scholarly journals RASBURICASE INDUCED METHEMOGLOBINEMIA: A SYSTEMATIC REVIEW OF DESCRIPTIVE STUDIES

2021 ◽  
Author(s):  
BH Vidhyashree ◽  
Mohammed Zuber ◽  
Shifa Taj ◽  
Rajesh Venkatraman ◽  
BP Sathish Kumar ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Oxygen Therapy ◽  
Treatment Approach ◽  
Grey Literature ◽  
Data Abstraction ◽  
Careful Monitoring ◽  
Search Terms ◽  
Study Selection ◽  
Registration Number ◽  
Bibliographic Search

Abstract Purpose: There are an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes. Methodology: PubMed and grey literature databases were searched from inception to January 2021 using search terms “rasburicase” and “methemoglobinemia” without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer. Result: A total of 22 reports including 25 patients (21 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 6 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia. Conclusion: Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD. PROSPERO Registration number: CRD42021234132

scholarly journals Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 532-550 ◽  
Author(s):  
Jan L. Jensen ◽  
Alix J.E. Carter ◽  
Jennifer Rose ◽  
Sarah Visintini ◽  
Emmanuelle Bourdon ◽  
...  
Keyword(s):  
Service Utilization ◽  
Outcome Measures ◽  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Reference List ◽  
Inclusion Criteria ◽  
Program Leaders ◽  
Study Selection ◽  
Bibliographic Search

AbstractObjectivesEmergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs.Data SourceBroad systematized bibliographic and grey literature searches were conducted.Study SelectionInclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure.Data ExtractionThe reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described.Data SynthesisThe bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported.ConclusionsNumerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.

scholarly journals Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection

2021 ◽  
Vol 13 (3) ◽  
pp. 363-382
Author(s):  
Mario Dioguardi ◽  
Angela Pia Cazzolla ◽  
Claudia Arena ◽  
Diego Sovereto ◽  
Giorgia Apollonia Caloro ◽  
...  
Keyword(s):  
Innate Immunity ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Viral Disease ◽  
Receptor Expression ◽  
Virus Infections ◽  
Search Terms ◽  
Bibliographic Search ◽  
Meta Analyses

COVID-19 (Coronavirus Disease 2019) is an emerging viral disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which leads to severe respiratory infections in humans. The first reports came in December 2019 from the city of Wuhan in the province of Hubei in China. It was immediately clear that children developed a milder disease than adults. The reasons for the milder course of the disease were attributed to several factors: innate immunity, difference in ACE2 (angiotensin-converting enzyme II) receptor expression, and previous infections with other common coronaviruses (CovH). This literature review aims to summarize aspects of innate immunity by focusing on the role of ACE2 expression and viral infections in children in modulating the antibody response to SARS-CoV-2 infection. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles deemed potentially eligible were considered, including those dealing with COVID-19 in children and providing more up-to-date and significant data in terms of epidemiology, prognosis, course, and symptoms, focusing on the etiopathogenesis of SARS-CoV-2 disease in children. The bibliographic search was conducted using the search engines PubMed and Scopus. The following search terms were entered in PubMed and Scopus: COVID-19 AND ACE2 AND Children; COVID-19 AND Immunity innate AND children. The search identified 857 records, and 18 studies were applicable based on inclusion and exclusion criteria that addressed the issues of COVID-19 concerning the role of ACE2 expression in children. The scientific literature agrees that children develop milder COVID-19 disease than adults. Milder symptomatology could be attributed to innate immunity or previous CovH virus infections, while it is not yet fully understood how the differential expression of ACE2 in children could contribute to milder disease.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

scholarly journals How do cancer screening guidelines trade off benefits versus harms and burdens of screening? A systematic survey

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038322
Author(s):  
Linan Zeng ◽  
Lise Mørkved Helsingen ◽  
Fernando Kenji Nampo ◽  
Yuting Wang ◽  
Liang Yao ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Data Abstraction ◽  
Relative Importance ◽  
Eligibility Criteria ◽  
Trade Off ◽  
Screening Guidelines ◽  
Registration Number ◽  
Data Source ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

ObjectivesCancer screening guidelines differ in their recommendations for or against screening. To be able to provide explicit recommendations, guidelines need to specify thresholds for the magnitude of benefits of screening, given its harms and burdens. We evaluated how current cancer screening guidelines address the relative importance of benefits versus harms and burdens of screening.Data sourceWe searched the Guidelines International Network, International Guideline Library, ECRI Institute and Medline. Two pairs of reviewers independently performed guideline selection and data abstraction.Eligibility criteriaWe included all cancer screening guidelines published in English between January 2014 and April 2019.ResultsOf 68 eligible guidelines, 25 included a statement regarding the trade-off between screening benefits versus harms and burdens (14 guidelines), or a statement of direction of the net effect (defined as benefits minus harms or burdens) (13 guidelines). None of these 25 guidelines defined how large a screening benefit should be to recommend screening, given its harms and burdens. 11 guidelines performed an economic evaluation of screening. Of these, six identified a key benefit outcome; two specified a cost-effectiveness threshold for recommending a screening option. Eight guidelines commented on people’s values and preferences regarding the trade-off between benefits versus harms and burdens.ConclusionsCurrent cancer screening guidelines fail to specify the values and preferences underlying their recommendations. No guidelines provide a threshold at which they believe the benefits of screening outweigh its harms and burdens.PROSPERO registration numberCRD42019138590.

