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Prophylactic Use (prophylactic + use)
Selected AbstractsProphylactic use of anti-emetic medications reduced nausea and vomiting associated with exenatide treatment: a retrospective analysis of an open-label, parallel-group, single-dose study in healthy subjectsDIABETIC MEDICINE, Issue 10 2010C. Ellero Diabet. Med. 27, 1168,1173 (2010) Abstract Aims, Transient nausea and, to a lesser extent, vomiting are common adverse effects of exenatide that can be mitigated by dose titration and usually do not result in treatment discontinuation. This retrospective analysis of data from a phase 1, open-label, parallel-group, single-dose study in healthy subjects evaluated the effect of oral anti-emetics on exenatide-associated nausea and vomiting and on the pharmacokinetics of exenatide. Methods, A single subcutaneous dose (10 ,g) of exenatide was administered to 120 healthy subjects (19,65 years, BMI 23,35 kg/m2). Incidences of nausea and vomiting were compared between 60 subjects premedicated with two oral anti-emetics 30 min before the exenatide dose and 60 non-premedicated subjects. Similarly, the area under the concentration-time curve (AUC) and the maximum observed concentration (Cmax) of plasma exenatide concentrations over 8 h post-dose were compared. Results, Among all subjects [61% male, 32 ± 12 years, body mass index (BMI) 29.1 ± 3.4 kg/m2 (mean ± sd)], mild to moderate nausea was the most frequent adverse event after exenatide dosing. Vomiting was also observed. Subjects premedicated with anti-emetics experienced significantly less nausea and vomiting (16.7 and 6.7%, respectively) vs. non-premedicated subjects (61.7 and 38.3%, respectively; P -value < 0.0001 for both nausea and vomiting). The mean area under the concentration-time curve and the maximum observed concentration AUC and Cmax of plasma exenatide concentrations during 8 h post-dose were not significantly different between groups. Conclusion, Administration of oral anti-emetics before a single 10-,g exenatide dose was associated with significant reductions in treatment-emergent nausea and vomiting, with no discernible effect on the pharmacokinetics of exenatide. Use of anti-emetic therapy may provide a short-term strategy to minimize the nausea and vomiting associated with exenatide treatment. [source] Bradycardia and sinus arrest during percutaneous ethanol injection therapy for hepatocellular carcinomaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2004A. Ferlitsch Abstract Background, Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC) and considered a safe procedure, with severe complications occurring rarely. Cardiac arrhythmias have not been reported to date. Aim of the study was to investigate the occurrence of dysrhythmias during PEI. Patients and methods, Twenty-six consecutive patients with inoperable HCC were included. During ultrasound-guided PEI with 95% ethanol, electrocardiogram (ECG) monitoring was performed before starting and continuously during PEI. Results, During PEI a significant reduction in mean heart rate (> 20%) was seen in 15 of 26 (58%) patients. In 11 of 26 patients (42%) occurrence of sinuatrial block (SAB) or atrioventricular block (AVB) was observed after a median time of 9 s (range 4,50) from the start of PEI with a median length of 24 s (range 12,480). Clinical symptoms were seen in two patients, including episodes of unconsciousness, seizure-like symptoms in both and a respiratory arrest during PEI in one patient, requiring mechanical ventilation. In four of 12 patients with repeat interventions, dysrhythmias were reproducible during monthly performed procedures. There was a significant association between the occurrence of SAB or AVB and the amount of instilled alcohol (P = 0·03) and post-PEI serum ethanol levels (P = 0·03). Conclusions, Bradycardia and block formation occur frequently during PEI. These symptoms could be explained by a vasovagal reaction and/or the direct effect of ethanol on the sinus node or the right atrial conduction system. Ethanol dose is an important factor for the occurrence of SAB/AVB. ECG-monitoring seems mandatory during PEI. Prophylactic use of intravenously administered Atropine might be useful. [source] Atropine for prevention of cardiac dysrhythmias in patients with hepatocellular carcinoma undergoing percutaneous ethanol instillation: a randomized, placebo-controlled, double-blind trialLIVER INTERNATIONAL, Issue 5 2009Ferlitsch Arnulf Abstract Introduction: Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC). During this procedure, severe cardiac bradyarrhythmias can occur. A preemptive