Variations In Clinical Parameters Research Articles

Factors Influencing Drug Prescribing for Patients with Hospitalization History in Circulatory Disease: Patient Severity, Composite Adherence, and Physician-Patient Relationship - A Retrospective Cohort Study.

With countries promoting generic drug prescribing, their growth may plateau, warranting further investigation into the factors influencing this trend, including physician and patient perspectives. Additional strategies may be needed to maximize the switch to generic drugs while ensuring healthcare system sustainability, focusing on factors beyond mere low cost. Emphasizing affordability and clarifying other prescription considerations are essential. This study aimed to provide initial insights into how patient severity, composite adherence, and physician-patient relationships impact generic switching. This study utilized a long-term retrospective cohort design by analyzing data from a national healthcare database. The population included patients of all ages, primarily older adults, who required primary-to-tertiary preventive actions with a history of hospitalization for cardiovascular diseases (CVDs) (International Classification of Diseases, Tenth Revision) during April 2014 to March 2018 (4 years). We focused on switching to generic drugs, with temporal variations in clinical parameters as independent variables. Lifestyle factors (smoking and drinking) were also considered. Adherence was measured as a composite score comprising 11 elements. The physician-patient relationship was established based on the interval between physician change and prescription. Logistic regression analysis and propensity score matching (PSM) were employed, along with complementary analysis of physician-patient relationships, proportion of days covered (PDC), and adherence for a subset of the population. The study included 48,456 patients with an average follow-up of 36.1±8.8 months. The mean age was 68.3 ± 9.9 years, body mass index was 23.4 ± 3.4 kg/m2, systolic blood pressure was 131.2 ± 15.0 mmHg, low-density lipoprotein cholesterol (LDL-C) was 116.6 ± 29.3 mg/dL, hemoglobin A1c (HbA1c) was 5.9% ± 0.8%, and serum creatinine was 0.9 ± 0.8 mg/dL. Logistic regression analysis revealed significant associations between generic switching and systolic blood pressure (odds ratio [OR], 0.996, 95% confidence interval [CI]: 0.993-0.999), serum creatinine levels (OR, 0.837, 95% CI: 0.729-0.962), glutamic oxaloacetic transaminase levels (OR, 0.994, 95% CI: 0.990-0.997), PDC score (OR, 0.959, 95% CI: 0.948-0.970), and adherence score (OR, 0.910, 95% CI: 0.875-0.947). Additionally, generic drug rates increased with improvements in the HbA1c level band and smoking level (P<.01, P<.001). The group with a superior physician-patient relationship after PSM had a significantly higher rate of generic drug prescribing (51.6±15.2%) than the inferior relationship group (47.7±17.7%) (P<.001). Although physicians' understanding influences the choice of generic drugs, patient condition (severity) and adherence also impact this decision. For example, improved creatinine levels are associated with generic drug choice, while stronger physician-patient relationships correlate with higher rates of generic drug utilization. These findings may contribute to the appropriate prescription of pharmaceuticals if the policy diffusion of generic drugs begins to slow down. Thus, preventing serious illness while building trust may result in clinical benefits and positive socio-economic outcomes.

Anxiety and variation of clinical parameters during third molar surgery

During dental appointments, patients often present anxiety and exacerbated fear, especially in surgical procedures. These reactions can promote systemic alterations, such as elevated blood pressure, fainting, and convulsions. The aim of this study was to evaluate the level of anxiety of patients during the lower third molar extraction procedure, seeking indicative parameters of possible complications and, at the same time, contributing to a safe and less uncomfortable procedure for the patient. Forty patients needing extraction of the lower third molar were selected. The study had an evaluator to monitor the systemic variables: blood pressure, oxygen saturation, respiratory and heart rate - while the same surgeon performed the surgical procedures, always using the same surgical technique for all patients. At the anamnesis and at the end of the surgery, the patients answered a visual analogue scale (VAS) questionnaire on anxiety. The results showed that for the four variables observed during the surgery, only the oxygen saturation did not present a statistically significant variation during the procedure. All the others showed changes, mainly during the use of the high-speed engine. We concluded that anxiety, fear and stress showed influences on systemic factors during the extraction procedure. It shows the importance of careful anamnesis and the knowledge of patient systemic diseases before starting any surgery to prevent risks or complications.

