Therapeutics and Clinical Risk Management最新文献

Objective: Mesalazine is a widely used medication for treating mild to moderate inflammatory bowel disease (IBD). First identified as a potential cause of acute pancreatitis (AP) in 1989, the link between mesalazine and AP has primarily been established through case reports and a limited number of retrospective studies. This study aims to explore the characteristics of mesalazine-induced AP.

Methods: The databases of CNKI, Wanfang Data, VIP, PubMed and Web of Science were searched (up to March, 2024), and the case reports of mesalazine-related AP in IBD patients were collected and descriptively analyzed.

Results: Thirty-four reports were included, describing 42 patients (22 males, 16 females, 4 unspecified) with mesalazine-related AP. The onset of pancreatitis occurred a median of 14 days (range 1-730 days) after starting mesalazine. Common symptoms included abdominal pain (100%), vomiting (38.1%), fever (21.4%), and nausea (21.4%). Most patients had elevated serum amylase and lipase levels, with some showing raised C-reactive protein and erythrocyte sedimentation rate. Imaging tests, such as computed tomography and B-scan ultrasonography, revealed edematous infiltration and inflammation. Discontinuation of mesalazine led to symptom resolution in all patients, with 93.3% improving within a week. Alternative treatments or switching to other forms of 5-aminosalicylic acid may be considered for ongoing management. Rechallenge with mesalazine led to recurrence of AP in 21 cases, with a shorter median time to symptom onset.

Conclusion: Mesalazine-induced AP is a rare but significant adverse reaction, not related to drug dosage, and can occur at any point during treatment, typically within two weeks. The reaction can recur upon rechallenge. Discontinuation of mesalazine and symptomatic treatment typically resolves the condition.

Introduction: Traumatic patients with cervical spine motion restriction have difficulty with endotracheal intubation (ETI) due to the limitations of neck movement and mouth opening. Nevertheless, the removal of the cervical collar for ETI in a prehospital setting may lead to a deterioration in neurological outcomes. This study compares the success rate of ETI utilizing a video laryngoscope (VL) on a manikin, contrasting manual in-line stabilization (MILS) without a cervical hard collar against full immobilization.

Methods: A randomized, non-crossover study was conducted involving 56 paramedic students assigned by SNOSE to utilize various box sizes for VL intubation with MILS without a cervical hard collar or full immobilization technique on a manikin. The primary outcome was the intubation success rate. Secondary outcomes included attempts, time for successful intubation, and Cormack-Lehane classification.

Results: Fifty-six participants were evaluated; 28 were in the full immobilization group, and another 28 were in the MILS without cervical hard collar group. Baseline characteristics showed no difference between both groups. The success rate of VL intubation showed no difference between the full immobilization group and the MILS without a cervical hard collar group (28 [100%] vs 28 [100%]; 24 [85.71%] vs 27 [96.43%] on first attempt; 4 [14.29%] vs 1 [3.57%] on second attempt; p-value 0.352). Time required to perform successful intubation (median [IQR] 17.20 [12.53, 24.40] vs 17.53 [14.06, 23.73], p-value 0.694) and Cormack-Lehane classification (11 [39.29%] vs 10 [35.71%] in grade I; 16 [57.14%] vs 17 [60.71%] in grade II; 1 [3.57%] vs 1 [3.57%] in grade III, p-value 1.000) showed no statistical difference between the two groups.

Conclusion: It is unnecessary to remove the cervical hard collar when performing endotracheal intubation while using a video laryngoscope.

Gaucher disease (GD) is a rare lysosomal storage disorder resulting from a deficiency of the lysosomal enzyme glucocerebrosidase caused by biallelic variants in the GBA1 gene. Patients may present with a wide spectrum of disease manifestations, including hepatosplenomegaly, thrombocytopenia, bone manifestations, and in the case of GD types 2 and 3, neurodegeneration, cognitive delay, and/or oculomotor abnormalities. While there is no treatment for neuronopathic GD, non-neuronopathic manifestations can be efficiently managed with enzyme replacement therapy or substrate reduction therapy. However, many patients with GD experience a lengthy diagnostic odyssey, which can negatively affect their access to care and clinical outcomes. The cause of this diagnostic delay is multifaceted. Since genotype/phenotype correlations in GD are not always clear, it is difficult to predict the presence, severity, and onset of clinical manifestations. This heterogeneity, combined with the molecular complexity of the GBA1 locus, low disease prevalence, and limited knowledge of GD among providers serves as a barrier to early diagnosis of GD. In this review, we discuss such obstacles and challenges, considerations, and future steps toward improving the diagnostic journey for patients with GD.

