Examination regarding the tolerability of the homochord Acidum L(+)-lacticum at a dosage of sixty drops three times daily

In Germany, the commission D recommends in its current dosage guidelines from March 17, 2004, that homeopathic dilutions higher than 24x will be prescribed in a daily application of five drops once. This recommendation is decisive for the German Regulatory Authority. Even though the homochord Acidum L(+)-lacticum 4x/6x/12x/30x/200x contains dilutions above 24x, it is commonly used in clinical practice for over 30 years in a dosage of 60 drops three times daily. In order to explore the clinical safety and tolerability of Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily, as well as lower dosages, a therapist survey was designed to address the questions. Highly experienced and licensed therapists, including general and alternative practitioners, reported their usual dosage of homochord, incidences of drug reactions, initial homeopathic aggravations as well as the diagnoses that led to the prescription of Acidum L(+)-lacticum 4x/6x/12x/30x/200x. 167 therapist responses were analyzed. Only four therapists reported occurrences that classify as initial aggravation, (2.40 %), compared to 159 with no incidences (95.21 %). Four therapists made no statement. Nevertheless, there were no adverse drug reactions documented in the survey. Consequently, Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily or lower dosages may be construed to be clinically tolerable and safe. This evidence might lead to further re-evaluations of other homochords, and rigorous clinical trials for its safety and tolerability.

Mobile Health Apps Related to Emergency Drugs: Systematic Search on App Stores and Content Analysis (Preprint)

BACKGROUND Drug referencing mobile apps are among the most frequently apps used by emergency health professionals. Currently there are no studies about the quantity and quality of apps related to emergency drugs. OBJECTIVE The aim of this study was to identify apps designed to assist emergency healthcare professionals in managing drugs and to analyze their contents. METHODS We performed an observational, cross-sectional, descriptive study of apps about emergency drugs. A search was conducted in February 2021 on the iOS and Android platforms. Apps identified were downloaded and their main characteristics were evaluated by 2 independent researchers. Developer affiliation, cost, updates, user ratings and number of downloads were analyzed. We also evaluated the number of drugs described, the inclusion of bibliographic references and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interaction with other medicinal products, use in pregnancy and lactation, adverse reactions, method of preparation and administration, stability data/incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation and cost. RESULTS We identified a total of 49 apps. Of these, 32 (65.3%) were found at both digital platforms, 11 (22.4%) were only available for Android and 6 (12.2%) for iOS. A total of 20 (40.8%) required payment (ranging from 0.59€ to 179.99€) and 11 (22.4%) were developed by non-healthcare professionals. The weighted user rating mean was 4.023 out of 5 (SD 0.71). Overall, 22 apps (44.9%) were focused on emergency drugs and 27 (55.1%) on emergency medicine. More than a half (61.7%) did not include bibliographic references or had not been updated for more than a year (59.2%). The median number of drugs was 66 (range 4 to 5000+). Most apps included information about usual dosage (87.8%) and therapeutic indications (79.2%), while information about contraindications (55.3%) and adverse reactions (51.1%) was only found in about half of apps. Dose adjustment for renal failure (31.9%), interactions (21.3%) and use in pregnancy and lactation (31.9%) were described in less than a half of apps. Furthermore, only 3 (6.4%) identified high-alert medications and 1 (2.1%) included information about medication reconciliation. Health-related developer, main topic of the app (emergency drugs or emergency medicine) and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09 and P=.31, respectively). CONCLUSIONS We provide a comprehensive review of apps related to emergency drugs. Our findings show that information on authorship, drug characteristics and bibliographic references is frequently scarce, so we propose some recommendations to take into account when developing an app of these characteristics. Future efforts should be done to increase regulation of drug referencing apps and to carry out a more frequent and documented review of their clinical content.

Does Dopamine Replacement Medication Affect Postural Sequence Learning in Parkinson’s Disease?

Deficits in sequence-specific learning (SSL) may be a product of Parkinson’s disease (PD) but this deficit could also be related to dopamine replacement. The purpose of this study was to determine whether dopamine replacement affected acquisition and retention of a standing Continuous Tracking Task in individuals with PD. SSL (difference between random/repeated Root Mean Square Error across trials) was calculated over 2 days of practice and 1 day of retention for 4 groups; 10 healthy young (HY), 10 healthy elders, 10 individuals with PD on, 9 individuals with PD off their usual dosage of dopamine replacement. Improvements in acquisition were observed for all groups; however, only the HY demonstrated retention. Therefore, age appeared to have the largest effect on SSL with no significant effect of medication. Additional research is needed to understand the influence of factors such as practice amount, task difficulty, and dopamine replacement status on SSL deficits during postural tasks.

Antimicrobial selection, administration and dosage : continuing education

Various types of information contribute to the selection of an antimicrobial agent. Initial requirements are diagnosis of the site and nature of the infection, assessment of the severity of the infectious process and medical condition of the diseased animal; these are embodied in clinical experience. Additional considerations include identification of the causative pathogenic microorganism, knowledge of its susceptibility to antimicrobial agents (microbiological considerations) and of the pharmacokinetic properties of the drug of choice and alternative drugs, and their potential toxicity (pharmacological considerations) in the animal species. Select an antimicrobial drug and dosage form appropriate for use in the particular animal species. Usual dosage regimens may be applied, except in the presence of renal or hepatic impairment, when either modified dosage or a drug belonging to another class should be used. The duration of therapy is determined by monitoring the response both by clinical assessment and bacterial culture. A favourable clinical response is the ultimate criterion of successful therapy.

Pharmacokinetics of cefepime during continuous venovenous hemodiafiltration.

The objective of this study was to analyze the pharmacokinetics of cefepime, in six patients with acute renal failure related to septic shock, during continuous venovenous hemodiafiltration (CVVHD) (Hemospal AN 69S hemofilter; Hospal, Lyon, France). Six patients, mean age 65 +/- 4 years (range, 61 to 69), were included and each received 2 g of cefepime by intravenous infusion over a 30-min period every 12 h. Prefilter serum, dialysate outlet (DO), and ultrafiltrate samples were collected 0.47, 0.50, 0.57, 1, 3, 5, 7, and 12 h after the beginning of infusion. The time design of samples was optimized in accordance with the theory of D optimality. The cefepime concentrations were measured by high-performance liquid chromatography. The pharmacokinetics computation was carried out using P-PHARM software. Mean serum concentration peaks were 53 +/- 21.9 mg/liter (range, 13.0 to 68.9) one-half hour after the infusion. The mean elimination half-life was 8.11 +/- 2.22 h (range, 4.76 to 10.84). DO clearance was 66.57 +/- 30.14 ml/min (range, 38.66 to 119.87). The mean volume of distribution was 0.71 +/- 0.37 liters/kg of body weight. CVVHD was effective for cefepime elimination. In these subjects, the elimination half-life and DO clearance were almost constant. The results of this study suggested that a 2-g twice-daily infusion (usual dosage) was required for an effective concentration in this group of patients.