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1.
Yakugaku Zasshi ; 140(12): 1415-1419, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33268682

RESUMO

Management of chemotherapy-induced adverse effects and the associated pharmaceutical interventions as well as supportive care evidence creation are the most important responsibilities of oncology pharmacists. We have evaluated the (1) efficacy of long-term and successive pharmaceutical care in outpatient chemotherapy and (2) nephroprotective effects of magnesium (Mg) against cisplatin-induced nephrotoxicity (CIN). The results revealed that the adoption rate of pharmaceutical proposals was 98%, and that approximately 70% of the proposals attenuated painful symptoms. Moreover, approximately 60% of pharmaceutical interventions were established after the third visit; in particular, approximately 20% were suggested after the tenth visit. These results have shown that long-term and successive pharmaceutical care by oncology pharmacists in outpatient chemotherapy contributes to a safe and less onerous chemotherapy implementation. CIN frequency and serum creatinine elevation were significantly attenuated by Mg premedication during the cisplatin, docetaxel, and fluorouracil regimen, without changes in adverse effects and response rate. Mg premedication has been suggested to exert a protective effect against CIN without influencing on adverse effects and anti-tumor efficacy. The nephroprotective effect of Mg against CIN was evaluated using Wistar rats. Cisplatin (2.5 mg/kg) was administered once or three times weekly with or without 40 mg/kg MgSO4. The results revealed that Mg regulates the expression of organic cation transporter 2, multidrug and toxin extrusion protein 1, and copper transporter 1, leading to reduced renal platinum accumulation, which results in CIN attenuation. In conclusion, evaluation of pharmaceutical care and supportive care by oncology pharmacists is necessary for advanced care of cancer patients.


Assuntos
Antineoplásicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Oncologia , Farmacêuticos , Pré-Medicação , Especialização , Animais , Antiporters/genética , Antiporters/metabolismo , Cisplatino/efeitos adversos , Docetaxel/efeitos adversos , Fluoruracila/efeitos adversos , Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Sulfato de Magnésio/farmacologia , Proteínas de Transporte de Cátions Orgânicos/genética , Proteínas de Transporte de Cátions Orgânicos/metabolismo , Transportador 2 de Cátion Orgânico/genética , Transportador 2 de Cátion Orgânico/metabolismo , Ratos
2.
Medicine (Baltimore) ; 99(46): e22801, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181650

RESUMO

BACKGROUND: Magnesium sulfate combined with low-dose aspirin can significantly reduce adverse reactions and effectively lower blood pressure in patients with pregnancy induced hypertension, but the overall efficacy and safety of the combination of drugs are not clear. The purpose of this study was to evaluate the efficacy and safety of magnesium sulfate combined with low-dose aspirin in the treatment of pregnancy induced hypertension. METHODS: Randomized controlled trials focusing on the administration of magnesium sulfate combined with low-dose aspirin for pregnancy induced hypertension were searched from PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and the Chongqing VIP Chinese Science and Technology Periodical Database. Two researchers independently screened titles, abstracts, and full texts, and extracted relevant data. The RevMan 5.3 software and Stata 14 software were used for statistical analysis. RESULTS: The effect and safety of magnesium sulfate combined with low-dose aspirin in the treatment of pregnancy induced hypertension were assessed by summarizing the related randomized controlled trials. CONCLUSION: This article provides theoretical support for the clinical application of magnesium sulfate combined with low-dose aspirin in the treatment of pregnancy induced hypertension. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/SZFGB.


Assuntos
Aspirina/administração & dosagem , Protocolos Clínicos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Sulfato de Magnésio/administração & dosagem , Aspirina/uso terapêutico , Feminino , Humanos , Sulfato de Magnésio/uso terapêutico , Metanálise como Assunto , Gravidez , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
Cardiovasc Ther ; 2020: 1494506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072188

RESUMO

Background: Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the effect of early initiation of high-dose intravenous magnesium sulfate on cardiac adverse events in stroke patients. Methods: This is a secondary analysis of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized phase-3 clinical trial, conducted from 2005-2013. Consecutive patients with suspected acute stroke and a serum magnesium level within 72 hours of enrollment were selected. Twenty grams of magnesium sulfate or placebo was administered in the ambulance starting with a 15-minute loading dose intravenous infusion followed by a 24-hour maintenance infusion in the hospital. Results: Among 1126 patients included in the analysis of this study, 809 (71.8%) patients had ischemic stroke, 277 (24.6%) had hemorrhagic stroke, and 39 (3.5%) with stroke mimics. The mean age was 69.5 (SD13.4) and 42% were female. 565 (50.2%) received magnesium treatment, and 561 (49.8%) received placebo. 254 (22.6%) patients achieved the target, and 872 (77.4%) did not achieve the target, regardless of their treatment group. Among 1126 patients, 159 (14.1%) had at least one CAE. Treatment with magnesium was not associated with fewer cardiac adverse events. A multivariate binary logistic regression for predictors of CAEs showed a positive association of older age and frequency of CAEs (R = 1.04, 95% CI 1.03-1.06, p < 0.0001). Measures of early and 90-day outcomes did not differ significantly between the magnesium and placebo groups among patients who had CAEs. Conclusion: Treatment of acute stroke patients with magnesium did not result in a reduction in the number or severity of cardiac serious adverse events.


