Association Between Atorvastatin Exposure and Low Folate Status: A Case–Control Study

Withania somnifera is an important Ayurvedic Rasayana herb, the roots of which are often used in traditionally known systems of medicine as tonic or for rejuvenation purposes. Effects of a single and ten daily oral doses (10, 20 and 40 mg/kg) of an analytically well standardized Withania somnifera root extract against foot shock stress triggered transient hyperthermia and hotplate test for analgesics in male mice were quantified. Body weights and basal rectal temperatures of animals were recorded on all observational days and on the 11th and 12th day of the experiment, all animals were subjected to tail suspension and pentobarbital hypnosis tests respectively. Daily dose dependent efficacy of the tested extract in stress induced hyperthermia test and in hot plate test increased with increasing number of treatment days, and its dose dependent inhibitory effect on immobility time in tail suspension were observed after its 11 daily oral doses. Daily handling and intermittent foot shock stress triggered body weight losses and elevations in basal core temperatures were almost completely prevented even by its lowest daily dose (10 mg/kg/day) tested. Repeated daily low oral doses of the Withania somnifera extract is effective in suppressing diverse stress responses, and its centrally acting analgesics and anxiolytics or antidepressants like efficacies increase with increasing numbers of treatment days. These observations reaffirm that Withania somnifera is an adaptogenic herb, and suggest that its effective therapeutic doses has to be adjusted according to the pre-existing allostatic load of patients.

Healthcare Cost Analysis of Short-Course vs. Long-Course Pre-Operative Radiotherapy Schedules for Rectal Cancer

This study aimed to assess the risk of hyperlactatemia (LA) in patients who received atorvastatin (ATV) treatment. For this, an observational and retrospective study using a case-crossover study design. The participants who received atorvastatin (10 - 80 mg) were included in the sample. The main variable in the study was the total number of treatment days for all the medications administered to each patient (PD). All PDs with lactate>4mmol/L were cases, while all PDs with lactate≤4mmol/L were co

The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.

Background and ImportanceTo support a simple and quality-assured outpatient parenteral antibiotic therapy (OPAT) workflow, the hospital pharmacy offers specially prepacked boxes for use in the patient’s home after discharge. There...

Comparing antimicrobial exposure based on sales data

The effect of duration of induction treatment on complete response (CR) and event-free survival (EFS) (time to death or relapse) was evaluated in 162 "good-risk" germ cell tumor (GCT) patients treated from November 1982 to July 1986 in a randomized prospective trial with VAB-6 (cyclophosphamide + vinblastine + bleomycin + dactinomycin + cisplatin; 81 patients) versus etoposide + cisplatin (EP; 81 patients). Patients received three cycles of VAB-6 every 28 days or four cycles of EP every 21 days. Treatment cycle with either regimen was routinely postponed for 7 days for leukocytes less than 3000/mm3 or platelets less than 100,000/mm3 and then administered regardless of blood count. The number of treatment days was calculated for each patient from initial treatment day to final induction date plus 28 days for VAB-6 and plus 21 days for EP. The proportion of CR and the EFS for good-risk GCT patients treated with cisplatin-based chemotherapy were not influenced by a less than or equal to 7-day delay resulting from chemotherapy-induced myelosuppression. Short, planned delays in chemotherapy for good-risk GCT patients (less than or equal to 7 days per cycle) appear to be acceptable since they may prevent serious toxicity in this curable patient population. Delays of longer than 7 days are strongly discouraged except in extraordinary life-threatening circumstances.

Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group (p = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease.

Efficacy of a selective COX-2 inhibitor for controlling irregular uterine bleeding in DMPA users

A meaningful portion of patients receiving psychological treatment do not respond to treatment. Identifying variables associated with non-response may allow clinicians to better predict who is less likely to respond, and alter treatment procedures accordingly. Therefore, this study aimed to characterize patients who did not respond to treatment in a partial hospitalization program and identify baseline variables that are most predictive of non-response. Variables were compared between responders and non-responders using chi-square tests of independence and independent samples t-tests. Two logistic LASSO regression models were conducted to separately identify variables associated with treatment non-response in a sample of patients with elevated anxiety or depression, respectively. 24.8% of patients with elevated anxiety symptoms were classified as anxiety non-responders (n = 315), while 36.3% of patients with elevated depression symptoms were classified as depression non-responders (n = 445). Non-responders in both groups were characterized by greater clinical severity at baseline and discharge. Non-response in both groups was predicted by more comorbid diagnoses, greater functional impairment at baseline at discharge, and a greater number of treatment days attended and missed. These results suggest that patients with greater levels of clinical severity, more functional impairment, and a greater number of absences were less likely to respond to PHP treatment. It is important to replicate these findings in independent samples to further examine what variables may be associated with non-response in this treatment setting, and therefore identify clinical strategies to reduce this phenomenon.

Pretreatment social network characteristics relate to increased risk of dropout and unfavorable outcomes among women in a residential treatment setting for substance use

Introduction: Meningitis is a devastating disease with a high case fatality rate, which can lead to serious long-term sequelae if not timely diagnosed, and treated.Objectives: Describing on the clinical, subclinical characteristics and analysing some factors related to the treatment results in meningitis patients at Thai Nguyen National Hospital.Methods: A cross-sectional descriptive study was conducted on 48 meningitis patients were treated at the Department of Neurology and Department of Tropical Diseases at Thai Nguyen National Hospital.Results: The average age of patients in the study was 43.27±15,31 (year); The percentage of male patients was 75,0%. The most common clinical symptom was headache (89.6%), fever (75%); The average white blood cell count in the CSF on admission was 509.92±681.27 (cells/ml) and at discharge was 94.42±102.60 (cells/ml); Protein in CSF on admission was 1.70±1.45 (g/L) and at discharge was 0.72±0.55 (g/L). The everage day of treatment was 12.57.Conclusion: The popularr symptoms of patients with bacterial meningitis are headache, fever, vomiting, nausea, constipation, and stiff neck. There was no relationship between age, gender, white blood cell count and white blood cell count in the CSF at admission to the number of treatment days in meningitis patients.

In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team’s site and the patient’s location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014–2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of >30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team’s site and the patient’s location is not the only determining factor; other causes must be considered.

For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or waiting time and is open every day of the week. In addition, it was examined whether and to what extent there are cost advantages for day hospital treatment. Patients who were admitted to the hospital with a referral to an inpatient admission were treated randomly either fully inpatient or in the acute day hospital. As a pilot study, 44 patients were admitted to the study. Evidence of efficacy could be provided for both treatment settings based on significant reduction in psychopathological symptoms and improvement in functional level in the course of treatment. There were no significant differences between the two settings in terms of external assessment of symptoms, subjective symptom burden, functional level, quality of life, treatment satisfaction, and number of treatment days. Treatment in the day hospital was about 45% cheaper compared to inpatient treatment. The results show that acutely ill psychiatric patients of different symptom severity can be treated just as well in an acute day hospital instead of being admitted to the hospital. In addition, when direct treatment costs are considered, there are clear cost advantages for day hospital treatment.

Muscle-invasive bladder cancer treated with external beam radiation: influence of total dose, overall treatment time, and treatment interruption on local control