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At least 919 records · Page 51Linked to original sources
PubMed2006

Fenofibrate therapy and cardiovascular protection in diabetes: recommendations after FIELD.

PURPOSE OF REVIEW: The aim of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study was to provide valuable information on the ability of fibrates to reduce cardiovascular risk in type 2 diabetes. The purpose of this review is to analyse results from FIELD and to see whether they may lead to modify the recommendations for treatment of diabetic dyslipidemia. RECENT FINDINGS: In FIELD, fenofibrate therapy was associated with a nonsignificant 11% reduction in the primary endpoint (coronary heart disease death, nonfatal myocardial infarction), corresponding to a significant 24% reduction in nonfatal myocardial infarction (P = 0.010) and a nonsignificant 19% increase in CHD mortality. Fenofibrate reduced CHD events only in patients in primary prevention, but not in secondary prevention. Fenofibrate treatment was associated with less albuminuria progression and less retinopathy needing laser treatment. SUMMARY: FIELD's results are somewhat disappointing. The relatively low cardiovascular risk population from FIELD and the 'pollution' by statin therapy may not totally explain the weak results of fenofibrate in the reduction in CHD events. The significant increase in plasma homocysteine observed with fenofibrate could partly explain not only the higher number of venous thrombotic events, but also the poor effect of fenofibrate in reducing clinical outcomes, more particularly in patients with previous cardiovascular disease.

Cardiovascular Diseases↗
PubMed2006

Dopamine is not an independent risk factor for reduced amikacin clearance in extremely low-birth-weight infants.

INTRODUCTION: Important inter-individual variability in amikacin clearance was observed in preterm infants, only in part explained by gestational age (GA), birth weight, or coadministration of nonselective cyclo-oxygenase (COX) inhibitor. We therefore evaluated whether dopamine had an additional effect on amikacin clearance. METHODS: Clinical characteristics (GA, weight, COX inhibitor, dopamine, prenatal betamethasone) and amikacin pharmacokinetics were retrospectively collected in a cohort of preterm infants (GA of <31 wks, early neonatal life on respiratory support, between January 1, 1999 and January 6, 2005). Pharmacokinetics were calculated by assuming a one-compartment model with instantaneous input and first-order output based on paired samples collected for therapeutic drug monitoring before and following second administration. Monovariate analysis (Spearman, Mann-Whitney U test) was used to study the impact of clinical characteristics on amikacin clearance, and logistic regression was used to assess their potential independent effect. RESULTS: Paired amikacin samples were available for 240 neonates (mean GA, 28 wks; birth weight, 1042 g). Amikacin clearance was 0.46 (range, 0.09-2.33) mL/kg/min and distribution volume was 0.54 (range, 0.17-2.31) L/kg. GA, birth weight, COX inhibitor, and dopamine had a significant effect on amikacin clearance. In a logistic regression model, dopamine was no longer a significant variable when GA, birth weight, or cotreatment of a nonselective COX inhibitor was entered as second variable. CONCLUSIONS: Dopamine is an indicator but not an independent marker of reduced amikacin clearance in early neonatal life in extremely low-birth-weight infants. Therefore, neither dose nor interval should be adapted when dopamine is prescribed, if GA and coadministration of nonselective COX inhibitors already have been taken into account.

Amikacin↗
PubMed2006

Management of hepatitis C/HIV coinfection.

PURPOSE OF REVIEW: One third of HIV-infected individuals in Europe and the USA have a hepatitis C coinfection. With the introduction of highly active antiretroviral therapy for treatment of HIV, liver disease caused by chronic hepatitis C virus infection has now become an increasingly important cause of morbidity and mortality among HIV-infected patients. Therefore, treatment strategies for management of hepatitis C coinfection in HIV-infected individuals are urgently needed. RECENT FINDINGS: With the introduction of pegylated interferon/ribavirin combination therapy significantly improved treatment options for HIV/hepatitis C virus-coinfected patients have become available, leading to sustained virological response rates of over 40%. Increasing knowledge on the management of adverse events under hepatitis C therapy and optimized selection of antiretrovirals in HIV/hepatitis C virus-coinfected patients has helped to reduce complications and improve overall treatment outcome. SUMMARY: Treatment with pegylated interferon plus ribavirin is safe and effective in HIV/hepatitis C virus-coinfected patients. Longer treatment durations of 48 weeks are recommended for genotype 2 or 3. Positive predictive factors for sustained response are hepatitis C virus genotype 2 or 3 and early treatment response.

Antiviral Agents↗
PubMed2000

Estimating risk difference in multicenter studies under baseline-risk heterogeneity.