Effect of Laparoscopic Sleeve Gastrectomy on HbA1C Level in Children with Type 2 Diabetes Mellitus.

Background and Objectives: A third of the American adult population is currently pre-diabetic/morbidly obese and is, therefore, at an elevated risk for developing type 2 diabetes. Unfortunately, such a condition does not spare children from also developing morbid obesity, where incidence rates of childhood obesity—coupled with type 2 diabetes—are markedly elevated. Laparoscopic sleeve gastrectomy (LSG) is gradually becoming the novel benchmark in bariatric surgery for the treatment of morbid obesity and associated co-morbidities, also within pediatric cases. However, no comprehensive study has been conducted in children that emphasizes the effect of LSG on HbA1C levels within such a patient population suffering from type 2 diabetes. Aim: Since HbA1C is a major biomarker for type 2 diabetes progression, this study aimed to identify any dysregulated serum levels for this key molecular player (together with other parameters), for post-surgical monitoring of the beneficial metabolic effects of LSG surgery on type 2 diabetes amelioration/remission within pediatric patients. Materials and Methods: A total of 64 pediatric patients, ranging in age from 5 to 14 years old, were enrolled in this retrospective study. Multiple laboratory-based analyses datasets were also collected from individual study participants, including HbA1C and random blood sugar (RBS). All participating patients were designated for undergoing laparoscopic sleeve gastrectomy, as per standardized surgical protocols and each participant was followed-up for two years post-surgery. Laboratory investigations were re-performed in order to identify any major variations in clinical parameters. Results: HbA1c was significantly reduced among children, from 6.0 ± 0.8 (pre-LSG) to 5.4 ± 0.4 post-surgery, with a reduction rate of 10.9% (p = 0.001). Furthermore, RBS significantly decreased from 102.9 ± 34.0 (pre-LSG) to 87.1 ± 17.3 post- surgery, with a reduction rate of 15.4% (p = 0.036). Conclusions: This study provides further concrete evidence for the beneficial metabolic influence provided by LSG surgery on morbidly obese, childhood-aged patient populations, with effectiveness in reducing co-morbidity progress, in the form of type 2 diabetes, through the reduction in HbA1c levels within such patients post-surgery.

Redefinition of Successful Treatment of Patients With Hypothyroidism. Is TSH the Best Biomarker of Euthyroidism?

In recent years evidence has accumulated supporting a revised view of the nature of euthyroidism and the biomarkers of thyroid function. Within the normal range, variations in thyroid hormone levels are associated with variations in clinical parameters and outcomes. There are therefore no readily identified individually specific optimum levels of thyroid hormones for any individual. Levels around the middle of the normal population range may best reflect euthyroidism. These levels may have evolutionary advantages on the basis that adverse outcomes often increase with divergence from such levels, and physiological processes tend to minimise such inter-individual and intra-individual divergence. In populations of predominantly untreated individuals, levels of thyroid hormones and in particular levels of free thyroxine (FT4) correlate more often with clinical parameters than do levels of thyrotropin (TSH). Levels of thyroid hormones may therefore be regarded as the best available biomarkers of euthyroidism and dysthyroidism. It follows that ‘subclinical hypothyroidism’ (normal FT4/raised TSH levels), rather than being an accurate marker of peripheral tissue hypothyroidism is more a marker of decreased thyroid reserve and prognosis. The recent evidence suggests that treatment of hypothyroxinemia, regardless of the TSH level, and monitoring therapy using FT4 and/or triiodothyronine levels, depending on the replacement regime, may result in more successful treatment of hypothyroidism than relying on thyrotropin levels for patient selection and subsequent treatment monitoring. The equivalents of mid-range levels of thyroid hormones (especially FT4), adjusted by individual comorbidity concerns, may be rational general replacement targets. These implications of the new evidence may create opportunities for novel trials of thyroid replacement therapy.

