How Do You Implement the Diet?

2016 ◽  
Author(s):  
A. G. Christina Bergqvist
Keyword(s):  
Side Effects ◽  
Ketogenic Diet ◽  
Consensus Statement ◽  
Great Variability ◽  
Professional Practices ◽  
Duration Of Treatment ◽  
Support Structure ◽  
Full Diet ◽  
Intravenous Alimentation ◽  
Family Centered

There is great variability in how the ketogenic diet (KD) is implemented. Most of the differences are preference based. A consensus statement attempted to unify professional practices. The KD can be safely used in all ages, modified for specific dietary needs, and administered as food, formula, or intravenous alimentation. Effectiveness, compliance, and minimal side effects are achieved using a team-based, family-centered support structure. The KD is commonly initiated in an in-patient setting with a gradual advancement of the fat. Some centers still begin the KD with a brief fast. Out-patient initiation with slower advancement to a full diet can be challenging but safely executed. Time to determine response and duration of treatment in responders varies. Side effects are better understood and best managed proactively by monitoring, but cannot always be prevented and must be weighed with the benefit of continuing the therapy.

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

scholarly journals European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis

Obesity Facts ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 222-245
Author(s):  
Giovanna Muscogiuri ◽  
Marwan El Ghoch ◽  
Annamaria Colao ◽  
Maria Hassapidou ◽  
Volkan Yumuk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Body Composition ◽  
Body Weight ◽  
Side Effects ◽  
Ketogenic Diet ◽  
Meta Analysis ◽  
Dietary Treatment ◽  
Obesity Management ◽  
Weight Loss Interventions

<b><i>Background:</i></b> The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. The VLCKD is characterized by a low carbohydrate content (&#x3c;50 g/day), 1–1.5 g of protein/kg of ideal body weight, 15–30 g of fat/day, and a daily intake of about 500–800 calories. <b><i>Objectives:</i></b> The aim of the current document is to suggest a common protocol for VLCKD and to summarize the existing literature on its efficacy in weight management and weight-related comorbidities, as well as the possible side effects. <b><i>Methods:</i></b> This document has been prepared in adherence with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, and quality appraisal were performed independently by 2 authors and the data were collated by means of a meta-analysis and narrative synthesis. <b><i>Results:</i></b> Of the 645 articles retrieved, 15 studies met the inclusion criteria and were reviewed, revealing 4 main findings. First, the VLCKD was shown to result in a significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. Second, when compared with other weight loss interventions of the same duration, the VLCKD showed a major effect on reduction of body weight, fat mass, waist circumference, total cholesterol and triglyceridemia as well as improved insulin resistance. Third, although the VLCKD also resulted in a significant reduction of glycemia, HbA1c, and LDL cholesterol, these changes were similar to those obtained with other weight loss interventions. Finally, the VLCKD can be considered a safe nutritional approach under a health professional’s supervision since the most common side effects are usually clinically mild and easily to manage and recovery is often spontaneous. <b><i>Conclusions:</i></b> The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. <b><i>Prospero Registry:</i></b> The assessment of the efficacy of VLCKD on body weight, body composition, glycemic and lipid parameters in overweight and obese subjects: a meta-analysis (CRD42020205189).

scholarly journals Antiviral Treatment on Pregnancy with COVID-19 Infection : A Systematic Review

2021 ◽  
Vol 4 (2s) ◽  
pp. 78-85
Author(s):  
Tigor Peniel Simanjuntak ◽  
◽  
Angela Putri Kakerissa ◽  
Grady Ivan Kurniawan
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Pregnant Women ◽  
Gestational Age ◽  
Treatment Duration ◽  
Case Reports ◽  
Antiviral Treatment ◽  
Inclusion Criteria ◽  
Duration Of Treatment ◽  
Retrospective Case

