scholarly journals Effect of low dose ASV with supportive care in poisonous snake bites in Marathwada region, Aurangabad, Maharashtra, India

2015 ◽  
Vol 1 (8) ◽  
pp. 307
Author(s):  
Mangala S. Borkar ◽  
Chandrakant G. Lahane ◽  
Akshay A. Kashid ◽  
Swati U. Chavan ◽  
Sandeep G. Uppod
Keyword(s):  
Low Dose ◽  
Fresh Frozen Plasma ◽  
Average Dose ◽  
Low Doses ◽  
Number Of Patients ◽  
Snake Bites ◽  
Significant Difference ◽  
Male Preponderance ◽  
Fresh Frozen ◽  
High Doses

<p class="abstract"><strong>Background:</strong> Due to a large number of patients and severe scarcity of ASV with patches of unavailability and unaffordable high cost, low doses of ASV had to be compulsorily used for treatment of poisonous snakebites. The main objective is to study the effectiveness of low dose ASV (total &lt;50 ml) in the management of poisonous snake bites in the scenario of global ASV scarcity.</p><p class="abstract"><strong>Methods:</strong> Patients of snake bites with signs of envenomation were included in this observational, prospective study. Immediately, low dose (30 to 50 ml) of ASV was started after carefully testing intravenously. The patients were kept under intensive observation with supportive management (artificial ventilation, neostigmine-atropine, blood and fresh frozen plasma, as needed).  </p><p class="abstract"><strong>Results:</strong> In the study of 309 patients, slight male preponderance was seen (161 males and 148 females).144 patients had vasculotoxic, 122 patients had neurotoxic and 43 patients had mixed type (both vasculotoxic and neurotoxic) of envenomation. Average dose of ASV given was 35.30 ml. 297 patients survived, 12 died. In 42 cases having both neurological and vasculotoxic (mixed) snake bite, 7 patients (16.66%) died. Among 122 neuroparalytic cases, 5 (4.0983%) died. We did not get any mortality in the 145 cases of vasculotoxic snake bites. There was no statistically significant difference in the outcome of the patients whether they received higher or low doses of ASV.</p><strong>Conclusions:</strong> There was no significant difference in the outcome of poisonous snake bites whether low dose (&lt;50 ml) or high doses (&gt;50 ml) of ASV were given and practically all the victims who came on time, survived with low doses of ASV. This is very important in developing countries like India where there is high incidence of poisonous snake bites and scarcity of ASV.

scholarly journals A fatal toxic shock-like syndrome post COVID-19 infection in a child

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Houda Ajmi ◽  
Wissem Besghaier ◽  
Wafa Kallala ◽  
Abdelhalim Trabelsi ◽  
Saoussan Abroug
Keyword(s):  
Ejection Fraction ◽  
Pediatric Intensive Care ◽  
Fresh Frozen Plasma ◽  
Multiple Organ ◽  
Clinical Feature ◽  
Fresh Frozen ◽  
Life Threatening ◽  
High Doses ◽  
Definition Of ◽  
High Level

Abstract Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

scholarly journals Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

2021 ◽  
pp. 175045892095066
Author(s):  
Minna Kallioinen ◽  
Mika Valtonen ◽  
Marko Peltoniemi ◽  
Ville-Veikko Hynninen ◽  
Tuukka Saarikoski ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prothrombin Complex Concentrate ◽  
Fresh Frozen Plasma ◽  
Blood Products ◽  
Rotational Thromboelastometry ◽  
Number Of Patients ◽  
Fresh Frozen ◽  
The Mean ◽  
To Receive ◽  
Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

Abstract WP304: Prothrombin Complex Concentrate Rapidly Reverses Coagulopathy but does not Alter Mortality in Warfarin Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Xuemei Cai ◽  
Susannah Orzell ◽  
Sarah Suh ◽  
Linda Bresette ◽  
Farzaneh Sorond ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Vitamin K ◽  
Conventional Therapy ◽  
Prothrombin Complex Concentrate ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Thromboembolic Complication ◽  
Complication Rates ◽  
Significant Difference ◽  
Fresh Frozen

