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PubMed1984

Unstable angina. Rational approach to management.

Unstable angina can be defined by the development of chest pain at rest, usually with reversible S-T segment changes. It has been found in patients in whom angina developed at rest in the cardiac catheterization laboratory that a decrease in coronary sinus oxygen saturation preceded changes in left ventricular relaxation and contractility that preceded the development of chest pain and/or electrocardiographic changes. Increases in heart rate and/or blood pressure followed, rather than preceded, these ischemic episodes. These findings suggest that a decrease in oxygen supply, rather than an increase in oxygen demand, is the cause of episodes of angina at rest. Although principles of treatment of effort angina have emphasized the reduction of myocardial oxygen demand, treatment of rest angina should logically emphasize therapies that improve oxygen supply. A stepwise approach to the treatment of patients admitted to the Coronary Care Unit with unstable angina is proposed. The initial step consists of replacing oral and/or transcutaneous nitrates with an intravenous infusion of nitroglycerin while maintaining beta-blockers and calcium blockers at their previous doses. Nitroglycerin dilates coronary arteries and intercoronary collateral channels in addition to reducing preload and afterload. Intravenous administration allows faster titration to an effective dose and also more rapid reversal of hemodynamic effects, if the patient's status changes. The second step would consist of maintaining the nitroglycerin infusion and beta-blockers and adding or increasing the dose of calcium channel blockers. Slow channel calcium blockers dilate coronary arteries and prevent or reverse coronary spasm in addition to reducing afterload. The third step consists of adding or increasing the dose of beta-blockers in subgroups of patients with resting tachycardia and/or arterial hypertension. The fourth and final step would be to employ intra-aortic balloon counterpulsation therapy and/or to perform urgent coronary angiography. In patients with suitable coronary anatomy, angiography could be followed by percutaneous transluminal angioplasty or coronary artery bypass surgery.

Adrenergic beta-Antagonists↗
PubMed2025

Rice transcription factor bHLH25 confers resistance to multiple diseases by sensing H2O2.

Hydrogen peroxide (H2O2) is a ubiquitous signal regulating many biological processes, including innate immunity, in all eukaryotes. However, it remains largely unknown that how transcription factors directly sense H2O2 in eukaryotes. Here, we report that rice basic/helix-loop-helix transcription factor bHLH25 directly senses H2O2 to confer resistance to multiple diseases caused by fungi or bacteria. Upon pathogen attack, rice plants increase the production of H2O2, which directly oxidizes bHLH25 at methionine 256 in the nucleus. Oxidized bHLH25 represses miR397b expression to activate lignin biosynthesis for plant cell wall reinforcement, preventing pathogens from penetrating plant cells. Lignin biosynthesis consumes H2O2 causing accumulation of non-oxidized bHLH25. Non-oxidized bHLH25 switches to promote the expression of Copalyl Diphosphate Synthase 2 (CPS2), which increases phytoalexin biosynthesis to inhibit expansion of pathogens that escape into plants. This oxidization/non-oxidation status change of bHLH25 allows plants to maintain H2O2, lignin and phytoalexin at optimized levels to effectively fight against pathogens and prevents these three molecules from over-accumulation that harms plants. Thus, our discovery reveals a novel mechanism by which a single protein promotes two independent defense pathways against pathogens. Importantly, the bHLH25 orthologues from available plant genomes all contain a conserved M256-like methionine suggesting the broad existence of this mechanism in the plant kingdom. Moreover, this Met-oxidation mechanism may also be employed by other eukaryotic transcription factors to sense H2O2 to change functions.

Hydrogen Peroxide↗
PubMed1978

[Progressive myoclonic encephalopathy in dialysis patients. Clinical, electroencephalographic and neuropathological study. Pathogenetic discussion].