Assuntos
Cardiopatias/prevenção & controle , Hospitalização , Sulfato de Magnésio/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Esquema de Medicação , Feminino , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Incidência , Los Angeles/epidemiologia , Sulfato de Magnésio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(40): e22524, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019455

RESUMO

TRIAL DESIGN: The current study is a meta-analysis designed to assess the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. METHODS: The protocol was registered in PROSPERO with the number CRD42020177618. PubMed, Cochrane library, Web of Science, and Google Scholar were searched for randomized controlled trials investigating the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. The continuous data were presented as Ratio of means (RoM). Risk ratio (RR) along with 95% confidence interval (CI) was utilized to assess the dichotomous data. RESULTS: Ten trials were involved in the present study with 720 adult patients. Compared with control, intrathecal magnesium prolonged time to the first analgesic requirement by an estimate of 1.23 (RoM: 1.23; 95%CI: 1.13-1.33; P < .00001), prolonged adequate sensory block duration for surgery by an estimate of 1.16 (RoM: 1.16; 95%CI: 1.05-1.27; P = .003), delayed time to maximum sensory level by an estimate of 1.38 (RoM: 1.38; 95%CI: 1.07-1.78; P = .01) and reduced the incidence of shivering following spinal anesthesia (risk ratio: 0.38; 95%CI: 0.18 to 0.81, P = .01) without influence on time to full motor recovery or incidences of hypotention, bradycardia, nausea, and vomiting or pruritis. CONCLUSION: Intrathecal magnesium, when added to a combination of intrathecal bupivacaine and fentany, prolongs the analgesic duration of spinal anesthesia without increased incidences of side effects.


Assuntos
Raquianestesia/métodos , Anestésicos/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Raquianestesia/efeitos adversos , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Bupivacaína/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Fentanila/uso terapêutico , Humanos , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tremor por Sensação de Frio/efeitos dos fármacos , Fatores de Tempo
5.
Pan Afr Med J ; 36: 175, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32952819

RESUMO

Eclampsia is one of the leading causes of maternal death worldwide. The purpose of our study was to determine maternal and perinatal prognosis of eclampsia at the Timbuktu Hospital in Mali. We conducted a descriptive, retrospective study of patients with eclampsia during pregnancy or delivery at the Timbuktu Hospital from January 1, 2013 to December 31, 2017. Out of 4.951 deliveries, 116 were marked by eclampsia, reflecting an overall rate of 2.3%. These patients were mainly women younger than 26 years (85.3%), primiparous (81%), admitted on average 8 hours after the first crisis. Cesarean section was performed in 77.6% of cases. Magnesium sulphate was used in 75% of cases. Maternal and perinatal mortality accounted for 4.3% and 21.5%, respectively. Poor maternal prognosis factor was Glasgow score ≤ 8 on admission (p: 0.004). Poor perinatal prognosis factors were to be resident outside the city of Timbuktu (p: 0.000), the absence of antenatal consultation (p: 0.020) and vaginal delivery (p: 0.012). Thus, improving maternal and perinatal prognosis requires proper monitoring of pregnancies and reduction of delays in accessing adequate care.


Assuntos
Cesárea/estatística & dados numéricos , Eclampsia/epidemiologia , Sulfato de Magnésio/administração & dosagem , Resultado da Gravidez , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Mali , Mortalidade Materna , Mortalidade Perinatal , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Am J Otolaryngol ; 41(6): 102722, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32950829

RESUMO

PURPOSE: This randomized, double-blind study was planned to evaluate the effect of perioperative magnesium sulfate with controlled hypotension on intraoperative bleeding, postoperative ecchymosis and edema, and side-effects. MATERIALS AND METHOD: Forty-nine patients undergoing open rhinoplasty were divided into two groups - magnesium sulfate and control. The magnesium sulfate group received 30-50 mg·kg-1 intravenously as a bolus before induction of anesthesia, followed by 10-20 mg·kg-1 h-1 by continuous intravenous infusion during surgery. Anesthesia was induced with propofol 3 mg·kg-1, fentanyl 15 µg·kg-1 and cisatracurium 0.6 mg·kg-1. Mean arterial pressure was maintained at 50 to 60 mmHg under controlled hypotensive anesthesia with magnesium sulfate titration. Hemodynamic variables, operational bleeding, early postoperative side-effects and postoperative first-, third- and seventh-day ecchymosis and edema were compared between the groups. Ecchymosis and edema were evaluated using a graded scale from 0 to 4. RESULTS: In the magnesium sulfate group, mean arterial pressure decreased during most of the perioperative period. Intraoperative bleeding also decreased. A distinct reduction in ecchymosis and edema was observed in both the upper and lower eyelids on the first, third and seventh days. Patients in the magnesium sulfate group also had a more peaceful postoperative course with less postoperative nausea vomiting, and shivering. CONCLUSION: Magnesium sulfate with controlled hypotension can lower ecchymosis and edema of the upper and lower eyelids in rhinoplasty surgery by reducing bleeding.


