Female sexual function has been shown to improve with overactive bladder (OAB) treatment.
The objective of this study was to evaluate the effects of anticholinergics (ACHs) or a beta-agonist (BAG) on ...female sexual function.
This was a prospective multicenter cohort study. Sexually active women with OAB completed the Overactive Bladder questionnaire (OAB-q) and Female Sexual Function Index (FSFI) prior to and after 12 weeks of therapy. Sample sizes of 63 per group were calculated to detect a clinically relevant difference in the FSFI.
The primary outcome was FSFI change from baseline at 12 weeks.
A total of 157 patients were recruited, and 91 completed follow-up (58/108, ACH; 31/49, BAG). There were within-group FSFI differences from pre- to posttreatment: a worsening of arousal in the ACH group (
= .046) and an improvement in overall FSFI (
= .04) and pain (
= .04) in the BAG group. After treatment, postmenopausal women in the BAG group had significantly better overall FSFI (
= .01), desire (
= .003), arousal (
= .009), and orgasm (
= .01).
While further research is necessary, this study provides information about the comparative effects of OAB treatments on female sexual function, which may ultimately lead to better patient selection and outcomes.
While there was no difference between the subjects who completed the study and those who did not, the study remained underpowered after the loss to follow-up. The multicenter cohort design allows for generalizability of results.
Although this study was underpowered, an improvement in overall sexual function was seen with BAGs, while ACHs were associated with worsening aspects of sexual function.
Large-scale randomised controlled trials (RCTs) have demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers decrease mortality and hospitalisation ...in patients with heart failure (HF) associated with a reduced left ventricular ejection fraction. This has led to high prescription rates; however, these drugs are generally prescribed at much lower doses than the doses achieved in the RCTs. A number of strategies have been evaluated to improve medication titration in HF, including forced medication up-titration protocols, point-of-care decision support and extended scope of clinical practice for nurses and pharmacists. Most successful strategies have been multifaceted and have adapted existing multidisciplinary models of care. Furthermore, given the central role of general practitioners in long-term monitoring and care coordination in HF patients, these strategies should engage with primary care to facilitate the transition between the acute and primary healthcare sectors.
Medications that affect the renin-angiotensin-aldosterone system (RAAS) form the mainstay of current heart failure (HF) therapy in patients with reduced ejection fraction. Concerns about the risk of ...hyperkalaemia have created a significant barrier to optimal RAAS inhibitor therapy in patients with HF, however, and many patients are discontinuing or receiving suboptimal doses of these lifesaving therapies. This has serious health and economic implications due to adverse renal and cardiovascular events. There is therefore an important unmet need for novel therapeutic options for the long-term management of patients with, and at risk for, hyperkalaemia. Two new potassium-binding agents, patiromer and ZS-9, have been shown to be effective and safe for the treatment of hyperkalaemia, as well as the maintenance of normokalaemia, without dose reduction or discontinuation of RAAS inhibitors. In addition, the fast onset of ZS-9 action suggests that it may be useful in the treatment of acute hyperkalaemia. These agents may allow for dose optimisation of RAAS inhibitors for the long-term maintenance and protection of the renal and cardiovascular system.
Despite the availability of new drugs and devices, the treatment of cardiovascular disease remains suboptimal. Single-pill combination therapy offers a number of potential advantages. It can combine ...different classes of drugs to increase efficacy while mitigating the risks of treatment-related adverse events, reduce pill burden, lower medical cost, and improve patient adherence. Furthermore, in hypertension, single pill combinations include standard to lower doses of each drug than would be necessary to achieve goals with monotherapy, which may explain their better tolerability compared with higher dose monotherapy. Combination therapy is now established in the treatment of hypertension. In ischaemic heart disease, the concept of a preventative polypill has been studied, but its benefits have not been established conclusively. However, the combination of ivabradine and beta-blockers has proven efficacy in patients with stable angina pectoris. This combination has also demonstrated benefits in patients with chronic heart failure.
Neurohormonal Blockade in Heart Failure von Lueder, Thomas G; Kotecha, Dipak; Atar, Dan ...
Cardiac failure review,
04/2017, Letnik:
3, Številka:
1
Journal Article
Recenzirano
Odprti dostop
A key feature of chronic heart failure (HF) is the sustained activation of endogenous neurohormonal systems in response to impaired cardiac pumping and/or filling properties. The clinical use of ...neurohormonal blockers has revolutionised the care of HF patients over the past three decades. Drug therapy that is active against imbalance in both the autonomic and renin-angiotensin-aldosterone systems consistently reduces morbidity and mortality in chronic HF with reduced left ventricular ejection fraction and in sinus rhythm. This article provides an assessment of the major neurohormonal systems and their therapeutic blockade in patients with chronic HF.
