Academic literature on the topic 'Triptani'
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Journal articles on the topic "Triptani"
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Evers, di Stefan, and e. Carlo Lisotto. "Algoritmo del trattamento dell’emicrania." European Neurological Review 8, no. 2 (2013): 149. http://dx.doi.org/10.17925/enr.2013.08.02.149a.
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Nel corso di un simposio satellite tenutosi nel corso del XXI Congresso Mondiale di Neurologia 2013 è stata presentata la terza edizione della Classificazione Internazionale delle Cefalee, con una descrizione sintetica delle variazioni apportate rispetto alla precedente edizione, che riflettono l’importanza della diagnosi basata sulla fenomenologia piuttosto che sull’eziologia dei disturbi. Per questo motivo è stato creato un algoritmo di trattamento per l’emicrania, mirato a valutare il percorso corretto e a rafforzare il messaggio che i triptani rappresentano l’opzione terapeutica più efficace. Nel corso del simposio sono state inoltre discusse le nuove linee guida sui parametri di efficacia utilizzati negli studi clinici, sottolineando l’importanza della protratta scomparsa del dolore senza recidiva, un parametro di grande rilevanza per i pazienti. Gli studi incrossoverdi preferenza del paziente rappresentano un reale confronto intra-individuale tra diversi triptani e consentono di valutareendpointsmultipli definiti dalla preferenza del paziente invece che dallo sperimentatore. Negli studi clinici frovatriptan ha mostrato una tollerabilità favorevole e un effetto protratto nel tempo, con un tasso di recidive inferiore a quello riportato con gli altri triptani. Questi risultati sono stati ottenuti dai diversi studi di preferenza condotti in Italia e in altri paesi europei.
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Marcus, Steven C., Anand R. Shewale, Stephen D. Silberstein, Richard B. Lipton, William B. Young, Hema N. Viswanathan, and Jalpa A. Doshi. "Comparison of healthcare resource utilization and costs among patients with migraine with potentially adequate and insufficient triptan response." Cephalalgia 40, no. 7 (March 29, 2020): 639–49. http://dx.doi.org/10.1177/0333102420915167.
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Background Triptans are the most commonly prescribed acute treatments for migraine; however, not all triptan users experience adequate response. Information on real-world resource use and costs associated with triptan insufficient response are limited. Methods A retrospective claims analysis using US commercial health plan data between 2012 and 2015 assessed healthcare resource use and costs in adults with a migraine diagnosis newly initiating triptans. Patients who either did not refill triptans but used other non-triptan medications or refilled triptans but also filled non-triptan medications over a 24-month follow-up period were designated as potential triptan insufficient responders. Patients who continued filling only triptans (i.e. triptan-only continuers) were designated as potential adequate responders. All-cause and migraine-related resource use and total (medical and pharmacy) costs over months 1–12 and months 13–24 were compared between triptan-only continuers and potential triptan insufficient responders. Results Among 10,509 new triptan users, 4371 (41%) were triptan-only continuers, 3102 (30%) were potential triptan insufficient responders, and 3036 (29%) did not refill their index triptan or fill non-triptan medications over 24 months’ follow-up. Opioids were the most commonly used non-triptan treatment (68%) among potential triptan insufficient responders over 24 months of follow-up. Adjusted mean all-cause and migraine-related total costs were $5449 and $2905 higher, respectively, among potential triptan insufficient responders versus triptan-only continuers over the first 12 months. Conclusions In a US commercial health plan, almost one-third of new triptan users were potential triptan insufficient responders and the majority filled opioid prescriptions. Potential triptan insufficient responder patients had significantly higher all-cause and migraine-related healthcare utilization and costs than triptan-only continuers.
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Panconesi, A., E. Pavone, M. Franchini, N. Mennuti, ML Bartolozzi, L. Guidi, and R. Banfi. "Triptans: Low utilization and high turnover in the general population." Cephalalgia 30, no. 5 (October 1, 2009): 576–81. http://dx.doi.org/10.1111/j.1468-2982.2009.02001.x.
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Studies performed in selected populations have shown a poor utilization of triptans for migraine. Our study was aimed at establishing patterns of triptans utilization in a large community using the pharmaceutical prescriptions database of two consecutive years in a regional Health Authority in Italy. About 0.5% of the population observed received triptans prescriptions in a year, but > 50% of the cases received only one prescription. On the other hand, 46% of triptan users did not receive a triptan prescription in the following year (past users): in 80% of cases, patients received only 1–2 triptan packages. The evaluation of the discontinued triptan type has shown percentages varying between 30 and 70%. The percentage of triptan users who received a triptan prescription for the first time in the successive year of study (new users) was 52%. These findings together highlight a high turnover in triptans utilization. Less than 15% of subjects received more than one triptan product in the 2 years. In conclusion, we observed a low percentage of triptan users and a low rate of utilization, associated with a high percentage of discontinuation and new utilization (high turnover), without any substantial increase in triptans utilization during the years. All these data probably do not support optimal satisfaction with triptan therapy.
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Lipton, Richard B., Steven C. Marcus, Anand R. Shewale, David W. Dodick, Hema N. Viswanathan, and Jalpa A. Doshi. "Acute treatment patterns in patients with migraine newly initiating a triptan." Cephalalgia 40, no. 5 (March 5, 2020): 437–47. http://dx.doi.org/10.1177/0333102420905307.
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Background Triptans are the most commonly used acute treatment for migraine. This study evaluated real-world treatment patterns following an initial triptan prescription to understand refill rates and use of non-triptan medications for the acute treatment of migraine. Methods Commercially-insured adult patients over 18 years of age with a triptan prescription between 1/1/2013 to 31/12/2013 were identified from the Optum Clinformatics™ Data Mart database, with date of the first triptan fill designated as index date. Inclusion was limited to those with no fills for a triptan in the 12 months prior to index date (i.e. new users or initiators of triptans) and continuous enrollment in the 12 months pre- and 24 months post-index date. Fills for index triptan, non-index triptan, and other acute treatments for migraine were assessed for up to 24 months post-index. Results Among 10,509 patients, 50.8% did not refill the initial triptan within 12 months and 43.6% did not refill within 24 months. In the 12 months post-index, 90.5% of patients used only one type of triptan, 8.4% used two different triptans, and 1.0% used three or more triptans. Among patients with and without a triptan refill, use of opioids (39% vs. 42%), non-steroidal anti-inflammatory drugs (22% vs. 22%), and butalbital-containing products (9% vs. 10%) were similar. Conclusion More than half of those who newly initiated a triptan did not refill their initial prescription, and less than 1 in 10 used two or more triptans within 12 months. High rates of non-triptan acute medication use were found over 12 and 24 months of follow-up, most commonly opioids.
