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Vancomycin is a glycopeptide antibiotic widely used against Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus. Several studies have found that in adults, continuous in...
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Vancomycin is a glycopeptide antibiotic widely used against Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus. Several studies have found that in adults, continuous infusions of vancomycin showed earlier attainment of desired target drug concentrations and reduced nephrotoxicity relative to intermittent infusion. In the pediatric population, there is no consensus on the best vancomycin infusion method. The present study developed and validated a simple and cost-effective UPLC method to determine serum vancomycin levels in pediatric patients and applied it to the therapeutic drug monitoring of vancomycin in children who were treated with either continuous infusion or intermittent infusion of vancomycin. The sample preparation procedure involves only protein precipitation and filtration, and the UPLC method takes 5 min/sample. The assay was linear from 5 mg/L to 100 mg/L (R-2 = 0.999). The precision and accuracy were determined at 4 concentration levels. The intraday variability (%CV) ranged from 1.23% to 6.01% (n = 6), and the interday variability ranged from 3.02% to 9.75% (n = 18). The accuracies were good and ranged from 91.21% to 112.63%. Serum vancomycin was stable at room temperature for 12 h or for 3 freeze/thaw cycles, and the processed sample was stable in an autosampler within 15.5 h. (C) 2019 Elsevier B.V. All rights reserved.
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Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial membranes and progressive joint destruction. Increased understanding of the immunopathology of RA has resulted in the developm...
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Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial membranes and progressive joint destruction. Increased understanding of the immunopathology of RA has resulted in the development of new therapies to manage the disease, including several infusion-based therapies. Abatacept, a selective costimulation modulator, has been shown to be effective in clinical trials. Abatacept has a mechanism of action that is different from any other biologic RA therapy, and it provides a valuable alternative for RA patients. This article provides practical guidance for nurses to ensure safe administration and to maximize patient outcomes with abatacept.
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BACKGROUND: The monoclonal antibody natalizumab is a novel therapeutic option in the treatment of relapsing forms of multiple sclerosis. In general, therapy with natalizumab is well tolerated. Allergic reactions and acute infusion...
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BACKGROUND: The monoclonal antibody natalizumab is a novel therapeutic option in the treatment of relapsing forms of multiple sclerosis. In general, therapy with natalizumab is well tolerated. Allergic reactions and acute infusion reactions typically occur during or shortly after infusion, with a peak at the second infusion. Delayed infusion reactions resembling serum sickness-type reactions (type III reaction) are commonly reported in other monoclonal antibody therapies (eg, infliximab and rituximab), but are not described yet for natalizumab. RESULTS: Delayed infusion reactions occurred in 4 of 40 relapse-remitting multiple sclerosis patients treated with natalizumab. CONCLUSIONS: Clinicians need to consider the occurrence of infusion reactions, with especially delayed reactions occurring more frequently than previously assumed. Our cases illustrate that some of these infusion reactions may be treated effectively with steroids and reduction of the infusion rate. In cases of antibody-mediated reactions, treatment should be stopped immediately.
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This paper describes the development and optimization of a low flow open-loop infusion device for continuous delivery of protein therapeutics. Specifically, a non-electronic polymer device is actuated with responsive hydrogels to ...
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This paper describes the development and optimization of a low flow open-loop infusion device for continuous delivery of protein therapeutics. Specifically, a non-electronic polymer device is actuated with responsive hydrogels to infuse at 2 μL/hr for 12 hours. Hydrogel actuators transduce a chemical signal (change in pH of the local environment) into a mechanical response (swelling) generating the pressure to drive the infusion. The hydrogel actuators are separated from the drug reservoir by an elastomeric impermeable membrane. As the hydrogel actuators expand, the expansion deflects the flexible membrane down and reduces the volume of the drug reservoir causing the infusion of drug through the needle that is the only outlet for the reservoir.
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Infliximab is a tumour necrosis factor (TNF)-alpha antagonist that has revolutionised the treatment of Crohn's disease and rheumatoid arthritis. However, infliximab therapy can be complicated by a variety of adverse reactions. Acu...
