P1380A SYSTEM FOR FORECASTING OF DRUG DOSAGE FOR ANEMIA CORRECTION IN PATIENTS ON CHRONIC DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dmitriy Zinovev ◽  
Vladimir Novitskiy ◽  
Andrey Malkoch
Keyword(s):  
Drug Therapy ◽  
Drug Dosage ◽  
Hemodialysis Patients ◽  
Chronic Dialysis ◽  
Target Range ◽  
Iron Supplements ◽  
System Usage ◽  
Number Of Patients ◽  
Forecasting System ◽  
Logical Rules

Abstract Background and Aims Anemia is a most common complication of CKD in patients on chronic dialysis. Adequacy of anemia correction directly affects both patient’s life quality and patient’s long-term survival. The most important aspect of anemia correction is drug therapy. In this work, we present a system for forecasting of iron supplements and ESA (Epoetin alfa) dosage, that is based on logical rules and artificial intelligence (AI) models. Method As an input dataset, system uses patient’s anthropomorphic parameters, results of laboratory studies, and information on previous drug therapy. The output of the system are dosages of ESA an iron supplements that have to be administered in order to bring the patient’s hemoglobin as close as possible to target range of values (100-120 g/l). The system consists of two sequentially triggering forecasting models (for ESA and for iron supplements), where each model is a combination of logical rules and artificial neural network, that has been trained on a data, collected in more than 20 “Nefrosovet” hemodialysis clinics for the period of 3 years. The effect of system usage was examined for the group of 356 hemodialysis patients with median follow-up time of 4 month. The primary end-point was a number of patients in target range of hemoglobin values (100-120 g/l). Results During the study we determined that as a result of using the dose forecasting system, number of patients in target range of hemoglobin values significantly increased from 239 patients at the beginning of system employment to 266 patients at the end of the study (p=.0318). Furthermore, we observed that there was a concomitant effect of system usage – significant reduction of average monthly ESA dosage from 14300 IU at the beginning of system employment to 13900 IU at the end of the study (p=.0331). Conclusion Employment of automated drug dosage forecasting system based on logical rules and AI models, allows to improve the efficiency of anemia correction in hemodialysis patients and reduce the dosage of administered ESA, which, in turn, reduces the risk of possible complications and treatment cost.

P1393A SYSTEM FOR FORECASTING OF DRUG DOSAGE FOR BONE MINERAL DISORDERS CORRECTION IN PATIENTS ON CHRONIC DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dmitriy Zinovev ◽  
Vladimir Novitskiy ◽  
Andrey Malkoch
Keyword(s):  
Neural Network ◽  
Artificial Neural Network ◽  
Drug Dosage ◽  
Chronic Dialysis ◽  
Target Range ◽  
Forecasting Models ◽  
Number Of Patients ◽  
Forecasting System ◽  
Artificial Neural ◽  
Range Of Values

Abstract Background and Aims Bone and mineral disorders (BMD) is a common complication of CKD in patients on chronic dialysis. Timely and adequate correction of BMD is the most important aspect of patient's treatment. This work presents a system for forecasting of phosphate-binding agents (PBA) dosage and vitamin D receptor activators (VDRA) dosage. The system consists of sequentially triggering artificial neural network forecasting models (separate model for each drug type). Method As an input dataset, system uses patient’s results of laboratory studies (blood calcium, phosphate and PTH) for the period of 6 months, information on previous drug therapy and data on adequacy of patient’s dialysis therapy. The output of the system are dosages of PBA an VDRA that have to be administered in order to bring the patient’s parameters as close as possible to target range of values (2.1-2.5 mmol/l for calcium, 0.87-1.5 mmol/l for phosphate and 150-300 pg/ml for PTH). The system consists of two sequentially triggering forecasting models (for PBA and for VDRA), where each model is an artificial neural network, that has been trained on a data, collected in more than 20 “Nefrosovet” hemodialysis clinics for the period of 3 years. The effect of system usage was examined for the group of 356 hemodialysis patients with median follow-up time of 3 month. The primary end-points were a number of patients in target range of values With respect to calcium (2.1-2.5 mmol/l), phosphate (0.87-1.5 mmol/l) and PTH (150-300 pg/ml). Results During the study we determined that as a result of using the dose forecasting system, number of patients in target range of values significantly increased with respect to calcium (from 178 to 209, p=.0196), phosphate (from 99 to 152, p=.0000), and PTH (from 83 to 109, p=.0281). Conclusion Employment of automated drug dosage forecasting system based on artificial neural network models, has a positive effect on BMD correction quality, which, in turn, reduces the risk of possible complications.

