OBJECTIVESEvaluation of the effectiveness of home care through a telemonitoring system in reducing the incidence of new colonization by Pseudomonas Aeruginosa in a population of patients with Cystic ...Fibrosis (CF) followed by the CF clinic of the Bambino Gesù Hospital in Rome over a period of 36 months. MATERIALS AND METHODSTwo groups of patients were recruited, homogeneous for age, sex, BMI, FEV1, prevalence of CF-related Diabetes and CF-related Hepatopathy, access to new therapies with modulators: a) an IN group (N = 44 ) followed through a home telemonitoring system, b) an OUT control group (N = 110) followed according to the standards of care. The following parameters were detected for all patients: pulmonary colonization of the lungs, number and type of hospital admissions, respiratory function, BMI. RESULTThe OUT group had a statistically significant increase in the prevalence of Pseudomonas Aeruginosa infections during the observation period. Furthermore, a significant decrease in lung function assessed through FEV1 was also observed in the OUT group. CONCLUSIONAdolescent and adult patients belonging to the CF center who are not followed through the dedicated home telemonitoring service show, in the three-year period 2017-19, an increase in Pseudomonas Aeruginosa infections and a greater decrease in respiratory function. The use of telemedicine in CF is therefore an effective system not only in monitoring the disease but also as a treatment strategy, in the context of an evolving multidisciplinary model. As advantages, telemedicine can reduce the number of Pseudomonas Aeruginosa lung infections and the greater stability of respiratory function over time.
What is known and objective
Immunosuppression is the main goal in the treatment of autoimmune diseases, chronic inflammatory diseases, and solid organ and tissue transplantation. However, due to a ...lack of liquid‐form medications, it is challenging to achieve adequate immunosuppression when the patient is using enteral feeding tubes. It is necessary to transform solid oral medications into other forms for administration. Besides that, the occupational risk should be considered, and safety‐handling measures should be taken. This review aimed to investigate the available evidence regarding the use of immunosuppressive drugs through enteral feeding tubes, focusing on the administration technique, efficacy and treatment safety.
Methods
We performed an integrative review using the databases PubMed, LILACS, SciELO, Cochrane and Google Scholar, including papers published between 1997 and 2017 in Portuguese, English and Spanish. We excluded editorials, theoretical reflections, s presented at events, dissertations, theses, monographs and studies with extemporaneous formulations administered only by the oral route. In addition, we investigated the references of the included papers, as well as pharmaceutical guides, books and package inserts of selected drugs for additional evidence. Information and recommendations found were analysed and classified according to the GRADE system.
Results and discussion
Fifty papers were identified, and 14 met the selection criteria. Among the assessed immunosuppressive drugs, we observed that tacrolimus, mycophenolic acid derivatives and azathioprine were the most studied, and they have more guided recommendations regarding their use through enteral feeding tubes. We noted the need for personal protective equipment for the conversion of the solid oral dosage forms, along with special caution during administration, due to occupational hazard. Other important factors identified were the position of the tube and interactions with the enteral nutrition, because they may compromise absorption, bioavailability and serum blood levels of immunosuppressive agents. However, the studies found have methodological limitations and poor quality, and this was taken into consideration during the classification of the evidence.
What is new and conclusion
The lack of information about the administration of immunosuppressive drugs through enteral feeding tubes should not be a limiting factor, considering the need for treatment of patients in these circumstances. Risks and benefits must be carefully analysed, and factors regarding compounding and administration through the enteral tube must be considered before beginning treatment. Hence, more primary studies are necessary for better fundamental clinical management.
We review 20 years in 5 online databases and 3 languages on the use of immunosuppressives through enteral feeding tubes and ranked the evidence found according to the GRADE system. Only mycophenolate sodium has restriction reports through this route. Tacrolimus, everolimus, mycophenolate mofetil and azathioprine serum levels and adverse effects should be monitored.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
This study describes an electroanalytical approach for the quantification of ofloxacin (OFL) through an electrochemical sensor based on a glassy carbon electrode modified with composite material (Zn
...2
SnO
4
-rGO/GCE) using square wave voltammetry. Zn
2
SnO
4
was synthesized by hydrothermal treatment and characterized by X-ray diffraction, Fourier-transform infrared and Raman spectroscopy and scanning electron microscopy. The analysis suggests a synergistic effect between the composite material, indicating irreversible oxidation of OFL in its protonated form (OFL
+
), involving two electrons. The electroanalytical methodology was successfully applied to determine OFL in ophthalmic solutions samples, achieving recovery rates ranging from 98.03% to 104.91%. Furthermore, it demonstrated high stability in both repeatability (RSD = 3.20%, n = 12) and reproducibility (RSD = 4.64%, n = 7), with no observed interference when additional substances were added. These results suggest the potential electroanalytical application of Zn
2
SnO
4
and recommend the developed methodology as an alternative tool for OFL determination in commercial pharmaceutical samples.
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