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Aliskiren Dual Therapy Beats Amlodipine for BP : Central systolic BP was reduced by 30 mm Hg in two studies.
Major Finding: In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
Data Source: A subset of patients totaling 775 from two safety and efficacy studies of aliskiren/hydrochlorothiazide.
Disclosures: Novartis Pharmaceuticals supported the study. Dr. Ferdinand had no financial conflicts to disclose, but one of the study coauthors is an employee of Novartis Pharmaceuticals.
CRYSTAL CITY, VA. — Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Findings from previous studies have suggested that cardiovascular morbidity might be more closely associated with central blood pressure than it is with systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and his colleagues.
Additional studies have shown that central blood pressure tends to be higher in healthy young African American men, compared with that in healthy young white men, the researchers noted in a poster at the meeting.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in African Americans with stage II hypertension, Dr. Ferdinand and his colleagues reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment, the researchers noted.
Changes in the peripheral measure of systolic blood pressure were not significant in either of the groups.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in patients in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In that study, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women.
Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
Major Finding: In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
Data Source: A subset of patients totaling 775 from two safety and efficacy studies of aliskiren/hydrochlorothiazide.
Disclosures: Novartis Pharmaceuticals supported the study. Dr. Ferdinand had no financial conflicts to disclose, but one of the study coauthors is an employee of Novartis Pharmaceuticals.
CRYSTAL CITY, VA. — Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Findings from previous studies have suggested that cardiovascular morbidity might be more closely associated with central blood pressure than it is with systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and his colleagues.
Additional studies have shown that central blood pressure tends to be higher in healthy young African American men, compared with that in healthy young white men, the researchers noted in a poster at the meeting.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in African Americans with stage II hypertension, Dr. Ferdinand and his colleagues reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment, the researchers noted.
Changes in the peripheral measure of systolic blood pressure were not significant in either of the groups.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in patients in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In that study, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women.
Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
Major Finding: In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
Data Source: A subset of patients totaling 775 from two safety and efficacy studies of aliskiren/hydrochlorothiazide.
Disclosures: Novartis Pharmaceuticals supported the study. Dr. Ferdinand had no financial conflicts to disclose, but one of the study coauthors is an employee of Novartis Pharmaceuticals.
CRYSTAL CITY, VA. — Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Findings from previous studies have suggested that cardiovascular morbidity might be more closely associated with central blood pressure than it is with systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and his colleagues.
Additional studies have shown that central blood pressure tends to be higher in healthy young African American men, compared with that in healthy young white men, the researchers noted in a poster at the meeting.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in African Americans with stage II hypertension, Dr. Ferdinand and his colleagues reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment, the researchers noted.
Changes in the peripheral measure of systolic blood pressure were not significant in either of the groups.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in patients in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively).
But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In that study, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women.
Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
Concussion Rates Are Rising in Younger Athletes Aged 8-13 Years
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8–13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. Dr. Bakhos conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009–3101]).
"First, many parents, coaches, teachers, and other adults feel that because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is, of course, not the case," said Dr. Bakhos, who is currently an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.
In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, "which leads to conjecture that younger children would suffer the same — if not more — deficits long term."
However, the link between sports-related concussion and cognitive deficits needs further study, she commented.
The American Academy of Pediatrics has just released a new clinical report, "Sport-Related Concussion in Children and Adolescents" to aid in this effort (Pediatrics 2010 Aug. 30 [doi:10.1542/peds. 2010–2005]).
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and her colleagues reviewed data from the NEISS (National Electronic Injury Surveillance System) from 1997 through 2007, and from the NEISS-AIP (All-Injury Program) from 2001 through 2005.
The NEISS system allows researchers to investigate injury- and product-related ED visits.
In 2001–2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8–13 years and 46% of visits in those aged 14–19 years.
Put another way, approximately 4 in 1,000 children aged 8–13 years and 6 in 1,000 of those aged 14–19 years went to the ED for a sports-related concussion.
During the 10-year period of 1997–2007, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
"The take-home message for pediatricians is, take concussion seriously even in the very young athlete," said Dr. Bakhos. "Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents."
"We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times," she emphasized.
The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
To help clinicians manage sports-related concussions in young athletes, the AAP published a new clinical report that "outlines the current state of knowledge on pediatric and adolescent sport-related concussions," wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.
