Academic literature on the topic 'Adverse effects/therapeutic use'
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Journal articles on the topic "Adverse effects/therapeutic use"
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Nahata, Milap C. "Antiviral Drugs: Pharmacokinetics, Adverse Effects, and Therapeutic Use." Journal of Pharmacy Technology 3, no. 3 (May 1987): 100–108. http://dx.doi.org/10.1177/875512258700300305.
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Attardo, Silvia, Olimpia Musumeci, Daniele Velardo, and Antonio Toscano. "Statins Neuromuscular Adverse Effects." International Journal of Molecular Sciences 23, no. 15 (July 28, 2022): 8364. http://dx.doi.org/10.3390/ijms23158364.
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Statins are drugs widely prescribed in high-risk patients for cerebrovascular or cardiovascular diseases and are, usually, safe and well tolerated. However, these drugs sometimes may cause neuromuscular side effects that represent about two-third of all adverse events. Muscle-related adverse events include cramps, myalgia, weakness, immune-mediated necrotizing myopathy and, more rarely, rhabdomyolysis. Moreover, they may lead to peripheral neuropathy and induce or unmask a preexisting neuromuscular junction dysfunction. A clinical follow up of patients assuming statins could reveal early side effects that may cause neuromuscular damage and suggest how to better modulate their use. In fact, statin dechallenge or cessation, or the alternative use of other lipid-lowering agents, can avoid adverse events. This review summarizes the current knowledge on statin-associated neuromuscular adverse effects, diagnosis, and management. It is conceivable that the incidence of neuromuscular complications will increase because, nowadays, use of statins is even more diffused than in the past. On this purpose, it is expected that pharmacogenomic and environmental studies will help to timely predict neuromuscular complications due to statin exposure, leading to a more personalized therapeutic approach.
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Spahn, Joseph D., and Alan K. Kamada. "Special Considerations in the Use of Glucocorticoids in Children." Pediatrics In Review 16, no. 7 (July 1, 1995): 266–72. http://dx.doi.org/10.1542/pir.16.7.266.
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GCs are used commonly for the treatment of various inflammatory and autoimmune diseases. Although potent and generally effective, they are not without risks for producing serious adverse effects, especially when used in high doses for prolonged periods of time. Thus, the clinician must balance the therapeutic effects of GCs with their risks for adverse effects; using the lowest possible effective GC doses as well as maximizing other therapeutic modalities are means by which this goal can be achieved. Early recognition and appropriate management are other methods to minimize GC-induced adverse effects. Maximization of therapy, early recognition, and appropriate management of adverse effects can minimize the potential severe complications of GC therapy.
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Grbovic, Leposava, and Miroslav Radenkovic. "Therapeutic use of glucocorticoids and immunosuppressive agents." Srpski arhiv za celokupno lekarstvo 133, Suppl. 1 (2005): 67–73. http://dx.doi.org/10.2298/sarh05s1067g.
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Pharmacotherapy of autoimmune thyroid disease (AITD) is complex. Apart from the replacement hormone therapy, antithyroid agents, beta adrenoceptor blockers and other drugs, in regard to the present symptoms, it also includes the administration of glucocorticoids and immunosuppressive agents. Physiological actions of glucocorticoids are significant in number, well known and described in details. The most prominent pharmacological properties of glucocorticoids, that are important for their clinical use, are antiinflammatory and immunosuppressive actions. In this article, the most notable clinical pharmacology aspects of glucocorticoids have been presented, including the basic principles of their therapeutic use, as well as the most important indications with the examples of dosing regiments (rheumatic disorders, renal diseases, allergic reactions, bronchial asthma, gastrointestinal inflammatory diseases, thrombocytopenia, organ transplantation, and Graves? ophthalmopathy). In addition, adverse and toxic effects of glucocorticoids as well as their interactions with other drugs have been described. Immunosuppressive agents have important role in treatment of immune disorders, including the reduction of immune response in autoimmune diseases and organ transplantation. Apart from glucocorticoids, immunosuppressive agents consist of calcineurin inhibitors (cyclosporine, tacrolimus), antiproliferative and antimetabolic agents (sirolimus, azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide), monoclonal antibodies: anti-CD3 antibody (muromonab-CD3), anti- CD25 antibody (daclizumab), anti-TNF-alpha antibody (infliximab). In this part, the most updated facts about mechanism of action, rational therapeutic use, as well as adverse and toxic effects of immunosuppressive agents have been reviewed.
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Jabbour, Serge A. "The Importance of Reducing Hyperglycemia While Preserving Insulin Secretion—The Rationale for Sodium-coupled Glucose Co-transporter 2 Inhibition in Diabetes." US Endocrinology 05, no. 01 (2009): 75. http://dx.doi.org/10.17925/use.2009.05.1.75.
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The prevalence of type 2 diabetes continues to rise in a number of countries, presenting a need for additional effective therapeutic options to be developed. This condition has often been treated with medications that can lead to hypoglycemia (sulfonylureas), weight gain (thiazolidinediones), or other side effects, including the gastrointestinal side effects sometimes experienced with metformin. Sodium-coupled glucose co-transporter 2 (SGLT2) inhibitors are a novel class of drugs under investigation that target the kidney’s ability to reabsorb glucose into the bloodstream, improving glycemic control and aiding weight loss without inducing hypoglycemia. These compounds have shown encouraging results in several studies without any serious adverse events. They could therefore potentially become an important addition to the currently available diabetes treatments.
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Salman, Saad, Sayyed Muhammad Ashhad Halimi, and Inzemam Khan. "Olanzapine Use in Schizophrenia and the Modulation of Its Response by Genetic Variations." Molecular Medicine Communications 2, no. 01 (June 30, 2022): 43–76. http://dx.doi.org/10.55627/mmc.002.001.0038.
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Schizophrenia is a chronic disease with diverse psychopathology and multiple phases of illness. Consequently, numerous factors must be considered when assessing the benefits of a given treatment over short- and long-term periods. Olanzapine is an atypical antipsychotic reported to be effective without producing many of the disabling extrapyramidal adverse effects associated with older, typical antipsychotic drugs. Despite the fact that olanzapine is still associated with a known risk of metabolic side effects, including weight gain, many clinicians continue to prescribe olanzapine for the treatment of schizophrenia with the expectation of additional therapeutic antipsychotic efficacy relative to other first-line atypical antipsychotics. This review focuses on the epidemiology, pathogenesis, and treatment of schizophrenia with special emphasis on the role of olanzapine in the treatment of schizophrenia. Genetic variants associated with the therapeutic efficacy and adverse effects of olanzapine are reviewed and those with the potential to act as a clinical predictor of therapeutic response and/or adverse effects are discussed. Recommendations are made for the use of some of these genetic variants in clinical medicine.
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Sirasanagandla, Srinivasa Rao, Isehaq Al-Huseini, Hussein Sakr, Marzie Moqadass, Srijit Das, Norsham Juliana, and Izuddin Fahmy Abu. "Natural Products in Mitigation of Bisphenol A Toxicity: Future Therapeutic Use." Molecules 27, no. 17 (August 24, 2022): 5384. http://dx.doi.org/10.3390/molecules27175384.
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Bisphenol A (BPA) is a ubiquitous environmental toxin with deleterious endocrine-disrupting effects. It is widely used in producing epoxy resins, polycarbonate plastics, and polyvinyl chloride plastics. Human beings are regularly exposed to BPA through inhalation, ingestion, and topical absorption routes. The prevalence of BPA exposure has considerably increased over the past decades. Previous research studies have found a plethora of evidence of BPA’s harmful effects. Interestingly, even at a lower concentration, this industrial product was found to be harmful at cellular and tissue levels, affecting various body functions. A noble and possible treatment could be made plausible by using natural products (NPs). In this review, we highlight existing experimental evidence of NPs against BPA exposure-induced adverse effects, which involve the body’s reproductive, neurological, hepatic, renal, cardiovascular, and endocrine systems. The review also focuses on the targeted signaling pathways of NPs involved in BPA-induced toxicity. Although potential molecular mechanisms underlying BPA-induced toxicity have been investigated, there is currently no specific targeted treatment for BPA-induced toxicity. Hence, natural products could be considered for future therapeutic use against adverse and harmful effects of BPA exposure.
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Huestis, Marilyn A., Renata Solimini, Simona Pichini, Roberta Pacifici, Jeremy Carlier, and Francesco Paolo Busardò. "Cannabidiol Adverse Effects and Toxicity." Current Neuropharmacology 17, no. 10 (September 13, 2019): 974–89. http://dx.doi.org/10.2174/1570159x17666190603171901.
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Background: Currently, there is a great interest in the potential medical use of cannabidiol (CBD), a non-intoxicating cannabinoid. Productive pharmacological research on CBD occurred in the 1970s and intensified recently with many discoveries about the endocannabinoid system. Multiple preclinical and clinical studies led to FDA-approval of Epidiolex®, a purified CBD medicine formulated for oral administration for the treatment of infantile refractory epileptic syndromes, by the US Food and Drug Administration in 2018. The World Health Organization considers rescheduling cannabis and cannabinoids. CBD use around the world is expanding for diseases that lack scientific evidence of the drug’s efficacy. Preclinical and clinical studies also report adverse effects (AEs) and toxicity following CBD intake. Methods: Relevant studies reporting CBD’s AEs or toxicity were identified from PubMed, Cochrane Central, and EMBASE through January 2019. Studies defining CBD’s beneficial effects were included to provide balance in estimating risk/benefit. Results: CBD is not risk-free. In animals, CBD AEs included developmental toxicity, embryo-fetal mortality, central nervous system inhibition and neurotoxicity, hepatocellular injuries, spermatogenesis reduction, organ weight alterations, male reproductive system alterations, and hypotension, although at doses higher than recommended for human pharmacotherapies. Human CBD studies for epilepsy and psychiatric disorders reported CBD-induced drug-drug interactions, hepatic abnormalities, diarrhea, fatigue, vomiting, and somnolence. Conclusion: CBD has proven therapeutic efficacy for serious conditions such as Dravet and Lennox-Gastaut syndromes and is likely to be recommended off label by physicians for other conditions. However, AEs and potential drug-drug interactions must be taken into consideration by clinicians prior to recommending off-label CBD.
