Rosiglitazone in the treatment of HAART-associated lipodystrophy--a randomized double-blind placebo-controlled study

Highly active antiretroviral therapy (HAART) is associated with metabolic adverse events such as insulin resistance and lipodystrophy, that is, atrophy of subcutaneous fat and accumulation of intra-abdominal fat. Currently, there is no pharmacological treatment for lipoatrophy. Glitazones, a novel class of insulin-sensitizing anti-diabetic agents, increase subcutaneous fat in patients with type 2 diabetes. There are no controlled studies of glitazones in patients with HAART-associated lipodystrophy (HAL). In this randomized, double-blind, placebo-controlled study, 30 patients with HAL received either rosiglitazone (8 mg daily) or placebo for 24 weeks. Baseline characteristics were compared to a group of 30 age-, sex- and weight-matched HIV-negative controls. At baseline, patients with HAL had 1.8-fold (P<0.001) more intra-abdominal and 2.4-fold (P<0.05) more liver fat than HIV-negative controls, who had 1.8-fold (P<0.001) more subcutaneous fat than the patients. After 24 weeks of treatment, rosiglitazone had no effect on body weight, subcutaneous or intra-abdominal fat (magnetic resonance imaging), total body fat (bioimpedance analysis), anthropometric measurements or serum leptin concentrations (a circulating marker of adipose tissue mass). However, rosiglitazone decreased % liver fat (spectroscopy) and serum insulin concentrations, and normalized liver function tests. During the first 12 weeks of rosiglitazone treatment, serum triglycerides increased from 3.5 +/- 0.5 to 6.5 +/- 2.0 mmol/l (from 310 +/- 44 to 575 +/- 177 mg/dl) (P<0.05) and serum cholesterol from 6.0 +/- 0.4 to 7.8 +/- 0.7 mmol/l (from 232 +/- 15 to 301 +/- 27 mg/dl) (P<0.01). Contrary to data in other patient groups, rosiglitazone did not increase subcutaneous fat in patients with HAL after 24 weeks of treatment. Rosiglitazone seemed to ameliorate insulin resistance judged by the decreased serum insulin concentrations and % liver fat. Rosiglitazone unexpectedly caused significant increases in serum triglyceride and cholesterol concentrations, which must be carefully monitored if glitazones are used in these patients.     

Collagenase 2/matrix metalloproteinase 8 in critically ill patients with secondary peritonitis

Secondary peritonitis is an important indication for surgical intensive care admissions, and it is associated with high morbidity and mortality. Collagenase 2/matrix metalloproteinase (MMP) 8 is a tissue matrix-degrading enzyme that is released from leukocytes upon inflammatory stimuli and may thus contribute to peritonitis-associated organ damage. We studied the levels and activity of MMP-8 in the peritoneal fluid of 15 critically ill patients with secondary peritonitis. The MMP-8 levels were measured from the patients' peritoneal fluid, serum, and urine, and from the serum and urine of 10 healthy controls by immunofluorometric assay. Median MMP-8 level in peritoneal fluid supernatant was 1,317 microg/L (interquartile range [IQR]) (1,254-1,359 microg/L) being significantly higher than in the sera of the patients (P=0.008). Molecular forms and isoform distribution of MMP-8, MMP-1, and MMP-13 in peritoneal fluid, assessed by Western immunoblotting, revealed that the neutrophil-type MMP-8 was the major collagenase species in peritoneal fluid, and it was partially in an activated form. Catalytically competent, active MMP-8 produced the characteristic cleavage products from intact human type I collagen. The serum levels of MMP-8 were higher in the patients, 49 microg/L (IQR, 23-214 microg/L), than in the controls, 11 microg/L (IQR, 8-24 microg/L) (P<0.01). The MMP-8 levels in the urine were higher in the patients, 0.27 microg/L (IQR, 0.04-1.89 microg/L), than in the controls, 0.03 microg/L (IQR, 0.0-0.05 microg/L) (P=0.013). Our data demonstrate for the first time that MMP-8 levels are remarkably elevated and in an active and catalytically competent form in the peritoneal fluid samples of patients with secondary peritonitis.     

The complex interplay between pain intensity,depression, anxiety and catastrophising with respect to quality of life and disability

Purpose. To identify subgroups of patients with chronic pain based on the occurrence of depression, anxiety and catastrophising and the duration of pain and pain intensity. In addition to this, the relationship between the subgroups with respect to background variables, diagnosis, pain-related disability and perceived quality of life are investigated.

Methods. This study used 433 patients with chronic pain including 47 patients with spinal cord injury-related pain, 150 with chronic whiplash associated disorders and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological and health-related items.

Results. On the basis of depression, anxiety, catastrophising, pain intensity and duration, we identified subgroups of patients with chronic pain that differed with respect to perceived quality of life, disability and diagnosis. The psychological factors, especially depression, significantly influenced perceived quality of life and disability. Pain intensity and duration play a minor role with respect to quality of life, although pain intensity is associated to perceived disability.

Conclusions. The results of this study highlight the importance of not looking at patients with chronic pain as a homogenous entity. A detailed assessment, including psychological factors with emphasis on depressive symptoms, might be essential for planning and carrying through treatment and rehabilitation.     

