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  1. Article: Voxelotor Modulates the Analgesic Effect of Certain Opioids.

    Ballas, Samir K

    Journal of clinical medicine research

    2021  Volume 13, Issue 2, Page(s) 130–132

    Language English
    Publishing date 2021-02-25
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2548987-2
    ISSN 1918-3011 ; 1918-3003
    ISSN (online) 1918-3011
    ISSN 1918-3003
    DOI 10.14740/jocmr4384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic.

    Ballas, Samir K

    Journal of clinical medicine

    2021  Volume 10, Issue 3

    Abstract: Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark ... ...

    Abstract Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management continues to lag behind and depend mostly on the use of opioids. This review describes the history of opioids from the ancient times of opium to the current use of the many controversial opioids. In addition, the major cause of death of patients with SCD is the complications of the disease itself and not the use of opioids. The use of opioids by patients with SCD has been stable over the years. Judicious use of opioids to treat sickle cell pain according to available guidelines could minimize the unnecessary suffering experienced by patients with SCD.
    Language English
    Publishing date 2021-01-23
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm10030438
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Opioids are not a major cause of death of patients with sickle cell disease.

    Ballas, Samir K

    Annals of hematology

    2021  Volume 100, Issue 5, Page(s) 1133–1138

    Abstract: According to the Center of Disease Control and Prevention (CDC) database, the total number of deaths due to opioid overdose from 1999 through 2018 was 840,629. Given the alarming nature of these statistics, patients who requested prescription for opioids ...

    Abstract According to the Center of Disease Control and Prevention (CDC) database, the total number of deaths due to opioid overdose from 1999 through 2018 was 840,629. Given the alarming nature of these statistics, patients who requested prescription for opioids became targets of suspicion and possible accusation of maladaptive behavior. Patients with sickle cell disease (SCD) were often not exempt from such accusations and became guilty by association. In order to clarify the effect of opioids on the mortality of patients with SCD, the mortality rates for children and adults with SCD were investigated using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database which is based on all the death certificates issued in the USA from 1999 to 2018. The data showed that 15,765 patients with SCD died from 1999 to 2018. Only 348 patients with SCD died due to opioids. The CDC database contains 27 categories of death based on ICD-10 codes in patients with SCD, and opioids were the 19th ranking cause of death. Surprisingly the most common causes of death of patients with SCD included circulatory, infection, respiratory, genitourinary, and vaso-occlusive crises/acute chest syndrome disorders in decreasing frequency. The mean age of death of females was 41.9 years and of males 39.3 years (p < 0.0001). Death due to SCD and death due to SCD and opioids were highest in the Southern Region of the USA.
    MeSH term(s) Adolescent ; Adult ; Analgesics, Opioid/adverse effects ; Anemia, Sickle Cell/complications ; Anemia, Sickle Cell/mortality ; Cause of Death ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Middle Aged ; Opiate Overdose/complications ; Opiate Overdose/mortality ; United States ; Young Adult
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-03-23
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1064950-5
    ISSN 1432-0584 ; 0939-5555 ; 0945-8077
    ISSN (online) 1432-0584
    ISSN 0939-5555 ; 0945-8077
    DOI 10.1007/s00277-021-04502-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uh III Zs.181: Show issues Location:
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  4. Article: How I Treat Acute and Persistent Sickle Cell Pain.

    Ballas, Samir K

    Mediterranean journal of hematology and infectious diseases

    2020  Volume 12, Issue 1, Page(s) e2020064

    Abstract: Sickle pain is the hallmark of sickle cell disease (SCD). It could be acute, persistent/relapsing, chronic, or neuropathic. Although there is a general consensus that pain is a major manifestation of SCD, there is a controversy as to the types of pain ... ...

