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2.
Medicine (Baltimore) ; 100(36): e27161, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516509

RESUMO

BACKGROUND: Huachansu injection (HCS) is a widely used traditional Chinese medicine for advanced non-small cell lung cancer (NSCLC) to alleviate the adverse drug reactions (ADRs) and enhance the clinical efficacy of chemotherapy. OBJECTIVE: To evaluate the efficacy and safety of HCS as an adjunctive treatment to platinum-based chemotherapy (PBC) for advanced NSCLC. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. A total of nine databases were searched to select randomized controlled trials (RCTs) of HCS plus PBC to treat NSCLC from inception to October 10, 2020. RCTs on HCS plus PBC vs PBC alone for advanced NSCLC were included. Dichotomous data were pooled as risk ratio (RR) with 95% confidence intervals. RCTs compared to HCS plus PBC vs PBC alone were included. Primary outcomes were objective response rate (ORR) and disease control rate (DCR), and secondary outcomes were survival rate, quality of life (QOL), and adverse drug reactions (ADRs). GRADE software was used to access the quality of evidence. RESULTS: A total of 32 RCTs, including 2753 patients, were included. Compared to PBC alone, HCS plus PBC improved the ORR, DCR, 1- and 2-year survival rates, and QOL and alleviated neutropenia, thrombocytopenia, nausea, vomiting, anemia, liver injury, renal injury, and alopecia. CONCLUSIONS: Compared to PBC alone, HCS plus PBC improved the clinical efficacy and alleviated the ADRs in advanced NSCLC patients. Considering the limitations of the included RCTs, high-quality trials with longer follow-ups are needed to further confirm the results.


Assuntos
Venenos de Anfíbios/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Compostos de Platina/uso terapêutico , Venenos de Anfíbios/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma Pulmonar de Células não Pequenas/patologia , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Humanos , Infusões Intravenosas , Neoplasias Pulmonares/patologia , Masculino , Fitoterapia , Compostos de Platina/administração & dosagem , Resultado do Tratamento
3.
Adv Emerg Nurs J ; 43(3): 186-193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397493

RESUMO

Atrial fibrillation/flutter (AF) remains the most common rhythm disturbance in adult patients presenting to emergency departments (EDs). Although pharmacologic cardioversion has been established as safe and effective in recent-onset AF, its use in U.S. EDs is uncommon. The purpose of this study was to assess the safety and efficacy of intravenous (IV) procainamide for pharmacologic cardioversion in patients presenting to the ED with AF of <48-hr duration. Patients presenting to the ED with recent-onset AF (<48 hr) undergoing a cardioversion strategy with IV procainamide from 2017 to 2019 were reviewed. Clinical outcomes assessed included rates of cardioversion, hospital admission, stroke, and return ED visits for arrhythmia or serious adverse events. A total of 64 patients received procainamide therapy-60.9% achieved cardioversion and 35.9% were admitted to the hospital. The mean dose was 1062.4 mg (12.1 mg/kg). No patients returned to the ED secondary to stroke and 9.4% experienced complications attributed to procainamide, the most common being hypotension. Within 30 days of therapy, 20.3% of patients returned to the ED secondary to arrhythmia recurrence. Patients experiencing cardioversion with procainamide were less likely to be admitted to the hospital (25.6% vs. 52.0%; p = 0.04) or receive a rate control agent (17.9% vs. 64.0%; p = 0.001). There was no significant difference in the rate of 30-day return between those who experienced pharmacologic cardioversion and those who did not (p = 0.220). The implementation of a procainamide-based acute cardioversion strategy for patients presenting to the ED with recent-onset AF resulted in a 60% cardioversion rate, which was associated with a significantly higher rate of discharge from the ED. Transient hypotension was the most common adverse event. Further investigation into ED-based protocols for management of recent-onset AF is necessary to better understand their safety and efficacy.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Serviço Hospitalar de Emergência , Procainamida/administração & dosagem , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Cornea ; 40(9): 1204-1206, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34351874

RESUMO

PURPOSE: The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). METHODS: The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. RESULTS: Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. CONCLUSIONS: These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.


