Need For Intravenous Infusion Research Articles

HSD42 Modelling Time and Costs Associated With Daratumumab Treatment Delivery in the Home Care Setting Versus the Hospital in Spain to Understand Potential Benefits to Patients and Hospitals

Subcutaneous (SC) formulations of daratumumab replace the previous need for intravenous infusion, potentially enabling treatment to be provided at alternative sites of care. This research aims to evaluate if daratumumab SC injection for multiple myeloma in the home care setting can provide value to patients and hospitals in terms of time spent on treatment and associated costs, versus receiving treatment in the Spanish hospital setting.

Современные подходы к лечению обезвоживания у детей и взрослых

Обезвоживание является причиной многих летальных исходов, в первую очередь обусловленных диареей. Значительным достижением, позволившим спасти миллионы человеческих жизней, было создание оральной регидратационной соли (ОРС). ОРС для лечения обезвоживания при инфекционных диареях была создана в Международном исследовательском центре по изучению диарейных заболеваний в Бангладеш в конце 60-х годов XX века для лечения холеры. В последующем для лечения нехолерных диарей была разработана усовершенствованная формула ОРС. По данным ВОЗ, по сравнению со стандартным раствором ОРС раствор, имеющий пониженную осмолярность, позволяет сократить на 33 % потребность в проведении внутривенных инфузий. Кроме того, этот раствор также позволяет снизить частоту возникновения рвоты на 30 % и частоту стула — на 20 %. У 68,5 % детей с респираторными заболеваниями, которые были госпитализированы в инфекционный стационар, отмечались признаки обезвоживания. Как и при диареях, обезвоживание при респираторных заболеваниях является одним из показателей тяжести состояния. Оральная регидратация в настоящее время используется в различных странах мира у 99 % детей, больных диареей. Своевременная и адекватная регидратационная терапия является первоочередной и наиболее важной составной частью в лечении обезвоживания как у детей, так и у взрослых. Раннее использование адекватной регидратационной терапии является главным условием быстрого и успешного лечения заболевания.

Management Modalities and their Outcome in Patients of Acute Pancreatitis: A Cross Sectional Study

Background: Acute pancreatitis is a potentially serious condition with wide variation in severity rangingfrom mild and self-limiting to a rapidly progressive illness leading to multi-organ failure.Aim and Objective: To study early enteral feeding and their outcome in patients of acute pancreatitis.Methodology: Present study was a prospective study carried out in 60 patients out of 50 were male (83.3%) and 10 female (16.6 %) admitted as acute pancreatitis in the department of surgery, Shalinitai Meghehospital and Research centre, Datta Meghe Medical College, Nagpur. A thorough history was taken anddetailed clinical examination was conducted of all the patients on admission. All the patients were subjectedto biochemical and Radiological investigations. Radiological investigations like X-Ray chest abdomen andUltrasonography were carried out initially in all the patients. CT Abdomen performed as per requirement.Severity of disease was accessed on admission on the basis of BISAP scoring system. Conservativemanagement was instituted with early enteral feeding for all patients. All patients who recovered weredischarged and followed up on outpatient basis. Data was analyzed with appropriate statistical tests.Results: All the patients were initially managed conservatively with early enteral feeding. Type of feedingwas according to the severity of the illness. Oral in mild / moderate pancreatitis and nasogastric feedingin severe pancreatitis. Mild and moderate variety tolerated enteral feeding well thus need for intravenousinfusion was obviated. Out of these, 1 patient (1.7 %) required interventional management due to acutenecrotizing pancreatitis. This patient later required intravenous infusion and TPN in view of progressiveclinical deterioration due to necrotizing pancreatitis. The management of complications was essentiallyconservative. Acute necrotizing pancreatitis has a mortality of 100 % even with aggressive management.The overall mortality rate in our study was 1.7% .Conclusion: Conservative management is the mainstay of treatment in acute pancreatitis. Early enteralfeeding obviates the need for intravenous infusion in mild and moderate pancreatitis and in selected casesof severe acute pancreatitis. Early enteral feeding has advantages over Parenteral nutrition and reducesmortality, infectious complications, preventing malnutrition, reduction in length of hospital stay. Earlydetection and aggressive management of in acute severe pancreatitis can prevent its progression to acutenecrotizing pancreatitis and its complications.

Ravulizumab in the treatment of paroxysmal nocturnal hemoglobinuria

ABSTRACT Introduction Eculizumab, the anti-C5 monoclonal antibody therapeutic, has revolutionized the treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH) and has shown efficacy in other complement-mediated disorders including atypical Hemolytic Uremic Syndrome (aHUS) and Myasthenia Gravis (MG). Despite the effectiveness of eculizumab, challenges remain in the treatment of these diseases, including breakthrough hemolysis, frequent intravenous infusions, and cost; in an effort to mitigate these challenges, the new monoclonal therapeutic ravulizumab has been developed. Areas covered In this paper, we review the characteristics and clinical performance of ravulizumab and assess its potential utility in the treatment of PNH, and its position in this rapidly-developing therapeutic landscape. A review of published data up to Phase III of ravulizumab had been performed. Studies were identified via Google Scholar, PubMed, the United States National Library of Medicine Clinical Trials, citation chasing, and topic knowledge of the authors. Expert opinion Ravulizumab represents an important advance in the clinical care of complement-mediated disorders. Clinical trials demonstrate non-inferior efficacy and indistinguishable safety and tolerability to eculizumab, with added patient-preferred benefits including longer intervals between infusions. Though improved, physicians should be aware of the limitations of ravulizumab, including the need for intravenous infusions and possible breakthrough hemolysis.

