scholarly journals Principles and rationale of infusion therapy in tuberculosis

2020 ◽  
pp. 239-240
Author(s):  
T.I. Petrenko
Keyword(s):  
Drug Resistance ◽  
Treatment Group ◽  
Oral Administration ◽  
Intravenous Administration ◽  
Vena Cava ◽  
Medical Community ◽  
Infusion Therapy ◽  
Intravenous Therapy ◽  
Pulmonary Tb ◽  
Number Of Patients

Background. In 2018 7 million new cases of tuberculosis (TB) were registered, which is more than in previous years. Undoubtedly, TB is one of the most important threats to the public health globally. In developing countries, where there are no new TB drugs (TBD) and modern medical services, this threat is even more serious. Intravenous administration is an option to optimize the existing drug regimens, as it is accompanied by increased bioavailability. Objective. To substantiate the rationality of infusion therapy in TB. Materials and methods. Analysis of literature data on this topic; own study involving 106 patients with newly diagnosed infiltrative and disseminated pulmonary TB with bacterial excretion. Results and discussion. The medical community is concerned not only about the increase in the TB incidence, but also about the increase in the number of drug resistance (DR) cases. Improper treatment is one of the causes of DR. In case of oral administration absorption disorders of the drug are possible in people with digestive system diseases, in addition, part of the drug is metabolized by passing through the liver. In contrast, intravenous drugs enter the superior vena cava system, right ventricle, and pulmonary arteries. In a number of patients’ subgroups, it is not possible to achieve a sufficient concentration of drugs in serum when taken orally for various reasons. In particular, these reasons include host organism factors (features of drug metabolism (fast acetylators are more likely to have DR than slow ones), malabsorption, drug clearance, inability of the drug to reach lung tissue) and mycobacteria factors (biofilm formation, drug resistance due to efflux pumps, metabolic status of the bacterium – division phase or sleep phase). These factors are considered to be the consequences of continuous oral administration of TBD. Achieving a high concentration of TBD in the source of infection due to intravenous administration allows to overcome the DR of mycobacteria. In the own study, oral (n=33) and intravenous (n=73) modes of TBD administration were compared. The groups were identical in age, sex, and TB stage. In the intravenous treatment group there was a significantly higher proportion of complete closure of the decay cavities (90.5 % vs. 60.4 % in the oral treatment group; p=0.04), as well as the significantly lower number of toxic reactions (14.3 % vs. 57.9 %; p=0.001) and poor tolerability of treatment (31 % vs. 57.9 %; p=0.04). On the background of intravenous therapy less fluoroquinolone DR was observed. Conclusions. 1. Intravenous therapy in patients with pulmonary TB is more effective than standard in terms of closure of the decay cavities. 2. Intravenous therapy is accompanied by significantly less toxicity and better tolerability. 3. Intravenous TB therapy is less likely to provoke the development of DR.

scholarly journals Analysis of the intermediate results of the INVENT-1 clinical trial: open-label, randomized, multicenter study

2020 ◽  
pp. 78-79
Author(s):  
O.S. Denysov
Keyword(s):  
Treatment Group ◽  
Oral Administration ◽  
Oral Therapy ◽  
Therapy Group ◽  
Oral Treatment ◽  
Long Term Results ◽  
Intensive Phase ◽  
Pulmonary Tb ◽  
Infusion Group ◽  
Intravenous And Oral Administration

