Examination regarding the tolerability of the homochord Acidum L(+)-lacticum at a dosage of sixty drops three times daily

In Germany, the commission D recommends in its current dosage guidelines from March 17, 2004, that homeopathic dilutions higher than 24x will be prescribed in a daily application of five drops once. This recommendation is decisive for the German Regulatory Authority. Even though the homochord Acidum L(+)-lacticum 4x/6x/12x/30x/200x contains dilutions above 24x, it is commonly used in clinical practice for over 30 years in a dosage of 60 drops three times daily. In order to explore the clinical safety and tolerability of Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily, as well as lower dosages, a therapist survey was designed to address the questions. Highly experienced and licensed therapists, including general and alternative practitioners, reported their usual dosage of homochord, incidences of drug reactions, initial homeopathic aggravations as well as the diagnoses that led to the prescription of Acidum L(+)-lacticum 4x/6x/12x/30x/200x. 167 therapist responses were analyzed. Only four therapists reported occurrences that classify as initial aggravation, (2.40 %), compared to 159 with no incidences (95.21 %). Four therapists made no statement. Nevertheless, there were no adverse drug reactions documented in the survey. Consequently, Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily or lower dosages may be construed to be clinically tolerable and safe. This evidence might lead to further re-evaluations of other homochords, and rigorous clinical trials for its safety and tolerability.

Exploration of interethnic variation and repurposed drug efficacy in the treatment of SARS-CoV-2 Infection (COVID-19)

ABSTRACTThe COVID-19 global pandemic has led to repurposing of drugs, with little underlying evidence for treatment safety and efficacy. This may increase complications for patients with acute viral respiratory infections. UGT1A1 and CYP2D6 enzymes are involved in the metabolism of atazanavir and fluvoxamine repurposed for COVID-19. This study aimed to elucidate the role of interethnic variation in these enzymes in the efficacy of repurposed drug therapies. A retrospective cohort of 101 Jordanian Arab samples were genotyped using Affymetrix DMET Plus Premier Package. Comprehensive global population genetic structure analyses were performed for CYP2D6 and UGT1A1 allele frequencies across multi-ethnic populations of over 131,000 global subjects from 417 published reports, revealing that Jordanian Arabs share the closest sequence homology to European and Near East populations. The East Asian populations have significantly over-representaiton of individuals with diplotype pairs for reduced atazanavir metabolism compared to the African populations and are more likely to show impaired UGT1A1 metabolism. East Asian populations are also 4.4x more likely to show impaired fluvoxamine metabolism than South Central Asian and Oceanian populations, and 8x more likely than other ancestry populations. The results here support previous findings that interethnic variation should be used for developing proper population-specific dosage guidelines.

Population pharmacokinetic evaluation and optimization of amikacin dosage regimens for the management of mycobacterial infections

Background There is limited information on amikacin pharmacokinetics (PK) and dose requirements in patients with mycobacterial infections. Objectives To conduct a population PK analysis of amikacin data from patients with mycobacterial infections and compare predicted concentrations from standard and modified dosage guidelines with recommended target ranges. Methods A population PK model was developed using NONMEM. Cmax, Cmin, concentration 1 h post-infusion (C1h) and AUC0–24 using 15 mg/kg daily (once daily), the WHO table, 25 mg/kg three times weekly (TTW) and modified guidelines were compared using Monte Carlo simulations of 1000 patients. Results Data were available from 124 patients (684 concentrations) aged 16–92 years. CL was 4.64 L/h per 100 mL/min CLCR; V was 0.344 L/kg. With once-daily regimens, Cmax was 35–45 mg/L in 30%–35% of patients and 35–50 mg/L in 46%–48%; C1h was 25–40 mg/L in 53%–59%. The WHO table produced high Cmax values in patients <60 kg and low in patients >75 kg. With TTW dosing, around 30% of Cmax values were 65–80 mg/L, 40% were 60–80 mg/L, and 48% of C1h were 45–65 mg/L. Increasing the dosage interval for patients with CLCR <50 mL/min reduced Cmin values >2 mg/L from 34% to 25% for once-daily dosing and from 18% to 13% for TTW. In patients whose Cmin was <2 mg/L, 82% of AUC0–24 values were 100–300 mg.h/L. Conclusions Standard amikacin dosing guidelines achieve low percentages of target concentrations for mycobacterial infections. Extending the dosing interval in renal impairment and widening target ranges would reduce the need for dose adjustment.