Assuntos
Anestesia/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Equimose/prevenção & controle , Edema/prevenção & controle , Doenças Palpebrais/prevenção & controle , Hipotensão Controlada/métodos , Complicações Intraoperatórias/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Nariz/cirurgia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Rinoplastia/efeitos adversos , Adulto , Método Duplo-Cego , Edema/etiologia , Doenças Palpebrais/etiologia , Feminino , Humanos , Infusões Intravenosas , Injeções Intravenosas , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Rinoplastia/métodos
7.
Cochrane Database Syst Rev ; 8: CD012977, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32767571

RESUMO

BACKGROUND: Asthma is an illness that commonly affects adults and children, and it serves as a common reason for children to attend emergency departments. An asthma exacerbation is characterised by acute or subacute worsening of shortness of breath, cough, wheezing, and chest tightness and may be triggered by viral respiratory infection, poor compliance with usual medication, a change in the weather, or exposure to allergens or irritants. Most children with asthma have mild or moderate exacerbations and respond well to first-line therapy (inhaled short-acting beta-agonists and systemic corticosteroids). However, the best treatment for the small proportion of seriously ill children who do not respond to first-line therapy is not well understood. Currently, a large number of treatment options are available and there is wide variation in management. OBJECTIVES: Main objective - To summarise Cochrane Reviews with or without meta-analyses of randomised controlled trials on the efficacy and safety of second-line treatment for children with acute exacerbations of asthma (i.e. after first-line treatments, titrated oxygen delivery, and administration of intermittent inhaled short-acting beta2-agonists and oral corticosteroids have been tried and have failed) Secondary objectives - To identify gaps in the current evidence base that will inform recommendations for future research and subsequent Cochrane Reviews - To categorise information on reported outcome measures used in trials of escalation of treatment for acute exacerbations of asthma in children, and to make recommendations for development and reporting of standard outcomes in future trials and reviews - To identify relevant randomised controlled trials that have been published since the date of publication of each included review METHODS: We included Cochrane Reviews assessing interventions for children with acute exacerbations of asthma. We searched the Cochrane Database of Systematic Reviews. The search is current to 28 December 2019. We also identified trials that were potentially eligible for, but were not currently included in, published reviews. We assessed the quality of included reviews using the ROBIS criteria (tool used to assess risk of bias in systematic reviews). We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials. Primary outcomes were length of stay, hospital admission, intensive care unit admission, and adverse effects. We summarised all findings in the text and reported data for each outcome in 'Additional tables'. MAIN RESULTS: We identified 17 potentially eligible Cochrane Reviews but extracted data from, and rated the quality of, 13 reviews that reported results for children alone. We excluded four reviews as one did not include any randomised controlled trials (RCTs), one did not provide subgroup data for children, and the last two had been updated and replaced by subsequent reviews. The 13 reviews included 67 trials; the number of trials in each review ranged from a single trial up to 27 trials. The vast majority of comparisons included between one and three trials, involving fewer than 100 participants. The total number of participants included in reviews ranged from 40 to 2630. All studies included children; 16 (24%) included children younger than two years of age. Most of the reviews reported search dates older than four years. We have summarised the published evidence as outlined in Cochrane Reviews. Key findings, in terms of our primary outcomes, are that (1) intravenous magnesium sulfate was the only intervention shown to reduce hospital length of stay (high-certainty evidence); (2) no evidence suggested that any intervention reduced the risk of intensive care admission (low- to very low-certainty evidence); (3) the risk of hospital admission was reduced by the addition of inhaled anticholinergic agents to inhaled beta2-agonists (moderate-certainty evidence), the use of intravenous magnesium sulfate (high-certainty evidence), and the use of inhaled heliox (low-certainty evidence); (4) the addition of inhaled magnesium sulfate to usual bronchodilator therapy appears to reduce serious adverse events during hospital admission (moderate-certainty evidence); (5) aminophylline increased vomiting compared to placebo (moderate-certainty evidence) and increased nausea and nausea/vomiting compared to intravenous beta2-agonists (low-certainty evidence); and (6) the addition of anticholinergic therapy to short-acting beta2-agonists appeared to reduce the risk of nausea (high-certainty evidence) and tremor (moderate-certainty evidence) but not vomiting (low-certainty evidence). We considered 4 of the 13 reviews to be at high risk of bias based on the ROBIS framework. In all cases, this was due to concerns regarding identification and selection of studies. The certainty of evidence varied widely (by review and also by outcome) and ranged from very low to high. AUTHORS' CONCLUSIONS: This overview provides the most up-to-date evidence on interventions for escalation of therapy for acute exacerbations of asthma in children from Cochrane Reviews of randomised controlled trials. A vast majority of comparisons involved between one and three trials and fewer than 100 participants, making it difficult to assess the balance between benefits and potential harms. Due to the lack of comparative studies between various treatment options, we are unable to make firm practice recommendations. Intravenous magnesium sulfate appears to reduce both hospital length of stay and the risk of hospital admission. Hospital admission is also reduced with the addition of inhaled anticholinergic agents to inhaled beta2-agonists. However, further research is required to determine which patients are most likely to benefit from these therapies. Due to the relatively rare incidence of acute severe paediatric asthma, multi-centre research will be required to generate high-quality evidence. A number of existing Cochrane Reviews should be updated, and we recommend that a new review be conducted on the use of high-flow nasal oxygen therapy. Important priorities include development of an internationally agreed core outcome set for future trials in acute severe asthma exacerbations and determination of clinically important differences in these outcomes, which can then inform adequately powered future trials.