P–469 Period Tracker Applications – are they giving women accurate menstrual cycle information?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Worsfold ◽  
L Marriott ◽  
S Johnson ◽  
J Harper
Keyword(s):  
Menstrual Cycle ◽  
Cycle Length ◽  
Data Entry ◽  
Accurate Information ◽  
Menstrual Cycles ◽  
Conflicting Information ◽  
Search Terms ◽  
Fertile Window ◽  
Registration Number ◽  
Almost All

Abstract Study question Are period trackers giving women accurate information about their periods and ovulation? Summary answer The top 10 period trackers gave conflicting information on period dates, ovulation day and the fertile window. What is known already Period tracking applications allow women to track their menstrual cycles and receive a prediction for their periods. The majority of applications also provide predictions of day of ovulation and the fertile window. Previous research indicates applications are basing predictions on assuming women undergo a textbook 28-day cycle with ovulation occurring on day 14 and a fertile window between days 10 and 17. Study design, size, duration An audit of menstrual cycle apps was conducted on the Apple app store using menstrual cycle tracker/period tracker as the search terms. The top ten apps that followed the inclusion and exclusion criteria were analysed and used for this study. All apps had the ability to allow retrospective data entry giving future cycle predictions and fertile window, and nine of the apps predicted a day of ovulation. Participants/materials, setting, methods Five women’s profiles for 6 menstrual cycles were created and entered into each app. Cycle length (CL) and ovulation day (OD) for the 6th cycle were; Woman 1 – Constant 28 day CL, 0D 16, Woman 2 – Average 23 day CL, OD 13, Woman 3 – Average 28 day CL, OD 17, Woman 4 – Average 33 day CL, OD 20 and Woman 5 – Irregular, average 31 day CL, OD 14. Main results and the role of chance For cycle length, the apps all predicted woman 1’s cycles correctly but for women 2–5, the apps predicted 0 to 8 days shorter or longer than expected. For day of ovulation; for woman 1, no apps predicted this correctly; the apps ranged from day 13–15. For woman 2, 1 app was correct and overall the apps showed a lot of variation from day 8 to 13. For woman 3, no apps got it right, with a range of day 13–16. For woman 4, 2 apps got it right, but the apps ranged from day 13–20. For woman 5, no apps got right; the apps ranged from day 13–21. Irrespective of cycle length, 7 apps predicted a fertile window of 7 days in almost all cases; except 1 app that predicted 6 days for woman 2 and a different app which predicted 8 days for woman 4. For the remaining 3 apps, one always predicted a 10 day fertile window. One app predicted an 11 day fertile window in 4/5 women. One app predicted a 12 day fertile window in 4/5 women. Limitations, reasons for caution The five profiles created spanned a range of observed cycle characteristics, but many permutations are possible. A Monte Carlo type analysis could be conducted to examine these possibilities to provide more precise assessment of app performance, but as data had to be added manually into apps, this was not possible. Wider implications of the findings: The apps do not use the same algorithm and show variation. The information given by these apps is not 100% accurate, especially for the day of ovulation and the fertile window which can only be predicted if using a marker of ovulation, such as basal body temperature or ovulation sticks. Trial registration number Not applicable

Primary Angiosarcoma of the Bladder

2006 ◽  
Vol 130 (10) ◽  
pp. 1543-1547 ◽  
Author(s):  
Raja R. Seethala ◽  
Jose A. Gomez ◽  
Funda Vakar-Lopez
Keyword(s):  
Data Extraction ◽  
Locally Advanced ◽  
Female Ratio ◽  
Primary Angiosarcoma ◽  
Study Selection ◽  
Pathologic Features ◽  
Male Female Ratio ◽  
Bibliographic Search ◽  
Primary Bladder ◽  
Microscopic Pathology