The prevalence of scapular dyskinesia in patients with back, neck, and shoulder pain and the effect of this combination on pain and muscle shortness.

The aim of the study was to evaluate the prevalence of scapular dyskinesia in patients with neck, back, and shoul-der pain and examine the variations in clinical parameters cause by this combination. A total of 121 patients with neck, back, or shoulder pain were included in this prospective cross-sectional study. De-mographic and clinical data of the patients were recorded. It was evaluated the intensity of pain with the visual analog scale (VAS), the presence of muscle shortness with muscle shortness tests, and scapular dyskinesia with the Lateral Scapular Slide Test. The prevalence of scapular dyskinesia was 41.9% in the study population. Patients were divided into groups, with or without scapular dyskinesia for evaluation, and compared. The presence of scapular dyskinesia was significantly higher in pa-tients with back and shoulder pain (p<0.05). When the distribution of scapular dyskinesia pathological types was evaluated, it was found that Type 1 was the most common in the study population. No significant difference was observed in pain intensity at rest and during activity between the groups (p>0.05), but the VAS score at night was significantly higher in patients with scapular dyskinesia (p<0.05). The pectoral, latissimus dorsi, and rhomboids muscle shortness were significantly higher in the group with scapular dyskinesia (p<0.05). The evaluation of the presence of scapular dyskinesia in a physical examination in patients with neck, back, and/or shoulder pain will be a guide for the diagnosis and treatment of pain-related problems.

Selenium: a sole treatment for erosive oral lichen planus (randomized controlled clinical trial)

Objectives Oral lichen planus (OLP) is a chronic disease with immune-mediated pathogenesis. Selenium (Se), an antioxidant, plays a role in modulating immunity. The aim of this clinical trial was to evaluate 2 Se forms (novel topical hydrogel and oral capsules), solely, in treating erosive OLP based on clinical evaluation and salivary oxidative stress markers. To date, to our knowledge, this is the first study to evaluate the role of Se solely in treating erosive lesions associated with erosive OLP. This clinical trial has been registered in the Cochrane Database under registry number PACTR201901531815403. Methods Patients were allocated into 1 of 3 groups: group I, topical corticosteroids and topical antifungal as an adjunctive therapy; group II, novel topical Se hydrogel; or group III, systemic Se. Treatment lasted for 6 weeks. Patients were clinically evaluated at baseline and at 6 and 12 weeks for reduction in pain scores and clinical lesion size. Biochemical analysis was performed for salivary malondialdehyde (MDA) and total antioxidant capacity (TAC) levels at baseline and 6 weeks. Correlation between clinical signs and symptoms and salivary oxidative stress markers was measured at 6 weeks. Two-way analysis of variance (ANOVA) followed by a post hoc Tukey test was performed to assess for significant differences in mean pain scores, clinical lesion size, and salivary MDA and TAC levels at 6 weeks. One-way ANOVA was used to test for significant variations in clinical parameters at 12-week follow-up. Principal component analysis and nonmetric dimensional scaling were performed to test for correlation and possible relationships between clinical parameters and salivary oxidative stress markers. Results There was a significant reduction in signs and symptoms in response to all treatment modalities. However, there was no significant difference among the 3 groups at 6 weeks. At 12 weeks, group II had significantly lower pain scores than group I. Salivary MDA levels showed a significant decrease in patients in group I and group III. TAC levels showed no significant difference in response to treatment. Conclusions Se can be proposed as a treatment for OLP. Salivary MDA levels can be a biomarker for OLP disease severity. Oral lichen planus (OLP) is a chronic disease with immune-mediated pathogenesis. Selenium (Se), an antioxidant, plays a role in modulating immunity. The aim of this clinical trial was to evaluate 2 Se forms (novel topical hydrogel and oral capsules), solely, in treating erosive OLP based on clinical evaluation and salivary oxidative stress markers. To date, to our knowledge, this is the first study to evaluate the role of Se solely in treating erosive lesions associated with erosive OLP. This clinical trial has been registered in the Cochrane Database under registry number PACTR201901531815403. Patients were allocated into 1 of 3 groups: group I, topical corticosteroids and topical antifungal as an adjunctive therapy; group II, novel topical Se hydrogel; or group III, systemic Se. Treatment lasted for 6 weeks. Patients were clinically evaluated at baseline and at 6 and 12 weeks for reduction in pain scores and clinical lesion size. Biochemical analysis was performed for salivary malondialdehyde (MDA) and total antioxidant capacity (TAC) levels at baseline and 6 weeks. Correlation between clinical signs and symptoms and salivary oxidative stress markers was measured at 6 weeks. Two-way analysis of variance (ANOVA) followed by a post hoc Tukey test was performed to assess for significant differences in mean pain scores, clinical lesion size, and salivary MDA and TAC levels at 6 weeks. One-way ANOVA was used to test for significant variations in clinical parameters at 12-week follow-up. Principal component analysis and nonmetric dimensional scaling were performed to test for correlation and possible relationships between clinical parameters and salivary oxidative stress markers. There was a significant reduction in signs and symptoms in response to all treatment modalities. However, there was no significant difference among the 3 groups at 6 weeks. At 12 weeks, group II had significantly lower pain scores than group I. Salivary MDA levels showed a significant decrease in patients in group I and group III. TAC levels showed no significant difference in response to treatment. Se can be proposed as a treatment for OLP. Salivary MDA levels can be a biomarker for OLP disease severity.

