RESUMEN
OBJECTIVE: To assess the ability of avocado-soybean unsaponifiable-Expanscience (ASU-E) to slow radiographic progression in symptomatic hip osteoarthritis (OA). METHODS: Prospective, randomised, double blind, parallel group, placebo controlled 3 year trial. Patients with symptomatic (painful ≥1 year, Lequesne Index between 3 and 10) hip OA (American College of Rheumatology criteria) and a minimum joint space width (JSW) of the target hip between 1 and 4 mm on a pelvic radiograph were randomly assigned to 300 mg/day ASU-E or placebo. Standing pelvis, target hip anteroposterior (AP) and oblique views were taken annually. The primary outcome was JSW change at year 3, measured at the narrowest point on pelvic or target hip AP view (manual measure using a 0.1 mm graduated magnifying glass). The full analysis dataset (FAS) included all patients having at least two successive radiographs. An analysis of covariance Mixed Model for Repeated Measurements with Missing at Random (for missing data) was performed to compare adjusted 3 year JSW changes (primary outcome) and the percentages of 'progressors' (JSW loss≥0.5 mm) between groups. RESULTS: 399 patients were randomised (345 kept in the FAS), aged 62 (35-84) years, 54% women, mean body mass index 27 (SD 4) kg/m(2), mean symptom duration 4 (SD 5) years, 0-100 normalised Lequesne Index 30 (SD 9) and global pain visual analogue scale 37 (SD 23) mm. Mean baseline JSW was 2.8 (0.9) mm. There was no significant difference on mean JSW loss (-0.638 mm vs -0.672 mm, p=0.72, in the ASU-E and placebo groups, respectively) but there were 20% less progressors in the ASU-E than in the placebo group (40% vs 50%, respectively, p=0.040). No difference was observed on clinical outcomes. Safety was excellent. CONCLUSIONS: 3 year treatment with ASU-E reduces the percentage of JSW progressors, indicating a potential structure modifying effect in hip OA to be confirmed, and the clinical relevance requires further assessment.
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Osteoartritis de la Cadera/tratamiento farmacológico , Fitosteroles/uso terapéutico , Extractos Vegetales/uso terapéutico , Vitamina E/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Progresión de la Enfermedad , Método Doble Ciego , Esquema de Medicación , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/patología , Dimensión del Dolor/métodos , Fitosteroles/efectos adversos , Fitoterapia/métodos , Extractos Vegetales/efectos adversos , Estudios Prospectivos , Radiografía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vitamina E/efectos adversosAsunto(s)
Acné Vulgar/epidemiología , Dermatosis Facial/epidemiología , Complicaciones del Embarazo/epidemiología , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/patología , Adolescente , Adulto , Edad de Inicio , Antibacterianos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/patología , Femenino , Francia/epidemiología , Gluconatos/administración & dosificación , Humanos , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/patología , Mujeres Embarazadas , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND & AIMS: Saccharomyces boulardii is a probiotic yeast that has been shown to have beneficial effects on the intestinal epithelial barrier and digestive immune system. There is preliminary evidence that S boulardii could be used to treat patients with Crohn's disease (CD). We performed a randomized, placebo-controlled trial to evaluate the effects of S boulardii in patients with CD who underwent remission during therapy with steroids or aminosalicylates. METHODS: We performed a prospective study of 165 patients who achieved remission after treatment with steroids or salicylates; they were randomly assigned to groups given S boulardii (1 g/day) or placebo for 52 weeks. The primary end point was the percentage of patients in remission at week 52. Time to relapse, Crohn's disease activity index scores, and changes in parameters of inflammation were secondary end points. RESULTS: CD relapsed in 80 patients, 38 in the S boulardii group (47.5%) and 42 in the placebo group (53.2%, a nonsignificant difference). The median time to relapse did not differ significantly between patients given S boulardii (40.7 weeks) vs placebo (39.0 weeks). There were no significant differences between groups in mean Crohn's disease activity index scores or erythrocyte sedimentation rates or in median levels of C-reactive protein. In a post hoc analysis, nonsmokers given S boulardii were less likely to experience a relapse of CD than nonsmokers given placebo, but this finding requires confirmation. CONCLUSIONS: Although the probiotic yeast S boulardii is safe and well tolerated, it does not appear to have any beneficial effects for patients with CD in remission after steroid or salicylate therapies.
