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Braz. J. Pharm. Sci. (Online) ; 59: e22690, 2023. tab, graf
Article in English | LILACS | ID: biblio-1505850


Abstract Improving vaccine immunity and reducing antigen usage are major challenges in the clinical application of vaccines. Microneedles have been proven to be painless, minimally invasive, highly efficient, and have good patient compliance. Compared with traditional transdermal drug delivery, it can effectively deliver a large-molecular-weight drug into the skin, resulting in a corresponding immune response. However, few studies have examined the relationship between microneedle loading dose and immune effects. In this study, the hyaluronic acid (HA) conical and pyramidal dissolving microneedles were prepared by the two-step vacuum drying method, respectively. The model drug ovalbumin (OVA) was added to HA to prepare dissolving microneedles with different loading amounts. The mass ratios of HA to OVA were 5:1, 5:3, and 5:5. The mechanical properties of the dissolving microneedles were characterized using nanoindentation and in vitro puncture studies. The immune effects of the matrix and drug content were studied in Sprague-Dawley (SD) rats. Finally, the diffusion behavior of OVA and the binding mode of HA and OVA in the microneedles were simulated using Materials Studio and Autodocking software. The experimental results showed that the conical microneedles exhibited better mechanical properties. When the mass ratio of HA to OVA was 5:3, the immune effect can be improved by 37.01% compared to subcutaneous injection, and achieved a better immune effect with relatively fewer drugs. This conclusion is consistent with molecular simulations. This study provides theoretical and experimental support for the drug loading and efficacy of microneedles with different drug loadings

Injections, Subcutaneous/adverse effects , Pharmaceutical Preparations/analysis , Vaccines/analysis , Immunization/classification , Mechanical Tests/instrumentation , Hyaluronic Acid/agonists , Antigens/adverse effects
Med. infant ; 29(2): 119-122, Junio 2022. Tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1381840


Las inmunodeficiencias primarias constituyen enfermedades determinadas genéticamente, caracterizadas por la alteración cuantitativa y/o funcional de distintos mecanismos implicados en la respuesta inmunitaria. Algunas de ellas se caracterizan por una alteración en la producción de anticuerpos, por lo que algunos pacientes se benefician con la administración supletoria de gammaglobulina, la cual se administra mayormente por vía endovenosa, siendo la vía subcutánea una alternativa terapéutica. La siguiente revisión sistemática tiene por objetivo determinar si la gammaglobulina subcutánea tiene alguna ventaja frente al clásico uso de gammaglobulina endovenosa, en pacientes pediátricos con inmunodeficiencias primarias, revisando la bibliografía disponible hasta la actualidad (AU)

Primary immunodeficiencies are genetically determined diseases characterized by the quantitative and/or functional alteration of different mechanisms involved in the immune response. Some of these diseases are characterized by an alteration in the antibody production and therefore some patients benefit from the supplementary administration of gamma globulin, which is mostly administered intravenously, with the subcutaneous route being a therapeutic alternative. The following systematic literature review aims to determine whether subcutaneous gamma globulin has any advantage over the classic use of intravenous gamma globulin in pediatric patients with primary immunodeficiencies (AU)

Humans , Child, Preschool , Child , Adolescent , Immunoglobulins/therapeutic use , gamma-Globins/therapeutic use , Primary Immunodeficiency Diseases/drug therapy , Injections, Subcutaneous , Patient Safety
Chinese Journal of Pediatrics ; (12): 291-296, 2022.
Article in Chinese | WPRIM | ID: wpr-935689


