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Usual Doses (usual + dose)
Selected AbstractsPatients at risk of onychomycosis , risk factor identification and active preventionJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2005A Tosti ABSTRACT Objectives, The aims of this workshop were to identify risk factors for onychomycosis and to reach consensus on the management of high-risk groups to allow the development of guidelines to help doctors recognize risk factors that complicate treatment. Results and Conclusions, Previous Trichophyton rubrum infection, older age, abnormal nail morphology, immunodeficiency and genetic factors were identified as risk factors for initial infections. Risk factors for recurrence (relapse and re-infection) are largely the same. The experts agreed that the prevention of onychomycosis and its recurrence should be based on the correct treatment of tinea pedis, screening family members and adequate patient education. In addition, generic management recommendations for each high-risk group were discussed: ,,Immunosuppressed patients ,,Usual dose and treatment length not appropriate ,,Follow-up required ,,Beware of drug interactions ,,Diabetics ,,Prophylactic foot care combined with nail treatment ,,Good opportunity for patient education, footwear, foot care, etc. ,,Beware of drug interactions ,,Psoriatics and patients with abnormal nails ,,Dermatophyte eradication does not restore normal nails ,,Children ,,High failure rate possibly due to compliance problems. [source] Efficacy of etoposide, cyclophosphamide, and total body irradiation in allogeneic bone marrow transplantation for adult patients with hematological malignanciesCLINICAL TRANSPLANTATION, Issue 5 2004Tomomi Toubai Abstract:, Introduction:, A combination of fractionated total body irradiation (TBI) with etoposide (VP-16) and cyclophosphamide (CY) as a preconditioning regimen (VP/CY/TBI) has been reported to be safe and effective for both adults and children undergoing allogeneic bone marrow transplantation (allo-BMT). However, the reported doses of VP-16 were different. We evaluated the efficacy and safety of a VP-16 (at less than the usual dose)/CY/TBI regimen for adults with hematological malignancies who are required to receive allo-BMT. Patients and methods:, Thirty-eight patients received VP-16, CY and TBI (VP/CY/TBI) as a preconditioning regimen for allo-BMT. Twenty-one patients were in first complete remission (1CR), six patients were in second remission (2CR) and 11 patients were in non-remission status (non-CR) before allo-BMT. These patients received allo-BMT from related donors (n = 14) and unrelated donors (n = 24). The preconditioning regimen consisted of VP-16 (15 mg/kg/d for 2 d), CY (60 mg/kg/d for 2 d) and 12 Gy TBI in six fractions for 3 d. Results:, Two patients died on day 30 after transplantation. The median follow-up period for all patients was 35.0 months (range 0.8,159.6 months). At the time of analysis, 10 patients had died. Seven of those 10 patients died because of relapse. The estimated 5-yr disease-free survival (DFS) rates for all cases and acute myelogenous leukemia and acute lymphoblastic leukemia cases were 73.6, 66.7 and 100%, respectively. The estimated 5-yr DFS rates for 1CR, 2CR and non-CR cases were 90.5, 83.3 and 40.9%, respectively (p < 0.05). Conclusion:, Based on these findings, we suggest that a VP/CY/TBI regimen is effective and safe for adult patients with hematological malignancies in 1CR and 2CR. [source] Inhibition of human cytochrome P450 isoforms and NADPH-CYP reductase in vitro by 15 herbal medicines, including Epimedii herbaJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2006K. H. Liu PhD Summary Objective:, We evaluated the potential of 15 herbal medicines (HMs), commonly used in Korea, to inhibit the catalytic activities of several cytochrome P450 (CYP) isoforms and microsomal NADPH-CYP reductase. Methods:, The abilities of 1,1000 ,g/mL of freeze-dried aqueous extracts of 15 HMs to inhibit phenacetin O -deethylation (CYP1A2), tolbutamide 4-methylhydroxylation (CYP2C9), S -mephenytoin 4,-hydroxylation (CYP2C19), dextromethorphan O -demethylation (CYP2D6), chlorzoxazone 6-hydroxylation (CYP2E1), midazolam 1-hydroxylation (CYP3A4) and NADPH-CYP reductase were tested using human liver microsomes. Results:, The HMs Epimedii herba, Glycyrrhizae radix and Leonuri herba inhibited one or more of the CYP isoforms or NADPH-CYP reductase. Of the three HMs, Epimedii herba extracts were the most potent inhibitors of several CYP isoforms (IC50 67·5 ,g/mL for CYP2C19, 104·8 ,g/mL for CYP2E1, 110·9 ,g/mL for CYP2C9, 121·9 ,g/mL for CYP3A4, 157·8 ,g/mL for CYP2D6 and 168·7 ,g/mL for CYP1A2) and NADPH-CYP reductase (IC50 185·9 ,g/mL). Conclusion:, These results suggest that some of the HMs used in Korea have the