scholarly journals Intoxicação por Supervarfarina

2015 ◽  
Vol 28 (3) ◽  
pp. 389 ◽  
Author(s):  
Ana Freixo ◽  
Luís Lopes ◽  
Manuela Carvalho ◽  
Fernando Araújo
Keyword(s):  
Dosage Reduction ◽  
Treatment Guidelines ◽  
Anticoagulant Activity ◽  
International Normalized Ratio ◽  
Easy Access ◽  
Minor Bleeding ◽  
Long Time ◽  
Bleeding Episodes ◽  
Human Poisoning ◽  
Long Acting

The superwarfarin-type anticoagulant rodenticides are used throughout the world and distinguish themselves from warfarin for its high potency and long acting anticoagulant activity. Easy access to these products enables the accidental or deliberate human poisoning. A case of voluntary rodenticide poisoning (RATIBRON®) by a woman who ingested an estimated 27.5 mg of bromadiolone total quantity for two weeks, with minor bleeding episodes, whose reversal of the anticoagulant effect with the correction of the abnormal values of the clotting tests took about one month to reverse is reported here. The correction of the haemostasis defects takes usually a long time<br />and there are no treatment guidelines, but a gradually vitamin K dosage reduction, as out patients, along with the monitoring of the International Normalized Ratio levels, allows a safe evaluation of the therapeutic response.

Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

1998 ◽  
Vol 11 (01) ◽  
pp. 19-22 ◽  
Author(s):  
A. Steiner ◽  
Gaby Hirsbrunner
Keyword(s):  
Standard Treatment ◽  
Delayed Union ◽  
Surgical Debridement ◽  
Rigid Fixation ◽  
Skin Defect ◽  
Long Time ◽  
Metaphyseal Fracture ◽  
External Stabilization ◽  
Long Acting ◽  
Local Antibiotic

SummaryA newborn calf was admitted for evaluation of a primarily closed comminuted metaphyseal fracture of metacarpus III/IV. Closed reduction and application of transfixation pins and a fibreglass cast were performed. Ten days after pin removal, radiographs revealed that the initially healed fracture had collapsed, and osteomyelitis was diagnosed. Bacteriological culture from the deep draining tract yielded Actinomyces pyogenes and Staphylococcus aureus. Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation, and long-time administration of antibiotics. In this case, we used surgical debridement, administration of a new long-acting local antibiotic (gentamicin- impregnated collagen sponges), and minimal external stabilization. At day 27 after initiation of this treatment, the skin defect had healed, and the fracture was stable on manual palpation.Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation and prolonged administration of antibiotics. In the case described, we used surgical debridement, administration of a long-acting local antibiotic (gentamicin-impregnated collagen sponges), and minimal external stabilization. The promising outcome of this case and the good results in human surgery warrant further investigation in the use of gentamicin-impregnated collagen sponges in veterinary orthopaedics.

Bleeding Classification in Clinical Trials: Observer Variability and Clinical Relevance

1997 ◽  
Vol 78 (04) ◽  
pp. 1189-1192 ◽  
Author(s):  
Yvonne P Graafsma ◽  
Martin H Prins ◽  
Anthonie W A Lensing ◽  
Rob J de Haan ◽  
Menno V Huisman ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Clinical Relevance ◽  
Area Under The Curve ◽  
Weighted Kappa ◽  
Clinical Severity ◽  
Minor Bleeding ◽  
Recent Trial ◽  
Bleeding Episodes ◽  
The Impact ◽  
Adjudication Committee

