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1.
Medicine (Baltimore) ; 100(15): e25551, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847683

RESUMO

BACKGROUND: The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). METHODS: In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. RESULTS: Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ±â€Š33.7 vs 93.4 ±â€Š30.9, P = .016; 114.3 ±â€Š34.3 vs 94.7 ±â€Š33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ±â€Š10.5 vs 13.5 ±â€Š5.0, P = .003; 20.2 ±â€Š7.4 vs 15.2 ±â€Š5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ±â€Š30.9 vs 112.1 ±â€Š31.9, P = .739), cTFC (19.4 ±â€Š7.2 vs 19.3 ±â€Š7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. CONCLUSIONS: The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.


Assuntos
Alprostadil/administração & dosagem , Cardiotônicos/administração & dosagem , Infarto do Miocárdio/terapia , Nicorandil/administração & dosagem , Nitroglicerina/administração & dosagem , Vasodilatadores/administração & dosagem , Idoso , Vias de Administração de Medicamentos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Coração/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Perfusão , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
2.
J Med Internet Res ; 23(1): e21212, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33393910

RESUMO

BACKGROUND: The complex unfolding of the US opioid epidemic in the last 20 years has been the subject of a large body of medical and pharmacological research, and it has sparked a multidisciplinary discussion on how to implement interventions and policies to effectively control its impact on public health. OBJECTIVE: This study leverages Reddit, a social media platform, as the primary data source to investigate the opioid crisis. We aimed to find a large cohort of Reddit users interested in discussing the use of opioids, trace the temporal evolution of their interest, and extensively characterize patterns of the nonmedical consumption of opioids, with a focus on routes of administration and drug tampering. METHODS: We used a semiautomatic information retrieval algorithm to identify subreddits discussing nonmedical opioid consumption and developed a methodology based on word embedding to find alternative colloquial and nonmedical terms referring to opioid substances, routes of administration, and drug-tampering methods. We modeled the preferences of adoption of substances and routes of administration, estimating their prevalence and temporal unfolding. Ultimately, through the evaluation of odds ratios based on co-mentions, we measured the strength of association between opioid substances, routes of administration, and drug tampering. RESULTS: We identified 32 subreddits discussing nonmedical opioid usage from 2014 to 2018 and observed the evolution of interest among over 86,000 Reddit users potentially involved in firsthand opioid usage. We learned the language model of opioid consumption and provided alternative vocabularies for opioid substances, routes of administration, and drug tampering. A data-driven taxonomy of nonmedical routes of administration was proposed. We modeled the temporal evolution of interest in opioid consumption by ranking the popularity of the adoption of opioid substances and routes of administration, observing relevant trends, such as the surge in synthetic opioids like fentanyl and an increasing interest in rectal administration. In addition, we measured the strength of association between drug tampering, routes of administration, and substance consumption, finding evidence of understudied abusive behaviors, like chewing fentanyl patches and dissolving buprenorphine sublingually. CONCLUSIONS: This work investigated some important consumption-related aspects of the opioid epidemic using Reddit data. We believe that our approach may provide a novel perspective for a more comprehensive understanding of nonmedical abuse of opioids substances and inform the prevention, treatment, and control of the public health effects.


Assuntos
Analgésicos Opioides/uso terapêutico , Mineração de Dados/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Mídias Sociais/normas , Analgésicos Opioides/farmacologia , Vias de Administração de Medicamentos , Humanos
3.
ACS Appl Mater Interfaces ; 13(3): 3722-3737, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33439616

