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American Family Physician Apr 2000Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. Patients... (Review)
Review
Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. Patients with giant cell arteritis typically have a localized headache, nonspecific systemic symptoms, temporal artery tenderness and a high erythrocyte sedimentation rate (ESR). The diagnosis is confirmed by characteristic pathologic findings on temporal artery biopsy. Patients with polymyalgia rheumatica usually have similar nonspecific systemic symptoms, proximal muscle pain and stiffness, and an elevated ESR. The diagnosis is based on the clinical findings. Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg per day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). Symptom relief in response to treatment is rapid and reinforces the diagnosis. After normalization of the ESR, the corticosteroid is tapered, with the patient monitored closely for symptom recurrence. Most patients require corticosteroid therapy for two to three years and experience one or more treatment complications.
Topics: Giant Cell Arteritis; Humans; Patient Education as Topic; Polymyalgia Rheumatica; Teaching Materials; United States
PubMed: 10779249
DOI: No ID Found -
Interactive Cardiovascular and Thoracic... Apr 2021A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration... (Review)
Review
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.
Topics: Administration, Topical; Anti-Infective Agents; Cardiac Surgical Procedures; Gentamicins; Humans; Meta-Analysis as Topic; Sternotomy; Sternum; Surgical Wound Infection; Treatment Outcome; Vancomycin
PubMed: 33346346
DOI: 10.1093/icvts/ivaa292 -
Nanomaterials (Basel, Switzerland) Nov 2023Nanoparticles are increasingly being used by industry to enhance the outcomes of various chemical processes. In many cases, these processes involve over-dosages that...
Nanoparticles are increasingly being used by industry to enhance the outcomes of various chemical processes. In many cases, these processes involve over-dosages that compensate for particle losses. At best, these unique waste streams end up in landfills. This circumstance is inefficient and coupled with uncertain impacts on the environment. Pozzolanic nanoparticle treatments have been found to provide remarkable benefits for strength restoration and the mitigation of durability problems in ordinary Portland cement and concrete. These treatments have been accompanied by significant particle losses stemming from over-dosages and instability of the colloidal suspensions that are used to deliver these materials into the pore structure. In this study, new methods involving simple tools have been developed to monitor and sustain suspension stability. Turbidity measurement was introduced to monitor the progress of electrokinetic nanoparticle treatment. This tool made it possible to amend a given dosing strategy in real time while it remains possible to make effective treatment adjustments. By monitoring the particle stability and using pH and electric field controls to avoid suspension collapse, successful electrokinetic treatment dosage strategies were demonstrated using 20 nm NALCO 1056 alumina-coated silica particles. These trials indicated that turbidity measurements could track the visually imperceptible phenomena of particle flocking early on at the inception of its development. Suspensions of these nanoparticles were successfully delivered into 5 cm diameter by 10 cm tall hardended cement paste (HCP) specimens by monitoring fluid turbidity along with the specific gravity and using these values to guide the active management of the treatment dosage and pH. Under this new strategy, these losses were reduced to 5% as compared to the 80% losses associated with other treatment approaches. The relationship between the turbidity and the specific gravity was found to be linear. These plots indicated regions of turbidity and specific gravity that were associated with particle flocking. The tools, guidelines, and strategies developed in this work made it possible to manage efficient (low-particle-loss) electrokinetic nanoparticle treatments by signaling in real time when adjustments to electric field, pH, and particle dosage increments were needed.
PubMed: 38063741
DOI: 10.3390/nano13233045 -
Internal and Emergency Medicine Aug 2021We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7,... (Observational Study)
Observational Study
We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23-0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26-1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.
Topics: Aged; Body Mass Index; COVID-19; Cohort Studies; Enoxaparin; Female; Heparin, Low-Molecular-Weight; Hospitalization; Humans; Male; Middle Aged; Pre-Exposure Prophylaxis; Venous Thromboembolism; COVID-19 Drug Treatment
PubMed: 33389568
DOI: 10.1007/s11739-020-02585-9 -
Archives of Disease in Childhood Jun 2013The treatment of inborn errors of metabolism (IEM) has seen significant advances over the last decade. Many medicines have been developed and the survival rates of some... (Review)
Review
BACKGROUND
The treatment of inborn errors of metabolism (IEM) has seen significant advances over the last decade. Many medicines have been developed and the survival rates of some patients with IEM have improved. Dosages of drugs used for the treatment of various IEM can be obtained from a range of sources but tend to vary among these sources. Moreover, the published dosages are not usually supported by the level of existing evidence, and they are commonly based on personal experience.
