Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background: In patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (summarized as pulmonary vascular disease; PVD), it is unclear whether the brain is protected against acute hypoxia and whether acute pulmonary vascular dilatation by sildenafil would influence cerebral and muscle tissue oxygenation whilst breathing normoxia or hypoxia. Methods: Adult patients with PVD underwent right heart catheterization, while cerebral and muscular tissue oxygenation and tissue hemoglobin index were measured using near-infrared spectroscopy along with arterial and mixedvenous blood gases. Participants underwent a four-stage protocol in which they were blinded to breathing either normoxia (FiO2 0.21) or normobaric hypoxia (FiO2 0.15), both before and after a single oral dose of sildenafil (50 mg) according to a randomized, crossover design. Results: In 22 PVD patients (9 women, age 54 ± 14 y) under hypoxia, mean cerebral tissue oxygenation decreased by −2% (95% CI −4 to 0%, p = 0.046), muscular tissue oxygenation by −1% (95% CI −3 to 0%, p = 0.011) and mean arterial partial pressure of oxygen by −2.3 kPa (95% CI −2.7 to −1.8 kPa, p < 0.0001). Sildenafil improved the cerebral tissue hemoglobin index under hypoxia compared to hypoxia without sildenafil by 0.12 (95% CI 0.00 to 0.23, p = 0.049), but not the muscular tissue hemoglobin index. Conclusions: In PVD patients, acute exposure to normobaric hypoxia leads to a reduction in arterial oxygenation as well as cerebral and muscular tissue oxygenation. Sildenafil improves cerebral blood flow but has no effect on arterial, cerebral or muscular oxygenation....
Objectives: Piperacillin/tazobactam (P/T) is a broad-spectrum β-lactam antibiotic frequently used in outpatient parenteral antimicrobial therapy programs (OPAT). We aim to compare the clinical outcomes of P/T treatment in two models of OPAT care in order to maximize the utilization of health resources. Material and methods: We conducted a prospective observational study with retrospective analysis of a cohort of patients treated with P/T delivered every 24 or 48 h in an OPAT program. The primary outcomes were treatment failure during the OPAT episode and 30 day treatment failure. A bivariate and multivariate logistic regression model was built. A two-sided p < 0.05 was considered statistically significant. Results: Between 2012 and 2022, 247 patients were treated with P/T. Treatment was delivered daily in 176 patients (Group 24) and every two days in 71 patients (Group 48). The rate of treatment failure during OPAT in Group 24 and Group 48 was 12.4% (n = 22) and 5.6% (n = 4), respectively (p = 0.112); and the rate of treatment failure 30 days after OPAT treatment end was 18.2% (n = 32) and 21.1% (n = 15) in Group 24 and Group 48, respectively (p = 0.594). Treatment every 24 or 48 h was not associated with higher treatment failure during OPAT or 30 days after finishing OPAT in either bivariate or multivariate analysis. Conclusions: P/T administration in OPAT programs being replaced every two days is feasible without an increase in treatment failure, relapse, or mortality compared to daily drug replacement. These findings should motivate further research to facilitate the implementation of this novel delivery strategy in OPAT programs....