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Lipton, Richard B., Andrew Blumenfeld, Christopher M. Jensen, Robert Croop, Alexandra Thiry, Gilbert L’Italien, Beth A. Morris, Vladimir Coric, and Peter J. Goadsby. "Efficacy of rimegepant for the acute treatment of migraine based on triptan treatment experience: Pooled results from three phase 3 randomized clinical trials." Cephalalgia 43, no. 2 (February 2023): 033310242211416. http://dx.doi.org/10.1177/03331024221141686.
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Background This post-hoc analysis from three phase 3 treatment trials of rimegepant 75 mg — an oral small molecule calcitonin gene-related peptide receptor antagonist for acute and preventive treatment of migraine — assessed efficacy in adults with migraine based on triptan treatment experience. Methods Participants were assigned to one of four groups based on triptan treatment experience: insufficient response (e.g. lack of efficacy and/or poor tolerability) to 1 triptan, insufficient response to ≥2 triptans, current triptan users, and triptan-naïve participants. The co-primary efficacy endpoints were pain freedom and most bothersome symptom freedom at two hours postdose. Results In the three trials (N = 3507; rimegepant n = 1749, placebo n = 1758), 1235 (35.2%) participants had a history of insufficient response to 1 triptan (n = 910 [25.9%]) or ≥2 triptans (n = 325 [9.3%]), and 2272 (64.8%) had no history of insufficient response to triptans (current use = 595 [17.0%], naïve = 1677 [47.8%]). Rimegepant was effective on the co-primary endpoints in all subgroups ( p ≤ 0.013), except for freedom from the most bothersome symptom in the triptan-naïve group ( p = 0.06). No differences on co-primary endpoints were found in pairwise comparisons of rimegepant-treated participants. Conclusions Rimegepant was effective for the acute treatment of migraine in adults with a history of insufficient response to 1 or ≥2 triptans and in current triptan users. Efficacy on co-primary endpoints did not differ based on the number of insufficient triptan responses. Trial registration: Clinicaltrials.gov: NCT03235479, NCT03237845, NCT03461757
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Davidsson, Olafur B., Isa A. Olofsson, Lisette JA Kogelman, Michael Asger Andersen, Klaus Rostgaard, Henrik Hjalgrim, Jes Olesen, and Thomas Folkmann Hansen. "Twenty-five years of triptans – a nationwide population study." Cephalalgia 41, no. 8 (February 14, 2021): 894–904. http://dx.doi.org/10.1177/0333102421991809.
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Background The efficacy of triptans as the main acute treatment strategy for migraine headache at the population-wide level needs to be understood to inform clinical decision-making. We summarise key trends in triptan use using more than 25 years of Danish nationwide data. Methods We conducted a nationwide register-based cohort study based on all Danish residents with access to public healthcare between 1 January 1994 and 31 October 2019 and summarise informative trends of all purchases of triptans in Denmark in the same period. Complete purchase records of Sumatriptan, Naratriptan, Zolmitriptan, Rizatriptan, Almotriptan, Eletriptan, and Frovatriptan were used. Findings Over a 25-year period, triptan use increased from 345 to 945 defined daily doses (DDD) per 1000 inhabitants per year and the yearly prevalence of triptan use increased from 5.17 to 14.57 per 1000 inhabitants. Between 2014 and 2019, 12.3% of the Danish migraine population purchased a triptan. Following their initial purchase, 43% of patients had not repurchased triptans within 5 years. At most, 10% of patients indicating triptan discontinuation tried more than one triptan. The prevalence of triptan overuse, defined as having purchased at least 20 DDDs of triptans per month for 3 consecutive months, increased in parallel with the prevalence of triptan use, prevalent in 56 of every 1000 triptan users every year between 2014 and 2019. Interpretation In a cohort with access to free clinical consultations and low medication costs, we observed low rates of triptan adherence, likely due to disappointing efficacy and/or unpleasant side effects rather than economic considerations. Triptan success continues to be hindered by poor implementation of clinical guidelines and high rates of treatment discontinuance.
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Katić, Božena J., Srini Rajagopalan, Tony W. Ho, Ya-Ting Chen, and X. Henry Hu. "Triptan persistency among newly initiated users in a pharmacy claims database." Cephalalgia 31, no. 4 (October 11, 2010): 488–500. http://dx.doi.org/10.1177/0333102410383058.
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Objective Our study was conducted to describe prescription refill patterns among patients newly treated with triptans. Background Although triptans are efficacious in treating migraine headache, the persistency of triptan use among newly initiated users has not been well described. Methods From a US pharmacy claims database, we identified patients receiving new triptan monotherapy prescriptions from 2001 to 2005. Prescription refill information was gathered for two years for each patient. Persistency was defined as sustained refills of the index triptan prescription, regardless of duration between refills. Results Of 40,892 patients receiving a new triptan prescription, 53.8% (N=22031) did not persistently refill their index triptan. Of these, 25.5% discontinued prescription migraine therapy, 7.4% switched to a different triptan, and 67.1% switched to a non-triptan migraine medication at the time of their first refill. Only 46.2% of patients received at least one persistent refill. Conclusions Migraine patients were more likely to discontinue their triptan after their index prescription than at any other time in their prescription refill history. The majority of patients did not persistently refill triptans, but filled prescriptions for non-specific migraine therapies such as opioids and non-steroidal anti-inflammatory drugs. Reasons for triptan discontinuation warrant further investigation.
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Lucas, C., J.-P. Auray, A.-F. Gaudin, J.-F. Dartigues, G. Duru, P. Henry, M. Lantéri-Minet, A. Pradalier, G. Chazot, and A. El Hasnaoui. "Use and Misuse of Triptans in France: Data from the Grim2000 Population Survey." Cephalalgia 24, no. 3 (March 2004): 197–205. http://dx.doi.org/10.1111/j.1468-2982.2003.00651.x.
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The extent and nature of triptan use for headache relief has been evaluated in a large epidemiological survey in the French general population. Over 25 000 individuals were screened for headache and for triptan use. Of this sample, 290 triptan users were identified from whom extensive data on headache characteristics and healthcare resource consumption were obtained. The use of triptans is relatively infrequent, 0.2% in the general population, with only 7.5% of migraine sufferers using these drugs. The majority of triptan users were female (80%) and presented headache characteristics typical of migraine (80%). The remaining 20% of subjects were thus using triptans for headache types in which the utility of these drugs has not been demonstrated. Among migraineurs, triptan consumers reported more frequent and severe headaches than non-consumers, and reported a higher incidence of nausea and vomiting. The principal determinant of triptan prescription was consultation with a general practitioner (GP), which may itself have been triggered by the severity of the headaches. GPs, rather than specialists, are the primary prescribers of triptans in France.
