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Biomedical subjects

J F Bergmann

Publications and source records attributed to J F Bergmann.

At least 37 records · Page 2Linked to original sources
PubMed2000

Oral ganciclovir systemic exposure is enhanced in HIV-infected patients with diarrhea and weight loss.

OBJECTIVE: To determine whether diarrhea and intestinal malabsorption during HIV infection alter oral ganciclovir systemic exposure. METHODS: We studied the oral disposition of ganciclovir in 42 HIV-infected patients stratified into three groups: A (n = 15), HIV (stage A and B); B (n = 13), AIDS (stage C); and C (n = 14), AIDS with chronic diarrhea and wasting syndrome (10% or more weight loss). Each patient was evaluated for nutritional (body mass index, serum albumin and transferrin), immunologic (CD4 count, plasma viral load) and intestinal status (D-xylose test, fecal fat and nitrogen excretion, and intestinal permeability). Following an overnight fast, 1 g oral ganciclovir was given to patients. Six blood samples were collected over 24 hours. Serum was analyzed for ganciclovir by high performance liquid chromatography. Drug disposition was characterized using a population pharmacokinetic approach. RESULTS: Mean intestinal permeability increased as HIV disease progressed (0. 05, 0.1, and 0.2 for groups A, B, and C, respectively). Average weight-adjusted maximum concentration (Cmax) in group C was twofold more than that in group A and B patients (12.5 versus 6 and 6.4 ng/ml/kg), and average area under the curve (AUC0-infinity) was threefold greater in group C patients (193 versus 59 and 65 ng. hour/ml/kg in groups A and B, respectively). Mean oral clearance was threefold lower in group C (96 versus 258 and 212 L/hour in groups A and B, respectively). CONCLUSION: Because systemic exposure of oral ganciclovir is enhanced in AIDS patients with diarrhea and wasting syndrome, oral ganciclovir therapy may benefit these patients.

Administration, Oral↗
PubMed2000

[Reading a clinical trial report].

To improve medical knowledge by reading clinical trial reports it is necessary to check for the respect of the methodological rules, and to analyze and criticize the results. A control group and a randomisation are always necessary. Double blind assessment, sample size calculation, intention to treat analysis, a unique primary end point are also important. The conclusions of the trial are valid only for the population included and the clinical signification of the results, depending on the control treatment, has to be evaluated. Respect of the reading rules is necessary to assess the reliability of the conclusions, in order to promote evidence-based practice.

Double-Blind Method↗
PubMed2000

[Multifactorial cardiovascular risk].

IMPORTANCE OF RISK ASSESSMENT: The prevention of cardiovascular disease is a major public health goal. Cardiovascular diseases are the number one cause of mortality in industrialized countries and account for an important part of health care expenditures. In this context, assessment of the cardiovascular risk for a given subject based on epidemiological data and individual risk factors can be used to determine his/her risk of ischemic heart disease or stroke. THE FRAMINGHAM FORMULA: The most widely used assessment method is the Framingham formula which integrates age, sex, blood pressure, smoking habits and presence or not of diabetes. This formula gives an objective, reproducible estimation of the cardiovascular risk and is a useful tool for therapeutic rationale and primary and secondary prevention. INTEREST AND LIMITATIONS: This new global approach to the individual patient has interesting practical and economic implications but remains imperfect due to certain limitations (other risk factors not taken into account because they are difficult to quantify or occurred recently). For daily practice however, it provides a useful tool appreciated by clinicians and patients.

Cardiovascular Diseases↗
PubMed2000

Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review.

Aspirin and angiotensin-converting enzyme inhibitors (ACEIs) are often associated for the treatment of coronary disease and/or chronic heart failure, but conclusions of some prospective and retrospective studies show a possible negative interaction between aspirin and ACEIs. ACEIs inhibit the conversion of angiotensin I to angiotensin II and also the catabolism of bradykinin, which results in increased synthesis of vasodilatory agents [prostaglandins and nitric oxide (NO)], whereas aspirin inhibits prostaglandin synthesis. Thus, a potential interaction from the opposing effects of aspirin and ACEIs could affect the metabolism of bradykinin. We conducted an extensive Medline search, as well as a manual search, of published literature including pharmacodynamic studies and clinical trials concerning the impact of aspirin on the effect of ACEIs in hypertension, coronary disease and chronic heart failure. A review of this literature shows five studies in hypertension (all prospective and using blood pressure as the main criterion of assessment), five in coronary disease (three retrospective and two prospective trials, four of which use mortality as the criterion of assessment) and 13 in chronic heart failure (eight using haemodynamic measurements of which seven are prospective--one prospective study using pulmonary tests, four using clinical events including mortality as criterion of assessment of which two are prospective). The counteraction of ACEI efficacy by aspirin is demonstrated in one out of five studies in hypertension, one out of four of studies in coronary disease and nine out of thirteen in chronic heart failure. This counteraction is more often observed with high dosages of aspirin (greater than 250 mg/day, four out of six studies) and less often with lower dosages (less than or equal to 250 mg/day, three out of 11 studies). These studies are retrospective analyses or use haemodynamic end-points, so there is as yet no methodological argument strong enough to contraindicate the aspirin-ACEI association or to prove the clinical relevance of this interaction. In conclusion, prospective studies using mortality as a criterion of assessment are needed to offer the practitioner the answer to the question of ACEI-aspirin association.