Assuntos
COVID-19/diagnóstico , Infecções Oculares Virais/diagnóstico , SARS-CoV-2/isolamento & purificação , Esclerite/diagnóstico , Adalimumab/uso terapêutico , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Ciclofosfamida/uso terapêutico , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Infusões Intravenosas , Infusões Subcutâneas , Masculino , Prednisolona/uso terapêutico , SARS-CoV-2/genética , Esclerite/tratamento farmacológico , Esclerite/virologia
5.
Medicine (Baltimore) ; 100(32): e26884, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397908

RESUMO

ABSTRACT: High tibial osteotomy (HTO) is a promising surgery that can treat osteoarthritis of the medial septum of the knee. However, the extensive release of soft tissue and the osteotomy gap may produce intraoperative and postoperative bone bleeding. Tranexamic acid (TXA) is an effective blood management strategy, as it competitively inhibits the activation process of plasminogen and prevents fibrinolytic enzymes from degrading fibrin. Therefore, we compared the operative bone bleeding of patients who underwent HTO who received either intravenous (IV) or topical TXA in this research.The medical records of a total of 191 patients (including 72 who received IV TXA, 64 who received topical TXA and 55 control patients) who received open-wedge HTO were retrospectively reviewed from January 2016 to August 2019. There were no obvious demographic differences between the groups. Here, we used independent parameters to assess the efficacy of topical and IV TXA in reducing blood loss.Compared with the IV TXA group, patients receiving topical TXA therapy had greater blood loss (622 ±â€Š231 ml versus 451 ±â€Š231 ml, mean difference 171 mL [95% CI, 87-254]; p < 0.001). The hemoglobin concentration of the IV TXA group was obviously higher than that of the topical medication group. No patients had thromboembolic complications during the entire study period.In our study, it seemed that either IV or topical use of TXA might reduce blood loss after open-wedge HTO, and the blood loss and amount of drainage in the IV TXA group showed huge decreases compared to those in the topical group.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Osteotomia/métodos , Hemorragia Pós-Operatória/prevenção & controle , Tíbia/cirurgia , Ácido Tranexâmico/administração & dosagem , Administração Tópica , Adulto , Idoso , Antifibrinolíticos/administração & dosagem , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Clin Immunol ; 230: 108826, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34418548

RESUMO

BACKGROUND: Intravenous immunoglobulins (IVIg) are the major treatment in inborn errors of immunity (IEI) disorders; However, IVIg infusions show some adverse effects. We aimed to assess the adverse reactions of IVIg infusions. METHODS: Data of IVIg infusions in IEI patients were collected from 2011 to 2021. Totally, 363 IEI patients received IVIg regularly in Iran entered the study. The adverse reactions are classified regarding their severity and chronicity. RESULTS: 22,667 IVIg infusions were performed in the study. 157 patients (43.2%) and 1349 (5.9%) infusions were associated with at least one type of adverse reaction. The highest rates of adverse reactions were seen in severe combined immunodeficiency. Myalgia, chills, headache, fever, and hypotension were the most frequent adverse effects of IVIg. CONCLUSION: The reactions affect almost half of the patients mainly in the first infusions which necessitate the close observation of IEI patients receiving IVIg.


Assuntos
Imunoglobulinas Intravenosas/efeitos adversos , Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/terapia , Adolescente , Adulto , Agamaglobulinemia/genética , Agamaglobulinemia/imunologia , Agamaglobulinemia/terapia , Idoso , Ataxia Telangiectasia/genética , Ataxia Telangiectasia/imunologia , Ataxia Telangiectasia/terapia , Criança , Pré-Escolar , Estudos de Coortes , Imunodeficiência de Variável Comum/genética , Imunodeficiência de Variável Comum/imunologia , Imunodeficiência de Variável Comum/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Síndromes de Imunodeficiência/imunologia , Lactente , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
N Engl J Med ; 385(9): 803-814, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34379916

