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Major Adverse Effects (major + adverse_effects)
Selected AbstractsAmiodarone or Procainamide for the Termination of Sustained Stable Ventricular Tachycardia: An Historical Multicenter ComparisonACADEMIC EMERGENCY MEDICINE, Issue 3 2010Keith A. Marill MD Abstract Objectives:, The objective was to compare the effectiveness of intravenous (IV) procainamide and amiodarone for the termination of spontaneous stable sustained ventricular tachycardia (VT). Methods:, A historical cohort study of consecutive adult patients with stable sustained VT treated with IV amiodarone or procainamide was performed at four urban hospitals. Patients were identified for enrollment by admissions for VT and treatment with the study agents in the emergency department (ED) from 1993 to 2008. The primary measured outcome was VT termination within 20 minutes of onset of study medicine infusion. A secondary effectiveness outcome was the ultimate need for electrical therapy to terminate the VT episode. Major adverse effects were tabulated, and blood pressure responses to medication infusions were compared. Results:, There were 97 infusions of amiodarone or procainamide in 90 patients with VT, but the primary outcome was unknown after 14 infusions due to administration of another antidysrhythmic during the 20-minute observation period. The rates of VT termination were 25% (13/53) and 30% (9/30) for amiodarone and procainamide, respectively. The adjusted odds of termination with procainamide compared to amiodarone was 1.2 (95% confidence interval [CI] = 0.4 to 3.9). Ultimately, 35/66 amiodarone patients (53%, 95% CI = 40 to 65%) and 13/31 procainamide patients (42%, 95% CI = 25 to 61%) required electrical therapy for VT termination. Hypotension led to cessation of medicine infusion or immediate direct current cardioversion (DCCV) in 4/66 (6%, 95% CI = 2 to 15%) and 6/31 (19%, 95% CI = 7 to 37%) patients who received amiodarone and procainamide, respectively. Conclusions:, Procainamide was not more effective than amiodarone for the termination of sustained VT, but the ability to detect a significant difference was limited by the study design and potential confounding. As used in practice, both agents were relatively ineffective and associated with clinically important proportions of patients with decreased blood pressure. ACADEMIC EMERGENCY MEDICINE 2010; 17:297,306 © 2010 by the Society for Academic Emergency Medicine [source] A Case of Foul Genital Odor Treated with Botulinum Toxin ADERMATOLOGIC SURGERY, Issue 9 2004Jae-Bong Lee MD Background. Genital odor is an uncommon condition characterized by an offensive and malodorous smell in the genital area. Although the etiology of foul genital odor is multifactorial, an important cause is sweat secretion and decomposition of sweat components by bacteria. Different methods are effective in reducing body odor secondary to bromhidrosis. Conservative methods only act for a short period of time, and more invasive surgical methods carry risk of complications or are inapplicable for the genital region. Methods. A patient with localized foul odor in the genital hair bearing area was treated with botulinum toxin A. Results. Botulinum toxin A was effective in creating an odorless and anhydrous response in the genital region, and no major adverse effects were noted during a follow-up of 9 months after injection. Conclusion. Local injection of botulinum toxin A appears to be a useful treatment for foul genital odor related to sweat glands activity. [source] An Effective Treatment of Dark Lip by Frequency-Doubled Q-Switched Nd:YAG LaserDERMATOLOGIC SURGERY, Issue 1 2001Somyos Kunachak MD Background. Dark lip is a common cosmetic problem in Southeast Asia. There is no known effective treatment. Objective. To propose an effective method for treating dark lips of varying causes with frequency-doubled Q-switched Nd:YAG laser. Methods. Seventy patients with dark lip, of which 22 were congenital, 24 acquired, and 24 of uncertain cause, were treated by frequency-doubled Q-switched Nd:YAG laser at a fluence of 2,3.5 J/cm2 (mode 2.5 J/cm2) after application of topical anesthesia. The endpoint of treatment was complete clearance of the pigment. Follow-up time was 24,36 months (mean 29 months). Results. All patients attained complete clearance of the lesion after an average of 2.5 treatments in the congenital group, 2.2 treatments in the acquired group, and 1.8 treatments in the group with uncertain etiology. The mean (±SD) number of treatments required by the whole group was 2.1 ± 1.4. Recurrence was observed in one case of congenital origin 3 months after the last treatment. In the remaining cases, results persisted up to the time of follow-up. Herpes simplex reactivation was noted in one case 3 days after treatment. There was no dyschromia, scar formation, or change of skin texture. Conclusion. Dark lip can be effectively treated by frequency-doubled