Possible benefits of reformulating antiviral drugs with nanoemulsion system in the treatment of novel coronavirus infection

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Manish Kumar ◽  
Chandra Prakash Jain
Keyword(s):  
Drug Delivery ◽  
Drug Therapy ◽  
Pulmonary Surfactant ◽  
Antiviral Drug ◽  
Treatment Strategies ◽  
Drug Dosage ◽  
Antiviral Drugs ◽  
Antiviral Action ◽  
Coronavirus Infection ◽  
Novel Coronavirus

Background: An outbreak of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection or COVID 19, causing serious threats to all around the world. Until an effective and safe vaccine for novel coronavirus is developed by scientists, current drug therapy should by optimize for the control and treatment of COVID 19. Objective: In this manuscript, we are presenting a perspective on possible benefits of reformulating antiviral drug dosage form with nanoemulsion system against novel coronavirus infection. Methods: Literature review has been done on COVID 19, treatment strategies, novel drug delivery systems and role of pulmonary surfactant on lungs protection. Results: Nanoemulsion system and its components have certain biophysical properties which could increase the efficacy of drug therapy. Antiviral drugs, delivered through a nanoemulsion system containing P-gp inhibitor (surfactant and cosolvent), can inhibit the cellular resistance to drugs and would potentiate the antiviral action of drugs. Pulmonary surfactant (PS) assisted antiviral drug delivery by nanoemulsion system could be another effective approach for the treatment of COVID 19. Use of functional excipients like pulmonary surfactant (PS) and surfactant proteins (SPs), in the formulation of the antiviral drug-loaded nanoemulsion system can improve the treatment of coronavirus infection. Conclusion: In our opinion for synergizing antiviral action, lipid and protein portion of PS and their commercial analogs should be explored by pharmaceutical scientists to use them as a functional excipient in the formulation of antiviral drugloaded nanoemulsion system.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

scholarly journals Self-Care IoT Platform for Diabetic Mellitus

2021 ◽  
Vol 11 (5) ◽  
pp. 2006
Author(s):  
Jai-Chang Park ◽  
Seongbeom Kim ◽  
Je-Hoon Lee
Keyword(s):  
Blood Glucose ◽  
Self Care ◽  
Target Range ◽  
Process Data ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Iot Platform ◽  
Number Of Patients ◽  
Glucose Management ◽  
The Relationship

Diabetes mellitus is a severe chronic disease, and the number of patients has increased. To manage blood glucose levels, patients should frequently measure their blood glucose and analyze which lifestyle habits affect blood glucose levels. However, it is hard to record and analyze the relationship between their blood glucose levels and lifestyle. The internet of things (IoT) is useful to interconnect, monitor, obtain, and process data between various devices used in everyday life to fulfill a common objective. This paper proposes an intelligent self-care platform using IoT technology that helps patients with chronic diabetes manage their blood glucose levels in their target range. In particular, we developed various devices called the self-care IoT pack. It consists of five different types of devices to obtain blood glucose levels, physical activities, food intake, medication, sleeping, and so on. They can collect blood glucose levels with lifestyles that automatically impact the patient’s blood glucose level. We also devised a self-care application to display and analyze the data obtained from the IoT pack. Consequently, the proposed self-care IoT platform collects the blood glucose levels and the lifestyles without any burden of record. By reviewing the accumulated information, the patients can find bad habits in blood glucose management and improve their lifestyle.

