Search

Introduction: Tramadol/paracetamol combination is one of the most prescribed pain medications in Portugal. At the Regional Health Administration of Lisbon and Tagus Valley, 1 119 229 packages of tramadol/paracetamol were prescribed for 12 months, corresponding to the second most prescribed analgesic. We ask whether this drug is prescribed for acute and irruptive pain or if it is prescribed as a long-term treatment for chronic pain. Methods: This cross-sectional study describes the prescription of tramadol/paracetamol in a Portuguese primary care unit. The population studied corresponds to the 344 patients who received a tramadol/paracetamol prescription between July 2020 and June 2021. Results: In this period, a total of 687 prescriptions were made, corresponding to 2500 packages of tramadol/paracetamol, of which 1874 were bought. There was no statistically significant difference between the number of packages bought over the 4 trimesters (p = 0.275) and 35.3% of the patients bought this medication in more than one trimester. We found that 16.5% bought tramadol/paracetamol in an amount that allows a use of more than 90 days. Conclusion: This demonstrates that the tramadol/paracetamol combination plays a central role in the treatment of pain and that a significant percentage of patients use this medication chronically, questioning the adequacy of this therapy in these patients. However, larger studies that assess pain control are needed to support the results presented in this work.

Background There is still a lack of research on which diabetic drugs are more effective in preventing stroke. Our network metaanalysis aimed to compare cerebrovascular benefits among glucose-lowering treatments. Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry for clinical trials from inception through May 25, 2021. We included both prespecified cerebrovascular outcomes and cerebrovascular events reported as severe adverse events. Subgroup analyses were conducted by stroke subtype, publication type, age of patients, baseline glycosylated hemoglobin (HbA1c), duration of type 2 diabetes mellitus, and cardiovascular risks. Results Of 2,861 reports and 1,779 trials screened, 79 randomized controlled trials comprising 206,387 patients fulfilled the inclusion criteria. In the pairwise meta-analysis, the use of glucagon-like peptide-1 (GLP-1) agonist was associated with a lower risk of total stroke compared with placebo (relative risk [RR], –0.17; 95% confidence interval [CI], –0.27 to –0.07). In the network meta-analysis, only the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitor was associated with a reduction of total stroke, compared with placebo (RR, 0.81; 95% CI, 0.67 to 0.98). In the subgroup analyses, the use of SGLT-2 inhibitor and GLP-1 agonist was associated with a lower risk of stroke in those with high HbA1c (≥8.0) and low-risk of cardiovascular disease, respectively. Conclusion SGLT-2 inhibitors and GLP-1 agonists were shown to be beneficial for stroke prevention in patients with type 2 diabetes mellitus.

Type 2 diabetes (T2D) is a progressive disease in which it is challenging to achieve long-term durable glycemic control. However, intensive glycemic control is crucial for preventing diabetes-related complications. Previous studies showed that monotherapy with a stepwise add-on approach was seldom effective for long-term durable glycemic control. Combination therapy, which refers to the use of two or more drugs to control hyperglycemia, has multiple benefits, including the ability to target a variety of pathophysiological processes underlying hyperglycemia. In clinical trials, initial combination therapy showed better glycemic control than monotherapy or a stepwise approach. Emerging evidence indicates that initial combination therapy is associated with preserved β-cell function and fewer complications in T2D. However, cost-effectiveness and adverse events with combination therapy are issues that should be considered. Therefore, initial combination therapy is an important option for patients with T2D that clinicians should consider with a view toward balancing benefits and potential harms. In this review, we summarize the literature addressing initial combination therapy in T2D, and we suggest optimal strategies based on clinical situations and patient characteristics.

Background To investigate the efficacy and safety of moderate-intensity rosuvastatin/ezetimibe combination compared to highintensity rosuvastatin in high atherosclerotic cardiovascular disease (ASCVD) risk patients with type 2 diabetes mellitus (T2DM). Methods This study was a randomized, multicenter, open, parallel phase 4 study, and enrolled T2DM subjects with an estimated 10-year ASCVD risk ≥7.5%. The primary endpoint was the low-density lipoprotein cholesterol (LDL-C) change rate after 24-week rosuvastatin 10 mg/ezetimibe 10 mg treatment was non-inferior to that of rosuvastatin 20 mg. The achievement proportion of 10-year ASCVD risk

