Administration Of Therapy In Patients Research Articles

Possible biomarkers of therapy effective

Administration of the disease modifying therapy in patients with multiple sclerosis is associated with alterations in immune system reactivity. Interferon’s IFN-β-1a and IFN-β-1b are included in the first-line treatment for multiple sclerosis cure. However, as protein substances, they are potentially immunogenic, hence neutralizing antibodies (Nab) can appear after 3–6 months in the serum of a multiple sclerosis patient, reducing IFN-molecules activity. Detection of the NAb to the administrated IFN-medication enables to change the patient management strategy. The level of inflammatory and apoptotic caspases in serum and cerebrospinal fluid may also be considered as a prognostic biomarker for the IFN-therapy efficiency. In addition, the level of microRNA, neurofilaments in serum and secreted glycoproteins (chitinases) in cerebrospinal fluid have certain prognostic value. Increasing of medical substances action specificity, searching for new pathogenesis links as targets for the therapeutic action and identification of the effective prognostic biomarkers are the main strategies of multiple sclerosis treatment nowadays.

The Patterns of Antihypertensive Drugs use in Acute Hemorrhagic Stroke Patients

Hypertension is the highest risk factor of hemorrhagic strokes. Therefore, controlling blood pressure consistently after a stroke occurrenceis to decrease morbidity and mortality in patients. This study aimed to describe the patterns of antihypertensive drugs use, the effect of antihypertensive drugs administration on patient with high blood pressure, and potential drug related problems that occur in patients with acute hemorrhagic stroke. This study was an observational study with a retrospective method. The population study was hemorrhagic stroke patients with hypertension. The samples were 24 patients diagnosed with acute hemorrhagic stroke who got antihypertensive therapy. The instrument in this study were the patient's medical record data. The data was analyzed descriptively. From the medical record data, we obtained information related to the antihypertensive therapy in patients which included drug selection, route of administration, dose, frequency of administration, and duration of therapy. The first antihypertensive drug given in the acute phase include nicardipine, diltiazem, nimodipin, irbesartan, valsartan, amlodipine, captopril and candesartan. As many as 87.5% of antihypertensive drug administration in patients was in accordance with the doses listed in the PERDOSSI 2011 guidelines and the American Society of Health-System Pharmacists 2011. However, there were some patients who received doses exceeding or less thanthe dosage of literature. This was due to patients’ blood pressure who experiencedsignificant fluctuations and titration of intravenous antihypertensive doses. Changing a single therapy into a combination was done because blood pressure increased. The most common combination of antihypertensive drugs types are amlodipine and valsartan. In addition, drug interactions occur between amlodipine-simvastatin, potassium valsartan, and captopril and antacids. The drug side effects found in 1 patient were tachycardia which might be caused by nicardipine. The administration of antihypertensive drugs therapy in patients with acute hemorrhagic stroke was in accordance with the guidelines of the Indonesian Neurologists Specialist 2011, the American Society of Health-System Pharmacists 2011, and Guidelines for hospital clinical practice. Some of the antihypertensive drugs that commonly given, namely nicardipine, diltiazem, nimodipine, irbesartan, valsartan, amlodipine, captopril and candesartan, and combination antihypertensive drugs, such as amlodipine and valsartan. There were major drug interactions in potential patients. There were also allegations of drug side effects in patients. Therefore, it is necessary to record more complete the drug usage and clinical data of the patients to make it easier in monitoring the effects of antihypertensive drugs administration on patients ’blood pressure and drug related problems.

Factors affecting the administration of adjuvant therapy in patients with pancreatic adenocarcinoma.

e15087 Background: Adjuvant therapy for pancreatic adenocarcinoma is now considered standard of care. The proportion of patients receiving adjuvant therapy (ADT) following pancreatic resection is a good quality indicator of cancer care. The aim of this study was to evaluate factors associated with receiving ADT in patients with pancreatic cancer. Methods: Between years 2000-2010, all patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma at a single high-volume hepatotopancreatobiliary center were evaluated. The impact of demographic, peri-operative and pathological risk factors affecting the administration of ADT were analyzed using univariate and multivariate logistic regression analysis. Results: There were 258 patients identified. Median age was 65 (37-84) years, 54% were females. There was a 15% margin positivity rate, 14% pancreatic leak rate, 14.7% major complication rate, and 1.2% 90 day/in-hospital mortality rate. Overall, 160/258 (70%) of patients received adjuvant therapy. On multivariate analysis; age, presence of major complications, node-negative disease and earlier era (2000-2004) were significantly associated with a lower probability of receiving ADT. Reasons for not receiving ADT were; patient preference: 20/67 (32%), not recommended: 14/67 (23%), disease recurrence: 12/67 (9.5%) and being medically unfit for ADT: 18/67 (11.5%). None of these reasons were different between time-periods except for fewer patients being offered ADT from 2000-2005 (15.4% vs. 2.5%, p <0.001). Conclusions: Thirty percent of patients do not receive ADT following pancreatectomy. Those with advanced age; node-negative disease and those who had major complications after pancreaticoduodenectomy were less likely to receive ADT. The impact of these factors should be taken into account when considering the administration of ADT.

Walking the tightrope of survival and quality of life with ADT

A recent study has highlighted the risks and benefits associated with the administration of intermittent androgen deprivation therapy in patients with metastatic prostate cancer. Although there are improvements in many quality-of-life domains, these improvements must be carefully weighed against the potential harms of intermittent androgen deprivation therapy in this patient population.