injection of atropine is recommended by professional guidelines to prevent these dysrhythmias. Methods: Patients scheduled for PEI were randomized 1:1 to receive 0.5 mg atropinehydrochloride or placebo in a double-blind randomized placebo-controlled trial. Patients were electrocardiogram monitored, which were then analysed by an experienced rhythmologist blinded to the treatment arm. Results: Patients in 40 consecutive PEI sessions were included. During PEI, a significant reduction in the mean heart rate (>15%) was seen in 15% of patients in the placebo group (median, ,37%; range, 15,41%) and in 25% of patients receiving atropine (median, ,20%; range, 16,64%). There was no significant difference between both groups. During PEI, two patients (10%) in the placebo group developed a sinuatrial block (SAB). Four patients in the atropine group (20%) developed arrhythmias: three patients SAB, one of them with escape rhythm and one AV-bundle block. Blood ethanol levels post-PEI, amount of instilled ethanol, tumour size and location were not different between patients with or without dysrhythmias. Conclusion: In this randomized-controlled trial, a preprocedure atropine injection did not prevent the occurrence of bradyarrhythmias. Prophylactic use of atropine might not be effective and therefore cannot be recommended as a routine procedure. Clinicaltrials.gov-identifier: NCT00575523. [source] Outcome of children with B cell lymphoma in Venezuela with the LMB-89 protocolPEDIATRIC BLOOD & CANCER, Issue 5 2004G. Acquatella MD Abstract Background We analyzed the results of the LMB-89 protocol performed in seven centers in Venezuela in 96 children having B-cell non-Hodgkin lymphoma treated from 1995 to 2002. Procedure Mean age was 7.1 years with 71 (74%) been male. Eighty-two patients (85%) had diffuse small cell lymphoma Burkitt and Burkitt-like, and 14 (15%) had diffuse large B-cell lymphoma. Initial disease sites included the abdomen in 67%, peripheral nodes in 8%, and mediastinal in 4%. Treatment was directed to risk groups as described for LMB-89 protocol. Group A: seven patients (7%), group B: 80 patients (83%), and group C: nine patients (9%). Results Mean follow-up was 35,±,31 months. Complete remission (CR) occurred in 70 patients (73%); four patients (6%) had relapse during the first year and ten patients (10%) had progressive disease. Overall survival (OS) and event free survival (EFS) were 85 and 80% at 1 year, and 82 and 75% at 2 years, respectively. The EFS by therapeutic groups at 3 years was A: 100%; B: 76%, and C: 56%. Toxicity: neutropenia in 75%, thrombocytopenia in 63%, febrile neutropenia in 39%. Viral infections: hepatitis B in 20%, hepatitis C in 2%, and Herpes zoster in 3%. Tumor lysis syndrome (TLS) occurred in 9% during induction phase with a high mortality of 44% (urate-oxidase was available only at the end of the study). Conclusions The high mortality rate during induction phase prohibited a better EFS. Prophylactic use of xantine-oxidase may improve future results. The high incidence of hepatitis B requires a vaccination program. © 2004 Wiley-Liss, Inc. [source] Predictors of Toxicity and Toxicity Profile of Adjuvant Chemotherapy in Elderly Breast Cancer PatientsTHE BREAST JOURNAL, Issue 4 2009Praveen Garg MD Abstract:, Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7,1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient. [source] The benefits of prophylactic treatment with APCC in patients with haemophilia and high-titre inhibitors: a retrospective case seriesHAEMOPHILIA, Issue 3 2009L. A. VALENTINO Summary., Prophylactic infusion of factor concentrates is a safe, effective intervention for preventing arthropathy in patients with haemophilia; on-demand treatment is insufficient to prevent the orthopaedic complications and subsequent haemophilic arthropathy that stem from recurrent joint haemorrhages. The usefulness of prophylaxis in haemophilia patients without inhibitors suggests that patients with haemophilia and inhibitors could derive similar benefits. In patients with haemophilia and high-titre (>5 BU mL,1) inhibitors, bleeding episodes are treated with bypassing agents such as activated prothrombin complex concentrates (APCCs) and recombinant activated factor VII (rFVIIa, NovoSeven®; Novo Nordisk A/S, Bagsvaerd, Denmark). It is possible to administer bypassing therapy regularly to prevent haemorrhages, with the goal of limiting arthropathy and serious life- and limb-threatening bleeding. The data evaluating the efficacy and safety of this approach in patients with inhibitors are limited, consisting of results from one prospective trial and retrospective