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Early Treatment (early + treatment)
Selected AbstractsHidradenitis Suppurativa: Importance of Early Treatment; Efficient Treatment with ElectrosurgeryDERMATOLOGIC SURGERY, Issue 2 2008A. BURHAN AKSAKAL MD BACKGROUND Hidradenitis suppurativa is a challenging condition, both for the physicians and for the patients. Many surgical and medical approaches with different success rates have been undertaken. Early and appropriate intervention is a factor that significantly increases the success rate of the treatment of the disease. OBJECTIVE This study was conducted to evaluate the efficiency of electrosurgery treatment in early hidradenitis suppurativa. MATERIALS AND METHODS This study comprised 12 patients aged between 29 and 38 years (mean, 34 years) with a diagnosis of hidradenitis suppurativa Grade I (n=9) or Grade II (n=3). A surgical method consisted of excision of the areas with nodules and sinuses, up to the level of subcutaneous fat tissue, and leaving the surgical defect for secondary healing. RESULTS All patients completed the study. In 10 of 12 (83%) patients, 26 of 30 (86%) lesions, cure was observed in a mean of 16 days (range 15 to 21 days). Four lesions in 2 patients with Grade II became infected and required a short course of antibiotic therapy. CONCLUSION Electrosurgery will decrease the need for other systemic treatments, owing to its high cure rates. Our results showed that electrosurgery should be considered a top alternative in the treatment algorithm of hidradenitis suppurativa. [source] One-year outcome of an early intervention in psychosis service: a naturalistic evaluationEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007Swaran P. Singh Abstract Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [source] Acetaminophen, Aspirin, and Caffeine Versus Sumatriptan Succinate in the Early Treatment of Migraine: Results From the ASSET Trial,A CommentHEADACHE, Issue 4 2007Frederick J. Derosier DO No abstract is available for this article. [source] Acetaminophen, Aspirin, and Caffeine Versus Sumatriptan Succinate in the Early Treatment of Migraine: Results From the ASSET trial,A response to Drs. Derosier and KoriHEADACHE, Issue 4 2007Jerome Goldstein MD No abstract is available for this article. [source] Telangiectasia evaluated with adaptive optics and HR-OCTACTA OPHTHALMOLOGICA, Issue 2009K ATMANI Purpose Type 2 Macular Telangiectasia is a progressive disease starting in the fifth to seventh decade and characterized by a progressive damage of the neurosensory retina.. The purpose of this study is to compare the images obtained using two non-invasive techniques, High-Resolution Optical Coherence Tomography (HR-OCT) and Adaptive Optics (AO), in Type 2 Macular Telangiectasia. Methods Nine eyes of 5 patients affected by Type 2 Macular Telangiectasia underwent examination including visual acuity measurement with ETDRS (Early Treatment of Diabetic Retinopathy Study) chart, color photographs, monochromatic photographs, Spectral-Domain Optical Coherence Tomography with Heidelberg SpectralisÔ OCT and Adaptive Optics assessment with Imagine EyesÔ System. The neurosensory retina and the photoreceptor layer were analyzed using both HR-OCT and AO imaging. Results The disruptions of the photoreceptor layer on HR-OCT correspond to a cellular loss on Adaptive Optics Imaging. On the other hand, Adaptive optics Imaging allows the measurement of cellular density in areas which have a normal aspect on HR-OCT. Conclusion The diagnosis of Macular Telangiecctasia is based on biomicroscopy and fluorescein angiography. Adaptive Optics Imaging is helpful to analyze the retinal damages, especially the cone abnormalities. This technique will certainly allow a better understanding of this rare disease. Author Disclosure Information: K. Atmani, None; N. Leveziel, None G. Soubrane, None. [source] Natural course of sensitization to cow's milk and hen's egg in childhood atopic dermatitis: ETACTM Study GroupCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2002A. Wolkerstorfer Background Sensitization to food allergens has been implicated in the pathogenesis of atopic diseases, in particular atopic dermatitis (AD). The aim of the present paper is to investigate the natural course of sensitization to egg and to cow's milk and its relationship with the severity of AD. Methods The placebo intention-to-treat population of the ETACTM (Early Treatment of the Atopic Child) study consisted of 397 children with AD aged 12,24 months (mean±,SD: 17.2 ± 4.1 months) who were followed for 18 months. All children were examined for objective SCORing Atopic Dermatitis (SCORAD) and specific IgE amongst other, to egg and to cow's milk at inclusion and after 3, 12 and 18 months. Fifteen patients were excluded from this analysis due to major protocol violations thus leaving 382 patients in the analysed population. Results