P1574EFFECTS OF BRAZILIAN GREEN PROPOLIS EXTRACT (EPP-AF) ON INFLAMMATION IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marcelo Silveira ◽  
Flavio Teles ◽  
Erica Melo ◽  
Valeria Borges ◽  
Filipe Miranda ◽  
...  
Keyword(s):  
Control Period ◽  
Prospective Trial ◽  
Hemodialysis Patients ◽  
Intermittent Hemodialysis ◽  
Plant Materials ◽  
Propolis Extract ◽  
End Point ◽  
Number Of Patients ◽  
The Impact ◽  
Brazilian Green Propolis

Abstract Background and Aims End-stage chronic kidney disease is associated with the condition of chronic inflammation, impacting increased cardiovascular mortality in this specific population. Patients on hemodialysis are known to be predisposed to several factors that predispose to inflammation: dialysis membranes, central venous catheters, oxidative stress, fluid overload, sodium overload, uraemic toxins. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties. The aim of this study was to evaluate the impact of Brazilian green propolis extract on inflammation in hemodialysis patients. Here we present preliminary results of the trial NCT04072341. Method We performed a prospective trial, open-label 9-week crossover study examining the effect of Brazilian green propolis (250mg/day, in capsules) on inflammation in hemodialysis patients. We included patients over 18 years, under intermittent hemodialysis (thrice per week), on hemodialysis for at least 1 month and until now 37 patients were included. We excluded pregnant women, cancer carried and patients who developed infection or underwent any surgical procedure during the study period. Each period was 4 weeks in duration with a 1-week washout period in between. The primary end point was change in serum level of high-sensitivity c-reactive protein (HsCRP). Secondary end point evaluated the safety of propolis use in hemodialysis patients. Results Their mean age was 58.6 ± 15.2 years (mean ± SD), and 22 (59.4%) were men. The proportion of patients with hypertension was 14 (37.8%) and diabetes was 9 (24.3%). The number of patients using arteriovenous fistula were 26 (70.2%). The HsCRP presented (mean ± SE) 5.31 ± 1.02 mg/L at baseline, 4.26 ± 0.76 mg/L after propolis period and 4.56 ± 1.32 mg/L in control period, p = 0.0042. Safety parameters were analyzed such as amylase, aspartate aminotransferase (AST) and creatine phosphokinase (CPK); there was no difference between them before and after the use of propolis. None of the participants reported any adverse effects or allergic reactions during the treatment. Conclusion Patients on hemodialysis have an increased inflammatory state. For the best of our knowledge it was the first clinical trial who demonstrated the safety of propolis in hemodialysis patients. Brazilian green propolis demonstrated a tendency to reduce inflammation in these patients.

scholarly journals Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Miral Subhani ◽  
Kaleem Rizvon ◽  
Paul Mustacchia
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Drug Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Comorbid Conditions ◽  
Endoscopic Evaluation ◽  
Number Of Patients ◽  
Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

Relative risk for cardiovascular morbidity in hemodialysis patients regarding gene polymorphism for IL-10, IL-6, and TNF

2016 ◽  
Vol 94 (10) ◽  
pp. 1106-1109 ◽  
Author(s):  
J. Tosic Dragovic ◽  
J. Popovic ◽  
P. Djuric ◽  
A. Jankovic ◽  
A. Bulatovic ◽  
...  
Keyword(s):  
Gene Polymorphism ◽  
Cerebrovascular Accident ◽  
Gene Polymorphisms ◽  
Cardiovascular Events ◽  
Medical Center ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Cardiovascular Morbidity ◽  
Number Of Patients ◽  
Tnf Gene