case reports. This report describes our experience with the prophylactic use of the APCC Factor Eight Inhibitor Bypassing Activity, Anti-Inhibitor Coagulant Complex, Vapor Heated (FEIBAÔ; Baxter AG, Vienna, Austria). Data from patients at one treatment centre were retrospectively evaluated. Case records of six patients with haemophilia A or B and high-titre inhibitors were identified. When APCC was administered regularly, most patients exhibited a reduction in the numbers of haemorrhages, an improvement in orthopaedic status, and an improvement in quality of life. Prophylaxis with APCC can reduce haemorrhages and halt further joint deterioration in patients with haemophilia and inhibitors. [source] Cluster headache: aetiology, diagnosis and management.HEADACHE, Issue 3 2003K Ekbom Drugs. 2002;62(1):61-69 Cluster headache is characterised by repeated attacks of strictly unilateral pain in the orbital region associated with local autonomic symptoms or signs. The attacks are brief but of a very severe, almost excruciating intensity. For unknown reasons males are affected more often than females. Recent studies suggest that an autosomal dominant gene has a role in some families with cluster headache. Hormonal studies indicate a dysfunction in the central nervous system. Neuroimaging has revealed primary defects in the hypothalamic grey matter. Local homolateral dilatation in the intracranial segment of the internal carotid and ophthalmic arteries during attacks is the result of a generic neurovascular activation, probably mediated by trigeminal parasympathetic reflexes. Sumatriptan 6mg subcutaneously is the drug of choice in the treatment of acute attacks. Inhalation of 100% oxygen can also be recommended. In the prophylactic treatment, verapamil is the first option. Other drugs that can be considered are corticosteroids, which may induce a remission of frequent, severe attacks, and lithium. Oral ergotamine tartrate may be sufficient for patients with night attacks and/or short, rather mild to moderately severe cluster headache periods. Third line drugs are serotonin inhibitors (methysergide and pizotifen) and valproic acid. Patients should be encouraged to keep headache diaries and be carefully instructed about the nature and treatment of the headaches. Alcohol can bring on extra attacks and should not be consumed during active periods of cluster headache. Comment: A useful review of clinical options. Given the effectiveness of injectable sumatriptan and the prophylactic use of ergotamine mentioned, one might speculate that the new intranasal formulations of triptans (eg, zolmitriptan) and triptans with a longer half-life (eg, frovatriptan) may prove to be effective in the treatment of cluster headache. DSM [source] Treatment-emergent behavioural side effects with selective serotonin re-uptake inhibitors in adults with learning disabilitiesHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2001A. B. Biswas Abstract Selective serotonin re-uptake inhibitors are widely used for the treatment of depression suffered by adults with learning disabilities. However, the presentation, time of onset and prevalence of treatment emergent symptoms, have not been extensively studied in adults with learning disabilities. The aim of this study was to determine these aspects of treatment. The study design involved retrospective analysis of case notes of all adults with learning disabilities treated with either fluoxetine or paroxetine for depression. During 31% of treatment episodes, patients suffered treatment emergent symptoms during treatment with either selective serotonin re-uptake inhibitor (SSRI). These symptoms subsided on discontinuation of the SSRI. The common emergent symptoms in this group were elevated mood (39%), decreased sleep (35%), hyperactivity (30%), overtalkativeness (26%), agitation (24%) and aggression (37%). In 20% symptoms developed within 1 month and in 67% within 7 months of starting treatment with a SSRI. There were no significant differences noted in the frequency and nature of treatment emergent symptoms between fluoxetine and paroxetine. Few guidelines, if any, exist for initiating and continuing antidepressant treatment for therapeutic or prophylactic use in this patient population. Close monitoring of efficacy and tolerability, including treatment emergent psychiatric symptoms is warranted. Copyright © 2001 John Wiley & Sons, Ltd. [source] Medical management of patients with aneurysmal subarachnoid haemorrhageINTERNATIONAL JOURNAL OF STROKE, Issue 3 2008Gabriel J. E. Rinkel Abstract Treating patients with aneurysmal subarachnoid haemorrhage is taking care of acutely