Sensitization to egg and to cow's milk was more common in atopic children with severe AD at all time-points. At inclusion, children sensitized to both egg and to cow's milk had the most severe AD (Kruskall-Wallis test P = 0.007). The degree of sensitization expressed in RAST classes was significantly related to the severity of AD. Furthermore, children sensitized to egg or to cow's milk at inclusion had a higher risk of persistence of AD (84% and 67%, respectively, vs. 57% in those not sensitized) and a higher objective SCORAD after 18 months follow-up. Conclusion We found an association between severity of AD and sensitization to egg or to cow's milk. Moreover, sensitization to egg, and to a lesser extent cow's milk, indicates a worse outcome of AD in terms of persistence and severity of the disease. [source] Prevalence and associations of diabetic retinopathy in indigenous Australians within central Australia: the Central Australian Ocular Health StudyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2010John Landers MBBS MPH PhD Abstract Purpose:, To determine the prevalence and associations of diabetic retinopathy (DR) within the indigenous Australian population living in central Australia. Methods:, 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of ,central Australia' were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Following dilated slit-lamp fundoscopy, the amount of DR in participants with diabetes mellitus (DM) was quantified using the Early Treatment of Diabetic Retinopathy Study criteria. The presence of any DR and vision-threatening DR (clinically significant macular oedema and/or proliferative DR) in one or both eyes was presented. Results:, Of those with diabetes, 22.2% (25.4% of those aged 40 years or older) had any DR and 7.0% (8.4% of those aged 40 years or older) had vision-threatening DR. Both the presence of any DR and vision-threatening DR were associated with advancing age and HbA1c level, but neither subcategory was associated with sex or self-reported hypertension. Conclusion:, Our study has shown similar prevalence rates for DR in indigenous Australians compared with non-indigenous Australians. However, as DM is far more prevalent among indigenous Australians, the proportion of those affected by DR across the population should be considerably higher when compared with non-indigenous Australians. [source] Treatment of Superficial Infantile Hemangiomas of the Eyelid Using the 595-nm Pulsed Dye LaserDERMATOLOGIC SURGERY, Issue 5 2010CHRISTOPHER M. HUNZEKER MD BACKGROUND Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76,100%), good (51,75%), moderate (26,50%), or poor (0,25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid. Roy G. Geronemus, MD, is on the Medical Advisory Board for Candela Laser Corp. [source] Outcomes of Childhood Hemangiomas Treated with the Pulsed-Dye Laser with Dynamic Cooling: A Retrospective Chart AnalysisDERMATOLOGIC SURGERY, Issue 12 2009CARINA RIZZO MD BACKGROUND Laser treatment of childhood hemangiomas remains controversial. Previous studies have used outdated technology, resulting in a potential overrepresentation of adverse outcomes. OBJECTIVE To evaluate outcomes of hemangiomas treated with the most current laser technology. METHODS A retrospective chart analysis of 90 patients with a median age of 3.0 months and a total of 105 hemangiomas were enrolled over a 2.5-year period. All were treated with the 595-nm long-pulse pulsed-dye laser (LP-PDL) with dynamic epidermal cooling at 2- to 8-week intervals depending on the stage of growth. Exclusion criteria were previous laser, surgical, or corticosteroid treatment. Three reviewers assessed outcomes. RESULTS Near-complete or complete clearance in color were achieved for 85 (81%) and in thickness for 67 (64%) hemangiomas. There was no scarring or atrophy. Ulceration occurred in one case and resolved during treatment. Hyperpigmentation and hypopigmentation occurred in 4% and 14% of hemangiomas, respectively. CONCLUSION Early treatment of childhood hemangiomas with the 595-nm LP-PDL with dynamic cooling may reduce the proliferative phase and result in excellent rates of clearing and few adverse events. [source] Preservation of sight in diabetes: developing a national risk reduction programmeDIABETIC MEDICINE, Issue 9 2000L. Garvican SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source] Mortality risk up to 25 years after initiation of treatment among 420 Swedish women with alcohol addictionADDICTION, Issue 3 2009Brit Haver ABSTRACT Aims Women treated for alcohol addiction have mortality rates three to five times those of women from the general population (GP). However, these figures may be inflated because socially disadvantaged women with advanced drinking careers are over-represented in previous studies. Our aim was to study the long-term mortality of socially relatively well-functioning patients coming to their first