Clinical and Neuropathological data on sixteen cases of progressive myoclonic encephalopathy are reported. This neurological syndrome appears after an average duration of thirty two months of haemodialysis and leads to death in four and a half months, and is characterized by myoclonus, speech disorder, epileptic seizures, and mental-status changes. At first, clinical signs and symptoms are related to haemodialysis, later they become permanent. An early diagnosis is based on EEG which is the only useful laboratory test, demonstrating bisynchronous slow-wave bursts. The caracteristic histopathologic findings are neuronal depopulation, lipofuscin accumulation, and appearance of Neurofibrillary degeneration, especially in Motor cortex, red nucleus and dentato-olivary systems. It seems to be justified to attribute P.M.D.E. to aluminium chronic poisonning; the source of the aluminium intoxication is not aluminium containing phosphate-binding gels but intravenously administreted tape-water. The intracellular binding of aluminium is shown from a histochemical study employing fluorescent stain Morin.

Adult↗
PubMedDate not supplied

Polyethylene glycol conjugated interleukin-2: clinical and immunologic effects in patients with advanced renal cell carcinoma.

Recombinant interleukin-2 (rIL-2) modified with monomethoxypolyethylene glycol (PEG IL-2) was utilized in patients with metastatic renal cell carcinoma in two separate multi-institutional trials. PEG IL-2 was administered as an I.V. bolus days 1, 8, 15, and 22 with cycles repeated every six weeks. The two trials employed different dose levels: A) 20 x 10(6) I.U./m2 day 1 followed by 12 x 10(6) I.U./m2 days 8, 15, 22; and B) 12 x 10(6) I.U./m2 days 1, 8, 15, 22. Thirty-five patients were entered and 31 were evaluable for response (A-15/18, B-16/17). Two of 31 patients had partial responses. Median therapy duration was four weeks (range 1-15), and dose reduction for grade III or IV toxicity was required in 14/35 patients (A-6/18, B-8/17). Toxicity (> or = grade III) seen included: hypotension 51%, dyspnea 17%, seizures 6%, and mental status changes 11%. No differences in response or toxicity between the two schedules were noted. Hematologic changes included lymphocytosis and eosinophilia in the majority of patients. PEG IL-2 given once weekly has significant toxicity, and may produce tumor regression in patients with renal cell carcinoma.

Adult↗
PubMed2000

First-stroke recovery process: the role of family social support.

OBJECTIVE: To determine the role of family social support in three stroke rehabilitation variables (functional status, depression, social status) during a 6-month recovery period. DESIGN: Assessment of first-stroke patients' functional status, depression, and social status before discharge and at 1, 3, and 6 months after stroke onset, in comparison with the amount of family social support received. The family social support scale--compliance, instrumental, and emotional support--was employed in the first month. SETTING: A university hospital and patients' residences. PATIENTS: A consecutive sample of 43 first-stroke patients meeting the inclusion criteria. MAIN OUTCOME MEASURES: Changes of patients' rehabilitation variables over the 6-month period were tested by use of repeated multivariate analysis of variance measures. RESULTS: Observers of functional, depression, and social status changes were blind to patient grouping according to levels of family support. These three variables were significantly affected by higher levels of support (p = .001, p = .001, p = .020, respectively), but a significant interaction was found only with regard to functional status adjusted for initial stroke severity (p = .019). Patients with moderate/severe stroke and high levels of social support attained a significantly better and progressively improving functional status than those with less support. CONCLUSIONS: High levels of family support--instrumental and emotional--are associated with progressive improvement of functional status, mainly in severely impaired patients, while the psychosocial status is also affected.

Adult↗
PubMed1995

Marital status, change in marital status, and mortality in middle-aged British men.