ill patients, and should be performed in centres where a multidisciplinary team is available 24 hours a day 7 days a week, and where enough patients are managed to maintain and improve standards of care. There is no medical management that improves outcome by reducing the risk of rebleeding, therefore occlusion of the aneurysm, nowadays preferably by means of coiling, remains an important goal in treating patients with aneurysms. Because the poor outcome after subarachnoid haemorrhage is caused to a large extent by complications other than rebleeding, proper medical management to prevent and treat these complications is therefore essential. On basis of the available evidence, oral (not intravenous) nimodipine should be standard care in patients with subarachnoid haemorrhage. It is rational to refrain from treating hypertension unless cardiac failure develops and to aim for normovolaemia, even in case of hyponatraemia. There is no evidence for prophylactic hypervolaemia, and the strategy of hypervolaemia and hypertension in patients with secondary cerebral ischaemia is based on case reports and uncontrolled observational series of patients. Magnesium sulphate and statins are promising therapies, and large trials on effectiveness in improving clinical outcome are underway. There is no evidence for prophylactic use of anti epileptic drugs, and routine use of corticosteroids should be avoided. [source] Perioperative Ventricular Arrhythmias in Patients Undergoing Partial Left VentriculectomyJOURNAL OF CARDIAC SURGERY, Issue 2 2001Toshimi Ujiie M.D. Background: Although incidence of ventricular arrhythmias after partial left ventriculectomy (PLV) has been reported, there are no studies comparing incidence before and after PLV. Although operative scars may give rise to arrhythmias, improved energetic efficiency after PLV may decrease their incidence. Methods: Pre- and postoperative ventricular arrhythmias were monitored by Holter ECG and analyzed in 17 patients undergoing PLV in Curitiba, Brazil. Results: Although total 24-hour heart beat (THB) increased significantly (p = 0.018), ventricular premature contractions (VPCs) decreased markedly (p = 0.036), excluding one patient dying in low cardiac output (LOS) who had terminal arrhythmias increased multifold. In the remaining 16 patients, VPC pairs were also reduced significantly on the average (p = 0.038). In contrast, ventricular tachycardia (VT; more than three consecutive VPCs) disappeared in five patients, decreased in two patients, and newly occurred in four patients, with five patients showing no change; one of them developed a prolonged VT, successfully reversed by external cardioversion. Conclusions: Despite notable significant increase in THB immediately after PLV, PVC and PVC pairs were significantly decreased in contrast to VT, which disappeared in some patients and newly occurred in other patients, remaining constant on the average. Sustained VT occurring in a patient with all other arrhythmias suppressed may suggest a unique electrophysiological substrate, may justify prophylactic use of amiodarone or an implantable cardioverter-defibrillator, and may underscore the importance of further and extended studies. [source] The use of antipyretic medications in the prevention of febrile convulsions in childrenJOURNAL OF CLINICAL NURSING, Issue 4 2000Edward Purssell BSc ,,Febrile convulsions are a relatively common outcome in paediatric febrile illness, although it is not known why some children suffer these. ,,Antipyretic medications may form the basis for some treatment regimens, although they are not recommended in published guidelines. ,,There is little evidence that the prophylactic use of antipyretics has any effect in reducing the incidence of febrile convulsions. ,,Consequently, educational interventions aimed at reducing parental fear and helping them to care for their children during febrile illnesses may be more efficacious. [source] GRAPE SEED PROANTHOCYANIDIN EXTRACT CHELATES IRON AND ATTENUATES THE TOXIC EFFECTS OF 6-HYDROXYDOPAMINE: IMPLICATIONS FOR PARKINSON'S DISEASEJOURNAL OF FOOD BIOCHEMISTRY, Issue 2 2010TZU-HUA WU ABSTRACT Proanthocyanidins are potent antioxidants associated with protection against diseases. We tested the reducing capacity, iron chelating activity, and anti-auto-oxidation ability of grape seed proanthocyanidin extract (GSPE). The mechanisms underlying GSPE attenuation of oxidative processes induced by 6-hydroxydopamine (6-OHDA), a neurotoxin used to induce Parkinson's disease, were investigated in cell-based systems. At high concentrations, GSPE (50 µg/µL) was a mild pro-oxidant in a Fenton-type