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1.
Braz. dent. sci ; 25(1): 1-13, 2022. tab, ilus
Article in English | LILACS, BBO | ID: biblio-1353764

ABSTRACT

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively. Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus were evaluated for one week postoperatively. Results: There was no significant difference between the three groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days. The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower maximum interincisal opening measurement than group II after two days. Conclusion: Local administration of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain, and less facial edema and trismus at the second postoperative day compared to the submucosal injection and transalveolar application. However, at one week the difference in measurements of the three variables between the groups was not significant. (AU)


Objetivo: O objetivo deste estudo foi fornecer evidências para comparar a eficácia de três diferentes vias de administração local de dexametasona na dor pós-operatória, edema e trismo após a remoção cirúrgica do terceiro molar inferior impactado. Material e Métodos: Quarenta e cinco pacientes foram submetidos à remoção cirúrgica de terceiros molares inferiores impactados e distribuídos aleatoriamente no pós-operatório em 3 grupos: 8 mg de dexametasona injetados na submucosa vestíbular próximo ao local da cirurgia (grupo I), 8 mg de dexametasona injetados no espaço pterigomandibular (grupo II) e 10 mg de pó de dexametasona aplicados no local da extração, após o controle do sangramento (grupo III). Edema facial e abertura interincisal máxima foram medidos no pré-operatório. A dor foi medida pela resposta do paciente a uma escala visual analógica. Percepção de dor, edema facial e trismo foram avaliados por uma semana de pós-operatório. Resultados: Não houve diferença significativa entre os três grupos em relação à dor após 1, 2, 5, 7 dias de acompanhamento. No entanto, o grupoII mostrou menos dor em 3 e 4 dias. A diferença entre as medidas de edema não foi significativa nos três grupos em 1, 5, 7 dias, embora nos grupos I e II o edema cedeu a partir do dia 2. Quanto ao trismo, os grupos I e III apresentaram medida de abertura interincisal máxima inferior estatisticamente significativa do que o grupo II depois de dois dias. Conclusão: A administração local de dexametasona por três vias diferentes é benéfica na redução das sequelas pós-operatórias após a cirurgia do terceiro molar. A injeção de dexametasona no espaço pterigomandibular resultou na resolução mais precoce da dor e menos edema facial e trismo no segundo dia de pós-operatório em comparação com a injeção submucosa e a aplicação transalveolar. No entanto, em uma semana, a diferença nas medidas das três variáveis entre os grupos não foi significativa.(AU)


Subject(s)
Humans , Surgery, Oral , Dexamethasone , Molar, Third
2.
Rev. bras. oftalmol ; 81: e0008, 2022. graf
Article in English | LILACS | ID: biblio-1360919

ABSTRACT

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.


RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.


Subject(s)
Humans , Female , Middle Aged , Uveitis/drug therapy , Cataract Extraction/adverse effects , Uveitis, Anterior/etiology , Postoperative Complications , Titanium , Trabecular Meshwork/surgery , Tropicamide/administration & dosage , Dexamethasone/administration & dosage , Stents , Glaucoma, Open-Angle/surgery , Injections, Intraocular , Intraocular Pressure , Acetazolamide/administration & dosage
3.
Rev. cuba. anestesiol. reanim ; 20(3): e717, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1351984

ABSTRACT

Introducción: La administración epidural de esteroides constituye un pilar del tratamiento del dolor radicular cervical y lumbosacro. Objetivo: Describir los mecanismos fisiológicos y características farmacológicas de los corticosteroides utilizados en el tratamiento del dolor, así como las complicaciones derivadas de la administración epidural de esteroides particulados. Métodos: Se realizó una revisión no sistemática de la literatura en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID y el buscador académico Google Scholar, en los meses de julio a septiembre del año 2020. Desarrollo: Los corticoides utilizados en la medicina del dolor son derivados de la prednisolona. Estos se clasifican en particulados (de depósito, de suspensión) o no particulados (de dilución), en función de la presencia o ausencia de un componente molecular sólido (moléculas tipo éster, insolubles en agua). Los fármacos más empleados son la dexametasona, betametasona, triamcinolona y metilprednisolona. Conclusiones: La administración epidural de esteroides particulados está relacionada con la incidencia de complicaciones graves, aunque poco frecuentes, como paraplejía, tetraplejía, infarto de la médula espinal, hemorragia y edema cerebral. La evidencia disponible muestra una efectividad analgésica similar a los compuestos no particulados. Por lo tanto, no se recomienda su utilización rutinaria durante el abordaje del espacio epidural(AU)


