Tests Oftalmologia

 

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Eye 23

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Annunci

 
ophthalmo

Published in: on 26 marzo 2009 at 13:50  Comments (1)  

Ospedali!

OSPEDALE IN AMERICA!

Usa, J.Hopkins hospital

Usa, J.Hopkins hospital

OSPEDALE IN GERMANIA.

Monaco di Baviera

Monaco di Baviera

OSPEDALE IN ITALIA….

Milano

Milano

Published in: on 12 febbraio 2009 at 17:35  Comments (1)  

Tests Cardiologia

 

 

doll

 

 

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test 18

Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation

Stefan H. Hohnloser, M.D., Harry J.G.M. Crijns, M.D., Martin van Eickels, M.D., Christophe Gaudin, M.D., Richard L. Page, M.D., Christian Torp-Pedersen, M.D., Stuart J. Connolly, M.D., for the ATHENA Investigators

ABSTRACT

Background Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation.

Methods We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were randomly assigned to receive dronedarone, 400 mg twice a day, or placebo. The primary outcome was the first hospitalization due to cardiovascular events or death. Secondary outcomes were death from any cause, death from cardiovascular causes, and hospitalization due to cardiovascular events.

Results The mean follow-up period was 21±5 months, with the study drug discontinued prematurely in 696 of the 2301 patients (30.2%) receiving dronedarone and in 716 of the 2327 patients (30.8%) receiving placebo, mostly because of adverse events. The primary outcome occurred in 734 patients (31.9%) in the dronedarone group and in 917 patients (39.4%) in the placebo group, with a hazard ratio for dronedarone of 0.76 (95% confidence interval [CI], 0.69 to 0.84; P<0.001). There were 116 deaths (5.0%) in the dronedarone group and 139 (6.0%) in the placebo group (hazard ratio, 0.84; 95% CI, 0.66 to 1.08; P=0.18). There were 63 deaths from cardiovascular causes (2.7%) in the dronedarone group and 90 (3.9%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.03), largely due to a reduction in the rate of death from arrhythmia with dronedarone. The dronedarone group had higher rates of bradycardia, QT-interval prolongation, nausea, diarrhea, rash, and an increased serum creatinine level than the placebo group. Rates of thyroid- and pulmonary-related adverse events were not significantly different between the two groups.

Conclusions Dronedarone reduced the incidence of hospitalization due to cardiovascular events or death in patients with atrial fibrillation. (ClinicalTrials.gov number, NCT00174785 [ClinicalTrials.gov] .)

Published in: on 12 febbraio 2009 at 16:17  Lascia un commento  

Genetic Determinants of Response to Clopidogrel and Cardiovascular Events

Tabassome Simon, M.D., Ph.D., Céline Verstuyft, Pharm.D., Ph.D., Murielle Mary-Krause, Ph.D., Lina Quteineh, M.D., Elodie Drouet, M.Sc., Nicolas Méneveau, M.D., P. Gabriel Steg, M.D., Ph.D., Jean Ferrières, M.D., Nicolas Danchin, M.D., Ph.D., Laurent Becquemont, M.D., Ph.D., for the French Registry of Acute ST-Elevation and Non–ST-Elevation Myocardial Infarction (FAST-MI) Investigators

ABSTRACT

Background Pharmacogenetic determinants of the response of patients to clopidogrel contribute to variability in the biologic antiplatelet activity of the drug. The effect of these determinants on clinical outcomes after an acute myocardial infarction is unknown.

Methods We consecutively enrolled 2208 patients presenting with an acute myocardial infarction in a nationwide French registry and receiving clopidogrel therapy. We then assessed the relation of allelic variants of genes modulating clopidogrel absorption (ABCB1), metabolic activation (CYP3A5 and CYP2C19), and biologic activity (P2RY12 and ITGB3) to the risk of death from any cause, nonfatal stroke, or myocardial infarction during 1 year of follow-up.

