Management of hereditary angioedema involves treating acute attacks, preventing attacks, and improving quality of life. Treatment strategies include treating acute attacks, preventing attacks short-term before procedures, and long-term prophylaxis. Therapies include C1 inhibitor replacement, bradykinin receptor antagonists, attenuated androgens, and antifibrinolytics. An individualized treatment plan is recommended based on a patient's attack frequency, severity and location, as well as their medication access and preferences.
The document discusses Streptococcus pneumoniae, also known as pneumococcus, including its transmission, colonization in humans, pathogenesis, clinical syndromes, risk factors, vaccines (polysaccharide vs conjugate), recommendations for vaccination in different populations, and increasing antibiotic resistance. It provides detailed information on pneumococcal disease, the bacteria that causes it, and guidelines for optimizing prevention through vaccination.
This document provides information on immunizations for women in 2014. It discusses myths versus facts about vaccines, explains that vaccines do not cause autism or the diseases they protect against. It addresses safety and effectiveness of the influenza and Tdap vaccines during pregnancy. It recommends that all pregnant women receive the inactivated influenza vaccine each year from 27-36 weeks of pregnancy and the Tdap vaccine in each pregnancy. Minor and temporary side effects are common with vaccines while severe reactions are extremely rare.
Malaria in pregnancy by dr alka mukherjee nagpur m.s. indiaalka mukherjee
An estimated 125 million pregnancies per year are at risk of malaria around the world.1 For both mother and child, malaria is potentially life-threatening. MMV’s MiMBa strategy aims to raise the standard of care for pregnant women and their newborns affected by malaria.
Key elements of the MiMBa strategy include:
• Ensuring drug supplies for children and pregnant women;
• Generating data on existing compounds to inform on their use in pregnant women and neonates;
• Developing new antimalarial medicines to address the needs of pregnant women and neonates;
• Strengthening the capture of safety data from routine clinical use of antimalarial medicines during pregnancy;
• Advocating for changes in drug development that promote the safe inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population.
• Pregnant women are especially susceptible to malaria infection. Without existing immunity, severe malaria can develop requiring emergency treatment, and pregnancy loss is common. In semi-immune women, consequences of malaria for the mother include anaemia while stillbirth, premature delivery and foetal growth restriction affect the developing foetus. Preventive measures include insecticide-treated nets and (in some African settings) intermittent preventive treatment. Prompt management of maternal infection is key, using parenteral artemisinins for severe malaria, and artemisinin combination treatments (ACTs) in the second and third trimesters of pregnancy. ACTs may soon also be recommended as an alternative to quinine as a treatment in the first trimester of pregnancy. Monitoring the safety of antimalarials and understanding their pharmacokinetics is particularly important in pregnancy with the altered maternal physiology and the risks to the developing foetus. As increasing numbers of countries embrace malaria elimination as a goal, the special needs of the vulnerable group of pregnant women and their infants should not be overlooked.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
This document outlines Sanofi's strategic roadmap for 2015-2020. It discusses Sanofi's vision of being a focused global healthcare company in pharmaceuticals, vaccines, and consumer healthcare. The roadmap identifies four strategic priorities: 1) reshaping the portfolio, 2) delivering outstanding launches, 3) simplifying the organization, and 4) sustaining innovation in R&D. Specific goals and initiatives are outlined for each of Sanofi's global business units.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
This document provides an overview of Abbott Laboratories and the infant and baby nutrition market. Abbott Laboratories generates revenue from nutritional products, diagnostic products, established pharmaceuticals, and medical devices. Their nutritional segment includes products for infants, children, and adults. The global baby food market was estimated at $53 billion in 2015 and is projected to reach $76 billion by 2018. Leading players include Abbott, Nestle, and Mead Johnson. The Pakistan baby nutrition market was worth $17 billion in 2017 and is estimated to reach $26 billion by 2022, growing at 11% annually.
This document summarizes research on wheat allergy. It finds that wheat allergy prevalence is approximately 0.4-1% in children and 0.3-0.5% in adults. Symptoms typically present as skin reactions, gastrointestinal issues, or respiratory symptoms. Wheat allergy often resolves by ages 6-7. Key wheat allergens include alpha-amylase inhibitors, lipid transfer proteins, gliadins and glutenins. Diagnosis involves tests for wheat-specific IgE or oral food challenges. Wheat allergy is associated with increased risk of developing respiratory allergies.
The document discusses Streptococcus pneumoniae, also known as pneumococcus, including its transmission, colonization in humans, pathogenesis, clinical syndromes, risk factors, vaccines (polysaccharide vs conjugate), recommendations for vaccination in different populations, and increasing antibiotic resistance. It provides detailed information on pneumococcal disease, the bacteria that causes it, and guidelines for optimizing prevention through vaccination.
This document provides information on immunizations for women in 2014. It discusses myths versus facts about vaccines, explains that vaccines do not cause autism or the diseases they protect against. It addresses safety and effectiveness of the influenza and Tdap vaccines during pregnancy. It recommends that all pregnant women receive the inactivated influenza vaccine each year from 27-36 weeks of pregnancy and the Tdap vaccine in each pregnancy. Minor and temporary side effects are common with vaccines while severe reactions are extremely rare.
Malaria in pregnancy by dr alka mukherjee nagpur m.s. indiaalka mukherjee
An estimated 125 million pregnancies per year are at risk of malaria around the world.1 For both mother and child, malaria is potentially life-threatening. MMV’s MiMBa strategy aims to raise the standard of care for pregnant women and their newborns affected by malaria.
Key elements of the MiMBa strategy include:
• Ensuring drug supplies for children and pregnant women;
• Generating data on existing compounds to inform on their use in pregnant women and neonates;
• Developing new antimalarial medicines to address the needs of pregnant women and neonates;
• Strengthening the capture of safety data from routine clinical use of antimalarial medicines during pregnancy;
• Advocating for changes in drug development that promote the safe inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population.
