Continuous Ambulatory Peritoneal Dialysis with Three-Liter Exchanges: A Prospective Study

1984 ◽  
Vol 4 (2) ◽  
pp. 82-85 ◽  
Author(s):  
Donald Kim ◽  
Ramesh Khanna ◽  
George Wu ◽  
Sheila Clayton ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Prospective Study ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Shortness Of Breath ◽  
Group A ◽  
Scrotal Swelling ◽  
Group B ◽  
A Prospective Study

In a prospective study all new patients entering our CAPD program were dialyzed with three-liter exchanges during the first training day and continued with this volume if they tolerated it. Of 47 new patients, 17 (36%) (Group A) tolerated three-liter exchanges, whereas the remaining 30 (Group B) were treated with 4 x two-liter exchanges per day. Group A contained 14 men and three women with an average age of 47 years and a mean body surface area of 1.7 m2. Group B had 15 men and 15 women with an average age of 52 years and a mean body surface area of 1.6 m2. The average follow-up period was 6.4 and 7.1 months respectively. In Group A, eight pa. tients continued on three-liter CAPD, six were transplanted, and three were converted to two-liter exchanges because of penile and scrotal swelling, nausea and vomiting, and shortness of breath. The two groups showed no difference in biochemical and B.P. control. The 24-hour protein losses in the dialysate were also similar. The incidence of peritonitis in Group A was one episode every 55 patient months, significantly lower (p < 0.05) than that in Group B -one episode every 14 patient months.

scholarly journals A PROSPECTIVE STUDY TO ANALYSE THE SIDE EFFECTS OF OLMESARTAN MEDOXOMIL AND ENALAPRIL IN HYPERTENSIVE SUBJECTS

2018 ◽  
Vol 11 (12) ◽  
pp. 258
Author(s):  
Parminderpal Singh ◽  
Kiranjit Kiranjit
Keyword(s):  
Drug Therapy ◽  
Side Effects ◽  
Postural Hypotension ◽  
Olmesartan Medoxomil ◽  
National Commission ◽  
Group A ◽  
Group B ◽  
Taste Alteration ◽  
A Prospective Study

Objective: The present study was aimed to analyze the side effects of olmesartan medoxomil and enalapril in hypertensive subjects.Methods: The study consisted of newly diagnosed hypertension categorized according to 7th report of Joint National Commission on prevention, detection, evaluation, and treatment of high blood pressure. The subjects were divided into two groups. The Group A subjects received olmesartan, and Group B subjects received enalapril. Pressure was recorded both in supine and sitting positions. The appearance of side effects was observed in the follow-up, i.e., dry cough, headache, postural hypotension, angioedema, dizziness, skin rashes, taste alterations, and urticaria. A statistical data were prepared on the basis of information obtained and analyzed thoroughly for antihypertensive effects and side effects of olmesartan and enalapril. SPSS software was used for analysis.Results: There was observed an increase in the incidence of taste alteration with drug therapy in Group B (Enalapril). There was observed an increase in the incidence of postural hypotension with drug therapy in both groups. In Group A (Olmesartan), the incidence of postural hypotension at the beginning of trial, 4 weeks, and 8 weeks was 0%, 2%, and 2%, respectively. In Group A (Olmesartan), there was no incidence of a headache at the beginning of trial, at 4 weeks and 8 weeks.Conclusion: From the study, it can be concluded that both olmesartan and enalapril are effective in Stage I and Stage II hypertension, but olmesartan is tolerated well with lesser side effects.

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

scholarly journals A Comparative Study of Efficacy and Safety Between Tamsulosin and Terazosin in the Treatment of Symptomatic Benign Prostatic Hyperplasia

2016 ◽  
Vol 15 (1) ◽  
pp. 17-21
Author(s):  
Sakhawat Mahmud Khan ◽  
Md Matiar Rahaman Khan ◽  
Shahin Akhter ◽  
Md Mizanur Rahman
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Common Disease ◽  
Efficacy And Safety ◽  
College Hospital ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Group A ◽  
Group B ◽  
A Prospective Study

