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Drugs in Context 2021Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children... (Review)
Review
BACKGROUND
Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic 'symptom flare-ups' or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used.
METHODS
We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines.
DISCUSSION
Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning.
CONCLUSIONS
AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.
PubMed: 34113386
DOI: 10.7573/dic.2020-12-7 -
Journal of Nuclear Cardiology :... Oct 2021As the coronavirus pandemic progresses, patients that have recovered from COVID-19-related hospitalization require resumption of care for other medical issues. Thus far,...
BACKGROUND
As the coronavirus pandemic progresses, patients that have recovered from COVID-19-related hospitalization require resumption of care for other medical issues. Thus far, the literature has not detailed the experience of stress testing in this patient population.
METHODS
We retrospectively reviewed patients that recovered from COVID-19-related hospitalizations and underwent SPECT MPI studies at the University of Alabama at Birmingham Medical Center.
RESULTS
15 patients (median age 60 years, 67% male) were identified with COVID-19-related hospitalization and then underwent SPECT MPI imaging after recovery. During COVID-19-related hospitalization (median length of stay 8 days), patients received various COVID-19 therapies; 3 required mechanical ventilation. Stress tests (4 Exercise, 11 Pharmacologic) were performed 65 days (interquartile range 31-94 days) after the diagnosis of COVID-19. None of the patients experienced serious adverse events during or after stress testing. One patient required regadenoson reversal using aminophylline due to chest pain.
CONCLUSION
Over time, more patients that recover from COVID-19 infection will require MPI testing for myocardial ischemia evaluation. Our study provides some information regarding performing stress testing in patients who have recently recovered from COVID-19 infections requiring hospitalization. Further studies are recommended to establish formal protocols for testing in this cohort.
Topics: COVID-19; Exercise Test; Female; Hospitalization; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Respiration, Artificial; Retrospective Studies; Time Factors; Tomography, Emission-Computed, Single-Photon
PubMed: 33904148
DOI: 10.1007/s12350-021-02606-w -
BMC Anesthesiology Apr 2021This study compared the effects of premedication with different doses of aminophylline on the recovery profile after general anaesthesia. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
This study compared the effects of premedication with different doses of aminophylline on the recovery profile after general anaesthesia.
METHODS
Forty-five patients scheduled for pelvic-abdominal surgeries were divided into 3 groups: Group C: the patients received 100 ml of IV normal saline, Group A1: the patients received 2 mg/kg IV aminophylline, and Group A2: the patients received 4 mg/kg IV aminophylline 30 min before induction of general anaesthesia. The following data were recorded: demographic data, ASA physical status, duration of anaesthesia and surgery, heart rate, mean arterial blood pressure, propofol dose, fentanyl dose, times to reach BIS (48 ± 2) after induction of anaesthesia and to reach a value of 80 after discontinuation of sevoflurane anaesthesia, time to recovery of consciousness and to tracheal extubation and to discharge from the post-anaesthesia care unit, and side effects of aminophylline.
RESULTS
The time to reach a BIS of 48 ± 2 was significantly lower for the control group than group A2 (70.67 ± 22.50 and 106.67 ± 34.77 s for groups C and A2, respectively, p -value =0.01). The time to reach a BIS of 80 was significantly longer for the control group than group A1 andA2 (5.6 ± 1.40,3.5 ± 1.93and 2.53 ± 1.72 min for groups C,A1 and A2, respectively, p -value < 0.01). The time to ROC was significantly longer for the control group than groups A1 and A2 (8.93 ± 0.92, 5.6 ± 2.47 and 4.53 ± 3.33 min for groups C, A1 and A2, respectively; p -value < 0.01). The extubation time was significantly longer for the control group than groups A1 and A2 (12.4 ± 1.08, 7.87 ± 3.27 and 6.6 ± 2.47 min for groups C, A1 and A2, respectively; p -value < 0.01).
CONCLUSION
Premedication with aminophylline enhanced the recovery profile after pelvic-abdominal surgeries under general anaesthesia without cardiovascular complications.