Objective: To analyze the factors affecting the efficacy of mite subcutaneous immunotherapy (SCIT) in allergic asthma patients aged 5-18 years, and to find the best predictive model for the curative effect. Methods: The data of 688 patients aged 5-18 years with allergic asthma who completed more than 3 years of mite SCIT from December 2006 to November 2021 in the Department of Respiratory Medicine, Children's Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Male, results of skin prick test (SPT), age, daily medication score (DMS), visual analogue scale (VAS) score, and enrollment season were defined as independent variables. R language models, including Logistic regression model, random forest model and extreme gradient boosting (XGboost) model, were used to analyze the impact of these independent variables on the outcomes. The receiver operating characteristic curve was applied to compare the predictive ability of the models. Hypothesis testing of the area under curve (AUC) of the 3 models was performed using DeLong test. Results: There were 435 males and 253 females in the 688 patients. There were 349 patients aged 5-<8 years, 240 patients aged 8-<11 years, and 99 patients aged 11-18 years. SPT showed that 429 cases (62.4%) were only allergic to mite, and 259 cases (37.7%) were also allergic to other allergens. According to the efficacy after 3 years of SCIT, 351 cases (51.0%) discontinued the treatment and 337 cases (49.0%) required continued treatment. The DMS was 4 (3, 6) at initiation, 3 (2, 5) at 3 months, 3 (2, 5) at 4 months, 2 (1, 3) at 12 months, and 0 (0, 1) at 3 years of SCIT treatment. The VAS was 3.5 (2.5, 5.2) at initiation, 3.2 (2.2, 4.8) at 3 months, 2.6 (1.4, 4.1) at 4 months, 1.0 (0.6, 1.8) at 12 months, and 0.5 (0, 1.2) at 3 years of treatment. At 3, 4, and 12 months, the rate of decline in DMS was 0 (0, 20%), 16.7% (0, 33.3%), and 50.0% (31.0%, 75.0%), respectively; and the VAS decreased by 7.1% (3.2%,13.8%), 27.6% (16.7%,44.4%), and 70.2% (56.1%, 82.3%), respectively. Regarding the enrollment season, 99 cases were in spring, 230 cases in summer, 171 cases in autumn, and 188 cases in winter. The R language Logistic regression model found that DMS>3 points at 3 months (OR=-3.5, 95%CI:-4.3--2.7, P<0.01), male (OR=-1.7, 95%CI:-2.3--1.0), P<0.01), DMS decline rate>16.7% at 4 months (OR=-1.6, 95%CI:-2.3--0.8, P<0.01) and DMS decline rate>0 at 3 months (OR=-0.7, 95%CI:-1.3--0.2, P<0.05) had higher possibility of drug discontinuation; whereas, the decline rate of DMS at 12 months>50.0% (OR=0.7, 95%CI: 0.1-1.3, P<0.05), VAS at 12 months>1.0 points (OR=0.9, 95%CI: 0.3-1.6, P<0.05), and initial VAS<4.0 points (OR=1.0, 95%CI: 0.4-1.6, P<0.01) had lower possibility of drug discontinuation. Both the random forest model and the XGboost model showed that DMS>3 points at 3 months (mean decrease accuracy=30.9, importance=0.45) had the greatest impact on drug discontinuation. The AUC of the random forest model was the largest at 0.900, with an accuracy of 78.2% and a sensitivity of 84.5%. Logistic regression model had AUC of 0.891, accuracy of 80.0%, and sensitivity of 80.0%; XGboost model had AUC of 0.886, accuracy of 76.9%, and sensitivity of 84.5%. The AUC of the pairwise comparison model by DeLong test found that all three models could be used for the prediction of this data set (all P>0.05). Conclusions: The more drugs used to control the primary disease, and the more careful reduction of the control medicine after starting SCIT treatment, the more favorable it is to stop all drugs after 3 years. The random forest model is the best predictive model for the efficacy of mite SCIT in asthmatic children.

Adolescent , Animals , Child , Child, Preschool , Female , Humans , Male , Allergens , Asthma/therapy , Desensitization, Immunologic/methods , Immunotherapy/methods , Injections, Subcutaneous , Mites , Retrospective Studies
Rev. Soc. Bras. Clín. Méd ; 19(3): 199-204, set 2021.
Article in Portuguese | LILACS | ID: biblio-1391967


O objetivo deste artigo foi comparar o uso da ivermectina e do albendazol em pacientes transplantados e relatar os respectivos sucessos terapêuticos nessa população. Foram analisados artigos que abordassem relatos de casos publicados nos últimos 4 anos no PubMed® relacionando os descritores "transplante de órgãos", "estrongiloidíase" e "tratamento". Foram encontrados e analisados dez relatos de caso que abordaram a estrongiloidíase em situa- ção pós-transplante contemplando 13 indivíduos. Desses, cinco (38,5%) utilizaram ambos os medicamentos, dos quais quatro (80%) se curaram, tendo recebido albendazol e ivermectina por via subcutânea (50%) ou albendazol e ivermectina por vias oral/ subcutânea (50%). O paciente que morreu recebeu albendazol e ivermectina por via subcutânea. Sete (53,8%) indivíduos utiliza- ram apenas ivermectina, dos quais três (42,8%) se curaram tendo recebido o medicamento oral (dois pacientes) ou subcutâneo (um paciente); dois (28,6%) morreram recebendo o medicamento via oral, dois (28,6%) usaram profilaticamente via oral e apenas um não manifestou sintomas. Apenas um (7,7%) indivíduo utilizou somente albendazol via oral tendo sobrevivido à infecção. A uti- lização combinada dos medicamentos ivermectina e albendazol parece ter efeito positivo no tratamento da estrongiloidíase. A administração da ivermectina por via subcutânea apresentou resultados promissores, contudo estudos controlados de siner- gia medicamentosa e vias de administração devem ser realizados para efetiva avaliação.

The objective of this article was to compare the use of ivermec- tin and albendazole in transplanted patients and to report the respective therapeutic successes in this population.Articles ad- dressing case reports published in the last 4 years in the PubMed relating the descriptors "organ transplantation", "strongyloidia- sis", and "treatment" were analyzed. Ten case reports addres- sing strongyloidiasis in a post-transplant situation, covering 13 individuals, were found and analyzed. Of these, five (38.5%) used both drugs of which 4 (80%) were cured having received subcu- taneous albendazole and ivermectin (50%) or oral/subcutaneous albendazole and ivermectin (50%). The patient who died received subcutaneous albenzadole and ivermectin. Seven (53.8%) indi- viduals used only ivermectin, of which three (42.8%) were cured having received the oral (2/3) or subcutaneous (1/3) medication, two (28.6%) died receiving the oral medication, and two (28.6%) used oral medication prophylactically, and only one did not show symptoms. Only one (7.7%) individual used only oral albenzadole and survived the infection. The combined use of the drugs iver- mectin and albendazole seems to have a positive effect on the treatment of strongyloidiasis. The administration of subcuta- neous Ivermectin has shown promising results; however, con- trolled studies of drug synergy and administration routes shall be performed for effective evaluation.