treatment, compared to matched GP controls. Design The mortality rates and causes of death were compared between patients and their matched GP controls, using data from the Causes of Death Register throughout the follow-up period (0,25 years). Setting A specialized treatment programme for women only, called ,Early treatment for Women with Alcohol Addiction' (EWA) at the Karolinska Hospital, Stockholm, Sweden. Participants Subjects (n = 420) receiving their first treatment at the EWA programme, compared to a group of matched GP women (n = 2037). Findings The women patients had significantly higher mortality than matched GP controls throughout the whole follow-up period, with a relative risk of 2.4. However, the younger women had four times higher mortality than their matched controls. The peak of deaths occurred during the first 5 years, and alcohol-related causes of death were highly over-represented, as were uncertain suicides and accidents. Conclusions First-time-treated women with alcohol addiction have a substantially lower mortality than reported previously from clinical samples, except for the youngest group. Our figures were corrected for confounding factors such as socio-demographic status. We believe our results could apply to broader groups of heavy drinking women, inside or outside specialized treatment settings. [source] Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stentingEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2008K. Gröschel A recently symptomatic carotid artery stenosis carries a high risk of subsequent ischaemic events and thus requires rapid treatment. We investigated the influence of the time delay between the last symptomatic event of a carotid stenosis and subsequent carotid artery stenting (CAS) with respect to the combined 30-day outcome of stroke and death. In a group of 320 patients undergoing CAS the median delay before the intervention was 19 days (interquartile range 10,36) and the combined 30-day complication rate was 8.4%. Time delay was not significantly associated with peri-procedural complications, regardless of whether this variable was dichotomized (<14 days and ,14 days), separated into interquartile ranges or analysed as a continuous variable. Our results indicate that early CAS is not associated with an increased complication rate in patients with a recently symptomatic carotid stenosis. Thus, if CAS has been selected as the treatment modality for a patient, it should be performed as soon as possible to maximize the benefit of the intervention in reducing the risk of stroke. [source] Long-term follow-up after successful interferon therapy of acute hepatitis CHEPATOLOGY, Issue 1 2004Johannes Wiegand Early treatment of acute hepatitis C infection with interferon alfa-2b (IFN-,-2b) prevents chronicity in almost all patients. So far, no data are available on the long-term outcome after interferon (IFN) therapy of acute hepatitis C. The aim of this study was to assess the clinical, virological, and immunological long-term outcome of 31 successfully treated patients with acute hepatitis C infection who were followed for a median of 135 weeks (52-224 weeks) after end of therapy. None of the individuals had clinical evidence of liver disease. Alanine aminotransferase (ALT) levels were normal in all but 1 patient. Serum hepatitis C virus (HCV) RNA was negative throughout follow-up, even when investigated with the highly sensitive transcription-mediated amplification (TMA) assay (cutoff 5-10 IU/mL). In addition, no HCV RNA was detected in peripheral blood mononuclear cells (PBMC) of 15 cases tested. The patients' overall quality-of-life scores as determined by the SF-36 questionnaire did not differ from the German reference control cohort. Ex vivo interferon gamma (IFN-,) ELISPOT analysis detected HCV-specific CD4+ T-helper cell reactivity in only 35% of cases, whereas HCV-specific CD8+ T-cell responses were found in 4 of 5 HLA -A2,positive individuals. Anti-HCV antibody levels decreased significantly during and after therapy in all individuals. In conclusion, early treatment of symptomatic acute hepatitis C with IFN-,-2b leads to a long-term virological, biochemical, and clinical response. Waning of anti-HCV humoral immunity and presence of HCV-specific CD8+ (but not CD4+) T cells highlights the complexity of T-cell and B-cell memory to HCV, which might be significantly altered by IFN treatment. (HEPATOLOGY 2004;40:98,107.) [source] The diagnosis and management of Kawasaki diseaseJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2005J Royle Abstract:, Kawasaki disease (KD) is a systemic vasculitis of childhood with a predilection for the coronary arteries. It is the predominant cause of paediatric acquired heart disease in developed countries. The aetiology of KD remains unknown and consequently there is no diagnostic test. The diagnosis is made using a constellation of clinical criteria