The effects of marital status and change in marital status on mortality among middle-aged British men were examined in a prospective cohort study, the British Regional Heart Study. This is a nationally representative cohort of men selected at random from general medical practices in 24 towns in England, Wales, and Scotland. It comprises 7,735 men aged 40-59 recruited in 1978-1980 and followed up for 11.5 years. Marital status and a wide range of biologic and lifestyle variables were measured at screening, and changes in marital status were assessed after 5 years. Single (never-married) men had an increased risk of cardiovascular disease mortality (relative risk (RR) = 1.5, 95% confidence interval (CI) 1.0-2.2) and noncancer, noncardiovascular mortality (RR = 1.8, 95% CI 1.1-3.3) after adjustment for potentially confounding variables: age, social class, smoking, recall of ischemic heart disease, recall of diabetes mellitus, use of antihypertensive drugs, body mass index, physical activity, alcohol intake, employment status, systolic blood pressure, blood cholesterol, and forced expiratory volume in 1 second. Divorced/separated men were not at increased risk of mortality, and widowed men were only at increased risk of other non-cardiovascular disease mortality (RR = 2.4, 95% CI 1.1-5.3). There was no effect of marital status on cancer mortality. Men who divorced during the follow-up period were at increased risk of both cardiovascular disease mortality (RR = 1.9, 95% CI 0.9-3.9) and other non-cardiovascular disease mortality (RR = 4.0, 95% CI 1.5-10.6), but men who became widowed during this time were not at increased risk. The excess mortality among single and recently divorced men was not explained by poor health or by exposure to a wide range of risk factors. It is unlikely that selection bias, chance, or artifact is responsible for the general relation between marital status and mortality. Variable and incomplete control for confounding by socioeconomic status and risk factors for common diseases may explain some of the inconsistencies observed between studies and between different categories of unmarried men (i.e., never-married, widowed, and divorced). It is possible that the social support offered by marriage exerts a protective effect for some men.

Adult↗
PubMed1998

Symptom distress and functional status changes during the first seven days after ambulatory surgery.

UNLABELLED: In this study, we describe changes in symptom distress and functional status 24 h, 4 days, and 7 days after ambulatory surgery. Adult patients aged 18-64 yr, ASA physical status I-III, were studied. The General Symptom Distress Scale was used to score 11 general symptoms; scores range from 0 (no symptoms present) to 4 (symptoms present, constant, cannot be ignored, and, in a 24-h period, remained distressing for more than half the time). The Functional Status Questionnaire was used to evaluate basic and intermediate activities of daily living. Procedure-specific analyses of covariance were performed using multiple linear regression analyses. These models were used to obtain estimates of change while adjusting for preoperative index values of age, ASA physical status, type of anesthesia, and study site. Models for hernia (n = 41) and laparoscopy (n = 59) procedures used F statistics to test the overall significance of the model. Symptom distress persisted until the 7th postoperative day after ambulatory surgery. Patients experienced decreased functional status during the first 7 postoperative days, especially after hernia repair. Older laparoscopy patients tended to have more symptom distress and decreased functional status than younger patients. Only 22% of patients had returned to full- or part-time work by the 7th postoperative day. We conclude that although major morbidity is uncommon after ambulatory surgery, symptom distress and reduced functional status are common 7 days postoperatively. IMPLICATIONS: Previous studies of patient status after ambulatory surgery have focused on mortality, major morbidity, and unanticipated hospitalization. In this study, we examined clinically significant but less life-threatening patient outcomes. Important problems in ambulatory surgery are posed by complications that occur at home. Careful assessment of discharge criteria is important to avoid these problems in this growing patient population.

Absenteeism↗
PubMed1988

The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.

We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Modernization and status change among aged men and women.

This study investigates the differences between the relationship between elderly occupational status and modernization for men and women. Consonant with previous findings, it finds that economic development is associated with relative losses of elderly men in professional and technical occupations. Augmenting those findings, however, it finds an even stronger association between development and such losses for women. In accounting for the differences, several explanations are advanced and tested, using data from fifty-one nations.

Aged↗
PubMed1987

Profile of Danish women undergoing reversal of sterilization, 1978-1983.

To help identify those women who might regret undergoing sterilization, the Danish women refertilized from 1978 to 1983 were contacted by mailed questionnaire. Eighty-three percent (120/144) responded. These women were younger at the time of sterilization than Danish women sterilized in the same period (mean age 29 years versus 34 years). Furthermore, they had more children at the time of sterilization and had their first and last child at a younger age than Danish women generally, in the same age group. Their social and educational status was lower than the background population and fewer were in gainful employment. At sterilization, most of the women were in an emotionally stressful situation (e.g., marital disharmony (78% of the married women), single parenthood (28%), unwanted pregnancy (27%], or had chronic health problems in the family. Alternative contraceptive methods had not been fully explored. Thirty-eight percent complained of late secondary effects attributable to the sterilization, but the main reason for wanting reversal of sterilization was a new partner (75%). The study suggests that the psycho-social situation and contraceptive alternatives should be carefully evaluated in women requesting sterilization, especially in those below the age of 30.

