Efficacy Of Various Medications Research Articles

RESISTANCE OF KLEBSIELLA PNEUMONIAE TO ANTIBIOTICS OF CAT TREATED AT ANIMAL CLINIC

The antibiotic resistance of Klebsiella pneumoniae has become a global health concern, leading in a reduction in the efficacy of various medications. This study seeks to determine the antibiotic resistance of K. pneumoniae isolated from cats hospitalized in Depok veterinary clinics. Surveys, sample collection, isolation, identification, and antibiotic susceptibility testing comprised the research technique. Seven K. pneumoniae isolates were discovered. There were seven cefotaxime resistant isolates, three amoxicillin resistant isolates, one gentamicin resistant isolate, and one enrofloxacin resistant strain. At the same concentration, one isolate shown intermediate susceptibility to amoxicillin, enrofloxacin, and doxycycline. Sensitivity was demonstrated by six gentamicin isolates, six doxycycline isolates, five enrofloxacin isolates, and three amoxicillin isolates. This information should help veterinarians choose the best efficient antibiotic to treat infections caused by these bacteria.

Polyethylene glycol (PEG): The nature, immunogenicity, and role in the hypersensitivity of PEGylated products.

Polyethylene glycol (PEG) is a versatile polymer that is widely used as an additive in foods and cosmetics, and as a carrier in PEGylated therapeutics. Even though PEG is thought to be less immunogenic, or perhaps even non-immunogenic, with a variety of physicochemical properties, there is mounting evidence that PEG causes immunogenic responses when conjugated with other materials such as proteins and nanocarriers. Under these conditions, PEG with other materials can result in the production of anti-PEG antibodies after administration. The antibodies that are induced seem to have a deleterious impact on the therapeutic efficacy of subsequently administered PEGylated formulations. In addition, hypersensitivity to PEGylated formulations could be a significant barrier to the utility of PEGylated products. Several reports have linked the presence of anti-PEG antibodies to incidences of complement activation-related pseudoallergy (CARPA) following the administration of PEGylated formulations. The use of COVID-19 mRNA vaccines, which are composed mainly of PEGylated lipid nanoparticles (LNPs), has recently gained wide acceptance, although many cases of post-vaccination hypersensitivity have been documented. Therefore, our review focuses not only on the importance of PEGs and its great role in improving the therapeutic efficacy of various medications, but also on the hypersensitivity reactions attributed to the use of PEGylated products that include PEG-based mRNA COVID-19 vaccines.

Molnupiravir in Combination with Remdesivir for Severe COVID-19 Patients Admitted to Hospital: a Case Series

Since the start of the COVID-19 pandemic, a large number of trials have examined the efficacy of various medications as potential treatments for COVID-19, but a promising therapeutic option is still missing and under investigation. Molnupiravir is an investigational oral antiviral medication and a nucleoside analogue that suppresses SARS-CoV-2 replication and has been found to be active against common virus variations (including the Delta variant). Several phase 2 and 3 clinical trials have shown high efficacy for direct antiviral activity of molnupiravir as well as its favorable safety and tolerability in mild to moderate Covid-19 patients. The current study was done on five hospitalized, severe COVID-19 patients. It seems that in combination with remdesivir, this novel antiviral could exert a synergistic effect on reducing the severity of symptoms as well as the duration of hospitalization. However, further clinical studies on the use of molnupiravir in the treatment of severe COVID-19 are warranted.

COVID-19 treatment in children: A systematic review and meta-analysis.

Background:Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature.Methods:Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity.Results:From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, P = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%.Conclusion:Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.

The Evaluation of Effective Drugs for the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review and Network Meta-Analysis.

Purpose: Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis are two forms of fatty liver disease with benign and malignant nature, respectively. These two conditions can cause an increased risk of liver cirrhosis and hepatocellular carcinoma. Given the importance and high prevalence of NAFLD, it is necessary to investigate the results of different studies in related scope to provide a clarity guarantee of effectiveness. Therefore, this systematic review and meta-analysis aim to study the efficacy of various medications used in the treatment of NAFLD. Methods: A systematic search of medical databases identified 1963 articles. After exclusion of duplicated articles and those which did not meet our inclusion criteria, eta-analysis was performed on 84 articles. Serum levels of alanine aminotransferase (ALT), aspartate amino transferase (AST) were set as primary outcomes and body mass index (BMI), hepatic steatosis, and NAFLD activity score (NAS) were determined as secondary outcomes. Results: Based on the P-score of the therapeutic effects on the non-alcoholic steatohepatitis (NASH), we observed the highest efficacy for atorvastatin, tryptophan, orlistat, omega-3 and obeticholic acid for reduction of ALT, AST, BMI, steatosis and NAS respectively. Conclusion: This meta-analysis showed that atorvastatin. life-style modification, weight loss, and BMI reduction had a remarkable effect on NAFLD-patients by decreasing aminotransferases.

Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center.

The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.

Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations.

Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.

The neuropsychiatry of tinnitus: a circuit-based approach to the causes and treatments available.

Patients presenting with tinnitus commonly have neuropsychiatric symptoms with which physicians need to be familiar. We provide an overview of tinnitus, including its types and pathophysiology. We discuss how recent methods such as transcranial magnetic stimulation, positron emission tomography, MRI, magnetoencephalography and quantitative EEG improve our understanding of the pathophysiology of tinnitus and connect tinnitus to the neuropsychiatric symptoms. We then explain why treatment of the tinnitus patient falls within the purview of neuropsychiatry. Psychiatric problems such as depression, anxiety and personality disorders are discussed. We also discuss how stress, headache, cognitive processing speed and sleep disturbance are associated with tinnitus. Finally, we provide a brief overview of treatment options and discuss the efficacy of various medications, including benzodiazepines, antidepressants, antipsychotics and mood-stabilising agents, and various non-pharmacological treatment options, such as cognitive behavioural therapy, habituation therapy and acupuncture. We also discuss how brain stimulation therapies are being developed for the treatment of tinnitus. In conclusion, a review of the literature demonstrates the varied neuropsychiatric manifestations of tinnitus. Imaging studies help to explain the mechanism of the association. However, more research is needed to elucidate the neurocircuitry underlying the association.

Vertigo as a Migraine Phenomenon

Migraine is a complex disorder with many different manifestations. There has been an increasing interest in the association of migraine and vertigo. Many different terms have been developed to describe this concept, the more popular being vestibular migraine, migrainous vertigo, and migraine-associated vertigo. The most commonly cited diagnostic criteria are that of Neuhauser though this has yet to be included in the International Classification of Headache Disorders (2nd edition). At this time, there is a lack of consensus regarding migraine-related vertigo and its pathomechanism. Regardless, a few randomized controlled prospective studies have been performed to evaluate the efficacy of various medications. Topiramate has been shown to be effective for migraine-related vertigo. At this time there is no specific treatment for migraine-related dizziness outside of conventional migraine management. The genetics have yet to be fully realized though an autosomal dominant familial migraine vertigo disorder has been identified.

The Use of Selective Serotonin Reuptake Inhibitors in Elderly Patients

Depression is common among the elderly, and several factors need to be taken into account in selecting the appropriate antidepressant in this age group. Various physiologic changes occur in individuals as they age, potentially leading to changes in the pharmacodynamic and pharmacokinetic properties of drugs in elderly individuals. The efficacy of various medications, their side-effect profiles, and the potential for drug-drug interactions may differ in older patients compared to younger ones. The selective serotonin reuptake inhibitors (SSRIs), which are seen as being among the first-line agents for treatment of depression in elderly patients, have been shown to be effective but carry with them side effects and drug-drug interactions that warrant special attention when these medications are prescribed to older individuals. This review focuses on the pharmacology of SSRIs in elderly patients and on practical issues related to using these medications.

Treatment of fragile X-associated tremor ataxia syndrome (FXTAS) and related neurological problems

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a progressive neurological disorder that affects older adult carriers, predominantly males, of premutation alleles (55 to 200 CGG repeats) of the fragile X (FMR1) gene. Principal features of FXTAS are intention tremor, ataxia, parkinsonism, cognitive decline, and peripheral neuropathy; ancillary features include, autonomic dysfunction, and psychiatric symptoms of anxiety, depression, and disinhibition. Although controlled trials have not been carried out in individuals with FXTAS, there is a significant amount of anecdotal information regarding various treatment modalities. Moreover, there exists a great deal of evidence regarding the efficacy of various medications for treatment of other disorders (eg, Alzheimer disease) that have substantial phenotypic overlap with FXTAS. The current review summarizes what is currently known regarding the symptomatic treatment, or potential for treatment, of FXTAS.

Quetiapine for agitation or psychosis in patients with dementia and parkinsonism

To assess the efficacy and tolerability of quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Multicenter randomized, double-blind, placebo-controlled parallel groups clinical trial involving 40 patients with dementia with Lewy bodies (n = 23), Parkinson disease (PD) with dementia (n = 9), or Alzheimer disease with parkinsonian features (n = 8). The main outcome measure for efficacy was change in the Brief Psychiatric Rating Scale (BPRS) from baseline to 10 weeks of therapy. For tolerability it was change in the Unified PD Rating Scale (UPDRS) motor section over the same time period. The trial was confounded by the need for a design change and incomplete recruitment. No significant differences in the primary or secondary outcome measures of efficacy were observed. An unexpectedly large placebo effect, inadequate dosage (mean 120 mg/day), and inadequate power may have contributed to lack of demonstrable benefit. Quetiapine was generally well-tolerated and did not worsen parkinsonism, but was associated with a trend toward a decline on a measure of daily functioning. Quetiapine was well-tolerated and did not worsen parkinsonism. Although conclusions about efficacy may be limited, the drug in the dosages used did not show demonstrable benefit for treating agitation or psychosis in patients with dementia and parkinsonism. These findings are in keeping with prior studies reporting limited efficacy of various medications for reducing behavioral problems in demented patients.