Humans , Strongyloidiasis/drug therapy , Ivermectin/therapeutic use , Albendazole/therapeutic use , Transplant Recipients , Anthelmintics/therapeutic use , Strongyloidiasis/prevention & control , Administration, Oral , Bone Marrow Transplantation , Heart Transplantation , Kidney Transplantation , Pancreas Transplantation , Fatal Outcome , Drug Therapy, Combination , Injections, Subcutaneous
Einstein (Säo Paulo) ; 19: eRC6064, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249742


ABSTRACT We report the cases of two adolescent siblings with severe atopic dermatitis, who, despite weighing approximately 40kg, presented a good response to dupilumab with the off-label dose for individuals aged 12 years and weighing 60kg. Both had already used cyclosporine, azathioprine, methotrexate and oral corticosteroids for long periods, plus topical treatments with no adequate disease control. Skin lesions were constant and widespread, with frequent skin infections and very poor quality of life, with numerous physical and psychosocial consequences, such as dropping out of school activities due to severe itching, appearance and bullying. They also showed delayed growth and development. In 2018, dupilumab, an immunobiological agent, was approved for treatment of moderate to severe atopic dermatitis in adults and, in 2019, extended to the 12-17-year age group. Although it had already been approved by the Brazilian Health Surveillance Agency, the 200mg presentation (indicated for the weight of patients) was not available, with no expected arrival date. Therefore, weighing the risks and benefits of the situation of both, we chose to treat them with an adult dose (loading dose of 600mg subcutaneously, and 300mg subcutaneously every 2 weeks) despite the low weight. So far, they have received eight injections, showing significant improvement of disease and quality of life. There were no major adverse effects, only worsening of allergic conjunctivitis in one of them. The patients and their family are very satisfied, and we believe that the therapy has been successful.

RESUMO Relatamos os casos de dois irmãos adolescentes com dermatite atópica grave e que, apesar de pesarem cerca de 40kg, apresentaram boa resposta ao dupilumabe com a dose off-label para indivíduos com 12 anos e peso de 60kg. Ambos já tinham usado ciclosporina, azatioprina, metotrexato e corticoide oral por longos períodos, acrescidos de tratamentos tópicos sem controle adequado da doença. As lesões cutâneas eram constantes e disseminadas, e os irmãos apresentavam infeções de pele frequentes e qualidade de vida muito ruim, com inúmeras consequências físicas e psicossociais, como o abandono da atividade escolar pelo prurido intenso, pela aparência e pelo bullying sofrido. Apresentavam também retardo de crescimento e de desenvolvimento. Em 2018, o dupilumabe, um agente imunobiológico, foi aprovado para o tratamento de dermatite atópica moderada a severa para adultos e, em 2019, ampliado para faixa etária de 12 a 17 anos. Embora já tivesse a aprovação da Agência Nacional de Vigilância Sanitária no Brasil, a apresentação de 200mg (indicada para o peso dos pacientes) não estava disponível, sem previsão de chegada. Assim, pesando os riscos e benefícios da situação de ambos, optamos por tratá-los com dose de adulto (ataque de 600mg por via subcutânea e 300mg por via subcutânea a cada 2 semanas) apesar do baixo peso. Até o momento, eles realizaram oito aplicações, apresentando importante melhora da doença e da qualidade de vida. Não houve efeitos adversos importantes - apenas a piora da conjuntivite alérgica em um deles. Os pacientes e sua família estão muito satisfeitos, e nós avaliamos que a terapia está sendo bem-sucedida.

Humans , Child , Adolescent , Adult , Dermatitis, Atopic/drug therapy , Quality of Life , Severity of Illness Index , Brazil , Double-Blind Method , Treatment Outcome , Antibodies, Monoclonal, Humanized , Injections, Subcutaneous , Antibodies, Monoclonal/therapeutic use
Arq. gastroenterol ; 57(4): 491-497, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142345


BACKGROUND: Biological therapy and new drugs have revolutionized the treatment of inflammatory bowel disease. Ideally, the choice of medication should be a shared decision with the patient, aiming at greater satisfaction, compliance, and consequently, favorable clinical outcome. OBJECTIVE: This study aims to evaluate patient's preferences in the choice of their therapy and the factors that influence this choice. METHODS: This cross-sectional study enrolled 101 outpatients with Crohn's disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients' preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors' indication). RESULTS: The mean age was 43.6±13.5 years, 75.3% were female, and 81.2% were cases of ulcerative colitis. Regarding the mode of administration, the majority of patients preferred oral (87.1%), followed by intravenous (6.93%) and subcutaneous (5.94%) medications. The reasons were "I prefer to take it at home" (42.57%), "I have more freedom" (36.63%), "I don't like self-application" (29.70%), and "I believe it works better" (19.80%). Younger patients and patients in clinical disease activity preferred intravenous mode compared to the oral route (P<0.05). Doctor's opinion (98%) was an important factor associated with the medication choice. CONCLUSION: Oral route was the preferred mode of administration and most patients took their physician's opinion into account in their choice of medication.

