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Vinson D, Molet-Benhamou L, Degboé Y, den Broeder A, Ibrahim F, Pontes C, Westhovens R, Závada J, Pham T, Barnetche T, Constantin A, Ruyssen-Witrand A. Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis: a systematic analysis of the literature and meta-analysis. Arthritis Res Ther 2020; 22:97. [PMID: 32349791 PMCID: PMC7191828 DOI: 10.1186/s13075-020-02188-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To systematically review the impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and severe adverse events (SAEs) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) in remission or low disease activity (LDA) state. MATERIALS AND METHODS A meta-analysis based on a systematic review of PubMed, Embase, Cochrane, until August 2019, as well as relevant databases of international conferences, was used to evaluate the risk difference (RD) at 95% confidence interval (95% CI) of incidence density of serious infections, SAEs, malignancies, cardiovascular adverse events (CV AEs), or deaths after tapering (dose reduction or spacing) compared to continuation of targeted therapies. RESULTS Of the 1957 studies initially identified, 13 controlled trials (9 RA and 4 SpA trials) were included in the meta-analysis. 1174 patient-years were studied in the tapering group (TG) versus 1086 in the usual care group (UC). There were 1.7/100 patient-year (p-y) serious infections in TG versus 2.6/100 p-y in UC (RD (95% CI) 0.01 (0.00 to 0.02), p = 0.13) and 7.4/100 p-y SAEs in TG versus 6.7/100 p-y in UC (RD 0.00 (- 0.02 to 0.02), p = 0.82). The risk of malignancies, CV AEs, or deaths did not differ between the tapering and the usual care groups. Subgroup analysis (RA and SpA) detected no significant differences between the two groups. CONCLUSION We could not show significant impact of tapering bDMARD or JAKi over continuation concerning the risk of serious infections, SAEs, malignancies, CV AEs, or deaths in RA and SpA patients in remission or LDA state.
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Affiliation(s)
- D Vinson
- Rheumatology Department, CHU Sainte Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France.
| | | | - Y Degboé
- INSERM U1043, CPTP, Toulouse, France
| | - A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, 6500 GM, Nijmegen, The Netherlands
| | - F Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - C Pontes
- Department of Pharmacology, Therapeutics and Toxicology, Unitat docent Parc Taulí-Medical School-Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - R Westhovens
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, Rheumatology University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - J Závada
- First Faculty of Medicine, Institute of Rheumatology and Department of Rheumatology, Charles University, Na Slupi 4, Prague, Czech Republic
| | - T Pham
- Rheumatology Department, CHU Sainte Marguerite, 270 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - T Barnetche
- Rheumatology Department, Pellegrin Hospital, Bordeaux, France
| | - A Constantin
- Rheumatology Department, Hôpital Purpan, Toulouse, France
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Salazar C, Obach M, Fontanet J, Garrido G, Feliu A, Riba M, Umbria M, Gasol M, Prat A, Vallano A, Pontes C. Consistency of ESMO-MCBS scores with drug access recommendations in Catalonia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3
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Ribeiro G, Camacho M, Santos O, Pontes C, Torres S, Oliveira-Maia AJ. Association between hedonic hunger and body-mass index versus obesity status. Sci Rep 2018; 8:5857. [PMID: 29643337 PMCID: PMC5895788 DOI: 10.1038/s41598-018-23988-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/23/2018] [Indexed: 01/25/2023] Open
Abstract
Obesity-associated differences in hedonic hunger, while consistently reported, have not been adequately quantified, with most studies failing to demonstrate strong correlations between Body Mass Index (BMI) and hedonic hunger indicators. Here, we quantified and assessed the nature of the relationship between hedonic hunger and BMI, in a cross-sectional study using the Portuguese version of the PFS (P-PFS) to measure hedonic hunger. Data were collected from 1266 participants belonging to non-clinical, clinical (candidates for weight-loss surgery) and population samples. Across samples, significant but weak positive associations were found between P-PFS scores and BMI, in adjusted linear regression models. However, in logistic regression models of data from the clinical and non-clinical samples, the P-PFS Food Available domain score was significantly and robustly associated with belonging to the clinical sample (OR = 1.8, 95%CI: 1.2–2.8; p = 0.008), while in the population sample it was associated to being obese (OR = 2.1, 95%CI: 1.6–2.7; p < 0.001). Thus, hedonic hunger levels are associated with obesity status with the odds of being obese approximately doubling for each unit increase in the P-PFS Food Available score.
