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[PMID]:29194242
[Au] Autor:Hurley TV
[Ad] Endereço:About the Author Teresa V. Hurley, DHEd, MS, RN, is associate professor of nursing, Mount Saint Mary College School of Nursing, Newburgh, New York. For more information, contact her at teresa.hurley@msmc.edu.
[Ti] Título:Experiential Teaching Increases Medication Calculation Accuracy Among Baccalaureate Nursing Students.
[So] Source:Nurs Educ Perspect;38(1):34-36, 2017 Jan/Feb.
[Is] ISSN:1536-5026
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Safe medication administration is an international goal. Calculation errors cause patient harm despite education. The research purpose was to evaluate the effectiveness of an experiential teaching strategy to reduce errors in a sample of 78 baccalaureate nursing students at a Northeastern college. A pretest-posttest design with random assignment into equal-sized groups was used. The experiential strategy was more effective than the traditional method (t = -0.312, df = 37, p = .004, 95% CI) with a reduction in calculation errors. Evaluations of error type and teaching strategies are indicated to facilitate course and program changes.
[Mh] Termos MeSH primário: Cálculos da Dosagem de Medicamento
Bacharelado em Enfermagem/métodos
Erros de Medicação/prevenção & controle
Ensino/tendências
[Mh] Termos MeSH secundário: Adulto
Competência Clínica
Feminino
Seres Humanos
Masculino
Pesquisa em Educação de Enfermagem
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1097/01.NEP.0000000000000097


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[PMID]:27778525
[Au] Autor:Brice AE; Hernandez GA; Sanchez M; Haynick M; Mendoza CE
[Ad] Endereço:a Division of Cardiology, Jackson Memorial Hospital , University of Miami Miller School of Medicine , Miami , FL , USA.
[Ti] Título:In-stent thrombosis when switching ticagrelor to clopidogrel after percutaneous coronary intervention.
[So] Source:Platelets;28(3):305-309, 2017 May.
[Is] ISSN:1369-1635
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.
[Mh] Termos MeSH primário: Adenosina/análogos & derivados
Substituição de Medicamentos/efeitos adversos
Intervenção Coronária Percutânea
Inibidores da Agregação de Plaquetas/uso terapêutico
Antagonistas do Receptor Purinérgico P2Y/uso terapêutico
Trombose/diagnóstico
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Adenosina/uso terapêutico
Plaquetas/efeitos dos fármacos
Plaquetas/metabolismo
Plaquetas/patologia
Esquema de Medicação
Cálculos da Dosagem de Medicamento
Feminino
Seres Humanos
Masculino
Meia-Idade
Ativação Plaquetária/efeitos dos fármacos
Agregação Plaquetária/efeitos dos fármacos
Guias de Prática Clínica como Assunto
Infarto do Miocárdio com Supradesnível do Segmento ST/sangue
Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
Stents
Trombose/etiologia
Trombose/patologia
Ticlopidina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); 0 (Purinergic P2Y Receptor Antagonists); A74586SNO7 (clopidogrel); GLH0314RVC (Ticagrelor); K72T3FS567 (Adenosine); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1080/09537104.2016.1235687


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[PMID]:29320619
[Au] Autor:Dragovic T; Marinkovic D; Kikovic S; Pejovic J; Hajdukovic Z
[Ti] Título:Some specificities in the management of hyperglycemia in patients with diabetic kidney disease.
[So] Source:Vojnosanit Pregl;73(9):857-63, 2016 Sep.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Mh] Termos MeSH primário: Glicemia/efeitos dos fármacos
Diabetes Mellitus/tratamento farmacológico
Nefropatias Diabéticas/terapia
Hipoglicemiantes/administração & dosagem
Diálise Renal
Insuficiência Renal Crônica/terapia
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Glicemia/metabolismo
Diabetes Mellitus/sangue
Diabetes Mellitus/epidemiologia
Nefropatias Diabéticas/sangue
Nefropatias Diabéticas/epidemiologia
Cálculos da Dosagem de Medicamento
Seres Humanos
Hipoglicemia/sangue
Hipoglicemia/induzido quimicamente
Hipoglicemia/prevenção & controle
Hipoglicemiantes/efeitos adversos
Rim/efeitos dos fármacos
Rim/fisiopatologia
Diálise Renal/efeitos adversos
Insuficiência Renal Crônica/sangue
Insuficiência Renal Crônica/epidemiologia
Insuficiência Renal Crônica/fisiopatologia
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Blood Glucose); 0 (Hypoglycemic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150321008D


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[PMID]:29173794
[Au] Autor:Xiong Y; Fukuda T; Knibbe CAJ; Vinks AA
[Ad] Endereço:Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6018, Cincinnati, OH 45229-3039, USA.