RESUMO

BACKGROUND: Additional interventions are needed to reduce the morbidity and mortality caused by malaria. METHODS: We conducted a two-part, phase 1 clinical trial to assess the safety and pharmacokinetics of CIS43LS, an antimalarial monoclonal antibody with an extended half-life, and its efficacy against infection with Plasmodium falciparum. Part A of the trial assessed the safety, initial side-effect profile, and pharmacokinetics of CIS43LS in healthy adults who had never had malaria. Participants received CIS43LS subcutaneously or intravenously at one of three escalating dose levels. A subgroup of participants from Part A continued to Part B, and some received a second CIS43LS infusion. Additional participants were enrolled in Part B and received CIS43LS intravenously. To assess the protective efficacy of CIS43LS, some participants underwent controlled human malaria infection in which they were exposed to mosquitoes carrying P. falciparum sporozoites 4 to 36 weeks after administration of CIS43LS. RESULTS: A total of 25 participants received CIS43LS at a dose of 5 mg per kilogram of body weight, 20 mg per kilogram, or 40 mg per kilogram, and 4 of the 25 participants received a second dose (20 mg per kilogram regardless of initial dose). No safety concerns were identified. We observed dose-dependent increases in CIS43LS serum concentrations, with a half-life of 56 days. None of the 9 participants who received CIS43LS, as compared with 5 of 6 control participants who did not receive CIS43LS, had parasitemia according to polymerase-chain-reaction testing through 21 days after controlled human malaria infection. Two participants who received 40 mg per kilogram of CIS43LS and underwent controlled human malaria infection approximately 36 weeks later had no parasitemia, with serum concentrations of CIS43LS of 46 and 57 µg per milliliter at the time of controlled human malaria infection. CONCLUSIONS: Among adults who had never had malaria infection or vaccination, administration of the long-acting monoclonal antibody CIS43LS prevented malaria after controlled infection. (Funded by the National Institute of Allergy and Infectious Diseases; VRC 612 ClinicalTrials.gov number, NCT04206332.).


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antimaláricos/uso terapêutico , Malária Falciparum/prevenção & controle , Adulto , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/farmacocinética , Anticorpos Antiprotozoários/sangue , Antimaláricos/administração & dosagem , Antimaláricos/efeitos adversos , Antimaláricos/farmacocinética , Relação Dose-Resposta a Droga , Voluntários Saudáveis , Humanos , Infusões Intravenosas/efeitos adversos , Injeções Subcutâneas/efeitos adversos , Pessoa de Meia-Idade , Plasmodium falciparum/imunologia , Plasmodium falciparum/isolamento & purificação
10.
Rheumatol Int ; 41(10): 1839-1843, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34409510

RESUMO

The outcomes of COVID-19 in patients treated with biologic agents are a subject of intense investigation. Recent data indicated that patients under rituximab (RTX) may carry an increased risk of serious disease. We performed an electronic search in Medline and Scopus using the keywords rituximab and COVID-19. We present a rare case of severe, protracted COVID-19 pneumonia in a patient with mixed connective tissue disease (MCTD) who was infected a few days following RTX treatment. In a relevant literature search, we identified 18 cases of patients with rheumatic diseases (6 RA, 8 ANCA vasculitis, 3 systemic sclerosis and 1 polymyositis) treated with RTX who experienced an atypical and/or prolonged course of COVID-19 pneumonia with no evidence of cytokine storm. Our case indicates that RTX may unfavorably affect outcomes following SARS-CoV-2 infection. B cell depletion may dampen the humoral response against the virus; we may hypothesize that B cell-depleted patients may be protected from cytokine storm but on the other hand may have difficulties in virus clearance leading to a protracted course. Taking into account that COVID-19 vaccines are available we may consider delaying RTX infusions at least in patients without life threatening disease, until vaccination is completed.