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Affiliation(s)
- Gabriela Ribeiro
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. de Brasília, Doca de Pedrouços, 1400-038, Lisboa, Portugal.,Lisbon Academic Medical Centre PhD Program, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Marta Camacho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. de Brasília, Doca de Pedrouços, 1400-038, Lisboa, Portugal.,John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, CB2, 0SP, UK
| | - Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Cristina Pontes
- Psychiatry and Mental Health Clinic, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Sandra Torres
- Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.,Centro de Psicologia da Universidade do Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. de Brasília, Doca de Pedrouços, 1400-038, Lisboa, Portugal. .,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira, 126, 1340-019, Lisboa, Portugal. .,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal. .,Champalimaud Research, Champalimaud Centre for the Unknown, Av. de Brasília, Doca de Pedrouços, 1400-038, Lisboa, Portugal.
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Brinkman DJ, Tichelaar J, Schutte T, Benemei S, Böttiger Y, Chamontin B, Christiaens T, Likic R, Maˇiulaitis R, Marandi T, Monteiro EC, Papaioannidou P, Pers YM, Pontes C, Raskovic A, Regenthal R, Sanz EJ, Tamba BI, Wilson K, Vries TD, Richir MC, Agtmael MV. Essential competencies in prescribing: A first european cross-sectional study among 895 final-year medical students. Clin Pharmacol Ther 2016; 101:281-289. [PMID: 27648725 PMCID: PMC5260337 DOI: 10.1002/cpt.521] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/23/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
Abstract
European medical students should have acquired adequate prescribing competencies before graduation, but it is not known whether this is the case. In this international multicenter study, we evaluated the essential knowledge, skills, and attitudes in clinical pharmacology and therapeutics (CPT) of final‐year medical students across Europe. In a cross‐sectional design, 26 medical schools from 17 European countries were asked to administer a standardized assessment and questionnaire to 50 final‐year students. Although there were differences between schools, our results show an overall lack of essential prescribing competencies among final‐year students in Europe. Students had a poor knowledge of drug interactions and contraindications, and chose inappropriate therapies for common diseases or made prescribing errors. Our results suggest that undergraduate teaching in CPT is inadequate in many European schools, leading to incompetent prescribers and potentially unsafe patient care. A European core curriculum with clear learning outcomes and assessments should be urgently developed.
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Affiliation(s)
- D J Brinkman
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - J Tichelaar
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - T Schutte
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - S Benemei
- Unit of Clinical Pharmacology, University of Florence, Florence, Italy
| | - Y Böttiger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - B Chamontin
- Department of Internal Medicine and Hypertension, University of Toulouse, Toulouse, France
| | - T Christiaens
- Department of Clinical Pharmacology, Ghent University, Ghent, Belgium
| | - R Likic
- Unit of Clinical Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - R Maˇiulaitis
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - T Marandi
- Department of Cardiology, University of Tartu, Tartu, Estonia
| | - E C Monteiro
- Faculty of Medicine, NOVA Medical School, Lisbon, Portugal
| | - P Papaioannidou
- Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Y M Pers
- Clinical Immunology and Osteoarticular Diseases Unit, University of Montpellier, Montpellier, France
| | - C Pontes
- Department of Pharmacology, Autonomous University of Barcelona, Barcelona, Spain
| | - A Raskovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Novi Sad, Novi Sad, Serbia
| | - R Regenthal
- Department of Clinical Pharmacology, Leipzig University, Leipzig, Germany
| | - E J Sanz
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - B I Tamba
- Department of Pharmacology and Algesiology, Gr. T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - K Wilson
- Faculty of Medicine, University of Manchester, Manchester, UK
| | - Tp de Vries
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - M C Richir
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Ma van Agtmael
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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5
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Affiliation(s)
- C Pontes
- Unitat Docent Parc Taulí. Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
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6
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Arévalo Salaet M, Aparicio M, Pontes C, Torres F, Salman T, Blanco F, Sellas A, Sanmarti R, Gratacos J. SAT0404 Evaluation of The Clinical Usefulness of A Standardized Dose Reduction Protocol for Maintenance of Remission in Patients with As under anti-TNF Treatment: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Cardesin A, Pontes C, Rosell R, Escamilla Y, Marco J, Escobar MJ, Bernal-Sprekelsen M. A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia. Rhinology 2015; 53:107-15. [PMID: 26030032 DOI: 10.4193/rhino14.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. METHODS A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. RESULTS A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. CONCLUSION The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.
