Similar Clinical Profiles Research Articles

Clinical and Economic Value of Performing Dialysis Vascular Access Procedures in a Freestanding Office‐Based Center as Compared with the Hospital Outpatient Department among Medicare ESRD Beneficiaries

Dialysis vascular access (DVA) care is being increasingly provided in freestanding office-based centers (FOC). Small-scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4-year sample (2006-2009) of Medicare claims (USRDS) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department (HOPD). Using propensity score matching techniques, cases with a similar clinical and demographic profile from these two sites of service were matched. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts (n=27,613). Patients treated in the FOC had significantly better outcomes (p<0.001), including fewer related or unrelated hospitalizations (3.8 vs. 4.4), vascular access-related infections (0.18 vs. 0.29), and septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%) as were PMPM payments ($4,982 vs. $5,566). This study shows that DVA management provided in a FOC has multiple advantages over that provided in a HOPD.

Antimicrobial therapy for chronic bacterial prostatitis.

Chronic bacterial prostatitis (CBP) is frequently diagnosed in men of fertile age, and is characterized by a disabling array of symptoms, including pain in the pelvic area (for example, perineum, testicles), voiding symptoms (increased frequency and urgency, also at night; pain or discomfort at micturition), and sexual dysfunction. Cure of CBP can be attempted by long-term therapy with antibacterial agents, but relapses are frequent. Few antibacterial agents are able to distribute to the prostatic tissue and achieve sufficient concentrations at the site of infection. These agents include fluoroquinolones, macrolides, tetracyclines and trimethoprim. After the introduction of fluoroquinolones into clinical practice, a number of studies have been performed to optimize the antimicrobial treatment of CBP, and to improve eradication rates and symptom relief. To assess and compare the efficacy and harm of antimicrobial treatments for chronic bacterial prostatitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, other national or international databases and abstracts from conference proceedings on 8 August 2012. We included all randomized controlled comparisons of one antimicrobial agent versus placebo or one or more comparator antimicrobial agents, combined or not with non-antimicrobial drugs. We also included trials comparing different doses, treatment durations, dosing frequencies, or routes of administration of antimicrobial agents. We excluded studies in which patients were not diagnosed according to internationally recommended criteria, or were not subjected to lower urinary tract segmented tests. Study data were extracted independently by two review authors. Study outcomes were microbiological efficacy (pathogen eradication), clinical efficacy (symptom cure or improvement, or symptom scores) at test-of-cure visits or at follow-up, or both, and adverse effects of therapy. Secondary outcomes included microbiological recurrence rates.Statistical analysis was performed using a fixed-effect model for microbiological outcomes and a random-effects model for clinical outcomes and adverse effects. The results were expressed as risk ratios for dichotomous outcomes (with 95% confidence intervals) or as standardized mean differences for continuous or non-dichotomous variables. We identified 18 studies, enrolling a total of 2196 randomized patients. The oral fluoroquinolones ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin and prulifloxacin were compared. There were no significant differences in clinical or microbiological efficacy or in the rate of adverse effects between these fluoroquinolones. In chlamydial prostatitis, (i) azithromycin showed improved eradication rates and clinical cure rates compared to ciprofloxacin, with no significant differences regarding adverse effects; (ii) azithromycin was equivalent to clarithromycin, both microbiologically and clinically; (iii) prulifloxacin appeared to improve clinical symptoms, but not eradication rates, compared to doxycycline. In ureaplasmal prostatitis, the comparisons ofloxacin versus minocycline and azithromycin versus doxycycline showed similar microbiological, clinical and toxicity profiles. The microbiological and clinical efficacy, as well as the adverse effect profile, of different oral fluoroquinolones are comparable. No conclusions can be drawn regarding the optimal treatment duration of fluoroquinolones in the treatment of CBP caused by traditional pathogens.Alternative antimicrobial agents tested for the treatment of CBP caused by traditional pathogens are co-trimoxazole, beta-lactams and tetracyclines, but no conclusive evidence can be drawn regarding the role of non-fluoroquinolone antibiotics in the treatment of CBP caused by traditional pathogens.In patients with CBP caused by obligate intracellular pathogens, macrolides showed higher microbiological and clinical cure rates compared to fluoroquinolones.