Bispecific Antibody Emicizumab for Haemophilia A: A Breakthrough for Patients with Inhibitors.

Current unmet needs in haemophilia A patients with inhibitors include the need for intravenous infusion of replacement therapy and the high burden of treatment associated with prophylaxis. Emicizumab is a humanised bispecific monoclonal antibody designed to address these unmet needs and has completed phase III clinical trials in adolescents/adults (HAVEN 1) and paediatric (HAVEN 2) inhibitorpopulations. In HAVEN 1, there was an 80% bleed reduction across all bleeds, 89% reduction in treated jointbleeds, 92% reduction in treated spontaneous bleeds, and 95% reduction in treated target jointbleeds on emicizumab compared with no prophylaxis. In HAVEN 2, there was a 63% reduction in all bleeds, 94.7% reduction in treated bleeds, 94.7% reduction in treatedspontaneous bleeds, 100% reduction in treated joint bleeds, and 100% reduction in treated target jointbleeds on emicizumab prophylaxis whencompared with no prophylaxis. For patients on bypassing agent prophylaxis, emicizumab resulted in a 68% reduction in bleeds in HAVEN 1 and a 100% reduction in bleed rates in HAVEN 2. In HAVEN 1, three patients developed thrombotic microangiopathy (TMA) and two developed thrombosis when emicizumab was used together with an activated prothrombin complex concentrate (aPCC)at high or frequent doses. When the combination was avoided in HAVEN 2, no patient developed TMA or thrombosis. In both studies, no anti-emicizumab antibodies developed and the pharmacokinetic profile of emicizumab was similar. Emicizumab use is currently being explored in haemophilia A patients without inhibitors as well as in combination with other haemophilia A replacement therapies. The role of emicizumab in combination with current factor VIII replacement therapies and evolving non-replacement therapies remains to be established.

Subcutaneous infusión of furosemide administered by elastomeric pumps for decompensated heart failure treatment after discharge. Coordination between Cardiology, Comunity nurses and telecare data

Managing Heart Failure (HF) consumes more than 1% of the healthcare budget and two-thirds of this expenditure is due to hospitalizations. Diuretics are the main treatment and furosemide is the most commonly used drug. The need for intravenous infusion often involving hospitalization, even though subcutaneous administration is available. Elastomeric infusion pumps are nonelectric, disposable, continuous-flow pumps that are widely used in outpatient setting. This implantation route is accessible in 100% of patients, presents no technical difficulties, and is not painful; the device is simple and comfortable to transport, facilitates toileting, and allows patient mobility. All patients included (14) were in an advanced functional class (IV) at baseline, past six months they had three or more admissions, serious comorbidities or did not hinder the response to oral treatment. Paliative care and quality of live improvement is treatment objetive. The daily furosemide dose was calculated at the discretion of the prescribing physician (telecare data) if dosage changes were comunicated by phone. At least twice per week, comunity nurses have the opportunity to reach vulnerable and frail patients who might not be able to come to a heart failure clinic. Special telecare devices collect on and transmit weight, blood pressure, heart rate, transcutaneous O2 saturations and clinical questionary. Everyday was possible to know patient situation. The effectiveness of treatment was assessed by weight loss and clinical questionary. “End of treatment” was achieved when functional class improved or dry weight was maintained without parenteral diuretic therapy. The average time of treatment was 90 days, The typical initial infusion dose was 120 mg/d. There was significant weight loss, but no significant changes in serum creatinine, potassium, and sodium concentrations. Functional class improved in most patients, did not change in 25%, but nobody worsened. There were no treatment-related deaths, but 50% died (as expected) but without disnea at rest. Hospital heart failure admission or interruption of treatment was required in 18%, as local adverse effects. New models of care coordination nursing in the future will continue to provide hight quality care for heart failure patients who need their expert care and specific treatment at home.

Stable isotope tracers and exercise physiology: past, present and future.

