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Baseline Clinical (baseline + clinical)
Terms modified by Baseline Clinical Selected AbstractsDeterminants of Mortality in Patients Undergoing Cardiac Resynchronization Therapy: Baseline Clinical, Echocardiographic, and Angioscintigraphic Evaluation Prior to ResynchronizationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2005ANTONIO DE SISTI Background: In dilated cardiomyopathy (DCM) patients (pts) with cardiac resynchronization therapy (CRT) for ventricular dyssynchrony, long-term predictors of mortality and morbidity remain poorly investigated. Method and Results: We reviewed data of 102 pts, 68 ± 10 years, NYHA Class II,IV (14 Class II, 67 Class III, 21 Class IV), who benefited from CRT (69 CRT, 33 CRT-ICD). Fifty-two patients had an ischemic DCM, 36 a previously implanted conventional PM/ICD, 29 a permanent atrial fibrillation, and 19 needed dobutamine in the month preceding implant. QRS duration was 187 ± 35 ms, left ventricular end-diastolic diameter 72 ± 10 mm, mitral regurgitation severity 1.9 ± 0.8, echographic aorto-pulmonary electromechanical delay 61.5 ± 25 ms and septo-lateral left intraventricular delay 86 ± 56 ms, pulmonary artery pressure (PAP) 43 ± 11 mmHg, angioscintigraphic left ventricular ejection fraction (EF) 20 ± 9%, and right ventricular EF 30.5 ± 14%. Over a mean follow-up of 23 ± 20 months, 26 pts died (18 heart failures (HFs), 1 arrhythmic storm, 7 noncardiac deaths). Positive univariate predictors of death from any cause were NYHA Class IV (P < 0.001), and need for dobutamine the month preceding CRT (P < 0.008), while use of ,-blocking agents (P < 0.08) and left ventricular EF (P < 0.09) were negative ones. NYHA Class IV was the only independent predictor at multivariate analysis (P < 0.01). Survival at 24 months was 85% in Class II, 80% in Class III, and 37% in Class IV (II vs III, P = ns; III vs IV, P < 0.001). When using a composite endpoint of death from any cause and unplanned rehospitalization for a major cardiovascular event, there were 48 events (14 HF deaths, 3 noncardiac deaths, 26 HF rehospitalizations, 2 paroxysmal atrial fibrillation, 2 sustained ventricular tachycardia, 1 nonfatal pulmonary embolism). Predictors of death from any cause/unplanned rehospitalization for a major cardiovascular event in the follow-up were NYHA Class IV (P < 0.001), need for dobutamine during the month preceding CRT (P < 0.002), and PAP (<0.02). NYHA Class IV was the only independent predictor at multivariate analysis (P < 0.05). Event-free proportion at 24 months was 70% in Class II, 64% in Class III, and 37% in Class IV (II vs III, P = ns; III vs IV, P < 0.01). When considering determinants of mortality only in NYHA Class IV patients, no variable was significantly correlated to mortality. Need for dobutamine during the last month preceding CRT did not add an adjunctive mortality risk. Conclusion: Baseline NYHA Class IV at implantation appears as the most important determinant of a poor clinical outcome in terms of both mortality and morbidity. No predictive criteria seem available for NYHA Class IV patients, in order to discriminate who will die after CRT and who will not. NYHA Class IV strongly influences the clinical outcome, suggesting that, in future studies planned on mortality and rehospitalization as major endpoints, baseline NYHA Class IV should be separately taken into account. [source] Real World, Long-Term Outcomes Comparison Between Paclitaxel-Eluting and Sirolimus-Eluting Stent PlatformsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2010M.B.A., MANDEEP S. SIDHU M.D. We compare real-world, extended target vessel revascularization (TVR)-free survival following percutaneous coronary intervention (PCI) for patients receiving either sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) following an index drug-eluting stent (DES) supported procedure. We analyzed 2,363 consecutive patients having first DES-supported PCI at receiving PES (n = 1,012) or SES (n = 1,332) from April 2004 to July 2006. Baseline clinical and procedural characteristics and in-hospital outcomes were recorded during the time of the index procedure and extended clinical outcomes data were obtained thereafter. TVR and all cause mortality were