Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature

2019 ◽  
Vol 19 (3) ◽  
pp. 253-258 ◽  
Author(s):  
W. Serra ◽  
A. Fantin ◽  
C. Longo ◽  
G. Rabia ◽  
F. De Rosa ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Daily Practice ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cardiovascular Adverse Event ◽  
Baseline Evaluation ◽  
Risk Patients ◽  
Monitoring Protocols ◽  
Dose Dependent

Background: Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects. Objective: There is evidence supporting that adverse effects are dose dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols. Results: In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course. Our goal was to present two cases of daily practice, which highlighted the complexity of their management and led to underline how baseline evaluation and close follow-up with echocardiography and cardiac biomarkers, including natriuretic peptides, remain an important tool for the cardiotoxicity surveillance. Conclusion: These reflections should lead to further studies in order to identify high risk patients for cardiovascular adverse event and clarify the real incidence of cardiotoxicity of this drug and adequate follow-up timing. Finally further research is needed to evaluate strategies for prevention and attenuation of cardiovascular complications of cancer therapy.

Glucocorticoids

2020 ◽  
pp. 339-354
Author(s):  
Johannes W.G. Jacobs ◽  
Marlies C. van der Goes ◽  
Johannes W.J. Bijlsma ◽  
José A.P. da Silva
Keyword(s):  
Adverse Effects ◽  
Fasting Blood Glucose ◽  
Daily Practice ◽  
Immunosuppressive Drugs ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Ankle Oedema ◽  
Rheumatic Conditions ◽  
Rheumatic Patients

Glucocorticoids still are the most effective, broadly applicable, and cheapest immunosuppressive drugs used in the treatment of rheumatic conditions. In rheumatoid arthritis (RA) they are applied for their symptomatic effects but also for disease-modifying properties. The risk of adverse effects of glucocorticoid therapy in RA is dependent on patient (age, comorbidity, and comedication), glucocorticoid dose, type and route of administration, and treatment duration. Toxicity is important in treatment decisions, but for low-dose glucocorticoids, overestimation of the risk of adverse effects should be avoided. Monitoring safety of this therapy only requires that good follow-up of rheumatic patients in daily practice is extended with screening for osteoporosis, and pretreatment assessments of fasting blood glucose levels, risk factors for glaucoma, and a check for ankle oedema.

Neurosonographic Findings in Infants Treated by Extracorporeal Membrane Oxygenation (ECMO)

1989 ◽  
Vol 4 (1_suppl) ◽  
pp. S52-S61 ◽  
Author(s):  
Aurelio Matamoros ◽  
Joseph C. Anderson ◽  
James McConnell ◽  
David L. Bolam
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Imaging Modality ◽  
Major Complication ◽  
Hyaline Membrane Disease ◽  
Cardiovascular Complications ◽  
Membrane Oxygenation ◽  
Cranial Sonography ◽  
Baseline Evaluation ◽  
Ischemic Encephalopathy

Extracorporeal membrane oxygenation (ECMO) is an approved therapy for some neonates who have respiratory failure that is due to hyaline membrane disease, meconium aspiration, persistent pulmonary hypertension, congenital diaphragmatic hernia, or sepsis. The major complication of this therapy is hemorrhage, with intracranial hemorrhage having the highest morbidity and mortality. Seizures, incisional bleeding and bleeding in the pleural space, hypoxic-ischemic encephalopathy, renal failure, and cardiovascular complications account for most of the other complications. Cranial sonography provides an ideal imaging modality for baseline evaluation and daily follow-up; however, computed tomography and magnetic resonance imaging, because of better sensitivity, are important for assessment after ECMO. The changes in intracranial blood flow related to ECMO can be noninvasively evaluated by Doppler ultrasound modalities. (J Child Neurol 1989;4:S52-S61).

scholarly journals Multimodality diagnosis of cardiac involvement in COVID-19 patients

2021 ◽  
Vol 31 (1) ◽  
pp. 17-26
Author(s):  
Anca Balinisteanu ◽  
Hayat Memis ◽  
Gratiela Postulache-Cosmulescu ◽  
Diana Mihalcea ◽  
Sorina Mihaila ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Wide Spectrum ◽  
Multiorgan Failure ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
The Novel ◽  
Correct Treatment ◽  
And Function