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Dussault G, Correia T, Pontes C. Impact of the economic crisis on human resources for health policies in Southern EU countries. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Pontes C, Fontanet J, Gomez-Valent M, Rios Guillermo J, Vives Vilagut R, Morros R, Martinalbo J, Torrent-Farnell J, Torres F. Clustering of rare medical conditions based on clinical features which determine applicability of investigative designs and methods to their study. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Pontes C, Vives Vilagut R, Torres F, Cardesín Revilla A, Rosell Ferrer R, Escamilla Carpintero Y, Marco Valls J, Bernal Sprekelsen M. Generation of efficacy data to support routine clinical practice: use of clonidine as adjunctive to anesthesia to reduce surgical field bleeding in endoscopic naso-sinusal Surgery. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pontes C. Heterogeneity, the problem with the averages and the new regulatory challenge: “whom to treat”. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Pontes C, Fontanet J, Gomez-Valent M, Rios Guillermo J, Vives Vilagut R, Morros R, Martinalbo J, Torrent-Farnell J, Torres F. Milestones On Orphan Medicinal Products Development: The 100 First Drugs for Rare Diseases Approved Throughout Europe. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pontes C, Morros R, Marsal J, de Abajo F, Castillo J, Rios J, Carné X, Du Souich P. OP0019 Osteoarthritis, Drug Use and Risk of Cardiac Ischaemic Events: A Case-Control Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moreno M, Lisbona M, Luelmo J, Gallardo F, Ferran M, Pontes C, Vives R, Gratacόs J, Maymo J. THU0429 Ultrasound Differences Between Psoriatic Onychopathy and Onychomycosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Cardesin A, Pontes C, Rosell R, Escamilla Y, Marco J, Escobar M, Bernal Sprekelsen M. A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia. Rhinology 2015. [DOI: 10.4193/rhin14.185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Cabré M, Rudi N, Pontes C, Vergara M, Parra I, Gorgas MQ. GRP-121 Multidisciplinary Monitoring of Psychiatric Morbidity of HCV-Infected Patients Treated with Interferon and Ribavirin. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pontes C. Recommended core curriculum for a specialist training program in neurology. Consensus document of the EFNS/EBN: Final Draft Paris September 2004. Eur J Neurol 2005; 12:743-6. [PMID: 16190911 DOI: 10.1111/j.1468-1331.2005.01368.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Pontes
- Servico de Neurologia, Faculdade de Medicina/Hospital de S. João, Porto, Portugal.
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Abreu P, Azevedo E, Lobo L, Moura C, Pontes C. [Cerebral Whipple disease without gastrointestinal symptoms]. Rev Neurol 2005; 40:255. [PMID: 15765321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Cox DG, Pontes C, Guino E, Navarro M, Osorio A, Canzian F, Moreno V. Polymorphisms in prostaglandin synthase 2/cyclooxygenase 2 (PTGS2/COX2) and risk of colorectal cancer. Br J Cancer 2004; 91:339-43. [PMID: 15173859 PMCID: PMC2409800 DOI: 10.1038/sj.bjc.6601906] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammation plays a key role in the development of colorectal cancers. We have investigated the relationship between PTGS2 (COX2) polymorphisms and colorectal cancer risk in a hospital based case-control study. We recruited 292 patients with colorectal cancer and 274 controls from new patients admitted to Bellvitge Hospital, Barcelona, Spain, from 1996 to 1998. Subjects responded to a questionnaire on risk factors. Genotypes of the eight more frequent polymorphisms of PTGS2 were determined. Two polymorphisms are located in the promoter sequence, one in the untranslated region of exon 1, one in exon 3, one in intron 5, two in the untranslated region of exon 10, and one downstream of the last polyadenylation (poly-A) signal. Associations were analysed with logistic regression models assuming a dominant effect for rare variants to increase statistical power. An association was detected between colorectal cancer and a polymorphism in the untranslated region of exon 10 of PTGS2, with an odds ratio (OR) of 2.49, 95% confidence interval (CI) of 1.17-5.32, P=0.01. A nearby polymorphism downstream of the last poly-A signal also showed a nonsignificant increase in risk (OR 2.17, 95% CI 0.99-4.78, P=0.05). Analysis of haplotypes confirmed that individuals with these variants were at increased risk of colorectal cancer (OR compared to the most frequent haplotype: 2.17, 95% CI 0.97-4.84, P=0.06) Interactions between PTGS2 genotype and use of nonsteroidal anti-inflammatory drugs and risk of colorectal cancer were also explored.
