Reversibility Of Adverse Effects Research Articles

Ablative neurosurgery and deep brain stimulation for obsessive-compulsive disorder

Despite advancements in pharmacotherapeutic and behavioral interventions, a substantial proportion of patients with obsessive-compulsive disorder (OCD) continue to have disabling and treatment-refractory illness. Neurosurgical interventions, including ablative procedures and deep brain stimulation (DBS), have emerged as potential treatment options in this population. We review the recent literature on contemporary surgical options for OCD, focusing on clinical aspects such as patient selection, presurgical assessment, and safety and effectiveness of these procedures. Given the invasiveness and limited evidence, these procedures have been performed in carefully selected patients with severe, chronic, and treatment-refractory illness. Along with informed consent, an independent review by a multidisciplinary team is mandated in many centers. Both ablative procedures and DBS have been found to be helpful in around half the patients, with improvement observed months after the procedure. Various targets have been proposed for either procedure, based on the dominant corticostriatal model of OCD. There is no strong evidence to recommend one procedure over the other. Hence, the choice of procedure is often based on the factors such as affordability, expertise, and reversibility of adverse effects. Surgery is not recommended as a standalone treatment but should be provided as part of a comprehensive package including medications and psychotherapeutic interventions. Available evidence suggest that the benefits of the procedure outweigh the risks in a treatment-refractory population. Advances in neurosurgical techniques and increasing knowledge of neurobiology are likely to bring about further progress in the efficacy, safety, and acceptability of the procedures.

Patient Preferences for Psoriasis Treatments

To assess patients' preferences for psoriasis treatments and to identify the effect of sociodemographic and socioeconomic characteristics on these preferences. A computer-based conjoint analysis experiment was conducted to analyze the preferences of individuals with moderate or severe psoriasis for outcome attributes (probability, magnitude, and duration of benefit, as well as probability, severity, and reversibility of adverse effects) and process attributes (treatment location, frequency, duration, delivery method, and individual cost) of psoriasis treatments. Relative importance scores (RISs) for each attribute were calculated. The effect of sociodemographic (age, sex, and marital status) and socioeconomic (income and employment) characteristics and Psoriasis Area and Severity Index and Dermatology Life Quality Index scores on preferences was assessed using analysis of variance, post hoc testing, and multivariate regression analysis. Outpatient dermatology clinic at a German university medical center. Patients with moderate or severe psoriasis (N = 163). Relative importance scores for treatment attributes. The attribute considered to be most important in patients' preferences for psoriasis treatments was treatment location (RIS, 26.76), followed by probability of benefit (RIS, 23.77) and method of delivery (RIS, 23.49). The RISs for all process attributes were higher than for adverse effect-related attributes. Older individuals (≥65 years) were less concerned about the probability of benefit (β = -0.24; P = .005) compared with younger individuals. When choosing among treatment options, individuals with psoriasis appear to be willing to accept treatment-related adverse effects to obtain process attributes compatible with their personal and professional life. Incorporating preferences in shared decision making may facilitate treatment adherence and optimize outcome.

Statins And Stroke

Pharmacological studies highlighted pleiotropic effects of statins, that seem to influence atherogenesis not only by increasing atherosclerotic plaque stability but also by modulating endothelial function and inflammation and acting on platelet aggregation and thrombosis. Despite a strong association between increased levels of low-density lipoprotein cholesterol (LDL-C) and the incidence of coronary heart disease (CHD) has been well proven, it not yet established whether serum LDL-C levels are related to stroke incidence. The major aim of this paper is to perform a comprehensive up-to-date review of research papers, meta-analyses and randomized controlled clinical trials reporting the effects of statins in primary and secondary stroke prevention strategies. In addition, our work provides an overview on statin chemical structure, mechanism of action and pharmacological properties, investigating also most common adverse effects and relationship between statin therapy and haemorrhagic stroke risk, in order to assess drugs safety. Although studies are heterogeneous, our analysis shows that statins reduce the risk of stroke occurrence in high risk patients and seem also to reduce stroke recurrence. Moreover, the low incidence and reversibility of adverse effects, and the unclear association with hemorrhagic events, support the safe use of these drugs.

Survey of Acute Mountain Sickness on Mauna Kea

Although thousands of people ascend 4205 m to visit the summit of Mauna Kea each year, there has been no information on the rate of altitude illness triggered by such visits. Two surveys were used: one for tourists driving up to the summit and the other for summit astronomy workers staying at lodging facilities at intermediate altitude. The surveys included the standardized Lake Louise Self-report Acute Mountain Sickness (AMS) Questionnaire that, when scored, gave the Lake Louise Symptoms Score (LLSS). Thirty percent of surveyed day visitors and 69% of surveyed professional astronomy staff had AMS, defined as a LLSS score of 3 or greater, with headache. Nine participants reported "disorientation/confusion" or greater consciousness changes. A majority of astronomy professionals reported fatigue, disturbed sleep, reduced activity, and mental status changes. Few took any AMS medications. The incidence of AMS in visitors to Mauna Kea's summit warrants increased education and increased availability of supplemental oxygen at the summit. The absence of reported serious altitude illness in the community is probably due to the rapid descent available on Mauna Kea, with prompt reversibility of adverse effects.