Algorithm for differential administration of combination antihypertensive therapy in patients with Type 2 diabetes mellitus

Aim. To compare the effectiveness of three variants of long-term combination antihypertensive therapy (AHT), based on two methods of renin-angiotensinaldosterone system (RAAS) inhibition (angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARAII)) or on calcium channel blockade with a dihydropyridine calcium channel blocker (CCB), all of which were administered in order to achieve target levels of blood pressure (BP). To develop an algorithm for differential administration of combination AHT in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 71 patients (mean age 56,8±6,5 years) with AH and DM-2, but without clinically manifested nephroangopathy. The therapy course (30–32 weeks) was completed by 69 patients. All participants were randomised into three groups. The ACEI+CCB group (n=22) received perindopril (5–10 mg/d), indapamide SR (1,5 mg/d), and amlodipine (5–10 mg). The ARAII+CCB group (n=25) was administered valsartan (80–160 mg/d), indapamide SR, and amlodipine. The CCB+BAB group (n=22) received amlodipine (5–10 mg/d), indapamide SR, and metoprolol succinate (50–100 mg/d). The doses of AHT were increased stepwise. At baseline and after 30–32 weeks of the treatment, 24-hour BP monitoring (BPM), renal artery ultrasound and Doppler ultrasound, carbohydrate and lipid metabolism assessment, and 24-hour albumin excretion measurement were performed. Results. Target BP levels were achieved in the majority of patients from all three groups. For the two-component combination AHT, target BP levels were achieved more often with the combination of RAAS inhibitors and indapamide SR, compared to the combination of CCB and indapamide SR. Most patients receiving the latter combination required additional administration of a third medication, in order to achieve adequate BP control. The combination of CCB and BAB increased intrarenal vascular resistance and less effectively controlled night-time systolic AH, compared to the combination of RAAS inhibitors and CCB. The combination of ACEI and CCB, compared to the ARAII+CCB combination, was associated with improved glycemic control, effective reduction of the duration of night-time diastolic AH and night-time heart rate, and normalisation of initially elevated intrarenal vascular resistance at the level of segmental intrarenal arteries. These findings were used for the development of the algorithm for differential administration of combination AHT in patients with AH and DM-2. Conclusion. In DM-2 patients, long-term combination AHR with ACEI and CCB demonstrates more beneficial effects on the metabolic and neurohumoral regulation processes, compared to the combination of ARAII and CCB. These benefits are particularly pronounced in patients with inadequate glycemic control and increased intrarenal vascular resistance. The combination of CCB and BAB inadequately controls night-time systolic AH and does not improve renal hemodynamics.

HCV Cardiomyopathy; raising a regional alert

The global prevalence of Hepatitis C Virus “HCV” carriers is estimated to average 3%, ranging from 0.1% to ⩾10% among different countries, 17–30% of them complain of HCV Cardiomyopathy. To raise regional awareness of HCV as a cardiotropic virus through sharing four stages of our HCV Cardiomyopathy research. Fifty HCV positive patients with 50 controls were enrolled in first stage where conventional echocardiography was used to evaluate LV systolic and diastolic function. Tissue Doppler imaging was used in the second stage to evaluate 30 HCV patients and 30 controls. Forty five HCV positive patients with 45 controls were evaluated by Strain Rate Imaging to assess left atrial tissue dynamics in addition to measuring NTproBNP. At our fourth stage, we evaluated combined antiviral and anti-inflammatory therapy in 13 patients complaining of HCV Cardiomyopathy. Speckle tracking echocardiography was our tool to assess myocardial function before and after administration of therapy. HCV group showed significant increase in QTc interval, significant increase in A wave, Deceleration time in addition to highly significant decrease in tissue Doppler E a , highly significant decrease in A a and highly significant increased E / E a ratio. Evaluation of Left atrial function revealed significant increase in left atrial ejection fraction, ejection time, ejection force. Significant improvement of global myocardial strain was showed after administration of therapy in patients with HCV Cardiomyopathy. HCV is a cardiotropic virus. HCV derived heart diseases are chronic and devastating diseases. The combined anti-viral and anti-inflammatory treatment may cure HCV derived cardiomyopathy.

Effectiveness of recombinant human erythropoietin, vitamin D3and iron therapy on long-term survival of patients with end-stage renal disease receiving haemodialysis: analysis of 702 patients after 10-year follow-up

Few studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD). A retrospective cohort study. The largest regional hospital renowned for haemodialysis in northern Taiwan. A total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated. The rate of overall use of rhEPO, vitamin D3 or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0.38, 95 % CI 0.30, 0.47, P < 0.0001). Similar findings were noted for patients receiving vitamin D3 (HR = 0.36, 95 % CI 0.21, 0.64, P = 0.0004) and Fe (HR = 0.45, 95 % CI 0.33, 0.61, P < 0.0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0.30, 95 % CI 0.22, 0.42) or without (HR = 0.48, 95 % CI 0.38, 0.61) combined use of Fe or vitamin D3. We demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3 and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.

Delay factors on the administration of thrombolytic therapy in patients diagnosed with acute myocardial infarction in a general hospital

To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. The average age of the studied population was 57.5 +/- 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 +/- 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 +/- 7.3 minutes and the door-to-needle time was 51.1 +/- 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.

Pharmacokinetics, Tolerability and Efficacy of Bolus-Dose vs Continuous-Infusion Granisetron in the Prevention of Vomiting in Patients Undergoing Haematopoietic Stem-Cell Transplantation

Objective: We compared bolus-infusion with continuous-infusion administration of granisetron antiemetic therapy in patients undergoing haematopoietic stem-cell transplantation.