identified during the study period. Adjusted Kaplan-Meier and Cox's proportional hazard survival methods were performed. TVR-free survival at 2.3 years was 91.3% for SES compared with 88.9% for PES (P = 0.06). Kaplan-Meier survival curves did not significantly differ (adjusted hazard ratio ,1.39 [95% CI 0.99,1.97]) between the SES and PES patient cohorts. TVR was similar between the stent platforms at one (96.6% for SES [95% CI 95.3,97.6] vs. 95.7% for PES [95% CI 94.1,96.9]) and two (95.0%[95% CI 93.0,96.4] for SES vs. 93.7% for PES [95% CI 91.6,95.3]) years. Overall survival at 2 years was 96.2% for SES (95% CI 94.7,97.3) and 95.3% for PES (95% CI 93.7,96.5). SES and PES drug-eluting stent platforms have good and similar extended outcomes in this real world registry of unselected patients having PCI. (J Interven Cardiol 2010;23:167-175) [source] Efficacy of Sirolimus-Eluting Stents as Compared to Paclitaxel-Eluting Stents for Saphenous Vein Graft InterventionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2006Ph.D., WILLIAM W. CHU M.D. Background: Saphenous vein graft (SVG) intervention is associated with a significantly increased rate of periprocedural complications and late clinical and angiographic restenosis. In the contemporary drug-eluting stent (DES) era, the comparison of the efficacy of sirolimus-eluting stents (SES) with paclitaxel-eluting stents (PES) in SVG interventions is currently unknown. We conducted this retrospective analysis to investigate this issue. Methods and Results: Forty-seven patients with 50 SVG lesions who underwent standard percutaneous coronary intervention (PCI) with SES (SES group) were compared with 42 patients with 45 SVG lesions with PES (PES group). All patients received distal protection devices (DPDs) during the interventions. The in-hospital, 30-day, and 6-month clinical outcomes in both groups were compared. Baseline clinical and procedural characteristics were balanced between both groups except for the proximal and mid lesions. There were no deaths or Q-wave myocardial infarctions (MIs) during the index hospitalization. Non-Q-wave MI was similar between the two groups (SES vs PES, 4.3% vs 7.1%, P = 0.55). At 30-day and 6-month follow-ups, all the clinical outcomes were similar between the two groups. There was no subacute thrombosis (SAT) or late thrombosis in either group. The event-free survival at 6 months was also similar between both groups (P = 0.75). Conclusions: The use of DES in patients undergoing SVG intervention with a DPD is clinically safe and feasible. As compared to SES, PES have the same efficacy and clinical outcomes in SVG interventions up to 6 months. [source] Analysis of the diversity of the HIV-1 pol gene and drug resistance associated changes among drug-naïve patients in Burkina FasoJOURNAL OF MEDICAL VIROLOGY, Issue 10 2009Denis M. Tebit Abstract A cross-sectional study was undertaken among drug-naïve HIV patients at the University Hospital in Ouagadougou shortly before and after the introduction of large-scale antiretroviral therapy (ART) in Burkina Faso. Baseline clinical and virological data as well as protease (PR) and 5, reverse transcriptase (RT) sequences from 104 HIV infected patients were analyzed. Genotypic classification revealed the following subtypes and recombinant forms: CRF06_cpx, n,=,46 (44.2%); CRF02_AG, n,=,39 (37.5%); subtype A, n,=,4 (3.8%); CRF09_cpx, n,=,2 (1.9%); and unclassified, n,=,13 (12.5%). Bootstrap analysis of CRF02_AG and CRF06_cpx viruses showed that >80% had a similar structure to their respective prototypes. The prevalence of primary drug resistance mutations was 12.5%, all mutations arising in the RT sequences in accordance with the dominance of this drug class in Burkina Faso. The mutations were distributed as follows: NRTI (10.6%): M41L (n,=,2), D67N (n,=,2), K70K/E (n,=,2), L210W (n,=,1), T215S/Y (n,=,2), and K219K/Q (n,=,2); NNRTI (6.1%): K103K/N (n,=,2), Y181C (n,=,2), G190G/A (n,=,1), and P236P/L (n,=,1). Subtype specific secondary polymorphisms such as K20I and M36I in the PR were observed in almost all patients. Drug resistance mutations occurred at similar frequencies (12.8% and 10.8%, respectively) among patients infected with CRF02_AG and CRF06_cpx. Some subtype specific polymorphisms were observed within important HLA epitopes, including B35, B7, and A2 in the RT, and A*6802 in the PR sequences. The observed resistance mutations are most likely to have been transmitted based on the timing of the study but prior undocumented use of ART cannot be excluded. J. Med. Virol. 