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Biomedical subjects

Y Alamercery

Publications and source records attributed to Y Alamercery.

8 recordsLinked to original sources
PubMed2001

New insights into the postnatal growth of infants born 'idiopathic' small for gestational age.

Infants born small for gestational age (SGA) are defined as those with a birth weight and/or birth length below two standard deviations for gestational age. Postnatal catch-up growth is absent in 8-12% of children born SGA and these children achieve adult heights far below their target height. The objectives of our retrospective study were to confirm the prevalence of catch-up growth and to refine the kinetics of the catch-up process. The 'Lyon series' of patients consisted of 179 children with 'idiopathic' SGA, of whom 8% did not achieve catch-up growth (i.e. their height remained below -2 SD throughout the study). The number of days that the mother was hospitalized before delivery was found to be significantly correlated with lack of catch-up growth. Maternal hypertension, term delivery and postnatal parenteral nutrition were also associated with lack of catch-up growth, but the relationship was not significant. In addition, an oscillatory growth velocity pattern was observed in boys and girls born SGA, with alternating periods of growth acceleration and deceleration. This suggests that catch-up growth is regulated in a sophisticated way by the hypothetical 'Somatostat', although further confirmation of this process is needed.

Female↗
PubMed1996

Comparison between a bid and a tid regimen: improved compliance with no improved antihypertensive effect. The EOL Research Group.

OBJECTIVES: To compare compliance with an antihypertensive treatment administered either twice daily or three times daily. The two formulations of the antihypertensive treatment used (nicardipine) "regular tablets" (t.d.) and "slow release tablets" (b.d.) are bioequivalent at the daily dosage used in the study. STUDY DESIGN: Open, controlled, parallel designed study with centralised, randomised allocation to the treatment groups: TID group: A nicardipine 20 mg tablet, three times daily for 3 months. BID group: A capsule of slow release (SR) nicardipine, 50 mg twice daily for 3 months. PATIENTS: 7274 hypertensive patients were investigated by 2.651 general practitioners. Compliance with the nicardipine was assessed by means of standardised interviews with the patients and by a questionnaire for the investigators. RESULTS: Compliance was slightly higher in the BID than in the TID group; 71.2% and 24.5% of patients in the first group declared their compliance was 100% and 80% compared to 82.3% and 15% in the second group. A statistically significant relationship was shown between compliance with nicardipine and the decrease in blood pressure after three months of therapy. However, no significant difference was noticed between the two groups of patients in the absolute decrease in blood pressure after the treatment period: 25.7/14.7 mm Hg in the TID group compared with 25.9/15.0 mm Hg in the BID group. CONCLUSIONS: A difference in compliance between the bioequivalent BID and TID formulations of the same active agent was shown in hypertensive patients. However, the difference was not large enough to lead to a difference either in the number of controlled patients or in the decrease in blood pressure. Reducing the number of daily doses does not automatically lead to greater efficacy of treatment.

Antihypertensive Agents↗
PubMed1991

Do prescribers know the results of key clinical trials? GEP (Groupe d'étude de la Prescription).

A survey was run on a sample of 134 French GPs from the Rhône-Alpes region, in an attempt to investigate the way they recollect important clinical trials that should have an impact on their practice. It was found that 1) most of them did not remember these trials (however, the awareness score did vary throughout the trials); 2) the correlation between prescription claims and awareness score was very poor.

Breast Neoplasms↗
PubMed1987

Growth hormone (GH) response to a single intravenous injection of synthetic GH-releasing hormone in prepubertal children with growth failure.

In this collaborative study involving 27 European medical centers, the plasma GH response to a single iv bolus dose of 2 micrograms/kg BW synthetic GHRH-(1-44)NH2 was determined in 574 children with growth failure of various etiologies. Analysis of the plasma GH response to GHRH was performed in 394 validated prepubertal children; these children were subdivided into 3 groups according to the degree of GH deficiency assessed within 6 months by conventional provocative tests (insulin, arginine, etc.): normal GH status (n = 210), partial GH deficiency (n = 73), or severe GH deficiency (n = 111). The mean peak GH values (+/- 2 SEM) after GHRH treatment in the three groups were 45.8 +/- 4.8, 29.2 +/- 6.3, and 16.8 +/- 3.1 microU/mL, respectively, and were greater than those after the conventional tests. The GH responses were consistent with the degree of GH deficiency based on the responses to the conventional tests. In addition, the areas under the GH response curves in the three groups were significantly different (P less than 0.0001). Among children with severe idiopathic GH deficiency 77% had a peak plasma GH level after GHRH above 10.0 microU/mL and 39% had a peak GH above 20.0 microU/mL. In these children, a single GHRH injection provides information on both their GH secretory capacity and the putative supresellar etiology of their GH deficiency, and may be of potential therapeutic value.

Adolescent↗
PubMed1986

Functional equality of coordinating centers in a multicenter clinical trial. Experience of the International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT).

The International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT) included clinical centers in both Europe and North America. The clinics were monitored by two Regional Coordinating Centers: one located in Baltimore, Maryland, for North American clinics; the other in Lyon, France, for European clinics. These coordinating Centers were in turn monitored by an independent Data Audit Center located in Chicago, Illinois. This article describes how computer systems and operational procedures were developed to allow the three IMPACT centers to exchange processed files for a common analysis by the two Regional Coordinating Centers. The problems encountered and the advantages of this organization are described and discussed.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Clinical trials in general practice. The telematics solution].

Clinical trials with private practitioners pose a series of specific problems. Among them, the large number of investigators, the scarcity of time that each investigator can allocate to the study, may be eased by using computerized network. The telematic (Minitel) solution has the advantage to be cheap, to allow nested communication between investigators, the coordinating center and the audit center (if any). Central randomization, on line data editing, immediate personalized patient following schedule are helpful by products. Experience of several years is described.

Clinical Trials as Topic↗
PubMedDate not supplied

[Example of a phase IV trial involving several physicians and aiming at answering a scientific question: EOL].

The aim of this trial was to test the hypothesis that a reduced number of doses improves compliance in current medical practice. Compliance with twice a day dosage was compared with compliance with three doses a day. Two bioequivalent presentations of nicardipine were used, the regular presentation (t.i.d.) and the slow-release (b.i.d.). The trial was controlled, randomized, open, in two parallel groups: (1)'t.i.d.' group: one tablet of regular nicardipine, 20 mg, three times a day, three months; (2) 'b.i.d.' group: one capsule of slow-release nicardipine, twice a day, three months. 2651 general practitioners randomized 7274 hypertensive patients. The primary criterion was documented in 93.7 per cent of the cases at the end of the trial. The remaining 6.3 per cent comprised treatment withdrawal (2.8 per cent) and patients lost to follow-up (3.5 per cent). The primary criterion study was compliance, assessed by a self-questionnaire filled in by the patient and a standardised interview by the physician. Compliance was slightly better in the b.i.d. group than in the t.i.d. group (p < 0.001). Remaining pill count was also used but it was a failure. A random sample of investigators made on-site visits. Discordant data were infrequent and were limited to dates of visits. Difficulties with on-site visits were mostly due to a rather frequent lack of source records.

Antihypertensive Agents↗