Many Categories Of Patients Research Articles

Use of elexacaftor/tezacaftor/ivacaftor combination in pregnancy.

Management of cystic fibrosis has recently stepped forward with the introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, although data on potential adverse effects are lacking for many categories of patients, such as pregnant women. We report one of the first reports on the outcome of pregnancy in a woman treated with Elexacaftor/Tezacaftor/Ivacaftor during the second and third trimester of pregnancy, showing a significant improvement of respiratory status, compared with the first trimester when the medication was discontinued due to unknown and, therefore, potential teratogenic effects. Also, we performed the review of the existing literature on the topic. The course of pregnancy was uneventful, with reference to major obstetric complications, and the patient delivered a healthy neonate. These results were similar to those coming from other short series of pregnant women affected by cystic fibrosis and treated with CFTR modulators during pregnancy. Thus, despite the lack of evidence on the topic, the use of Elexacaftor/Tezacaftor/Ivacaftor in pregnancy seems to be apparently not associated with major adverse events, thus opening optimistic scenarios in terms of management of these patients.

Prediction of development of disease among contacts of COVID-19 patients

Abstract Objectives Coronavirus disease 2019 (COVID-19) is a very progressive disease that concerns everyone regarding its infection and spread. This study predicted infection among people who came in contact with COVID-19-infected patients. The authors observed many categories of patients to get the best results. The aim of this work was to study the contact status of patients with COVID-19 in Sharkia Governorate, Egypt, and to assess the criteria of contacts being infected. Patients and methods This is a retrospective cohort study that used the data of Zagazig University Hospitals in Sharkia Governorate, reviewing people who came in contact with COVID-19 cases for appearance of symptoms, so that the authors can predict (later on) the probability of contacts getting infected. Results Of the 101 contacts, 49 were positive according to symptoms, 27 were positive according to computed topography (CT), and 38 were positive according to laboratory investigations, so contacts who were getting infected were according to the definition of suspect and probable cases. Overall, the suspect and probable contacts were 61, and about 27 (of 68 contacts who did CT from our sample) were moderate and severe cases. Conclusion Contact cases with comorbidity and old age were more liable to get infected and to be more serious cases than young age with no comorbidity. Of all contacts (101), 42 had comorbidities and about 31 of them had the disease.

Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients

Background: Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. Objective: The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. Methods: From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5%). Results: No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). Conclusion: Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients.

Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5%). No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

Obesity and hormonal contraception: an overview and a clinician's practical guide.

The growing prevalence of obesity among the fertile female population poses a considerable problem to contraceptive providers. Obese women, who are more at risk for venous thromboembolism and cardiovascular events due to their condition, might be at an even higher risk of developing thromboembolic events when on medical contraception. Combined hormonal contraceptives might be less effective in obese women and may lead to unacceptable metabolic side effects for this population. In addition, the lack of safety data for weight loss drugs and the higher risk for complications during and after pregnancy require a close surveillance of the fertility status of obese patients. The aim of this narrative review is to summarize the available medical contraceptive options and to give the readers a practical guidance for a wise contraceptive choice with regards to obesity. A general literature review of peer-reviewed publications on the topic "obesity and contraception" was performed using the PubMed database. Nowadays, there are many useful tools that help clinicians in choosing among the wide range of therapeutic possibilities, such as the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use. Furthermore, the great diversity of hormonal contraceptive formulations (combined hormonal formulations; progestin-only methods) and active substances (different estrogens and progestins) allow physicians to tailor therapies to patients' clinical peculiarities. Long-acting reversible contraceptives [progestin-only implants, levonorgestrel-intra-uterine devices (IUDs) and copper IUDs] and progestin-only methods in general are excellent options for many categories of patients, including obese ones. V, narrative review.

