Switching between clotting factor products is becoming increasingly common as product choice increases and financial pressure grows to choose the most cost-effective options. Guidance on carrying out the switch recommends a complex and long process that may benefit from being defined in a protocol. Haemophilia nurses may be responsible for managing product switches; anecdotal evidence suggests that clinical practice is variable.
To explore the role of specialist nurses in switching between clotting factor products and their use of a protocol.
Nurses attending the 2018 World Federation of Hemophilia Congress were surveyed about clinical practice at their treatment centre and use of a protocol for switching clotting factor products.
Of 192 nurses attending the conference, 49 nurses returned completed questionnaires, 45 of which were included in the study after exclusions. Responses were exclusively from economically developed countries. Almost all respondents (96%) had direct experience of switching. Half of those who responded to a question about protocol-based switching reported that switches were based on a protocol. When authorship was reported, the protocol was written by haemophilia nurses in about half of cases. Practice about blood testing to determine individual pharmacokinetic parameters prior to the switch was variable, but most nurses (86%) reported screening for inhibitors prior to switching. Respondents agreed to share their protocols among their peers, although only four were received by the research team.
Clinical practice in switching between clotting factor products is variable. Some nurses are switching treatments for patients without the supported of a written protocol, whereas others are involved in writing and implementing protocols. Sharing protocols is a first step in helping to establish best practice.
Patients with haemophilia who are not adequately treated experience a lifetime burden of joint complications and loss of functional ability due to repeated bleeding episodes caused by low levels of clotting factor VIII or IX in the blood. These complications can significantly impact day-to-day life, including active participation in school and academic study in children with haemophilia (CwH). Treatment with factor replacement therapy can help to prevent this, but access to factor has been challenging in low-resource settings such as Northeast India. This study shows the impact of factor replacement therapy on bleeding episodes, joint complications and school absence among CwH in this setting.
A retrospective observational study was undertaken to examine the impact of receiving regular factor replacement therapy (prophylaxis or on demand) on school absences among CwH registered with the haemophilia treatment centre at Assam Medical College and Hospital. Annual bleed rate (ABR), Haemophilia Joint Health Score (HJHS) and Functional Independence Score in Haemophilia (FISH) were also assessed.
Thirty-eight CwH were eligible for the study; 26 (68.4%) were on prophylaxis therapy and 12 (31.5%) received on-demand therapy. In the year before starting regular treatment, the mean ABR was 37.8 (+20.0), HJHS was 31.1 (+18.1) and mean FISH score was 21.1 (+4.2). At the end of the study period the mean (+SD) ABR in prophylactic therapy was significantly lower at 5.8 (+4.6) (p<0.001) and the HJHS was significantly lower at 4.7 (+4.6). FISH score significantly improved to 27.9 (+3.3) (p<0.001). Prophylaxis showed better (but not significant) results in comparison to on-demand therapy.
Treatment with factor replacement significantly reduces school absence in CwH and correlates strongly with joint health and functional improvement, with the effect slightly better with prophylaxis than on-demand therapy. Low dose prophylaxis is a good treatment option in low-resource settings, but improvements are also needed in rates of diagnosis.
The use of corticosteroids might be associated with the sequelae of psychiatric comorbidity – manic and depressive symptoms, psychosis, and cognitive impairment.
We report a case of the 35 years old man who presented seven months period of irritability, occasional low mood, and sleep disturbances without the concurrent hallucinations or delusions. The patient had a history of nephrotic syndrome and for this reason, required prednisolone. The corticosteroid induced irritability that has appeared three months after the treatment has started. The psychiatric examination showed neither the psychomotor retardation, manic or depressed mood, nor hallucinations and delusions. However, the level of irritability was undoubtedly increased.
Corticosteroids are drugs commonly used in many systemic diseases. During a psychiatric examination, a careful evaluation is necessary to distinguish the side effects of corticosteroids from the primary psychiatric disorders.
Several Transylvanian chemists and pharmacists have played an important role in the development ad advancement of modern Hungarian chemical sciences. Regarding these prominent personalities we paid tribute in our series to the career and role of Lajos Ilosvay, Lajos Winkler and Tibor Széki in Budapest, Hungary. Pál Scheitz who was born 150 years ago in Marosvásárhely/Târgu-Mures worked at the Chemistry Institute of Professor Lajos Ilosvay. After graduating from the University of Munich and earning a PhD degree, he worked at the University of Kolozsvár/Cluj for a short period of time after which he pursued a full-time academic career at the Budapest University of Technology for the rest of his life. During his relatively short life (1870-1912) he managed to produce some outstanding works in the field of analytical chemistry. His most significant work is a contemporary book on methods of qualitative chemical analysis, which was printed in two editions. His studies and investigations of litmus dyes are also significant, which are still considered to be the most comprehensive studies of the Hungarian scientific literature.
In case of chronic diseases patient compliance to long-term treatment is of utmost importance. Patient compliance is generally higher for pharmaceutical forms dispersing in the oral cavity. One classic example for long-term therapy is hypertension. The aim of this study is to obtain nebivolol hydro-chloride containing orally disintegrating tablets. As manufacturing technology, direct compression was chosen and rapid disintegration was aimed to be achieved using superdisintegrants. Various formulae have been developed, containing Kollidon and Polyplasdone in different concentrations, and the obtained dry powder mixtures were studied for their rheological properties. Afterwards these mixtures were compressed to obtain tablets. Active ingredient was embedded in the formulations with the shortest dis-integration times (15 and 18 seconds) and the obtained tablets were studied for disintegration time, mechanical resistance, drug content and dissolution. Our results show that the pharmaceutical formulations containing Kollidon CL 5% or Polyplasdone XL 3% fulfill the requirements of orally disintegrating tablets, having a disintegration time under 3 minutes, proper mechanical resistance (greater than 80N) and the dissolution of the active ingredient is greater than 80% in 30 minutes.
