Additional Medication Research Articles

The Road Less Traveled: Ciliary Sulcus Implantation of the Preserflo MicroShunt

Introduction: Herein, we report on the option and clinical advantage of the Preserflo MicroShunt insertion into the posterior chamber ciliary sulcus in a patient with advanced pseudoexfoliation glaucoma at a high risk of corneal decompensation. Case Presentation: We describe a 64-year-old advanced pseudoexfoliation glaucoma patient who despite maximal tolerated medical therapy and two failed glaucoma surgeries, still suffered from uncontrolled intraocular pressure (IOP) of 36 mm Hg in his left eye. The patient underwent the implantation of the Preserflo MicroShunt. The shunt was placed nasally into an area of unscarred conjunctiva, with the anterior part of the shunt inserted into the ciliary sulcus. Postoperatively, the patient’s IOP dropped to 6 mm Hg on the first day and stabilized at 11 mm Hg at the 6-month mark. An elevated, posteriorly located bleb was observed, and the patient no longer required additional topical medications. Endothelial cell (EC) count remained stable with no signs of corneal edema. The patient did not experience any serious postoperative complications. Conclusion: Implantation of the Preserflo MicroShunt into the ciliary sulcus appears to be a viable option for patients at high risk of corneal decompensation, hence, offering effective IOP control while minimizing EC loss. Further studies with larger patient groups are warranted to better evaluate the safety and efficacy of this technique.

Effectiveness of a Web-Based Medication Education Course on Pregnant Women's Medication Information Literacy and Decision Self-Efficacy: Randomized Controlled Trial.

Medication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events. This study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women's MIL and decision self-efficacy. A randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping×time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial. A total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time×group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time×group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively). Web-based medication education courses based on the theory of planned behavior can effectively improve pregnant women's MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care. Chinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685.

Once-weekly IcoSema versus once-weekly semaglutide in adults with type 2 diabetes: the COMBINE 2 randomised clinical trial.

COMBINE 2 assessed the efficacy and safety of once-weekly IcoSema (a combination therapy of basal insulin icodec and semaglutide) vs once-weekly semaglutide (a glucagon-like peptide-1 analogue) 1.0 mg in individuals with type 2 diabetes inadequately managed with GLP-1 receptor agonist (GLP-1 RA) therapy, with or without additional oral glucose-lowering medications. This 52 week, randomised, multicentre, open-label, parallel group, Phase IIIa trial was conducted across 121 sites in 13 countries/regions. Adults with type 2 diabetes (HbA1c 53.0-85.8 mmol/mol [7.0-10.0%]) receiving GLP-1 RA therapy with or without additional oral glucose-lowering medications were randomly assigned 1:1 to once-weekly IcoSema or once-weekly semaglutide 1.0 mg. The primary endpoint was change in HbA1c from baseline to week 52; superiority of IcoSema to semaglutide 1.0 mg was assessed. Secondary endpoints included change in fasting plasma glucose and body weight (baseline to week 52), and combined clinically significant (level 2; <3.0 mmol/l) or severe (level 3; associated with severe cognitive impairment requiring external assistance for recovery) hypoglycaemia (baseline to week 57). Overall, 683 participants were randomised using a Randomisation and Trial Supply Management system to IcoSema (n=342) or semaglutide 1.0 mg (n=341). Mean ± SD baseline characteristics were as follows: HbA1c 64.0±8.2 mmol/mol (8.0±0.7%); diabetes duration 12.6±6.9 years; and BMI 31.1±4.7 kg/m2. From baseline to week 52, mean change in HbA1c was -14.7 mmol/mol (-1.35%-points) in the IcoSema group and -9.88 mmol/mol (-0.90%-points) in the semaglutide group; the estimated treatment difference (ETD) was -4.85 (95% CI -6.13, -3.57) mmol/mol (-0.44 [95% CI -0.56, -0.33]%-points), confirming superiority of IcoSema to semaglutide (p<0.0001). The estimated mean change in fasting plasma glucose from baseline to week 52 was statistically significantly reduced with IcoSema vs semaglutide (-2.48 mmol/l vs -1.43 mmol/l, respectively; ETD -1.05 [95% CI -1.36, -0.75] mmol; p<0.0001). Mean change in body weight from baseline to week 52 was statistically significantly different between groups: +0.84 kg for IcoSema vs -3.70 kg for semaglutide (ETD 4.54 kg [95% CI 3.84, 5.23]; p<0.0001). There was no statistically significant difference in the rate of combined clinically significant or severe hypoglycaemia between IcoSema and semaglutide (0.042 vs 0.036 episodes per person-year of exposure; estimated rate ratio 1.20 [95% CI 0.53, 2.69]; p=0.66). The proportion of participants experiencing gastrointestinal adverse events was similar between treatment groups (IcoSema 31.4%; semaglutide 34.4%). In people living with type 2 diabetes inadequately managed with GLP-1 RA therapy, with or without additional oral glucose-lowering medications, switching to once-weekly IcoSema in comparison with once-weekly semaglutide 1.0 mg demonstrated superiority in HbA1c reduction, similar rates of clinically significant or severe hypoglycaemia, and similar frequency of gastrointestinal adverse events. However, weight change from baseline to week 52 was statistically significantly in favour of semaglutide 1.0 mg. ClinicalTrials.gov NCT05259033 FUNDING: This trial was funded by Novo Nordisk.