Introduction: Epidural administration of steroids is a cornerstone for the treatment of cervical and lumbosacral radicular pain. Objective: To describe the physiological mechanisms and pharmacological characteristics of the corticosteroids used for pain treatment, as well as the complications derived from the epidural administration of particulate steroids. Methods: A nonsystematic review of the literature was carried out, from July to September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID and the academic search engine Google Scholar. Development: The corticoids used in pain medicine are derived from prednisolone. These are classified into particulate (deposit, suspension) or non-particulate (dilution), depending on the presence or absence of a solid molecular component (ester-type molecules, insoluble in water). The most commonly used drugs are dexamethasone, betamethasone, triamcinolone, and methylprednisolone. Conclusions: The epidural administration of particulate steroids is related to the incidence of serious, although infrequent, complications, such as paraplegia, tetraplegia, spinal cord infarction, hemorrhage and cerebral edema. Available evidence shows analgesic effectiveness similar to that of non-particulate compounds. Therefore, its routine usage is not recommended during the managment of the epidural space(AU)


Subject(s)
Humans , Male , Female , Dexamethasone , Prednisolone , Adrenal Cortex Hormones , Analgesics , Quadriplegia
4.
Hematol., Transfus. Cell Ther. (Impr.) ; 43(4): 437-442, Oct.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350817

ABSTRACT

ABSTRACT There have been significant improvements in therapeutic options for relapsed multiple myeloma (MM) over the past two decades, with many novel agents including proteasome inhibitors, immunomodulatory agents, and more recently monoclonal antibodies demonstrating efficacy in this setting. However, there is a paucity of real-world data comparing outcomes seen in patients treated with novel agents as opposed to older agents. We report a historical single center cohort of patients diagnosed with myeloma between the years 1991-2012 in order to explore possible differences in outcomes. A total of 139 patients who underwent stem cell transplantation were included in our study. In our study, 88 patients were treated with cyclophosphamide and steroids alone at relapse whereas 51 patients were treated with Len-Dex. In the multivariate analysis, TTNT was shorter for patients who received Cyclo compared to Len-Dex (HR = 1.74; 95% CI, 1.01-2.99; p = 0.04); however, we could not detect an overall survival benefit (HR = 1.20; 95% CI 0.63-2.29; p = 0.57). Adverse event rates were similar in the two groups. In this retrospective single center analysis, Len-Dex was associated with longer TTNT compared with Cyclo at first relapse following autoSCT in MM; however its effect on overall survival in this setting was less clear.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Multiple Myeloma/drug therapy , Dexamethasone/therapeutic use , Cyclophosphamide/therapeutic use , Lenalidomide/therapeutic use , Glucocorticoids/therapeutic use
5.
Electron. j. biotechnol ; 52: 52-58, July. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1283505

ABSTRACT

BACKGROUND: Osteoporosis attacks approximately 10% of the population worldwide. Sika Deer (Cervus nippon), one of China's precious traditional medicinal animals, has been widely recorded in ancient Chinese medical books and claimed for centuries to have numerous medical benefits including bone strengthening. This study aimed to find the use of Sika Deer bone in treating osteoporosis according to traditional records and to investigate the protective effect of Sika Deer bone polypeptide extract on glucocorticoidinduced osteoporosis (GIOP) in rats. RESULTS: Sika Deer bone polypeptide extract could increase serum Ca2+ and BGP, decrease serum P3+, ALP, PTH, and CT, but had no effect on serum NO in rats with GIOP. The immunohistochemical iNOS results of the rats' distal femur were negative in each group. Besides the model group, the eNOS color reaction in osteoblasts was strongly positive in the other three groups. CONCLUSIONS: Sika Deer bone polypeptide extract can improve pathological changes in the microstructure and stimulate the expression of eNOS in osteoblasts. The protective effect on bone might be mediated by eNOS-dependent NO generation.