The report outlines recommendations regarding sports-related concussion, including the following:
▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. Younger athletes need more recovery time and a more conservative approach than do college or professional athletes.
▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.
▸ Rest mind and body. All young athletes should refrain from physical activity until they are asymptomatic at rest and when active. Rest includes mental as well as physical rest.
Some evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.
In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The state laws were a consideration, but the AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program in the department of orthopedics at Washington University in St. Louis.
"We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic," he said in an interview.
"The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review.
"We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published.
"We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing," Dr. Halstead said.
Dr. Walter added, "I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different than today."
Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they "toughed it out" and "are fine now," said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.
The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.
I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the emergency department, there are even more injuries occurring that are not being reported.
I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis.
For example, loss of consciousness is actually less predictive than loss of memory. (I published a paper in 2003 showing that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.
As we continue to peel the onion on concussion, we realize that it is an extremely complex injury, and that there are more problems in those who are injured—particularly kids. Also, we now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.
Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.
One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.
MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He also coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians.
I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the emergency department, there are even more injuries occurring that are not being reported.
I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis.
For example, loss of consciousness is actually less predictive than loss of memory. (I published a paper in 2003 showing that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.
As we continue to peel the onion on concussion, we realize that it is an extremely complex injury, and that there are more problems in those who are injured—particularly kids. Also, we now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.
Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.
One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.
MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He also coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians.
I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the emergency department, there are even more injuries occurring that are not being reported.
I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis.
For example, loss of consciousness is actually less predictive than loss of memory. (I published a paper in 2003 showing that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.
As we continue to peel the onion on concussion, we realize that it is an extremely complex injury, and that there are more problems in those who are injured—particularly kids. Also, we now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.
Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.
One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.
MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He also coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians.
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8–13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. Dr. Bakhos conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009–3101]).
"First, many parents, coaches, teachers, and other adults feel that because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is, of course, not the case," said Dr. Bakhos, who is currently an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.
In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, "which leads to conjecture that younger children would suffer the same — if not more — deficits long term."
However, the link between sports-related concussion and cognitive deficits needs further study, she commented.
The American Academy of Pediatrics has just released a new clinical report, "Sport-Related Concussion in Children and Adolescents" to aid in this effort (Pediatrics 2010 Aug. 30 [doi:10.1542/peds. 2010–2005]).
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and her colleagues reviewed data from the NEISS (National Electronic Injury Surveillance System) from 1997 through 2007, and from the NEISS-AIP (All-Injury Program) from 2001 through 2005.
The NEISS system allows researchers to investigate injury- and product-related ED visits.
In 2001–2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8–13 years and 46% of visits in those aged 14–19 years.
Put another way, approximately 4 in 1,000 children aged 8–13 years and 6 in 1,000 of those aged 14–19 years went to the ED for a sports-related concussion.
During the 10-year period of 1997–2007, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
"The take-home message for pediatricians is, take concussion seriously even in the very young athlete," said Dr. Bakhos. "Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents."
"We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times," she emphasized.
The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
To help clinicians manage sports-related concussions in young athletes, the AAP published a new clinical report that "outlines the current state of knowledge on pediatric and adolescent sport-related concussions," wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.
The report outlines recommendations regarding sports-related concussion, including the following:
▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. Younger athletes need more recovery time and a more conservative approach than do college or professional athletes.
▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.
▸ Rest mind and body. All young athletes should refrain from physical activity until they are asymptomatic at rest and when active. Rest includes mental as well as physical rest.
Some evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.
In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The state laws were a consideration, but the AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program in the department of orthopedics at Washington University in St. Louis.
"We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic," he said in an interview.
"The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review.
"We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published.
"We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing," Dr. Halstead said.
Dr. Walter added, "I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different than today."
Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they "toughed it out" and "are fine now," said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.
The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8–13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. Dr. Bakhos conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009–3101]).
"First, many parents, coaches, teachers, and other adults feel that because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is, of course, not the case," said Dr. Bakhos, who is currently an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.
In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, "which leads to conjecture that younger children would suffer the same — if not more — deficits long term."
However, the link between sports-related concussion and cognitive deficits needs further study, she commented.
