PubMed · 11838115
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Masaru Baba, Hiroshi Hasegawa. 2002. [Hepatitis A].. https://pubmed.ncbi.nlm.nih.gov/11838115/
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Cataract prevalence increases with age. As the world's population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent or delay cataract formation, and treat that which does occur. Genetic and environmental factors contribute to cataract formation. However, reducing ocular exposure to UV-B radiation and stopping smoking are the only interventions that can reduce factors that affect the risk of cataract. The cure for cataract is surgery, but this is not equally available to all, and the surgery which is available does not produce equal outcomes. Readily available surgical services capable of delivering good vision rehabilitation must be acceptable and accessible to all in need, no matter what their circumstances. To establish and sustain these services requires comprehensive strategies that go beyond a narrow focus on surgical technique. There must be changes in government priorities, population education, and an integrated approach to surgical and management training. This approach must include supply of start-up capital equipment, establishment of surgical audit, resupply of consumables, and cost-recovery mechanisms. Considerable innovation is required. Nowhere is this more evident than in the pursuit of secure funding for ongoing services.
The effect of adjuvant tamoxifen treatment on bone mineral density (BMD) and bone turnover markers was studied in postmenopausal breast cancer patients. The relationship of tamoxifen's effect with the genetic polymorphisms of estrogen receptor (ER)-alpha and ER-beta gene was also studied. Twenty-one postmenopausal breast cancer patients were given tamoxifen (20 mg/day) as the adjuvant treatment after the surgery. BMD of the lumbar supine (dual emission X-rays absorptiometry) and bone resorption (deoxypyridinoline, aminoterminal telopeptide of type I collagen, and carboxyterminal telopeptide of type I collagen) and formation (propeptide of type I procollagen, osteocalcin, and bone-specific alkaline phosphatase) markers were examined at baseline (before the surgery), 6 and 12 months after the start of tamoxifen treatment. Genetic polymorphisms analyzed were TA dinucleotide repeats polymorphism in the promoter region and PvuII and XbaI restriction fragment length polymorphism for the ER-alpha gene and the CA dinucleotide repeats polymorphism in the intron 5 for the ER-beta gene. Tamoxifen significantly increased BMD of the lumbar spine at both 6 (P<0.01) and 12 months (P<0.01) after the start of tamoxifen as compared with that at baseline. The mean percent increase in BMD was 3.3% at 6 months and 2.7% at 12 months. All bone resorption and formation markers significantly decreased at both 6 and 12 months. Among the four genetic polymorphisms studied, only ER-beta CA repeat polymorphism was found to be significantly associated with BMD at 12 months, i.e. BMD of the 21 CA repeats allele carriers was significantly higher than that of the non-carriers (P=0.025). These results suggest that tamoxifen increases BMD of the lumbar supine by reducing the bone turnover in postmenopausal breast cancer patients, and this bone restoring effect of tamoxifen is more marked in ER-beta 21 CA repeats allele carriers than non-carriers.
PURPOSE: To determine why Polish patients included in the International Stroke Trial (IST) had a higher early case fatality than patients from other countries. METHODS: Of 19,435 patients randomised to IST, 17,370 had CT or autopsy-confirmed ischaemic stroke. We compared the baseline clinical state and 14-day case fatality of patients randomised in Polish centres with those from all other IST countries. We examined: age, gender, presence of atrial fibrillation (AF), conscious level, neurological deficit, cause of death and aspirin use in the 3 days before stroke. RESULTS: In Poland, the 14-day case fatality rate was significantly higher than in other IST countries (13% vs. 9.6%; odds ratio, OR, 1.5, 95% confidence interval, CI, 1.2-1.9). In Poland, a significantly higher proportion of deaths was attributed to coronary heart disease (2.5% vs. 0.7%) and pulmonary embolism (1.0% vs. 0.4%). Polish patients had higher percentage of AF and drowsiness, but were younger. When these factors were adjusted for, Polish patients still had approximately a 57% higher risk of death within 14 days compared with other countries. A logistic regression analysis revealed that an increased risk of death within 14 days in Poland compared to other IST patients was present among patients younger than 75 years (OR 1.7; 95% CI 1.3-2.4), females (OR 1.8; 95% CI 1.3-2.5), patients who were alert at onset (OR 2.4; 95% CI 1.7-3.4), with partial anterior circulation syndrome (PACS) (OR 2.0; 95% CI 1.4-2.8) or lacunar syndrome (LACS) (OR 2.4; 95% CI 1.1-5.0) and without AF (OR 1.8; 95% CI 1.3-2.4). Polish patients were less likely to have been on aspirin before their stroke than other countries (7.6% vs. 20.8%). CONCLUSION: The 14-day case fatality was significantly higher in Poland than in other countries in IST. Part of the increase was due to greater stroke severity in the Polish patients. However, differences persisted even after adjustment for baseline stroke severity. Several factors may have contributed the excess: poor attention to treatment of cardiovascular disease, less attention to treatment of secondary complications of stroke and some other--as yet unidentified--factor specific to Poland.