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Siroka, Z., and Z. Svobodova. "The toxicity and adverse effects of selected drugs in animals – overview." Polish Journal of Veterinary Sciences 16, no. 1 (March 1, 2013): 181–91. http://dx.doi.org/10.2478/pjvs-2013-0027.
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Abstract Therapeutic products quite often are causes of poisoning in both small and large animals. Drug poisonings in animals occur commonly due to off-label use of medicines, wrong dosage, negligence, accidental ingestion and deliberate poisonings. Toxicity of veterinary drugs may become evident also in therapeutic doses when adverse effects may occur. The aim of this review is to inform veterinary specialists about both veterinary and human drugs, specifically antiparasitics, non-steroidal anti-inflammatory drugs and other medicinal substances, which are most often reported to cause acute poisonings or adverse reactions in animals and to contribute to their broader knowledge and more accurate use of medicines, improving instructions to the animal owners and, hopefully, decrease the incidence of drug poisonings in animals.
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Walczewska, Sylwia, and Agata Wawrzyniak. "N-acetylcysteine in clinical practice – properties, use and adverse effects." Pediatria i Medycyna Rodzinna 16, no. 3 (October 30, 2020): 243–46. http://dx.doi.org/10.15557/pimr.2020.0044.
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N-acetylcysteine is a simple chemical compound with antioxidant and mucolytic properties. Currently, it is the primary treatment for acetaminophen poisoning. Prior to the introduction of acetylcysteine, acetaminophen overdose was associated with high mortality due to acute liver failure. Owing to its antioxidant properties, acetylcysteine maintains appropriate levels of glutathione, thereby protecting the liver from damage by toxic metabolites of paracetamol. Acetylcysteine is also used for infections with excess respiratory secretions. The mechanism of action of cysteine derivatives involves cleavage of disulfide bonds between the macromolecules present in the mucus and, consequently, reduction of mucus viscosity. Clinical trials have shown that N-acetylcysteine also plays an important role in relieving cough by eliminating mucus from the airways. Owing to its antioxidant properties, it can also prevent contrast-induced nephropathy. It was shown that prophylactic doses of acetylcysteine administered the day before and at the day of contrast administration are effective in preventing contrastinduced nephropathy in patients with chronic kidney disease. The compound can also modulate pathophysiological processes involved in many mental and neurological disorders. There is also evidence supporting the efficacy of acetylcysteine in mental disorders such as autism, schizophrenia, Alzheimer’s disease, psychoactive substance dependence or bipolar disorder. However, in addition to its therapeutic activity, the drug may also induce adverse effects. Adverse effects of varying severity have been reported since the introduction of acetylcysteine into clinical use.
Dissertations / Theses on the topic "Adverse effects/therapeutic use"
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Miron, Veronique. "The effects of CNS-accessible multiple sclerosis-directed immuno-modulatory therapies on oligodendroglial lineage cells, myelin maintenance, and remyelination /." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=115701.
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Myelin and oligodendrocytes (OLGs) are the apparent targets of the immune-mediated injury that underlies the development of multiple sclerosis (M8). Recovery from M8 clinical relapses likely reflects remyelination attributed to recruitment and differentiation of oligodendrocyte progenitor cells (OPCs), rather than to new process formation by previously myelinating OLGs. Newly emerging M8-directed immuno-modulatory therapies (statins and FTY720) can readily cross the blood-brain barrier and have been shown to impact signaling pathways implicated in cytoskeletal regulation, differentiation, migration, and survival; these are cellular events presumably important for myelin integrity and remyelination.Statins inhibit the production of cholesterol (concentrated in the myelin membrane) and isoprenoids (post-translational attachments regulating the functions of proteins such as the Rho GTPases). We showed that treatment of human and rodent-derived OPCs with lipophilic statins induced an initial process extension associated with enhanced differentiation and impaired spontaneous migration, whereas prolonged treatment induced process retraction and cell death. Rodent and human mature OLGs demonstrated similar cytoskeletal and survival responses. Chronic simvastatin therapy of mice inhibited remyelination following demyelination induced by the OLG toxin, cuprizone, attributed to a block in OPC differentiation and consequent decrease in mature OLGs. Even fully myelinated animals treated with simvastatin over the long-term demonstrated a decrease in myelin in the brain by maintaining oligodendroglial cells in the pre-OLG state and preventing continual replacement of mature OLGs.
FTY720 is an agonist of G-protein-coupled receptors S1P1, 3, 4, and 5, that are associated with distinct receptor isotype-selective activation of Rho GTPases. In human OPCs, FTY720 could induce initial S1P3/5-dependent process retraction associated with an inhibition of differentiation, and subsequent S1P1-dependent process extension. Mature OLGs showed a dose-dependent cyclic modulation of process extension and retraction was observed over time. Both human OPCs and OLGs were rescued by FTY720 under death-promoting environments. Both cell types also demonstrated a cyclic and reciprocal modulation of S1P1 and S1P5 mRNA levels, reflected in the recurring receptor isotype-dependent functional responses over time. Studies using organotypic cerebellar slice cultures demonstrated that FTY720 did not impact myelin integrity under basal conditions, yet accelerated remyelination following lysolecithin-induced demyelination. Both treatment regimens were associated with an extension of OPC and mature OLG processes.
Our observations demonstrate that drug concentrations used to modulate immune function can have differential dose and time-dependent effects on OPCs, OLGs, as well as on myelin and remyelination processes. Our findings indicate the need to monitor the effects of putative immuno-modulatory therapies on myelin-related processes in MS patients.
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Lau, Kai-ming Eric, and 劉繼明. "Write to heal: how cognitive-change-promoting expressive writing may relieve the adverse effects of stressful lifeevents." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B37596524.
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Wilchesky, Machelle 1965. "Arrhythmia risk associated with the use of bronchodilators in patients with chronic obstructive pulmonary disease : cohort studies and methodological issues." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=115713.
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Whereas first line therapy for chronic obstructive pulmonary disease (COPD) usually includes a short-acting bronchodilator, there are suggestions that these agents may increase the risk of cardiac arrhythmias. In this thesis, we first assessed the risks associated with short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), ipratropium bromide (IB), and methyl xanthines (MX) within a cohort of COPD patients using the health databases of Saskatchewan. In order to confirm these findings and to address some methodological issues we then replicated this analysis within a larger cohort of patients using the health databases of Quebec.Our first study cohort consisted of 6,018 adults aged 55 and older, newly treated with bronchodilator medications. We found that new users of both IB and LABA increased the risk of arrhythmia (RR 2.39 [95% CI 1.42-4.05] and (RR 4.55 [95% CI 1.43-14.45] respectively). When the cohort was restricted by excluding subjects who had recently either been hospitalised or experienced an exacerbation, the elevated risk associated with the new use of IB persisted (RR 3.65 [95% CI 1.72-7.74]), an effect was detected with new use of MX (RR 5.17 [95% CI 1.38-19.30]), but there was insufficient power to detect an effect associated with the new use of LABA.
Due to both power issues and the limited availability of LABA within the Saskatchewan data, we replicated the analysis in a larger new-user cohort of 76,661 Quebec adults aged 67 and over. This study confirmed our earlier results, with an elevated risk of arrhythmia associated with the new use of both IB and LABA (RR 1.43 [95% CI 1.08-1.88]) and (RR 1.54 [95% CI 1.00-2.36]) respectively, as well as with new use of SABA (RR 1.28 [95% CI 1.02-1.61]). Finally, using marginal structural models, we demonstrated that both exacerbations of COPD as well as minor non-event arrhythmias were moderate time-dependent confounders within this setting.
In conclusion, we found that new use of bronchodilators in COPD, particularly IB and LABA, was associated with an increase in the risk of cardiac arrhythmias. We also demonstrated the method by which the time-dependent confounder status of specific model covariates may be evaluated.
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Belfort, M. A. "The cardiovascular and cerebrovascular effects of laryngoscopy and endotracheal intubation in neonatal piglets, and the modification of these effects by topical lignocaine." Doctoral thesis, University of Cape Town, 1990. http://hdl.handle.net/11427/26294.
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Branco, Klébia Magalhães Pereira Castello. "Análise clínica evolutiva do uso do tacrolimus como droga imunossupressora em transplante cardíaco pediátrico." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-24052011-163915/.