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Terapia Biológica/métodos , Enfermedad de Crohn/prevención & control , Enfermedad de Crohn/terapia , Probióticos/administración & dosificación , Saccharomyces/crecimiento & desarrollo , Adolescente , Adulto , Ácidos Aminosalicílicos/administración & dosificación , Antiinflamatorios/administración & dosificación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placebos/administración & dosificación , Probióticos/efectos adversos , Estudios Prospectivos , Prevención Secundaria , Esteroides/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the expression of innate immunity markers at the site of nodules caused by hidradenitis suppurativa (HS). DESIGN: Prospective analysis of 12 patients with HS. SETTING: Unité de Cancéro-Dermatologie, Nantes Hospital, Nantes; Service de Dermatologie, Poitiers Hospital, Poitiers; and Service de Dermatologie, Clinique de Courlancy, Reims, France PATIENTS: Twelve patients (Hurley stage I or II) in whom the disease had progressed for at least 6 months and who had a minimum of 2 closed nodules in typical sites. MAIN OUTCOME MEASURES: Two biopsies were performed at baseline: one in a closed inflammatory nodule and one in healthy adjoining skin. Patients were treated for 3 months with zinc gluconate at a dosage of 90 mg/d. A new biopsy was then performed in the same nodule. Innate immunity markers (toll-like receptors 2, 3, 4, 7, and 9; intercellular adhesion molecule 1; interleukin [IL] 6 and 10; tumor necrosis factor; α melanocyte stimulating hormone; transforming growth factor ß; ß-defensin 2 and 4; and insulinlike growth factor 1) were studied by immunohistochemical analysis. RESULTS: We observed significantly decreased expression (P < .001) of all the innate immunity markers studied except IL-10 in nonlesional and lesional HS skin. The downregulation of innate markers was significantly stronger in lesional HS skin compared with normal skin except for tumor necrosis factor. Three months of zinc treatment induced a significant increase in the expression of all the markers involved in innate immunity. CONCLUSION: Our study demonstrates for the first time, to our knowledge, that a deficiency of the main innate immunity markers in typical HS sites may explain the development of chronic inflammatory nodules in this disease.
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Gluconatos/farmacología , Hidradenitis Supurativa/inmunología , Inmunidad Innata/efectos de los fármacos , Piel/inmunología , Adulto , Biomarcadores/metabolismo , Regulación hacia Abajo/efectos de los fármacos , Femenino , Gluconatos/uso terapéutico , Hidradenitis Supurativa/tratamiento farmacológico , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Molécula 1 de Adhesión Intercelular/metabolismo , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Estudios Prospectivos , Estadísticas no Paramétricas , Receptores Toll-Like/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Adulto Joven , alfa-MSH/metabolismo , beta-Defensinas/metabolismoRESUMEN
Nephropathic cystinosis is a multisystem autosomal recessive disease caused by cystine accumulation, which is usually treated by oral cysteamine. In order to determine long-term effects of this therapy, we enrolled 86 adult patients (mean age 26.7 years) diagnosed with nephropathic cystinosis, 75 of whom received cysteamine. Therapy was initiated at a mean age of 9.9 years with a mean duration of 17.4 years. By last follow-up, 78 patients had end-stage renal disease (mean age 11.1 years), 62 had hypothyroidism (mean age 13.4), 48 developed diabetes (mean age 17.1 years), and 32 had neuromuscular disorders (mean age 23.3 years). Initiating cysteamine therapy before 5 years of age significantly decreased the incidence and delayed the onset of end-stage renal disease, and significantly delayed the onset of hypothyroidism, diabetes, and neuromuscular disorders. The development of diabetes and hypothyroidism was still significantly delayed, however, in patients in whom therapy was initiated after 5 years of age, compared with untreated patients. The life expectancy was significantly improved in cysteamine-treated versus untreated patients. Thus, cysteamine decreases and delays the onset of complications and improves life expectancy in cystinosis. Hence, cysteamine therapy should be introduced as early as possible during childhood and maintained lifelong.