[Ti] Título:Drug Dosing in Obese Children: Challenges and Evidence-Based Strategies.
[So] Source:Pediatr Clin North Am;64(6):1417-1438, 2017 Dec.
[Is] ISSN:1557-8240
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With the alarming increase of obesity in children, pediatricians are increasingly being confronted with difficult dosing decisions. Many drug labels do not provide specific dosing instructions for children who are obese. In this article, we describe the physiologic parameters altered by obesity and their influences on drug disposition and effect. We review the principles of allometry, and the key pharmacokinetic parameters that can be used to derive age appropriate dosing regimens. Last, we illustrate how appropriate weight descriptors can be selected, and how important PK parameters can be extrapolated for dosing in obese children when pediatric pharmacokinetic information is available.
[Mh] Termos MeSH primário: Cálculos da Dosagem de Medicamento
Obesidade Pediátrica/tratamento farmacológico
[Mh] Termos MeSH secundário: Peso Corporal
Criança
Relação Dose-Resposta a Droga
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29173792
[Au] Autor:Puia-Dumitrescu M; Smith PB
[Ad] Endereço:Department of Pediatrics, Division of Neonatal Medicine, Duke University Medical Center, 2424 Erwin Road, Suite 504, Durham, NC 27705, USA; Department of Pediatrics, Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA.
[Ti] Título:Antifungal Drugs in Newborns and Children.
[So] Source:Pediatr Clin North Am;64(6):1389-1402, 2017 Dec.
[Is] ISSN:1557-8240
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Invasive fungal infections are a significant cause of morbidity and mortality in infants and children. Early diagnosis is critical, and treatment with the appropriate drug and dose should be initiated promptly. Although an increasing number of studies have examined dosing of antifungals in this population, pediatric safety and efficacy data are lacking.
[Mh] Termos MeSH primário: Antifúngicos/uso terapêutico
Micoses/tratamento farmacológico
[Mh] Termos MeSH secundário: Antifúngicos/efeitos adversos
Criança
Cálculos da Dosagem de Medicamento
Seres Humanos
Lactente
Recém-Nascido
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antifungal Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29059432
[Au] Autor:Goldstein DA; Gordon N; Davidescu M; Leshno M; Steuer CE; Patel N; Stemmer SM; Zer A
[Ad] Endereço:Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel; Winship Cancer Institute, Emory University, Atlanta, GA; Ben Gurion University of the Negev, Beer Sheva, Israel; Clalit Health Services Headquarters, Tel Aviv, Israel; Sackler Faculty of Medicine and Faculty of Management, Tel Aviv
[Ti] Título:A Phamacoeconomic Analysis of Personalized Dosing vs Fixed Dosing of Pembrolizumab in Firstline PD-L1-Positive Non-Small Cell Lung Cancer.
[So] Source:J Natl Cancer Inst;109(11), 2017 Nov 01.
