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Background and Purpose: We found patients with unknown onset stroke with positive 90-day outcomes after THAWS' low-dose thrombolysis showed promising 90-day outcomes. Patients with stroke requiring inversion recovery on a time last-known-well > 4. 5 hours who revealed a mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery were randomly assigned either alteplase at 0. 6 mg/kg intravenously or standard medical therapy. Patients with DWI-ASPECTS 5 to 8 were more prevalent in the alteplase group than in the control group, although not in patients with DWI-ASPECTS 9 to 10. In any dichotomized patients, the incidence of any intracranial hemorrhage did not differ significantly between the two treatment groups. Patients with unknown onset strokes with DWI-ASPECTS 5 to 8 had more frequent outcomes after low-dose thrombolysis than after standard therapy.
Source link: https://doi.org/10.1161/strokeaha.120.030848
Background: The optimal dose of efavirenz for HIV-infected patients receiving a tuberculosis therapy containing rifampicin is uncertain, particularly for overweight subjects over the age of 50 kilograms. We measured plasma efavirenz concentrations from Cambodian adults with tuberculosis in the CAMELIA controlled trial six weeks after the introduction of antiretroviral therapy. Plasma efavirenz concentrations were elevated in the 332 patients who weighed 50 kg compared to the 150 who weighed 50 kg. However, the percentage of patients with efavirenz concentrations below 1,000 ng/ml was not different between those who weighed less than or more than 50 kg and those with a body mass over 50 kg was not affected by a higher risk of plasma efavirenz concentrations below 1,000 ng/ml.
Source link: https://doi.org/10.3851/imp2483
Meloxicam was administered intravenously, intramuscularly, and orally to eight healthy adult nurse sharks intravenously, intramuscularly, and orally, with a minimum 4-week washout period between administrations. After the IM administration, Meloxicam orally did not produce detectable concentrations in blood plasma, though mean peak plasma concentration was 0. 38 0. 08 g/ml. According to IV and IM injections, the mean terminal half-life was 10. 71 2. 77 h and 11. 27 3. 96 h for IV and IM injections. Meloxicam-infused IM had a mean absolute bioavailability of 52. 2 13. 29%. These results support meloxicam's use in nursehounds, raise dosage regimens, and show the need for further PK studies in sharks and rays.
Source link: https://doi.org/10.3389/fvets.2022.845555
The authors had previously reported that intravenous administration of midazolam before surgery reduced the risk of emergence agitation in children with sevoflurane anesthesia but the emergence time took longer. This research was intended to prove the possibility that a lower midazolam dose could reduce emergence agitation with minimal disruption of the emergence time in children with sevoflurane anesthesia. In patients receiving 0. 03 mg/kg of midazolam and patients receiving 0. 05 mg/kg of midazolam, relative to that in patients given saline compared to those in patients receiving saline. Compared to those in patients receiving 0. 05 mg/kg of midazolam or saline, the outbreak time in patients receiving 0. 05 mg/kg of midazolam was longer in patients receiving 0. 05 mg/kg of midazolam. Summary: Intravenous administration of 0. 03 mg/kg of midazolam right before surgery reduces emergence agitation while delaying the onset of fever in children undergoing strabismus surgery with sevoflurane anesthesia.
Source link: https://doi.org/10.1097/aln.0000000000000181
In Japanese stroke guidelines in March 2019, IV alteplase at 0. 6 mg/kg for acute wake-up and vague onset strokes was suggested. Methods: This is a multicenter observational research, enrolling acute ischemic stroke patients in a time of last-known-well > 4. 5 h who have a mismatch between DWI and FLAIR treated with intravenous alteplase. Any vessel occlusion in 52 patients was found in 42 patients. At wake-up time, 40 patients identified stroke signs at wake-up time, and the average time between last-known-well and admission was 6. 5 h. The change in the Northern IrelandHSS was -5. 18. 1. Two patients had symptomatic ICH within 36 hours. Conclusions: IV alteplase for wake-up and vague onset stroke patients with DWI-FLAIR mismatch seemed to be safe and effective in clinical practice, compared to previous randomized control trials. Mechanical thrombectomy can be combined with alteplase safely and effectively, with mechanical thrombectomy.
