P eople with nonrheumatic atrial fibrillation (NRAF) who have had a transient ischemic attack (TIA) or a minor ischemic stroke are at high-risk of recurrent stroke. Both warfarin and aspirin have been shown to reduce the recurrence of vascular events.
ObjectivesThe objective of this review was to compare the effect of anticoagulants with antiplatelet agents, for secondary prevention, after a stroke or TIA, in patients with NRAF.
Search StrategyThis review has drawn on the search strategy developed for the Stroke Group as a whole. Relevant trials were identified in the Stroke Group Trials Register (last search June 9, 2003). We also contacted researchers in the field to identify further published and unpublished studies.
Selection CriteriaRandomized trials comparing oral anticoagulants with antiplatelet agents in patients with NRAF and a previous TIA or minor ischemic stroke.
Data Collection and AnalysisBoth reviewers assessed trial quality and extracted data. The main outcomes considered were (1) fatal or nonfatal recurrent stroke; (2) all major vascular events: vascular death (including fatal bleeds), recurrent stroke (both ischemic and hemorrhagic), myocardial infarction, and systemic embolism; (3) any intracranial bleed; (4) major extracranial bleed.
ResultsTwo trials were identified. In the European Atrial
Implications for PracticeIn patients with NRAF and a recent nondisabling stroke or TIA, oral anticoagulants were more effective than antiplatelet agents for preventing recurrent stroke and major vascular events. However, anticoagulants were associated with a significant increase in the risk of major extracranial bleeds. These data support the routine use of oral anticoagulants in patients with NRAF and a recent nondisabling stroke or TIA.
Implications for ResearchThe excess of major extracranial bleeds with warfarin highlights the need to identify safer anticoagulant regimens or new agents of comparable efficacy but greater safety. Similarly, there is a need to identify more effective antiplatelet
The objective of the study is to determine the prevalence of Pseudomonas aeruginosa from burn patients, antibiotic resistance pattern and occurrence of acquired MBL-producing P. aeruginosa among isolates collected from burn patients. In this study, two phenotypic methods were used for the detection of MBL-producing P. aeruginosa: zone enhancement with EDTA-impregnated imipenem and ceftazidime discs, and modified Hodge test. One hundred fifty-four isolates of P. aeruginosa were obtained from July 2007 to July 2008. Infection was increased up to 95% in hospitalized patients for >50 days. Highest infection of 39% was found in patients, who had 41 to 50% of burn area followed by 19% in patients with 31 to 40% of burn area. The most common bacteria isolated were P. aeruginosa (55.0%), followed by Staphylococcus aureus (19.29%) and Klebsiella spp. (11.43%). Sixteen percent isolates of P. aeruginosa were positive for metallo-beta-lactamase production by both methods. Antibiotic resistance pattern of MBL-positive strains showed the highest resistance to ceftazidime (70%) followed by chloramphenicol (68%) and gentamicin (62.5%). Routine detection of MBLs ensuring optimal patient care and careful in vitro testing before antibiotic use may help in the prevention and treatment of burn patients infected with metallo-beta- lactamase-producing P. aeruginosa.
Objective: The aim of the present investigation was to form matrix type transdermal patches containing imipramine hydrochloride were prepared using two polymers by solvent evaporation technique to minimise the dose of the drug for lesser side effect and increase the bioavailability of a drug.
Methods:In the present study, drug loaded matrix type transdermal films of imipramine hydrochloride were prepared by the solvent evaporation method with the help of polymers along with polyethene glycol (PEG) 400 was used as plasticizer and dimethyl sulfoxide (DMSO) was used as penetration enhancer. Drug-polymer interactions determine by FTIR and a standard calibration curve of imipramine hydrochloride was determined by using UV estimation.
Results:The formulated transdermal patch by using PVP K-30, HPMC K100M showed good physical properties. All prepared formulations indicated good physical stability. The formulation F-1 gave the most suitable transdermal film with all desirable physicochemical properties. The thickness of the patches was varied from 0.263±0.67 mm to 0.301±0.61 mm, uniformity of patches showed that patches prepared by solvent evaporation while low standard deviation values ensued by thickness measurements of the film, and weights ranged between 50.5±0.75 mg and 52.15±2.15 mg, which indicates that different batches patch weights, were comparatively similar. Folding endurance was found to be>200 that is satisfactory for the patches, drug content was found to be 5.33±0.14 mg to 5.57±0.095 mg. In vitro, drug permeation studies of formulations were performed by using K-C diffusion cells using abdomen skin of the albino rat. The results were best in in-vitro skin permeation through rat skin as compared to all other formulations prepared with a hydrophilic polymer containing permeation enhancer. The formulation, F1 is considered as the best formulation, since it shows maximum in vitro drug release as 84.71±3.07 % at 24 h. The drug release kinetics studies showed that the majority of formulations were governed by Higuchi model and mechanism of release was non-Fickian mediated.
Conclusion:In conclusion, controlled release transdermal drug delivery system (TDDS) patches of imipramine hydrochloride can be prepared using the polymer combinations, with plasticizer and enhancer. The release rate of drug through patched increased simultaneously as the concentration of hydrophilic polymer was increased. However, the mechanism of drug release of all formulations was non-Fickian. The properties of a film did not change during the period of study.
The effect of NaCl on two vital processes of cyanobacterial metabolism, viz. N(2) fixation and oxygenic photosynthesis, was studied in the cyanobacterium Nostoc muscorum grown diazotrophically. An increase in NaCl concentration suppressed the formation of heterocyst and adversely affected the nitrogenase activity in the parent, whereas in Li(+)-R and Na(+)-R mutants NaCl stress did not cause any adverse effect. The rate of photosynthetic O(2)-evolution was also adversely affected by the NaCl stress, but the magnitude was less than that of nitrogenase activity. L-Proline, the well-known osmoprotectant, provided protection to the cyanobacterium against NaCl stress. The parent strain utilized L-proline as a nitrogen source and suppressed heterocyst formation and nitrogenase activity, while mutants showed normal heterocyst frequency and nitrogenase activity. Therefore, it may be that the proline metabolism is altered as a result of mutation. The intracellular levels of proline in the parent were enhanced about threefold in the medium containing 1 mol x m(-3) proline, while in mutants there was no significant increase in the intracellular level of proline. In the medium containing both NaCl and proline, the intracellular level of proline was enhanced in the parent as well as in both mutant strains. This suggests that the parent strain possessed both normal proline uptake and salt-induced proline uptake systems, whereas the mutant strains were defective in normal proline uptake and had only salt-induced proline uptake. The over-accumulation of proline in the presence of NaCl stress is due either to the loss of proline oxidase activity or to the accumulation of exogenous proline.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.