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O Tacrolimus é uma potente droga imunossupressora introduzida no transplante cardíaco no início da década de 90. Pacientes com rejeição refratária ou intolerância à ciclosporina podem responder à terapia de resgate com o tacrolimus. Os objetivos deste estudo foram: avaliar a evolução clínica das crianças submetidas ao transplante cardíaco que necessitaram da conversão de ciclosporina para tacrolimus por rejeição refratária, tardia ou efeitos adversos de difícil controle; avaliar a incidência de rejeição após a conversão para o tacrolimus e comparar a sobrevida dos pacientes em uso de tacrolimus e ciclosporina. Realizou-se estudo coorte, observacional, prospectivo, em 28 crianças submetidas ao transplante cardíaco no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e que foram submetidas à conversão da ciclosporina ao tacrolimus, no período de julho de 1999 a dezembro de 2009. Avaliou-se a incidência de episódios de rejeição e a sobrevida após a conversão. Realizou-se, também, a comparação entre os pacientes em uso de tacrolimus e os pacientes que permaneceram em uso de ciclosporina submetidos ao transplante cardíaco no mesmo período. A idade média no momento do transplante foi de 5,3 anos, e no momento da conversão de 8,2 anos. As causas de conversão foram efeitos adversos em 50% dos pacientes, rejeição tardia em 32% e rejeição refratária em 18%. O tempo médio de conversão e seguimento foram 36 meses e 74 meses, respectivamente. Observou-se resolução completa dos episódios de rejeição refratária e melhora dos efeitos adversos em todos os pacientes. A taxa de incidência (x100) de episódios de rejeição antes da conversão foi de 7,98 e após a conversão foi de 2,11 (p=0,0001). A taxa de episódios de infecção antes da conversão foi de 5,89 e após a conversão 4,18 (p=0,023). Pela análise das complicações pré e pós-conversão ao tacrolimus, não se evidenciou diferença estatisticamente significativa em relação a incidência de tumor, insuficiência renal, hipertensão arterial sistêmica, dislipidemia, litíase biliar, diabetes melito, anemia, alterações neurológicas, hirsutismo e hiperplasia gengival. Houve maior prevalência da doença vascular do enxerto após conversão para tacrolimus (p=0,004). Ao se comparar os pacientes com tacrolimus e os com ciclosporina, identificou-se diminuição significativa na taxa de incidência de episódios de rejeição (p=0,001), e na taxa de incidência de episódios de infecção (p=0,002), nos pacientes em uso de tacrolimus. Os pacientes convertidos ao tacrolimus apresentaram menor incidência de complicações neurológicas, hirsutismo e hiperplasia gengival, porém maior prevalência de anemia. Em relação à sobrevida, observou-se uma mortalidade de 25% nos pacientes em uso de tacrolimus, após um período médio de conversão de sessenta meses. Três óbitos foram secundários à rejeição, dos quais apenas um, no primeiro ano de transplante. Evidenciou-se menor sobrevida nos pacientes em uso de ciclosporina. O estudo clínico das crianças submetidas ao transplante cardíaco e que necessitaram de conversão do esquema de imunossupressão permitiu concluir que o tacrolimus foi eficaz como terapia de resgate para rejeição refratária e constitui opção terapêutica como droga imunossupressora de manutenção na faixa etária pediátricaTacrolimus is a potent calcineurin inhibitor that was introduced in heart transplantation therapy in the early 1990s. Organ transplant recipients with refractory rejection or intolerance to conventional immunosuppressant may respond to rescue therapy with tacrolimus. The aim of this study was to evaluate the clinical outcome of children undergoing heart transplantation who required conversion from a cyclosporine to a tacrolimus-based immunosuppressive regimen due to refractory rejection, late rejection or cyclosporine intolerance. We performed a prospective observational cohort study in 28 children who underwent cardiac transplantation at the Heart Institute (InCor) University of São Paulo Medical School and who required conversion from July 1999 to December 2009. The clinical outcome of the patients was evaluated after tacrolimus conversion. We also compared the patients on tacrolimus to the patients who remained on cyclosporine, and who had undergone heart transplantation during the same period. The mean age at the time of transplantation was 5.3 years and 8.2 years at the time of conversion. The causes of conversion were adverse side effects in 50% of patients, late rejection in 32% and refractory rejection in 18%. The mean time from heart transplant to conversion was 36 months and the mean follow-up period was 74 months. We observed complete resolution of refractory rejection episodes and adverse side effects in all patients. The incidence rate (x100) of rejection episodes before and after conversion was 7.98 and 2.11, respectively (p = <0.0001). The rate of infectious episodes before conversion was 5.89 and after conversion was 4.18 (p = 0.023). There was no statistically significant difference in relation to tumor, renal failure requiring dialysis, systemic arterial hypertension, dyslipidemia, gallstones, diabetes mellitus, anemia, neurological complications, hirsutism and gingival hyperplasia after conversion. A significant incidence of cardiac allograft vasculopathy after conversion to tacrolimus was found (p = 0.004). When comparing patients on tacrolimus to patients on cyclosporine, there was a significant decrease in the incidence of rejection (p = 0.001), and infectious episodes (p = 0.002) in patients using tacrolimus. Patients converted to tacrolimus when compared to patients on cyclosporine had lower neurological complications, hirsutism and gingival hyperplasia, but higher prevalence of anemia. There was a 25% mortality rate in patients using tacrolimus after a mean period of 60 months after conversion. Three deaths were secondary to rejection, and only one in the first year after transplant. Patients using tacrolimus showed greater survival rate when compared to patients taking cyclosporine. The clinical outcome of children undergoing heart transplantation and who required conversion of immunosuppressive regimen allowed us to conclude that tacrolimus is effective as rescue therapy for refractory rejection and is a therapeutic option in pediatric patients
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Júnior, Otacílio de Oliveira Maia. "Efeitos do acetonido de triancinolona associado à panfotocoagulação na retinopatia diabética proliferativa." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5149/tde-29042008-133531/.
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INTRODUÇÃO: O tratamento padrão estabelecido pelo Early Treatment Diabetic Retinopathy Study (ETDRS) para retinopatia diabética proliferativa (RDP), com ou sem edema macular clinicamente significativo (EMCS), é a panfotocoagulação com laser. Essa forma de tratamento reduz o risco de perda visual, mas não proporciona ganho de visão. O objetivo deste estudo é avaliar os efeitos do acetonido de triancinolona associado à panfotocoagulação na RDP. MÉTODOS: Realizou-se um ensaio clínico randomizado, prospectivo e aberto com portadores de RDP bilateral e simétrica, submetidos à panfotocoagulação com laser em ambos os olhos. Portadores de EMCS foram tratados com fotocoagulação focal na região macular no primeiro episódio da panfotocoagulação. A injeção intravítrea de acetonido de triancinolona (4 mg/0,1 ml) foi administrada aleatoriamente em um dos olhos (grupo estudo), após último episódio da laserterapia, e o contralateral foi adotado para comparação (grupo controle), sendo seguidos por 6 meses. Os parâmetros adotados para avaliar os efeitos terapêuticos foram: acuidade visual com melhor correção óptica (tabela do ETDRS), medidas de espessura central e de volume macular por meio da tomografia de coerência óptica e taxa de sangramento (hemorragia pré-retiniana ou vítrea). As potenciais complicações da droga foram avaliadas durante o seguimento (pressão intra-ocular, catarata, endoftalmite e pseudo-endoftalmite). RESULTADOS: Foram incluídos 28 (vinte e oito) indivíduos com diabetes melito tipo 2. Quanto ao EMCS, 22 olhos apresentaram no grupo estudo e 23, no grupo controle (p= 0,317). A média de idade foi de 61,36 ± 5,77 anos, com predominância do sexo ferminino (57,1%). A maioria era portadora de hipertensão arterial sistêmica (82,1%) e usuária de insulina (75,0%). Não houve diferença significante nas médias de número de disparos da panfotocoagulação e da fotocoagulação na região macular entre os grupos. Quanto à acuidade visual, o grupo estudo apresentou pior acuidade antes do tratamento em relação ao grupo controle (p= 0,040), não havendo diferença significativa na primeira semana do tratamento. Durante o seguimento, o grupo estudo evoluiu com melhora na acuidade visual no primeiro (p< 0,001), no terceiro (p< 0,001) e no sexto meses (p< 0,001) em relação ao controle. Em relação às medidas de espessura central e de volume macular, os grupos não apresentaram diferença significativa antes do tratamento, no entanto, o grupo estudo apresentou medidas significativamente menores na primeira semana, no primeiro, no terceiro e no sexto meses em relação ao controle. Quanto à taxa de sangramento, 9 olhos (32,1%) do grupo controle evoluíram com sangramento e nenhum do grupo estudo (p< 0,001). Os grupos apresentaram diferença na pressão intra-ocular apenas na primeira semana do tratamento, quando as medidas do grupo estudo foram maiores que as do controle (p< 0,05). Nenhum dos olhos apresentou catarata com indicação cirúrgica, endoftalmite ou pseudo-endoftalmite. CONCLUSÃO: Os resultados deste estudo sugerem que a injeção intravítrea de triancinolona é um procedimento seguro e pode melhorar o prognóstico funcional e estrutural da mácula em olhos com RDP submetidos a panfotocoagulação com laser.INTRODUCTION: The gold standard treatment for proliferative diabetic retinopahty (PDR) with and without clinically significant macular edema (CSME), as stablished by the Early Treatment Diabetic Retinopathy Study (ETDRS), is panretinal photocoagulation (PRP). This treatment lowers the rate of severe vision loss, but does not increase vision. The aim of this study is to evaluate the efficacy and safety of triamcinolone acetonide associated to PRP for the management of PDR. METHOD: This is a prospective, randomized clinical trial for patients with bilateral and symmetrical PDR who had undergone PRP in both eyes. Patients who had CSME were treated with macular focal photocoagulation on the first episode of the PRP. Intravitreal injection of triamcinolone acetonide (4 mg/0.1 ml) was given to the study eye after the last episode of PRP and the fellow eye was used as control. Follow up was 6 months long. Best-corrected visual acuity (BCVA) using ETDRS charts, central macular thickness and macular volume as measured by the optical coherence tomography software, and the amount of bleeding (both preretinal and vitreous) were the parameters chosen to analyse outcome. Side effects of triamcinolone acetonide such as intraocular pressure, cataracts and severe inflammation, were also followed during the study. RESULTS: Twenty eight diabetes type 2 patients were included. Twenty two study eyes and 23 fellow eyes (controls) presented with CSME (p= 0.317). Mean age was 61.36 ± 5.77 years, with 57.1% females. Many patients had hypertension (82.1%) and used insulin (75.0%). There was no significant difference on the number of spots used for PRP or macular photocoagulation in between the groups. The study eyes had lower BCVA on baseline than the control eyes (p= 0.040). One week after the treatment, there was no difference on BCVA between the study and control eyes. During the follow up, the study group increased their BCVA on the first (p< 0.001), third (p< 0.001) and sixth month (p< 0.001) compared to control. Even thought there was no significant difference on central macular thickness and macular volume between groups on baseline, the study eyes had significant lower measurements on the first week and first, third and sixth months in comparison to controls. Nine control eyes (32.1%) had hemorrhages and none study eyes (p< 0.001). Injected eyes had higher intraocular pressure than controls on the first week of treatment (p< 0.05). None of the eyes developed cataracts that needed surgery, endophthalmits or severe inflammation. CONCLUSION: This study suggests intravitreal injection of triamcinolone is a safe procedure that increases funcional and anatomical prognosis of the macula in PDR eyes that underwent PRP.
