scholarly journals Management of Fetal Supraventricular Tachycardia: Case Series from a Tertiary Perinatal Cardiac Center

2021 ◽  
pp. 1-7
Author(s):  
Elisha Broom ◽  
Joseph T. Thomas ◽  
Scott Petersen ◽  
Alex Gooi ◽  
Cameron Ward ◽  
...  
Keyword(s):  
Supraventricular Tachycardia ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Treatment Modalities ◽  
Study Cohort ◽  
First Line Therapy ◽  
Line Therapy ◽  
Therapy Choice ◽  
Prognostic Feature ◽  
Adverse Perinatal Outcomes

<b><i>Background:</i></b> Fetal supraventricular tachycardia is a relatively uncommon cardiac rhythm abnormality which is often associated with adverse perinatal outcomes if untreated. Although there are several treatment modalities and protocols in use globally, there is no consensus as to the most effective antiarrhythmic to manage this condition. <b><i>Aim:</i></b> This study aimed to evaluate perinatal outcomes following prenatal maternal therapy for fetal supraventricular tachycardia. <b><i>Materials and Methods:</i></b> This was a 20-year retrospective cohort study. Institutional records were reviewed for antenatal therapy choice and maternal and fetal outcomes. <b><i>Results:</i></b> Sixty-nine cases met diagnostic criteria for fetal SVT, of which 56 (81%) received maternal antiarrhythmic therapy. Digoxin was the most common, but least effective, first-line therapy in 28 patients, achieving successful rate reversion in 35.7%. Thirty-one patients (55%) required second-line therapy, and this was most successful with digoxin and flecainide polytherapy achieving rate reversion in 17 of 18 cases (94.5%) at a median of 3 days (1.5–7). Hydrops was present in 23 (33%) cases at initial presentation, 16 of which achieved rate reversion. There was minimal difference in treatment efficacy comparing single- or multiple-agent treatment in the setting of hydrops (50% vs. 42.8%). Side effects occurred in 14/56 treated patients (25%) but were severe in only 8 (14.3%) women, most commonly with digoxin and flecainide polytherapy (6 of 8 cases). There were 3 (4%) fetal deaths amongst the study cohort. <b><i>Conclusions:</i></b> Digoxin and flecainide polytherapy were well tolerated and successfully achieved rhythm and rate control in fetuses with prenatally diagnosed supraventricular tachycardia. The presence of hydrops was a poor prognostic feature.

Reassessment of treatment modalities for paediatric patients with chronic immune thrombocytopenia

2009 ◽  
Vol 29 (02) ◽  
pp. 171-176 ◽  
Author(s):  
G. Janssen ◽  
A. Borkhardt ◽  
H. J. Laws
Keyword(s):  
Lupus Erythematosus ◽  
Immune Thrombocytopenia ◽  
Spontaneous Recovery ◽  
Treatment Modalities ◽  
First Line ◽  
Second Line Therapy ◽  
Chronic Itp ◽  
First Line Therapy ◽  
Line Therapy ◽  
Acute Form

SummaryApproximately 70% of children have the acute form of immune thrombocytopenia (ITP), which is defined by recovery within six months of presentation with or without treatment. Chronic ITP is to be reserved for patients with platelets < 100 000/μl for more than twelve months and exclusion of other diagnosis like systemic lupus erythematosus or bone marrow failures. In children, the chance of spontaneous recovery is 52% after diagnosis of chronic ITP. The Intercontinental Childhood ITP Study group recommends that children without bleeding may not require therapy regardless of their platelet count. Whereas in patients with bleeding symptoms first line therapy is defined and includes steroids or immunoglobuline, second line therapy in refractory patients with significant hemorrhagic problems is unclear. Guidelines recommend splenectomy, but for more than 50 years patients and physicians look for pharmacological alternatives. It may be that rituximab is a promising option which has been proven to be effective with few adverse effects. Till now the treatment has focused on immunomodulation. Research has now focused on stimulating platelet production. In this review we discuss old and new therapy modalities for children with cITP.

scholarly journals Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wen-Fang Li ◽  
An-Shine Chao ◽  
Shuenn-Dyh Chang ◽  
Po-Jen Cheng ◽  
Lan-Yan Yang ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Gestational Age ◽  
Odds Ratio ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Brain ◽  
Brain Image ◽  
Fetal Survival ◽  
Gestational Age At Delivery ◽  
Adverse Perinatal Outcomes

Abstract Background To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. Methods A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. Results In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. Conclusions Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.

scholarly journals Nintedanib Treatment for Idiopathic Pulmonary Fibrosis Patients Who Have Been Switched from Pirfenidone Therapy: A Retrospective Case Series Study

