, and no overt strokes occurred. CONCLUSION: Implementation of HU in infancy for patients with SCD in community practice is feasible and is highly effective in preventing disease complications.


Assuntos
Anemia Falciforme , Transfusão de Sangue , Hospitalização , Hidroxiureia/administração & dosagem , Anemia Falciforme/sangue , Anemia Falciforme/terapia , Criança , Pré-Escolar , Feminino , Hemoglobina Fetal/metabolismo , Febre/sangue , Febre/prevenção & controle , Seguimentos , Hemoglobina Falciforme/metabolismo , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos , Viroses/sangue , Viroses/prevenção & controle
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