Assuntos
Antirreumáticos/efeitos adversos , COVID-19/imunologia , Contraindicações de Medicamentos , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Rituximab/efeitos adversos , Idoso , Antirreumáticos/administração & dosagem , COVID-19/diagnóstico , Evolução Fatal , Feminino , Humanos , Infusões Intravenosas , Masculino , Rituximab/administração & dosagem , SARS-CoV-2
11.
N Engl J Med ; 385(6): 493-502, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34215024

RESUMO

BACKGROUND: Transthyretin amyloidosis, also called ATTR amyloidosis, is a life-threatening disease characterized by progressive accumulation of misfolded transthyretin (TTR) protein in tissues, predominantly the nerves and heart. NTLA-2001 is an in vivo gene-editing therapeutic agent that is designed to treat ATTR amyloidosis by reducing the concentration of TTR in serum. It is based on the clustered regularly interspaced short palindromic repeats and associated Cas9 endonuclease (CRISPR-Cas9) system and comprises a lipid nanoparticle encapsulating messenger RNA for Cas9 protein and a single guide RNA targeting TTR. METHODS: After conducting preclinical in vitro and in vivo studies, we evaluated the safety and pharmacodynamic effects of single escalating doses of NTLA-2001 in six patients with hereditary ATTR amyloidosis with polyneuropathy, three in each of the two initial dose groups (0.1 mg per kilogram and 0.3 mg per kilogram), within an ongoing phase 1 clinical study. RESULTS: Preclinical studies showed durable knockout of TTR after a single dose. Serial assessments of safety during the first 28 days after infusion in patients revealed few adverse events, and those that did occur were mild in grade. Dose-dependent pharmacodynamic effects were observed. At day 28, the mean reduction from baseline in serum TTR protein concentration was 52% (range, 47 to 56) in the group that received a dose of 0.1 mg per kilogram and was 87% (range, 80 to 96) in the group that received a dose of 0.3 mg per kilogram. CONCLUSIONS: In a small group of patients with hereditary ATTR amyloidosis with polyneuropathy, administration of NTLA-2001 was associated with only mild adverse events and led to decreases in serum TTR protein concentrations through targeted knockout of TTR. (Funded by Intellia Therapeutics and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT04601051.).


Assuntos
Neuropatias Amiloides Familiares/genética , Neuropatias Amiloides Familiares/terapia , Sistemas CRISPR-Cas , Edição de Genes , Pré-Albumina/genética , Feminino , Técnicas de Transferência de Genes , Humanos , Infusões Intravenosas , Lipossomos , Masculino , Pessoa de Meia-Idade , Nanopartículas , Pré-Albumina/análise , RNA Mensageiro
13.
Int J Pharm Compd ; 25(4): 330-335, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297695

RESUMO

Dexmedetomidine is a sedative medication with co-analgesic effects that has been used primarily in critical care and anesthesia as a continuous intravenous infusion. Its utility in the treatment of refractory agitated delirium is being investigated in other settings including palliative care, but continuous intravenous infusions are not always feasible during end-of-life care. Subcutaneous infusions are more commonly used in this setting, but smaller volumes and higher concentrations are typically required. Investigations into stability at these higher concentrations are required to address preparation and administration feasibility issues. The objective of this research was to study the chemical stability of high-concentration dexmedetomidine 20 mcg/mL prepared in polyvinyl chloride bags with 0.9% sodium chloride and storage up to 9 days under refrigeration and room temperature conditions. A total of four solutions of dexmedetomidine 20 mcg/mL in 0.9% sodium chloride were prepared in polyvinyl chloride bags under sterile conditions. Two bags were stored under refrigeration and two bags at room temperature. Duplicate samples were withdrawn from each bag at hours 0, 24, 48, 72, 96, 120, 144, 168, 192, and 216 and frozen at -20°C (total of 4 samples per time point at each storage condition). These samples were thawed and transferred to glass vials prior to their analysis by high-performance liquid chromatography electrospray ionization-tandem mass spectrometry and pH testing. All samples of dexmedetomidine 20 mcg/mL met stability criteria by retaining more than 90% of the initial concentration after 9 days under refrigeration and room temperature. There was no evidence of precipitation or color change during the study period. The pH reduced slightly over time under both refrigerated (5.7 to 4.5) and room temperature conditions (5.7 to 4.6). Dexmedetomidine solutions of 20 mcg/mL intended for subcutaneous use were stable in polyvinyl chloride bags containing 0.9% sodium chloride for 9 days under refrigeration and room temperature.