Subject(s)
Animals , Male , Rats , Osteoporosis/prevention & control , Peptides/pharmacology , Bone and Bones/metabolism , Deer , Osteoblasts , Dexamethasone , Rats, Wistar , Nitric Oxide Synthase Type III/drug effects
6.
Rev. méd. Urug ; 37(supl.1): s48-s48, jun. 2021.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1361716
7.
Bol. latinoam. Caribe plantas med. aromát ; 20(3): 315-323, may. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1343489

ABSTRACT

To investigate effectsof Yangyinyiqi Mixture on pulmonary fibrosis caused by bleomycin. SD ratswere divided randomly into: model group(distilled water,1 mL·0.1 kg-1), dexamethasone acetate group (dexamethasone acetate, the dosage was reduced gradually), low-dose group (Yangyinyiqi Mixture, 11 g·kg-1), moderate-dose group (Yangyinyiqi Mixture, 22 g·kg-1), high-dose group (Yangyinyiqi Mixture, 44 g·kg-1) and control group (distilled water, 1 mL·0.1 kg-1). Yangyinyiqi Mixture and dexamethasone acetate were intragastrically administrated. Lung tissue was collected for histopathological examination. Compared with control group, collagen markedly increased and HYP content significantly increased on 7th day in model group (p<0.01). On 28th day, collagen was diffusely deposited, alveolar was destroyed, and HYP content significantly increased (p<0.01). Compared with model group, bleomycin-induced suffering injury caused MMP-9 expression levels to rapidly increase (7and 14 days, p<0.01). TIMP-1 markedly increased (7and 14 days, p<0.01) and stayed at a high level to28th day. Yangyinyiqi Mixture exerted an effect against pulmonary fibrosis, which could involved prevention of collagen deposition through inhibitingMMP-9 and TIMP-1 expression.


El trabajo investiga los efectos de la mezcla Yangyinyiqi sobre la fibrosis pulmonary causada por bleomicina. Ratas SD se dividieron aleatoriamente en: grupo modelo (agua destilada, 1 mL·0.1 kg-1), grupo acetate de dexametasona (acetate de dexametasona, la dosis se redujo gradualmente), grupo de dosis baja (mezcla Yangyinyiqi, 11 g·kg-1), grupo de dosis moderada (mezcla Yangyinyiqi, 22 g·kg-1), grupo de dosis alta (mezcla Yangyinyiqi, 44 g·kg-1) y grupo control (agua destilada, 1 Ml·0.1 kg-1). La mezcla de Yangyinyiqi y el acetate de dexametasona se administraron por vía intragástrica. Se recolectó tejido pulmonary para examen histopatológico. En comparación con el grupo control, el colágeno aumentó notablemente y el contenido de HYP aumentó significativamente el séptimo día en el grupo modelo (p<0.01). El día 28, el colágeno se depositó difusamente, se produjo destrucción alveolar y el contenido de HYP aumento significativamente (p<0.01). En comparación con el grupo modelo, la lesión inducida por bleomicina causó que los niveles de expression de MMP-9 aumentaron rápidamente (7 y 14 días, p<0.01). TIMP-1 aumentó notablemente (7 y 14 días, p<0.01) y se mantuvo en un nivel alto hasta el día 28. La mezcla Yangyinyiqi ejerció un efecto contra la fibrosis pulmonary, lo que podría implicar la prevención del deposito de colágenio mediante la inhibición de la expression de MMP-9 y TIMP-1.


Subject(s)
Animals , Male , Rats , Pulmonary Fibrosis/drug therapy , Drugs, Chinese Herbal/administration & dosage , Tissue Inhibitor of Metalloproteinases/metabolism , Matrix Metalloproteinase 9/metabolism , Bleomycin , Dexamethasone/administration & dosage , Blotting, Western , Rats, Sprague-Dawley , Matrix Metalloproteinase 1 , Disease Models, Animal , Hydroxyproline/analysis
8.
Rev. bras. oftalmol ; 80(2): 140-142, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1280115

ABSTRACT

ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).


RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).


Subject(s)
Humans , Female , Middle Aged , Dexamethasone/administration & dosage , Uveitis, Intermediate/complications , Macular Edema/etiology , Macular Edema/drug therapy , Visual Acuity , Uveitis, Intermediate/diagnosis , Macular Edema/diagnosis , Tomography, Optical Coherence , Drug Implants/administration & dosage , Intravitreal Injections
9.
Rev. argent. salud publica ; 13(Suplemento COVID-19): 1-2, 2021.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1177597

ABSTRACT

La dexametasona es, en la actualidad, uno de los pocos tratamientos que ha demostrado ser efectivo en los pacientes con neumonía moderada o grave por el nuevo coronavirus 2019. Una dosis de 6 mg/día de dexametasona base durante 10 días ha demostrado disminuir de manera significativa la mortalidad en estos pacientes. En Argentina, existen diferentes presentaciones comerciales de dexametasona para la administración por vía intravenosa, que contienen distintas sales (dexametasona fosfato sódico y dexametasona fostato ácido). Por este motivo, es importante conocer cuál es la equivalencia de estas presentaciones en relación con la dexametasona base, con el objetivo de asegurar la administración de la dosis de 6 mg/día que demostró disminuir la mortalidad