METHODS
A literature search was conducted to identify key material published in English in relation to the dosages of medicines used for specific IEM. Textbooks, peer reviewed articles, papers and other journal items were identified. The PubMed and Embase databases were searched for material published since 1947 and 1974, respectively. The medications found and their respective dosages were graded according to their level of evidence, using the grading system of the Oxford Centre for Evidence-Based Medicine.
RESULTS
83 medicines used in various IEM were identified. The dosages of 17 medications (21%) had grade 1 level of evidence, 61 (74%) had grade 4, two medications were in level 2 and 3 respectively, and three had grade 5.
CONCLUSIONS
To the best of our knowledge, this is the first review to address this matter and the authors hope that it will serve as a quickly accessible reference for medications used in this important clinical field.
Topics: Dose-Response Relationship, Drug; Evidence-Based Medicine; Humans; Metabolism, Inborn Errors; Randomized Controlled Trials as Topic
PubMed: 23532493
DOI: 10.1136/archdischild-2012-303131 -
The Cochrane Database of Systematic... Jan 2007Hypertensive disorders during pregnancy are important causes of maternal mortality and morbidity worldwide. The long-term outcome of surviving mothers will depend... (Review)
Review
BACKGROUND
Hypertensive disorders during pregnancy are important causes of maternal mortality and morbidity worldwide. The long-term outcome of surviving mothers will depend largely on whether intracranial haemorrhage or renal failure developed. Low-dose dopamine is used for the prevention and treatment of acute renal failure, but its role in the management of pregnant women with severe pre-eclampsia is unclear.
OBJECTIVES
To assess the effects of low-dose dopamine used for oliguria in severe pre-eclampsia on mothers and their children.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006).
SELECTION CRITERIA
Randomised trials comparing low-dose dopamine (dosages not higher than 5 microgram/kg/minute) with either placebo or no dopamine in women with severe pre-eclampsia and acute renal failure, or who are considered to be at risk of acute renal failure.
DATA COLLECTION AND ANALYSIS
The two review authors assessed trial quality and data independently.
MAIN RESULTS
Only one randomised placebo controlled trial of six hours' duration, including 40 postpartum women, was found. This study showed a significant increase in urinary output over six hours in women receiving dopamine. It is unclear if this was of any benefit to the women.
AUTHORS' CONCLUSIONS
It is unclear whether low-dose dopamine therapy for pre-eclamptic women with oliguria is worthwhile. It should not be used other than in prospective trials.
Topics: Dopamine; Dopamine Agents; Female; Humans; Pre-Eclampsia; Pregnancy; Urination
PubMed: 17253491
DOI: 10.1002/14651858.CD003515.pub2 -
Alzheimer's Research & Therapy Jun 2021Associations of Apolipoprotein (APOE) ε2 or ε4 (APOE2 or APOE4) dosages with cognitive change may differ across racial groups.
BACKGROUND
Associations of Apolipoprotein (APOE) ε2 or ε4 (APOE2 or APOE4) dosages with cognitive change may differ across racial groups.
METHODS
Longitudinal data on 1770 middle-aged White and African American adults was compiled from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS 2004-2013) study. APOE2 and APOE4 dosages were the two main exposures, while v and annual rate of change in cognitive performance (between v and v) on 11 test scores were the main outcomes of interest (v1: 2004-2009 and v2: 2009-2013). Mixed-effects linear regression models were conducted adjusting for socio-demographic, lifestyle, and health-related potential confounders. Race (African American vs. White) and sex within racial groups were main effect modifiers.
RESULTS
Upon adjustment for multiple testing and potential confounders, APOE4 allelic dosage was associated with faster decline on a test of verbal memory among Whites only (CVLT-List A: γ = - 0.363 ± 0.137, p = 0.008), but not among African Americans. In contrast, among African American women, APOE4 dosage was linked to slower decline on a test of attention (BTA: γ = + 0.106 ± 0.035, p = 0.002), while no association was detected among African American men. APOE2 and APOE4 dosages showed inconsistent results in other domains of cognition overall and across racial groups that did not survive correction for multiple testing.
CONCLUSIONS
In conclusion, APOE4 dosage was associated with faster decline on a test of verbal memory among Whites only, while exhibiting a potential protective effect among African American women in the domain of attention. Further longitudinal studies are needed to replicate our race and sex-specific findings.
Topics: Adult; Black or African American; Apolipoproteins E; Cognition; Cognitive Dysfunction; Female; Genotype; Humans; Male; Middle Aged; Sex Factors; White People
PubMed: 34193248
DOI: 10.1186/s13195-021-00855-y -
Pharmaceutics May 2021Dopamine is crucial for neuroplasticity, which is considered to be the neurophysiological foundation of learning and memory. The specific effect of dopamine on...