Analgesics, Non-Narcotic↗
PubMed2000

Drug-induced diarrhoea.

Diarrhoea is a relatively frequent adverse event, accounting for about 7% of all drug adverse effects. More than 700 drugs have been implicated in causing diarrhoea; those most frequently involved are antimicrobials, laxatives, magnesium-containing antacids, lactose- or sorbitol-containing products, nonsteroidal anti-inflammatory drugs, prostaglandins, colchicine, antineoplastics, antiarrhythmic drugs and cholinergic agents. Certain new drugs are likely to induce diarrhoea because of their pharmacodynamic properties; examples include anthraquinone-related agents, alpha-glucosidase inhibitors, lipase inhibitors and cholinesterase inhibitors. Antimicrobials are responsible for 25% of drug-induced diarrhoea. The disease spectrum of antimicrobial-associated diarrhoea ranges from benign diarrhoea to pseudomembranous colitis. Several pathophysiological mechanisms are involved in drug-induced diarrhoea: osmotic diarrhoea, secretory diarrhoea, shortened transit time, exudative diarrhoea and protein-losing enteropathy, and malabsorption or maldigestion of fat and carbohydrates. Often 2 or more mechanisms are present simultaneously. In clinical practice, 2 major types of diarrhoea are seen: acute diarrhoea, which usually appears during the first few days of treatment, and chronic diarrhoea, lasting more than 3 or 4 weeks and which can appear a long time after the start of drug therapy. Both can be severe and poorly tolerated. In a patient presenting with diarrhoea, the medical history is very important, especially the drug history, as it can suggest a diagnosis of drug-induced diarrhoea and thereby avoid multiple diagnostic tests. The clinical examination should cover severity criteria such as fever, rectal emission of blood and mucus, dehydration and bodyweight loss. Establishing a relationship between drug consumption and diarrhoea or colitis can be difficult when the time elapsed between the start of the drug and the onset of symptoms is long, sometimes up to several months or years.

Anti-Bacterial Agents↗
PubMed2000

[Prevention of deep venous thrombosis in medical patients].

Prophylaxis of deep vein thrombosis with standard heparin and low molecular weight heparin has been studied in many clinical trials in surgical patients and in few and various medical conditions in hospitalized subjects. Clinical trials have been conducted in patients with recent myocardial infarction, heart failure, stroke, pulmonary sepsis, cancer, or any acute disease with a high risk factors for deep vein thrombosis (previous thromboembolism, thrombophilia, obesity, recent bedridden, dehydratation.). The combination of a high risk disease with a high risk factor related to the history of the patient might reasonably conduct to a prophylaxis with low molecular weight heparins. The duration of this treatment has to be short and limited to the period of the acute medical condition inducing a high risk for deep vein thrombosis. Prophylaxis has to be offered to patients with ischemic stroke, cardiac failure, recent myocardial infarction, active cancer or any other acute medical disease in patients with a previous thromboembolism or thrombophilia history. Bedridden status and age are not, by themselves, an indication for prophylaxis with heparins. A widespread diffusion of these recommendations is needed to reduce overprescriptions.

Hospitalization↗
PubMed1999

Inclusion and exclusion criteria of importance in irritable bowel syndrome trials.