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Ng-Mak, Daisy S., Ya-Ting Chen, Tony W. Ho, Bianca Stanford, and Montse Roset. "Results of a 2-year retrospective cohort study of newly prescribed triptan users in European nationwide practice databases." Cephalalgia 32, no. 12 (July 24, 2012): 875–87. http://dx.doi.org/10.1177/0333102412449929.
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Objective: This study was conducted to characterize prescription refill patterns for triptans among European patients with new prescriptions of triptans. Background: Persistency with prescriptions of triptan monotherapy for migraine headache among newly prescribed users in European primary-care practices has not been well described. Methods: Using electronic medical databases in the UK ( N = 3618), France ( N = 2051) and Germany ( N = 954), we conducted a retrospective cohort analysis to identify refill patterns over 2 years among migraineurs receiving new prescriptions of triptan monotherapy in 2006. Results: Of all patients, >33% of migraineurs with new triptan prescriptions received ≥1 refill of their index triptan prescriptions (UK, 44.3%; France, 34.2%; Germany, 37.7%). More than 50% never received index-triptan refill prescriptions (UK, 55.7%; France, 65.8%; Germany, 63.3%). Small proportions of patients (<7.0%) switched to alternative triptans, and even fewer switched to different prescription-medication classes (UK and Germany, 2.3%; France, 4.0%). More than 48% of patients received no further prescriptions for migraine after index prescriptions (UK, 48.5%; France, 54.9%; Germany, 54.7%). After the second year, >83.0% of patients in each country had no further prescriptions for migraine medications, <14.0% remained persistent with index prescriptions, <4.0% switched to other triptans, and <3.0% switched to alternative medication classes. Conclusions: In migraine patients who received new prescriptions of triptan monotherapy from their primary-care physicians, poor triptan prescription refill frequency was observed in Europe. Although consistent with potential clinical challenges in migraine management, our findings should be interpreted with caution given certain inherent limitations associated with the database study design. Further research is warranted to confirm our findings and to identify reasons for, or predictors of, triptan discontinuation.
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Pavone, E., R. Banfi, M. Vaiani, and A. Panconesi. "Patterns of Triptans Use: A Study Based on the Records of a Community Pharmaceutical Department." Cephalalgia 27, no. 9 (September 2007): 1000–1004. http://dx.doi.org/10.1111/j.1468-2982.2007.01401.x.
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Studies performed in selected populations show that the use of triptans for migraine is low. Our study was aimed at establishing patterns of triptan utilization in a large community using the drug prescription database of a regional Health Authority in Italy. In a population of 224 065 residents, 0.55% received at least one prescription of triptans in 1 year: 77.9% were female and 22.1% male. Oral dosage forms accounted for 94% of prescriptions. About 60% of patients received a single prescription (containing one or two packages) of one triptan in 1 year. Age distribution showed that 7% of patients were aged >65 years. They received 14% of packages, prevalently sumatriptan and zolmitriptan (the two triptans with the longest commercialization in Italy); 5.7% of patients received 40% of packages. Moreover, 3.2% of triptans users received >120 dosage units in the year in the form of tablets (>10 single doses/month), and were potential triptan abusers. Our data indicate suboptimal treatment of migraine patients and also incorrect treatment of some patients (potential triptans abusers, the elderly).
Dissertations / Theses on the topic "Triptani"
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Roberto, Giuseppe. "Pattern di utilizzo e sicurezza cardiovascolare dei triptani nella pratica clinica." Doctoral thesis, Università degli studi di Padova, 2013. http://hdl.handle.net/11577/3426184.
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The topic of this PhD thesis concerns the pattern of use and the post-marketing cardiovascular (CV) safety of 5HT1b/d receptor agonists, a class of specific antimigraine agents commonly called “triptans”.
With the aim to describe the pattern of utilization of triptans in a wide sample of the Italian general population, the Emilia-Romagna Regional Health Authority Database was analyzed. All patients receiving at least one triptan prescription in 2007 (N=34915) were followed for 12 months after the date of first prescription. On the basis of triptan exposure during the 12 months preceding the date of recruitment, prevalent users were divided into two groups, new users (N=18104) and already in treatment (N=16811); the respective frequency of triptan use and percentage of subject receiving CV co-prescription (suggestive of potential vasoconstrictive risk or absolute contraindication to triptan use) were described. Results from the analysis provided an estimation of the incidence and the prevalence of triptan use in the general population (0,4% e 0,8% respectively), also highlighting important differences between new users and already in treatment patients. The latter population, whose patients can be considered more “familiar” to the treatment, showed a markedly higher frequency of use compared to new users and, in particular, also a wider percentage of subjects taking >180 posologic units/year, thus potentially affected by chronic headache related to triptan overuse (0.3% vs 15,3%; p<0,001). Even users that received CV co-prescription were more often present among already in treatment patients (12% vs 27,6%; p<0,001). Therefore, on the basis of these evidence, periodic patient monitoring should be recommended and informative intervention should be implemented in order to promote appropriate prescription and safe use of these antimigraine drugs.
