Penttila T.,University of Tampere |
Makynen H.,University of Tampere |
Hartikainen J.,Kuopio University Hospital |
Hyppola H.,Kuopio University Hospital |
And 44 more authors.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2017
Background: Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED. Methods: All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED. Results: The study population consisted of 1013 consecutive patients (mean age 70±13years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2±0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs. Conclusions: Our data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups. Trial registration:NCT01990105. Registered 15 November 2013. © 2017 The Author(s).
Bourgeault E.,Laval University |
Bujold J.,Maria Hospital |
Doucet M.-E.,Maria Hospital
Journal of Cutaneous Medicine and Surgery | Year: 2017
Background: Oestrogen dermatitis is a rare disorder characterised by cyclical eruptions in association with a woman's menstrual cycle. Methods: A 43-year-old woman with an 8-year history of cyclical inguinal dermatitis, with a negative patch test, was tested with intradermal progesterone and oestrogen. Results: Intradermal testing was positive for oestrogen only. Conclusion: In a female patient with cyclical dermatitis, it is important to consider oestrogen or progesterone dermatitis in the differential diagnosis. © The Author(s) 2016.
Sow A.,Service de Sante des Armees |
Van Gompel A.,Institute of Tropical Medicine |
Vandeurzen K.,Maria Hospital
Journal of Travel Medicine | Year: 2010
Flights departing from malarious areas are sprayed with pyrethroids. They are presumed to be safe since reports of adverse responses among passengers or crew were only anecdotal. However, asthmatic reactions after domestic and occupational exposure have been published. We present the first case description of pyrethroid allergy in an airplane. © 2010 International Society of Travel Medicine.
Cambron M.,Vrije Universiteit Brussel |
Mostert J.,Rijnstate Hospital |
Haentjens P.,Vrije Universiteit Brussel |
D'Hooghe M.,National Center Melsbroek |
And 20 more authors.
Trials | Year: 2014
Background: Currently available disease-modifying treatments acting by modifying the immune response are ineffective in progressive multiple sclerosis (MS), which is caused by a widespread axonal degeneration. Mechanisms suspected to be involved in this widespread axonal degeneration are reduced axonal energy metabolism, axonal glutamate toxicity, and reduced cerebral blood flow. Fluoxetine might theoretically reduce axonal degeneration in MS because it stimulates energy metabolism through enhancing glycogenolysis, stimulates the production of brain-derived neurotrophic factor, and dilates cerebral arterioles. The current document presents the protocol of a clinical trial to test the hypothesis that fluoxetine slows down the progressive phase of MS.Methods/Design: The FLUOX-PMS trial is a multi-center, randomized, controlled and double-blind clinical study. A total of 120 patients with the diagnosis of either secondary or primary progressive MS will be treated either by fluoxetine (40 mg daily) or placebo for a total period of 108 weeks. The primary endpoint is the time to confirmed disease progression defined as either at least a 20% increase in the timed 25-Foot Walk or at least a 20% increase in the 9-Hole Peg Test. Secondary endpoints include the Hauser ambulation index, cognitive changes, fatigue, magnetic resonance imaging of the brain, and in a small subgroup optical coherence tomography.Discussion: The FLUOX-PMS trial will gives us information as to whether fluoxetine has neuroprotective effects in patients with progressive MS.Trial Registration: Eudra-CT: 2011-003775-11. © 2014 Cambron et al.; licensee BioMed Central Ltd.
Mattila E.,University of Helsinki |
Uusitalo-Seppala R.,Satakunta Central Hospital |
Wuorela M.,Turku City Hospital |
Lehtola L.,Maria Hospital |
And 9 more authors.
Gastroenterology | Year: 2012
Background & Aims: Treatment of recurrent Clostridium difficile infection (CDI) with antibiotics leads to recurrences in up to 50% of patients. We investigated the efficacy of fecal transplantation in treatment of recurrent CDI. Methods: We reviewed records from 70 patients with recurrent CDI who had undergone fecal transplantation. Fecal transplantation was performed at colonoscopy by infusing fresh donor feces into cecum. Before transplantation, the patients had whole-bowel lavage with polyethylene glycol solution. Clinical failure was defined as persistent or recurrent symptoms and signs, and a need for new therapy. Results: During the first 12 weeks after fecal transplantation, symptoms resolved in all patients who did not have strain 027 C difficile infections. Of 36 patients with 027 C difficile infection, 32 (89%) had a favorable response; all 4 nonresponders had a pre-existing serious condition, caused by a long-lasting diarrheal disease or comorbidity and subsequently died of colitis. During the first year after transplantation, 4 patients with an initial favorable response had a relapse after receiving antibiotics for unrelated causes; 2 were treated successfully with another fecal transplantation and 2 with antibiotics for CDI. Ten patients died of unrelated illnesses within 1 year after transplantation. No immediate complications of fecal transplantation were observed. Conclusions: Fecal transplantation through colonoscopy seems to be an effective treatment for recurrent CDI and also for recurrent CDI caused by the virulent C difficile 027 strain. © 2012 AGA Institute.
De Vita D.,Battipaglia Hospital |
Antell H.,Neurosurgery Research Group |
Antell H.,Maria Hospital |
Giordano S.,University of Turku
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2013
Introduction and hypothesis: Glycosaminoglycan hyaluronic acid (HA) and chondroitin sulphate (CS) protect the urothelium. Damage to the urothelium may increase bacterial adherence and infection risk. This meta-analysis evaluated the effect of intravesical HA and HA and CS (HA-CS) combination therapy in recurrent bacterial cystitis (RBC) in adult women. Methods: A systematic literature search was performed. Primary outcomes were urinary tract infection (UTI) rate per patient-year, and UTI recurrence time (days). Secondary outcomes were 3-day voids and Pelvic Pain and Urgency/Frequency (PUF) symptom scale total score. Results: Four studies involving a total of 143 patients were retrieved and assessed in this analysis. Two were randomized, and two were nonrandomized. A significantly decreased UTI rate per patient-year [mean difference (MD) -3.41, 95 % confidence interval (CI) -4.33 to -2.49, p < 0.00001) was found. Similarly, pooled analysis showed a significantly longer mean UTI recurrence time (days) using either HA or HA-CS therapy (MD 187.35, 95 % CI 94.33-280.37, p < 0.0001). Two studies using HA and HA-CS therapy reported outcomes on 3-day voids, which were not significantly improved after therapy (MD -3.59, 95 % CI -8.43-1.25, p = 0.15), but a significantly better PUF total score (MD -7.17, 95 % CI -9.86 to -4.48, p < 0.00001) was detected in HA-CS groups. Conclusions: Intravesical HA and HA-CS in combination significantly reduced cystitis recurrence, mean UTI recurrence time, and PUF total score. Study limitations include the small number of patients and possible bias. Further studies are needed to validate this promising treatment modality. © 2012 The International Urogynecological Association.