Dopamine is crucial for neuroplasticity, which is considered to be the neurophysiological foundation of learning and memory. The specific effect of dopamine on plasticity such as long-term potentiation (LTP) and long-term depression (LTD) is determined by receptor subtype specificity, concentration level, and the kind of plasticity induction technique. In healthy human subjects, the dopamine precursor levodopa (L-DOPA) exerts a dosage-dependent non-linear effect on motor cortex plasticity. Low and high dosage L-DOPA impaired or abolished plasticity, while medium-dose preserved and reversed plasticity in previous studies. Similar dosage-dependent effects were also observed for selective D1-like and D2-like receptor activation that favor excitatory and inhibitory plasticity, respectively. However, such a dosage-dependent effect has not been explored for a nonselective dopamine agonist such as apomorphine in humans. To this aim, nonfocal and focal motor cortex plasticity induction using paired associative stimulation (PAS) and transcranial direct current stimulation (tDCS) were performed respectively in healthy participants under 0.1, 0.2, 0.3 mg apomorphine or placebo drug. Transcranial magnetic stimulation-elicited motor-evoked potentials were used to monitor motor cortical excitability alterations. We hypothesized that, similar to L-DOPA, apomorphine will affect motor cortex plasticity. The results showed that apomorphine with the applied dosages has an inhibitory effect for focal and nonfocal LTP-like and LTD-like plasticity, which was either abolished, diminished or reversed. The detrimental effect on plasticity induction under all dosages of apomorphine suggests a predominantly presynaptic mechanism of action of these dosages.
PubMed: 34068263
DOI: 10.3390/pharmaceutics13050718 -
Pharmaceutics Dec 2022Over 75 kinase inhibitors (KIs) have been approved for the treatment of various cancers. KIs are orally administrated but mostly lack pediatric age-appropriate dosage... (Review)
Review
Over 75 kinase inhibitors (KIs) have been approved for the treatment of various cancers. KIs are orally administrated but mostly lack pediatric age-appropriate dosage forms or instructions for dose manipulation. This is highly problematic for clinical practice in pediatric oncology, as flexible oral formulations are essential to individually set dosages and to adjust it to a child's swallowability. Most KIs are poorly soluble, categorized in Biopharmaceutics Classification System (BCS) class II or IV, and improperly manipulating the KI formulation can alter pharmacokinetics and jeopardize KI drug safety and efficacy. Therefore, the goals of this review were to provide practical recommendations for manipulating the formulation of the 15 most frequently used KIs in pediatric oncology (i.e., bosutinib, cabozantinib, cobimetinib, crizotinib, dabrafenib, dasatinib, entrectinib, imatinib, larotrectinib, nilotinib, ponatinib, ruxolitinib, selumetinib, sunitinib and trametinib) based on available literature studies and fundamental drug characteristics and to establish a decision tool that supports decisions regarding formulation manipulation of solid oral dosages of KIs that have been or will be licensed (for adult and/or pediatric cancers) but are not included in this review.
PubMed: 36559327
DOI: 10.3390/pharmaceutics14122834 -
Respiratory Medicine Dec 2011The use of inhaled therapies for chronic respiratory infections in cystic fibrosis represents a substantive treatment burden to patients. In this paper, we review the... (Review)
Review
The use of inhaled therapies for chronic respiratory infections in cystic fibrosis represents a substantive treatment burden to patients. In this paper, we review the evidence supporting two commonly used inhaled antibiotic regimens for chronic respiratory infections - continuous vs. intermittent (28 days on followed by 28 days off) therapy. We included trials of good methodological quality and excluded those in which the primary intent was eradication. In total, we included 13 trials (5 of intermittent therapy and 8 of continuous therapy) and summarized their main findings, placing particular emphasis on change in FEV(1), emergence of resistance and patient adherence. What is evident from our review is that both continuous and intermittent inhaled therapies work. Although an intermittent regimen would be intuitively "better" in terms of cost savings and patient tolerability, there is currently a lack of head-to-head trials that compare the same drugs (and dosages) using the two different regimens to make such a recommendation based on robust clinical evidence.
Topics: Administration, Inhalation; Aerosols; Anti-Bacterial Agents; Chronic Disease; Cystic Fibrosis; Female; Forced Expiratory Volume; Humans; Male; Medication Adherence; Pseudomonas Infections; Pseudomonas aeruginosa; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Treatment Outcome
PubMed: 22208548
DOI: 10.1016/S0954-6111(11)70022-1