Nail incorporation kinetics of terbinafine in onychomycosis patients

Patients with toe-nail onychomycosis were treated with terbinafine (250 mg daily, n= 20) for either 6 or 12 weeks in a randomized double-blind study. Plasma and distal nail clippings were taken before initiation of therapy and 1, 6, 12, 18, 24, 36 and 48 weeks thereafter. Analytical data of terbinafine extracted from nail clippings or plasma were obtained by high-performance liquid chromatography (HPLC). Nail extracts and isolated HPLC terbinafine peaks were analysed using a combined gas chromatography - mass spectroscopy system (GC-MS) for unequivocal identification of the drug. Terbinafine could be detected in the distal nail in the majority of the patients within 1 week of starling therapy. Maximum terbinafine levels of 0·52 and 1·01 μg;g were measured after 18 weeks in the 6- and 12-week treatment groups, respectively. While plasma levels decreased rapidly after termination of therapy terbinaiine was detected in the nails as long as 36 weeks (6 weeks treatment) and 36 weeks (12 weeks treatment) after termination of therapy at a range of 0·–0·19 μg/g. The drug concentrations measured at all time points are well above the minimum inhibitory concentration (MIC) tor dermatophytes and other fungi, These data suggest that the drug readies the nail plate rapidly and persists there for several months after cessation of active treatment.     

Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study

Summary Fifty-five patients with psoriatic arthritis were treated with a low dose of cyclosporin A (CyA) (mean dose 2.7 mg/kg per day) for a period of 6 months to investigate the efficacy of CyA on disease parameters. Significant improvement in the joint complaints and inflammation parameters was observed including a decrease in the number of painful (-46%) and swollen (-45%) joints, tenderness (Ritchie Index: -50%) and degree of swelling (-46%), patient's assessment of pain (-35%), the duration of morning joint stiffness (-37%), as well as a decrease in C-reactive protein (-52%). A 50% reduction of joint complaints required a total of 24 weeks, whereas a 50% reduction of skin involvement was achieved after 5–6 weeks of treatment. Four patients left the study due to adverse events: creatinine level increase in two patients, hypertension in one patient and gastroenteritis in the fourth patient. Joint scintigraphy in 18 patients indicated an improvement or stable condition in 61% of cases after a mean follow-up of approximately 8 months. The results of this prospective study show that low-dose CyA effectively improves not only skin lesions, but also joint complaints in psoriatic arthritis.     

Music Listening Preferences and Preadmission Dysfunctional Psychosocial Behaviors of Adolescents Hospitalized on an In-Patient Psychiatric Unit

This study investigated the relationship between music listening preferences and preadmission, dysfunctional psychosocial behaviors (PDPB) of 60 adolescents who were hospitalized on an in-patient psychiatric unit. Findings were that hospitalized adolescents who primarily listened to music with negative lyrics/themes had a history of more PDPB than hospitalized adolescents who primarily listened to music that did not contain negative lyrics/themes; and hospitalized adolescents who primarily listened to heavy metal music had a history of more PDPB than hospitalized adolescents who primarily listened to other types of music.     

Evaluation of 6 weeks treatment of terbinafine in tinea unguium in a double-blind trial comparing 6 and 12 weeks therapy

Terbinafine (Lamisil) has been registered throughout the world for the treatment of finger and toenail onychomycosis. The recommended duration of treatment of toenail onychomycosis based on phase III studies is 12 weeks. This study was designed to determine: (i) if patients in whom the proximal part of the toenails was not affected respond as well after 6 weeks treatment as after 12 weeks treatment; (ii) to identify factors which may allow selection of patients for shorter treatment duration; and (iii) confirm that 6 weeks therapy is sufficient in fingernail mycosis. One hundred and forty-eight patients received 250 mg terbinafine daily for either 6 or 12 weeks in a double- blinded manner, and were followed until 48 weeks after start of therapy. Cure of the nail infection was defined as negative mycological tests (mycological cure) and progressive growth of normal nail (clinical cure). Mycological cure was recorded in 43 of 72 (59.7%) in the 6-week group and 55 of 76 (72.4%) in the 12-week group. In those who completed the study per protocol in the 6-week group. 34 of 61 (55.7%) were cured mycologically corresponding to 46 of 56 (82.1%) in the 12-week group. The overall clinical and mycological cure rates for the two groups were 28 of 61 (45.9%) and 33 of 56 (58.9%), respectively. In the small number of patients with associated fingernail infection, all were improved and six of eight (75.0%) were cured after a duration of treatment of 6 weeks. A priori risk factors for failure of cure could not be identified in either group. However, shorter duration of disease prior to treatment and no involvement of the big toenail was associated with a trend toward better responses in both groups. It can be concluded from this study that, in toenail mycosis without visible matrix involvement, 6 weeks treatment of terbinafine is generally not sufficient, whereas fingernail infections respond well to this short therapy.     

Characteristics of transient ischaemic episodes in patients with silent and symptomatic exercise-induced myocardial ischaemia

To evaluate transient ischaemic episodes during daily life inpatients with coronary artery disease and exercise-induced myocardialischaemia, 38 patients underwent ambulatory ST-segment monitoringover 48 h. Sixteen patients had painless ischaemia during exerciseand occasional angina, and 12 patients had symptomatic ischaemiaand frequent angina during daily life. Ten patients with provencoronary artery disease but normal exercise electrocardiogramsserved as controls. The extent of coronary artery lesions andthe prevalence of myocardial infarction were similar in allgroups. ST-segment monitoring revealed 817 min and 98 episodesof ST depression in 13/16 patients of the asymptomatic groupand 111 min and 21 episodes in 5/12 patients of the symptomaticgroup (P<0.03). Subjective scores for physical activity duringHolter monitoring were significantly higher in the first groupthan in the second. The majority of ischaemic episodes in bothgroups was asymptomatic. No ischaemic ST changes occurred incontrol patients. Results indicate a higher frequency of transientischaemic episodes related to a higher level of physical activityin patients with silent ischaemia than in patients with symptomaticexercise-induced ischaemia.