Assuntos
Antiasmáticos/uso terapêutico , Asma/terapia , Broncodilatadores/uso terapêutico , Progressão da Doença , Revisões Sistemáticas como Assunto , Doença Aguda , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Aminofilina/administração & dosagem , Aminofilina/efeitos adversos , Antiasmáticos/administração & dosagem , Antibacterianos/uso terapêutico , Asma/tratamento farmacológico , Viés , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Antagonistas Colinérgicos/uso terapêutico , Hélio , Humanos , Lactente , Tempo de Internação , Antagonistas de Leucotrienos/uso terapêutico , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/efeitos adversos , Sulfato de Magnésio/uso terapêutico , Náusea/induzido quimicamente , Náusea/prevenção & controle , Oxigênio/administração & dosagem , Respiração com Pressão Positiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Vômito/induzido quimicamente , Trabalho Respiratório/efeitos dos fármacos
8.
Arch Razi Inst ; 75(1): 83-91, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32292006

RESUMO

This study aimed at investigating the effects of intraperitoneal (IP) administration of magnesium sulfate (MgSO4) on testicular ischemia-reperfusion (IR) injury in rats. In total, 50 adult Wistar rats were randomly divided into 5 groups. Group 1 received no injection (control); however, group 2 was subjected to 2 h of I and 24 h of R. Subsequently, group 3 was subjected to 2 h of 1, and after 1 h of I, 125 mg/kg MgSO4 was injected intraperitoneally followed by 24 h of R. Groups 4 and 5 were subjected to the same process as group 3, whereas the rats were injected with 250 and 500 mg/kg of MgSO4, respectively. After 24 h, the left testes of all rats were removed for histological analysis and antioxidant activities. According to the results, there was a significant increase in tissue malondialdehyde (MDA) among I/R rats (P&lt;0.05), whereas MgSO4 decreased I/R-induced MDA (P&lt;0.05). Furthermore, experimental I/R diminished glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels significantly (P&lt;0.05). Moreover, MgSO4 (250 and 500 mg/kg) increased GPx and SOD activity significantly in I/R rats (P&lt;0.05). Furthermore, seminiferous tubules degenerated, and few spermatocytes were observed in the testis tubules of the I/R rats. Regarding pathological parameters, seminiferous tubules and spermatocyte were normal in the testes of MgSO4 (250 and 500 mg/kg)-treated experimental I/R-induced rats. In conclusion, this study demonstrated the beneficial effects of MgSO4 on testicular IR injury in rats.


Assuntos
Sulfato de Magnésio/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Doenças Testiculares/tratamento farmacológico , Animais , Antioxidantes/metabolismo , Injeções Intraperitoneais , Sulfato de Magnésio/administração & dosagem , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar
9.
Anesthesiology ; 133(1): 64-77, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304405

RESUMO

BACKGROUND: Catheter-related bladder discomfort occurs because of involuntary contractions of the bladder smooth muscle after urinary catheterization. Magnesium is associated with smooth muscle relaxation. This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort. METHODS: In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50 mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg · h during the intraoperative period. Patients in the control group similarly received normal saline. The primary outcome was the incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively. None, mild, moderate, and severe catheter-related bladder discomfort at 1, 2, and 6 h postoperatively, patient satisfaction, and magnesium-related adverse effects were also assessed. RESULTS: The incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively was significantly lower in the magnesium group than in the control group (13 [22%] vs. 46 [77%]; P < 0.001; relative risk = 0.283; 95% CI, 0.171 to 0.467; absolute risk reduction = 0.55; number needed to treat = 2); similar results were observed for catheter-related bladder discomfort above a moderate grade at 1 and 2 h postoperatively (5 [8%] vs. 17 [28%]; P = 0.005; relative risk = 0.294; 95% CI, 0.116 to 0.746; and 1 [2%] vs. 14 [23%]; P < 0.001; relative risk = 0.071; 95% CI, 0.010 to 0.526, respectively). Patient satisfaction on a scale from 1 to 7 was significantly higher in the magnesium group than in the control group (5.1 ± 0.8 vs. 3.5 ± 1.0; P < 0.001; 95% CI, 1.281 to 1.919). Magnesium-related adverse effects were not significantly different between groups. CONCLUSIONS: Magnesium reduced the incidence of catheter-related bladder discomfort above a moderate grade and increased patient satisfaction among patients having transurethral resection of bladder tumor.


