Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 9 Articles
Introduction. Sign and symptoms of rheumatoid arthritis have circadian rhythms and are more prominent in the morning. Timing\r\nof glucocorticoid administration may be important with respect to the natural secretion of endogenous glucocorticoids. Herein,\r\nwe intended to test the hypothesis that bedtime administration of prednisolone could be more efficient in controlling signs and\r\nsymptoms in patients with RA.Material andMethods. Sixty patients with stable disease were treated with single dose prednisolone\r\nat 8 a.m. for the first three months and thereafter with similar dose at 10PM for the next three months (before-after method).\r\nWe compared fatigue scores, morning stiffness and pain scores, Clinical Disease Activity Indices, erythrocyte sedimentation\r\nrates, C Reactive Protein, and profile of adverse effects. Results. The mean of morning stiffness, fatigue scores, CRP and CDAI\r\ndecreased statistically when prednisolone was administrated at 10 p.m. The means of pain scores and ESR were also decreased\r\nwhen the patients took prednisolone at night, without significant statistical difference. Conclusion. Administration of low-dose\r\noral prednisolone could reduce disease activity scores in morning in clinically stable patients with RA. So it could be supposed that\r\nadministrating bedtime prednisolone may permit the smallest possible dose....
Ultra-low-dose aspirin has shown a prothrombotic effect in the laser-induced thrombosis model. Several studies of our laboratory\r\nhave shown a positive effect in rats with two different experimental models of portal hypertension: portal vein ligation, a model\r\nwith an almost normal liver, and 30 days of bile duct ligation, a model with cirrhosis and presence of ascitis. In both models of\r\nportal hypertensive rats, bleeding time was prolonged and thrombi formation, in a laser-induced model of thrombi production,\r\ndecreased. The hypotheses of the presented studies were that ultra-low-dose aspirin could decrease the bleeding complications in\r\nthese models and that the mechanism for these effects could act thorough the COX pathway. In different studies, ultra-low dose\r\nof aspirin normalized the induced hemorrhage time, thrombi production, and platelet-endothelial cell interaction. The possible\r\nbeneficial role of these doses of aspirin and mechanism of COX 2 inhibition are discussed....
Introduction: The use of low-dose steroid therapy in the management of septic shock has been extensively\r\nstudied. However, the association between the timing of low-dose steroid therapy and the outcome has not been\r\nevaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality\r\nin patients with septic shock.\r\nMethods: We retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid\r\ntherapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were\r\nused to adjust for potential confounding factors in the association between the time to initiation of low-dose\r\ncorticosteroid therapy and in-hospital mortality.\r\nResults: The study population consisted of 107 men and 71 women with a median age of 66 (interquartile range,\r\n54 to 71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median\r\nof 8.5 (3.8 to 19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose\r\ncorticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours versus 10.4 hours; P =\r\n0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose\r\ncorticosteroid therapy (P = 0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified\r\nAcute Physiology Score (SAPS) 3 (P < 0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P = 0.0007),\r\ndose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P < 0.0001), need for mechanical\r\nventilation (P = 0.0001) and renal replacement therapy (P < 0.0001), while the impaired adrenal reserve did not\r\naffect 28-day mortality (81% versus 82%; P = 0.8679). After adjusting for potential confounding factors, the time to\r\ninitiation of low-dose corticosteroid therapy was still significantly associated with 28-day mortality (adjusted odds\r\nratio (OR) 1.025, 95% confidence interval (CI) 1.007 to 1.044, P = 0.0075). The early therapy group (administered\r\nwithin 6 hours after the onset of septic shock, n = 66) had a 37% lower mortality rate than the late therapy group\r\n(administered more than 6 hours after the onset of septic shock, n = 112) (32% versus 51%, P = 0.0132).\r\nConclusions: Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortali...
The aim of this preliminary study was to evaluate the effect of low-dose oral vitamin D in combination with current diseasemodifying\r\ntherapy on the prevention of progression of relapsing-remitting multiple sclerosis (RRMS). A phase II double-blind\r\nplacebo-controlled randomized clinical trial conducted between October 2007 and October 2008 included 50 patients with\r\nconfirmed RRMS aged 25 to 57 years and normal serum 25-hydroxyvitamin D. They were randomly allocated to receive 12 months\r\nof treatment with either escalating calcitriol doses up to 0.5 �µg/day or placebo combined with disease-modifying therapy. Response\r\nto treatment was assessed at eight-week intervals. In both groups, the mean relapse rate decreased significantly (P < 0.001). In the\r\n25 patients treated with placebo, the mean (SD) Expanded Disability Status Scale (EDSS) increased from 1.70 (1.21) at baseline to\r\n1.94 (1.41) at the end of study period (P < 0.01). Average EDSS and relapse rate at the end of trial did not differ between groups.\r\nAdding low-dose vitamin D to routine disease-modifying therapy had no significant effect on the EDSS score or relapse rate. A\r\nlarger phase III multicenter study of vitamin D in RRMS is warranted to more assess the efficacy of this intervention....
