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Building key competencies in clinical research: CONSCIOUS curriculum projects 建立临床研究的关键能力:有意识的课程项目
Q4 Health Professions Pub Date : 2023-02-08 DOI: 10.36290/far.2022.026
J. Rychlíčková, Zora Cechova, K. Nebeska, L. Součková
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引用次数: 0
Neonatal abstinence syndrome: window to the latest treatment practice out of The Czech Republic 新生儿戒断综合征:捷克共和国最新治疗实践的窗口
Q4 Health Professions Pub Date : 2022-11-03 DOI: 10.36290/far.2022.018
Kateřina Olga Koutská
Introduction : The article summarizes the latest findings in the pharmacological treatment and non-pharmacological care of neonatal abstinence syndrome (NAS), diagnosis P96.1. Methods: This article reviews randomized clinical trials on the therapeutic treatment of NAS with the active substances morphine, methadone, buprenorphine, phenobarbital and clonidine with parameters of treatment duration and length of hospital stay. The source for this article is freely accessible publications searchable in the medical bibliographic database PubMed. Results: The progressive increase in scientific works in the field of treatment optimization about the median length of hospitalization and length of treatment is reflected in practice by the creation of a whole series of treatment protocols. For both measured parameters, median hospitalization and treatment duration, the buprenorphine molecule achieves better results compared to methadone and morphine. Phenobarbital was a significantly better adjunctive therapy than clonidine in methadone treatment also in both measured parameters. Conclusion: Aspects such as the choice of a suitable preparation, its pharmaceutical form and a standardized globally recognized treatment protocol remain a still controversial topic and the point of interest for further research.
引言:本文总结了新生儿禁欲综合征(NAS)的药物治疗和非药物护理的最新发现,诊断P96.1。方法:对活性物质吗啡、美沙酮、丁丙诺啡、苯巴比妥和可乐定治疗NAS的随机临床试验进行综述,并以治疗时间和住院时间为参数。这篇文章的来源是可在医学文献数据库PubMed中免费检索的出版物。结果:通过制定一系列治疗方案,在实践中反映了治疗优化领域关于住院时间中位数和治疗时间长度的科学工作的逐步增加。与美沙酮和吗啡相比,丁丙诺啡分子在两个测量参数、中位住院时间和治疗持续时间方面都取得了更好的效果。在美沙酮治疗中,苯巴比妥是一种明显优于可乐定的辅助疗法,在两个测量参数方面也是如此。结论:选择合适的制剂、药物形式和全球公认的标准化治疗方案等方面仍然是一个有争议的话题,也是进一步研究的兴趣点。
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引用次数: 0
COVID-19 and the lung: from interstitial pneumonia to pulmonary fibrosis COVID-19与肺:从间质性肺炎到肺纤维化
Q4 Health Professions Pub Date : 2022-11-03 DOI: 10.36290/far.2022.016
Š. Laššán, M. Laššánová
The novel coronavirus-induced disease led to a pandemic that poses a global threat to human health. The most common cause of hospitalisation for COVID-19 is interstitial pneumonia that may be complicated by Acute Respiratory Distress Syndrome (ARDS). The monitoring of patients who have recovered from COVID-associated pneumonia demonstrates that the significant reduction in diffuse lung capacity and associated fibrotic signs in the lung parenchyma are factors associated with a negative prognosis. Thus, the long-term consequences of COVID-19 appear crucial. Risk factors, histopathological characterization, prevalence, and management of post-COVID-19 pulmonary fibrosis are poorly understood. This review addresses underlying pathobiological mechanisms and the possible predictors which might lead to the development of fibrotic lung remodeling. Potential therapeutic modalities include anti-fibrotic drugs, prolonged use of corticosteroids, other anti-inflammatory and immunosuppressive drugs, spironolactone, azithromycine, with further multiple novel compounds under investigation. Copyright © 2022, SOLEN s.r.o.. All rights reserved.