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Corley, Amanda. "The use of a securement bundle to prevent peripheral intravenous catheter failure." Thesis, Griffith University, 2022. http://hdl.handle.net/10072/413292.
Full textAbstract:
Background: Peripheral intravenous catheters (PIVCs) are the most common invasive medical device and up to 70% of hospitalised patients require one or more during their hospital stay. However, up to 69% of PIVCs fail before treatment is complete, resulting in pain and discomfort for patients from reinsertion attempts, and financial liability for healthcare institutions. Effective PIVC dressing and securement is an important nurse-led strategy to prevent PIVC complications and failure; however, the most effective way of achieving this is yet to be determined. PIVC securement bundles are a multiproduct combination consisting of a primary dressing and securement in addition to supplementary securement products to provide extra stability. Despite growing evidence that a single dressing or securement product is not effective at preventing PIVC complications and failure, there has been very limited research attention to date on the concept of a securement bundle for the prevention of PIVC failure. Aims and objectives The overarching aim of this PhD was to investigate the use of a securement bundle to reduce PIVC complications and failure. There were three objectives guiding the research: 1) describe global usage of dressing and securement products, including supplementary securements, to secure PIVCs; 2) determine associations between (a) PIVC dressing and securement products, individually and in combination, and PIVC complications, and (b) patient, PIVC, and institutional factors, and suboptimal dressing integrity; and 3) establish the feasibility of testing securement bundles to prevent PIVC complications and failure in a pilot randomised controlled trial (RCT). Design Two frameworks were used to guide this research. The Vessel Health and Preservation Framework was used to contextualise this research within the PIVC continuum of care. The methodological framework underpinning the research methods was the Canadian Critical Care Trials Group programmatic model of research. This work was informed by an integrative review of contemporaneous literature regarding medical adhesive tapes and supplementary securement products and consisted of two phases: a secondary analysis of an existing data set of PIVC insertion, maintenance, and outcome data; and a pilot RCT testing two dressing and securement bundles against standard care for the prevention of PIVC complications and failure. Phase 1 Study design: Secondary analysis of a global cross-sectional study of PIVC characteristics, management, and outcomes. Setting: 407 rural, regional, and metropolitan hospitals in 51 countries. Sample: 40,637 PIVCs in paediatric and adult patients. Measurements: Institution, PIVC, and patient-level data were collected in the parent study. Selected data were extracted from the parent study data set for the secondary analysis, specifically those focusing on PIVC dressing and securement policy and practice. Main results: Dressing and securement practices, and local hospital policy regarding dressing change frequency varied. One-fifth of dressings (21%, n = 8519) were not clean, dry, and intact. The prevalence of PIVC insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.50, 0.68) and better dressing integrity (OR 0.68; 95% CI 0.59, 0.77). Compared with no securement, non-sterile tape at the insertion site was associated with more site complications (OR 2.39, 95% CI 2.22, 2.57) and poorer dressing integrity (OR 1.64, 95% CI 1.51, securement combinations were associated with fewer site and dressing complications, compared with a bordered polyurethane dressing and non-sterile tape. Local PIVC guidelines advocating 4-hourly insertion site inspection (OR 0.84, 95% CI 0.72, 0.98) and dressing replacement between 1 3 days (OR 0.80, 95% CI 0.71, 0.90) were associated with better PIVC dressing integrity than those inserted prehospital (OR 1.84, 95% CI 1.52, 2.24); or with no documentation of site assessment within the last 24 hours (OR 1.63, 95% CI 1.54, 1.72); and the absence of hospital PIVC insertion and maintenance guidelines (OR 2.58, 95% CI 2.38, 2.81). Phase 2 Study design: A non-masked, single centre, three-group pilot RCT. Setting: General medical/surgical wards of a large quaternary hospital in Queensland, Australia. Sample: Adult patients requiring a PIVC for > 24 hours, who had no laboratory-confirmed positive blood culture within 24 hours of screening. Interventions: Participants were randomised into one of three groups: 1. Standard care sterile with Border 1635, 10.5 x 8.5cm, 3M, St Paul, Minnesota, USA); plus two non-H Soft Cloth Surgical Tape, 3M, St Paul, Minnesota, USA). 2. Securement bundle 1 one sterile tape strip in chevron pattern around PIVC hub and one sterile tape strip over hub (Steri- Minnesota, USA); plus Standard care 3. Securement bundle 2 Bundle 1; plus non-compression tubular bandage (Tubifast, Mölnlycke Heath Care, Belrose, Australia). Outcome measures: The primary outcome was the feasibility of conducting a fully powered definitive RCT based on a composite of eligibility, recruitment, retention, protocol fidelity, missing data, participant/staff satisfaction at insertion and removal, and the ability to provide effect estimates. Secondary outcomes included: PIVC failure, PIVC dwell time, adverse skin events, PIVC colonisation and cost. Main results: Of 109 randomised participants, 104 were included in final analyses. Feasibility outcomes were met, except for the eligibility criterion (79%) indicating that screening processes should be streamlined. Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1, and 23.5% (8/34) for Standard care. The incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% CI 0.4, 2.7) and 2.1 (95% CI 0.9, 5.1) for Bundles 1 and 2, respectively. The incidence of adverse skin events, commonly bruising, was 13%. Additional securements, either non-sterile tape and/or a tubular bandage, were applied in 45% of PIVCs; however, this practice occurred more commonly in the standard care arm compared to the securement intervention arms. Conclusion: Global PIVC dressing and securement practice is associated with site complications and poor dressing integrity, both of which are highly prevalent in clinical practice. Phlebitis symptoms and poor dressing integrity are associated with the use of non-sterile tape at the PIVC insertion site, and this practice should be de-implemented. This research introduced the novel concept of securement bundles as an intervention to address current high PIVC failure rates and showed promising results, with three of the four bundles tested in a secondary analysis of a large global data set being significantly associated with fewer site complications, and two of the four associated with fewer dressing complications. Subsequent pilot testing of two securement bundles against standard care demonstrated it is feasible and safe to conduct a large definitive trial testing this intervention to address PIVC failure. Importantly, the interventions were acceptable to staff and participants. Nurses commonly apply reinforcements to PIVC dressings, the reasons for which are not clear and require further exploration. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates, and securement bundles should be investigated as a matter of priority to improve patient outcomes. This doctoral research program has advanced the understanding of the role of dressing and securement in PIVC failure, demonstrated that securement bundles should be tested in a definitive trial, and has made an important contribution to addressing the pervasive problem of PIVC failure.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
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Pessotti, Cristiane Felix Ximenes. "Estudo comparativo do uso do antiagregante plaquetário e anticoagulante oral na profilaxia de trombose em pacientes submetidos à operação cavopulmonar total com tubo extracardíaco: análise ecorcardiográfica, angiotomográfica, cintililográfica, laboratorial e clínica." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-07022014-160413/.