With the aim to highlight rare, unexpected or poorly documented adverse CV events concerning triptan therapy, reports of suspected adverse drug reaction from the Food and Drugs Administration_Adverse Event Reporting System (FDA_AERS) database were analyzed. The data-mining process applied to estract reports of potential interest was based on the following steps: duplicate removal, drugs mapping through the ATC classification, estraction of CV event on the basis of the MedDRA classification, application of the Reporting Odds Ratio (ROR) and subsequent statistical adjustment of its values considering co-reported CV drugs as a row proxy of a pre-existing CV condition). Through this approach, all CV events that were more frequently reported in association to triptans rather than to all other drugs in the database were identified. The analysis was based on over two millions reports entered into the database between 2004 and 2010. Among a total of 7808 reports with triptan exposure, the application of the ROR highligthed three main groups of events that could be considered unexpected/poorly documented concerning triptan treatment: cerebrovascular events, aneurysm and dissection, and pregnancy related vascular events. On the basis of these results, a subsequent study was performed in order to focus on the cerebrovacular events previously highlighted, with the aim to provide more details on the actual relation between the drug and the event. Therefore, the further analysis was performed on the same dataset used for the previous study. It was based on two different approaches: i) a case-by-case analysis concerning reports of a specific cerebrovascular event considered of interest (quantitative approach); ii) the selection of a cluster of cerebrovascular events, on the basis of the MedDRA classification, and the calculation of the stratified and adjusted ROR values for triptan exposure on the basis of potentially confounding/modifying factors (quantitative approach). Results from the qualitative analysis demonstrated a possible role of triptans in the onset/exacerbation of a rare cerebrovascular event such as the dissection of the carotid artery. Moreover, the quantitative analysis allowed for identification of sub-populations of users that could be at risk for cerebrovascular accident related to the triptan treatment (i.e. patients aged 18-44, estrogens/contraceptive users). These findings should be considered as specific hypothesis to be tested through further large scale ad hoc epidemiological studies to better define the safety profile of this class of antimigraine agents.La presente tesi di dottorato ha avuto come oggetto lo studio delle modalità di utilizzo ed il profilo di sicurezza cardiovascolare (CV) post-marketing degli agonisti selettivi dei recettori 5HT1b/d, una classe di specifici agenti antiemicranici, comunemente chiamati “triptani”. Al fine di descrivere le modalità di prescrizione dei triptani in un ampio campione della popolazione italiana, è stata analizzata la banca dati regionale di Assistenza Farmaceutica Territoriale dell’Emilia-Romagna. Tutti i pazienti che durante il 2007 avevano ricevuto almeno una prescrizione contenente un triptano (N=34915) sono stati osservati per i 12 mesi successivi alla data di prima prescrizione. Sulla base dell’esposizione al farmaco nei 12 mesi precedenti al reclutamento, gli utilizzatori prevalenti sono suddivisi in due distinte popolazioni, new users (N=18104) e already in treatment (N=16811), le quali sono state successivamente confrontate in termini di frequenza di utilizzo del farmaco e percentuale di soggetti che ricevevano co-prescrizioni di farmaci CV, utilizzate come proxy di un potenziale rischio vasocostrittivo o una controindicazione assoluta verso la terapia con triptani. I risultati dell’analisi hanno permesso di stimare l’incidenza e la prevalenza annuale d’utilizzo dei triptani nella popolazione generale (0,4% e 0,8% rispettivamente), mettendo in luce, inoltre, importanti differenze fra new users e i pazienti already in treatment. Questi ultimi, che possono essere considerati come pazienti più “familiari” al trattamento, mostravano una frequenza d’uso marcatamente più elevata rispetto ai new users e, in particolare, una percentuale significativamente più elevata di soggetti che assumevano >180 unità posologiche/anno, quindi potenzialmente affetti da cefalea cronica correlata all’ uso eccessivo di triptani (0.3% vs 15,3%; p<0,001). Anche i pazienti che ricevevano una co-prescrizione CV erano più spesso presenti fra i pazienti already in treatment (12% vs 27,6%; p<0,001). Pertanto, sulla base delle evidenze raccolte, sarebbero auspicabili interventi informativi ad hoc al fine di promuovere l’appropriatezza prescrittiva e l’uso sicuro di questi farmaci antiemicranici, raccomandando ai medici prescrittori un monitoraggio periodico dei pazienti. Allo scopo di mettere in evidenza eventi di natura CV rari, non noti o poco documentati rispetto alla terapia con triptani, sono state analizzate le segnalazione di sospetta reazione avversa a farmaco presenti nel database internazionale del Food and Drugs Administration_Adverse Event Reporting System (FDA_AERS). Per l’estrazione delle segnalazioni di possibile interesse è stato applicato uno specifico processo di data-mining basato sui seguenti passaggi: rimozione dei duplicati, mappatura dei farmaci tramite la classificazione ATC, estrazione degli eventi CV secondo la classificazione MedDRA, applicazione del Reporting Odds Ratio (ROR) e successivo aggiustamento statistico per la concomitante assunzione di farmaci CV (proxy grezzo di un disturbo CV di base). In tal modo sono stati evidenzati tutti gli eventi CV che venivano segnalati più frequentemente in associazione ad un qualsiasi triptano rispetto a tutti i restanti farmaci presenti nel database. L’analisi si è basata su oltre due milioni di segnalazioni inserite nel database fra il 2004 ed il 2010. Tra i 7808 report riguardanti almeno un triptano, l’applicazione del ROR ha evidenziato una possibile relazione fra l’assunzione di un triptano ed una serie di eventi che potevano essere considerati inattesi rispetto alla terapia con questi farmaci: eventi di natura cerebrovascolare, aneurismi e dissezioni, ed eventi correlati alla gravidanza. Sulla base di questi risultati, nel successivo studio è stato possibile focalizzare l’attenzione sui soli eventi cerebrovascolari messi precedentemente in evidenza, allo scopo di acquisire maggiori informazioni sulla relazione tra farmaco ed evento. L’analisi, effettuata sullo stesso dataset del precedentemente studio, si è basata sull’applicazione di due differenti approcci: i) una case-by-case analysis riguardante le segnalazioni di uno specifico evento giudicato d’interesse (approccio quantitativo); ii) la selezione di un cluster di eventi cerebrovascolari, tramite la classificazione MedDRA, ed il calcolo del ROR riguardo l’esposizione a triptani, stratificato ed aggiustato statisticamente sulla base di variabili potenzialmente confondenti/modificanti (approccio quantitativo). I risultati dell’analisi qualitativa hanno dimostrato un ruolo possibile dei triptani nell’insorgenza/esacerbazione di un evento cerebrovascolare raro quale la dissezione dell’arteria carotide. Inoltre, l’analisi quantitativa ha permesso di mettere in evidenza alcune sottopopolazioni di utilizzatori che potrebbero essere potenzialmente esposte ad un maggior rischio di accidenti cerebrovascolari correlati all’assunzione di triptani (i.e. 18-44 anni ed utilizzatori di estrogeni/contraccettivi). Tali risultati, potranno essere utilizzati come ipotesi da testare attraverso successivi studi epidemiologici su larga scala che saranno utili a meglio definire il profilo di sicurezza di questi farmaci.
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Poiron, Stéphanie. "Les effets indésirables neuropsychiatriques des triptans : pharmacovigilance, étude de 43 observations." Poitiers, 2000. http://www.theses.fr/2000POIT1545.
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Campourcy, Pierre. "Apport des triptans dans le traitement de la crise de migraine." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2P033.
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Ndayishimiye, Médic. "Analyse coût-efficacité de deux triptans contre la crise aiguë de la migraine." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ61357.pdf.
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Virmout, Marie Anne-Noëlle Bobin-Dubigeon Christine. "Les céphalées par abus médicamenteux." [S.l.] : [s.n.], 2008. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=37346.
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Spielmann, Kevin [Verfasser]. "Pregnancy outcome after anti-migraine triptan use: a prospective observational cohort study / Kevin Spielmann." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1176635476/34.
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Wood, Mollie E. "Causal Inference Methods for Assessing Neurodevelopment in Children Following Prenatal Exposure to Triptan Medications: A Dissertation." eScholarship@UMMS, 2015. http://escholarship.umassmed.edu/gsbs_diss/768.