新型冠状病毒引发的疾病导致了一场对人类健康构成全球威胁的大流行。新冠肺炎最常见的住院原因是间质性肺炎,可能并发急性呼吸窘迫综合征(ARDS)。对新冠肺炎相关肺炎康复患者的监测表明,弥漫性肺容量的显著降低和肺实质中相关的纤维化迹象是与不良预后相关的因素。因此,新冠肺炎的长期后果似乎至关重要。COVID-19后肺纤维化的危险因素、组织病理学特征、患病率和管理尚不清楚。这篇综述探讨了潜在的病理生物学机制和可能导致纤维化肺重塑发展的预测因素。潜在的治疗方式包括抗纤维化药物、长期使用皮质类固醇、其他抗炎和免疫抑制药物、螺内酯、叠氮霉素,以及正在研究的多种新化合物。版权所有©2022,SOLEN s.r.o.。保留所有权利。
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引用次数: 0
Comparison of MwPharm 3.30 (DOS) and MwPharm ++ (Windows) Versions of Pharmacokinetic Software for PK/PD Modelling of Vancomycin in Continuous Administration 连续给药万古霉素PK/PD建模药代动力学软件MwPharm 3.30(DOS)和MwParm++(Windows)版本的比较
Q4 Health Professions Pub Date : 2022-11-03 DOI: 10.36290/far.2022.014
M. Hricová, B. Koristkova, Eliška Vavreckova, I. Kacířová, H. Brozmanova, M. Grundmann
Objective: For a long time, the MwPharm software suite (MEDIWARE, Prague, Czech Republic/Groningen, Netherlands) has been used for PK/PD modelling in therapeutic drug monitoring (TDM). The aim of this study was to find the best model in the newer Windows version of MwPharm++ 1.3.5.558 (WIN) for continuous administration of vancomycin. Patients: Twenty adult patients with a mean age of 66 ± 12 years, body weight 85 ± 16 kg, and median dose 1,625 g/24 h were repeatedly examined for vancomycin. Methods: Concentrations predicted by “#vancomycin_adult_k_C2”, “#vancomycin_adult_C2”, “vancomycin_adult_C2”, “van-comycin_C1” WIN models and “vancomycin (cont.inf.) %ahz” (DOS1) and “vancomycin adult” DOS models were compared with the measured values and with the DOS1 model. Statistics: Percentage prediction error (%PE) calculated as (predicted-measured)/measured or (predicted-DOS1)/DOS1, RMSE, Bland-Altman bias, Pearson’s coefficient of rank correlation (R), Student’s t-test. Statistical analysis was performed using the GraphPad Prism version 5.00 for Windows. Results: %PE values varied between −3.2 ± 33.0% and −7.4 ± 36.7%, with the exception of “vancomycin_C1” , the only one--compartment model, where it was −20.8 ± 39.4%. The best outcomes were achieved with “vancomycin adult” . The “#vancomy-cin_adult_k_C2” model produced the lowest %PE, RMSE, and Bland-Altman bias among the WIN models, but its correlation (Pearson’s R) was less tight. RMSE was the same in “vancomycin_adult_C2” while %PE and Bland-Altman bias were similar, with slightly better correlation when compared to “#vancomycin_adult_k_C2” . The %PE value between the two DOS models was 4.1 ± 13.9% (NS); “vancomycin adult” produced slightly better outcomes than DOS1. Conclusion: “vancomycin_adult_C2” and “#vancomycin_adult_k_C2” produced the best outcomes between WIN models. Both DOS models produced lower bias and their prediction was comparable.
目的:长期以来,MwPharm软件套件(MEDIWARE, Prague, Czech Republic/Groningen, Netherlands)一直被用于治疗药物监测(TDM)中的PK/PD建模。本研究的目的是在较新的Windows版本MwPharm++ 1.3.5.558 (WIN)中寻找万古霉素持续给药的最佳模型。患者:20例成人患者,平均年龄66±12岁,体重85±16 kg,中位剂量1625 g/24 h反复检查万古霉素。方法:将“#vancomycin_adult_k_C2”、“#vancomycin_adult_C2”、“vancomycin_adult_C2”、“van-comycin_C1”WIN模型和“万古霉素(cont.inf.) %ahz”(DOS1)、“万古霉素成人”DOS模型预测的浓度与实测值和DOS1模型进行比较。统计学:预测误差百分比(%PE)计算为(预测-测量)/测量或(预测-DOS1)/DOS1,均方根误差,Bland-Altman偏差,皮尔逊等级相关系数(R),学生t检验。使用GraphPad Prism version 5.00 for Windows进行统计分析。结果:%PE值介于- 3.2±33.0%和- 7.4±36.7%之间,万古霉素c1模型为- 20.8±39.4%,是唯一的单室模型。万古霉素成药组疗效最好。在WIN模型中,“#vancomy-cin_adult_k_C2”模型产生了最低的%PE、RMSE和Bland-Altman偏差,但其相关性(Pearson’s R)不太紧密。“vancomycin_adult_C2”的RMSE相同,而%PE和Bland-Altman偏差相似,与“#vancomycin_adult_k_C2”相比,相关性略好。两种DOS模型的%PE值为4.1±13.9% (NS);“万古霉素成人组”的疗效略好于DOS1组。结论:“vancomycin_adult_C2”和“#vancomycin_adult_k_C2”在WIN模型间的疗效最好。两种DOS模型都产生了较低的偏差,并且它们的预测具有可比性。