INTRODUCTION: Warfarin-associated intracerebral hemorrhage (wICH) remains the most lethal form of iatrogenic stroke. Conventional therapy with fresh frozen plasma (FFP) and intravenous vitamin K takes up to 30 hrs to normalize the international normalized ratio (INR). Prothrombin complex concentrate (PCC) does not require cross-match and is fast acting. We hypothesized that PCC can rapidly reverse coagulopathy and reduce mortality in wICH. Methods: We identified 130 consecutive adult wICH patients over five years from a prospectively collected database. 33 patients were excluded for death or withdrawal of care within 48 hours of admission and 8 patients were excluded for antecedent head trauma, leaving 89 patients for analysis. Forty patients received FFP and vitamin K (conventional therapy) and 49 received PCC in addition to conventional therapy. We compared 6-month mortality, time to INR normalization, quantity of FFP transfused, and thromboembolic complication rates between the two groups. We used logistic regression to adjust for important confounders. Results: PCC-treated and conventional therapy patients had similar distributions of age, sex, co-morbidities, ICH location, initial blood pressure and INR. PCC-treated patients had a higher incidence of intraventicular hemorrhage (IVH) (67% vs 33%). PCC-treated patients required less FFP (mean 6.8 units vs 3.3 units, p<0.0001) and had faster time to INR normalization (mean 3.8 hrs vs 9.8 hrs, p<0.0001). Incidence of ICH expansion was low in both groups. There was no difference in the incidence of deep venous thrombosis and pulmonary embolism (p=0.236) or troponin elevation (p=0.573). There was no significant difference in 6-month mortality (p=0.437) after adjusting for age, ICH location, ICH volume, and presence of IVH. Conclusions: PCC use in wICH was associated with shorter time to INR normalization and reduced FFP transfusion but was not associated with 6-month mortality in this cohort. There was no difference in thromboembolic complication rates between PCC-treated and FFP and vitamin K treated patients. Prospective trials of PCC are necessary to determine if its use can improve morbidity and mortality in wICH and to identify potential subgroups of wICH patients who may benefit from PCC.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

scholarly journals Proteins as targets for high dilutions of drugs: Interaction between ?-amylase and mercuric chloride.

2021 ◽  
Vol 17 (2) ◽  
pp. 24-25
Author(s):  
Nirmal Chandra Sukul ◽  
Tandra Sarkar ◽  
Atheni Konar ◽  
Anirban Sukul
Keyword(s):  
Mercuric Chloride ◽  
Binding Sites ◽  
Low Dose ◽  
Soluble Starch ◽  
Low Doses ◽  
Substrate Interaction ◽  
Enzyme Substrate ◽  
High Dilutions ◽  
High Doses ◽  
Mother Tincture

Background: High dilutions of drugs, used in homeopathy, are usually applied by oral route or foliar spray. These dilutions first come in contact with membrane or circulating proteins. Ultra low doses of mercuric chloride, called potencies, promote activity of diastase or ?-amylase in terms of breakdown of starch, a polysaccharide into a disaccharide maltose in a cell-free medium in test tubes. Merc cor or HgCl2 in high doses inhibits the enzyme activity. Aims: To see (i) whether the high and ultra low dose effects of HgCl2 involve different binding sites of the enzyme and (ii) to find an explanation for the low dose effect of HgCl2 in spite of absence of its original molecules. Methodology: Merc cor mother tincture (147 mM HgCl2) in distilled water was used undiluted in this experiment. Merc cor 200c and 1000c were prepared from the mother tincture (MT) by successive dilution with water 1:100 followed by succussion in 200 and 1000 steps, respectively, and finally preserved in 90% EtOH. These potencies and blank 90% ethanol, were diluted with deionized, distilled (DD) water 1:1000 to minimize ethanol content in test solutions. Each test solution or control was mixed with the enzyme 1:10 just before experiment. The control consisted of DD water. An isothermal calorimetry (ITC) instrument was used to measure the interaction between soluble starch and ?-amylase mixed with each potency (200c/1000c) of Merc cor, its mother tincture, ethanol and control. ITC is a thermodynamic technique which helps in measuring directly very small amount of heat evolved during chemical reaction. Soluble starch 90 µM was injected into 300 µl of 15µM ?-amylase at 2 µl / injection. Twenty injections, one every 2 min, were given. The enzyme substrate interaction in terms of heat released (exothermic) or absorbed (endothermic) were monitored by the ITC instrument. All ITC measurements were calculated and analyzed statistically by an in-built software Origin 7. Results and discussion: The data are presented in figures. While Merc cor MT shows endothermic reaction, all its potencies, ethanol and water control show exothermic reactions. There is wide variation in enthalpy (?H), entropy (?S), binding constant (K) and Gibbs free energy change (?G) among the treatments with Merc cor MT, potencies, ethanol and also control. The results indicate that Merc cor MT and its potencies act on different binding sites of the enzyme. The variation in thermodynamic parameters suggest difference in binding interaction between the drug solutions and the enzyme. This in turn influences the enzyme substrate interaction as reported in earlier studies. The potencies are virtually water modified by the starting substance HgCl2. Conclusion: The mother tincture and potencies of mercuric chloride produce different effects on the enzyme substrate interaction. Potencies show wide variation in ?H, ?S, K and ?G values. It appears from the results that the drugs used in homeopathy produce dual action on proteins. At high doses they act on a binding site(s) but at ultra low doses they act on a different binding site(s). Proteins in an organism may serve as targets for initiation of action of homeopathic potencies.