The American Academy of Pediatrics has just released a new clinical report, "Sport-Related Concussion in Children and Adolescents" to aid in this effort (Pediatrics 2010 Aug. 30 [doi:10.1542/peds. 2010–2005]).
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and her colleagues reviewed data from the NEISS (National Electronic Injury Surveillance System) from 1997 through 2007, and from the NEISS-AIP (All-Injury Program) from 2001 through 2005.
The NEISS system allows researchers to investigate injury- and product-related ED visits.
In 2001–2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8–13 years and 46% of visits in those aged 14–19 years.
Put another way, approximately 4 in 1,000 children aged 8–13 years and 6 in 1,000 of those aged 14–19 years went to the ED for a sports-related concussion.
During the 10-year period of 1997–2007, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
"The take-home message for pediatricians is, take concussion seriously even in the very young athlete," said Dr. Bakhos. "Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents."
"We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times," she emphasized.
The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
To help clinicians manage sports-related concussions in young athletes, the AAP published a new clinical report that "outlines the current state of knowledge on pediatric and adolescent sport-related concussions," wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.
The report outlines recommendations regarding sports-related concussion, including the following:
▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. Younger athletes need more recovery time and a more conservative approach than do college or professional athletes.
▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.
▸ Rest mind and body. All young athletes should refrain from physical activity until they are asymptomatic at rest and when active. Rest includes mental as well as physical rest.
Some evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.
In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The state laws were a consideration, but the AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program in the department of orthopedics at Washington University in St. Louis.
"We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic," he said in an interview.
"The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review.
"We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published.
"We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing," Dr. Halstead said.
Dr. Walter added, "I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different than today."
Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they "toughed it out" and "are fine now," said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.
The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.
Concussion Rates Rising in Younger Athletes
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005, according to a study published online Aug. 30 in Pediatrics.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead study author Dr. Lisa Bakhos of Brown University, Providence, R.I., said in an interview.
“First, many parents, coaches, teachers, and other adults feel that, because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is of course not the case,” she said.
“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same, if not more, deficits long term.” However, the link between sports-related concussion and cognitive deficits needs further study, she added.
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and colleagues reviewed data from the National Electronic Injury Surveillance System (NEISS) from 1997 through 2007, and from the NEISS All Injury Program from 2001 through 2005. The NEISS allows researchers to investigate injury- and product-related ED visits (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).
Between 2001 and 2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. Put another way, approximately 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.
During the 10-year period from 1997 through 2007, ED visits for the most popular organized team sports – football, ice hockey, soccer, basketball, and baseball – doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
“The take-home message for pediatricians is take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents,” she said.
“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly the use of helmets at all times,” she emphasized.
The study was limited by the exclusion of sports-related concussions treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
The researchers said that they had no financial conflicts to disclose.
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005, according to a study published online Aug. 30 in Pediatrics.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead study author Dr. Lisa Bakhos of Brown University, Providence, R.I., said in an interview.
“First, many parents, coaches, teachers, and other adults feel that, because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is of course not the case,” she said.
“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same, if not more, deficits long term.” However, the link between sports-related concussion and cognitive deficits needs further study, she added.
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and colleagues reviewed data from the National Electronic Injury Surveillance System (NEISS) from 1997 through 2007, and from the NEISS All Injury Program from 2001 through 2005. The NEISS allows researchers to investigate injury- and product-related ED visits (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).
Between 2001 and 2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. Put another way, approximately 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.
During the 10-year period from 1997 through 2007, ED visits for the most popular organized team sports – football, ice hockey, soccer, basketball, and baseball – doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
“The take-home message for pediatricians is take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents,” she said.
“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly the use of helmets at all times,” she emphasized.
The study was limited by the exclusion of sports-related concussions treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
The researchers said that they had no financial conflicts to disclose.
Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005, according to a study published online Aug. 30 in Pediatrics.
There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead study author Dr. Lisa Bakhos of Brown University, Providence, R.I., said in an interview.
“First, many parents, coaches, teachers, and other adults feel that, because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is of course not the case,” she said.
“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same, if not more, deficits long term.” However, the link between sports-related concussion and cognitive deficits needs further study, she added.
To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and colleagues reviewed data from the National Electronic Injury Surveillance System (NEISS) from 1997 through 2007, and from the NEISS All Injury Program from 2001 through 2005. The NEISS allows researchers to investigate injury- and product-related ED visits (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).