EDTA chelation reappraisal following new clinical trials and regular use in millions of patients: review of preliminary findings and risk/benefit assessment

EDTA chelation therapy is regularly used in thousands of patients worldwide. An FDA approval of more than 50 years ago for heavy metal detoxification prompted many physicians to use EDTA as an alternative medicine for many categories of patients. Recently, NIH initiated the so-called Trial to Assess Chelation Therapy (TACT), which has been designed to evaluate whether EDTA and high dose oral vitamins and mineral therapy could offer clinical, quality of life, and economic benefits for patients with a previous myocardial infraction. A 50% reduction of urinary Pb and improvement of systolic blood pressure was observed in 33 cardiovascular patients following 20 iv administrations. In another study involving 15 patients of different categories, EDTA also has been shown to be an effective and nontoxic chelator for the removal of xenobiotic metals such as Pb, Cd, Ni and Al. Administration of iv EDTA on weekly basis appears to be a sufficient and nontoxic protocol for treating patients with suspected overload and toxicity of xenobiotic metals especially Pb and Cd. The causative effect of xenobiotic metals in cancer, cardiovascular, neurodegenerative, renal and other diseases needs further investigation. Similarly, the use of EDTA chelation therapy in other conditions, which are not related to xenobiotic metal toxicity needs further investigation and confirmation of therapeutic use from controlled randomized clinical trials. Metal balance and drug interaction studies are required to clarify the risk/benefit assessment for the long term use of EDTA in patients with excess xenobiotic metal toxicity and in other conditions.

From paper electrophoresis to computer-supported interpretation of capillary electrophoresis--clinical plasma protein analysis in Malmö, Sweden.

Protein analyses have been used in Malmö as a routine clinical diagnostic tool since 1953. Most serum samples are submitted for "protein profiles" including capillary zone electrophoresis and rate immune nephelometric quantification of nine proteins (five in urines), although analysis of single proteins may be requested. Standardization between laboratories in our region has been greatly improved by automation, CRM 470 calibration and external quality assurance. We are further extending standardization by developing computer supported interpretations using a program with improved user interface and graphical representation of electrophoretic curves superimposed upon a shaded reference interval. Programming is underway to provide complete automatic interpretation of these curves. Together, capillary electrophoresis (with access to mathematical analysis) and immunochemical quantifications allow a highly automated process accessible to further digital analysis and automated interpretation. Rapid, cost-effective and standardized analysis of serum protein profiles should improve the diagnostic evaluation of many categories of patients.

Fourth international study of infarct survival: Protocol for a large simple study of the effects of oral mononitrate, of oral captopril, and of intravenous magnesium

The fundamental aim of the International Studies of Infarct Survival (ISIS) collaborative group is to assess reliably the balance of any benefits and risks for widely practicable treatments that might produce moderate but worthwhile mortality reductions in patients with suspected acute myocardial infarction. Substantial numbers of lives might be saved by such treatments, but benefits of the size that can realistically be expected may be reliably detected only by randomized trials involving some tens of thousands of patients. In order to recruit such numbers, ISIS involves almost no extra work for collaborators: hence, busy general hospitals—where the majority of acute myocardial infarction patients are actually treated—can take part easily. The ability of the ISIS trials to yield clear, reliable answers depends entirely on the collaboration of many doctors and nurses in the participating hospitals. For this reason, publication of the final results is in the names of all the collaborators. All patients, high risk as well as low risk, presenting within 24 hours of the onset of suspected acute myocardial infarction are eligible for ISIS-4, provided that the responsible physician does not initially consider there to be any clear indications for, or clear contraindications to, any one of the trial treatments—nitrate, angiotensinconverting enzyme inhibitor, or magnesium. Patients are randomized between 1 month of oral controned-release mononitrate or placebo; between 1 month of oral captopril or placebo; and between 24 hours of intravenous magnesium or open control (i.e., no infusion). (Patients who are to be given intravenous or other non-trial nitrate for just a few days can still be entered.) In this trial, 3 quite different treatments will each be evaluated. At first glance, this may appear to complicate the results, but in fact appropriate statistical analysis of this “factorial” design will allow all patients to contribute fully to assessment of the separate effects of each treatment (while also providing important information about the combined effects). Apart from giving the trial treatments, all other aspects of individual patient management are left entirely to the responsible physician to decide. For example, previous trials in suspected acute myocardial infarction have shown that, for many categories of patients, antiplatelet and fibrinolytic therapy can save lives. Hence, most collaborating doctors will wish to give antiplatelet therapy routinely and to start fibrinolytic therapy in many of their patients before randomizing them in ISIS-4. Some physicians may also wish to use certain other treatments (such as intravenous β blockers, anticoagulants) routinely in particular categories of patients. There are no restrictions on this in ISIS-4. Thus, ISIS-4 will provide good evidence about the effects of adding the trial treatments to various standard treatments. By including many different types of patients from many different types of hospitals with a wide variation in ancillary management (which is in any case unavoidable), the ISIS-4 results will be of direct clinical relevance to the heterogeneous realities of clinical practice worldwide.