SummaryTo evaluate the bleeding classification in a recent trial on venous thrombosis treatment, a selection of reported bleeding episodes was adjudicated twice by an independent committee and graded by the treating physician and independent clinical experts on the clinical severity and impact on the patient’s life.The kappa values for the dichotomy major bleeding versus minor or no bleeding were 0.79 (95% CI, 0.57-1.0) for the agreement between the two members of the adjudication committee and 0.77 (95% CI, 0.52-1.0) for the agreement between both adjudication sessions. The kappa values for the dichotomy major or minor bleeding versus no bleeding were 0.42 and 0.44. The weighted kappa values for the agreement between the treating physician and the independent experts were 0.76 for the Clinical severity and 0.79 for the impact on the patient’s life (95% CI, 0.63-0.88 and 0.70-0.89). The association between the adjudication result expressed as major bleeding or minor or no bleeding and the Clinical grading by the treating physician resulted in an ROC curve with an area under the curve of 0.98 for the Clinical severity and 0.99 for the impact on the patient’s life. The dichotomy major or minor bleeding versus no bleeding resulted in areas under the curve of 0.70 and 0.66.In conCIusion, the applied criteria for major bleeding are reproducible and Clinically relevant. The criteria for minor bleeding are not reproducible and are less associated with the observed Clinical relevance.

Fenofibrate Potentiates Warfarin Effects

2003 ◽  
Vol 37 (2) ◽  
pp. 212-215 ◽  
Author(s):  
Karissa Y Kim ◽  
Michael A Mancano
Keyword(s):  
White Woman ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Dosage Reduction ◽  
International Normalized Ratio ◽  
Drug Regimen ◽  
Warfarin Dosage ◽  
Therapeutic Doses ◽  
Anticoagulant Response

OBJECTIVE: To describe 2 patients in whom the initiation of fenofibrate potentiated warfarin's anticoagulant effects. CASE SUMMARY: A 71-year-old white woman and an 80-year-old white woman with multiple medical conditions were both stabilized on long-term warfarin therapy. During the course of anticoagulation, both patients were prescribed fenofibrate and experienced threefold and twofold increases in international normalized ratio (INR), respectively, requiring total weekly warfarin dosage reductions of 30–40%. Before starting fenofibrate therapy, both patients' coagulation values were within the therapeutic range. When interviewed, patients and caregivers denied bleeding, bruising, changes in diet, alcohol ingestion, nonadherence with therapy, or changes in drug regimen except for the addition of fenofibrate. Upon chart review, evaluation of potentially contributory parameters, such as other changes in drug therapy, thyroid function, liver function, and drug–disease interactions, showed that these parameters remained stable and were ruled noncontributory. DISCUSSION: The addition of fenofibrate in 2 patients on stable and therapeutic doses of warfarin increased the anticoagulant response to warfarin. A clear temporal relationship with the addition of fenofibrate and the appearance of the interaction was seen. Fenofibrate is highly protein bound, with the potential to displace warfarin from its binding protein, leading to an enhanced hypoprothrombinemic effect. Fenofibrate is also a mild to moderate inhibitor of CYP2C9, the enzyme responsible for warfarin metabolism. The combination of these effects — displacement of warfarin by fenofibrate coupled with decreased metabolism of warfarin — may increase the anticoagulant response to warfarin. Using the Naranjo probability scale, these interactions were designated as probable. CONCLUSIONS: We suggest serial monitoring of INR and consider an empiric 20% reduction in warfarin dosage when fenofibrate is initiated, with the possibility for a greater warfarin dosage reduction based on INR results.

Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents

2021 ◽  
pp. 106002802110592
Author(s):  
Barbara Blaylock ◽  
Xiaoli Niu ◽  
H. Edward Davidson ◽  
Stefan Gravenstein ◽  
Ronald DePue ◽  
...  
Keyword(s):  
Nursing Home ◽  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Chronic Obstructive ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Treatment Pathways ◽  
Selection Of Variables ◽  
Long Acting

Background Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. Objective The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. Methods A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider–completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. Results Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). Conclusion and Relevance The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.

scholarly journals Anti-inhibitor Coagulant Complex (Autoplex) for treatment of factor VIII inhibitors in hemophilia

Blood ◽  
1980 ◽  
Vol 56 (6) ◽  
pp. 978-984 ◽  
Author(s):  
CF Abildgaard ◽  
JA Penner ◽  
EJ Watson-Williams
Keyword(s):  
Soft Tissue ◽  
Factor Viii ◽  
Prothrombin Complex Concentrate ◽  
Activated Partial Thromboplastin Time ◽  
Minor Bleeding ◽  
Puncture Wound ◽  
Monitoring Therapy ◽  
Concurrent Use ◽  
Activated Prothrombin Complex Concentrate ◽  
Bleeding Episodes

