Drug discoveries & therapeutics
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Randomized Controlled Trial
Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation.
In order to investigate whether the hemodynamic indices, including stroke volume variation (SVV) and pulse pressure variation (PPV) could predict fluid responsiveness in patients undergoing protective one-lung ventilation. 60 patients scheduled for a combined thoracoscopic and laparoscopic esophagectomy were enrolled and randomized into two groups. The patients in the protective group (Group P) were ventilated with a tidal volume of 6 mL/kg, an inspired oxygen fraction (FiO2) of 80%, and a positive end expiratory pressure (PEEP) of 5 cm H2O. Patients in the conventional group (Group C) were ventilated with a tidal volume of 8 mL/kg and a FiO2 of 100%. ⋯ The receive operating characteristic (ROC) analysis showed that the thresholds for SVV and PPV to discriminate responders were 8.5% for each, with a sensitivity of 66.7% (SVV) and 75% (PPV) and a specificity of 50% (SVV) and 83.3% (PPV) in Group P. However, the thresholds for SVV and PPV were 8.5% and 7.5% with a sensitivity of 80% (SVV) and 90% (PPV) and a specificity of 70% (SVV) and 80% (PPV) in Group C. We found SVV and PPV could predict fluid responsiveness in protective one-lung ventilation, but the accuracy and ability of SVV and PPV were weak compared with the role they played in a conventional ventilation strategy.
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Meta Analysis
Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials.
Tranexamic acid (TXA) is an antifibrinolytic drug which has been widely used in many areas of surgery. The purpose of our meta-analysis was to review randomized controlled trials (RCT) of the effectiveness and safety of topical TXA treatment in reducing total blood loss and transfusion rate for patients undergoing primary total hip arthroplasty (THA). A literature search was undertaken. ⋯ The topical administration of TXA groups revealed lower total blood loss(mean difference - 347 ml, 95% CI, - 411 to - 282 mL; p < 0.00001) and transfusion rate (OR, 0.23 (p < 0.00001; 95% CI, 0.14-0.38)) compared with control groups. Meanwhile there was no statistically significant difference in the risk of developing thromboembolic events (OR, 1.64 (95% CI, 0.39-6.97); p = 0.5). Topical administration of TXA could significantly reduce total blood loss and transfusion requirements in primary THA, without increased thromboembolic complications.
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Drug-induced pulmonary parenchymal disease (DIPPD) can be caused by a variety of agents, including antibiotics, chemotherapeutic drugs, antiarrhythmic agents and non-steroidal anti-inflammatory drugs (NSAIDs). DIPPD includes acute bronchospasm, organizing pneumonia, alveolar hypoventilation and hypersensitivity reactions. History, physical examination and investigations are required mainly to exclude other causes of lung diseases. ⋯ Recognition of DIPPD is difficult because the clinical, radiologic, and histologic findings are nonspecific. Management includes drug withdrawal and in some cases corticosteroid therapy. In this article we reviewed the various drugs known to cause pulmonary parenchymal diseases, various patterns of parenchymal diseases observed and their management.
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The Ebola outbreak in West Africa this year is causing global panic. The high mortality of this disease is largely due to lack of effective preventive vaccines or therapeutic drugs. ⋯ Several representative candidate drugs that demonstrate potent anti-Ebola activity in preclinical studies have been pushed forward to higher research stages to obtain an earlier official license. It is expected that proven preventive or therapeutic regimens could be established in the near future.
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Case Reports
Management of inappropriate sinus tachycardia with ivabradine in a renal transplant recipient.
Inappropriate sinus tachycardia (IST) is a syndrome characterized by unexplained tachycardia (heart rate > 100 beats /min) and related symptoms at rest. We describe a case of a 35 year old male with end stage renal disease who developed IST after renal transplant in the surgical intensive care unit. Management of IST is usually nonspecific and includes bradycardic agents, radiofrequency ablation or surgical ablation of the sinus node. This patient was well managed with ivabradine (If pacemaker current inhibitor) after failure and intolerance of β-adrenergic blockers.