For cardiac transplant (CTx) recipients, the recommended everolimus (EVL) dose is 0.75 mg bid or 1.5 mg bid and the target\r\ntrough blood level is 3ââ?¬â??8 Ã?µg/L. We studied a cohort of 56 CTx patients with chronic kidney disease receiving 0.75 mg bid EVL to\r\nmaintain blood levels of 5ââ?¬â??8 ug/L (designated RD group) and a cohort of 51 CTx patients with chronic kidney disease receiving\r\n0.5 mg bid to maintain blood levels of 3ââ?¬â??5 ug/L (designated LD group). The primary endpoint was a composite of death, rejection\r\nand premature EVL discontinuation up to 1 year after introduction of EVL. The primary endpoint was reached by 32% of patients\r\nin the LD group and by 41.1% of patients in the RD group (P = 0.361). Biochemical safety parameters were comparable in both\r\ngroups. Our results indicate that low-dose EVL may be as effective and safe as regular dose EVL....
Introduction: The renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but\r\nexperiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the\r\nadrenergic balance is modified.\r\nMethods: Sixty females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to\r\ncontrol group and received only the conventional anesthetic drugs and 20 ml/kg of lactated Ringerâ��s over 30 mins.\r\nThe others were also given an infusion of 50 �µg/kg/min of esmolol (beta1-receptor blocker) or 0.01 �µg/kg/min of\r\nphenylephrine (alpha1-adrenergic agonist) over 3 hours. The distribution and elimination of infused fluid were\r\nstudied by volume kinetic analysis based on urinary excretion and blood hemoglobin level.\r\nResults: Both drugs significantly increased urinary excretion while heart rate and arterial pressure remained largely\r\nunaffected. The urine flows during non-surgery were 43, 147, and 176 ml in the control, esmolol, and\r\nphenylephrine groups, respectively (medians, P < 0.03). When surgery had started the corresponding values were\r\n34, 65 and 61 ml (P < 0.04). At 3 hours, averages of 9%, 20%, and 25% of the infused volume had been excreted in\r\nthe three groups (P < 0.01). The kinetic analyses indicated that both treatments slowed down the distribution of\r\nfluid from the plasma to the interstitial fluid space, thereby preventing hypovolemia.\r\nConclusions: Esmolol doubled and phenylephrine almost tripled urinary excretion during anesthesia-induced\r\ndepression of renal fluid clearance...
Purpose. To evaluate the results and quality of life of patients with resistant of castration-resistant tumors previously treated with\r\nInsulin-potentiation therapy (IPT) combined with hormone therapy. Materials and methods. Sixteen patients with metastasis\r\nprostate tumors after bilateral castration, androgenic blockade, and progression of the disease were observed during the study.\r\nThe patients were divided into two groups: group A consisting of 8 patients treated with low-dose chemotherapy Epirubicin,\r\nVinblastine, and Cyclophosphamide combined with LHRH agonist and group B consisting of another 8 patients treated with lowdose\r\nchemotherapy Docetaxel combined with LHRH agonist. Results. The overall (groups A and B) results concerning PSA after\r\nthe sixth IPT show partial effect in 8 out of 16 (50%) patients, stabilization in 4 out of 16 (25%), and progression in 4 out of\r\n16 (25%). The median survival for all treated patients is 11,7 months (range 3ââ?¬â??30 months). During the treatment no significant\r\nside effects were observed, and no lethal cases occurred. Conclusion. In spite of the small number of the treated patients with\r\ncastration-resistant prostate tumors, the preliminary results are promising and this gives us hope and expectations for future\r\nserious multicenter research over the possibilities for routine implementation of IPTLD....
Introduction: In early rheumatoid arthritis (RA), low-dose oral prednisone (PDN) co-medication yields better clinical\nresults than monotherapy with disease-modifying anti-rheumatic drugs (DMARDs). In addition, ultrasonography (US)\nevaluation reveals rapid and significant effects of glucocorticosteroids on subclinical synovitis. No data currently\nexist that examine the clinical and US results offered by glucocorticoid co-medication over DMARD monotherapy\nin early RA patients.\nMethods: Two hundred and twenty patients with early RA (< 1 year from clinical onset) were treated according to\na low disease activity (LDA) targeted step-up protocol including methotrexate (MTX) and, in the active treatment\narm, low-dose (6.25 mg/day) oral PDN over 12 months. Clinical disease activity measures were collected at\nbaseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months.\nGrey-scale and power Doppler (PD) synovitis were scored (0 to 3) for each joint. At 12 months, clinical remission\naccording to the disease activity score among 28 joints was defined as the clinical outcome, and a total joint PD\nResults: Each group included 110 patients with comparable demographic, clinical, laboratory and US characteristics.\nAt 12 months, the LDA rate was similar in the two groups, whilst the clinical remission rate (risk ratio = 1.61 (95%\nconfidence interval = 1.08, 2.04)) and PD negativity rate (risk ratio = 1.31 (95% confidence interval = 1.04, 1.64)) were\nsignificantly higher in the MTX+PDN group.\nConclusion: In early RA, despite a similar response rate in terms of LDA, low-dose oral PDN co-medication led to a\nhigher proportion of clinical remission and PD negativity compared with MTX monotherapy, thus ensuring a better\ndisease activity control....
Fast dissolving film of domperidone was prepared by solvent casting method using super disintegrating agent. The orofilm were evaluated by some physiochemical parameters like weight variation, thickness, tensile strength, folding endurance, drug content, disintegrating and dissolution parameters. The orofilm were disintegrated at 12 seconds and having good dissolution behavior. From these concluded that domperidone orofilm have suitable for prevent quick vomiting....
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