Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: Results from the clopidogrel for high atherothrombotic risk and ischemic stabilization, management, and avoidance (CHARISMA) trial
Berger P.B.,Center for Clinical Studies |
Bhatt D.L.,Harvard University |
Fuster V.,Mount Sinai Medical Center |
Steg P.G.,University Paris Diderot |
And 8 more authors.
Circulation | Year: 2010
Background-Uncertainty exists about the frequency, correlates, and clinical significance of bleeding with dual antiplatelet therapy (DAPT), particularly over an extended period in a stable population. We sought to determine the frequency and time course of bleeding with DAPT in patients with established vascular disease or risk factors only; identify correlates of bleeding; and determine whether bleeding is associated with mortality. Methods and Results-We analyzed 15 603 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, a double-blind, placebo-controlled, randomized trial comparing long-term clopidogrel 75 mg/d versus placebo; all patients received aspirin (75 to 162 mg) daily. Patients had either established stable vascular disease or multiple risk factors for vascular disease without established disease. Median follow-up was 28 months. Bleeding was assessed with the use of the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) criteria. Severe bleeding occurred in 1.7% of the clopidogrel group versus 1.3% on placebo (P=0.087); moderate bleeding occurred in 2.1% versus 1.3%, respectively (P<0.001). The risk of bleeding was greatest the first year. Patients without moderate or severe bleeding during the first year were no more likely than placebo-treated patients to have bleeding thereafter. The frequency of bleeding was similar in patients with established disease and risk factors only. In multivariable analysis, the relationship between moderate bleeding and all-cause mortality was strong (hazard ratio, 2.55; 95% confidence interval, 1.71 to 3.80; P<0.0001), along with myocardial infarction (hazard ratio, 2.92; 95% confidence interval, 2.04 to 4.18; P<0.0001) and stroke (hazard ratio, 4.20; 95% confidence interval, 3.05 to 5.77; P<0.0001). ConclusionS-: In CHARISMA, there was an increased risk of bleeding with long-term clopidogrel. The incremental risk of bleeding was greatest in the first year and similar thereafter. Moderate bleeding was strongly associated with mortality. © 2010 American Heart Association, Inc.
Downing C.,Center for Clinical Studies |
Ramirez-Fort M.K.,Center for Clinical Studies |
Ramirez-Fort M.K.,Tufts Medical Center |
Doan H.Q.,University of Texas Health Science Center at Houston |
And 5 more authors.
Journal of Clinical Virology | Year: 2014
Background: Hand, foot, and mouth disease (HFMD) is generally considered a rare illness in adults. Classically, HFMD has been strongly associated with coxsackievirus strain A16 and enterovirus 71. The coxsackievirus A6 (CVA6) strain has been linked to severe worldwide outbreaks since 2008. CVA6 is associated with a more severe and profound course of disease, affecting both children and adults. Objectives: To present a series of five adult patients diagnosed with HFMD due to CVA6. We investigate method of diagnosis and compare clinical presentation of adult cases to those in children. Study design: Each patient underwent a full-body skin exam as well as inspection of the oral cavity. Rapid plasma reagin (RPR) and serologic assays by complement fixation against coxsackievirus B (1-6) and A (2,4,7,9,10,16) were performed as indicated. As standard serological testing does not detect CVA6, real-time reverse transcription-polymerase chain reaction (qRT-PCR) of serum, buccal swabs, and skin scrapings were performed by the Centers for Disease Control and Prevention (CDC). Results: Each patient had clinical findings consistent with various stages of HFMD. One patient presented with delayed onychomadesis and desquamation of the palms and soles. RPR and serologic assays by complement fixation against CVB (1-6) and CVA (2,4,7,9,10,16) were mostly negative, although elevated in two patients due to cross-reactivity. qRT-PCR identified CVA6 genetic material in samples from all patients. Conclusion: This series demonstrates that there is a wide array of disease presentation of CVA6 associated HFMD in adults. © 2014 Elsevier B.V.
Nguyen H.P.,Baylor College of Medicine |
Ramirez-Fort M.K.,Center for Clinical Studies |
Rady P.L.,University of Texas Health Science Center at Houston
Current Problems in Dermatology (Switzerland) | Year: 2014
Human papillomaviruses (HPVs) are small, double-stranded DNA viruses that cause lesions in cutaneous and mucosal tissue and are responsible for carcinomas of the cervix, vagina, vulva and penis. HPVs sort into 5 genera with a total of approximately 150 species that have been sequenced. Its genome is comprised of an early (E) region encoding the viral regulatory proteins, a late (L) region encoding the viral structural proteins and a noncoding region that is essential to the viral life cycle. For infection to occur, the virus must access the basal epidermal layer where, following endocytosis and viral capsid disassembly, the L2 protein mediates viral genome transfer to the nuclei of mitotic keratinocytes. The viral genome is maintained in episomal form during the normal life cycle and replicates in synchrony with the host cell DNA under the mediation of E1, E2, E4 and E5 viral proteins. In most high-grade cervical neoplasms, however, the viral DNA is integrated into the host genome through the disruption of the E2 open reading frame. The oncoproteins E6 and E7, which were previously suppressed by E2, are then free to inhibit the Rb and p53 tumor suppressor pathways. The viral life cycle concludes with the packaging of the viral genome and virus release, which entails the E2-mediated recruitment of L2 to regions of replication, the expression of L1 and the assembly of the icosahedral capsid in the nucleus. Overall, the complex biology of HPV continues to be an important area of research with substantial implications for public health. © 2014 S. Karger AG, Basel.