Background: Patients after head and neck tumor reconstruction surgery frequently require deep sedation and analgesia in the ICU. However, the risk factors for delirium associated with propofol-based sedation remain unclear.

Objective: The study aimed to explore the risk factors of delirium of propofol singled or combined sedation.

Methods: This retrospective study analyzed ICU patients who underwent head and neck tumor reconstruction surgery. The patients were divided into three groups: propofol (P), propofol + midazolam (PM), and propofol + dexmedetomidine (PD) groups. We utilized univariate and multivariate logistic regression to identify risk factors of delirium.

Results: Delirium occurred in 4 (7.02%), 11 (28.21%), and 5 (20.83%) patients in the P, PM and PD groups, respectively. Elevated mean arterial pressure (MAP), increased aspartate aminotransferase (AST) levels, and the combined use of midazolam were determined to be significant risk factors for delirium in this patient cohort. The combined use of midazolam is the strongest predictor of delirium, which can increase the risk of delirium by 3.218 times (95% CI = 1.041-9.950, p = 0.042).

Conclusion: Propofol combined with midazolam for sedation in patients after head and neck tumor reconstruction surgery may increase the risk of delirium.

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality, often requiring emergency department (ED) management. Integrated Nursing Interventions play a critical role in the care of TBI patients, but limited research has evaluated their efficacy in this setting. This study aims to assess the impact of Integrated Nursing Interventions on patient outcomes and complications in the ED.

Methods: This retrospective study included 246 patients with mild traumatic brain injury (mTBI) treated in the emergency department from January 2022 to December 2022. Of these, 138 patients received Integrated Nursing Interventions, while 108 did not. Baseline characteristics, clinical outcomes, and complications were compared between the two groups. Descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curve analysis were used to evaluate the effect of nursing interventions on outcomes such as mortality, complications, and hospital stay.

Results: Among the 246 mTBI patients, those receiving Integrated Nursing Interventions (n=138, 56.1%) experienced significantly lower rates of adverse events, including perioperative intracranial hemorrhage (4.3% vs 12.0%, P=0.025) and shorter hospital stays (6±2 days vs 11±3 days, P<0.001). The study sample included 56.5% female, with 80.1% age ≤ 80. Integrated Nursing Interventions refer to coordinated care strategies that combine multiple nursing approaches tailored to address both physical and psychological needs of patients. For instance, the use of patient education combined with individualized pain management strategies. Logistic regression analysis revealed that Integrated Nursing Interventions were associated with a significant reduction in in-hospital mortality (OR=1.828, 95% CI: 1.619-2.318, P<0.001). ROC curve analysis demonstrated strong predictive accuracy for outcomes such as readmission rate (AUC=0.757), 30-day mortality (AUC=0.836), and 90-day mortality (AUC=0.760).

Conclusion: Integrated Nursing Interventions in the emergency department significantly improve patient outcomes for mTBI patients, reducing mortality, complications, and length of hospital stay. These interventions, which include early assessment, timely intervention, patient education, and collaborative care, are essential for optimizing TBI management. The high predictive value of these interventions further underscores their importance in emergency care. Future research should focus on the long-term effects of Integrated Nursing Interventions on patient outcomes across different age groups, particularly in chronic disease management. Further studies could explore the role of digital health tools in enhancing integrated care.

Non-NF2 schwannomatosis is a rare syndrome characterized by multiple benign schwannomas that primarily affect nerve sheaths, with chronic, treatment-resistant pain as the most common symptom. No protocol has been established for pain management, and pharmacotherapies, including molecular target therapies, are being evaluated. Neuromodulation therapies such as scrambler therapy and surgical options are also employed; however, surgery may lead to persistent or recurrent pain caused by nerve damage or tumor recurrence. The lack of accurate animal models hampers understanding of pain mechanisms and tumor development, necessitating further basic research and clinical trials to improve treatment strategies.