81:1691,1701, 2009. © 2009 Wiley-Liss, Inc. [source] Risk factors for progression to gastric neoplastic lesions in patients with atrophic gastritisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2010L. VANNELLA Aliment Pharmacol Ther,31, 1042,1050 Summary Background, Atrophic gastritis, involving the gastric body mucosa, predisposes to gastric neoplastic lesions (GNL). However, regular gastroscopic-histological follow-up for GNL is not recommended for patients with atrophic gastritis. Aim, To evaluate risk factors for the progression to GNL in a cohort of patients with atrophic gastritis. Methods, A total of 300 patients with atrophic gastritis [205 women, aged 54 (18,78) years] underwent gastroscopy with six gastric antrum and body biopsies. All patients had at least one follow-up gastroscopy/histology at an interval of at least 1 year after the atrophic gastritis diagnosis. Baseline clinical and histological features were analysed as risk factors for the development of GNL by Cox-regression. Results, During a median follow-up of 4.3 (1,16.5) years, 15 GNL were detected in 14 of the 300 patients with atrophic gastritis: three were gastric cancer, whereas 12 were non-invasive neoplasia. The annual incidence for GNL was 1%. Cox-regression analysis identified the following risk factors: age over 50 years (HR 8.8, 95%CI 1.2,68.4), atrophic pangastritis (HR 4.5, 95% CI 1.5,14.1) and severe intestinal metaplasia in the gastric body (HR 4.0, 95% CI 1.3,11.8). Conclusions, Atrophic pangastritis, severe body intestinal metaplasia and/or age over 50 years increase the risk for developing GNL in patients with atrophic gastritis. In this subset of patients, an endoscopic-histological follow-up for GNL surveillance may be worthwhile. [source] "Head-to-head comparison between sirolimus-eluting and paclitaxel-eluting stents in patients with complex coronary artery disease: An intravascular ultrasound study"CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2006FSCAI, Pavel, ervinka MD Abstract Background: The aim of this study was to assess neointimal hyperplasia following sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) implantation in a patients with complex coronary disease. Method: Between January to December 2004, 70 patients were enrolled in this study (SES = 37; PES = 33. The primary objective was to assess the efficacy of SES and PES on neointimal proliferation inhibition in patients with complex coronary lesions by volumetric 3D intravascular ultrasound (IVUS) assessment at six-month follow-up. Results: Baseline clinical, demographic or angiographic characteristics were well balanced in both groups. All procedures as well as hospitalisation were uneventful. The percentage of B2/C lesions in our study was >90% in both groups. The IVUS-assessed in-stent mean neointimal hyperplasia volume was significantly lower in lesions treated with SES compared to PES (4.1 ± 11 mm3 vs. 17.4 ± 23 mm3, p < 0.002) at 6 month follow-up. No difference in both MACE (3.0 versus 6.0%, p = NS) and restenosis (5.4 versus 9.1%, p = NS) were found. The in-segment late loss at six month was 0.26 mm in the SES and 0.48 mm in the PES group (p = NS). Conclusions: The present study showed reduced neointimal proliferation after sirolimuseluting as compared to paclitaxel-eluting stents in patients with complex coronary artery disease. Both SES and PES were associated with low rate of angiographic restenosis or major adverse cardiovascular events. © 2006 Wiley-Liss, Inc. [source] Clinical outcomes for sirolimus-eluting stent implantation and vascular brachytherapy for the treatment of in-stent restenosisCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2004Francesco Saia MD Abstract The purpose of this study was to compare the mid-term clinical outcome of sirolimus-eluting stent (SES) implantation and vascular brachytherapy (VBT) for in-stent restenosis (ISR). We assessed the 9-month occurrence of major adverse cardiac events (MACE) in 44 consecutive patients