Clinical Effectiveness and Dose Titration in Pediatric Practice

The study included patients with a verified diagnosis of “Traction retinal detachment” (RD) in pediatric (50 patients, mean age 13.8 ± 1.1 years, age range from 11 to 18 years) and adults (50 patients, mean age 54, 6 ± 2.2 years, age range 19 to 72 years). The control groups included 25 children (mean age 13.1 ± 1.2 years) and 25 adults (mean age 52.8 ± 1.6 years) patients without pathology of the organ of vision. A comprehensive examination of the functional state of the visual analyzer was performed, including the assessment of clinical (maximum corrected distance visual acuity, BCVA), subjective (Quality of Life, QOL), hemodynamic (pulsation index in the central retinal artery, PI), electrophysiological (threshold of electrical sensitivity of the retina (PESR); threshold of electrical lability of the retina; critical frequency of fusion and flashing (presentation of a red object); photostress test) and biochemical (antioxidant activity in the lacrimal fluid, AOA; superoxide dismutase indicator, PS in the lacrimal fluid) indicators of the visual system. The data obtained indicate some differences in the studied parameters in patients with OS in pediatric and adult practice. In particular, a higher level of BCVA in adults was found (by 18.8 %, p < 0.001). Along with this, it was determined that RD in children is accompanied by more pronounced disorders of hemodynamic and antioxidant parameters, which is associated with a more pronounced degree of proliferative vitreoretinopathy and preservation of antioxidant defense mechanisms. The results of stepwise discriminant analysis of the statistical characteristic F, which determines the weighting coefficient of the relationship in the regression equation of the basic AOA parameter with each indicator in the general array, determined the following most informative indicators (F > 3.0) of the visual system of patients with OS associated with antioxidant protection: in an adult practice — BCVA, QOL, PI, PESR, PS; in pediatric practice — BCVA, PI, PESR, PS. The obtained similar results of statistical analysis for children and adults are actualized by research in pediatric practice aimed at increasing the clinical effectiveness of vitrectomy for RD based on antioxidant protection methods tested in adult practice.

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Mukolitics in the therapy of respiratory diseases in pediatric practice

Medical Council ◽

10.21518/2079-701x-2020-10-48-54 ◽

2020 ◽

pp. 48-54

Author(s):

E. L. Rashitova ◽

A. M. Zakirova ◽

A. G. Kadriev ◽

A. A. Kadriev

Keyword(s):

Respiratory Diseases ◽

Clinical Symptoms ◽

Recovery Period ◽

Dynamic Control ◽

Clinical Effectiveness ◽

Main Group ◽

Pediatric Practice ◽

Treatment Standards ◽

Cough Syrup ◽

Wet Cough

Introduction. Mucolytic drugs are included in treatment standards and clinical guidelines for the management of children with respiratory diseases.Target. To study the effectiveness of mucoactive therapy through its comparative evaluation in pediatric practice with respiratory pathology.Materials and methods. A total of 48 patients (mean age 8.6 ± 4.1 years) with respiratory diseases were examined. They received conventional therapy and were divided into groups: the main one took Ambroxol (26) in syrup 15 mg/5 ml three times a day 4 days; comparison – a complex cough syrup with marshmallow (22) three times a day – 7 days. Dynamic control of clinical symptoms through statistical analysis and on special scales, accounting for clinical symptoms were evaluated out on the 1st, 3rd, 5th, 7th and 10th day from the start of mucoactive therapy.Results and discussion. The reception of ambroxol was accompanied by a pronounced muco-regulatory effect. On the 2nd day of treatment: significant relief of sputum discharge (p = 0.0002), dry cough stopped faster (p = 0.0007), wet cough remained in the recovery period for a short time (p = 0.003); by the 4th–6th day of treatment, a significant decrease in sputum volume and its production period (p = 0.017), shorter duration of dry (3.82 ± 0.84 and 1.79 ± 0.18 days; p = 0.022) and wet rales in the lungs (3.57 ± 0.78 and 1.61 ± 0.21 days; p = 0.024), the severity of dry cough in the main group by 5–7 days in children with allergopathology was less (p = 0.0001). On the 7th day, the severity of wet rales in patients of the main group was 0.08 ± 0.05 points, and in the comparison group 0.18 ± 0.07 points (p = 0.0003), the duration of wet cough (4.4 ± 0.23 against 5.71 ± 0.38 points), sputum discharge (4.63 ± 0.38 against 5.74 ± 0.35 points) and rhinorrhea (2.69 ± 0.57 against 4.42 ± 0.32 points) (p < 0.05).Findings. The clinical effectiveness of secretolitics is confirmed by reliably quick relief of dry and wet cough, sputum production intensity.