Results Death occurred in 225 patients, and nonfatal myocardial infarction or stroke in 94 patients, during the follow-up period. None of the selected single-nucleotide polymorphisms (SNPs) in CYP3A5, P2RY12, or ITGB3 were associated with a risk of an adverse outcome. Patients with two variant alleles of ABCB1 (TT at nucleotide 3435) had a higher rate of cardiovascular events at 1 year than those with the ABCB1 wild-type genotype (CC at nucleotide 3435) (15.5% vs. 10.7%; adjusted hazard ratio, 1.72; 95% confidence interval [CI], 1.20 to 2.47). Patients carrying any two CYP2C19 loss-of-function alleles (*2, *3, *4, or *5), had a higher event rate than patients with none (21.5% vs. 13.3%; adjusted hazard ratio, 1.98; 95% CI, 1.10 to 3.58). Among the 1535 patients who underwent percutaneous coronary intervention during hospitalization, the rate of cardiovascular events among patients with two CYP2C19 loss-of-function alleles was 3.58 times the rate among those with none (95% CI, 1.71 to 7.51).

Conclusions Among patients with an acute myocardial infarction who were receiving clopidogrel, those carrying CYP2C19 loss-of-function alleles had a higher rate of subsequent cardiovascular events than those who were not. This effect was particularly marked among the patients undergoing percutaneous coronary intervention. (ClinicalTrials.gov number, NCT00673036 [ClinicalTrials.gov] .)

Published in: on 12 febbraio 2009 at 16:00  Comments (1)  

Simultaneous surgery in bilateral congenital cataract. A. Magli, F. Fimiani, V. Passaro, A. Iovine

Abstract
PURPOSE. To assess the efficiency of simultaneous surgery in bilateral congenital cataract not only in patients with a high anesthesiologic risk profile.

METHODS. A retrospective study was carried out on 40 bilateral congenital cataract patients (80 eyes) who presented to the outpatient department of pediatric ophthalmology of the University Federico II of Naples in the period from 1990 to 2005. All patients had undergone cataract extraction from both eyes in a single surgical session. Visual rehabilitation was achieved in all patients by corneal lenses; successively 25 patients had a secondary intraocular lens implant in the posterior chamber after a period of 2.5–3 years.

RESULTS. The mean age at cataract surgery was 7 months (1–17 months). Visual acuity (VA) was assessed in 52 eyes: 8 eyes (15%) presented VA ≤20/200, 21 eyes (41%) showed VA 20/200 < 20/40, 23 eyes (44%) presented VA ≥20/40. Ocular motility disorders were seen in 28 patients (70%). Eight patients had postoperative complications: the formation of secondary membranes in five patients, and secondary glaucoma in three patients. There were no cases of endophthalmitis.

CONCLUSIONS. Simultaneous surgery in bilateral congenital cataract may be taken into consideration not only for patients with a high anesthesiologic risk profile.

Published in: on 12 febbraio 2009 at 10:32  Lascia un commento  

Le lenti a contatto.

Le lenti a contatto sono ormai di uso comune per chi ha problemi di vista o per chi ha solo voglia di cambiare colore degli occhi per uno o più giorni. Restano però un presidio sanitario e come tale vanno utilizzate e gestite. Tra i circa 2 milioni di portatori, dice una indagine Nextplora, solo 2 su 10 le usano adeguatamente. L’articolo è pubblicato dal settimanale Salute di Repubblica.

Published in: on 10 febbraio 2009 at 20:07  Comments (2)  

Ogni cuore è diverso.

Ogni cuore è diverso, aiutaci a conoscere meglio il tuo”, recita lo slogan della fondazione “Per il tuo cuore-Heart Care Foundation”. La ricerca cardiologica vuole occuparsi di casi estremi per meglio personalizzare le cure, al momento infatti si applicano protocolli standard per tutti, ben sapendo però che ogni cuore è diverso dall’altro. L’articolo è del settimanale Salute del Corriere.

Published in: on 10 febbraio 2009 at 15:35  Lascia un commento