Between 2001 and 2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. Put another way, approximately 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.
During the 10-year period from 1997 through 2007, ED visits for the most popular organized team sports – football, ice hockey, soccer, basketball, and baseball – doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.
“The take-home message for pediatricians is take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents,” she said.
“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly the use of helmets at all times,” she emphasized.
The study was limited by the exclusion of sports-related concussions treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.
But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.
The researchers said that they had no financial conflicts to disclose.
Major Finding: Concussions in children aged 8-13 years playing organized team sports doubled between 1997 and 2007.
Data Source: A review of data from 1997-2007 and 2001-2005 NEISS injury databases.
Disclosures: The researchers said they had no financial conflicts to disclose.
Stent Thrombosis Occurs More Often in Blacks
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Stent Thrombosis Occurs More Often in Blacks
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults published online Aug. 30 in Circulation.
To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.
The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).
For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.
The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.
In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.
“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.
Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), although the difference was not significant.
In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.
The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.
“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.
The researchers said that they had no financial conflicts to disclose.
Major Finding: Black patients receiving drug-eluting stents were significantly more likely than nonblack patients to develop stent thrombosis .
Data Source: Retrospective study of 7,236 adults who underwent PCI between 2003 and 2008.
Disclosures: The researchers said they had no financial conflicts to disclose.
WHO Declares End to 2009 H1N1 Influenza Pandemic
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
Two Combination Therapies Work Equally Well to Reduce Acne
Combination topical tretinoin and clindamycin was as effective as combination salicylic acid and clindamycin for reducing lesions in patients with mild to moderate acne, based on data from a 12-week randomized trial.
The findings were published online July 28 in the Journal of the European Academy of Dermatology and Venereology.
Several types of combination treatments allow clinicians to target different causes of acne vulgaris, but the safety and efficacy of tretinoin/clindamycin phosphate and salicylic acid/clindamycin phosphate have not previously been compared, according to Dr. A. Babayeva of Dokuz Eyll University in Izmir, Turkey, and colleagues.
Researchers randomized 46 acne patients aged 18-31 years to one of the two combination therapies: 3% salicylic acid plus clindamycin phosphate 1% lotion (SA/CDP) or all trans retinoic acid 0.05% cream plus clindamycin phosphate 1% lotion (all-TRA/CDP). The average lesion count at baseline was 67 in both groups, and the proportion of inflammatory and noninflammatory lesions was similar between the groups (J. Eur. Acad. Dermatol. Venerol. 2010 July 28 [doi:10.1111/j.1468-3083.2010.03793.x]).
After 12 weeks, the average total lesion count was 13 in the SA/CDP group and 10 in the all-TRA/CDP group; the difference was not statistically significant. The average inflammatory and noninflammatory lesion counts were not significantly different between the two groups (5 vs. 4 and 8 vs. 6, respectively).
After 2 weeks of treatment, significantly more patients in the all-TRA/CDP group showed a 50% reduction in total lesion counts, compared with the SA/CDP group, but there were no significant differences in lesion counts between the groups when patients were assessed after 4, 8, and 12 weeks of treatment, according to the investigators.
All reported side effects were mild to moderate, and most occurred during the first 2 weeks of treatment. The most common reported side effects were dryness, peeling, erythema, burning, and itching. The proportion of patients reporting at least one side effect was similar between the SA/CDP and all-TRA/CDP groups (83% vs. 74%).
Although the efficacy of the all-TRA/CDP was higher in the first 2 weeks, the end results were similar, suggesting SA/CDP can be an effective alternative to all-TRA/CDP, the researchers found. The results support data from previous studies, and they suggest that CDP can help reduce the irritation associated with all-TRA.
The researchers had no financial conflicts to disclose.
Combination topical tretinoin and clindamycin was as effective as combination salicylic acid and clindamycin for reducing lesions in patients with mild to moderate acne, based on data from a 12-week randomized trial.
The findings were published online July 28 in the Journal of the European Academy of Dermatology and Venereology.
Several types of combination treatments allow clinicians to target different causes of acne vulgaris, but the safety and efficacy of tretinoin/clindamycin phosphate and salicylic acid/clindamycin phosphate have not previously been compared, according to Dr. A. Babayeva of Dokuz Eyll University in Izmir, Turkey, and colleagues.