Background: Lower urinary tract symptoms suggestive of symptomatic Benign Prostatic Hyperplasia (BPH) are a very common disease in elderly men .The incidence of benign prostatic hyperplasia is age related.Objectives: To compare the efficacy and safety of Tamsulosin and Terazosin in the treatment of symptomatic Benign Prostatic Hyperplasia.Methods: This was a prospective study carried out in the Department of Urology, Chittagong Medial College Hospital, Chittagong, Bangladesh during the period of July to December 2014. Total 40 patients of 45-80 years of age were consequently selected according to inclusion criteria. After completion of baseline clinical evaluation and investigations, participants were divided into two groups, group A and group B. Group A (n=20) was given Terazosin 1mg daily for 3 days at bed time and then 2 mg daily at bed time for 2 months. Group B (n=20) was given Tamsulosin, 0.4 mg per day for 2 months. Efficacy was evaluated of each group after 2 month follow up and lastly a comparison was made between them. The parameters monitored were International Prostate Symptoms Score (IPSS) Maximum urine flow rate (Qmax) and Post Voidal Residual Volume (PVR). Tamsulosin 0.4 mg and Terazosin 2 mg once daily for 8 weeks both are effective in relieving symptoms of BPH but Tamsulosin is superior to Terazosin in improvement of total IPSS (p<0.001) and Qmax (p<0.01) PVR (p<0.01) at the end point.Results: Outcome of parameters at follow up after 2 months. Tamsulosin group showed significant improvement of IPSS (p<0.05) PVR (p<0.001) and Qmax (p<0.001) than Terazosin. The incidence of adverse events by administration of Tamsulosin was less than that by Terazosin.Conclusion: Tamsulosin appears to have more efficacy and safety than Terazosin in symptomatic BPH.Chatt  Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 17-21

scholarly journals CALGB 100801 (Alliance): A Phase II Multi-Center NCI Cooperative Group Study of the Addition of Azacitidine (AZA) to Reduced-Intensity Conditioning (RIC) Allogeneic Transplantation for High Risk Myelodysplasia (MDS) and Older Patients with Acute Myeloid Leukemia (AML): Results of a “test dose” Strategy to Target Busulfan Exposure

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 543-543 ◽  
Author(s):  
Ravi Vij ◽  
Vera Hars ◽  
William Blum ◽  
Tsiporah B. Shore ◽  
Aaron P. Rapoport ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Older Patients ◽  
Research Funding ◽  
Progression Free Survival ◽  
Test Dose ◽  
Validation Sample ◽  
Free Survival