Estriol, conjugated equine estrogens, and alendronate therapy for osteoporosis

This study retrospectively evaluated the efficacy of various medications prescribed to women for osteoporosis between 1992 and 2005 at the Menopause Clinic of Tokyo Medical and Dental University Hospital, Japan. Inclusion criteria were being postmenopausal; having been diagnosed with primary osteoporosis according to the criteria of the Japanese Society for Bone and Mineral Research; being aged between 40 and 69 years; and having been treated for 2 or more years with a single medication.

Quantitative imaging of the structural changes of osteoarthritis: an exciting challenge for the new millennium.

The progression of structural changes, including cartilage degradation in knee OA, over time is an extremely important parameter that must not be overlooked in the study of therapeutic interventions for this disease. Existing radiologic methods used to evaluate the disease progression are useful and allow for several clinical trials to take place. However, these methods are imperfect and time consuming. A faster and more accurate method to evaluate the efficacy of various medications on the progression of OA is required. Current tools lack sensitivity to change over short periods of observation (plain and standardized radiographs) or are invasive (arthroscopy). Due to its greater sensitivity to change, evaluation by MRI is promising and appears to surpass the other available technologies in measuring the structural changes of knee OA, including the gradual loss of cartilage. The development of the new software tool will allow for the MRI technology to provide quantitative measurement, and the evaluation of the efficacy of new therapeutic interventions in a more accurate and rapid fashion, dramatically changing the way knee OA clinical trials are conducted. Studies will be performed in a time-wise fashion, allowing for the testing of a larger number of molecules having the potential to retard or stop progression of the disease.

A meta-analytic review of the preventive treatment of recurrences of febrile seizures

Objective: To assess the efficacy of various medications in the prevention of recurrent febrile seizures. Study design: A meta-analysis of all published randomized, placebo-controlled trials of the preventive treatment of febrile seizures published in English; 45 articles were found, but only 9 trials were randomized and placebo-controlled—4 using phenobarbital; 3, diazepam; 1, pyridoxine; and 1, phenytoin. In one of the phenobarbital trials, valproate was also compared with placebo. Results: The risk of recurrences was significantly lower in children receiving continuous phenobarbital therapy than placebo (odds ratio 0.54, 95% confidence intervals 0.33 to 0.90, p = 0.017). The odds ratio for recurrences in the valproate group was 0.09, 95% CI 0.01 to 0.78, p = 0.011. No difference in the risk was found for recurrences between children receiving intermittent diazepam and placebo (odds ratio 0.81, 95% CI 0.54 to 1.22, p = 0.31). The risk for recurrences in children receiving pyridoxine or phenytoin did not differ from the risk among children receiving placebo. Four children would have to be treated with valproate (95% CI 2 to 11) or eight children would have to be treated with phenobarbital (95% CI 5 to 27), continuously, to prevent one febrile seizure. Conclusions: Because both agents found to be effective in prevention of recurrent febrile seizures have known adverse effects, prophylaxis of febrile seizures cannot be recommended. (J Pediatr 1997;131:922-5)

AUTONOMIC DYSREFLEXIA

Autonomic dysreflexia (AD) is a syndrome that often occurs in patients with spinal cord injuries above T-6 and can have life-threatening results if not properly managed. The hypertension associated with AD can cause a great deal of morbidity and mortality, requiring quick and effective blood pressure reduction. Both pharmacologic and nonpharmacologic methods are used to prevent or alleviate the symptoms associated with an acute episode of AD. We found that current literature is lacking in controlled, prospective, randomized studies comparing the efficacy of various medications used in the treatment of AD. We conducted a nationwide survey to determine the consensus among clinicians concerning the management of AD. The survey was designed to determine the current clinical status of AD, to assess methods of treatment being used and to summarize and give a rationale for the drugs most commonly prescribed. Finally, a suggestion for a wallet-sized card briefly outlining effective treatments of AD in an emergency situation is included. Results indicate that most clinicians feel that after nonpharmacologic measures have failed, antihypertensive medication is useful in controlling the symptoms of AD while the inciting cause is being found and treated. Agents used most frequently include, but are not limited to, nifedipine, phenoxybenzamine, prazosin, mecamylamine and nitrates.