Assuntos
Dexmedetomidina , Cloreto de Polivinila , Cromatografia Líquida de Alta Pressão , Embalagem de Medicamentos , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Infusões Intravenosas , Infusões Subcutâneas , Cloreto de Sódio
14.
Math Biosci Eng ; 18(4): 3491-3501, 2021 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-34198397

RESUMO

PURPOSE: In order to improve the accuracy of liquid level detection in intravenous left auxiliary vein infusion and reduce the pain of patients with blood returning from intravenous infusion, we propose a deep learning based liquid level detection model of infusion levels to facilitate this operation. METHOD: We implemented a Yolo v3-based detection model of infusion level images in intravenous infusion, and at the same time, compare it with SURF image processing technique, RCNN, and Fast-RCNN methods. RESULTS: The model in this paper is better than the comparison algorithm in Intersection over Union (IoU), precision, recall and test time. The liquid level detection model based on Yolo v3 has a precision of 0.9768, a recall rate of 0.9688, an IoU of 0.8943, and a test time of 2.9 s. CONCLUSION: The experimental results prove that the liquid level detection method based on deep learning has the characteristics of high accuracy and good real-time performance. This method can play a certain auxiliary role in the hospital environment and improve work efficiency of medical workers.


Assuntos
Algoritmos , Redes Neurais de Computação , Humanos , Processamento de Imagem Assistida por Computador , Infusões Intravenosas
15.
Psychiatry Res ; 303: 114086, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34246008

RESUMO

Herein we evaluate the impact of COVID-19 restrictions on antidepressant effectiveness of intravenous (IV) ketamine in adults with treatment-resistant depression (TRD). We conducted a case series analysis of adults with TRD (n = 267) who received four ketamine infusions at an outpatient clinic in Ontario, Canada, during COVID-19 restrictions (from March 2020 - February 2021; n = 107), compared to patients who received treatment in the previous year (March 2019 - February 2020; n = 160). Both groups experienced significant and comparable improvements in depressive symptoms, suicidal ideation, and anxiety with repeated ketamine infusions. Effectiveness of IV ketamine was not attenuated during the COVID-19 period.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Ketamina , Adulto , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos , Infusões Intravenosas , Ketamina/uso terapêutico , Ontário , Pandemias , SARS-CoV-2
16.
N Engl J Med ; 385(7): 609-617, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34297496

RESUMO

BACKGROUND: The role of factor XI in the pathogenesis of postoperative venous thromboembolism is uncertain. Abelacimab is a monoclonal antibody that binds to factor XI and locks it in the zymogen (inactive precursor) conformation. METHODS: In this open-label, parallel-group trial, we randomly assigned 412 patients who were undergoing total knee arthroplasty to receive one of three regimens of abelacimab (30 mg, 75 mg, or 150 mg) administered postoperatively in a single intravenous dose or to receive 40 mg of enoxaparin administered subcutaneously once daily. The primary efficacy outcome was venous thromboembolism, detected by mandatory venography of the leg involved in the operation or objective confirmation of symptomatic events. The principal safety outcome was a composite of major or clinically relevant nonmajor bleeding up to 30 days after surgery. RESULTS: Venous thromboembolism occurred in 13 of 102 patients (13%) in the 30-mg abelacimab group, 5 of 99 patients (5%) in the 75-mg abelacimab group, and 4 of 98 patients (4%) in the 150-mg abelacimab group, as compared with 22 of 101 patients (22%) in the enoxaparin group. The 30-mg abelacimab regimen was noninferior to enoxaparin, and the 75-mg and 150-mg abelacimab regimens were superior to enoxaparin (P<0.001). Bleeding occurred in 2%, 2%, and none of the patients in the 30-mg, 75-mg, and 150-mg abelacimab groups, respectively, and in none of the patients in the enoxaparin group. CONCLUSIONS: This trial showed that factor XI is important for the development of postoperative venous thromboembolism. Factor XI inhibition with a single intravenous dose of abelacimab after total knee arthroplasty was effective for the prevention of venous thromboembolism and was associated with a low risk of bleeding. (Funded by Anthos Therapeutics; ANT-005 TKA EudraCT number, 2019-003756-37.).