Pulmonary arterial hypertension (PAH) is a rare and potentially fatal condition characterized by progressive increases in blood pressure in the arteries of the lungs. Oral selexipag, approved by the Food and Drug Administration (FDA) in 2015 for the treatment of PAH, targets prostacyclin receptors on pulmonary arterial vascular smooth muscle and endothelial cells to improve blood flow through the lungs and reduce pulmonary vascular resistance. Oral selexipag is effective, but may be discontinued due to factors like side effects, emergency conditions, or inability to take oral medication, potentially leading to severe adverse events, such as rebound pulmonary hypertension and right heart failure. To address treatment interruptions, intravenous (IV) selexipag was introduced as an alternative for patients who are temporarily unable to take oral medications. IV selexipag bypasses hepatic metabolism, requiring a 12.5% higher dose compared to the oral form to achieve similar therapeutic effects. It is administered via IV infusion twice daily over 80 minutes, typically for short-term use. However, caution is needed when prescribing selexipag to patients with hepatic or renal issues, and it is contraindicated with strong CYP2C8 inhibitors. A Phase III clinical trial confirmed that switching between oral and IV selexipag was safe, with comparable efficacy and tolerability, though it was limited by small sample size and short duration. Given the risks of treatment interruption and the complexity of managing PAH, this review provides essential insights into the practical use of IV selexipag as a bridging therapy. Furthermore, it calls for larger clinical trials to refine dosing strategies, explore long-term outcomes, and identify patient populations most likely to benefit from IV selexipag.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often severe, debilitating and difficult to treat. Recent randomised control trials (RCTs) of biologics that target key inflammatory pathways have demonstrated clinical efficacy in treating CRSwNP. Such RCTs must facilitate meta-analysis. Here we report the need for urgent improvement in double-blind randomised controlled trials of biologics in CRSwNP, having previously undertaken a systematic review and meta-analysis of such studies. The RCTs included in that systematic review did not conform to a standard study design. Patient selection criteria was not consistent in studies with several heterogeneous disease subgroups of CRSwNP patients present in each study. Different durations of treatment and variable outcome measures also made the comparative assessment of efficacy between different biologics difficult. Data presentation to allow extraction for meta-analysis was not always clear, such that on occasion selected data sets or even an entire RCT had to be excluded from further evaluation. As such, the high heterogeneity between studies made the overall interpretation of the findings difficult. We make an urgent call to design and conduct future RCTS of biologics in CRSwNP in a more standardised manner, and to present data in a clear way that is easily extractable. This will facilitate more inclusive and thus robust evaluation and interpretation via meta-analysis, which will in turn enable clearer insight into which CRSwNP patient subgroups might benefit from specific biologics and thus achieve better clinical outcomes.

Purpose: Analyze the incidence and risk factors of thyroid dysfunction in patients with advanced nasopharyngeal carcinoma (LA-NPC) after intensity-modulated radiotherapy (IMRT) and PD⁃1 inhibitor treatment and their relationship with treatment efficacy and prognosis.

Methods: Eighty-five LA-NPC patients treated with IMRT and PD-1 inhibitors were retrospectively collected from March 1, 2019, to May 30, 2022. The incidence of thyroid dysfunction after combination therapy was analyzed. The Kaplan-Meier method was used to analyze the relationship between thyroid dysfunction and patient prognosis. Logistic regression analysis was used to screen independent risk factors for thyroid dysfunction.

Results: As of data cutoff (May 31, 2024), the median follow-up time was 27.8 months (range: 25.6 to 32.0 months). The median time of onset of thyroid dysfunction was 8.26 months. The incidence of thyroid dysfunction is 47.06% (40/85), with clinical hypothyroidism being the main cause at an incidence rate of 28.24% (24/85) and clinical hyperthyroidism at an incidence rate of 3.53% (3/85). The incidence of grade 1 thyroid immune-related adverse events (irAEs) was 29.41% (25/85), and the incidence of grade 2 thyroid irAEs was 17.65% (15/85). Patients with thyroid dysfunction had longer overall survival, progression-free survival, and distant metastasis-free survival at both one and two years compared to patients with normal thyroid function, but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis showed that pretreatment lactate dehydrogenase (LDH) (p = 0.079) is an independent predictor of thyroid dysfunction after radiotherapy in combination with immunotherapy for LA-NPC.

Conclusion: The study found that the addition of immunotherapy increases the risk and shortens the onset time of thyroid dysfunction in LA-NPC patients treated with chemoradiotherapy. Pretreatment LDH may serve as an independent risk factor for thyroid dysfunction for LA-NPC patients.