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G Joffe

Publications and source records attributed to G Joffe.

14 recordsLinked to original sources
PubMed2000

Risperidone versus clozapine in treatment-resistant schizophrenia: a randomized pilot study.

1. The atypical antipsychotic risperidone may constitute an alternative to clozapine, the current treatment of choice for refractory schizophrenia. The objectives of this study were to evaluate the effectiveness of risperidone in comparison to clozapine in everyday practice and to assess the feasibility of a pragmatic trial procedure. 2. Patients were randomly assigned to open-label clozapine or risperidone treatment for 10 weeks and treatment outcomes were assessed blindly. Twenty-one patients were recruited and nineteen entered the randomized phase. 3. Five of 10 participants allocated to clozapine and one of nine risperidone participants dropped out before study completion. Five clozapine patients and six risperidone patients achieved clinical improvement, defined as a 20% decrease in the Positive and Negative Symptom Scale (PANSS) total score. No significant differences between the groups were detected in baseline or endpoint positive or negative symptoms, disease severity, or global or social functioning scores. Patients' opinion on the drugs did not differ between groups. 4. The findings of the intention-to-treat analysis of this study corroborates previous findings that risperidone may be equally effective as clozapine, and supports the feasibility and need of a multicenter randomized pragmatic trial with sufficient power to detect differences between treatments.

Adult↗
PubMed1999

Adjunctive nefazodone in neuroleptic-treated schizophrenic patients with predominantly negative symptoms: an open prospective pilot study.

A combination of nefazodone with a conventional neuroleptic would lead to a serotonin (5-HT)2 and D2 receptor blockade resembling that of an atypical neuroleptic, with an additional increase of 5-HT (and noradrenaline) turnover. This may be of benefit in some cases of schizophrenia. In this study, eight patients with schizophrenia with predominantly negative and/or depressive symptoms underwent an open prospective 26-week trial with nefazodone, added to conventional neuroleptics. The total Positive and Negative Syndrome Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores (the last observations carried forward, LOCF) significantly (P < 0.05) decreased in these eight patients by a mean of 31% and 63%, respectively, mainly within the first 6 weeks. Positive symptoms, observed in three patients and panic attacks in two patients disappeared entirely. The doses of neuroleptics, stable during the first 6 weeks of the trial, subsequently were able to be decreased by 28%. Extrapyramidal symptoms noticeably improved during the phase of stable neuroleptic dose regimen. Of the three patients who discontinued the trial prematurely (after 14 weeks or more), only one evidenced a nefazodone-related adverse event. Adjunctive nefazodone may be a useful treatment option in this patient population, but additional studies are recommended.

Adolescent↗
PubMed1997

Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group.

OBJECTIVE: Our goal was to identify risk factors for the development of preeclampsia in nulliparous women enrolled in a multicenter trial comparing calcium supplementation to a placebo. STUDY DESIGN: A total of 4589 women from five centers was studied. Analysis of risk factors for preeclampsia was performed in 4314 who carried the pregnancy to > 20 weeks. Baseline systolic and diastolic blood pressure, demographic characteristics, and findings after randomization were examined for the prediction of preeclampsia. Preeclampsia was defined as hypertension (diastolic blood pressure > or = 90 mm Hg on two occasions 4 hours to 1 week apart) and proteinuria (> or = 300 mg/24 hours, a protein/creatinine ratio > or = 0.35, one dipstick measurement > or = 2+ or two dipstick measurements > or = 1+ at an interval as specified for diastolic blood pressure). RESULTS: Preeclampsia developed in 326 women (7.6%). The first analysis treated each risk factor as a categoric variable in a univariate regression. Maternal age, blood group and Rh factor, alcohol use, previous abortion or miscarriage, private insurance, and calcium supplementation were not statistically significant. Risk factors initially found to be significant were body mass index, systolic blood pressure, diastolic blood pressure, non-white race (African-American and other), clinical center, and smoking. Adjusted odds ratios computed with a logistic regression model revealed that body mass index (odds ratio 3.22 for > or = 35 kg/m2 vs < 19.8 kg/m2), systolic blood pressure (odds ratio 2.66 for > or = 120 vs < 101 mm Hg), diastolic blood pressure (odds ratio 1.72 for > or = 61 mm Hg vs < 60 mm Hg), and clinical center (odds ratio 1.85 for Memphis vs the other clinical centers) were statistically significant predictors of preeclampsia. Results of the final model fit revealed that preeclampsia risk increases significantly (p < 0.0001) with increased body mass index at randomization, as well as with increased systolic and diastolic blood pressure at randomization. Calcium supplementation had no effect on the risks posed by body mass index and blood pressure. Among risk factors developing after randomization, an abnormal results of a glucose screen (plasma glucose > or = 140 mg/dl 1 hour after a 50 gm glucose challenge) was not found to be associated with a significant risk of preeclampsia. CONCLUSION: These risk factors should be of value in counseling women regarding preeclampsia and should aid in understanding the pathophysiologic characteristics of this syndrome.

Adolescent↗
PubMed1996

The effect of clozapine on the course of illness in chronic schizophrenia: focus on treatment outcome in out-patients.

