Stroke prevention in women: role of aspirin versus ticlopidine

Article Abstract:

Stroke is the most catastrophic outcome of hypertension or atherosclerosis. Clot formation within the brain, associated with build-up of fatty plaque inside the cerebral arteries, causes many more strokes than do cerebral emboli (clots formed elsewhere which lodge in brain blood vessels) or bleeding within or around the brain. Patients who experience a transient ischemic attack (TIA), a temporary loss of oxygen flow to the brain that is severe enough to result in altered function and consciousness, are at high risk for strokes within a year. Aspirin is most commonly accepted as therapy for prevention of stroke following TIA, but its effectiveness in women has been disputed. Studies on strokes in women and on therapy with aspirin or ticlopidine, a new drug active against the action of platelets (blood cells important in clotting), were assessed. Hypertension is most strongly associated with strokes; other risk factors include TIAs, heart disease, smoking, diabetes, and age. The risk of stroke in older women with fat distributed in the abdomen seems to reflect the link between fat and hypertension and diabetes. Oral contraceptives increase the risk of stroke, and this effect is additive with smoking. Effects of gender on prevalence of strokes and reasons for decreased incidence of strokes vary among studies. Effective therapy to prevent strokes is needed as much for women as for men. Aspirin results in up to a 30 percent decrease in incidence of stroke after TIA, but studies differ as to whether this is true for women as wall as men. Laboratory studies support differences in platelet and blood vessel function in the presence and absence of testosterone, a male hormone. Ticlopidine inhibits platelet aggregation and clot formation by a mechanism different from that of aspirin. Large studies have shown that ticlopidine decreases the risk of stroke, heart attack, and cardiovascular death in women as well as in men, and is apparently more effective than aspirin. Diarrhea and rash were significantly more common in subjects given ticlopidine, while aspirin caused more digestive tract complaints. Neutropenia (decrease in white blood cells) was the most serious side effect of ticlopidine, necessitating close monitoring with repeated blood cell counts during early therapy. These studies indicate that ticlopidine and aspirin are effective tools, along with anti-hypertensive treatment and stopping smoking, in preventing strokes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Stroke (Disease), Stroke, Ticlopidine

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Single-dose oral temafloxacin versus parenteral ceftriaxone in the treatment of gonococcal urethritis/cervicitis

Article Abstract:

The frequency of gonorrhea caused by penicillin- and tetracycline-resistant Neisseria gonorrhoea is increasing. These strains of N. gonorrhoea are not eradicated by the effects of the antibiotics that have traditionally been used to treat gonorrhea infections. Currently, the drug that is most commonly used to treat gonorrhea is ceftriaxone. However, strains of bacteria are evolving with decreased sensitivity to this drug also. The fluoroquinolones are new group of antibiotics that have recently become available; temafloxacin is one of the newest fluoroquinolones. These antibiotics are effective in killing a wide range of bacteria including various strains of Neisseria gonorrhoea. The effectiveness of temafloxacin was compared with ceftriaxone in a study of 421 patients with gonorrheal infection in the urinary tract or uterus. The rates of clinical improvement or cure were 94 percent for temafloxacin and 95 percent for ceftriaxone. Both drugs were well tolerated by the patients. These results demonstrate that temafloxacin is a safe and effective treatment for uncomplicated gonococcal urethritis or cervicitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Sexually transmitted diseases, Drug therapy, Fluoroquinolones, Oral medication, Oral drugs, Quinolones, Ceftriaxone, Ceftriaxone sodium, Temafloxacin

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Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal

Article Abstract:

This paper studied the decision process and costs for routine testing for gonorrhea infections of the cervix. /Gonorrhea is a sexually transmitted infectious disease.~ The authors compared performing cervical cultures of all women seeking routine gynecologic care to a no-test strategy. Routinely testing for gonorrhea reduced overall medical costs when the general prevalence of infection exceeded 1.5 percent. The result was most sensitive to variations in cost and the assumption that treatment prevents the subsequent occurrence of further difficulties. The authors advocate the strategy of testing and treating selected women with risk factors for gonorrhea, as they believe that this will both reduce the likelihood of further problems and result in a reduction of medical costs.

Management, Economic aspects, Medical care, Cost of, Health care costs, Gonorrhea, Gynecologic examination

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