These findings indicate that the 7,500 IU dalteparin dosage is appropriate for the majority of morbidly obese patients undergoing bariatric surgery. The present study, however, suggests that this dose might not be sufficient for patient with a very high body weight.
Background: A reduction in the rate of death and hospitalisations in patients with heart failure (HF) with reduced ejection fraction receiving sacubitril/valsartan compared to enalapril was demonstrated in the PARADIGM-HF study. However, tolerability when initiating and optimising sacubitril/valsartan treatment in real clinical practice is unknown. Methods: We performed a prospective cohort study of clinical and biochemical parameters of the first 100 patients receiving sacubitril/valsartan in a tertiary HF clinic. Patients had titration of the molecule guided by an algorithm developed by pharmacists and cardiologists in the clinic. The objective was to evaluate the proportion of patients reaching the maximal dosage, the time to reach maximal dosage, and the rate of adverse events, as well as the required modification of other HF therapy during the sacubitril/valsartan titration. Results: Forty-six per cent of patients reached the sacubitril/ valsartan maximal dose of 97/103 mg (200 mg) twice daily and 73% received at least 49/51 mg (100 mg) twice daily. Mean titration time was 30 ± 9 days. Symptomatic hypotension, renal dysfunction (increase in creatinine level > 30%) and hyperkalaemia (potassium level > 5.5 mmol/l) occurred in nine, four and 2% of patients, respectively. Background HF pharmacological treatment remained stable during the sacubitril/valsartan titration but daily dosage of furosemide was reduced by 13% (p = 0.0005). Conclusions: This algorithm is a safe and easy-to-use tool in daily clinical practice for the introduction and titration of sacubitril/valsartan. Almost half of the patients reached the maximal dose, with a tolerability profile in line with the original study.
* BACKGROUND AND OBJECTIVE: In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery. * PATIENTS AND METHODS: A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994-1995 and 1998-1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study. * RESULTS: Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail. * CONCLUSIONS: The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia. [Ophthalmic Surg Lasers Imaging 2005 ;36: 103107.]
Fully hydrated liposomes of dipalmitoyl-phosphatidylcholine have been labelled with 5 (or 7, 10, 12, 16)-doxy1 stearic acid at pH 6 and 8, and studied by the continuous-wave e.s.r.-saturation technique. The e.s.r. spectral magnitude depends on the hyperfrequency power P and on both and T, relaxation times. Saturation, i.e. the non-linearity of the spectral magnitude plotted us. dP can be quantified by a P+ parameter (power at which the signal is half as great as it would be without saturation). If we assume & is weakly modified by spin exchange between the paramagnetic spin probe and oxygen in its triplet state, P i is inversely proportional to and becomes a sensitive parameter to appreciate the oxygen transport (oxygen diffusionconcentration product) inside the bilayers. According to the DPPC bilayer phase-transition diagrams, Pi (oxygen diffusion-concentration) is related to the thermodynamic state of the membrane. This technique provides further information on a particular property of a radioprotective agent, cystearnine, which seems to inhibit spin-triplet exchange and hence maximizes (minimizes PL). Since radioprotective agents are known to act by scavenging radiation-inkuced free radicals and by inhibiting oxygen-dependent free radical processes, such a result may contribute to the elucidation of radioprotecting mechanisms.
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