Abstract Relapse remains the major cause of death in older patients transplanted for AML in first complete remission (CR1) or for patients with advanced MDS at any age. Conventional myeloablative conditioning followed by allogeneic blood or marrow transplantation is associated with significantly less relapse compared with RIC when performed in younger patients with AML or MDS, but the toxicity of this approach in older patients is prohibitive. We hypothesized that pharmacokinetic targeting to optimize busulfan (Bu) exposure, combined with the administration of AZA post transplantation would mitigate the risk of relapse while avoiding non-relapse mortality (NRM) and ultimately improve progression free survival (PFS). Here we report the results of a Bu test dose strategy targeting daily Bu exposure as determined by the area under the plasma concentration versus time curve (AUC). The primary endpoint of the study was two year progression free survival (PFS). An important secondary objective was to determine whether administration of a test dose of Bu with post test sampling would enable achievement of a daily target Bu AUC level of 4000 uM*min in at least 80% of the recipients. We used this strategy as part of a RIC regimen on a prospective multi-center phase II trial conducted by the Alliance (formerly Cancer and Leukemia Group B (CALGB)). Eligibility included patients with AML in CR1 aged 60-74 years inclusive, MDS with IPSS risk > Int-2 with less than 10% marrow blasts and age <75, availability of a well matched sibling or volunteer unrelated donor (VUD), and absence of significant end-organ damage prior to transplantation. The study completed accrual in 10/2013. 67 patients were registered, and 63 transplanted with 39 receiving grafts from VUDs and 23 from matched siblings. The donor type was not documented at the time of this abstract for one patient. The median age was 63 (44-74), 18 had AML and 45 had MDS. Ten centers enrolled at least one patient. All patients were conditioned with a uniform regimen consisting of fludarabine IV (days -7 to -3), busulfan IV (Bu) targeted to a daily AUC of 4000uM*min (Days -6 to -3) following administration of a 25mg/m2 test dose on one day between Days -14 to -9, and antithymocyte globulin (days -6, -5 and-4 (two doses for matched sibs and three for VUDs only). Body surface area was calculated using a corrected weight formula in overweight individuals (ideal weight + 25% of the difference between ideal and actual weight). Beginning day +42, all patients were planned to receive up to six monthly cycles of AZA at 32mg/m2 subcutaneously x 5days. The proportion of patients who actually received AZA and the median number of cycles received will be reported at the time of abstract presentation. 58 patients received a test dose of Bu and had target validation samples drawn on day -6, following the first dose. Test dose was infused over 45 minutes and blood samples were drawn at end of infusion and 1, 2, 4, and 6 hours after test dose completion. Bu target level validation samples were then obtained at the same time points following the Day-6 dose of Bu. The validation results are depicted in the table: Table Test dose AUC Body surface area (median) Targeted daily Bu dose received(mg/m2) (median; range) Median AUC achieved on validation sample(median,range) Median AUC/4000 927.5uM*min 1.9m2 107 (32-198) 4170uM*min (3284-6642) 1.043 90% of patients were within 20% of the target AUC (95% CI=0.79-0.96) based on the validation sample. Maximum non-hematologic CTCAE v4.0 toxicity was grade 3 in 28 (50%), grade 4 in 6 (11%), and grade 5 in 5 (9%) of the 56 patients with available adverse event data. There were ten deaths within the first 100 days after transplant; six of these were due to NRM. With a median follow up of 564 days, the estimated overall survival at 2 years was 39 %. In conclusion, the preliminary results of this prospective multi-center trial suggest a strategy of targeting busulfan exposure to an AUC of 4000uM*min based on a prior “test dose” is successful in the majority of patients without causing excessive non-hematologic toxicity even in older patients. Further follow up is necessary to determine whether this results in less relapse and improved PFS. Disclosures Vij: celgene: Honoraria, Research Funding. Off Label Use: Busulfan, fludarabine, thymoglobulin: conditioning for transplant Azacytidine: post allogeneic transplant. Blum:Celgene: Consultancy. Shea:CALGB/Alliance: CALGB Board of Directors Other. Devine:sanofi: Research Funding.

Is Double Dose of Tamsulosin Monotherapy Superior to Combination of Conventional Dose of Tamsulosin and Finasteride in Symptomatic Benign Prostatic Hyperplasia

2020 ◽  
Vol 20 (2) ◽  
pp. 94-98
Author(s):  
Md Zahid Hussain ◽  
SM Khan ◽  
AKMA Islam ◽  
S Akhter ◽  
Suhel Al Mujahid Reza ◽  
...  
Keyword(s):  
Prostate Volume ◽  
Combination Group ◽  
Double Dose ◽  
Efficacy And Safety ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Conventional Dose ◽  
Group A ◽  
Group B ◽  
A Prospective Study

Background: The primary aim of the medical therapy for BPH is to improve quality of life by relieving the lower urinary tract symptoms and prevent complications. Objectives: To compare efficacy and safety of double dose of tamsulosin monotherapy with combination of conventional dose of tamsulosin and finasteride in symptomatic BPH. Methods: This was a prospective study carried out in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period of July 2005 to June 2006. Total 60 patients of 45-80 years of age were consequently selected according to inclusion criteria. After completion of baseline clinical evaluation and investigations, participants were divided into two groups, group A and group B. Group A were given tamsulosin 0.4 mg for 1 week. Then double dose of tamsulosin (0.8 mg) were given from 2nd week for 12 months. Group B were given tamsulosin 0.4 mg and finasteride 5 mg for the same duration. Efficacy was evaluated at 6 month and 12 month follow up visit and a comparison was made between them. During follow up each was observed for any adverse effect. The parameters monitored were International Prostate Symptom Score (IPSS), Maximum urine flow rate (Qmax), Post Voidal Residual Volume (PVR) and Prostate volume. Results : Both double dose of tamsulosin 0.8 mg and combination of conventional dose of tamsulosin 0.4 mg and finasteride 5 mg are effective in relieving symptoms of BPH but combination dose is superior to double dose monotherapy. Outcome parameters at end point follow up after 12 months showed significant improvement of IPSS (p<0.05), PVR(p<0.001), Q max (p<0.001) and prostate volume (p<0.001) in combination group than double dose group .The incidence of adverse events were also significantly less in combination group (p<0.05). Conclusion: Combination of conventional dose of tamsulosin with finasteride appears to have more efficacy and safety than double dose of tamsulosin in symptomatic BPH. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.94-98