Subject(s)
Argentina , Dexamethasone , Mortality , Coronavirus Infections
10.
Autops. Case Rep ; 11: e2021285, 2021. graf
Article in English | LILACS | ID: biblio-1249016

ABSTRACT

Acquired Hemophagocytic Lymphohistiocytosis is a rare and deadly syndrome resulting from an overactive immune system, with uncontrolled activation of macrophages and lymphocytes, hypercytokinemia, and systemic inflammatory response. A 75-year-old male presented with typical anginal pain and was diagnosed with the acute coronary syndrome, which required a percutaneous transluminal coronary angioplasty. Instead of resolving the symptoms, the patient began to exhibit pyrexia and worsening altered sensorium with progressing renal failure, anemia, thrombocytopenia and respiratory failure. This constellation of symptoms caused the patient to require mechanical ventilation and hemodialysis. Upon laboratory analysis, hyperferritinemia provided an indication to the diagnosis of acquired hemophagocytic lymphohistiocytosis. After the initiation of dexamethasone, the patient made a significant recovery and was discharged from the hospital.


Subject(s)
Humans , Male , Aged , Lymphohistiocytosis, Hemophagocytic/complications , Hyperferritinemia/diagnosis , Dexamethasone/therapeutic use , Acute Coronary Syndrome/complications , Glucosephosphate Dehydrogenase Deficiency
11.
Article in Chinese | WPRIM | ID: wpr-880044

ABSTRACT

OBJECTIVE@#To investigate the short-term efficacy and safety of generic bortezomib in the treatment of Chinese patients with multiple myeloma (MM).@*METHODS@#Clinical data of 62 MM patients (median age of 62 years) who had accepted at least 2 cycles of chemotherapy based on generic bortezomib in our center from December 2017 to July 2019 were retrospectively analyzed, including 47 newly diagnosed patients and 15 with disease recurrence or progression.@*RESULTS@#Anemia, renal dysfunction, hypoproteinemia and high level of β @*CONCLUSION@#The disease severity can be rapidly alleviated after generic bortezomib-based chemotherapy, and a favorable short-term efficacy and survival have been observed with a generally acceptable toxicity profile. However, the long-term outcomes will be examined through further follow-up.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bortezomib/therapeutic use , Dexamethasone/therapeutic use , Disease-Free Survival , Humans , Middle Aged , Multiple Myeloma/drug therapy , Neoplasm Recurrence, Local , Retrospective Studies , Transplantation, Autologous , Treatment Outcome
12.
Article in Chinese | WPRIM | ID: wpr-880043

ABSTRACT

OBJECTIVE@#To investigate the efficacy, survival and adverse effects of non-transplanted multiple myeloma (MM) patients treated with bortezomib maintenance.@*METHODS@#A total of 25 newly diagnosed/relapsed non-transplanted MM patients treated in West District of Beijing Chaoyang Hospital from June 2004 to November 2015 were analyzed retrospectively. All patients received PD regimen (bortezomib and dexamethasone), including bortezomib at a dose of 1.3 mg/m@*RESULTS@#Till November 1, 2017, 5 patients achieved stringent complete response (sCR), 8 patients achieved complete response (CR), 7 patients achieved very good partial response (VGPR), 4 patients achieved partial reponse (PR), while 1 patient achieved stable disease (SD). After maintenance therapy, 21 patients maintained the efficacy above PR, of which 1 patient was improved from CR to sCR; 4 patients adjusted chemotherapy after disease progressed. Median maintenance therapy was 9 cycles (range from 6 to 31), and the median maintenance time was 27 months (range from 18 to 97). Median follow-up time was 73 months (range from 25 to 171). Median progress-free survival (PFS) time was 30 months (range from 9 to 105) and overall survival (OS) time was 57 months (range from 27 to 160). Till November 1, 2019, 3-year survival rate was 84% (21/25), and 5-year survival rate was 72% (13/18). The most common adverse events were transient leukopenia, thrombocytopenia and peripheral neuropathy, which the patients could tolerate after the prevention and treatment.@*CONCLUSION@#Bortezomib-based maintenance therapy for non-transplanted MM patients can be an option in consideration of its safety and efficacy.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Bortezomib/therapeutic use , Dexamethasone/therapeutic use , Disease-Free Survival , Humans , Multiple Myeloma/drug therapy , Retrospective Studies , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-879906