Impact of mitomycin C on surgical outcomes of PAUL glaucoma implant in neovascular glaucoma: 12-month follow-up results.

To evaluate the effectiveness of the PAUL Glaucoma Implant (PGI) and the adjunctive impact of intraoperative Mitomycin C (MMC) on surgical outcomes in patients with neovascular glaucoma (NVG). This retrospective, comparative study included NVG patients who underwent PGI implantation. The cohort was divided into two groups: Group 1 (PGI without MMC) and Group 2 (PGI with MMC). Inclusion criteria encompassed a minimum 12-month postoperative follow-up and preoperative light perception. Surgical success was defined as maintaining intraocular pressure (IOP) between 6-21 mmHg without additional surgical intervention from the third month to the end of the 12-month follow-up. Failure due to hypotony was defined as an IOP ≤5 mmHg. The study enrolled a total of eighty-one patients, with 40 patients in Group 1 and 41 in Group 2. There were no significant differences in the demographic data and baseline ocular characteristics between the groups. Group 1 required more medications at 1, 3, 6, and 12 months (p < 0.05 for all). Surgical success rates at 12 months were 85% for Group 1 and 87.8% for Group 2, with no statistically significant difference between the groups (p = 0.140). Group 2 demonstrated a lower frequency of additional glaucoma procedures (p = 0.003) and delayed ripcord suture removal (p = 0.0001). Incorporating MMC as an adjunct to PGI implantation may improve IOP control and decrease the requirement for additional medications and surgical interventions in NVG patients. However, there was no statistically significant difference between the two groups in terms of the surgical success criterion.

Topical Caspofungin 0.5% Monotherapy for Filamentous Fungal Keratitis.

To describe a case series of patients with 12 fungal keratitis treated with caspofungin 0.5% eye drops. In this study, 12 patients diagnosed with fungal keratitis were treated with topical compounded caspofungin 0.5% eye drops. The authors also reviewed the existing literature on topical caspofungin 0.5% for managing fungal keratitis. The average age of the patients was 50.16 ± 13.74 years, and the average time to presentation was 9.66 ± 6 days from the onset of symptoms. Out of the 12 patients, 10 were males, and 2 were females. Three (25%) patients had infiltrates extending up to the mid-stromal level, whereas 9 (75%) had superficial infiltration. Topical caspofungin monotherapy successfully treated the fungal infection in 8 (66.6%) patients, whereas 4 patients required additional medication and/or surgical intervention. The average size of the infiltration was 3.44 ± 1.21 mm. The group that responded to treatment had better final visual acuity compared to the nonresponding group, with values of 0.41 ± 0.48 logarithm of the minimum angle of resolution and 1.39 ± 0.10 logarithm of the minimum angle of resolution (P-value = 0.023), respectively. Topical caspofungin 0.5% is a safe and effective treatment for selected cases of fungal keratitis. However, cases with larger or deeper initial infiltrates, or those caused by Fusarium infection, may not respond adequately to topical caspofungin monotherapy.