Assuntos
Sulfato de Magnésio/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Doenças da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Administração Intravenosa , Idoso , Método Duplo-Cego , Feminino , Humanos , Sulfato de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Relaxamento Muscular/efeitos dos fármacos , Dor Pós-Operatória , Satisfação do Paciente , Comportamento de Redução do Risco , Resultado do Tratamento , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/complicações , Cateterismo Urinário/efeitos adversos
10.
BJOG ; 127(10): 1217-1225, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32237024

RESUMO

OBJECTIVE: To study the effect of antenatal magnesium sulphate (MgSO4 ) on cerebral palsy (CP) in a manner that also provides adequate power for a linked trial sequential analysis. DESIGN: Double-blind, randomised, placebo-controlled, multi-centre trial. SETTING: Fourteen Danish obstetric departments. POPULATION: In total, 560 pregnant women at risk for preterm delivery before 32 weeks of gestation were randomised from December 2011 to January 2018. Those women gave birth to 680 children. METHODS: Women were randomised to receive either a loading dose of 5 g MgSO4 followed by 1 g/hour or a placebo in identical volumes. The children were followed up at a corrected age of 18 months or older with a review of their medical charts and with the Ages and Stages Questionnaire. MAIN OUTCOME MEASURE: The primary outcome measure was moderate to severe CP. Secondary outcomes included mortality, neonatal morbidity, blindness and mild CP. RESULTS: The crude rates of moderate to severe CP in the MgSO4 group and the placebo group were 2.0% and 3.3%, respectively. The adjusted odds of moderate to severe CP were lower in the MgSO4 group than in the placebo group (odds ratio 0.61; 95% CI 0.23-1.65). CONCLUSIONS: Antenatal MgSO4 before 32 weeks of gestation decreases the likelihood of moderate to severe CP; these results are entirely consistent with other randomised evidence summarised in the linked trial sequential analysis. TWEETABLE ABSTRACT: Antenatal magnesium sulphate may decrease the risk of moderate to severe cerebral palsy in children born before 32 weeks of gestation.


Assuntos
Paralisia Cerebral/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Nascimento Prematuro/tratamento farmacológico , Adulto , Dinamarca , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Índice de Gravidade de Doença
11.
Am J Perinatol ; 37(8): 866-868, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32330970

RESUMO

Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. KEY POINTS: · Acute COVID-19 infection is associated with a high rate of preterm delivery.. · Standard treatment for preterm labor such as intravenous magnesium sulfate, antepartum steroid therapy and antibiotic prophylaxis for group B streptococcus infection were effective in this patient.. · In the absence of maternal or fetal compromise, acute COVID-19 infection is not an indication for early elective delivery..


Assuntos
Infecções por Coronavirus , Glucocorticoides/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Antibioticoprofilaxia/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Recém-Nascido , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Tocolíticos/administração & dosagem
12.
Am J Health Syst Pharm ; 77(7): 546-551, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32086507

RESUMO

PURPOSE: Evaluation of mechanisms used to cope with an i.v. fluid shortage to determine if prescribing habits were changed and if substitution of an i.v. dose of magnesium with an oral dose impacted patient outcomes. METHODS: A single-center, retrospective analysis of electronic medical record (EMR) alerts and medical records covering 6-month periods before and during an i.v. fluid shortage was conducted. Records of adult medical and surgical inpatients admitted during these periods who had an order for i.v. or oral magnesium were screened for inclusion. The primary outcome of part 1 of the study was the percent acceptance of drug shortage-related EMR alert recommendations associated with i.v. magnesium. The primary outcome of part 2 of the study was the change in serum magnesium concentration (SMC) after an i.v. or oral dose of magnesium was administered. RESULTS: Of the 7,476 EMR alerts generated during provider ordering of i.v. magnesium products, 4.8% resulted in the provider accepting the recommendation to switch to an oral alternative, 89% resulted in continuation of an i.v. magnesium order, and 6.2% resulted in order cancellation. Among patients who received magnesium doses, SMC values increased by a mean (SD) of 0.135 (0.08) mg/dL per gram of i.v. magnesium sulfate administered (n = 251), compared to an increase of 0.058 (0.08) mg/dL per 400-mg tablet of magnesium oxide administered (n = 42). CONCLUSION: Acceptance of the EMR alert recommendations was low. Both i.v. magnesium sulfate and oral magnesium oxide are viable options for increasing SMC.