2020 ◽  
Vol 9 (2) ◽  
pp. 422 ◽  
Author(s):  
Andrea Vianello ◽  
Francesco Salton ◽  
Beatrice Molena ◽  
Cristian Turato ◽  
Maria Laura Graziani ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Progression ◽  
Safety Profile ◽  
Real Life ◽  
Case Series ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Case Series Study

Background: The efficacy and effectiveness of nintedanib as a first-line therapy in idiopathic pulmonary fibrosis (IPF) patients have been demonstrated by clinical trials and real-life studies. Our aim was to examine the safety profile and effectiveness of nintedanib when it is utilized as a second-line treatment in subjects who have discontinued pirfenidone. Methods: The medical charts of 12 patients who were switched from pirfenidone to nintedanib were examined retrospectively. The drug’s safety was defined by the number of adverse events (AEs) that were reported; disease progression was evaluated based on the patient’s vital status and changes in forced vital capacity (FVC) at 12-month follow-up. Results: The numbers of patients experiencing AEs and of the AEs per patient in our study group didn’t significantly differ with respect to a group of 56 individuals who were taking nintedanib as a first-line therapy during the study period (5/12 vs. 22/56; p = 0.9999, and 0.00 (0.00–1.00) vs. 0.00 (0.00–3.00); p = 0.517, respectively). Two out of the 3 patients who had been switched to nintedanib due to a rapid disease progression showed stabilized FVC values. Conclusions: Nintedanib was found to have an acceptable safety profile in the majority of the IPF patients switched from pirfenidone. Prospective studies are warranted to determine if the drug can effectively delay disease progression in these patients.

Patterns of pharmaceutical therapy in advanced melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20014-e20014 ◽  
Author(s):  
Aikaterini Bilitou ◽  
Zhongyun Zhao ◽  
Beth L. Barber ◽  
Genevieve Sian Clapton ◽  
Deborah Saltman
Keyword(s):  
Braf Mutation ◽  
Standard Of Care ◽  
Advanced Melanoma ◽  
Treatment Modalities ◽  
Second Line ◽  
Wild Type ◽  
First Line ◽  
Pharmaceutical Therapy ◽  
First Line Therapy ◽  
Line Therapy

e20014 Background: Since 2011, two therapies that provide novel approaches to the treatment of advanced (unresectable or metastatic) melanoma have been introduced to the market: ipilimumab for second line and vemurafenib for BRAF mutation-positive melanoma. It is not known how the new drugs influence treatment; this study investigated current treatment patterns in advanced melanoma. Methods: A clinician-validated, web-based survey was administered between August and November 2012 to clinicians who treat advanced melanoma in France, Germany, Italy, Spain, and the UK. Respondents were asked about their treatment of patients in the previous 12 months, including treatment modalities and pharmaceutical therapies used, and factors that affect treatment choice. Results: 150 oncologists and dermatologists completed the survey, 30 in each country. Pharmaceutical therapy was more commonly used than other treatment modalities and varied by stage of disease. A high proportion of patients with late stage of disease were treated with pharmaceutical therapy in Germany (85% in M1B) and France (83% in M1C). Among the countries, 51% (Italy) to 87% (France) of respondents test BRAF mutation status. In patients with wild-type BRAF tumors, dacarbazine, which has not been shown to provide any overall survival benefit, was the most commonly used drug for first-line therapy in all countries. In mutated BRAF tumors, vemurafenib was the most commonly used drug in first line therapy in 3 of 5 countries. There was no standard of care in second line for either patients with wild-type or mutated-BRAFtumors; therapies used included fotemustine, temozolomide, interferon, paclitaxel, and ipilimumab. Conclusions: Treatment options for patients with advanced melanoma are limited, particularly for patients with wild-type BRAF disease. In second line, there does not appear to be an established standard of care: a range of treatments are used, including several not indicated for melanoma.

Pregnancy-Related and Perinatal Outcomes in Women With Multiple Sclerosis

2021 ◽  
Vol 11 (4) ◽  
pp. 280-290
Author(s):  
Johanna Balslev Andersen ◽  
Tine Iskov Kopp ◽  
Finn Sellebjerg ◽  
Melinda Magyari
Keyword(s):  
Multiple Sclerosis ◽  
General Population ◽  
Perinatal Outcomes ◽  
Cross Sectional Study ◽  
Study Cohort ◽  
Sectional Study ◽  
Cross Sectional ◽  
Comparison Cohort ◽  
Adverse Perinatal Outcomes ◽  
In Pregnancy