Abstract Context.—Primary bladder angiosarcomas are extremely rare, and their clinical and pathologic features are not well described. Objective.—To further refine the clinical features of primary bladder angiosarcomas and define their pathologic spectra. Data Sources.—Relevant sources were identified using MEDLINE and a subsequent bibliographic search of all pertinent reports and reviews. We also searched the M. D. Anderson pathology archives. Study Selection.—After excluding 4 cases that likely secondarily involved the bladder, we identified 9 true primary bladder angiosarcomas. Data Extraction.—Data were extracted on the following: demographics, clinical presentation, predisposing factors, gross pathology, microscopic pathology, immunophenotype, therapy, and outcomes. Data Synthesis.—Primary bladder angiosarcomas were found at a mean age of 64.2 years, with a male-female ratio of 8:1. Two cases arose in a postirradiation setting. Primary bladder angiosarcomas typically presented with hematuria and were grossly hemorrhagic, raised masses (mean size, 6.7 cm) of the trigone and/or dome. Histologically, most showed classic anastomosing channels lined by plump hyperchromatic cells, though many showed variant histology such as solid growth and epithelioid cytology. Three (43%) of 7 patients died within a year, but only 1 patient died with evidence of disease. The remaining patients were alive at the time of publication of their respective cases (mean, 22 months). Conclusions.—Primary angiosarcomas of the bladder are typically rare tumors of middle-aged and elderly men that present with locally advanced disease and show a wide histologic spectrum. However, their prognosis may be better than previously thought.

Diagnostic and Therapeutic Approach to Autoimmune Neurologic Disorders

2018 ◽  
Vol 38 (03) ◽  
pp. 392-402 ◽  
Author(s):  
Eoin Flanagan ◽  
A. López-Chiriboga
Keyword(s):  
Side Effects ◽  
Early Diagnosis ◽  
Neurological Disorders ◽  
Laboratory Testing ◽  
Treatment Approach ◽  
Objective Assessment ◽  
Careful Monitoring ◽  
Neurologic Disorders ◽  
Clinical Syndromes ◽  
Neurologic Function

AbstractThe field of autoimmune neurology is evolving rapidly. The discovery of autoantibodies that target neural antigens has expanded swiftly in the last decade. Recognition of the clinical syndromes associated with autoimmune neurologic disorders, and our understanding of the pathophysiology, has progressed significantly. Radiographic, electrophysiological, and laboratory testing (particularly neural autoantibody testing) are fundamental in the diagnosis of autoimmune neurological disorders and in the exclusion of mimics. Furthermore, investigations may serve as a baseline from which objective assessment of improvement or detection of relapse can be made. These disorders can be associated with underlying neoplasms, and screening for malignancy is an essential component of the investigations. Early diagnosis and prompt initiation of immunotherapy can improve neurologic function. The use of immunotherapy, however, can be associated with diverse side effects, and careful monitoring is crucial to prevent complications. Herein the authors address the diagnostic and treatment approach of autoimmune neurologic disorders, with particular focus on antibody-mediated neurologic autoimmunity.

scholarly journals Commercial tobacco and indigenous peoples: a stock take on Framework Convention on Tobacco Control progress

2018 ◽  
Vol 28 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Raglan Maddox ◽  
Andrew Waa ◽  
Kelley Lee ◽  
Patricia Nez Henderson ◽  
Genevieve Blais ◽  
...  
Keyword(s):  
New Zealand ◽  
Tobacco Control ◽  
Indigenous Peoples ◽  
Tobacco Use ◽  
Data Extraction ◽  
Indigenous Populations ◽  
High Rate ◽  
Search Terms ◽  
Study Selection ◽  
Indigenous Participation

BackgroundThe health status and needs of indigenous populations of Australia, Canada and New Zealand are often compared because of the shared experience of colonisation. One enduring impact has been a disproportionately high rate of commercial tobacco use compared with non-indigenous populations. All three countries have ratified the WHO Framework Convention on Tobacco Control (FCTC), which acknowledges the harm caused to indigenous peoples by tobacco.Aim and objectivesWe evaluated and compared reporting on FCTC progress related to indigenous peoples by Australia, Canada and New Zealand as States Parties. The critiqued data included disparities in smoking prevalence between indigenous and non-indigenous peoples; extent of indigenous participation in tobacco control development, implementation and evaluation; and what indigenous commercial tobacco reduction interventions were delivered and evaluated.Data sourcesWe searched FCTC: (1) Global Progress Reports for information regarding indigenous peoples in Australia, Canada and New Zealand; and (2) country-specific reports from Australia, Canada and New Zealand between 2007 and 2016.Study selectionTwo of the authors independently reviewed the FCTC Global and respective Country Reports, identifying where indigenous search terms appeared.Data extractionAll data associated with the identified search terms were extracted, and content analysis was applied.ResultsIt is difficult to determine if or what progress has been made to reduce commercial tobacco use by the three States Parties as part of their commitments under FCTC reporting systems. There is some evidence that progress is being made towards reducing indigenous commercial tobacco use, including the implementation of indigenous-focused initiatives. However, there are significant gaps and inconsistencies in reporting. Strengthening FCTC reporting instruments to include standardised indigenous-specific data will help to realise the FCTC Guiding Principles by holding States Parties to account and building momentum for reducing the high prevalence of commercial tobacco use among indigenous peoples.