[Is] ISSN:1460-2105
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: In October 2016, pembrolizumab became the new standard of care for firstline treatment of patients with metastatic non-small cell lung cancer (mNSCLC) whose tumors express programmed death ligand 1 in at least 50% of cells. The US Food and Drug Administration-recommended dose is 200 mg every three weeks. Multiple studies have demonstrated equivalent efficacy with weight-based doses between 2 mg/kg and 10 mg/kg. The objective of this study was to compare the economic impact of using personalized dosing (2 mg/kg) vs fixed dosing (200 mg) in the firstline setting of mNSCLC. Methods: We performed a budget impact analysis from the US societal perspective to compare fixed dosing with personalized dosing. We calculated the target population and weight of patients who would be treated with pembrolizumab annually in the firstline setting. Using survival curves from the KEYNOTE 024 trial with Weibull extrapolation, we estimated the mean number of cycles that patients would receive. Using the Medicare average sales price, we calculated the difference in cost between personalized and fixed dosing. Results: Our base case model demonstrates that the total annual cost of pembrolizumab with fixed dosing is US $3 440 127 429, and with personalized dosing it is US $2 614 496 846. The use of personalized dosing would lead to a 24.0% annual savings of US $825 630 583 in the United States. Conclusions: Personalized dosing of pembrolizumab may have the potential to save approximately $0.825 billion annually in the United States, likely without impacting outcomes. This option should be considered for the firstline management of PD-L1-positive advanced lung cancer.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/administração & dosagem
Anticorpos Monoclonais Humanizados/economia
Antineoplásicos/administração & dosagem
Antineoplásicos/economia
Antígeno B7-H1/metabolismo
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico
Neoplasias Pulmonares/tratamento farmacológico
[Mh] Termos MeSH secundário: Peso Corporal
Orçamentos
Carcinoma Pulmonar de Células não Pequenas/metabolismo
Carcinoma Pulmonar de Células não Pequenas/mortalidade
Carcinoma Pulmonar de Células não Pequenas/secundário
Intervalo Livre de Doença
Custos de Medicamentos
Cálculos da Dosagem de Medicamento
Seres Humanos
Neoplasias Pulmonares/metabolismo
Neoplasias Pulmonares/mortalidade
Neoplasias Pulmonares/patologia
Método de Monte Carlo
Medicina de Precisão/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Antineoplastic Agents); 0 (B7-H1 Antigen); DPT0O3T46P (pembrolizumab)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171024
[St] Status:MEDLINE
[do] DOI:10.1093/jnci/djx063


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[PMID]:29049110
[Au] Autor:Zhu A; Benzon HA; Anderson TA
[Ad] Endereço:From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and †Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations: A Systematic Review.
[So] Source:Anesth Analg;125(5):1569-1587, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:While a large number of studies has examined the efficacy of opioid-sparing analgesics in adult surgical populations, fewer studies are available to guide postoperative pain treatment in pediatric patients. We systematically reviewed available publications on the use of systemic nonopioid agents for postoperative analgesia in pediatric surgical populations. A comprehensive literature search identified meta-analyses and randomized controlled trials (RCTs) assessing the effects of systemic, nonopioid agents on postoperative narcotic requirements or pain scores in pediatric surgical populations. If a meta-analysis was located, we summarized its results and any RCTs published after it. We located and reviewed 11 acetaminophen RCTs, 1 nonsteroidal anti-inflammatory drug (NSAID) meta-analysis, 2 NSAID RCTs, 1 dexamethasone meta-analysis, 3 dexamethasone RCTs, 2 ketamine meta-analyses, 5 ketamine RCTs, 2 gabapentin RCTs, 1 clonidine meta-analysis, 3 magnesium RCTs, 2 dexmedetomidine meta-analyses, and 1 dextromethorphan RCT. No meta-analyses or RCTs were found assessing the perioperative efficacy of intravenous lidocaine, amantadine, pregabalin, esmolol, or caffeine in pediatric surgical patients. The available evidence is limited, but suggests that perioperative acetaminophen, NSAIDs, dexamethasone, ketamine, clonidine, and dexmedetomidine may decrease postoperative pain and opioid consumption in some pediatric surgical populations. Not enough, or no, data exist from which to draw conclusions on the perioperative use of gabapentin, magnesium, dextromethorphan, lidocaine, amantadine, pregabalin, esmolol, and caffeine in pediatric surgical patients. Further pharmacokinetic and pharmacodynamics studies to establish both the clinical benefit and efficacy of nonopioid analgesia in pediatric populations are needed.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Analgésicos/administração & dosagem
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Analgésicos/efeitos adversos
Analgésicos Opioides/efeitos adversos
Criança
Pré-Escolar
Esquema de Medicação
Cálculos da Dosagem de Medicamento
Medicina Baseada em Evidências
Seres Humanos
Lactente
Recém-Nascido
Metanálise como Assunto
Medição da Dor
Dor Pós-Operatória/diagnóstico
Dor Pós-Operatória/etiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002434


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[PMID]:29038104
[Au] Autor:Cho JH; Youn SJ; Moore JC; Kyriakakis R; Vekstein C; Militello M; Poe SM; Wolski K; Tchou PJ; Varma N; Niebauer MJ; Bhargava M; Saliba WI; Wazni OM; Lindsay BD; Wilkoff BL; Chung MK
[Ad] Endereço:From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH. Current address for Dr Cho: Cedars-Sinai Heart Institute, Los Angeles, CA. Current address for Dr Youn: Department of Internal Medicine, Cleveland Clinic, OH. Current address for Dr Moore: Minneapolis
[Ti] Título:Safety of Oral Dofetilide Reloading for Treatment of Atrial Arrhythmias.
