155. Incidence of Inefficacy and Side Effects of Golimumab in Rheumatoid Patients: A University Hospitals of Leicester Audit

Abstract Background Spinal anaesthesia (SA) is the preferred anaesthesia technique for Caesarean section. Hypotension and bradycardia are the most common side effects encountered and are more pronounced in pregnant patients, the incidence being as high as 52.6% and 2.5% in normal patients. The occurrence of hypotension can be dangerous as it compromises placental circulation and can have a detrimental effect on the foetus. Objectives The purpose of this study is to assess the efficacy of ondansetron versus dexamethasone in decreasing incidence of spinal induced hypotension in parturient undergoing cesarean surgery. Patients and Methods This study was conducted at Ain Shams University Hospitals between March 2019 till September 2019. After approval is obtained from the research ethics committee of faculty of medicine, Ain Shams University & patients’ informed consents consent from each patient after full explanation of the procedure possible side effects and complications., 75 healthy parturient, (ASA)physical status I and II undergoing elective cesarean delivery under spinal anesthesia. Results 8 mg ondansetron is more effective than 8 mg dexamethasone in the attenuation of post spinal hypotension. Also, that Dexamethasone 8 mg was as effective as ondansetron 8 mg in providing a simple, safe, cheap, and effective intra and postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden. Conclusion The present study demonstrated that, among patients who received spinal anesthesia with bupivacaine and fentanyl as adjuvant for elective for cesarean section, prophylactic intravenous 8 mg ondansetron compared to dexamethasone significantly decreases hypotension, HR fluctuation, yet the need for rescue doses for ephedrine were significantly higher in ondansetron.

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Effect of High Dose Tranexamic Acid and Etamsylate in Reducing Blood Loss during Trans-Urethral Resection of Prostate, Bladder Tumours and Percutaneous Nephrolithotomy

QJM ◽

10.1093/qjmed/hcaa070.017 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M Safan ◽

M Samir ◽

A M Saeed ◽

A S I Farag

Keyword(s):

Side Effects ◽

Blood Loss ◽

Tranexamic Acid ◽

Vital Role ◽

Control Group ◽

High Dose ◽

University Hospitals ◽

Dose Combination ◽

Group 2 ◽

Control Study

Abstract Background Bleeding is one of the most serious events that can occur intra-operative as well as post-operative in TURP, TURBT, PCNL and minimizing blood loss is of vital role in preventing or reducing morbidity and mortality following these procedures. Aim of the Work The aim of the present study was to to evaluate the efficacy of high dose tranexamic acid and etamsylate in reducing blood Loss during TURP, PCNL, TURBT and to determine if we can use them as a routine or not. Patient and Methods The study, was a prospective randomized control study, would be conducted on 70 patients admitted through the outpatient urology clinic in Ain shams University Hospitals and Nasser institute hospital. The 70 patients were divided into two main groups. Each one was 35 patients, each group is subdivided into 3 subgroups ((a)TURP,(b)PCNL AND (c)TURBT). Group 1 (all did not receive the combination of high dose tranexamic acid and ethamsylate) Group 2 (all received the combination of high dose tranexamic acid 2g per day and ethamsylate2.5g per day). Results We found that hemoglobin and hematocrit drop was significantly smaller in cases group and subgroups compared with the control group and subgroups, we also found that blood transfusion is reduced in control group and subgroups than in cases. Also procedure time was highly significant decreased in cases compared with controls. the high dose combination tranexamic acid 2g per day and ethamsylate2.5g per day was found to be safe without side effects especially thromboembolic side effects. Conclusion The study showed that High dose tranexamic acid and etamsylate is safe and effective in reducing blood loss during TURP,PCNL and TURBT. but we still cannot use them as a routine in all patients because our study is conducted on patients with selected criteria so further studies are needed.

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A comparative study of Fractional co2 laser combined with topical methotrexate versus Fractional co2 laser combined with topical [Calcipotriol + Betamethasone] in the treatment of nail psoriasis

QJM ◽

10.1093/qjmed/hcab093.021 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Maha Adel Shahin ◽

Ahmed Abd -Elfattah Afify ◽

Mahmoud Gamal El - Sadek El-Banna

Keyword(s):