scholarly journals Pharmacokinetics and Ex Vivo Antimalarial Activity of Artesunate-Amodiaquine plus Methylene Blue in Healthy Volunteers

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Chu Xuan Anh ◽  
Marina Chavchich ◽  
Geoffrey W. Birrell ◽  
Karin Van Breda ◽  
Thomas Travers ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Antimalarial Activity ◽  
Ex Vivo ◽  
Area Under The Curve ◽  
Plasma Samples ◽  
Open Label ◽  
Content Type ◽  
Registration Number ◽  
Clinical Trials Registry

ABSTRACT High rates of artemisinin-based combination therapy (ACT) failures in the treatment of Plasmodium falciparum malaria in Southeast Asia have led to triple-drug strategies to extend the useful life of ACTs. In this study, we determined whether methylene blue [MB; 3,7-bis(dimethylamino)phenothiazin-5-ium chloride hydrate] alters the pharmacokinetics of artesunate-amodiaquine (ASAQ) and enhances the ex vivo antimalarial activity of ASAQ. In an open-label, randomized crossover design, a single oral dose of ASAQ (200 mg AS/540 mg AQ) alone or with MB (325 mg) was administered to 15 healthy Vietnamese volunteers. Serial blood samples were collected up to 28 days after dosing. Pharmacokinetic properties of the drugs were determined by noncompartmental analysis. After drug administration, plasma samples from seven participants were assessed for ex vivo antimalarial activity against the artemisinin-sensitive MRA1239 and the artemisinin-resistant MRA1240 P. falciparum lines, in vitro. MB significantly increased the mean area under the curve of the active metabolite of AS, dihydroartemisinin (1,246 ± 473 versus 917 ± 405 ng·h/ml, P = 0.009) but did not alter the pharmacokinetics of AQ, AS, or desethylamodiaquine. Comparing the antimalarial activities of the plasma samples from the participants collected up to 48 h after ASAQ plus MB (ASAQ+MB) and ASAQ dosing against the MRA1239 and MRA1240 lines, MB significantly enhanced the blood schizontocidal activity of ASAQ by 2.0-fold and 1.9-fold, respectively. The ring-stage survival assay also confirmed that MB enhanced the ex vivo antimalarial activity of ASAQ against MRA1240 by 2.9-fold to 3.8-fold, suggesting that the triple-drug combination has the potential to treat artemisinin-resistant malaria and for malaria elimination. (This study has been registered in the Australian New Zealand Clinical Trials Registry [https://anzctr.org.au/] under registration number ACTRN12612001298808.)

Dexrazoxane: A New Cardioprotective Agent

1998 ◽  
Vol 14 (5) ◽  
pp. 182-190 ◽  
Author(s):  
Beverly D Abbott ◽  
Cindy M Ippoliti
Keyword(s):  
Supportive Care ◽  
English Language ◽  
Bolus Dose ◽  
Cardiac Tissue ◽  
Data Extraction ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms ◽  
Study Selection ◽  
Clinically Significant

Objective: To review the literature discussing the use of dexrazoxane (e.g., Zinecard, ICRF-187) to prevent doxorubicin-induced cardiotoxicity. Data Sources: Pertinent English-language reports of studies in humans were retrieved from a MEDLINE search (January 1980-January 1997); search terms included chelating agents, razoxane, dexrazoxane, Zinecard, ICRF-187, ADR-529, and ICRF-159. Study Selection: Representative articles discussing the chemistry, pharmacology, pharmacokinetics, dosing, and administration of dexrazoxane and those discussing clinical trials were selected. Data Extraction: Data were extracted and analyzed if the information was relevant and consistent. Studies were selected for review in the text on the basis of study design and clinical end points. Data Synthesis: Dexrazoxane is a chemoprotective agent developed to prevent cardiac tissue toxicity. Dexrazoxane exerts a cardioprotective effect with some clinically significant toxicities; it may also interfere with the antitumor activity of doxorubicin. Until there are sufficient data to support its use in first-line supportive care therapy, dexrazoxane should be reserved for use in patients responding to doxorubicin-based chemotherapy but who have risk factors for cardiac toxicity or have received a cumulative doxorubicin bolus dose of 300 mg/m2. Conclusions: The management of doxorubicin-induced cardiotoxicity has led to the development of supportive care drugs that specifically counteract the dose-limiting toxicities. Dexrazoxane may not completely eliminate the concern about doxorubicin-induced cardiotoxicity, but it may open new avenues for continuing doxorubicin-based chemotherapy.

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