Background. Attempts to treat tuberculosis (TB) with the help of intravenous drugs have been made since the early XX century. However, XXI century medicine recommends treating TB with pills, and invasive anti-TB drugs (ATBD) are rarely used. International expert groups recommend intravenous administration only for critically ill patients or for patients with absorption disorders. Meanwhile, the advantages of intravenous ATBD include direct monitoring of treatment, accurate dosing for each patient, fewer side effects, and avoidance of taking a large number of tablets. Objective. To evaluate the efficacy, safety, and tolerability of intravenous and oral administration of ATBD in the intensive phase of treatment in patients with advanced destructive pulmonary TB with bacterial excretion. Materials and methods. The study involved 318 patients from 9 clinical centres. The total duration of the study was 18 months. Intravenous and oral administration of isoniazid, rifampicin and ethambutol were compared. The intensive phase of the study lasted 2 months, the maintenance phase lasted 4 months. Inclusion criteria were the following: age 18-65 years, diagnosis of pulmonary TB, at least one positive test result for TB mycobacteria, radiological confirmation of lung destruction and advance TB process, in women – negative urine test for pregnancy, informed consent, negative GenXpert MTB/RIF analysis, and verbal consent to abstain from alcohol during the study. Results and discussion. Due to the resistance to 1st line drugs 14 people were excluded from the study, due to the lack of data on culture – 16 people, for other reasons – 7 people. In the infusion treatment group, 52.63 % had disseminated TB, and 47.37 % had infiltrative TB. In the group of tablet treatment disseminated TB occurred in 35.2 % of patients, infiltrative – in 61.8 %, miliary – in 3 %. At 4th visit, the efficacy of abacillation in both treatment groups was comparable: 34.2 % in the infusion group and 35.26 % in the oral treatment group. But as of the 6th visit, the share of abacillation in the infusion group was 57.42 %, and in the oral treatment group – 46.96 %. Analysis of the time needed to achieve a negative result on mycobacterium TB also revealed the benefits of infusions. Thus, up to the 3rd visit this parameter was reached by 15.78 % of the infusion group patients, and by 13.76 % of oral therapy group patients. The total proportion of patients with a negative test for mycobacterium TB and clinical improvement in the infusion group was 60 %, and in the oral therapy group – 52.90 %. In infiltrative TB, 27.8 % of the infusion group and only 9.5 % of the tablet therapy group reached abacillation by the 3rd visit. In disseminated TB, abacillation was achieved up to 3rd visit in 5 % of the infusion group and 8.3 % of the tablet treatment group, however, the total numbers at the end of the study were 45 and 25 %, respectively. Conclusions. 1. Monitoring the patient’s treatment is a cornerstone of TB therapy. 2. There is a tendency to the greater effectiveness of TB treatment using intravenous ATBD in the intensive phase of therapy. 3. It is necessary to analyze the long-term results of treatment and the impact of both treatment regimens on the recurrence of the process.

A prospective observational study on oral administration of Ellagic Acid and Annona Muricata in patients affected by non-muscle invasive bladder cancer not undergoing maintenance after 6-week intravesical prophylaxis

2021 ◽  
pp. 039156032110222
Author(s):  
Vincenzo Serretta ◽  
Ettore De Berardinis ◽  
Alchiede Simonato ◽  
Alessio Guarneri ◽  
Nino Dispensa ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Oral Administration ◽  
Ellagic Acid ◽  
Invasive Bladder Cancer ◽  
Prophylactic Effect ◽  
Annona Muricata ◽  
Muscle Invasive Bladder Cancer ◽  
Number Of Patients ◽  
Muscle Invasive

Introduction: BCG and MMC shortage and Covid-19 pandemic, more recently, limit accessibility to maintenance regimen in intravesical prophylaxis against recurrence of non-muscle invasive bladder cancer (NMIBC). Ellagic acid (EA) and Annona muricata (AM) exert antitumor activity against different human tumours. An observational prospective study on the prophylactic effect of oral administration of EA+AM in patients avoiding maintenance regimen is presented. Materials and methods: Patients affected by NMIBC and not undergoing maintenance after a 6-week course of intravesical prophylaxis with MMC or BCG were entered. Tis and very high-risk tumours were excluded. After informed consent, the patients were subdivided in relation to the oral assumption or not of EA (100 mg) plus AM (100 mg), daily for 6 months. All patients were submitted to 3-month cytology and cystoscopy. Results: 162 (90%) of 180 entered patients are evaluable, 90 and 72 receiving or not EA+AM. No difference emerged in patients’ characteristics between the two groups. BCG was given in 86 (54%) and chemotherapy in 74 (46%) patients. The recurrence free rate at 3, 6 and 12 months in patients assuming or not EA was 96.5% versus 84.6% ( p = 0.003), 85.4% versus 64.8% ( p = 0.005) and 74.2% versus 60.6% ( p = 0.246), respectively. The recurrence free survival at 12 months in patients assuming or not EA was 63.0% versus 34.5% ( p < 0.0001). Discussion and conclusions: Our study suffers several limits: not randomized trial although prospective, limited number of patients and short follow-up, nevertheless it shows the prophylactic effect of oral EA+AM in absence of maintenance after intravesical chemotherapy or immunotherapy induction.