that in isolation have poor sensitivity and specificity. Early treatment prevents overt coronary artery damage in the majority of children. The long-term effects of childhood KD on later cardiovascular health remain unknown. A recent study showed that treatment of KD in Australia is suboptimal, with late diagnosis occurring in approximately half of the cases and an unacceptably high incidence of acute cardiac involvement. These guidelines highlight the difficulties in the diagnosis of KD and offer some clues that may assist early recognition of this important paediatric disease. They also detail current treatment recommendations and the evidence on which they are based. Increased awareness of the epidemiology and spectrum of the clinical presentation of KD is essential for early recognition and optimal management. [source] Ataxia with isolated vitamin E deficiency: A clinical, biochemical and genetic diagnosisJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2000G Alex Abstract: A case of ataxia with isolated vitamin E deficiency, in conjunction with supportive genetic studies, is reported. This is a neurodegenerative condition that involves a mutation in the tocopherol (,) transfer protein gene (TTPA). Measurement of serum vitamin E concentration should be included as part of the investigations in children with progressive ataxia, even in the absence of fat malabsorption. Early treatment with vitamin E may protect such patients against further neurological damage. [source] Left ventricular hypertrophy in chronic renal failure patientsNEPHROLOGY, Issue 2002Henry KRUM SUMMARY: Left ventricular hypertrophy is an important risk factor for cardiovascular disease, which is a major component of premature death among renal failure patients. Early treatment of progressive renal insufficiency has the opportunity to attempt prevention of, or reduction in, the development of LVH. Therapies specifically targeted at regression of LVH (e.g. antihypertensive regimens and epoetin-,) may, therefore, impact favourably on future cardiovascular events. Importantly, these approaches appear complementary and should be used in unison to maximize cardiovascular risk reduction in renal failure patients. [source] Early treatment during a primary malaria infection modifies the development of cross immunityPARASITE IMMUNOLOGY, Issue 1 2004M. Legorreta-Herrera SUMMARY We have used a murine model to study the kinetics of cross-protection when a primary infection is halted at different times. We analysed how parasitaemia is modified during a second infection with the homologous parasite, a heterologous parasite, or a mixture of the two. In addition, possible mechanisms involved in cross-protection were analysed. Results show that treatment with pyrimethamine on day 5 during a primary infection with P. chabaudi AS (non-lethal), prevents the generation of cross-protection to a new challenge with lethal P. yoelii 17XL. In contrast, when treatment is on day 7, mice survive a P. yoelii infection. Differences between both groups suggest that in order for ,preimmune' mice to survive a lethal challenge, a predominantly TH2-type response is required, with a higher mRNA expression level of IL-4 and IL-10, and a lower mRNA expression of IFN-,. This work shows that an early treatment of a malaria infection produced by a non-lethal parasite drives the immune response towards a loss of cross-protection to further infections, in particular with more virulent parasites. This finding should be taken into account for the development of effective malaria vaccines. [source] Early treatment with l -thyroxine in children and adolescents with type 1 diabetes, positive thyroid antibodies, and thyroid gland enlargementPEDIATRIC DIABETES, Issue 4 2007Olga Kordonouri Aim:, To investigate whether early treatment with l -thyroxine may prevent deterioration of thyromegaly and progression to subclinical or clinical hypothyroidism in pediatric patients with type 1 diabetes, positive thyroid antibodies, and ultrasound abnormalities of the thyroid gland. Methods:, The development of thyroid gland volume and function in patients without l -thyroxine treatment (group A, n = 8) was assessed and compared with that in patients receiving l -thyroxine treatment (group B, n = 7) with median follow-up time of 2.0 yr (range 0.6,3.0 yr). Standard deviation score (SDS) of thyroid gland volume was calculated according to gender- and age-corresponding data. Results:, Median thyroid gland volume SDS at study entry was 4.8 (range 2.0-15.3) in group A and 5.6 (3.6,13.9) in group B. At follow-up, median thyroid volume SDS has increased by 0.8 (,3.9 to 6.0) at 1 yr and by 2.0 (,4.5 to 10.9) at 2 yr in group A but decreased significantly by ,3.4 (,10.0 to 0.4) and ,5.3 (,12.3 to ,1.7) in group B, respectively. The change of thyroid gland volume was significantly different between the two groups (p = .043 and .032, respectively). In