• Pregnant women are especially susceptible to malaria infection. Without existing immunity, severe malaria can develop requiring emergency treatment, and pregnancy loss is common. In semi-immune women, consequences of malaria for the mother include anaemia while stillbirth, premature delivery and foetal growth restriction affect the developing foetus. Preventive measures include insecticide-treated nets and (in some African settings) intermittent preventive treatment. Prompt management of maternal infection is key, using parenteral artemisinins for severe malaria, and artemisinin combination treatments (ACTs) in the second and third trimesters of pregnancy. ACTs may soon also be recommended as an alternative to quinine as a treatment in the first trimester of pregnancy. Monitoring the safety of antimalarials and understanding their pharmacokinetics is particularly important in pregnancy with the altered maternal physiology and the risks to the developing foetus. As increasing numbers of countries embrace malaria elimination as a goal, the special needs of the vulnerable group of pregnant women and their infants should not be overlooked.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
This document outlines Sanofi's strategic roadmap for 2015-2020. It discusses Sanofi's vision of being a focused global healthcare company in pharmaceuticals, vaccines, and consumer healthcare. The roadmap identifies four strategic priorities: 1) reshaping the portfolio, 2) delivering outstanding launches, 3) simplifying the organization, and 4) sustaining innovation in R&D. Specific goals and initiatives are outlined for each of Sanofi's global business units.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
This document provides an overview of Abbott Laboratories and the infant and baby nutrition market. Abbott Laboratories generates revenue from nutritional products, diagnostic products, established pharmaceuticals, and medical devices. Their nutritional segment includes products for infants, children, and adults. The global baby food market was estimated at $53 billion in 2015 and is projected to reach $76 billion by 2018. Leading players include Abbott, Nestle, and Mead Johnson. The Pakistan baby nutrition market was worth $17 billion in 2017 and is estimated to reach $26 billion by 2022, growing at 11% annually.
This document summarizes research on wheat allergy. It finds that wheat allergy prevalence is approximately 0.4-1% in children and 0.3-0.5% in adults. Symptoms typically present as skin reactions, gastrointestinal issues, or respiratory symptoms. Wheat allergy often resolves by ages 6-7. Key wheat allergens include alpha-amylase inhibitors, lipid transfer proteins, gliadins and glutenins. Diagnosis involves tests for wheat-specific IgE or oral food challenges. Wheat allergy is associated with increased risk of developing respiratory allergies.
Sitosterolemia is a rare autosomal recessive genetic disorder caused by mutations in the ABCG5 or ABCG8 genes, which code for the sterolin protein. This leads to an inability to eliminate dietary plant sterols from the body, resulting in their accumulation and deposition in tissues. Symptoms include premature atherosclerosis, fatty deposits under the skin called xanthomas, and blood abnormalities. Treatment focuses on a strictly plant sterol-restricted diet, cholesterol-lowering medications, and potentially bile acid sequestrants.
This document presents a case report of a 41-year-old man admitted with fever, respiratory symptoms, and deranged liver function tests. Further investigations revealed pancytopenia, hyperferritinemia over 11,000 ng/ml, and bone marrow biopsy showing hemophagocytosis, leading to a diagnosis of acquired hemophagocytic lymphohistiocytosis (HLH) secondary to Epstein-Barr virus infection. HLH is a rare but under-recognized hyperinflammatory condition that can cause multi-organ dysfunction resembling sepsis. It requires specific treatment including dexamethasone, cyclosporine A, and etoposide to control the uncontrolled activation of macrophages and lymphocytes driving the hyperinflammatory state. The
New agents for the treatment of drug resistant Mycobacterium TuberculosisAreej Abu Hanieh
This document summarizes several new agents for treating drug-resistant Mycobacterium tuberculosis. It discusses imidazopyridine (Q203), which acts on the respiratory chain and has excellent killing properties for chronic TB. Feropenem is an oral beta-lactam antibiotic used to treat various bacterial infections. Several DPR1E inhibitors including PBTZ169, BTZ043 and TCA1 block cell wall synthesis and have activity against replicating and nonreplicating TB. TCA1 in particular works through two mechanisms and is effective against XDR-TB. The document evaluates the mechanisms, administration, pharmacokinetics and potential of these new anti-TB therapies.
The document discusses adult immunization strategies in India. It notes there is a lack of consensus on optimal adult immunization strategies in developing countries like India due to a lack of reliable epidemiological data, efficacy and safety data of vaccination strategies, and data on monitoring immunization adequacy. The document provides guidance on recommended vaccines for different adult groups and schedules for vaccines including tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, HPV, influenza, measles, mumps, rubella, varicella, herpes zoster and pneumococcal vaccines.
Who is responsible for emergence and spread of AMR? How ?o handle it?Bhoj Raj Singh
Is there anyone who is responsible for AMR? Everyone say no, or if accept, accept it partly. The community which is most readily accept the partial responsibility is Veterinarians and with some reluctance are the Medicos but others will either say Ï am not or will point this or that fellow or will show innocence or utter irrelevance. Who are those vets and medicos readily accept the responsibility or painted for AMR? All those from developing and poor countries, why? In India, there is a saying, “wife of a poor is Bhabhi of all”, that is poor are legalized to be blamed. All the responsible keep them behind thick curtains of the legal, philanthropic and humanitarian veil or with their right to Veto and might. In this presentation tried to understand the role of those behind veils and those are blamed.
Hereditary angioedema (HAE) is caused by C1 inhibitor deficiency or dysfunction. There are three main types: HAE type I and II involve C1INH mutations, while HAE type III has normal C1INH levels. Symptoms include non-pruritic swelling of the skin or mucosa. Abdominal or laryngeal attacks can be life-threatening. Diagnosis involves evaluating C1INH antigenic and functional levels. Treatment focuses on preventing attacks or treating acute episodes. Acquired angioedema has similar symptoms but later onset and is sometimes associated with lymphoproliferative disorders.
Pfizer Inc. is a Delaware corporation that was originally incorporated in 1942 as Chas. Pfizer & Co. Inc. Pfizer has since grown to be the largest pharmaceutical company in the world. The document outlines Pfizer's history from its founding in 1849, leadership structure, board of directors, product portfolio, market share and competitors. It also discusses Pfizer's corporate social responsibility initiatives and corporate governance policies.
