Metered dose inhalers (MDIs) are one of the most common device types for delivering inhaled therapies. However, there are several technical challenges in development and drug delivery of these medications. In particular, suspension-based MDIs are susceptible to suspension heterogeneity, in vitro drug-drug interactions, and patient handling errors, which may all affect drug delivery. To overcome these challenges, new formulation approaches are required. The AerosphereTM inhaler, formulated using co-suspension delivery technology, combines drug crystals with porous phospholipid particles to create stable, homogenous suspensions that dissolve once they reach the airways. Two combination therapies using this technology have been developed for the treatment of COPD glycopyrrolate/formoterol fumarate (GFF MDI; dual combination) and budesonide/glycopyrrolate/formoterol fumarate (BGF MDI; triple combination). Here, we review the evidence with a focus on studies assessing dose delivery, lung deposition, and effects oneral airways. check details Future studies may provide additional evidence to further characterize the clinical benefits of these technical improvements in MDI drug delivery.

Despite evidence from clinical guideline development that physicians and patients show discordance in what they consider important in outcome selection and prioritization, it is unclear to what extent outcome preferences are concordant between experts and citizens when it comes to the context of primary prevention. Therefore, the objective of this study was to assess whether expert judgments about the importance of beneficial and harmful outcomes differ from citizen preferences when considering intervention options for a periodic health examination (PHE) program.

We conducted an online survey using a modified Delphi approach. The target population for the survey consisted of citizens who had attended the PHE (n=18) and experts who made evidence-based recommendations (n=11). Citizens and experts assigned a score on a 9-point Likert scale for each outcome of 14 interventions. We analyzed the intragroup agreement based on Krippendorff’s alpha and the intergroup agreement using the cube root product measure (the involvement of citizens in guideline panels for preventive services is important.

The INPULSIS-ON study suggested the safety and tolerability of long-term nintedanib treatment for idiopathic pulmonary fibrosis (IPF). However, there are no real-world studies on long-term nintedanib treatment. The main aim of the study was to investigate the efficacy and the tolerability of long-term treatment with nintedanib for IPF in clinical practice.

This retrospective study enrolled 104 IPF patients who underwent treatment with nintedanib. Among these patients, 51 were able to receive nintedanib for more than 12 months (ie, treatment with nintedanib over 12 months was possible [P group]) and 53 were not able to receive nintedanib for more than 12 months (ie, treatment with nintedanib over 12 months was impossible [I group]). The tolerability and efficacy of nintedanib were compared between the two groups.

In the I group, 29 patients were unable to continue nintedanib therapy because of adverse effects, including diarrhea and nausea/anorexia. In addition, 19 and four patients could not continue nintedanib treatment because of IPF progression and worsening of performance status (PS), respectively. One patient suddenly died during nintedanib treatment. The incidence of nausea/anorexia in the I group was significantly higher than in the P group (49.06 vs 25.49%). The survival time was significantly longer in the P group than in the I group (35 vs 12 months). The decline in forced vital capacity was significantly larger in the I group than in the P group (165 vs 10 mL/year). Poor PS at nintedanib initiation was the only significant risk factor for nintedanib treatment discontinuation over 12 months. Finally, the survival time was significantly longer in patients with good PS than in those with poor PS (27 vs 13 months).

Poor PS can result in discontinuation of nintedanib after 12 months. Long-term nintedanib treatment may be effective for survival.

Poor PS can result in discontinuation of nintedanib after 12 months. Long-term nintedanib treatment may be effective for survival.

To describe the primary cancer sites and clinical features of choroidal metastasis in Mexican patients.

This was a retrospective, observational, and multi-center study. Data were recollected from 6 ophthalmological hospitals in Mexico from patients with choroidal metastasis diagnosed from 2000 to 2018.

Seventy-eight patients were studied 43 were female and 35 were male. Mean age at presentation was 57.6 years. Overall, primary cancer sites were 1) breast 27 cases (34.6%); 2) lung 19 cases (24.3%); 3) unknown 8 cases (10.2%); 4) gastrointestinal 7 cases (8.9%); 5) renal 5 cases (6.4%); 6) testicular 3 cases (3.8%); 7) ovary 3 Cases (3.8%); 8) prostate 2 cases (2.5%); 9) thyroid 2 cases (2.5%); 10) carcinoid 1 case (1.2%); and 11) multiple myeloma 1 case (1.2%). Divided by gender, for women, the main three sites were breast, unknown, and ovary. For men, the main three sites were lung, gastrointestinal, and testicular. Oldest cases were breast cancer (87 and 85 years); youngest cases were testicular (23 an taken into account when studying Mexican patients living abroad.

To report the causes of uveitis in a referral ocular inflammation clinic in Upper Egypt.

Retrospective medical chart review of all uveitis cases visiting a referral uveitis clinic during the period between January 2015 and January 2020.

A total of 982 patients were included. Uveitis was bilateral in 51.7% of the patients. Anterior uveitis was the most common type, followed by posterior uveitis, affecting 34.4% and 25.6% of the study cohort, respectively. About one-third of our patients were beneath the age of 18, and among that group, no specific etiology of uveitis could be determined in about a quarter of the patients by the end of the study period, and juvenile idiopathic arthritis was the most common disease entity.

In conclusion, the present report attempted to illustrate the most common causes of uveitis in Upper Egypt. Tuberculosis followed by sarcoidosis were the two leading causes of uveitis in our group of patients.

In conclusion, the present report attempted to illustrate the most common causes of uveitis in Upper Egypt.