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引用次数: 0
Use of taurolidine in the prevention and treatment of catheter infections 牛磺酸在导管感染预防和治疗中的应用
Q4 Health Professions Pub Date : 2022-11-03 DOI: 10.36290/far.2022.017
J. Visek, L. Ryskova, A. Machačová, M. Maříková, V. Bláha
Žilní katétr se používá k celé řadě léčebných procedur. Nebezpečnou komplikací implantovaného katétru s potenciálně velmi závažnými následky je katétrová infekce. V prevenci a léčbě těchto infekcí se uplatňují antimikrobiální zámky. Taurolidin [bis-(1,1-dioxoperhydro-1,2,4-thiadiazinyl-4)-methan] je derivát aminokyseliny taurinu. Tato látka postupně nahrazuje dříve používané antimikrobiální zámky s etanolem nebo antibiotiky. Má široké antimikrobiální účinky. Mechanismem účinku je vazba hydroxymetylové skupiny na buněč nou stěnu mikroorganismu, čímž dojde k jejímu ireverzibilnímu poškození. Preventivní použití taurolidinu je spojeno s čtyřnásobnou redukcí rizika vzniku katétrové infekce. Vzhledem k minimu nežádoucích účinků, širokému antimikrobiálnímu spektru a absenci rezistencí se stává postupně zlatým standardem v prevenci i léčbě katétrových infekcí. Klíčová slova: taurolidin, žilní katétr, katétrová infekce, antimikrobiální zámek.
静脉导管用于各种医疗程序。植入导管的一个危险并发症是导管感染,可能会产生非常严重的后果。抗菌锁用于预防和治疗这些感染。牛磺酸[双-(1,1-二氧代全氢-1,2,4-噻二嗪基-4)-甲烷]是氨基酸牛磺酸的衍生物。这种物质逐渐用乙醇或抗生素取代以前使用的抗菌锁。它具有广泛的抗菌作用。作用机制是羟甲基与微生物的细胞壁结合,导致其不可逆的损伤。预防性使用牛磺内酯可使导管感染风险降低四倍。由于副作用小、抗菌谱广、无耐药性,它正逐渐成为预防和治疗导管感染的金标准。关键词:牛磺酸;静脉导管;导管感染;抗菌锁。
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引用次数: 0
Is pharmacological eradication of HIV possible? 药物根除艾滋病毒可能吗?
Q4 Health Professions Pub Date : 2022-11-03 DOI: 10.36290/far.2022.015
S. Snopková, P. Husa, S. Kozáková
Rychlý nástup celosvětové pandemie infekce HIV na přelomu 80. a 90. let minulého století způsobil, že se toto onemocnění stalo jednou z nejstudovanějších infekčních nemocí v historii medicíny. Tomu odpovídal také rychlý vývoj účinných antiretrovirotik. Antiretrovirová léčba je v klinické praxi od roku 1996. Léčba významně prodloužila a zkvalitnila život lidí žijících s HIV, zachránila a stále zachraňuje miliony infikovaných na celém světě. Po více než dvaceti letech je však evidentní, že léčba vedená v intencích současné farmakoterapie není zcela optimální a má své limity. Její potenciál je pouze supresivní, nikoli eradikační. Určitým specifickým rysem HIV je jeho schopnost integrovat svůj genom ve formě provirové DNA do genomu hostitelské buňky. Tyto buňky neindukují na svém povrchu expresi virových antigenů, imunitním systémem není virové agens rozpoznáno a antiretrovirotiky je zcela nedoknutelné. Rezervoár latentně infikovaných buněk tvoří mnohočetné buněčné typy a tkáňové kompartmenty, které se stávají bariérou efektivní léčby a možné eradikace HIV. Byly vymezeny dva základní směry vývoje terapeutické intervence – sterilizační a funkční. Ideálním cílem sterilizační léčby je dosažení eliminace aktivních i latentních virových agens z lidského organismu. Cílem funkční léčby je navození dlouhodobé remise jako důsledku silné hostitelovy obranné reakce, zprostředkované imunitními mechanismy, i když kompetentní virové agens nadále zůstává v organismu. V uvedeném textu jsou zmiňovány hlavní oblasti současného výzkumu nových léčiv a nové principy léčby: dlouhodobě působící pomalu uvolňovaná antiretrovirotika, imunoterapie, buněčná a genová terapie, strategie šokovat a zabít a strategie zablokovat a zamknout. Klíčová slova: HIV, antiretrovirová léčba, eradikace HIV, imunoterapie, neutralizační protilátky.
