RESUMO
In an open-label, multicenter trial, de novo kidney transplant recipients at low to medium immunological risk were randomized at week 7 posttransplant to remain on CsA (n = 100, controls) or convert to everolimus (n = 102), both with enteric-coated mycophenolate sodium and corticosteroids. The primary endpoint, change in measured GFR (mGFR) from week 7 to month 12, was significantly greater with everolimus than controls: 4.9 (11.8) mL/min versus 0.0 (12.9) mL/min (p = 0.012; analysis of covariance [ANCOVA]). Per protocol analysis demonstrated a more marked difference: an increase of 8.7 (11.2) mL/min with everolimus versus a decrease of 0.4 (12.0) mL/min in controls (p < 0.001; ANCOVA). There were no differences in graft or patient survival. The 12-month incidence of biopsy-proven acute rejection (BPAR) was 27.5% (n = 28) with everolimus and 11.0% (n = 11) in controls (p = 0.004). All but two episodes of BPAR in each group were mild. Adverse events occurred in 95.1% of everolimus patients and 90.0% controls (p = 0.19), with serious adverse events in 53.9% and 38.0%, respectively (p = 0.025). Discontinuation because of adverse events was more frequent with everolimus (25.5%) than controls (3.0%; p = 0.030). In conclusion, conversion from CsA to everolimus at week 7 after kidney transplantation was associated with a greater improvement in mGFR at month 12 versus CNI-treated controls but discontinuations and BPAR were more frequent.
Assuntos
Inibidores de Calcineurina , Taxa de Filtração Glomerular , Imunossupressores/uso terapêutico , Transplante de Rim , Sirolimo/análogos & derivados , Idoso , Everolimo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sirolimo/uso terapêuticoRESUMO
BACKGROUND: Beta-blockade usually causes a slight reduction in exercise capacity among healthy subjects, while more variable results have been observed in chronic heart failure (CHF), probably related to patients studied, methods and agent used. The effect of metoprolol controlled release/extended release (CR/XL) on peak oxygen uptake (peak VO(2)) in this patient population has not previously been investigated. AIMS: We examined the effect of long-term treatment with the selective beta(1)-receptor blocker metoprolol CR/XL once daily on exercise capacity in patients with CHF. METHODS: Ninety-four patients (70 males and 24 females; mean age 63.6+/-10.6 years) with chronic symptomatic heart failure in New York Heart Association (NYHA) functional class II-IV, and with ejection fraction Assuntos
Tolerância ao Exercício/efeitos dos fármacos
, Insuficiência Cardíaca/tratamento farmacológico
, Metoprolol/administração & dosagem
, Idoso
, Doença Crônica
, Intervalos de Confiança
, Preparações de Ação Retardada
, Método Duplo-Cego
, Esquema de Medicação
, Feminino
, Seguimentos
, Insuficiência Cardíaca/fisiopatologia
, Testes de Função Cardíaca
, Hemodinâmica/efeitos dos fármacos
, Humanos
, Assistência de Longa Duração
, Masculino
, Pessoa de Meia-Idade
, Consumo de Oxigênio/fisiologia
, Probabilidade
, Valores de Referência
, Resultado do Tratamento
RESUMO
BACKGROUND: Selection routines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with symptomatic gallstone disease should give a low frequency of both false-negative ERCP results and residual common bile duct stones (CBDS). OBJECTIVE: To validate a discriminant function (DF) based on retrospectively collected data, for characterization of patients with symptomatic gallstone disease as regards presence of CBDS, and to compare clinical, ultrasonographic, and DF characterization. DESIGN: Prospective registration of CBDS criteria in consecutive patients with symptomatic gallstone disease. SETTING: A department of surgical gastroenterology in a Norwegian central hospital. PATIENTS: One hundred ninety-two patients with gallbladder stones. INTERVENTION: Laparoscopic cholecystectomy or ERCP with or without endoscopic sphincterotomy. MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of the clinical, ultrasonographic, and DF characterizations, and test of the validity of the DF. RESULTS: Thirty-two patients had CBDS. The clinical criteria of CBDS were present in 152 patients (79.2%): 21.1% of these patients had CBDS and there were no false-negative results (sensitivity, 100%; specificity, 25%). The risk of CBDS in patients with normal bile ducts at ultrasonographic examination was 8 of 124, and in patients with dilated ducts or suspected CBDS, 17 of 47 (sensitivity, 68%; specificity, 80%). The DF was positive in 50 patients (26%): 60% of these had CBDS, and there were 2 false-negative results (sensitivity, 94%; specificity, 88%). A discriminant analysis of the prospectively registered data selected the same set of CBDS criteria, and a new DF did not alter the characterization of any patient. CONCLUSIONS: Clinical characterization had a higher sensitivity for CBDS detection than ultrasonography alone, but a lower specificity. The DF analysis was both more sensitive and specific than ultrasonography, and seemed efficient in selecting symptomatic gallstone patients for ERCP. It was reproducible and simple to use.