Speech and language development of children born at 32 weeks' gestation: a 5-year prospective follow-up study

Speech and language comprehension and production were assessed at the age of 5 years in a cohort of children born preterm at 32 weeks' gestational age ( N =55) in comparison with children born at term and of similar age, sex, and social backgrounds. Data both including and excluding major neurological disabilities are presented. Mean performance for the entire group of preterm children was significantly lower than for the controls on most of the measures including the composite IQ scores. When the nine children who had major neurological disabilities were excluded from the preterm "group, statistically significant differences were found on four of the total 12 speech and language measures. Intellectually normal preterm children without major neurological disability were slower than the controls on rapid word retrieval. In addition, difficulties in comprehending relative concepts were typical for the preterm children. The results suggest 'subtle dysnomia', which is indicative of later reading problems. On global verbal measures and on the basic speech and language aspects the study groups did not differ. Specific language impairment, defined as a discrepancy of ID between Performance IQ and Verbal IQ scores, showed a tendency to be more common in the control group. Within both the study groups, the boys showed a tendency for a greater discrepancy between their Performance and Verbal IQ scores.     

Levetiracetam-induced myoclonic status epilepticus in myoclonic-astatic epilepsy: a case report.

We report on a 3-year-old boy with myoclonic-astatic epilepsy who developed myoclonic status epilepticus with continuous twitching of the face and unresponsiveness under monotherapy with levetiracetam. Recently, a nonconvulsive status epilepticus in an adult epilepsy patient has also been described. Our observation points to the possibility of a causal relationship between the induction of myoclonic status by levetiracetam in certain patients with Doose's syndrome. However, a spontaneous evolution cannot be excluded. Levetiracetam is a well-known drug for the control of myoclonic seizures. A controlled study would provide a better understanding of any possible aggravating role in certain forms of myoclonic-astatic epilepsy.     

Caries frequency among 6–17-year-old participants of the Finnish public dental care during 1975–79

Temporal trends of caries frequency in 6-17-year-old children in Finland and its counties during 1975-79 are reported. Initially the attendance rate was 70%: during the 4-year follow-up it increased to 84%. The cross-sectional annual proportion of children needing curative treatment diminished from 80% to 67% at the age of 8 years; the changes among the 12- and 16-year-old children were 78-66% and 86-76%, respectively. The proportion of entirely caries-free children increased from 2.5% to 9.2% at the age of 8 years, only a slight increase was found in the older age groups. The mean DMFT value decreased continuously at all ages: in the 8-year-old children it decreased from 2.7% to 1.7%, in 12-year-olds from 6.7% to 5.2% and at the age of 16 from 13.4% to 11.6%. The caries scores decreased most in areas where the initial values were highest. In the county with high fluoride levels, where the initial caries scores were smallest, only slight improvement in the caries situation was found; this indicates no major change in recording of caries. Although a simultaneous improvement of the national attendance rate and the caries scores were observed, no consistent associations were found between the changes in the attendance rate and the changes in various caries indices when age and geographical area were considered in the analyses. It is concluded that the marked decrease in caries frequency is mainly due to preventive measures.     

Steroidbelastung bei Posner-Schlossmanschem Syndrom

Zusammenfassung Eine Belastung mit 0,1% Beta-Methason wurde an 15 Patienten mit Posner-Schlossmanschem Syndrom ausgeführt.Ein glaukomatozyklitischer Anfall konnte weder durch Wasserbelastung noch Steroidbelastung hervorgerufen werden. Die Reduktion der C-Werte und/oder Drucksteigerung nach Belastung wiesen interessante Aspekte auf. Das befallene Auge zeigte viermal nach 6 Wochen Beta-Methasonbelastung eine positive Reaktion (27%). Zusätzliche Wasserbelastung führte fünfmal (33%) zu positiver Reaktion. Im kontralateralen Auge waren entsprechende Zahlen 6 Augen (40%) nach Steroidbelastung und nach zusätzlicher Wasserbelastung 7 Augen (47%). Eine Regulationsstörung der Kammerwasserdynamik lag auch zwischen den Anfällen vor. Die erhobenen Befunde wiesen auf einen peripheren Schaden mit dem Trabekel als Endorgan.

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Summary Betamethasone (0.1%) was administered topically four times daily for six weeks into both eyes of 15 patients with glaucomatocyclitic atacks (Posner-Schlossman syndrome). All patients were in the interval of the disease. Steroid- and/or water-provocation did not produce atacks.Hypotony was a typical sign of the affected eyes. Positive steroid provocation was found in 4 affected eyes (27 per cent). Steroid- and water-provocation gave a positive reaction in 33 per cent of the affected eyes and 47 per cent of the contralateral eyes. A connection with simplex glaucoma was suggested possible.

     

Epidemiologic study of joined primary teeth in Finnish children

The frequency of geminated and fused primary teeth was studied in a sample of 1141 Finnish children aged 3-4 years. The prevalence was 0.7%. All the joined teeth were found in the anterior area of the mouth. In seven cases the diagnosis was a fusion of two separate teeth, and in one case it was a gemination of a single tooth. A correlation between joined teeth in primary dentition and numerical variations of teeth in permanent dentition was noted in three cases.