reaction. GSPE (300 µg/mL) was as potent as 30 µM deferoxamine in its iron-chelating capacity, and as efficient as 5 mM ascorbic acid in delaying 6-OHDA auto-oxidation. In PC-12 cell cultures, 100 and 300 µg/mL GSPE significantly protected (P < 0.05) cells from 6-OHDA-induced (400 µM) toxicity. GSPE-induced cytoprotection is enhanced by a nitric oxide synthase inhibitor (NOSI), implying that the cytoprotective effect of GSPE does not require NOS activation. In conclusion, the iron-chelating activity of GSPE minimizes its pro-oxidant activity and delays 6-OHDA auto-oxidation to provide cytoprotection. PRACTICAL APPLICATIONS Parkinson's disease is a neurodegenerative disorder characterized by the degeneration of dopaminergic neurons. The recognized pharmacological strategies to prevent or treat Parkinson's disease include the minimization of oxidative stress, iron release and excitotoxicity resulting from excess nitric oxide formation. One of the best ways to delay or prevent the onset of the disease is to improve the biological antioxidant status by providing additional radical scavengers that are not pro-oxidants. The pro-oxidant activity, such as that of the antioxidant ascorbic acid, enhances radical cycling under certain conditions, and therefore may be detrimental. Grape seed proanthocyanidin extracts (GSPEs) are used as a dietary supplement in food products in several countries. Our current report provides evidence that GSPE has limited pro-oxidant activity, presumably because of its iron-chelating abilities, and protects cells from neurotoxic insults. GSPE may be effective as a dietary supplement for prophylactic use against the progressive neurodegeneration seen in Parkinson's disease. [source] A comparison of management options for leatherjacket populations in organic crop rotations using mathematical modelsAGRICULTURAL AND FOREST ENTOMOLOGY, Issue 2 2009Rod P. Blackshaw Abstract 1,Pest management in organic systems is challenged by the paucity of options for direct interventions to control damaging populations compared with conventional agriculture. Consequently, a greater emphasis has to be placed on managing pest numbers through a rotation. In the present study, simulation modelling is used to evaluate the effects of different management options on populations of Tipula paludosa (leatherjackets) in organic rotations. 2,The growth of leatherjacket populations in grass was simulated over 5 years for different starting numbers. A significant risk of leatherjacket attack to subsequent crops can be avoided by limiting the fertility building phase of a rotation to a maximum of 2 years. 3,The effect of cultural control through additional cultivation interventions was compared in rotations comprising a grass/clover fertility building phase with host and/or nonhost crops. It is concluded that the effects are marginal and that prophylactic use cannot be recommended. 4,The prophylactic use of biological control agents in permanent grass and grass/arable rotations was investigated. Maximum population reductions in grass were achieved through annual autumn applications but the optimal economic strategy was less frequent than this. Application in the autumn preceding a spring-sown arable crop provided the best risk reduction. 5,A model decision support system for the control of pests in organic systems using data for leatherjacket damage to spring barley is presented. Economic threshold concepts are used to define when cultural control (as additional cultivation) and biocontrol applications should be used. 6,The present study shows the potential benefits of simulation modelling for the rapid evaluation of a wide range of pest management options. Any conclusions drawn from such simulations, however, are provisional until they can be tested experimentally. [source] Management of skin toxicity during radiation therapy: A review of the evidenceJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2010S Kumar Summary Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were divided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice. [source] Impact of Copper Sulfate on Plankton in Channel Catfish Nursery PondsJOURNAL OF THE WORLD AQUACULTURE SOCIETY, Issue 1 2009Charles C. Mischke Many fish culturists are interested in applying copper sulfate pentahydrate (CSP) to channel catfish, Ictalurus punctatus, nursery ponds as a prophylactic treatment for trematode infection and proliferative gill disease by killing snails and Dero sp., respectively, before stocking fry. However, copper is an algaecide and may adversely affect phytoplankton and zooplankton populations. We evaluated the effects