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Affiliation(s)
- D G Cox
- Genome Analysis Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, Cedex 08, France
| | - C Pontes
- Cancer Epidemiology Service, Catalan Institute of Oncology, Barcelona, Spain
| | - E Guino
- Cancer Epidemiology Service, Catalan Institute of Oncology, Barcelona, Spain
| | - M Navarro
- Medical Oncology Service, Catalan Institute of Oncology, Barcelona, Spain
| | - A Osorio
- Digestive Surgery Service, Ciudad Sanitaria i Universitaria de Bellvitge, University of Barcelona, Barcelona, Spain
| | - F Canzian
- Genome Analysis Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, Cedex 08, France
- Genome Analysis Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, Cedex 08, France. E-mail:
| | - V Moreno
- Cancer Epidemiology Service, Catalan Institute of Oncology, Barcelona, Spain
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de la Sierra A, Gil-Extremera B, Calvo C, Campo C, García-Puig J, Márquez E, Oliván J, Roca Cusachs A, Sanz de Castro S, Pontes C, Delgadillo J. Comparison of the antihypertensive effects of the fixed dose combination enalapril 10 mg/nitrendipine 20 mg vs losartan 50 mg/hydrochlorothiazide 12.5 mg, assessed by 24-h ambulatory blood pressure monitoring, in essential hypertensive patients. J Hum Hypertens 2004; 18:215-22. [PMID: 14973517 DOI: 10.1038/sj.jhh.1001655] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fixed combinations of calcium channel blockers and angiotensin converting enzyme inhibitors represent an alternative to diuretic-based combination therapy. The aim of the present study was to compare the antihypertensive efficacy of the combination enalapril 10 mg/nitrendipine 20 mg (E/N) vs losartan 50 mg/hydrochlorothiazide 12.5 mg (L/H), assessed by 24-h ambulatory blood pressure monitoring. This multicentre, double-blind, parallel study included 97 hypertensive patients (office diastolic blood pressure (DBP) 90-109 mmHg and daytime DBP > 85 mmHg). After a 2- to 3-week period of single-blind placebo, they were randomized to receive double-blind treatment with E/N (n = 48) or L/H (n = 49) for a 4-week period. The primary outcome measure was the difference in 24-h DBP reduction between treatments from randomization to the end of the double-blind period. Secondary efficacy variables included differences in 24-h systolic (S) BP reduction, daytime, night-time and office SBP and DBP reduction, proportion of responders and controlled patients, trough-to-peak ratio and smoothness indexes. Safety was assessed by the proportion of patients with adverse events and the detection of laboratory abnormalities. No significant differences were observed in the primary outcome measure. The group receiving E/N tended to show greater reductions in most measures (24 h, daytime and office SBP and DBP) and higher BP control rates, but only the difference in the rate of office SBP control (< 140 mmHg) reached statistical significance (42.2 vs 22.4%; P = 0.048). The trough-to-peak ratios and smoothness indexes were similar in both groups. The incidence of adverse events related to the treatment was 27.1% (95% CI 14.5-39.6%) in E/N-treated patients and 14.3% (95% CI 4.5-45.8%) in the L/H group, but differences were not significant. The kind of event more frequently observed were flushing and headache in E/N, and dizziness and asthenia in L/H; all observed adverse events were mild. We conclude that E/N and L/H have a similar antihypertensive efficacy, assessed by office or ambulatory blood pressure monitoring. E/N achieved a significantly higher office SBP control rate, but this was accompanied by an apparently higher proportion of mild adverse events.
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Affiliation(s)
- A de la Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Clinic, Barcelona, Spain.