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Cisteamina/uso terapéutico , Cistinosis/tratamiento farmacológico , Progresión de la Enfermedad , Síndrome Nefrótico/tratamiento farmacológico , Protectores contra Radiación/uso terapéutico , Adolescente , Adulto , Factores de Edad , Sistemas de Transporte de Aminoácidos Neutros/genética , Niño , Preescolar , Cisteamina/efectos adversos , Cistinosis/complicaciones , Cistinosis/genética , Complicaciones de la Diabetes/complicaciones , Escolaridad , Empleo , Síndrome de Fanconi , Femenino , Estudios de Seguimiento , Humanos , Hipotiroidismo/complicaciones , Lactante , Estimación de Kaplan-Meier , Fallo Renal Crónico/etiología , Masculino , Persona de Mediana Edad , Síndrome Nefrótico/complicaciones , Síndrome Nefrótico/genética , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades Neuromusculares/complicaciones , Protectores contra Radiación/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Neuropathic pain is often severe and adversely affects patients' quality of life. OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine-medicated plaster, in patients attending pain centres. METHODS: Medical records from 467 patients treated with 5% lidocaine-medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow-up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age. RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post-traumatic pain. The time from onset to referral was more than one year in two- thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11-point numerical rating scale score 5.2 ± 2.4 to 8.2 ± 1.6). Treatment with 5% lidocaine-medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications. CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine-medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.
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Analgésicos/uso terapéutico , Lidocaína/uso terapéutico , Neuralgia/tratamiento farmacológico , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Femenino , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Neuralgia/diagnóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Assessment of pain in children is an important aspect of pain management and can be performed by observational methods or by self-assessment. The Faces Pain Scale-Revised (FPS-R) is a self-report tool which has strong positive correlations with other well established self-report pain intensity measures. It has been recommended for measuring pain intensity in school-aged children (4 years and older). The objective of this study is to compare the concordance and the preference for two versions, electronic and paper, of the FPS-R, and to determine whether an electronic version of the FPS-R can be used by children aged 4 and older. METHODS: The study is an observational, multicenter, randomized, cross-over, controlled, open trial. Medical and surgical patients in two pediatric hospitals (N=202, age 4-12 years, mean age 8.3 years, 58% male) provided self-reports of their present pain using the FPS-R on a personal digital assistant (PDA) and on a paper version. Paper and electronic versions of the FPS-R were administered by a nurse in a randomized order: half the patients were given the PDA version first and the other half the paper version first. The time between the administrations was planned to be less than 30 minutes but not simultaneous. Two hundred and thirty-seven patients were enrolled; 35 were excluded from analysis because of misunderstanding of instructions or abnormal time between the two assessments. RESULTS: Final population for analysis comprised 202 children. The overall weighted Kappa was 0.846 (95%CI: 0.795; 0.896) and the Spearman correlation between scores on the two versions was rs=0.911 (p<0.0001). The mean difference of pain scores was less than 0.1 out of 10, which was neither statistically nor clinically significant; 83.2% of children chose the same face on both versions of the FPS-R. Preference was not modified by order, sex, age, hospitalization unit (medical or surgical units), or previous analgesics. The PDA was preferred by 87.4% of the children who expressed a preference. CONCLUSION: The electronic version of the FPS-R can be recommended for use with children aged 4 to 12, either in clinical trials or in hospitals to monitor pain intensity.
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Niño Hospitalizado/psicología , Computadoras de Mano , Dimensión del Dolor/instrumentación , Papel , Prioridad del Paciente , Niño , Preescolar , Estudios Cruzados , Femenino , Humanos , MasculinoRESUMEN
Acne can have an important psychological impact. We surveyed 852 adolescents aged 12-25 years about their knowledge of acne and its treatment in a non-medical context. The study involved a questionnaire administered to callers to a youth telephone helpline in France. Callers were categorized into those who currently had acne, those who had had acne previously, and those who had never had acne. Most respondents (66.2%) had experienced acne symptoms, which were mild in 50.2% of cases and severe in 16% of cases. Often, acne had been long-lasting (>12 months in 49.6% of cases). Many thought that gender, excess weight, eating dairy products, and physical activity did not influence acne, and that frequent washing could improve acne. Eating chocolate and snacks, smoking cigarettes, sweating, not washing, touching/squeezing spots, eating fatty foods, using make-up, pollution, and menstruation were thought to worsen acne. The majority (80.8%) did not believe acne to be a disease, but rather a normal phase of adolescence, yet 69.3% agreed it should be treated. There was a preference for topical vs. systemic treatment. Many (38.6%) of the respondents with acne had not consulted a physician. Almost two-thirds of respondents wanted more information about acne. Providing more information about acne might increase the likelihood of them consulting a physician and getting better treatment for the condition.