RESUMO CONTEXTO: A terapia biológica e os novos medicamentos revolucionaram o tratamento da doença inflamatória intestinal. A escolha do medicamento deve ser compartilhada com o paciente, visando maior satisfação, adesão e, consequentemente, desfecho clínico favorável. OBJETIVO: Este estudo teve como objetivo avaliar as preferências do paciente na escolha de sua terapia e os fatores que influenciaram essa escolha. MÉTODOS: Este estudo transversal incluiu 101 pacientes ambulatoriais com doença de Crohn ou retocolite ulcerativa. Os critérios de inclusão foram idade ≥18 anos e nenhuma exposição prévia à terapia biológica. A preferência dos pacientes foi avaliada por meio de perguntas que abordaram o modo de administração preferido (oral, subcutâneo ou intravenoso) e os fatores que determinaram a escolha do medicamento (eficácia, indicação médica, medo da injeção, conveniência, modo de aplicação e opinião pessoal do médico). RESULTADOS: A idade média foi de 43,6±13,5 anos, 75,3% eram mulheres e 81,2% eram portadores de retocolite ulcerativa. Em relação ao modo de administração, a maioria dos pacientes preferiu os medicamentos orais (87,1%), seguidos dos endovenosos (6,93%) e subcutâneos (5,94%). Os motivos foram "prefiro aplicar em casa" (42,57%), "tenho mais liberdade com essa medicação" (36,63%), "não gosto de autoaplicação" (29,70%) e "acredito que funcione melhor" (19,80%). Pacientes jovens e pacientes em atividade clínica preferiram a via intravenosa em comparação com a via oral (P<0,05). A opinião do médico (98%) foi um fator importante associado à escolha do medicamento. CONCLUSÃO: A via oral foi preferida e a maioria dos pacientes levou em consideração a opinião do seu médico na escolha do medicamento.

Humans , Male , Female , Adult , Middle Aged , Aged , Gastrointestinal Agents/administration & dosage , Inflammatory Bowel Diseases/drug therapy , Colitis, Ulcerative/drug therapy , Administration, Oral , Patient Satisfaction , Patient Preference , Injections, Subcutaneous/statistics & numerical data , Biological Therapy , Gastrointestinal Agents/therapeutic use , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Middle Aged
An. bras. dermatol ; 95(4): 511-513, July-Aug. 2020. graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1130905


Abstract The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.

Humans , Bacterial Infections , Mycobacterium , Mycobacterium Infections, Nontuberculous , Injections, Subcutaneous , Anti-Bacterial Agents , Nontuberculous Mycobacteria
Biomédica (Bogotá) ; 40(2): 228-232, abr.-jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1124220


La estrongiloidiasis es una enfermedad causada por el nematodo Strongyloides stercoralis, endémico en las regiones rurales de los países tropicales y subtropicales. Los pacientes inmunosuprimidos tienen un mayor riesgo de infección con este parásito y pueden terminar desarrollando un síndrome de hiperinfección que conlleva un alto riesgo de muerte. En el tratamiento se utiliza la ivermectina, pero, ni en Colombia ni en el mundo, existe una presentación parenteral del medicamento para uso en humanos, lo cual es un problema en aquellos pacientes que puedan tener comprometida la absorción intestinal, como es el caso de aquellos con obstrucciones intestinales. Se reporta el caso de un síndrome de hiperinfección por S. stercoralis en Colombia tratado con ivermectina subcutánea; la idea al presentarlo es incentivar los estudios de farmacocinética y farmacodinamia que analicen esta vía de administración como alternativa para el tratamiento de pacientes con riesgo de fracaso terapéutico con la vía oral.

Strongyloidiasis is a disease caused by the nematode Strongyloides stercoralis that is endemic in rural regions in tropical and subtropical countries. Immunosuppressed patients have an increased risk of infection by this parasite and are at risk of developing a hyperinfection syndrome which involves a higher risk of death. The syndrome is treated with ivermectin, however, there is no parenteral presentation of this medication for human use in Colombia or the world, which is an important problem in patients who have compromised enteral absorption, for instance, those with intestinal obstructions. We present a case of hyperinfection syndrome by Strongyloides stercoralis in Colombia, which was treated with subcutaneous ivermectin. Our purpose is to encourage pharmacokinetic and pharmacodynamic studies to establish this route of administration in the future as an alternative for those patients who have a high risk of therapeutic failure with the oral route.

Strongyloidiasis/drug therapy , Ivermectin , Immunosuppression Therapy , Injections, Subcutaneous , Intestinal Obstruction
Article in Chinese | WPRIM | ID: wpr-879777


OBJECTIVE@#To investigate the incidence of systemic reactions (SR) to subcutaneous immunotherapy (SCIT) for bronchial asthma and/or allergic rhinitis in children and their risk factors.@*METHODS@#A retrospective analysis was performed on 198 children with bronchial and/or allergic rhinitis. According to the presence or absence of SR and local reactions (LR) during SCIT, the patients were divided into two groups: SR (with SR and LR, n=31) and control (without SR or LR, n=142). A multivariate logistic regression analysis was used to determine the risk factors associated with SR.@*RESULTS@#Among the 198 patients who received 8 157 injections of SCIT, 25 (12.6%) experienced SR (31 times, 0.38%), including grade I SR (18 times, 58%), grade II SR (10 times, 32%), grade III SR (3 times, 10%), and no grade IV SR. The multivariate logistic regression analysis showed that multiple sensitization with both food and inhaled allergens, specific IgE to dust mites (grade 6), total IgE (grade 6), and a history of LR were independent risk factors for SR (P<0.05).@*CONCLUSIONS@#SCIT is a safe treatment for bronchial asthma and/or allergic rhinitis in children, with a low incidence of SR. Children with multiple sensitization with both food and inhaled allergens, a hypersensitive state (specific IgE to dust mites, grade 6; total IgE, grade 6), and a history of LR have an increased risk of SR to SCIT.