ABSTRACT

OBJECTIVE@#To study the effect of dexamethasone (DEX) on the expression of Dynein heavy chain (DHC) and Dynactin in the cytoplasm of fetal rat cerebral cortical neurons cultured @*METHODS@#Primary cerebral cortical neurons of fetal rats were cultured @*RESULTS@#There was no significant difference in the mRNA expression levels of DHC and Dynactin among the three groups at all time points (@*CONCLUSIONS@#DEX affects the protein expression of DHC and Dynactin in the fetal rat cerebral cortical neurons cultured


Subject(s)
Animals , Cytoplasm , Dexamethasone/pharmacology , Dynactin Complex/genetics , Dyneins , Neurons , Rats
14.
J. bras. econ. saúde (Impr.) ; 12(3): 189-194, Dezembro/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1141296

ABSTRACT

Objetivo: Estimar o custo de tratamento das novas terapias de combinação tripla com lenalidomida no manejo dos pacientes com mieloma múltiplo recidivado/refratário (MMRR) sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Os custos associados da combinação de lenalidomida + dexametasona com carfilzomibe (KRd), daratumumabe (DRd), elotuzumabe (ERd) e ixazomibe (IRd) foram comparados. Para cada terapia, a duração de tratamento foi estimada pela média do tempo de sobrevida livre de progressão (SLP) restrita a três anos a partir de dados de SLP dos estudos pivotais das respectivas terapias. Os custos de tratamento foram estimados para a duração de tratamento, considerando a posologia específica dos regimes terapêuticos. Os preços dos medicamentos foram baseados no preço fábrica de abril de 2020. Não foi considerado o compartilhamento de doses. O custo total do tratamento, o custo médio por ciclo e o custo por taxa de resposta objetiva (TRO) em três anos foram comparados. Resultados: A duração de tratamento no período de três anos foi de 23,3, 27,6, 20,3 e 20,9 meses para KRd, DRd, ERd e IRd, respectivamente. O custo médio total de tratamento foi estimado em 975.557 reais (BRL) para KRd, 1.507.544 BRL para DRd (+55% versus KRd), 1.207.899 BRL para ERd (+24% versus KRd) e 983.917 para IRd (+1% versus KRd). KRd teve o menor custo médio por mês de SLP (horizonte de três anos) entre as terapias, 41.957 BRL versus 54.709 BRL para DRd (+30% versus KRd), 59.635 BRL para ERd (+42% versus KRd) e 47.147 para IRd (+12% versus KRd). Similarmente, o custo por TRO foi 31% menor para KRd (1.119.770 BRL), comparado ao DRd (1.621.015 BRL), 27% menor, comparado ao ERd (1.528.986 BRL), e 11% menor, comparado ao IRd (1.256.064). Conclusões: Resultados da presente análise indicam que KRd está associado a um menor custo médio de tratamento, acompanhado de maior previsibilidade, menor custo por TRO e por mês de SLP, comparado ao DRd, ERd e IRd no horizonte de três anos sob a perspectiva do sistema de saúde privado brasileiro. Os resultados estão associados com alguma incerteza em razão das diferenças nas populações dos estudos, desenho dos estudos (duração fixa de carfilzomibe vs. tratamento até a progressão para daratumumabe, elotuzumabe e ixazomibe) e porque a duração de tratamento é tipicamente menor do que a SLP.


Objective: To estimate treatment costs for novel triple-combination therapies with lenalidomide in the management of relapsed/refractory multiple myeloma (RRMM) patients from the Brazilian private healthcare perspective. Methods: Treatment costs associated with lenalidomide + dexamethasone combinations with carfilzomib (KRd), daratumumab (DRd), elotuzumab (ERd) and ixazomib (IRd) were compared. For each therapy, treatment duration was estimated as the mean progression-free survival (PFS) time restricted to three years using published PFS data from pivotal trials available for these treatments. Treatment costs were estimated for the modeled treatment duration considering therapy-specific dosing schedules. Drug prices were based on April 2020 Brazilian list prices. No vial sharing was assumed. Total treatment costs, average cost per cycle, and cost per overall response rate (ORR) over the three-year period were compared. Results: Modeled treatment duration over the three-year period was 23.3, 27.6, 20.3 and 20.9 months for KRd, DRd, ERd and IRd respectively. Corresponding average total treatment costs were estimated to be 975,557 Brazilian Real (BRL) for KRd; 1,507,544 BRL for DRd (+55% versus KRd); 1,207,899 BRL for ERd (+24% versus KRd) and 983,917 for IRd (+1% versus KRd). KRd had the lowest average cost per month of restricted PFS (3-year time frame) among the therapies, 41,957 BRL versus 54,709 BRL for DRd (+30% versus KRd); 59,635 BRL for ERd (+42% versus KRd); and 47,147 for IRd (+12% versus KRd). Similarly, the cost per achieved ORR was lower for KRd (1,119,770 BRL) than that for DRd (1,621,015 BRL); ERd (1,528,986 BRL); and IRd (1,256,064) by 31%, 27% and 11%, respectively. Conclusions: Results of the present analysis indicate that KRd is associated with lower mean treatment costs and more predictable costs, lower cost per ORR and per month in PFS than DRd, ERd and IRd over a relevant three-year time horizon from the Brazilian private healthcare perspective. The results are associated with some uncertainty due to differences in trial populations, trial design (fixed duration for carfilzomib vs treatment till progression for daratumumab, elotuzumab and ixazomib) and because treatment duration is typically shorter than PFS.


