Prevention of infection from contrast agents

Until now, automatic contrast agent injector syringes licensed for consecutive one-time use have been employed with a number of patients. In 2016, regulation of automatic injector syringes ensured their single use, and reuse was strictly limited by law. However, this regulation creates the social problems of rising medical costs and resource waste. Many doctors are not significantly concerned about infection from contrast agent injection because the needle and connection lines on the patient side are set up for single use, the connections between syringes and contrast agents are reusable, and there are no reports of excessive infection. However, infection can nevertheless occur with injection of contrast agents. We should therefore implement the correct and safe use of contrast agents and take precautions against infection. To prevent infection due to contrast agents, syringes and connection lines for injection of such agents should be used once per patient, or multi-use licensed products should be used. In the latter case, reverse flow prevention filters must be used on the patient's side.

TREATMENT OF ANEMIA AND IMPROVEMENT OF QUALITY OF LIFE AMONG PATIENTS WITH CROHN'S DISEASE: experience using ferric carboxymaltose

Objectives - Anemia is the most common hematological alteration in patients with Crohn's disease, and is frequently related to intestinal inflammatory activity. Its cause is multifactorial and mostly associated with absolute iron deficiency (iron deficiency anemia) and/or functional iron deficiency (inflammation anemia or anemia of chronic disease). It may also be identified through other causes, such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications (salicylic derivatives and immunosuppressive drugs). In the present study, patients with active Crohn's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose. We discuss the therapeutic schemes (doses), safety, results and improvement of quality of life. Methods - In the present prospective study, 10 consecutive patients with Crohn's disease, with moderate to severe activity, with anemia (Hb: 6.7 to 10 g/dL), who were attended between March 2014 and March 2015, were evaluated. Six (60%) were men and four were women, all with moderate or severe anemia (hemoglobin <10 g/dL). They were treated with a maximum of three intravenous infusions of 1000 mg of ferric carboxymaltose, of at least 15 minutes in duration. It was also sought to correlate the inflammatory Crohn's disease activity degree (measured using the Crohn's Disease Activity Index, CDAI) and C-reactive protein level with the severity of anemia. The primary outcome was an increase in Hb of ≥2 g/dL and the secondary outcome was the normalization of anemia (Hb ≥12 g/dL for women and ≥13 g/dL for men) and the improvement in quality of life seen 12 weeks after the last application of carboxymaltose. Results - Among the 10 patients studied, parenteral iron supplementation was administered in three cases during hospitalization and the others received this on an outpatient basis. The total iron dose ranged from 1,000 to 2,000 mg, with an average of 1,650 mg. Crohn's disease activity measured using CDAI and C-reactive protein correlated with the intensity of anemia. An increase of 2 g/dL occurred in eight (80%) patients after 12 weeks and normalization of anemia was found in seven (70%) patients. Improvements in quality-of-life scores were found for all (100%) patients after 12 weeks. Carboxymaltose was well tolerated. Three patients presented adverse reactions (two with nausea and one with headache) of mild intensity. Conclusions - Anemia is a frequent complication for Crohn's disease patients. Intravenous iron therapy has been recommended for Crohn's disease patients, because for these patients, oral iron absorption is very limited. This is because of the inflammatory state and "blocking" of iron entry into enterocytes through hepcidin action on ferroportin, along with the elevated rates of gastrointestinal adverse events that compromise adherence to treatment and possibly aggravate the intestinal inflammatory state. The degree of Crohn's disease activity, as measured using CDAI and C-reactive protein, correlates with the severity of anemia. Carboxymaltose is a safe drug, which can be administrated in high doses (up to 1,000 mg per application per week) and corrects anemia and iron stocks over a short period of time, with consequent improvement in quality of life.