Patient Satisfaction ◽

Side Effects ◽

Co2 Laser ◽

Negative Impact ◽

Negative Consequences ◽

University Hospitals ◽

Nail Psoriasis ◽

Fractional Co2 Laser ◽

Clinical Difference ◽

Calcipotriol Betamethasone

Abstract Background Nail psoriasis is a distressing clinical condition as it is known that psoriasis on visible areas of the skin, such as the face, hands and nails, may have a substantial negative impact on physical, psychological, and social dimensions of quality of life. The additional negative consequences of nail involvement in psoriasis are pain, inability to grasp small objects, tie shoe laces or button clothes, and cause an altered sense of fine touch. Objective To evaluate and compare the efficacy, safety and side effects of co2 laser combined with topical methotrexate in one side and topical (calcipotriol +betamethasone) in the other side of the patient for the treatment of nail psoriasis. Patients and Methods This comparative pilot study included 20 patients with nail psoriasis. They were recruited from the dermatology out-patient clinic of Ain–Shams University Hospitals, during the period from March 2019 till October 2019. The study was approved by Research Ethical Committee of Ain Shams University (FMASU M S 71/2019) and fulfilled all the ethical aspects required for a human research. Results Our study revealed that both medications showed marked statistical and clinical improvement of the nail condition in a period of 2 months when applied topically after nail exposure to fractional co2 laser which facilitated the delivery of both medications through the nail plates to the site of the psoriasis inflammation in therapeutic concentrations by creating pores through the nails. There was no statistical or clinical difference between both medications regarding the improvement of the NAPSI scores or the level of patient satisfaction. However, there were some nail symptoms that didn’t show any improvement as (sub-ungual hyperkeratosis and nail ridging). Conclusion Our treatment protocol’s side effects based mainly on the action of fractional co2 laser which caused pain and nail bleeding during sessions for some of the patients in each group, while topical methotrexate caused nail yellowish discoloration for the all involved group. However, these side effects lasted for very short time and didn’t have any impact on the level of the patient satisfaction. There was no statistical difference in the level of the patient satisfaction between both groups.

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P184 Developing a pathway for tocilizumab treatment in giant cell arteritis: a South London regional experience

Rheumatology ◽

10.1093/rheumatology/keaa111.179 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Pratyasha Saha ◽

Virinderjit Sandhu ◽

Helena Robinson ◽

Amara Ezeonyeji ◽

Israa Al-Shakarchi ◽

...

Keyword(s):

Side Effects ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Case Series ◽

Liver Function Tests ◽

University Hospitals ◽

Antibody Treatment ◽

Hub And Spoke ◽

Monoclonal Antibody Treatment ◽

Gastroprotective Agent

Abstract Background Tocilizumab is now approved by the National Institute of Health and Care Excellence (NICE) for up to a year in relapsing or refractory giant cell arteritis (GCA). The practicalities of developing a pathway for referral using a hub and spoke model were previously unknown. Here we discuss our novel experiences utilising tocilizumab for GCA in its first year of licensing, after the introduction of a new regional multi-disciplinary team referral pathway. Methods We assessed all patients started on tocilizumab for GCA between August 2018-May 2019. The central assessing hub is St George’s University Hospitals NHS Foundation Trust, a large tertiary rheumatology department in the South of England, serving a population of 1.3 million. Results As per Table 1 below. A total of 9 patients were identified: 6 female and 3 male, with an average age of 74.2 (range 63-80). 5 patients were referred internally from clinicians at St George’s Hospital, with the remainder from local district general hospitals. Steroid protocols between patients were varied, and two-thirds required a 3-day IV methylprednisolone course, including all 4 patients with visual symptoms. A third of patients were on concurrent methotrexate, a disease-modifying antirheumatic drug. 8 of 9 patients were on alendronate, vitamin D/calcium, and a gastroprotective agent, and 7 were on aspirin. Reported side effects from steroids were common, with weight gain, increased appetite and osteoporosis noted. All our 9 patients continue their tocilizumab injections, with one individual having a 3-month break for a routine hip operation, and another a 1-month hiatus due to temporary derangement in liver function tests. Tocilizumab proffered improved disease control and few side effects were noted. 3 patients have now been on tocilizumab for 12 months and raise interesting discussions about ongoing funding and treatment efficacy. Conclusion Our case series shows the development and delivery of an effective hub and spoke referral pathway for tocilizumab treatment in GCA. We show that steroid dosing could be reduced with tocilizumab, and that all subjects received full funding for treatment. Our referral pathway has encouraged the uptake of the IL-6 monoclonal antibody treatment for GCA and compliance with NICE guidelines. Disclosures P. Saha None. V. Sandhu None. H. Robinson None. A. Ezeonyeji None. I. Al-Shakarchi None. S. Chander None. R. Suresh None. A. Kaul None. N. Sofat None.

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Sarcoidosis diagnosed in the elderly: a case–control study

QJM ◽

10.1093/qjmed/hcaa171 ◽

2020 ◽

Author(s):

A Bert ◽

T Gilbert ◽

V Cottin ◽

J Mercier ◽

M Gerfaud-Valentin ◽

...