Animals , Child , Humans , Allergens , Asthma/drug therapy , Desensitization, Immunologic , Injections, Subcutaneous , Retrospective Studies , Rhinitis, Allergic/therapy , Risk Factors
Braz. J. Pharm. Sci. (Online) ; 56: e18447, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142492


T0001 is the first mutant of etanercept with a higher affinity to tumor necrosis factor α (TNF-α) than etanercept. In order to investigate the safety and tolerability of T0001, a study was carried out in healthy Chinese subjects. A first-in-human, dose escalation study was conducted in healthy Chinese subjects. Fifty-six subjects were divided into six dose cohorts (10 mg, 20 mg, 35 mg, 50 mg, 65 mg and 75 mg) to receive a single subcutaneous injection of T0001. Safety and tolerability assessment were based on the records of vital signs, physical examinations, clinical laboratory tests, 12-lead electrocardiograms and adverse events (AEs). All subjects were in good compliance and none withdraw due to AEs. No serious AEs occurred. A total of twenty-three AEs in sixteen subjects were recorded, and eighteen of these AEs were believed to be related to T0001. The most frequently reported AEs were injection site reactions and white blood cell count increase. All these AEs were of mild to moderate intensity and most of them recovered spontaneously within 14 days. In this study, no dose-limiting toxicity was observed, and the maximum tolerated dose was identified as 75 mg. T0001 was considered safe and generally well tolerated at doses up to 75 mg in healthy Chinese volunteers

Humans , Male , Female , Adolescent , Adult , Safety , Volunteers , Single Dose/drug effects , Etanercept/analogs & derivatives , Physical Examination , Arthritis, Rheumatoid/pathology , Tumor Necrosis Factor-alpha/classification , Clinical Laboratory Techniques , Asian People/classification , Electrocardiography , Injection Site Reaction , Injections, Subcutaneous/classification
Rev. Esc. Enferm. USP ; 54: e03653, 2020. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1143714


RESUMO Objetivo: Identificar a conduta referida de profissionais da enfermagem, do estado de São Paulo, sobre Práticas de Medicações Injetáveis. Método: Estudo tipo survey que identificou a frequência referida sobre Práticas de Medicações Injetáveis mediante resposta de questionário eletrônico, validado, entre setembro e dezembro de 2017. Resultados: Considerando as 1.295 respostas computadas, foram identificadas inconformidades como compartilhamento de frascos multidoses para dois ou mais pacientes (10,8%), reutilização de insumos de uso único, como seringas para salinização de pacientes diferentes (1,2%) e reencape de agulhas após uso (4,9%). Foram referidas maior adesão ao uso de luvas para administração de injeções endovenosas (80,5%) e falta de treinamento para manipulação de dispositivos de segurança (13%). Dados correlacionais apontaram que, quanto maior a idade, melhor era a conduta referida na prática de injetáveis. Conclusão: Embora a maioria das condutas configure-se dentro das Boas Práticas de Medicações Injetáveis, há relatos de práticas de risco, como compartilhamento de insumos de uso único. O treinamento para uso de dispositivos de segurança ainda não é uma realidade para todos os profissionais, visto que muitos o referiram como raro.

RESUMEN Objetivo: Identificar la conducta de profesionales de enfermería del estado de São Paulo sobre Prácticas de Medicaciones Inyectables. Método: Se trata de un estudio tipo survey, el cual identificó la frecuencia de Prácticas de Medicaciones Inyectables mediante respuesta de un cuestionario electrónico, validado entre septiembre y diciembre de 2017. Resultados: Teniendo en cuenta las 1.295 respuestas computadas, se identificaron inconformidades como el uso de frascos de dosis múltiples para dos o más pacientes (10,8%), la reutilización de insumos de un solo uso, como jeringas para la salinización de diferentes pacientes (1,2%) y el reencapuchado de agujas después de su uso (4,9%). Sobresalió la adhesión al uso de guantes para las inyecciones intravenosas (80,5%) y la falta de capacitación sobre la manipulación de dispositivos de seguridad (13%). Los datos correlativos señalaron que, a mayor edad, mejor la conducta referida en la práctica de los inyectables. Conclusión: Aunque la mayoría de las conductas se configuran dentro de las Buenas Prácticas de Medicaciones Inyectables, se informa sobre la existencia de prácticas de riesgo, como el compartir insumos de un solo uso. La capacitación en el uso de dispositivos de seguridad aún no es una realidad para todos los profesionales y muchos han declarado que raramente se los entrena en esa área.