Researchers randomized 46 acne patients aged 18-31 years to one of the two combination therapies: 3% salicylic acid plus clindamycin phosphate 1% lotion (SA/CDP) or all trans retinoic acid 0.05% cream plus clindamycin phosphate 1% lotion (all-TRA/CDP). The average lesion count at baseline was 67 in both groups, and the proportion of inflammatory and noninflammatory lesions was similar between the groups (J. Eur. Acad. Dermatol. Venerol. 2010 July 28 [doi:10.1111/j.1468-3083.2010.03793.x]).
After 12 weeks, the average total lesion count was 13 in the SA/CDP group and 10 in the all-TRA/CDP group; the difference was not statistically significant. The average inflammatory and noninflammatory lesion counts were not significantly different between the two groups (5 vs. 4 and 8 vs. 6, respectively).
After 2 weeks of treatment, significantly more patients in the all-TRA/CDP group showed a 50% reduction in total lesion counts, compared with the SA/CDP group, but there were no significant differences in lesion counts between the groups when patients were assessed after 4, 8, and 12 weeks of treatment, according to the investigators.
All reported side effects were mild to moderate, and most occurred during the first 2 weeks of treatment. The most common reported side effects were dryness, peeling, erythema, burning, and itching. The proportion of patients reporting at least one side effect was similar between the SA/CDP and all-TRA/CDP groups (83% vs. 74%).
Although the efficacy of the all-TRA/CDP was higher in the first 2 weeks, the end results were similar, suggesting SA/CDP can be an effective alternative to all-TRA/CDP, the researchers found. The results support data from previous studies, and they suggest that CDP can help reduce the irritation associated with all-TRA.
The researchers had no financial conflicts to disclose.
Combination topical tretinoin and clindamycin was as effective as combination salicylic acid and clindamycin for reducing lesions in patients with mild to moderate acne, based on data from a 12-week randomized trial.
The findings were published online July 28 in the Journal of the European Academy of Dermatology and Venereology.
Several types of combination treatments allow clinicians to target different causes of acne vulgaris, but the safety and efficacy of tretinoin/clindamycin phosphate and salicylic acid/clindamycin phosphate have not previously been compared, according to Dr. A. Babayeva of Dokuz Eyll University in Izmir, Turkey, and colleagues.
Researchers randomized 46 acne patients aged 18-31 years to one of the two combination therapies: 3% salicylic acid plus clindamycin phosphate 1% lotion (SA/CDP) or all trans retinoic acid 0.05% cream plus clindamycin phosphate 1% lotion (all-TRA/CDP). The average lesion count at baseline was 67 in both groups, and the proportion of inflammatory and noninflammatory lesions was similar between the groups (J. Eur. Acad. Dermatol. Venerol. 2010 July 28 [doi:10.1111/j.1468-3083.2010.03793.x]).
After 12 weeks, the average total lesion count was 13 in the SA/CDP group and 10 in the all-TRA/CDP group; the difference was not statistically significant. The average inflammatory and noninflammatory lesion counts were not significantly different between the two groups (5 vs. 4 and 8 vs. 6, respectively).
After 2 weeks of treatment, significantly more patients in the all-TRA/CDP group showed a 50% reduction in total lesion counts, compared with the SA/CDP group, but there were no significant differences in lesion counts between the groups when patients were assessed after 4, 8, and 12 weeks of treatment, according to the investigators.
All reported side effects were mild to moderate, and most occurred during the first 2 weeks of treatment. The most common reported side effects were dryness, peeling, erythema, burning, and itching. The proportion of patients reporting at least one side effect was similar between the SA/CDP and all-TRA/CDP groups (83% vs. 74%).
Although the efficacy of the all-TRA/CDP was higher in the first 2 weeks, the end results were similar, suggesting SA/CDP can be an effective alternative to all-TRA/CDP, the researchers found. The results support data from previous studies, and they suggest that CDP can help reduce the irritation associated with all-TRA.
The researchers had no financial conflicts to disclose.
From the Journal of the European Academy of Dermatology and Venereology
Major Finding: After 12 weeks, the average total lesion count was 13 in the SA/CDP group and 10 in the all-TRA/CDP group; the difference was not statistically significant.
