scholarly journals The effect of Clofazimine Concentration on QT prolongation in patients treated for tuberculosis

2021 ◽  
Author(s):  
Mahmoud Tareq Abdelwahab ◽  
Richard Court ◽  
Daniel Everitt ◽  
Andreas H. Diacon ◽  
Rodney Dawson ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Qt Prolongation ◽  
Current Standard ◽  
Nonlinear Mixed Effects Model ◽  
Tuberculosis Patients ◽  
Resistant Tuberculosis ◽  
Increased Risk ◽  
Current Standard Treatment ◽  
Pre Treatment ◽  
Group B

Rationale Clofazimine is classified as a WHO group B drug for the treatment of rifampicin-resistant tuberculosis. QT prolongation, which is associated with fatal cardiac arrhythmias, is caused by several anti-tubercular drugs, including clofazimine, but there are no data quantifying the effect of clofazimine concentration on QT prolongation. Objectives To describe the effect of clofazimine exposure on QT prolongation Methods Fifteen adults drug-susceptible tuberculosis patients received clofazimine mono-therapy as 300 mg daily for three days followed by 100 mg daily in one arm of a 2-week, multi-arm early bactericidal activity trial in South Africa. Pre-treatment Fridericia-corrected QT (QTcF) (105 patients, 524 ECGs) and QTcF’s from the clofazimine-monotherapy arm matched with clofazimine plasma concentrations (199 ECGs) were interpreted with a nonlinear mixed-effects model. Measurements and Main Results Clofazimine was associated with significant QT prolongation described by an Emax function. We predicted clofazimine exposures using 100-mg daily doses and two-weeks loading with 200 and 300 mg daily, respectively. The expected proportions of patients with QTcF change from baseline above 30 ms (ΔQTcF>30) were 2.52%, 11.6%, and 23.0% for 100, 200, and 300-mg daily doses, respectively. At steady state, the expected proportion with ΔQTcF>30 ms was 23.7% and for absolute QTcF>450 ms was 3.42% for all simulated regimens. Conclusions The use of loading doses of 200 and 300 mg is not predicted to expose patients to increased risk of QT prolongation, compared to the current standard treatment, and is, therefore, an alternative option to achieve therapeutic concentrations faster.

scholarly journals Intestinal perforation after radical cystectomy due to drain: Case report

2014 ◽  
Vol 86 (4) ◽  
pp. 295
Author(s):  
Salih Budak ◽  
Hüseyin Aydemir ◽  
Hasan Salih Saglam ◽  
Oztug Adsan
Keyword(s):  
Bladder Cancer ◽  
Case Report ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Potential Risk ◽  
Intestinal Perforation ◽  
Standard Treatment ◽  
Foley Catheter ◽  
Current Standard ◽  
Current Standard Treatment

The current standard treatment for nonmetastatic invasive bladder cancer is radical cystectomy with urinary diversion. Radical cystectomy surgery carries a serious potential risk of complications. In this case report, an intestinal perforation which was thought to be occurred due to a Foley catheter placed as a drain after the cystectomy is presented.

scholarly journals Congenital Pulmonary Alveolar Proteinosis

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Saber Hammami ◽  
Khaled Harrathi ◽  
Khaled Lajmi ◽  
Samir Hadded ◽  
Chebil Ben Meriem ◽  
...  
Keyword(s):  
Pulmonary Surfactant ◽  
Standard Treatment ◽  
Pulmonary Alveolar Proteinosis ◽  
Late Onset ◽  
Spontaneous Remission ◽  
Lung Lavage ◽  
Current Standard ◽  
Whole Lung Lavage ◽  
Current Standard Treatment ◽  
Alveolar Proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare syndrome characterized by pulmonary surfactant accumulation within the alveolar spaces. It occurs with a reported prevalence of 0.1 per 100,000 individuals. Two clinically different pediatric types have been defined as congenital PAP which is fatal and a late-onset PAP which is similar to the adult form and less severe. The clinical course of PAP is variable, ranging from spontaneous remission to respiratory failure. Whole-lung lavage is the current standard treatment for PAP patients. We report a new congenital case of PAP.

scholarly journals Endovascular thrombectomy for the treatment of acute ischemic stroke

2015 ◽  
Vol 74 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Cleusa P. Ferri ◽  
Anna Buehler ◽  
Uri Adrian Prync Flato ◽  
Paulo Puglia Junior ◽  
Jefferson G. Fernandes
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Current Standard ◽  
Clinical Trial Registry ◽  
Endovascular Thrombectomy ◽  
Randomized Controlled ◽  
Current Standard Treatment ◽  
Unknown Status ◽  
New Treatments

ABSTRACT Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

scholarly journals Initial treatment of CLL: integrating biology and functional status

Blood ◽  
2015 ◽  
Vol 126 (4) ◽  
pp. 463-470 ◽  
Author(s):  
Nitin Jain ◽  
Susan O’Brien
Keyword(s):  
Older Patients ◽  
Standard Treatment ◽  
Lymphocytic Leukemia ◽  
First Line ◽  
Current Standard ◽  
Phase 3 ◽  
First Line Therapy ◽  
Line Therapy ◽  
Current Standard Treatment ◽  
Ongoing Phase

Abstract A better understanding of the biology of chronic lymphocytic leukemia (CLL) has led to significant advances in therapeutic strategies for patients with CLL. Chemoimmunotherapy (CIT) has been the standard first-line therapy for CLL. Age and comorbidities can help decide which patients may benefit from a CIT approach. FCR (fludarabine, cyclophosphamide, and rituximab) is the current standard treatment option for younger patients with CLL. For older patients and for patients with renal dysfunction, bendamustine and rituximab may be a better option. For older patients with comorbidities who may not be able to tolerate intensive CIT, the combination treatment of chlorambucil and obinutuzumab or ofatumumab is an option. For patients with del(17p), ibrutinib is the treatment of choice. Several ongoing phase 3 clinical trials with novel therapies will further refine the frontline therapy of CLL.

scholarly journals Novel agents in a young patient with osteosarcoma: A short review

2021 ◽  
Author(s):  
Oskar Steinbrecher ◽  
Thomas Brodowicz ◽  
Wolfgang Lamm
Keyword(s):  
Surgical Resection ◽  
Standard Treatment ◽  
Clinical Course ◽  
Lung Metastases ◽  
Short Review ◽  
Current Standard ◽  
Malignant Bone Tumors ◽  
Isolated Lung ◽  
Current Standard Treatment ◽  
Localized Disease

SummaryOsteosarcomas are rare malignant bone tumors, most frequently occurring in children as well as adolescents and young adults. Therapy of initially localized disease consists of neoadjuvant chemotherapy followed by surgical resection and adjuvant chemotherapy. Osteosarcomas often present relapses, most commonly lung metastases. Treatment of isolated lung metastasis most commonly includes surgical resection. The correct adjuvant treatment option is still under investigation. In this manuscript we describe the clinical course of an osteosarcoma patient and give a review of the literature regarding current standard treatment for localized as well as pulmonary metastatic disease.

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