A Protocol for the Rapid Normalization of INR in Trauma Patients with Intracranial Hemorrhage on Prescribed Warfarin Therapy

2008 ◽  
Vol 74 (9) ◽  
pp. 858-861 ◽  
Author(s):  
Michael Kalina ◽  
Glen Tinkoff ◽  
Adebayo Gbadebo ◽  
Paula Veneri ◽  
Gerard Fulda
Keyword(s):  
Intracranial Hemorrhage ◽  
Prothrombin Complex Concentrate ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Operative Intervention ◽  
Trauma Patients ◽  
Number Of Patients ◽  
Fresh Frozen ◽  
Factor Concentrate

Trauma patients on prescribed warfarin therapy sustaining intracranial hemorrhage can be difficult to manage. Rapid normalization of coagulopathy is imperative to operative intervention and may affect outcomes. To identify and expedite warfarin reversal, we designed a protocol to administer a prothrombin complex concentrate. A Proplex T protocol was instituted in May 2004. It dictated that trauma patients with an International Normalized Ratio (INR) greater than 1.5, history of prescribed warfarin therapy, and intracranial hemorrhage on CT scan receive a prothrombin complex concentrate for reversal of their coagulopathy. Neither the protocol nor the factor concentrate was validated for use in this subset of trauma patients; therefore, adherence to the protocol and use of the factor concentrate was not mandatory. Patients not administered the prothrombin complex concentrate received vitamin K and fresh-frozen plasma. The protocol resulted in an increased number of patients receiving Proplex T (54.3% vs 35.4%, P = 0.047). Protocol patients had improved times to normalization of INR (331.3 vs 737.8 minutes, P = 0.048), number of patients with reversal of coagulopathy (73.2% vs 50.9%, P = 0.026), and time to operative intervention (222.6 vs 351.3 minutes, P = 0.045) compared with control subjects. There were no differences in intensive care unit (ICU) days, hospital days, or mortality. The Proplex T protocol increased the number of patients who received prothrombin complex concentrate, provided rapid normalization of INR, and improved time to operative intervention.

scholarly journals Disposition of Cocaine and Its Metabolites in Human Sweat after Controlled Cocaine Administration

2005 ◽  
Vol 51 (11) ◽  
pp. 2085-2094 ◽  
Author(s):  
Sherri L Kacinko ◽  
Allan J Barnes ◽  
Eugene W Schwilke ◽  
Edward J Cone ◽  
Eric T Moolchan ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Gas Chromatography Mass Spectrometry ◽  
Low Doses ◽  
Cocaine Exposure ◽  
Limit Of Quantification ◽  
Noninvasive Technique ◽  
Monitoring Drug ◽  
Significant Difference ◽  
Sweat Testing ◽  
High Doses

Abstract Background: Sweat testing is a noninvasive technique for monitoring drug exposure in treatment, criminal justice, and employment settings. Methods: We evaluated cocaine excretion in 9 participants’ sweat after they received 3 low doses (75 mg/70 kg) of cocaine HCl subcutaneously within 1 week and, 3 weeks later, 3 high doses (150 mg/70 kg). Six additional participants completed portions of the study. PharmChek® sweat patches (n = 1390) were collected throughout a 3-week washout period, reflecting previously self-administered drugs, and during and after controlled dosing. Results: Cocaine was the primary analyte detected with 24% of patches positive at the gas chromatography–mass spectrometry limit of quantification of 2.5 ng/patch and 7% of patches at the proposed Substance Abuse and Mental Health Services Administration cutoff of 25 ng/patch. Ecgonine methyl ester (EME) was detected more often and at generally higher concentrations than benzoylecgonine. In patches containing both metabolites, there was no statistically significant difference in the benzoylecgonine/EME ratio based on length of patch wear. During washout, 2 participants’ weekly patches tested positive (≥25 ng/patch) during the first week; one remained positive during week 2; and none were positive during week 3. Cocaine and EME were detectable within 2 h; benzoylecgonine was not detected until 4–8 h after low doses and slightly sooner after high doses. The majority of drug was excreted within 24 h. Over 70% of weekly patches worn during low doses were positive for cocaine (≥25 ng/patch), increasing to 100% during high doses. Conclusion: Sweat testing is an effective and reliable method of monitoring cocaine exposure.