Assuntos
Colecistectomia Laparoscópica , Colelitíase/diagnóstico , Cálculos Biliares/diagnóstico , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Colelitíase/complicações , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Análise Discriminante , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/etiologia , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Esfinterotomia Endoscópica , UltrassonografiaRESUMO
OBJECTIVE: To investigate the influence of regional fat mass (FM) on insulin resistance and dyslipidaemia in obese postmenopausal women (BMI >30 kg/m(2)) compared to overweight women (BMI <30 kg/m(2)). Leg FM may attenuate the increased risk of cardiovascular disease and diabetes imposed by increased trunk FM in normal and overweight postmenopausal women. MATERIAL AND METHODS: Cross-sectional and consecutively referred patients comprising 63 obese and 36 overweight postmenopausal women. Body composition and regional FM by dual X-ray absorptiometry (DXA), fasting glucose, fasting insulin and C-peptide, insulin resistance by homeostasis model assessment (HOMA-IR), insulin sensitivity by quantitative insulin sensitivity check index (QUICKI) and metabolic clearance rate (MCRestOGTT), insulin secretion (HOMAsecr) and serum lipids were assessed. RESULTS: In obese subjects, leg FM was favourably associated with HOMA-IR (p<0.05), QUICKI (p<0.05), fasting glucose (p<0.05), fasting insulin (p<0.05), HOMAsecr (p<0.05) and total cholesterol/HDL ratio (p<0.05). Trunk FM was unfavourably associated with MCRestOGTT (p<0.01), QUICKI (p<0.05) and fasting insulin (p<0.05). Compared to leg FM, leg/trunk FM ratio was more strongly associated with fasting insulin (p<0.001), fasting C-peptide (p<0.001), HOMA-IR (p<0.001), MCRestOGTT (p<0.001), QUICKI (p<0.001), HOMAsecr (p<0.001), fasting glucose (p<0.01) and triglycerides (p<0.01). Stepwise multiple regression demonstrated that leg/trunk FM ratio was the most important variable with partial R (2) = 0.26 (p<0.001) for HOMA and R (2) = 0.37 (p<0.001) when QUICKI was used as the dependent variable. In overweight women, no associations between fat mass and parameters of insulin resistance or dyslipidaemia were found. CONCLUSIONS: A high leg/trunk FM ratio as measured by DXA may give relative protection against diabetes and cardiovascular disease in obese postmenopausal women, but not in overweight women.