    Abstract Sickle pain is the hallmark of sickle cell disease (SCD). It could be acute, persistent/relapsing, chronic, or neuropathic. Although there is a general consensus that pain is a major manifestation of SCD, there is a controversy as to the types of pain and their interrelationship between acute, chronic, relapsing, persistent, etc. This report first reviews the general approach to the management of acute vaso-occlusive crisis (VOC) pain, including education, counseling, pharmacotherapy, non-pharmacotherapy, and fluid therapy. This is followed by the presentation of five patients that represent typical issues that are commonly encountered in the management of patients with SCD. These issues are: individualized treatment of pain, bilaterality of pain, use of illicit drugs, tolerance to opioids, opioid-induced hyperalgesia, and withdrawal syndrome. The clinical aspects and management of each of these issues are described. Moreover, such complications as tolerance and withdrawal may persist after discharge and may be mistaken as chronic pain rather than resolving, persistent or relapsing pain.
    Language English
    Publishing date 2020-09-01
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2674750-9
    ISSN 2035-3006
    ISSN 2035-3006
    DOI 10.4084/MJHID.2020.064
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: The Evolving Pharmacotherapeutic Landscape for the Treatment of Sickle Cell Disease.

    Ballas, Samir K

    Mediterranean journal of hematology and infectious diseases

    2020  Volume 12, Issue 1, Page(s) e2020010

    Abstract: Sickle cell disease (SCD) is an extremely heterogeneous disease that has been associated with global morbidity and early mortality. More effective and inexpensive therapies are needed. During the last five years, the landscape of the pharmacotherapy of ... ...

    Abstract Sickle cell disease (SCD) is an extremely heterogeneous disease that has been associated with global morbidity and early mortality. More effective and inexpensive therapies are needed. During the last five years, the landscape of the pharmacotherapy of SCD has changed dramatically. Currently, 54 drugs have been used or under consideration to use for the treatment of SCD. These fall into 3 categories: the first category includes the four drugs (Hydroxyurea, L-Glutamine, Crizanlizumab tmca and Voxelotor) that have been approved by the United States Food and Drug Administration (FDA) based on successful clinical trials. The second category includes 22 drugs that failed, discontinued or terminated for now and the third category includes 28 drugs that are actively being considered for the treatment of SCD. Crizanlizumab and Voxelotor are included in the first and third categories because they have been used in more than one trial. New therapies targeting multiple pathways in the complex pathophysiology of SCD have been achieved or are under continued investigation. The emerging trend seems to be the use of multimodal drugs (i.e. drugs that have different mechanisms of action) to treat SCD similar to the use of multiple chemotherapeutic agents to treat cancer.
    Language English
    Publishing date 2020-01-01
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2674750-9
    ISSN 2035-3006
    ISSN 2035-3006
    DOI 10.4084/MJHID.2020.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Opioids and Sickle Cell Disease

    Samir K. Ballas

    Journal of Clinical Medicine, Vol 10, Iss 3, p

    From Opium to the Opioid Epidemic

    2021  Volume 438

    Abstract: Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark ... ...

    Abstract Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management continues to lag behind and depend mostly on the use of opioids. This review describes the history of opioids from the ancient times of opium to the current use of the many controversial opioids. In addition, the major cause of death of patients with SCD is the complications of the disease itself and not the use of opioids. The use of opioids by patients with SCD has been stable over the years. Judicious use of opioids to treat sickle cell pain according to available guidelines could minimize the unnecessary suffering experienced by patients with SCD.
    Keywords sickle cell disease ; opium ; opioids ; epidemic ; mortality ; pandemic ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Indications for RBC Exchange Transfusion in Patients with Sickle Cell Disease: Revisited.

    Ballas, Samir K

    Annals of clinical and laboratory science

    2019  Volume 49, Issue 6, Page(s) 836–837

    Abstract: Clinically, sickle cell disease (SCD) is characterized by chronic hemolytic anemia, recurrent acute vaso-occlusive crises, and progressive multi-organ failure. The management for SCD varies greatly among patients, and in the same patient longitudinally. ... ...