Although numerous diseases may mimic or be confused with irritable bowel syndrome (IBS), a detailed and precise clinical history and a normal clinical examination usually lead to an accurate diagnosis of IBS. The presence of symptom criteria and the absence of warning signs must be established. Before entering a clinical trial, several routine tests are generally required: total blood count, erythrocyte sedimentation rate, biochemistry screen, stool culture and examination for occult blood, ova, and parasites, and a recent (<2 years) normal flexible sigmoidoscopy or colonoscopy with biopsy. Blood and stool tests are not necessary for the diagnosis of IBS but are important in the framework of controlled trials. Esophagogastroduodenoscopy, abdominal ultrasonography, and malabsorption tests are needed only in patients with atypical IBS or for phase II trials in certain subgroups of patients. Chronic diseases, drugs, and toxic agents that may mimic IBS symptoms or exacerbate the disorder must be excluded. Errors in patient inclusion will be minimized if the duration and severity of IBS symptoms before inclusion is sufficient and will have little effect on the result of the trial if the new drug is really effective and the study well randomized with a correct calculation of sample size.

Clinical Trials as Topic↗
PubMed1999

Intestinal absorption and permeability in human immunodeficiency virus-infected patients.

BACKGROUND: Impaired intestinal function could account for diarrhoea and weight loss, which are common features of advanced human immunodeficiency virus (HIV) infection. METHODS: We assessed intestinal permeability to lactulose and mannitol and absorption of D-xylose in 96 HIV-infected patients (group I: asymptomatic subjects (CDC-A); group II: symptomatic subjects (CDC-B or C) without body weight loss and/or diarrhoea; group III: 25 acquired immunodeficiency syndrome (AIDS) patients (CDC-C) with severe body weight loss and/or diarrhoea) and 10 healthy subjects as controls. RESULTS: An incremental decrease in urinary D-xylose recoveries was observed, with all groups statistically different from each other. Impaired intestinal permeability was only found in patients of group III (statistically different from all other groups). CONCLUSIONS: These findings suggest a loss of intestinal functional absorptive surface as HIV disease progresses. This process may be present at the early stage of infection. Impaired intestinal permeability is observed later in AIDS patients when digestive signs are present, particularly diarrhoea.

Adult↗
PubMed1999

Validation of a specific quality of life questionnaire for functional digestive disorders.

BACKGROUND: Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life. Their similarities justify the elaboration of a single specific questionnaire for the two conditions. AIMS: To examine the process leading to the validation of the psychometric properties of the functional digestive disorders quality of life questionnaire (FDDQL). METHODS: Initially, the questionnaire was given to 154 patients, to assess its acceptability and reproducibility, analyse its content, and reduce the number of items. Its responsiveness was tested during two therapeutic trials which included 428 patients. The questionnaire has been translated into French, English, and German. The psychometric validation study was conducted in France, United Kingdom, and Germany by 187 practitioners. A total of 401 patients with dyspepsia or irritable bowel syndrome, defined by the Rome criteria, filled in the FDDQL and generic SF-36 questionnaires. RESULTS: The structure of the FDDQL scales was checked by factorial analysis. Its reliability was expressed by a Cronbach's alpha coefficient of 0.94. Assessment of its discriminant validity showed that the more severe the functional digestive disorders, the more impaired the quality of life (p<0.05). Concurrent validity was supported by the correlation found between the FDDQL and SF-36 questionnaire scales. The final version of the questionnaire contains 43 items belonging to eight domains. CONCLUSIONS: The properties of the FDDQL questionnaire, available in French, English, and German, make it appropriate for use in clinical trials designed to evaluate its responsiveness to treatment among patients with dyspepsia and irritable bowel syndrome.

Adult↗
PubMed1998

Quality of life in irritable bowel syndrome, effect of therapy.

BACKGROUND: Irritable bowel syndrome (IBS) is a common disease in the general population. Evaluation of IBS symptoms does not cover all the complaints of patients who report restrictions to social life, the need to diet and psychosocial repercussions. Quality of life (QOL) measurement permits a precise approach to patient status. METHODS: The generic QOL questionnaires SF 36 and two validated specific QOL questionnaires--IBSQOL and Functional Digestive Disorders FDDQL--have been used for the evaluation of IBS patient outcome. IBSQOL measures 9 domains and its reliability and validity have been demonstrated. FDDQL measures 8 domains, an international psychometric validation was obtained in French, English and German by comparison with the SF36. The discriminant validity and responsiveness of the FDDQL have been evaluated. RESULTS: Generic QOL evaluation and specific questionnaires like the FDDQL were able to measure changes in IBS patient status and QOL during several clinical trials. CONCLUSION: Specific QOL questionnaires have been validated in IBS patients and are available for controlled studies. Development of effective new drugs are needed for IBS treatment, complete and precise evaluation of outcome will involve QOL analysis in association with specific validated questionnaires.

Activities of Daily Living↗