Fibrotische interstitielle Lungenerkrankungen: Supportive und palliative Konzepte in die Behandlung integrieren

2021 ◽  
pp. 70-72
Author(s):  
Fotios Drakopanagiotakis ◽  
Andreas Günther
Keyword(s):  
Respiratory Depression ◽  
Oral Morphine ◽  
Symptom Burden ◽  
Visual Analogue Score ◽  
Interstitial Lung Diseases ◽  
Controlled Study ◽  
Morphine Group ◽  
Increased Risk ◽  
Safety Parameters

Background: Patients suffering from fibrotic interstitial lung diseases (fILD) have a poor prognosis and a high symptom burden. Palliative treatment includes relief of symptoms such as breathlessness. There is no evidence-based treatment for chronic breathlessness but opioids are often used despite concerns due to the hypothetical risk of respiratory depression. This study investigated the effect of oral morphine drops in patients with fILD on chronic breathlessness and safety. Methods: In a double-blinded placebo-controlled study, 36 patients with fILD were randomised to either four daily doses of 5 mg of oral morphine drops or placebo for 1 week. Endpoints and safety parameters were obtained at baseline, at follow-up after 1 h and 1 week. Results: The primary endpoint, the visual analogue score (VAS) of dyspnea was reduced by 1.1 ± 0.33 cm in the morphine group at follow-up compared to baseline (P < 0.01), whereas the reduction was 0.35 ± 0.47 cm in the placebo group. However, the difference between the two groups was not statistically significant (p = 0.2). Oral morphine drops did not affect respiratory frequency, pulse rate, blood pressure, peripheral saturation or the 6-min walk test. More patients treated with morphine reported constipation, nausea and confusion. Conclusions: Oral administration of morphine drops, 20 mg a day, in patients with fILD did not significantly reduce dyspnea VAS score during 1 week compared to placebo. Oral morphine did not induce respiratory depression, but was related to an increased risk of constipation, nausea and confusion. Trial registration: The trial is registered in clinicaltrials.gov (Identifier: NCT02622022). Registered 4 December 2015.

Hallucinations in children with conduct and emotional disorders: II. The follow-up study

1984 ◽  
Vol 14 (3) ◽  
pp. 597-604 ◽  
Author(s):  
M. E. Garralda
Keyword(s):  
Emotional Disorders ◽  
Conduct Disorders ◽  
Depressive Illness ◽  
Controlled Study ◽  
Follow Up Study ◽  
Increased Risk ◽  
Organic Brain ◽  
The Mean ◽  
Altered Awareness

SynopsisIn a controlled study, 20 children with hallucinations and emotional or conduct disorders were followed up into adulthood. The mean follow-up time was 17 years and the mean age at follow-up was 30 years. Hallucinations in childhood did not carry an increased risk for psychoses, depressive illness, organic brain damage or other psychiatric disorders. The continuation of hallucinations and episodes of altered awareness in some of the subjects may indicate a special predisposition to hallucinate.

scholarly journals Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders

2016 ◽  
Vol 48 (3) ◽  
pp. 818-825 ◽  
Author(s):  
Christine Cramer ◽  
Vivi Schlünssen ◽  
Elisabeth Bendstrup ◽  
Zara Ann Stokholm ◽  
Jesper Medom Vestergaard ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Hypersensitivity Pneumonitis ◽  
Cox Regression ◽  
Interstitial Lung Diseases ◽  
Protective Measures ◽  
National Patient Registry ◽  
Hazard Ratios ◽  
Increased Risk ◽  
National Patient

We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977–2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26–1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10–25.44) and 1.33 (95% CI 1.05–1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

scholarly journals Interleukin-1 blockade with RPH-104 in patients with acute ST-elevation myocardial infarction: study design and rationale

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
M. Samsonov ◽  
V. Bogin ◽  
B. W. Van Tassell ◽  
A. Abbate
Keyword(s):  
Myocardial Infarction ◽  
Inflammatory Response ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Interleukin 1 ◽  
Controlled Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
Echocardiographic Parameters

