Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

European Journal of Clinical Pharmacology - The aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and...     

Rituximab-based immunosuppression for autoimmune haemolytic anaemia in infants

We report a case series of four infants with severe autoimmune haemolytic anaemia (AIHA) who responded to treatment with rituximab and cyclosporine after having failed first line therapy with high-dose steroid (prednisolone 4–8 mg/kg/d). Rituximab was started at 11–90 d from onset due to continued haemolysis; three infants also received cyclosporine A. Three of four infants reached complete response, defined as normal haemoglobin, reticulocytes and negative indices of haemolysis, at 7–21 months from diagnosis. In long-term follow-up two infants remained disease-free with normal immunology, one had undefined immunodeficiency and one had autoimmune lymphoproliferative syndrome.     

Comparison of high and low dose of the inhaled steroid, budesonide, as an initial treatment in newly detected asthma

The importance of early initiation of inhaled steroids even in mild asthma has been documented in several studies. It is not, however, clear whether the treatment should be started with a high or a low dose of the inhaled steroid. We have compared the effects of high and low dose inhaled steroid, budesonide, in patients with newly detected asthma. We studied 101 adult patients with newly detected bronchial asthma who were without inhaled steroid or any regular pharmacological treatment for their asthma. The patients were randomly allocated to two treatment groups: one to receive 800 microg inhaled budesonide per day and the other to receive 200 microg inhaled budesonide per day. The drugs were given with a Turbuhaler dry powder inhaler. During the 3-month treatment period, no significant differences between the treatment groups were noted in morning or evening PEF values, in spirometric parameters, in asthmatic symptoms or in the use of rescue beta2-agonists. The decrease in bronchial hyperresponsiveness was, however, more marked in the high dose budesonide group, reaching a borderline significance (P=0.10 high vs. low dose budesonide). In addition, in serum markers of asthmatic inflammation significant differences were shown between the treatment groups. The decrease in the number of blood eosinophils during the treatment was more marked in the high dose budesonide group (P=0.02; high vs. low dose budesonide). In serum ECP no change was observed in the low dose budesonide group, but a marked decrease in the high-dose budesonide group (P=0.008; high vs. low dose budesonide). The change was even more marked with regard to serum EPX (P=0.005; high vs. low dose budesonide). Our results support the view that the treatment of newly detected asthma should be started with a high dose of inhaled steroid. The low dose may not be enough to suppress asthmatic inflammation despite good clinical primary response.     

Carotid endarterectomy in patients 55 years of age and younger

Prior studies have suggested that young patients may be more prone to recurrent disease after carotid endarterectomy (CEA). The goal of this study was to review a series of CEAs performed on younger patients (< or = 55 years) and to determine if these patients are more likely to develop recurrent stenosis. A review was conducted of CEAs performed from 1985 through 1994. Analysis was performed on a study group of 94 young patients who underwent 109 CEAs during this time. A control group of 222 patients older than 55 years who underwent 256 CEAs during the years 1991 through 1993 was selected for comparison. During a mean of nearly 4 years of follow-up, younger patients were significantly more likely to experience a late failure of CEA, including total occlusion of the operated artery, or recurrent stenosis requiring redo surgery. Careful patient evaluation is important in choosing younger patients who require CEA. Implications of these data include mandating careful noninvasive follow-up examinations for younger patients undergoing CEA.     

Emergent Properties of Microglia

More than 80 years ago, Pio Del Rio‐Hortega recognized that one of the “main controversial points in regard to the microglia” is “whether it belongs to the reticulo‐endothelial system [i.e. monocytes and macrophages] and possesses the ordinary characteristics of this system or has a more specialized function.” The notion of microglia having functions that are different from those of other macrophages has gained significant support in recent years. The brain represents a unique environment and shows species, developmental and regional specialization. Thus, any consideration of microglial activity has to be thought of in this tissue context. Contexts may be normal (health, physiology) or disease conditions showing either primary or secondary microglial involvement. Subclinical, reversible “soft pathologies” (Kreutzberg) such as pain that involves microglia also exist. Here, we examine a multilayered approach to understanding microglia that illustrates the emergent character of the microglial (population) phenotype. Accordingly, terms such as microglial “activation” and microgliosis, which are of increasing importance for our understanding of neurological disorders, need to be filled with refined meaning. It is suggested that the pathophysiological context guides nomenclatorial considerations; for example, development, trauma or pain‐associated microglia is preferred over the traditional but less distinctive “microglial activation.” This should also help to tease out the different functional subtypes currently hidden under the umbrella term “neuroinflammation,” which is being applied so widely that it has become effectively useless in practice and even inhibits research progress because both true and pseudo‐inflammation are covered by this term.     

Absorption of tranexamic acid as a prodrug in healthy volunteers

The absorption of trans-4-(aminomethyl)cyclohexanecarboxylic acid (tranexamic acid, Cyklokapron) administered as the prodrug trans-4-(aminomethylcyclohexanecarboxylate hydrochloride (Kabi 2161) was investigated in 3 healthy volunteers. Kabi 2161 was given orally in doses of 1, 2, 3 and 3.5 mmol, respectively, and as a reference a clinical dose of 1.5 g tranexamic acid (9.6 mmol) was administered. At 3 mmol of Kabi 2161 the same maximum plasma concentration of tranexamic acid was obtained as with the reference drug but with Kabi 2161 it appeared earlier. The recovery of tranexamic acid in the urine 0-48 h after administration of Kabi 2161 was 84.7, 82.4, 89.4 and 97.5%, resp., of the increasing doses. For the tranexamic acid 37.0% could be recovered. A similar result was seen in the areas under the plasma concentration-time curves normalized for dose. With Kabi 2161, 13.1, 19.6, 14.4 and 14.3 mg.h/l.mmol were found compared to 8.0 mg.h/l.mmol with tranexamic acid. From these results it was concluded that Kabi 2161 markedly increased the bioavailability of tranexamic acid in man.     

Fenfluramine treatment of twenty children with autism

The effects of fenfluramine were examined on 20 children with autism over a 48-week period utilizing a double-blind placebo-controlled crossover design. Blood and urine samples and psychological tests (Griffith's Developmental Scales and Real Life Rating Scale) were obtained at each crossover period. The only significant improvement was a decrease in abnormal motor behavior. We did not find any significant improvement in intellectual functioning or any correlation between good clinical response and low baseline serotonin levels or high baseline IQ. Serotonin decreased 53% after fenfluramine treatment and rebounded to a level 35% higher than baseline following a placebo period. Fenfluramine and the active metabolite norfenfluramine were determined in plasma samples.The authors thank Eva Mattsson-Mårn and Elisabeth Lilie for assistance in psychological testing, Suzanne Steffenburg for help with data collection, Ulla Themnér for assistance in obtaining laboratory samples, Per Karlsson for assistance in statistical analysis, and Margareta Säker and Ingegerd Blomkvist for assistance in laboratory analysis. This work was supported by the St. Göran's Fund, Alfred Benzon AB, the Emil and Maria Palm's Foundation, the Sven Jerring Fund, the Bror Gadelius Foundation, the Karolinska Institute, the Fund for Neurobiological Research, the Swedish Medical Research Council, and the Nyström Memorial Foundation.