Full textAbstract:
Estudo prospectivo e randomizado de 30 pacientes, submetidos a derivação cavopulmonar total com tubo extracardíaco. Os dados refletem o período de 2008 a 2011, com seguimento de dois anos, por meio de avaliação clínica, laboratorial, ecocardiográfica, angiotomográfica e cintilográfica. Neste estudo, procuramos comparar a eficácia do ácido acetil salicílico (AAS) e da Varfarina na profilaxia da trombose na população estudada. Para tanto, analisamos alterações nos fatores de coagulação (VII, VIII e Proteína C ); ou nos dados clínicos que predispusessem a ocorrência de trombo no pós-operatório. Além disso, no pós-operatório, após a randomização (15 pacientes randomizados para receber Varfarina, Grupo I, e 15 pacientes randomizados para receber AAS, Grupo II), estudamos a interferência da fenestração na ocorrência de trombo; alterações hemodinâmicas que pudessem contribuir com a ocorrência de trombo (fluxo lento pelo tubo extracardíaco), por meio de ecocardiograma transesofágico realizado com até 10 dias de pós operatório, 3, 6, 12 e 24 meses de pós operatório. A presença do fenômeno tromboembólico era pesquisada, além dos ecocardiogramas acima citados, por meio de consultas clínicas realizadas com a mesma periodicidade e que avaliavam, ainda, efeitos colaterais ou complicações no uso de cada uma das drogas. Avaliamos também a viabilidade e aderência ao uso de cada uma delas. O seguimento contou igualmente com a realização de angiotomografia aos 6, 12 e 24 meses de pós-operatório para avaliação de alterações na parede interna do tubo, bem como trombos e cintilografia pulmonar, ventilação-perfusão para avaliar possível tromboembolismo pulmonar. Durante o seguimento, ocorreram dois óbitos, ambos no grupo em uso de Varfarina. Ao todo, durante os dois anos de seguimento, 33,3% dos pacientes apresentaram fenômeno tromboembólico. Sendo que, entre os paciente em uso de AAS, 46,7% apresentaram tal complicação e 20% entre os pacientes em uso de Varfarina (p=0,121). Com relação a avaliação pré-operatória, a ocorrência prévia de trombo e baixos níveis de proteína C da coagulação foram os únicos fatores que influenciaram no tempo de sobrevida livre de trombo, com valores de p de 0,035 e 0,047 respectivamente. Ao final de dois anos de seguimento, na avaliação angiotomográfica, 35,7% dos pacientes em uso de AAS tinham material hiper-refringente depositado em tubo extracardíaco com espessura superior a 2mm ( p= 0,082). Já na avaliação por cintilografia de ventilação-perfusão, dois pacientes apresentaram sinais de tromboembolismo pulmonar, ambos em uso de AAS (p=0,483), e um deles com evolução desfavorável do circuito tipo Fontan. Com relação a segurança e aderência ao tratamento, cinco pacientes tiveram dificuldade de aderência (só viabilizada por tratar-se de protocolo de estudo), entre eles, quatro em uso de Varfarina e apresentando INR variando de 1 a 6,4. Para comprovação numérica, com força estatística dos dados encontrados, uma força tarefa deve ocorrer para que se consiga um grupo maior de pacientes incluídos neste estudo. No entanto, a diferença entre os dois grupos na evolução livre de trombo nos dois primeiros anos de pós-operatório não pode, e nem deve, ser ignoradaProspective randomized trial of 30 patients who had undergone total cavopulmonary anastomosis via an extracardiac conduit. The data reflect the period between 2008 and 2011, with two-year follow-up, through clinical, laboratorial, echocardiographic, angiotomographic, and scintigraphic assessment. In this study, we aimed to compare the efficiency of ASA (Aspirin) and Warfarin in the preventive treatment of thrombosis in the tried population. For such, we\'ve analyzed changes in coagulation factors (VII, VIII and Protein C) or in the clinical data which would predispose the occurrence of postoperative thrombus. Moreover, during postoperative care, after randomization (15 patients randomly selected to be trated with Warfarin, referred to as Group I, and 15 patients randomly selected to be treated with ASA, referred to as Group II), we also studied the influence of fenestration in the occurrence of thrombus; hemodynamic variations which could contribute to the occurrence of thrombus (slow blood flow in the extracardiac conduit), with postoperative transesophageal echocardiogram being performed within 10 days, and thereafter 3, 6, 12 and 24 months. Besides the echocardiograms aforementioned, the presence of thromboembolic events was sought after by clinical appointments taking place with the same frequency, which evaluated, apart from thromboembolism, side effects or complications from the usage of each of the drugs. We\'ve also evaluated the compliance to and feasibility of each of them. Postoperative angiotomography was also performed during the follow-up, within 6, 12 and 24 months, for the evaluation of changes on the inside wall of the extracardiac conduit, as well as thrombi, and pulmonary ventilation/perfusion scintigraphy for assessment of pulmonary thromboembolism possibility. During the follow-up, two deaths were registered, both in the group being treated with Warfarin. Overall, in the two-year follow-up, 33,3% of the patients presented thromboembolic events. Among the group being treated with ASA, 46,7% presented such complication, whereas in the group being treated with Warfarin, 20% had the same complication (p=0,121). Regarding the preoperative evaluation, prior occurrence of thrombus and low levels of coagulation factor Protein C were the only variables which influenced living time without thrombus, with p-values of 0,035 and 0,047. At the end of the two-year follow-up, in the angiotomographic evaluation, 35,7% of patients treated with ASA presented material accumulation inside the extracardiac conduit, with over 2mm of thickness (p=0,082). As for the ventilation/perfusion scintigraphy, two patients presented traces of pulmonary thromboembolism, both treated with ASA (p=0,483), one of whom with unfavorable development of the Fontan circuit. Concerning safety and compliance to the treatment, five patients had difficulty to comply with the treatment (only viable for its trial nature), among those, four under treatment with Warfarin and presenting INR values ranging from 1 to 6,4. For quantitative verification, providing statistic value to the data, an effort must be made for a larger number of patients to be gathered and tried with this treatment. However, the difference in results concerning thrombus-free recovery between the two groups during the two years following surgery cannot, and must not, be ignored
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Sauer, Herbert. "Tratamento transureteroscópico do cálculo ureteral com HOLMIUM: YAG laser." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-19032007-104915/.
Full textAbstract:
Objetivo: O Holmium:YAG laser é o método de litotripsia intracorpórea para cálculos urinários mais recentemente introduzido em nosso meio. O objetivo deste estudo é analisar a eficácia e as complicações imediatas do tratamento de pacientes com cálculos ureterais com essa fonte de energia. Casuística e Métodos: Foram tratados 16 pacientes, nove homens e sete mulheres, portadores de cálculos ureterais sintomáticos, maiores ou iguais a 6 mm, ou com evolução superior a 30 dias. A média de idade foi 42 anos (6- 68 anos). Quatro cálculos estavam localizados no ureter superior, seis no ureter médio e seis no ureter inferior. A técnica empregada foi a de vaporização do cálculo com Holmium:YAG laser, através de ureteroscopia. Utilizou-se exclusivamente ureteroscópio semi-rígido de 7 Fr. Resultados: A taxa de sucesso obtida foi de 87,5%, sem diferença estatisticamente significativa em relação ao relatado na literatura. Todos os cálculos foram fragmentados. Os dois insucessos da série ocorreram com cálculos localizados em ureter superior, em que fragmentos foram deslocados para o rim. As complicações observadas foram três perfurações ureterais e dois casos de febre. Conclusão: O Holmium:YAG laser é eficaz no tratamento endoscópico do cálculo ureteral. Medidas destinadas a prevenir a migração retrógrada do cálculo ou de seus fragmentos devem ser tomadas, principalmente no tratamento dos cálculos localizados em ureter superior. A litotripsia com Holmium:YAG laser não é, entretanto, um método isento de complicações, particularmente no que se refere ao tratamento de cálculos impactados de ureter superior.Objetive: Holmium:YAG laser is the more recently method of intracorporeal lithotripsy of urinary calculi introduced in our area. The purpose of this study is to analyze the technique and to evaluate the immediate results and complications in the treatment of patients with ureteral calculi. Casuistry and Methods: Sixteen patients were treated, nine men and seven women, carrying symptomatic ureteral stones, bigger than 6 mm or with evolution superior to 30 days. The average age was 42 years old (6-88 years old). Four stones were localized in upper ureter, six in middle ureter, and six in lower ureter. The technique employed was the vaporization of the stone with Holmium:YAG laser, through ureteroscopy. It was used exclusively 7-Fr semirigid ureteroscope. Results: The rate of success attained was of 87.5%, with no statistically significant differences regarding the reports in literature. All the stones were fragmented. The two failures of the series occurred with stones localized in upper ureter, in which fragments were displaced to kidney. The complications observed were three ureteral perforations and two fever cases. Conclusion: Holmium:YAG laser is effective in the endoscopic treatment of ureteral stones. Measures aimed at preventing retrograde migration of stones or fragments should be taken, mainly when the stone are located in the upper ureter. However, lithotripsy with Holmium:YAG laser may be associated with complications, particularly in what concerns the treatment of impacted stones.
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Szabó, Zoltán. "Diabetes and coronary surgery : metabolic and clinical studies on diabetic patients after coronary surgery with special reference to cardiac metabolism and high-dose GIK /." Linköping : Univ, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5219.
Full textBooks on the topic "Adverse effects/therapeutic use"
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Aspirin: Therapeutic uses, adverse effects, and pharmacokinetics. Hauppauge, N.Y: Nova Science Publishers, 2011.
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Tvildiani, Djavakhi, and Kakha Gegechkori. Opioids: Pharmacology, clinical uses and adverse effects. New York: Nova Science Publishers, Inc., 2012.
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J, McLean Michael, Engström Stefan, and Holcomb Robert R. 1940-, eds. Magnetotherapy: Potential therapeutic benefits and adverse effects. New York, NY: TFG Press, 2003.
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United States. Agency for Healthcare Research and Quality, ed. Garlic: Effects on cardiovascular risks and disease, protective effects against cancer, and clinical adverse effects. [Rockville, Md: Agency for Healthcare Research and Quality, 2000.
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United States. Agency for Healthcare Research and Quality, ed. Milk thistle: Effects on liver disease and cirrhosis and clinical adverse effects. [Rockville, Md: Agency for Healthcare Research and Quality, 2000.
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I, Quinn Paul, ed. Aspirin and health research progress. New York: Nova Science Publishers, 2008.
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Zimmerman, Roy. Adverse effects of lithium: Medical subject analysis with reference bibliography. Washington, D.C: ABBE Publishers Association, 1987.
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Phenylpropanolamine: A critical analysis of reported adverse reactions and overdosage. Fort Lee, N.J: J.K. Burgess, 1986.
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Fischer, Leoni M. Brachytherapy: Types, dosing, and side effects. Hauppauge, N.Y: Nova Science Publishers, 2010.
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Steroids. Santa Barbara, California: Greenwood, 2014.
Find full textBook chapters on the topic "Adverse effects/therapeutic use"
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Frye, Richard Eugene, James P. Andrus, Kevin V. Lemley, Stephen C. De Rosa, Pietro Ghezzi, Arne Holmgren, Dean Jones, et al. "Pharmacology, Formulations, and Adverse Effects." In The Therapeutic Use of N-Acetylcysteine (NAC) in Medicine, 387–94. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-5311-5_21.
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Bossi, Paolo, and Luigi Lorini. "Optimal Supportive Measures during Primary Treatment." In Critical Issues in Head and Neck Oncology, 221–30. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-63234-2_15.
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AbstractSupportive care during curative treatment of head and neck cancer patients has different scopes: reducing the burden of acute toxicities and limiting the risk of developing late adverse effects; increasing the quality of life of the patients; allowing to perform optimal curative therapy, maintaining treatment dose intensity; preventing higher grade toxicities so to reduce also the costs associated with hospitalization, examinations, visits and use of drugs. At the same time, it is necessary to give uniformity in the supportive care protocols, as these preventive and therapeutic measures may influence the results of oncological treatments and their efficacy should be evaluated in a consistent manner. Several preventive and therapeutic interventions are available, particularly in the context of chemoradiotherapy, where the adverse events are more prominent. An accurate evaluation of the patient and a tailored approach with preventative indications and therapeutic interventions represent key factors. This approach could be easily identified within a “simultaneous care” strategy, as the optimal supportive measures are provided concurrently to the best therapeutic approach since the beginning of the treatment.
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Frohns, A., and F. Frohns. "Safety of Water-Filtered Infrared A (wIRA) on the Eye as a Novel Treatment Option for Chlamydial Infections." In Water-filtered Infrared A (wIRA) Irradiation, 259–69. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-92880-3_22.