Misuse of Therapeutic Drug Monitoring: An Analysis of Causes and Methods for Improvement

The quantification of serum drug levels provides physicians with an indication of attainment of the desired pharmacologic goals. However, based on the preceding evidence, therapeutic drug monitoring (TDM), which is commonly used in conjunction with the prescribing of anticonvulsants, antiarrythmics, cardiac glycosides, antibiotics, antineoplastics, bronchodilators, lithium, antidepressants, neuroleptics, benzodiazepines, and other psychotropic drugs, is not used effectively for therapeutic intervention in the elderly. In addition to determining if a blood level is within the therapeutic range, TDM can also be helpful in identifying the reasons why a patient is not responding to a prescribed drug or is exhibiting toxic signs or symptoms, as well as in elucidating causes of coma, patient noncompliance, poor absorption, and excessively rapid metabolism. Furthermore, drug blood levels can be an asset in the diagnosis and monitoring of treatment programs for alcohol and drug abuse. Despite the existence of computerized programs for drug level determination in clinical laboratories, and the existence of individualized computer programs for optimizing the choice and dosage of drugs for many categories of patients with a multitude of metabolic and pathophysiologic problems, most physicians still rely on tradition, imitation, and information provided by drug advertising and sales representatives to choose therapeutic regimens for patients. To make proper use of TDM, a physician has to have at least a working knowledge of the basic concepts of pharmacokinetics. This advancing medical science also demands a thorough knowledge of the routes of absorption, distribution, metabolism, and excretion of drugs. Results from TDM determinations indicate how effectively the appropriate amount of drug is delivered to the desired location of action from the site of administration. One of the most common reasons for misuse of TDM results is that physicians order specimens for drug monitoring to be drawn at inappropriate times. Accurate TDM requires that (most) specimens be drawn at trough levels, after steady-state levels have been attained. Trough levels occur immediately prior to the administration of the next dose. Such measurements avoid the absorptive peaking levels that occur shortly (usually) after drug administration. Steady-state levels are attained when the amount of drug absorbed and the amount excreted are essentially equal. This usually occurs after the drug has been administered for approximately five half-lives.(ABSTRACT TRUNCATED AT 400 WORDS)

Legal Restraints on Restraint

This inevitably led to the expansion of medical decision making over many categories of patients defined as mentally ill. The practical effect was a proliferation of paternalistic civil commitment systems in which decision making regarding forced civil confinement rested with psychiatrists and was only rubber stamped by the courts. Civil commitment as a means of managing dangerously violent persons had four distinguishable goals: (a) to provide care and treatment to those who required it; (b) to protect irresponsible people from themselves; (c) to protect society from dangerous acts; and (d) to relieve society or the family of persons who, although not dangerous, were bothersome(1). Due process rights were largely ignored. Patients were committed, often without review, to state institutions for long hospitalizations. Many entered, never to return to their families or communities.