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McPherson Kyed posted an update 6 months, 2 weeks ago
Strong CYP3A induction, in contrast, resulted in mean decreases by 57-90% (mean decrease in midazolam exposure 86%). Namely, the magnitude of the observed induction effects varied from weak to strong. Our data might provide an impetus to revisit the currently applied clinical recommendations for oral contraceptives, especially for levonorgestrel and norethindrone containing products, and they might give an indication as to which progestin could be used, if requested, by women taking weak CYP3A inducers – although it is acknowledged that the exact exposure-response relationship for contraceptive efficacy is currently unclear for most progestins. This article is protected by copyright. Fingolimod All rights reserved.The soaring demand for acrylic nails has resulted in a rapid increase in the frequency of allergic contact dermatitis (ACD) to (meth)acrylates1,2 . However, traditional nail varnish remains widely used. Nail varnish is a mixture of film formers and include nitrocellulose, adipic acid/neopentyl glycol/trimellitic anhydride copolymer (AA), and phthalic anhydride/trimellitic anhydride/glycols copolymer (PA). This article is protected by copyright. All rights reserved.The in vitro affinity of a compound for its target is an important feature in drug discovery, but what remains is how predictive in vitro properties are of in vivo therapeutic drug exposure. We assessed the relationship between in vitro potency and clinically efficacious concentrations for marketed small molecule drugs (n=164) and how they may differ depending on therapeutic indication, mode-of-action, receptor type, target localisation and function. Approximately 70 % of compounds had a therapeutic unbound plasma exposure lower than in vitro potency; the median Ratio of exposure in relation to in vitro potency was 0.32, and 80% had Ratios within 0.007 and 8.7. We identified differences in the in vivo-to-in vitro potency Ratio between indications, mode-of-action, target type and matrix localisation, and whether or not the drugs had active metabolites. The in vitro-assay variability contributions appeared to be the smallest, within the same drug target and mode of action the within-variability was slightly broader, but both were substantially less compared to the overall distribution of Ratios. These data suggest that in vitro potency conditions, estimated in vivo potency, required level of receptor occupancy and target turnover are key components for further understanding the link between clinical drug exposure and in vitro potency. This article is protected by copyright. All rights reserved.Ultrasound imaging of the lung and associated tissues may play an important role in the management of patients with COVID-19 associated lung injury. Compared to other monitoring modalities, such as auscultation or radiographic imaging, we argue lung ultrasound has high diagnostic accuracy, is ergonomically favourable and has fewer infection control implications. By informing the initiation, escalation, titration and weaning of respiratory support, lung ultrasound can be integrated into COVID-19 care pathways for patients with respiratory failure. Given the unprecedented pressure on healthcare services currently, supporting and educating clinicians is a key enabler of the wider implementation of lung ultrasound. This narrative review provides a summary of evidence and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID-19 associated lung injury. Mechanisms by which the potential lung ultrasound workforce can be deployed are explored, including a pragmatic approach to training, governance, imaging, interpretation of images and implementation of lung ultrasound into routine clinical practice. This article is protected by copyright. All rights reserved.The use of point-of-care ultrasound (POCUS) performed by non-radiologists has become more widespread and is entering new arenas of clinical care, particularly in the world of pediatrics. Children are prime candidates for ultrasound because they are more at risk to the harmful effects of ionizing radiation than adults. This is the second part of a two-part article reviewing 10 uses of POCUS that pediatricians can apply to their practice in both inpatient and outpatient settings. . Copyright 2020, SLACK Incorporated.Congenital anomalies of the female reproductive tract are relatively common and can be both confusing to understand as well as challenging to diagnose and manage in a busy pediatric clinical practice. Here, we lay out some of the most common genitourinary tract anomalies in female pediatric patients. We highlight the key embryologic development, present case examples, and discuss appropriate testing, treatment, and counseling for patients and their families regarding congenital disorders of the vulva, vagina, uterus, ovaries, and associated pathology. The goal of this review is to demystify these conditions and provide a practical guide for the general pediatrician who is often at the frontline making the initial diagnosis and caring for these patients. . Copyright 2020, SLACK Incorporated.Adnexal masses in adolescents, such as functional cysts, are often benign and can usually be managed expectantly since they typically regress on their own. The most common ovarian neoplasm in adolescents is a benign cystic teratoma. Both functional cysts and benign cystic teratomas are associated with ovarian torsion. Of concern, ovarian torsion requires a high level of suspicion when adolescents present with acute abdominal pain, as almost one-half of cases have no associated adnexal masses. The most common malignant adnexal masses in this age group include germ cell tumors, followed by epithelial cell tumors. Finally, ectopic pregnancy and tubo-ovarian abscesses must be considered in the differential diagnosis of adnexal mass, as delays in treatment may seriously affect an adolescent’s health and future fertility. Obtaining an accurate history, including a sexual history, requires reviewing this history with the adolescent privately. Management of adnexal mases should prioritize fertility preservation. [Pediatr Ann.
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