Drug development and the importance of ethnicity: lessons from heart failure management and implications for hypertension

Heart failure is a common condition, associated with both poor prognosis and poor quality of life. In contrast to all other cardiovascular diseases, the prevalence of heart failure is increasing in the western world, and is likely to continue to do so as the population ages. In the UK, a significant proportion of patients with heart failure come from South Asian and African Caribbean ethnic groups. A large body of evidence exists that there may be epidemiological and pathophysiological differences between patients with heart failure from different ethnic groups. Treatments such as ACE inhibitors, which are now part of standard heart failure therapy, have an evidence base consisting of trials in patients of almost exclusively white ethnicity. Such treatments may not be equally effective in patients from other ethnic groups. This review will discuss the current evidence for heart failure management with respect to ethnicity, and consider the implications for future drug development and implications for antihypertensive therapy.     

Household-acquisition of measles and illness severity in an urban community in the United States.

Studies from developing countries suggest that persons with household-acquired (HA) measles are at greater risk of severe illness than persons with community-acquired (CA) infection. Reported measles cases occurring among Milwaukee residents from May 1989 to June 1990 were used to assess whether household-acquisition was a risk factor for severe measles in the United States. A case was classified as HA if onset of rash occurred 7-18 days after onset of rash in another case in the same household. Hospitalization rates were similar for 128 patients with HA measles (27%) and for 1004 patients with CA measles (26%). Multiple logistic regression was used to evaluate the association between hospitalization and household-acquisition after controlling for socioeconomic status, measles vaccination history, age, race, and date of onset of rash. Patients with HA measles were no more likely to be hospitalized than patients with CA measles (odds ratio 0.9, 95% confidence interval 0.6, 1.5). HA measles cases were not more severe than CA measles cases during this urban outbreak in the United States.     

Own experience with the use of Charnley hip arthroplasty and preliminary results of treatment in the materials of the Department]

Early clinical and radiological results of Charnley hip arthroplasties performed in 1995-1998 in Department of Orthopaedics and Traumatology of Zeromski's City Hospital in Cracow are presented. Control evaluation was made in 86 hips (76 patients) among 155 hips (170 patients) which were done in this Department. 97 per cent good results in clinical and 100 per cent good results in radiological evaluation were found in controlled group. In group of 170 alloplasties were 4.1 per cent local and none system complications. Results in this series confirm Charnley prosthesis as a most effective device in treatment of many hip pathologies.     

The analysis of causes of divergence between clinical and radiological results of conservative treatment for distal radius fracture in patients over 50 years of age]

A series of 231 distal radius fractures treated with closed manipulation and cast immobilization has been retrospectively evaluated. Excellent and good results were reported in 69.7% (according to patient's evaluation), in 67.1% according to Gartland-Werley clinical criteria and in 52.4% according to Sarmiento radiologic scale. Fair and poor results constitute circa 30% of results; their share increases as the Frykman fracture type increases and so increases the divergence between clinical and radiologic results.     

Anatomic and functional reconstruction of the joint in severe bone and ligamentous knee instability with semi-constrained systems of total knee replacement

Background. The study was made to evaluate efficiency of semi-constrained systems of TKR in correction of severe bone and ligamentous instability in knee joint with degenerative disease. Material and methods. Retrospective investigation of the 50 consecutive TKRs performed in 40 patients (40 women) between 1995-2000 was made. There were following prosthesis implanted: GSB - 45 and Endo-Model - 5. 48 knees were evaluated. Patients' mean age was 65,6 years old. Mean time of follow-up was 32,8 months (range: 1-5 years). Functional status was evaluated according to KSS scale and radiographic results were investigated with standard plain x-ray pictures. Anatomic results were investigated by the computed posturography with the use of Metrecom Systems. Results. In study group there were: 26% excellent, 68% good, 4% fair and 2% poor results respectively in Knee Score (KSS). There are no statistical differences between anatomical and radiological results of TKR in the knee joints with severe deformity. A little poorer efficiency of the semi-constrained system of total knee arthroplasty in functional reconstruction of the knee joint was due to poor general-health status of the patients and multi-joint nature of their disease. Conclusions. 1. Results of TKR with semi-constrained systems in short-term follow-up (1-5 years) are very good. 2. Posturographic and radiographic studies show that with semi-constrained system of TKR allows for reconstruction of proper anatomy of the knee joint even in severe deformed cases. 3. Functional results of TKR with semi-constrained systems are good in severely unstable and deformed knee joints.     

Effect of osteonecrosis on bone density and its management on the results of revision arthroplasty of the hip]

128 hips after revision arthroplasty in 115 patients which had been operated in our Ward in 1990-2001 were retrospectively evaluated. There were 99 women and 16 men with mean age: 68.9 years old. The mean time of follow-up was 28.6 months (form 3 to 120 months). In 98 hips there were aseptic loosening of the both elements of the prosthesis, in 13 hips there were aseptic loosening of the stem, in 17 hips there were aseptic loosening of the cup only. Cement total hip rearthroplasty was made in 112 cases and cementless total hip rearthroplasty was made in 16 hips. In presented material there were used the acetabular bone grafts in 114 cases, and the femoral bone grafts in 97 cases--all with allogenic frozen bone grafts. The additional implants were used in 31 cases (meshwork, wire, screw). The bone defects in acetabulum and femoral stem was based on Paprovsky classification. There were good and excellent results in 90% and poor or bad results in 10% according to clinical and radiological evaluation. Mean clinical result was 78.5 p. in Harris Hip Score. The radiological results were poor in 13 hips (according to criterion proposed by joined committee of The Hip Society, SICOT and AAOS). Osteointegration of bone allografts was radiologically confirmed in 81% of cases. Complication rates is 20%. There is no correlation between the type of acetabular or femoral bone defects and results of revision hip arthroplasty. Poor results are correlated with use of SKT or Weller stem. Wagner femoral osteotomy and the lack of bone allografts healing.