CLINICAL TRIAL REGISTRATION
Name of the registry: [email protected] Trial registration number: ClinicalTrials.gov Identifier: NCT04151381. Date of registration, November 5, 2019, 'Retrospectively registered'.
Topics: Abdomen; Adult; Airway Extubation; Aminophylline; Anesthesia Recovery Period; Anesthesia, General; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Pelvis; Phosphodiesterase Inhibitors; Premedication; Young Adult
PubMed: 33874898
DOI: 10.1186/s12871-021-01340-7 -
Medicine Apr 2021Cis-atracurium as an intermediate-acting non-depolarizing neuromuscular blocker is widely used clinically with less causing cyclic fluctuations and less histamine...
RATIONALE
Cis-atracurium as an intermediate-acting non-depolarizing neuromuscular blocker is widely used clinically with less causing cyclic fluctuations and less histamine release. As the use rate increases, allergic reactions and anaphylactoid reactions caused by cis-atracurium increase.
PATIENT CONCERNS
A 23-year-old woman underwent laparoscopic bariatric surgery. Airway spasm occurred after anesthesia induction and the operation was suspended. After adjustment, the anesthesia was performed with the same anesthetic scheme again. After induction, skin flushing and airway resistance increased, then the symptoms were relieved. When the cis-atracurium was given again, the symptoms of airway spasm reappeared immediately, and after communicating with the family, the operation was successfully completed with rocuronium.
DIAGNOSES
Serious bronchospasm induced by cisatracurium besylate.
INTERVENTIONS
The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and aminophylline 250 mg, methylprednisolone 80 mg were given intravenously.
OUTCOMES
There was no any obvious discomfort in the patient's self-report during the next day's visit. The patient was discharged 7 days later. No abnormalities were observed during following 4 weeks.
LESSONS
Although the anaphylactoid reactions caused by cis-atracurium are rare, the bronchospasm and anaphylactic shock caused by it greatly increase the risk of anesthesia, which should be taken seriously by clinicians. Increased vigilance in diagnosis, and treatment are essential to prevent aggravation and further complication.
Topics: Anaphylaxis; Anesthesia, General; Atracurium; Bariatric Surgery; Bronchial Spasm; Female; Humans; Laparoscopy; Neuromuscular Blocking Agents; Young Adult
PubMed: 33847670
DOI: 10.1097/MD.0000000000025516 -
Asia Pacific Journal of Clinical... 2021To investigate the efficacy of beclomethasone and aminophylline combined with enteral nutrition in the treatment of elderly patients with chronic obstructive pulmonary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
To investigate the efficacy of beclomethasone and aminophylline combined with enteral nutrition in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and the associated effects of these drugs on patient nutritional status and immune function.
METHODS AND STUDY DESIGN
In total, 115 elderly patients with COPD were included and were randomized into an enteral nutrition (EN) group and a control (CON) group. Aminophylline, in combination with beclomethasone, was administered to the CON group, whereas aminophylline and beclomethasone in combination with EN was administered to the EN group.
RESULTS
Patients in the EN group showed significant improvement in partial pressure of carbon dioxide, forced expiratory volume in 1 sec/ expiratory forced vital capacity, and partial pressure of oxygen than those in the CON group. The levels of IgM, IgG, and IgA as well as the number of CD4+/CD8+ and CD4+/CD3+ T cells were higher in the EN group than those in the CON group (p<0.05); the EN group also exhibited higher levels of inflammatory cytokines, such as tumor necrosis factor-α and interleukin (IL)-1β (p<0.05), and lower levels of IL-6 than the CON group. In addition, patients in the EN group showed a significant increase in serum total protein, albumin, and transferrin levels than those in the CON group (p<0.05).
CONCLUSIONS
Elderly patients with COPD showed a marked response to a regimen of beclomethasone, aminophylline, and EN, which significantly improved their immune function and nutritional status.