group A, three of eight patients without therapy developed subclinical hypothyroidism with thyroid-stimulating hormone elevation. Conclusion:, These data demonstrate that treatment with l -thyroxine in patients with diabetes, positive thyroid antibodies, and elevated gland volume leads to a significant reduction of thyromegaly. Prospective randomized clinical trials are required to prove these preliminary findings. [source] Biochemical findings in common inborn errors of metabolism,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 2 2006Marzia Pasquali Abstract The application of tandem mass spectrometry (MS/MS) to newborn screening has led to the detection of patients with a wider spectrum of inborn errors of metabolism. A definitive diagnosis can often be established early enough to start treatment before symptoms appear. Here, we review common biochemical findings in disorders caused by deficiency of 3-methylcrotonyl-CoA carboxylase, isobutyryl-CoA dehydrogenase, 2-methyl-3-hydroxybutyryl-CoA dehydrogenase, 3-ketothiolase, 2-methylbutyryl-CoA dehydrogenase, and medium chain acyl CoA dehydrogenase. The diagnosis of these disorders requires biochemical confirmation by measurement of plasma acylcarnitine profile, urine organic acids, and urine acylglycine profiles followed by measurement of enzyme activity or detection of causative mutations. Early treatment can improve the outcome of these disorders. © 2006 Wiley-Liss, Inc. [source] Latest news and product developmentsPRESCRIBER, Issue 9 2008Article first published online: 21 MAY 200 Dabigatran launched Dabigatran (Pradaxa), an orally active direct thrombin inhibitor, has been introduced for the prophylaxis of venous thromboembolism in patients undergoing elective total hip or knee replacement. Treatment is initiated within four hours of surgery and continued for 10 days after knee replacement and 28-35 days after hip replacement. Dabigatran has been shown to be as effective and well tolerated as enoxaparin (Clexane). The launch was widely publicised in the lay media; the charity Lifeblood claimed it could help prevent tens of thousands of deaths. NICE is preparing a technology appraisal of the new agent but it has not announced a publication date. Loop diuretics may increase bone loss Continuous use of a loop diuretic appears to double the rate of bone loss in men compared with nonusers, an observational study suggests (Ann Intern Med 2008;168: 735-40). Up to five years' follow-up of 3269 men aged over 65 revealed that the mean rate of bone loss in the hip among those who did not use a loop diuretic was 0.33 per cent compared with 0.78 per cent among users and 0.58 per cent in those who had intermittently used a loop diuretic. Use of these agents should be included as a risk factor for fractures, the authors suggest. Rosuvastatin not for heart failure patients? Prescribers should pause before using rosuvastatin (Crestor). in patients with heart failure and ischaemic heart disease, the National Prescribing Centre (NPC). says. Commenting on the CORONA trial (N Engl J Med 2008; published online 5 Nov 2007; 10.1056/NEJMoa 0706201)., which found no reduction in cardiovascular events or mortality in older patients with systolic heart failure despite a reduction in LDL-C, the NPC says GPs should still consider evidence-based statins such as simvastatin in this patient group. The reason for the outcome of CORONA is unclear but the NPC points out that not all statins affect mortality equally. Rimonabant CV benefits sustained Two-year follow-up of the RIO-Europe trial has shown that the benefits of rimonabant (Acomplia). on weight loss and cardiovascular risk factors are sustained with continuing treatment (Eur Heart J 2008; published online doi: 10.1093/ eurheartj/ehn076). In addition to a dietary deficit of 600kcal per day, rimonabant 20mg per day achieved greater mean weight loss (5.5 vs 1.2kg). and improvements in waist circumference, HDL-cholesterol, triglycerides, fasting glucose and insulin levels, insulin resistance, and metabolic syndrome prevalence compared with placebo. Many patients discontinued treatment (placebo 42 per cent, rimonabant 45 per cent). but, although psychiatric events were more common with rimonabant during the first year, there was little difference in patients remaining in the second year. Early glatiramer cuts MS progression risk Early treatment with glatiramer acetate (Copaxone). appears to reduce the risk of progression to multiple sclerosis (MS), according to a study presented at the 60th Annual Meeting of the American Academy of Neurology in Chicago. Interim analysis of the PreCISE trial showed that, in patients with a single episode and MRI suggestive of MS, glatiramer was associated with a lower incidence of progression to a second episode of MS compared with placebo (25 vs 43 per cent). The placebo arm of the trial has now been stopped. NRT before quitting