全球艾滋病疫情在80年代之交迅速爆发。和90。上个世纪的几年使这种疾病成为医学史上研究最多的传染病之一。有效的抗逆转录病毒药物的迅速发展也反映了这一点。抗逆转录病毒疗法自1996年以来一直在临床实践中。这种治疗极大地延长和改善了艾滋病毒感染者的生活,拯救并仍在拯救全世界数百万感染者。然而,二十多年后,很明显,按照目前药物治疗的意图进行的治疗并不完全是最佳的,而且有其局限性。它的潜力只是抑制性的,而不是根除性的。HIV的一个特殊特征是它能够以前病毒DNA的形式将其基因组整合到宿主细胞的基因组中。这些细胞不会在其表面诱导病毒抗原的表达,免疫系统不会识别病毒制剂,抗逆转录病毒药物是完全不可能的。潜伏感染细胞的库由多种细胞类型和组织隔室组成,这些细胞类型和隔室成为有效治疗和可能根除艾滋病毒的障碍。定义了治疗干预的两个基本发展方向——绝育和功能性。杀菌治疗的理想目标是从人体中消除活性和潜在的病毒制剂。功能性治疗的目的是诱导长期缓解,这是由免疫机制介导的强大宿主防御反应的结果,即使有效的病毒制剂仍留在体内。文中提到了目前新药和新治疗原理研究的主要领域:长效缓释抗逆转录病毒药物、免疫疗法、细胞和基因治疗、休克和杀伤策略以及阻断和锁定策略。关键词:HIV,抗逆转录病毒治疗,HIV根除,免疫疗法,中和抗体。
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引用次数: 0
Is it possible to influence the onset and course of COVID-19 infection? (Results of a study by nurses at the University Hospital Ostrava) 是否有可能影响COVID-19感染的发病和病程?(俄斯特拉发大学医院护士的一项研究结果)
Q4 Health Professions Pub Date : 2022-07-07 DOI: 10.36290/far.2022.009
J. Bystroň, Tomáš Balner, Jana Kačorová
A pilot monocentric study evaluated the effect of Imunor on the prevention of COVID-19 in 51 nurses at the University Hospital Ostrava during the third wave of the COVID-19 pandemic (delta variant) in the Czech Republic. The primary objective of the study was to determine whether regular administration of Imunor for 1 month, 2 months, and 1 month after discontinuation prevented SARS-CoV2 infection in nurses working in outpatient and inpatient settings in high-risk environments. with patients with COVID-19. The secondary objective of the study was to evaluate whether the course of the disease would be milder in COVID-19. The need for hospitalization of study subjects for COVID-19 and the overall tolerability of the study preparation were also monitored. A set of other nurses working at the same hospital who were vaccinated against SARS-Cov2 during the study was used as a control. Throughout the study period (during treatment and 1 month after treatment), only 2 nurses experienced a mild course of COVID-19 disease that did not require hospitalization, patients were only isolated for 2 weeks at home with only symptomatic treatment. and after 2 weeks they returned to full workload. Statistical analysis confirmed a statistically highly significant preventive effect (p ≤ 0.00001) for 70% of the study days. In the remaining 30% of days (when there was always only 1 nurse on incapacity for work), it was not possible to express statistical significance for a small number of study subjects.
