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Biomedical subjects

D R Chadha

Publications and source records attributed to D R Chadha.

At least 19 recordsLinked to original sources
PubMed1996

Meta-analysis of morbidity and mortality in five exercise capacity trials evaluating ramipril in chronic congestive cardiac failure.

In 5 separate exercise capacity trials in similar patients with chronic congestive heart failure performed in Europe, the United States, and South Africa, 627 patients were randomized to ramipril and 428 to placebo. The dose of ramipril ranged from 1.25 to 20 mg/day. Follow-up was at 12 or 24 weeks. None of the trials were designed to assess efficacy with regard to clinical outcome. To assess in the combined experience whether there was an effect of ramipril on mortality, hospitalization, functional classification (New York Heart Association class), and exercise capacity, we pooled data from each trial and performed a mata-analysis. Of the patients randomized to ramipril and placebo, respectively, and based on intention to treat, 14 (2.2%) and 18 (3.8%) patients died (odds ratio 0.60, 95% confidence interval 0.28 to 1.29), and 59 (9.4%) and 67 (14.3%) patients died or were hospitalized (odds ratio 0.68, 95% confidence interval 0.46 to 1.00). The New York Heart Association class improved in 29% and 25% respectively, whereas 8% and 15% deteriorated (p=0.04, based on intention to treat; death and hospitalization considered as deterioration). In ranked comparisons based on intention to treat and with imputation of exercise time as 0 for patients who were unable to exercise because of death or who were hospitalized, exercise capacity was significantly improved by rampril. We concluded that rampiril is likely to have an effect on mortality, morbidity, and functional capacity in patients with chronic congestive heart failure similar to that of other angiotensin-converting enzyme inhibitors.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Endometriosis: treatment with gonadotropin-releasing hormone agonist Buserelin.

Fifty-one women with pelvic endometriosis were treated with the gonadotropin-releasing hormone agonist (GnRHa) Buserelin (Hoechst Holland N.V., Amsterdam, The Netherlands) 300 micrograms three times a day intranasally for 6 months. Forty-nine women completed treatment; 42 were available for 6 months of follow-up following treatment. Symptoms showed prompt and significant improvement. Follow-up after treatment revealed persistent relief from dysmenorrhea and dyspareunia in, respectively, 58.6% and 88.2% of the women, whereas pelvic pain returned to pretreatment scores. Serum estradiol (E2) was suppressed to predominantly early follicular phase concentrations. Laparoscopy at the end of therapy showed significant reduction of scores for implants only. There was no relation between the degree of E2 suppression during therapy and the improvement of symptoms or the reduction of endometriosis. Statistical analysis in 22 infertile patients, of whom 7 conceived during follow-up, revealed no differences in E2 levels during therapy, improvement of symptoms, or reduction of endometriosis. Buserelin appears to be safe, well tolerated, and effective in the management of endometriosis and associated complaints.

Adult↗
PubMed1987

Metastatic cancer of the prostate managed with buserelin versus buserelin plus cyproterone acetate.

We recruited 71 previously untreated patients with metastatic prostatic carcinoma to 2 separate consecutive prospective phase 2 studies done by the same group of investigators according to the same protocols in which only the treatment regimens differed. Of the patients 58 were treated with the luteinizing hormone-releasing hormone analogue buserelin alone (0.4 mg. 3 times daily intranasally) and 13 were treated with buserelin combined with cyproterone acetate, a potent antiandrogen (50 mg. 3 times daily orally). The objective of the study was to investigate the efficacy, safety and tolerability of the medication used during at least 12 months by studying adequate endocrine parameters, the rate and duration of response, as well as the rate of progression and possible side effects. All endocrine parameters were studied in 1 laboratory. Modified response criteria of the National Prostatic Cancer Project were used. The endocrine studies showed an effective suppression of plasma testosterone to castration levels by buserelin after an initial increase during the first 2 weeks. Luteinizing hormone and follicle-stimulating hormones were lowered significantly and could not be re-stimulated by the intravenous application of luteinizing hormone-releasing hormone. There was no correlation of plasma testosterone with response and progression. However, a significant correlation existed between higher basal cortisol levels at entry, and after 3 and 6 months, and progression. Response is reported for all patients at the 12-month interval and did not seem to differ among treatment groups. The rate of progression after all patients had been treated for 1 year was 37.9 per cent in the buserelin group and 41 per cent in the buserelin plus cyproterone acetate group. Three early deaths occurred in the buserelin group. Except for impotence, only mild side effects were noted. Our study shows that treatment of metastatic prostatic cancer by means of the luteinizing-hormone-releasing hormone analogue buserelin is safe and effective. The results obtained are compatible with those obtained by castration. In our study a superiority of total androgen withdrawal over testicular suppression alone could not be shown.