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Background: Migraine headache is a chronic pain condition that affects 20% of women of reproductive age, and is often treated with triptans. Triptans are serotonin 1B, 1D, and 1F receptor agonists that act as vasoconstrictors and inhibitors of the trigeminal cervical complex as well as peripheral neurons; they cross the blood brain barrier and placenta, and as such are plausible neurodevelopmental teratogens. No studies have examined risk of neurodevelopmental problems in children with prenatal triptan exposure. This dissertation had three aims: (1) to examine risk of behavioral problems in children using in the presence of time-varying confounding by concomitant medication use; (2) to examine risk of temperamental, motor, and communication disturbances associated with prenatal triptans exposure, adjusting for unmeasured confounding by migraine type and severity; and (3) to examine changes in neurodevelopment over time associated with prenatal triptan exposure.
Methods: This dissertation used data from the Norwegian Mother and Child Cohort Study, a prospective birth cohort including more than 100,000 women recruited during their first prenatal ultrasound visit. Aims 1 and 3 used marginal structural models to assess the risk of (1) neurodevelopmental problems at age 36 months (Aim 1), or (2) change in risk of neurodevelopmental problems from 18 to 36 months (Aim 3) associated with prenatal triptan exposure. Aim 2 used propensity matching and calibration to adjust for unmeasured confounding by migraine type, severity, and attitudes towards medication use in pregnancy. Neurodevelopmental outcome measures included the Child Behavior Checklist (CBCL), the Emotionality, Activity, and Temperament Scale (EAS), and the Ages and Stages Questionnaire (ASQ). Exposure to triptans was ascertained by self-report.
Results: Prenatal triptan exposure was associated with greater externalizing behavior problems at 18 and 36 months, as well as greater increases in emotionality and activity from 18 to 36 months. We observed no association between triptan exposure and motor skills or communication problems; triptan use during pregnancy was associated with migraine severity but not migraine type, and adjustment for unmeasured migraine characteristics moved effect estimates towards the null.
Conclusions: Prenatal triptan exposure is associated with externalizing-type behaviors and temperament in children, while migraine itself is associated with internalizing-type behaviors and temperament. The use of concomitant medications and the severity of the underlying condition both exerted substantial influence on observed effect estimates, and should be considered in any future studies of triptan medication use in pregnancy.
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Bicho, Diana Stefanía Faria. "Utilização da triptase como marcador de prognósticos em doentes com gamopatias monoclonais." Master's thesis, Universidade da Beira Interior, 2011. http://hdl.handle.net/10400.6/886.
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As Gamopatias Monoclonais (GM) são um grupo de doenças associado à hiperprodução monoclonal de células plasmocitárias na medula óssea, as quais produzem uma quantidade anormal de uma imunoglobulina monoclonal ou apenas fragmentos desta, usualmente IgA ou IgG. O Mieloma Múltiplo (MM), um dos tipos mais comuns e mortíferos de GM, constitui aproximadamente 10 % das neoplasias hematológicas. Encontra-se fundamentado que os mastócitos (MC) se encontram intimamente associados ao processo de angiogénese tumoral, assumindo esta especial importância na formação e crescimento de tumores, entre eles o MM. Assim, a angiogénese da medula óssea e as contagens de MC encontram-se altamente correlacionados em doentes com Gamopatia Monoclonal de Significado Indeterminado e em doentes com MM activo e não activo. A triptase, libertada por mastócitos (MC) após desgranulação, estimula a proliferação das células endoteliais vasculares humanas, promove a formação do tubo vascular em culturas e também degrada a matriz do tecido conjuntivo para providenciar espaço para o crescimento neovascular. A triptase desempenha ainda uma função autócrina já que a sua libertação pelos MC leva à desgranulação dos MC adjacentes, providenciando uma amplificação do sinal. A triptase tem sido vastamente utilizada como indicador do número e da activação de MC e, mais recentemente, como marcador de prognóstico em diversas doenças, tais como a mastocitose sistémica e reacções anafilácticas. Pelo referido, justifica-se a necessidade de apresentar um método não invasivo que ajude no diagnóstico das GM. Deste modo, o principal objectivo deste estudo foi a avaliação da triptase como potencial marcador independente para as GM. Os 304 participantes neste estudo foram recrutados na Unidade Local de Saúde (ULS) da Guarda e foram divididos em dois grupos: um grupo controlo composto por amostras de 77 indivíduos adultos sem GM e por um grupo teste formado por amostras de 229 indivíduos seleccionadas na seroteca do Serviço de Patologia Clínica, a partir do proteinograma por apresentarem suspeita de GM. Cada um destes grupos foi depois dividido em dois subgrupos: atópicos e não atópicos. Os resultados mostraram a existência de diferenças estatisticamente significativas na concentração de triptase para os indivíduos atópicos e não atópicos do grupo controlo e nos indivíduos não atópicos com e sem GM. Também se verificaram diferenças significativas entre os níveis séricos de triptase nos indivíduos não atópicos do grupo teste que apresentavam GM do tipo IgM e IgG. Por último, observaram-se diferenças significativas na concentração de IgE específica para aeroalergénios nos indivíduos atópicos com e sem GM. Deste modo foi possível verificar uma relação entre a atopia e os níveis séricos de triptase nos indivíduos sem GM e a existência de um efeito inibitório dos clones tumorais sobre os MC afectando os níveis de triptase nos indivíduos do grupo teste. Os resultados sugerem que a triptase, apesar do seu papel na neoangiogénese, não parece constituir um marcador diferencial no prognóstico das GM nos indivíduos atópicos.The Monoclonal Gammopathies (GM) are a group of diseases associated with overproduction of monoclonal plasma cells in bone marrow, which produce an abnormal amount of monoclonal immunoglobulin or just fragments of it, usually IgG or IgA. The Multiple Myeloma (MM), one of the most common and fatal of GM, is approximately 10% of hematologic malignancies. It is reasoned that the mast cells (MC) are closely associated with the process of tumor angiogenesis, therefore assuming particular importance in the formation and growth of tumors, including MM. Thus, bone marrow angiogenesis and MC counts are highly correlated in patients with Monoclonal Gammopathy of Undetermined Significance and MM patients with active and not active disease. The tryptase released by mast cells (MC) after degranulation, stimulates the proliferation of human vascular endothelial cells, promotes vascular tube formation in cultures and also degrades the connective tissue matrix to provide space for neovascular growth. The tryptase also plays an autocrine role since its liberation by the MC leads to adjacent MC degranulation providing a signal amplification. The tryptase has been widely used as an indicator of the number and activation of MC and, more recently, as a prognostic marker in several diseases such as systemic mastocytosis and anaphylactic reactions. Taking into account the need of a noninvasive method that helps in the diagnosis of GM, the main objective of this study was the evaluation of tryptase as a potential independent marker for GM. The 304 participants in this study were recruited from the Local Health Unit (ULS) of the Guarda and were divided into two groups: a control with samples from 77 adults with no GM and a study group with samples of 229 individuals selected at serotec of Clinical Pathology Laboratory. This group was selected based on suspected GM protein profile. Each of these groups was then divided in atopic and nonatopic individuals. The results showed statistically significant differences in the concentration of tryptase for atopics and nonatopics of control group and for non-atopic individuals with and without GM. There were also significant differences between serum tryptase levels in non-atopic study group with IgM and IgG GM. Finally, there were significant differences in the concentration of specific IgE to aeroalergens in atopic individuals with and without GM. It was observed a relationship between atopy and serum tryptase levels in patients without GM and the existence of inhibitory effect of tumor clones in MC affecting the levels of tryptase in the study group subjects. Despite the role of tryptase in neoangiogenesis, this protein does not seem to be a differential marker in the prognosis of GM at least for atopic individuals.
