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To determine whether isotretinoin increases the risk of cardiovascular outcomes.
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When assessing the individual groups, the following conclusions have been drawn: lack of the relationship between the diagnosis and the therapeutical process in the group of patients locally treated and in the groups of sick persons cured by other methods; there exists a very significant relationship between the diagnosis and the therapeutical process in the group of patients to whom the isotretinoin preparation was administered and in the group of patients locally cured. The obtained results showed that the most frequently encountered diagnoses, i.e. acne conglobata and acne papulous-pustular were treated by the isotretinoin preparation and via local therapy, respectively. In the period of hospitalization, the value p=0.5570 testifies to lack of relationship between the number of side effects and the treatment period. All side effects occurred almost exclusively in patients cured by the isotretinoin preparation. The test value, p=0.0418 computed for all the periods, has revealed statistically significant relationships between the female/male sex and the side effects, most frequently reported in male patients. For the purpose of analysis the two (2) more often groups of symptoms were taken into consideration: dermal changes and biochemical disturbances and/or dysfunctions. The value p=0.5312 (p>0.05) excludes the existence of statistically significant relationship between the kind of a specific symptom and the therapy period.
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Data from 2 pharmaceutical marketing research databases, the National Prescription Audit Plus and the National Disease and Therapeutic Index, and from 2 health plan networks were obtained and analyzed.
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Oral isotretinoin is highly effective in all forms and grades of acne, even in lower dosages (<0.5 mg/kg/day). There is a paucity of comparative data on the various low-dose regimens of oral isotretinoin in the Indian literature.
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One hundred and four patients with acne completed a questionnaire derived from the Cardiff Acne Disability Index Questionnaire. In addition, 59% of patients returned an identical follow-up questionnaire 6 months later. Significant disability from acne was identified in many patients, with the median initial Acne Disability Index (ADI) being 6 (maximum possible 15), improving to 3 after treatment. Scores correlated poorly with the clinical severity of acne. The questionnaire proved useful for identifying patients with poor self-image who might benefit from more potent treatment for their acne, and to evaluate the effect of treatment.
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13-cis Retinoic acid is rapidly absorbed into cells and exerts its anti-proliferative effect on human sebocytes by specific isomerization to high levels of all-trans retinoic acid and binding the retinoic acid receptors. In this study, we have shown that bovine serum albumin, an extracellular binding protein for 13-cis retinoic acid, plays an important part in the uptake of 13-cis retinoic acid in human sebocytes, its intracellular isomerization to all-trans retinoic acid, and the induction of its anti-proliferative effect. The addition of highly concentrated bovine serum albumin (20 mg per ml) to the serum-free maintenance medium resulted in a rather controlled uptake of constant levels of 13-cis and all-trans retinoic acid into the cells over the 72 h of treatment. As a consequence, significantly reduced and delayed isomerization of 13-cis retinoic acid to all-trans retinoic acid was detected. In parallel experiments, the anti-proliferative activity of 13-cis retinoic acid on SZ95 sebocytes was abrogated by adding 20 mg bovine serum albumin per ml into the serum-free medium. These results indicate a critical function of serum albumin as retinoid-binding protein in reducing the concentration of active retinoids and restricting their biologic effects on human sebocytes.
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Persistent keratoacanthoma may be challenging to diagnose and manage, presenting a clinical conundrum. Careful review of the clinicopathologic presentation and an understanding of the various treatment options may result in a successful outcome.
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A total of 132 acne patients with a mean age of 22.9 +/- 6.2 years were treated with oral isotretinoin (Roaccutane) and followed-up from 1999 through 2005. Each patient was started with a dose of 0.75 mg/kg per day until all active lesions healed, followed by a maintenance dose of 20 mg/kg per day for one more month. Laboratory tests were done at monthly intervals. Evaluation of clinical response was based on Leeds technique. Patients were followed-up for a mean period of 4.4 years.
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The pathogenesis of inflammatory bowel disease (IBD) is multifactorial and results from an interaction between genetic, immunologic, microbial, and environmental factors. Certain drugs could act as a trigger for the disease and have been implicated in the development of new onset IBD in a number a studies. These relationships are based on case reports and cohort studies, as proving this in the context of randomized controlled trials would be difficult. Drugs that have been linked to causing or worsening IBD include isotretinoin, antibiotics, nonsteroidal antiinflammatory drugs, oral contraceptives, mycophenolate mofetil, etanercept, ipilimumab, and rituximab. Bowel preparation for colonoscopy has also been associated with aphthoid lesions that may be confused with IBD. However, given the source of these reports we have to be cautious in the interpretation of the data before concluding that these drugs trigger IBD and what is being observed is not related to other confounding factors. Different pathogenic mechanisms have been suggested for the different drugs listed above. In order to clarify the confusion a comprehensive literature review was performed with the goal of advancing the knowledge on this subject.
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We suggest that in the treatment of patient with neuroblastoma, MLT is very effective and also this effect can be augmented by combination with 13-cis-RA.