Buserelin↗
PubMed1986

Treatment with a luteinising hormone-releasing hormone analogue (Buserelin) in danazol-resistant endometriosis patients.

Luteinising hormone-releasing hormone agonist (Buserelin) therapy administered for a period of 6 months in 4 patients with longstanding, severe, danazol-resistant endometriosis, was found to be effective in reducing all complaints related to endometriosis. From 2 weeks on, nearly half of the E2 determinations were below the sensitivity level of the assay, while the other values were predominantly in the range of the early follicular phase. Side effects associated with the induced hypoestrogenemia were mild and well tolerated. After six months of follow-up without treatment, one patient who desired pregnancy conceived shortly after cessation of therapy and one patient showed lasting amelioration of her complaints. The symptoms relapsed in the other two, possibly due to inadequate dose and/or duration of treatment.

Adult↗
PubMed1986

Serum potassium and body weight during treatment with two fixed combinations of beta-blockers and diuretics in hypertensive patients: a controlled study.

Two fixed combinations of beta-blockers and diuretics, penbutolol plus furosemide and pindolol plus clopamide, were compared with respect to efficacy, safety, and tolerability in hypertensive out-patients. The two preparations were equally effective in reducing blood pressure when given as a single daily dose. Doubling the dosage for those patients who responded poorly did not improve therapeutic response. The group treated with pindolol-clopamide had a significant increase in mean body weight and a substantial decrease in serum potassium concentrations. No direct relationship between these findings could be demonstrated, but the loss of potassium would be an important consideration when treating patients who are particularly vulnerable to the consequences of hypokalemia.

Adrenergic beta-Antagonists↗
PubMed1983

Diuretic effect of slow-release furosemide in elderly patients.

To compare the natriuretic and diuretic effects of a slow-release and a standard formulation of furosemide, 18 elderly patients with stable congestive heart failure were hospitalized and treated with one of these formulations in a double blind randomized trial. Patients received placebo on the first 2 days, furosemide on the third day and placebo again on the last 2 days of the study. In patients receiving the standard formulation mean urine output was increased only on the day of active treatment. However, in patients who had received the slow-release preparation, increased urine excretion was seen both on the day of active treatment and on the subsequent day. The total diuresis (0-48 h) in the 2 groups was equal, but a peak diuresis (0-6 h) was seen only in patients on the standard formulation of furosemide. Sodium excretion followed the pattern of urine excretion. Furosemide in a slow-release formulation offers advantages in maintenance therapy in congestive heart failure, especially in elderly patients.

Aged↗
PubMed1983

Molsidomine, an effective long-acting anti-anginal drug.

Molsidomine was compared with propranolol for anti-anginal efficacy in a double-blind, cross-over, fixed-dose clinical trial, involving 39 patients with moderate, stable angina pectoris, and objective evidence of coronary sclerosis. The incidence of anginal attacks under molsidomine did not differ statistically from that under propranolol. However, propranolol was more effective in reducing the nitroglycerin requirement at the doses used. Ergometry showed that both drugs increased exercise tolerance to a comparable extent. However the rate pressure product during exertion indicates that these drugs achieve this result via different paths, molsidomine having a nitrate-like effect. Unwanted effects during the four week treatment periods were minor and generally tolerable. Molsidomine is an effective long-acting anti-anginal agent with nitrate-like effects and should be a useful addition to the drugs already in use.

Angina Pectoris↗
PubMed1983

A comparison of a combination of penbutolol and frusemide with the two compounds individually in the treatment of hypertension.

Forty-one patients completed a randomized, double-blind, between-group comparison of a combination of penbutolol and frusemide, with penbutolol alone, and frusemide alone in the management of mild to moderate essential hypertension. The results suggest that the combination caused a superior reduction in systolic and diastolic pressure compared with penbutolol and a superior reduction in systolic blood pressure compared with frusemide.

Adult↗
PubMed1982

Once-daily penbutolol or atenolol can replace combination therapy in essential hypertension.

Antihypertensive therapy was stopped in twenty-one patients with moderate hypertension. Almost all of them had been on combination therapy, usually propranolol or metoprolol with chlorthalidone, for more than a year. After a placebo 'wash-out' period of 4 weeks patients were randomly allocated in a controlled trial to a fixed daily dose of either 100 mg atenolol or 40 mg penbutolol for 6 weeks. Single-agent therapy at these doses successfully controlled the blood pressure in nineteen of the twenty-one patients, including six previously inadequately controlled on a combination. Although no conclusions can be drawn about the long-term benefits, in the patient population under study either penbutolol or atenolol given at a standard dose should provide good initial blood pressure control in most patients with mild to moderate hypertension.

