Adherence of NSAID Administration in Patients with Mild and Moderate Traumatic Brain Injury in Dr. Soetomo General Hospital, Surabaya

Introduction: Traumatic brain injury (TBI) has a concerning incidence rate. One of the therapies for patients with TBI is non-steroidal anti-inflammatory drugs (NSAID) administration as an analgesic with proper adherence to achieve optimal therapy results. This research aimed to evaluate physicians’ NSAID administration adherence in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya.Methods: This was an observational descriptive study with a retrospective design. NSAID administration adherence was graded by evaluating the dose, route, frequency, and interval of NSAID administration. The variables were evaluated by observing the medical records of inpatients with mild and moderate TBI from 1 January to 31 December 2018.Results: NSAIDs used for TBI management were metamizole, paracetamol, mefenamic acid, and ketorolac. Metamizole was administered in 10 patients (34.5%), paracetamol in 1 patient (3.4%), metamizole and paracetamol in 15 patients (51.7%), metamizole and mefenamic acid in 1 patient (3.4%), metamizole and paracetamol with mefenamic acid in 1 patient (3.4%), and metamizole and ketorolac in 1 patient (3.4%). Adherence of paracetamol, mefenamic acid, and ketorolac administration in patients with mild and moderate TBI were well-administered in every evaluated variable. Metamizole administration’s adherence was already well-administered in drug dosage and drug administration route, but it was not well-administered in drug administration interval and frequency.Conclusion: Physicians’ adherence to NSAID administration in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya was well-administered, except for metamizole.

An assessment of canine ectoparasiticide administration compliance in the United States based on timing of ectoparasiticide purchases recorded in veterinary hospital transactions.

Background: This study evaluated the timing of dog owner ectoparasiticide purchases to estimate administration compliance and assess the consequent impact of dose purchase gaps on the proportion of time that dogs are protected over a 12-month period. Methods: Ectoparasiticide purchase transactions over a 12-month period were evaluated for dogs from 626 U.S. veterinary hospitals to determine dose purchase timing and identify consequent gaps between dose administration. Orally administered prescription ectoparasitic medications with active ingredients from the isoxazoline family (afoxolaner, fluralaner, lotilaner, or sarolaner) are included in the analysis. A period was calculated for each of the four isoxazoline-containing medications that represented the duration of protection provided by two doses of ectoparasiticide plus the average gap between these two doses. The maximum percentage of time possible for ectoparasiticide protection for this aggregate period was then calculated for each active. Results: Ectoparasiticide transaction records were analyzed for 506,637 dogs. Of these, 43% of dog owners purchased just one dose over the 12 months. If a dog owner purchased more than one dose, then the timing of these transactions could create a time gap between the completion of ectoparasite protection from the first dose and onset of protection from the subsequent purchase and administration of the second dose. Such gaps were observed in purchases made by 31-65% of dog owners depending on the selected active ingredient and number of doses. The average gap duration between dose purchases was calculated for all possible dose combinations over 12 months of ectoparasite protection. Time gaps between the first and second doses are as follows: for sarolaner (20.3 weeks), afoxolaner (12.9 weeks), fluralaner (12.8 weeks), and lotilaner (8.9 weeks). The proportion of time when protection was provided during the aggregate period between administration of the first and second doses was fluralaner 65%, lotilaner 49%, afoxolaner 40,% and sarolaner 30%. Conclusions: Dog owner ectoparasiticide purchase transactions show that there are time gaps between doses leading to reduced ectoparasite protection. The longer re-administration interval of fluralaner, which results from its extended duration, results in dog owners gaining the greatest proportion of ectoparasite protection time compared with shorter-acting monthly re-treatment medications.

