RESUMEN
BACKGROUND AND OBJECTIVES: Patients with beta-thalassemia require lifelong blood transfusions, leading to chronic iron overload, which can lead to growth retardation, as well as hinder sexual development during the adolescent period and dysfunction of organs such as heart, pancreas, and endocrine glands. These patients are in need of lifelong transfusion therapy and hence lifelong iron chelation therapy as well. Hence, this study was aimed to assess the effectiveness of deferasirox for iron chelation in pediatric thalassemia cases in a tertiary care hospital of Eastern India. SUBJECTS AND METHODS: This prospective, observational, hospital-based study was conducted from June 2015 to December 2016. Two hundred and fifty patients were assessed for eligibility, of which 174 were included. Effectiveness of deferasirox was observed by measuring serum ferritin levels which were monitored at the end of every 3 months till 1 year. We also evaluated the compliance with deferasirox therapy in the same study cohort. RESULTS: The serum ferritin level reduced significantly at the end of 12 months in comparison to baseline (P = 0.04). There was a mean absolute decrease in serum ferritin only in the dose range of 21-30 mg/kg/day. Approximately 90% of the patients had 100% compliance with deferasirox therapy. CONCLUSIONS: Deferasirox is an effective iron chelator when started at an optimum time and with optimum dose. At least 1 year of deferasirox therapy is needed for a significant lowering of serum ferritin levels of pediatric thalassemia patients on multiple blood transfusions.
Asunto(s)
Transfusión Sanguínea , Deferasirox/uso terapéutico , Quelantes del Hierro/uso terapéutico , Sobrecarga de Hierro/prevención & control , Talasemia beta/terapia , Adolescente , Factores de Edad , Biomarcadores/sangre , Niño , Preescolar , Deferasirox/efectos adversos , Femenino , Ferritinas/sangre , Humanos , India , Quelantes del Hierro/efectos adversos , Sobrecarga de Hierro/sangre , Sobrecarga de Hierro/diagnóstico , Masculino , Estudios Prospectivos , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento , Talasemia beta/sangre , Talasemia beta/diagnósticoRESUMEN
OBJECTIVE: Timely delivery of ß-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METHODS: Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions. A time series design was used to analyze outcomes with baseline data and continuous monitoring during active intervention steps. The primary outcomes analyzed were the times to first ß-agonist and steroid administration. Secondary outcomes included admission rate, ED length of stay, and ED revisits. RESULTS: Assignment of the Pediatric Asthma Score, our initial pathway step, occurred in most patients within the first several months. Time to first ß-agonist administration decreased from the baseline mean of 76 minutes to 27 minutes. Time to steroid administration decreased from the baseline mean of 108 minutes to 49 minutes. Mean monthly admission rate remained at 22% with no special cause variation identified. The ED revisit rate was not negatively impacted and, in most months, was 0%. CONCLUSIONS: By standardizing asthma care in our ED and redesigning care delivery processes, care variation decreased and significant improvements in timeliness of ß-agonist and steroid administration occurred.
Asunto(s)
Corticoesteroides/administración & dosificación , Agonistas Adrenérgicos beta/administración & dosificación , Asma/tratamiento farmacológico , Tiempo de Internación/estadística & datos numéricos , Ruidos Respiratorios/efectos de los fármacos , Tiempo de Tratamiento/normas , Adolescente , Corticoesteroides/uso terapéutico , Agonistas Adrenérgicos beta/uso terapéutico , Asma/complicaciones , Asma/epidemiología , Niño , Preescolar , Servicio de Urgencia en Hospital/normas , Humanos , Tiempo de Internación/tendencias , Ruidos Respiratorios/etiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The objective of this study was to evaluate any abnormal change in plasma glucose levels in patients treated with L-asparaginase (L-Asp)-based chemotherapy regimen in patients of acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: This retrospective, hospital-based study was conducted in patients of ALL, admitted to the Clinical Haematology Department of a tertiary care hospital of Odisha from August 2014 to July 2015. Indoor records of 146 patients on multi-centered protocol-841 were evaluated for any alteration in plasma glucose level, time of onset of hypo/hyperglycemia, and persistence of plasma glucose alteration. RESULTS: Twenty-one percent of patients showed abnormal plasma glucose level. Most of these patients developed hypoglycemia and were of lower age group. Most of these patients developed hypoglycemia and were of lower age group, whereas a majority of higher age group patients developed hyperglycemia. In majority of the cases, abnormal glucose developed after three doses of L-Asp. Hypoglycemia subsided whereas hyperglycemia persisted till the end of our observation period. CONCLUSIONS: L-Asp produces more incidences of hypoglycemia than hyperglycemia in a good number of ALL patients towards which clinicians should be more vigilant. However, hyperglycemia persists for a longer duration than hypoglycemia.
Asunto(s)
Antineoplásicos/efectos adversos , Asparaginasa/efectos adversos , Glucemia/análisis , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangre , Antineoplásicos/uso terapéutico , Asparaginasa/uso terapéutico , Preescolar , Femenino , Humanos , Hiperglucemia/inducido químicamente , Hipoglucemia/inducido químicamente , India , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Centros de Atención Terciaria , Adulto JovenRESUMEN
AIM: To correlate the level of anxiety with nonadherence to antiretroviral medication. MATERIALS AND METHODS: This observational, cross-sectional, hospital-based study was conducted in 78 patients attending antiretroviral therapy (ART) center of a tertiary care hospital of Odisha. The study duration was 6 months. Patients were designated as nonadherent by referring to the white card. Utilization of ART drugs and adverse drug reactions were included in a predesigned format. The anxiety level of all included patients was scored as per Hamilton Anxiety Rating Scale. Mean anxiety score of the adherent group was compared with that of the nonadherent group. Possible causes of nonadherence leading to high anxiety level were evaluated. RESULTS: 46% of patients in the nonadherent group had very severe, 17% had moderate to severe, 28% had mild to moderate and 9% had a mild level of anxiety. In the adherent group, however, mild to moderate level of anxiety was observed only in 10% patients. CONCLUSIONS: Anxiety is associated with sub-optimal medication adherence in HIV infected patients.
Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Ansiedad/etiología , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Adolescente , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/uso terapéutico , Ansiedad/complicaciones , Ansiedad/epidemiología , Ansiedad/fisiopatología , Estudios de Casos y Controles , Estudios Transversales , Quimioterapia Combinada/efectos adversos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria , Adulto JovenRESUMEN
Barrier wound therapy is commonplace in the health care environment and functions to limit bacterial colonization and infection in both acute wounds and recalcitrant chronic wounds. This article reviews the nature of acute and chronic wounds and their available adjunctive barrier therapies.