Anthropometric and Pharmacotherapeutic Variables on Acute Emesis Induced by Cisplatin-Containing Chemotherapy

2000 ◽  
Vol 34 (5) ◽  
pp. 573-579 ◽  
Author(s):  
José Luis Catalán Arlandis ◽  
N Víctor Jiménez Torres
Keyword(s):  
Prognostic Factors ◽  
Odds Ratio ◽  
Logistic Model ◽  
Therapeutic Failure ◽  
High Dose ◽  
Anthropometric Parameters ◽  
Cycle Number ◽  
Chemotherapeutic Regimen ◽  
Acute Emesis ◽  
First Choice

OBJECTIVE: To characterize the effects of anthropometric and pharmacotherapeutic variables on acute emesis induced by cisplatin-containing regimens with dosages ·50 mg·m−2. METHODS: A prospective, cross-sectional, noncontrolled study was performed to analyze acute vomiting during the first 24 hours in patients treated in a Spanish hospital. The patients received an intravenous combination of drugs (2 doses of metoclopramide 3 mg/kg, dexamethasone 20 mg) as first-choice antiemetic therapy. Intravenous ondansetron 8 mg and dexamethasone 20 mg served as an alternative regimen in patients <30 years old with a history of extrapyramidal manifestations or emesis in previous cycles. Therapeutic failure was used as a dependent variable, defined as three or more vomiting episodes documented by the patients. Other variables were the chemotherapeutic regimen; antiemetic regimen; patient gender, age, weight, and height; and cycle number. The reference logistic model and two reduced-models derived from the latter were designed. The logistic models were subsequently validated by means of receiving operating characteristic curves. RESULTS: A total of 319 cycles involving 106 patients were studied. The metoclopramide regimen was administered in 66% of the cycles. The therapeutic failure rate was 21% for the metoclopramide regimen and 32% for the ondansetron treatment. The logistic model developed identified the type of chemotherapeutic regimen provided as the most significant prognostic variable (p < 0.0001). Patient weight (odds ratio 1.64) and height (odds ratio 1.28) were identified as prognostic factors related with therapeutic failure. CONCLUSIONS: The type of chemotherapeutic regimen administered and the anthropometric characteristics of the patients exert a clear conditioning effect on risks associated with therapeutic failure against acute emesis following high-dose cisplatin therapy. Such anthropometric parameters have not been previously identified as prognostic factors.

scholarly journals The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh

2021 ◽  
Vol 18 (11) ◽  
pp. 5646
Author(s):  
Sally Sonia Simmons ◽  
John Elvis Hagan ◽  
Thomas Schack
Keyword(s):  
Public Health ◽  
Body Mass Index ◽  
Waist Circumference ◽  
Body Mass ◽  
Odds Ratio ◽  
Height Ratio ◽  
Anthropometric Parameters ◽  
Anthropometric Indices ◽  
Waist To Hip Ratio ◽  
Waist To Height Ratio

Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.

scholarly journals Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2934
Author(s):  
Sabine Seidel ◽  
Michelle Margold ◽  
Thomas Kowalski ◽  
Alexander Baraniskin ◽  
Roland Schroers ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Clinical Trials ◽  
Nervous System ◽  
Prognostic Factors ◽  
Central Nervous System Lymphoma ◽  
Initial Response ◽  
Early Response ◽  
Multicenter Trial ◽  
High Dose ◽  
Therapeutic Trials

Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation.

scholarly journals 5 giorni di antibiotico per le polmoniti non complicate sono sufficienti: i risultati di non inferiorità del SAFER RCT

2021 ◽  
Vol 28 (5) ◽  
pp. 1
Author(s):  
Gruppo di lettura di Reggio Emilia
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Protocol Analysis ◽  
Brief Therapy ◽  
Community Acquired Pneumonia ◽  
High Dose ◽  
Evidence Based ◽  
Clinical Recovery ◽  
First Choice

5 days of antibiotic for uncomplicated pneumonia is enough: the non-inferiority results of the SAFER RCT The most important guidelines for the treatment of community-acquired pneumonia (CAP) indicate amoxicillin as the drug of first choice, however there is a lack of evidence-based indications about the duration of this therapy. This study conducted in 2 emergency departments in Canada randomized 281 children aged 6 months to 10 years with CAP without the need for hospitalization to treatment with high-dose amoxicillin for 5 days versus a traditional 10 day therapy. In terms of clinical recovery, both groups presented comparable results. In fact, the “per protocol” analysis, recommended for a “non-inferiority” design, did not formally provide this result. The exclusively clinical recruitment criteria (any investigations were optional), well reflect the reality of primary care, and the results, albeit with some limitations, suggest that in uncomplicated CAP, brief therapy should be considered in the guidelines.