Mode of death in patients with pulmonary arterial hypertension

Purpose: Right ventricular failure is considered the most frequent mode of death in pulmonary arterial hypertension (PAH), but it is a common clinical experience that PAH patients often die suddenly (SD) or following an acute illness. Methods: We conduced a retrospective analysis of 202 consecutive PAH patients. According to the ACME classification, mode of death was classified as due to right heart failure (RHF), SD and triggered by extra cardiac cause (ExC). Results: After a mean follow-up of 885±890 days, we observed 71 deaths (35%). The actuarial survival rate was 80%, 71%, 60% and 58% at 1, 2, 3 and 4 years, respectively. RHF was observed in 43 (60%), SD in 9 (13%) and ExC in 19 (27%) patients. RHF goup showed a trend towards longer survival compared to the others, and had a higher NYHA class (RHF 3.0±0.6, SD 2.7±0.5, ExC 2.8±0.6; p ns) and a lower effort tolerance (6-minute walk distance: RHF 296±107 m, SD 393±84 m, ExC 362±114 m; p<0.001) and cardiac index (RHF 2.0±0.7 l/min/m2, SD 2.2±0.7 l/min/m2, ExC 2.3±0.8 l/min/m2; p<0.05). SD or ExC patients had a similar clinical and hemodynamic profile of survivors, and ExC group had a lower body mass index (BMI: RHF 24±5 kg/m2, SD 24±5 kg/m2, ExC 21±4 kg/m2; p<0.03). View this table: Comparison among the four groups Conclusions: Death in PAH is not exclusively due to refractory RHF, as SD and ExC could account for about 40% of the overall deaths. The findings that these latter groups have a hemodynamic profile similar to survivors should be confirmed in a larger population. Further prospective multicenter study is needed in order to better define the modality of death in PAH, and analyse specific risk factors for SD and ExC.

Occurrence and Predictors of Obstructive Sleep Apnea in a Revascularized Coronary Artery Disease Cohort

Knowledge about the prevalence of obstructive sleep apnea (OSA) in coronary artery disease (CAD) is insufficient. The aim of the current report was to evaluate the occurrence and predictors of OSA among revascularized patients with CAD within the framework of a randomized controlled trial (Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea [RICCADSA]), evaluating the impact of continuous positive airway pressure on cardiovascular outcomes in CAD patients with OSA. All patients undergoing percutaneous coronary intervention or coronary artery bypass grafting between September 2005 and November 2010 (n = 1,291) were invited to participate. Anthropometrics and medical history were obtained, ambulatory sleep recording was performed, and all subjects completed the Epworth Sleepiness Scale (ESS) questionnaire. In total, 662 patients participated in the sleep study. OSA, defined as an apnea-hypopnea index equal to or greater than 15/hour, was found among 422 (63.7%). The prevalence of hypertension was 55.9%; obesity (body mass index ≥ 30 kg/m²), 25.2%; diabetes mellitus, 22.1%; and current smoking, 18.9%. The patients with CAD who did not participate in the study demonstrated an almost similar anthropometric and clinical profile compared with the studied group. The majority (61.8%) of the patients with OSA were nonsleepy (ESS score < 10). Patients with OSA had a higher prevalence of obesity, hypertension, diabetes mellitus, and history of atrial fibrillation, whereas current smoking was more common in the non-OSA group. Age, male sex, body mass index, and ESS score, but not comorbidities, were independent predictors of OSA. The occurrence of unrecognized OSA in this revascularized CAD cohort was higher than previously reported. We suggest that OSA should be considered in the secondary prevention protocols in CAD.