RESUMO

Pulmonary delivery of small interfering RNA (siRNA)-based drugs is promising in treating severe lung disorders characterized by the upregulated expression of disease-causing genes. Previous studies have shown that the sustained siRNA release in vitro can be achieved from polymeric matrix nanoparticles based on poly(lactide-co-glycolide) (PLGA) loaded with lipoplexes (LPXs) composed of cationic lipid and anionic siRNA (lipid-polymer hybrid nanoparticles, LPNs). Yet, the in vivo efficacy, potential for prolonging the pharmacological effect, disposition, and safety of LPNs after pulmonary administration have not been investigated. In this study, siRNA against enhanced green fluorescent protein (EGFP-siRNA) was either assembled with 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP) to form LPX or co-entrapped with DOTAP in PLGA nanoparticles to form LPNs. The disposition and clearance of LPXs and LPNs in mouse lungs were studied after intratracheal administration by using single-photon emission computed tomography/computed tomography (SPECT/CT) and gamma counting. Fluorescence spectroscopy, Western blot, and confocal laser scanning microscopy were used to evaluate the silencing of the EGFP expression mediated by the LPXs and LPNs after intratracheal administration to transgenic mice expressing the EGFP gene. The in vivo biocompatibility of LPXs and LPNs was investigated by measuring the cytokine level, total cell counts in bronchoalveolar lavage fluid, and observing the lung tissue histology section. The results showed that the silencing of the EGFP expression mediated by LPNs after pulmonary administration was both prolonged and enhanced as compared to LPXs. This may be attributed to the sustained release characteristics of PLGA, and the prolonged retention in the lung tissue of the colloidally more stable LPNs in comparison to LPXs, as indicated by SPECT/CT. The presence of PLGA effectively alleviated the acute inflammatory effect of cationic lipids to the lungs. This study suggests that PLGA-based LPNs may present an effective formulation strategy to mediate sustained gene silencing effects in the lung via pulmonary administration.


Assuntos
Pulmão/metabolismo , Nanopartículas/química , Poliglactina 910/química , Interferência de RNA , RNA Interferente Pequeno/administração & dosagem , Células A549 , Animais , Vias de Administração de Medicamentos , Proteínas de Fluorescência Verde/genética , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , RNA Interferente Pequeno/genética
4.
Methods Mol Biol ; 2223: 1-17, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33226583

RESUMO

Mouse models of allergic disease offer numerous advantages when compared to the models of other animals. However, selection of appropriate mouse models is critical to advance the field of food allergy by revealing mechanisms of allergy and for testing novel therapeutic approaches. All current mouse models for food allergy have weaknesses that may limit their applicability to human disease. Aspects such as the genetic predisposition to allergy or tolerance from the strain of mouse used, allergen dose, route of exposure (oral, intranasal, intraperitoneal, or epicutaneous), damage of the epithelial barrier, use of adjuvants, food matrix effects, or composition of the microbiota should be considered prior to the selection of a specific murine model and contemplated according to the intended purpose of the study. This chapter reviews our current knowledge on the application of mouse models to food allergy research and the variables that may influence the successful development of each type of model.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Alérgenos/administração & dosagem , Modelos Animais de Doenças , Hipersensibilidade Alimentar/imunologia , Regulação da Expressão Gênica/imunologia , Alérgenos/química , Animais , Toxinas Bacterianas/administração & dosagem , Misturas Complexas/administração & dosagem , Misturas Complexas/química , Vias de Administração de Medicamentos , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/genética , Hipersensibilidade Alimentar/patologia , Fatores de Troca do Nucleotídeo Guanina/genética , Fatores de Troca do Nucleotídeo Guanina/imunologia , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C3H , Camundongos Knockout , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/imunologia , Especificidade da Espécie , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/imunologia
5.
Am J Hematol ; 96(3): 330-337, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33326116

RESUMO

Induction therapy for multiple myeloma with bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (d) (VRd) was traditionally administered as bortezomib given twice weekly on a 3 week cycle. A modified schedule of weekly bortezomib has been adopted over time to decrease treatment burden for patients and reduce treatment-emergent neuropathy. This study evaluates the response rates and outcomes with different schedules of bortezomib in VRd administered for first-line treatment for patients with newly diagnosed MM (NDMM). We retrospectively analyzed patients treated with upfront VRd from June 30th 2008 to December 31st 2018, for variations of bortezomib administration. Five hundred and fifty-five (555) NDMM patients met inclusion criteria; median age 63 years and 61% men. Bortezomib was administered twice weekly every 21 days in 43%, once weekly every 21 days in 41% and once weekly every 28 days in 16%. Though peripheral sensory neuropathy was more frequent with twice weekly dosing (P = .002), this group achieved shorter time to best response (P = .01). Weekly every 21-day treatment saw higher VGPR or better rates (P = .02). However, with median follow up time of 37 months (IQR 22-56), we found no difference in PFS or OS among the groups. While small differences in response rates were found among the varying administration schedules of bortezomib administration, there was no significant effect on PFS or OS. Given that VRd remains a first line standard of care option for newly diagnosed MM, in the absence of a large trial comparing bortezomib dosing schedule modifications, these results are helpful in supporting current practices of once weekly administration.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bortezomib/administração & dosagem , Dexametasona/administração & dosagem , Vias de Administração de Medicamentos , Esquema de Medicação , Feminino , Humanos , Hibridização in Situ Fluorescente , Estimativa de Kaplan-Meier , Lenalidomida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/mortalidade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto Jovem
6.
Methods Mol Biol ; 2248: 167-183, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33185875