ABSTRACT Objective: To identify the self-reported injectable medications of nursing professionals in the state of São Paulo. Method: Survey study that assessed the self-reported frequency of injection medications through a validated electronic questionnaire, applied from September to December 2017. Results: The 1,295 computed responses showed non-compliances such as sharing multidose vials for two or more patients (10.8%), reusing single-use supplies, such as use of saline flush syringes for different patients (1.2%) and needle recapping after use (4.9%). Greater adherence to glove use for administration of intravenous injections (80.5%) and lack of training for handling safety devices (13%) were reported. Correlational data showed that, the older the age, the better the self-reported injecting practices. Conclusion: Although most practices are within Safe Injecting practices, there are reports of risky practices, such as sharing single-use supplies. Training for the use of safety devices is not yet a reality for all professionals, since many reported it as rare.

Injections, Intramuscular/nursing , Injections, Intravenous/nursing , Injections, Subcutaneous/nursing , Medication Therapy Management , Patient Safety , Licensed Practical Nurses , Nurse Practitioners , Nursing Assistants
Arq. bras. med. vet. zootec. (Online) ; 71(4): 1227-1235, jul.-ago. 2019. tab, graf
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1038598


O objetivo deste estudo foi avaliar o efeito metafilático de minerais traços e vitaminas A e E injetáveis, em parâmetros do estresse oxidativo e na função de neutrófilos em fêmeas da raça Holandesa no período de transição. Sessenta animais foram divididos em dois grupos: animais que receberam minerais traços e vitaminas A e E injetáveis (GMTV) (n= 30) e grupo controle (GC) (n= 30). Não houve diferença significativa entre os grupos nos parâmetros avaliados, porém observou-se diferença significativa entre tratamento e dia para os valores da SOD, com maior atividade dessa enzima em fêmeas GMTV, nas semanas próximas ao parto. Observou-se diferença de dia e para interação tratamento e dia para o TBARS, em que fêmeas GMTV mostraram menores valores de TBARS em todos os momentos, exceto sete dias após o parto. Houve efeito significativo de dia para leucócitos, interação tratamento e dia para neutrófilos e interação tratamento e dia para fagocitose de neutrófilos, em que as fêmeas GMTV apresentaram valores menores de leucócitos e neutrófilos próximo ao parto, além de maior fagocitose de neutrófilos. Pode-se observar que houve melhora no sistema oxidativo e imune de fêmeas GMTV, resposta que provavelmente está relacionada com a administração dos minerais traços e vitaminas A e E.(AU)

This study evaluates the metaphylactic of the subcutaneous administration of a trace minerals and vitamins A and E, on the oxidative stress and neutrophil function in Holsteins cows under the transition period. Sixty females were divided in two groups: group with trace minerals and vitamins (GMTV) (n= 30) and group control (GC) (n= 30). There was no significant difference between those groups; however, we find significant difference between treatment and day for Superoxide dismutase (SOD) values with higher activity of this enzyme in females GMTV on the weeks next to the parturition. Still, there was difference on day and, for interactions between treatment and day for TBARS, were females GMTV showed lower values of TBARS in all moments, except on day seven after the parturition. For leucocytes, there is a significant effect by day, interaction on treatment and day on neutrophils, and interaction treatment and day for neutrophil phagocytosis, were females GMTV showed lower values of leucocytes and neutrophils next to the parturition, and an increase of neutrophils phagocytosis. In summary, cows from the GMTV group had an improvement on the immune and oxidative systems, probably correlated with the administration of this supplement.(AU)

Animals , Female , Cattle , Trace Elements/analysis , Vitamin A/administration & dosage , Vitamin E/administration & dosage , Oxidative Stress , Neutrophils , Injections, Subcutaneous/veterinary
Rev. gaúch. enferm ; 40(spe): e20180311, 2019. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1004097


Resumo OBJETIVO Descrever a elaboração e validação de um checklist como estratégia de administração segura de medicamentos. MÉTODO Estudo de validação por consenso de especialistas conduzido de janeiro a junho de 2018 em um Centro de Pesquisa Clínica de um hospital universitário. O checklist foi validado por três enfermeiros assistenciais, dois técnicos de enfermagem, um farmacêutico, dois enfermeiros professores e um médico professor, todos com ampla experiência na administração de medicamentos e em pesquisa clínica. Para a lista final foi considerado consenso de 100% entre os especialistas. RESULTADOS Elaborou-se um guia composto por seis itens a serem checados pela equipe assistencial antes, durante e após a administração de medicamentos de Pesquisa Clínica. CONCLUSÃO A validação do checklist forneceu elementos norteadores para a prevenção de comportamentos que podem levar ao risco de eventos adversos e também permitiu que as equipes assistenciais buscassem estratégias seguras de cuidado na administração de medicamentos.