Objetivos - Anemia é a alteração hematológica mais comum em portadores de doença de Crohn, estando frequentemente relacionada à atividade inflamatória intestinal. Sua causa é multifatorial, está associada na maioria das vezes com deficiência absoluta de ferro (anemia ferropriva) e/ou deficiência funcional de ferro (anemia da inflamação ou anemia de doença crônica), podendo também ser identificada outras causas como deficiência de ácido fólico ou vitamina B12 e secundária a efeitos adversos de medicamentos (derivados salicílicos e imunossupressores). Neste trabalho, avaliamos portadores de doença de Crohn em atividade com anemia que foram tratados com carboximaltose férrica endovenosa, e discutimos os esquemas terapêuticos (doses), a segurança e os resultados, assim como a melhora da qualidade de vida. Métodos - Neste estudo prospectivo, avaliamos 10 consecutivos pacientes portadores de doença de Crohn de moderada a grave atividade com anemia (Hb: 6,7 a 10 g/dL) que foram atendidos no período de março de 2014 a março de 2015. Eram seis (60%) do sexo masculino e quatro do sexo feminino, todos com anemia moderada ou grave (hemoglobina <10g/dL), tratados com no máximo três infusões de 1000 mg de carboximaltose férrica por via endovenosa em, pelo menos, 15 minutos. Procurou-se também correlacionar o grau de atividade inflamatória da doença de Crohn (mensuração realizada com o IADC-índice de atividade da doença de Crohn) e dosagem da proteína C reativa com a gravidade da anemia. O desfecho primário foi aumento da Hb de ≥2 g/dL e desfecho secundário a normalização da anemia (Hb ≥12 g/dL para mulheres e ≥13 g/dL para homens) e melhora na qualidade de vida após 12 semanas da aplicação da última dose de carboximaltose férrica. Resultados - Dos 10 pacientes estudados, em 3 a suplementação parenteral de ferro foi realizada durante internação hospitalar, o restante em regime ambulatorial. A dose total de ferro administrada variou de 1.000 a 2.000 mg, sendo a média de 1.650 mg. A atividade da doença de Crohn mensurada pelo IADC e pelo PCR se correlacionou com a intensidade da anemia. O aumento de 2 g/dL ocorreu em oito (80%) pacientes após 12 semanas e a normalização da anemia foi observada em sete (70%). Melhora do escore de qualidade de vida foi observada em todos (100%) após 12 semanas. A carboximaltose férrica foi bem tolerada, três pacientes apresentaram reações adversas (2 - náusea e 1 - cefaléia) de leve intensidade. Conclusões - Anemia é uma complicação frequente em portadores de doença de Crohn. A terapia com ferro por via endovenosa tem sido a recomendada em portadores de doença de Crohn, pois nestes pacientes a absorção do ferro oral é bastante limitada devido ao estado inflamatório e "bloqueio" da entrada de ferro nos enterócitos por ação da hepcidina sobre a ferroportina, além das elevadas taxas de eventos adversos gastrointestinais que comprometem a adesão ao tratamento e podem agravar o estado inflamatório intestinal. O grau de atividade da doença de Crohn mensurado pelo IADC e PCR se correlaciona com a severidade da anemia. A carboximaltose férrica é uma droga segura, pode ser administrada em altas doses (até 1.000 mg por aplicação por semana), corrige a anemia e os estoques de ferro em curto espaço de tempo, com consequente melhora da qualidade de vida.

Comparison of pharmacodynamics of rocuronium administered by intermittent bolus injection according to body surface area and real body weight / 实用医学杂志

Objective To compare the pharmacodynamics of rocuronium intermittently administered according to body surface area and real body weight and individual differences. Method Forty-two patients undergoing elective surgery under general anesthesia were enrolled into the body surface area group (BSA group) and the real body weight group (RBW group), with 21 patients in each group. The patients in the two groups were induced with 2ED95 of rocuronium according to body surface area and real body weight (16.64 mg/m2 in BSA group; 0.6 mg/kg in RBW group). Whenever T1 recovered to 10%, a dosage of 0.5ED95 was administred repeatedly for 30 min before the end of the operation. The time of neuromuscular blockade and recovery of muscle relaxation were recorded, and the dosage of rocuronium was also recorded. Results No significant difference in each index of neuromuscular block time-effect was found between the two groups (P > 0.05). The single dosage and maintainance amount of muscle relaxation were less in the BSA group than that in RBW group (P < 0.05). Compared with the RBW group, the single dosage, dosing intervals, pharmacological duration and the time TOFr recovered to 0.7 between the different individuals were less in the BSA group (P < 0.05). Conclusion The intermittent administration of rocuronium can maintain the same clinical efficacy according to body surface area as that according to real body weight , with significantly less dosageand reducing the differences of individuals in blockade time-effect of muscle relaxation.