This document discusses allergies to fruits and vegetables. It begins with an introduction to panallergens like profilin, nsLTPs and Bet v 1 that can cause cross-reactivity between plant foods and pollen. The epidemiology section notes that the prevalence of fruit allergies ranges from 0.1-4.3% while vegetable allergies range from 0.1-0.3%. Several case studies are presented demonstrating pollen-food allergy syndromes. Key allergens like profilin, nsLTPs, Bet v 1 and GRPs are discussed in depth, outlining their clinical relevance and evaluation.
This document provides definitions and classifications of adverse drug reactions and drug allergies. It discusses how drugs can act as antigens and cause immune-mediated reactions. Drugs can be antigens by themselves as foreign macromolecules, or they can gain antigenicity through metabolism into haptenic forms that bind to proteins and activate the immune system. Adverse drug reactions are classified in different ways, including by mechanism (pharmacodynamic, toxic, allergic), time of onset (acute, delayed), or clinical manifestations. Drug allergies represent a subset of reactions that involve demonstrated immunological mechanisms.
This document discusses antimicrobial resistance and antibiotic use. It defines antibiotics and their classifications including site of action, mode of action, and spectrum of activity. It discusses the misuse of antibiotics and factors that can lead to drug resistance. Antimicrobial resistance has reached crisis levels and is linked to overuse of antibiotics. The document recommends educating healthcare professionals, hospitals, pharmacists, students and patients about appropriate antibiotic usage to curb rising antimicrobial resistance.
Fungal infections remain a major cause of illness and death, especially in immunocompromised patients. Voriconazole is a broad-spectrum triazole antifungal that is effective against a wide range of fungi including Aspergillus and Candida. Studies have shown voriconazole to have higher response and survival rates compared to amphotericin B for invasive aspergillosis. It is also as effective as fluconazole for esophageal candidiasis. Voriconazole can be used alone or in combination with other antifungals as salvage therapy for refractory infections.
Introduction to one of best medicine company Glaxo-smith-kline commonly known as GSK. this presentation gives detail introduction about GSK functions and products. Also global strategies which company is using.
This document summarizes information about wheat allergy, including its prevalence, wheat proteins and allergens, clinical manifestations, diagnosis, and management. Some key points:
- Wheat allergy prevalence varies by age and region, ranging from <1% to over 3% in Europe and the US. It is less common in Asia-Pacific regions.
- Major wheat allergens include alpha-amylase inhibitors, lipid transfer proteins, gliadins like omega-5-gliadin, and glutenins. These can cause reactions from baker's asthma to food allergy.
- Clinical manifestations depend on exposure route and age. Symptoms include immediate reactions like anaphylaxis as well as
The study asked whether drinking milk containing the probiotic Lactobacillus rhamnosus GG would reduce respiratory and gastrointestinal symptoms in children aged 2-6 with respiratory illnesses compared to normal milk. The results found that probiotic milk reduced respiratory symptoms with an odds ratio of 5.03, while normal milk had an odds ratio of 5.17. Both results were statistically significant and precise. The treatment is applicable to similar patients and feasible locally. Potential benefits are reduced symptoms and harms were not discussed. Patients would value decreased illness and a natural treatment option.
mechanism of resistance of antibiotics, ESBL, b lactums, enterobactericae, metallobactums, carbapenemases, types of mechanism of resistance, history of antibiotics and resistance
A 92-year-old female presented with post renal obstruction and hematuria. She was initially diagnosed with acute cystitis and started on Meropenem on October 31st, then switched to Augmentin on November 4th. On November 5th, she returned to the emergency room with a widespread rash on her trunk and legs. A skin biopsy showed subcorneal pustules and dermal inflammation consistent with acute generalized exanthematous pustulosis, likely caused by Augmentin. Her rash resolved after discontinuing Augmentin and treating with topical steroids.
The document discusses T-regulopathies, which are monogenic diseases resulting from regulatory T-cell deficiencies. It describes various diseases caused by defects in genes important for regulatory T-cell development and function, such as FOXP3 in IPEX syndrome and CTLA-4 deficiency. The presentation, diagnosis, and treatment of these conditions are explored.
Ceftazidime-Avibactam Is Superior toOther Treatment Regimens againstCarbape...Abdullatif Al-Rashed
Ceftazidime-Avibactam Is Superior to Other Treatment Regimens against Carbapenem-Resistant Klebsiella pneumoniae Bacteremia
This study compared outcomes of patients with carbapenem-resistant K. pneumoniae bacteremia treated with ceftazidime-avibactam to other regimens. It found that patients who received ceftazidime-avibactam had significantly higher clinical success and survival rates compared to those who received carbapenem plus aminoglycoside, carbapenem plus colistin, or other therapies. This provides evidence that ceftazidime-avibactam may be superior as first-line treatment for carbapenem-resistant K.
This document summarizes information on chronic urticaria, including its prevalence, causes, impact on quality of life, and treatment options. It notes that chronic urticaria affects approximately 1% of people with acute urticaria and has a significant negative impact on quality of life. First-line treatment includes non-sedating antihistamines, sometimes at higher off-label doses. If patients do not respond sufficiently to antihistamines alone, second-line options include doxepin, leukotriene antagonists, short-term corticosteroids, dapsone, sulfasalazine, and narrowband UVB phototherapy. The document reviews evidence on the efficacy and safety of these second-
This document discusses deep vein thrombosis (DVT) prophylaxis. It notes that the incidence of DVT in critically ill patients ranges widely from 10-80% depending on patient population and diagnosis methods. It identifies several risk factors for DVT including immobility, recent surgery/trauma, older age, sepsis, and central lines. The document describes primary and secondary prophylaxis methods, DVT risk scoring systems, pharmacological and non-pharmacological prophylaxis treatments, and considerations for prophylaxis duration and dosing in critically ill patients. It also discusses heparin-induced thrombocytopenia (HIT) diagnosis and treatment as well as the use of oral anticoagulants for prophyl
Sitosterolemia is a rare autosomal recessive genetic disorder caused by mutations in the ABCG5 or ABCG8 genes, which code for the sterolin protein. This leads to an inability to eliminate dietary plant sterols from the body, resulting in their accumulation and deposition in tissues. Symptoms include premature atherosclerosis, fatty deposits under the skin called xanthomas, and blood abnormalities. Treatment focuses on a strictly plant sterol-restricted diet, cholesterol-lowering medications, and potentially bile acid sequestrants.