Assuntos
Adiposidade , Dislipidemias/prevenção & controle , Resistência à Insulina , Perna (Membro) , Tamanho do Órgão , Absorciometria de Fóton , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade , Sobrepeso , Pós-Menopausa , Fatores de RiscoRESUMO
BACKGROUND: Dual X-ray absorptiometry (DXA) is the preferred method for measuring body composition in clinical practice, but interchange between devices may pose problems with the interpretation of results. OBJECTIVE: To establish conversion equations for body composition variables between three fan-beam DXA systems. METHODS: Body composition was assessed in 21 subjects using Lunar Expert (Expert), Lunar Prodigy (Prodigy) and Hologic Delphi W (Delphi). Weekly measurements of Hologic whole body phantom 164 were performed. RESULTS: There were no significant differences between DXA-measured means of body weight, fat mass and lean body mass. Bland-Altman analysis revealed that Lunar Expert increasingly overestimated fat mass with increasing total mass (p<0.001) relative to Delphi and Prodigy, while Delphi produced a constant underestimation of fat mass. Correlations between scale weights and DXA-measured body weights, and between DXA-measured body weights and the sum of fat masses, lean body masses and bone mineral contents (BMC) between the three instruments, were excellent (Rsqr 0.998-0.910; p<0.001). Conversion factors to Prodigy for Expert and Delphi were respectively 1.003 and 1.011 for total body mass, 0.954 and 1.079 for fat mass, 1.018 and 0.967 for lean body mass and 1.049 and 1.136 for BMC (Rsqr 0.999-0.991; p<0.001). Standard error of estimate (SEE) for the slopes ranged from 0.20% to 2.10%. Phantom studies revealed stable instrument function with CV% commonly<2%, except for lean mass for Delphi (5.5%). CONCLUSIONS: Despite the significant differences in measurement of body composition between DXA fan-beam instruments, clinically relevant conversion factors can be established.
Assuntos
Absorciometria de Fóton/instrumentação , Composição Corporal , Imagens de Fantasmas , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos TestesRESUMO
This article reports quality of life (QoL) aspects of a study that investigated the efficacy of three treatment regimens in gastro-oesophageal reflux disease patients. Following a 4-week symptom-control phase (esomeprazole 40 mg once daily), patients were randomised to 6 months' esomeprazole 20 mg once daily continuously (n = 658), on-demand (n = 634) or ranitidine 150 mg twice daily continuously (n = 610). Esomeprazole 40 mg once daily improved QoL during the symptom-control phase. At 6 months, both esomeprazole regimens were more effective than ranitidine in all dimensions of the Quality of Life in Reflux and Dyspepsia questionnaire (p < 0.0001). Esomeprazole continuous and on-demand led to a significant improvement in symptoms (Overall Treatment Evaluation questionnaire) compared with ranitidine (continuous: 80.2%, on-demand: 77.8%, vs. ranitidine 47.0%; p < 0.001). Esomeprazole once daily continuously maintained QoL better than esomeprazole on-demand and was associated with greater patient satisfaction. In conclusion, esomeprazole 20 mg once daily continuously and on-demand were more effective than ranitidine continuously for maintaining QoL.
Assuntos
Antiulcerosos/administração & dosagem , Esomeprazol/administração & dosagem , Refluxo Gastroesofágico/prevenção & controle , Inibidores da Bomba de Prótons , Ranitidina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medicina de Família e Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Resultado do TratamentoRESUMO
This study assesses the difference in direct medical costs between on-demand treatment with esomeprazole 20 mg, continuous treatment with esomeprazole 20 mg once-daily and continuous treatment with ranitidine 150 mg twice-daily to prevent symptomatic relapse in patients with gastroesophageal reflux disease over 26 weeks. Two hundred eighty-one GP clinics in Norway enrolled 2156 patients to an open, randomized, parallel group, Norwegian society perspective study during 2000-2001. The total direct medical costs of each strategy were 171.9 Euros for on-demand esomeprazole (n = 634), 221.6 Euros for ranitidine (n = 610) and 248.8 Euros for continuous esomeprazole (n = 658). The total costs for on-demand and continuous esomeprazole treatment and ranitidine treatment were 221.5, 286.5 and 295.8 Euros, respectively. The highest proportion of costs was because of the study medication cost in each strategy. The on-demand and continuous treatment strategies with esomeprazole were found to be cost-effective, compared with ranitidine.