The Preparation of a Novel Poly(Lactic Acid)-Based Sustained H2S Releasing Microsphere for Rheumatoid Arthritis Alleviation

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease that mainly erodes joints and surrounding tissues, and if it is not treated in time, it can cause joint deformities and loss of function. S-propargyl-cysteine (SPRC) is an excellent endogenous hydrogen sulfide donor which can relieve the symptoms of RA through the promotion of H2S release via the CSE/H2S pathway in vivo. However, the instant release of H2S in vivo could potentially limit its further clinical use. To solve this problem, in this study, a SPRC-loaded poly(lactic acid) (PLA) microsphere (SPRC@PLA) was prepared, which could release SPRC in vitro in a sustained manner, and further promote sustained in vivo H2S release. Furthermore, its therapeutical effect on RA in rats was also studied. A spherical-like SPRC@PLA was successfully prepared with a diameter of approximately 31.61 μm, yielding rate of 50.66%, loading efficiency of 6.10% and encapsulation efficiency of 52.71%. The SPRC@PLA showed significant prolonged in vitro SPRC release, to 4 days, and additionally, an in vivo H2S release around 3 days could also be observed. In addition, a better therapeutical effect and prolonged administration interval toward RA rats was also observed in the SPRC@PLA group.

Re-induction With Intravenous Ustekinumab in Patients With Crohn’s Disease and a Loss of Response to This Therapy

Background A significant percentage of patients treated with ustekinumab may lose response. Our aim was to evaluate the short-term efficacy and safety of intravenous re-induction with ustekinumab in patients with Crohn’s disease who have lost the response to the treatment. Methods This is a retrospective, observational, multicenter study. Treatment efficacy was measured at week 8 and 16; clinical remission was defined when the Harvey-Bradshaw Index was ≤4 points, and clinical response was defined as a decrease of ≥3 points in the index compared with the baseline. Adverse events and treatment decisions after re-induction were also collected. Results Fifty-three patients from 13 centers were included. Forty-nine percent had previously failed to respond to 2 biological treatments, and 24.5% had failed to respond to 3. The average exposure time to ustekinumab before re-induction was 17.7 ± 12.8 months. In 56.6% of patients, the administration interval had been shortened to every 4 to 6 weeks before re-induction. At week 8 and 16 after re-induction, 49.0% (n = 26) and 43.3% (n = 23), respectively, were in remission, whereas 64.1% (n = 34) and 52.8% (n = 28) had a clinical response. Patients who achieved remission at week 16 had lower C-reactive protein levels than those who did not respond (2.8 ± 1.6 vs 12.5 ± 9.5 mg/dL; P = 0.001). No serious adverse events related to re-induction were observed. Conclusion Intravenous re-induction with ustekinumab is an effective and safe strategy that recovers the response in approximately half of the patients with refractory Crohn’s disease who experience a loss of response. Re-induction can be attempted before switching out of the therapy class.

Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data

Background The 2015 AHA guidelines recommend that amiodarone should be used for patients with refractory ventricular fibrillation (RVF). However, the optimal time interval between the incoming call and amiodarone administration (call-to-amiodarone administration interval) in RVF patients has not been investigated. We hypothesized that the time elapsed until amiodarone administration could affect the neurological outcome at hospital discharge in patients with RVF. Methods and results This study is a retrospective analysis of prospectively collected data. One hundred thirty-four patients were enrolled. In univariate logistic regression, the probability of a good neurological outcome at hospital discharge decreased as the time elapsed until amiodarone administration increased (OR 0.89 [95% CI = 0.80–0.99]). In multivariate logistic regression, the patients who were administered amiodarone in less than 20 min showed higher rates of prehospital ROSC, survival at hospital arrival, any ROSC, survival at admission, survival to discharge, and good CPC at hospital discharge. The call-to-amiodarone administration interval of ≤20 min (OR 6.92, 95% CI 1.72–27.80) was the independent factor affecting the neurological outcome at hospital discharge. Conclusion Early amiodarone administration (≤ 20 min) showed better neurological outcome at hospital discharge for OHCA patients who showed initial ventricular fibrillation and subsequent RVF.