scholarly journals CUMULATIVE CHOLINOLYTIC EFFECT IN CLINICAL PRACTICE (LITERATURE REVIEW)

2021 ◽  
Vol 21 (1) ◽  
pp. 188-193
Author(s):  
R.B. Savchenko
Keyword(s):  
Clinical Practice ◽  
Absolute Risk ◽  
Anticholinergic Effect ◽  
Medical Community ◽  
Anticholinergic Drugs ◽  
Anticholinergic Agents ◽  
Review Of The Literature ◽  
Aged Patients ◽  
Anticholinergic Activity ◽  
Analytical Review

Anticholinergic agents are widely used in clinical practice. However, they can cause various cumulative side effects (dry mouth, drowsiness, confusion, residual urine accumulation, etc.). The purpose of the study is to perform an analytical review of the literature dedicated to causes, complications and rehabilitation of patients with cumulative anticholinergic effect. The analytical review of the literature highlights the risks and benefits of using anticholinergic drugs. Anticholinergic agents make up to one third of all medicines for the aged people. Recent data have proved the relationship between the long-term use of anticholinergics and dementia. New results relating to the cholinergic system in the regulation of cerebral vascularisation and in neuritis indicate that anticholinergics may contribute to the absolute risk and progression of neurodegenerative diseases. It has been proven that more than 600 drugs taken by aged patients carry the so-called "anticholinergic load". The number of drugs with anticholinergic properties is constantly increasing, they include: antidepressants, antihistamines, antiparkinsonian, antipsychotic, antispasmodic, mydriatic drugs, drugs for the treatment of overactive bladder and many others. Conclusions. The number of drugs that have anticholinergic activity and can cause complications associated with anticholinergic load is increasing. To assess the anticholinergic action of drugs, several methods have been proposed, taking into account the amount of dose and the intensity of anticholinergic activity of drugs. The research of the general medical community about the anticholinergic load problem and high alertness when prescribing drugs with anticholinergic properties can prevent the cumulative anticholinergic effect development and severe complications, and, thus, save the life and health of patients.

Use of Anticholinergics in the Nursing Home: An Empirical Study and Review

1983 ◽  
Vol 17 (6) ◽  
pp. 470-473 ◽  
Author(s):  
Randall Seifert ◽  
John Jamieson ◽  
Russell Gardner
Keyword(s):  
Nursing Home ◽  
Utilization Review ◽  
Anticholinergic Drugs ◽  
Cognitive Deterioration ◽  
Review Committee ◽  
Aged Patients ◽  
Anticholinergic Activity ◽  
Anticholinergic Effects ◽  
Nursing Home Patients ◽  
Daily Dose

The Medicare Utilization Review Committee conducted a survey to determine the use of drugs with anticholinergic effects in confused elderly nursing home patients. Twenty-nine patients (34.5 percent) were receiving anticholinergic drugs, predominantly from the antidepressant and antipsychotic class. Thioridazine (Mellaril) was the most frequently used antipsychotic. No patients received higher than the equivalent recommended daily dose of atropine when calculated in terms of relative anticholinergic potency. No statistically significant correlation could be found between the presence of confusion and the amount of anticholinergics administered. Confusion and cognitive deterioration frequently are encountered when caring for aged patients. Clinical experience and recent studies suggest that anticholinergics may increase the risk of or exacerbate existing confusion, and this possible effect of anticholinergic activity should be considered when prescribing for elderly patients.

scholarly journals Prevention and management of major complications in percutaneous endoscopic gastrostomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000628
Author(s):  
Kurt Boeykens ◽  
Ivo Duysburgh
Keyword(s):  
Clinical Practice ◽  
Abdominal Wall ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Early Recognition ◽  
Endoscopic Technique ◽  
Abdominal Wound ◽  
Review Of The Literature ◽  
Endoscopic Gastrostomy ◽  
Major Complications ◽  
Life Threatening

BackgroundPercutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only few major complications. Nevertheless these complicationscan be sometimes life-threatening or generate serious morbidity.MethodAnarrative review of the literature of major complications in percutaneousendoscopic gastrostomy.ResultsThis review was written from a clinical viewpoint focussing on prevention andmanagement of major complications and documentedscientific evidence with real cases from more than 20 years of clinical practice.ConclusionsMajorcomplications are rare but prevention, early recognition and popper management areimportant.

scholarly journals New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature

2020 ◽  
Vol 22 (1) ◽  
pp. 43
Author(s):  
Irina Lousa ◽  
Flávio Reis ◽  
Idalina Beirão ◽  
Rui Alves ◽  
Luís Belo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Renal Damage ◽  
Recent Literature ◽  
Therapeutic Interventions ◽  
Review Of The Literature ◽  
Medical Need ◽  
Early Use ◽  
Reasonable Approach

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and the mortality rate continues to be unacceptably high. The biomarkers currently used in clinical practice are considered relevant when there is already significant renal impairment compromising the early use of potentially successful therapeutic interventions. More sensitive and specific biomarkers to detect CKD earlier on and improve patients’ prognoses are an important unmet medical need. The aim of this review is to summarize the recent literature on new promising early CKD biomarkers of renal function, tubular lesions, endothelial dysfunction and inflammation, and on the auspicious findings from metabolomic studies in this field. Most of the studied biomarkers require further validation in large studies and in a broad range of populations in order to be implemented into routine CKD management. A panel of biomarkers, including earlier biomarkers of renal damage, seems to be a reasonable approach to be applied in clinical practice to allow earlier diagnosis and better disease characterization based on the underlying etiologic process.

Therapies for Onychomycosis

2015 ◽  
Vol 105 (4) ◽  
pp. 357-366 ◽  
Author(s):  
Aditya K. Gupta ◽  
Deanne Daigle ◽  
Maryse Paquet
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Treatment Efficacy ◽  
Meta Analysis ◽  
Pulse Therapy ◽  
Controlled Trials ◽  
Review Of The Literature ◽  
Mycological Cure ◽  
Randomized Controlled ◽  
Topical Treatments

New therapies for onychomycosis continue to be developed, yet treatments are seldom directly compared in randomized controlled trials. The objective of this study was to compare the rates of mycological cure for oral and topical onychomycosis treatments using network meta-analysis. A systematic review of the literature on onychomycosis treatments published before March 25, 2013, was performed, and data were analyzed using network meta-analysis. Terbinafine, 250 mg, therapy was significantly superior to all treatments except itraconazole, 400 mg, pulse therapy; itraconazole, 200 mg, therapy was significantly superior to fluconazole and the topical treatments; and fluconazole, efinaconazole, ciclopirox, terbinafine nail solution, and amorolfine treatments were significantly superior to only placebo. These results support the superiority of 12-week continuous terbinafine, 250 mg, therapy and itraconazole, 400 mg, pulse therapy (1 week per month for 3 months) while suggesting the equivalence of topical therapies. These results reflect findings from the literature and treatment efficacy observed in clinical practice.

Modern imagine methods in diagnostics of acute pancreatitis in clinical practice

2020 ◽  
pp. 14-25
Author(s):  
G. R. Ahunova ◽  
R. R. Ahunova
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Practice ◽  
Mortality Rate ◽  
High Mortality ◽  
Surgical Pathology ◽  
Diagnostic Radiology ◽  
Common Disease ◽  
Review Of The Literature ◽  
Abdominal Organs ◽  
Comprehensive Examination

Acute pancreatitis is one of the most frequent and formidable diseases, and rates as one of the most common disease in the structure of acute surgical pathology of the abdominal organs. In the last decade, there has been an increase in the proportion of necrotic forms of the disease with damage to various departments of the retroperitoneal space and a stably high mortality rate. The diagnostics problem of acute pancreatitis is still relevant due to difficulties that persist despite the possibility of a comprehensive examination of patients upon admission to the hospital and during treatment. This article presents a review of the literature, reflecting the state of the problem and aspects of diagnostic radiology of acute pancreatitis.

