Expert opinion on pharmacotherapy
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Acute chest syndrome (ACS), a leading cause of morbidity and mortality in sickle cell disease (SCD), is an acute illness characterized by fever and/or respiratory symptoms, accompanied by a new pulmonary infiltrate on a chest X-ray. There is increasing knowledge regarding the etiology and pathogenesis of ACS in SCD. A high index of suspicion is required for the diagnosis of ACS. Treatment of ACS involves the judicious use of intravenous fluids and analgesics, aggressive incentive spirometer and pulmonary toileting, antibiotics and transfusion therapy. ⋯ Despite an increased understanding of its etiology and pathogenesis, ACS remains a leading cause of morbidity and mortality in SCD. In patients admitted with a painful crisis, there is need for a high index of suspicion, as pain episodes may be a prodrome for the development of ACS. Patients with a diagnosis of ACS should be aggressively managed to prevent clinical deterioration. Clinical trials using novel drugs for the treatment of ACS are greatly warranted.
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Expert Opin Pharmacother · Jun 2013
ReviewJuvenile idiopathic arthritis: an update on current pharmacotherapy and future perspectives.
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Therapeutic advances in the treatment of JIA are occurring at a rapid rate, resulting in more ambitious therapeutic goals and increasing numbers of children experiencing complete clinical remission. ⋯ With advances in pharmacotherapy, physical and functional outcomes in children with JIA have improved immensely. The establishment of research consortia among the pediatric rheumatology community has allowed for large controlled studies and enabled a better understanding of the safety and efficacy of these therapeutic agents in children. Long-term safety data remain limited and thus longer, larger safety studies are warranted.
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Expert Opin Pharmacother · Jun 2013
EditorialPerioperative statin therapy: current knowledge and future directions.
Perioperative statin therapy has come to represent a cornerstone of risk reduction for millions of patients who undergo cardiac and noncardiac surgeries. While large-scale, robust, randomized controlled studies support the use of statins in cardiac surgery, their role in noncardiac surgery has become ambiguous following concerns regarding scientific misconduct in many pivotal studies. In this edition of the Expert Opinion on Pharmacotherapy, Irwin et al. comprehensively summarize the evidence for perioperative statin treatment. The authors add to this review by providing expert opinions regarding the state of the science and future paths for research and enquiry.
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Expert Opin Pharmacother · Jun 2013
CommentPercutaneous coronary intervention with drug-eluting stents or coronary artery bypass surgery in subjects with type 2 diabetes.
There is a debate as to whether percutaneous coronary intervention (PCI) with drug-eluting stents or coronary artery bypass surgery (CABG) is the best procedure for subjects with type 2 diabetes and coronary artery disease requiring revascularization. There is some evidence that by following these procedures, there is less further revascularization with CABG than PCI in subjects with diabetes. ⋯ However, the rates of stroke may be higher with CABG than PCI with drug-eluting stents in this population. Thus, if CABG is going to be preferred to PCI in subjects with type 2 diabetes and multivessel coronary disease, consideration should be given as to how to reduce the rates of stroke with CABG.