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Biomedical subjects

A J Scheen

Publications and source records attributed to A J Scheen.

At least 163 records · Page 9Linked to original sources
PubMed2000

[Evidence-based medicine. Input of controlled clinical trials].

Controlled clinical trials are the support of Evidence-Based Medicine. In most instances, only them can indeed provide the demonstration of both the efficacy and safety of a pharmacological treatment, based upon rigorous scientific experimental observations avoiding potential bias due to subjective interpretation. In order to be able to extrapolate conclusions of drug trials to clinical practice and to positively influence physician's attitudes, "explanatory" trials, which aim at proving the intrinsic activity of the molecule, should be completed by "pragmatic" trials, which aim at demonstrating the clinical utility of the drug.

Attitude of Health Personnel↗
PubMed2000

[On the inapplicability of certain therapeutic guidelines in practice: the example of reimbursement for hypolipidemic agents in Belgium].

International guidelines from the Task Force of European and other Societies on Coronary Prevention and national guidelines from the Belgian Lipid Club recently emphasized the potential interest of adequate management of patients with even moderate hypercholesterolaemia. However, current criteria for the reimbursement of lipid-lowering drugs in Belgium do not allow to follow these guidelines. A solution should be urgently found in order to bridge the gap and permit practitioners, after diet failure, to effectively prescribe lipid-lowering agents in patients who should benefit in priority of such a treatment. It is certainly the case in secondary prevention as well as, in high risk individuals, in primary prevention, i.e. in situations where these drugs have provided enough evidence of their efficacy with an acceptable cost-benefit ratio.

Anticholesteremic Agents↗
PubMed2000

[Recommendations of the Belgian Lipid Club for the diagnosis and treatment of hyperlipidemias: summary for the practitioner].

The present paper summarizes the last recommendations of the Belgian Lipid Club for the diagnosis and treatment of hyperlipidaemias which were published in 1999. These guidelines are in agreement with the "Recommendations of the second Task Force of European and other societies on Coronary Protection", published in 1998. We will briefly describe the evidence supporting the treatment of dyslipidaemias, especially hypercholesterolaemia, to improve coronary prognosis of at high risk subjects as well as the general strategies, lipid objectives and therapeutic means, in a practical way for the clinician.

Anticholesteremic Agents↗
PubMed2000

[Recommendations for the treatment of obesity].

Obesity represents a major medical problem which is now considered more seriously from a scientific, clinical and economical point of view. Such an evolution was mandatory when considering the usual contempt for what is now considered as a chronic disease and especially the charlatanism which was observed among medical and non-medical spheres. Hence, as for numerous other pathologies, international guidelines have recently been published to optimize the management of obesity, from the view point of efficacy and, more particularly, safety. We will summarize the main recommendations as far as diet and physical treatment, pharmacotherapy and bariatric surgery are concerned. Finally, we will briefly describe general guidelines on the management of obese subjects taking into account the degree of weight excess and the presence of complications.

Diet↗
PubMed2000

[GLycemic control in the diabetic patient. Recommendations after the DCCT and UKPDI studies].

Diabetes mellitus is a chronic disorder characterized by microvascular and cardiovascular complications that substantially increase the morbidity and mortality associated with the disease. Several studies showed the association between the complications of diabetes and elevated blood glucose levels. Clinical trials have also demonstrated that treatment that lowers blood glucose reduces the risks of diabetic complications (mainly microvascular complications). The control of diabetes is assessed by frequent measurements of HbA1c. A reasonable goal in type 1 diabetes is a value of HbA1c < or = 7.2%. In type 2 diabetes, the optimal goal is a value of HbA1c < or = 6.5%, but a value < or = 8% seems to be an acceptable goal in these patients.

Diabetes Complications↗
PubMed2000

[Guidelines for the treatment of arterial hypertension in diabetic patients].

Diabetes mellitus is frequently associated with arterial hypertension and the combination of the two entities markedly increases the cardiovascular risk and accelerates the progression of microangiopathy (more particularly nephropathy) in both type 1 and type 2 diabetic patients. Numerous international guidelines have been published during the last few years to help the practitioner in targeting ideal arterial blood pressure levels (lower in diabetic than in non-diabetic patients) and in selecting first-choice antihypertensive agents. We will concisely summarize the main messages of these recommendations and insist upon the persistence of uncertainties, or even the existence of inconsistencies, more particularly regarding preferential indications of antihypertensive agents in diabetic patients.

Antihypertensive Agents↗
PubMed2000

[Pharma-clinics. The drug of the month. Rofecoxib (Vioxx)].

Rofecoxib (Vioxx, Merck Sharp & Dohme) is a potent and selective inhibitor of the COX-2 isoform of cyclooxygenase which is used as a nonsteroidal anti-inflammatory drug (NSAID). It is indicated in the symptomatic relief of pain due to osteoarthritis. The initial oral dosage of rofecoxib is 12.5 mg once daily in adults, and this dose may be increased up to a maximal dosage of 25 mg once daily if necessary. Its clinical efficacy seems to be similar to that of other NSAIDs at maximal recommended dosages, but its safety profile, especially gastrointestinal tolerance, is much better because of the COX-2 selectivity. Ongoing clinical trials are performed in patients with rheumatoid arthritis.