Association between the intima-media thickness of the brachiocephalic trunk and white matter hyperintensity in brain MRI

The intima-media thickness (IMT) of the brachiocephalic trunk (BCT) can be measured using duplex carotid ultrasonography, which is used for imaging the common carotid artery (CCA). However, the clinical significance of the BCT-IMT has not been studied. We reviewed 1109 stroke-free participants in the registry of the Okinawa General Health Maintenance Association. We compared the association between the BCT-IMT or the CCA-IMT with deep and subcortical white matter hyperintensity (DSWMH). The BCT-IMT was correlated with the CCA-IMT, and like CCA-IMT, it increased with advancing age. The increase in both the BCT-IMT and the CCA-IMT quartiles was correlated with the development of DSWMH. The multivariate logistic regression analysis indicated that, as observed for the CCA-IMT, the increase in the BCT-IMT was associated with a higher prevalence of significant DSWMH (Fazekas grade 2 or 3 per 0.1 mm increase in IMT; OR 1.02, 95% confidence interval 1-1.04; P=0.04). The increase in quartiles of the BCT-IMT was only associated with a higher prevalence of significant DSWMH in subjects with lower CCA-IMT (1st and 2nd quartiles, R(2)=0.18, P<0.05) but not in subjects with higher CCA-IMT (3rd and 4th quartiles). Combinations of the CCA-IMT and BCT-IMT quartiles failed to have an additive effect on the prevalence of significant DSWMH. The BCT-IMT has a similar clinical profile to the CCA-IMT in terms of its association with DSWMH. However, the CCA-IMT and the BCT-IMT did not predict DSWMH in an additive manner, and distinct mechanisms might underlie the observed thickening of the IMT in the CCA and BCT.

AB0458 Better retention rate at 5 years of anti-TNF agents used in conjonction with methotrexate over time in patients with rheumatoid arthritis: Real-life data from rhumadata computarized database

BackgroundAnti-TNF agents have been in used in Canada for the last ten years. Although a vast body of clinical experience has been accumulated since that time, there are still areas...

Lymphoma outbreak in a GASH:Sal hamster colony

We have detected a high incidence of lymphomas in a colony of GASH:Sal Syrian golden hamsters (Mesocricetus auratus). This strain is characterised by its ability to present convulsive crises of audiogenic origin. Almost 16 % (90 males and 60 females) of the 975 animals were affected during a 5-year period by the development of a progressing lymphoid tumour and exhibited similar clinical profiles characterised by lethargy, anorexia, evident abdominal distension, and a rapid disease progression resulting in mortality within 1 to 2 weeks. A TaqMan® probe-based real-time PCR analysis of genomic DNA from different tissue samples of the affected animals revealed the presence of a DNA sequence encoding the hamster polyomavirus (HaPyV) VP1 capsid protein. Additionally, immunohistochemical analysis using HaPyV-VP1-specific monoclonal antibodies confirmed the presence of viral proteins in all hamster tumour tissues analysed within the colony. An indirect ELISA and western blot analysis confirmed the presence of antibodies against the VP1 capsid protein in sera, not only from affected and non-affected GASH:Sal hamsters but also from control hamsters from the same breeding area. The HaPyV genome that accumulated in tumour tissues typically contained deletions affecting the noncoding regulatory region and adjacent sequences coding for the N-terminal part of the capsid protein VP2.

Relation of Aspirin Response to Age in Patients With Stable Coronary Artery Disease

Recent studies have suggested that clopidogrel response may vary significantly with age. Limited data are available exploring the age dependency of ex vivo aspirin response in young and old patients with stable coronary artery disease. Patients with stable coronary artery disease (n= 583) who had been treated with aspirin 75 to 325 mg/day for ≥1 week were recruited from a general cardiology practice. The study cohort was divided into 2groups: patients aged <75 years (n= 438) and patients aged ≥75 years (n= 145). Aspirin response was determined using the VerifyNow Aspirin Test, and resistance was defined as ≥500 or 550 aspirin reaction units (ARU). The independent predictive value of age on VerifyNow score (as a continuous function) was determined using multivariate linear regression, adjusted for gender, body mass index, and diabetes mellitus. Younger and older patients had similar baseline clinical profiles, including relative doses of aspirin therapy. The mean VerifyNow Aspirin Test score was significantly higher in patients aged ≥75 years: 450 ± 54 versus 434 ± 53 ARU (p= 0.0007). After accounting for the primary covariates, age remained a predictor of VerifyNow score (p= 0.007). Aspirin resistance on the basis of the 500-ARU cutoff was higher in older patients (19% vs 11%, p= 0.009), but there was no difference when the 550-ARU cutoff was used (7% vs 5%, p= 0.40). In conclusion, aspirin response differs significantly by age in patients with stable CAD.