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Infliximab is a tumour necrosis factor (TNF)-alpha antagonist that has revolutionised the treatment of Crohn's disease and rheumatoid arthritis. However, infliximab therapy can be complicated by a variety of adverse reactions. Acute infusion reactions occur during or shortly after infusion and typically consist of fever, chills, nausea, dyspnoea and headaches. Delayed reactions, characterised by myalgias, arthralgias, fever, rash, pruritus, facial, hand or lip oedema, dysphagia, urticaria, sore throat and headache may occur 3-12 days after infusion. Although the mechanisms of these reactions are not yet clearly defined, emerging evidence indicates that these reactions may be associated with the immune response against infliximab and the development of antibodies to infliximab.A number of studies have identified protective factors that may minimise adverse reactions, presumably related to the immune response against infliximab. Factors that may be protective by helping to establish immune tolerance for the foreign infliximab protein include concomitant administration of immunomodulators or corticosteroids, starting infliximab therapy with a 0, 2, 6-week induction regimen, maintenance dose administration with infusions every 8 weeks or less, and avoiding long periods between infusions.Infliximab therapy also may have other immunological consequences. There is evidence that infliximab may impede the appropriate immune response to a number of pathogens, prohibiting its use in patients with active infections. In addition, patients should be screened and appropriately treated for tuberculosis before initiating infliximab therapy. The development of autoantibodies, such as antinuclear antibody or anti-ds-DNA, has also been described with infliximab therapy, although the development of clinical lupus-like syndrome is rare. While there is a theoretical risk of increased rate of malignancies due to antagonism of TNFalpha, to date there is no clear evidence of such an effect. In addition, cardiac and neurological adverse events associated with infliximab therapy have been described. The mechanism for these adverse events is unclear.In summary, infliximab therapy can be an effective treatment for Crohn's disease; however, a number of immunological consequences and adverse events may complicate the infusion of this agent. Appropriate prophylaxis and therapy of these adverse reactions will allow infliximab to be used safely in the vast majority of patients.
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The patient is a 75-year-old male. Abdominal ultrasound tomography in June 2002 revealed hepatocellular carcinoma with intrahepatic metastasis (IM3) and tumor thrombi (Vp4, Vv3) at S4 in the major portal and hepatic vein. From Jul...
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The patient is a 75-year-old male. Abdominal ultrasound tomography in June 2002 revealed hepatocellular carcinoma with intrahepatic metastasis (IM3) and tumor thrombi (Vp4, Vv3) at S4 in the major portal and hepatic vein. From July 2002, he received hepatic arterial infusion therapy (FAP: 5-fluorouracil, CDDP and adriamycin) for these lesions. In December 2002, these lesions had disappeared completely after 6 sessions of arterial infusion therapy. The patient is still alive with no recurrence after 2 years since the beginning of this treatment. Recently, we treated 9 patients with combined arterial infusion chemotherapy (FAP), and the response rate (CR and PR) was 44% and no major side effect was observed. In conclusion, some patients may obtain longer survival through this treatment, even in cases of advanced HCC with tumor thrombus in the major trunks of portal vein and/or hepatic vein.
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BACKGROUND: Assessment of response to invasive aspergillosis (IA) therapy has been challenging in treatment trials. METHODS: The causes of death over 12 weeks were categorized prospectively by a blinded data review committee using...
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BACKGROUND: Assessment of response to invasive aspergillosis (IA) therapy has been challenging in treatment trials. METHODS: The causes of death over 12 weeks were categorized prospectively by a blinded data review committee using a priori defined criteria in participants in a randomized comparative trial of voriconazole versus amphotericin B as first-line therapy of proven or probable IA. RESULTS: Death occurred in 98 of 277 patients during the 12-week course of study. Seventy-three of the 98 deaths (74%) occurred in the first 6 weeks; 25 deaths occurred during the second 6 weeks. Of the 73 deaths during the first 6 weeks, 50 (68%) were judged to be attributable to IA. Of the 25 deaths during the second 6 weeks, only 6 (24%) were judged to be attributable to IA. Fifty of the 56 deaths (89%) attributable to IA occurred during the first 6 weeks. CONCLUSIONS: These data suggest that most deaths due to IA occur during the first 6 weeks after the start of therapy and 6 weeks may be a better interval to judge the effectiveness of antifungal therapy because most deaths after 6 weeks are due to causes related to the underlying disease and its treatment rather than due to IA. Attributable mortality when assessed using a priori definitions and conducted in a blinded manner by a central data review committee can be useful in the assessment of IA therapy.
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With continuous hepatic artery infusion (HAI), 2 cases including multiple hepatic lesions became lesion free, meaning a complete response (CR) to this treatment. Besides chemotherapy, we controlled the diet with a healthy food gui...
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With continuous hepatic artery infusion (HAI), 2 cases including multiple hepatic lesions became lesion free, meaning a complete response (CR) to this treatment. Besides chemotherapy, we controlled the diet with a healthy food guidance plan containing low salt & fat, and a lot of juice. The 1st case is a 63-year-old female, suffered from simultaneous multisided metastatic liver tumor from advanced rectal cancer. Four months after the low anterior resection of the rectum, we recommended the diet 2 months later. The patient was treated by a 24-hour continuous HAI and the metastatic lesion disappeared (CR) within 8 weeks. The 2nd case is a 58-year-old male with hepatocellular carcinoma, suffered from 4 recurrent tumors in the retained liver. After 11 treatments of HAI, the tumors disappeared completely, and he has survived for 11.5 years. We believe it was due to the immunoactivation of functional foods such as unmilled-grain, fresh vegetables and fruits, seaweeds, honey, and mushrooms with the restriction of animal fat and meat intake. Dietary guidance in metabolic-nourishment therapy is very useful in the treatment of far advanced cancer patients.