Resumen OBJETIVO Describir la elaboración y validación de un checklist como estrategia de administración segura de medicamentos. MÉTODO Estudio de validación por consenso de especialistas conducido de enero a junio/2018 en Centro de Investigación Clínica de un hospital universitario. El checklist fue validado por tres enfermeros asistenciales, dos técnicos de enfermería, un farmacéutico, dos enfermeros profesores y un médico profesor todos con amplia experiencia en administración y supervisión de medicamentos y investigación clínica. Para la lista final se consideró consenso del 100% entre los expertos. RESULTADOS Elaboró ​​un guía compuesto por seis ítems a ser chequeados por el equipo asistencial antes, durante y después de la administración de medicamentos de Investigación Clínica. CONCLUSIÓN La validación del checklist proporcionó elementos orientadores para la prevención de comportamientos que pueden llevar al riesgo de eventos adversos y también permitió a los equipos asistenciales buscar estrategias seguras de cuidado en la administración de medicamentos.

Abstract OBJECTIVE To describe the elaboration and validation of a checklist as a strategy for safe drug administration. METHOD It is a Validation study by consensus of experts conducted from January to June 2018, in a Clinical Research Center of a university hospital. The checklist was validated by three nurses, two nursing technicians, a pharmacist, two nurse teachers and one medical teacher, all with extensive experience in drug administration and in clinical research. For the final version of the checklist, a consensus of 100% was considered. RESULTS A guide was prepared consisting of six items to be checked by the care team before, during and after administration of Clinical Research drugs. CONCLUSION The validation of the checklist provided guiding elements for the prevention of behaviors that could lead to the risk of adverse events and also allowed the care teams to seek safe strategies of care in drug administration.

Humans , Pharmaceutical Preparations/administration & dosage , Research Subjects , Patient Identification Systems , Brazil , Consensus , Drug-Related Side Effects and Adverse Reactions/prevention & control , Checklist , Patient Safety , Administration, Intravenous , Personal Protective Equipment , Hospitals, University , Injections, Subcutaneous , Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Nursing Staff, Hospital
Article in English | WPRIM | ID: wpr-764056


BACKGROUND AND OBJECTIVES: Beneficial effects of human adipose-derived stromal vascular fraction (SVF) cell injection on microcirculation have been recently reported in in vitro and in vivo studies. However, no clinical studies have reported its effect in diabetic patients who commonly experience compromised tissue perfusion, regardless of the status of intravascular blood flow. The present piloting study was designed to clinically examine the possibility of SVF cell injection to accelerate microcirculation, particularly in ischemic diabetic feet. METHODS: Ten diabetic feet were included to receive subcutaneous injection of SVF cells around wounds. Transcutaneous partial oxygen pressure (TcPO2) and cutaneous microvascular blood flow were measured before and every four weeks after cell injection until the 12th week visit. RESULTS: TcPO2 values increased from 31.3±7.4 before injection to 46.4±8.2 mmHg at 12 weeks after SVF injection (1.5-fold, p<0.05). Cutaneous microvascular blood flow levels increased from 34.0±21.1 before injection to 76.1±32.5 perfusion unit at 12 weeks after SVF injection (2.2-fold, p<0.05). There were no adverse events related to SVF cell injection. CONCLUSIONS: Results of this study demonstrate that adipose-derived SVF cell injection have the possibility to provide beneficial effects on microcirculation in ischemic diabetic feet.

Humans , Diabetic Foot , In Vitro Techniques , Injections, Subcutaneous , Microcirculation , Oxygen , Perfusion , Pilot Projects , Wounds and Injuries
Article in English | WPRIM | ID: wpr-759976


OBJECTIVE: Osteoporosis is one of the most common causes of vertebral compression fractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the first anabolic agent for the treatment of osteoporosis. The aim of this study was to determine whether 3 months of teriparatide could be effective for patients with osteoporotic VCF at the thoracolumbar spine. METHODS: We reviewed 25 patients with thoracolumbar osteoporotic compression fractures between July 2012 and October 2016 who could be followed up for more than 1 year. Patients were divided into 2 groups depending on the use of teriparatide: 14 patients received teriparatide through subcutaneous injection (group I) and 11 patients did not receive teriparatide (group II). Demographic data, bone mineral density, hospitalization period, changes in the visual analogue scale (VAS) score, body mass index, and medical history such as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were also reviewed to evaluate vertebral body compression percentages and kyphotic angles. RESULTS: Overall changes of VAS score between injury and follow-up were statistically improved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvement at a specific time between the 2 groups was not statistically significant. Overall kyphotic angle and compression percentage between injury and follow-up time were increased in group II than those in group I, although the difference between the 2 groups was not statistically significant. CONCLUSION: Three-month of teriparatide did not show protective effects on progression of fractured vertebral body collapse or kyphotic changes in patients with osteoporosis.

Humans , Body Mass Index , Bone Density , Follow-Up Studies , Fractures, Compression , Hospitalization , Injections, Subcutaneous , Osteoporosis , Osteoporotic Fractures , Parathyroid Hormone , Smoke , Smoking , Spine , Teriparatide , Thoracic Vertebrae , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-772565


With the increasing incidence of diabetes mellitus in China, hypodermic injection of artificial insulin to control blood sugar has been popularized. Insulin pen needles are widely used in hospitals, communities and families. This article attempts to explore and think about the harm and countermeasures brought about by the reuse of insulin pen needles from the perspective of medical device supervision.