Effects of Immediate Postpartum Diuretic Treatment on Postpartum Blood Pressure among Individuals with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Hypertensive disorders of pregnancy (HDP) are associated with ongoing postpartum hypertension (HTN) and increased morbidity. Extravascular water and sodium mobilization is implicated in postpartum blood pressure (BP) elevation, however trials of postpartum diuretics in HDP have had mixed results. Our meta-analysis aimed to analyze the impact of postpartum diuretics on postpartum hypertension following HDP. Systematic review identified randomized controlled trials (RCTs) studying the efficacy of diuretics in the treatment of postpartum BP. Meta-analysis outcomes included persistent HTN up to 10 days postpartum, mean postpartum systolic and diastolic BPs, and use of additional antihypertensive medications. From 9 RCTs, 1273 subjects were included in the meta-analysis. Postpartum diuretic use was associated with lower systolic BP (SMD standard mean difference]: -0.36; 95% confidence interval [CI]: -0.72; -0.01) without a difference in diastolic BP (SMD: 0.01; 95% CI: -0.22; 0.23) compared with controls. There was no difference in rates of persistent HTN between the postpartum diuretics group versus controls (OR: 0.70; 95% CI: 0.4; 1.05) or in antihypertensive medication use (OR: 0.66; 95% CI: 0.42; 1.05). Postpartum diuretic use was associated with lower systolic BP compared with controls and non-significant trends of lower rates of persistent HTN and postpartum antihypertensive medication use. Due to the low certainty of evidence, uniform postpartum diuretic use with HDP cannot be recommended. Future studies are needed to evaluate specific HDP subgroups who may benefit from diuretic use.

Effect of Ripasudil on the Change Rates of the Circumpapillary Retinal Nerve Fiber Layer Thickness in Patients With Primary Open-Angle Glaucoma.

Purpose: The effect of the Rho-kinase inhibitor ripasudil on the retinal optic nerve fiber layer (RNFL) remains unclear. We aimed to determine this effect in patients with primary open-angle glaucoma (POAG) using optical coherence tomography (OCT) measurements and linear mixed analysis. Methods: This study prospectively included outpatients from a single center with POAG without a history of vitreoretinal or glaucoma surgery from December 2014 to June 2020, in whom the circumpapillary RNFL thickness (cpRNFLT) was measured more than three times before and after ripasudil initiation, without additional medication or surgery during the period. Measurements were performed using OCT in the follow-up mode. The cpRNFLT change rates were compared before and after treatment using linear mixed models with adjustments for intraocular pressure (IOP) changes. Results: Thirty eyes of 20 patients (12 males and eight females) were included. Upon ripasudil prescription, the average cpRNFLT was 60.2 ± 2.1 μm. The average IOP was 15.1 ± 0.5 and 13.5 ± 0.5 mmHg, respectively, before and after treatment initiation, with a difference of -1.6 ± 0.3 mmHg. Analysis of 343 cpRNFLT measurements using linear mixed models revealed that the cpRNFLT change rate was -0.91 ± 0.15 and -0.40 ± 0.14 μm/year, respectively, before and after treatment onset, with an increase of 0.51 ± 0.21 μm/year. After adjusting for IOP changes, the improvement in cpRNFLT change rate was 0.33 ± 0.23 μm/year, albeit not statistically significant. Conclusion: The cpRNFLT change rate significantly increased after ripasudil administration, whereas the contribution of the IOP decline was not significant.