RESUMO

Genetic deficiency of ectodysplasin A (EDA) causes X-linked hypohidrotic ectodermal dysplasia, a congenital condition characterized by the absence or abnormal formation of sweat glands, teeth, and several skin appendages. Stimulation of the EDA receptor (EDAR) with agonists in the form of recombinant EDA or anti-EDAR antibodies can compensate for the absence of Eda in a mouse model of Eda deficiency, provided that agonists are administered in a timely manner during fetal development. Here we provide detailed protocols for the administration of EDAR agonists or antagonists, or other proteins, by the intravenous, intraperitoneal, and intra-amniotic routes as well as protocols to collect blood, to visualize sweat gland function, and to prepare skulls in mice.


Assuntos
Receptor Edar/metabolismo , Transdução de Sinais/efeitos dos fármacos , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Vias de Administração de Medicamentos , Displasia Ectodérmica/tratamento farmacológico , Displasia Ectodérmica/genética , Displasia Ectodérmica/metabolismo , Receptor Edar/genética , Camundongos , Fenótipo , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento
7.
Yakugaku Zasshi ; 140(11): 1373-1380, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33132273

RESUMO

The treatment of acute ischemic stroke usually involves argatroban administration by continuous infusion for 2 d and by intravenous infusion twice a day for 5 d after that. However, the appropriate dose of argatroban to be administered is not clear. Therefore, no studies have been reported a comparison of intravenous and continuous argatroban infusion after day 3 for acute ischemic stroke patients. We aimed to identify the connection between differences in argatroban administration and worsening of symptoms after day 3 in ischemic stroke patients. We retrospectively evaluated the data of 107 ischemic stroke patients who received treatment with argatroban. The study endpoint was defined as the worsening of symptoms from days 3 to 7. Logistic regression analysis was used to determine the risk factors that were significantly associated with worsening of symptoms. Patients were administered argatroban, with rates of 72.0%, and 28.0% for continuous, and intravenous infusion, respectively. A total of 10 (9.3%) patients experienced worsening of symptoms. In the single logistic regression analysis, carotid stenosis [non-adjusted odds ratio (OR) 5.775, 95% confidence interval (CI) 1.486-22.442, p=0.011] was only significantly associated with worsening of symptoms. Worsening of symptoms was not related to either intravenous or continuous infusion group (16.7% vs. 6.5%, p=0.104). Bleeding was also not associated with either group (6.7% vs. 3.9%, p=0.618). We suggest that the differences in the mode of argatroban administration were not related to the worsening of symptoms in ischemic stroke patients. We also found that safety was equivalent regardless of the administration route.


Assuntos
Administração Intravenosa/métodos , Ácidos Pipecólicos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Exacerbação dos Sintomas , Idoso , Idoso de 80 Anos ou mais , Arginina/análogos & derivados , Vias de Administração de Medicamentos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Ácidos Pipecólicos/efeitos adversos , Estudos Retrospectivos , Segurança , Sulfonamidas
8.
Notas enferm. (Córdoba) ; 20(36): 57-69, nov.2020.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, BINACIS, UNISALUD | ID: biblio-1140730

