International journal of clinical practice
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Int. J. Clin. Pract. · Mar 2004
ReviewCurrent perspectives on the treatment of venous thromboembolism: need for effective, safe and convenient new antithrombotic drugs.
Treatment of venous thromboembolism (VTE) has evolved significantly over the last decade. Low-molecular-weight heparins have largely replaced unfractionated heparin in the treatment of deep-vein thrombosis (DVT) but the majority of patients with pulmonary embolism (PE) continue to be treated with unfractionated heparin. ⋯ The two large randomised MATISSE trials demonstrated that fondaparinux was at least as effective and as safe as previous reference heparin therapies in the treatment of VTE. Fondaparinux should further simplify the treatment of this frequent disease since a single once-daily fixed dosage regimen may effectively and safely treat both DVT and PE, an important point especially considering the frequent though clinically silent concomitance of these two thrombotic events.
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Int. J. Clin. Pract. · Feb 2004
ReviewLong-term glycaemic control with pioglitazone in patients with type 2 diabetes.
Patients with type 2 diabetes have dual defects: insulin resistance and beta-cell dysfunction. Thiazolidinediones (TZDs), a new class of oral drugs used for the treatment of type 2 diabetes, reduce insulin resistance via an action on peroxisome proliferator-activated receptors. There is also growing evidence that TZDs may preserve beta-cell function. ⋯ As well as maintaining glycaemic control over the long term, pioglitazone also confers benefits in terms of improvements in fasting insulin, lipid parameters, C-peptide and 32,33-split proinsulin (independent predictors of cardiovascular risk) and hypoglycaemia compared with other monotherapies or combination therapies. It is well tolerated, with a low incidence of adverse events. These long-term data support the concept that pioglitazone should be used earlier in the treatment of type 2 diabetes, either as monotherapy or as add-on therapy.
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Prolonged airway entrapment of a foreign body is a rare occurrence. We report a case of a chicken bone retained in the right main bronchus for 14 years and highlight the importance of a foreign body in the airway in the differential diagnosis of chronic and intractable cough.
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Int. J. Clin. Pract. · Oct 2003
ReviewState of the art in beta2-agonist therapy: a safety review of long-acting agents.
Despite concerns in the 1970s and 1980s about the safety of short-acting beta2-agonists, it is now generally accepted that these agents, used at appropriate doses, provide safe and effective treatment for asthma symptoms. After their introduction, beta2-agonists with a long duration of action--formoterol and salmeterol--became widely used as maintenance therapy with inhaled corticosteroids (ICS). ⋯ Formoterol produces long-lasting bronchoprotection against exercise-induced bronchoconstriction, even in patients receiving regular maintenance therapy; its fast onset of effect (similar to salbutamol) allows formoterol to be used as a reliever. Clinically the safety of formoterol and salmeterol has been demonstrated in several studies, both with ICS and alone.