Gender-Related Differences in Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TTC) predominantly occurs in elderly women. Men comprise 10% of the patients, with a similar clinical profile. In contrast to myocardial infarction, age distribution; symptoms, such as angina; and prehospital delay in TTC are not different between genders. In men, physical stress as a triggering event and shock or cardiac arrest on presentation are more frequent. Gender-related differences in TTC need to be carefully investigated at the clinical and experimental levels to explain the evident gender discrepancy in the prevalence of TTC, to clarify the pathogenetic background, and to develop preventive and therapeutic means against this life-threatening disease.

Hunter syndrome presenting as heart failure: A case report

Introduction: Hunter syndrome (Mucopolysaccharidosis type II, MPS II) is a genetic disorder associated with deficiency of lysosomal enzyme iduronate­2­sulfatase and impairment of glycosaminoglycans (GAGs) metabolism. Hunter syndrome is well described in medical literature but less is known about heart failure. We are presenting a rare case of Hunter­syndrome with heart failure. Case Report: A 17­year­old boy presented to emergency department with chief complaint of dyspnea on exertion for last seven days. He also had history of progressive abdominal swelling since five years of age. On examination, he was tachypneic with raised jugular venous pressure and bilateral pitting pedal edema. His head was dolicocephalic in shape with coarse facial features. His abdomen was distended with hepatosplenomegaly and an umbilical hernia. He has one younger brother with similar clinical profile and one normal younger sister. Suspecting mucopolysaccharidosis, we performed a skeletal survey. A lateral X­ray of the skull showed an enlarged and J­shaped sella turcica. Patient’s and his brother’s enzyme assays for iduronate­2­sulfatase were markedly low. Based on the clinicoradiological and enzyme assay diagnosis of Hunter syndrome (MPS II) was made. Conclusion: Various clinical and radiological features are typical of MPS II. A detailed clinical evaluation and radiological investigations help in diagnosis of MPS II. The enzyme assay is required to confirm the diagnosis.

Subgroup of Common Variable Immunodeficiency patients with distinct clinical and biological features revealed by B-cell immunophenotyping