This document presents a case report of a 41-year-old man admitted with fever, respiratory symptoms, and deranged liver function tests. Further investigations revealed pancytopenia, hyperferritinemia over 11,000 ng/ml, and bone marrow biopsy showing hemophagocytosis, leading to a diagnosis of acquired hemophagocytic lymphohistiocytosis (HLH) secondary to Epstein-Barr virus infection. HLH is a rare but under-recognized hyperinflammatory condition that can cause multi-organ dysfunction resembling sepsis. It requires specific treatment including dexamethasone, cyclosporine A, and etoposide to control the uncontrolled activation of macrophages and lymphocytes driving the hyperinflammatory state. The
New agents for the treatment of drug resistant Mycobacterium TuberculosisAreej Abu Hanieh
This document summarizes several new agents for treating drug-resistant Mycobacterium tuberculosis. It discusses imidazopyridine (Q203), which acts on the respiratory chain and has excellent killing properties for chronic TB. Feropenem is an oral beta-lactam antibiotic used to treat various bacterial infections. Several DPR1E inhibitors including PBTZ169, BTZ043 and TCA1 block cell wall synthesis and have activity against replicating and nonreplicating TB. TCA1 in particular works through two mechanisms and is effective against XDR-TB. The document evaluates the mechanisms, administration, pharmacokinetics and potential of these new anti-TB therapies.
The document discusses adult immunization strategies in India. It notes there is a lack of consensus on optimal adult immunization strategies in developing countries like India due to a lack of reliable epidemiological data, efficacy and safety data of vaccination strategies, and data on monitoring immunization adequacy. The document provides guidance on recommended vaccines for different adult groups and schedules for vaccines including tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, HPV, influenza, measles, mumps, rubella, varicella, herpes zoster and pneumococcal vaccines.
Who is responsible for emergence and spread of AMR? How ?o handle it?Bhoj Raj Singh
Is there anyone who is responsible for AMR? Everyone say no, or if accept, accept it partly. The community which is most readily accept the partial responsibility is Veterinarians and with some reluctance are the Medicos but others will either say Ï am not or will point this or that fellow or will show innocence or utter irrelevance. Who are those vets and medicos readily accept the responsibility or painted for AMR? All those from developing and poor countries, why? In India, there is a saying, “wife of a poor is Bhabhi of all”, that is poor are legalized to be blamed. All the responsible keep them behind thick curtains of the legal, philanthropic and humanitarian veil or with their right to Veto and might. In this presentation tried to understand the role of those behind veils and those are blamed.
Hereditary angioedema (HAE) is caused by C1 inhibitor deficiency or dysfunction. There are three main types: HAE type I and II involve C1INH mutations, while HAE type III has normal C1INH levels. Symptoms include non-pruritic swelling of the skin or mucosa. Abdominal or laryngeal attacks can be life-threatening. Diagnosis involves evaluating C1INH antigenic and functional levels. Treatment focuses on preventing attacks or treating acute episodes. Acquired angioedema has similar symptoms but later onset and is sometimes associated with lymphoproliferative disorders.
Pfizer Inc. is a Delaware corporation that was originally incorporated in 1942 as Chas. Pfizer & Co. Inc. Pfizer has since grown to be the largest pharmaceutical company in the world. The document outlines Pfizer's history from its founding in 1849, leadership structure, board of directors, product portfolio, market share and competitors. It also discusses Pfizer's corporate social responsibility initiatives and corporate governance policies.
This document discusses allergies to fruits and vegetables. It begins with an introduction to panallergens like profilin, nsLTPs and Bet v 1 that can cause cross-reactivity between plant foods and pollen. The epidemiology section notes that the prevalence of fruit allergies ranges from 0.1-4.3% while vegetable allergies range from 0.1-0.3%. Several case studies are presented demonstrating pollen-food allergy syndromes. Key allergens like profilin, nsLTPs, Bet v 1 and GRPs are discussed in depth, outlining their clinical relevance and evaluation.
This document provides definitions and classifications of adverse drug reactions and drug allergies. It discusses how drugs can act as antigens and cause immune-mediated reactions. Drugs can be antigens by themselves as foreign macromolecules, or they can gain antigenicity through metabolism into haptenic forms that bind to proteins and activate the immune system. Adverse drug reactions are classified in different ways, including by mechanism (pharmacodynamic, toxic, allergic), time of onset (acute, delayed), or clinical manifestations. Drug allergies represent a subset of reactions that involve demonstrated immunological mechanisms.
This document discusses antimicrobial resistance and antibiotic use. It defines antibiotics and their classifications including site of action, mode of action, and spectrum of activity. It discusses the misuse of antibiotics and factors that can lead to drug resistance. Antimicrobial resistance has reached crisis levels and is linked to overuse of antibiotics. The document recommends educating healthcare professionals, hospitals, pharmacists, students and patients about appropriate antibiotic usage to curb rising antimicrobial resistance.
Fungal infections remain a major cause of illness and death, especially in immunocompromised patients. Voriconazole is a broad-spectrum triazole antifungal that is effective against a wide range of fungi including Aspergillus and Candida. Studies have shown voriconazole to have higher response and survival rates compared to amphotericin B for invasive aspergillosis. It is also as effective as fluconazole for esophageal candidiasis. Voriconazole can be used alone or in combination with other antifungals as salvage therapy for refractory infections.
Introduction to one of best medicine company Glaxo-smith-kline commonly known as GSK. this presentation gives detail introduction about GSK functions and products. Also global strategies which company is using.
This document summarizes information about wheat allergy, including its prevalence, wheat proteins and allergens, clinical manifestations, diagnosis, and management. Some key points:
- Wheat allergy prevalence varies by age and region, ranging from <1% to over 3% in Europe and the US. It is less common in Asia-Pacific regions.
- Major wheat allergens include alpha-amylase inhibitors, lipid transfer proteins, gliadins like omega-5-gliadin, and glutenins. These can cause reactions from baker's asthma to food allergy.