Abstract Fourteen individuals with severe hemophilia complicated by factor VIII inhibitors (1 to 132 Bethesda Units) were treated for 33 bleeding episodes with a new activated prothrombin complex concentrate, Anti- Inhibitor Coagulant Complex (Autoplex, Hyland, Glendale, Calif.). Excellent or good results were observed in 21 of 25 minor bleeding episodes treated, which included joint, soft tissue, and mucous membrane hemorrhages. Eight major bleeding problems (an epidural bleed, a puncture wound, 2 serious soft tissue hemorrhages, 2 lacerations, and 2 major surgical procedures) were treated with excellent (6) or good (2) results. No serious complications were encountered, but two children developed transient hypofibrinogenemia following Autoplex infusion. Although some shortening of the prothrombin time and activated partial thromboplastin time was noted after infusion of Autoplex, there is no useful laboratory test for monitoring therapy. Despite the unknown mechanism of action for bypassing factor VIII, Autoplex appears to be a useful and needed interim product and is safe and effective. In view of the possible potentiation of thrombosis concurrent use of fibrinolytic inhibitors should be avoided.

Regular Prophylaxis with Recombinant Factor VIIa in a Patient with Severe Congenital FVII Deficiency.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4075-4075
Author(s):  
Angela Huth-Kuehne ◽  
Peter Lages ◽  
Rainer Zimmermann
Keyword(s):  
Treatment Option ◽  
Half Life ◽  
Base Line ◽  
Minor Bleeding ◽  
Bleeding Tendency ◽  
Self Administration ◽  
Short Half Life ◽  
Bleeding Episodes ◽  
Fvii Deficiency

Abstract Introduction Congenital FVII deficiency is a rare bleeding disorder with autosomal recessive inheritance and an estimated prevalence of 1/0.5 Mio/year. Besides plasma derived FVII concentrates, recombinant activated FVII (rFVIIa, NovoSeven, Novo Nordisk A/S Denmark) represents a new therapeutic option. Due to the short half-life of FVII, regular prophylaxis with FVII has not routinely been adopted. We report our experiences with long-term prophylactic treatment with rFVIIa in a female patient with congenital FVII deficiency suffering from severe recurrent bleedings. Case report: Since the first week after her birth in 1987, the patient experienced severe mucosal bleeding, soft tissue hematomas and easy bruising. Congenital FVII deficiency was diagnosed with a residual FVII activity of 3%. Initially the patient received red blood cells and fresh frozen plasma (FFP) in severe bleeding. After a third episode of severe colorectal bleeding, regular prophylaxis (2x/week) with prothrombin complex concentrates (PCC) was started and in 1988 switched to pdFVII 3x/week (15 IU/kg). Bleeding tendency decreased significantly except rare joint bleedings. As a young girl she also suffered from menorrhagia. During menses FVII was given 1-2x/d. Due to safety reasons and availability, it was decided in 1999 to switch to rFVIIa. To assess efficacy we compared a 24h recovery with 20μg/kg rFVIIa and 20IU pdFVII (see table 1). With both factor concentrates the residual FVII activity declined almost to base line levels 24 hrs post infusion. Recovery time [h] rFVIIa [%] pdFVII [%] 0 9 10 0,5 148 85 1 86 70 2 60 55 4 34 35 6,5 17 26 24 12 11 During the last 6 years the patient received rFVIIa in a dosage of 20μg/kg and frequency of 3x/week and during menstruation 1x/d. Under prophylaxis with rFVIIa bleeding tendency decreased further and no severe joint bleeding was observed, although FVII activity decreased to base line levels after 24 h. During a 16 months period (12/2001– 03/2003) the following 9 minor bleeding episodes were recorded: subcutaneous haematoma (4x), epistaxis (2x), gum bleeding (2x), superficial wound bleeding (1x). Therapy was well tolerated without any side-effects, especially no signs of systemic activation of coagulation. All bleeding episodes have been treated with excellent efficacy of rFVIIa. The patient performs home treatment and is able to live an almost normal life without limitation in her activities. The short injection time and small injection volume supports the acceptance of regular prophylaxis and self administration in this setting. The cost of prophylaxis is accepted by the health insurance due to a positive cost/benefit ratio and the fact that rFVIIa is the less costly treatment option for FVII deficiency compared to pd FVII concentrate in Germany. Conclusion: In congenital FVII deficiency with severe and frequent bleeding episodes, regular prophylaxis is very effective in reducing bleeding tendency despite the short half-life of the infused FVII. rFVIIa is a safe, effective and economic treatment option for long- term prophylaxis in patients with severe congenital FVII deficiency and well accepted by the patient. A dose of 20μg/kg/bolus is effective in our patient.