scholarly journals A study on the incidence of tuberculosis in Narail district of Bangladesh

Mediscope ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. 12-15
Author(s):  
MS Mallick
Keyword(s):  
Control Program ◽  
Situational Analysis ◽  
Pulmonary Tb ◽  
Tb Control ◽  
Related Data ◽  
Number Of Patients ◽  
Case Rate ◽  
Extra Pulmonary ◽  
The Government ◽  
Tb Control Program

The aim of this descriptive type of study on diagnosed tuberculosis (TB) cases was to evaluate the incidence of TB in Narail district to have a situational analysis with the achievement of National TB Control Program. Related data were collected from the Civil Surgeon Office, Narail district. The data of 3 upazilas- Narail Sadar, Kalia, and Lohagora were used. The study period was from January 1, 2016 to December 31, 2016. The overall TB case rate was 156.6 per 100000 population and separately 170.9 per 100000 population in Narail Sadar, 142.2 per 100000 population in Kalia and 156.6 per 100000 population in Lohagora. Of the cases, 56.4% were male and 43.6% female. Overall, 89.7% of the TB cases had pulmonary TB and 10.3% had extra-pulmonary TB. The population with higher age had higher proportion having TB. The highest number of patients were referred for diagnosis by sastha sebika (nurse) and non-government field staff. The TB incidence in Narail district was considered to be lower than the National situation. However, it seems that TB will remain as a continuous concern for many years in future for the country as well as Narail district. The activities of National TB Control Program of the Government of Bangladesh needs to be strengthened further to combat TB in BangladeshMediscope Vol. 5, No. 2: Jul 2018, Page 12-15

scholarly journals Effects of Diabetes Mellitus Induced by Alloxan on the Pharmacokinetics of Metformin in Rats: Restoration of Pharmacokinetic Parameters to the Control State by Insulin Treatment

2008 ◽  
Vol 11 (1) ◽  
pp. 88 ◽  
Author(s):  
Myung G. Lee ◽  
Young H Choi ◽  
Inchul Lee
Keyword(s):  
Diabetes Mellitus ◽  
Oral Administration ◽  
Protein Expression ◽  
Intravenous Administration ◽  
Insulin Treatment ◽  
Pharmacokinetic Parameters ◽  
Mrna Levels ◽  
Altered Pharmacokinetic ◽  
Intravenous And Oral Administration ◽  
Control State

To test the effect of insulin treatment on the pharmacokinetics of metformin in rats with diabetes mellitus induced by alloxan (DMIA rats). The following results were reported from other studies. Metformin was metabolized via hepatic CYP2C11, 2D1, and 3A1/2 in rats. In DMIA rats, the protein expression and mRNA levels of hepatic CYP2C11 and 3A1/2 decreased and increased, respectively. In rat model of diabetes mellitus induced by streptozotocin, the protein expression of hepatic CYP2D1 was not changed. The increase in hepatic CYP1A2, 2B1, and 2E1, and decrease in hepatic CYP2C11 in DMIA rats was returned to the controls by insulin treatment. METHODS. Metformin (100 mg/kg) was administered intravenously and orally to the control rats, DMIA rats, and DMIA rats with insulin treatment for 3 weeks (DMIA rats with insulin). RESULTS. After intravenous administration of metformin to the DMIA rats, the CLR and CLNR of the drug were significantly slower than the controls. After oral administration of metformin to the DMIA rats, the AUC of the drug was also significantly greater than the controls. After intravenous administration of metformin to the DMIA rats with insulin, the significantly slower CLNR of the drug in the DMIA rats was returned to the controls. The altered pharmacokinetic indices observed following intravenous and oral administration of metformin to DMIA rats returned to the control values in the DMIA rats with insulin. CONCLUSIONS. The significantly slower CLNR of metformin in the DMIA rats could be due to the decrease in hepatic CYP2C11 than the controls. The comparable CLNR of metformin between the DMIA rats with insulin and the control rats could be due to restoration of hepatic CYP enzyme changes in DMIA rats to the controls.