Beginning nicotine replacement therapy (NRT) before stopping smoking may double the six-month success rate compared with beginning treatment on the scheduled quit day, a meta-analysis suggests (Addiction 2008;103: 557-63). The analysis of four trials involving 755 participants found that starting NRT two to four weeks before the agreed quit date was twice as likely as the conventional strategy to achieve abstinence after six weeks and six months. Copyright © 2008 Wiley Interface Ltd [source] Early treatment of a quetiapine and sertraline overdose with Intralipid®,ANAESTHESIA, Issue 2 2009S. D. H. Finn Summary We describe the initial management and subsequent recovery of a 61 year-old male patient following attempted suicide by oral ingestion of a potentially fatal overdose of quetiapine and sertraline. Intravenous Intralipid® was given soon after initiation of basic resuscitation. There was a rapid improvement in the patient's level of consciousness. No other clinical signs of drug toxicity were observed. Intralipid may have reversed the deep coma associated with ingestion and prevented other manifestations of drug toxicity occurring, thus expediting this patient's recovery. [source] Real-life impact of early interferon, therapy in relapsing multiple sclerosis,ANNALS OF NEUROLOGY, Issue 4 2009M. Trojano MD Objective Recent findings support greater efficacy of early vs. delayed interferon beta (IFN,) treatment in patients with a first clinical event suggestive of multiple sclerosis (MS). We aimed to evaluate the effectiveness of early IFN, treatment in definite relapsing-remitting MS (RRMS) and to assess the optimal time to initiate IFN, treatment with regard to the greatest benefits on disability progression. Methods A cohort of 2,570 IFN,-treated RRMS patients was prospectively followed for up to 7 years in 15 Italian MS Centers. A Cox proportional hazards regression model adjusted for propensity score (PS) quintiles was used to assess differences between groups of patients with early vs. delayed IFN, treatment on risk of reaching a 1-point progression in the Expanded Disability Status Scale (EDSS) score, and the EDSS 4.0 and 6.0 milestones. A set of PS-adjusted Cox hazards regression models were calculated according to different times of treatment initiation (within 1 year up to within 5 years from disease onset). A sensitivity analysis was performed to assess the robustness of findings. Results The lowest hazard ratios (HRs) for the three PS quintiles,adjusted models were obtained by a cutoff of treatment initiation within 1 year from disease onset. Early treatment significantly reduced the risk of reaching a 1-point progression in EDSS score (HR = 0.63; 95% CI = 0.48,0.85; p < 0.002), and the EDSS 4.0 milestone (HR = 0.56; 95% CI = 0.36,0.90; p = 0.015). Sensitivity analysis showed the bound of significance for unmeasured confounders. Interpretation Greater benefits on disability progression may be obtained by an early IFN, treatment in RRMS. Ann Neurol 2009;66:513,520 [source] Sustained improvement of spinal muscular atrophy mice treated with trichostatin a plus nutritionANNALS OF NEUROLOGY, Issue 4 2008Heather L. Narver VMD Early treatment with the histone deacetylase inhibitor, trichostatin A, plus nutritional support extended median survival of spinal muscular atrophy mice by 170%. Treated mice continued to gain weight, maintained stable motor function, and retained intact neuromuscular junctions long after trichostatin A was discontinued. In many cases, ultimate decline of mice appeared to result from vascular necrosis, raising the possibility that vascular dysfunction is part of the clinical spectrum of severe spinal muscular atrophy. Early spinal muscular atrophy disease detection and treatment initiation combined with aggressive ancillary care may be integral to the optimization of histone deacetylase inhibitor treatment in human patients. Ann Neurol 2008; 64:465,470 [source] Rapamycin prevents epilepsy in a mouse model of tuberous sclerosis complexANNALS OF NEUROLOGY, Issue 4 2008Ling-Hui Zeng MD Objective Tuberous sclerosis complex (TSC) represents one of the most common genetic causes of epilepsy. TSC gene inactivation leads to hyperactivation of the mammalian target of rapamycin signaling pathway, raising the intriguing possibility that mammalian target of rapamycin inhibitors might be effective in preventing or treating epilepsy in patients with TSC. Mice with conditional inactivation of the Tsc1 gene primarily in glia (Tsc1GFAPCKO mice) develop glial proliferation, progressive epilepsy, and premature death. Here, we tested whether rapamycin could prevent or reverse epilepsy, as well as other cellular and molecular brain abnormalities in Tsc1GFAPCKO mice. Methods Tsc1GFAPCKO mice and littermate control animals were treated with rapamycin or vehicle starting at postnatal day 14 (early treatment) or 6 weeks of age (late