Outcomes for Ximelagatran Compared with Warfarin According to INR Control: Results from SPORTIF III and V Atrial Fibrillation Trials.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 902-902 ◽  
Author(s):  
Scott Kaatz ◽  
Harvey D. White ◽  
Michael Gruber ◽  
Gregory W. Albers
Keyword(s):  
Atrial Fibrillation ◽  
Oral Dose ◽  
Major Bleeding ◽  
Total Mortality ◽  
International Normalized Ratio ◽  
Lower Mortality ◽  
Thrombin Inhibitor ◽  
Control Group ◽  
Minor Bleeding ◽  
Coagulation Monitoring

Abstract Background: Warfarin effectively reduces the risk of stroke in patients with atrial fibrillation, but requires regular monitoring to maintain the target international normalized ratio (INR). Ximelagatran, a novel direct thrombin inhibitor, does not require coagulation monitoring and can be administered at a fixed oral dose. Methods: Outcomes in warfarin patients (n = 3587) from the SPORTIF III and V trials according to time spent in the therapeutic target INR range of 2–3 (≥ 76% of the time = good INR control [n = 1190]; 60–75% of the time = moderate INR control [n = 1207]; and &lt; 60% of the time = poor INR control [n = 1190]) were compared with ximelagatran patients (n = 3664). The primary endpoint was stroke/systemic embolic event (SEE). Results: Mean follow-up was 16.6 (± 6.3) months. Outcomes in warfarin patients according to INR control are shown in the table. Ximelagatran patients had numerically lower stroke/SEE rates than the warfarin patients with poor INR control (1.43%/yr vs 2.10%/yr; P = 0.08), as well as lower mortality (2.36%/yr vs 4.20%/yr; P &lt; 0.01) and major bleeding (1.89%/yr vs 3.85%/yr; P &lt; 0.01). The incidence of stroke/SEE and major bleeding did not differ statistically among the moderate INR control, good INR control, and ximelagatran groups. However, major + minor bleeding was more common in the moderate INR control group than the ximelagatran group (41.8% vs 32.5%; P &lt; 0.01). Conclusions: In warfarin-treated atrial fibrillation patients, the risks of stroke/SEE, mortality, and major bleeding are related to INR control, with a significant reduction in these events with good vs poor INR control. Compared with the one-third of patients who experienced poor INR control, patients randomized to ximelagatran administered at a fixed oral dose without the need for coagulation monitoring had a lower mortality rate and less major bleeding. Outcome Poor INR Control Moderate INR Control Good INR Control Poor vs Moderate Poor vs Good Good vs Moderate Stroke/SEE, %/yr 2.10 1.34 1.07 P = 0.09 P = 0.02 P &lt; 0.01 Total mortality, %/yr 4.20 1.84 1.69 P &lt; 0.01 P &lt; 0.01 P &lt; 0.01 Major bleeding, %/yr 3.85 1.96 1.58 P &lt; 0.01 P &lt; 0.01 P &lt; 0.01

scholarly journals A review of national guidelines for management of COPD in Europe