Safety assessment of a highly bioavailable curcumin-galactomannoside complex (CurQfen) in healthy volunteers, with a special reference to the recent hepatotoxic reports of curcumin supplements: A 90-days prospective study.

Recently, there is a growing concern about the use of curcumin supplements owing to a few reported hepatotoxicity related adverse events among some of the long-term consumers. Even though no clear evidence was elucidated for the suspected toxicity, the addition of adjuvants that inhibits body's essential detoxification pathways, adulteration with synthetic curcumin, and presence of contaminants including heavy metals, chromate, illegal dyes, non-steroidal anti-inflammatory agents, and pyrrole alkaloids were suggested as plausible reasons. Considering these incidences and speculations, there is a need to critically evaluate the safety of curcumin supplements for prolonged intake. The present study is an evaluation of the safety of curcumin-galactomannoside complex (CGM), a highly bioavailable curcumin formulation with demonstrated high free curcuminoids delivery. Twenty healthy human volunteers were evaluated for toxic manifestations of CGM when supplemented with 1000 mg per day (∼380 mg curcuminoids) for 90-days. CGM supplementation did not cause any adverse effects or clinically significant variations in the vital signs, hematological parameters, lipid profile and renal function markers of the volunteers, indicating its safety. Liver function enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and bilirubin were in the normal range after 90-day supplementation of CGM. In summary, no adverse effects were observed under the conditions of the study. CGM can be considered as a safe curcumin supplement for regular consumption and is devoid of any adulterants or contaminants.

