Palonosetron <i>versus</i> Granisetron in Combination with Aprepitant and Dexamethasone for the Prevention of Chemotherapy-Induced Nausea and Vomiting after Moderately Emetogenic Chemotherapy: A Single-Institutional Retrospective Cohort Study

Postoperative nausea and vomiting (PONV) frequently complicates surgical recovery and is considered to be one of the least desirable surgical side effects. Granisetron (Kytril) 1 mg intravenously (IV) was approved by the FDA for the prevention and treatment of PONV in August 2002. Objective This cohort study evaluated outcomes and utilization associated with granisetron use for PONV prevention and treatment. Methods This was a retrospective cohort study of 400 patient records from 10 US hospitals. Patients included were those greater than or equal to 18 years of age having elective surgery under general anesthesia with granisetron administered IV for prevention or treatment of PONV. Excluded were those with concurrent radiation or chemotherapy, or those observed less than 2 hours in the post anesthesia care unit. Results Mean age was 50 y ± 17 with 272 females (68%). The majority was at moderate-high (n = 230; 58%) or mild-moderate risk of PONV (n = 155; 39%). Granisetron was administered predominantly perioperatively and at 0.1 mg dose (n = 382; 96%) from prefilled syringes extemporaneously prepared from 4 mg/4 mL vials. Total control (absence of nausea and vomiting) was experienced in 330 patients (83%), with 16 (4%) having a vomiting episode. In 167 patients at lower risk of PONV, symptoms were prevented in 148 (less than 90%). Regression analysis indicates that, in addition to absence of key risk factors, combination antiemetic prophylaxis was highly associated with optimal outcome. Granisetron dose did not impact outcome. Conclusion The majority of granisetron use for PONV was prophylactic, administered perioperatively at a 0.1 mg dose. Most patients experienced excellent control, even in the highest risk groups, particularly when granisetron was administered in combination with dexamethasone or metoclopramide.

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Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

International Journal of STD & AIDS ◽

10.1177/0956462416653559 ◽

2016 ◽

Vol 28 (5) ◽

pp. 480-485 ◽

Cited By ~ 5

Author(s):

J Hiesgen ◽

C Schutte ◽

S Olorunju ◽

J Retief

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Mortality Risk ◽

Retrospective Cohort Study ◽

Cryptococcal Meningitis ◽

Retrospective Cohort ◽

Nausea And Vomiting ◽

People Living With Hiv

Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient’s socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients’ mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2–81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6–131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7–23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

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