Regional Anesthesia for Wrist Fractures and Dislocations: Are We Really Blocking Opioid Prescribing?

The aim of this study was to evaluate the impact of regional anesthesia for the treatment of wrist fractures or dislocation on opioid prescription-filling patterns. Patients undergoing surgery for hand and wrist fractures or dislocations from 2010 to 2018 were identified by using a national insurance claims database. Patients were stratified by procedures conducted with and without regional anesthesia. Preoperative opioids were defined by a filled opioid prescription within 1 month prior to surgery, postoperative within 1 month following the surgery, and prolonged postoperative 3 to 6 months following surgery. Patients' demographic data, comorbidities, additional medications, 30-day emergency department (ED) visits, and hospital readmissions were analyzed. A total of 24 598 patients treated with and 115 199 patients treated without a regional nerve block for wrist fractures and dislocations were identified. Regional anesthesia was associated with greater postoperative opioid prescription but fewer prolonged postoperative prescriptions. There was an increased odds of all-cause 30-day ED visits but a decreased odds of 30-day hospital readmissions when patients received a regional nerve block prior to surgery. In this study, receiving regional anesthesia prior to surgical intervention for wrist fractures or dislocations was associated with increased filling of postoperative opioid prescriptions, but not prolonged postoperative opioid prescriptions. Additional investigation is needed to identify and implement nonnarcotic multimodal analgesia regimens that may help decrease usage of narcotic medications surrounding these procedures. Level III, retrospective cohort study.

Pain Management for Patients With Opioid Use Disorders.

As the prevalence of opioid use disorder (OUD) continues to rise, it is crucial clinicians are prepared to deliver safe and effective therapy to individuals affected by this disorder. The occurrence of pain among patients with OUD is not uncommon; effective management is complex and requires a comprehensive approach developed in collaboration with patients, their families and specialists in substance use disorders. Most patients with OUD require long-term treatment. For many, this involves chronic medications including buprenorphine, methadone or naltrexone. First-line pain management therapy with nonpharmacologic or non-opioid pharmacotherapy, including multimodal strategies should be maximized first and tailored to underlying pain etiology. In some settings, patients may require additional opioid medications for pain control. In this review, we describe an approach to pain management in patients receiving medications for OUD as well as those with untreated OUD.

Amlodipine versus nifedipine ER for the management of postpartum hypertension: a noninferiority randomized controlled trial.

Postpartum hypertension is an increasingly prevalent problem and optimizing its treatment is imperative in reducing maternal morbidity and improving long-term health outcomes. Despite this, data on treatment of postpartum hypertension is limited. While most available studies focus on labetalol and nifedipine ER, these medications are not frequently used for hypertension treatment in the non-obstetric setting. As we aim to establish best practices for managing postpartum hypertension, use of more commonly encountered antihypertensives should be evaluated. To evaluate the use of amlodipine for the treatment of postpartum hypertension, as assessed by postpartum length of stay. In a pragmatic, randomized controlled noninferiority trial, patients were assigned to amlodipine or nifedipine ER for treatment of postpartum hypertension. The primary outcome was time from delivery until discharge with a noninferiority limit of 24 hours. A sample size of 132 was needed to achieve 80% power with a 2-tailed alpha of 0.05. Intent-to-Treat and Per Protocol analyses were performed. Prespecified secondary outcomes included the need for additional antihypertensives, side effects, medication discontinuation, breastfeeding satisfaction, and readmission rate. A post-hoc analysis of time from medication initiation until hospital discharge was also performed. From April 2021 to December 2022, 7618 patients were screened and 175 patients were randomized, with 132 meeting criteria for antihypertensive initiation. Baseline demographics were similar between groups. Amlodipine had a non-inferior length of stay compared to nifedipine ER (Intent-to-Treat Wilcoxon pseudo-median amlodipine=73.5 hours, nifedipine ER=72.0 hours, 95% CI -8.00 to 6.00). The remainder of analyses were performed only on the Per Protocol cohort. Time from medication initiation until hospital discharge was similar between groups (amlodipine=45.0 hours, nifedipine ER=45.5 hours, 95% CI -8.00 to 13.00). There were no differences in use of additional antihypertensives or patient-reported side effects or breastfeeding outcomes, but hypotension and tachycardia were less common with amlodipine use. Amlodipine was significantly less likely to be discontinued due to side effects (amlodipine n=0, nifedipine ER n=7 (10.1%), p=.02). Readmission rates were similar between groups. Amlodipine is noninferior to nifedipine ER for postpartum hypertension treatment, as defined by median length of postpartum stay. Rates of side effects were similar between groups, but there was a statistically significant difference in medication discontinuation rates. Clinicaltrials.gov, www. gov, NCT04790279.