scholarly journals Comparison between Allopurinol and Febuxostat in management of gout patients - a prospective study

2012 ◽  
Vol 10 (4) ◽  
pp. 257-259 ◽  
Author(s):  
KK Singal ◽  
S Goyal ◽  
P Gupta ◽  
BK Aggawal
Keyword(s):  
Side Effects ◽  
Serum Urate ◽  
End Point ◽  
Daily Dose ◽  
Group A ◽  
Baseline Values ◽  
Group B ◽  
A Prospective Study ◽  
Gout Flare

Aim:To assesses the efficacy of a relatively new drug-Febuxostat in management of gout and its comparison with allopurinol. Method: A comparative study of both Allopurinol and Febuxostat was done on 100 patients of gout. Both were studied for efficacy. side effects and for gout flare up. Results: Primary efficacy end point (baseline values) - a serum urate concentration of less than 6.0mg per deciliter at the last three measurements was reached by 54 %( 27/50) of group A patients taking 80mgs of febuxostat and 25 %( 12/50) of group B patients taking allopurinol 300mgs per day (P<0.001) Secondary efficacy end point(follow up values)- At first visit( after 2 weeks of onset of study), the proportions of subjects with serum urate concentration of less than 6.0mg/dl was significantly higher in the group A receiving febuxostat than the group B receiving allopurinol(P<0.001)[Tableno-1]. Conclusion: Febuxostat, at a daily dose was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate. Results of side effects and gout flare up were similar in both groups. Key words: Allopurinol; febuxostat; uric acid; goutDOI: http://dx.doi.org/10.3329/bjms.v10i4.7522 BJMS 2011; 10 (4): 257-259

scholarly journals A prospective study of diathermy versus scalpel skin incision in abdominal surgery

2019 ◽  
Vol 6 (10) ◽  
pp. 3554
Author(s):  
Arun Kumar Gupta ◽  
Tejinder Singh Dall ◽  
Darpan Bansal
Keyword(s):  
Prospective Study ◽  
Harmonic Scalpel ◽  
Skin Incision ◽  
Recent Past ◽  
Medical Sciences ◽  
Power Set ◽  
Group A ◽  
Group B ◽  
A Prospective Study ◽  
Time Of Administration

Background: Various methods of skin incision have been identified in the recent past. Traditional skin incisions were made with stainless steel scalpel but recently electrocautery instruments like harmonic scalpel are also in use. With rise of seropositive cases, we aimed to evaluate whether the electrocautery can replace scalpel in operation theater, to avoid unfortunate injury to surgeons with scalpel. So we compared the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: This prospective study designed to include 120 patients admitted in the Department of General Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar and who were undergoing elective abdominal surgical procedures namely cholecystectomy, appendectomy and inguinal hernia repair etc. Patients were randomly allocated into 2 groups of 60 patients each. In Group A, incision were made with electrocautery on cut mode and power set to 60-70. In group B, skin incisions were made with scalpel.Results: No statistical difference was found between group A and group B with regard to time of administration of pain killer injection, seroma formation, discharge being noticed from wound in both groups. Moreover the results were statistically non-significant for vascularity, pigmentation and pliability of wound observed.Conclusions: We concluded that electrocautery can effectively and efficiently replace scalpel in operation theater.

scholarly journals A prospective study on effectiveness of use of papain urea based preparation in dressings compared with regular conventional dressings in diabetic foot ulcers