of prophylactic use of copper sulfate in catfish nursery ponds on water quality and phytoplankton and zooplankton populations. In 2006, treatments of 0 mg/L CSP, 3 mg/L CSP (0.77 mg/L Cu), and 6 mg/L CSP (1.54 mg/L Cu) were randomly assigned to 0.04-ha ponds. In 2007, only treatments of 0 and 3 mg/L CSP were randomly assigned to the 16 ponds. Ponds treated with CSP had significantly higher pH and significantly lower total ammonia concentrations. Treatment of both CSP rates increased total algal concentrations but reduced desirable zooplankton groups for catfish culture. CSP has been shown to be effective in reducing snail populations at the rate used in this study. CSP treatment also appears to be beneficial to the algal bloom, shifting the algal population to green algae and increasing total algal biomass within 1 wk after CSP treatment. Although zooplankton populations were adversely affected, populations of important zooplankton to catfish fry began rebounding 6,12 d after CSP treatment. Therefore, if CSP is used to treat catfish fry ponds of similar water composition used in this study, fry should not be stocked for about 2 wk after CSP application to allow time for the desirable zooplankton densities to begin increasing. [source] Prevention of venous thromboembolism after acute ischemic strokeJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 6 2005P. W. KAMPHUISEN Summary., Venous thromboembolism (VTE) is a common complication after acute ischemic stroke. When screened by 125I fibrinogen scanning or venography, the incidence of deep-vein thrombosis (DVT) in stroke patients is comparable with that seen in patients undergoing hip or knee replacement. Most stroke patients have multiple risk factors for VTE, like advanced age, low Barthel Index severity score or hemiplegia. As pulmonary embolism is a major cause of death after acute stroke, the prevention of this complication is of crucial importance. Prospective trials have shown that both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective in reducing DVT and pulmonary embolism in stroke patients. Current guidelines recommend the use of these agents in stroke patients with risk factors for VTE. Some clinicians are concerned that the rate of intracranial bleeding associated with thromboprophylaxis may outweigh the benefit of prevention of VTE. Low-dose LMWH and UFH seem, however, safe in stroke patients. Higher doses clearly increase the risk of cerebral bleeding and should be avoided for prophylactic use. Both aspirin and mechanical prophylaxis are suboptimal to prevent VTE. Graduated compression stockings should be reserved to patients with a clear contraindication to antithrombotic agents. [source] Yet another ten stories on antiviral drug discovery (part D): Paradigms, paradoxes, and paraductionsMEDICINAL RESEARCH REVIEWS, Issue 4 2010Erik De Clercq Abstract This review article presents the fourth part (part D) in the series of stories on antiviral drug discovery. The stories told in part D focus on: (i) the cyclotriazadisulfonamide compounds; (ii) the {5-[(4-bromophenylmethyl]-2-phenyl-5H -imidazo[4,5- c]pyridine} compounds; (iii) (1H,3H -thiazolo[3,4- a]benzimidazole) derivatives; (iv) T-705 (6-fluoro-3-hydroxy-2-pyrazinecarboxamide) and (v) its structurally closely related analogue pyrazine 2-carboxamide (pyrazinamide); (vi) new strategies for the treatment of hemorrhagic fever virus infections, including, as the most imminent, (vii) dengue fever, (viii) the veterinary use of acyclic nucleoside phosphonates; (ix) the potential (off-label) use of cidofovir in the treatment of papillomatosis, particularly RRP (recurrent respiratory papillomatosis); and (x) finally, the prophylactic use of tenofovir to prevent HIV infections. © 2009 Wiley Periodicals, Inc. Med Res Rev, 30, No. 4, 667,707, 2010 [source] The effect of aprotinin on transfusion requirements in pediatric orthotopic liver transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2003Toni M. Rentoul Abstract: The use of aprotinin to reduce blood loss by inhibiting fibrinolysis thereby decreasing transfusion requirements during orthotopic liver transplantation (OLT), is well-documented in adults. We set out to test the hypothesis that the prophylactic use of aprotinin reduced blood product requirements during pediatric OLT. A retrospective study was performed, reviewing data from 24 OLTs performed over a 4-yr period. Six patients did not receive aprotinin (group 1), while 18 (group 2) received a weight-based dose of aprotinin. Both groups were comparable with respect to demographics, baseline characteristics and surgical variables except for a