RESUMO

El profesional de enfermería cumple un papel relevante en el procedimiento de administración de medicamentos y la seguridad del paciente, en el mantenimiento de la calidad en salud en las instituciones mitigando el margen de error y protegiendo al máximo la integridad del paciente. Por ello en su formación se deben usar metodologías para fortalecer el proceso de enseñanza-aprendizaje, en concordancia debe cambiar sus métodos constantemente en búsqueda de mejorar y ofrecer nuevas herramientas para contar con profesionales competentes que cumplan con los retos laborales e intelectuales. El objetivo: evaluar el impacto del uso de una aplicación tecnológica que fomente el aprendizaje autodidacta, afianzando conocimientos adquiridos en el aula de clase y que a futuro permita consulta rápida durante el desarrollo de la profesión, además el aporte al desarrollo de habilidades de estudio autodidacta y formación continua en todo el personal de enfermería durante su formación y graduación. Metodología: enfoque mixto-descriptivo; se inicio: con una primera fase para la identificación de errores más comunes en la administración de medicamentos, una segunda fase para la construcción de una aplicación tecnológica para que el estudiante de enfermería la utilizara en clase de cuidado al adulto con enfasis en paciente en estado agudo, previa aplicación de pretest de conocimientos, una tercera fase: aplicación de postest para conocer el impacto de la aplicación en su aprendizaje. Resultados: fueron satisfactorios pues en términos generales la aplicación tuvo aceptación y se mostró un avance significativo en sus conocimientos con énfasis en el cálculo de dosis de medicamentos como vasopresores y vasodilatadores. Conclusión: el impacto de la herramienta virtual es positivo en el grupo de estudiantes de la asignatura de quinto semestre, además la investigación promueve la inclusión de la tecnología en el proceso enseñanza-aprendizaje de asignaturas de enfermería y fortalece el estudio autónomo y así las competencias del saber para permitir brindar cuidados adecuados y prácticas seguras al paciente quien es el pilar de la profesión[AU]


The nursing professional plays a relevant role in the drug administration procedure and patient safety, in maintaining quality in health in institutions, mitigating the margin of error and protecting the integrity of the patient as much as possible. For this reason, in their training, they must use methodologies to strengthen the teaching-learning process, according to which they must change their methods constantly in search of improvement and offer new tools to have competent professionals who meet work and intellectual challenges. The objective: to implement a technological application that encourages self-taught learning, consolidating knowledge acquired in the classroom and that in the future allows quick consultation during the development of the profession, in addition to contributing to the development of self-taught study skills and continuous training throughout the nursing staff during their training and graduation. Methodology: mixed-descriptive approach; Where it started: with a first phase for the identification of the most common errors in the administration of medications, a second phase for the construction of a technological application for the nursing student to use in the adult care class with emphasis on patient in acute state, prior application of knowledge pretest, a third phase: posttest application to know the impact of the application on their learning. Results were satisfactory because in general terms the application was accepted and a significant advance was shown in its knowledge with emphasis on the calculation of doses of drugs such as vasopressors and vasodilators. Conclusion, the impact of the virtual tool is positive in the student group of the Fifth semester subject, the research also promotes the inclusion of technology in the teaching - learning process of nursing subjects and strengthens the autonomous study and thus allows to provide adequate care and safe practices to the patient who is the pillar of the profession[AU]


O profissional de enfermagem desempenha papel relevante no procedimento de administração de medicamentos e na segurança do paciente, na manutenção da qualidade da saúde nas instituições, amenizando a margem de erro e protegendo ao máximo a integridade do paciente. Por isso, em sua formação, devem utilizar metodologias que fortaleçam o processo de ensino- aprendizagem, segundo as quais devem mudar seus métodos constantemente em busca de aprimoramento e oferecer novas ferramentas para ter profissionais competentes que atendam aos desafios do trabalho e intelectuais. Objetivo: implementar uma aplicação tecnológica que incentive a aprendizagem autodidata, consolidando os conhecimentos adquiridos em sala de aula e que no futuro permita uma consulta rápida durante o desenvolvimento da profissão, além de contribuir para o desenvolvimento de competências de estudo autodidata e formação contínua ao longo do equipe de enfermagem durante sua formação e graduação. Metodologia: abordagem descritiva mista; Onde começou: com uma primeira fase para identificação dos erros mais comuns na administração de medicamentos, uma segunda fase para a construção de uma aplicação tecnológica para o aluno de enfermagem utilizar na aula de adulto com ênfase no paciente em estado agudo, aplicação prévia do pré-teste de conhecimentos, uma terceira fase: aplicação do pós-teste para saber o impacto da aplicação na sua aprendizagem. Os resultados foram satisfatórios, pois em termos gerais o pedido foi aceito e mostrou-se um avanço significativo no seu conhecimento com ênfase no cálculo de doses de fármacos como vasopressores e vasodilatadores Conclusão, o impacto da ferramenta virtual é positivo no grupo de alunos do Disciplina do quinto semestre, a pesquisa também promove a inclusão da tecnologia no processo ensino-aprendizagem das disciplinas de enfermagem e fortalece o estudo autônomo e, assim, permite prestar cuidados adequados e práticas seguras ao paciente que é o pilar da profissão[AU]