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Febuxostat: a new drug for an old disease. Do we really need it?

Italian Journal of Medicine ◽

10.4081/itjm.2009.103 ◽

2013 ◽

pp. 103-106

Author(s):

Giovanni Gulli ◽

Luigi De Filippis

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Acid Concentration ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Fixed Dose ◽

Dose Titration ◽

Uric Acid Concentration ◽

Once Daily ◽

Serum Uric Acid Concentration

BACKGROUND Febuxostat is a non-purine selective inhibitor of xanthine oxidase whose therapeutic effect is decreasing the serum uric acid concentration. Febuxostat has a marketing authorisation for the treatment of chronic hyperuricaemia in conditions where urate/uric acid deposition has already occurred. The recommended dose of febuxostat is 80 mg once daily. If the person’s serum uric acid concentration is above 6 mg/dL after 2-4 weeks, febuxostat 120 mg once daily may be considered. The most common side effects associated with febuxostat are diarrhoea, nausea, headache, liver function test abnormalities and rash. The evidence in support of the clinical effectiveness of febuxostat in comparison with allopurinol is not strong. DISCUSSION A meta-analysis showed that although the urate-lowering efficacy of febuxostat was statistically significantly higher than fixed-dose allopurinol (300 mg/day), a higher proportion of patients receiving febuxostat needed treatment for gout flares compared with those receiving fixed-dose allopurinol. For the febuxostat 80 mg/day group this difference was not statistically significant (p > 0.18), but for the 120 mg/day febuxostat group it was. Moreover, guidelines recommend dose titration for allopurinol according to therapeutic targets. It is possible that dose-titrated allopurinol may be more effective than fixed-dose allopurinol. CONCLUSIONS Febuxostat is a plausible improvement on current second-line options. These options are considered where allopurinol is not appropriate, e.g. because of chronic kidney disease, intolerance or lack of response.

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Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol

American Journal of Nephrology ◽

10.1159/000518545 ◽

2021 ◽

Vol 52 (10-11) ◽

pp. 798-807

Author(s):

George Fadda ◽

Michael J. Germain ◽

Varshasb Broumand ◽

Andy Nguyen ◽

November McGarvey ◽

...

Keyword(s):

Extended Release ◽

Randomized Clinical Trials ◽

Clinical Effectiveness ◽

Vitamin D Insufficiency ◽

Dose Titration ◽

Hydroxyvitamin D ◽

Included Patient ◽

Ckd Stage ◽

Before And After ◽

History Of

Introduction: The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC’s efficacy and safety in increasing serum 25-hydroxyvitamin D (25D) and reducing parathyroid hormone (PTH) in the indicated population. Materials and Methods: Medical records of 174 patients who met study criteria from 15 geographically representative United States nephrology clinics were reviewed for 1 year before and after initiation of ERC treatment. Enrolled subjects had ages ≥18 years, stage 3 or 4 CKD, and a history of SHPT and VDI. Key study variables included patient demographics, medication usage, and laboratory results, including serial 25D and PTH determinations. Results: The enrolled subjects had a mean age of 69.0 years, gender and racial distributions representative of the indicated population, and were balanced for CKD stage. Most (98%) received 30 mcg of ERC/day during the course of treatment (mean follow-up: 24 weeks). Baseline 25D and PTH levels averaged 20.3 ± 0.7 (standard error) ng/mL and 181 ± 7.4 pg/mL, respectively. ERC treatment raised 25D by 23.7 ± 1.6 ng/mL (p < 0.001) and decreased PTH by 34.1 ± 6.6 pg/mL (p < 0.001) with nominal changes of 0.1 mg/dL (p > 0.05) in serum calcium (Ca) and phosphorus (P) levels. Discussion/Conclusion: Analysis of postlaunch data confirmed ERC’s effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%.

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