A national survey of clinical practice of surveillance for post-traumatic brain injury hypopituitarism in the United Kingdom and Ireland

Background: Traumatic brain injury (TBI) is the most common cause of death and disability in young adults in industrialised countries. Post-TBI hypopituitarism (PTHP) is thought to occur in one-third of patients, however the natural history and predictive factors are not fully understood and as such guidelines for surveillance vary. The aim of this study was to assess the variations in current surveillance practices across the Neurosurgery Centres within the United Kingdom.Methods: A questionnaire was developed following discussions with an expert panel and distributed to members of the Society of British Neurosurgeons (SBNS), by email and printed copy, to survey surveillance practices for PTHP. The questionnaire primarily aimed to determine how commonly screening was performed and the clinical parameters used to guide these surveillance practices.Results: There were 45 responders representing Neurosurgery units in regions of England, Scotland and Ireland. The majority of participants (86.7%) considered PTHP to be a problem but only 25% (11/45) routinely screened for PTHP. There was wide variation in the criteria used to determine which patients were screened.Conclusions: Our survey suggests that few Neurosurgeons routinely screen for PTHP and those that do use a wide variation of clinical parameters to guide surveillance practice. A UK-wide prospective cohort study may help identify patients at risk of developing PTHP.

Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life.

A prospective cross-sectional study. To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. 2.

The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?

Steroids are still the mainstay of therapy in primary chronic glomerulonephritis (PCGN), regardless of underlying disturbance or pathology. Moreover, relationship between known abnormalities and disease manifestation is stochastic, therefore treatment continues to be empirical. It is not known whether responsiveness is related to immune phenotype. We performed flowcytometric lymphocyte (Ly) phenotyping (CD19, CD3, CD3CD4, CD3CD8, CD56/16) on 16 patients (pts) (12M, 4F), mean age 37.6 ±13 years with primary chronic glomerulonephritis (PCGN): minimal change disease (MCD)—6 pts, focal and segmental glomerulosclerosis (FSGS)—4 pts, mesangial proliferative glomerulonephritis—5 pts, mesangiocapillary glomerulonephritis—1 pt, before and at 7 days of oral Prednisone 1 mg/kg/day (in 2 divided doses). Before steroids: 4/16 pts(25%) had elevated BP; 9/16(56.2) showed nephrotic proteinuria. Serum creatinine was > 1.2 mg% in 6/16(37.5%). At 7 days WBC count increased (13,079.37 ± 4966.4/μl vs. 8021.25 ± 2077.4/μl; p = 0.0007), Ly percentage (%) decreased (20.30 ± 9% vs. 29.9 ± 10.4%; p = 0.0095), while absolute (abs.) Ly count remained unchanged. Both CD19 Ly% and CD19 Ly abs. count increased (16.13 ± 6.5% vs. 9.52 ± 3.7%; p = 0.0015, and 410.012 ±29.7/μl vs. 223.56 ± 123.8/μl; p = 0.0077, respectively). NK (natural killer)% decreased (9.15 ± 5.2% vs. 14.19 ± 7.1%; p = 0.0296). CD3, CD3CD4, CD3CD8 Ly subsets and CD4/CD8 ratio showed no change. Variation in proteinuria (2.88 ± 2.1 g/24 h vs. 3.45 ±1.7 g/24 h; p = 0.4) did not reach statistical significance (Wilcoxon–Mann–Whitney). In 11 pts we performed an additional analysis at 1 month. Compared to levels before steroids, there was an increase in WBC, CD19 Ly% and CD19 Ly abs. count and a decrease in NK% and NK abs. count. Other Ly subsets and CD4/CD8 ratio remained unchanged. Variation in clinical parameters (proteinuria, serum Creatinine, BP) did not reach statistical significance. Changes in Ly profile precede changes in clinical parameters and thus are divergent. While our patients proved to be early non-responders, further studies to elucidate whether profile changes provide for response specification are warranted.

The Danish Twin Registry in the New Millennium

AbstractThe Danish Twin Registry is the oldest national twin register in the world, initiated in 1954, and, by the end of 2005, contained more than 75,000 twin pairs born in the between 1870 and 2004. The Danish Twin Registry is used as a source for studies on the genetic influence on normal variation in clinical parameters associated with the metabolic syndrome and cardiovascular diseases, clinical studies of specific diseases, and aging and age-related health problems. The combination of survey data, clinical data and linkage to national health-related registers enables follow-up studies of both the general twin population and twins from clinical studies. This paper summarizes the newest extension of the register and gives examples of new developments and phenotypes studied.