- Clinical manifestations depend on exposure route and age. Symptoms include immediate reactions like anaphylaxis as well as
The study asked whether drinking milk containing the probiotic Lactobacillus rhamnosus GG would reduce respiratory and gastrointestinal symptoms in children aged 2-6 with respiratory illnesses compared to normal milk. The results found that probiotic milk reduced respiratory symptoms with an odds ratio of 5.03, while normal milk had an odds ratio of 5.17. Both results were statistically significant and precise. The treatment is applicable to similar patients and feasible locally. Potential benefits are reduced symptoms and harms were not discussed. Patients would value decreased illness and a natural treatment option.
mechanism of resistance of antibiotics, ESBL, b lactums, enterobactericae, metallobactums, carbapenemases, types of mechanism of resistance, history of antibiotics and resistance
A 92-year-old female presented with post renal obstruction and hematuria. She was initially diagnosed with acute cystitis and started on Meropenem on October 31st, then switched to Augmentin on November 4th. On November 5th, she returned to the emergency room with a widespread rash on her trunk and legs. A skin biopsy showed subcorneal pustules and dermal inflammation consistent with acute generalized exanthematous pustulosis, likely caused by Augmentin. Her rash resolved after discontinuing Augmentin and treating with topical steroids.
The document discusses T-regulopathies, which are monogenic diseases resulting from regulatory T-cell deficiencies. It describes various diseases caused by defects in genes important for regulatory T-cell development and function, such as FOXP3 in IPEX syndrome and CTLA-4 deficiency. The presentation, diagnosis, and treatment of these conditions are explored.
Ceftazidime-Avibactam Is Superior toOther Treatment Regimens againstCarbape...Abdullatif Al-Rashed
Ceftazidime-Avibactam Is Superior to Other Treatment Regimens against Carbapenem-Resistant Klebsiella pneumoniae Bacteremia
This study compared outcomes of patients with carbapenem-resistant K. pneumoniae bacteremia treated with ceftazidime-avibactam to other regimens. It found that patients who received ceftazidime-avibactam had significantly higher clinical success and survival rates compared to those who received carbapenem plus aminoglycoside, carbapenem plus colistin, or other therapies. This provides evidence that ceftazidime-avibactam may be superior as first-line treatment for carbapenem-resistant K.
This document summarizes information on chronic urticaria, including its prevalence, causes, impact on quality of life, and treatment options. It notes that chronic urticaria affects approximately 1% of people with acute urticaria and has a significant negative impact on quality of life. First-line treatment includes non-sedating antihistamines, sometimes at higher off-label doses. If patients do not respond sufficiently to antihistamines alone, second-line options include doxepin, leukotriene antagonists, short-term corticosteroids, dapsone, sulfasalazine, and narrowband UVB phototherapy. The document reviews evidence on the efficacy and safety of these second-
This document discusses deep vein thrombosis (DVT) prophylaxis. It notes that the incidence of DVT in critically ill patients ranges widely from 10-80% depending on patient population and diagnosis methods. It identifies several risk factors for DVT including immobility, recent surgery/trauma, older age, sepsis, and central lines. The document describes primary and secondary prophylaxis methods, DVT risk scoring systems, pharmacological and non-pharmacological prophylaxis treatments, and considerations for prophylaxis duration and dosing in critically ill patients. It also discusses heparin-induced thrombocytopenia (HIT) diagnosis and treatment as well as the use of oral anticoagulants for prophyl
This document provides a nursing student's response to a case study on medications for a patient named Mr. MP. It includes details of the medications, their uses, dosages, side effects and special considerations. It also lists potential problems related to the medications, assessments to monitor for side effects, and healthcare providers to collaborate with including the physician, respiratory therapist, pharmacist, and physical therapist. The student identifies risks of bleeding, infection, and falls and interventions like careful injections, hand washing, and fall precautions. Assessments include respiratory, cardiovascular and musculoskeletal exams.
This document reviews recommendations for managing chronic medication therapies in the perioperative period based on a literature review. It summarizes guidelines for various drug classes, including cardiovascular drugs like beta-blockers which should generally be continued, and ACE inhibitors/ARBs which may need to be discontinued. It also reviews antiplatelet drugs like aspirin that may need to be stopped before some surgeries depending on bleeding risk. Recommendations are provided for anticoagulants as well, noting that factors like kidney function and surgery bleeding risk must be considered for drugs like the new oral anticoagulants. The review aims to help clinicians safely manage patients' chronic medications in the perioperative setting.
This document discusses total intravenous anesthesia (TIVA) using target-controlled infusion (TCI) in elderly patients. It notes that pharmacokinetics change with age, so TIVA in elderly requires starting at low drug concentrations and avoiding large changes in plasma levels. TIVA may reduce postoperative delirium and cognitive dysfunction in elderly versus inhalational anesthesia. However, very low anesthetic depth as indicated by triple low values of BIS <45, MAP <75 mmHg and MAC <0.8 is associated with increased mortality and length of stay. When using TIVA in elderly patients, it is important to titrate doses carefully and avoid excessively deep levels of anesthesia.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins of the legs or pelvis. Risk factors include prolonged immobility, surgery, cancer, and genetic factors. Symptoms include leg swelling, pain, and warmth. Diagnosis is made through ultrasound or venography. Treatment involves anticoagulants like heparin, low molecular weight heparin, or warfarin to prevent clot extension and pulmonary embolism. Chronic therapy aims to prevent recurrence and typically lasts at least 3-6 months or indefinitely for high-risk patients.
Traumatic brain injury (TBI) is a major public health problem in Egypt. The document outlines guidelines for the management of severe TBI based on the PROTECT III trial. It describes protocols for airway management, oxygenation, ventilation, blood pressure control, volume resuscitation, and intracranial pressure (ICP) monitoring. The guidelines provide a tiered approach for controlling ICP that includes head elevation, sedation, ventricular drainage, mannitol, hypertonic saline, barbiturates, and decompressive craniectomy. It also covers other aspects of care such as seizures prophylaxis, metabolic monitoring, surgery indications, and nutritional support.
This document discusses various biological agents used to treat uveitis, including tumor necrosis factor inhibitors like infliximab, adalimumab, etanercept, golimumab, and certolizumab. It provides dosing information and potential adverse effects for each drug. Anti-interleukin therapies like daclizumab, anakinra, tocilizumab, rituximab, gevokizumab, and secukinumab are also summarized. Key points are provided on initiating and monitoring patients on biological therapies to help maximize efficacy and safety. Biologics are described as potent treatments for uveitis when conventional therapies have failed or been poorly tolerated.