Q-switched Nd:YAG laser without major adverse effects. [source] Fate and effects of triclosan in activated sludgeENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2002Thomas W. Federle Abstract Triclosan (TCS; 5-chloro-2-[2,4-dichloro-phenoxy]-phenol) is a widely used antimicrobial agent. To understand its fate during sewage treatment, the biodegradation and removal of TCS were determined in activated sludge. In addition, the effects of TCS on treatment processes were assessed. Fate was determined by examining the biodegradation and removal of TCS radiolabeled with 14C in the 2,4-dichlorphenoxy ring in laboratory batch mineralization experiments and bench-top continuous activated-sludge (CAS) systems. In batch experiments with unacclimated sludge, TCS was mineralized to 14CO2, but the total yield varied as a function of test concentration. Systems that were redosed with TCS exhibited more extensive and faster mineralization, indicating that adaptation was a critical factor determining the rate and extent of biodegradation. In a CAS study in which the influent level of TCS was incrementally increased from 40 ,g/L to 2,000 ,g/L, removal of the parent compound exceeded 98.5% and removal of total radioactivity (parent and metabolites) exceeded 85%. Between 1.5 and 4.5% of TCS in the influent was sorbed to the wasted solids, whereas >94% underwent primary biodegradation and 81 to 92% was mineralized to CO2 or incorporated in biomass. Increasing levels of TCS in the influent had no major adverse effects on any wastewater treatment process, including chemical oxygen demand, biological oxygen demand, and ammonia removal. In a subsequent experiment, a CAS system, acclimated to TCS at 35 ,g/L, received two separate 4-h shock loads of 750 ,g/L TCS. Neither removal of TCS nor treatment processes exhibited major adverse effects. An additional CAS study was conducted to examine the removal of a low level (10 ,g/L) of TCS. Removal of parent equaled 94.7%, and biodegradation remained the dominant removal mechanism. A subsequent series of CAS experiments examined removal at four influent concentrations (7.5, 11, 20, and 50 ,g/L) of TCS and demonstrated that removal of parent ranged from 98.2 to 99.3% and was independent of concentration. Although TCS removal across all experiments appeared unrelated to influent concentration, removal was significantly correlated (r2 = 0.87) with chemical oxygen demand removal, indicating that TCS removal was related to overall treatment efficiency of specific CAS units. In conclusion, the experiments show that TCS is extensively biodegraded and removed in activated-sludge systems and is unlikely to upset sewage treatment processes at levels expected in household and manufacturing wastewaters. [source] Effects of rumen-protected methionine in a low protein ration on metabolic traits and performance of early lactating cows as opposed to rations with elevated crude protein contentJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 5 2000T. F. Kröber Summary A 5-week experiment with 24 multiparous early lactating Brown Swiss cows was conducted to investigate the effects of supplementary rumen-protected methionine in conjunction with dietary protein reduction on metabolism and performance after 1 week of control measurement. Three rations containing 175, 150 and 125 g of crude protein/kg feed dry matter were supplemented with methionine. The fourth ration, also only containing 125 g of crude protein/kg dry matter, remained unsupplemented. The four treatment groups had a similar metabolic supply of other essential amino acids, protein and energy, as calculated by various approaches. The two low protein rations were, however, slightly deficient in ruminally degraded protein. Treatment effects remained low on feed intake, forage meal pattern, milk yield and fat as well as lactose content. In contrast, the content and yield of milk protein significantly declined only in the unsupplemented low protein ration relative to the initial value. Compared with this ration, the decline in milk protein yield was clearly delayed in the supplemented low protein ration. Blood plasma methionine tended to be reduced without supplementation and to be increased with additional methionine. Supplementation of methionine reduced other plasma amino acids. Plasma insulin, glucose, lactate, ketone bodies and aspartate amino transferase activity indicated a certain liver stress and a somewhat elevated energy requirement with high and particularly with low protein content (when unsupplemented). Methionine improved metabolic protein utilization, followed by the lowest plasma, urine and milk urea levels in the supplemented low protein diet. In conclusion, no major adverse effects were assessed under the conditions tested. Supplementation of methionine may nevertheless be useful in rations with particularly low protein content fed to early lactating cows in order to prevent negative long-term effects