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Acné Vulgar/psicología , Conducta del Adolescente , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Acné Vulgar/diagnóstico , Acné Vulgar/terapia , Adolescente , Adulto , Niño , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Aceptación de la Atención de Salud , Educación del Paciente como Asunto , Percepción , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Melanoma is one of the fastest growing cancers worldwide. We need to have tools to identify patients with high risk of melanoma. We carried out a case-control study and tested three methods to develop an individual score of melanoma risk, usable in routine practice. All cases included newly diagnosed invasive cutaneous melanoma of stage I or II (6th American Joint Committee on Cancer) seen in 2007 at the Skin Cancer Unit of Nantes Hospital, France. Controls included 1500 consecutive patients consulting their general practitioners. A self-administrated questionnaire was used for assessment of melanoma risk factors. Three methods of scoring were used and compared: one with common relative risks reported in the literature, one with odds ratios estimated by logistic regression, and a combinatorial analysis. The method based on combinatorial analysis permitted one to obtain a simple rule to define individuals at risk: the association of the rule 'presence of at least three risk factors or presence of more than 20 naevi on the arms' for the patients aged under 60 years and 'presence of at least three risk factors or presence of freckles' for the patients aged 60 years and above (sensitivity: 63.2% and specificity: 68.8%). The tool we propose is easy to use every day in routine health care to select patients with high risk of melanoma. It can be assessed without any computer or calculator and is based on the self-assessment of the melanoma risk factors by the patient and thus is not medical time consuming.
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Melanoma/etiología , Neoplasias Cutáneas/etiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Francia , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Modelos Estadísticos , Invasividad Neoplásica , Oportunidad Relativa , Pronóstico , Curva ROC , Factores de Riesgo , Autoevaluación (Psicología) , Sensibilidad y Especificidad , Neoplasias Cutáneas/patología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: The objective of this study was to compare ecological and recalled pain intensity assessments over 29 days in hip and knee osteoarthritis (O) and chronic low back pain (L). PATIENTS AND METHODS: Rheumatologists were asked to enroll patients with O and L, with pain intensity above 40 mm, in a prospective study for 29 days. Pain intensity was assessed with physicians on Days 1 and 29, and ecologically, over the intervening 28-day period, by random phone calls. RESULTS: We carried out correlation analyses for 353 (159 O, 194 L) patients: Overall recalled daily pain was strongly correlated with calculated 3-day mean pain assessments (r=0.96 [O]; 0.93 [L]) and evening pain (r=0.96 [O], 0.90 [L]). Correlations between ecological and recalled measures were stronger for recall over the last 7 days than for recall over the last 28 days in osteoarthritis patients (r=0.78, r=0.63), but were similar for both recall periods in low back pain patients (r=0.70, r=0.72). Correlations between assessments for the last 7 and 28 days were stronger for ecological (r=0.88 [O], 0.91 [L]) than for clinical (r=0.77 [O]; 0.86 [L]) assessments. After adjustment for current pain intensity, correlations remained significant for ecological assessments, but not for clinical assessments. Recalled pain assessments were more accurate when made after 24 hours (r=0.71 [O]; 0.70 [L]) than when made after 48 hours (r=0.63 [O]; 0.61 [L]). CONCLUSIONS: For both low back pain and osteoarthritis, overall daily pain recall is a reliable measurement correlated with daily ecological measurements, whereas a rapid decrease in recall occurs after 48 hours. The most reliable period for pain recall was 7 days, but the results obtained were influenced by current pain.