with ISR treated with SES implantation and 43 consecutive patients treated with VBT in the period immediately prior. Baseline clinical and angiographic characteristics of the two groups were similar. During follow-up, three patients (7%) died in the VBT group and none in the SES group. The incidence of myocardial infarction was 2.3% in both groups. Target lesion revascularization was performed in 11.6% of the VBT patients and 16.3% of the SES patients (P = NS). The 9-month MACE-free survival was similar in both groups (79.1% VBT vs. 81.5% SES; P = 0.8 by log rank). The result of this nonrandomized study suggests that sirolimus-eluting stent implantation is at least as effective as vascular brachytherapy in the treatment of in-stent restenosis. Catheter Cardiovasc Interv 2004;62:283,288. © 2004 Wiley-Liss, Inc. [source] Restenosis and Progression of Coronary Disease after Balloon Angioplasty in Patients with Diabetes MellitusCLINICAL CARDIOLOGY, Issue 12 2000Yoseph Rozenman M.D. Abstract Background: Patients with diabetes mellitus (D) (both insulin-requiring D [IRD] and non-IRD) who undergo angioplasty have worse long-term outcome than do non-D patients. Few data are available in the literature that explain these findings. Hypothesis: The study was undertaken to compare restenosis and progression of coronary disease after angioplasty in IRD patients, in non-IRD patients, and in non-D patients. Methods: Diabetic patients who underwent coronary angioplasty were separated into two subgroups: IRD and non-IRD patients. Their angiographic outcome was compared with non-D patients. We examined retrospectively 353 coronary angiograms of patients who were referred for diagnostic angiography > 1 month after successful angioplasty. Quantitative angiography was used to determine the outcome in dilated narrowings (restenosis) and in nondilated narrowings (disease progression). Results: Baseline clinical and angiographic characteristics were similar in all groups. Restenosis rate was higher in IRD (61 %) than in non-IRD (36%) and non-D (35%) patients (p = 0.04). Late luminal loss after angioplasty was two times greater in IRD patients than in the other two groups (p=0.01). Disease progression of nondilated narrowings was significantly more prominent in non-IRD than in non-D patients: Diameter stenoses were similar in the initial angiogram, but narrowings were significantly more severe (p=0.02) in the final angiogram (70 ± 27% and 60 ± 33%, respectively). New narrowings were more common in non-IRD than in non-D patients: there was a 23% increase in the number of narrowings in the follow-up angiogram in non-IRD patients compared with only 12% in non-D patients (p < 0.003). These new narrowings were more common (p=0.01) in angioplasty arteries (57 narrowings on 420 arteries,13.6%) than in nonangioplasty arteries (54 narrowings on 639 arteries,8.5%). Conclusion: Restenosis is more common in IRD patients and explains the high rate of adverse cardiac events within the first year after coronary intervention in these patients (mainly target lesion revascularization). Disease progression (including new narrowings) is the main determinant of patient outcome > 1 year after coronary intervention and is accelerated in non-IRD compared with non-D patients. [source] Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection programACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009I. Joa Objective:, Psychotic disorders often start in adolescence. We aim to investigate premorbid and baseline differences characterizing patients with an onset of psychosis in adolescence versus adulthood. Method:, We compare first-episode, DSM-IV non-affective psychosis with onset before (n = 43) and after (n = 189) 18 years on duration of untreated psychosis (DUP), level of symptoms, suicidal behaviour, and other baseline clinical and demographic characteristics. Results:, Adolescent onset patients had poorer premorbid functioning, a longer DUP, higher suicidality, and more depressive symptoms. They also had better cognition, fewer psychotic symptoms, and were more likely to be treated on an out-patient basis. Conclusion:, Adolescents with first-episode psychosis may have a slower and more silent, i.e. insidious onset, and are at risk of experiencing