Topics: Aged; Aminophylline; Beclomethasone; Enteral Nutrition; Humans; Immunity; Nutritional Status; Pulmonary Disease, Chronic Obstructive
PubMed: 33787041
DOI: 10.6133/apjcn.202103_30(1).0008 -
Journal of Analytical Methods in... 2021A simple, fast, and validated HPLC method was developed for the simultaneous quantization of five cardiovascular agents: dopamine (DPM), dobutamine (DBM), phentolamine...
A Fast and Validated HPLC Method for Simultaneous Determination of Dopamine, Dobutamine, Phentolamine, Furosemide, and Aminophylline in Infusion Samples and Injection Formulations.
A simple, fast, and validated HPLC method was developed for the simultaneous quantization of five cardiovascular agents: dopamine (DPM), dobutamine (DBM), phentolamine (PTM), furosemide (FSM), and aminophylline (APL) either in infusion samples or in an injection dosage form. The proposed method was achieved with a 150 mm × 4.6 mm, 5.0 m C column, by using a simple linear gradient. Mobile phase A was buffer (50 mM KHPO) and mobile Phase B was acetonitrile at a flow rate of 1.0 mL/min. The column temperature was kept at 30°C, and the injection volume was 20 L. All analytes were separated simultaneously at a retention time (tr) of 3.93, 5.84, 7.06, 8.76, and 9.67 min for DPM, DBM, PTM, FSM, and APL, respectively, with a total run time of less than 15.0 min. The proposed method was validated according to ICH guidelines with respect to accuracy, precision, linearity, limit of detection, limit of quantitation, and robustness. Linearity was obtained over a concentration range of 12.0-240.0, 12.0-240.0, 20.0-200.0, 6.0-240.0, and 10.0-200.0 g/mL DPM, DBM, PTM, FSM, and APL, respectively. Interday and intraday accuracy and precision data were recorded in the acceptable limits. The new method has successfully been applied for quantification of all five drugs in their injection dosage form, infusion samples, and for evaluation of the stability of investigated drugs in mixtures for endovenous use. The results of the stability study showed that mixtures of DPM, DBM, PTM, FSM, and APL in 5% glucose or 0.9% sodium chloride injection were stable for 48 hours when stored in polypropylene syringes at 25°C.
PubMed: 33728093
DOI: 10.1155/2021/8821126 -
Breathe (Sheffield, England) Dec 2020https://bit.ly/3o7IJV1.
https://bit.ly/3o7IJV1.
PubMed: 33664832
DOI: 10.1183/20734735.0081-2020 -
Journal of Traditional Chinese Medicine... Dec 2020To investigate the efficacy of Yiqigubiao pill (YQGB) on chronic obstructive pulmonary disease (COPD) in rats with the COPD induced by lipopolysaccharide (LPS) and...
OBJECTIVE
To investigate the efficacy of Yiqigubiao pill (YQGB) on chronic obstructive pulmonary disease (COPD) in rats with the COPD induced by lipopolysaccharide (LPS) and cigarette- smoke fumigation.
METHODS
In this study, six groups of rats were set up, including control group, model group, positive control group (aminophylline) and YQGB (high, medium and low doses) groups. Tracheal injection of lipopolysaccharide (LPS) and cigarette-smoke fumigation induced COPD in rats. The general condition, incubation period and coughing times, lung function, level of inflammatory factors, leukocyte condition and pathological changes of bronchus and lung tissue were observed in rats of each group.
RESULTS
In the COPD rats, the latent period of coughing was shortened and the cough frequency was increased significantly; the pulmonary function was significantly decreased, which was manifested by the increased lung tissue resistance and respiratory system resistance, and the decreasing percentage of forced expiratory volume and forced expiratory volume in the 0.3 s (FEV0.3/FVC); the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-4 in serum were obviously increased, and the NEUT% in bronchoalveolar lavage fluid was significantly increase. YQGB could obviously prolong the latent period of cough, and reduce the cough frequency and the content of TNF-α in serum. YQGB can also significantly reduce respiratory resistance and increase FEV0.3/FVC value. The results of histopathology showed that YQGB significantly reduced the pathological changes of tracheal mucosa and lung caused by COPD. YQGB obviously increased level of AQP1, which was down-regulated in the COPD rats.