一项单中心试点研究评估了在捷克共和国第三波COVID-19大流行(delta型)期间,俄斯特拉发大学医院的51名护士使用Imunor预防COVID-19的效果。该研究的主要目的是确定在停药后1个月、2个月和1个月定期给药Imunor是否能预防在高风险环境中门诊和住院工作的护士感染SARS-CoV2。COVID-19患者该研究的次要目的是评估COVID-19患者的病程是否会更温和。还监测了研究对象因COVID-19住院的需要和研究准备的总体耐受性。在同一家医院工作的一组其他护士在研究期间接种了SARS-Cov2疫苗作为对照。在整个研究期间(治疗期间和治疗后1个月),只有2名护士出现了不需要住院的COVID-19轻度病程,患者仅在家中隔离2周,仅进行对症治疗。两周后,他们回到了全负荷工作状态。统计分析证实,在70%的研究天数中,预防效果具有显著的统计学意义(p≤0.00001)。在剩余30%的天数中(始终只有1名护士丧失工作能力),少数研究对象无法表达统计学意义。
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引用次数: 0
Clinical experience with facilitated subcutaneous immunoglobulin treatment 促进皮下免疫球蛋白治疗的临床经验
Q4 Health Professions Pub Date : 2022-07-07 DOI: 10.36290/far.2022.007
Z. Chovancova
Preparáty pro imunoglobulinovou substituční léčbu slouží k náhradě nedostatečné tvorby opsonizačních a neutralizačních protilátek proti široké škále patogenů u pacientů s vrozenými nebo získanými poruchami tvorby protilátek. Mezi základní způ­ soby aplikace patří intravenózní, konvenční subkutánní a nejnověji také subkutánní podání facilitované hyaluronidázou (fSCIG). Podkožní aplikace tohoto enzymu v úvodu léčby umožní dočasně rozmělnit extracelulární matrix, a tím pádem aplikovat objem normálního lidského imunoglobulinu v dávce a intervalu podání jako při intravenózní aplikaci (0,4–0,8 g/kg/měsíc jednou za 2–4 týdny). Biologická dostupnost fSCIG léčby se pohybuje kolem 93 % a je vyšší než při konvenčním subkutánním podávání. Většinou dochází k aplikaci do 1–2 míst. Maximální doporučená rychlost podávání je 300 ml/h. Mezi nejčastější nežádoucí účinky léčby patří lokální reakce charakteru bolesti či dyskomfortu v místě vpichu, svědění, zarudnutí nebo otok. Specifickým problémem fSCIG léčby je možná tvorba protilátek proti hyaluronidáze, které však nejsou neutralizační a jejich přítomnost nekoreluje s výskytem nežádoucích reakcí. Základní výhodou fSCIG léčby je subkutánní podávání v delším časovém intervalu v domácím prostředí. Klíčová slova: imunoglobulinová substituční léčba, rekombinantní lidská hyaluronidáza, facilitované subkutánní podávání, poruchy tvorby protilátek.
免疫球蛋白替代疗法用于替代先天性或获得性抗体产生障碍患者对多种病原体产生的调理和中和抗体不足。静脉注射、常规皮下注射以及最近的透明质酸酶促进皮下注射(fSCIG)是基本的给药方法。在治疗开始时皮下应用这种酶将使细胞外基质暂时稀释,从而在给药剂量和给药间隔内应用正常人免疫球蛋白的体积,就像静脉应用一样(0.4–0.8 g/kg/月,每2-4周一次)。fSCIG治疗的生物利用度约为93%,高于常规皮下给药。它通常应用于1-2个地方。建议的最大给药速率为300毫升/小时。治疗最常见的副作用包括注射部位疼痛或不适的局部反应、瘙痒、红肿。fSCIG治疗的一个具体问题是可能形成抗透明质酸酶的抗体,这些抗体不是中和性的,它们的存在与不良反应的发生无关。fSCIG治疗的基本优点是在家中以较长的时间间隔皮下给药。关键词:免疫球蛋白替代疗法,重组人透明质酸酶,促进皮下给药,抗体产生障碍。
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引用次数: 0
Vericiguat: pharmacological profile Vericiguat:药理学概况
Q4 Health Professions Pub Date : 2022-07-07 DOI: 10.36290/far.2022.013
K. Urbánek
Approximately 53 % of the administered dose is excreted in the urine, while 45% in the faeces. The biological elimination half-life in healthy volunteers averaged 20 hours and in patients with heart failure averaged 30 hours. Its most common adverse effect with an incidence of about 16% is hypotension. It has minimal potential for drug interactions.
大约53%的给药剂量通过尿液排出,而45%通过粪便排出。健康志愿者的生物消除半衰期平均为20小时,心力衰竭患者的平均为30小时。其最常见的不良反应是低血压,发生率约为16%。它与药物相互作用的可能性很小。
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引用次数: 0
Melatonin in the management of sleep disorders associated with atopic dermatitis - from theory to practice 褪黑素在治疗特应性皮炎相关睡眠障碍中的作用——从理论到实践
Q4 Health Professions Pub Date : 2022-07-07 DOI: 10.36290/far.2022.011
Paula Ďuríková
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引用次数: 0
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Klinicka Farmakologie a Farmacie
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