Objective: To examine the impact of balloon atrial septostomy (BAS) on cardio-respiratory status, need for prostaglandin E 1 (PGE 1 ) and postoperative outcomes in infants with transposition of great arteries (TGA).Study Design: Single-center retrospective review of consecutive neonates with dTGA.Result: BAS was performed in 42 (70%) infants and resulted in a significant increase in minimum (61 to 76%) and maximum (80 to 90%) oxygen (O 2 ) saturations and a drop in FiO 2 . BAS was 'successful,' that is, PGE 1 was discontinued in 16 (38%) infants. Three infants died; four infants developed strokes, all of whom had undergone BAS. The duration of hospitalization, ventilation and O 2 need did not differ between infants without BAS, 'successful' BAS and unsuccessful BAS. PGE 1 duration correlated with duration of hospitalization, ventilation, O 2 need and peak respiratory severity score (P<0.03). Conclusion:We speculate that limiting BAS for clinical hypoxemia and aggressive weaning of PGE 1 following BAS would improve outcomes.
This open-label phase I trial assessed potential pharmacokinetic interactions between oral levodopa/carbidopa and transdermal rotigotine treatment at steady state. Twenty-four participants with idiopathic restless legs syndrome (12 per group) received levodopa/carbidopa (100 mg/25 mg bid) and rotigotine (initial dose 2 mg/24 h for 3 days, followed by 4 mg/24 h) in a randomized sequence as monotherapy and in combination during hospitalization for 13 days. Primary pharmacokinetic parameters were AUC(ss) and C(max,ss) of levodopa, carbidopa, and rotigotine at steady state. Mean concentration-time profiles of the 3 agents were similar during monotherapy and combination treatment. The point estimate for the ratio of geometric means (combined vs monotherapy) for AUC(ss) and C(max,ss) for levodopa (0.98 and 1.04), carbidopa (1.03 and 1.06), and unconjugated rotigotine (1.02 and 0.98) was near unity. All 90% confidence intervals were within the acceptance range for bioequivalence (0.8, 1.25). The most frequently documented adverse events were application site reactions (itching and reddening at application site) and headache. Most adverse events were mild to moderate in intensity, but 2 were of severe intensity (headache and extrasystoles); no serious adverse events occurred. The data presented indicate that rotigotine and levodopa/carbidopa can be coadministered without pharmacokinetic interactions between the compounds.
Celiprolol, a novel beta blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta-1-receptor selectivity and its vasodilator property. In the present report 53 patients with angiographic coronary artery disease but uncompromised left ventricular function and with electrocardiographically documented recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual administration of nitroglycerin were studied. They were randomized for treatment with equipotent doses of either the nonselective beta blocker propranolol (80 mg/day) or the selective beta blocker with beta-2-agonistic property, celiprolol (200 mg/day) during one week. Angina frequency was higher in the propranolol group (P < 0.01), whereas myocardial oxygen demand as estimated by the double product (DP = SBP x HR, systolic blood pressure x heart rate) was equally reduced by the two beta blockers. Forearm blood flow was essentially higher in the celiprolol group (P < 0.001). A stepwise logistic regression analysis showed that the beneficial effects of the beta blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product. The authors conclude that (1) Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. (2) Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product or for systolic blood pressure plus heart rate it performs even eight times better. (3) The similar effects of the two compounds on the double product and the essentially different effects on peripheral flow support the conclusion that celiprolol exerts its beneficial effect to a large extent through its vasodilator property.
Growing economies require methods and technologies to develop the capabilities of a high number of people in short time. Elearning approaches cover the standard repertoire of academic knowledge, but the distribution of experience and expert knowledge is merely addressed. This paper describes the design of an initiative to deliver expert knowledge and experience by e-learning technology.
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