scholarly journals Prognostic Marker for Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Analysis of Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Forced Expiratory Volume in One Second (FEV1)

2021 ◽  
Author(s):  
Juwhan Choi ◽  
Jae Kyeom Sim ◽  
Jee Youn Oh ◽  
Young Seok Lee ◽  
Gyu Young Hur ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Length Of Hospital Stay ◽  
Forced Expiratory Volume ◽  
Curve Analysis ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Roc Curve Analysis ◽  
Obstructive Pulmonary Disease

Abstract Background: It is important to assess the prognosis and classify patients in chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) treatment. Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.Methods: We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD events using DLCO and FEV1. We defined the prognostic factors of severe AECOPD as the length of hospital stay, mortality in hospital, experience of mechanical ventilation, and experience of intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.Results: In univariate and multivariate analyses, DLCO was shown to predict mortality rate (odds ratio = 4.408; 95% confidence interval, 1.070–18.167; P = 0.040), experience of ventilator (odds ratio = 2.855; 95% confidence interval, 1.216–6.704; P = 0.016) and ICU (odds ratios = 2.685; 95% confidence interval, 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In the correlation analysis, both DLCO and FEV1 showed a negative correlation with length of hospital stay. The correlation rate was more pronounced in the DLCO (DLCO; B = -0.103, P < 0.001) (FEV1; B = -0.075, P = 0.007). In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.Conclusion: DLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

scholarly journals Admission blood glucose and in-hospital clinical outcome among patients with acute stroke in Inner Mongolia, China

2009 ◽  
Vol 32 (2) ◽  
pp. 151 ◽  
Author(s):  
Ning Wang ◽  
Dawei Qiao ◽  
Weijun Tong ◽  
Fengshan Zhang ◽  
Zhong Ju ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Inner Mongolia ◽  
Odds Ratio ◽  
Logistic Model ◽  
Hemorrhagic Stroke ◽  
Blood Glucose Concentration ◽  
Hospital Death ◽  
Stroke Patients

Purpose: There is still controversy about the association between admission blood glucose concentration and outcome of acute stroke. We studied the association between admission blood glucose and in-hospital death / dependency among acute stroke patients in Inner Mongolia, China. Methods: 2,178 acute ischemic and 1,760 hemorrhagic stroke patients in six hospitals were included in the study. Blood glucose and other study variables were collected within the first 24-hr of hospital admission. Clinical outcomes were evaluated by neurologists during hospitalization. The associations between admission blood glucose and the risk of in-hospital death/dependency were analyzed using a multiple logistic model. Results: There were associations between admission blood glucose and in-hospital death/dependency among patients with acute ischemic or hemorrhagic stroke. Compared with patients with blood glucose < 6.1mmol/L, multivariate-adjusted odds ratio (95% confidence interval) of death/dependency were 0.53 (0.23, 1.27), 2.22 (1.21, 4.11), 1.92 (1.12, 3.33) and 1.91 (1.00, 3.64) for ischemic stroke patients, and 0.93 (0.44, 1.96), 1.42 (0.65, 3.10), 1.98 (1.10, 3.55) and 2.93 (1.40, 6.11) for hemorrhagic stroke patients, with blood glucose 6.1-6.9, 7.0-7.7, 7.8-11.0 and ?11.1mmol/L, respectively. Conclusion: Increased admission blood glucose was associated with death/dependency among patients with acute hemorrhagic and ischemic stroke.

scholarly journals 150 Severe Drug Interactions (SDIs) and Potentially Inappropriate Prescriptions (PIPs) in Older Adults with Cancer

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Amanda Lavan ◽  
Deirdre O'Mahony ◽  
Mary Buckley ◽  
Denis O'Mahony ◽  
Paul Gallagher
Keyword(s):  
Older Adults ◽  
Drug Interactions ◽  
Odds Ratio ◽  
P Value ◽  
High Dose ◽  
Cancer Therapies ◽  
Start Criteria ◽  
Co Morbidity ◽  
Oncology Centre ◽  
Inappropriate Prescriptions