The rapid development of molecular biology over the past seventy years led to the molecular understanding of the structure and function of hereditary material in the living world. Through the processing of the gigantic amount of data obtained as a result of technological advances and the exploration of different mechanisms of action, information technology has become an indispensable part of genomic research. This article addresses the background of the genomic and bioinformatics revolution, its application areas, and the perspective of personalized medicine.
Introduction: as an outcome of sterile inflammation-inducing acute ischemic processes, many splenic cells enter the circulatory system and migrate into the lesion, defending tissues against the spread of ischemia or enhancing necrosis.
Objective: investigating the therapeutic effect of splenic morphological response to sterile inflammation-inducing myocardial infarction.
Material and method: We examined the weight and structure of the heart and spleen of 106 patients deceased due to acute myocardial infarction. These data were correlated with demographic (personal) and epidemiological data, and disease history. After morphological investigation of archived myocardial and splenic tissue samples, the acute ischemia-induced structural alterations of splenic samples were quantified using a digital morpho-metric method. Results were evaluated in comparison to the myocardial ischemia coefficient. Changes in distribution of ischemia-induced cell types were characterized by defining the immunological phenotypes of macrophages (M1 vs. M2). Spleen samples from patients without history of ischemia were used as controls.
Results: The modification of the spleen weight was associated with an increase in peripheral blood leucocyte levels. Our morphological analysis proved a positive correlation between the ischemia coefficient and the decrease of spleen weight. Structural analysis of splenic tissue revealed the collapse of red pulp sinusoids, a significant size decrease of the white pulp marginal zone (p<0.05), and depleted follicles with irregular margins without any distinct germinative centers. Concurrently, with the proliferation of granulocytes, the increase of M1 macrophages was observed in the myocardium, and a higher M1/M2 ratio was detected in the marginal zone of splenic follicles.
Conclusion: On the background of acute ischemia, time critically determines the dynamic structural changes of the spleen. Along with reducing the marginal zone, immunomodulation targeting its cellular composition will be a putative therapeutic approach in the future.
Urinary tract infections are the third most common infections in human medicine worldwide. Citrobacter species present a challenge to both clinicians and clinical microbiologists, due to various intrinsic and acquired resistance mechanisms. This study includes microbiological and resistance data on urine samples positive for Citrobacter spp. between January 1, 2008 and December 31, 2017 at the Department of Clinical Microbiology, University of Szeged. Citrobacter species represented 0.7% (n=129) of outpatient samples and 0.6% (n=138) of inpatient samples. Their higher prevalence at advanced age (> 60 years) is consistent with that reported in the literature, whereas the clinical origin (inpatient/outpatient) of the urine specimens did not influence their isolation rates. Overall, the highest levels of resistance were observed with ceftriaxone (29.8% and 47.5%), whereas in case of gentamicin (8.3% and 25.4%) and fosfomycin (9.3 and 13.8%), the lowest level of resistance was detected, respectively. As these pathogens may cause nosocomial epidemics (usually in vulnerable patients groups), close and continuous monitoring is required at both institutional and national level.
Background: Finding the appropriate treatment for advanced rectal cancer patients represents a challenge for surgeons. Determining the right diagnosis and the proper treatment requires multidisciplinary collaboration. Our aim is to present a case with advanced stage rectum cancer, who received successful multidisciplinary treatment.
Material and method: A prospective multidisciplinary research is being conducted at our Department from 2018 within which patients with malignant rectal cancer are examined. Patients’ treatment is realized by the same multidisciplinary team. The patient’s preoperative investigations included MRI and a lymph node map designated by radiologists.
Results: In case of a 60-year-old patient the preoperative MRI showed a stenotic formation in the middle level of the rectum that penetrated the seminal vesicle. During surgery, we found a 10x10 cm stenotic, perforated rectal cancer, which penetrated the bladder, seminal vesicle, prostate and sacrum, respectively a metastatic lesion in the livers 8th segment. During surgery R2 recto-sigmoid resection was performed with colostomy. The patient was mobilized on the first postoperative day and bowel movements were regained on the second day. The patient left the hospital on the eighth postoperative day.
Conclusions: Adequate treatment of patients with advanced rectal cancer can be achieved only through multidisciplinary co-operation. Preoperative radiological examinations are mandatory. A map representing the positive colorectal lymph nodes, implemented by the radiologists, can significantly help the surgeons and pathologists.
Factor replacement is currently the standard of care to prevent or treat bleeding episodes in haemophilia patients. This study examined current prescribing practices of factor therapy for patients at haemophilia treatment centres (HTCs) in the United States.
The aims were to evaluate the driving forces for prescribing factor products, to evaluate current attitudes and knowledge toward factor product and industry, and to discuss the implications for health care providers in practice.
An anonymous electronic survey was distributed to 744 HTC health care providers (HCPs); 118 responses were analysed.
The most common driving force for HCPs to change a patient's factor product was poor response to current therapy, while the most common perception of patients’ motivation to switch products was the potential for fewer infusions. HCPs with strong influence over the prescribed therapy identified inadequate pharmacokinetic (PK) studies as an important driving force; patients/caregivers perceived as having a strong influence over which therapy is prescribed selected less frequent dosing as an important motivator. HCPs who allow patients/caregivers to have a strong influence over which factor is prescribed were more likely to cite patient/caregiver request as a significant driving force for change in therapy.
The haemophilia treatment landscape continues to evolve and is becoming increasingly complex. The multitude of treatment options available now offer choices, presenting a need to focus on patient-centric prophylaxis.