Pharmacotherapy
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Effect of Statins on the Incidence of Postoperative Atrial Fibrillation after Cardiac Valve Surgery.
To evaluate the effect of preoperative statin use on the incidence of postoperative atrial fibrillation (POAF) in patients undergoing isolated cardiac valve surgery. ⋯ Preoperative statin use was not associated with a decreased incidence of POAF in patients undergoing isolated cardiac valve surgery. Additional studies are needed to further elucidate the pharmacodynamics of statins in patients undergoing cardiac surgery because statins have demonstrated a decrease in the risk of POAF in other cardiac surgery populations.
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Literature reviews summarize information from individual studies and are an important tool in the practice of evidence-based medicine. Various types of reviews, including narrative and systematic reviews, may be found within the biomedical literature. Systematic reviews are the strongest type and are often rated as the highest level of evidence. ⋯ This article is intended to enhance clinicians' understanding of the unique methods commonly used in systematic reviews by using the reporting standards to formulate evaluation principles. Explanations of the statistical tests and types of biases that are frequently encountered in systematic reviews are discussed. Lastly, an evaluation of a meta-analysis using these principles is provided.
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The treatment of cancer has largely relied on killing tumor cells with nonspecific cytotoxic therapies and radiotherapy. This approach, however, has limitations including severe systemic toxicities, bystander effects on normal cells, recurrence of drug-resistant tumor cells, and the inability to target micrometastases or subclinical disease. An increased understanding of the critical role of the immune system in cancer development and progression has led to new treatment strategies using various immunotherapies. ⋯ We also compare and contrast their current place in cancer therapy and patterns of immune-related toxicities, and discuss the role of dual immune checkpoint inhibition and strategies for the management of immune-related adverse events. The immune checkpoint inhibitors have demonstrated a dramatic improvement in overall survival in patients with advanced melanoma and squamous NSCLC, along with acceptable toxicity profiles. These agents have a clear role in the first-line treatment of advanced melanoma and in the second-line treatment of advanced squamous NSCLC.
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Review
Dalbavancin and Oritavancin: An Innovative Approach to the Treatment of Gram-Positive Infections.
Health care-associated infections, especially those caused by multidrug-resistant gram-positive organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are a growing public health threat. In 2014, the U. S. ⋯ This addition allows for these agents to have prolonged half-lives, giving them unique dosing profiles. In addition, by concentrating at the site of action, they have increased potency against MRSA compared with vancomycin, the current mainstay of therapy. In this review, we focus on comparing and contrasting these two new agents with regard to their pharmacology, mechanisms of action, spectrum of activity, safety profiles, dosage and administration, and drug and laboratory interactions, and we review the clinical trials evaluating their use.
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The use of cannabinoids for the treatment of chronic diseases has increased in the United States, with 23 states having legalized the use of marijuana. Although currently available cannabinoid compounds have shown effectiveness in relieving symptoms associated with numerous diseases, the use of cannabis or cannabinoids is still controversial mostly due to their psychotropic effects (e.g., euphoria, laughter) or central nervous system (CNS)-related undesired effects (e.g., tolerance, dependence). ⋯ This approach could be beneficial for conditions with prominent peripheral pathophysiologic mechanisms (e.g., painful diabetic neuropathy, chemotherapy-induced neuropathy). In this article, we discuss the scientific evidence to target the peripheral cannabinoid system as an alternative to cannabis use for medical purposes, and we review the available literature to determine the pros and cons of potential strategies that can be used to this end.