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Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Recuerdo Mental , Osteoartritis de la Cadera/fisiopatología , Osteoartritis de la Rodilla/fisiopatología , Dimensión del Dolor/métodos , Dolor/psicología , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Extremidad Inferior/patología , Extremidad Inferior/fisiopatología , Persona de Mediana Edad , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Rodilla/complicaciones , Dolor/etiología , Dolor/fisiopatología , Estudios Prospectivos , Factores de TiempoRESUMEN
Providing information to patients regarding appropriate management of LBP is a crucial component of primary care and treatment of low back pain (LBP). Limited knowledge is available, however, about the information delivered by physicians to patients with low back pain. Hence, this study aimed at evaluating (1) the self-reported practices of French physicians concerning information about patients with acute LBP (2) the consistency of these practices with the COST B13 guidelines, and (3) the effects of the delivery of a leaflet summarizing the COST B13 recommendations on the management of patient information, using the following study design: 528 French physicians [319 general practitioners (GP) and 209 rheumatologists (RH)] were asked to provide demographic information, responses to a Fear Avoidance Beliefs questionnaire adapted for physicians and responses to a questionnaire investigating the consistency of their practice with the COST B13 guidelines. Half of the participants (163 GP and 105 RH) were randomized to receive a summary of the COST B13 guidelines concerning information delivery to patient with low back pain and half (156 GP and 104 RH) were not given this information. The mean age of physicians was 52.1±7.6 years, 25.2% were females, 75% work in private practice, 63.1% reported to treat 10-50 patients with LBP per month and 18.2%<10 per month. The majority of the physicians (71.0%) reported personal LBP episode (7.1% with a duration superior to 3 months). Among the 18.4% (97) of the physicians that knew the COST B13 guidelines, 85.6% (83/97) reported that they totally or partially applied these recommendations in their practice. The average work (0-24) and physical activity (0-24) FABQ scores were 21.2±8.4 and 10.1±6.0, respectively. The consistency scores (11 questions scored 0 to 6, total score was standardized from 0 to 100) were significantly higher in the RH group (75.6±11.6) than in GP group (67.2±12.6; p<0.001). The delivery of a summary of the COST B13 guidelines significantly improved the consistency score (p=0.018). However, a multivariate analysis indicated that only GP consistency was improved by recommendations' delivery.The results indicated that GP were less consistent with the European COST B13 guidelines on the information of patients with acute LBP than RH. Interestingly, delivery of a summary of these guidelines to GP improved their consistency score, but not that of the RH. This suggests that GP information campaign can modify the message that they deliver to LBP, and subsequently could change patient's beliefs on LBP.
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Médicos Generales/normas , Adhesión a Directriz/normas , Dolor de la Región Lumbar/terapia , Educación del Paciente como Asunto/normas , Práctica Profesional/normas , Reumatología/normas , Enfermedad Aguda , Adulto , Femenino , Francia , Adhesión a Directriz/tendencias , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Relaciones Médico-Paciente , Estudios Prospectivos , Encuestas y Cuestionarios/normasRESUMEN
OBJECTIVE: To compare the accuracy of daily and recalled pain measurements in hip and knee osteoarthritis (OA). METHODS: A prospective study investigating pain intensity over 29 days in patients with painful OA. Pain was assessed on days 1 and 29 during visits. Between these two visits, daily (worst, least, usual, mean, at rest and during daily life) and recalled pain intensities were randomly recorded by telephone interview with a numerical rating scale. RESULTS: We studied 129 patients, with a mean age of 67.7 ± 10.0 years, 27.1% males. Daily prospective assessments demonstrated that the strongest correlations were between 'mean daily' and 'usual' pain (r=0.88) and between 'mean daily' and 'worst' pain (r=0.86). Retrospective assessments demonstrated a strong correlation between recalled pain intensities and calculated mean of daily assessments over the seven and 28 days (0.78 and 0.67, respectively), but weakened by adjustment for pain intensity on the day of recalled pain assessment. Anxiety and depression scores did not affect pain recall for 7 and 28 days. CONCLUSIONS: In hip and knee OA, prospective daily pain assessment can be performed either by assessing 'usual pain' or 'worst pain' of the day. When recalled over one and four weeks, recall pain intensity is well correlated with calculated mean of prospective daily pain assessments during the same period, but correlations are weaker as the length of period increases. Either for 1 and 4 weeks, retrospective assessments are influenced by current pain intensity at the end of the period.