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Antoñanzas F, Velasco M, Abbas I, Pontes C, Delgadillo J, Terán M. [Theoretical model of a cost-effectiveness analysis of combined enalapril-nitrendipine therapy for treating hypertension]. Aten Primaria 2003; 31:366-71. [PMID: 12716571 PMCID: PMC7681723 DOI: 10.1016/s0212-6567(03)70700-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2002] [Accepted: 12/02/2002] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Cost-effectiveness analysis of combined enalapril-nitrendipine therapy (E/N), as second-line therapy for light or moderate hypertension. DESIGN Theoretical model of cost-effectiveness, based on the norms of hypertension treatment in primary care, the considered view of a panel of experts and the direct costs of health resources and purchase of medication. SETTING Spanish National Health system. PARTICIPANTS Simulation of 1000 patients with hypertension, with a time horizon of one year. INTERVENTIONS After a prior failure of the first-line treatment with either enalapril or nitrendipine, an evaluation was made of the possibilities of increasing dosage of the first-line treatment, changing the drug or administering the E/N combination. MAIN MEASUREMENT The likelihoods, in the primary care context, of controlling diastolic pressure, of abandonment and of using the two strategies or not were measured, as were the use of health resources in each situation, and costs of resource use and of medication. RESULTS The cost-effectiveness quotient of the combined E/N treatment was consistently more efficient than the increase in dose or change to another drug. This was so, whether the treatment was started with enalapril (301.06 euros vs 337.97 euros and 588.42 euros) or with nitrendipine (331.5 euros vs 469.88 euros and 579.76 euros). CONCLUSIONS Combined therapy (E/N) is, on the basis of the assumptions made in the model, an efficient therapy option. Therefore, it can be recommended for prescription.
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Affiliation(s)
- F. Antoñanzas
- Soikos, SL, Barcelona, España
- Departamento de Economía y Empresa, Universidad de La Rioja, Logroño, España
| | | | | | - C. Pontes
- Vita-Invest, SA, Sant Joan Despí (Barcelona), España
| | - J. Delgadillo
- Vita-Invest, SA, Sant Joan Despí (Barcelona), España
| | - M. Terán
- Vita-Invest, SA, Sant Joan Despí (Barcelona), España
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Abstract
There is insufficient information on the prognosis and safety of anticoagulation in acute cerebral vein and dural sinus thrombosis (CVDST). To describe the clinical aspects and medical management of CVDST in Portuguese hospitals, to evaluate the safety of anticoagulation in this setting, and to identify subgroups of CVDST patients with different prognoses, we registered symptomatic CVDST patients admitted to Portuguese hospitals since 1980. Cases were collected from file review up to 6/95 and from consecutively admitted patients from 6/95 to 6/98. One hundred and forty-two patients were included from 20 centers (51 retrospectively and 91 prospectively). One hundred and twelve patients (79%) were anticoagulated. There were only 6 new intracranial hemorrhages (4 in anticoagulated patients) and 2 systemic hemorrhages. Nine (6%) patients died. At discharge, 96 (68%), had recovered completely and only 6 (4%) were dependent (Rankin > or = 3). Significant multivariate predictors of death/dependency were central nervous system infection as a predisposing cause (odds ratio, OR = 15.4; 95% confidence interval CI = 111-1.1), encephalopathy on admission (OR = 5.2; 95% CI = 18.7-1.5) and hemorrhage on admission CT/MR (OR = 3.6; 95% CI = 12.9-1). Significant predictors of complete recovery were no encephalopathy on admission (OR = 5; 95% CI = 12.5-2.1), age < 45 years (OR = 3.8; 95% CI = 9.2-1.6) and anticoagulation (OR = 3.8; 95% CI = 9.6-1.5). It is possible to identify CVDST patients with potential bad or good prognosis in the acute phase. Anticoagulation was safe and a predictor of complete recovery in acute CVDST.
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Affiliation(s)
- J M Ferro
- Department of Neurology, Hospital Santa Maria, Lisboa, Portugal.