2017 ◽  
Vol 4 (6) ◽  
pp. 1984 ◽  
Author(s):  
Balasubrahmanya K. S. ◽  
Praveen M. Pawar ◽  
Srinidhi M. ◽  
Shruthi S. ◽  
Jinumon K. V. ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Necrotic Tissue ◽  
Group A ◽  
Group B ◽  
A Prospective Study

Background: Diabetic foot ulcer is a very common condition encountered in surgical practise. Wound management pose a good challenge for a treating surgeon due to its physical, mental and social implications. The devitalised necrotic tissue present in ulcer does not favour the wound healing as it increases the chance of infection and delays appearance of granulation tissue. Hence debriding of devitalised tissue plays a key role in wound care. In present study ,we used papain urea based preparation in dressings which is a autolytic agent. This study was conducted to evaluate the effectiveness of use of papain urea based preparations compared with regular conventional dressing in diabetic foot ulcer management.Methods: This was a prospective study conducted in K. R. Hospital, Mysore, Karnataka, India. 60 eligible subjects with diabetic foot ulcers were selected and subjects were randomly allocated into two groups Group A and Group B with 30 subjects in each group. Subjects in Group A underwent dressing with papain urea based preparation and in Group B underwent regular conventional dressing. Results were assessed with respect to percentage decrease in necrotic tissue, incidence of infection, appearance of granulation and hospital stay.Results: Among Group A subjects percentage reduction of necrotic tissue was more, granulation appeared early and the hospital stay was less compared to Group B subjects which were statistically significant. However, there was no significant difference with respect to incidence of infection in both groups.Conclusions: Papain urea based preparation is effective in diabetic foot ulcer care.

Left ventricular function in pulmonary atresia with intact ventricular septum after systemic-to-pulmonary arterial shunt

1994 ◽  
Vol 4 (2) ◽  
pp. 110-116
Author(s):  
Giuseppe Pacileo ◽  
Carlo Pisacane ◽  
Maria Giovanna Russo ◽  
Raffaele Calabrò
Keyword(s):  
Ejection Fraction ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Pulmonary Atresia ◽  
Shape Index ◽  
Left Ventricular ◽  
Ventricular Septum ◽  
Intact Ventricular Septum

AbstractTo investigate the left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum without coronary-cardiac fistulas after a modified Blalock-Taussig shunt, 14 patients (age range 15 days-16.5 months, mean 4.03±5.6 months) and eight control subjects, matched for age, body surface area and heart rate were evaluated by cross-sectional and Doppler echocardiography. The follow-up interval after palliative procedures ranged from 12 days to 16.3 months (mean 3.67±5.6 months). Compared to controls, in the group of patients the ejection fraction was decreased (61±7% vs 68±5%, p=0.022) while the left ventricular end-diastolic volume indexed for body surface area was increased (72.7±10.8 cc/m246.1±12 cc/m2p=0.0001) with normal values of left ventricular mass indexed for body surface area (67.88±20.9 g/m2vs 76±10 g/m2p=NS). Mass-to-volume ratio was lower in patients with pulmonary atresia (0.95±0.38 vs 1.24±0.3, p=0.031). The left ventricular shape index was increased in all patients with pulmonary atresia (1.27±0.26 vs 1±0.01, p=0.009). A significant inverse correlation was noted between the ejection fraction and follow-up (r=−0.71, p=0.04). as well as between the ejection fraction and shape index (r=−0.76, p=0.048). Moreover, the patients with pulmonary atresia had decreased E/A velocity ratio (0.65±0.16 vs 1.35±0.90, p=0.009), decreased normalized peak filling rate (4.16±0.13 sv/s vs 6.88±0.68 sv/s, p=0.0001), increased peak A velocity (0.95±0.17 m/s vs 0.51±0.16 m/s, p=0.0001) and prolonged isovolumic relaxation time (46±5.4 ms vs 34±6.2 ms, p=0.0001) and deceleration time (196.4±32.2 ms vs 116±21.4 ms, p=0.0001). There was a good correlation between the normalized peak filling rate and follow-up (r=−0.80, p=0.04). These data show a progressive compromise of the left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum without ventriculocoronary fistulas who had undergone systemic-to-pulmonary arterial shunting. Thus, an earlier biventricular or Fontan type procedure should be recommended.

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