Oral vinorelbine in first line treatment of NSCLC in elderly: Updated results of a low dose schedule in a single institution experience

18192 Background: Oral Vinorelbine has been reported as an effective treatment option for advanced NSCLC in patients not suitable for CDDP containing schedules. Methods: With the aim to improve the toxicity profile of oral Vinorelbine therapy in the elderly setting, from 01/2004 to 05/2006, 31 patients with stage IIIB-IV NSCLC were treated with single agent oral Vinorelbine at the dose of 60 mg/m2 day 1,8,15 every 3 weeks. Median age of patients was 75 (range 65 to 82) and M/F ratio 1,6. All patients were untreated and received oral Vinorelbine as first line chemotherapy. 24/31 pts were first diagnosed and not suitable for surgery (14/24 locally advanced, 4/24 not operable for comorbidity, 6/24 stage IV at diagnosis), 7/31 recurring after surgery. Pathology reports 15/31 adenocarcinoma, 9/31 squamous, 7/31 non-small cells (citology). Sites of distant metastases were as follow: liver in 13%, bone in 16%, mediastinal lymph nodes in 71%. Median Karnofsky performance status was 80 (range 60–90). Results: Adverse event were experienced by 35% of patients, but were generally mild (grade 1–2). In particular fatigue was reported by 13%, parhestesias by 16%, gastrointestinal disconfort (mild nausea/diarrea) by 26%, costipation/abdominal pain by 10%, trombocytopenia by 6%; no patient experienced anorexia, emesis nor febrile neutropenia. Dose reduction was never required.Complete reversal of adverse effects was always documented. No patient experienced CR; 6/31 (19%) PR and 8/31 (26%) SD were reported with clinical benefit in 14/31 patients (45%). Median time to progression and overall survival were 4,2 and 9 months, not different from data reported in recent literature for higher intensity schedule (Gridelli C, et al.: Eur J Cancer 40:2424–43, 2004) Conclusions: Treatment with oral Vinorelbine at the 60 mg/m2 day 1,8,15 every 3 weeks schedule has a low toxicity profile and seems to be better tolerated than the conventional dose of 80 mg/m2, representing a valide alternative for elderly patients with advanced NSCLC. No significant financial relationships to disclose.

Reversal of adverse effects of neoadjuvant chemotherapy on bone turnover in pre- and post-menopausal women with zoledronic acid

556 Background: Ovarian failure secondary to adjuvant chemotherapy is known to have an adverse effect on bone mineral density and to increase bone turnover markers. The effects of chemotherapy with growth factor support in the absence of hormonal changes have not been described. The impact of zoledronic acid on these changes was also explored. Methods: We evaluated bone turnover markers in 82 women undergoing neoadjuvant chemotherapy for localized stage II/III breast cancer at initial diagnosis prior to treatment and after 4 cycles of epirubicin (75mg/m2)-docetaxel (75mg/m2) with pegylated G-CSF support with or without zoledronic acid. 47% of patients were post-menopausal and all groups were balanced for other variables. Women were randomized to receive zoledronic acid 4 mg IV every 3 weeks concurrently with chemotherapy (n=41) versus no bisphosphonate treatment (n=41). Bone turnover markers included: urinary N-telopeptide (NTx), serum bone specific alkaline phosphatase (BAP)and osteocalcin (OSTEO). Results: Women, regardless of menopausal status, who received no bisphosphonate had statistically significant increases in NTx, from baseline after 3 months of neoadjuvant chemotherapy using multivariable mixed repeated measures (p=0.0213). Women who received zoledronic acid concurrently with neoadjuvant chemotherapy had statistically significant decreases in NTx (p<0.0001), BAP (p<0.0001) and OSTEO (p=0.0295) from baseline. This is the first demonstration that anthracycline-taxane chemotherapy with growth factor support increased bone turnover markers in both post-menopausal and pre-menopausal women independent of hormone therapy, radiation therapy and surgery. Conclusions: Neoadjuvant chemotherapy with anthracycline- taxane and growth factor support increased bone resorption markers in both post-menopausal and pre-menopausal women. Zoledronic acid given concurrently with each cycle of chemotherapy reversed this increase in bone turnover markers. No significant financial relationships to disclose.

Reversal of adverse effects of heavy ammonium sulphate application on growth and nutrient status of a kikuyu pasture

Adverse effects resulting from fertilization with high rates of ammonium sulphate were determined on a kikuyu grass (Pennisetum clandestinum) pasture grown on a krasnozem in a sub-tropical environment. Corrective fertilizer practices using lime and phosphorus were evaluated.