ObjectiveTo investigate differences in pregnancy-related and perinatal outcomes in women with multiple sclerosis (MS) compared with the general population.MethodsWe conducted a cross-sectional study including pregnancies from January 1, 1997, to December 31, 2016, to women registered in the Danish Multiple Sclerosis Registry (the study cohort). Pregnancy-related and perinatal outcomes were compared with a randomly selected subcohort of pregnancies from the general population (the comparison cohort) using logistic regression adjusted for possible confounders.ResultsIn total, 2,930 pregnancies were included in the study cohort and 56,958 pregnancies in the comparison cohort. No differences were found in pregnancy-related complications (preeclampsia/gestational diabetes or placenta complications), emergency caesarean section (c-section), instrumental delivery, low Apgar score, stillbirth, preterm birth, or congenital malformations. Elective c-section (odds ratio [OR] 1.89 [95% confidence interval (CI) 1.65–2.16]), induced delivery (OR 1.15 [95% CI 1.01–1.31]), and being born small for gestational age (SGA) (OR 1.29 [95 %CI 1.04–1.60]) had a higher prevalence in the study cohort, whereas the prevalence of signs indicating asphyxia was lower in the study cohort (OR 0.87 [95% CI 0.78–0.97]) relative to the comparison cohort.ConclusionWe found a higher prevalence of elective c-sections, induced delivery, and infants being SGA among newborns to women with MS, whereas the prevalence of asphyxia was lower in the study cohort. There were no significant differences in severe adverse perinatal outcomes when comparing women with MS and their newborns with those of the general population.

ST-Segment Resolution on ECG after Streptokinase with Stemi in Diabetics

2021 ◽  
Vol 15 (7) ◽  
pp. 1767-1768
Author(s):  
Saira Fayyaz ◽  
Azher Mehmood Kiani ◽  
Qazi Abdul Saboor ◽  
Husnain Bashir ◽  
Rakesh Bahadur Adhikari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Case Series ◽  
First Line ◽  
Exclusion Criteria ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
First Line Therapy ◽  
Line Therapy ◽  
St Segment

Objective: observe effectiveness of streptokinase in diabetic cases presenting with ST-segment elevation myocardial infarction Methodology: In this descriptive case series we enrolled 200 cases fulfilling inclusion/exclusion criteria from the emergency department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi. The inj. Streptokinase 1.5 million units diluted in 100 ml of normal saline administered over 1 hour and efficacy was observed. Results: Of 200 diabetic STEMI cases, the effectiveness in terms of ST segment resolution by streptokinase in diabetics presenting with ST-segment elevation myocardial infarction (STEMI) was recorded as 38.5%(n=77). Conclusion: The frequency of effectiveness of streptokinase in diabetic cases for resolution of STEMI is encouraging and it can be used as first line therapy. Keywords: STEMI, Diabetics, Streptokinase, efficacy

scholarly journals Preference and practice of Indian physicians towards the use of vasodilator di-hydralazine in the management of resistant hypertension

2020 ◽  
Vol 7 (12) ◽  
pp. 1781
Author(s):  
Pravin Kahale ◽  
Pijush Kanti Biswas ◽  
Sunil George ◽  
Sree Ranga P. C. ◽  
Pankaj Singh ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Randomized Clinical Trials ◽  
Treatment Modalities ◽  
Physician Survey ◽  
First Line ◽  
Web Based ◽  
Patient Profile ◽  
First Line Therapy ◽  
Line Therapy ◽  
Geographical Regions

Background: The treatment modalities of resistant hypertension (RH) remain a clinical challenge, often requiring secondary/add-on drugs with first-line therapy to control blood pressure (BP). This study was conducted to explore and understand the preferences and practices of Indian physicians towards the use of vasodilator (especially di-hydralazine) in the management of RH.Methods: This was a cross-sectional, observational, web-based physician survey. The study included cardiologist, nephrologist and consultant physicians from different geographical regions of India. A web-based physician survey questionnaire (PSQ) was created in google forms and the link was circulated to the physicians. Responses obtained were analysed.Results: A total of 457 physicians participated in this survey. In majority of the physicians, vasodilators were the treatment choice as secondary or add-on drugs with first line therapy to control BP in RH; especially hydralazine/di-hydralazine preferred the most. Majority of the physicians preferred to combine vasodilator with beta blocker and diuretic in patients with uncontrolled and RH. Cardiac failure, followed by chronic kidney disease (CKD), diabetes, dyslipidaemia, hypertensive emergency and angina were the common patient profile in RH in which majority physicians prescribed vasodilator (di-hydralazine). Majority of the physicians rated vasodilator di-hydralazine as “good-very good” in terms of efficacy, safety, tolerability, patient compliance and patient satisfaction in RH.Conclusions: Overall, vasodilators (hydrazinophthalazine derivatives) are preferred as add-on drugs along with first-line drugs in RH. Physician’s opinion towards the use of di-hydralazine was positive. Di-hydralazine may be preferred as an add-on therapeutic option to control BP in RH, however randomized clinical trials are needed for recommendation in cardio-renal medicine.

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