Outcome of Patients (pts) Treated for Myelodysplastic Syndrome (MDS) and Secondary Acute Myeloid Leukemia (s AML) After Azacitidine (AZA) Failure

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 443-443 ◽  
Author(s):  
Thomas Prebet ◽  
Steven D. Gore ◽  
Benjamin Esterni ◽  
Raphael Itzykson ◽  
Sylvain Thepot ◽  
...  
Keyword(s):  
Low Dose ◽  
Response Rate ◽  
Univariate Analysis ◽  
Initial Response ◽  
Multivariate Model ◽  
Published Data ◽  
High Dose ◽  
Number Of Patients ◽  
Significant Difference ◽  
Number Of Cycles

Abstract Abstract 443 Background: AZA is the current standard of care for IPSS int-2 and high (“higher”) risk MDS. However, most pts will experience primary or secondary treatment failure. To date, there is no published data on the outcome of those pts. Design: 565 patients from 4 independent cohorts, who had not responded to or relapsed after response to AZA, were included. The datasets included 3 prospective trials (AZA001 (n=138; Lancet Onc, 2009), J9950 (n=26; Cancer Res 2006), J0443 (n=32; NCT00101179) trials) and data from the French ATU compassionate use program (n=369). Two cohorts administered AZA as single agent (AZA001 and French ATU) while two combined AZA with a histone deacetylase inhibitor (J9950, sodium phenylbutyrate; J0443, entinostat). 339 patients had no clinical response to AZA while 226 relapsed after initial response. The influence of pre treatment variables and salvage treatment options on the outcome after AZA failure was analyzed. Survival was measured from the date of failure of AZA. Results: The cohort included 475 MDS (including 117 RAEB-T) and 90 sAML (AML secondary to MDS). Median age was 69 years and the median number of cycles of AZA before failure was 6 (range [1-41]). Patients were randomly assigned to one learning (n=377) and one validation (n=188) set stratified on the number of deaths. There was no difference in the baseline characteristics of the 2 sets. With a median follow-up of 15 months after AZA failure, the median overall survival (OS) was 6 months and the 2-year probability of OS was 15%. The multivariate model constructed with the learning set showed that age (HR 1.02/y, 95%CI [1.01-1.03], p=0.002), sex (female 7 months vs male 5.6 months HR 1.3 [1.01-1.67] p=0.04), cytogenetics (favorable 8 months vs intermediate 5.9 months HR 1.49 [1.06-2.08] p=0.02, vs high risk 4.6 months HR 2.19 [1.63-2.91] p<0.001), bone marrow blast % before AZA (below 10% 7.8 months vs 10 to 20% 5.8 months HR 1.34 [0.97-1.84] p=0.07, vs 21%+ 4.3 months HR 1.92 [1.36-2.7] p<0.001), and the number of cycles of AZA (6 or less 4.7 months vs more 7.2 months HR 0.69 [0.54-0.9] p=0.005) were significantly associated with survival. Initial response to AZA was significant in univariate analysis (non responders 4.7 m vs 7.3 m in responders, p=0.02) but did not retain significance in the multivariate model. These results were confirmed with the validation set. Data on the treatment administered after AZA failure were available for 350 patients. Allogeneic transplantation (n= 50) (median OS 18.3 months, range [3-55+]) and investigational therapies (n= 56, including epigenetic drugs, IMIDs, and non registered compounds; median OS 13.2 months, range [1-36+]) were associated with significantly better survival than palliative care (median OS 3.3 months) or conventional cytotoxic chemotherapy (median OS 7.6 months, including AML like induction chemo and low dose chemo such as cytarabine or 6-MP). Conclusions: Outcome of patients with AZA failure was poor, although pts receiving allo SCT or investigational treatments had a somewhat better outcome. This work highlights the potential predictors of outcome and defined the baseline survival data that will help in the design of second line trials in higher risk MDS having failed treatment with AZA. *: Overall response rate for each treatment group is presented with the number of patients evaluable for response in each cohort. For the CT group, response rate for low dose chemotherapy and high dose (AML like, marked with **) chemo have been individualized. Univariate analysis (log-rank test) showed significant difference between PC and CT (p=0.002), IT (p<0.001) or ASCT (p<0.001). There was also significant differences between CT and IT (p=0.004) or ASCT(p=0.001). Difference between IT and ASCT reached borderline significance (p=0.053). Disclosures: Gore: Celgene: Research Funding, Stock options. Beach:Celgene: Employment.