    Abstract Clinically, sickle cell disease (SCD) is characterized by chronic hemolytic anemia, recurrent acute vaso-occlusive crises, and progressive multi-organ failure. The management for SCD varies greatly among patients, and in the same patient longitudinally. Some patients may benefit from minimal therapy and infrequent transfusions, while others are transfusion dependent. Transfusion therapy can consist of simple transfusions, which often lead to iron overload and require iron chelation therapy. Simple transfusion, however, cannot reduce HbS levels rapidly, which may be required in certain critical conditions such as acute chest syndrome (ACS) or stroke. On the other hand, red blood cell exchange transfusion (RBCEX) can prevent iron overload and achieve rapid HbS reduction. In RBCEX, the red blood cells (RBCs) of the patient are replaced with normal RBCs, and the removed plasma is returned to the patient with minimal alteration. Plasma of patients with SCD is known to contain increased levels of several inflammatory mediators in the steady state that increase during crises. This finding explains why some patients with severe complications do not respond to RBCEX, but do much better after using plasma exchange in addition to RBCEX, as previously reported. Based on this, a revision of the indications for RBCEX in patents with SCD is recommended. DISCUSSION: In the 1980s and 1990s we used the Haemonetics Corporation's V-50 machine to perform intermittent whole blood (WB) exchange to treat severe complications of sickle cell disease (SCD.) The results were excellent, as previously described [1].
    MeSH term(s) Anemia, Sickle Cell/blood ; Anemia, Sickle Cell/therapy ; Erythrocyte Transfusion/methods ; Humans ; Iron Overload/prevention & control ; Plasma Exchange
    Language English
    Publishing date 2019-12-20
    Publishing country United States
    Document type Letter
    ZDB-ID 193092-8
    ISSN 1550-8080 ; 0091-7370 ; 0095-8905
    ISSN (online) 1550-8080
    ISSN 0091-7370 ; 0095-8905
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 942: Show issues Location:
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  8. Article ; Online: Of pools, oceans, and the Dead Sea.

    Ballas, Samir K

    Blood

    2017  Volume 130, Issue 24, Page(s) 2578–2579

    MeSH term(s) Electrolytes ; Fluid Therapy ; Humans
    Chemical Substances Electrolytes
    Language English
    Publishing date 2017-12-14
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 80069-7
    ISSN 1528-0020 ; 0006-4971
    ISSN (online) 1528-0020
    ISSN 0006-4971
    DOI 10.1182/blood-2017-10-811091
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  9. Article: The Sixth Vital Sign: Body Mass Index in Patients With Sickle Cell Disease.

    Ballas, Samir K

    Journal of clinical medicine research

    2017  Volume 9, Issue 10, Page(s) 889–890

    Language English
    Publishing date 2017-09-01
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2548987-2
    ISSN 1918-3011 ; 1918-3003
    ISSN (online) 1918-3011
    ISSN 1918-3003
    DOI 10.14740/jocmr3137w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Sickle cell disease: Classification of clinical complications and approaches to preventive and therapeutic management.

    Ballas, Samir K

    Clinical hemorheology and microcirculation

    2018  Volume 68, Issue 2-3, Page(s) 105–128

    Abstract: Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure that has no established cure in adult patients. Cure has been achieved in selected children with sickle cell anemia (SCA) using allogeneic bone marrow transplantation or cord ... ...

    Abstract Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure that has no established cure in adult patients. Cure has been achieved in selected children with sickle cell anemia (SCA) using allogeneic bone marrow transplantation or cord blood transplantation. SCD is essentially a triumvirate of (1) pain syndromes, (2) anemia and its sequelae and (3) organ failure, including infection. Pain, however, is the hallmark of SCD and dominates its clinical picture throughout the life of the patients. The prevalence of these complications varies with age from infancy through adult life. However, pain, infections and anemia requiring blood transfusion occur throughout the life span of affected patients. The overall medical care of patients with SCD in developed countries has improved such that their life expectancy has almost doubled since 1951. Currently, there are at least five major approaches for the general management of SCD and its complications. These include (i) symptomatic management, (ii) supportive management, (iii) preventive management, (iv) abortive management, and (v) curative therapy.
    MeSH term(s) Adult ; Anemia, Sickle Cell/complications ; Humans
    Language English
    Publishing date 2018
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1381750-4
    ISSN 1875-8622 ; 1386-0291
    ISSN (online) 1875-8622
    ISSN 1386-0291
    DOI 10.3233/CH-189002
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    In stock of ZB MED Cologne/Königswinter

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