Assuntos
Antiulcerosos/administração & dosagem , Esomeprazol/administração & dosagem , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons , Ranitidina/administração & dosagem , Adulto , Antiulcerosos/economia , Análise Custo-Benefício , Custos de Medicamentos , Esomeprazol/economia , Feminino , Refluxo Gastroesofágico/economia , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Noruega , Satisfação do Paciente , Estudos Prospectivos , Ranitidina/economiaRESUMO
One option for patients with symptoms of gastroesophageal reflux disease (GERD) is treatment with proton pump inhibitors without prior endoscopy. Continuous or on-demand maintenance therapy are options for symptom-free patients. This study assessed the efficacy of three different treatment options in GERD patients in Norway. About 395 General Practitioners enrolled 2156 patients with symptoms of GERD in an open, randomised, parallel group trial. Following a 4-week symptom control phase [esomeprazole 40 mg once daily (od)], patients received either esomeprazole 20 mg od continuously or on-demand or ranitidine 150 mg twice-daily continuously for 6 months. The percentage of patients with no heartburn at the end of the study was maintained most effectively in the esomeprazole 20 mg continuous group (72.2%) and least effectively in the ranitidine group (32.5%). Significantly, more patients were completely/very satisfied with esomeprazole continuous (82.2%) and esomeprazole on-demand (75.4%) than with ranitidine continuous (33.5%) treatment (p < 0.0001). More patients were kept in remission, symptom free and were overall more satisfied with esomeprazole treatment than ranitidine.
Assuntos
Antiulcerosos/administração & dosagem , Esomeprazol/administração & dosagem , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Noruega , Satisfação do Paciente , Estudos ProspectivosRESUMO
To assess parent satisfaction with hospital care and needs for improvement, questionnaires were sent to parents of children participating in a study of bio-psychosocial factors at the onset of juvenile rheumatic diseases. At 16 months follow-up (range 12-22 months) 85 (82%) of 106 parents answered. Twenty-four of these were also interviewed. 95-98% of parents were satisfied with the way they had been received, the ward setup and the atmosphere, the examination of the child by the physicians and the examination and treatment by the physiotherapists, whereas 86% were satisfied with information regarding illness and treatment, and 78% were satisfied with the hospital school. Dissatisfaction was positively correlated to mental distress of the mothers at the first stay and their assessment of disease severity at follow-up. The interviewed parents seemed to prefer inpatient care to outpatient care for the initial multiprofessional assessment. This may enhance the initial process of coping with chronic childhood illness and increase compliance with treatment regimens.
Assuntos
Departamentos Hospitalares , Hospitalização , Reumatologia , Adolescente , Criança , Pré-Escolar , Comportamento do Consumidor , Feminino , Seguimentos , Hospitais Especializados , Humanos , Lactente , Masculino , Pais , Pediatria , Psicologia , Estudos Retrospectivos , Doenças Reumáticas/terapia , Inquéritos e QuestionáriosRESUMO
The aim of the study was to assess the therapeutic efficacy of loratadine on pruritus in patients with atopic dermatitis, considering the patients' sensation of itch. Sixteen patients, mean age 24.8 years, with moderate or severe atopic dermatitis were included in a double-blind and placebo-controlled study with a six-period, multi-crossover design. The patients were given 10 mg loratadine or placebo every day, alternating between loratadine and placebo every 2 weeks. The degree of pruritus during the day and during the night was recorded by the patients every morning and every evening, respectively, on a 10-cm visual analog scale. The study detected a significant effect of loratadine, as compared with placebo, on pruritus during the day, pruritus during the night, and severity of rash. At least nine of the 16 patients included were classified as responders and only one as a nonresponder to loratadine treatment. It is concluded that loratadine may be tried as an adjuvant therapy in the management of severe and moderate atopic dermatitis, in patients complaining of pruritus.
Assuntos
Dermatite Atópica/tratamento farmacológico , Loratadina/uso terapêutico , Prurido/tratamento farmacológico , Adulto , Ritmo Circadiano , Dermatite Atópica/complicações , Método Duplo-Cego , Feminino , Humanos , Masculino , Prurido/etiologia , Índice de Gravidade de Doença , Fatores de TempoRESUMO
The prevalence of chronic family difficulties, recent stressful life events and socioeconomic status were assessed in 106 families of children with juvenile arthritis, divided in 5 groups according to disease course types. Chronic family difficulties were assessed by semi-structured parent interviews and life events by questionnaires and interviews. Both chronic family difficulties and recent stressful life events appeared in about 2/3 of the families, but a correlation between these were found only for the pauci and polyarticular groups. Chronic family difficulties and recent stressful life events did not differ between groups and were not associated to severity of disease. To what extent stress influences the course of various disease types of juvenile arthritis warrants longitudinal follow-up. For this a life event questionnaire may be valuable.