Coagulation Disorder after Treatment of Pegaspargase and L-Asparaginase

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4876-4876
Author(s):  
Linwei Xu ◽  
Xiaolei Wei ◽  
Yongqiang Wei ◽  
Fen Huang ◽  
Xiaoxiao Hao ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Remission Rate ◽  
Fresh Frozen Plasma ◽  
Coagulation Disorder ◽  
Acute Lymphatic Leukemia ◽  
Coagulation Function ◽  
Lymphatic Leukemia ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Continuous Use

Abstract Introduction: Pegaspargase(PEG-ASP) and L-asparaginase(L-ASP) has been widely used in the treatment of acute lymphatic leukemia, changes of coagulation function after treatment are not actually the same. So we performed the present study to analyze coagulation disorder after PEG-ASP and L-ASP treatment of adults with acute lymphatic leukemia. Methods and materials: Totally 153 hospitalized patients with acute lymphatic leukemia treated with L-ASP or PEG-ASP were studied from January, 2010 to January, 2015. Of all 153 patients analyzed, they received L-ASP treatment 158 dose times and PEG-ASP treatment 60 dose times respectively. Results: There is no difference of the distribution of age, sex, white blood cell count at diagnosis and risk factors of the disease. Agranulocytosis combining with intestinal infection, bleeding or thrombosis and the inducing remission rate between the two groups has no significant difference (p=0.11,0.61,0.33). The total infusion of fresh frozen plasma or cryoprecipitate or fibrinogen after treatment shows no significant difference between the two groups (p=0.11,0.75,0.21).Fibrinogen level decreases slower in the treatment of PEG-ASP(9.37 day vs 7.40 day, p=0.02) than that of L-ASP. What's more, fibrinogen decreases slower when L-ASP used at interval compared with continuous use, however, the incidence rate of bleeding and related complications is higher when used at interval early (p =0.028). Conslusion: Because of the preponderance to monitor the changes of fibrinogen and the equal rate of complications and inducing remission rate, it is recommended to use PEG-ASP. L-ASP used at interval can monitor the coagulation function easily than continuous use, but the early use of L-ASP may overlay the drug side effects and related hematology toxicity caused by chemotherapy, then cause an increased incidence of complications. Disclosures No relevant conflicts of interest to declare.

scholarly journals Evaluation of the use of low-dose quetiapine and the risk of metabolic consequences: A retrospective review

2016 ◽  
Vol 6 (6) ◽  
pp. 308-313 ◽  
Author(s):  
Chelsea N. Carr ◽  
Shruti Lopchuk ◽  
Mary E. Beckman ◽  
Terrence Bradley Baugh
Keyword(s):  
Blood Pressure ◽  
Sleep Disturbances ◽  
Low Dose ◽  
Fasting Blood Glucose ◽  
Final Analysis ◽  
Metabolic Effects ◽  
Current Evidence ◽  
Average Dose ◽  
Low Doses

Abstract Introduction: Quetiapine fumarate is an atypical antipsychotic approved for the treatment of schizophrenia, major depressive disorder, and bipolar disorder. Due to the sedative effects observed at low doses, prescribers use quetiapine to aid patients with sleep disturbances. Current evidence has established that quetiapine can cause negative changes in metabolic parameters, but it is unknown if these consequences also occur at low doses. Due to the use of quetiapine for sleep, the purpose of this study is to identify if metabolic effects are also a risk with the use of low-dose quetiapine. Methods: Eligible subjects were identified through the Veterans Affairs electronic medical records as having an active prescription for quetiapine from June 30, 2012, through September 1, 2013. Subjects were then evaluated using inclusion and exclusion criteria for determination of study entrance. Descriptive statistics and t tests were utilized to identify clinical and statistical differences in outcomes. Results: A total of 403 subjects were included in the final analysis. The average dose of quetiapine was 116.8 mg and average duration of therapy was 44 months. Increases were observed in systolic blood pressure (+1.95 mmHg; P = .036), diastolic blood pressure (+1.97 mmHg; P = .001), body mass index (+0.52; P = .001), weight (+1.88 kg; P = .002), and fasting blood glucose (+6.71 mg/dL; P = .002). Conversely, a decrease in total cholesterol (−10.06 mg/dL; P &lt; .001) was recognized. Discussion: As a result of the findings, there may be negative metabolic consequences with the use of low-dose quetiapine. Routine prescribing of low doses for sleep as a first-line medication should be avoided.

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