Assessment of causality and severity of various reported adverse drug reactions by different classes of anti-cancer drugs

Background: Chemotherapy involves highly complex regimens and hence accounts to high susceptibility towards Adverse Drug Reactions. All antineoplastic drugs have potential to cause one or more Adverse Drug Reactions which may vary from mild to severe form. So the aim of this study was to determine the prevalence of Adverse Drug Reactions in patients treated with chemotherapy.Methods: After getting approval from the Institutional Ethical Committee, the prospective observational study was conducted in the Department of Pharmacology in association with Department of Radiation Oncology and Department of Medicine, Government Medical College, Srinagar between April 2015 to October 2016. All patients of either sex and any age receiving anti-cancer drugs in the inpatient department of radiation oncology were included. The mean age of the study population was 51 years and 53.9% of them were males and 46.1% of them were females. The WHO-UMC system was used for assessment of case programme and case reports. The severity of adverse drug reactions was determined by using modified Hart wig and Siegel scale.Results: Most of the reported ADR’s were moderate to mild in severity according to modified Hart wig and Siegel scale. Most of the frequent ADR’s were certain followed by probable and possible according to WHO-UMC causality assessment.Conclusions: Antineoplastic drugs have a narrow therapeutic index and the dosage needed to achieve a therapeutic response usually proves toxic to the body’s rapidly proliferating cells. Measures need to be put into place to reduce the physical, emotional and economic burden on the patient due to adverse drug reactions. Therefore, there is a need for vigilant ADR monitoring to decrease morbidity and mortality due to ADR’s which require further studies on large populations.

Indicadores biológicos séricos em veado-campeiro ( Ozotoceros bezoarticus bezoarticus, Linnaeus 1758) de vida livre do Pantanal Sul-Mato-Grossense / Serum biological indicators in free-living pampas deer (Ozotoceros bezoarticus bezoarticus, Linnaeus 1758) of the Pantanal Sul-Mato-Grossense

O objetivo com este estudo foi estabelecer os intervalos de referência de diferentes analitos séricos em Ozotoceros bezoarticus bezoarticus de vida livre. Foram coletadas amostras de sangue de 54 fêmeas e 14 machos adultos, capturados no Pantanal de Mato Grosso do Sul. A determinação das concentrações de cálcio total, albumina, colesterol total, creatinina, glicose, fósforo, proteína total, triglicerídeos e ureia séricas e a atividade das enzimas alanina aminotransferase, aspartato aminotransferase, creatina quinase fração MB e fosfatase alcalina foi realizada em equipamento automático. Valores de globulinas, cálcio total e proporções (razões) entre analitos foram realizados por meio de cálculo matemático. Esta é a primeira descrição do intervalo de referência de parâmetros bioquímicos séricos em veado-campeiro de vida livre do Pantanal de Mato Grosso do Sul. O tamanho da amostra e a distribuição dos dados indicam que os valores médios obtidos são representativos e podem ser usados para a monitorização da saúde, do estado nutricional e do diagnóstico de enfermidades nesse estrato populacional.(AU)

The objective of the present study is to establish the reference intervals of different serum analytes in free - living Ozotoceros bezoarticus bezoarticus. Blood samples were drawn from the 54 females and 14 males, adults, captured in the Pantanal of Mato Grosso do Sul. A determination of total calcium, albumin, total cholesterol, creatinine, glucose, phosphorus, total protein, triglycerides, and serum urea concentrations and an activity of the enzymes alanine aminotransferase, aspartate aminotransferase, creatine kinase MB fraction and alkaline phosphatase were performed in automated equipment. Values of globulins, total calcium and proportions among analytes were performed by means of mathematical calculations. This is a first description of the reference parameters for serum biochemistry of free - living pampas deer in the Pantanal of Mato Grosso do Sul. Sample size and distribution of data indicate that the mean values obtained are representative and can be used for a health monitoring, nutritional status, and diagnosis of diseases in this population stratum.(AU)

Discricionariedade e arbitrariedade judicial na perspectiva positivista de Kelsen e Hart / Judicial discretion and arbitrariness in the positivist perspective of Kelsen and Hart

Com auxílio do método dedutivo, o presente estudo investiga a evolução dos positivismos jurídicos em três momentos em virtude de eventuais inverdades e incertezas que envolvem o tema, bem como analisa a discricionariedade judicial, e sua distinção de arbitrariedade, em Kelsen e Hart. Desta forma, através do procedimento histórico crítico, efetua-se uma abordagem histórica e conceitual do positivismo exegético, analisando suas características e à relação destas com o período histórico ao qual pertence. Posteriormente, apresenta-se o positivismo normativista, com ênfase nas premissas kelsenianas e na discricionariedade judicial advinda deste momento do positivismo, no qual atribuir-se uma função criativa ao intérprete dentro da ideia de moldura da lei criada por Kelsen. Em seguida, a despeito de Hart traçar novos contornos ao positivismo jurídico neste terceiro momento, observa-se ainda a discricionariedade judicial como um problema na interpretação judicial além de sua distinção entre arbitrariedade. Neste sentido, diante dos aportes teóricos e conceituais investigados,percebeu-se que apesar de distintas, discricionariedade judicial e arbitrariedade, ambas não enfrentam a questão da impossibilidade de controle conteudístico da decisão judicial ao ficar à mercê da livre consciência do intérprete para decidir em cada caso concreto. Assim, a dedicação e esforço dos pensadores do direito devem manter-se concentrados na preocupação de“resolver” a discricionariedade judicial – e arbitrariedade, visto que sua presença não seria democrática e nem se coadunaria com a ordem constitucional ao criar o direito conforme uma subjetividade singular dentro de um sistema jurídico plural e democráticos.