Event Abstract Back to Event Subgroup of Common Variable Immunodeficiency patients with distinct clinical and biological features revealed by B-cell immunophenotyping Veronika Kanderova1*, Eva Fronkova1, Jan Stuchly1, Marcela Vlkova2, Ivana Hermanova1, Ladislav Krol1, Ondrej Hrusak1, Anna Sediva3, Jiri Litzman2 and Tomas Kalina1 1 Charles University, 2nd Faculty of Medicine, Dpt. Pediatric Hematology/Oncology, Czechia 2 St Anne’s University Hospital and Masaryk University, Faculty of Medicine, Dpt. Clinical Immunology and Allergology, Czechia 3 Charles University, 2nd Faculty of Medicine, Dpt. Immunology, Czechia Common Variable Immunodeficiency (CVID) is characterized by low levels of IgG, IgA, and/or IgM, impaired specific antibody response after antigen challenge and the resulting bacterial infections. Investigation of peripheral blood cellular compartments revealed abnormalities in B- and T-cells. Due to high number of analysed parameters it is difficult to define CVID subgroups that possibly share the same ethiopathological mechanisms. We have compared distribution of cells within all possible immunophenotypes with 8 color flow cytometry and probability binning to reduce CVID heterogeneity. Ninety-eight patients and 47 healthy donors have created hierarchical tree according to B-cell phenotype similarities. The cohort has split into 11 phenotype clusters. B-cell cluster no.5 has been distinguished by aberrant phenotype of T-cells. Cluster 5 CD4+ T-cells have been reduced and presented with decreased proportion of naive cells and increased proportion of intermediate effector memory cells (CD27-CD28+). Increased expression of CD57, PD-1, CD69 and CD70 has suggested a chronic activation but activating cytokine levels have not been elevated. Moreover cluster 5 patients suffer from autoimmunity and splenomegaly. Similar clinical presentation and phenotypic profile have supported the idea that similar pathological mechanism might be responsible for this phenotypically defined subgroup of patients. Whole-exome sequencing has yielded 23 possibly damaging gene alterations (e.g. single-nucleotide polymorphisms) presented in three cluster 5 patients, but not in control samples that are currently being investigated. B-cell profiling of large group of CVID patients revealed subcluster with distinct T-cell profile, clinical presentation and shared germline genetic variations. Acknowledgements NT/11414-5, NT/13271, P302/12/G101, UNCE204012 Keywords: CVID, Immunophenotyping, Probability binning, Cytokines, Whole-exome sequencing Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Immune-mediated disease pathogenesis Citation: Kanderova V, Fronkova E, Stuchly J, Vlkova M, Hermanova I, Krol L, Hrusak O, Sediva A, Litzman J and Kalina T (2013). Subgroup of Common Variable Immunodeficiency patients with distinct clinical and biological features revealed by B-cell immunophenotyping. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00833 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 20 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Veronika Kanderova, Charles University, 2nd Faculty of Medicine, Dpt. Pediatric Hematology/Oncology, Prague, 15006, Czechia, kanderov@seznam.cz Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Veronika Kanderova Eva Fronkova Jan Stuchly Marcela Vlkova Ivana Hermanova Ladislav Krol Ondrej Hrusak Anna Sediva Jiri Litzman Tomas Kalina Google Veronika Kanderova Eva Fronkova Jan Stuchly Marcela Vlkova Ivana Hermanova Ladislav Krol Ondrej Hrusak Anna Sediva Jiri Litzman Tomas Kalina Google Scholar Veronika Kanderova Eva Fronkova Jan Stuchly Marcela Vlkova Ivana Hermanova Ladislav Krol Ondrej Hrusak Anna Sediva Jiri Litzman Tomas Kalina PubMed Veronika Kanderova Eva Fronkova Jan Stuchly Marcela Vlkova Ivana Hermanova Ladislav Krol Ondrej Hrusak Anna Sediva Jiri Litzman Tomas Kalina Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Choice of Treatment with Antidepressants: Influencing Factors

Depressive disorders place a large burden on patients and on society. Although efficacious treatment options for unipolar depressive disorders exist, substantial gaps in care remain. In part, the challenge lies in the matching of individual patients with appropriate care. This is complicated by the steady increases in the variety of antidepressants available in the market. The goal of this study is to highlight the decision processes in the selection of antidepressants by clinicians, given that most treatments have similar clinical effectiveness profiles. We conducted a systematic literature review of studies that referred to the decisions surrounding treatment with antidepressants for the treatment of non-psychotic unipolar depression. Our analysis of the literature reveals that the choice of treatment is based on a variety of factors, of which clinical evidence is only one. These factors can be categorized into clinical factors such as illness and treatment characteristics, individual factors such as patient and physician characteristics, and contextual factors such as setting characteristics, decision supports and pharmacoeconomic aspects. Illness characteristics are defined by the type and severity of depression. Treatment characteristics include drug properties, efficacy, effectiveness and favorable as well as unintended adverse effects of the drug. Examples for patient characteristics are co-morbidities and individual preferences, and physician characteristics include knowledge, experience, values and beliefs, and the relationship with the patient. Treatment guidelines, algorithms, and most recently, computational supports and biological markers serve as decision supports.