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Artralgia/diagnóstico , Artralgia/etiología , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor/métodos , Actividades Cotidianas , Anciano , Ansiedad/diagnóstico , Artralgia/psicología , Ritmo Circadiano , Depresión/diagnóstico , Femenino , Humanos , Masculino , Recuerdo Mental , Persona de Mediana Edad , Actividad Motora , Estudios Prospectivos , DescansoRESUMEN
Esthetic or functional repercussions in localized scleroderma may be considerable. Numerous treatments have been proposed with limited effectiveness. The purpose of this study was to evaluate the efficacy of high-dose zinc gluconate in the treatment of morphea. We are reporting a retrospective study of 17 patients with histologically confirmed localized scleroderma active for more than one year and whose treatment with a high potency dermocorticosteroid was a failure. The patients received 60 to 90 mg of zinc metal daily. The clinical evaluation was performed by the physician and the patient. An efficacy of 53% was obtained (5 partial remissions and 4 complete remissions) with a mean dose of 83.3 mg/day of zinc metal. Two patients (11.8%) had epigastralgia; no discontinuation of zinc gluconate for poor tolerability was noted.We conclude that high-dose zinc gluconate can therefore be a valuable alternative treatment for localized scleroderma, with good tolerability, although placebo-controlled studies are necessary to confirm our results.
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Fármacos Dermatológicos/uso terapéutico , Gluconatos/uso terapéutico , Esclerodermia Localizada/tratamiento farmacológico , Zinc/uso terapéutico , Administración Oral , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Inducción de Remisión , Estudios RetrospectivosRESUMEN
Existing scoring systems for facial acne focus on the lesions themselves, but clinical decisions are based on a general assessment of severity, including the time since onset, the site(s) of involvement, the patient's history, and the response to prior treatments. The aim of this study was to investigate the influence of some of these factors on the global assessment of acne severity. Involvement of the trunk, prior systemic treatment and a positive family history of acne increased the severity score. Inclusion of these factors could help to compose more homogeneous groups for clinical trials.
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Acné Vulgar/epidemiología , Humanos , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
STUDY DESIGN: A prospective study. OBJECTIVE: To identify factors potentially influencing patient self-evaluation of chronic low back pain (CLBP) and their interactions. SUMMARY OF BACKGROUND DATA: The impact of the time, context, and/or recall on the self-assessment of chronic pain intensity remains poorly understood. METHODS: A prospective study investigated patients' CLBP intensity over 29 days. Patients were evaluated on days 1 and 29 by the investigator with a pain intensity visual analog scale (0-100), and interviewed by phone on days 8, 15, and 22 to 28 to evaluate pain intensity with a numerical rating scale (0-10), either thrice daily (time-associated group), or during rest/activities (activity-associated group). Current and/or recalled pain intensities were also assessed. Means of recorded pain intensity and overall assessment of patient's pain intensity of the day were subjected to statistical analyses with analysis of variance and test of correlation. RESULTS: Among the 203 patients included, 194 (56.2% women; mean age: 47.5 +/- 12.1 year) were considered in the analysis (9 patients were not followed until day 24). Strong correlations were obtained between mean pain intensity (time-associated group = 44 patients) and overall assessment of pain intensity of the day. Strong correlations were also obtained between overall assessment of pain intensity of the day and intensity measured during each activity, but not between current pain intensity and remembered pain 24 of 48 hours earlier (activity-associated group = 150 patients). Recalled pain intensities for the last 7 or 28 days were strongly correlated with current pain intensity, but the correlations were markedly weaker after adjustment for day 29-pain intensity. CONCLUSION: For CLBP patients, overall assessment of pain intensity of the day at evening is accurate to assess pain on 1 day. Overall assessment of pain intensity of the day is very close with usual pain. Furthermore, 24 and 48 hours remembered pain intensity are not accurate measures. Recalls of pain on the 7 or 28 last days were very dependant of the pain intensity of the day of the assessment. These findings could contribute to improving pain intensity assessment in CLBP patients avoiding multiple assessments, especially during clinical trials.
