Need For Treatment Of Patients Research Articles

Abstract 4165: Impact of the National Cholesterol Education Program Third Adult Treatment Panel Lipid-Lowering Recommendations on the Management of Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

Background : The National Cholesterol Education Program Third Adult Treatment Panel (NCEP ATP III) recently added an optional secondary prevention low-density lipoprotein (LDL) cholesterol goal (<70 mg/dL) for high-risk patients, such as those with acute coronary syndromes (ACS). The effect of the optional goal on the need for treatment in patients (pts) presenting with non-ST-segment elevation (NSTE) ACS is unclear. Methods : We evaluated pts with NSTE ACS (positive cardiac markers and/or ischemic ECG changes) included in the CRUSADE initiative between January 2001 and July 2004 with a LDL cholesterol drawn before or during hospitalization. This population was stratified by prehospitalization use of lipid-lowering therapy and divided into LDL cholesterol categories of <70, ≥70 to <100, ≥100 to 130, and ≥130 mg/dL. Results : Of 129,054 total pts in CRUSADE, 71,814 (55.7%) had a LDL cholesterol available (Figure ). Of those with an LDL cholesterol, 23,728 (33.0%) received lipid-lowering therapy prior to hospitalization, including 22,046 (30.7%) on statin therapy. Of the 71,814 pts, 34,258 (47.8%) were at the NCEP-ATP III recommended treatment goal of <100 mg/dL, and 12,463 (17.4%) were at the optional aggressive treatment goal of <70 mg/dL on presentation with NSTE ACS. Conclusions : The majority of pts presenting with NSTE ACS are not on lipid-lowering therapy prior to admission, most are not at the NCEP ATP III recommended LDL goal, and a minority are at the optional LDL goal for high-risk patients.

Bodily symptoms in moderate and severe depression

The aim of this study was to describe bodily symptoms in severe depression, testing the hypotheses that patients with depression compared with healthy controls have several specific bodily symptoms and complaints, and furthermore that changes in severity of depression correlate to changes in bodily symptoms. Inpatients (n=29) with a diagnosis of moderate to severe depression (ICD-10) and 29 matched healthy controls were included in the study. Bodily symptoms were assessed with the Body Awareness Scale (BAS) and the severity of depression with the Hamilton Depression Scale (HDS). Patients were assessed twice, i.e. when admitted to hospital and again when discharged. The patients with severe depression had more muscular tension, pain-complaints, restricted breathing, negative attitudes towards own body and lesser centring in movements compared with the healthy controls (p<0.001). Improvement in bodily symptoms was statistically significant (p<0.01), and an improvement in depression score was observed. The findings of the study may underline the importance of investigating bodily symptoms in depression and indicates a need for a specific physiotherapeutic treatment of patients with moderate to severe depression.

Current and novel immunosuppressive therapy for autoimmune hepatitis

Corticosteroids alone or in conjunction with azathioprine is the treatment of choice in patients with autoimmune hepatitis (AIH) and results in remission induction in over 80% of patients. Sustained response to therapy may result in substantial regression of fibrosis even in advanced cases. The outcome of rapid withdrawal of immunosuppression is disease relapse in many patients. Consequently, the use of 2 mg/kg/d of azathioprine as a sole agent to maintain remission has been widely accepted in clinical practice. Persistent severe laboratory abnormalities or histologic abnormalities such as bridging necrosis or multilobular necrosis are absolute indications for treatment based on controlled clinical trials, but debate exists as to whether all patients with AIH need treatment. Examination of liver tissue remains the best method of evaluating both treatment response and need for treatment in patients who have little biochemical activity. Alternative strategies in patients who have failed to achieve remission on “standard therapy” of corticosteroids with or without azathioprine or patients with drug toxicity include the use of cyclosporine, tacrolimus, or mycophenolate mofetil. Liver transplantation is the treatment of choice in managing decompensated disease. In this review we examine current management strategies of AIH, and evaluate available data pertaining to the use of novel immunosuppressive agents in this condition. (H EPATOLOGY 2002;35:7-13.)

The Role of Losartan in Cost-effective Hypertension Control

SummaryDespite recent guidelines emphasising the need for aggressive treatment in patients with elevated blood pressure, the control of hypertension in Europe and the USA is poor, imposing a considerable burden in terms of patient morbidity and mortality, and associated healthcare costs. A major factor contributing to the suboptimal control of hypertension is the failure of patients to adhere to their prescribed therapy. Drug side-effects are an important cause of non-compliance and prescribing a well-tolerated agent that promotes good compliance is therefore the key to the cost-effective management of hypertension. Several studies have demonstrated that patients are more likely to remain on therapy with the angiotensin II antagonist losartan than other antihypertensives.Although the acquisition costs of new antihypertensives such as losartan are greater than for older drugs, such costs represent only a small proportion of the total cost of prescribing antihypertensive therapy. When accessory costs are also considered, the total cost of care with newer antihypertensives is comparable with those for diuretics. The costs involved if therapy has to be switched due to unacceptable side-effects also need to be taken into account when assessing relative cost-effectiveness. Furthermore, savings may accrue from the non-haemodynamic benefits of losartan, such as improved cognitive function and renal protection. Further studies will increase awareness of the true cost-effectiveness of antihypertensive drugs.

TREATMENT OF ACUTE AND CHRONIC HEPATITIS C

Interferon is currently the only available treatment for chronic hepatitis C but is effective in only about 40% of patients. Most of these responding patients relapse after short courses, so that sustained long-term viral-negative responses are uncommon (10% to 20%). However, longer treatment courses have significantly reduced relapse, thereby increasing sustained response rates. Furthermore, the combination of ribavirin with interferon shows promise for reducing relapse even further. The challenge for the future is to develop antiviral agents that will be effective in the large proportion of patients who do not respond to interferon.

New guidelines for management and prevention of meningococcal disease in Australia

The incidence of invasive meningococcal disease in Australia has increased over the past decade, and in April 1997 the National Health and Medical Research Council published guidelines for management of patients with meningococcal disease and their contacts. These guidelines emphasise the need for immediate intravenous antibiotic treatment of patients with suspected meningococcal disease, before transfer to hospital or lumbar puncture. When possible, blood for culture should be collected before antibiotic therapy, if this does not delay treatment.