longer treatment delays than adults. They fit the description of what used to be labeled process (versus reactive) schizophrenia. [source] Biliary reconstruction using non-penetrating, tissue everting clips versus conventional sewn biliary anastomosis in liver transplantationHPB, Issue 2 2006K. Tyson Thomas Background. Biliary complications occur following approximately 25% of liver transplantations. Efforts to decrease biliary complications include methods designed to diminish tissue ischemia. Previously, we reported excellent short-term results and decreased biliary anastomosis time in a porcine liver transplant model using non-penetrating, tissue everting clips (NTEC), specifically VCS® clips. Methods. We examined the incidence of biliary anastomotic complications in a group of patients in whom orthotopic liver transplantation was performed with biliary reconstruction using NTEC and compared that group to a matched group treated with biliary reconstruction via conventional end-to-end sewn choledochocholedochostomy. Patients were matched in a 1:2 fashion by age at transplantation, disease etiology, Child-Turcot-Pugh scores, MELD score or UNOS status (prior to 1998), cold and warm ischemia times, organ donor age, and date of transplantation. Results. Seventeen patients had clipped anastomosis and 34 comparison patients had conventional sewn anastomosis. There were no differences between groups in terms of baseline clinical or demographic data. The median time from completion of the hepatic artery anastomosis to completion of clipped versus conventional sewn biliary anastomosis was 45 (interquartile range = 20 min) versus 47 min (interquartile range = 23 min), respectively (p=0.12). Patients were followed for a mean of 29 months. Biliary anastomotic complications, including leak or anastomotic stricture, were observed in 18% of the clipped group and 24% of the conventional sewn group. Conclusions. Biliary reconstruction can be performed clinically using NTEC as an alternative to conventional sewn biliary anastomoses with good results. [source] Change in subgingival microbial profiles in adult periodontitis subjects receiving either systemically-administered amoxicillin or metronidazoleJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2001M. Feres Abstract Aim: The current investigation evaluated changes in levels and proportions of 40 bacterial species in subgingival plaque samples during, immediately after and up to 1 year after metronidazole or amoxicillin therapy combined with SRP. Method: After baseline clinical and microbiological monitoring, 17 adult periodontitis subjects received full mouth SRP and 14 days systemic administration of either metronidazole (250 mg, TID, n=8) or amoxicillin (500 mg, TID, n=9). Clinical measurements including % of sites with plaque, gingival redness, bleeding on probing and suppuration, pocket depth (PD) and attachment level (AL) were made at baseline, 90, 180 and 360 days. Subgingival plaque samples were taken from the mesial surface of all teeth in each subject at baseline, 90, 180 and 360 days and from 2 randomly selected posterior teeth at 3, 7, and 14 days during and after antibiotic administration. Counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. Significance of differences over time was determined using the Quade test and between groups using ANCOVA. Results: Mean PD was reduced from 3.22±0.12 at baseline to 2.81±0.16 (p<0.01) at 360 days and from 3.38±0.23 mm to 2.80±0.14 mm (p<0.01) in the amoxicillin and metronidazole treated subjects respectively. Corresponding values for mean AL were 3.21±0.30 to 2.76±0.32 (p<0.05) and 3.23±0.28 mm to 2.94±0.23 mm (p<0.01). Levels and proportions of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were markedly reduced during antibiotic administration and were lower than baseline levels at 360 days. Counts (×105, ±SEM) of B. forsythus fell from baseline levels of 0.66±0.16 to 0.04±0.02, 0.13±0.04, 0.10±0.03 and 0.42±0.19 in the amoxicillin group at 14, 90, 180 and 360 days respectively (p<0.001). Corresponding values for metronidazole treated subjects were: 1.69±0.28 to 0.02±0.01, 0.20±0.08, 0.22±0.06 and 0.22±0.08 (p<0.001). Counts of Campylobacter species, Eubacterium nodatum, Fusobacterium nucleatum