The Use of Immunomodulators, Biologic Therapies, and Small Molecules in Patients With Inflammatory Bowel Disease and Solid Organ Transplant.

Patients with inflammatory bowel diseases (IBDs) may require solid organ transplants (SOTs) for multiple reasons, making its prevalence slightly higher than the general population. Although immunosuppression used in SOT may help control IBD-related inflammation, many patients still require additional immunosuppressive medications. We aim to assess the effectiveness and safety of the combination of SOT-related immunosuppression and IBD medications in patients with liver, kidney, or heart transplantation. We conducted a clinical review using PubMed, Scopus, MEDLINE, Embase, and Google Scholar databases for our search. We included data from systematic reviews, meta-analyses, case series, and case reports to assess the safety, effectiveness, and side effect profile of immunomodulators, biologic therapies, and small molecules in patients with SOT. Our review encompassed 25 liver, 6 kidney, and 1 heart transplant studies involving patients with IBD. Common liver transplant immunosuppressants included tacrolimus, mycophenolate mofetil, cyclosporine, and steroids. Anti-TNF agents, widely used in all SOT types, showed no significant safety issues, though infections and malignancies were noted. Patients with liver transplant on tacrolimus responded well to anti-integrins and ustekinumab without major complications. For kidney transplants, cyclosporine and tacrolimus were prevalent, and their combination with anti-TNF or ustekinumab was generally safe, with rare reports of malignancy or infection. Hence, the use of anti-TNF, anti-integrin agents, and ustekinumab appears to be safe in patients with SOT, regardless of their transplant related immunosuppression. More studies are needed in patients with kidney and heart transplants and in patients treated with small molecules for their IBD.

Trends in the prevalence of obesity and estimation of the direct health costs attributable to child and adolescent obesity in Brazil from 2013 to 2022.

Childhood obesity is a major global public health issue globally and in Brazil. The impacts of childhood obesity include higher risk of disease during childhood and of obesity and non-communicable diseases in adulthood and represent an important epidemiological and economic burden to countries. This study aims to analyze the trends and to estimate the direct healthcare costs of childhood and adolescent obesity to the National Health System from 2013 to 2022. We used Prais-Winsten regressions for determining the trends in the prevalence of obesity and modeled the attributable to childhood and adolescent obesity in the Brazilian National Health System using previous meta-analysis of studies. The hospitalizations of children and adolescents with obesity as a primary cause totaled Int$2.6 million to the Brazilian National Health System from 2013 to 2022, demonstrating that obesity is rarely considered as a cause of hospitalization especially among children and adolescents. The additional costs of hospitalizations attributable to childhood obesity totaled Int$101.5 million during the same period. The additional non-hospital, outpatient and medication cost attributable to childhood obesity in Brazil were estimated at Int$6.0 million, so the total estimated healthcare costs were of approximately Int$107.5 million in the last decade. This study highlights that childhood and adolescent obesity are increasing for most age-groups and that its costs are not limited to the economic impacts on adult health and represent a relevant economic burden to the Brazilian National Health System and to families because of additional costs during childhood and adolescence. Therefore, the prevention and control of childhood and adolescent obesity must be public health priorities.

