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1. When did this patient commence drug therapy for hyperlipidaemia? 2. Familial hyperlipidaemia FH ; 2.1 Does this patient suffer from familial hyperlipidaemia? 2.2 Please list signs of FH if present 3. Is there a family history of premature arteriosclerotic disease, eg myocardial infarction stroke? If "YES", please provide details below: Father Event description Age at time of event death 3.1 Primary hyperlipidaemia 3.2 Please attach the diagnosing lipogram. The application cannot be reviewed if this is not submitted. The CIB will not fund medication in patients with less than a 20% risk of a coronary event in the next ten years. This is a funding decision to ensure the long-term sustainability of this benefit and does not in any way question your clinical decision. It is based on local and international treatment guidelines and is in line with the Medical Scheme Council Clinical Algorithm. Mother YES Brother NO Sister YES NO.
From Washington University School of Medicine, St. Louis, Missouri; University of Washington and Veterans Affairs Puget Sound Health Care, for example, bisoprolol anxiety.
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119 Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease: Multicenter Unsustained Tachycardia Trial. N Engl J Med 1999; 341: 188290. Antiarrhythmics versus Implantable Defibrillators AVID ; Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997; 337: 157683. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 87783. Lechat P, Hulot JS, Escolano S, Mallet A, et al. Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial. Circulation 2001; 103: 142833. Joglar JA, Acusta AP, Shusterman NH, et al. Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retrospective analysis of the US Carvedilol Heart Failure Trials Program. Heart J 2001; 142: 498501. Krum H, Ninio D, MacDonald P. Baseline predictors of tolerability to carvedilol in patients with chronic heart failure. Heart 2000; 84: 61519. Salpeter SS, Ormiston T, Salpeter E, Poole P, Cates C. Cardioselective beta-blockers for chronic obstructive pulmonary disease Cochrane Review ; . Cochrane Database Syst Rev 2002; 2: CD003566. 126 Andreas S. Central sleep apnea and chronic heart failure. Sleep 2000; 23: S22023. 127 Floras JS, Bradley TD. Sleep apnoea: a therapeutic target in congestive heart failure. Eur Heart J 1998; 19: 82021. Tkacova R, Dajani HR, Rankin F, Fitzgerald FS, Floras JS, Douglas Bradley DT. Continuous positive airway pressure improves nocturnal baroreflex sensitivity of patients with heart failure and obstructive sleep apnea. J Hypertens 2000; 18: 125762. Kaneko Y, Flora JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003; 348: 123341. Scall RR, Petrucci RJ, Brozena SC, Cavarocchi NC, Jessup M. Cognitive function in patients with symptomatic dilated cardiomyopathy before and after cardiac transplantation. J Coll Cardiol 1989; 14: 166672. Cacciatore F, Abete P, Ferrara N et al. Congestive heart failure and cognitive impairment in the elderly. Arch Gerontol Geriatr 1995; 20: 6368. Sever P. The SCOPE Trial. J Renin Angiotensin Aldosterone Syst 2002; 3: 6162. Krum H, McMurray JJV. Statins and chronic heart failure: do we need a large-scale outcome trial? J Coll Cardiol 2002; 39: 156773. Investigators. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study 4S ; . Lancet 1994; 344: 138389. Long-Term Intervention with Pravastatin in Ischaemic Disease LIPID ; Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 134957. Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997; 18 suppl ; : S13744. 137 McMurray J, Chopra M, Abdullah I, Smith WE, Dargie HJ. Evidence of oxidative stress in chronic heart failure in humans. Eur Heart J. 1993; 14: 149398. Rauchhaus M, Coats AJ, Anker SD. The endotoxin-lipoprotein hypothesis. Lancet 2000; 356: 93033. Rauchhaus M, Doehner W, Francis DP, et al. Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation 2000; 102: 306067. Niebauer J, Volk HD, Kemp M, et al. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet 1999; 353: 183842. Kjekshus J, Pedersen TR, Olsson AG, Faergeman O, Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997; 3: 24954. Segal R, Pitt B, Poole Wilson P, Sharma D, Bradstreet DC, Ikeda LS. Effects of HMG-CoA reductase inhibitors statins ; in patients with heart failure. Eur J Heart Fail 2000; 2 suppl ; : 96. 143 Kaneider NC, Reinisch CM, Dunzendorfer S, Meierhofer C, Djanani A, Wiedermann CJ. Induction of apoptosis and inhibition of migration of inflammatory and vascular wall cells by cerivastatin. Atherosclerosis 2001; 158: 2333.
Combined Nomenclature headings and corresponding PRODCOM codes - Year 2007 1516 20 Vegetable fats and oils and their fractions, partly or wholly hydrogenated, inter-esterified, re-esterified or elaidinised, whether or not refined, in immediate packings of 1 kg another form excl. fats and oils and their fractions, further prepared, hydrogenated castor oil and subheading 1516.20.95 and 1516.20.96 ; kg S Vegetable fats and oils and their fractions partly or wholly hydrogenated, inter-esterified, reesterified or elaidinized, but not further prepared including refined ; Margarine containing 10% but 15% milkfats excl. liquid ; Margarine and reduced and low fat spreads excluding liquid margarine ; Margarine containing 10% milkfats excl. liquid ; Margarine and reduced and low fat spreads excluding liquid margarine and zebeta.