Abstract Objective to evaluate antiviral treatment, duration, and side effects on pregnant women based on gestational age and severity of COVID-19 infection. Method: a systematic review of antiviral treatment, duration, and side effects on pregnant women based on gestational age and severity of COVID-19 infection. Systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement. Result 948 papers accessed through Pubmed, Scopus, Science Direct, Cohcrane, and other with keywords “Antiviral”, “Pregnancy” “Pregnant” “Coronavirus” “COVID-19” “SARS-CoV-2”. Duplicate papers were excluded (n=302), topics and abstracts that do not meet the criteria (n=612), and 25 papers that did not meet the inclusion criteria. 9 papers that meet the inclusion criteria (case reports and cohort retrospective case study) discussed 20 pregnant women with COVID-19 infection (16 moderate and severe cases received Remdesivir, 3 moderate and mild cases received Lopinavir-ritonavir combination, and 1 moderate case received Arbidol). Conclusion, remdesivir is an antiviral frequently used in pregnancy on trimester II and III with severe COVID-19 infection with a duration of treatment of 5-10 days. Remdesivir should be monitored because some show side effects of increasing liver function. Key word: Antiviral, Pregnant, COVID-19

scholarly journals Oral Antioxidants Mitigate Levels of Malonedialdehyde and Protein Carbonyl and Improve Semen Parameters in Men with Oligoasthenozoospermia

2020 ◽  
Author(s):  
Vegim Zhaku ◽  
Sheqibe Beadini ◽  
Nexhbedin Beadini ◽  
Gazmend Amzai
Keyword(s):  
Oxidative Stress ◽  
Standard Deviation ◽  
Side Effects ◽  
Semen Analysis ◽  
Pearson Correlation ◽  
Protein Carbonyl ◽  
Semen Parameters ◽  
Duration Of Treatment ◽  
Treatment Regimens ◽  
Raising Awareness

Abstract Raising awareness about treating options in North Macedonia, while sperm parameters are decreasing because of increased oxidative stress, in a terrain like this, represents a big challenge. All the patients that fulfilled the required criteria, 37 were enrolled in the study signing a document that explains nature of the study. The first semen sample was collected with at least three days of abstinence. From the sample 0.5 ml was used for standard semen analysis, 1.2 ml was used to evaluate the levels of malonedialdehyde (MDA) and protein carbonyl (PC). The last sample was collected after 6 months. Mean, Standard Deviation, the Pearson Correlation and an independent student t-test were used for statistical analyses. Concentration and motility were significantly increased after 6 months of treatment (p<0.001).The level of MDA shows significantly lower values after six months of therapy with antioxidants (p<0.001).Whereas another marker which is denoted by PC was also lower after the treatment, but was not statistically significant (p=0.0554). There is, however, lack of agreement, because improvement is not consistent and there is wide variation in the treatment regimens, on the dose and duration of treatment and whether mono or combined oral antioxidants should be administered. Always keep on mind that, antioxidants are not free from potential side effects “antioxidant paradox”.

CURRENTLY USED ANTI-TUBERCULAR AGENTS, THEIR ANALOGUES AND RECENTLY DEVELOPED DRUGS

INDIAN DRUGS ◽  
2012 ◽  
Vol 49 (07) ◽  
pp. 5-19
Author(s):  
A Mohammad ◽  
Keyword(s):  
Antimicrobial Activity ◽  
Side Effects ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Duration Of Treatment ◽  
Duration Of Therapy ◽  
Drug Molecules ◽  
Prolonged Duration ◽  
Resistant Strains ◽  
Reduced Toxicity

Tuberculosis (TB) is one of most prevailing diseases, responsible for the morbidity and mortality of a large number of populations worldwide. Traditionally, it has relied on a limited number of drugs such as isoniazid, rifampicin, ethambutol, streptomycin, ethionamide and pyrazinamide. However, many of these drugs have different disadvantages such as prolonged duration of treatment, host toxicity and ineffectiveness against resistant strains. This has motivated the search of newer drug molecules, capable of rapid mycobactericidal action with shortened duration of therapy, reduced toxicity and enhanced activity against multidrug resistant strains. These observations have been guiding for the currently used and newly developed anti-tubercular agents that possess potent antimicrobial activity and their side effects, activity against multi drug resistant Mycobacterium, and also in patients co-infected with HIV/AIDS.