treatment), corresponding to times before and after onset of neurological abnormalities in Tsc1GFAPCKO mice. Mice were monitored for seizures by serial video-electroencephalogram and for long-term survival. Brains were examined histologically for astrogliosis and neuronal organization. Expression of phospho-S6 and other molecular markers correlating with epileptogenesis was measured by Western blotting. Results Early treatment with rapamycin prevented the development of epilepsy and premature death observed in vehicle-treated Tsc1GFAPCKO mice. Late treatment with rapamycin suppressed seizures and prolonged survival in Tsc1GFAPCKO mice that had already developed epilepsy. Correspondingly, rapamycin inhibited the abnormal activation of the mammalian target of rapamycin pathway, astrogliosis, and neuronal disorganization, and increased brain size in Tsc1GFAPCKO mice. Interpretation Rapamycin has strong efficacy for preventing seizures and prolonging survival in Tsc1GFAPCKO mice. Ann Neurol 2008 [source] Distinct mechanisms of action of anti-CD154 in early versus late treatment of murine lupus nephritisARTHRITIS & RHEUMATISM, Issue 9 2003Sergio A. Quezada Objective Treatment with anti-CD154 antibody is known to ameliorate murine lupus nephritis when given early in the disease. The aims of this study were to identify the mechanism of this early effect, to determine whether late anti-CD154 treatment could halt established nephritis, and, if so, to examine potential mechanisms of late efficacy. Methods We studied the effects of anti-CD154 treatment on autoantibody production and immune complex deposition, renal pathology, survival, and renal cytokine and chemokine messenger RNA (mRNA) expression both in (NZB × NZW)F1 mice (BW mice) and in NZM.2410 mice. Results Early treatment with anti-CD154 produced long-term survival in BW mice, with abrogation of renal immune complex deposition for months after treatment was stopped. Late anti-CD154 treatment, started after development of nephritis, could halt disease in ,40% of mice. In some mice, proteinuria could be reversed repeatedly with sequential courses of anti-CD154 antibody. The remissions induced by late treatment with anti-CD154 occurred despite ongoing renal immune complex deposition. In preliminary studies, responding mice had rapid reductions in renal mRNA for transforming growth factor ,, interleukin-10, and tumor necrosis factor ,. Conclusion Amelioration of murine lupus by anti-CD154 therapy is mediated by distinct mechanisms in early versus late intervention. We postulate that anti-CD154 therapy prevents autoantibody production and renal immune complex deposition in the early, induction phase and limits secondary tissue damage in situ in the late, effector phase. These data demonstrate that CD40,CD154 interactions are critical for the maintenance of autoimmunity and suggest a potential role for anti-CD154 as a therapeutic agent in established human lupus. [source] Botulinumtoxin A treatment in toddlers with cerebral palsyACTA PAEDIATRICA, Issue 8 2010K Tedroff Abstract Aims:, In this study the aim was to evaluate the effect of botulinum toxin A (BoNT-A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP). Method:, Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT-A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait-analysis was performed at 5 years of age. Results:, Plantarflexor muscle tone in the BoNT-A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change-score in knee-flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT-A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM-66 or PEDI. Conclusion:, Early treatment of BoNT-A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive. [source] Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatmentACTA PAEDIATRICA, Issue 10 2003TG Krediet Aim: The incidence of necrotizing enterocolitis (NEC) strongly increased in an neonatal intensive care unit (NICU) in 1997 and 1998 compared with previous years, which coincided with increased incidence of nosocomial sepsis. Specific risk factors related to this NICU and a possible relationship between NEC and nosocomial sepsis were studied retrospectively, including all patients with NEC since 1990 and matched controls. Methods: Clinical and bacteriological data from the period before the development of NEC and a similar period for the controls were collected retrospectively and corrected for birthweight and gestational age. Statistical analysis was performed by a stepwise regression model. Results: Data of 104 neonates with NEC and matched controls were analysed. The median day of onset of NEC was 12 d (range 1,63 d). Significant risk factors for NEC were: insertion of a peripheral artery catheter [odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.3-3.9] and a central venous catheter (OR 5.6, 95% CI 3.1-10.1), colonization with Klebsiella sp. (OR 3.4, 95% CI 1.5-7.5) and Escherichia