International journal of clinical practice. Supplement
-
Int J Clin Pract Suppl · Jul 2002
ReviewThe effects of glucose fluctuation on cognitive function and QOL: the functional costs of hypoglycaemia and hyperglycaemia among adults with type 1 or type 2 diabetes.
It is traditionally believed that while acute hypoglycaemia has detectable negative consequences, such as unpleasant symptoms and cognitive-motor disruptions, acute hyperglycaemia is not associated with such consequences. However, recent research with adults affected by either type 1 or 2 diabetes mellitus demonstrates that relatively mild hyperglycaemia is associated with unpleasant symptoms and cognitive disruptions. Both hyperglycaemia and hypoglycaemia can be associated with patient experiences of physical, affective, and cognitive symptoms, as well as cognitive-motor disruptions. ⋯ If the person is engaging in a relatively dangerous task, such as driving a vehicle, significant consequences could follow. Both hypoglycaemia and hyperglycaemia have been demonstrated to have not only acute, but also chronic effects in patients with type 1 as well as those with type 2 diabetes. Although hypoglycaemia occurs at a lower rate among patients with type 2 diabetes than among those with type 1, the number of patients with type 2 diabetes is so large that even this low rate results in many persons being affected.
-
Int J Clin Pract Suppl · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialAnti-hyperalgesic effects of nimesulide: studies in rats and humans.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used as analgesics. Despite the fact that clinical experience indicates a considerable disparity in the analgesic efficacy of NSAIDs, the animal models of nociception do not allow a clear distinction to be made between the analgesic properties of these agents. In contrast to nociceptive pain, clinical pain is characterised by hyperalgesia. ⋯ Moreover, nimesulide (100 mg) was significantly more effective than rofecoxib (25 mg). Overall, our data demonstrate that NSAIDs may show different anti-hyperalgesic properties. Nimesulide seems to be particularly effective and fast-acting against inflammatory pain.
-
Int J Clin Pract Suppl · Jun 2002
ReviewThe tolerability and safety of cholinesterase inhibitors in the treatment of dementia.
Cholinesterase inhibitors (ChEIs) are dosed in two phases for the treatment of dementia, an initial dose-escalation phase to achieve a therapeutic dose and a maintenance phase where the therapeutic dose is given for long-term therapy. ChEIs are associated with a range of side effects as a result of cholinergic stimulation in different areas of the brain and the periphery Acute, centrally-mediated gastrointestinal events (mostly nausea and vomiting) are class effects of all ChEIs, and are reported mostly during the dose-escalation phase of therapy. These events have been associated more with the dual acetylcholinesterase/butyrylcholinesterase (AChE/BuChE) inhibitor rivastigmine than with the AChE-selective inhibitors donepezil and galantamine, probably due to rivastigmine's higher potency. ⋯ When dosed with care, ChEIs are well tolerated and patient compliance and patient and caregiver acceptability are good. The favourable tolerability and safety profiles of these agents make them suitable first-line therapy for dementia. In addition, patients who have tolerability and/or safety problems in maintenance treatment that limit the use of donepezil or galantamine may benefit from switching to rivastigmine.
-
Int J Clin Pract Suppl · Mar 2002
ReviewCommunity-acquired lower respiratory tract infections: clinical experience with beta-lactam/beta-lactamase inhibitors.
Once universally susceptible to aminopenicillins and cephalosporins, an increasing percentage of the common respiratory pathogens that cause community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are now resistant to these agents and exhibit cross-resistance to other commonly used antibiotics. In an era of multidrug resistance, guidelines for the management of both CAP and AECB can help to guide appropriate antibiotic prescribing, encourage the rational use of antibiotics, which will help to limit the emergence of resistance, and conserve the use of new antimicrobial agents for more serious infections. Central to all current management guidelines is risk assessment, which includes an appreciation of local antibiotic resistance patterns. beta-Lactam antibiotics are still considered among the drugs of choice for the treatment of CAP and AECB, although their use can be compromised by high rates of resistance. The beta-lactam/beta-lactamase inhibitor combinations, such as ampicillin/sulbactam, provide a means of overcoming such resistance and represent a suitable alternative.