scholarly journals P0331ASSESSMENT OF DELIVERY OF NICE APPROVED USE OF TOLVAPTAN (JINARC) IN ADULTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE IN A UK RENAL CENTRE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aaron Acquaye ◽  
Kate Naylor ◽  
Sunil Bhandari
Keyword(s):  
Side Effects ◽  
Liver Enzymes ◽  
Retention Rate ◽  
Pressure Control ◽  
Lifestyle Changes ◽  
University Teaching ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Duration Of Treatment ◽  
Tract Infections

Abstract Background and Aims Until recently, the management of ADPKD has largely been limited to lifestyle changes (smoking cessation, salt avoidance and diet with weight loss) and tight blood pressure control, in addition to kidney pain management and prompt treatment of complications such as infections. The approval of Tolvaptan, a highly selective vasopressin V2 receptor antagonist, by NICE, following the pivotal TEMPO 3:4 trial provides clinicians with an opportunity to modify the progression of ADPKD and preserve kidney function. Tolvaptan works by slowing cyst growth patients with ADPKD (and therefore potentially reducing kidney pain, urinary tract infections and haematuria). During the TEMPO 3:4 trial, a reversible elevation (&gt; 3X upper limit) of liver enzymes was observed in 4.4% patients taking tolvaptan vs 1% on placebo. The onset of liver injury was between 3 – 14 months of initiation of tolvaptan; therefore, monthly blood tests are required to mitigate the potential injury associated with the increase in liver enzymes. The main side effects are polyuria and thirst. The aims for the audit were Method We carried out a prospective questionnaire-based study on all patients who were on tolvaptan therapy. All patients received a comprehensive explanation of the merits and side-effects of Tolvaptan with written literature and a copy of their initial assessment consultation prior to commencement of therapy. In addition, we reviewed patients’ clinic attendances, relevant biochemical results and liver function test as per licence agreement tolvaptan therapy. This was approved by the Hull University Teaching Hospitals (HUTH) NHS Trust Audit department with a signed Clinical Governance Form 1. Results In total, 27 patients, consisting of 18 males and 9 females [mean age 44.5yrs] and all Caucasian on tolvaptan therapy were evaluated. The median duration of treatment was 10months. Two patients [7.4%] dropped out of treatment: one patient opted out of treatment due to the polyuria interfering with his job requirements and the other had relocated to another country; giving HUTH a retention rate of 92.6%. 55.5% of patients responded to not having missed a dose of drug at any time at any time despite a significant number experiencing side-affects (Figure1). Some purposely missed medication due to a social event. Although 100% of patients did respond to experiencing side effects of tolvaptan, 74% of patients said it did not interfere with their quality of life. 88.8% of patients were on the full dose of 90mg in the morning and 30mg after 8 hours. The Tolvaptan clinic in HUTH is run as a pharmacist led with consultant oversight. Currently no issues have arisen but the patients’ view of a pharmacist led-clinic is currently being studied. Conclusion This study demonstrates that despite a number of expected side-affects; with good patient education and follow-up, few patients stopped therapy and most patients remain compliant to tolvaptan therapy. Currently a pharmacist led, consultant backed tolvaptan clinic has not adversely affected this success.