Uso em Longo Prazo de Anticoagulantes Orais na Cardiologia

Os anticoagulantes orais são medicações amplamente utilizadas na cardiologia. Durante muito tempo, a varfarina foi a única opção disponível no mercado para esta terapia, tendo ainda hoje papel singular em determinadas situações. Porém, com o surgimento dos anticoagulantes orais de ação direta (DOACs), no século XXI, o tratamento anticoagulante vem apresentando grande avanço, dispondo de novas opções terapêuticas que ofertam mais segurança e efetividade à terapia. Diversos cenários da cardiologia requerem o seu uso e, recentemente, muitos estudos têm sido realizados a fim de esclarecer os riscos e benefícios de sua empregabilidade, a segurança e eficácia dos fármacos disponíveis em variadas situações clínicas, bem como a interação dessas drogas com outras medicações amplamente utilizadas na cardiologia. Dessa forma, os DOACs vêm cada vez mais ganhando espaço nos diversos cenários, apresentando maior segurança, menor perfil de interações medicamentosas e alimentares, maior comodidade posológica, acarretando maior adesão dos pacientes à terapia, além de melhor eficácia, se comparados à varfarina. É importante ressaltar que o uso dessa nova classe de droga está reservado a situações específicas, tendo em vista que não mostrou benefício em determinadas situações e, em outras situações, essas drogas precisam ser estudadas para terem seu uso validado na prática clínica. O objetivo dessa revisão é promover uma atualização, à luz dos principais e mais robustos ensaios clínicos publicados até o momento, sobre o uso dos anticoagulantes orais nos diversos cenários da cardiologia, abordando as suas principais indicações, contraindicações, assim como o tempo de uso dessa terapia e orientações posológicas em cada situação, com base nas melhores e mais atuais evidências sobre o tema. Oral anticoagulants are medications widely used in cardiology. For a long time, warfarin was the only option available on the market for this therapy, and today it still has a unique role in some cases. However, with the emergence of direct oral anticoagulants (DOACs) in the 21st century, anticoagulant treatment has had a big breakthrough, constituting a new therapeutic option that offers more safety and effectiveness for anticoagulant therapy. Several cardiology scenarios require its uses. Recently, many studies have been carried out in order to clarify the risks and benefits of their use, the safety and efficiency of the drugs available in many clinical situations, and the interaction of these drugs with other medications commonly used in cardiology. Thus, DOACs are increasingly finding spaces in several settings, presenting safety, a lower profile of drug and food interactions, a better dosage convenience, adhesion of patients to the therapy, and efficiency when compared to warfarin. The use of this new class of drugs is reserved for specific situations, considering that it didn’t show any benefits in some conditions, and in many situations, these drugs need to be studied to have their use validated in clinical practice. The purpose of this review is to promote an update of the use of oral anticoagulants in many cardiology scenarios, considering the most robust clinical trials published to date to discuss the main indications, contraindications, as well as, time of use and dosage guidelines in each situation.

Essential Medicines

The concept of essential medicines (EM) was developed by the World Health Organization (WHO) to promote equitable access to safe, effective, and low-cost medicines. Access to EM is considered part of the right to health and is critical to the provision of palliative care. Access to EM is often disrupted in the setting of humanitarian crises, leading to further physical and psychological suffering. The recently published WHO document, Integrating Palliative Care and Symptom Relief into the Response to Humanitarian Emergencies and Crises, provides guidance on the prioritization and utilization of EM as part of an essential package of care. This chapter draws on the recommendations of the WHO as well as those of other expert committees and multilateral organizations. It provides an overview of commonly used medicines in palliative care and is applicable to the delivery of palliative care in humanitarian crises. It also provides general dosage guidelines.

UJI KELAYAKAN PESAWAT SINAR-X TERHADAP PROYEKSI PA (POSTERO-ANTERIOR) DAN LAT (LATERAL) PADA TEKNIK PEMERIKSAAN FOTO THORAX

Research has been conducted to determine feasibility test of the X-ray planePA and LAT projections on chest x-ray techniques. The study using a water phantom object as a substitute for patients with variations in interval distance ofthe 100-180 cm. Measurement of radiation dose X-rays performed five repetitions , measurable doses had be read on the device electrometer. Exposition factors to the PA projection using a tube voltage of 75 kV, current and time of 3,2 mAs, the irradiation field areaof (30 x 30) cm2.For the LAT projection tube voltage of 80 kV, current and time of 6,3 mAs, and the irradiation field area of (20 x 30) cm2. It the study of the radiation dose X-ray plane projection PA and LAT is optimal is below the limit value at the level of dosage guidelines BAPETEN No 08 of 2011. Obtained PA projections are below the value of 0,4 mGy while LAT projection is below the value of 1,5 mGy. The radiation dose X-rays plane using a variation of 100-180 cm distance is still below the dose limit values ??, thus meeting the objectives anssurance quality and quality control.