CONCLUSION
YQGB could significantly improve the pulmonary function, reduce inflammation and alleviate lung and bronchial diseases in the COPD rats.
Topics: Animals; Cigarette Smoking; Drugs, Chinese Herbal; Humans; Interleukin-4; Lipopolysaccharides; Lung; Male; Pulmonary Disease, Chronic Obstructive; Rats; Rats, Sprague-Dawley; Smoke; Tumor Necrosis Factor-alpha
PubMed: 33258350
DOI: 10.19852/j.cnki.jtcm.20201104.001 -
International Journal of Health Sciences 2020Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not... (Review)
Review
OBJECTIVES
Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not clear. This meta-analysis aimed to assess the efficacy and effectiveness of aminophylline for pediatric AKI.
METHODS
We carried out a systematic search of six databases: PubMed, EMBASE/Excerpta Medica, Scopus, Cochrane library, and Google Scholar from January 1995 up till May 2019. Summary measures of risk ratios and standard mean difference were calculated using the random effects model.
RESULTS
We identified seven papers containing data on aminophylline use in children with AKI. Meta-analysis of single-arm studies indicated no statistically significant difference in mean rate of serum creatinine clearance (-0.39 [-0.80-1.58], = 0.52), mean urine output (1.99 [-1.43-5.42]; = 0.25), or mean blood urea nitrogen levels (0.83 [-1.86-3.03], = 0.54) before and after aminophylline administration. However, among double-arm studies, aminophylline administration in the intervention arm significantly reduced the serum creatinine level as compared to control arm (mean diff = -34 [-55.18--12.83]; = 0.002). Mean urine output (-112.68 [-27.43-48.9], = 0.17), incidence of AKI (RR = 1.05 [0.80-1.37], = 0.72), and mortality rates (RR = 0.79 [0.42-1.47], = 0.45) were found to be statistically insignificant.
CONCLUSIONS
Aminophylline administration in children with AKI reduces serum creatinine level without significant adverse effects or effect on the incidence of AKI, urine output, or mortality. Further, large-scale well-planned randomized controlled trials are needed to evaluate its use and its potential long-term effects.
PubMed: 33192231
DOI: No ID Found -
Pediatrics and Neonatology Mar 2021To characterize the prevalence and profile of drug-drug interactions (DDIs), the drugs most related to major DDIs and risk factors of their prescription in a neonatal...
BACKGROUND
To characterize the prevalence and profile of drug-drug interactions (DDIs), the drugs most related to major DDIs and risk factors of their prescription in a neonatal intensive care unit (NICU).
METHODS
Neonates admitted to a NICU who had at least one medication prescribed and a hospital stay >24 h were included in a prospective cohort study (August 2017 to July 2018). All medications prescribed during the hospitalization were collected from all neonates (n = 220), with the screening for DDIs. Prevalence and type of DDIs was identified. Network analysis was used to identify the drugs more implicated with DDIs. Logistic regression was used for the analysis of risk factors (p < 0.05).
RESULTS
Over 70% of neonates were exposed to DDIs and 29% were exposed to major DDIs. The network analysis identified furosemide, fentanyl, aminophylline and fluconazole as most implicated with DDI, fentanyl was especially associated with major DDIs. The number of drugs (OR 1.60, p < 0.01), caesarean delivery (OR 2.68, p < 0.05), gestational age (OR 1.03, p < 0.01) and APGAR score (OR 0.78, p < 0.01) were identified as risk factors for exposure to DDI.
CONCLUSION
Neonates in intensive care have a high exposure to DDIs and the occurrence of major DDIs is related specifically to the prescription of fentanyl. The number of prescribed drugs, gestational age, cesarean delivery and low APGAR score in the first minute were identified as risk factors for DDIs in NICU.
Topics: Apgar Score; Cesarean Section; Cohort Studies; Drug Interactions; Drug Utilization; Female; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Male; Pregnancy; Risk Factors
PubMed: 33158761
DOI: 10.1016/j.pedneo.2020.10.006