Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

Guidelines for aerosol devices in infants, children and adults: which to choose, why and how to achieve effective aerosol therapy.

Multiple types of aerosol devices are commonly used for the administration of medical aerosol therapy to patients with pulmonary diseases. All of these devices have been shown to be effective in trials where they are used correctly. However, failure to operate any of these devices properly has been associated with poor clinical response and limited patient adherence to therapy. Therefore, the selection of the best aerosol device for the individual patient is very important for optimizing the results of medical aerosol therapy.

This article presents the rationale for selecting the most appropriate aerosol device to administer inhaled drugs in specific patient populations, with emphasis on patient-, drug-, device- and environment-related factors and with a comparison between the available devices. The following recommendations for the selection of the 'best' aerosol device for each patient population are intended to help clinicians gain a clear understanding of the specific issues and challenges so that they can optimize aerosol drug delivery and its therapeutic outcomes in patients.

Treatment of Upper-Extremity Deep-Vein Thrombosis.

Upper extremity deep-vein thrombosis (DVT) can result in fatal pulmonary embolism if not treated. Patients with malignancy may be at particularly high risk. Heparin or low-molecular-weight heparin followed by warfarin has been used as standard treatment for lower extremity DVT. However, a paucity of studies exist reporting efficacy and safety of these regimens in patients with upper extremity DVT.

We studied the effectiveness and safety of treatment with dalteparin sodium followed by warfarin and also dalteparin sodium monotherapy for 3 months in patients with confirmed upper extremity DVT.

Methods: Consecutive patients with confirmed upper extremity DVT received daily dalteparin sodium for 5-7 days followed by warfarin therapy for 3 months (phase I) or dalteparin sodium monotherapy for 3 months (phase II). The primary outcome measure was the incidence of new symptomatic venous thromboembolism during the 3 month follow-up period. The outcome measure of safety was the incidence of major and minor bleeding.

Results: Of 631 consecutive patients screened, 74 were eligible and 67 enrolled. No patients receiving either phase I (0%, 95% CI 0% to 12%) or phase II (0%, 95% CI 0% to 9%) therapy had venous thromboembolism on 3 month follow-up. One patient (4%, 95% CI 0% to 18%) receiving phase I therapy experienced major bleeding. Five patients died during the follow-up period; none were attributed to pulmonary embolism.

Conclusions: Patients with upper extremity DVT may be treated safely with either dalteparin sodium followed by warfarin, or dalteparin sodium monotherapy for 3 months with a good prognosis.

Long-term clinical outcome of patients with persistent right ventricle dysfunction or pulmonary hypertension after acute pulmonary embolism.

AIMS: Persistent, echocardiography-assessed right ventricle dysfunction (RVD) and/or pulmonary hypertension (PHT) are relatively frequent findings after an acute pulmonary embolism (PE). It has been suggested that echocardiography might predict long-term adverse events.

Our objectives were to evaluate the prognostic value of RVD or isolated PHT 6 months after an acute PE with regard to all-cause mortality or venous thromboembolism (VTE) recurrence.

METHODS AND RESULTS: In a previous study, echocardiography was used to assess RVD or PHT on admission and 6 months after an acute PE in 101 consecutive, haemodynamically stable pulmonary patients. We assessed the subsequent vital status and incidence of recurrent VTE in these patients. Six patients were lost for follow-up. The other 95 patients were categorized as those (i) with RVD or PHT 6 months after PE (17 cases, 17.8%) and (ii) patients with neither RVD nor PHT (78 cases, 82.1%). After a mean ± SD of 2.8 ± 1.06 years, there were 9 (9.4%) deaths and 12 (12.6%) VTE recurrences. At multivariate analysis, only age predicted all-cause mortality [hazard ratio (HR): 1.081, 95% confidence interval (CI): 1.003-1.166, P = 0.004]. RVD or PHT persistence did not appear to increase the risk of mortality or recurrent VTE.

CONCLUSION: Persistent echocardiographic signs of right ventricular pressure overload 6 months after an acute PE did not predict long-term adverse outcome events in this study.

Predictive value of D-dimer test for recurrent venous thromboembolism at hospital discharge in patients with acute pulmonary embolism.

D-dimer can be used to exclude acute pulmonary embolism (PE) for its high negative predictive value (NPV). Also, it is a predictor of recurrent venous thromboembolism (VTE) after anticoagulation withdrawal.

The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE when tested at hospital discharge. Plasma D-dimer levels were repeatedly measured at hospital discharge in 204 consecutive patients with the first episode of acute pulmonary embolism. Patients were categorized to two groups by D-dimer levels at hospital discharge and followed up at 3, 6, and 12 months and yearly thereafter.

The primary end point was symptomatic, recurrent fatal or nonfatal VTE. D-dimer levels were persistently abnormal in 66 patients (32%). After 31±19 months follow-up, patients with persistently abnormal D-dimer level levels showed a higher rate of of recurrent VTE (14 patients, 21%) compared to those with D-dimer regression (8 patients, 6%) (P = 0.001). At the multivariate analysis, after adjustment for other relevant factors, persistently abnormal D-dimer level levels were an independent predictor of recurrent VTE in all subjects investigated, (hazard ratio, 4.10; 95% CI, 1.61-10.39; P = 0.003), especially in those with unprovoked PE (hazard ratio, 4.61; 95% CI, 1.85-11.49; P = 0.001). The negative predictive value of D-dimer was 94.2 and 92.9% in all subjects or those with unprovoked PE, respectively.

Persistently abnormal D-dimer level levels at hospital discharge have a high negative predictive value for recurrence in patients with acute pulmonary embolism, especially in subjects with an unprovoked previous event.

Increased risk of venous thrombosis in persons with clinically diagnosed superficial vein thrombosis: results from the MEGA study.

Superficial vein thrombosis (SVT) is regarded a self-limiting disorder, although recent studies showed that ultrasonographically diagnosed SVT is a precursor for venous thrombosis.

We aimed to determine whether the same holds true for clinically diagnosed SVT, and to what extent it is associated with thrombophilia in a population-based case-control study (MEGA).

We found that a history of clinical SVT was associated with a 6.3-fold (95%CI 5.0-8.0) increased risk of deep-vein thrombosis and a 3.9-fold (95%CI 3.0-5.1) increased risk of pulmonary embolism. Blood group non-O and factor V Leiden showed a small increase in SVT risk in controls, with odds ratios of 1.3 (95%CI 0.9-2.0) and 1.5 (95%CI 0.7-3.3), respectively.

In conclusion, clinically diagnosed SVT was a risk factor for venous thrombosis. Given that thrombophilia was only weakly associated with SVT, it is likely that other factors (varicosis, obesity, stasis) also play a role in its etiology.

Search

Search