Keyword(s):

Side Effects ◽

Elderly Patients ◽

Case Control Study ◽

Clinical Presentation ◽

The Elderly ◽

Pulmonary Involvement ◽

Case Control ◽

University Hospitals ◽

Elderly Onset ◽

Control Study

Summary Background Studies on sarcoidosis in elderly patients are scarce and none have specifically evaluated patients aged ≥75 at onset. Aim We aimed to analyse the characteristics of patients with sarcoidosis diagnosed after 75 and to compare them with those of younger patients. Design Multicenter case–control study comparing elderly-onset sarcoidosis (EOS) with young-onset sarcoidosis (YOS) seen at Lyon University Hospitals between 2006 and 2018. Methods Using our institutional database, we included 34 patients in the EOS group and compared them with 102 controls from the YOS group in a 1:3 ratio. Demographic characteristics, medical history, clinical presentation, laboratory and imaging findings, sites of biopsies, histological analyses, treatments and outcomes were recorded using a comprehensive questionnaire. Results There were more Caucasians in the EOS group (94.1% vs. 59.8%; P < 0.001), who had significantly more comorbidities (mean, 3.1 ± 2 vs. 1.1 ± 1.6; P < 0.001). In the EOS group, there was less pulmonary involvement (26.5% vs. 49%; P = 0.022), less lymphadenopathy (2.9% vs. 16.7%; P = 0.041), no erythema nodosum (0% vs. 12.8%; P = 0.029) and no arthralgia (0% vs. 25.5%; P = 0.001). Conversely, uveitis was more common in the EOS group (55.9% vs. 20.6%; P < 0.001). Pathological confirmation was obtained significantly less frequently in the EOS group (67.7% vs. 85.3%; P = 0.023). Corticosteroid-related side effects were significantly more common in the EOS group (100% vs. 75.9%; P = 0.030). Conclusion Epidemiology and clinical presentation of EOS differs from YOS, including more comorbidities and more uveitis. Elderly patients are more prone to corticosteroid side effects.

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Poppers Use and High Methaemoglobinaemia: ‘Dangerous Liaisons’

Pharmaceuticals ◽

10.3390/ph14101061 ◽

2021 ◽

Vol 14 (10) ◽

pp. 1061

Author(s):

Malcolm Barrangou-Poueys-Darlas ◽

Marie Gerardin ◽

Sylvie Deheul ◽

Marion Istvan ◽

Marylène Guerlais ◽

...

Keyword(s):

Retrospective Study ◽

Side Effects ◽

Prevalence Ratio ◽

P Value ◽

University Hospitals ◽

Before And After ◽

Clinical File

Poppers are legal and largely used in France despite severe side effects, such as methaemoglobinaemia (MetHbia). Our work aimed to assess the prevalence of poppers consumers among patients with a MetHbia higher than or equal to 5% in French university hospitals and its evolution before and after the legalization of poppers in France. We conducted a national multicentre observational retrospective study. All patients for whom at least one MetHbia measurement was performed from 2012 to 2017 in university hospitals where the French addictovigilance network (FAN) is implanted were included. For each MetHbia measurement exceeding or equal to 5%, a return to the clinical file was made by the FAN to assess poppers consumption. We calculated the prevalence of MetHbia exceeding or equal to 5% and 25% and the prevalence of poppers consumption before and after the legalization. A total of 239 (0.14%) patients had a MetHbia level exceeding or equal to 5% with 25 (10.46%) cases of poppers consumption. Poppers consumption represented 68.4% (13 out of 19) of cases with MetHbia greater than or equal to 25%. Poppers consumption among patients with MetHbia exceeding or equal to 5% increased after the legalization from 4.76% to 11.67% (prevalence ratio PR = 2.45, 95% CI = [0.98–8.37], p-value = 0.190). The proportion of patients with a MetHbia level of 25% or more increased after the legalization from 4.76% to 8.63% (PR = 1.81, 95% CI = [0.68–6.82], p-value = 0.374). The use of poppers is very frequently reported by patients with MetHbia greater than or equal to 25%.

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Clinical Significance of Credé's Prophylaxis in Germany at Present

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744993000080 ◽

1993 ◽

Vol 1 (1) ◽

pp. 32-36 ◽

Cited By ~ 10

Author(s):

Udo B. Hoyme

Keyword(s):

Staphylococcus Aureus ◽

Side Effects ◽

Silver Nitrate ◽

Obstetrics And Gynecology ◽

University Hospitals ◽

Prophylactic Measure ◽

Ophthalmia Neonatorum ◽

Preventive Policy ◽

Neonatal Conjunctivitis ◽

In Pregnancy

The introduction of silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum is one of the milestones of preventive medicine. However, in our time an increasing necessity to review Credé's prophylaxis from both a human rights and a medical standpoint is required. The chairmen of the obstetrics and gynecology departments of the German university hospitals were questioned to learn about their policy and experience. Data were provided by 22 of 28 consulted institutions, representing 31,700 annual deliveries seen over a mean period of 5.5 years. Ocular prophylaxis was in use in 16 (73%) of the reporting hospitals (1% silver nitrate in 14 and gentamicin in 2). A nonspecific conjunctival reaction occurred in 5–10% of the newborns, but no major side effects were seen. Non-gonococcal ophthalmia neonatorum was observed in less than 0.1%; however, institutions without a preventive policy reported up to a 5% incidence of neonatal conjunctivitis, mostly due toStaphylococcus aureus, as well asNeisseria gonorrhoeaein two newborns. Application of silver nitrate is considered a necessary prophylactic measure and safe if it is properly administered. However, major efforts should be directed toward its replacement by alternative antiseptic substances as well as toward chlamydial screening and therapy in pregnancy.