subspecies, F. periodonticum and Prevotella nigrescens were also detected at lower mean levels during and immediately after therapy, but gradually increased after withdrawal of the antibiotics. Members of the genera Actinomyces, Streptococcus and Capnocytophaga were minimally affected by metronidazole. However, amoxicillin decreased the counts and proportions of Actinomyces species during and after therapy. Conclusions: The data suggest that metronidazole and amoxicillin are useful in rapidly lowering counts of putative periodontal pathogens, but must be accompanied by other procedures to bring about periodontal stability. Zusammenfassung Ziel: Die gegenwärtige Untersuchung evaluiert die Veränderungen in den Niveaus und Proportionen von 40 bakteriellen Spezies in subgingivalen Plaqueproben während, sofort nach und bis zu 1 Jahr nach Metronidazol- oder Amoxicillintherapie in Kombination mit SRP. Methoden: Nach der klinischen und mikrobiologischen Basisuntersuchung erhielten 17 erwachsene Personen mit Parodontitis eine vollständige SRP und 14 Tage eine systemische Gabe von entweder Metronidazol (250 mg, TID, n=8) oder Amoxicillin (500 mg, TID, n=9). Die klinischen Messungen schlossen die Prozentwerte der Flächen mit Plaque, der gingivalen Rötung, der Provokationsblutung und Suppuration, der Sondierungstiefe (PD) und des Stützgewebeniveaus (AL) ein. Die Messungen wurden zur Basis, am 90., am 180. und 360. Tag gemacht. Die subgingivalen Plaqueproben wurden von der mesialen Oberfläche aller Zähne zur Basis, zum 90., zum 180. und 360. Tag von jedem Probanden genommen sowie von 2 zufällig ausgesuchten posterioren Zähnen am Tag 3, 7 und 14 während und nach der Antibiotikaverordnung. Die Mengen von 40 subgingivalen Spezies wurden unter Nutzung einer checkerboard DNA-DNA Hybridisation bestimmt. Die Signifikanzen der Differenzen über die Zeit wurden mit dem Quade-Test und zwischen den Gruppen mit der ANCOVA überprüft. Ergebnisse: Die mittleren PD reduzierten sich von 3.22±0.12 mm zur Basis zu 2.81±0.16 mm (p<0.01) zum 360. Tag und von 3.38±0.23 mm zu 2.80±0.14 mm (p<0.01) bei den mit Amoxicillin bzw. mit Metronidazol behandelten Patienten. Korrespondierende Werte für die mittleren AL waren 3.21±0.30 zu 2.76±0.32 (p<0.05) und 3.23±0.28 mm zu 2.94±0.23 mm (p<0.01). Die Niveaus und die Verteilung von Bacteroides forsythus, Porphyromonas gingivalis und Treponema denticola wurden während der Antibiotikabehandlung deutlich reduziert und waren am 360. Tag niedriger als zur Basis. Die Mengen (×105, ±SEM) von B. forsythus fielen von der Basis von 0.66±0.16 auf 0.04±0.02, 0.13±0.04, 0.10±0.03 und 0.42±0.19 in der Amoxicillin Gruppe an den Tagen 14, 90, 180 und 360 (p<0.001). Korrespondierende Werte für die mit Metronidazol behandelten Personen waren: 1.69±0.28 zu 0.02±0.01, 0.20±0.08, 0.22±0.06 und 0.22±0.08 (p<0.001). Die Mengen von Campylobacter sp., Eubacterium nodatum, Fusobacterium nucleatum subspecies, F. peridonticum und Prevotella nigrescens waren in den mittleren Niveaus während und sofort nach der Therapie auch niedriger, aber graduell erhöht nach Absetzen der Antibiotika. Mitglieder der Klassen Actinomyces, Streptococcus und Capnocytophaga wurden durch Metronidazol minimal beeinflußt. Jedoch verringerte Amoxicillin die Mengen und Verhältnisse von Actinomyces sp. während und nach der Therapie. Zusammenfassung: Die Daten suggerieren, daß Metronidazol und Amoxicillin in der schnellen Verringerung der Mengen von putativen parodontalen Pathogenen nützlich sind, daß dies aber durch andere Prozeduren begleitet wurden muß, um parodontale Stabilität zu erbringen. Résumé But: La présente recherche a évalué les modifications de niveaux et de proportions de 40 espèces bactériennes dans des prélèvements de plaque sous gingivale pendant, immédiatement après, et jusqu'à un an après un traitement par métronidazole ou amoxicilline associè avec le détartrage/surfaçage radiculaire. Méthode: Après avoir relevé les paramètres cliniques et microbiologiques initiaux, 17 sujets atteints de parodontite de l'adulte ont subi un détartrage/surfaçage radiculaire de toute la bouche et l'administration systémique pendant 14 jours de métronidazole (250 mg, 3× fois par jour, n=8) ou d'amoxicilline (500 mg, 3× par jour, n=9). Les mesures cliniques relevées initialement, à 