Assuntos
Óxido de Magnésio/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Sistemas de Registro de Ordens Médicas , Padrões de Prática Médica/estatística & dados numéricos , Administração Intravenosa , Administração Oral , Adulto , Idoso , Registros Eletrônicos de Saúde , Feminino , Hidratação , Humanos , Óxido de Magnésio/sangue , Sulfato de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Sports Sci ; 38(6): 607-611, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31997718

RESUMO

Hot water immersion, known as a hot bath, is used by MMA athletes to produce rapid weight loss (RWL) by means of passive fluid loss. This study investigated the magnitude of body mass losses using a standardized hot bath protocol with or without the addition of salt. In a crossover design, eleven male MMA athletes (28.5 ± 4.6 y; 1.83 ± 0.07 m; 82.5 ± 9.1 kg) performed a 20-min immersion at 37.8°C followed by a 40-min wrap in a warm room. This bath and wrap was performed twice per visit. During one visit, only fresh water was used (FWB), and in the other visit, magnesium sulphate (1.6% wt/vol) was added to the bath (SWB). Prior to each visit, 24 h of carbohydrate, fibre, and fluid restriction was undertaken as part of the RWL protocol. Body mass losses induced by the hot bath protocols were 1.63 ± 0.75 kg and 1.60 ± 0.80 kg for FWB and SWB, respectively, and equivalent to ~2.1% body mass. Under the conditions employed, the magnitude of body mass loss in SWB was similar to FWB. However, further research should explore bathing in a temperature that is consistent with that habitually used by fighters, and/or higher concentrations of salt.


Assuntos
Temperatura Alta , Imersão , Sulfato de Magnésio/administração & dosagem , Artes Marciais/fisiologia , Perda de Peso , Adulto , Índice de Massa Corporal , Estudos Cross-Over , Desidratação , Humanos , Masculino , Concentração Osmolar , Urina/fisiologia , Adulto Jovem
14.
Int J Gynaecol Obstet ; 149(1): 37-42, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31833059

RESUMO

OBJECTIVE: To assess the effectiveness of a 12-hour versus 24-hour intravenous maintenance dose of magnesium sulfate (MgSO4 ) in women with pre-eclampsia, and the maternal and fetal outcomes. METHODS: This was a randomized controlled trial conducted at the labor ward complex of University College Hospital, Ibadan, Nigeria between May and August 2014. Pregnant women with severe pre-eclampsia were randomized to receive a 12-hour versus 24-hour maintenance dose of MgSO4 . Study outcomes were occurrence of seizures, adverse maternal effects, neonatal survival, and admission to the intensive care unit. Data analysis involved descriptive statistics and bivariate analysis using Statistical Package for Social Science (SPSS) version 20. RESULTS: There were 80 patients randomized to the 12-hour (n=40) and 24-hour (n=40) groups. The participants in the two groups had comparable demographic features. There was no significant difference (P>0.999) between the satisfactory maternal outcome following the 12-hour maintenance dose and the standard 24-hour regimen (95.0% vs 97.5%). Similarly, there was no significant difference (P=0.276) in perinatal mortality in the 12-hour versus 24-hour arm (17.5% vs 12.5%, respectively). No case of eclampsia and maternal death was recorded. CONCLUSION: A 12-hour maintenance dose of intravenous MgSO4 in the management of severe pre-eclampsia is effective and safe when compared with the 24-hour maintenance dose.


Assuntos
Sulfato de Magnésio/administração & dosagem , Pré-Eclâmpsia/tratamento farmacológico , Administração Intravenosa , Adulto , Esquema de Medicação , Feminino , Humanos , Recém-Nascido , Sulfato de Magnésio/efeitos adversos , Nigéria , Mortalidade Perinatal , Gravidez , Convulsões/prevenção & controle
15.
Curr Drug Deliv ; 17(2): 140-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31845631

RESUMO

OBJECTIVE: In vitro diffusion experiments were performed to assess the permeation of magnesium sulfate across pig skin. METHODS: The mean thickness of the dermatomed porcine skin was 648 ± 12 µm. Magnesium concentration was measured using inductively coupled plasma-optical emission spectroscopy. Transdermal flux of magnesium sulfate across MN-treated and untreated porcine skin was obtained from the slope of the steady-state linear portion of cumulative amount versus time curve. RESULTS: Statistical analysis of the results was done with Student's t-test. The transdermal flux of magnesium sulfate across microneedle-treated porcine skin was 134.19 ± 2.4 µg/cm2/h and transdermal flux across untreated porcine skin was 4.64 ± 0.05 µg/cm2/h. Confocal microscopy was used to visualize the microchannels created by a solid microneedle roller (500 µm). CONCLUSION: From our confocal microscopy studies, it was evident that the 500 µm long microneedles disrupted the stratum corneum and created microchannels measuring 191 ± 37 µm. The increase in transdermal flux across the microneedle-treated skin was statistically significant compared to that of controls, i.e., without the application of microneedles. With the application of microneedles, the transdermal flux of magnesium permeated over 12 h was approximately 33-fold higher in comparison to passive diffusion across an intact stratum corneum.