Background: Heart failure (HF) with pulmonary hypertension due to left-sided heart disease (PH-LHD) is associated with poor prognosis. Dapagliflozin showed benefits in terms of ejection fraction (EF); meanwhile, sildenafil improved pulmonary pressures and right ventricular function in PH -LHD in recent clinical studies. This study assesses the potential additive effects of dapagliflozin and sildenafil on cardiac function and pulmonary hemodynamics in this population. Methods: In this prospective, randomized, controlled trial, 93 participating patients with HF and PH-LHD were randomly assigned to receive dapagliflozin (control group, n = 48) or dapagliflozin plus sildenafil 25 mg/day (test group, n = 45) in addition to conventional therapy for HF for 12 weeks. The primary outcomes were assessing changes in echocardiographic hemodynamic parameters. Secondary outcomes included outcomes, changes in cardiac enzyme (troponin), kidney function (serum creatinine), and lipid profile. Results: The average baseline median left ventricular ejection fraction (LVEF) for both groups was 30%, and the Pulmonary Artery Systolic Pressure (PASP) median was 50 mmHg. At follow-up, PASP had declined, and EF had improved compared to baseline. However, there were no statistically noticeable variations between the groups (p = 0.458, 0.331, respectively). No notable changes were observed in secondary and safety outcomes, including hospitalization rate, number of deaths, kidney function, and cardiac enzymes (p = 0.524, 1, 0.923, and 0.574, respectively). Conclusions: Addition of sildenafil to dapagliflozin did not demonstrate any significant clinical or hemodynamic benefit over dapagliflozin monotherapy in HF patients and PH-LHD. Further studies are warranted to evaluate the effects over the long term....
Background/objective: The objective of this research was to evaluate how different antibiotic prophylaxis protocols influence the development of postoperative complications after the extraction of impacted mandibular third molars. Methods: This investigation was designed as a double-blind, randomized controlled trial. A total of eighty patients who fulfilled the inclusion criteria were randomly allocated to one of three treatment groups. Group 1 (n = 27) was administered 2 g of oral amoxicillin one hour prior to the procedure; Group 2 (n = 27) received 500 mg of oral amoxicillin every eight hours for five days following the surgery; and Group 3 (n = 26) was given 750 mg of oral amoxicillin every eight hours for the same postoperative period. The outcome variables measured were infectious complications, postoperative pain, postoperative inflammation, and others such as the rescue medication taken by the patient. Results: Two patients in each group showed signs of infection after the extraction of the impacted third molar (p = 0.412). No significant differences were observed in pain intensity between the different study groups, nor in the intensity of inflammation. No statistically significant differences were observed in the consumption or non-consumption of rescue analgesics. Conclusions: The results of the present study suggest that the preoperative administration of 2 g of amoxicillin in the extraction of impacted third molars in healthy patients could be sufficient to prevent infectious complications. The administration of postoperative doses of 500 mg every 8 h or 750 mg every 8 h does not generate benefits in patients in terms of postoperative pain or inflammation....
Objectives: This study aims to evaluate the safety and tolerability of estetrol/drospirenone in adolescents. Methods: In this Phase 3 open-label study, postmenarchal adolescents (12–17 years) received estetrol (E4)/drospirenone (DRSP) 15 mg/3 mg orally for six cycles (24 active/4 placebo regimen). Safety was evaluated through adverse event (AE) reporting. Participants also recorded daily pill intake, bleeding/spotting, dysmenorrhea, and pain medication use in e-diaries. Descriptive statistics were used. Results: Of 112 enrolled participants, 105 received treatment (mean age: 15.2 years), and 84.8% were completers. No serious treatment-related AEs or safety concerns were observed. Nausea and dysmenorrhea (each 1.9%) were the most common treatment-related AEs. Over 71% of participants took all tablets in each cycle. The percentage of participants with unscheduled bleeding and/or spotting decreased from 45.8% (Cycle 1) to 14.5% (Cycle 5), and the number of days with unscheduled bleeding and/or spotting decreased from nine to six days per cycle. The scheduled bleeding and/or spotting rate ranged between 77.4% and 90.5%, with a duration decreasing from six to four days in Cycle 1 to Cycle 5. Absence of scheduled bleeding increased from 9.5% in Cycle 3 to 22.6% in Cycle 5. The proportion of participants reporting dysmenorrhea decreased by 34.8%, with a median visual analogue scale score dropping from 5.0 at baseline to 3.7 at Cycle 6. Pain medication use decreased from 63.9% to 31.6% in Cycle 6. Conclusions: The use of E4/DRSP in adolescents raised no safety concerns, was well tolerated, resulted in a clear and stable cyclic bleeding pattern, and reduced pain associated with dysmenorrhea....
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