[So] Source:Circ Arrhythm Electrophysiol;10(10), 2017 Oct.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although dofetilide labeling states that the drug must be initiated or reinitiated with continuous electrocardiographic monitoring and in the presence of trained personnel, the risks of dofetilide reloading justifying repeat hospitalization have not been investigated. METHODS AND RESULTS: Patients admitted for dofetilide reloading for atrial arrhythmias were retrospectively reviewed. The need for dose adjustment and the incidence of torsades de pointes (TdP) were identified. The incidence of TdP in dofetilide reloading was compared with patients admitted for dofetilide initial loading. Of 138 patients admitted for dofetilide reloading for atrial arrhythmias, 102 were reloaded at a previously tolerated dose, 30 with a higher dose from a previously tolerated dose and 2 at a lower dose; prior dosage was unknown in 4 patients. Dose adjustment or discontinuation was required in 44 patients (31.9%). No TdP occurred in the same dose reloading group, but TdP occurred in 2 patients admitted to increase dofetilide dosage (0% versus 6.7%; =0.050). Dofetilide dose adjustment or discontinuation was required in 30 of 102 patients (29.4%) reloaded at a previously tolerated dose and in 11 of 30 patients (36.7%) admitted for an increase in dose. CONCLUSIONS: Although no TdP occurred in patients admitted to reload dofetilide at the same dose as previously tolerated, dosage adjustments or discontinuation was frequent and support the need for hospitalization for dofetilide reloading. Patients admitted for reloading with a higher dose tended to be at higher risk for TdP than patients reloaded at a prior tolerated dose.
[Mh] Termos MeSH primário: Antiarrítmicos/administração & dosagem
Arritmias Cardíacas/tratamento farmacológico
Frequência Cardíaca/efeitos dos fármacos
Fenetilaminas/administração & dosagem
Sulfonamidas/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Antiarrítmicos/efeitos adversos
Arritmias Cardíacas/diagnóstico
Arritmias Cardíacas/fisiopatologia
Esquema de Medicação
Cálculos da Dosagem de Medicamento
Eletrocardiografia Ambulatorial
Feminino
Átrios do Coração/efeitos dos fármacos
Átrios do Coração/fisiopatologia
Seres Humanos
Masculino
Registros Médicos
Meia-Idade
Admissão do Paciente
Fenetilaminas/efeitos adversos
Valor Preditivo dos Testes
Estudos Retrospectivos
Fatores de Risco
Sulfonamidas/efeitos adversos
Fatores de Tempo
Torsades de Pointes/induzido quimicamente
Torsades de Pointes/diagnóstico
Torsades de Pointes/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Arrhythmia Agents); 0 (Phenethylamines); 0 (Sulfonamides); R4Z9X1N2ND (dofetilide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171115
[Lr] Data última revisão:
171115
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171018
[St] Status:MEDLINE


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[PMID]:29016653
[Au] Autor:Anderson-Berry A; Thoene M; Wagner J; Lyden E; Jones G; Kaufmann M; Van Ormer M; Hanson C
[Ad] Endereço:Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
[Ti] Título:Randomized trial of two doses of vitamin D3 in preterm infants <32 weeks: Dose impact on achieving desired serum 25(OH)D3 in a NICU population.
[So] Source:PLoS One;12(10):e0185950, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recommendations for vitamin D supplementation for preterm infants span a wide range of doses. Response to vitamin D supplementation and impact on outcomes in preterm infants is not well understood. OBJECTIVE: Evaluate serum 25(OH)D3 concentration changes after 4 weeks in response to two different doses of vitamin D3 supplementation in a population of premature infants and quantify the impact on NICU outcomes. DESIGN: 32 infants born at 24-32 weeks gestation were prospectively randomized to receive 400 or 800 IU/day vitamin D3 supplementation. Serum 25(OH)D3 levels were measured every 4 weeks. The Wilcoxon signed rank test was used to compare serum levels of 25(OH)D3 at 4 weeks and each subsequent time point. A p-value of <0.05 was considered statistically significant. RESULTS: Serum 25(OH)D3 levels at birth were 41.9 and 42.9 nmol/l for infants in the 400 IU group and 800 IU group, respectively (p = 0.86). Cord 25(OH)D3 concentrations significantly correlated with gestational age (r = 0.40, p = 0.04). After 4 weeks of D3 supplementation, median 25(OH)D3 levels increased in both groups (84.6vs. 105.3 nmol/l for 400 vs. 800 IU/day respectively, with significantly more improvement in the higher dose (p = 0.048). Infants in the 400 IU group were significantly more likely to have dual energy x-ray absorptiometry (DEXA) bone density measurements <10 percentile (56% vs 16%, p = 0.04). CONCLUSIONS: Improvement in 25(OH)D3 levels at 4 weeks, bone density, and trends towards improvement in linear growth support consideration of a daily dose of 800 IU of vitamin D for infants <32 weeks cared for in the NICU.