coli (OR 2.1, 95% CI 1.CM1.5), and the occurrence of sepsis, in particular due to coagulase-negative staphylococci (OR 2.6, 95% CI 1.4-5.1). The risk for NEC was decreased after the early use (<48h after birth) of amoxicillin-clavulanate and gentamicin (OR 0.3, 95% CI 0.2-0.6). Conclusion: Insertion of central venous and peripheral arterial catheters is positively associated with NEC, as is colonization with the Gram-negative bacilli Klebsiella and E. coli and the occurrence of sepsis, particularly due to coagulase-negative staphylococci. Early treatment with amoxicillin-clavulanate and gentamicin is negatively associated with NEC and may be protective against NEC. [source] The rationale for early intervention in schizophrenia and related disordersEARLY INTERVENTION IN PSYCHIATRY, Issue 2009Merete Nordentoft Abstract Aim: To examine the rationale and evidence supporting an early intervention approach in schizophrenia. Methods: A selective literature review was conducted. Results: During the onset of schizophrenia, there is often a significant delay between the emergence of psychotic symptoms and the initiation of treatment. The average duration of untreated psychosis is around 1,2 years. During this period, brain function may continue to deteriorate and social networks can be irreversibly damaged. Studies have consistently linked longer duration of untreated psychosis with poorer outcomes and this relationship holds even after controlling for the potential confounding variable of premorbid functioning. In Norway, the early Treatment and Intervention in PSychosis study demonstrated that duration of untreated psychosis is amenable to intervention with the combination of educational campaigns and specialized early detection units substantially decreasing the period from onset of symptoms to treatment initiation. Furthermore, recent evidence from the randomized controlled OPUS and the Lambeth Early Onset trial studies have linked phase-specific early interventions to improved outcomes spanning symptoms, adherence to treatment, comorbid drug abuse, relapse and readmission. Some benefits persist after cessation of the intervention. Conclusions: Early intervention in schizophrenia is justified to reduce the negative personal and social impact of prolonged periods of untreated symptoms. Furthermore, phase-specific interventions are associated with improved outcomes, at least in the short term. Further research is needed to establish the optimum duration of such programmes. [source] Pulmonary Hypertension in Patients after Repair of Transposition of the Great ArteriesCONGENITAL HEART DISEASE, Issue 2 2010Ellen Chan MD ABSTRACT One well-documented complication of unrepaired d-transposition of the great arteries (d-TGA) is progressive pulmonary vascular disease. It is generally accepted that pulmonary vascular disease will not develop if d-TGA repair is performed early in life. Herein, we report a number of repaired d-TGA, especially in older patients with Mustard/Senning procedures, in whom pulmonary vascular disease developed years after their original repair. The etiology of this phenomenon is unknown, warranting further investigation. Our case reports highlight an overlooked, possible long-term complication following d-TGA repair. From this experience, we recommend that evidence of progressive pulmonary vascular disease may need to be regularly sought during the follow-up of patients after d-TGA repair, especially Mustard/Senning repairs, as early treatment of pulmonary hypertension may improve long-term clinical outcomes. [source] Early detection and treatment of schizophrenia: how early?ACTA PSYCHIATRICA SCANDINAVICA, Issue 2006A. Riecher-Rössler Objective:, Whereas early detection and therapy of schizophrenic psychoses until some time ago concentrated on frank schizophrenia, during the last years some centres have also started to treat patients even before a clear diagnosis could be established. This paper attempts to discuss if and when this is justified in the light of recent research. Method:, Mini review of literature. Results:, The rationale for early detection and treatment of schizophrenia is based on several observations: diagnosis and treatment of schizophrenia are often seriously delayed. Consequences of the disease are severe already in the early undiagnosed phase of the disorder and early treatment seems to improve the course of the disease. It can therefore be stated quite safely that patients should be treated as early as possible. However, the question of how early has not been sufficiently answered up to now. Conclusion:, We are at the moment in an ethical dilemma between either diagnosing and treating this disorder too late or too early. The only way and prerequisite for solving this dilemma is a more reliable identification of individuals at risk and the beginning disease process. [source] | ||||||||||||||||||||||||||||||||||||||||