Errores en prescripción y transcripción de medicamentos endovenosos en Servicios Pediátricos, Hospital Dr. Hernán Henríquez Aravena: Temuco, 2008-2009 / Frequency of prescription and transcription errors for intravenous medications in four pediatric services

Background: Errors in the prescription and transcription of medications in pediatric services is a source of adverse events that can be prevented. Aim: To determine and compare the frequency of prescription and transcription errors for intravenous drugs in four pediatric services in a regional general hospital. Material and Methods: Cross sectional analysis of a probabilistic sample of 500 prescriptions of intravenous medications. Information was gathered using an instrument from the American Academy of Pediatrics. Results: The detected prescription errors were illegible indications in 20 percent, lack of dosing indication in 11 percent, omission of the administration route in 24 percent and omission of the frequency of administration in 15 percent. Transcription errors were illegible transcription in 3 percent, not transcribing all indicated medications in 4 percent and transcription of medications that were not prescribed in 3 percent. Twenty one percent of prescriptions and 6 percent of transcriptions had at least one incorrect action. In the different services studied there was a significant association between the percentage of incorrect prescriptions and transcriptions and between illegible prescriptions and transcriptions. Conclusions: A high percentage of errors in prescription of intravenous medications and their transcriptions, was detected in these services. A better quality of care control is required.

Effect of penehyclidine hydrochloride on oleic acid-induced acute lung injury in rats: A comparison between inhalation and intravenous therapy / 第二军医大学学报

Objective: To compare the therapeutic effects of penehyclidine hydrochloride on rat with oleic acid (OA)-induced acute lung injury (ALI) when given via inhalation and intravenous injection. Methods: Forty male Sprague-Dawley rats were randomly divided into 4 equal groups: normal control group(group I), ALI group(group II), penehyclidine hydrochloride inhalation group(group III), and intravenous penehyclidine hydrochloride group (group IV). The blood pressure (BP), pulmonary artery pressure (PAP), and airway pressure (Paw) were determined every 60 min during the experiment and the artery blood gas analysis and mixed venous blood gas analysis were performed. The wet to dry lung weight ratio (W/D) and the serum concentration of tumor necrosis factor alpha (TNF-α) were determined 240 min after the experiment in each group. Results: The OA-induced increase of PAP, Paw and decrease of PaO2/FiO2 were improved in the group III and group IV compared with those in the group II(P<0.05 for group III). The W/D and serum TNF-α concentration were lower in the group III and group IV compared with those in the group II (P<0.05 for group III). Conclusion: Penehyclidine hydrochloride can relieve the symptoms of OA-induced ALI. Inhalation approach is more effective than intravenous injection when the same dose of penehyclidine hydrochloride is given.

Clinical assessment of the effect of intravenous PCA and epidural PCA in postoperative analgesia / 中华麻醉学杂志

To compare the clinical effect and side-effect of intravenous PCA(PCIA) with epidural PCA (PCEA). Method: One hundred and eighty postoperative patients, who were randomly divided into three groups: group PCIA, group PCEA and control, were observed for 3 days after operation. Result: Overall patients in two PCA groups were satisfied with the postoperative analgesia. The incidence of urinary retention in group PCIA were significantly lower than that in group PCEA (P0.05). 10% in group PCIA were in medium sedation whereas no eases in group PCEA were in sedation. At 6th hour after operation,serum cortisol level of control patients was much higher than that of PCA patients. Conclusion=Both PCIA and PCEA have excellent analgesia and reduce stress response after operation. PClA has lower incidence of urinary retention and is performed easily,but inhibits gastrointestinal motility much more and has higher sedative incidence compared with PCEA.