Abstract Background Myocardial injury of ST-segment elevation myocardial infarction (STEMI) initiates an intense inflammatory response that contributes to further damage and is a predictor of increased risk of death or heart failure (HF). Interleukin-1 (IL-1) is a key mediator of local and systemic inflammatory response to myocardial damage. We postulate that the use of the drug RPH-104, which selectively binds and inactivates both α and β isoforms of IL-1 will lead to a decrease in the severity of the inflammatory response which will be reflected by decrease in the concentration of hsCRP, as well as the rate of fatal outcomes, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP) and changes in structural and functional echocardiographic parameters. Methods This is a double blind, randomized, placebo-controlled study in which 102 patients with STEMI will receive a single administration of RPH-104 80 mg, RPH-104 160 mg or placebo (1:1:1). The primary endpoint will be hsCRP area under curve (AUC) from day 1 until day 14. Secondary endpoints will include hsCRP AUC from day 1 until day 28, rate of fatal outcomes, hospitalizations due to HF and other cardiac and non-cardiac reasons during 12-month follow-up period, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP, NT-pro-BNP), changes in structural and functional echocardiographic parameters during 12-month follow-up period compared to baseline. The study started in October 2020 and is anticipated to end in 2Q 2022. Trial registration: ClinicalTrials.gov, NCT04463251. Registered on July 9, 2020

scholarly journals Interleukin-1 Blockade With RPH-104 in Patients With Acute ST-Elevation Myocardial Infarction: Study Design and Rationale.

2021 ◽  
Author(s):  
Mikhail Samsonov ◽  
Vlad Bogin ◽  
Benjamin Van Tassel ◽  
Antonio Abbate
Keyword(s):  
Myocardial Infarction ◽  
Inflammatory Response ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Interleukin 1 ◽  
Controlled Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
Echocardiographic Parameters

Abstract BackgroundMyocardial injury of ST-segment elevation myocardial infarction (STEMI) initiates an intense inflammatory response that contributes to further damage and is a predictor of increased risk of death or heart failure (HF). Interleukin-1 (IL-1) is a key mediator of local and systemic inflammatory response to myocardial damage. We postulate that the use of the drug RPH-104, which selectively binds and inactivates both α and β isoforms of IL-1 will lead to a decrease in the severity of the inflammatory response which will be reflected by decrease in the concentration of hsCRP, as well as the rate of fatal outcomes, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP) and changes in structural and functional echocardiographic parameters. MethodsThis is a double blind, randomized, placebo-controlled study in which 102 patients with STEMI will receive a single administration of RPH-104 80 mg, RPH-104 160 mg or placebo (1:1:1). The primary endpoint will be hsCRP area under curve (AUC) from Day 1 until Day 14. Secondary endpoints will include hsCRP AUC from Day 1 until Day 28, rate of fatal outcomes, hospitalizations due to HF and other cardiac and non-cardiac reasons during 12-month follow-up period, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP, NT-pro-BNP), changes in structural and functional echocardiographic parameters during 12-month follow-up period compared to baseline. The study started in October 2020 and is anticipated to end in 2Q 2022.Trial registrationClinicalTrials.gov, NCT04463251. Registered on July 9, 2020.

scholarly journals A comparative study of effectiveness of autologus serum therapy with oral antihistamines versus oral methotrexate and oral antihistamines in chronic urticaria patients

2019 ◽  
Vol 5 (4) ◽  
pp. 751
Author(s):  
Amit Kumar Pandey ◽  
Suryakant Ojha ◽  
Aayushi Mohan ◽  
Sunil Prajapati
Keyword(s):  
Chronic Urticaria ◽  
Autologous Serum ◽  
Controlled Study ◽  
Pill Burden ◽  
Total Period ◽  
Randomized Controlled ◽  
Safety Parameters ◽  
Serum Therapy ◽  
Treatment Safety