Assuntos
Artrite Juvenil/etiologia , Características da Família , Acontecimentos que Mudam a Vida , Estresse Psicológico/complicações , Adolescente , Comportamento do Adolescente , Artrite Juvenil/psicologia , Criança , Comportamento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Entrevista Psicológica/métodos , Masculino , Condições Sociais , Estresse Psicológico/psicologia , Fatores de TempoRESUMO
We describe physical symptoms and signs, laboratory data and psychosocial assessments for 84 children (age 1-17) hospitalized for the first time with suspected or definite rheumatic disease. At 16 months (range 7-28) followup change of disease severity was assessed based on hospital records. The patients were categorized as unchanged/worse (n = 36) or improved (n = 48). A linear discriminant model applying a combined set of 6 medical and 2 psychosocial variables characterized correctly 68 of 84 patients (81%). The variables were age at onset, disease severity, months of disease duration, presence of rheumatic disease in the family, erythrocyte sedimentation rate (ESR), thrombocytes, total behavior problem score on the Child Behavior Checklist and maternal distress. By discriminant function analysis of biopsychosocial variables more homogeneous groups may be obtained. Study of such groups may improve prediction of the prognosis.
Assuntos
Comportamento Infantil , Doenças Reumáticas/fisiopatologia , Criança , Pré-Escolar , Análise Discriminante , Humanos , Lactente , Recém-Nascido , Modelos Teóricos , Doenças Reumáticas/psicologia , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND: Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause. METHODS: We conducted a 4-week randomized, double-blind, placebo-controlled study in 116 individuals selected by a 7-item questionnaire to determine whether the antifungal agent nystatin given orally was superior to placebo. At the onset of the study, the patients were free to select either their regular diet or a sugar- and yeast-free diet, which resulted in four different subgroups: nystatin + diet (ND); placebo + diet (PD); nystatin (N); and placebo (P). RESULTS: Nystatin was significantly better than placebo in reduction of the overall symptom score (P < 0.003). In six of the 45 individually recorded symptoms, the improvement was significant (P < 0.01). All three active treatment groups reduced their overall symptom scores significantly (P < 0.0001), while the placebo regimen had no effect (P = 0.83). The benefit of diet was significant within both the nystatin (ND > N) and the placebo groups (PD > P). CONCLUSIONS: Nystatin is superior to placebo in reducing localized and systemic symptoms in individuals with presumed fungus hypersensitivity as selected by a 7-item questionnaire. This superiority is probably enhanced even further by a sugar- and yeast-free diet.
Assuntos
Antifúngicos/uso terapêutico , Sacarose Alimentar/efeitos adversos , Fadiga/microbiologia , Doenças Urogenitais Femininas/microbiologia , Gastroenteropatias/microbiologia , Doenças Urogenitais Masculinas , Transtornos da Memória/microbiologia , Micoses/dietoterapia , Micoses/tratamento farmacológico , Nistatina/uso terapêutico , Dor/microbiologia , Doenças Respiratórias/microbiologia , Dermatopatias/microbiologia , Adulto , Idoso , Análise de Variância , Método Duplo-Cego , Medicina de Família e Comunidade/métodos , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Deficiência Múltipla de Carboxilase , Micoses/complicações , Micoses/diagnóstico , Micoses/imunologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: To characterize responders/nonresponders to 2 nonsteroidal antiinflammatory drugs by a combination of start variables in the treatment of patients with osteoarthritis (OA) of the hip(s)/knee(s). METHODS: Two hundred eight patients participated in a 3-week randomized double blind parallel group trial. RESULTS: The responder rate to tiaprofenic acid and naproxen was 52 and 59%, respectively. Correctly characterized by use of a combination of 6 baseline variables were 79% of the patients treated with tiaprofenic acid and 81% treated with naproxen. CONCLUSION: Both active drugs were found effective compared with placebo in patients with OA, but with different characteristics.