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AbstractwIRA has been shown to reduce chlamydial infections in vitro and in vivo and might therefore offer an innovative therapeutic approach for fighting trachoma. However, since the eye is a highly temperature- and radiation-sensitive organ, a safety assessment of the ocular structures affected by wIRA treatment is required to establish wIRA as a potentially successful treatment option for clinical application. A prerequisite for this is to demonstrate that wIRA does not have adverse side-effects such as inducing a non-physiological temperature increase which causes cell stress and damage to ocular tissues and which, in turn, is ultimately associated with impaired vision. Likewise, the potential negative impact of non-thermal photochemical effects of wIRA irradiation needs to be investigated. Data from our ex vivo studies in pig and mouse models, as well as in vivo data in a guinea pig model, provide good evidence for the safe use of wIRA to treat chlamydial infections. These studies have excluded a non-physiological temperature rise as well as the activation of heat and stress-induced proteins after wIRA irradiation with therapy-relevant irradiances. Nevertheless, additional detailed in vitro and in vivo studies are needed to further advance the clinical use of wIRA.
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Kim, Suck Won, and Jon E. Grant. "Electroconvulsive Therapy: Indications, Use and Adverse Effects." In The Medical Basis of Psychiatry, 919–24. New York, NY: Springer New York, 2016. http://dx.doi.org/10.1007/978-1-4939-2528-5_41.
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Neubert, Diether, Robert J. Kavlock, Hans-Joachim Merker, and Jane Klein. "General Discussion: Use of Biologically Based Models." In Risk Assessment of Prenatally-Induced Adverse Health Effects, 289–90. Berlin, Heidelberg: Springer Berlin Heidelberg, 1992. http://dx.doi.org/10.1007/978-3-642-77753-0_22.
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Basu, T. K. "Possible Adverse Effects of the Pharmacological Use of Vitamins." In Drug∼Nutrient Interactions, 92–106. Dordrecht: Springer Netherlands, 1988. http://dx.doi.org/10.1007/978-94-011-7081-9_5.
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Fernández, Xavier, Rafael Guimarães dos Santos, Marta Cutchet, Sabela Fondevila, Débora González, Miguel Ángel Alcázar, Jordi Riba, José Carlos Bouso, and Josep María Fábregas. "Assessment of the Psychotherapeutic Effects of Ritual Ayahuasca Use on Drug Dependency: A Pilot Study." In The Therapeutic Use of Ayahuasca, 183–96. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-40426-9_11.
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Schmid, Janine Tatjana. "Healing with Ayahuasca: Notes on Therapeutic Rituals and Effects in European Patients Treating Their Diseases." In The Therapeutic Use of Ayahuasca, 77–93. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-40426-9_5.
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Duffus, John H., and Morrell H. Draper. "Approaches to Identifying Adverse Health Effects of Chemicals in Use." In Chemical Safety, 459–84. Weinheim, Germany: VCH Verlagsgesellschaft mbH, 2007. http://dx.doi.org/10.1002/9783527616039.ch30.
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Mead, Phillip G. "Assessment of Design Configurations for the Therapeutic use of Daylight." In Biologic Effects of Light 2001, 75–82. Boston, MA: Springer US, 2002. http://dx.doi.org/10.1007/978-1-4615-0937-0_6.
Full textConference papers on the topic "Adverse effects/therapeutic use"
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Soares, Mariana, Ana Clara Mota Gonçalo, Kaline dos Santos Kishishita Castro, and Victoria de Menezes Sá Lazera. "Use of cannabidiol as a therapeutic method in epilepsy." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.388.
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Introduction: Cannabis sativa has several therapeutic properties and has been used for millennials for healing purposes. Among its benefits are analgesic, antiemetic and tranquilizing effects, acting strongly on the nervous system. Objective: This study aims to emphasize the importance of Cannabidiol as a therapeutic purpose for epilepsy, especially in Brazil, where its use is still controlled. Method: A systematic literature review, using bibliographic searches carried out in the electronic databases LILACS, PubMed and SciELO with the descriptors “cannabidiol” and “epilepsy”. Of 1645 searches found, 06 were used in the study. Results: Epileptic seizures can be generalized or partial and are determined by the affected area. The treatment for epilepsy are drugs that decrease the arousal capacity of neural tissue and a significant percentage of individuals cannot control them with traditional drugs alone. Endocannabinoids work in response to epileptiform activity, to activate CB1 receptors for excitatory neurons, to contain excess neuronal activity, which occurs during seizures. It is proven that patients who use it do not have toxic adverse effects. Conclusions: In Brazil, Cannabis is a controlled drug and the fact that it is imported, interfere in the treatment, who is interrupted while patient waits the new dosage. The importance of cannabidiol as a target for research and studies is verified, as it has ample potential in the treatment of epilepsy and reduces brain damage caused by it. In order that patients with epilepsy, have improvements in their quality of life.
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Seixas, Júlia Maia, Hygor Kleber Cabral Silva, Maria Alice Rocha Lopes, Kamila Castro Oliveira Camargos, Lara Silveira Marques, Maria Tereza Nogueira Fonseca e. Souza, Bianca Henriques Parreiras, Alice Carvalho Hoffmann, and Letícia Fernanda Saraiva Jardim. "Phytocannabinoids use in Alzheimer’s disease." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.671.
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Background: Alzheimer’s disease (AD) is the most common cause of dementia among older adults impacting quality of life. Nowadays, four drugs are indicated to manage AD symptoms, however, none of them have shown effectiveness to prevent the disease’s progress, and they are associated with adverse effects. In this scenario, the endocannabinoid system has the attention of researchers and physicians, because of its relation with processes involved in the AD physiopathology. Therefore, in the last decade, studies that evaluate the use of Cannabidiol (CBD) and other phytocannabinoids, like tetrahydrocannabinol (THC) and cannabinol (CBN), as an alternative treatment to this illness, have multiplied. Objectives: To bring updated information about this new and promising therapeutic. Methods: A bibliographic research in PubMed with the terms “Cannabidiol and Alzheimer” was made, with the filters “Free full text” and “Publication Date 5 years”. The research obtained 31 results, from which were chosen 10. Results: In vivo studies with CBD, THC and CBN have shown their properties: anti-inflammatory, antioxidant, attenuation of toxic accumulation of β-amyloid protein and to reverse cognitive deficits, all AD physiopathological processes. It was also demonstrated that the combination between THC and CBD shows better efficiency and fewer adverse effects than CBD isolated use. Conclusions: Despite needing deeper and stronger studies with better conducted clinical trials, the researches about phytocannabinoids use in AD seem promising, and they might become the biggest ally in the treatment of this and other neurodegenerative conditions.
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Figueiredo, Camila Angelo Vidal de, Kaline dos Santos Kishishita Castro, and Sílvia Raimunda Costa Leite. "Therapeutic management of movement disorders present in Huntington’s Disease: a literature review." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.430.
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Background: Huntington’s Disease (HD) is a hereditary neurodegenerative genetic disease with motor, cognitive and behavioral repercussions that interferes in several areas of the patients’ lives. Therefore, to increase the quality of life for patients the therapeutic management of symptoms is necessary. Objective: to elucidate the main forms of treatment that reduces motor disorders present in HD. Methods: an integrative literature review was conducted using scientific articles published between 2016-2020 about this topic found in Pubmed and Google Scholar databases. Results: the chorea treatment in HD can be done using Tetrabenazine, deutetrabenazine or antipsychotics. During a study by the Huntington Study Group (HSG), tetrabenazine proved its efficacy, however, due to several adverse effects, its use was reduced. Thus, deutetrabenazine was created, which consists in a tetrabenazine deuterated version, with a longer half- life and less adverse effects. Studies by the HSG found that besides reducing chorea, it also improves motor function in general in patients. Antipsychotics are used when the patient has behavioral and psychiatric symptoms that prevent him from using the other drugs. The dystonia treatment involves physiotherapy and botulinum toxin injections, which are also used in the bruxism therapy, along with mouth protectors. Abnormal gait and balance problems can be reduced with psychomotor rehabilitation, physiotherapy, and using a walker. Conclusion: the control of HD motor symptoms is an important way to increase patients’ quality of life. Therefore, more studies are necessary to expand the effective therapeutic options.
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Pereira, Camila Nakamura Perissê, Lamys Fernandes Kozak, Victor Fernandes Feitosa Braga, Pedro Henrique Bersan de Menezes, and Alexandre Sampaio Rodrigues Pereira. "The use of erenumab for preventing migraine." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.191.
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Background: In 2018, calcitonin gene-related peptides (CGRP) were approved in the United States as the first class of specific migraine prevention drugs. Objectives: To analyze the efficacy and therapeutic safety of erenumab for preventing migraine. Methods: A narrative literature review was carried out by researching in the PubMed/MEDLINE and SciELO databases, using the descriptor “migraine disorders” and the keyword “erenumab” combined by the Boolean operator AND. Eight articles were selected, between 2017 and 2020. Results: The pathophysiology of migraine is related to CGRP through nociceptive modulation in the trigeminovascular system. Therefore, erenumab was developed, which is a human monoclonal antibody that binds selectively and potently to the canonical receptor of CGRP and acts as an antagonist of CGRP. Evidence indicates that the monthly dose of 70mg or 140mg reduces the frequency, quality and intensity of acute and chronic migraines. Studies report a decrease of two to six days of migraine using erenumab. The same adverse reactions occurred in both placebo and experimental groups, including upper respiratory tract viral infection, pain at the injection site and nausea. Conclusions: Erenumab is a promising drug, because it showed efficacy in the first days of treatment, absence of significant side effects and low rate of discontinuation. Aspects such as safety, effect durability, impact on quality of life and cost require further research.
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Gabrielli, Ângelo, Camila Sousa Bragunce Alves, Bruna Oliveira Bicalho, and Débora Pimenta Alves. "Benefits and Challenges of Cannabis Use in the Treatment of Refractory Epilepsy." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.239.