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del Palacio A, Sanz F, Sánchez-Alor G, Garau M, Calvo MT, Boncompte E, Algueró M, Pontes C, Gómez de la Cámara A. Double-blind randomized dose-finding study in acute vulvovaginal candidosis. Comparison of flutrimazole site-release cream (1, 2 and 4%) with placebo site-release vaginal cream. Mycoses 2000; 43:355-65. [PMID: 11105539 DOI: 10.1046/j.1439-0507.2000.00575.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A double-blind randomized comparative phase II study of flutrimazole site-release vaginal cream (1, 2 and 4%) with placebo site-release vaginal cream was undertaken in patients with acute vulvovaginal candidosis. Vaginitis was demonstrated by both positive findings on microscopic examination of vaginal smears and positive culture as well as by the presence of clinical signs and symptoms. The vaginal monodose treatment was inserted in the evening at bedtime using a vaginal applicator and, in addition, all four groups of patients received additional topical external cream for application to the vulva twice-daily for 7 days; the placebo group received a placebo cream and the active therapy groups all received a 2% flutrimazole cream. A total of 133 patients who were seen over a 10-month period were screened and randomized: five patients did not take the allocated medication, and four patients whose menstrual period began shortly after study entry were excluded from the study, leaving 124 patients who were randomly allocated to receive a monodose vaginal 1% cream (regimen A, 28 patients), a monodose vaginal 2% cream (regimen B, 32 patients), a monodose vaginal 4% cream (regimen C, 31 patients) or a monodose vaginal placebo cream (regimen D, 33 patients). At the assessment 9 days after the end of therapy the proportion of patients who were cured was 82% in group A, 87.4% in group B, 83.8% in group C and 63.5% in group D. Three patients (10.7%) in group A, four (12.5%) in group B, one (3.2%) in group C and 12 (36.36%) in group D did not respond to the treatment. One patient (3.5%) in group A, and two patients (6.4%) in group C terminated the treatment prematurely due to intolerance. There was a significant association between Candida glabrata and treatment failure (P < 0.04) and C. glabrata and carrier state (P = 0.01) in vagina (chi 2 test, P = 0.01) and vulvovagina (chi 2 test, P = 0.00001). At the assessment 4 weeks after the end of therapy the proportion of cured patients was 60.6% in group A, 78% in group B, 80.6% in group C and 48.4% in group D. Group D (placebo) versus group B (2%) and group C (4%) showed a significant difference (P = 0.01 and P = 0.007, respectively). Although there were no significant differences in clinical and mycological activity between the three active groups, group B (flutrimazole 2% site-release vaginal cream) was chosen for clinical use due to its tolerance profile. Seven patients (25%) in group A, three (9.3%) in group B, two (6.4%) in group C and five (15.1%) in group D relapsed 4 weeks after the end of therapy; the relapse rate was not significantly associated with positive culture results 9 days after treatment. There was a significant association between C. glabrata and the carrier state (P < 0.01). The overall ineffective treatment (includes failures at control 1, relapses at control 2 and premature terminations) was 39% in group A, 21.7% in group B, 16% in group C and 51.3% in group D. There was a significant difference in the overall ineffective treatment when C and D groups were compared with placebo (P = 0.01 and P = 0.003, respectively).
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Affiliation(s)
- A del Palacio
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Maillard MP, Rossat J, Nussberger J, Ramis J, Pontes C, Burnier M, Brunner HR. Pharmacologic profile of UR-7247, an orally active angiotensin II AT1 receptor antagonist, in healthy volunteers. p6. J Cardiovasc Pharmacol 2000; 35:383-9. [PMID: 10710122 DOI: 10.1097/00005344-200003000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to assess the pharmacologic properties of the new orally active angiotensin II subtype I (AT1) antagonist UR-7247, a product with a half-life >100 h in humans. The experiment was designed as an open-label, single-dose administration study with four parallel groups of four healthy men receiving increasing single oral doses (2.5, 5, and 10 mg) of UR-7247 or losartan, 100 mg. Angiotensin II receptor blockade was investigated < or =96 h after drug intake, with three independent methods [i.e., the inhibition of blood pressure (BP) response to exogenous Ang II, an in vitro Ang II-receptor assay (RRA), and the reactive increase in plasma angiotensin II. Plasma drug levels also were measured. The degree of blockade observed in vivo was statistically significant < or = 96 h with all UR-7247 doses for diastolic BP (p < 0.05) and < or =48 h for systolic BP. The maximal inhibition achieved with 10 mg UR-7247 was measured 6-24 h after drug intake and reached 54 +/- 17% and 48 +/- 20% for diastolic and systolic responses, respectively. Losartan, 100 mg, induced a greater short-term AT1-receptor blockade than 2.5- and 5.0-mg doses of UR-7247 (p < 0.001 for diastolic BP), but the UR-7247 effect was longer lasting. In vivo, no significant difference was observed between 10 mg UR-7247 and 100 mg losartan 4 h after drug intake, but in vitro, the blockade achieved with 100 mg losartan was higher than that seen with UR-7247. Finally, the results confirm that UR-7247 has a very long plasma elimination half-life, which may be due to a high but also tight binding to protein binding sites. In conclusion, UR-7247 is a long-lasting, well-tolerated AT1 receptor in healthy subjects.