Data Source: A randomized trial of 46 patients aged 18-31 years with mild to moderate acne and an average lesion count of 67.
Disclosures: The researchers had no financial conflicts to disclose.
Study: Aliskiren Dual Therapy Beats Amlodipine for Blood Pressure Control in Blacks
CRYSTAL CITY, Va. – Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Previous studies have suggested that cardiovascular morbidity might be more closely linked to central blood pressure than to systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and colleagues. Additional studies have shown that central blood pressure tends to be higher in healthy young black men, compared with healthy young white men, the researchers noted.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in blacks with stage II hypertension, the researchers reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
The study findings were presented in a poster at the annual meeting of the International Society on Hypertension in Blacks.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment. Changes in the peripheral measure of systolic blood pressure were not significant in either group.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively). But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In study 2, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women. Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
The study was sponsored by Novartis Pharmaceuticals Corp. Dr. Ferdinand had no financial conflicts to disclose, but one of the study co-authors is an employee of Novartis Pharmaceuticals.
CRYSTAL CITY, Va. – Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Previous studies have suggested that cardiovascular morbidity might be more closely linked to central blood pressure than to systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and colleagues. Additional studies have shown that central blood pressure tends to be higher in healthy young black men, compared with healthy young white men, the researchers noted.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in blacks with stage II hypertension, the researchers reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
The study findings were presented in a poster at the annual meeting of the International Society on Hypertension in Blacks.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment. Changes in the peripheral measure of systolic blood pressure were not significant in either group.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively). But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In study 2, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women. Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
The study was sponsored by Novartis Pharmaceuticals Corp. Dr. Ferdinand had no financial conflicts to disclose, but one of the study co-authors is an employee of Novartis Pharmaceuticals.
CRYSTAL CITY, Va. – Aliskiren in combination with either hydrochlorothiazide or amlodipine reduced central systolic blood pressure significantly more than did amlodipine alone in an African American population, based on data from two studies of several hundred adults.
Previous studies have suggested that cardiovascular morbidity might be more closely linked to central blood pressure than to systolic blood pressure, according to Dr. Keith Ferdinand of Emory University in Atlanta, and colleagues. Additional studies have shown that central blood pressure tends to be higher in healthy young black men, compared with healthy young white men, the researchers noted.
To compare the effects of a combination aliskiren/hydrochlorothiazide (HCTZ) in blacks with stage II hypertension, the researchers reviewed a subset of patients from two safety and efficacy studies of aliskiren/HCTZ.
Overall, central systolic blood pressure was reduced by approximately 30 mm Hg from baseline in each study, the researchers said, which suggests that aliskiren combined with either a diuretic or calcium channel blocker might be equally effective in African American patients.
The study findings were presented in a poster at the annual meeting of the International Society on Hypertension in Blacks.
In study 1, which included 53 sites throughout the United States, 166 patients were randomized to 300 mg aliskiren/25 mg HCTZ, and 166 received 10 mg amlodipine.
In study 2, a total of 220 adults were randomized to receive 300 mg aliskiren/10 mg amlodipine, and 223 received 10 mg amlodipine.
In study 1, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/HCTZ group, compared with the amlodipine-only group (30.1 mm Hg and 21.2 mm Hg, respectively) after 8 weeks of treatment. Changes in the peripheral measure of systolic blood pressure were not significant in either group.
In study 2, the mean reduction in the central measure of systolic blood pressure was significantly greater in the aliskiren/amlodipine group, compared with the amlodipine-only group after 8 weeks of treatment (29.8 mm Hg and 24.2 mm Hg, respectively). But in this study, the mean reduction in the peripheral measure of systolic blood pressure also was significant (34.1 mm Hg and 28.9 mm Hg, respectively).
Aliskiren-based combination therapy also reduced diastolic blood pressure in both studies, but the mean reductions only reached significance in study 2. In study 2, the mean reductions in the central measure of diastolic blood pressure in the aliskiren/amlodipine group and the amlodipine-only group were 16.0 mm Hg vs. 9.9 mm Hg, respectively, and the mean reductions in the peripheral measure of diastolic blood pressure for the two groups were 14.3 mm Hg and 10.5 mm Hg, respectively.
The average age of the patients was 53 years, and approximately half were women. Patients with type 1 diabetes or type 2 diabetes who took insulin were excluded, as were patients with a history of heart failure, myocardial infarction, or other heart problems within a year of the study.