scholarly journals Bioresorbable collagen materials in surgery: 50 years of success

2020 ◽  
Vol 11 (1) ◽  
pp. 59-70
Author(s):  
A. L. Fayzullin ◽  
A. B. Shekhter ◽  
L. P. Istranov ◽  
E. V. Istranova ◽  
T. G. Rudenko ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Connective Tissue ◽  
World Literature ◽  
Medical Community ◽  
Keen Interest ◽  
Medical Products ◽  
Handling Characteristics ◽  
Current State ◽  
Over Time

Collagen materials are widely applied in medicine due to optimal handling characteristics, biocompatibility, controlled biodegradation, the ability to form complexes with drugs and facilitate regeneration. Researchers from Sechenov University developed, studied in experiments and introduced into medicine a variety of materials based on collagen — a protein of connective tissue. At the same time, new collagen materials were launched into clinical practice abroad. In this review of Russian and world literature, we described how scientific and applied studies of collagen materials developed over time and tried to illustrate the current state and trends of collagen application for a variety of medical purposes — from hemostatic sponges to tissue-engineered constructs. The range of available collagen-based medical products and the emergence of new collagen materials indicate the keen interest in this biomaterial from the medical community and the potential of future discoveries.

scholarly journals Povidone iodine — new possibilities of a familiar dressing (literature review)

2021 ◽  
Vol 8 (3) ◽  
pp. 14-20
Author(s):  
I. V. Borisov
Keyword(s):  
Clinical Practice ◽  
Literature Review ◽  
Povidone Iodine ◽  
Good Sensitivity ◽  
Review Of The Literature

The article provides a review of the literature on the assessment of the efficacy, safety and indications for the use of povidone iodine in modern clinical practice. The preservation of good sensitivity to the drug, despite its long-term use, as well as new opportunities associated with the effectiveness against biofilm forms of pathogens and viruses, in particular SARS-CoV-2, has been shown.

scholarly journals Identification of anticholinergic activity of drugs of the Brazilian National List of Essential Drugs

2020 ◽  
Vol 11 (2) ◽  
pp. 0350
Author(s):  
Mariana S. LIMA ◽  
Adriano M. REIS
Keyword(s):  
Clinical Practice ◽  
Cumulative Effect ◽  
Essential Medicines ◽  
Activity Measurement ◽  
Measurement Scales ◽  
Anticholinergic Activity ◽  
Essential Drugs ◽  
Central Nervous System Activity ◽  
Level 3 ◽  
Practice Methods

Objectives: Identify drugs from the National List of Essential Medicines-Rename 2018 that have anticholinergic activity and scales of anticholinergic activity available for use in clinical practice. Methods: Drug utilization study, emphasizing the analysis of supply. The drugs included in Brazilian National List of Essential Drugs (BNLED) 2018 were classified according to level 3 of the chemical therapeutic anatomical classification. A literature review was performed to identify anticholinergic activity measurement scales. Anticholinergic activity of BNLED 2018 drugs was determined using the Composite anticholinergic scale. Results: It was identified two systematic reviews, among the 13 identified scales, Duran's Scale and Composite Anticholinergic Scale. Composite Anticholinergic Scale is the most comprehensive with 197 drugs. It was found that 14.6% of the drugs have anticholinergic activity and 69.1% are included in the basic component of the national list. Drugs with central nervous system activity constitute about 50% of the substances with anticholinergic activity, mainly comprised of antipsychotics, followed by cardiovascular system drugs, mostly represented by betablockers. The cumulative effect of anticholinergic activities, from several drugs prescribed concomitantly, reflects the importance of verifying prescriptions and aware health professionals of strategies to reduce this impact. Conclusions: To measure anticholinergic load in clinical practice, 13 scales are available. The most comprehensive scale is the Composite Anticholinergic Scale. Although medicines with anticholinergic activity are uncommon among medicines included in BNLED 2018, it is needed to provide information to prescribers due to the negative clinical outcomes attributed to cumulative anticholinergic burden.

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