Subject(s)
Dexamethasone , Costs and Cost Analysis , Supplemental Health , Lenalidomide , Multiple Myeloma
15.
Rev. bras. anestesiol ; 70(6): 588-594, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155777

ABSTRACT

Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.


Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.


Subject(s)
Humans , Male , Female , Arthroscopy/methods , Shoulder Joint/surgery , Dexamethasone/administration & dosage , Ultrasonography, Interventional/methods , Brachial Plexus Block/methods , Anti-Inflammatory Agents/administration & dosage , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Arthroscopy/adverse effects , Time Factors , Vasoconstrictor Agents/administration & dosage , Pain Measurement , Double-Blind Method , Prospective Studies , Analysis of Variance , Postoperative Nausea and Vomiting/epidemiology , Saline Solution/administration & dosage , Levobupivacaine , Analgesia , Anesthetics, Local , Middle Aged
16.
Rev. cuba. anestesiol. reanim ; 19(3): e629, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1138880

ABSTRACT

Introducción: Las náuseas y vómitos posoperatorios son una secuela no deseada durante la etapa de recuperación anestésica. Objetivo: Evaluar la utilidad de la dexametasona en comparación con el ondansetrón para la prevención de las náuseas y vómitos posoperatorios después de procedimientos quirúrgicos ginecológicos mayores, bajo anestesia general orotraqueal. Método: Se realizó un estudio observacional analítico, prospectivo, en 84 pacientes mayores de 19 años, en el Hospital Clínico Quirúrgico Miguel Enríquez desde octubre de 2018 hasta septiembre de 2019, divididas de forma secuencial, en orden de llegada a la unidad quirúrgica, en dos grupos. Al grupo 1 se le administró dexametasona (4 mg endovenosa); al grupo 2 (4 mg de ondansetrón), 30 min antes de finalizar la cirugía. Resultados: Predominó de forma significativa el riesgo medio de náuseas y vómitos posoperatorios en los pacientes con edades comprendidas entre 41 y 50 años. Predominó la condición de excelente y buena (pgt;0,05) en cuanto a la efectividad del tratamiento profiláctico. La cefalea prevaleció de forma significativa en el grupo 2. La mayor parte de las pacientes no presentó eventos adversos. Conclusiones: El ondansetrón y la dexametasona son útiles para la profilaxis de las náuseas y vómitos posoperatorios en pacientes intervenidas de cirugía mayor ginecológica, bajo anestesia general orotraqueal por lo que se considera un tratamiento seguro, con eventos adversos leves y de fácil control(AU)


Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (pgt;0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control(AU)


Subject(s)
Humans , Female , Ondansetron/therapeutic use , Postoperative Nausea and Vomiting/drug therapy , Anesthesia, General , Gynecologic Surgical Procedures , Dexamethasone/therapeutic use , Prospective Studies , Postoperative Nausea and Vomiting/prevention & control
18.
Rev. bras. anestesiol ; 70(5): 477-483, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143958

ABSTRACT

Abstract Background: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery. Methods: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded. Results: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026). Conclusion: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.