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Affiliation(s)
- M P Maillard
- Division of Hypertension and Vascular Medicine, University Hospital of Lausanne, Switzerland.
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Ribeiro JA, Pereira S, Basto MA, Pontes C. [The initial loss of consciousness in spontaneous subarachnoid hemorrhage. What does it mean?]. ACTA MEDICA PORT 1998; 11:1085-90. [PMID: 10192982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND PURPOSE Poor outcome and rebleeding, after admission to hospital of patients with spontaneous subarachnoid hemorrhage (SAH) has been found to be predicted by loss of consciousness at ictus (LOCi). In this study, we assessed the clinical and neuro-radiological significance of the LOCi in non-traumatic SAH. PATIENTS AND METHODS The authors retrospectively studied 102 patients with SAH admitted to S. João Hospital between January 1, 1989 and December 31, 1992, who were divided into two groups with and without LOCi and compared according to clinical and imaging features. RESULTS Loss of consciousness at ictus was statistically associated with an age over 52 years (odds ratio, 2.9; 95% confidence interval, 1.1-7.8); a Hunt and Hess Scale score > ou = 3 (4.4; 1.6-12.3); finding of subarachnoid blood on initial cranial CT scan (5.5; 1.4-26.3); existence of aneurysm (3.4; 1.3-8.9); a Glasgow Outcome Scale score > ou = 3 (4.69; 1.6-14.1). A poor clinical condition on admission (5.2;1.8-14.5) and existence of aneurysm (4.1; 1.6-10.6) were the only two findings shown to have an independent power of significant association with loss of consciousness at ictus, using logistic regression analysis, with LOCi as a dependent variable. CONCLUSIONS In this study, LOCi has independent predictive power for a poor neurologic condition on admission and for the finding of aneurysm on angiogram. Loss of consciousness at ictus may be explained by the direct impact of the initial hemorrhage on the brain from a large tear in the aneurysmal wall, causing a quick rise in intracranial pressure (with LOCi) but a relatively short bleeding time.
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Affiliation(s)
- J A Ribeiro
- Serviço de Neurologia e Neurocirurgia, Hospital S. João, Faculdade de Medicina do Porto
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Augusto LG, Torres JP, Costa AM, Pontes C, Novaes TC. [The Aedes aegypti eradication program: useless, hazardous (and wasteful, in addition)]. CAD SAUDE PUBLICA 1998; 14:876-7. [PMID: 9878922 DOI: 10.1590/s0102-311x1998000400031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Arnau JM, Vallano A, Artigas R, Vallés JA, Agustí A, Colomé E, Pontes C, Diogene E. [Research on drug utilization in primary health care in national journals]. Aten Primaria 1991; 8:932-6. [PMID: 1807427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In order to discover the present state of research into the use of medication (UM) in primary care, articles published in the "Original Articles" sections of Medicina Clínica (MC) (Clinical Medicine) and Atención Primaria (AP) (Primary Care) between 1983 and 1990, were studied. A total of 130 articles that meet the definition of the WHO for studies into the use of Medications (SUM) were identified. The instigator and organiser of the research, the drugs included, the kind of study, the source of the data, the main variables used and the qualitative analysis made, were all studied. In conclusion we were able to point out that the characteristics of UM were met in the majority of the studies; although they are the main objective of the study in only a minority of cases. The people who undertook most of the research were those who themselves prescribed the drugs or dealt with very common pathologies. In general, the studies are only descriptive and have a poor level of assessment of the results.