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Jain, Tripti [Verfasser], and Klaus [Akademischer Betreuer] Schneider. "Nonblocking On-Chip Interconnection Networks / Tripti Jain ; Betreuer: Klaus Schneider." Kaiserslautern : Technische Universität Kaiserslautern, 2020. http://d-nb.info/121092501X/34.
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Balejo, Rodrigo Dalla Pria. "Efeito da inibição de triptase sobre o desenvolvimento de doença periodontal induzida em ratos." Universidade de Taubaté, 2009. http://www.bdtd.unitau.br/tedesimplificado/tde_busca/arquivo.php?codArquivo=448.
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Objetivos: Avaliar o efeito da inibição de triptase, com o uso da droga nafamostate mesilate (NM), sobre o desenvolvimento de doença periodontal induzida em ratos. Metodologia: Oitenta ratos Wistar machos foram divididos aleatoriamente em quatro grupos. Um grupo controle com injeção diária de NaCl 0,9%, grupo NM (injeção diária de 0.1mg/kg de NM, ip), grupo ligadura (colocada ao redor do primeiro molar inferior direito), e grupo NM + Ligadura. A quantidade de perda óssea alveolar (POA) na porção mesial da face lingual da raiz mésio-lingual do primeiro molar inferior foi determinada após o sacrifício aos sete e 14 dias com o auxílio de um estereomicroscópio, e a atividade de mieloperoxidase (MPO) foi analisada nos tecidos gengivais. Resultados: A inibição da triptase levou à diminuição significativa
(p <0,05) de POA em animais submetidos à ligadura e periodontite induzida. A inibição da triptase pelo NM não apenas preveniu o início da POA aos sete dias de experimento (0,44mm 0,16 e 0,60mm 0,22, p<0,05, NM + Ligadura versus Controle), como também diminuiu significativamente a POA aos 14 dias (0,97mm 0,17 versus 1,82mm 0,26, p <0,001, NM + Ligadura versus Ligadura). Além disso, a inibição da triptase diminuiu significativamente a atividade de MPO aos 14 dias (p<0.05). Conclusão: Os dados do presente estudo sugerem que a inibição da triptase modificou a progressão da periodontite induzida experimentalmente em ratos.Aim: To evaluate the effect of inhibition of tryptase, with the drug nafamostate mesylate (NM) on the development of periodontal disease induced in rats. Methodology: Eighty (80) male Wistar rats were randomly separated into four study groups as follows: saline Control group, NM group (daily injection of 0.1mg/kg body weight of NM, i.p.), Ligature group (ligature placed at the gingival margin level of lower right first molars), and NM + Ligature group. The amount of alveolar bone loss (ABL) around the mesial root surface of the first mandibulary molar was determined at sacrifice at seven and 14 days with the aid of a stereomicroscope, and the myeloperoxidase activity (MPO) was analyzed at the gingival tissues. Results: NM led to significantly (p<0.05) decreased ABL in animals subjected to ligature induced periodontitis. Tryptase inhibition not only prevented the onset of significant ABL at seven days of the experiment (0.440.16 and 0.600.22, p>0.05, NM+Ligature and Control, respectively) but also significantly decreased the ABL when compared with the Ligature group at 14 days (0.970.17 versus 1.820.26, p<0.001). In addition, NM significantly decreased MPO activity at 14 days (p<0.05). Conclusion: These data provide evidence that tryptase inhibition may modify the progression of experimentally induced periodontitis in rats.
Books on the topic "Triptani"
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Patrick, Humphrey, Olesen Jes, and Ferrari M. D, eds. The triptans: Novel drugs for migraine. Oxford: Oxford University Press, 2001.
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Stephen, Membe, and Canadian Agency for Drugs and Technologies in Health., eds. Triptans for acute migraine: Comparative clinical effectiveness and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2007.
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Tešić, Milosav. U krstu zemlje: Duže pesme, poemične pesme, poeme, ronda, triptisi : izbor. Banja Luka: Glas srpski, 2001.
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(Editor), Patrick Humphrey, Michel Ferrari (Editor), and Jes Olesen (Editor), eds. The Triptans: Novel Drugs for Migraine (Frontiers in Headache Research). Oxford University Press, USA, 2001.
Find full textBook chapters on the topic "Triptani"
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Nicolodi, Maria, and Federigo Sicuteri. "Triptans." In Advances in Experimental Medicine and Biology, 183–89. Boston, MA: Springer US, 1999. http://dx.doi.org/10.1007/978-1-4615-4709-9_24.
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Peter, Helga. "Triptane." In Springer Reference Medizin, 1. Berlin, Heidelberg: Springer Berlin Heidelberg, 2020. http://dx.doi.org/10.1007/978-3-642-54672-3_840-1.
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Pascual, J. "Therapy with Other Triptans: Almotriptan." In Drug Treatment of Migraine and Other Headaches, 197–205. Basel: KARGER, 2000. http://dx.doi.org/10.1159/000061589.
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Ferrari, M. D. "Which Oral Triptan to Choose?" In Drug Treatment of Migraine and Other Headaches, 216–21. Basel: KARGER, 2000. http://dx.doi.org/10.1159/000061591.
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Saxena, P. R., and P. De Vries. "Pharmacology of Some Other Triptans in Development." In Drug Treatment of Migraine and Other Headaches, 190–96. Basel: KARGER, 2000. http://dx.doi.org/10.1159/000061588.
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Bomhof, M. A. M. "Is er bezwaar tegen dagelijks gebruik van triptanen?" In Vademecum permanente nascholing huisartsen, 2831–33. Houten: Bohn Stafleu van Loghum, 2006. http://dx.doi.org/10.1007/978-90-313-8808-0_1482.