INTRODUCTIONDepression impacts many individuals with autism spectrum disorder (ASD), carrying increased risk of functional impairment, hospitalization, and suicide. Prescribing medication to target ...depression in patients with ASD occurs despite limited available systematic data describing medication management of depression in this population. PURPOSEThe purpose of this study is to discover prescribing patterns for individuals with MDD and ASD during this time period (2004-2012) to inform current and future prescribing practices with historical data. METHODDrawing from a large clinical database describing the prescribing practices in patients with ASD, we identified 166 individuals with ASD (mean age 14.5 ± 8.3 years old) who received medication targeting symptoms of depression. We report prescribing rates for specific drugs, drug treatment duration, and reasons for drug discontinuation when applicable. RESULTSSertraline, mirtazapine, and fluoxetine were the three most commonly prescribed medications to treat comorbid depression for this patient population. Among 241 drug starts, 123 (49%) drug treatments were continued at the final reviewed follow-up visit (average treatment duration of ± 0.72 years). The most common reason for discontinuation across all medications prescribed was loss of or lack of effectiveness. CONCLUSIONThis study raises concern that standard of care pharmacological treatments for depression in individuals with ASD may be less effective than in neurotypical populations. There remains a need to develop effective interventions for depression specifically tailored to the needs of individuals with ASD.
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Syarifah Ambami Rato Ebu General Hospital, Bangkalan, East Java, Indonesia
Background
The use of ...unfractionated heparin (UFH) has been renowned to reduce mortality in COVID-19. There are no data about the efficacy and safety of fondaparinux (FPX) in COVID-19.
Purpose
To evaluate the efficacy and safety of FPX as compared to UFH in patients hospitalised with severe COVID-19 and coagulopathy.
Methods
This was a single-center, open-label, equally randomised, parallel-group study conducted between April 1st and July 15th, 2021. Eligible and consenting patients were randomly assigned (1:1 ratio) to receive either FPX or UFH, in prophylactic and therapeutic dose. The primary efficacy endpoint was 28-day all-cause mortality; and secondary efficacy endpoints were episode of acute myocardial infarction (MI), objectively confirmed venous (VTE) or arterial thromboembolism (ATE), progression to non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), progression to ARDS, sepsis, acute kidney injury (AKI) and acute lung oedema (ALO). The primary safety endpoint was major bleeding (MB); and secondary safety endpoint was clinically relevant non-major bleeding (CRNMB). All composite endpoints were analysed on a 28-day intention-to-treat basis. All patients received guideline-driven therapy throughout the study.
Results
During allocated period, 250 (71%) of 352 patients were eligible and were assigned to either FPX or UFH group. The baseline characteristics were well-matched between the two groups (all p > 0.05). FPX compared with UFH revealed no significant difference in 28-day all-cause mortality (35.2% vs. 39.2%, hazard ratio HR 0.88, p = 0.59). FPX exhibited no significant difference in the trend of thromboembolic events i.e. acute MI (16.8% vs. 16.8%, HR 0.78, p = 0.53); VTE (2.4% vs. 3.2%, HR 0.49, p = 0.42); and ATE (1.6% vs. 1.6%, HR 0.94, p = 0.95) compared to UFH. Among those not on NIV or IMV at randomisation, FPX showed no significant difference in the proportion of patients meeting the composite endpoint of progression to NIV/IMV (33.6% vs. 35.2%, HR 0.91, p = 0.74) or ARDS (25.6% vs. 24.8%, HR 0.91, p = 0.77). FPX group demonstrated no significant difference in the progression to septic shock (24% vs. 24.8%, HR 0.97, p = 0.92), AKI (19.2% vs. 16%, HR 1.01, p = 0.98), and ALO (10.4% vs. 12%, HR 1.19, p = 0.79) than UFH. Allocation to FPX had no significant effect on the proportion of patients discharged from hospital within 28 days (64% vs. 59.2%, HR 0.72, p = 0.43). Regarding safety, there was no significant difference between FPX and UFH group in terms of major bleeding (1.6% vs. 1.6%, HR 0.88, p = 0.88) or CRNMB (8% vs. 8.8%, HR 0.74, p = 0.53) at 28 days. Our prespecified sub-analysis comparing patients who received the respective therapeutic or prophylactic dose revealed that the efficacy and safety outcomes at 28 days did not differ between the FPX and UFH group (all p > 0.05).
Conclusion
In patients hospitalised with severe COVID-19 and coagulopathy, FPX was associated with similar efficacy and safety as compared to UFH. Abstract Figure. Baseline characteristics of study groups Abstract Figure. Allocation of FPX on composite endpoints
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To evaluate the efficacy and safety of single combined (long‐ or short‐acting beta₂ agonist plus an inhaled ...corticosteroid (ICS)) inhaler only used as needed in people with mild asthma.
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