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Introduction: Refractory epilepsy (RE) is a disease that causes continuous and debilitating seizures. Due to the ineffectiveness of antiepileptic therapies, there is a growing interest in drugs made with cannabidiol (CBD), a substance extracted from Cannabis. Objective: To point out benefits and challenges of the use of CBD in the treatment of RE. Methods: Literature review performed at PubMed, with the descriptors Epilepsy, Drug Therapy and Cannabis. Results: It is suggested that CBD is mediated by cannabinoid receptors coupled to protein G, by blockade of NMDA receptors, by GABAergic modulation, glutamatergic synapses and / or mechanisms involving noncannabinoid receptors. CBD can also oppose the actions of exogenous and endogenous cannabinoid agonists, due to the negative allosteric modulation. The benefits of CBD are: great therapeutic diversity, safety and tolerability, rare and mild side effects, low risk of drug interactions, and milder cognitive effects, when compared to other antiepileptic drugs. Despite the benefits, CBD has adverse effects such as drowsiness, appetite reduction, diarrhea, increased activity of liver enzymes and interaction with substances metabolized by cytochrome P450. Still, the inefficient regulation generates variation in the composition of the marketed drugs, which can lead to Δ9 - tetrahydrocannabinol (THC) intoxication. Conclusions: Thus, it is essential that the scientific community remains open to investigate the effects of CBD, given the advantages of its use for treating RE.
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Aimufua, G. I. O., N. P. Onyechi, and U. A. Muhammad. "Development of Anti- Polypharmacy Management System." In 28th iSTEAMS Multidisciplinary Research Conference AIUWA The Gambia. Society for Multidisciplinary and Advanced Research Techniques - Creative Research Publishers, 2021. http://dx.doi.org/10.22624/aims/isteams-2021/v28p14.
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The prevalence of adverse drug reactions, adverse drug effects, avoidable deaths, and other drug-related problems arising from multiple drug administration is a wake-up call to our medical practitioners and the world at large, hence prompt action is required to this effect. In this paper, a computerized web-based system called “Anti-Polypharmacy Module” (APM) is being proposed which is geared towards checking the menace of polypharmacy by highlighting its adverse effect and drug-drug interactions. The drug library which contains most of the required information will be used to accomplish this task. The application is designed to be a user-friendly one. The system methodology for this work is the System Development Life Cycle (SDLC). This system is implemented using Java-servlet (JSP), JQuery, and SQL as a collection of software development tools. It is also a web-based application hence HTML5 and CSS3 are carefully crafted together for maximum user-friendliness. Apache Maven and Tomcat 7 are deployed for the back-end server technology. For database query optimization, the basic rules are strictly followed as discussed in the methodology. Keywords: Polypharmacy, Paediatrician, Therapeutic, Morbidity, Mortality, Drug-bank Database
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Đurđić, Tamara. "ODGOVORNOST ZA ŠTETU OD LEKOVA." In XV Majsko savetovanje: Sloboda pružanja usluga i pravna sigurnost. University of Kragujevac, Faculty of Law, 2019. http://dx.doi.org/10.46793/xvmajsko.667dj.
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The use of medicines implies a risk of damage to the patient. The danger of the use of a drug may be of a different nature, considering a chemical nature of the medical product, which also determines its pharmacological effect, thus disabling completely safe use of the drug. In fact, one should bear in mind the ambivalent effect of a drug which, besides therapeutic characteristic, has accompanying adverse effects on the health of the user, which is the risk one must count on. The institute of liability for damage (the responsible persons, the legal nature of the responsibility) is of particular importance for Serbian medical law, bearing in mind that it is not specifically regulated in the law. Further, this issue is complicated due to the fact that the implementation of the medical treatment involves a large number of persons: the doctor who prescribes the medicine, the drug manufacturer who issues the medicine, and the pharmacist who sells the drug. That is the reason why the liability for the damage using medicine, deserves special attention in the legal doctrine.
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Santos, Nathalia Lima Schramm dos, William Wallace dos Santos Silva, Geovanna da Silva Campos Conceição, Gabriel Serra Almeida, Jacqueline Oliveira Freitas, Breno Silva Reis, and Lucas Santos Silva. "CGRP antagonists: Perspectives on migraine prophylaxis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.193.
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Introduction: Migraine is a neurovascular disease characterized by headache attacks. Currently there are several preventive therapeutic strategies available, however some patients are not very responsive. Thus, more effective treatments have been researched, like the antagonists of the Calcitonin Gene Related Peptide, the Gepants. Objectives: To evaluate the effectiveness of Gepants in the treatment of migraine. Methods: This is an integrative literature review in the PubMed database, using the descriptors “gepants”, “migraine” and “efficacy”. Only randomized clinical trials conducted from January 2018 to September 2020 were included. Results: Twenty studies were listed, of which 17 use Gepants as a preventive treatment, 2 in acute use and 1 pharmacodynamic study. The Gepants have proved to be a viable option for patients irresponsible to the usual prophylactic regimens. Its significance in reducing migraine and associated symptoms is approximately 50% compared to the placebo group. Evidence of efficacy in the acute crisis is still insufficient. The adverse effects observed had not clinical impact, but more investigations are necessary since most studies exclude people with heart, liver and chronic kidney disease. Another limitation was the use of placebo as a control, not the current prophylactic regimens. Conclusion: This review points to Gepants as a viable option in patients with migraine resistant to the usual regimens. However, there is a need for further studies on adverse effects, comparison with current therapies, drug and pathological interactions.
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Chentsova, Victoria, Adrian Bravo, and Emily Norton. "From Adverse Childhood Experiences to Problematic Marijuana Use: Examining the Role of Distress Tolerance and Coping Motives on Negative Marijuana Use Consequences." In 2022 Annual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2022. http://dx.doi.org/10.26828/cannabis.2022.02.000.13.
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Background: Problematic marijuana use is highly prevalent globally, particularly in young adults, with marijuana use disorder affecting 5.8%, or 2.0 million, of young adults (ages 18 – 25) in the United States alone (SAMHSA, 2020). Previous research has reported a significant association between Adverse Childhood Experiences (ACEs) and later marijuana use (Scheidell et al., 2018). Though existing research reports an association between exposure to ACEs and marijuana use outcomes, the underlying mechanisms that could explain these associations are unclear. In previous research, general drug use coping motives have been shown to significantly mediate the relationship between childhood emotional, physical, and sexual abuse and later drug use problems (Hogarth et al., 2019). Other research has suggested that the factors like distress tolerance, typically negatively associated with childhood trauma (Robinson et al., 2021) and maladaptive coping strategies (Zvolensky et al., 2010), can also play a role in specifically predicting future problematic marijuana use (Buckner et al., 2018). Objective: The present study aimed to probe this relationship by exploring the associations between ACEs, distress tolerance, marijuana use coping motives, and negative marijuana-related consequences. Specifically, we hypothesized that greater experiences of ACEs would relate to more negative marijuana-related consequences via lower distress tolerance and higher coping motives. Method: Participants were 752 marijuana-using (i.e., used marijuana in the past month) U.S. college students (66.0% female) who completed an online survey including measures of basic marijuana use patterns, marijuana use consequences (Brief Marijuana Consequences Questionnaire (MACQ); Simons et al., 2012), marijuana use motivations (Marijuana Motives Questionnaire (MMQ); Simons et al., 1998), ACEs (Adverse Childhood Experiences International Questionnaire (ACE-IQ); WHO, 2018), and distress tolerance (Distress Tolerance Scale, Simons et al., 2005). To address study aims, path analysis was performed within the whole sample to test the serial unique associations between ACEs → distress tolerance → using marijuana to cope → negative marijuana-related consequences. Results: Within our analytic sample, we found that only marijuana coping motives uniquely indirectly influenced the relationship between ACEs and negative marijuana-related consequences (indirect β = .079, 99% CIs = .042, .121). Distress tolerance did not significantly uniquely indirectly influence the relationship between ACEs and negative marijuana-related consequences. However, a significant double-mediation effect was found illustrating that a higher endorsement of ACEs was associated with lower distress tolerance, which in turn was associated with higher using marijuana to cope motives, which in turn was associated with more negative marijuana-related consequences (indirect β = .011, 99% CIs = .002, .026). Conclusions: These findings provide support for the relevance of distress tolerance and coping motives as potential factors in linking ACEs to problematic marijuana use among college students. Our preliminary findings encourage further exploration of these associations in longitudinal or experimental studies. Further these results lend support to the therapeutic targeting of distress tolerance and using marijuana to cope to mitigate harms stemming from ACEs and its impact on problematic marijuana use.
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Souza, Ellen Lelis de, Marianna Tonaco Silva, Marianne Morais de Pinho da Fonseca, and Wanderson Stewart Parreira Miranda. "Integrative review, XIII Paulista Congress of Neurology, May 2021; São Paulo (SP). Efficacy of cannabidiol in improving the quality of life of Parkinson´s Patient; ITPAC-Palmas (TO); 2021." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.109.
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Introduction: Parkinson’s disease (PD) is a neurodegenerative disease, caused by an imbalance between the inhibitory action of dopamine and the excitatory action of acetylcholine due to dopamine restriction, characterized by motor and non-motor symptoms. The phytocannabinoid cannabidiol (CBD) may be effective for the treatment of symptoms in PD, offering better quality of life. Objectives: To verify the evidence for the efficacy of cannabidiol in the treatment of patients with PD about the improvement of quality of life. To analyze its applicability in controlling involuntary movements in PD patients. Methods: A search in the databases LILACS, BIREME, SCIELO, SCIENCE, EBSCO, PUBMED, using the bibliographic research method, and by means of integrative review. The descriptor cannabidiol was associated with the words: therapeutic use, parkinsonism, and quality of life. The selection included articles published between 2000 and 2020, in Portuguese, English and German languages. Results: Therapeutic effects of cannabidiol were promising in PD, such as neuroprotective action, reduction of motor symptoms, cognitive and quality of life improvement with few relevant adverse effects. Among the 16 articles, 8 demonstrate an improvement in symptoms and the others cite improvement in psychiatric and cognitive symptoms, thus reflecting that cannabidiol is a promising for quality of life improvement. Conclusion: Although cannabidiol has shown efficacy in the therapy of Parkinson’s patients in clinical and preclinical studies, there is still a need for further studies and investigations on the therapeutic effects of this compound. Thus, cannabidiol may become a first choice treatment for PD, promote patients and families a better living with the disease, and positive reflexes.