Assuntos
Humanos , Estudantes de Enfermagem , Vias de Administração de Medicamentos , Competência Clínica , Educação em Enfermagem , Segurança do Paciente , Aplicativos Móveis , Aprendizagem , Autonomia Profissional , Dosagem
10.
Rev Med Suisse ; 16(707): 1751-1755, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969612

RESUMO

Acute treatment of agitation in psychiatry is one of the urgent situations for which management recommendations are needed. Various existing international recommendations have been evaluated and adapted to our clinical practice and to the drugs available in Switzerland in order to propose a uniform management strategy in our hospital. This strategy includes a treatment choice algorithm with different options depending on the clinical situation and the possible route of administration. Dose recommendations for the oral and intramuscular routes, certain pharmacokinetic parameters, as well as risks of interactions and important warnings are also included in this clinical recommendation.


Assuntos
Algoritmos , Tomada de Decisão Clínica , Psiquiatria/métodos , Tranquilizantes/administração & dosagem , Tranquilizantes/uso terapêutico , Teoria da Decisão , Vias de Administração de Medicamentos , Humanos , Suíça , Tranquilizantes/farmacocinética
11.
Obstet Gynecol ; 136(4): 675-684, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925623

RESUMO

OBJECTIVE: To identify factors associated with serum estradiol (E2) levels among healthy postmenopausal women using hormone therapy (HT). METHODS: This is an unplanned post hoc analysis of data from ELITE (Early versus Late Intervention Trial with Estradiol), a randomized controlled trial of 1 mg oral E2 with or without vaginal progesterone in healthy early compared with late (<6 years compared with 10 or more years since menopause) postmenopausal women. We included results from visits when women reported at least 80% compliance with HT. Mixed-effects linear models identified factors associated with serum E2 levels while participants were taking HT, assessed every 6 months over a median follow-up of 4.8 years and adjusted for baseline E2 level, visit, and reduced E2 dose. Possible correlates evaluated included demographics, clinical characteristics, medication use, and biomarkers of liver and kidney metabolic function. RESULTS: The analysis included 2,160 E2 measurements in 275 postmenopausal women. Mean±SD age was 55.4±3.9 vs 64.4±5.5 years, and mean±SD time since menopause was 3.6±1.8 vs 16.0±5.6 years for early vs late postmenopausal women. Adjusted for pretreatment E2 level, visit, and reduced dose indicator, higher serum E2 levels were associated with higher body mass index (BMI), higher weight, surgical menopause, alcohol use, and antihypertensive medication use. Current and past smoking and antifungal medication use were associated with lower serum E2 levels. In the multivariable model, higher BMI and alcohol use were associated with higher serum E2 levels, whereas current and past smoking were associated with lower serum E2 levels. These factors were similar between early and late postmenopausal women. CONCLUSION: Factors associated with serum E2 levels among postmenopausal women taking HT include BMI, alcohol use, and smoking. As serum E2 levels relate to HT effect, achievement of desirable E2 levels may be maximized through personalized intervention. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00114517.


Assuntos
Estradiol/sangue , Terapia de Reposição de Estrogênios/métodos , Estrogênios/administração & dosagem , Pós-Menopausa , Progesterona/administração & dosagem , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Causalidade , Vias de Administração de Medicamentos , Monitoramento de Medicamentos/métodos , Feminino , Hormônios/administração & dosagem , Humanos , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Pessoa de Meia-Idade , Pós-Menopausa/sangue , Pós-Menopausa/efeitos dos fármacos , Fumar/epidemiologia
13.
Respir Med ; 170: 106045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32843175

RESUMO

The potential detrimental effects of steroids on the immune system to fight viral infections had always been a concern for patients on long term steroids in chronic conditions. A recent warning from WHO on systemic corticosteroid use amid COVID-19 raised suspicion among public and healthcare professionals regarding the safety of steroid use during the SARS-CoV-2 pandemic. The corticosteroids (inhaled and oral) are commonly prescribed in the management of asthma and COPD patients and any unsolicited changes in medications use may lead to potentially severe exacerbations and may risk patient lives. This article provides a critical review of clinical evidence and offers a detailed discussion on the safety and efficacy of corticosteroids in asthma and COPD patients, both with and without COVID-19.