Resumo Justificativa: Náusea e vômito no pós-operatório é a segunda queixa pós-operatória mais frequente após a dor. Sem profilaxia antiemética, a incidência de náusea e vômito no pós-operatório foi de 60−80% após cirurgia do ouvido médio. Dada a alta incidência relatada de náusea e vômito no pós-operatório, nosso objetivo foi avaliar o efeito da combinação de palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náusea e vômito no pós-operatório em pacientes submetidos a cirurgia do ouvido médio. Método: Sessenta e quatro pacientes programados para cirurgia de ouvido médio foram aleatoriamente divididos em dois grupos. Um recebeu a combinação de palonosetrona-dexametasona (grupo P) e o outro ondansetrona-dexametasona (grupo O) por via intravenosa antes da indução anestésica. A técnica anestésica foi padronizada em todos os pacientes. No pós-operatório, foram registradas incidência e gravidade das náuseas e vômitos, necessidade de antiemético de resgate, efeitos colaterais e índice de satisfação dos pacientes. Resultados: As características demográficas foram semelhantes nos grupos estudados. A diferença na incidência de náusea foi estatisticamente significante entre os grupos O e P apenas no intervalo de tempo entre 2 e 6 horas (p = 0,026). A incidência e gravidade de vômito não foram estatisticamente significantes entre os grupos O e P durante todo o período do estudo. A incidência geral de náusea e vômito no pós-operatório (0−24 horas de pós-operatório) foi de 37,5% no grupo O e de 9,4% no grupo P (p = 0,016). A combinação palonosetrona-dexametasona associou-se com redução do risco absoluto de 28%, redução do risco relativo de 75%, e o número necessário para tratar foi 4. O escore de satisfação do paciente foi maior no grupo P (p = 0,016). A frequência da medicação de resgate foi mais comum no grupo O (p = 0,026). Conclusão: A combinação de palonosetrona-dexametasona é superior à ondansetrona-dexametasona na prevenção da náusea e vômito no pós-operatório após cirurgia de ouvido médio.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Dexamethasone/administration & dosage , Ondansetron/administration & dosage , Postoperative Nausea and Vomiting/prevention & control , Palonosetron/administration & dosage , Double-Blind Method , Incidence , Prospective Studies , Patient Satisfaction , Postoperative Nausea and Vomiting/epidemiology , Drug Therapy, Combination , Ear, Middle/surgery , Middle Aged , Antiemetics/administration & dosage
19.
Rev. bras. anestesiol ; 70(5): 464-470, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143954

ABSTRACT

Abstract Introduction and objectives: The incidence of Postoperative Nausea and Vomiting (PONV) after video cholecystectomy is high. Progress in pharmacological PONV prophylaxis includes a new generation of 5-HT3 antagonists. This study aims to assess the effect of the 5-HT3 antagonist in postanesthetic antiemetic management of patients submitted to laparoscopic cholecystectomy with total intravenous anesthesia. Methods: Sixty individuals who underwent video cholecystectomy were randomized into three groups of 20 individuals according to the treatment administered: 0.125 mg of palonosetron (Group 1); 4 mg of ondansetron associated with 4 mg of dexamethasone (Group 2); 4 mg of dexamethasone (Group 3). General intravenous anesthesia was performed with propofol, remifentanil and rocuronium. The group to which the participant belonged was concealed from the investigator who assessed drug effect. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. Rescue medication was 0.655 to 1.5 mg of droperidol. Results: Group 1 presented a lower incidence of PONV and required less rescue medication in the first postoperative hour. There was no significant difference among the three groups regarding PONV incidence in the first 12 postoperative hours. Groups 1 and 2 were superior to Group 3 regarding the control of PONV from 12 to 24 hours, and after rescue medication from 12 to 24 hours. Group 1 showed significantly superior nausea control in the first 12 postoperative hours. Conclusions: The present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea.


Resumo Justificativa e objetivo: Náuseas e Vômitos no Pós-Operatório (NVPO) têm alta incidência após videocolecistectomia. Avanços na profilaxia farmacológica de NVPO incluem a nova geração de antagonista 5-HT3. O objetivo deste estudo foi avaliar o efeito do antagonista 5-HT3 no controle antiemético pós-anestésico em videocolecistectomia com anestesia venosa total. Método: Estudo realizado no HC-UFU (Hospital Terciário). Sessenta indivíduos submetidos a videocolecistectomia foram randomizados em três grupos de igual número, sendo administrados 0,125 mg de palonosetrona (Grupo 1); 4 mg de ondasetrona e 4 mg de dexametasona (Grupo 2); ou 4 mg de dexametasona (Grupo 3). A anestesia geral venosa foi realizada com propofol, remifentanil e rocurônio. O avaliador do efeito da droga desconhecia o grupo ao qual o indivíduo pertencia. NVPO foi avaliada aplicando a Escala de Rhodes após 12 e 24 horas do término da cirurgia. Para resgate terapêutico, foi estabelecido 0,655−1,5 mg de droperidol. Resultado: Observou-se no Grupo 1 menor incidência de NVPO e de resgate terapêutico na primeira hora de PO. Não foi observada diferença significativa entre os três grupos com relação a ocorrência de NVPO nas primeiras 12 horas de pós-operatório. Os grupos 1 e 2 foram superiores ao Grupo 3 no que se refere ao controle de NVPO de 12 a 24 horas e após o resgate de 12−24 horas. Observou-se que o controle de náuseas nas primeiras 12 horas de pós-operatório do Grupo 1 foi significantemente superior. Conclusão: O presente estudo mostrou evidências da superioridade da palonosetrona às demais drogas empregadas no que se refere ao efeito antiemético prolongado e menor necessidade de resgate, principalmente na capacidade de inibir completamente o desconfortável sintoma de náusea.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Cholecystectomy, Laparoscopic/methods , Anesthetics, Intravenous/administration & dosage , Postoperative Nausea and Vomiting/prevention & control , Antiemetics/administration & dosage , Dexamethasone/administration & dosage , Propofol/administration & dosage , Double-Blind Method , Ondansetron/administration & dosage , Rocuronium/administration & dosage , Remifentanil/administration & dosage , Palonosetron/administration & dosage , Middle Aged
20.
Int. j. morphol ; 38(5): 1398-1404, oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134455