90 jours, à 180 jours, et à 360 jours, étaient: le % de sites avec de la plaque, la rougeur gingivale, le saignement au sondage et la suppuration, la profondeur de poche (PD) et le niveau d'attache (AL). Des échantillons de plaque sous gingivale étaient prélevés sur la surface mésiale de toutes les dents, chez chaque sujet, initialement, à 90 jours, à 180 jours, et á 360 jours, et sur 2 dents postérieures choisies au hasard à 3, 7, et 14 jours pendant et après l'administration d'antibiotique. Le comptage de 40 expèces sous gingivales fut déterminé par la technique de l'hybridisation en damier DNA-DNA. La signification des différences au cours du temps fut déterminée par le test de Quade et entre les groupes par ANCOVA. Résultats: La profondeur moyenne des poches a étê réduite de 3.22±0.12 mm initialement à 2.81±0.16 mm (p<0.01) à 360 jours et de 3.38±0.28 mm à 2.80±0.14 mm (p<0.01) dans les groupes amoxicilline et metronidazole, respectivement. Les valeurs correspondantes pour AL étaient 3.21±0.30 à 2.76±0.32 (p<0.05) et 3.23±0.28 à 2.94±0.23 (p<0.01). Les niveau de B. forsythus, P. gingivalis et T. denticola, étaient fortement réduits pendant l'administration d'antibiotique et restaient plus bas à 360 jours qu'initialement. Les comptages (×105, ±SEM) de B. forsythus tombaient de niveaux initiaux de 0.66±0.16 à 0.04±0.02, 0.13±0.04, 0.10±0.03 et 0.42±0.19 dans le groupe amoxicilline à 14 jours, 90 jours, 180 jours, et 360 jours, respectivement (p<0.001). Les valeurs correspondantes pour les sujets traits par métronidazole étaient de: 1.69±0.28 à 0.02±0.01, 0.20±0.08, 0.22±0.06 et 0.22±0.08 (p<0.001). Les comptages des espèces Camopylobacter, Eubacterium nodatum, des espèces Fusobacterium nodatum, F. periodonticum et Prevotella nigrescensétaient également détectés à des niveaux moyens plus bas pendant, et immédiatement après traitement, mais augmentaient graduellement après cessation des antibiotiques. Les membres des genres Actinomyces, Streptococcus et Capnocytophagaétaient très peu affectés par le métronidazole. Par contre, l'amoxicilline diminuait les comptage et les proportions des Actinomyces pendant et après le traitement. Conclusions: Ces données suggèrent que le métronidazole et l'amoxicilline sont utiles pour diminuer rapidement les comptages des pathogènes parodontaux putatifs, mais qu'ils doivent être accompagnés d'autres procédés pour apporter une stabilité parodontale. [source] The European NEAT Program: An Integrated Approach Using Acamprosate and Psychosocial Support for the Prevention of Relapse in Alcohol-Dependent Patients With a Statistical Modeling of Therapy Success PredictionALCOHOLISM, Issue 10 2002Isidore Pelc Background A multicenter, prospective study was conducted in five European countries to observe outcome in alcohol misusers treated for 24 weeks with acamprosate and various psychosocial support techniques, within the setting of standard patient care. Methods Patients diagnosed as alcohol dependent using DSM-III-R criteria were treated, for 24 weeks, with acamprosate and appropriate psychosocial support. Potential predictor variables were recorded at inclusion. Drinking behavior was monitored throughout; the proportion of cumulative abstinence days was the principal outcome measure. The influence of baseline clinical and demographic variables on outcome was assessed using multiple regression analysis. Adverse events were recorded systematically. Results A total of 1289 patients were recruited; 1230 took at least one dose of the drug and provided at least one set of follow-up data; 543 (42.1%)patients were observed for the full 24-week period. The overall proportion of cumulative abstinence days was 0.48. Multiple physical and psychiatric comorbidities and a history of drug addiction were negatively correlated with outcome, as were, to a lesser extent, multiple previous episodes of detoxification, unemployment, and living alone. Older age and stable employment were positively associated with outcome. The difference in the unadjusted proportion of cumulative abstinence days between countries was significant (p < 0.001) but less so when adjusted for the predictive factors identified in the multivariate model (p < 0.019). Overall, outcome was not influenced by the nature of the