potential to inhibit CYP isoforms in vitro. Although the plasma concentrations of the active constituents of the HMs were not determined, some herbs could cause clinically significant interactions because the usual doses of those individual herbs are several grams of freeze-dried extracts. Controlled trials to test the significance of these results are necessary. [source] Hepatitis C: Retreatment and treatment of patients with renal failureJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2000Wan-Cheng Chow This paper addresses two difficult issues in the treatment of hepatitis C: patients who fail to achieve a sustained response after the first course of treatment, and those who simultaneously suffer from chronic renal failure. With the recent improvements in firstline treatment, retreatment is mainly applicable to those who have previously received 6-month of interferon monotherapy at 3 MU thrice weekly. For those who had an end-of-treatment response but relapsed, there is a choice between interferon monotherapy at increased dose and/or duration of treatment, or a 6-month course of combination therapy. Retreatment of non-responders is generally unsuccessful, but some patients may respond to interferon-alpha 3 MU and ribavirin 1.0,1.2 g/day. For patients with chronic renal failure and hepatitis C, combination treatment is not possible because ribavirin is contraindicated. Interferon given at a dose of 1.5 MU thrice weekly was reported to be fairly well tolerated by patients who were on dialysis and resulted in end-of-treatment and sustained biochemical and virological response in some cases. Interferon given in the usual doses may be associated with severe adverse effects in patients with renal failure, and can precipitate allograft rejection in patients who have undergone renal transplantation. [source] Chronic statin therapy and the risk of colorectal cancer,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2008MSCE, Yu-Xiao Yang MD Abstract Background and Aims Epidemiologic studies on a potential chemopreventive effect of statin therapy have yielded conflicting results. We sought to clarify whether long-term statin therapy has a chemopreventive effect on the risk of colorectal cancer (CRC) in a large, population-representative cohort. Methods A nested case,control study was conducted among patients ,50 years of age and with ,5 years of CRC-free initial follow-up in the General Practice Research Database (GPRD; 1987,2002). Cases consisted of all patients with incident CRC. Up to 10 controls were matched with each case on practice site and both duration and calendar time of follow-up prior to the index date. The primary exposure of interest was ,5 years of cumulative statin use. Results We identified 4432 incident CRC cases and 44,292 controls. The adjusted odds ratio (OR) for ,5 years of statin exposure was 1.1 (95% confidence interval (CI): 0.5,2.2). Chronic NSAID/aspirin use did not modify this primary association (test for interaction, p,=,0.5). Compared to statin non-users, the adjusted OR for 10 years of statin exposure was 1.3 (95% CI: 0.6,2.7), and the adjusted OR associated with the highest quartile of cumulative statin dose was 1.2 (95% CI: 0.9,1.7). There was a non-statistically significant trend towards a possible reduction in CRC risk among users of high daily statin dose. Conclusion Long-term statin therapy at usual doses was not associated with a significantly reduced risk of CRC. A chemopreventive effect at high daily doses cannot be excluded. Copyright © 2008 John Wiley & Sons, Ltd. [source] Naloxone-responsive acute dystonia and parkinsonism following general anaesthesiaANAESTHESIA, Issue 12 2009I. A. Iselin-Chaves Summary Various movement disorders such as dystonia may acutely develop during or at emergence from general anaesthesia in patients with or without pre-existing Parkinson disease. These movements are triggered by a variety of drugs including propofol, sevoflurane, anti-emetics, antipsychotics and opioids. The postulated mechanism involves an imbalance between dopaminergic and cholinergic neurotransmitters in the basal ganglia. We report an acute, severe and generalised dystonic reaction in an otherwise healthy woman at emergence from general anaesthesia, dramatically reversed by the administration of naloxone, pointing to a potential role of the fentanyl and morphine that the patient had received. Recent literature on the mechanisms of abnormal movements induced by opioids are discussed. The severity of the reaction with usual doses of opioids, in a patient with no prior history of parkinsonism, led to further investigation that demonstrated the possibility of an enhanced susceptibility to opioids, involving a genetically determined abnormal function of glycoproteine-P and catechol-O-methyltransferase. [source] | ||||||||||