Assuntos
Naproxeno/uso terapêutico , Osteoartrite/tratamento farmacológico , Propionatos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Análise Discriminante , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the morning and evening dose of 200 mg ketoprofen controlled release formulation with regard to both efficacy and GI tolerability. DESIGN: Double-blind, randomized multicentre prospective trial with cross-over design combined with a parallel design. PARTICIPANTS: One hundred and eight female and 55 male patients with osteoarthrosis in hip(s) or knee(s) necessitating treatment with nonsteroidal antiinflammatory drugs. MAIN OUTCOME MEASURE: The degrees of pain and stiffness and joint movement ability in joints with osteoarthrosis. RESULTS: Both the morning and the evening dose demonstrated a significant effect (p < 0.01) on all efficacy variables. The reduction in degree of pain in the afternoon and in the evening was significantly higher (p < 0.01) for the morning dose. The total frequency and degree of gastrointestinal discomfort increased significantly (p < 0.01) during both treatment periods. The increases were mainly caused by increased gastric pain and constipation. No significant differences were found between the two regimes regarding tolerability. CONCLUSION: Ketoprofen controlled release given once daily in the morning compared to the evening to patients with osteoarthrosis may increase the efficacy without reducing the tolerability of the drug.
Assuntos
Cetoprofeno/administração & dosagem , Articulação do Joelho , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Adolescente , Adulto , Idoso , Ritmo Circadiano , Preparações de Ação Retardada , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Cetoprofeno/efeitos adversos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/efeitos dos fármacosRESUMO
The efficacy of loratadine and terfenadine in perennial allergic rhinitis was evaluated in a double-blind, selected cross-over study consisting of two phases. During the first phase, 76 patients with perennial allergic rhinitis, 8-67 years old, were included in the study. Of these, 41 patients received loratadine 10 mg daily, and 35 patients received terfenadine 60 mg twice daily, for 2 weeks. According to symptoms and side-effects, 32 patients were classified as responders to loratadine, and 28 patients as responders to terfenadine. All observed symptoms were significantly reduced in both treatment groups, but with no significant differences between the two groups. Side-effects were few and mild. In patients with normal IgE, loratadine was significantly superior to terfenadine in relieving nasal secretion, whereas terfenadine was significantly superior to loratadine in relieving nasal congestion. In patients with increased IgE, patients treated with loratadine showed significantly greater reduction in sneezing than patients treated with terfenadine. A positive correlation between total IgE and reduction in overall symptoms was found for patients treated with loratadine, whereas a negative correlation was found for patients treated with terfenadine. During the second study phase, the nonresponders received the other drug for 2 weeks. All seven nonresponders to terfenadine responded to loratadine after crossing over, whereas four of nine nonresponders to loratadine responded to terfenadine. Nonresponders to one drug may respond to the other drug. Thus, more than one antihistamine drug should be tried in perennial allergic rhinitis if the first fails.
Assuntos
Loratadina/uso terapêutico , Rinite Alérgica Perene/tratamento farmacológico , Terfenadina/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Rinite Alérgica Perene/imunologia , Testes Cutâneos , Resultado do TratamentoRESUMO
The efficacy of oral magnesium supplementation in correcting magnesium deficiency was examined in a group of 40 elderly patients with suspected magnesium deficiency. The patients were randomized in a double-blind, placebo-controlled fashion to oral magnesium-lactate-citrate for 6 weeks. Magnesium status was assessed by an intravenous magnesium-loading test at baseline and after treatment. For comparison, another group of 23 patients received 30 mmol magnesium sulfate intravenously daily for 7 days. A group of 30 patients without known predisposition to magnesium deficiency and a group of 27 young healthy subjects served as controls. The initial magnesium-loading test in the placebo group reduced magnesium retention from a mean 41% (95% confidence intervals 34-49) to 22% (15-29) (p less than 0.01). In the group receiving oral magnesium supplementation for 6 weeks, magnesium retention decreased from 39% (31-47) to 10% (2-18) (p less than 0.01), which was significantly better than with placebo treatment (p less than 0.01). The magnesium retention after oral magnesium supplementation was comparable to that observed after parenteral administration of magnesium for 7 days, 6% (-4 to 16), and to that in the reference groups of patients 4% (-2 to 10) and healthy control subjects 3% (-2 to 8). The study suggests that the bioavailability of orally given magnesium-lactate-citrate is satisfactory, and that oral administration of magnesium for 6 weeks may restore magnesium depots in patients with magnesium deficiency.