Assuntos
Anticoagulantes/uso terapêutico , Artroplastia do Joelho , Enoxaparina/uso terapêutico , Fator XI/antagonistas & inibidores , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Relação Dose-Resposta a Droga , Enoxaparina/efeitos adversos , Fator XI/metabolismo , Feminino , Hemorragia/induzido quimicamente , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial
17.
Rev Esc Enferm USP ; 55: e03755, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34287485

RESUMO

OBJECTIVE: To analyze the causes and reasons associated with the occurrence of phlebitis in a Inpatient Medical Unit in a large and private general hospital. METHOD: Quantitative, exploratory-descriptive, retrospective and documentary research, carried out by consulting the electronic forms of notification of the occurrence of phlebitis in 2017. RESULTS: A total of 107 phlebitis related to 96 patients were reported, most of them (91.7%) with phlebitis, being male (53.1%), aged 60-69 years old (23.0%) and with a hospital stay of less than four days (30.2%). Most (68.2%) of the notifications were made by nurses, with the occurrence of phlebitis predominating in devices with less than 24h (38.3%); with the classification of phlebitis grade 2 (45.8%); with antibiotics infusion (46.7%); with the location of the bed far from the nursing station (52.3%); and with the presence of a companion (82.2%). The damage classification indicated that 93.5% of the patients suffered mild damage, 4.7% moderate damage and 1.9% did not suffer any damage. CONCLUSION: Knowing the causes and reasons associated with the occurrence of phlebitis can support decision-making, management and care processes regarding investments in preventive or risk mitigation strategies.


Assuntos
Cateterismo Periférico , Flebite , Idoso , Antibacterianos , Humanos , Infusões Intravenosas , Pacientes Internados , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Flebite/epidemiologia , Flebite/etiologia , Estudos Retrospectivos
18.
J Stroke Cerebrovasc Dis ; 30(9): 105959, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217067

RESUMO

PURPOSE: To assess the safety and efficacy of continuous infusion (CIV)-labetalol compared to -nicardipine in controlling blood pressure (BP) in the acute stroke setting. MATERIALS: Patients were eligible if they had a diagnosis of an acute stroke and were administered either CIV-labetalol or CIV-nicardipine. Study outcomes were assessed within the first 24 h of the antihypertensive infusion. RESULTS: A total of 3,093 patients were included with 3,008 patients in the CIV-nicardipine group and 85 in the CIV-labetalol group. No significant difference was observed in percent time at goal BP between the nicardipine (82%) and labetalol (85%) groups (p = 0.351). There was also no difference in BP variability between nicardipine (37%) and labetalol (39%) groups (p = 0.433). Labetalol was found to have a shorter time to goal BP as compared to nicardipine (24 min vs. 40 min; p = 0.021). While CIV-nicardipine did have a higher incidence of tachycardia compared to labetalol (17% vs. 4%; p <0.001), the incidence of hypotension (13% vs. 15%; p = 0.620) and bradycardia (24% vs. 22%; p = 0.797) were similar. CONCLUSIONS: These results indicate that CIV-labetalol and CIV-nicardipine are comparable in safety and efficacy in controlling BP for patients with acute stroke.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Hipertensão/tratamento farmacológico , Labetalol/administração & dosagem , Nicardipino/administração & dosagem , Acidente Vascular Cerebral/complicações , Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Bradicardia/induzido quimicamente , Bradicardia/fisiopatologia , Bloqueadores dos Canais de Cálcio/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/fisiopatologia , Hipotensão/induzido quimicamente , Hipotensão/fisiopatologia , Infusões Intravenosas , Labetalol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nicardipino/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
19.
Aging (Albany NY) ; 13(13): 17337-17348, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226296