Assuntos
Asma/tratamento farmacológico , Infecções por Coronavirus , Glucocorticoides/farmacologia , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Asma/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Vias de Administração de Medicamentos , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Resultado do Tratamento
17.
J Cancer Res Ther ; 16(3): 534-538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719263

RESUMO

Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB.


Assuntos
Bupivacaína/administração & dosagem , Dor do Câncer/terapia , Nervo Glossofaríngeo/efeitos dos fármacos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Neoplasias da Língua/terapia , Triancinolona Acetonida/administração & dosagem , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Dor do Câncer/etiologia , Dor do Câncer/patologia , Vias de Administração de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Neoplasias da Língua/patologia , Adulto Jovem
18.
Hosp Pract (1995) ; 48(4): 196-205, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720816

RESUMO

OBJECTIVE: This study examined anticoagulant use during and after a hospital encounter for venous thromboembolism (VTE), a transition of care largely uncharacterized in the literature. METHODS: Adults with a VTE diagnosis code during a hospital encounter (emergency department [ED], observation area [OBS], or inpatient hospital [IP]) from January 2012 to August 2017 were identified in an electronic health records database. The first such hospital encounter was defined as the index VTE encounter. Patients were linked to a claims database and required to be continuously enrolled for six months before the index admission date through six months after the index discharge date. Anticoagulants administered during the index VTE encounter and filled on or within 30 days of discharge were summarized descriptively overall, and by the type of index VTE encounter (IP, No IP) and anticoagulants administered during the index VTE encounter. RESULTS: Among 2,968 eligible patients, mean (SD) age was 64 (16) years, 51% were female, 67% had an IP index VTE encounter, and 77% received anticoagulation therapy during the index VTE encounter. In total, 60% filled a prescription order for anticoagulant within 30 days post-discharge. Of those who received a direct oral anticoagulant (DOAC), warfarin, or parenteral anticoagulant only during the index VTE encounter, 74%, 69%, and 34%, respectively, filled a prescription for the same anticoagulant post-discharge. Patients treated with a DOAC or warfarin during an ED or OBS VTE encounter without a subsequent inpatient hospitalization were more likely to remain on the same anticoagulation therapy post-discharge than those with an inpatient hospitalization (81% vs 69% for DOAC and 75% vs 68% for warfarin). CONCLUSIONS: Many patients treated with anticoagulation therapy during a VTE hospital encounter did not fill a prescription for an anticoagulant within 30 days post-discharge, highlighting an opportunity for improved management of care transitions in this patient population.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/classificação , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Tromboembolia Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Vias de Administração de Medicamentos , Feminino , Fidelidade a Diretrizes , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
20.
BMJ Support Palliat Care ; 10(3): 343-349, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32546559

RESUMO

BACKGROUND: Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic. AIMS AND OBJECTIVES: To investigate UK and Ireland clinicians' experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change. METHODS: Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling. RESULTS: Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made. CONCLUSIONS: The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.


Assuntos
Cuidadores , Vias de Administração de Medicamentos , Cuidados Paliativos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Assistência Terminal/métodos , Administração Bucal , Administração Sublingual , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fentanila/administração & dosagem , Clínicos Gerais , Cuidados Paliativos na Terminalidade da Vida/métodos , Hospitais para Doentes Terminais , Humanos , Hipnóticos e Sedativos/administração & dosagem , Irlanda/epidemiologia , Lorazepam/administração & dosagem , Metotrimeprazina/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Enfermeiras Especialistas , Medicina Paliativa , Pandemias , Médicos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Telemedicina/métodos , Adesivo Transdérmico , Reino Unido/epidemiologia
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