The Coronavirus disease 2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), exhibits a wide spectrum of manifestations, from asymptomatic presentations to acute respiratory failure, myocardial injury, arterial or venous thrombosis, multiorgan failure, and death. Although COVID-19 mainly disrupts the respiratory syndrome, it has been shown to have detrimental impact on cardiac morphology and function, resulting in a broad range of cardiovascular complications and poor outcome, increasing morbidity and mortality of these patients. This review will summarize the knowledge on characterization of myocardial injury in COVID 19, by using cardiac biomarkers, electrocardiographic, and cardiac multi-modality imaging findings for an early and accurate diagnosis, proper management, correct treatment, and follow-up of COVID-19 patients.

scholarly journals Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Jiahe Gan ◽  
Shi-Ming Li ◽  
Shanshan Wu ◽  
Kai Cao ◽  
Dandan Ma ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Cohort Studies ◽  
Low Dose ◽  
First Year ◽  
High Dose ◽  
Moderate Dose ◽  
Myopia Progression ◽  
Axial Elongation ◽  
Dose Dependent

Purpose: To evaluate the efficacy and safety of atropine for slowing myopia progression and to investigate whether the treatment effect remains constant with continuing treatment.Method: Studies were retrieved from MEDLINE, EMBASE, and the Cochrane Library from their inception to May 2021, and the language was limited to English. Randomized controlled trials (RCTs) and cohort studies involving atropine in at least one intervention and placebo/non-atropine treatment in another as the control were included and subgroup analysis based on low dose (0.01%), moderate dose (0.01%–<0.5%), and high dose (0.5–1.0%) were conducted. The Cochrane Collaboration and Newcastle-Ottawa Scale were used to evaluate the quality of RCTs and cohort studies, respectively.Results: Twelve RCTs and fifteen cohort studies involving 5,069 children aged 5 to 15 years were included. The weighted mean differences in myopia progression between the atropine and control groups were 0.73 diopters (D), 0.67 D, and 0.35 D per year for high-dose, moderate-dose, and low-dose atropine, respectively (χ2 = 13.76; P = 0.001, I2 = 85.5%). After removing studies that provided extreme findings, atropine demonstrated a significant dose-dependent effect on both refractive change and axial elongation, with higher dosages of atropine resulting in less myopia progression (r = 0.85; P = 0.004) and less axial elongation (r = −0.94; P = 0.005). Low-dose atropine showed less myopia progression (−0.23 D; P = 0.005) and less axial elongation (0.09 mm, P < 0.001) in the second year than in the first year, whereas in high-dose atropine more axial elongation (−0.15 mm, P = 0.003) was observed. The higher dose of atropine was associated with a higher incidence of adverse effects, such as photophobia with an odds ratio (OR) of 163.57, compared with an OR of 6.04 for low-dose atropine and 8.63 for moderate-dose atropine (P = 0.03).Conclusion: Both the efficacy and adverse effects of atropine are dose-dependent in slowing myopia progression in children. The efficacy of high-dose atropine was reduced after the first year of treatment, whereas low-dose atropine had better efficacy in a longer follow-up period.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

EFFICACY OF TREATMENT OF H.PYLORI EARDICATION WITH STANDARD TRIPLE THERAPY IN PEPTIC ULCER PATIENTS

2011 ◽  
pp. 122-129
Author(s):  
Quang Di Bui ◽  
Phuoc Lam Nguyen
Keyword(s):  
Peptic Ulcer ◽  
Adverse Effects ◽  
Triple Therapy ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Duodenal Ulcers ◽  
Ulcer Disease ◽  
Intention To Treat ◽  
Standard Triple Therapy