<p class="abstract"><strong>Background:</strong> Chronic urticaria (CU) is a worrisome problem and patients of CU suffer from the morbidity that arises from irritable itch thus they are subjected to a huge antihistamine pill burden. The symptoms are more prominent in autoreactive urticaria (AU) where auto-antibodies in blood causing recurrent flares. Therefore a need of adjunctive drug to reduce the pill burden is felt need.</p><p class="abstract"><strong>Methods:</strong> A randomized, controlled study was done. 50 patients were given AST and 50 patients were given oral pulse methotrexate (10-15 mg once weekly) along with levocetrizine in an on-demand basis in both groups. AST was given weekly for nine weeks and followed-up for a total period of 24 weeks. Urticaria total severity score (UTSS) was used to evaluate the effectiveness of treatment. Safety parameters assessed were the spontaneously reported adverse events and laboratory parameters.<strong></strong></p><p class="abstract"><strong>Results:</strong> UTSS showed significant improvement from baseline, 7th week and 8th week onwards in AST group and methotrexate group respectively. Group comparison showed significant improvement 4th week onwards.</p><p><strong>Conclusions:</strong> Autologous serum therapy as well as methotrexate both proved effective in chronic urticaria patients. On follow-up improvement is sustained for at least 3-4 months after the last injection in case of AST. </p>

scholarly journals Maternal PCOS status and metformin in pregnancy: Steroid hormones in 5–10 years old children from the PregMet randomized controlled study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257186
Author(s):  
Liv Guro Engen Hanem ◽  
Øyvind Salvesen ◽  
André Madsen ◽  
Jørn V. Sagen ◽  
Gunnar Mellgren ◽  
...  
Keyword(s):  
Free Testosterone ◽  
Reference Population ◽  
Controlled Study ◽  
Z Score ◽  
Follow Up Study ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Z Scores ◽  
In Pregnancy

Objective Polycystic ovary syndrome (PCOS) is a common endocrine disorder, with potential effects on offspring both genetically and through altered intrauterine environment. Metformin, which ameliorate hormonal disturbances in non-pregnant women with PCOS is increasingly used in pregnancy. It passes the placenta, and the evidence on potential consequences for offspring endocrine development is scarce. We explore the potential effects of maternal PCOS status and intrauterine metformin exposure on offspring steroid hormone levels. Design This is a follow-up study of 5–10 years old children from the PregMet-study–a randomized controlled trial comparing metformin (2000 mg/day) to placebo during PCOS pregnancies. Of the 255 children invited, 117 (46%) were included. Methods There was no intervention in this follow-up study. Outcomes were serum levels of androstenedione, testosterone, SHBG, cortisol, 17-hydroxyprogesterone, 11-deoxycortisol and calculated free testosterone converted to gender-and age adjusted z-scores from a Norwegian reference population. These were compared in i) placebo-exposed children versus children from the reference population (z-score zero) by the deviation in z-score by one-sample t-tests and ii) metformin versus placebo-exposed children by two-sample t-tests. Holm-Bonferroni adjustments were performed to account for multiple endpoints. Results Girls of mothers with PCOS (n = 30) had higher mean z-scores of androstenedione (0.73 (95% confidence interval (CI) 0.41 to 1.06), p<0.0001), testosterone (0.76 (0.51 to 1.00), p<0.0001), and free testosterone (0.99 (0.67 to 1.32), p<0.0001) than the reference population. Metformin-exposed boys (n = 31) tended to have higher 11-deoxycortisol z-score than placebo-exposed boys (n = 24) (mean difference 0.65 (95% CI 0.14–1.17), p = 0.014). Conclusion Maternal PCOS status was associated with elevated androgens in 5- to 10-year-old daughters, which might indicate earlier maturation and increased risk of developing PCOS. An impact of metformin in pregnancy on steroidogenesis in children born to mothers with PCOS cannot be excluded. Our findings need confirmation in studies that include participants that have entered puberty.

Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Sign in / Sign up

Export Citation Format

Share Document