Altered Fibrinolysis during and after Surgery

2021 ◽  
Author(s):  
Maria J. Colomina ◽  
Esther Méndez ◽  
Antoni Sabate
Keyword(s):  
Surgical Stress ◽  
Point Of Care ◽  
Vena Cava ◽  
Coagulation Factors ◽  
Major Surgery ◽  
Fibrinogen Concentration ◽  
Tissue Destruction ◽  
Inflammatory Reactions ◽  
Hematological Disorders ◽  
Number Of Patients

AbstractMajor surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a “physiologic” hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.

scholarly journals Interruzione del trattamento nei pazienti con schizofrenia che ricevono olanzapina o aripiprazolo: metanalisi degli studi clinici controllati

2005 ◽  
Vol 6 (1) ◽  
pp. 69-76
Author(s):  
Benedetta Santarlasci ◽  
Giovanni Biricolti ◽  
Cecilia Orsi
Keyword(s):  
Treatment Group ◽  
Literature Search ◽  
Drop Out ◽  
Inclusion Criteria ◽  
Antipsychotic Therapy ◽  
Therapy Discontinuation ◽  
Randomized Controlled ◽  
Drop Out Rate ◽  
Number Of Patients

BACKGROUND: In schizophrenia the drop-out rate can be used as proxy of effectiveness. The drop-out evaluation is also important considering the relevant economic impact for NHS of an antipsychotic therapy discontinuation in terms of patient hospitalization and other related healthcare resources consumption. OBJECTIVE: To analyze the differences in the rates of drop-out from clinical trials between olanzapine and aripiprazole. METHODS: Literature search was based on MEDLINE, on Iowa-IDIS and Drugdex databases (1966-Dec 2004). Analysis included 12 randomized controlled trials (3.778 patients), 8 for olanzapine (2.559 patients) and 4 for aripiprazole (1.219 patients). RCT inclusion criteria were: a) Patients affected by schizophrenia; b) Randomized assignment to olanzapine or aripiprazole treatment group; c) Number of patients included in the treatment group higher than 100; d) Drop-out frequency evaluation between 4th and 26th weeks of follow-up. RESULTS: The rate of treatment discontinuation was greater for aripiprazole than for olanzapine (42,2% vs. 31,6% respectively). The comparison between drop-out percentages is statistically significant (p

scholarly journals Results of observation of the postoperative period in patients with surgical aortic pathology after surgical intervention using cardiopulmonary bypass

2019 ◽  
Vol 23 (2) ◽  
pp. 267-276
Author(s):  
K. A. Khyzhniak ◽  
Y. V. Volkova ◽  
K. Y. Sharlai ◽  
M. V. Khartanovych
Keyword(s):  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Infusion Therapy ◽  
The Third ◽  
Group I ◽  
Aortic Pathology ◽  
Number Of Patients ◽  
Group Ii

The aim of the work was to analyze the results of the observation of the postoperative period in patients with surgical aortic pathology after surgical intervention using cardiopulmonary bypass. 118 patients with surgical aortic pathology (SAP) were examined. Patients were divided into 2 groups. Group I included 46 patients who were additionally prescribed a solution of meglumin sodium succinate (reamberin), group II included 46 patients who were additionally assigned a solution of D-fructose-1,6-diphosphate sodium hydrate salt (esophosphine). The control group (K) consisted of 26 patients who had surgical pathology of the aorta, all the criteria coincided with patients of groups I and II, but did not have additional substances as part of intensive care (IT) in order to prevent postoperative cognitive dysfunction (PСD). Analyzed the patient's condition on a scale of postoperative mortality prediction EuroSCORE II, the depth of anesthesia with a BIS monitor, the qualitative composition of the leukocyte formula, nasal and rectal temperature, blood gas composition, electrolyte level, glucose, lactate, coagulogram indices, hemolysis and phosphates; levels of autoantibodies to brain antigens (MBP, calcium binding protein S-100, NSE and GBA) were determined in the serum by ELISA a day before the operation and on the first, third, seventh and fourteenth day after surgery. The morphometric and functional properties of erythrocytes were investigated the day before the operation (starting level), 12:00 after the operation, and on the third day of hospital stay. The initial assessment of the cognitive abilities of the patients was made the day before the operation, on the third, seventh and fourteenth day of hospital stay. Used to determine the magnitude of the coefficient of linear Pearson correlation. In the analysis, no significant differences were found between the preliminary data on the phosphorus content in the patients' blood, however, the recovery dynamics of its numbers differed in the K, I and II patients. So, in group K and in group I, after 12:00 after surgery, the level of phosphatemia was 0.86 ± 0.21 mmol/l and 0.85 ± 0.18 mmol / l, on the 3rd day of hospital stay — 0,94 ± 0.08 mmol/l and 0.97 ± 0.04 mmol/l, on the 7th day — 1.04 ± 0.16 mmol/l and 1.07 ± 0.21 mmol/l and on The 14th day — 1.08 ± 0.12 mmol/l and 1.1 ± 0.14 mmol/l. It can be noted that the dynamics of blood phosphatemia in patients of groups K and I was identical, its figures almost coincided in terms of the level of phosphorus in the blood and the corresponding number of patients in the variation rows of patients in both groups. It may be noted that there is an unconditional positive effect on the course of the perioperative period of the option of infusion therapy in the IT complex in patients of group II.  