Atenolol↗
PubMed1982

Experience with once-daily and twice-daily slow-release frusemide in hypertension.

Out of thirty-six patients with mild to moderate hypertension twenty-six patients completed a double-blind comparison of slow-release frusemide at two dose levels, and placebo. The two groups differed in their age pattern, baseline level of blood pressure and response to a low-salt diet during the wash-out/run-in period. Despite the lack of comparability of the two groups, firm clinical inferences could be drawn from the study. Seven of the eighteen placebo patients had to be withdrawn from further participation because of deterioration in their hypertension: in contrast, fifteen of the eighteen frusemide patients showed an anti-hypertensive response and none was withdrawn because of lack of effect. Twice-daily administration of the slow-release formulation, however, produced an unacceptable level of such side-effects as nocturia, nausea and vomiting. Once-daily administration of the preparation is therefore preferred.

Adult↗
PubMed1981

Use of fixed doses of beta blocking drugs in the treatment of hypertension. Randomised study of atenolol and penbutolol.

Atenolol 100 mg and penbutolol 40 mg given once a day were both effective in controlling moderate hypertension, as judged by a randomised controlled, double-blind trial in 45 patients treated for six weeks. Both drugs significantly reduced the resting supine and erect blood pressures. No serious adverse effects could be attributed to either drug. Bradycardia occurred more frequently with atenolol than with penbutolol. Penbutolol, which possesses intrinsic sympathomimetic activity, may be useful in the treatment of patients in whom some other beta-blocker has failed to bring about adequate control of the blood pressure, despite marked bradycardia.

Adult↗
PubMed1977

Beta-2 adrenoceptor blocking activity of penbutolol and propranolol at very low doses.

The relative potency of penbutolol, a new beta adrenergic receptor blocking agent, was compared with propranolol by a four-point assay on healthy male subjects. A dose-response relationship to intravenous doses of propranolol in the microgram range was obtained during a steady state of infusion of epinephrine. Two subjects underwent the entire assay according to the Latin square design and four others each underwent one schedule of design on different days. The potency of penbutolol thus assessed was consistent with reported results. This study emphasizes the importance of intersubject variation and differential receptor sensitivity in individuals. The use of epinephrine as a beta receptor adrenergic agonist for evaluation of selective beta adrenergic receptor blocking activities is discussed.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Intense surveillance of adverse drug reactions. An analysis of 338 patients.

A prospective study of adverse drug reactions was recently completed at the Clinical Pharmacology Unit of J. J. Group of Hospitals. 338 patients were included in this study, and adverse reactions were noted by a team of workers including a nurse and a physician. World Health Organization definitions were used to describe adverse reactions. A total of 20 per cent of the patients showed adverse reactions to drugs. There was no difference with regard to age, occupation, or religion of the patients. Reaction was more common in the undernourished and also with a larger number of drugs or longer duration of stay in the hospital. The common reactions were neurologic, gastrointestinal, and allergic. Significant information is obtained by analysis of the percentage reaction in patients receiving drugs and the percentage of reactions per doses administered. It is confirmed that short-term intense surveillance programs are capable of providing useful data on incidence and types of adverse drug reactions.

Body Weight↗
PubMedDate not supplied

Slow-release furosemide and hydrochlorothiazide in congestive cardiac failure: a controlled trial.

Thirty-eight ambulatory patients with congestive cardiac failure took part in a double-blind clinical trial of 50 mg hydrochlorothiazide orally daily and slow-release formulation of 60 mg furosemide orally daily. Following a one-week period of placebo administration, patients were randomly allocated to the treatment which they continued for six weeks. Other diuretic drugs were discontinued at entry, but antihypertensive drugs and digoxin were continued during the study at constant dosage. A controlled sodium diet was prescribed. Clinical observations and biochemical and hematologic measurements were made before, during, and at the end of the study. There was an improvement in the clinical condition of patients in both treatment groups, but no significant difference between treatments (with or without digitalis) was detected. Both treatments were clinically well tolerated; however, the tendency of hypokalemia was more pronounced in the hydrochlorothiazide group. This could be hazardous in patients who receive a concomitant cardiac glycoside, especially when no clear-cut benefit of concomitant digitalis therapy is demonstrated.

Adult↗