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Hargreaves, Richard J. "Triptans to Calcitonin Gene-Related Peptide Modulators - Small Molecules to Antibodies - the Evolution of a New Migraine Drug Class." In Neurobiological Basis of Migraine, 157–74. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2017. http://dx.doi.org/10.1002/9781118967225.ch9.
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Storosum, J. G. "Is er een relatie tussen depressie en migraine en bestaat er een farmacologische interactie tussen SSRI's en triptanen?" In Vademecum permanente nascholing huisartsen, 2891–92. Houten: Bohn Stafleu van Loghum, 2006. http://dx.doi.org/10.1007/978-90-313-8808-0_1508.
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"Triptans." In Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions, 3525–28. Elsevier, 2006. http://dx.doi.org/10.1016/b0-44-451005-2/00392-2.
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"Triptans." In Meyler's Side Effects of Drugs, 205–10. Elsevier, 2016. http://dx.doi.org/10.1016/b978-0-444-53717-1.01601-2.
Full textConference papers on the topic "Triptani"
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van Wijk, J. "Triptank Levels After Pumping a Slug." In SPE Annual Technical Conference and Exhibition. Society of Petroleum Engineers, 1997. http://dx.doi.org/10.2118/38604-ms.
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Tent, Michiel. "EHF consensus on effective migraine treatment and triptan failure." In European Headache Congress, edited by Rachel Giles. Baarn, the Netherlands: Medicom Medical Publishers, 2023. http://dx.doi.org/10.55788/79085db1.
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Brieva Herrero, MT, E. Marquez-Fernández, and N. Sánchez-Devicente. "4CPS-134 Prevalence analysis of patients treated with triptans at risk of developing medication overuse headache and development of a prescription optimisation strategy." In 25th EAHP Congress, 25th–27th March 2020, Gothenburg, Sweden. British Medical Journal Publishing Group, 2020. http://dx.doi.org/10.1136/ejhpharm-2020-eahpconf.235.
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Okuda, Tetsuji, Tetsuji Okuda, Satoshi Sekitou, Satoshi Sekitou, Akira Umehara, Akira Umehara, Satoshi Asaoka, et al. "FATE OF SILTS AND CLAY FROM RIVER AND ITS CONTRIBUTION TO TRANSPARENCY." In Managing risks to coastal regions and communities in a changing world. Academus Publishing, 2017. http://dx.doi.org/10.31519/conferencearticle_5b1b9408d54ab6.64595606.
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Phytoplankton plays a key role as primary producer, forming the base of marine food webs. Knowledge in relation to permeability of light in water is important for the understanding of phytoplankton growth in the euphotic zone. In this study, we conducted laboratory experiments in relation to light attenuation using inorganic particle (silica particle) and field investigations in Osaka Bay. There was a positive correlation between the concentrations of the silica particle and integral values of the absorbance at photosynthetic active radiation (PAR: wavelength 400-700 nm) in the laboratory experiments. The highest integral value of the absorbance at PAR was observed for the particle size of 1.0 μm. In Osaka Bay, high contribution of the inorganic particle to light attenuation was observed compared to the organic particles. Multiple linear regression analysis using the particle size and the amount of total suspended solids (TSS: consisting of three component fractions; organic/inorganic tripton and phytoplanktons) showed that the particle size was an essential factor controlling the light attenuation in the coastal sea.
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Okuda, Tetsuji, Tetsuji Okuda, Satoshi Sekitou, Satoshi Sekitou, Akira Umehara, Akira Umehara, Satoshi Asaoka, et al. "FATE OF SILTS AND CLAY FROM RIVER AND ITS CONTRIBUTION TO TRANSPARENCY." In Managing risks to coastal regions and communities in a changing world. Academus Publishing, 2017. http://dx.doi.org/10.21610/conferencearticle_58b431603053e.
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Phytoplankton plays a key role as primary producer, forming the base of marine food webs. Knowledge in relation to permeability of light in water is important for the understanding of phytoplankton growth in the euphotic zone. In this study, we conducted laboratory experiments in relation to light attenuation using inorganic particle (silica particle) and field investigations in Osaka Bay. There was a positive correlation between the concentrations of the silica particle and integral values of the absorbance at photosynthetic active radiation (PAR: wavelength 400-700 nm) in the laboratory experiments. The highest integral value of the absorbance at PAR was observed for the particle size of 1.0 μm. In Osaka Bay, high contribution of the inorganic particle to light attenuation was observed compared to the organic particles. Multiple linear regression analysis using the particle size and the amount of total suspended solids (TSS: consisting of three component fractions; organic/inorganic tripton and phytoplanktons) showed that the particle size was an essential factor controlling the light attenuation in the coastal sea.
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"DOLOR CRÓNICO Y ABUSO DE SUSTANCIAS. A PROPÓSITO DE UN CASO." In 23° Congreso de la Sociedad Española de Patología Dual (SEPD) 2021. SEPD, 2021. http://dx.doi.org/10.17579/sepd2021p015s.
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Introducción: Cada vez son más frecuentes los pacientes con dolor crónico que son derivados a Salud Mental y en los que, una vez en tratamiento, se detecta un consumo de sustancias comórbido. Se plantea el desequilibrio monoaminérgico (serotonina, noradrenalina y dopamina) como nexo común entre la depresión, el dolor y el uso de sustancias. Las principales sustancias detectadas en los dispositivos de Salud Mental son el alcohol y el cannabis. El alcohol es utilizado para mitigar los estados emocionales desagradables y para disminuir la sensibilidad al dolor. El cannabis ha sido utilizado desde la antigüedad como analgésico, antiinflamatorio, orexigeno, antiemético y miorrelajante. Caso clínico: Mujer de 45 años derivada a Salud Mental con diagnóstico de Trastorno depresivo recurrente. Desde hace unos veinte años padece cefaleas resistentes a tratamiento con triptanes, amitriptilina, topiramato y ácido valproico. En consulta se detecta la existencia de un abuso de THC y benzodiazepinas. Se instauró tratamiento con antidepresivo dual y se realizó una intervención focalizada sobre la adicción a cannabis, presentando buena evolución del cuadro afectivo y mejoría de los síntomas de dolor. Conclusiones: En los casos de pacientes con patología dual que presenten sintomatología depresiva debe considerarse la posibilidad de que esté inducida por el consumo de cannabis, de alta prevalencia en los casos de dolor crónico. Se recomienda instaurar tratamiento farmacológico antidepresivo y alcanzar la abstinencia para mejorar el pronóstico. Teniendo en cuenta el dolor como fenómeno complejo donde intervienen elementos fisiopatológicos, neurobiológicos, cognitivos, así como sociales y otros subjetivos emocionales que conforman la experiencia de "sufrimiento", se recomienda incluir la intervención psicoterapéutica como parte de un abordaje integral.