In this paper, we consider the case of efficient estimation of the risk difference in a multicenter study allowing for baseline heterogeneity. We consider the optimally weighted estimator for the common risk difference and show that this estimator has considerable bias when the true weights (which are inversely proportional to the variances of the center-specific risk difference estimates) are replaced by their sample estimates. In addition, we propose a new estimator for this situation of the Mantel-Haenszel type that is unbiased and, in addition, has a smaller variance for small sample sizes within the study centers. Simulations illustrate these findings.

Bias↗
PubMed1995

The relationship between the control of pH and healing and symptom relief in gastro-oesophageal reflux disease.

Gastro-oesophageal reflux disease (GERD) is generally considered to be the result of a motility disorder which permits the abnormal and prolonged exposure of the lumen of the oesophagus to the acidic gastric contents. This view is supported by experimental data, intra-oesophageal pH measurement, and the dramatic results of symptom relief and healing seen with effective antisecretory treatment. Oesophageal mucosal injury is determined by the pH of the refluxate and duration of acid exposure. Most patients experience meal-stimulated reflux during the day and the more severe cases experience 24-h acid exposure. In contrast to the H2-receptor antagonists (H2RAs), the proton pump inhibitors (PPIs) are more effective at controlling meal-stimulated acid secretion when each is given in standard doses. Therefore, the degree and duration of acid suppression throughout 24 h is greater. Treatments which maintain intra-oesophageal pH > 4 for 96% or more of the 24 h normalize acid exposure and are associated with the highest healing rates. Peptic activity is minimized at or above pH 4. The time above pH 4 is significantly longer with the PPIs than with the H2RAs. Thus, the healing-time curves for GERD (grades II-IV) are shifted to the left for the PPIs which heal a significantly greater proportion of patients earlier than the H2RAs or sucralfate. Symptoms in GERD are related to the degree and duration of oesophageal acid exposure. Symptom relief is more rapid and complete with the PPIs than with the H2RAs or other treatments in standard doses.

Double-Blind Method↗
PubMed2004

Evidence-based treatment of haemophilia.

Haemophilia care is effective but therapy is expensive. Despite concentrates being available in some areas for more than 30 years, many scientific questions concerning the management of haemophilia, such as what doses and duration of factor are required for different bleeding episodes or for surgical procedures, remain inadequately answered. Modern rigorous methods of assessment of the evidence both assist in determining what facts are available, how reliable the evidence is, and also help to define what studies need to be done. Cochrane methodology can be applied to haemophilia, and an assessment of prophylaxis provides an example. International collaborative studies would be valuable and require enthusiastic participants.

Biomedical Research↗
PubMed1997

Therapeutic advances: protease inhibitors for the treatment of HIV-1 infection.

BACKGROUND: Anti-retroviral treatment of human immunodeficiency virus (HIV) infection is undergoing great changes, brought about by a better understanding of the disease pathology. One of the most recent advances has been the introduction of the protease inhibitors, reversible inhibitors of HIV aspartic protease. Published data on the clinical efficacy of these drugs are limited, but preliminary results suggest that, in combination with one or more nucleoside analogues, they represent an important advance in the treatment of patients with advanced HIV infection. The adverse effects and potential for drug interactions, together with the additional cost associated with prescribing these drugs, mean that careful selection and supervision of these patients is imperative. AIM: To present an up-to-date review of the three most recently introduced protease inhibitors. METHODS: Based on a review of the literature, abstracts from relevant meetings and information from the pharmaceutical companies. CONTENT: A review including background data on HIV infection and the treatment options. Detailed information on ritonavir, saquinavir and indinavir. CONCLUSIONS: These new drugs are useful additions to the therapeutic current aims for the treatment of HIV infection. They need to be used under close supervision by specialists.

Anti-Bacterial Agents↗
PubMed2006

Taking stock of evidence-based medicine: opportunities for its continuing evolution.

Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM; the unknown effectiveness of EBM; the clinician-centric focus of EBM; and the potential of EBM to harm patients.

Decision Making↗
PubMed2004

The ARIA/EAACI criteria for antihistamines: an assessment of the efficacy, safety and pharmacology of desloratadine.

BACKGROUND: The definition of allergic rhinitis and the classification of its severity and treatment have advanced in recent years following the publication of the Allergic Rhinitis and its Impact of Asthma (ARIA) document. The ARIA and the European Academy of Allergology and Clinical Immunology (ARIA/EAACI) have published a set of recommendations that outline the pharmacological and clinical criteria to be met by medications commonly used in the treatment of allergic rhinitis. METHODS: An international group of experts met to assess the profile of the antihistamine, desloratadine, under the ARIA/EAACI criteria. Data on desloratadine were collected from peer-reviewed clinical studies and review articles, which were corroborated and augmented by comprehensive public access documents from the European Medicines Evaluation Agency (EMEA). RESULTS AND CONCLUSION: Based on this systematic review, it was concluded that the efficacy, safety and pharmacology of desloratadine broadly meet the ARIA/EAACI criteria for antihistamines.

Animals↗