The Danish Twin Registry in the New Millennium

The Danish Twin Registry is the oldest national twin register in the world, initiated in 1954, and, by the end of 2005, contained more than 75,000 twin pairs born in the between 1870 and 2004. The Danish Twin Registry is used as a source for studies on the genetic influence on normal variation in clinical parameters associated with the metabolic syndrome and cardiovascular diseases, clinical studies of specific diseases, and aging and age-related health problems. The combination of survey data, clinical data and linkage to national health-related registers enables follow-up studies of both the general twin population and twins from clinical studies. This paper summarizes the newest extension of the register and gives examples of new developments and phenotypes studied.

The Danish Twin Registry: 127 birth cohorts of twins.

The Danish Twin Registry is the oldest national twin register in the world, initiated in 1954 by ascertainment of twins born from 1870 to 1910. During a number of studies birth cohorts have been added to the register, and by the recent addition of birth cohorts from 1931 to 1952 the Registry now comprizes 127 birth cohorts of twins from 1870 to 1996, with a total of more than 65,000 twin pairs included. In all cohorts the ascertainment has been population-based and independent of the traits studied, although different procedures of ascertainment have been employed. In the oldest cohorts only twin pairs with both twins surviving to age 6 have been included while from 1931 all ascertained twins are included. The completeness of the ascertainment after adjustment for infant mortality is high, with approximately 90% ascertained up to 1968, and complete ascertainment of all liveborn twin pairs since 1968. The Danish Twin Registry is used as a source for large studies on genetic influence on aging and age-related health problems, normal variation in clinical parameters associated with the metabolic syndrome and cardiovascular diseases, and clinical studies of specific diseases. The combination of survey data with data obtained by linkage to national health related registers enables follow-up studies both of the general twin population and of twins from clinical studies.

The Danish Twin Registry: 127 Birth Cohorts of Twins

The Danish Twin Registry is the oldest national twin register in the world, initiated in 1954 by ascertainment of twins born from 1870 to 1910. During a number of studies birth cohorts have been added to the register, and by the recent addition of birth cohorts from 1931 to 1952 the Registry now comprizes 127 birth cohorts of twins from 1870 to 1996, with a total of more than 65,000 twin pairs included. In all cohorts the ascertainment has been population-based and independent of the traits studied, although different procedures of ascertainment have been employed. In the oldest cohorts only twin pairs with both twins surviving to age 6 have been included while from 1931 all ascertained twins are included. The completeness of the ascertainment after adjustment for infant mortality is high, with approximately 90% ascertained up to 1968, and complete ascertainment of all liveborn twin pairs since 1968.The Danish Twin Registry is used as a source for large studies on genetic influence on aging and age-related health problems, normal variation in clinical parameters associated with the metabolic syndrome and cardiovascular diseases, and clinical studies of specific diseases. The combination of survey data with data obtained by linkage to national health related registers enables follow-up studies both of the general twin population and of twins from clinical studies.

Disfunción eréctil en atención primaria como posible marcador del estado de salud: factores asociados y respuesta al sildenafilo