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A Comparative Study between Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% in Patients Undergoing Infra Umbilical Surgeries

QJM ◽

10.1093/qjmed/hcab086.047 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Loay Ashraf Taha Mohammed ◽

Sherif Farouk Ibrahim ◽

Mohammed Mohammed Abd El-Fattah Ghoniem ◽

Ibrahem Mohamed El-Sayed Ahmed

Keyword(s):

Informed Consent ◽

Side Effects ◽

Comparative Study ◽

Local Anesthetics ◽

Motor Block ◽

University Hospitals ◽

Duration Of Action ◽

Suitable Alternative ◽

Fentanyl Group

Abstract Background Spinal anesthesia is a common technique for lower abdomen and lower limb surgery, but the use of local anesthetics alone may produce unwanted side effects such as prolonged motor and autonomic block, limited duration of action, besides, excessive local anesthetics can cause cardiac toxicity and central nervous system side effects. For these reasons, local anesthetics combined with other drugs, to utilize their synergistic analgesia and to reduce the dose of local anesthetics, has become a new option for anesthesiologists. Objectives This study is designed to assess and compare the effect of intrathecal Fentanyl and Dexmedetomidine as adjuvants to hyperbaric Levobupivacaine 0.5% regarding the onset, duration of sensory and motor block, duration of post operative analgesia and possible side effects in patients undergoing infra umbilical surgeries. Materials and Methods The study was performed at Ain Shams university hospitals. After obtaining ethical committee approval and informed consent from the patients. The study protocol was obtaining an informed consent; 75 patients admitted for infraumbilical surgeries in Ain Shams University hospitals operation theatre, were blindly randomized into three groups, using their medical record number (MRN) and subjected to a comparative study. A for Fentanyl group, group B for Dexmedetomidine group and group C for Levobupivacaine control group in the duration of 6 months from March to August 2019. Results The study showed that the quality of intraoperative analgesia was significantly better with dexmedetomidine than fentanyl group, and the requirement for opioids was significantly lower with dexmedetomidine than fentanyl group. The degree of motor block and postoperative analgesia was significantly denser with dexmedetomidine than fentanyl group. Conclusion From the current study we can conclude that using intrathecal 5 µg dexmedetomidine seems to be a suitable alternative to 25 µg fentanyl as adjuvants to 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Its associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of post operative analgesia as compared to fentanyl.

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High-Dose Dual Therapy versus Triple Therapy for Treatment of H. Pylori Infection: A Parallel Randomized Study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4437 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 2158-2164

Author(s):

Aya Ahmed ◽

Gehan F Balata ◽

Hany M Elsadek ◽

Mohamed Nour EL-Din ◽

Ahmed Amin

Keyword(s):

Side Effects ◽

Triple Therapy ◽

Patient Adherence ◽

Randomized Study ◽

Dual Therapy ◽

High Dose ◽

University Hospitals ◽

First Line ◽

Stool Antigen Test ◽

H Pylori

The prevalence of antibiotic resistance has considerably increased and as a result, the elimination pace of Helicobacter pylori (H.pylori) infection have decreased significantly to an unacceptable level. High dose dual therapy (HDDT) has been suggested as an alternative to standard triple therapy (TT) for the first-line treatment of H. pylori infection. The aim of the present work was to compare the effectiveness and tolerability of HDDT with standard TT, for treatment of H. pylori infection. This randomized parallel interventional study was carried out on 130 treatment naïve H. pylori infected patients, selected from outpatient clinic of Hepatology and Gastroenterology department of Zagazig University Hospitals, in the duration between November 2017 and December 2018. All patients were H. pylori positive as was evidenced by stool antigen test. Patients were divided into two groups; group A (n=65) received a 14-day HDDT (esomeprazole 40 mg twice daily and amoxicillin 1 g three times daily) whereas group B (n=65) received a 14-day TT (esomeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg, each administered twice daily). Eradication rates, side effects and drug compliance were compared among both groups. The eradication rate between the two regimens was not significantly different. The eradication rates were 80% for TT and 72.3% for HDDT (P= 0.3). No significant differences were observed between both groups regarding the side effects or patient adherence. HDDT is as effective and safe as TT as empiric first-line therapy for H pylori infection.

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