RESUMEN
BACKGROUND: Pancreatic exocrine insufficiency (PEI) and malnutrition are prevalent among patients with pancreatic adenocarcinoma. Pancreatic enzyme replacement therapy (PERT) can correct PEI but its use among patients with pancreatic cancer is unclear as are effects upon survival. This population-based study sought to address these issues METHODS: Subjects with pancreatic adenocarcinoma were identified from the UK Clinical Practice Research Datalink (CPRD). Propensity score matching generated matched pairs of subjects who did and did not receive PERT. Progression to all-cause mortality was compared using parametric survival models that included a range of relevant co-variables RESULTS: PERT use among the whole cohort (987/4554) was 21.7%. Some 1614 subjects generated 807 matched pairs. This resulted in a total, censored follow-up period of 1643 years. There were 1403 deaths in total, representing unadjusted mortality rates of 748 and 994 deaths per 1000 person-years for PERT-treated cases and their matched non-PERT-treated controls, respectively. With reference to the observed survival in pancreatic adenocarcinoma patients, adjusted median survival time was 262% greater in PERT-treated cases (survival time ratio (STR)â¯=â¯2.62, 95% CI 2.27-3.02) when compared with matched, non-PERT-treated controls. Survival remained significantly greater among subjects receiving PERT regardless of the studied subgroup with respect to use of surgery or chemotherapy CONCLUSIONS: This population based study observes that the majority of patients with pancreatic adenocarcinoma do not receive PERT. PERT is associated with increased survival among patients with pancreatic adenocarcinoma suggesting a lack of clinical awareness and potential benefit of addressing malnutrition among these patients.
Asunto(s)
Neoplasias Pancreáticas/complicaciones , Pancrelipasa/uso terapéutico , Anciano , Terapia de Reemplazo Enzimático , Insuficiencia Pancreática Exocrina/tratamiento farmacológico , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Neoplasias Pancreáticas/terapia , Estudios Retrospectivos , Análisis de Supervivencia , Neoplasias PancreáticasRESUMEN
AIMS: Clinical and observational studies have shown an increased risk of cardiovascular events and death associated with sulphonylureas versus metformin. However, it has never been determined whether this was due to the beneficial effects of metformin or detrimental effects of sulphonylureas. The objective of this study was therefore to compare all-cause mortality in diabetic patients treated first-line with either sulphonylurea or metformin monotherapy with that in matched individuals without diabetes. METHODS: We used retrospective observational data from the UK Clinical Practice Research Datalink (CPRD) from 2000. Subjects with type 2 diabetes who progressed to first-line treatment with metformin or sulphonylurea monotherapy were selected and matched to people without diabetes. Progression to all-cause mortality was compared using parametric survival models that included a range of relevant co-variables. RESULTS: We identified 78,241 subjects treated with metformin, 12,222 treated with sulphonylurea, and 90,463 matched subjects without diabetes. This resulted in a total, censored follow-up period of 503,384 years. There were 7498 deaths in total, representing unadjusted mortality rates of 14.4 and 15.2, and 50.9 and 28.7 deaths per 1000 person-years for metformin monotherapy and their matched controls, and sulphonylurea monotherapy and their matched controls, respectively. With reference to observed survival in diabetic patients initiated with metformin monotherapy [survival time ratio (STR) = 1.0], adjusted median survival time was 15% lower (STR = 0.85, 95% CI 0.81-0.90) in matched individuals without diabetes and 38% lower (0.62, 0.58-0.66) in diabetic patients treated with sulphonylurea monotherapy. CONCLUSIONS: Patients with type 2 diabetes initiated with metformin monotherapy had longer survival than did matched, non-diabetic controls. Those treated with sulphonylurea had markedly reduced survival compared with both matched controls and those receiving metformin monotherapy. This supports the position of metformin as first-line therapy and implies that metformin may confer benefit in non-diabetes. Sulphonylurea remains a concern.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Metformina/efectos adversos , Infarto del Miocardio/inducido químicamente , Accidente Cerebrovascular/inducido químicamente , Compuestos de Sulfonilurea/efectos adversos , Contraindicaciones , Diabetes Mellitus Tipo 2/mortalidad , Esquema de Medicación , Femenino , Humanos , Hipoglucemiantes/administración & dosificación , Masculino , Metformina/administración & dosificación , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Selección de Paciente , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Compuestos de Sulfonilurea/administración & dosificación , Reino Unido/epidemiologíaRESUMEN
Benbow and Benbow suggest that myopia and maleness are advantages in mathematical giftedness; however, the influence of these biological correlates on learning disabilities is not yet as clearly defined. 29 learning disabled children (aged 7-13 yr; eye class diagnosed) performed two Piagetian tasks on conservation of volume, one using numbered blocks to rebuild an original house whose "rooms" were cued by an illogically ordered system, and one using plain blocks to recreate an unnumbered house. A modification of the Preschool Observation Scale of Anxiety was used to observe frequencies of overt physiological behavioral indicators of anxiousness during task performances. No significance was noted by eye class; however, a significant interaction of sex by task did occur. Means differed by sex significantly on the numbered tasks. Implications are discussed in terms of certainty times versus correctness and facilitative versus debilitative anxiety.