Abstract Background The objectives of this study were to identify the prevalence of severe drug interactions (SDIs) and potentially inappropriate prescriptions (PIPs) in older adults with cancer. Methods A 12-month prospective observational study of patients ≥65 years admitted to an oncology centre was conducted. SDIs were assessed using Stockley’s interaction checker; PIPs were identified using STOPP/START criteria. Logistic regression was applied to determine the influence of age, gender, co-morbidities and medication number on the likelihood of an SDI and a PIP. Results We enrolled 186 participants; mean age 72.5 (SD5.7) years, 46.2% female, mean co-morbidity number 7.5 (SD3.4), median medication number 7 (IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. Systemic anti-cancer therapies (SACTs) were concomitantly prescribed to 60.2%. SDIs were identified in 50.5% participants; 7.5% ≥1 SACT-SACT SDI, 41.4% ≥1 drug-drug SDI and 10.2% ≥1 drug-SACT SDI. The most common SDIs were beta-blocker/alpha-blocker (n=12), Selective serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (n=11) and SSRI/Aspirin (n=8). A strong correlation between medication and SDI number was identified (r2=0.61, p-value <0.001). For each additional prescription, the odds of an SDI increased by 50.8% (Odds ratio 1.508, 95% CI1.288–1.764, p<0.001). PIPs were observed in 73.1%; median 2(IQR1-3). The most common PIPs were drugs prescribed beyond the recommended duration (46.8%), high-dose PPIs >8 weeks (34.9%) and regular opioids without laxatives (20.4%). Patients prescribed ≥1 PIP had more co-morbidities (8.4(SD3.4) vs 5.2(SD2.4), p< 0.001), a higher cumulative illness rating score (18(IQR12-20) vs 11(IQR10-14), p<0.001) and more prescribed medications (8(IQR6-10) vs 3(IQR1-4.25), p<0.001). For each additional prescription, the odds of receiving a PIP increased by 79.2% (Odds ratio 1.792, 95% CI1.459–2.02, p<0.001). Conclusion SDIs and PIPs are common in older adults with cancer and higher than previously reported. Comprehensive specialist medication evaluation, by a Geriatrician, may benefit patients.

ITI Treatment is not First-Choice Treatment in Children with Hemophilia A and Low-Responding Inhibitors: Evidence from a PedNet Study

2020 ◽  
Vol 120 (08) ◽  
pp. 1166-1172
Author(s):  
H. Marijke van den Berg ◽  
Maria Elisa Mancuso ◽  
Christoph Königs ◽  
Roseline D'Oiron ◽  
Helen Platokouki ◽  
...  
Keyword(s):  
Hemophilia A ◽  
Real Life ◽  
Tolerance Induction ◽  
High Dose ◽  
Severe Hemophilia ◽  
Limited Data ◽  
Treatment Regimens ◽  
First Choice ◽  
Lost To Follow Up

Abstract Background Limited data exist on the clinical impact of low-responding inhibitors and the requirement for immune tolerance induction (ITI) treatment to establish tolerance, reduce bleeding, and improve outcome. The aim of this article is to describe the therapeutic management of children with severe hemophilia A and low-responding inhibitors and its effect on bleeding phenotype. Methods The REMAIN (Real-life Management of Inhibitors) study is a satellite study of the PedNet registry. It included unselected children with severe hemophilia A (factor VIII [FVIII] < 0.01 IU/mL) born between January 1, 1990 and December 31, 2009 who developed clinically relevant inhibitors and were followed-up for at least 3 years after the first positive inhibitor test. Results A total of 260 patients with inhibitors were identified and 68 of them (26%) had low-responding inhibitors (peak < 5 BU/mL). Five patients were lost to follow-up and 63 were included in this study. The median follow-up was 3.7 years (interquartile range: 3.0–7.5). ITI was started in 51/63 (81%) patients. The median time from ITI start to first negative inhibitor titer was similar with low-dose and high-dose ITI regimens (2.5 and 3.1 months, respectively). Ten of the 12 patients who did not receive ITI were treated with regular prophylaxis and reached a negative titer after a median of 6.5 months. Bleeding rate was low in all patients with no difference between treatment regimens. Conclusion In children with low-responding inhibitors negative titers were reached with regular FVIII treatment irrespective of the regimen (i.e., prophylaxis or ITI).

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