scholarly journals A Comparative Study on Intranasal Versus Intravenous Lorazepam in the Management of Acute Seizure in Children

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 958-964
Author(s):  
Nandan Rudra ◽  
Taraknath Ghosh ◽  
Uttam Kumar Roy
Keyword(s):  
Emergency Situation ◽  
Pharmacokinetic Profile ◽  
Good Alternative ◽  
Cross Sectional Study ◽  
Medical Emergency ◽  
Line Treatment ◽  
First Line ◽  
Cross Sectional ◽  
Acute Seizure ◽  
First Line Treatment

Introduction: The acute seizure in childhood is a medical emergency which is usually managed by benzodiazepines used as a first line of therapy. There are no strict guidelines of using intranasal lorazepam in India. Many paediatricians use it in an emergency situation as it is inexpensive, easy to administer and even treatment can be started at home. Very few studies are available to compare efficacy and safety of intravenous lorazepam with intranasal lorazepam in childhood seizure, though both routes have comparable pharmacokinetic profile. Intravenous lorazepam (0.1 mg/kg) is already recommended as a first-line treatment of acute childhood seizures in India. There are very few studies regarding the usefulness of intranasal lorazepam. With this background, we compared intranasal lorazepam with the more widely accepted intravenous lorazepam for control of acute seizure. Aim: To compare effectiveness and safety of intranasal and intravenous lorazepam in acute seizure in children aged 5-12 years. Materials and methods: This is an analytical observational cross-sectional study involving patients with acute seizure who received lorazepam via either the intravenous or intranasal route. Formulation and dosage of lorazepam were the same in both routes. Results: Distributions of patient groups according to sex, age, and weight were statistically not significant (p=0.42, p=0.391, and p=0.605, respectively). Time to control seizure within 10 min and persistent cessation of seizure activity were similar in both groups. Safety parameters showed no differences statistically. Conclusions: Though intravenous lorazepam is recommended as first-line treatment, intranasal lorazepam may be a good alternative choice in a convulsing child.

scholarly journals Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

2021 ◽  
Vol 8 (11) ◽  
pp. 271
Author(s):  
Rita Rebocho ◽  
Marina Domínguez-Ruiz ◽  
Ryane E. Englar ◽  
Carolina Arenas ◽  
Maria Dolores Pérez-Alenza ◽  
...  
Keyword(s):  
Online Survey ◽  
Initial Dosage ◽  
Cross Sectional Study ◽  
Line Treatment ◽  
Sectional Study ◽  
First Line ◽  
Cross Sectional ◽  
Mailing Lists ◽  
Western European ◽  
First Line Treatment

This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.

Drug Use Review of Intravenous Levetiracetam in Patients with Epilepsy, Tertiary Care Hospital

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S81-S87
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Antiepileptic Drug ◽  
Line Treatment ◽  
First Line ◽  
Acute Seizure ◽  
Hospital Visits ◽  
Patients With Epilepsy ◽  
Control Seizure ◽  
First Line Treatment

Background: Epilepsy is a current important health problem. Status epilepticus is a medical emergency condition which may be lifethreatening, increased mortality rate and hospitalization. However, some patients with epilepsy could not control their symptoms and anticonvulsant medications have some adverse effects. Intravenous levetiracetam (ivLEV) is a new antiepileptic drug which its use tends to be increased. Objective: To study the prescription pattern of ivLEV and its adverse drug reactions (ADRs) in hospitalized patients and to define the efficacy of iv LEV as first line treatment for status epilepticus. Materials and Methods: This was a descriptive retrospective study to review medical records of all inpatients receiving ivLEV at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University during January 1st 2010 to December 31st 2014. Results: During the study period, there were 406 hospital visits that met the study criteria. The average age of the patients was 54.32+20.36 years with nearly equal sex distribution. The indications of ivLEV were status epilepticus (22.4%), previous treatment with oral levetiracetam (9.6%), perioperative craniectomy/craniotomy (8.6%), and acute seizure with non-status epilepticus (59%). Most of the patients (63.3%) received ivLEV as first line treatment antiepileptic drug and the most loading dose range of ivLEV that the patients received was 500 to 1,000 mg/day (78.3%). All of the patients had been followed vital signs and plasma electrolytes. 98.5% and 45.8% of hospital visits had been monitored liver/kidney function and electroencephalogram (EEG), respectively. Adverse effects during the treatment of ivLEV occurred 0.98%, which were hypotension, drowsiness, and maculopapular rash. No major ADRs were detected in any patients after the ivLEV treatment. Regarding process indicators, overall seizure control rate was 76.4%, of which 35.2% and 85.9% were for the patients with status epilepticus and acute seizure with non-status epilepticus, respectively. ivLEV could be used as first line treatment effectively in patients with status epilepticus (80.2%). In the patients with renal impairment receiving adjusted dosage regimen ivLEV could be control seizure 73.1%. Conclusion: The treatment of ivLEV was effective and safe for control seizure, including status epilepticus and acute seizure with non-status epilepticus. Thus, ivLEV could be the first line antiepileptic drug for the treatment of status epilepticus and brain surgery prevention. However, due to the high cost of the drug and the treatment course, there would be further study of cost-effectiveness. Keywords: Levetiracetam, Epilepsy, Acute seizure, Status epilepticus, Drug use review, Inpatient

Bismuth-containing quadruple therapy versus concomitant quadruple therapy as first-line treatment forHelicobacter Pyloriinfection in an area of high resistance to clarithromycin: A prospective, cross-sectional, comparative, open trial