psychosocial support provided. Adverse events were generally mild, with gastrointestinal disorders, which occurred in 21.5% of patients, being the most frequent. Conclusions This open-label study confirms the efficacy and safety of acamprosate in the treatment of alcohol dependence in the setting of standard patient care. Treatment benefit was observed irrespective of the nature of the psychosocial support provided. Predictors of the response to treatment were identified; their heterogeneous distribution within the study population explained, at least in part, the differences in outcome between countries. [source] Early magnetic resonance imaging findings in patients receiving tissue plasminogen activator predict outcome: Insights into the pathophysiology of acute stroke in the thrombolysis era,ANNALS OF NEUROLOGY, Issue 1 2004Julio A. Chalela MD We measured ischemic brain changes with diffusion and perfusion MRI in 42 ischemic stroke patients before and 2 hours (range approximately 1.5 to 4.5 hours) after standard intravenous tissue plasminogen activator (tPA) therapy. The median time from stroke onset to tPA was 131 minutes. Clinical and MRI variables (change in perfusion and/or diffusion weighted lesion volume) were compared between those with excellent outcome defined as 3-month modified Rankin score (mRS) of 0 to 1 and those with incomplete recovery (mRS >1). In multivariate logististic regression analysis, the most powerful independent predictor for excellent outcome was improved brain perfusion: hypoperfusion volume on mean transit time (MTT) map decrease >30% from baseline to 2-hour post tPA scan (p=0.009; odds ratio [95% confidence interval], 20.7 [2.1-203.9]). Except for age < 70 years, no other baseline clinical or imaging variable was an independent predictor of outcome. We propose MTT lesion volume decrease more than 30% 2 hours after tPA as an early marker of long-term clinical benefit of thrombolytic therapy. [source] Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis: Results from the Norfolk Arthritis Register Study, a large inception cohortARTHRITIS & RHEUMATISM, Issue 4 2002M. Bukhari Objective To identify the relative contributions of clinical and laboratory variables, determined at baseline, in predicting the deterioration of radiographic damage 5 years after presentation in patients with inflammatory polyarthritis. Methods Data from 439 subjects who sought primary care for inflammatory polyarthritis were analyzed. All subjects had paired radiographs, of which the first was obtained within 24 months of presentation and the second at 5 years after presentation. The contribution of baseline clinical and laboratory variables in predicting the degree of radiologic severity as judged by the Larsen score was assessed at both time points. Additionally, the role of these factors in predicting change after adjustment for baseline severity was also measured. Results By 5 years, 49% of subjects had evidence of erosions. The median Larsen score on the first film was 2 (interquartile range [IQR] 0,10) and the median score on the followup film was 7 (IQR 1,25). These corresponded to a median deterioration of 3 (IQR 0,14) in all subjects, whereas those subjects with evidence of erosions at first film showed a median deterioration of 15 (IQR 6,29) on followup. The rheumatoid factor (RF) status, C-reactive protein levels, the presence of nodules, and number of swollen joints at baseline were all predictive of radiographic severity at first film. Not surprisingly, the baseline radiographic score was a predictor of severity of deterioration. However, after adjusting for baseline severity, a high titer of RF (>1:160) was also an independent predictor of deterioration over 5 years: individuals with an initial RF at that level had a progression in their Larsen score that was 2.3 times (95% confidence interval 1.7,3.2) higher than that in the RF-negative individuals. Apart from this, only age had an independent effect, after adjusting for baseline severity, in predicting increasing radiographic joint damage. Conclusion High-titer RF is an important variable in predicting continuing severity of radiographic damage during the first 5 years after presentation with inflammatory polyarthritis. [source] | ||||||||||