Assuntos
Sistemas de Liberação de Medicamentos , Sulfato de Magnésio/administração & dosagem , Microinjeções , Agulhas , Pele/metabolismo , Administração Cutânea , Animais , Difusão , Microscopia Confocal , Absorção Cutânea , Suínos
16.
Eur J Clin Pharmacol ; 76(2): 175-184, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31814044

RESUMO

OBJECTIVES: In this study, changes in lactate clearance following magnesium supplementation were evaluated in critically ill patients with severe sepsis. METHODS: Fifty-eight patients with severe sepsis were randomly assigned to receive either magnesium (n = 30) or placebo (n = 28). Patients in the magnesium group received intravenous magnesium sulfate to maintain serum magnesium level around 3 mg/dL for 3 days. The placebo group received the same volume of normal saline. Change in lactate clearance was considered primary outcome of the study. RESULTS: Mean increase in the lactate clearance in the magnesium group was significantly higher than the placebo group on day 2 (27.53% vs. 23.79% respectively, p < 0.001) and day 3 (49.83% vs. 37.02% respectively, p < 0.001). Time to lactate clearance was also significantly shorter in the magnesium group than the placebo group (47.28 ± 20.59 vs. 61.20 ± 24.31 h respectively, p = 0.03). Sepsis-related mortality was not significantly different but median length of ICU stay was significantly shorter in the magnesium group than the placebo group (8 vs. 15 days respectively, p < 0.01). CONCLUSIONS: Magnesium supplementation increased lactate clearance in critically ill patients with severe sepsis. Optimizing serum magnesium level near the upper limit of the normal range may improve severe sepsis outcomes.


Assuntos
Ácido Láctico/metabolismo , Sulfato de Magnésio/administração & dosagem , Sepse/tratamento farmacológico , Administração Intravenosa , Adulto , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Sulfato de Magnésio/sangue , Sulfato de Magnésio/farmacologia , Masculino , Pessoa de Meia-Idade , Sepse/mortalidade , Sepse/fisiopatologia , Resultado do Tratamento
17.
J Matern Fetal Neonatal Med ; 33(2): 258-266, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29898629

RESUMO

Introduction: There is little information on the effect of maternal characteristics and on-admission laboratory parameters to the therapeutic serum magnesium sulfate (MgSO4) levels in women with preeclampsia (PE). We sought to identify factors that may predict timely attainment of therapeutic serum magnesium levels after intravenous administration for seizure prophylaxis.Materials and methods: On-admission factors of 360 women with PE who received intravenous MgSO4 (4-g loading and 2-g/h maintenance) for seizure prophylaxis were retrospectively reviewed. Parameters of those who attained therapeutic serum concentrations (4.8-8.4 mg/dL) within 2 h (Group A) and those who did not (Group B) were compared.Results: There was no seizure or magnesium toxicity in this cohort. Median (min-max) level of serum magnesium was 4.3 (2.5-8.4) mg/dL. Women in Group A (n = 105) had lower gestational age, body mass index (BMI), and platelets count, higher blood urea nitrogen (BUN), serum creatinine, uric acid, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, prothrombin, and partial thromboplastin times than those in Group B (n = 255) (p < .05). Women with mild PE were less likely to attain therapeutic serum magnesium levels compared with those with severe phenotypes (adjusted OR 23.57, 95% CI 8.20-67.76 versus adjusted OR 14.72, 95% CI 3.56-60.89, respectively; p < .05), which may be explained by their significantly lower serum BUN and uric acid (p < .05).Conclusions: On-admission factors, especially BMI and renal clearance indices, of women with PE may affect timely attainment of therapeutic serum magnesium levels. Validation of its clinical impact requires further study focusing on women with severe PE.


Assuntos
Sulfato de Magnésio/sangue , Pré-Eclâmpsia/sangue , Convulsões/prevenção & controle , Adulto , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Infusões Intravenosas/métodos , Sulfato de Magnésio/administração & dosagem , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
18.
J Matern Fetal Neonatal Med ; 33(6): 982-986, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30122071

RESUMO

Background: Preterm delivery <32-week gestation is associated with significant neurodevelopmental morbidity ranging from mild delay to profound disability. Several randomized trials have shown that magnesium sulfate (MgSO4) is an effective neuroprotectant, demonstrating reduced rates of cerebral palsy, death, and gross motor dysfunction for the neonate or infant. Dosing was not consistent among the major trials and the onus was placed on institutions by ACOG to develop and implement protocols with respect to MgSO4 as a neuroprotectant. A recent study demonstrated that MgSO4 exposure <12 h prior to delivery was associated with a decrease in CP compared to more remote exposure.Objective: To assess impact of dosing schedule on uptake of neuroprotective MgSO4 in patients delivering <32 weeks gestational age.Study design: A retrospective cohort study of all deliveries occurring <32 weeks' gestation at a single academic center between March-December 2014 and March-December 2015 was conducted. Institutional policy shifted in 2015 from MgSO4 bolus with continuous infusion based on the BEAM trial to a single bolus dose based on the PREMAG trial. Patients with preeclampsia, known fetal anomalies, and/or stillbirth were excluded from this analysis. Patients were identified through query of the Medical University of South Carolina Perinatal Information System (PINS) database with respect to whether or not they had received MgSO4 within 12 h of delivery. Chi-squared analysis was performed to compare the overall rate of MgSO4 exposure and MgSO4 exposure <12 h prior to delivery between groups. Fisher's exact test was used to evaluate maternal, obstetric, and neonatal variables among those receiving MgSO4 within 12 h of delivery in each cohort. Binary logistic regression analysis was performed to control for co-linear or potential confounding variables.Results: A total of 224 patients were identified, 115 delivered between March-December 2014 and 109 delivered between March-December 2015. With respect to MgSO4 exposure prior to delivery, 27 (23.5%) received MgSO4 in the 2014 cohort compared to 44 (40.4%) in the 2015 cohort (OR: 2.2, p < .01). Of those being exposed within 12 h of delivery, there were 16 (13.9%) maternal exposures in the 2014 cohort versus 28 (26.7%) in the 2015 cohort (OR: 2.15, p = .02). Of the 18 neonates delivered in 2014 there were four cases of grade III or IV intraventricular hemorrhage versus one case among the 36 neonates (2.7%) born in 2015 (0.04). This finding holds after controlling for race, preterm labor, gestational age, corticosteroid, birthweight, and indomethacin exposure.Conclusions: Dosing of neuroprotective MgSO4 according to PREMAG trial specifications was associated with a significantly greater percentage of patients having received neuroprotective magnesium at any point prior to delivery or within the 12 h prior to delivery when compared to dosing according to BEAM trial specifications.