The NICE-SUGAR trial was a large multicenter randomized controlled trial that compared intensive glycemic control (81-108 mg/dL) to conventional glycemic control (≤180 mg/dL) in over 6,000 critically ill patients. It found that intensive control increased 90-day mortality compared to conventional control, demonstrating that a target of <180 mg/dL resulted in lower mortality than 81-108 mg/dL. Limitations included the inability to blind treating teams and premature discontinuation of some patients from the study.
periodontal management of medically compromised patientsVishal Mishra
This document summarizes periodontal management considerations for various medically compromised patients. It covers cardiovascular diseases, renal diseases, pulmonary diseases, immunosuppression/chemotherapy, radiotherapy, endocrine disorders, and hemorrhagic/blood disorders. For each condition, it discusses precautions, management of dental treatment, and management of medical emergencies that could arise during treatment. The goal is to minimize risk and stress for patients with underlying medical conditions.
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Hereditary Angio-Oedema – A rare case report & review of management methodolo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent abscesses and scarring in the apocrine gland-bearing areas. It typically presents in young adults and is more common in women and people of African descent. Obesity, smoking, family history and certain drugs are associated risk factors. The pathogenesis involves occlusion of hair follicles leading to rupture, inflammation, abscess formation and scarring. Diagnosis is clinical though imaging and biopsy may help in some cases. Treatment aims to control flare-ups and prevent scarring. The course is usually chronic with intermittent flares and remissions.
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Managment of HAE..pptx
1. Management of hereditary
angioedema (HAE)
Marwa Abo Elmaaty Besar
Lecturer Of Internal Medicine
(Rheumatology Immunology Unit)
(Pediatric Rheumatology)
Mansoura University
2. Treatment of hereditary angioedema:-
• Since HAE-C1-INH is a genetic disease, a causal treatment is not currently
viable.
• Therapeutic strategies:-
The reversal and/or prevention of attacks,
Reduction of morbidity and mortality,
Improvement in quality of life.
Long term
prophylaxis
(LTP)
Short-term
prophylaxis
(STP)
Acute
“on-
demand”
3. Consensus Guidelines for an Individualized Care Plan for Patients with HAE
HAE, hereditary angioedema; HAEA, Hereditary Angioedema Association; HAWK, Hereditary Angioedema International Working group; LTP, long-term prophylaxis; WAO, World Allergy Organization
1. Zuraw BL, et al. J Allergy Clin Immunol Pract. 2013;1:458–67; 2. Cicardi M, et al. Allergy 2012;67:147–57; 3. Maurer M, et al. Allergy 2018;73:1575–96
| VV-MEDCOM-1845 | Updated November 2019
Recommend an individualized care plan for patients with HAE1–3
US Hereditary Angioedema
Association (HAEA) Medical
Advisory Board1
Hereditary Angioedema
International Working Group
(HAWK)2
World Allergy Organization
(European Academy of Allergy
and Clinical Immunology
(WAO/EAACI)3
Acute
(On-Demand)
Treatment
Short-term/
pre-procedural
prophylaxis
Long-term
prophylaxis
(LTP)
• Patients should be evaluated for LTP at every visit, with disease burden and patient preference taken into
consideration, and regularly assessed for the efficacy and safety of their LTP regimen; on-demand therapy should
also be available to treat breakthrough attacks3
4. The international WAO/EAACI guideline for the management of hereditary
angioedema—The 2021 revision and update
The international WAO/EAACI guideline for the management of hereditary angioedema 2021
RECOMMENDATION 4
We recommend that all attacks are considered for on-
demand treatment.
98% agreement, evidence level D
RECOMMENDATION 5
We recommend that any attack affecting or potentially
affecting the upper airway is treated.
100% agreement, evidence level C
RECOMMENDATION 6
We recommend that attacks are treated as early as
possible.
100% agreement, evidence level B
RECOMMENDATION 9
We recommend that all patients have sufficient
medication for on-demand treatment of at least two
attacks and carry on-demand medication at all times
100% agreement, evidence level D
RECOMMENDATION 10
We recommend considering short-term prophylaxis
before medical, surgical or dental procedures as well as
exposure to other angioedema attack-inducing events
94% agreement, evidence level C
RECOMMENDATION 12
We suggest considering prophylaxis prior to exposure to
patient-specific angioedema-inducing situations
90% agreement, evidence level D
RECOMMENDATION 14
We recommend that patients are evaluated for long-term
prophylaxis at every visit, taking disease activity, burden,
and control as well as patient preference into
consideration
96% agreement, evidence level D
5. For all types of C1-INH deficiency exacerbation of
angioedema
Supportive methods:
• The maintenance of a free airway.
• Early and accurate treatment,
• Severe oropharyngeal angioedema;
• Emergency intubation and/or tracheostomy.
• Monitored closely in a hospital setting until the attack
resolves.
British Journal of Hospital Medicine, July 2019, Vol 80, No 7
6. Acute attack “on demand”
• Usually works within 1 hour.
• Is used to ameliorate symptoms of attack.
• If requiring a repeat dose within 24 hours indicates worsening of an
attack.
• For abdominal attacks that require a second dose.
• Consideration should be given for other causes of an acute
abdomen.
• Decisions on which “on-demand” therapy to use should implement
shared decision strategies so patients can determine which treatment is
most suitable to their lifestyle and needs.
7. Acute attack “on demand”
4 S. Kesh and J.A. Bernstein / Ann Allergy Asthma Immunol 00
(2022) 1−10
8. Acute attack “on demand”
I-No evidence exists for efficacy of epinephrine, H1 and H2 antihistamines, or
corticosteroids????
These drugs for patients presenting with life threatening attacks.
II-Infusions of fresh frozen plasma; before 2009;
Administrated successfully as treatment of severe attacks
“double-edged sword”
it is a valuable alternative for C1-INH concentrate.
III-The attenuated synthetic androgen (danazol and, more recently,
stanazolol).
Danazol; 50 mg to 600 mg daily, (Occasionally alternate-day therapy)
Stanozolol; less masculinising potential.
During administration; C4 and C2 levels rise along with C1-INH levels with a stable C1-
INH activity.