Source link: https://doi.org/10.1161/str.52.suppl_1.mp6
Background and Purpose—We investigated whether lower-dose alteplase at 0. 6 mg/kg is safe and healthy for acute fluid-attenuated inversion recovery-negative strokes with unknown date of onset. Patients met the standard indication criteria for intravenous thrombolysis other than a time when the last known-well > 4. 5 hours was established. Patients were randomly assigned to receive alteplase at 0. 6 mg/kg or standard medical therapy if magnetic resonance imaging revealed acute ischemic lesion on diffusion-weighted imaging but no such hyperintensity on fluid-attenuated inversion recovery. The favorable result was comparable between the alteplase group and the control group. In 1/71 and 0/60, respectively, there was a patternic intracranial hemorrhage within 22 to 36 hours. Conclusions: No difference was seen between alteplase and control groups in patients with ischemic stroke in patients with unknown time of onset. The safety of alteplase at 0. 6 mg/kg was similar to that of regular therapy.
Source link: https://doi.org/10.1161/strokeaha.119.028127
Background and Purpose: A 90-gram intravenous alteplase for acute ischemic stroke has a maximum dose limit of 90 mg. Hence, patients over 100 kg body weight receive a reduced per-kilogram dose relative to those 100 kg. Methods— More than 27 910 patients enrolled in the Safe Implementation of Medication in Stroke—International Stroke Thrombolysis Register weighed 1190 weighed > 100 kg. After adjustment for baseline measurements, there was no difference between major neurological change or functional independence between > 100 kg and 100 kg, but > 100 kg patients had a higher risk ratio for symptomatic intracerebral hemorrhage and mortality, but > 100 kg patients had a higher risk ratio for symptomatic intracerebral hemorrhage and mortality. Despite the lower per-kilogram recombinant tissue plasminogen activator dose, there was a higher risk of symptomatic intracerebral hemorrhage in patients over 100 kg.
Source link: https://doi.org/10.1161/strokeaha.110.603514
Objective and Objectives: The purpose of this research was to determine more accurately the safety of 0. 6 mg/kg intravenous alteplase in patients with middle cerebral artery occlusion in a postmarketing Phase IV trial of prospective cohort study design. Methods— Alteplase was administered intravenously at 0. 6 mg/kg to patients with ischemic stroke within 3 hours of onset of MR angiography-documented middle cerebral artery occlusion within 3 hours of onset. Based on the updated Mori classification, vascular outcomes were monitored by MR angiography at 6 and 24 hours after symptom onset. Recanalization of 6-hour or 24-hour MR angiography in logistic regression models was an independent predictor of clinical outcome as well as the baseline National Institutes of Health Stroke Scale score. — Early recanalization of an occluded middle cerebral artery can be triggered by 0. 6 mg/kg intravenous alteplase, causing a positive clinical result.
Source link: https://doi.org/10.1161/strokeaha.109.573477
The aim of the Japan Post-Marketing Alteplase Registration Study, which was requested by MHLW at the time of approval, was to determine the safety and effectiveness of 0. 6 mg/kg alteplase in regular clinical usage for the Japanese. About — The proportion of patients with symptomsatic intracranial hemorrhage in 7492 patients was 4. 3 percent within 36 hours and 4. 4% at 3 months. The overall mortality rate was 13. 1%, with a 9. 9% hazard of patients with fatal symptomatic intracranial hemorrhage. Patients aged 18 to 80 years with a baseline NIHSS score of 25 indicated that the positive result at 3 months was 39. 0%. Conclusions: These results indicate that 0. 6 mg/kg intravenous alteplase within three hours of stroke onset could be safe and effective in Japanese routine clinical practice.
Source link: https://doi.org/10.1161/strokeaha.110.589606
Background and Purpose: We conducted a clinical trial with 0. 6 mg/kg, which is lower than the internationally approved dosage of 0. 9 mg/kg, aiming to determine the efficacy and safety of alteplase in acute ischemic stroke for the Japanese. Patients with a modified Rankin Scale score of 0 to 1 at 3 months, as well as the incidence of acute intracranial hemorrhage within 36 hours, were the key end points. Conclusions— The results and the incidence of sICH in patients receiving 0. 6 mg/kg alteplase were similar to published results for 0. 9 mg/kg. These results show that alteplase, when administered at 0. 6 mg/kg to Japanese patients, may have a clinical safety and safety that are comparable with data from North America and the European Union for a 0. 9 mg/kg dose.
Source link: https://doi.org/10.1161/01.str.0000227191.01792.e3
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