Assuntos
Doenças do Prematuro/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Transtornos do Neurodesenvolvimento/prevenção & controle , Fármacos Neuroprotetores/administração & dosagem , Nascimento Prematuro/tratamento farmacológico , Cuidado Pré-Natal/métodos , Relação Dose-Resposta a Droga , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Sulfato de Magnésio/uso terapêutico , Masculino , Fármacos Neuroprotetores/uso terapêutico , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
19.
Aust N Z J Obstet Gynaecol ; 60(1): 44-48, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31119725

RESUMO

BACKGROUND: Clinical practice guidelines recommend the use of antenatal magnesium sulphate for fetal neuroprotection before preterm birth at <30 weeks' gestation. AIMS: This survey assessed the use of antenatal magnesium sulphate for fetal neuroprotection to determine if use has changed since the previous survey in 2012, and to evaluate enablers and barriers to use. MATERIALS AND METHODS: A questionnaire was sent to clinical leaders at 29 hospitals with a neonatal intensive care unit in Australia and New Zealand asking at what gestational ages magnesium sulphate was given, if use was audited and any enablers and barriers  to use. RESULTS: Responses were received for 24 (83%) hospitals. The use of magnesium sulphate for fetal neuroprotection was reported as 89% (IQR 80-90%), an increase from 80% (IQR 53-90%) from the earlier survey. The majority of health professionals were reported as using magnesium sulphate at <30 weeks' gestation. The top enablers for use of magnesium sulphate were availability of pamphlets, posters, case record stickers and PowerPoint presentations. The main reasons as to why eligible women did not receive magnesium sulphate were imminent birth, the hospital being short staffed and the patient declined. The use of antenatal magnesium sulphate has been or is being audited in 11 (46%) of the hospitals. CONCLUSIONS: Clinical leaders at institutions in Australia and New Zealand report that uptake in the use of magnesium sulphate for fetal neuroprotection has continued to increase since the earlier, bi-national survey in 2012. Barriers to the use of magnesium sulphate identified have institutional and consumer implications.


Assuntos
Paralisia Cerebral/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Nascimento Prematuro/tratamento farmacológico , Tocolíticos/administração & dosagem , Austrália , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Fármacos Neuroprotetores , Nova Zelândia , Gravidez , Inquéritos e Questionários
20.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 158-163, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31186268

RESUMO

OBJECTIVE: To examine the differences and trends of outcomes of preterm boys and girls born at <29 weeks' gestation. DESIGN: A retrospective cohort study. SETTING: Data collected by the Canadian Neonatal Network. PATIENTS: Neonates born at <29 weeks' gestation between January 2007 and December 2016. MAIN OUTCOME MEASURES: We examined rate differences in mortality, major morbidities (bronchopulmonary dysplasia, severe brain injury, retinopathy of prematurity, necrotising enterocolitis and late-onset sepsis) and care practices (antenatal steroids, magnesium sulfate, maternal antibiotics, ventilation and surfactant administration) between boys and girls and evaluated trends in these rate differences over the study period. Our primary outcome was a composite of mortality and any one of the five morbidities. RESULTS: Our study included 8219 boys and 6934 girls with median gestational age of 26 (IQR 25-28) weeks. The composite of death or major morbidity was more common in boys (adjusted risk ratio 1.07, 95% CI 1.05 to 1.10) and remained higher in boys over the study period. The gap between boys and girls for mortality, however, decreased over time: the slope for boys was -0.043 (95% CI -0.071 to -0.015) and for girls was -0.012 (95% CI -0.045 to 0.020) (p=0.04). All other morbidities remained higher in boys. Care practices changed at similar rates between the sexes. CONCLUSION: The difference between the mortality rates for boys and girls decreased over the study period but the difference between rates of the major morbidities was unchanged. More research is needed to understand biological differences and outcome disparities.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Corticosteroides/administração & dosagem , Antibacterianos/administração & dosagem , Índice de Apgar , Peso ao Nascer , Canadá , Comorbidade , Feminino , Nível de Saúde , Humanos , Recém-Nascido , Doenças do Prematuro/mortalidade , Sulfato de Magnésio/administração & dosagem , Masculino , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais
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