Helicobacter ◽  
2018 ◽  
Vol 24 (1) ◽  
pp. e12546 ◽  
Author(s):  
Fernando Macías-García ◽  
Iria Bastón-Rey ◽  
Daniel de la Iglesia-García ◽  
Cristina Calviño-Suárez ◽  
Laura Nieto-García ◽  
...  
Keyword(s):  
High Resistance ◽  
Open Trial ◽  
Line Treatment ◽  
First Line ◽  
Cross Sectional ◽  
Quadruple Therapy ◽  
First Line Treatment

scholarly journals The Real World of Arsenic Uses in Chinese with Acute Promyelocytic Leukemia: A Cross-Sectional Survey

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5955-5955
Author(s):  
Hong-Hu Zhu ◽  
Feng-Mei Zheng ◽  
Xiao-Jun Huang
Keyword(s):  
Health Insurance ◽  
Acute Promyelocytic Leukemia ◽  
Real World ◽  
Outpatient Treatment ◽  
Promyelocytic Leukemia ◽  
Line Treatment ◽  
First Line ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
First Line Treatment

Abstract OBJECTIVE: Arsenic has become first-line treatment of acute promyelocytic leukemia (APL) since 2013 according to NCCN Guidelines Acute Myeloid Leukemia Version 2.2013, but little information is available about the real world of arsenic uses in China. We aimed to evaluate the usage of arsenic and assess the current status of the treatment of APL in China. METHODS: Noninterventional, cross-sectional survey using electronic questionnaires distributed to APL patients and answered anonymously. RESULTS: In total, 237 respondents were evaluable and 120 respondents (50.6%) were male. Median age was 40 years (range 15-68 years). Median time from diagnosis to this survey was 15 months. Valid submissions came from 28 of 34 provinces and municipalities. There were 77.64% respondents hospitalized within three days since diagnosis. The percentage of respondents received arsenic during induction treatment was 73.8% (175/237), including arsenic trioxide (ATO) (n=136) and oral arsenic (n=39). However, the percentage increased up to 100% (237/237) during the post-remission treatment phase, including ATO (n=137) and oral arsenic (n=100). Interestingly, 32.9% respondents considered the costs of ATO acceptable by themselves. However, 92.4% respondents regarded the burden of oral arsenic was high because it was not covered by health insurance, and 95.8% respondents appeal to oral arsenic covered by health insurance. The proportion of respondents covered by Basic Insurance for Urban Employees, Basic Insurance for Urban Residents, the New Rural Cooperative Medical Scheme and Commercial insurance were 3.8%, 44.3%, 38.4% and 5.9%. In total, 99.16% respondents hope to receive a chemotherapy-free outpatient treatment protocol CONCLUSIONS: High proportion of APL patients received arsenic as first-line treatment in China, which may result from the relative low price of arsenic. A chemotherapy-free outpatient treatment model worthy to explore. Disclosures No relevant conflicts of interest to declare.

scholarly journals Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 55
Author(s):  
Bhishma Pokhrel ◽  
Tapendra Koirala ◽  
Dipendra Gautam ◽  
Ajay Kumar ◽  
Bienvenu Salim Camara ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Public Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Line Treatment ◽  
Hospital Data ◽  
First Line ◽  
Cross Sectional ◽  
First Line Treatment

In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting.

scholarly journals Prevalence and socio-economic factors affecting the use of traditional medicine among adults of Katikekile Subcounty, Moroto District, Uganda

2021 ◽  
Vol 21 (3) ◽  
pp. 1410-1417
Author(s):  
Annie Logiel ◽  
Erik Jørs ◽  
Pardon Akugizibwe ◽  
Peder Ahnfeldt-Mollerup
Keyword(s):  
Traditional Medicine ◽  
Rural Areas ◽  
Health Sector ◽  
Line Treatment ◽  
Health Providers ◽  
First Line ◽  
Long Distance ◽  
Cross Sectional ◽  
Medical Fees ◽  
First Line Treatment

Background: In Uganda generally and in rural areas in particular, use of traditional medicine is a common practice, yet there remains lack of evidence on the overall utilization of traditional medicine and there are many aspects that remain unclear. Objective: To determine the use of traditional medicine and factors associated with this among the adults of Katikekile Subcounty in Moroto district. Methods: A descriptive cross-sectional study using quantitative and qualitative methods. Interviews among 323 respond- ents, and focus group discussions were carried out among village traditional birth attendants, village health team members, and traditional health providers. Results: Use of traditional medicine among the adults of Katikekile Subcounty was 68%. Usage was more prevalent among older people, and the majority of the adults used traditional medicine often as their first line-treatment for any illness. Herbs used for traditional medicines are usually locally available and free-of-charge. Long distance to health-facility based health care services, and medical fees contributed to the use of traditional medicine. Conclusion: Use of traditional medicine among adults of Katikekile Subcounty in Moroto in the Karamoja region in Uganda was high, and majority of the adults often used traditional medicine as first line-treatment. Both socioeconomic and health sector factors were associated with use of traditional medicine. Keywords: Intercultural medicine; indigenous; herbalists.

scholarly journals Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States

OTO Open ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 2473974X2110440
Author(s):  
David Forner ◽  
Christopher W. Noel ◽  
Amy Grant ◽  
Paul Hong ◽  
Martin Corsten ◽  
...  
Keyword(s):  
United States ◽  
Medical Management ◽  
Neck Surgery ◽  
The United States ◽  
Line Treatment ◽  
First Line ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
First Line Treatment

Objective The management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA. Study Design Cross-sectional survey. Setting The 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Methods An iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models. Results The survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO. Conclusion There is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.

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