which were only visible here as trends. Zusammenfassung Auswirkungen von pansengeschütztem Methionin in einer Niedrigproteinration im Vergleich zu Rationen mit erhöhtem Rohproteingehalt auf Stoffwechselmerkmale und Leistung von frischlaktierenden Milchkühen In einem fünfwöchigen Experiment mit 24 frischlaktierenden Braunviehkühen wurden die Auswirkungen einer Ergänzung mit pansengeschütztem Methionin bei gleichzeitiger Reduktion der Proteinzufuhr nach einer einwöchigen Kontrollphase geprüft. Drei Rationen mit 175, 150 und 125 g Rohprotein/kg T wurden mit Methionin ergänzt. Eine weitere Variante, ebenfalls nur mit 125 g Rohprotein/kg T, wurde nicht supplementiert. Die vier Varianten stellten gemäß verschiedener Futterbewertungsysteme eine vergleichbare metabolische Versorgung mit den übrigen essentiellen Aminosäuren, Protein und Energie sicher. Die Niedrigproteinvarianten enthielten allerdings etwas zu wenig pansenabbaubares Protein. Futteraufnahme, Muster des Grundfutterverzehrs, Milchleistung sowie Fett-und Laktosegehalt der Milch zeigten nur geringe Reaktion auf die Behandlungen. Milchproteingehalt und -menge waren nur in der nicht ergänzten Niedrigproteinvariante relativ zum Ausgangswert signifikant verringert. Im Vergleich zur unsupplementierten Niedrigproteinration war dagegen der Abfall mit Ergänzung deutlich verzögert. Gegenüber dem Ausgangswert war die Methioninkonzentration im Blutplasma ohne Ergänzung tendenziell erniedrigt, mit Ergänzung erhöht. Es erfolgte eine Verringerung der Plasmakonzentration anderer Aminosäuren durch die Methioninergänzung der Niedrigproteinration. Die Plasmaniveaus von Insulin, Glucose, Laktat, Ketonkörpern und Aspartataminotransferase-Aktivität lassen auf eine gewisse Leberbelastung und einen etwas höheren Energiebedarf mit hohem und besonders mit niedrigem Proteingehalt (unsupplementiert) schließen. Die Zulage an Methionin verbesserte die metabolische Proteinverwertung, so dass die Harnstoffgehalte in Blut, Milch und Harn in dieser Niedrigproteinvariante am niedrigsten waren. Insgesamt ergaben sich keine grösseren ungünstigen Effekte unter den getesteten Bedingungen. Dennoch könnte die Ergänzung von Rationen mit besonders niedrigem Rohproteingehalt mit Methionin beim Einsatz an frischlaktierende Kühe hilfreich sein, um negative Langzeitwirkungen zu verhindern, die sich hier lediglich andeuteten. [source] Use of oseltamivir in the treatment of canine parvoviral enteritisJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2010DACVECC, Michelle R. Savigny DVM Abstract Objective , To determine if oseltamivir with standard therapy for canine parvoviral enteritis ameliorates disease morbidity, mortality, or both; to document significant adverse effects associated with its use. Design , Prospective, randomized, blinded, placebo-controlled clinical trial. Setting , University veterinary teaching hospital. Animals , Thirty-five dogs. Interventions , Standard therapy was administered to all dogs. Treatment dogs also received oseltamivir, while control dogs received an equivalent volume of placebo. Measurements and Main Results , Dogs were monitored daily according to a clinical scoring system, physical parameters, and diagnostic evaluations. Dogs in the treatment group gained a significant percentage of weight during hospitalization (mean, +2.6%; SD, 7.1%) versus the control dogs (mean, ,4.5%; SD, 6.9%) (P=0.006). Treatment dogs did not have any significant changes in their white blood cell (WBC) count, while control dogs experienced a significant drop in their WBC counts during their initial stay. In addition, it did not appear that oseltamivir use was associated with any major adverse clinical effects. Conclusions , While a clear advantage to the use of oseltamivir was not established, a significant weight loss during hospitalization, as well as a significant decrease in WBC count were documented in the control group. No major adverse effects were identified that could be associated with oseltamivir administration. Based on these results, the true role of oseltamivir in the treatment of parvoviral enteritis remains speculative, although it is believed that further investigation is warranted. [source] Toremifene for premenstrual mastalgia: a randomised, placebo-controlled crossover studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2006S Oksa Objective, To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. Design, Double-blind, placebo-controlled crossover study. Setting, Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. Population, A total of 62 women aged 25,45 years with premenstrual mastalgia during at least three previous menstrual cycles. Methods, Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. Main outcome measures, Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. Results, About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. Conclusion, This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles. [source] | |||||||||||||