To find the factors linked to erectile dysfunction, to evaluate this as a possible marker of health status, to analyse the evolution of clinical parameters of associated illnesses and the response to Viagra.Design. Intervention study without a control. Alguazas Health Centre (Murcia). All the patients in the programme (125), with a figure on the sexual health in men index (SHIM) below 21.Interventions. Health education and administration of Viagra. Concomitant illnesses, pathologies previously unknown to the patient, changes in erectile function valued on the international index of erectile function (IIEF), and changes in blood pressure, glucaemia and lipids. Factors linked to erectile dysfunction were diabetes (50.4%), hypertension (33.6%), hypercholesterolaemia (22.4%), urological pathology (12.8%) and mental health disorders (33.6%). The hidden pathology detected was 15 cases of hypertension, 3 diabetes, 2 cardiopathies, 20 dyslipaemias, 3 depressions, 13 anxiety and 5 urological problems. The variations in clinical parameters at 3 months were: glucaemia, -38.3 mg (P<.001, Student s t=-5.186); HbA1c, -0.9 (P<.05, Student s t=-2.16); systolic blood pressure, -16 mm Hg (P<.01, Student s t=-3.486) and diastolic pressure -13 mm Hg (P<.001, Student s t=-4.594); and total cholesterol, -14.2% (P<.001, Student s t=7.01). Erectile function improved by 74% with Viagra. 2 out of every 3 patients with erectile dysfunction presented associated diseases; one in every 3 were ignorant of their health problem. Monitoring of chronic illnesses improved significantly. Finally, 3 in every 4 responded to Viagra.

Cost Effectiveness of Early Treatment with Oral Aciclovir in Adult Chickenpox*

Treatment of adult chickenpox with aciclovir is controversial because of the relatively high cost of medication and small proven benefits of therapy. A decision-tree model was used to estimate the cost effectiveness of aciclovir, from third-party payer and societal perspectives: the incremental cost per quality-adjusted life-year (QALY) gained was calculated for aciclovir treatment of chickenpox compared with no antiviral therapy in immunocompetent adults who presented within 24 hours of the onset of chickenpox rash. Incremental costs for aciclovir compared with no antiviral treatment were 42,900 US dollars per QALY gained, when viewed from a third-party payer perspective; however, results are sensitive to variation of clinical parameters. From a societal perspective, aciclovir therapy was cost saving compared with no antiviral treatment; aciclovir remained cost saving or cost effective (less than 50,000 US dollars per QALY gained) when probabilities, quality-of-life utility values and costs were varied within clinically plausible ranges, and when other scenarios for chickenpox severity and aciclovir effectiveness were examined. From a societal perspective, oral aciclovir is cost effective, and perhaps cost saving, when given within 24 hours of rash onset in adult chickenpox. The argument for antiviral use may be less strong when viewed from the perspective of a third-party payer.

Periodontal and systemic findings in children with marginal bone loss in the primary dentition

In a previous population-based study of 3896 7-9-year-old children living in Sweden, it was found that 32 children (0.8%) exhibited radiographic, periodontal bone loss at > or = 2 proximal surfaces of their deciduous teeth. In the present study, 26 of the 32 children were subjected to additional oral and systemic health examination. 20 other children without any radiographic evidence of bone loss in their primary dentition served as referents. None of the cases or the referents were detected to have any systemic disease. The frequency of bleeding and suppuration on probing, radiographic proximal calculus and probing attachment loss was higher among the cases than the referents. Actinobacillus actinomycetemcomitants was found subgingivally in 14 of the cases but in none of the referents. 11 of 22 cases analysed for presence of serum antibodies against A. actinomycetemcomitans leukotoxin were sero-positive compared to none of 7 referents available for analysis. Evaluation of the data from each child revealed wide variations in clinical parameters among the children in the case group. In this group, there were children with deep probing depths, probing attachment loss, suppuration on probing, proximal calculus and presence of subgingival A. actinomycetemcomitans, indicating current periodontitis. However, in the case group there were also children without positive signs of inflammatory disease, similar to the children in the reference group. In fact, the findings suggest that less than half of the number of individuals with > or = 2 proximal sites with bone loss had current periodontitis.