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Affiliation(s)
- J M Arnau
- Servicio de Farmacología Clínica, Ciudad Sanitaria Vall d'Hebron, Barcelona
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Cadnapaphornchai P, Pontes C, McDonald FD. Mechanism of effect of diphenylhydantoin on renal renin release. Am J Physiol 1984; 247:F418-22. [PMID: 6383076 DOI: 10.1152/ajprenal.1984.247.3.f418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study was undertaken to delineate the mechanism of the effect of diphenylhydantoin (DPH) on renal renin release. DPH at a dose of 0.18 mg X kg-1 X min-1 was infused for 30 min into the renal artery of anesthetized dogs with acute unilateral renal denervation. In the innervated kidney, DPH infusion increased renin secretion rate (RSR) from 189 +/- 54 to 939 +/- 279 ng ANG I X h-1 X min-1. In the contralateral denervated kidneys, RSR did not change. An identical study was done in a second group of dogs in which unilateral renal denervation was done 24 h prior to DPH infusion. In this group, DPH infusion increased RSR from 63 +/- 57 to 643 +/- 180 ng ANG I X h-1 X min-1 in the innervated kidneys. In the contralateral denervated kidneys, RSR did not change. In a separate group of indomethacin-treated nondenervated dogs, intrarenal infusion of DPH increased RSR from 131 +/- 32 to 452 +/- 88 ng ANG I X h-1 X min-1. The percent increase in RSR in the indomethacin-treated dogs was not significantly different from the non-indomethacin-treated dogs. These data suggest that the stimulatory effect of DPH on renin release is mediated by or requires the presence of renal nerves. The step(s) after the renal nerves is (are) not mediated by prostaglandins.
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Abstract
An ultrastructural study of a biopsy fragment from the cerebellar cortex of a patient with ataxia-telangiectasia was performed. There was a sharp reduction in the number of Purkinje cells and an increase in the number of Golgi epithelial cells. Despite the degeneration of Purkinje cell dendrites, the volumetric density of parallel fiber varicosities and the number of synapses in the molecular layer were only slightly reduced. No qualitative nor quantitative abnormalities were noted in the granular layer. An analysis is made of the severe changes in cerebellar circuitry of this patient and their probable functional implications.
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Abstract
Seventy patients admitted to hospital with bismuth encephalopathy had repeated clinical and EEG examinations. All the patients exhibited myoclonic jerks, but no paroxysmal features ever appeared on EEG. Computed tomography showed cortical hyperdensities. Seizures were observed in 22 patients, but epileptic EEG patterns appeared only when the bismuth blood level was below 1500 microgram/1. It is suggested that a high cortical intracellular bismuth concentration induces a "cortical inhibition" which causes suppression of physiological electrical brain activity, the absence of EEG paroxysmal phenomena during myoclonic jerks, and explains the rarity of epileptic seizures.
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Pontes C, Reis FF, Sousa-Pinto A. The auditory cortical projections onto the medial geniculate body in the cat. An experimental anatomical study with silver and autoradiographic methods. Brain Res 1975; 91:43-63. [PMID: 1131700 DOI: 10.1016/0006-8993(75)90465-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The auditory cortical projections to the medial geniculate body (MGB) were studied in the cat. Lesions carefully restricted to each one of the subdivisions of the auditory and peri-auditory cortex were made and degenerating fibres were mapped in the MGB. In other experiments L-[4-5-3-H]leucine was injected into the cortex of AI, AII and SF and its transport to the MGB was studied by autoradiography. The results show that fibres arise in the deep layers of the cortex of AI, pass through the deep subdivision of the dorsal nucleus of the MGB as well as through the magnocellular MGB. and end in the pars lateralis of the ventral nucleus of the MGB, Arising from AII, axons pass through the magnocellular MGB and end in the superficial and deep subdivisions of the dorsal nucleus extending to the most caudal part of the MGB. The ectosylvian posterior auditory cortex projects diffusely to all subdivisions of the MGB as well as to its magnocellular part. Of the peri-auditory areas, only the suprasylvian fringe projects to the parvicellular MGB, and it sends axons to the dorsal nucleus of the MGB. The SF and the ectosylvian anterior periauditory area send fibres to the magnocellular MGB. The insular cortex does not project to the MGB but sends heavy projections to lower nuclei of the auditory pathway. The complementary use of degeneration and autoradiographic methods shows that each method may be used to eliminate the drawbacks of the other. This strategy appears as being most adequate for the study of reciprocal projections such as those found between the MGB and the three auditory areas AI, AII, and the ectosylvian posterior auditory area.
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