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Encuestas Epidemiológicas , Dolor de la Región Lumbar/psicología , Memoria , Dimensión del Dolor/psicología , Autoevaluación (Psicología) , Actividades Cotidianas/psicología , Adulto , Femenino , Humanos , Entrevistas como Asunto , Dolor de la Región Lumbar/diagnóstico , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
PURPOSE: To investigate the relationship between high-sensitivity C-reactive protein and cardiovascular events following acute coronary syndrome. METHODS: This nationwide, cross-sectional, prospective study involved 439 patients with an acute coronary syndrome who presented to the hospital within 24 hours of symptom onset. Patients with a concomitant inflammatory process were excluded. Predischarge C-reactive protein samples were measured using a high-sensitivity method in a core laboratory. The outcome was the composite of death, acute myocardial infarction, stroke/transient ischemic attack, urgent hospitalization for unstable angina, and urgent revascularization within 1 year. RESULTS: At 1 year, event rates were 10.2% for the lowest, 8.2% for the middle, and 11.0% for the highest C-reactive protein tertiles (P = .75) with similar event-free survival (P = .70). The hazard ratio (HR) for event rates between the highest and lowest tertiles was 1.10 (95% confidence interval [CI]: 0.54 to 2.20) There was marked overlap of C-reactive protein values between patients with and without events (median [interquartile range]: 8.39 [3.27 to 32.63] vs 9.55 [4.07 to 24.02], respectively; P = .91). C-reactive protein was not an independent predictor of 1-year events (HR for highest tertile: 1.19; 95% CI: 0.58 to 2.43; P = .64) and performed poorly on receiver operating characteristic curve analysis (C statistic = 0.51). CONCLUSION: Predischarge high-sensitivity C-reactive protein level is a poor predictor of cardiovascular events at 1 year after acute coronary syndrome.
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Angina Inestable/sangre , Proteína C-Reactiva/metabolismo , Infarto del Miocardio/sangre , Adulto , Anciano , Anciano de 80 o más Años , Angina Inestable/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/metabolismo , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
AIM: Diarrhea is a significant problem in patients on total enteral nutrition (TEN) and may involve changes in intestinal short chain fatty acids or microflora. Recent studies suggest that the probiotic yeast Saccharomyces boulardii (Sb) may decrease its incidence. The aim of this study was to assess the effects of Sb on fecal flora and short-chain fatty acids (SCFA) in patients on long-term TEN. METHODS: Ten patients (3 females, 7 males, 59+/-5.5 years), on TEN for a median of 13 mo (1-125), and 15 healthy volunteers (4 females, 11 males, 32+/-2.0 years) received Sb (0.5 g bid PO) for 6 d. Two stool samples were taken before, on the last 2 d and 9-10 d after treatment, for SCFA measurement and for culture and bacterial identification. Values (mean+/-SE) were compared using sign tests and ANOVA. RESULTS: Fecal butyrate levels were lower in patients (10.1+/-2.9 mmol/kg) than in controls (19.2+/-3.9, P = 0.02). Treatment with Sb increased total fecal SCFA levels in patients (150.2+/-27.2 vs 107.5+/-18.2 mmol/kg, P = 0.02) but not in controls (129.0+/-28.6 vs 113.0+/-15.2 mmol/kg, NS). At the end of treatment with Sb, patients had higher fecal butyrate (16.0+/-4.4 vs 10.1 [2.9] mmol/kg, P = 0.004). Total SCFAs remained high 9 d after treatment was discontinued. Before the treatment, the anaerobe to aerobe ratio was lower in patients compared to controls (2.4+/-2.3 vs 69.8+/-1.8, P = 0.003). There were no significant changes in the fecal flora of TEN patients. CONCLUSION: Sb-induced increase of fecal SCFA concentrations (especially butyrate) may explain the preventive effects of this yeast on TEN-induced diarrhea.
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Diarrea/prevención & control , Ácidos Grasos Volátiles/metabolismo , Nutrición Parenteral Total/efectos adversos , Probióticos/administración & dosificación , Saccharomyces , Diarrea/etiología , Diarrea/terapia , Heces/química , Heces/microbiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Tetracyclines and macrolide antibiotics have been in use for acne treatment for more than 20 years. Since 1992 increasing resistance to these antibiotics, and especially to erythromycin, is reported with Propionibacterium acnes. Zinc salts have demonstrated their efficacy in inflammatory acne treatment as well as their bacteriostatic activity against Propionibacterium acnes. The objective of our work was firstly to determine whether the clinical anti-inflammatory efficacy of zinc salts was altered in the presence of erythromycin resistant strains in vivo, and secondly to study the in vitro and in vivo effect of zinc on the sensitivity of Propionibacterium acnes strains to erythromycin. Thirty patients with inflammatory acne were treated by zinc gluconate with a daily dose of 30 mg for two months and bacteriologic samples were taken at D0, D30 and D60. In vivo, this study displayed a reduction in the number of inflammatory lesions after a 2-month treatment whether or not Propionibacterium acnes carriage was present. Concurrently, in vitro addition of zinc salts in the culture media of Propionibacterium acnes reduced resistance of Propionibacterium acnes strains to erythromycin. Thus, association of zinc salts via a systemic route and topical erythromycin treatment seems an interesting option in the light of an increasing number of patients carrying erythromycin resistant Propionibacterium acnes strains.