Reports on the topic "Adverse effects/therapeutic use"
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Cabrera, Anahi Maldonado, Blayra Maldonado Cabrera, Dalia Isabel Sánchez Machado, and Jaime López Cervantes. Wound healing therapeutic effect of chitosan nanofibers: a systematic review and meta- analysis of animal studies. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0121.
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Review question / Objective: Review question: Does chitosan base nanofibers has significant wound healing therapeutics effects in animal models? A preclinical systematic review of intervention will be carried out to evaluate the therapeutic effects of chitosan nanofibers on animal skin lesions. The PICO (Population, Intervention, Comparator, Outcome) scheme will be used: Intervention: full-thickness skin lesions, and the application of chitosan nanofibers as treatment for animal skin lesions. Regardless of the concentration of chitosan or other added compounds used. Comparison: No intervention, topical placebo agents and standard skin lesions treatments will be included. Outcome: wound healing area, wound closure, type of wound closure (first, second or third intention), healing time, infectious processes (antibacterial/antifungal properties), blood loss (hemostatic properties) and adverse effects.
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Fitzpatrick, Daniel T. Human Factors of Night Vision Device Use in Southwest Asia: Reports of Sensory Illusions and Other Adverse Effects. Fort Belvoir, VA: Defense Technical Information Center, January 1992. http://dx.doi.org/10.21236/ada372962.
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Hernández, Juan. Open configuration options Selection Advantage of Corporate Venture Capitalists and Its Welfare Effects. Inter-American Development Bank, February 2022. http://dx.doi.org/10.18235/0003983.
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We develop a theoretical framework for corporate ventures where corporations' know-how gives them an advantage over regular financiers in identifying profitable projects. Corporations and venture capitalists compete to fund entrepreneurs in an environment featuring risk, adverse selection, and limited liability. The expected surplus of each project is independent of the financier and the efficient scale of each project differs among entrepreneurs. We characterize the optimal financial contracts arising in equilibrium and use this characterization to explore the effect corporations' knowledge has in this environment. We show that the presence of corporations in the financial market could be detrimental to welfare when corporations' selection advantage is small. When large, corporate venture capitalists' knowledge reduces the extensive margin inefficiency arising from adverse selection, meaning less socially inefficient projects are enacted. We also show that increasing the depth or breadth of corporations' knowledge leads to higher aggregate gains.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Ian Blazina, Erika Brodt, David I. Buckley, Tamara P. Cheney, et al. Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2020. http://dx.doi.org/10.23970/ahrqepccer240.
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Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed. Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking. Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: May 2021 Update. Agency for Healthcare Research and Quality (AHRQ), June 2021. http://dx.doi.org/10.23970/ahrqepccerplantpain3.
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Overview This is the third quarterly progress report for an ongoing living systematic review on cannabis and other plant-based treatments for chronic pain. The first progress report was published in January 2021 and the second in March 2021. The draft systematic review was available for public comment from May 19 through June 15, 2021, on the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care website. The systematic review synthesizes evidence on the benefits and harms of plant-based compounds (PBCs), such as cannabinoids and kratom, used to treat chronic pain, addressing concerns about severe adverse effects, abuse, misuse, dependence, and addiction. The purpose of this progress report is to describe the cumulative literature identified thus far. This report will be periodically updated with new studies as they are published and identified, culminating in an annual systematic review that provides a synthesis of the accumulated evidence. Main Points In patients with chronic (mainly neuropathic) pain with short-term treatment (4 weeks to <6 months): • Studies of cannabis-related products were grouped based on their tetrahydrocannabinol (THC) to cannabidiol (CBD) ratio using the following categories: high THC to CBD, comparable THC to CBD, and low THC to CBD. • Comparable THC to CBD ratio oral spray is probably associated with small improvements in pain severity and may be associated with small improvements in function. There was no effect in pain interference or serious adverse events. There may be a large increased risk of dizziness and sedation, and a moderate increased risk of nausea. • Synthetic THC (high THC to CBD) may be associated with moderate improvement in pain severity and increased risk of sedation, and large increased risk of nausea. Synthetic THC is probably associated with a large increased risk of dizziness. • Extracted whole-plant high THC to CBD ratio products may be associated with large increases in risk of withdrawal due to adverse events and dizziness. • Evidence on whole-plant cannabis, low THC to CBD ratio products (topical CBD), other cannabinoids (cannabidivarin), and comparisons with other active interventions was insufficient to draw conclusions. • Other key adverse event outcomes (psychosis, cannabis use disorder, cognitive deficits) and outcomes on the impact on opioid use were not reported. • No evidence on other plant-based compounds, such as kratom, met criteria for this review.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Rongwei Fu, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Agency for Healthcare Research and Quality (AHRQ), October 2021. http://dx.doi.org/10.23970/ahrqepccer250.
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Objectives. To evaluate the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies, submissions received after Federal Register request were searched to July 2021. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence. Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as high-THC to CBD ratio, comparable THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or synthetic. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square and the I2 test for inconsistency. Magnitude of benefit was categorized into no effect or small, moderate, and large effects. Results. From 2,850 abstracts, 20 RCTs (N=1,776) and 7 observational studies (N=13,095) assessing different cannabinoids were included; none of kratom. Studies were primarily short term, and 75 percent enrolled patients with a variety of neuropathic pain. Comparators were primarily placebo or usual care. The strength of evidence (SOE) was low, unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=28%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=24%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 30% vs. 8%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 22% vs. 16%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.20 to 2.78, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=39%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=0%; nausea: 2 RCTs, N=302, 12% vs. 6%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=0%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34). We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=50%; SOE: moderate). Evidence on whole-plant cannabis, topical CBD, low-THC to CBD, other cannabinoids, comparisons with active products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) and study withdrawal due to adverse events with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products in short-term treatment (1 to 6 months). Evidence for whole-plant cannabis, and other comparisons, outcomes, and PBCs were unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Benjamin J. Morasco, Devan Kansagara, Shelley Selph, Rebecca Holmes, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for iii Chronic Pain: 2022 Update. Agency for Healthcare Research and Quality (AHRQ), September 2022. http://dx.doi.org/10.23970/ahrqepccer250update2022.
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Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to April 4, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From 3,283 abstracts, 21 RCTs (N=1,905) and 8 observational studies (N=13,769) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 59 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Azrah Y. Ahmed, Christina Bougatsos, Benjamin J. Morasco, Rebecca Holmes, Terran Gilbreath, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2022 Update—Surveillance Report 2. Agency for Healthcare Research and Quality (AHRQ), January 2023. http://dx.doi.org/10.23970/ahrqepccer250.2022updatesr2.
Full textAbstract:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to October 24, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From a total of 3,568 abstracts, 21 RCTs (N=1,905) and 9 observational studies (N=15,079) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 60 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in pain severity (7 RCTs, N=632, 0 to 10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Wiley, Jenny L., Camille K. Gourdet, and Brian F. Thomas. Cannabidiol: Science, Marketing, and Legal Perspectives. RTI Press, April 2020. http://dx.doi.org/10.3768/rtipress.2020.op.0065.2004.
Full textAbstract:
Recent loosening of legal restrictions on cannabis and its chemical constituents, including phytocannabinoids such as Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has led to rapid proliferation and wide availability of products containing CBD. Although using pure CBD does not result in THC-like intoxication, it is not risk-free. In this review, we examine CBD from scientific, marketing, and regulatory perspectives. Specifically, we evaluate the evidence used to support statements concerning CBD’s real and putative medical effects and discuss misleading information that has been used in marketing approaches. Also, we explore the current legal landscape surrounding CBD. We conclude that further research is necessary to clarify legitimate therapeutic effects of CBD. Federal regulation is also necessary to assure quality, safety, and efficacy of CBD products. Until new regulations are enacted to ensure purity and label accuracy, consumers should balance any perceived benefits of CBD use against potential risks associated with using products of unknown quality.
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Duan, Liyang, Xiaoyu Li, Haiqin Rong, Haiju Sun, Yajun Zhang, Shipeng Song, Jianqiao Fang, and Yongqiang Sun. Scalp acupuncture for Post-stroke depression: A protocol for a systematic review and meta-analysis of randomized controlled clinical trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, April 2022. http://dx.doi.org/10.37766/inplasy2022.4.0059.
Full textAbstract:
Review question / Objective: To evaluate the efficacy and safety of scalp acupuncture for poststroke depression for the first time, and the results of this systematic review will be helpful for clinicians to use scalp acupuncture in the treatment of PSD. Condition being studied: Post-stroke depression (PSD) is one of the most common psychological sequelae of stroke, which is a state characterized by low mood and aversion to activity. It is one of the main obstacles in the process of stroke rehabilitation, which has a detrimental impact on functional recovery and quality of life and even increases mortality. Although the pathogenic factors of PSD are complex and diverse, it is now widely believed to involve complex interactions between neurobiological dysfunctions, psychosocial distress and biological factors. Despite increasing awareness and clinically based research on PSD, drugs to relieve and treat symptoms have made only limited gains. The use of antidepressants is accompanied by various unavoidable adverse effects, including headache, nausea, restlessness, and sexual dysfunction. A previous meta-analysis demonstrated that acupuncture can be safe and effective for the treatment of post-stroke depression. However, there is a lack of systematic reviews to evaluate the efficacy and safety of scalp acupuncture, which is a commonly used acupuncture modality in the treatment of PSD. Consequently, this study will assess the efficacy and safety of scalp acupuncture therapy for PSD compared to other treatments.