Humans , China , Diabetes Mellitus, Type 1 , Hypoglycemic Agents , Injections, Subcutaneous , Insulin , Needles
Journal of Experimental Hematology ; (6): 1654-1663, 2019.
Article in Chinese | WPRIM | ID: wpr-775669


OBJECTIVE@#To compare the effects of intravenous and subcutaneous injection of bortezomib on incidence and relative risk of peripheral neuropathy in patients with multiple myeloma(MM).@*METHODS@#The electronic database of PubMed, Embase, Cochrance library, CNKI and related meeting records were searched by computers. The data were derived all from a matched randomized controlled studies. The incidence, relative risk(RR) and 95% confidence interval of peripheral neuropathy caused by intravenous and subcustaneous injections were calculated by the statistical methods.@*RESULTS@#Four RCT studies were selected for meta-analysis, with a total of 911 patients (479 cases and 432 cases in the subcutaneous injection and intravenous injection groups, respectively). The incidence of peripheral neuropathy in the intravenous injection group was 41.4% (95% CI=0.137-0.692, P=0.003), and the incidence of >2 grade of peripheral neuropathy was 15.6% (95% CI=0.005-0.308, P=0.043). The corresponding incidence rates of the subcutaneous injection group were 16% (95% CI=0.021-0.299, P=0.024) and 3.4% (95% CI=-0.011-0.080, P=0.141) respectively. Compared with the intravenous injection group, the RR of peripheral neuropathy and the relative risk of peripheral neuropathy above grade 2 were 0.525, 95% CI=0.297-0.928 (P=0.027) and 0.376, 95% CI=0.196-0.722 (P=0.003) respectively.@*CONCLUSION@#Subcutaneous injection of bortezomib at therapeutic doses significantly reduces the incidence of peripheral neuropathy compared with intravenous injection.

Humans , Antineoplastic Agents , Bortezomib , Incidence , Injections, Subcutaneous , Multiple Myeloma , Peripheral Nervous System Diseases
Article in English | WPRIM | ID: wpr-763022


Udenafil, which is a PDE5 inhibitor, is used to treat erectile dysfunction. However, it is unclear whether udenafil induces hair growth via the stimulation of adipose-derived stem cells (ASCs). In this study, we investigated whether udenafil stimulates ASCs and whether increased growth factor secretion from ASCs to facilitate hair growth. We found that subcutaneous injection of udenafil-treated ASCs accelerated telogen-to-anagen transition in vivo. We also observed that udenafil induced proliferation, migration and tube formation of ASCs. It also increased the secretion of growth factors from ASCs, such as interleukin-4 (IL-4) and IL12B, and the phosphorylation of ERK1/2 and NFκB. Furthermore, concomitant upregulation of IL-4 and IL12B mRNA levels was attenuated by ERK inhibitor or NFκB knockdown. Application of IL-4 or IL12B enhanced anagen induction in mice and increased hair follicle length in organ culture. The results indicated that udenafil stimulates ASC motility and increases paracrine growth factor, including cytokine signaling. Udenafil-stimulated secretion of cytokine from ASCs may promote hair growth via the ERK and NFκB pathways. Therefore, udenafil can be used as an ASC-preconditioning agent for hair growth.

Animals , Male , Mice , Erectile Dysfunction , Hair Follicle , Hair , Injections, Subcutaneous , Intercellular Signaling Peptides and Proteins , Interleukin-4 , Organ Culture Techniques , Phosphorylation , RNA, Messenger , Stem Cells , Up-Regulation
Asia Pacific Allergy ; (4): e32-2019.
Article in English | WPRIM | ID: wpr-762877


BACKGROUND: Respiratory viral infections are the leading cause of asthma exacerbations. Eosinophil activation results in the formation of eosinophil extracellular traps (EETs), which release web-like structures of DNA and proteins that bind, disarm and extracellularly kill pathogens. OBJECTIVE: We investigated whether the respiratory syncytial virus (RSV) in vitro could induce EETs in bronchoalveolar lavage fluid eosinophils in a murine model of asthma. METHODS: BALB/cJ mice (6–8 weeks old) were sensitized with 2 subcutaneous injections of ovalbumin (20 μg) on days 0 and 7, followed by three intranasal challenges with ovalbumin (100 μg) on days 14, 15, and 16 of the protocol. The control group received Dulbecco's phosphate-buffered saline. Bronchoalveolar lavage fluid eosinophils of ovalbumin group or control group were stimulated with RSV (103 PFU/mL) in vitro for 3 hours. After that, culture supernatant was collected to perform the analyses proposed in this study. RESULTS: We verified an increase in extracellular DNA concentration in bronchoalveolar lavage fluid eosinophils from ovalbumin group stimulated with RSV (10³ PFU/mL) in vitro, which was confirmed by confocal microscopy. We demonstrated that most cells are negative for annexin V and propidium iodide in all groups evaluated. Also, RSV in vitro decreased interferon-ɣ in culture supernatant when compared to the ovalbumin group. CONCLUSION: In this study, we demonstrated for the first time that RSV in vitro induces EETs formation in eosinophils from asthmatic mice.

Animals , Mice , Annexin A5 , Asthma , Bronchoalveolar Lavage Fluid , DNA , Eosinophil Peroxidase , Eosinophils , Extracellular Traps , In Vitro Techniques , Inflammation , Injections, Subcutaneous , Microscopy, Confocal , Ovalbumin , Propidium , Respiratory Syncytial Viruses