significantly more prolonged activated partial thromboplastin time (APTT) in the aprotinin group (p = 0.015). Despite the fact that median values for transfused volumes of red blood cells (78.3 vs. 36.7 mL/kg) and fresh frozen plasma (51.9 vs. 23.7 mL/kg) were more than halved in the aprotinin group, there was no statistical difference demonstrated. The failure to reach statistical significance can probably be explained by the small number in group 1 and a high level of scatter. All patients in group 1 required intraoperative transfusion of RBC and fresh frozen plasma (FFP) while two patients in group 2 did not require RBC and seven received no FFP. There were four patients in group 1 and 17 in group 2 who did not receive platelets while five in group 1 and 12 in group 2 did not receive cryoprecipitate. The differences between the groups in avoidance of these blood products did not reach statistical significance. There was little difference between groups with respect to albumin and crystalloid requirements. No statistical difference was demonstrated in intraoperative hematologic profiles between the two groups except during the anhepatic phase of surgery when there was a statistically significant more prolonged prothrombin time (p = 0.04) and a greater international normalized ratio (p = 0.027) in group 2. [source] Probiotics for shrimp larviculture: review of field data from Asia and Latin AmericaAQUACULTURE RESEARCH, Issue 4 2008Olivier Decamp Abstract Disease problems have emerged as major constraints in aquaculture production. The prophylactic application of antibiotics is expensive and detrimental, i.e. selection of bacteria that are drug-resistant or more virulent and the prevalence of drug residues in reared animals. Probiotics, which compete with bacterial pathogens for nutrients and/or inhibit the growth of pathogens, could be a valid alternative to the prophylactic application of chemicals. A mixture of specific Bacillus strains was designed following a research programme on the ability of numerous Bacillus strains to inhibit a range of pathogenic Vibrio strains, to grow under conditions prevailing in shrimp hatcheries and to degrade waste products. These strains were then included in bioassays and challenge tests in order to confirm the lack of toxin production and pathogenicity to humans, target organisms and the environment. Here, we report on the performance of a commercially available mixture of Bacillus strains (SANOLIFE® MIC), using data from Asian and Latin-American hatcheries, with Penaeus monodon (Fabricius 1798) and Litopenaeus vannamei (Boone 1931). These results show that probiotics may be a suitable alternative to the prophylactic use of antibiotics. Obviously, minimizing the risk of vibriosis demands a multi-disciplinary approach, including good hygiene and sanitation measures to reduce the input of potential pathogens, as well as a suitable farm management. [source] Review: Alternatives to synthetic fungicides for Botrytis cinerea management in vineyardsAUSTRALIAN JOURNAL OF GRAPE AND WINE RESEARCH, Issue 1 2010M.A. JACOMETTI Abstract Botrytis cinerea (Pers.: Fr), the causal agent of botrytis bunch rot, is an important disease of grapevines worldwide, with canopy management and the prophylactic use of fungicides being the most common control methods. The latter has resulted in fungicide resistance and is increasingly raising concerns regarding residues in wine and effects on human and environmental health. Research-led alternatives to this practice are beginning to emerge, including a range of biotic and abiotic treatments that induce vine resistance to B. cinerea and inundative applications of biological control agents such as Trichoderma, Bacillus, Ulocladium and Streptomyces species. Also, habitat manipulation techniques that aim to improve the effectiveness of naturally occurring biological control are being developed using mulches brought into the vineyard, as well as mulched cover crops. These can accelerate decomposition of botrytis mycelium and sclerotia on the vineyard floor in winter. The challenges of these different techniques and the prospects for habitat manipulation for this fungal disease are discussed. Extensive tables on synthetic fungicides, biofungicides, essential oils and plant extracts effective against B. cinerea are included. [source] Efficacy of the prophylactic use of thiamine and pyridoxine in sheep during an outbreak of Phalaris aquatica ,Polioencephalo-malacia-like sudden death' poisoningAUSTRALIAN VETERINARY JOURNAL, Issue 10 2003CA BOURKE No abstract is available for this article. [source] Deep vein thrombosis in patients with