Lung Deposition of Fenoterol and Flunisolide Delivered Using a Novel Device for Inhaled Medicines: Materials and Methods

Posted by James White

The aims of the two randomized three-way crossover studies in healthy volunteers reported in this article were to examine, using gamma scintigraphy, the in vivo lung deposition of (1) the bronchodilator fenoterol and (2) the corticosteroid flunisolide following single-dose inhalation. Comparisons were made of the total and regional deposition of these drugs delivered by the new device, conventional MDIs, and MDIs with spacer devices. Furthermore, in the flunisolide study, the effect on lung deposition of a modification of the RESPIMAT by the addition of a baffle in the mouthpiece, designed to eliminate large, “nonrespirable” droplets from the spray, was investigated. Read the rest of this entry »

Lung Deposition of Fenoterol and Flunisolide Delivered Using a Novel Device for Inhaled Medicines

Posted by James White

Lung Deposition of Fenoterol and Flunisolide Delivered Using a Novel Device for Inhaled MedicinesCurrently, most drugs used in the treatment of asthma and airflow obstruction are given by the inhaled route. This includes bronchodilators such as β2-agonists and anti-cholinergics, and anti-inflammatory medications such as corticosteroids, cromolyn sodium, and nedocromil sodium. Inhaled medication is preferable to oral medication because the drug is delivered directly to the airways, allowing lower doses to be used, usually a more rapid onset of action, and a reduced incidence of side effects. The pressurized metered-dose inhaler (MDI) is the most widely used inhaler device. It has the advantages of being compact, portable, relatively cheap, and easy to use. However, many patients, especially children and the elderly, do not obtain optimal benefit because they fail to use their MDIs effectively. canadian pharmacy
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Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Conclusion

Posted by James White

A need for mechanical ventilation and the occurrence of renal failure requiring hemodialysis are of adverse significance for the short-term prognosis in ICU patients not infected with the HIV In our study, short-term survival was closely correlated with use of mechanical ventilation or hemodialysis. The duration of mechanical ventilation has been reported as an important prognostic marker in non-HIV-infected patients. Our multivariate analysis found that the duration of mechanical ventilation was significantly associated with a poor short-term outcome; in-ICU mortality rises from 23.7 to 67.6%, and in-hospital mortality goes from 54.2 to 76.2%. Read the rest of this entry »

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Outcome

Posted by James White

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: OutcomeWe found that HIV-related variables significantly influenced the in-hospital outcome and to a lesser extent, the in-ICU outcome. These variables were also closely associated with the long-term outcome. The number of previous opportunistic infections, as well as the stage and duration of AIDS, were significantly associated with the short- and long-term outcomes. The CD4 count is the prognostic marker most widely used in HIV-infected patients. However, as shown in Table 3 and Figure 2, differences in median and mean survival times across CD4+ lymphocyte count groups were modest. We believe that variations in CD4+ counts probably have little prognostic value in patients with CD4 counts <0.100X109/L. It has been reported that only logarithmic values are of interest in this population. HIV disease is a chronic disease that remains ultimately fatal, with a life expectancy that varies according to a number of clinical and laboratory marker 25,26 Clearly, the long-term outcome is closely dependent on this specific life expectancy. Bronchial Disease
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Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Discussion

Posted by James White

Previously reported 1-year survival rates after ICU discharge of non-HIV-infected patients have varied widely in the few available studies, from about 30% in patients with severe sepsis and 49% in elderly subjects (with a mean survival time of 18 ±10 months) to <5% in patients who required cardiopulmonary resuscitation and in bone marrow transplant recipients. Our results in HIV-infected patients compare favorably with those previously reported for other high-risk patients or patients with ultimately fatal illnesses. Treatment of Bronchial Read the rest of this entry »

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Follotv-up Study After ICU Discharge

Posted by James White

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Follotv-up Study After ICU DischargeCumulative survival rates in the 281 patients who were discharged from the ICU were 51 ±38% at 6 months, 28±38% at 12 months, and 18±30% at 24 months. Table 3 shows long-term outcome univariate and multivariate analysis results, as well as crude mean and median survival times. Figure 1 shows survival curves according to the admission cause group and functional status, and Figure 2 shows survival curves according to HIV disease stage and CD4+ count. Bronchoscopy
Median and mean survival times were 429 days and 432±331 days in the PCP subgroup vs 311 days and 391 ±392 days in the other respiratory failure causes subgroup (p — 0.32). In the neurologic failure group, median and mean survival times were 75 days and 202 ±253 days in the toxoplasmic encephalitis subgroup, 34 days and 88 ±116 days in the intracerebral space-occupying lesion subgroup, and 188 days and 299 ±360 days in the meningitis subgroup; these differences were not statistically significant. Read the rest of this entry »

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Short-term Outcome

Posted by James White

Overall in-ICU and in-hospital mortality rates were 20.6% and 39.0%; other mortality rates were as follows: respiratory failure group, 16.7% and 33.9%; neurologic failure group, 23.2% and 41.1%; heart failure group, 25.0% and 68.8%; severe sepsis group, 38.9% and 58.3%; and miscellaneous admission causes group, 12.1% and 24.2%. Significant differences were found across admission groups for in-ICU (p=0.026) and in-hospital mortality rates (p=0.002). Mortality rates were lowest in the respiratory and miscellaneous groups, and highest in the neurologic, cardiac, and sepsis groups. Flexible Bronchoscopy
The mean time between ICU discharge and hospital discharge or death was 18.3±15.8 days (median, 20 days).
Results of the univariate and multivariate analysis for short-term outcomes in all 354 patients are presented in Table 2. Read the rest of this entry »

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