Assuntos
Deficiência de Magnésio/terapia , Magnésio/administração & dosagem , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravenosas , Magnésio/urina , Masculino , Pessoa de Meia-IdadeRESUMO
Conjugated linoleic acid (CLA) has been shown to reduce body fat mass (BFM) in animals. To investigate the dose-response relationships of conjugated linoleic acid with regard to BFM in humans, a randomized, double-blind study including 60 overweight or obese volunteers (body mass index 25-35 kg/m(2)) was performed. The subjects were divided into five groups receiving placebo (9 g olive oil), 1.7, 3.4, 5.1 or 6.8 g conjugated linoleic acid per day for 12 wk, respectively. Dual-energy X-ray absorptiometry was used to measure body composition [measurements at wk 0 (baseline), 6 and 12]. Of the 60 subjects, 47 completed the study. Eight subjects withdrew from the study due to adverse events; however, no differences among treatment groups were found regarding adverse events. Repeated-measures analysis showed that a significantly higher reduction in BFM was found in the conjugated linoleic acid groups compared with the placebo group (P: = 0.03). The reduction of body fat within the groups was significant for the 3.4 and 6.8 g CLA groups (P: = 0.05 and P: = 0.02, respectively). No significant differences among the groups were observed in lean body mass, body mass index, blood safety variables or blood lipids. The data suggest that conjugated linoleic acid may reduce BFM in humans and that no additional effect on BFM is achieved with doses > 3.4 g CLA/d.
Assuntos
Tecido Adiposo/efeitos dos fármacos , Composição Corporal/efeitos dos fármacos , Ácido Linoleico/farmacologia , Obesidade/tratamento farmacológico , Absorciometria de Fóton , Adulto , Idoso , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Ácido Linoleico/administração & dosagem , Masculino , Pessoa de Meia-Idade , Obesidade/prevenção & controle , Inquéritos e QuestionáriosRESUMO
We have conducted a double-blind randomised placebo controlled trial with oral diclofenac to study the prophylactic effect on recurrence of renal colic and rate of spontaneous stone expulsion. 41 patients were given 50 mg oral diclofenac three times a day for seven days after being discharged for a colic episode from Oslo Emergency Hospital and 39 patients were given matching placebo tablets. The number of new ureteral colic episodes per accumulated patient treatment days was 64/287 in the diclofenac group and 119/273 in the placebo group (p < 0.01). The difference was greatest during the first four days of treatment. A similar trend was found for pain intensity, with the greatest difference on day one. There was no difference in reported type or frequency of side effects in the two treatment groups. Stone expulsion rate was almost identical. The effect of the treatment was not affected by fluid intake. Re-admission rates to Oslo Emergency Hospital or other hospitals were 10 and 67% (p < 0.001).
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Cólica/prevenção & controle , Diclofenaco/administração & dosagem , Cálculos Ureterais/prevenção & controle , Adulto , Método Duplo-Cego , Emergências , Feminino , Humanos , Masculino , RecidivaRESUMO
Endoscopic retrograde cholangiopancreatography (ERCP) has been used in patients referred to cholecystectomy when clinical information, biochemical values, or ultrasonography (clinical characterization) have indicated possible presence of common bile duct stones. A retrospective study of 599 patients treated for gallstone disease was used to develop a characterization procedure for predicting common bile duct stones by a discriminant analysis procedure. The variables selected by the analysis as the best combination for CBDS prediction were age (years), the values of bilirubin (micromol/l), ALAT (U/l) and gamma GT (U/l). The characterization was false positive in 22 cases (3.7%) and false negative in 11 cases (1.8%), compared to 198 false positive cases (33.1%) and three false negative cases (0.5%) by the clinical characterization. A leaving-one-out correction did not change the results. In a test set of 157 cholecystectomy patients, clinical characterization was false positive in 44.6% of the patients, compared to 4.5% false positive results when using the discriminant analysis procedure. The discriminant analysis procedure would have missed one patient with common bile duct stones. Selection by the discriminant analysis characterization procedure seems to reduce the frequency of preoperative ERCP significantly without an increase in undetected common bile duct stones.