Triple inhaler therapy in adolescents and adults with moderate or severe persistent asthma.

Expert guidelines, meta-analyses, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMAs) as an additive medication for patients with poorly controlled moderate or severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucus production. By adding this medication to other combination inhalers, patients can use a triple inhaler to improve FEV1 values and reduce exacerbations.

Management policy for postoperative acromegaly patients with normal IGF-1 and high GH levels on oral glucose tests.

Acromegaly patients occasionally achieve either of the remission criterion of IGF-1 or GH level postoperatively; however, treatment for patients with discordant IGF-1 and GH levels remains unclear. This study aimed to clarify the clinical courses and features of postoperative patients with normal IGF-1 and high GH levels and support their management. Overall, 110 acromegaly patients underwent initial surgery and a 75-g oral glucose tolerance test (OGTT) 3 months postoperatively. Of the 110, 23 patients with normal IGF-1 and nadir GH levels of ≥ 0.4µg/L on OGTT (high-GH group) were categorized into three subtypes based on their repeated examinations thereafter: late-remission type (nadir GH level on OGTT of < 0.4µg/L later), recurrence type (elevated IGF-1 and GH levels later), and persistent type (normal IGF-1 levels and constantly high nadir GH levels on OGTTs). Proportion of patients in the high-GH group was 23.6%, and they were distributed as follows: late-remission type (n = 10), recurrence type (n = 5), and persistent type (n = 8). There were significantly more women (P = 0.0178) than men in the late-remission type, and patients in the persistent type had significantly larger tumors (P = 0.0110) and higher preoperative GH levels (P = 0.0018) than those that achieved complete remission 3 months postoperatively. Careful monitoring without additional medications is recommended at first in acromegaly patients with normal IGF-1 and high GH levels considering the possibility of recurrence in the future.

Effects of Controlled Hypotension on Cerebral Oxygenation in Tympanoplasty and Tympanomastoidectomy Surgery

Background: Controlled hypotension can reduce bleeding and improve visualization of the surgical field. We aimed to evaluate the effects of deliberate controlled hypotension by using esmolol and nicardipine on cerebral oxygenation, hemodynamics, bleeding, surgical satisfaction and quality of recovery. Methods: Sixty patients between the ages of 18 and 65 who were scheduled tympanomastoidectomy surgery were included. Anesthesia induction was performed with propofol, rocuronium and general anesthesia was maintained with sevoflurane and remifentanil infusion. The mean arterial blood pressure was aimed to be &amp;lt;30% from baseline for controlled hypotension. Nicardipine infusion (1-5 µg/kg/min) was used in group N and Esmolol infusion (30-300 µg/kg/min) was used in group E. Surgical bleeding and surgical satisfaction, extubation and recovery time, postoperative side effects, antiemetic and additional analgesic medications were recorded. Results: There was no difference between the groups in demographic data, duration of anaesthesia, extubation time, recovery time, Aldrette recovery scores, and the use of antiemetic and additional analgesics. The NIRS values in N group were observed higher than E group at the 20th and 40th minutes on the left, and at the 25th, 30th, 35th, 40th, 45th and 60th minutes on the right (p&amp;lt;0.05). Mean arterial blood pressure at the 70th and 80th minutes, and heart rate at the 15th, 25th, 30th, 35th and 40th minutes were observed higher in N group when compared to the E group. In the esmolol group, it was observed mild bleeding in 23 patients, moderate bleeding in 7 patients. In the nicardipine group, it was observed mild bleeding in 11 patients, moderate bleeding in 18 patients, severe bleeding in 1 patient. Surgeon’s satisfaction was higher in the Esmolol group (p&amp;lt;0.05). Conclusion: It was concluded that both Nicardipine and Esmolol could be applied for controlled hypotension during the otologic surgery, cerebral oxygenation was maintained with at doses administered Nicardipine and Esmolol in sevoflurane-remifentanil anesthesia. Surgical bleeding was lesser and surgeon’s satisfaction was higher with the Esmolol group than the Nicardipine group.