RESUMO

Adjuvant concurrent chemoradiotherapy (CCRT) is the standard care for patients with resected advanced gastric cancer, but its survival benefits remain undetermined in patients undergoing D2 lymph node dissection (D2 dissection). We evaluated safety and efficacy of adjuvant CCRT with 5-fluorouracil (5-FU) versus chemotherapy alone in 110 gastric cancer patients with D2 dissection treated in Taiwan between January 2009 and January 2013. All the 71 patients receiving adjuvant CCRT were treated with daily infusional 5-FU and radiotherapy. Adjuvant CCRT was associated with higher risks of major hematologic (56.3% vs. 23.8%, p = 0.002) and gastrointestinal (46.9% vs. 14.3%, p = 0.027) toxicities and death (12.5% vs. 0.0%, p = 0.041) in patients above 70 years old, but this was not the case in those ≤70 years of age. Univariate Cox proportional regressions identified adjuvant CCRT as a factor for better overall survival (OS) (hazard ratio [HR]=0.52; 95% confidence interval [CI]: 0.27-0.99) and disease-free survival (DFS) (HR=0.46, 95% CI: 0.24-0.88), but it was not a significant factor for OS or DFS after adjusting for other factors in the multivariate analysis. However, in stratified analyses by age, we found adjuvant CCRT was an independent prognostic factor for better OS (HR=0.07; 95% CI: 0.01-0.38) in patients ≤70 years old, but not in those above 70 years of age. Therefore, it was concluded that age may to be a modifier of the effects of adjuvant CCRT.


Assuntos
Envelhecimento , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Fluoruracila/administração & dosagem , Fluoruracila/uso terapêutico , Neoplasias Gástricas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/efeitos adversos , Quimiorradioterapia Adjuvante/efeitos adversos , Intervalo Livre de Doença , Feminino , Fluoruracila/efeitos adversos , Humanos , Infusões Intravenosas , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Análise de Sobrevida , Taiwan , Resultado do Tratamento
20.
J Stroke Cerebrovasc Dis ; 30(9): 105988, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34271275

RESUMO

OBJECTIVE: Acute central retinal artery occlusion (CRAO) is an emergency with poor visual outcome. Intravenous thrombolysis within 4.5 h of vision loss is safe and may improve vision, but is rarely administered because of frequent delays in presentation. We describe a subgroup of CRAO patients presenting within 24 h of vision loss to a tertiary care center affiliated with a comprehensive stroke center. MATERIALS AND METHODS: Retrospective review of 181 consecutive CRAO patients seen at our institution from 2010 to 2020. RESULTS: Out of 181 CRAO patients, 62 (34%) presented within 24 h of vision loss and tended to live closer to the hospital. These patients were more likely to be admitted to the hospital and receive comprehensive stroke work-up compared to patients who presented after 24 h of vision loss. Patients presenting after 24 h did not necessarily receive prior appropriate work-up at outside institutions. Conservative treatments for CRAO were administered to 20/181 patients, and only 3 patients received intravenous thrombolysis. CONCLUSIONS: Patients with CRAO do not present to the emergency department fast enough and diagnosis of CRAO is often delayed. Despite having a protocol in place, only 3/181 patients received IV thrombolysis, emphasizing the difficulty in administering very acute treatments for CRAO. Public education regarding CRAO is necessary to improve presentation times, management, and visual outcomes. Hospitals need to develop accelerated diagnostic pathway protocols for patients with acute vision loss so that CRAO patients may be diagnosed and be considered for potential acute treatments as quickly as possible.


Assuntos
Fibrinolíticos/administração & dosagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Centros de Atenção Terciária , Terapia Trombolítica , Tempo para o Tratamento , Visão Ocular/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Programática de Saúde , Serviço Hospitalar de Emergência , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/fisiopatologia , Estudos Retrospectivos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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