ABSTRACT

SUMMARY: The objective of this study were bone defect complications that occur due to traumas or infections. Bone grafts are required to provide support, fill gaps and improve biological repair in skeletal damage. Dexamethasone plays role in calcium signaling modulation and used in diseases. Aim of this study was to evaluate osteonectin and osteopontin expressions in new bone development after dexamethasone application on tibial bone defects. Rats were divided into defect, defect+graft and defect+graft+dexamethasone treated groups. Tibial bone defect created, and rats were kept immobile for 28 days. Alloplastic material was placed in defect area in second and group third groups. 2.5 mg/kg Dex and normal saline were injected to dexamethasone and defect groups twice a week for 56 days. Inflammation and congestion were increased in defect and defect+graft groups. Defect+graft+dexamethasone group; increased number of osteoblast and osteocyte cells, dense bone matrix, formation of new bone trabeculae was observed. Defect+graft group; osteonectin expression in graft regions, osteoblast cells, some connective tissue cells and fibers were seen whereas in defect+graft+dexamethasone group; osteopontin expression in osteoblast and osteocyte cells of new bone trabeculae were observed. Dexamethasone may lead to formation of new bone trabeculae into the graft material resulting in increased osteoconduction and osteoinductive effect for differentiation of osteon.


RESUMEN: Los defectos óseos son complicaciones que ocurren debido a traumas o infecciones. Se requieren injertos óseos para proporcionar apoyo, llenar los espacios y mejorar la reparación biológica en el hueso dañado. La dexametasona desempeña un papel importante en la modulación de la señalización del calcio y se usa en enfermedades. El objetivo de este estudio fue evaluar las expresiones de osteonectina y osteopontina en el desarrollo óseo después de la aplicación de dexametasona en defectos óseos tibiales. Las ratas se dividieron en grupos: defecto, defecto + injerto y defecto + injerto + grupos tratados con dexametasona. Se creó un defecto óseo tibial, y las ratas se mantuvieron inmóviles durante 28 días. El material aloplástico se colocó en el área del defecto en el segundo y tercer grupo. Se inyectaron 2,5 mg / kg de dexametasona y solución salina normal a grupos de defectos dos veces por semana durante 56 días. La inflamación y la congestión aumentaron en los grupos de defectos y defectos + injerto; En el grupo defecto + injerto + grupo tratado con dexametasona se observó un aumento en el número de osteoblastos y osteocitos, de matriz ósea densa y en la formación de nuevas trabéculas óseas. En el grupo defecto + grupo de injerto se observó la expresión de osteonectina en las áreas de injerto, osteoblastos, algunas células y fibras de tejido conectivo, mientras que en el grupo defecto + injerto + dexametasona se observó la expresión de osteopontina en osteoblastos y osteocitos y formación de nuevas trabéculas óseas . En conclusión la dexametasona puede conducir a la formación de nuevas trabéculas óseas en el material de injerto, lo que resulta en un aumento de la osteoconducción y un efecto osteoinductivo para la diferenciación del osteón.


Subject(s)
Animals , Male , Rats , Tibia/surgery , Tibia/drug effects , Dexamethasone/administration & dosage , Bone Transplantation , Tibia/pathology , Bone Regeneration , Immunohistochemistry , Osteonectin/physiology , Bone Remodeling , Rats, Wistar , Disease Models, Animal , Osteopontin/physiology
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