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Acné Vulgar/tratamiento farmacológico , Acné Vulgar/microbiología , Eritromicina/uso terapéutico , Gluconatos/uso terapéutico , Propionibacterium acnes/efectos de los fármacos , Acné Vulgar/patología , Administración Oral , Adolescente , Adulto , Niño , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Farmacorresistencia Bacteriana , Eritromicina/farmacología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Probabilidad , Propionibacterium acnes/aislamiento & purificación , Medición de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Qvar Autohaler efficacy on asthma control, assessed with E. Juniper asthma control questionnaire (ACQ), was compared with fluticasone and budesonide. An open randomized study, stratified (2:1) on the intake of long-acting beta2-mimetics (LAbeta2), was performed in patients with moderate to severe poorly controlled asthma (defined by at least one nocturnal discomfort in the last 5 days or a mean of 2 puffs of short-acting beta2-mimetics in the last 7 days or exercise dyspnea) despite treatment with beclomethasone < or = 1000 microg/day (or equivalent). 460 patients received Qvar Autohaler 800 microg/day (n = 149), fluticasone Diskus 1000 microg/day (n = 149) or budesonide Turbuhaler 1600 microg/day (n = 162) during 12 weeks. Asthma control improved in all groups, with no difference between groups. For patients treated with LAbeta2 (n = 286) a significantly greater improvement of the ACQ score was obtained with Qvar Autohaler versus fluticasone (1.0 +/- 1.0 vs. 0.6 +/- 0.9; P = 0.019), but not versus budesonide (0.9 +/- 0.9). Pulmonary function test improvements were similar in the 3 groups. The significant improvement in asthma control in patients receiving LAbeta2 suggests potential advantages for extrafine aerosols as part of anti-inflammatory treatment optimization.
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Androstadienos/uso terapéutico , Antiinflamatorios/uso terapéutico , Asma/tratamiento farmacológico , Beclometasona/administración & dosificación , Broncodilatadores/uso terapéutico , Budesonida/uso terapéutico , Administración por Inhalación , Adulto , Aerosoles , Albuterol/análogos & derivados , Albuterol/uso terapéutico , Asma/fisiopatología , Beclometasona/uso terapéutico , Esquema de Medicación , Quimioterapia Combinada , Etanolaminas/uso terapéutico , Femenino , Fluticasona , Fumarato de Formoterol , Humanos , Antagonistas de Leucotrieno/uso terapéutico , Masculino , Inhaladores de Dosis Medida , Persona de Mediana Edad , Tamaño de la Partícula , Ápice del Flujo Espiratorio , Pruebas de Función Respiratoria , Xinafoato de SalmeterolRESUMEN
BACKGROUND: Calcium antagonists retard progression of intima-media thickness (IMT), but whether this retardation covers heterogeneous individual patient responses of IMT change is unknown. METHODS: Hypertensive patients treated for 4 years with nifedipine (n = 115) or coamilozide (n = 127) underwent ultrasound measurements of carotid IMT at baseline, 4 months later, and then every year. RESULTS: A histogram of individual slopes of IMT change (least square regression of IMT to time) during treatment identified three categories of slopes according to the 20th and 80th percentiles of distribution: lower, intermediate and higher percentiles of IMT slope; the proportion of categories of IMT slope differed between treatments (P < 0.05), due to a more frequent lower slope percentile under nifedipine (27%) than under coamilozide (14%); within-group differences between IMT slope categories were: (i) increased baseline IMT associated with lower IMT slope percentile in nifedipine group (P < 0.001) and (ii) more frequent carotid plaque associated with higher IMT slope percentile in both treatment groups (P < 0.05). Analysis of overall patients showed that IMT slope was associated negatively with nifedipine treatment (P < 0.01) and baseline IMT (P < 0.001) and positively with carotid plaque (P < 0.01); the relationship between IMT slope and baseline IMT was negative under nifedipine and flat under coamilozide, and the presence of plaque reset both relationships towards a higher IMT slope; the between-treatment difference in IMT slope was different between tertiles of baseline IMT (P = 0.016). CONCLUSIONS: The differences in IMT slope between nifedipine and coamilozide increase with increasing baseline IMT.