Stable isotope tracers have been invaluable assets in physiological research for over 80 years. The application of substrate-specific stable isotope tracers has permitted exquisite insight into amino acid, fatty-acid and carbohydrate metabolic regulation (i.e. incorporation, flux, and oxidation, in a tissue-specific and whole-body fashion) in health, disease and response to acute and chronic exercise. Yet, despite many breakthroughs, there are limitations to 'substrate-specific' stable isotope tracers, which limit physiological insight, e.g. the need for intravenous infusions and restriction to short-term studies (hours) in controlled laboratory settings. In recent years significant interest has developed in alternative stable isotope tracer techniques that overcome these limitations, in particular deuterium oxide (D2 O or heavy water). The unique properties of this tracer mean that through oral administration, the turnover and flux through a number of different substrates (muscle proteins, lipids, glucose, DNA (satellite cells)) can be monitored simultaneously and flexibly (hours/weeks/months) without the need for restrictive experimental control. This makes it uniquely suited for the study of 'real world' human exercise physiology (amongst many other applications). Moreover, using D2 O permits evaluation of turnover of plasma and muscle proteins (e.g. dynamic proteomics) in addition to metabolomics (e.g. fluxomics) to seek molecular underpinnings, e.g. of exercise adaptation. Here, we provide insight into the role of stable isotope tracers, from substrate-specific to novel D2 O approaches, in facilitating our understanding of metabolism. Further novel potential applications of stable isotope tracers are also discussed in the context of integration with the snowballing field of 'omic' technologies.

Intravenous immunoglobulin in pediatrics: A review

There has been a rapid expansion of the use of intravenous immunoglobulin (IVIG) for an ever-growing number of conditions. IVIG is used at a ‘replacement dose’ (400–600 mg/kg/month) in antibody deficiencies and is used at a high dose (2 g/kg) as an ‘immunomodulatory’ agent in an increasing number of immune and inflammatory disorders.1 The limitations for IVIG are the cost of the preparation and the need for intravenous infusions. Due to the cost, shortages and growing use of IVIG there have been attempts to develop evidence-based guidelines for the use of IVIG in a wide variety of immune disorders in children and neonates. This commentary provides the recommendations and recent publication regarding the use of IVIG in various conditions in children.

Laparoscopic‐Assisted and Open High Anterior Resection within an ERAS Protocol

Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol. The association between surgical approach (laparoscopic or open surgery), compliance to the ERAS protocol, postoperative symptoms, complications, and length of stay after surgery was studied. Between January 2007 to December 2010, 114 consecutive patients underwent elective high anterior resection with laparoscopic-assisted (n = 55) or open resection (n = 59). All clinical data (114 variables) were prospectively recorded. The overall preoperative ERAS-protocol compliance was 77% for both the laparoscopic and open group. Laparoscopic surgery resulted in shorter total length of stay (median 4 vs. 6 days, p = 0.04), earlier pain control (median 2 vs. 3 days, p = 0.008), shorter need for intravenous infusions, improved mobilization on the first postoperative day (POD1), and lower inflammatory response (CRP (POD1) 54 ± 24 vs. 67 ± 31 mg/l, p = 0.017) compared with open resection. The trends in fewer postoperative complications (9.1 vs. 16.9%; odds ratio (OR) 0.55; 95% confidence interval (CI) 0.17-1.81) and overall postoperative symptoms delaying recovery (20 vs. 30.5%; OR 0.63; 95% CI 0.22-1.34) in laparoscopic surgery were not statistically significant. The use of laparoscopy in colorectal surgery within an ERAS protocol results in faster recovery compared with open resection.

Oral antifungals as prophylaxis in haematological malignancy

In the standard treatment of patients with haematological malignancy, immunosuppressive therapy produces prolonged periods of neutropenia and mucositis, which increase the risk of systemic fungal infection. In allogeneic bone marrow transplantation, this risk extends well beyond the period of neutropenia when graft-versus-host disease, and its treatment, result in prolonged lymphocytopenia. Various agents are used for antifungal prophylaxis and treatment but all have limitations: amphotericin B is restricted by the need for intravenous infusion and the occurrence of adverse events, fluconazole by its narrow spectrum of activity and the emergence of fluconazole-resistant fungi and itraconazole capsules by erratic absorption. Oral administration of antifungals has clear advantages in prophylaxis and an important current strategy is to maximize the extent and reliability of the oral bioavailability of antifungal agents. Mucositis is the main obstacle for success of strategies based on oral delivery. In this review, the ability of these new oral formulations to deliver sufficient antifungal prophylaxis is evaluated.

Palliative transhepatic biliary drainage and enteral nutrition

Simultaneous intestinal and biliary obstruction is a rare but agonizing complication of metastatic abdominal cancer. Although endoscopic procedures exist that relieve jaundice or restore enteral nutrition, they can be impossible to perform for technical or anatomical reasons. We propose a palliative approach for these patients that includes transcutaneous common bile duct drainage, progressive dilation of the transhepatic channel over 1 wk, and, finally, insertion of a permanent silicon catheter that drains bile into the duodenum and is combined with an enteral feeding line. We report three patients whose metastatic abdominal tumors had led to simultaneous jaundice and gastric outlet obstruction, neither of which could be treated endoscopically. In all patients, the transcutaneous bile drainage catheter combined with the enteral feeding line was inserted and tumor symptoms resolved rapidly. As a result, the patients chose to return to home care with enteral nutrition and pain medication. The creation of a transhepatic access for simultaneous enteral bile drainage and nutrition is a technically simple procedure that causes little discomfort to a terminally ill patient. It relieves the symptoms of tumor obstruction, and the option of enteral nutrition and medication can obviate the need for intravenous infusions.