Effect of changes in CD34 cell level on various degrees of chronic left ventricular failure in the elderly / 中华老年医学杂志

Objective To observe the effect of changes in CD34+ cell level on various degrees of chronic heart failure (CHF) in the elderly. Methods The enrolled patients were divided into four CHF groups according to the New York Heare Association(NYHA) functional class: NYHA class I (n=23), Ⅱ (n=27), Ⅲ (n = 20) and IV group (n= 16) , and there were 41 healthy controls over the same period. The levels of peripheral blood CD34+ cells were measured, and the tumor necrosis factor-α (TNF-α). its soluble receptors (sTNFR-1 and sTNFR-2) and vascular endothelial growth factor (VEGF) were also measured. Results The levels of CD34+ cells were elevated in the early CHF and depressed in the advanced CHF in elderly patients. The levels of CD34+ cells were (0. 6± 0.2) 109/L in control group, (2.4±0. 4) 109/L in NYHA class I group, (1.9±0.2)×109/L in NYHA class Ⅱ group, (1.3±0.1)×109/L in NYHA class Ⅲ group and (0.5±0.2)×109/L in NYHA class Ⅳ group, respectively (all P<0.01).And TNF-α, sTNFR-1, sTNFR-2 and VEGF were increased in severe chronic left ventricular failure CNYHA class IV vs. I group:TNF-α: (61.4± 15.7) ng/L vs. (28.4±10.8)ng/L; sTNFR-1: (2820.9±1282.8)ng/L vs. (690.8±62.7) ng/L; sTNFR-2: (4113.1±1102.2) ng/L vs. (740.8± 112.3)ng/L; VEGF: (996.3±487.1)ng/L vs. (423. 3±147. 9)ng/L, all P<0. 013. Conclusions The changes of CD34+ cell level may predict various degrees of chronic heart failure in elderly patients.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

Application of the New Surgical Technique for Orthotopic Heart Transplantation in Dogs / 대한흉부외과학회지

BACKGROUND: Conventional cardiac transplantation with each atrial anastomosis designed by Shumway and associates has been used widely in cardiac transplantation because of its simplicity and efficiency. There have been many reports about the postoperative atrioventricular value regurgitation resulting from the alteration in atrial geometry after cardiac transplantation by Shumway's technique. New surgical technique of direct anastomosis of superior vena cava, inferior vena cava, right pulmonary vein and left pulmonary vein was introduced to overcome the those problems. We performed this study to test the feasibility of this new surgical technique prior to application to clinical practice. MATERIAL AND METHOD: Conventional cardiac transplantation was performed on 12 mongrel dogs(Group I) and cardiac transplantation with new surgical mthod of direct anastomosis of SVC, IVC, left and right pulmonary veins was performed on 11 mongrel dogs(Group II). After weaning from cardiopulmonary bypass, we compared the postoperative rhythm, hemodynamic data, and echocardiographic findings between two groups. RESULT: The cardiopulmonary bypass time and graft ischemic time were 119.0+/-4.4 minutes, 162.0+/-4.5 minutes respectively in group I, and 140.0+/-7.1 minutes, 180.5+/-5.4 minutes respectively in group II. The cardiopulmonary time and graft ischemic time in group II were longer than those of group I (p<0.05). There were 3 cases of failure to weaning from cardipulmonary bypass onein group I and two in group II, and this difference was not significant statistically. Sinus rhythm was regained postoperatively in 58% (group I) and 82%(group II), without statistical significant between 2 groups. Postoperative echolcardiography showed 2 cases of tricuspid value regurgitation and 1 case of mitral regurgitation in group I, and no regurgitation of atrioventricular value in group II. CONCLUSIONS: Although these was no statistically significant difference between 2 groups, there was tendency of less arrhythmia and less atrioventricular valvular regurgitation in group II. We suggested that the new surgical technique could be a useful strategy in heart transplantation, especially in the case of size mismatching between donor and recipient.

Association between heart period signal spectrum features and single nucleotide polymorphisms at 5 sites of nitric oxide synthase gene / 重庆医科大学学报

0.05).The comparison of the above HPS parameters showed that only APH was significantly lower than that in the group with TT allelic genotypes of NOS3 G894T(P