Isotretinoin Use in Acne: Prospective Evaluation of Adverse Events

2000 ◽  
Vol 4 (2) ◽  
pp. 66-70 ◽  
Author(s):  
Peter R. Hull ◽  
Coby Demkiw-Bartel
Keyword(s):  
Body Weight ◽  
Back Pain ◽  
Side Effects ◽  
Adverse Events ◽  
Prospective Analysis ◽  
Prospective Evaluation ◽  
Duration Of Treatment ◽  
Dry Eyes ◽  
Severe Acne ◽  
Lower Back

Background: Isotretinoin is an effective treatment for severe acne. Although the spectrum of side effects has been well documented, the changing incidence of such side effects over the course of treatment has not been studied in detail. Objectives: The purpose of our study was to examine a group of patients monthly over their course of treatment and prospectively document the side effects experienced. Methods: Over the period between January 1991 and July 1996, 124 courses of treatment with isotretinoin for severe acne were followed. The patients were treated for 4 months at a dose of 1 mg per kg body weight. A questionnaire was administered monthly, inquiring specifically about side effects known to be associated with isotretinoin. Any additional side effects were also noted. Results: The majority of patients experienced persistent dryness of lips. Dry eyes affected 40% of patients; this continued throughout treatment in 25%. Contact lens wearers were more likely to develop conjunctivitis. Lower back pain was reported early in about 30% of patients and fewer than 10% of patients would develop it later in the course of treatment. Arthralgia was noted in 16.5% of patients at the first visit and there was little change with ongoing treatment. Hair loss was experienced in a small percentage but was rarely noted on more than one occasion. Headaches occurred in less than 10% and were occasionally severe, but most often intermittent and recorded at a single visit. Depression occurred in 4% of patients and tended to persist throughout the treatment. All these patients completed the full course of treatment. Conclusion: This prospective analysis has shown that patients treated with isotretinoin experienced a predictable series of side effects. Some occurred fleetingly, but several persisted for the duration of treatment.

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (&gt; 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

scholarly journals CLINICAL EVALUATION OF AYURVEDIC FORMULATION OF COLICARMIN PLUS SYRUP ON COLIC, GRIPING PAIN, INDIGESTION, NAUSEA, VOMITING, AND OTHER DIGESTIVE DISORDERS IN PAEDIATRICS AND GERIATRICS PATIENTS.

2016 ◽  
pp. 114
Author(s):  
Devendra Mishra ◽  
Girish H Patel ◽  
Rupali Gathani
Keyword(s):  
Side Effects ◽  
Geriatric Patients ◽  
Total Duration ◽  
Nausea And Vomiting ◽  
Duration Of Treatment ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Number Of Patients ◽  
Digestive Disorders

<p>ABSTRACT<br />Objective: An open label study to assess the effect of colicarmin plus syrup on colic and griping pain, indigestion, nausea and vomiting in children,<br />and geriatric patients.<br />Methods: (a) A study was conducted on 75 number of patients to evaluate the effect of colicarmin plus syrup on colic and griping pain, indigestion,<br />nausea and vomiting in children, and adults, (b) mostly these children were selected from different classes of families, (c) all the patients were checked<br />on the 1<br />st<br />, 2<br />nd<br />, and 3<br />rd<br /> week after starting the therapeutic dose.<br />Dosage schedule: (a) Children: 1 Teaspoonful thrice a day after meals, (b) adults: 2 Teaspoonful twice to thrice a day after meals.<br />Results: (a) Colic and griping pain: In the total duration of treatment, no of patients recovering were 23-on 1<br />st<br /> week, 4-on 2<br /> week,<br />overall result is 93.54%, (b) indigestion: In the total duration of treatment, no of patients recovering were 26-on 1<br />st<br />nd<br /> week, and 3-on 3<br /> week, 3-on 2<br /> week, and 1-on<br />3<br />rd<br /> week, the overall result is 93.75%, (c) nausea and vomiting: In the total duration of treatment, no of patients recovering were 8-on 1<br /> week, 2-on<br />2<br />nd<br /> week, and 1-on 3<br />rd<br /> week, the overall result is 91.33%.<br />Conclusion: Based on the study, we can conclude that colicarmin plus syrup is an Ayurvedic formulation with benefits such as digestive, carminative,<br />anthelmintic, antiflatulent, antispasmodic, and devoid of side effects.<br />Keywords: Digestive, Carminative, Anthelmintic, Antiflatulent and Antispasmodic.<br />nd</p><p>st</p><p>rd</p>

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