Administration, Oral↗
PubMed2000

[What's new in the domain of obesity?].

We will briefly comment on some interesting topics presented at the 10th European Congress on Obesity (ECO, Antwerp, Belgium, 24-27 May 2000). Special attention has been focused upon: 1) the multi-endocrine function of the adipocyte cell; 2) the role of gene-environment interactions; 3) the regulatory mechanisms of energy balance; 4) the neuroendocrine hypothesis for the development of visceral adiposity; 5) the numerous complications associated with obesity, more particularly type 2 diabetes; and, finally, 6) obesity prevention, especially in childhood, and new pharmacological perspectives for the treatment of obesity.

Diabetes Mellitus, Type 2↗
PubMed2000

[Clinical study of the month. Prolonged insulin independence after transplantation of islets of Langerhans in a patient with type 1 diabetes: achievement of a dream?].

A Canadian research team recently reported a series of 7 consecutive patients with type 1 brittle diabetes who could achieve sustained excellent metabolic control in the absence of insulin therapy after successful islet transplantation. This exceptional success, which contrasts with previous less favourable results, is probably due to the transplantation of a higher number of islets of good quality and to the use of a new glucocorticoid-free immunosuppressive regimen. These remarkable results which provide proof of the principle that islet transplantation can be reproducibly successful, at least for one year, may raise new hope in patients with type 1 diabetes. However, the problem of supply and demand of islets is huge and will require a careful, and probably difficult, selection of the best candidates to benefit from this new therapeutic approach.

Diabetes Mellitus, Type 1↗
PubMed2000

[How I treat: from specialized pharmacology to drug therapy: a plea for an optimal educational program for rational therapeutics, from decision making to drug prescription].

Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important step of the medical approach. Such a learning should occur progressively throughout the medical education, focusing, first, on the therapeutic reasoning ("why?") and, second, on the practical application leading to the prescription ("how?"). The medical student should learn the difficult task of integrating disease, drug and patient, in order to optimize the benefit/risk ratio, while being informed about new concepts such as "Evidence-Based Medicine" and pharmacoeconomics.

Decision Making↗
PubMed2000

[Current therapeutics 2000].

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as its modalities of appropriate use in clinical practice will be emphasized.

Anti-Infective Agents↗
PubMed2000

[How I study anomalies of glucose metabolism, insulin secretion and the insulin sensitivity with an oral glucose tolerance test].

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of plasma glucose and insulin levels also allow to derive indices of insulin secretion and insulin sensitivity. Whereas OGTT is not considered anymore as the first choice for the diagnosis of diabetes mellitus, it remains useful for studying abnormalities of glucose metabolism as well as of insulin secretion and insulin action.

Diabetes Mellitus↗
PubMed2000

[Pharma-clinics. The drug of the month. Levofloxacin (Tavanic)].

Levofloxacin, the (-)-(S)-enantiomer isolated from the racemate ofloxacin, is launched by Aventis under the trade name of Tavanic. This new oral and parenteral antibiotic belongs to the fluoroquinolone family and exerts a bactericidal activity upon a large spectrum of microorganisms, including Gram negative and Gram positive bacilli (among which Streptococcus pneunomiae), and atypical respiratory pathogens. It also has interesting pharmacokinetic properties. Besides the classical indications of other fluoroquinolones (especially complicated urinary tract infections, including pyelonephritis, and severe skin and soft tissue infections), levofloxacin is indicated for the treatment of acute sinusitis, acute exacerbations of chronic bronchitis and community-acquired pneumonia.

Acute Disease↗
PubMed2000

[Meeting report. "MIRACL" study of "Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering"].

The results of the "MIRACL" trial ("Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering") were presented at the recent annual meeting of the American Heart Association in New Orleans last November 2000. This study demonstrates that atorvastatin, at a daily dose of 80 mg starting within the first 24 to 96 hours after an acute coronary event (unstable angina or non-Q-wave acute myocardial infarction) and maintained for 4 months, improves the cardiovascular prognosis by decreasing the combined risk of death (any cause), nonfatal myocardial infarction, resuscitated cardiac arrest and worsening angina with new objective evidence of ischemia requiring urgent hospitalization (-16% versus placebo, p < 0.05).

Anticholesteremic Agents↗
PubMed2000

[Pharma-clinics. The drug of the month. Dipyridamole-acetylsalicylic acid combination (Aggrenox)].

Aggrenox, launched in Belgium by Boehringer Ingelheim, is a fixed-dose combination of extended-release dipyridamole (200 mg) and aspirin (25 mg), two antiplatelet agents with different and complementary mechanisms of action. It is recommended, twice daily, in the protection against secondary stroke and transient ischaemic attacks. The placebo-controlled European study ESPS 2 (European Stroke Prevention Study 2) demonstrated that the administration of this combination was twice as effective as either agent alone in the secondary prevention of stroke in patients with prior stroke or transient ischaemic attack.

Aspirin↗