Reports of adverse events were similar between the two groups in each study, and the most common adverse events included headache, diarrhea, nausea, hypokalemia, nasopharyngitis, upper respiratory tract infection, peripheral edema, and pain.
The study was sponsored by Novartis Pharmaceuticals Corp. Dr. Ferdinand had no financial conflicts to disclose, but one of the study co-authors is an employee of Novartis Pharmaceuticals.
WHO Declares End to 2009 H1N1 Influenza Pandemic
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
The pandemic caused by the 2009 H1N1 influenza virus is over, according to a statement issued Aug. 10 by Dr. Margaret Chan, director-general of the World Health Organization.
The Emergency Committee of the WHO declared the end of the H1N1 pandemic after reviewing the most recent global influenza data, including reports from countries that are now in the midst of flu season.
The H1N1 virus has not gone away, but the absence of out-of-season flu outbreaks and the current disease intensity levels have changed significantly from a year ago and now resemble seasonal influenza, Dr. Chan said in her statement. Many countries are reporting a mix of flu viruses, compared with the domination of the 2009 H1N1 virus at this time last year, she said.
“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period,” Dr. Chan said.
The 2010-2011 flu vaccine has been formulated to protect against the 2009 H1N1 virus, an H3N1 virus, and an influenza B virus, according to the Centers for Disease Control and Prevention.
Acne Scar Patients Give Thumbs Up to CO2 Laser Treatment
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.
Single treatment with a carbon dioxide fractional laser was as effective for acne scars as a nonablative fractional system, according to results of a randomized split-face study.
Fractional lasers are well tolerated and widely used to treat scarring, but patients often need multiple sessions to achieve clinical improvement, reported Dr. S.B. Cho of Yonsei University College of Medicine in Seoul, Korea, and colleagues.
However, previous studies have shown that carbon dioxide fractional laser systems can improve scars in as few as three treatments.
In this study, the researchers directly compared improvements in acne scarring after half of a patient’s face underwent a single treatment with a nonablative 1550-nm erbium-doped fractional photothermolysis system (FPS) and the other half underwent a single treatment with an ablative 10,600-nm carbon dioxide fractional laser system (CO2 FS).
The eight patients in the study were Asian males (Fitzpatrick skin type IV) aged 20 to 23 years with mild to severe atrophic acne scars.
At follow-up 3 months after FPS treatment, six of the eight patients showed clinical improvements of 26%-50% from baseline, one patient showed a clinical improvement of 51%-75%, and one showed no clinical improvement (J. Eur. Acad. Dermatol. Venereol. 2010;24:921-5). As for CO2 FS results at 3 months, five of the eight patients had a 26%-50% clinical improvement from baseline, two patients had a 51%-75% improvement, and one had an improvement of over 76%.
The level of clinical improvement was not affected by the type of acne scar (boxcar, icepick, or rolling).
The average VAS pain score on a scale of 0, no pain, to 10, severe pain, was significantly higher after the CO2 FS treatment, compared with the FPS treatment (7.0 vs. 3.9, respectively). However, patient-reported satisfaction was higher after the CO2 FS treatment. Two patients (25%) were “very satisfied,” four (50%) were “satisfied,” one (12.5%) was “slightly satisfied,” and one (12.5%) was “unsatisfied.” After the FPS treatment, none of the patients were very satisfied, two (25%) were satisfied, five (62.5%) were slightly satisfied, and one (12.5%) was unsatisfied.
Common side effects associated with both treatments included crusting, scaling, and erythema. The average duration of crusting or scaling was significantly longer in the CO2 FS group, compared with the FPS group (7.4 days vs. 2.3 days, respectively). However, the difference in post-therapy erythema was not significantly different between the two groups (11.5 days vs. 7.5 days, respectively).
“We could not completely eliminate the possibility of subject bias as the participants experienced different posttreatment responses with FPS and CO2 FS,” the researchers wrote. But the results suggest that a single treatment with CO2 FS might be more effective than a single treatment with FPS.
Although the findings are not conclusive, given the study’s small size, they could serve as a reference for clinicians choosing among laser options for acne scar treatment, the researchers added.
Dr. Cho and colleagues had no financial conflicts to disclose.