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Ferreira, Maria Gabriela, Ralciane De Paula Menezes, Priscila Guerino Vilela Alves, Mário Paulo Amante Penatti, and Denise Von Dolinger De Brito Röder. "AVALIAÇÃO DA FORMAÇÃO DE BIOFILME POR ISOLADOS AMBIENTAIS DE STHAPHYLOCOCCUS EPIDERMIDES." In I Congresso Nacional de Microbiologia Clínica On-Line. Revista Multidisciplinar em Saúde, 2021. http://dx.doi.org/10.51161/rems/1185.
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Introdução: As infecções relacionadas ao ambiente hospitalar são uma das principais causas de morbimortalidade, sendo Sthaphylococcus epidermides uma das espécies mais frequentes. Este patógeno oportunista acomete principalmente pacientes, em uso de dispositivos invasivos e com o sistema imunológico imaturo, como exemplo os neonatos, sendo capaz de expressar fatores de virulência que contribuem para o aumento da sua patogenicidade, com destaque para a produção de biofilme, que dificulta a ação de diversas classes de antimicrobianos. Objetivos: Avaliar a produção de biofilme por isolados de Sthaphylococcus epidermides provenientes do ambiente da Unidade de Terapia Intensiva Neonatal de um hospital universitário. Material e Métodos: Foram avaliados 76 isolados, sendo: 16 do ar, 14 de superfícies de mesas, 19 de incubadoras, sete de monitores de respiradores, cinco obtidos dos dispenser de papel, quatro de bomba de infusão, quatro das maçanetas das portas da unidade, dois dos botões de sinais vitais, dois das bancadas de medicação, dois dos interruptores e um da gaveta de armário. A indução da formação de biofilme foi feita em placas de 96 poços com fundo chato, confeccionadas em poliestireno, e quantificado através de dois métodos colorimétricos: cristal violeta (para quantificar biomassa) e Safranina (para quantificação da matriz extracelular). Além disso, foi avaliada a viabilidade celular do biofilme formado através da contagem de unidades formadoras de colônias (UFC) após semeadura em placas de ágar Triptona de Soja. Resultados: todos os isolados foram considerados produtores de biofilme, sendo 72 (94,7%) classificados como fortes produtores, considerando a biomassa. Quando avaliado a matriz extracelular, 64 (84,2%) dos isolados foram considerados forte produtores de biofilme. A viabilidade celular média dos biofilmes formados foi de 6,7 x 10^9 CFU/mL. Conclusão: As análises realizadas neste estudo mostraram que a maioria dos isolados ambientais são capazes de formar biofilme. Logo, torna-se necessária a aplicação de métodos eficazes para desinfecção do ambiente hospitalar e das mãos dos profissionais de saúde, para evitar a colonização e subsequente formação de biofilmes em superfícies e dispositivos médicos por esses patógenos, impedindo tanto a sua permanência quanto a disseminação em ambiente hospitalar.
Reports on the topic "Triptani"
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Halker Singh, Rashmi B., Juliana H. VanderPluym, Allison S. Morrow, Meritxell Urtecho, Tarek Nayfeh, Victor D. Torres Roldan, Magdoleen H. Farah, et al. Acute Treatments for Episodic Migraine. Agency for Healthcare Research and Quality (AHRQ), December 2020. http://dx.doi.org/10.23970/ahrqepccer239.
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Objectives. To evaluate the effectiveness and comparative effectiveness of pharmacologic and nonpharmacologic therapies for the acute treatment of episodic migraine in adults. Data sources. MEDLINE®, Embase®, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO®, Scopus, and various grey literature sources from database inception to July 24, 2020. Comparative effectiveness evidence about triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) was extracted from existing systematic reviews. Review methods. We included randomized controlled trials (RCTs) and comparative observational studies that enrolled adults who received an intervention to acutely treat episodic migraine. Pairs of independent reviewers selected and appraised studies. Results. Data on triptans were derived from 186 RCTs summarized in nine systematic reviews (101,276 patients; most studied was sumatriptan, followed by zolmitriptan, eletriptan, naratriptan, almotriptan, rizatriptan, and frovatriptan). Compared with placebo, triptans resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (high strength of the body of evidence [SOE]). Data on NSAIDs were derived from five systematic reviews (13,214 patients; most studied was ibuprofen, followed by diclofenac and ketorolac). Compared with placebo, NSAIDs probably resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (moderate SOE). For other interventions, we included 135 RCTs and 6 comparative observational studies (37,653 patients). Compared with placebo, antiemetics (low SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), and acetaminophen (moderate SOE) reduced acute pain. Opioids were evaluated in 15 studies (2,208 patients).Butorphanol, meperidine, morphine, hydromorphone, and tramadol in combination with acetaminophen may reduce pain at 2 hours and 1 day, compared with placebo (low SOE). Some opioids may be less effective than some antiemetics or dexamethasone (low SOE). No studies evaluated instruments for predicting risk of opioid misuse, opioid use disorder, or overdose, or evaluated risk mitigation strategies to be used when prescribing opioids for the acute treatment of episodic migraine. Calcitonin gene-related peptide (CGRP) receptor antagonists improved headache relief at 2 hours and increased the likelihood of being headache-free at 2 hours, at 1 day, and at 1 week (low to high SOE). Lasmiditan (the first approved 5-HT1F receptor agonist) restored function at 2 hours and resolved pain at 2 hours, 1 day, and 1 week (moderate to high SOE). Sparse and low SOE suggested possible effectiveness of dexamethasone, dipyrone, magnesium sulfate, and octreotide. Compared with placebo, several nonpharmacologic treatments may improve various measures of pain, including remote electrical neuromodulation (moderate SOE), magnetic stimulation (low SOE), acupuncture (low SOE), chamomile oil (low SOE), external trigeminal nerve stimulation (low SOE), and eye movement desensitization re-processing (low SOE). However, these interventions, including the noninvasive neuromodulation devices, have been evaluated only by single or very few trials. Conclusions. A number of acute treatments for episodic migraine exist with varying degrees of evidence for effectiveness and harms. Use of triptans, NSAIDs, antiemetics, dihydroergotamine, CGRP antagonists, and lasmiditan is associated with improved pain and function. The evidence base for many other interventions for acute treatment, including opioids, remains limited.
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“Triptans” can relieve migraines in children and adolescents. National Institute for Health Research, September 2016. http://dx.doi.org/10.3310/signal-000296.
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