Effectiveness of the combination of netupitant and palonosetron in the prevention of nausea and vomiting during anthracycline-containing chemotherapy in patients with breast cancer

The incidence of early-stage breast cancer among young patients has shown a significant increase over the past twenty years, with a substantial portion of these patients requiring chemotherapy. Most treatment regimens used in both neo-adjuvant and adjuvant settings are characterized as moderately or highly emetogenic. Young patients typically lead socially active lives, balancing work and childcare, and strive to remain indistinguishable from healthy women. However, one of the most pronounced adverse effects of chemotherapy is nausea and vomiting, which significantly impair quality of life. One modern method for the prevention of nausea and vomiting involves the use of a combined NK1-receptor and 5-HT3-receptor antagonist, comprising the drugs netupitant and palonosetron (NEPA). This medication is administered as a single dose on the first day in conjunction with dexamethasone, without the need for additional medication on subsequent days. This review discusses the mechanisms of action of NEPA and pres ents studies focused on the effectiveness of the combination of netupitant and palonosetron in patients undergoing moderately and highly emetogenic therapy. According to literature the efficacy of NEPA in combination with dexamethasone reached 70.5% for complete response in the first cycle of treatment. A retrospective analysis involving 2,173 patients confirmed the high efficacy of NEPA, particularly in patients under 60 years of age. Data from real clinical practice further support the results of studies on the effectiveness of NEPA, demonstrating a complete control rate of nausea and vomiting ranging from 74 to 90%.

Increasing the number of pharmacist-led medication order reviews using the available workforce: a retrospective study

BackgroundDue to staffing constraints, several hospitals have defined targeting strategies for pharmacist-led medication order review, leaving non-targeted patients exposed to potential harmful drug-related problems (DRPs). Using targeting criteria to stratify...

Non-invasive electroencephalogram-based anesthesiological monitoring in geriatric patients in the ent-surgery

BACKGROUND: Demographic ageing of the society and the growing demand for medical service among the elderly citizens require perfecting the anesthesiology approaches. AIM: Evaluation of the efficiency of using various types of electroencephalography-based monitoring when performing general anesthesia in the settings of ENT-surgery in geriatric patients. METHODS: The randomized study included 99 patients (70–85 years old, ASA III–IV) who underwent surgery under general anesthesia for ENT pathology. The patients were distributed into three groups: Group A (n=33) — anesthesia controlled by CONOX — monitoring, Group В (n=33) — no cerebral monitoring, Group C (n=33) — controlled by BIS monitoring. The controlled parameters included the dosage of the medicinal products (Propofol, Fentanyl, Sevoflurane), the hemodynamics, the rates of intraoperative awakenings, postoperative nausea and vomiting, the need for additional pain medications and the parameters of the cognitive functions before and after surgery. RESULTS: The Propofol dosage in Group B was higher than in Groups А and С (p=0.016 and p=0.012 respectively). The concentration of Sevoflurane in Group С was lower (p=0.016), than in Groups А and В. Hemodynamic disorders and postoperative nausea/vomiting were more often observed in group В. Intraoperative awakenings were reported in 3% of the patients in Group А, in 9% for Group В and in 6% patients in Group С. Additional pain management was required in 39% of the patients in Groups А and В along with 42% in Group С, no statistical difference was found between the groups. Cognitive functions were better preserved in Group А with the duration of general anesthesia being more than 120 minutes (p=0.044). CONCLUSION: Anesthesiology monitoring based on electroencephalogram parameters, optimizing the dosages of the medicinal agents, decreases the rates of hemodynamic disorders, of intraoperative awakenings and of postoperative nausea and vomiting. Combined with the clinical monitoring of the electroencephalogram parameters, this accelerates rehabilitation and improves the surgery outcomes. The optimization of the dosage of opioids with controlling the anesthesia depth index (the Nociception Index, qNOX) positively affects the postoperative cognitive status of the patients.

Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill Patients.

Delirium and agitation are common syndromes in critically ill patients. Valproic acid (VPA) has shown benefit in intensive care unit (ICU)-associated delirium and agitation, but further evaluation is needed. The purpose of this study was to evaluate the effectiveness and safety of VPA for hyperactive delirium and agitation in critically ill adult patients. A retrospective cohort study at NYU Langone Health was conducted in critically ill patients treated with VPA for hyperactive delirium or agitation from October 1, 2017 to October 1, 2022. The primary outcome was effectiveness of VPA, defined as a reduction in the total number of any concomitant psychoactive medication by day 3 of VPA treatment. Secondary outcomes included the effect of VPA on the doses of concomitant medications and adverse events. A total of 87 patients were included in the final analysis. By day 3 of VPA treatment, a 33% reduction (P < .001) in the total number of concomitant psychoactive medications was observed. VPA decreased the need for sedatives, as assessed by midazolam equivalents, but no significant changes were seen with dexmedetomidine alone, opioids, or antipsychotics. A 10 mg/kg loading dose was utilized in 36% of the cohort and its use decreased the risk for initiating additional psychoactive medications by day 3 of therapy (OR 2.8, 95% CI 1.0-7.8, P = .047), with benefits noted as early as 48 h after initiation. Adverse events were low in the total cohort (10.3%). The addition of VPA to a complex pharmacologic regimen for hyperactive delirium and agitation is safe and can assist in the prevention of polypharmacy and overall workload in critically ill patients admitted primarily for cardiogenic shock and respiratory failure requiring mechanical ventilation.

Influence of perioperative therapy on filtration bleb formation and ophthalmotonus level after glaucoma surgery

Introduction. One limitation of glaucoma surgery is its reduced long-term effectiveness due to scarring of intraocular fluid outflow pathways. Appropriate perioperative therapy may extend the hypotensive effect by reducing scarring and improving the filtration bleb. Purpose: to evaluate the effect of perioperative use of Oku-Oku® on intraocular pressure (IOP) and filtration bleb condition in the early postoperative period following glaucoma surgery. Materials and methods. Thirty patients (30 eyes) who underwent non-penetrating glaucoma surgery (NPGS) were studied. The main group (15 eyes) received Oku-Oku® drops twice daily: the day before surgery, immediately before surgery, and for five days postoperatively. The control group (15 eyes) received no additional medication. Tonometry and assessment of conjunctival hyperemia were performed the day before surgery, and at 1 day, 2 weeks, and 1 month postoperatively. Filtration bleb characteristics were assessed using the Würzburg Clinical and Morphological Classification of Filtration Pads at the same time points, except for the preoperative assessment. Results. Glaucoma surgery significantly reduced IOP in both groups. After 1 month, the mean IOP in the main group was lower (15.1 ± 4.1 mm Hg) compared to the control group (17.9 ± 3.3 mm Hg). Conjunctival hyperemia was also lower in the main group (15.4 ± 2.7%) than in the control group (18.0 ± 3.1%). Filtration bleb parameters improved in both groups over time, with the greatest differences observed at 1 day and 2 weeks post-surgery. Conclusion. Perioperative use of Oku-Oku® reduced conjunctival hyperemia in the filtration bleb area during the first month after glaucoma surgery. This early improvement in the intraocular fluid deposition area may enhance the effectiveness of glaucoma surgery. Oku-Oku® can be used in comprehensive preparation for glaucoma surgery and other similar anterior segment procedures.