Phonological and Motor Errors in Individuals With Acquired Sound Production Impairment

This study aimed to compare sound production errors arising due to phonological processing impairment with errors arising due to motor speech impairment. Two speakers with similar clinical profiles who produced similar consonant cluster simplification errors were examined using a repetition task. We compared both overall accuracy and acoustic details of hundreds of productions with target consonant clusters to tokens with singletons. Changes in accuracy over the course of the study were also compared. In target words with consonant cluster simplification, the individual whose errors reflected phonological impairment produced articulatory timing consistent with singleton onsets. These productions improved when resyllabification was possible, but error rates were not affected by exposure. In contrast, the individual with motoric-based errors produced simplifications that contained the articulatory timing associated with clusters. Accuracy was not affected by the ability to resyllabify, but it did significantly improve following repeated production. Our findings reveal clear differences between errors arising in phonological processing and in motor planning that reflect the underlying systems. The changes over the course of the study suggest that error types with different sources are responsive to different intervention strategies.

Prevalence and clinical relevance of local allergic rhinitis

Evidence demonstrates the existence of local allergic rhinitis (LAR) in nonatopic patients, although its prevalence in the rhinitis population remains unknown. The aim, therefore, of this study was to evaluate the prevalence, clinical characteristics, and severity of LAR in a Spanish rhinitis population, compared with patients having classical allergic rhinitis (AR) with systemic atopy or nonallergic rhinitis (NAR). A group of 452 adult rhinitis patients were randomly selected from a total of 3860 who attended our allergy service over 1year. A clinical questionnaire, skin prick test (SPT), spirometry, and serum total and specific IgE (sIgE) were evaluated. A nasal allergen provocation test with multiple aeroallergens (NAPT-M), including Dermatophagoides pteronyssinus, pollens, alternaria, and dog epithelia, was performed in patients with negative SPT and serum sIgE. A total of 428 patients completed the study; 24 were excluded because of nasal hyper-reactivity. LAR was diagnosed in 25.7%, AR in 63.1%, and NAR in 11.2%. The LAR and AR patients had a similar clinical profile: a nonsmoking woman with severe, persistent perennial rhinitis frequently associated with conjunctivitis and asthma. More than 36% of LAR patients reported rhinitis onset in childhood. NAPT-M detected aeroallergen polysensitization in 37.3% of the LAR patients. Dermatophagoides pteronyssinus was the main sensitizing aeroallergen in LAR and AR (60% vs 54%, P>0.05). Local allergic rhinitis is a prevalent entity in patients evaluated with rhinitis. Persistent and severe symptoms associated with conjunctivitis and/or asthma and polysensitization were likely to be detected in LAR and AR.

Demystifying seronegative autoimmune pancreatitis

BackgroundAutoimmune pancreatitis (AIP) has been classified into type 1 and type 2 subtypes. Serum immunoglobulin G4 (IgG4) elevation characterizes type 1 AIP. Type 2 AIP and a subset of type 1 AIP are seronegative, i.e., have normal serum IgG4 levels. AimWe compared the profiles of the three subsets of AIP to identify the unique characteristics of seronegative type 1 AIP and type 2 AIP. MethodsWe compared the clinical profiles of 69 seropositive type 1 AIP patients, 21 seronegative type 1 AIP patients and 22 type 2 AIP patients. ResultsAmong type 1 AIP, seronegative group had similar clinical profiles when compared to seropositive group except that they were more likely to undergo surgical resection than seropositive patients (p = 0.001). Seronegative type I AIP patients were older (61.9 ± 13.7 vs 45.3 ± 17.4; p = 0.004), and differed in the occurrence of other organ involvement (OOI) (71.4% vs 0%; p < 0.001) and disease relapse (33.3% vs 0%; p = 0.005) when compared with type 2 AIP. All seronegative type 1 AIP patients had at least one of the following –OOI, disease relapse, and age >50 years while none of the type 2 AIP had OOI or disease relapse. ConclusionsSeronegative and seropositive type 1 AIP patients have similar clinical profiles, which are distinct from that of type 2 AIP. Among the seronegative AIP group, patients are more likely to have type 1 AIP rather than type 2 AIP if they are older than 50 years or have OOI or disease relapse.