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The recent worldwide pandemic of Covid-19 induced major issues through herbal medicine. This study was conducted between August? 2020 and March 2021, with the aim to evaluating the knowledge of the population on the usefulness of ...
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The recent worldwide pandemic of Covid-19 induced major issues through herbal medicine. This study was conducted between August? 2020 and March 2021, with the aim to evaluating the knowledge of the population on the usefulness of herbal medicine in the treatment? of Flu, cough, cold and Covid-19 and identifying therapeutic recipes used at Mbanga and Yaounde cities. The results showed that 88.46%? and 67.69% of population respectively at Mbanga and Yaoundé agreed to the use of medicinal plants. Of the 130 people interviewed per? city, the most affected were between 40-50 years old for Mbanga (33.07%) and 30-40 years old for Yaounde (43.84%). A total of 16? therapeutic recipes, mostly prepared by infusion or fermentation, were identified. These recipes use 11 plant species which belong to 9? genera and 9 botanical families. Herbal medicine seems to be a major solution in the treatment of upper respiratory diseases in these? cities, although some fear the risks associated with this practice, due to the dosage as dosing is not mastered.? ? English title: Recettes thérapeutiques faites à base de plantes médicinales utilisées pour le traitement de la Grippe, du rhume, de la toux? et du Covid-19 dans les villes de Mbanga et Yaoundé (Cameroun) La récente crise sanitaire du Covid-19 répandue à travers le monde a conduit à apporter des solutions en phytothérapie. La présente? étude a été menée entre ao?t 2020 et mars 2021, dans le but de recenser les connaissances des populations sur l’utilité de la? phytothérapie dans le traitement de la grippe, du rhume, de la toux et du Covid-19 et d’identifier les recettes thérapeutiques utilisées dans les villes de Mbanga et Yaoundé. En effet, les populations ont été très favorables à l’usage des plantes médicinales soit 88,46 et? 67,69% respectivement à Mbanga et Yaoundé. Des 130 personnes interviewées par ville, les plus affectées avaient respectivement un age? compris entre [40-50[ ans soit 33,07% à Mbanga , [30-40[ ans (43,84%) à Yaoundé. Au total 16 recettes thérapeutiques préparées pour la? plupart par infusion ou fermentation, ont été recensées. Cette étude a permis de recenser 11 espèces de plantes appartenant à 9 genres? et 9 familles botaniques pour les différentes espèces. La phytothérapie semble être une solution majeure dans le traitement des maladies? des voies respiratoires dans ces villes bien que certains redoutent des risques liés à cette pratique, d? à la posologie et aux? doses très peu connues.
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PURPOSE: To evaluate the effect of combined intralesional and sub-Tenon's administration of corticosteroids for the treatment of refractory periocular and orbital capillary haemangioma in a retrospective, non-comparative study. ME...
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PURPOSE: To evaluate the effect of combined intralesional and sub-Tenon's administration of corticosteroids for the treatment of refractory periocular and orbital capillary haemangioma in a retrospective, non-comparative study. METHODS: Seven infants with resistant periorbital and orbital capillary haemangioma who attended our tertiary centre from 2000 to 2005 were treated with an intralesional injection of a mixture of betamethasone 6 mg/cc and triamcinolone 10 mg/cc, by body weight, together with sub-Tenon's infusion of betamethasone 6 mg/cc and triamcinolone 40 mg/cc of a volume of 1 cc, close to the orbital lesion, in the same session. Visual axis, proptosis, pre- and post-treatment changes in four refractive parameters, and parental satisfaction were evaluated. RESULTS: None of the babies had proptosis or visual axis obstruction after treatment. Mean spherical power decreased by 22.7% (P=0.06). Mean spherical equivalent decreased in 34%, but the difference was not statistically significant (P=0.09). No early or late ocular side effects were observed. Mean intraocular pressure results were normal before and immediately after treatment, and during the follow-up period. Parental satisfaction score during follow-up was 9/10. Mean time to improvement was 96.43+/-58.3 days. CONCLUSIONS: Combined local corticosteroid administration by posterior sub-Tenon's infusion and intralesional injection in babies with extensive capillary haemangioma is associated with a satisfactory anatomical and functional outcome and there were no ophthalmic side effects.
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