Objectives: The aim of study is to evaluate the efficacy, tolerability and adverse effects of a standard triple therapy including Rabeprazole, Clarithromycin and Amoxicilline at Sai gon Hoan My hospital in order to consider treatment H.pylori for patients who have not yet eradicated before or need to be undertaked by alternative regimens. Methods: By descriptive cross-sectional study, the authors have examined 116 patients sufferring from peptic ulcer received 10-day therapy including Rabe (20mg b.d) plus Clari(500mg b.d) plus Amoxi(1g b.d). Eradication is confirmed with endoscopy after 4 weeks from completing of treatment. Results and Discussion: 100% of patients were initially included and noboby was dropped out of the follow-up satges. The mean age was 49 in which 62% was male, 73(62,9%) presented duodenal ulcer, 28(24,1%) gastric ulcer and 15(13%) simultaneous gastric and duodenal ulcers. All patients took medications correctly. Per-protocol and intention to treat eradication rates were both 75%(95% CI=73,4-78,3). Additionally, 62(53,4%) patients had at least one risky factor for peptic ulcer disease, smoking being the most common one 44(37,9%).The adverse effects were reported overall in 67% of the patients, mainly including changed taste, very bitter, tired 49%, trouble sleeping 12% and diarrhea 5%. Conclusion: this ten-day standard triple therapy used in this study is ineffective with high adverse effects.The first line eradication with new regimens should be alternative.

Correlation Between Recombinant Human Erythropoietin Dose and Inflammatory Status in Dialysed Patients

2017 ◽  
Vol 68 (2) ◽  
pp. 354-357 ◽  
Author(s):  
Andrei Niculae ◽  
Cristiana David ◽  
Razvan Florin Ion Dragomirescu ◽  
Ileana Peride ◽  
Flavia Liliana Turcu ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Recombinant Human Erythropoietin ◽  
Best Practice ◽  
Daily Practice ◽  
Therapeutic Benefit ◽  
Chronic Dialysis ◽  
Dialysis Patients ◽  
Protein Levels ◽  
Human Erythropoietin ◽  
Inflammatory Status

Once recombinant human erythropoietin (r-HuEPO) was introduced in daily practice, huge steps were made in combating the adverse effects induced by anemia in chronic kidney disease population. Still, r-HuEPO resistance and the doses ensuring the maximum therapeutic benefit remain matters of debate. The aim of our study was to assess the correlation between the presence and the degree of inflammation and the r-HuEPO requirements in chronic dialysis patients. We conducted a 2 years prospective study on 146 patients undergoing chronic dialysis treated with r-HuEPO. Based on their average CRP (C-reactive protein) levels, obtained from repeated samplings at 3 months interval, 3 groups were formed; we noted in each group the average values of r-HuEPO prescribed to achieve the optimum hemoglobin levels according to the dialysis best practice guidelines and all the adverse effects of the therapy. A direct correlation was observed between CRP levels and r-HuEPO requirements in the first 2 groups of patients (CRP under 6 mg/L and CRP values 6-20 mg/L), with significant increase in r-HuEPO doses between groups (p [ 0.001); the third group, CRP values over 20 mg/dL, showed a minor, insignificant increase in average r-HuEPO doses compared to mild inflammation group (p = 0.199) and more adverse effects of the therapy (p [ 0.05). Inflammation is an important determinant of anemia in chronic dialysis patients and can induce an increase in the doses of r-HuEPO. However, prescribing excessive r-HuEPO doses is not the answer in severe inflammatory status, due to lack of response and possible adverse effects.

A Review of Selected Adult Congenital Heart Diseases Encountered in Daily Practice

2020 ◽  
Vol 16 ◽  
Author(s):  
Farhan Bajwa ◽  
Syed M Jafri ◽  
Karthik Ananthasubramaniam
Keyword(s):  
Surgical Procedures ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Daily Practice ◽  
Congenital Heart Diseases ◽  
Congenital Diseases ◽  
Adult Congenital ◽  
The Common ◽  
Adult Congenital Heart Diseases

: The advancement in corrective surgical procedures and anaesthesia technology has resulted in the increase survival of patients with Congenital Heart Diseases (CHD). Most of the surviving CHD patients have successfully reached adulthood and those surviving adults now outnumber the infants born with the CHD. Unfortunately, the surviving adults with CHD do not get proper care due to either inconsistent follow up or not getting care from a specialist in the field of CHD. It is imperative for general practicing clinicians to be aware of the congenital diseases as well as the current clinical recommendations. This manuscript reviews some of the common congenital diseases seen in adults such as cardiac shunts, left heat obstructive lesions and aortopathies.

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