THE USE OF THORACOPLASTY IN THE TREATMENT OF DESTRUCTIVE PULMONARY TUBERCULOSIS

2021 ◽  
pp. 18-28
Author(s):  
Andrey V. Ivanov ◽  
Alexey A. Malov ◽  
Vadim A. Kichigin ◽  
Vasily A. Ivanov ◽  
Larisa V. Tarasova
Keyword(s):  
Drug Resistance ◽  
Body Weight ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Pulmonary Tuberculosis ◽  
Comparison Group ◽  
Main Group ◽  
Negative Reaction ◽  
Normal Body ◽  
Normal Body Weight

Despite a decrease in the incidence of pulmonary tuberculosis in the Russian Federation in recent years, among the newly diagnosed patients there remains a significant proportion of patients with bacterial excretion and destructive pulmonary tuberculosis. In patients with destructive pulmonary tuberculosis, surgical treatment is often the only possible method for saving lives. We studied the results of extrapleural posterosuperior thoracoplasty in 42 patients with destructive pulmonary tuberculosis. The comparison group consisted of 30 patients who received medicamentous therapy. The mortality rate for 3 years of follow-up in the conservative treatment group was 36.7%, in the surgical treatment group it was 23.8%, p = 0.237. Among patients with more than 2 years of disease experience, mortality was 45% in the main group, 88% in the comparison group, p = 0.070. In the absence of drug resistance, mortality in the main group was 4%, that in the comparison group – 14.2%, p = 0.283. Mortality in individuals with normal body weight was lower in the group of patients who underwent thoracoplasty than in the comparison group: 17.6% vs. 33.3% (p = 0.202). Among those who did not achieve sputum negative reaction, mortality was lower, and passing to the 3rd group of dispensary care was more common in the surgical treatment group – 41.7% vs. 71.4% (p = 0.077) and 33.3% vs. 21.4% (p = 0.426). Among patients with drug resistance or low body weight or unachieved sputum negative reaction, mortality rates were comparable in both groups. Thus, thoracoplasty, in comparison with conservative therapy, makes it possible to improve treatment results in patients regardless of the length of the disease in groups with Mycobacterium tuberculosis sensitive process, with normal body weight, with preservation of elimination of bacilli. The effectiveness of thoracoplasty decreases in patients with an increase in the disease duration.

The Role for Prophylaxis Inferior Vena Cava Filters in Patients Undergoing Bariatric Surgery: Replacing Anecdote with Evidence

2012 ◽  
Vol 78 (12) ◽  
pp. 1349-1361 ◽  
Author(s):  
Ben Shamian ◽  
Ronald S. Chamberlain
Keyword(s):  
Bariatric Surgery ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Early Mobilization ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Number Of Patients ◽  
Bariatric Patients

The number of patients choosing surgical alternatives for weight reduction continues to increase. Despite common thromboembolic preventive methods, which include perioperative subcutaneous heparin injections, early mobilization, and sequential compression devices, postoperative deep vein thrombosis/pulmonary embolism remains a devastating complication after bariatric surgery. The role prophylactic inferior vena cava (IVC) filters may play in bariatric surgery remains controversial, and this article aims to address the risks and benefits of prophylactic IVC filters in high-risk bariatric patients and suggest an evidence-based algorithm for their use.

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