Generally clinical remission is obtained within 1 to 2 weeks after start of therapy.
Not recommended in children, during pregnancy.
Gelfand et al, 1976
9. Acute attack “on demand”
IV-Antifibrinolytic agents, e-aminocaproic acid, analogue (tranexamic acid)
In dosages up to 8 g intravenously or orally
Shown to be beneficial, only when is started early.
No consequent increase in C4 and/or C1-INH, and probably act through inhibition
of plasmin.
Side effects e.g Muscle necrosis and a potential thrombotic effect.
Prescription of these agents has diminished in favour of the attenuated
androgens.
Constitutes:-
A valuable alternative in patients in which attenuated androgens are contra-
indicated.
That are suffering from severe or frequent attacks. Acta Clinica Belgica, 2000; 55-1
10. The treatment for acute attacks:-
• The treatment of choice is replacement therapy with purified
vapour-heated C1-INH.
Plasma-derived nanofiltered C1-INH (Berinert), IV
Recombinant human C1-INH (Ruconest), IV
• The use of the kallikrein inhibitor aprotinin (Trasylol®), SC
Is questionable, due to allergic reactions.
• Effective bradykinin receptor antagonists (Icatibant), SC
appear to be a promising approach to treatment of HAE
attacks.
Bork et al, 2008a; Zanichelli et al, 2015
11. Replacement therapy:
Purified vapour-heated C1-INH
• Safe, effective and well-tolerated.
• Indicated in patients in which the other available drugs are contra-
indicated or not tolerated.
• Plasma-derived C1-INH (pdC1-INH, Cinryze) is approved by (FDA) for
LTP, but it can be used clinically, if necessary, as on-demand therapy
• Value: are sufficient to stop severe attacks within 30-60 minutes.
• Dose; 1,000 to 2,000 u of C1-INH concentrate.
• Mech; recombinant cytokine activation of C1-INH genes, recombinant product
of a serpine gene mutated for increased C1-INH activity,
• Unfortunately, the presence of C1-INH antibodies; may need up to 10,000 U in
order to revert a severe attack.
Bork K., etal 1989
Visentin DE, etal 1988
12. Special situation:
I- Elective surgery, especially in the oropharyngeal region;
Prophylaxis against possible exacerbation.
Short-term prophylactic treatment with
• Attenuated androgens, increase dose for 5-10 days pre-operatively and 3 days
postoperatively (danazol 200 mg t.I.D., Stanozolol 1 mg q.I.D.).
+
• With fresh frozen plasma shortly prior to intervention
or
• An increment of the maintenance dosage (purified C1-INH concentrates).
• Preoperative administration, especially when time is pressing.
13. II-During labour:
• Pre-delivery administration of purified C1-INH concentrates;
Performed successfully
C1-INH does not cross the placental barrier,
Substitution of the mothers will not interfere with the
measurement of C1-INH in the new born.
14. Short-term Prophylaxis (STP)
• STP should be a shared decision process based on
Risk of the procedure,
Cost,
Patient preference.
Magerl
M,etal2017
Low risk
procedure
• Not to proceed with STP
• On-demand therapy be available for
the patient.
High risk
procedure
• Major dental surgery,
intubation,
• Oral surgery,
• Stressful events
Bork et al, 2011
15. Short-term Prophylaxis (STP)
• The two plasma-derived C1-INH concentrates (PdC1-INH) or
Recombinant C1-INH treatments as first-line treatments.
• If neither of the former are available,
1. Anabolic androgens
2. Subcutaneous plasma kallikrein inhibitor and bradykinin 2
receptor antagonist
Should not be used, their short half-life.
Effective only if IV C1-INH therapies are not available
British Journal of Hospital Medicine, July 2019, Vol 80, No
16. Long-term Prophylaxis (LTP).
• LTP is used to
Minimize the frequency and severity of attacks.
Optimize the patient’s quality of life.
• The need for LTP should be shared decision making with the patient.
• Initiation of LTP depends on
Frequency, severity, and location of attacks,
Availability of on-demand medications, as some insurance carriers limit 3
doses a month.
• Choice of therapy should be dependent on the patient’s age, route of
administration, and cost considerations.
• Patients should be monitored regularly for efficacy and tolerability of treatment
and on-demand therapy should be available to treat breakthrough attacks
Busse Pj,etal 2021
Longhurst and Zinser, 2017
17. Long-term Prophylaxis (LTP).
I- Plasma-derived C1-INH concentrates are commonly used as
prophylaxis.
• (Cinryze) was the only plasma-derived formulation licensed for long-term
prophylaxis.
Well tolerated and effective.
Requires intravenous administration, which may be a limiting factor.
• Subcutaneous C1-INH, haegarda (CSL behring),
Licensed in the USA for long-term prophylaxis.
More convenient
Easier for patients requiring long-term prophylaxis.
Maurer et al, 2018
Longhurst et al, 2017
18. Long-term Prophylaxis (LTP).
II-Attenuated androgens :
long-term prophylaxis for a long time.
Oral administration,
their effectiveness is high (83% average attack reduction)
often dose-dependent, side effects
the minimal effective dose, (maximum 100–200 mg/day danazol)
III-Tranexamic acid:
Not as effective as attenuated androgens,
Commonly used in children.
Is not generally recommended for long-term prophylaxis
Bork et al, 2008
Maurer et al, 2018
19. Home therapy and self-administration
• The World Allergy Organization recommends that patients have access to on-
demand therapy and are taught to self-administer.
Safely administered by the patient at home,
Reduces the duration and frequency of HAE attacks
Self-administration is also more convenient,
Improves patients’ quality of life and independence.
• Self-administration training includes a home therapy partner, who usually
provides support and may also be trained to administer the therapy.
• The intravenous C1-INH concentrates (Berinert, Cinryze and Ruconest) are
licensed for self-administration in children, adolescents and adults,
• The Subcutaneous C1-INH Haegarda is approved for self-administration in
adolescents and adults.
• Icatibant (Firazyr) is licensed for self-administration in adults and by a caregiver
for children.
Longhurst et al, 2010
Bygum et al, 2009
20. Treatment of HAE pipeline:
• A monoclonal antibody against plasma kallikrein, subcutaneous
lanadelumab,
For prophylactic treatment of hereditary angioedema attacks,
significantly reduced the mean attack rate.