Background This study investigates the long-term efficacy and safety of evogliptin add-on therapy in patients with inadequately controlled type 2 diabetes mellitus (T2DM) previously received dapagliflozin and metformin (DAPA/MET) combination. Methods In this multicenter randomized placebo-controlled phase 3 trial, patients with glycosylated hemoglobin (HbA1c) levels 7.0% to 10.5% (n=283) previously used DAPA 10 mg plus MET (≥1,000 mg) were randomly assigned to the evogliptin 5 mg once daily or placebo group (1:1). The primary endpoint was the difference in the HbA1c level from baseline at week 24, and exploratory endpoints included the efficacy and safety of evogliptin over 52 weeks (trial registration: ClinicalTrials.gov NCT04170998). Results Evogliptin add-on to DAPA/MET therapy was superior in HbA1c reduction compared to placebo at weeks 24 and 52 (least square [LS] mean difference, –0.65% and –0.55%; 95% confidence interval [CI], –0.79 to –0.51 and –0.71 to –0.39; P

Byline: Vishal. Tandon, Sheikh. Ismail, Amarjeet. Singh We hereby describe a rare case of levosulpiride-induced atypical parkinsonism presenting with sluggish movements, atypical kinetic tremors (tremors with voluntary movement), periorbital tremors, [...]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Transcatheter arterial chemoembolization (TACE) is recommended by domestic and international guidelines for the treatment of patients with unresectable hepatocellular carcinoma (uHCC), and it is one of the most common treatment methods for patients with uHCC. The chemotherapy drugs commonly used in TACE for HCC include epirubicin, cisplatin, and fluorouracil, while it is still unclear which chemotherapy drug has a better clinical effect. This article summarizes the studies of different TACE regimens using different chemotherapy drugs in the treatment of patients with uHCC in the recent five years. TACE combined with sorafenib can significantly improve the survival of patients with advanced HCC and has been recommended for the treatment of such patients by Chinese Society of Clinical Oncology guidelines, and the efficacy of TACE combined with other tyrosine kinase inhibitors (TKI) has become a research hotspot. Studies have shown that compared with TACE combined with sorafenib in the treatment of patients with advanced HCC, TACE combined with lenvatinib can achieve a significantly longer progression-free survival time and a tendency of increase in median overall survival time. However, due to the variation of target receptors or downstream signals, resistance to molecular-targeted agents is still a challenging problem. TKI combined with immune checkpoint inhibitors may be a promising strategy for the treatment of patients with uHCC. Some studies suggest that triple therapy using TACE combined with TKIs and anti-PD-1/PD-L1 monoclonal antibody has better efficacy in improving the survival of patients with uHCC. This article reviews the studies of the efficacy and safety of TACE combined with targeted agents and TACE combined with anti-PD-1/PD-L1 monoclonal antibody in the treatment of patients with uHCC in the recent five years. [ABSTRACT FROM AUTHOR]

Objective To observe the efficacy and prognosis of edaravone dexborneol combined with intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of ultra-early acute cerebral infarction (ACI). Methods A total of 163 patients with ultra-early ACI were randomly divided into the combination group (treated with edaravone dexborneol combined with intravenous thrombolysis with rt-PA, n=78) and the control group (treated with intravenous thrombolysis with rt-PA, n=85). Therapeutic effects and changes of superoxide dismutase (SOD), reactive oxygen species (ROS), malondialdehyde (MDA), neuron-specific enolase (NSE), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase-12 (MMP-12), central nervous system-specific protein β (S100β), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), D-dimer (D-D), C-reactive protein (CRP), the National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS) scores and activity of daily living (ADL) scores were observed before and after treatment in the 2 groups. The fatality rate and the incidence of adverse reactions were compared between the two groups. Results After treatment, the total effective rate, SOD level and ADL score were higher in the combination group than those in the control group. Levels of ROS, MDA, NSE, MMP-9 and S100β, NIHSS score and mRS score were lower in the combination group than those in the control group (P＜ 0.05). There were no significant differences in fatality rate and incidence of adverse reactions between the two groups (P＞ 0.05). Conclusion Edaravone dexborneol combined with intravenous thrombolysis with rt-PA can improve the clinical effect in the treatment of patients with ultra-early ACI, and improve the prognosis. [ABSTRACT FROM AUTHOR]