Relationship between behavior and asthma in children with atopic dermatitis. OBJECTIVE: The significance of psychological factors in asthma is a subject of considerable dispute. This study addressed the little investigated question of the potential role of psychological factors in the initial onset of asthma. MATERIALS AND METHODS: Data on the validated, standardized Behavior Screening Questionnaire were obtained prospectively from 35 to 53 months for 150 atopic children who had asthma by age 53 months and for 115 who did not. RESULTS: At each age, the children who had asthma by 53 months had more behavior problems. There was no evidence that the subsequent behavior of those children who had asthma became more problematic. However, for those children without asthma by 35 months, an elevated behavior problem score at that age was related to the subsequent onset of asthma by age 53 months. The behavior problem score added significantly to the prediction of asthma onset (OR adjusted: 1.15; 95% CI: 1.02-1.29) when known risk factors of asthma and IgE levels for grass pollen and house dust mite at age 17 months were taken into account. CONCLUSIONS: Behavior problems may precede asthma onset in young atopic children. In this age group, behavior problems are not secondary psychological reactions to asthma onset. They may act as a marker for stress in the child's life. The presence of behavior problems should alert clinicians that the child may be at increased risk for transition from atopic dermatitis to asthma. Journal ISSN: 1534-7796 Issue: 65-6 (2003 Nov-Dec) Pages: 971-5
An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. STUDY OBJECTIVES: Preoperative renal dysfunction is a risk factor for adverse events in cardiac surgery. This study compared creatinine clearance (ClCr), estimated from the Cockroft and Gault formula, and plasma creatinine level as predictors of outcome after cardiac surgery. DESIGN: Prospective, observational. SETTING: University hospital. PATIENTS: A total of 6,364 cardiac surgical patients. METHODS: The measured outcomes were postoperative renal failure requiring dialysis, and mortality and major morbidity. For each outcome, two multivariable risk models were developed, using either estimated ClCr as a measure of renal function, or plasma creatinine level. Risk-adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each outcome. Discrimination was compared using receiver operating characteristic (ROC) curves. RESULTS: For each 10 mL/min/1.73 m(2) decrement of estimated ClCr, the ORs for renal failure requiring dialysis, mortality, and major morbidity in the whole population were 1.52 (95% CI, 1.35 to 1.67), 1.27 (95% CI, 1.19 to 1.35), and 1.18 (95% CI, 1.14 to 1.21), respectively; for each 0.2 mg/dL increment of plasma creatinine, ORs were 1.20 (95% CI, 1.15 to 1.26), 1.08 (95% CI, 1.04 to 1.13), and 1.12 (95% CI, 1.09 to 1.15), respectively. The areas under the ROC curves for prediction of renal failure requiring dialysis were 0.83 with both risk models. For prediction of mortality and major morbidity, areas under the ROC curves were 0.83 and 0.72, respectively, with the models using estimated ClCr, and 0.74 and 0.65, respectively, with the models using plasma creatinine level (p < 0.001 vs estimated ClCr for both outcomes). In patients with normal plasma creatinine levels (n = 4,603), estimated ClCr remained a significant predictor of each outcome with similar ORs, but plasma creatinine level was not a predictor of any outcome. CONCLUSION: The risk-adjusted association between preoperative renal dysfunction and adverse events after cardiac surgery is stronger with estimated ClCr than with plasma creatinine level, particularly in patients with normal plasma creatinine levels. The routine preoperative estimation of ClCr may improve the identification of higher-risk cardiac surgical patients. Journal ISSN: 0012-3692 Issue: 124-5 (2003) Pages: 1852-62