• An oral plasma kallikrein inhibitor, BCX7353,
Is currently in development, Phase 1,2.
For the prevention of hereditary angioedema attacks
Significantly reduced the rate of hereditary angioedema attacks
Gastrointestinal adverse events
Riedl et al, 2017
Banerji et al, 2018
21. 4 S. Kesh and J.A. Bernstein / Ann Allergy Asthma Immunol 00
23. 1. All medical,
2. Dental procedures
Associated with any
mechanical impact to the
upper aerodigestive tract,
3. Surgical procedures
The international WAO/EAACI guideline for the management of hereditary
angioedema— C1 Inhibtor (Cinryze)
RECOMMENDATION 7
We recommend that attacks are treated with either intravenous C1
inhibitor, ecallantide or icatibant
96% agreement, evidence level A
RECOMMENDATION 11
We recommend the use of intravenous plasma-derived C1
inhibitor as first-line short-term prophylaxis
91% agreement, evidence level C RECOMMENDATION 15
We recommend the use of plasma-derived C1 inhibitor as
first-line long-term prophylaxis
87% agreement, evidence level A
On Demand
Long-term Prophylaxis
Short-Term Prophylaxis
RECOMMENDATION 22
We recommend plasma-derived C1 inhibitor as the
preferred therapy during pregnancy and lactation
100% agreement, evidence level D
Pregnancy & Lactation
The international WAO/EAACI guideline for the management of hereditary angioedema 2021
24. • Cinryze is made from purified human blood that is collected from selected
plasma donors.
• Samples go through a complex purification process (involving
pasteurisation and nanofiltration) to inactivate or remove viruses.
• However, the possibility of human blood or plasma passing on infection
cannot be totally excluded.
How is Cinryze made?
25. British Journal of Hospital Medicine, July 2019, Vol 80, N
Pathway of contact system activation and interaction with fibrinolytic system.
26. 3.1
KEY POINT
Indication:2
• Treatment and pre-procedural prevention of angioedema attacks in
adults, adolescents and children (>2 years of age) with hereditary angioedema (HAE)
• Routine prevention of angioedema attacks in
adults, adolescents and children (>6 years of age) with severe and recurrent attacks of HAE
who are
• intolerant of, or insufficiently protected by, oral prevention treatments,
• or patients who are inadequately managed with repeated acute treatment
*Cinryze is indicated for the second-line treatment of HAE
C1 Inhibitor
(Cinryze):-
KEY POINT
No drug-related AEs were associated with pre-
procedural Cinryze.
KEY POINT
Demonstrated efficacy with studies showing that, compared to placebo:
•Prophylaxis with Cinryze resulted in >2-fold reduction in the number
of HAE attacks, and attacks were also less severe.
•Acute treatment with Cinryze (within 4 hours of onset) resulted in >2-
fold decrease in the time to beginning of relief of the defining symptom.
KEY POINT
Repeated administration of Cinryze was well tolerated and
did not give rise to any safety concerns.
28. Cinryze – product overview:
Dosing details for adults and adolescents
29. HAE
Learning
Module
3
3.3
Cinryze – product overview:
Dosing details for Pediatrics
For paediatric patients aged 2–11
years who are >25kg, 1000 Units of
Cinryze is recommended at the first
sign of the onset of an acute attack
A second dose of 1000 Units may
be administered if the patient has
not responded adequately after 60
minutes
For paediatric patients aged 2–11
years <25kg, 500 Units of Cinryze
is recommended at the first sign
of the onset of an acute attack
A second dose of 500 Units may
be administered if the patient has
not responded adequately after
60 minutes
Recommended for pediatrics
patients aged 6–11 years for
routine prevention against
angioedema attacks
500 Units of Cinryze every 3
or 4 days is recommended as
the starting dose. This may
need to be adjusted according
to individual response
The continued need for
regular prophylaxis with
Cinryze should be
reviewed on a regular
basis
500 Units of Cinryze within 24
hours before a medical,
dental, or surgical procedure
11 years, >25kg:
1000 Units of Cinryze within
24 hours before a medical,
dental, or surgical procedure
2–11 years, 10–25kg:
30. Clinical studies have shown that:
•Within 1 hour after intravenous administration of Cinryze, there was a
significant increase in systemic levels of antigenic and functional C1-INH
•Administration of C1-INH increases serum levels of C1-INH activity and
temporarily restores the natural regulation of the contact, complement, and
fibrinolytic systems, thereby controlling the swelling or the propensity to
swell.
•Treatment with Cinryze resulted in elevation of C4 levels at 12 hours.
•The pharmacokinetics and excretion of Cinryze are not expected to be altered
by renal or hepatic impairment.
•The mean elimination half-life of functional C1 inhibitor after administration
of Cinryze was
• 56 hours for a single dose.
• 62 hours for the double dose.
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Editor's Notes
Key point
Consensus guidelines call for an individualized care plan for patients with HAE
Discussion points
Care should be optimized for each HAE patient based on patient- and drug-specific factors
Patient-specific
Attack profile, access to care, prior medical history, health literacy
Drug-specific
Efficacy, safety, administration, tolerability
Treatment Types
Acute (On-Demand)
Goal: Terminate an ongoing attack, and prevent disability and/or mortality
Use: As needed during an attack; i.e. necessary for every HAE patient
Prophylaxis
Goal: Minimize attack frequency and severity, and prevent ED visits and/or hospitalizations
Use: May be short-term or long-term
Figure 1. Pathway of contact system activation and interaction with fibrinolytic system. Contact system activation starts with the activation of factor XII. Activated factor XII converts plasma prekallikrein into plasma kallikrein. Kallikrein cleaves high molecular weight kininogen to produce bradykinin. Bradykinin causes vasodilatation and increases vascular permeability, leading to angioedema. The fibrinolytic system can also lead to bradykinin formation and vascular leakage via factor XII activation by plasmin. Kallikrein regulates the fibrinolytic system by cleaving pro-urokinase plasminogen activator into urokinase-type plasminogen activator, causing activation of plasminogen to plasmin. C1 inhibitor (C1-INH) regulates these pathways via inhibition (bold crosses).