Lokhandwala J.,Jacksonville University |
Best P.J.M.,Mayo Medical School |
Henry Y.,00 North Academy Avenue |
Berger P.B.,Center for Clinical Studies
Current Allergy and Asthma Reports | Year: 2011
Clopidogrel is a widely used antiplatelet agent, particularly after coronary stent implantation. About 1% of patients have allergic or hematologic adverse reactions to clopidogrel. This has important therapeutic implications, as premature discontinuation of clopidogrel is the strongest risk factor for stent thrombosis. Clopidogrel allergy most commonly manifests as a rash. It is important to distinguish this from other causes of rash occurring in patients who have had a recent coronary stent. Although antihistamines and short-term oral corticosteroids are effective in treating most clopidogrel hypersensitivity reactions, some persistent reactions may require discontinuation of clopidogrel. When discontinuation of clopidogrel is required, substitution with an alternative thienopyridine such as ticlopidine traditionally has been performed. However, a recent study suggests that there may be as high as a 27% risk of recurrence of non-life-threatening allergic reactions in such patients, which are usually similar to the allergic reactions that occurred with clopidogrel. No data are available regarding the frequency of cross-reactivity to prasugrel and ticagrelor; these may be potential therapeutic options in some patients. © 2010 Springer Science+Business Media, LLC.
Mays R.M.,Center for Clinical Studies |
Gordon R.A.,Center for Clinical Studies |
Wilson J.M.,University of Houston |
Silapunt S.,University of Houston
Dermatologic Therapy | Year: 2012
Acne and rosacea compromise a substantial portion of the dermatology clinical practice. Over the past century, many treatment modalities have been introduced with antibiotics playing a major role. Today, both oral and topical antibiotics are used in the management of acne and rosacea, with several novel formulations and/or combination regimens recently introduced. The latest studies suggest anti-inflammatory actions to be the most likely mechanism of antibiotics in acne and rosacea, shifting the focus to subantimicrobial-dose oral antibiotics and/or topical antibiotic regimens as the preferred first-line agents. Here we will discuss the most recent oral and topical antibiotic therapies available for treatment of acne and rosacea, with special focus on efficacy data, indication, dosing, and mechanism of action. © 2012 Wiley Periodicals, Inc.
Satyaprakash A.K.,Center for Clinical Studies |
Tyring S.K.,Center for Clinical Studies
Indian Journal of Dermatology, Venereology and Leprology | Year: 2010
Human papillomaviruses (HPV) are responsible for both benign anogenital warts and malignant disease in humans, especially cervical cancer. Dermatologists in India recognize a great many cases of anogenital warts, and afflicted individuals may be at increased risk of coinfection with oncogenic HPV types. For this reason, dermatologists are in a position to identify potential carriers of oncogenic HPV types in the population. By targeting these individuals and their partners, as well as unaffected individuals for vaccination with the quadrivalent HPV vaccine, dermatologists have the ability to impact the morbidity and mortality of cervical cancer in India.
Mendoza N.,Center for Clinical Studies
Skin therapy letter | Year: 2011
Human papillomavirus (HPV) has a predilection for infecting epidermal and mucosal surfaces such as those of the anogenital region. HPV causes substantial pre-malignant, malignant, and benign disease in both women and men, ranging from cervical, vulvar, penile, and anal cancers to condyloma acuminata (genital warts). Although HPV vaccination is becoming more common, infection rates remain high in both genders. Perception of HPV vaccine has largely centered on its ability to prevent cervical cancer in women, though indication for its use in men is expanding. The benefits to men include prevention of genital warts and, more recently, regulatory approval was expanded in the US for prevention of anal cancer. Herein, we review HPV vaccine with a focus on its new indication in men and existing controversies.
Gordon R.,Center for Clinical Studies
Skin therapy letter | Year: 2012
Biologic compounds are being used more frequently to treat a multitude of systemic inflammatory conditions. These novel compounds are composed of antibodies or other peptides that act through one of three mechanisms: inhibiting inflammatory cytokine signaling (typically tumor necrosis factor or TNF), inhibiting T-cell activation, or depleting B-cells. The increase in use and ever expanding list of new immune modulating therapies make knowledge of the infectious complications associated with immune modulation even more important. Of particular concern is the risk for developing atypical and opportunistic infections including tuberculosis, herpes zoster, Legionella pneumophila, and Listeria monocytogenes.