[Mh] Termos MeSH primário: Densidade Óssea/efeitos dos fármacos
Calcifediol/administração & dosagem
Calcifediol/sangue
Suplementos Nutricionais
[Mh] Termos MeSH secundário: Absorciometria de Fóton
Calcifediol/farmacocinética
Criança
Esquema de Medicação
Cálculos da Dosagem de Medicamento
Feminino
Seres Humanos
Lactente
Recém-Nascido
Recém-Nascido Prematuro
Unidades de Terapia Intensiva Neonatal
Masculino
Gravidez
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
P6YZ13C99Q (Calcifediol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185950


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[PMID]:28938465
[Au] Autor:Janssen JAMJL; Llauradó G; Varewijck AJ; Groop PH; Forsblom C; Fernández-Veledo S; van den Dungen ESR; Vendrell J; Hofland LJ; Yki-Järvinen H
[Ad] Endereço:Department of Internal Medicine, Division of Endocrinology, Erasmus MC, 3015 CE Rotterdam, The Netherlands.
[Ti] Título:Serum Insulin Bioassay Reflects Insulin Sensitivity and Requirements in Type 1 Diabetes.
[So] Source:J Clin Endocrinol Metab;102(10):3814-3821, 2017 Oct 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Insulin resistance could increase insulin requirements in type 1 diabetes (T1D). Current insulin immunoassays do not detect insulin analogs. Kinase insulin receptor (IR) activation (KIRA) bioassays specific for human IR isoforms A (IR-A) and B (IR-B) permit assessment of all circulating insulin bioactivity. We studied whether IR-A and IR-B KIRA assays are related to direct measures of insulin sensitivity or insulin doses in T1D. Design: We evaluated 31 adult patients with T1D (age 45.7 ± 1.6 years, body mass index 28.8 ± 0.7 kg/m2). Serum IR-A and IR-B bioactivities were measured by KIRA bioassays. Insulin sensitivity of glucose production (Ra) was measured by the euglycemic hyperinsulinemic clamp technique in which a low insulin dose (0.4 mU/kg/min for 240 minutes) was combined with D-[3-3H] glucose infusion to measure rates of Ra and utilization and insulin action on antilipolysis from suppression of serum free fatty acids. Results: Baseline circulating IR-A bioactivity was 53 ± 7 pmol/L, and IR-B bioactivity was 81 ± 11 pmol/L. Compared with baseline, insulin infusion significantly increased IR-A (P < 0.001) and IR-B (P < 0.001) bioactivities. Fasting IR-A and IR-B bioactivities were positively related to endogenous Ra (r = 0.44, P = 0.01 and r = 0.38, P < 0.05). Fasting IR-A (r = 0.43, P = 0.02) and IR-B (r = 0.47, P = 0.01) bioactivities were significantly correlated with insulin requirements and glycosylated hemoglobin (IR-A: r = 0.52, P = 0.002; IR-B: r = 0.48, P = 0.006). Conclusions: Circulating IR-A and IR-B bioactivities are associated with insulin resistance, high insulin requirements, and poor glycemic control in T1D. Measurement of IR bioactivity by KIRA assays provides a tool to assess the amount of biologically active insulin in groups of T1D patients treated with insulin analogs.
[Mh] Termos MeSH primário: Bioensaio/métodos
Análise Química do Sangue/métodos
Diabetes Mellitus Tipo 1/tratamento farmacológico
Hipoglicemiantes/administração & dosagem
Resistência à Insulina
Insulina/administração & dosagem
Insulina/sangue
[Mh] Termos MeSH secundário: Adulto
Glicemia/efeitos dos fármacos
Glicemia/metabolismo
Diabetes Mellitus Tipo 1/sangue
Cálculos da Dosagem de Medicamento
Feminino
Técnica Clamp de Glucose
Hemoglobina A Glicada/análise
Seres Humanos
Insulina/análise
Lipólise/efeitos dos fármacos
Masculino
Meia-Idade
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents); 0 (Insulin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2017-00892



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