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- Schön, Thomas, et al.
(författare)
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Effects of a food supplement rich in arginine in patients with smear positive pulmonary tuberculosis - A randomised trial
- 2011
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Ingår i: Tuberculosis. - : Elsevier. - 1472-9792 .- 1873-281X. ; 91:5, s. 370-377
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Tidskriftsartikel (refereegranskat)abstract
- In tuberculosis (TB), the production of nitric oxide (NO) is confirmed but its importance in host defense is debated. Our aim was to investigate whether a food supplement rich in arginine could enhance clinical improvement in TB patients by increased NO production. Smear positive TB patients from Gondar, Ethiopia (n = 180) were randomized to a food supplementation rich in arginine (peanuts, equivalent to 1 g of arginine/day) or with a low arginine content (wheat crackers, locally called daboqolo) during four weeks. The primary outcome was cure rate according to the WHO classification and secondary outcomes were sputum smear conversion, weight gain, sedimentation rate, reduction of cough and chest X-ray improvement as well as levels of NO in urine (uNO) or exhaled air (eNO) at two months. There was no effect of the intervention on the primary outcome (OR 1.44, 95% CI: 0.69-3.0, p = 0.39) or secondary outcomes. In the subgroup analysis according to HIV status, peanut supplemented HIV+/TB patients showed increased cure rate (83.8% (31/37) vs 53.1% (17/32), p andlt; 0.01). A low baseline eNO (andlt; 10 ppb) in HIV+/TB patients was associated with a decreased cure rate. We conclude that nutritional supplementation with a food supplement rich in arginine did not have any overall clinical effect. In the subgroup of HIV positive TB patients, it significantly increased the cure rate and as an additional finding in this subgroup, low initial levels of NO in exhaled air were associated with a poor clinical outcome but this needs to be confirmed in further studies.
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- Suppiah, Ravi, et al.
(författare)
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A Model to Predict Cardiovascular Events in Patients With Newly Diagnosed Wegener's Granulomatosis and Microscopic Polyangiitis
- 2011
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63:4, s. 588-596
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To create a prognostic tool to quantify the 5-year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without premorbid CV disease. Methods. We reviewed CV outcomes during the long-term followup of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as CV death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort. Results. Seventy-four (13.8%) of 535 patients with 5 years of followup from the EUVAS trials had at least 1 CV event: 33 (11.7%) of 281 WG versus 41 (16.1%) of 254 MPA. The independent determinants of CV outcomes were older age (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.11-1.90), diastolic hypertension (OR 1.97, 95% CI 0.98-3.95), and positive proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA) status (OR 0.39, 95% CI 0.20-0.74). The model was validated using the WGET cohort (area under the receiver operating characteristic curve of 0.80). Conclusion. Within 5 years of diagnosis of WG or MPA, 14% of patients will have a CV event. We have constructed and validated a tool to quantify the risk of a CV event based on age, diastolic hypertension, and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with a reduced CV risk compared to myeloperoxidase ANCA or negative ANCA status.
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- Westman, Anders E., 1946-, et al.
(författare)
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Fear-avoidance beliefs, catastrophizing, and distress : a longitudinal subgroup analysis on patients with musculoskeletal pain
- 2011
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 27:7, s. 567-577
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.
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