Adult↗
PubMedDate not supplied

Project Redirection: evaluation of a comprehensive program for disadvantaged teenage mothers.

An evaluation of Project Redirection, a two-year demonstration program designed to help pregnant teenagers and teenage mothers, shows that teenagers from a comparison group, who were not enrolled in the demonstration program, were significantly more likely than project participants to experience a repeat pregnancy after one year, but that after two years the difference was small and nonsignificant. Likewise, at 12 months into the program, the project participants proved more likely to be using contraceptives, but by 24 months the comparison group had caught up. After one year of participation, the project teenagers were more likely than the others either to be in school or to have graduated (56 and 49 percent, respectively). However, this differential also disappeared by 24 months. Nonetheless, even at that point, project teenagers who had dropped out prior to joining the program and those who had had a repeat pregnancy were more likely to be in school or to have completed school than were similar comparison teens. Project teenagers also were somewhat more likely to have held a job during the two-year period than were teenagers not enrolled in the program. All in all, the evaluation demonstrated that teenagers who participated in the project and remained in it for more than a year had consistently better outcomes in education, employment and repeat pregnancy than any other group had. Comparison teenagers who had never participated in any special program for pregnant teenagers, on the other hand, demonstrated consistently poorer outcomes than any other group.

Adolescent↗
PubMed1994

[Neuroleptic malignant syndrome. Case reports].

Neuroleptic malignant syndrome is a serious adverse reaction of neuroleptic drug therapy, composed of mental status changes, muscular rigidity, hyperthermia, signs of autonomic instability and typical laboratory findings. The syndrome has received increased attention in the scientific literature since 1980; nevertheless some weighty issues regarding clinical symptoms, etiopathogenesis and treatment require additional studies. This paper presents 9 cases of neuroleptic malignant syndrome prospectively observed in 8 inpatients and 1 outpatient with different psychiatric diagnosis. Levenson's diagnostic criteria were fulfilled in 7 cases; the remaining two had slighter symptoms. So neuroleptic malignant syndrome is to be considered a rare but not unusual side effect of neuroleptics. The risk of syndrome doesn't seem to be correlated with chemical class, D2 receptor affinity and total dosage of neuroleptics; a key factor seems instead to be a quick loading rate of neuroleptics. Seven of 9 cases displayed severe changes in mental status (clouding of consciousness that varies from stupor to coma), violent psychomotor excitement and aggressiveness before the onset of the syndrome. Such clinical features seem themselves, in our experience, to be potential risk factors besides reason for an increase of neuroleptic dosage. Neuroleptic malignant syndrome usually is preceded by prodromal signs, the most important appearing the worsening of alterations in consciousness. Symptoms of neuroleptic malignant syndrome usually appear abruptly and in some cases with a dramatic course; they last, in cases with favourable outcome, a few days to two weeks from neuroleptic withdrawal; by far the worst outcome, instead, occurs if diagnosis and drug discontinuation are not carried out early. The first measure in the treatment of neuroleptic malignant syndrome consists of prompt discontinuation of all neuroleptic medications and other psychopharmacological cures, except for benzodiazepines, and institution of supportive therapy; such interventions can resolve the most of cases. Three patients treated with bromocriptine and/or dantrolene didn't display a different duration of clinical symptoms and rate of complications if compared to patients treated with supportive therapy only. Use of bromocriptine or dantrolene, or both, therefore should be considered as a second line of action. In four cases, neuroleptics were reintroduced within few days of recovery; low potency neuroleptics were employed, given low doses which gradually increased: in none of the 4 cases did the patients experience partial or complete recurrence of neuroleptic malignant syndrome.

Adult↗