Human placental prednisolone metabolism: Pathway and kinetics

Steroids are still the mainstay of therapy in primary chronic glomerulonephritis (PCGN), regardless of underlying disturbance or pathology. Moreover, relationship between known abnormalities and disease manifestation is stochastic, therefore treatment continues to be empirical. It is not known whether responsiveness is related to immune phenotype. We performed flowcytometric lymphocyte (Ly) phenotyping (CD19, CD3, CD3CD4, CD3CD8, CD56/16) on 16 patients (pts) (12M, 4F), mean age 37.6 ±13 years with primary chronic glomerulonephritis (PCGN): minimal change disease (MCD)—6 pts, focal and segmental glomerulosclerosis (FSGS)—4 pts, mesangial proliferative glomerulonephritis—5 pts, mesangiocapillary glomerulonephritis—1 pt, before and at 7 days of oral Prednisone 1 mg/kg/day (in 2 divided doses). Before steroids: 4/16 pts(25%) had elevated BP; 9/16(56.2) showed nephrotic proteinuria. Serum creatinine was > 1.2 mg% in 6/16(37.5%). At 7 days WBC count increased (13,079.37 ± 4966.4/μl vs. 8021.25 ± 2077.4/μl; p = 0.0007), Ly percentage (%) decreased (20.30 ± 9% vs. 29.9 ± 10.4%; p = 0.0095), while absolute (abs.) Ly count remained unchanged. Both CD19 Ly% and CD19 Ly abs. count increased (16.13 ± 6.5% vs. 9.52 ± 3.7%; p = 0.0015, and 410.012 ±29.7/μl vs. 223.56 ± 123.8/μl; p = 0.0077, respectively). NK (natural killer)% decreased (9.15 ± 5.2% vs. 14.19 ± 7.1%; p = 0.0296). CD3, CD3CD4, CD3CD8 Ly subsets and CD4/CD8 ratio showed no change. Variation in proteinuria (2.88 ± 2.1 g/24 h vs. 3.45 ±1.7 g/24 h; p = 0.4) did not reach statistical significance (Wilcoxon–Mann–Whitney). In 11 pts we performed an additional analysis at 1 month. Compared to levels before steroids, there was an increase in WBC, CD19 Ly% and CD19 Ly abs. count and a decrease in NK% and NK abs. count. Other Ly subsets and CD4/CD8 ratio remained unchanged. Variation in clinical parameters (proteinuria, serum Creatinine, BP) did not reach statistical significance. Changes in Ly profile precede changes in clinical parameters and thus are divergent. While our patients proved to be early non-responders, further studies to elucidate whether profile changes provide for response specification are warranted.

Idiopathic isolated central hypothyroidism associated with congenital ichthyosiform desquamans erythrodermia

We report an idiopathic isolated central hypothyroidism,supposed as consequence of TRH deficiency, in a child with congenital icthyosiform desquamativa erythrodermia,first seen by us at the age of 10y. D.V. was born preterm, vaginally, after a referred uncomplicated pregnancy. Skin lesions appeared during the first days of life and stunted growth and feeding problems within the first months; intellectual development appeared as normal and a normal sexual development started at the age of 12 1/2y. Arginine, insulin,TRH and LHRH tests excluded GH,PRL,ACTH,FSH or LH deficiency. Two TRH tests showed Δ TSH=3.7 and 3.3 μU/ml (n.v.=12.5±4.0) with basal TSH values =1.2 and 0.9 μU/ml respectively; T4 and T3 basal levels were 6.6 μg/dl(8.9±2.2) and 123.3 ng/dl(163.4±29.7) respectively; Δ T3 was 33.7 ng/dl (65±38). Radioimmunological assays were performed in triplicate (Biodata,Milan).Electrolytes,karyotype,skull radiography were normal A thyroidal therapy (130 mg/day of desiccated thyroid) was started when he was 13 4/12y.old and after 3y.variations of clinical parame ters were:delay of height and bone age in respect to chronological age from-6 to -4y. and from-5 to-2 1/2y.respectively;height velocity grew from 4.8 to 10.0cm./y.;skin lesions did not improved. T3 serum reduced increase supports a TRH more likely than a TSH deficiency.