2016 ◽  
Vol 47 (2) ◽  
pp. 625-637 ◽  
Author(s):  
Marc Miravitlles ◽  
Claus Vogelmeier ◽  
Nicolas Roche ◽  
David Halpin ◽  
João Cardoso ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Treatment Goals ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
The Czech Republic ◽  
Criteria For Diagnosis ◽  
Long Acting

The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.

scholarly journals Klasifikasi Berita Olahraga Menggunakan Metode Naïve Bayes dengan Enhanced Confix Stripping Stemmer

2018 ◽  
Vol 5 (3) ◽  
pp. 269
Author(s):  
Yoga Dwitya Pramudita ◽  
Sigit Susanto Putro ◽  
Nurul Makhmud
Keyword(s):  
Naive Bayes ◽  
Naïve Bayes ◽  
Classification Method ◽  
Easy Access ◽  
Naive Bayes Classifier ◽  
Bayes Classifier ◽  
Naïve Bayes Classifier ◽  
News Stories ◽  
Long Time ◽  
Sports News

<p>Dokumen berita olahraga dalam bentuk web kini memiliki jumlah yang besar dalam kurun waktu singkat. Untuk kemudahan akses dokumen perlu melakukan pengelompokan dokumen berita kedalam beberapa kategori. Hal tersebut bertujuan agar berita olahraga tersusun sesuai dengan kategori yang ditentukan. Berita dapat dikelompokkan secara manual oleh manusia, akan tetapi hal tersebut membutuhkan waktu yang lama untuk melakukan kategorisasi. Metode klasifikasi diusulkan dalam penelitian ini untuk melakukan pengkategorian secara otomatis dokumen berita. Tujuan dilakukannya klasifikasi adalah untuk mempercepat dan mempermudah dalam pemberian kategori, sehingga dapat meningkatkan efisiensi waktu. Pada penelitian ini menggunakan metode klasifikasi Naïve Bayes Classifier. Sebelum dilakukan klasifikasi ada proses preprocessing dengan menggunakan Enhanced Confix Striping Stemmer.  Hal ini bertujuan untuk mengembalikan ke bentuk kata dasar, sehingga data berkurang dan proses komputasi menjadi lebih efisien. Pengujian dilakukan menggunakan 18 berita olahraga yang dipilih secara acak oleh user atau tester, dari 18 berita yang diujikan terdapat 14 berita yang bernilai benar atau relevan dengan analisis yang dilakukan use atau tester pada berita uji. Dari penelitian ini dapat disimpulkan bahwa Aplikasi Klasifikasi Berita Olahraga menggunakan Metode Naïve Bayes dengan Enhanced Confix Striping Stemmer mampu mengklasifikasi berita olahraga sesuai dengan kategori masing-masing, seperti Sepak Bola, Basket, Raket, Formula 1, Moto GP dan olahraga lainnya dengan keakuratan sebesar 77%.</p><p> </p><p class="Judul2"><strong><em>Abstract</em></strong></p><p class="Judul2"> </p><p>Web-based sports news currently has a considerable amount of documents. News documents need to be grouped into multiple categories for easy access. The goal is that sports news is structured according to the specified category. News can be grouped manually by humans, but it takes a long time to categorize if it involves large documents. Classification method is proposed in this research to categorize automatically news document. The purpose of doing the classification is to accelerate and simplify the granting of categories, thereby increasing the efficiency of time. In this research using the Naïve Bayes Classifier classification method. Prior to classification there is a preprocessing process using Enhanced Confix Striping Stemmer. It aims to return to the basic word form, so the data is reduced and the computing process becomes more efficient. From the test using 18 sports news randomly selected by the user or tester, there are 14 news stories that are true or relevant to the analysis by the user or the tester on the test news. This study concludes that the Sports News Classification Application using the Naïve Bayes Method with Enhanced Confix Striping Stemmer is able to classify sports news according to their respective categories, such as Football, Basket, Racquet, Formula 1, Moto GP and other sports with accuracy of 77%.</p>

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