Uremia-related inflammation is prone to be a key factor to explain high cardiovascular morbidity in hemodialysis patients. Genetic susceptibility may be of importance, including IL-10, IL-6, and TNF. The aim was to analyze IL-10, IL-6, and TNF gene polymorphisms in a group of hemodialysis patients and to correlate the findings with cardiovascular morbidity. This study included 169 patients on regular hemodialysis at Zvezdara University Medical Center. Gene polymorphisms for IL-10, IL-6 and TNF were determined using PCR. These findings were correlated with the cardiovascular morbidity data from patient histories. Heterozygots for IL-10 gene showed significantly lower incidence of cardiovascular events (p = 0.05) and twice lower risk for development of myocardial infarction, but experienced twice higher risk for left ventricular hypertrophy. Regarding TNF gene polymorphism, patients with A allele had 1.5-fold higher risk for cerebrovascular accident and cardiovascular events and 2-fold higher risk for hypertension and peripheral vascular disease. Patients with G allele of IL-6 gene experienced 1.5-fold higher risks for cerebrovascular accident. We need studies with larger number of patients for definitive conclusion about the influence of gene polymorphisms on cardiovascular morbidity in hemodialysis patients and its importance in everyday clinical practice.

Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24 ◽  
Author(s):  
M. Onaran ◽  
D. Erer ◽  
I. Şen ◽  
E.E. Elnur ◽  
E. Iriz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
Subcutaneous Tissue ◽  
Vascular Grafts ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

scholarly journals Insight of COVID-19/ SARS-CoV-2 and its Probable Treatment - A Mathematical Approach

2020 ◽  
Author(s):  
Amar Nath Chatterjee ◽  
Shubhankar Saha ◽  
Priti Kumar Roy ◽  
Fahad Al Basir ◽  
Evgenii Khailov ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Side Effects ◽  
Complex Dynamics ◽  
Medical Science ◽  
Threshold Value ◽  
Drug Dosage ◽  
Equilibrium Analysis ◽  
Combination Drug ◽  
Drug Dosing ◽  
Novel Coronavirus

Abstract The novel coronavirus disease (COVID19) emerged in Wuhan, China in December 2019. In a matter of weeks, the disease had spread well outside China, and now reaching countries in all parts of the globe. Its treatment and recovery are the two most primary concerns for every country. Recently, medical science has shown some studies that reveal post-infection Hydroxychloroquine (HCQ) treatment followed by lipopeptide EK1C4 could be an effective interference in prevention of the disease COVID19, spreaded by SARS-CoV-2. However, there are some side effects of these drugs, especially for aged persons, but this is yet to be explored by rescaling the drug dosage with a proper dosing time interval.We propose a mathematical model that explains combination drug therapy on the dynamics of SARSCoV-2/COVID19. We apply the method of impulsive differential equation in our model and it is useful for elucidating insights into regular drug dosing. Systematic approach of this combination of drug therapy allows us to gain more fruitful results.In this model, we first investigate the chaotic nature of the system induced by SARS-CoV-2 with and without any treatment. Then we enquire how drug therapy reduces the threshold value of infection and observe its complex dynamics. We perform equilibrium analysis, local and global stability analysis and find the region of safe dosing so that there occurs no side-effects during treatment and afterwards. Our results suggest that only proper treatment enhances the stability in a SARS-CoV-2 infected system.

scholarly journals Prevalence and Risk Factors for Chronic Kidney Disease in Family Relatives of a Cameroonian Population of Hemodialysis Patients: A CrossSectional Study

2019 ◽  
Vol 4 (1) ◽  
pp. 12-17
Author(s):  
Mazou Ngou Temgoua ◽  
Gloria Ashuntantang ◽  
Marie José Essi ◽  
Joël Nouktadie Tochie ◽  
Moussa Oumarou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fasting Blood Glucose ◽  
Hemodialysis Patients ◽  
Biological Data ◽  
Sub Saharan Africa ◽  
Herbal Remedies ◽  
Maintenance Hemodialysis ◽  
Number Of Patients

Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA. Objective: The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon. Methods: The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected. Results: A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P = 0.0015), female gender (P = 0.0357), hypertension (P = 0.0004), regular intake of herbal remedies (P = 0.0214), and diabetes mellitus (P = 0.0019). Conclusion: Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.

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