Statins but not aspirin reduce thrombotic risk assessed by thrombin generation in diabetic patients without cardiovascular events: the RATIONAL trial.

BackgroundThe systematic use of aspirin and statins in patients with diabetes and no previous cardiovascular events is controversial. We sought to assess the effects of aspirin and statins on the thrombotic risk assessed by thrombin generation (TG) among patients with type II diabetes mellitus and no previous cardiovascular events.Methodology/Principal FindingsProspective, randomized, open, blinded to events evaluation, controlled, 2×2 factorial clinical trial including 30 patients randomly allocated to aspirin 100 mg/d, atorvastatin 40 mg/d, both or none. Outcome measurements included changes in TG levels after treatment (8 to 10 weeks), assessed by a calibrated automated thrombogram. At baseline all groups had similar clinical and biochemical profiles, including TG levels. There was no interaction between aspirin and atorvastatin. Atorvastatin significantly reduced TG measured as peak TG with saline (85.09±55.34 nmol vs 153.26±75.55 nmol for atorvastatin and control groups, respectively; p = 0.018). On the other hand, aspirin had no effect on TG (121.51±81.83 nmol vs 116.85±67.66 nmol, for aspirin and control groups, respectively; p = 0.716). The effects of treatments on measurements of TG using other agonists were consistent.Conclusions/SignificanceWhile waiting for data from ongoing large clinical randomized trials to definitively outline the role of aspirin in primary prevention, our study shows that among diabetic patients without previous vascular events, statins but not aspirin reduce thrombotic risk assessed by TG.Trial RegistrationClinicalTrials.gov NCT00793754

Comparison of neuropsychological effects of adjunctive risperidone or quetiapine in euthymic patients with bipolar I disorder

Although associations between antipsychotic use and neuropsychological impairment in bipolar I disorder have been observed, there is a lack of studies comparing the effects of specific agents used in this population. We compared performance between patients receiving maintenance treatment with mood stabilizer monotherapy (n=15), adjunctive risperidone (n=15) or quetiapine (n=17), and a group of demographically matched healthy controls (n=28) on tests of executive function (working memory, set shifting, and inhibition) and verbal learning. Despite having a similar clinical profile, patients being treated with risperidone showed significantly impaired working memory, set-shifting, and verbal learning (P<0.05) compared with those either on mood stabilizer monotherapy or adjunctive quetiapine. Although randomized controlled trials are required to confirm the cognitive side effects of medications prescribed for maintenance treatment of bipolar I disorder, preliminary results indicate that addition of risperidone to a mood stabilizer has a negative impact on executive function and verbal learning, an effect not shared with quetiapine.

Clinical Profile and Outcomes of Hair Dye Poisoning in a Teaching Hospital in Nellore

Demographic profiles, volume consumed, time to hospitalization, clinical presentation, laboratory findings, treatment details, and outcomes of patients with hair dye poisoning were analyzed to assess the effect of Super Vasmol 33. The efficacy of methylprednisolone as compared to hydrocortisone in patients was also investigated. Findings show that there are significant differences in the clinical profiles laboratory markers such as markers of leukocytosis, rhabdomyolysis, and hepatitis among patients who consumed fewer volumes than larger volumes. Toxicity is dose dependent with increased morbidity and mortality. Consumption of even lower volumes resulted in hepatitis. For an apparently similar clinical and laboratory profile of patients, treatment with hydrocortisone is as effective as methylprednisolone in the clinical outcomes. These findings suggest that Super Vasmol 33 is emerging as a major source of poisoning.