Forty-eight consecutive schizophrenic patients treated with clozapine (mean daily dose 436 mg) for at least 1 year (mean 7.6, range 2.2-14.8 years) were studied retrospectively. The most favourable changes in the course of illness were observed in 39 out-patients, whose duration of hospitalization per year continuously and significantly declined after the introduction of clozapine. The out-patients who continued with clozapine treatment for more than 10 years (n = 8) did not need hospitalization at all during the last year of the observation period. The improvement in social functioning in the out-patient group correlated positively with the duration of clozapine medication (r = 0.384, p = 0.016) and with the duration of hospitalization (r = 0.372, p = 0.020) after introduction of clozapine. Out-patients with disorganized schizophrenia (later called hebephrenic according to the Finish version of DSM-III) showed more noticeable clinical (U = 226, p = 0.032) and social (U = 233, p = 0.024) improvements than non-hebephrenic patients. There appears to be a subgroup of hebephrenic patients who benefit from clozapine more than patients with other types of schizophrenia.

Adolescent↗
PubMed1994

Paternal pericentric inversion of chromosome 4 as a cause of recurrent pregnancy loss.

A paternal pericentric inversion of chromosome 4 was ascertained through karyotype analysis of an abortus specimen proven to be 46,XX,rec(4),dup q, inv (4)(p13q28). The relationship of paternal pericentric inversion to pregnancy loss is discussed, and a recommendation for karyotype analysis of recurrent abortion specimens is made.

Abortion, Habitual↗
PubMed1986

Some characteristics of circulating erythrocytes in polycythaemia vera: common features with normal young and foetal red blood cells.

Although it is well established that in polycythaemia vera (PV) both 'normal' and 'abnormal' erythroid progenitors proliferate, it is less known to what extent the circulating erythrocytes express normal characteristics. We found reduced erythrocyte densities, decreased MCHC, and increased lipid content. These properties, together with increased sialic acid, seem to explain the extremely low sedimentation rate and decreased deformability of polycythaemic blood samples. Other characteristics were high activity of glycolytic enzymes, increased in vitro production of lactate, and a concomitant decline in ATP and 2,3-diphosphoglycerate. Some of these properties have been described in foetal erythrocytes and are features of normal young red cells. However, they seem to represent true features of PV and not a consequence of younger cell populations. The similarity between mature erythrocytes in PV and in foetal life supports the possibility that the proliferation process in this disease has a mechanism in common with foetal erythropoiesis.

2,3-Diphosphoglycerate↗
PubMed1980

Monoclonal IgG immunoglobulinemia in psoriatic arthritis.

A 57-year-old man with skin psoriasis and psoriatic arthropathy, in whom an IgG-K monoclonal immunoglobulin was identified, is reported. A 7-year follow-up did not disclose any evidence of malignancy. The significance of this unusual occurrence is described.

Arthritis↗
PubMedDate not supplied

Will cervicovaginal interleukin-6 combined with fetal fibronectin testing improve the prediction of preterm delivery?

OBJECTIVE: We sought to investigate if determination of cervicovaginal interleukin-6 (IL-6) levels would enhance the positive predictive value of fetal fibronectin (fFN) for preterm birth. METHODS: A prospective cohort study was undertaken of 135 women between 24 and 34 weeks gestation with symptoms of suspected preterm labor. Cervicovaginal secretions were collected for both IL-6 and fFN and measured by immunoassay and ELISA, respectively. Outcome variables included preterm delivery in less than 48 h, within 7 days, and prior to 37 weeks. Statistical analysis was performed with Fisher's exact test, regression for logarithmic transform levels, and multivariate logistic regression. ROC curves were created for IL-6 levels. RESULTS: IL-6 and fFN levels were both elevated in cervicovaginal secretions of women with symptoms of preterm labor. IL-6 values >100 pg/ml resulted in a odds ratio for delivery at <37 weeks of 1.57 (95%CI=0.89-2.75, P=.11), whereas fFN values >50 ng/ml resulted in a preterm delivery risk of 4.58 (95%CI=1.54-13.35, P=.003). Combining IL-6 and fFN results did not improve upon the predictive value of fFN alone for preterm birth [odds ratio 4.00 (95%CI=1.31-12.17, P=.015)]. CONCLUSION: Cervicovaginal IL-6 levels did not provide any additional, independent effect on the prediction of preterm birth beyond that of fFN testing alone.

Cervix Uteri↗
PubMedDate not supplied

Hydatid mole with a coexisting pregnancy.

Hydatid mole with a coexisting pregnancy is rare and presents a high risk for maternal and fetal morbidity and mortality. A case of hydatid mole with coexisting pregnancy that progressed to 24 weeks' gestation is presented. Maternal religious beliefs regarding pregnancy termination affected the medical plan of care. Although the woman was aware of the potential complications, pregnancy termination and karyotype testing were refused. Because of uncontrollable hemorrhage, a cesarean delivery was done. The genotypically normal fetus died 10 hours after birth. After delivery, preeclampsia, pulmonary edema, and renal failure developed in the woman, which resolved within 4 days.

Acute Kidney Injury↗