Antidepressant-induced adverse reactions in a patient with hemorrhagic stroke. Antidepressant-induced adverse reactions in a patient with hemorrhagic stroke. OBJECTIVE: To report a case of antidepressant-induced adverse drug reactions in a patient with hemorrhagic stroke. CASE SUMMARY: A 56-year-old man developed life-threatening adverse reactions after fluoxetine was added to his previously prescribed regimen of buspirone and olanzapine. One week after starting fluoxetine 60 mg/day, the patient developed syndrome of inappropriate antidiuretic hormone secretion and serotonin syndrome concurrently. The patient had experienced a hemorrhagic stroke before the adverse drug reactions occurred. DISCUSSION: A patient with a history of hemorrhagic stroke developed serious adverse drug reactions when fluoxetine was added to his drug therapy. When the combination therapy was stopped, all adverse effects gradually disappeared and laboratory abnormalities were corrected. The likelihood that the adverse reactions were caused by fluoxetine is probable according to the Naranjo probability scale. In addition, a history of stroke may be a risk factor for the development of such reactions. CONCLUSIONS: Today, patients with depression after experiencing a stroke are treated more effectively, but antidepressant-induced adverse drug reactions may be serious. A growing number of patients are treated for post-stroke depression; they require close supervision and careful dosing of antidepressants to prevent full-blown adverse reactions from occurring. Journal ISSN: 1060-0280 Issue: 39-10 (2005) Pages: 1755-7
Acute phase and five-year follow-up study of fluoxetine in adolescents with major depression and a comorbid substance use disorder: A review. Acute phase and five-year follow-up study of fluoxetine in adolescents with major depression and a comorbid substance use disorder: A review. This paper reviews the results of an acute phase trial and a five-year follow-up study of fluoxetine in adolescents with major depression and a substance use disorder (SUD). This study included a 12-week open label acute phase study of 13 comorbid adolescents, followed by comprehensive assessments conducted 1, 3, and 5 years after entry into an acute phase fluoxetine trial. The results of the acute phase study and of the 1, 3, and 5-year follow-up assessments have already been published in four papers. The current paper was designed to cover the results of the study across the entire 5-year time spectrum of the study, and to summarize the clinical results across that entire time period. The data from this pilot study suggest that the long-term (5-year) clinical course for the Alcohol Dependence, Cannabis Dependence, and academic functioning of comorbid adolescents following acute phase treatment with SSRIs is generally good. However, the long-term clinical course for the Major Depression of that comorbid adolescent population is surprisingly poor. Journal ISSN: 0306-4603 Issue: - (2005) Pages:
Levocetirizine: new preparation. Me-too: simply the active enantiomer of cetirizine. Levocetirizine: new preparation. Me-too: simply the active enantiomer of cetirizine. Levocetirizine is the active enantiomer of cetirizine. According to the only available comparative trial in patients with seasonal allergic rhinitis, 5 mg levocetirizine is equivalent to 10 mg cetirizine. Journal ISSN: 1167-7422 Issue: 12-67 (2003) Pages: 171-2
Fluoxetine monotherapy of bipolar type II and bipolar NOS major depression: a double-blind, placebo-substitution, continuation study. Fluoxetine monotherapy of bipolar type II and bipolar NOS major depression: a double-blind, placebo-substitution, continuation study. Current guidelines for the treatment of bipolar type II (BP II) major depressive episode (MDE) recommend using either mood stabilizer monotherapy or the combination of a mood stabilizer with a selective serotonin reuptake inhibitor (SSRI). These guidelines are the result of concern over SSRI-induced manic switch episodes. We previously showed that fluoxetine monotherapy may be effective as an initial treatment for BP II and BP NOS MDE with a low manic switch rate. We now present the results of a double-blind, placebo-substitution continuation study of fluoxetine monotherapy in BP II and BP NOS patients who have recovered from their MDE. This was a two-phase study. In study phase I, patients received open-label fluoxetine monotherapy 20 mg daily for up to 8 weeks. Responders with a final 17-item Hamilton Rating Scale for Depression (HAM-D) score < or =9 were enrolled into study phase II which consisted of double-blind, placebo-substitution continuation therapy with fluoxetine 20 mg daily for up to 6 months. Outcome measures included the 17-item HAM-D and Young Mania Rating (YMR) scales. Changes in YMR scores were assessed using generalized estimating equation analysis. Relapse was assessed using Kaplan-Meier survival analysis and Fisher's exact test. In study phase II, 43% of fluoxetine-treated patients and 100% of placebo-treated patients relapsed during continuation therapy (P=0.08). The mean increase in YMR score in study phase II was slightly higher in the fluoxetine-treated patients (3.0+/-1.8) versus placebo-treated patients (0.2+/-0.4) (P=0.01). However, this difference was not clinically meaningful. No hypomanic switch episodes were observed during study phase II. Despite the limited sample size resulting in insufficient power to detect statistical significance in relapse rates or change in YMR scores between treatment conditions, these preliminary data appear to support previous observations demonstrating that initial and continuation fluoxetine monotherapy may be safe and effective for some patients with BP II or BP NOS MDE with a low manic switch rate. Larger-scale studies are needed to confirm these findings. Journal ISSN: 0268-1315 Issue: 20-5 (2005) Pages: 257-64
Fexofenadine hydrochloride, 180 mg, exhibits equivalent efficacy to cetirizine, 10 mg, with less drowsiness in patients with moderate-to-severe seasonal allergic rhinitis. Fexofenadine hydrochloride, 180 mg, exhibits equivalent efficacy to cetirizine, 10 mg, with less drowsiness in patients with moderate-to-severe seasonal allergic rhinitis. BACKGROUND: Previous studies have shown that fexofenadine and cetirizine effectively relieve symptoms of seasonal allergic rhinitis (SAR). OBJECTIVE: To compare the effects of fexofenadine hydrochloride, 180 mg, and cetirizine, 10 mg, on symptoms, drowsiness, and motivation in patients with moderate-to-severe SAR. METHODS: In this 2-week multicenter, double-blind, randomized study, 495 subjects with moderate-to-severe SAR received once-daily fexofenadine hydrochloride, 180 mg, or cetirizine, 10 mg, without regard to food intake. Daily 12-hour reflective (AM, PM) and instantaneous (AM) individual symptoms and total symptom score (TSS) were evaluated. Drowsiness and motivation were recorded daily using visual analog scale at 7 AM, 10 AM, and 3 PM. RESULTS: Between-treatment differences in reduction from baseline in AM instantaneous and 24-hour reflective TSS were -0.18 [95% confidence interval (CI), -0.55 to 0.20) and -0.22 (95% CI, -0.59 to 0.15), respectively. Since CIs for reduction in TSS between treatments fell within a 0.7 margin (defined a priori), treatments were considered statistically equivalent. Patients receiving fexofenadine experienced significantly less overall drowsiness vs baseline than those receiving cetirizine [-2.33 (95% CI, -3.80 to 0.86) vs 0.37 (95% CI, -1.10 to 1.84), P = .0110]. There was a trend toward greater improvements in overall motivation with fexofenadine compared with cetirizine [-2.36 (95% CI, -3.83 to 0.90) vs -0.30 (95% CI, -1.76 to 1.17), P = .0504]. CONCLUSIONS: Once-daily fexofenadine hydrochloride, 180 mg, given for 2 weeks caused statistically and clinically equivalent improvement in symptoms and significantly less drowsiness va baseline, compared with cetirizine, 10 mg, in patients with moderate-to-severe SAR. Journal ISSN: 1081-1206 Issue: 91-4 (2003) Pages: 354-61
Venlafaxine extended release versus conventional antidepressants in the remission of depressive disorders after previous antidepressant failure: ARGOS study. Venlafaxine extended release versus conventional antidepressants in the remission of depressive disorders after previous antidepressant failure: ARGOS study. Serotonin-norepinephrine reuptake inhibitors (SNRIs) may be used as an alternative treatment for depressed patients who do not tolerate or respond adequately to treatment with a conventional antidepressant. This randomized, open-label, multicenter study compared the effectiveness of the SNRI venlafaxine extended release (VXR) with that of conventional antidepressants (CA) in patients who were referred to an outpatient psychiatric specialty care setting for treatment after failure to tolerate or respond to at least 4 weeks of treatment with a CA in a primary care setting. Patients with a Hamilton Depression Rating Scale (HAM-D(17)) score >/=17 were randomly assigned to treatment with an alternative CA or VXR. Remission was defined as a score