Local Allergic Rhinitis is Highly Prevalent in a Population Attended for the Evaluation of Rhinitis

Evidence demonstrates the existence of local allergic rhinitis (LAR) in an important group of non-atopic patients. In this study we evaluated the prevalence and clinical characteristics of LAR in Málaga, Spain. A group of 388 adult rhinitis patients attended in our allergy service last year was randomly selected. Clinical questionnaire, SPT, spirometry, serum total and specific IgE (sIgE) were evaluated. Nasal allergen provocation test with multiple aeroallergens (NAPT-M) including D. pteronyssinus, pollens, and alternaria were performed in patients with negative SPT and serum sIgE. A total of 364 patients were studied, 24 were excluded because of nasal hyperreactivity. The prevalence of LAR was 23%, systemic allergic rhinitis (SAR) 65%, and non-allergic rhinitis (NAR) 12%. LAR and SAR patients had a similar clinical profile: a non-smoker woman with severe-persistent perennial rhinitis with 6 years of evolution, frequently associated to conjunctivitis (68.1% vs 67.6%, p>0.05) and asthma (41.2% vs 44.1%, p>0.05). NAPT-M detected aeroallergens polysensitization in 40.4% of LAR patients. D. pteronyssinus was the main sensitizing aeroallergen in LAR (75.6% vs 55.9%, p=0.071), and pollens in SAR (82.4% vs 62.5%, p=0.059). NAR diagnosis was achieved in 88 visits by NAPT-M instead of 352 visits that would be required by NAPT with a single aeroallergen. This study shows a high prevalence of LAR in rhinitis patients, with a clinical history of persistent and severe nasal symptoms frequently associated to conjunctivitis and asthma, and an important proportion of cases with aeroallergens polysensitization. NAPT-M is useful diagnostic test for screening of LAR.

Clinical use of gadobutrol for contrast-enhanced magnetic resonance imaging of neurological diseases

Clinical use of gadobutrol for contrast-enhanced magnetic resonance imaging of neurological diseases Kenneth T Cheng1, Hannah Y Cheng2, Kam Leung31Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA; 2Freelance Technical Writer, New Orleans, LA, USA; 3National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USAAbstract: Contrast-enhanced magnetic resonance imaging (CE-MRI) is an important clinical tool for diagnosing neurological diseases. The appropriate use of a suitable MRI contrast agent or contrast pharmaceutical is essential for CE-MRI to produce desirable diagnostic images. Currently, there are seven contrast agents (CAs) or pharmaceuticals approved for clinical imaging of the central nervous system (CNS) in the US, Europe, or Japan. All of the clinically approved CAs are water-soluble gadolinium-based contrast agents (GBCAs) which do not penetrate the CNS blood&ndash;brain barrier (BBB). These agents are used for imaging CNS areas without a BBB, or various pathologies, such as tumors and infection that break down the BBB and allow CAs to enter into the surrounding parenchyma. Clinically, GBCAs are most useful for detecting primary and secondary cerebral neoplastic lesions. Among these CNS GBCAs, gadobutrol (Gd-BT-DO3A, Gadovist&trade;) is a neutral, nonionic, macrocyclic compound that showed promising results from clinical trials of CNS imaging. In comparison with other GBCAs, Gd-BT-DO3A has relatively high in vitro kinetic stability and r1 relaxivity. Gd-BT-DO3A has been recently approved by the US Food and Drug Administration (FDA) in 2011 for CNS imaging. A review of available literature shows that Gd-BT-DO3A exhibits similar safety and clinical efficacy profiles to other GBCAs. Gd-BT-DO3A has the distinguishing feature that it is the only clinical agent commercially available in a formulation of 1.0 M concentration with a relatively higher in vitro T1 shortening per unit volume than other clinical GBCAs which are only available in 0.5 M concentration. This double concentration of Gd-BT-DO3A may allow a relatively higher concentration of the agent to localize in the CNS and produce a better contrast enhancement at the same clinical dose as other GBCAs. Several recent published multicenter clinical trials appeared to support this potential advantage of Gd-BT-DO3A.Keywords: Gadovist, Gd-BT-DO3A, CE-MRI, CNS imaging, MRI contrast agent, gadolinium