Kim S.R.,University of Texas Health Science Center at Houston |
Khan F.,Center for Clinical Studies |
Tyring S.K.,University of Texas Health Science Center at Houston |
Tyring S.K.,Center for Clinical Studies
Expert Opinion on Pharmacotherapy | Year: 2014
Introduction: Varicella zoster virus is a highly contagious virus that causes a primary infection known as varicella (chickenpox) that may reactivate years later to cause herpes zoster (HZ or shingles). After shingles heal, patients may develop post-herpetic neuralgia (PHN), neuropathic pain syndrome that can cause significant suffering for years and is often refractory to treatment. Areas covered: The wide range of treatment and management options for varicella, HZ and PHN are reviewed and discussed. PubMed was the database used for the literature search. Expert opinion: Antiviral therapy effectively treats acute varicella and HZ. However, PHN is still difficult to manage, especially with the numerous treatment measures that do not work consistently in all patients. The best approach is to prevent the complication from occurring in the first place by preventing HZ with the HZ vaccine, which have decreased the burden of illness caused by VZ and the incidence of HZ. Unlike the varicella vaccine, the uptake for the HZ vaccine is very low and thereby more patients over the age of 50 years should be encouraged to receive the vaccine to reduce the risk of developing HZ. Initiating treatment with gabapentin and antiviral concomitantly as soon as the rash develops may reduce the severity of complications but there is a lack of data showing these medications preventing the development of PHN. © 2014 Informa UK, Ltd.
News Article | December 16, 2016
1,25-Dihydroxyvitamin D (1,25[OH]2D) is the active, hormonal form of vitamin D. Circulating 1,25(OH)2D levels are regulated by serum calcium and phosphate concentrations; this is mediated by the calcium-regulating hormones. In the human body, 1,25(OH)2D has a broad range of actions which include endocrine, autocrine and paracrine properties. Due to its picomolar concentrations and its lipophilic nature, 1,25(OH)2D is a difficult analyte and represents a challenge to the analytical biochemist with respect to quantification. Until recently, relatively large sample volumes and extensive purification and separation steps were required to quantify 1,25(OH)2D. In this webinar, sponsored by DiaSorin, participants will learn the clinical relevance of circulating 1,25(OH)2D. Besides the well-known suppression of circulating 1,25(OH)2D in chronic kidney disease, it will become evident that circulating 1,25(OH)2D is also reduced in other diseases. In the clinical setting, however, there are still several gaps in the present knowledge on circulating 1,25(OH)2D. This webinar will delve into these gaps, which include incomplete data about the effect of activated vitamin D; the influence of dosing and initial 25OHD level on circulating 1,25(OH)2D; and the effect of different diseases on circulating 1,25(OH)2D. Attendees will learn the clinical conditions that would benefit from follow-up measurement for 1,25 dihydroxyvitamin D, as well as better understand why active vitamin D therapy should be accompanied by measuring 1,25 dihydroxyvitamin D. The speaker for this webinar will be Dr. Armin Zittermann, head of the Center for Clinical Studies in Thoracic and Cardiovascular Surgery at the Heart and Diabetes Center. As a nutritionist and head of the Center for Clinical Studies in Thoracic and Cardiovascular Surgery at the Heart and Diabetes Center in Bad Oeynhausen, Germany, Zittermann’s research focuses on the prevalence and the consequences of insufficient levels of vitamin D in humans, in particularly in patients with cardiovascular diseases. Zittermann also lectures at the Institute of Nutrition and Food Sciences at the University of Bonn on specific aspects of food security. LabRoots hosted the webinar December 7, which is now available on demand. To read full event details, learn about P.A.C.E continuing education credits, or to register for free, click here. About DiaSorin Headquartered in Italy and listed in the FTSE Italia Mid Cap Index, DiaSorin is a global leader in the In Vitro Diagnostics (IVD) field. For over 40 years the Company has been developing, producing and marketing reagent kits for IVD worldwide. Through constant investments in research and development, and using its own distinctive expertise in the field of immunodiagnostics to deliver a high level of innovation, DiaSorin offers today the broadest range of specialty tests available in the immunodiagnostics market and new tests in the molecular diagnostics markets, which identify DiaSorin Group as the IVD “diagnostics specialist.” About LabRoots LabRoots is the leading scientific social networking website and producer of educational virtual events and webinars. Contributing to the advancement of science through content sharing capabilities, LabRoots is a powerful advocate in amplifying global networks and communities. Founded in 2008, LabRoots emphasizes digital innovation in scientific collaboration and learning, and is a primary source for current scientific news, webinars, virtual conferences, and more. LabRoots has grown into the world’s largest series of virtual events within the Life Sciences and Clinical Diagnostics community.