multiple myeloma treated with thalidomide and chemotherapy: effects of prophylactic and therapeutic anticoagulationBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2004Maurizio Zangari Summary A group of 256 newly diagnosed myeloma patients were enrolled in a phase III study that included 4 monthly cycles of induction chemotherapy and tandem transplant. All patients were randomized to either receive or not receive thalidomide. A total of 221 patients (86%) received no prophylactic anticoagulation (cohort I); 35 patients received low dose coumadin (cohort II). The incidence of deep vein thrombosis (DVT) was significantly higher in the thalidomide arm hazard ratio: 4·5; P < 0·0001). As low dose coumadin (1 mg/d) failed to decrease thrombotic complications in 35 patients (cohort II), low molecular weight heparin (LMWH, enoxaparin 40 mg s.c. q.d.) was instituted as DVT prophylaxis in the thalidomide-treated patients (n = 68) of the subsequent cohort (n = 130, cohort III). This intervention eliminated the difference in DVT incidence between the two arms (thalidomide and no thalidomide). Within cohorts I and II, 36 patients, in whom thalidomide was discontinued after experiencing a thrombotic episode during chemotherapy, subsequently resumed the drug on full anticoagulation; with a median follow-up of 22 months, DVT recurred in four patients (11%). After completing induction and tandem transplantation, 55 patients were re-exposed to thalidomide and chemotherapy during consolidation treatment. Thrombotic complications were observed in 4%. Our experience, although not based on a randomized study, suggests that the excess frequency of thrombosis in patients treated with chemotherapy and thalidomide can be safely reduced by the prophylactic use of LMWH. The rate of DVT recurrence observed in our study upon thalidomide resumption was sufficiently low to allow its continuation in patients who may benefit from this therapeutic intervention. [source] Oral administration of an edible-mushroom-derived protein inhibits the development of food-allergic reactions in miceCLINICAL & EXPERIMENTAL ALLERGY, Issue 11 2003K.-Y. Hsieh Summary Background Food allergy is a common disease without effective treatment. Since strict elimination of food allergens may be difficult, strategies for effective intervention are urgently needed. Objective The aim was to investigate the prophylactic use of orally administrated FIP- fve, an immunomodulatory protein isolated from the edible mushroom Flammulina velutipes, in a murine model of food allergy. Methods BALB/c mice were immunized twice intraperitoneally with ovalbumin (OVA), at an interval of 2 weeks. Before and during each period of immunization, FIP- fve (200 ,g per mouse) or phosphate-buffered saline was given orally every other day with a total of five doses. Then OVA-specific antibodies and cytokine profiles were determined. Subsequently, the mice were orally challenged with OVA. Symptoms of anaphylaxis, levels of plasma histamine, and histology of intestines were examined. Results Mice receiving oral FIP- fve treatment during sensitization to OVA had an impaired OVA-specific IgE response with a Th1-predominant cytokine profile. These mice were protected from systemic anaphylaxis-like symptoms induced by subsequent oral challenge with OVA. Conclusion Oral administration of FIP- fve has a Th1-skewing effect on the development of the allergen-specific immune response, and may serve the purpose of immunoprophylaxis for food allergy and other allergic diseases. [source] Anti-cytomegalovirus prophylaxis in solid-organ transplant recipientsCLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2006M. E. Falagas Abstract Ganciclovir and its prodrug, valganciclovir, are more effective than acyclovir in preventing cytomegalovirus (CMV) infection and disease in solid-organ transplant recipients. However, the indirect effects of prophylactic use of ganciclovir and acyclovir are comparable, and the greater effectiveness of ganciclovir may be compensated for by less drug-related toxicity with acyclovir or valacyclovir. No conclusive data exist concerning the best technique and duration of surveillance for CMV infection in patients for whom active surveillance for late-onset CMV should be performed, i.e., those reaching the end of prophylaxis. Only large randomised controlled trials, with long follow-up periods, will provide definitive conclusions regarding the comparative prophylactic roles of the major antiviral agents in this population, and how their use fits with a strategy of active surveillance and pre-emptive therapy. [source] | |||||||||||||||||||||||||||||||