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Even if a patient has completed an advanced directive, the preferences she expressed when competent may well have been indeterminate guides for managing her actual problems. Those close to her might have different views about what ought to be done. Despite lack of evidence, those who care for and care about her must make decisions. The palliative care strategy described by the authors is grounded in the theory that decisions are the result of dialogue and consensus building. The physician's duty is to teach all participants that the patient has a chronic, irreversible, and ultimately fatal disease, at the same time learning from those who participate about the patient's values and quality of life. This frames decisions about hospitalization, antibiotics, and enteral nutritional support as medical choices that ultimately shape the way the patient will live in the last phase of life. Physicians can guide a highly emotional and personal process in a structured manner that has meaning for the patient, family, physician and other caregivers. Surrogates must try to represent the patient's voice. Differences should be explored through dialogue that focuses on the patient's best interests and seeks common ground. "Except when decisions seem to clearly violate the patient's best interests or prior wishes, the family has the final say in representing the patient in decision making. Families have to live with themselves and their role in these decisions long after the patient has died. " "Through the process of repeatedly listening to the perspectives of each participant and involving the participants in a consensusbased interaction, decisions that respect the patient's dignity and quality of life can generally be achieved." Annals Int. Med. May 18, 1999; 130 Commentary for the ACP-ASIM End-of Life Care Consensus Panel, first author Jason H T Karlawish. 5-23 EFFICACY OF TREMACAMRA, A SOLUBLE INTERCELLULAR ADHESION MOLECULE 1, FOR EXPERIMENTAL RHINOVIRUS INFECTION Rhinoviruses are the most frequent causes of the common cold. Approaches to prevention have not been feasible because of the large number of serotypes. Attachment of the majority of rhinovirus serotypes to cells is dependent on a single cellular receptor, termed "intercellular adhesion molecule-1 -- ICAM-1". It is possible that blocking the receptor could prevent infection. Now, a recombinant soluble ICAM-1 termed tremacamra ; has been prepared. It actually is a truncated form -- the intracellular and transmembrane domains have been deleted. The extracellular portion of the ICAM-1 remains. It effectively inhibits rhinovirus replication in cell culture. This study assessed the efficacy and safety of intranasal tremacamra in experimental rhinovirus colds. Conclusion: Tremacamra reduced severity of colds. STUDY 1. Randomized, double-blind, placebo-controlled trial entered almost 200 volunteers. All were in good health. None were immune to rhinovirus antibody titers 1: 4 to the challenge virus ; . 2. Randomized to: 1 ; tremacamra inhalation at 7 hours before inoculation of rhinovirus type 39, 2 ; 12 hours after inoculation, and 3 ; placebo. RESULTS: 1. Outcomes Total symptom score Clinical colds Nasal mucus weight common in the tremacamra group. Tremacamra 10 44% 15 g Placebo 18 67% 33 g and isoptin.
Thus far, Antipodean has synthesized kilogram batches of MitoQTM to GMP standard and formulated a stable tablet. The firm has also validated two analytical methods for MitoQTM. Absorption, distribution, metabolism and excretion ADME ; and toxicology studies required for approval of the firm's Investigational Brochure have been completed. MitoQTM is rapidly distributed to all body organs and penetrates the blood-brain barrier. MitoQTM pharmacokinetics supports once-daily dosing in humans. Clinical Development Program Recent clinical studies by the Parkinson's Study Group involving 10 sites in the US show that very high doses of Coenzyme Q10 appear to slow the deterioration of function in Parkinson's disease139. The marginal effect at high dose reflects the poor bioavailability of Coenzyme Q10 and the difficulty in penetrating mitochondria in key CNS brain regions. A targeted approach is therefore justified. Antipodean completed patient enrollment in a Phase II clinical efficacy study of MitoQTM in October 2006. This study enrolled a total of 128 patients with Parkinson's disease. The trial centers are the leading Neurology Departments in New Zealand and Australia. The randomized, double-blinded clinical.
Withdrawal of therapy for adverse events was 3% for patients receiving bisoprolol fumarate and 8% for patients on placebo and captopril.
6. Mller FU, Boheler KR, Eschenhagen T, Schmitz W, Scholz H. Isoprenaline stimulates gene transcription of the inhibitory G protein -subunit Gi -2 in the rat heart. Circ Res. 1993; 72: 696 Kudej RK, Iwase M, Uechi M, Vatner DE, Oka N, Ishikawa Y, Shannon RP, Bishop SP, Vatner SF. Effects of chronic -adrenergic receptor stimulation in mice. J Moll Cell Cardiol. 1997; 29: 27352746. Iaccarino G, Tomhave ED, Lefkowitz RJ, Koch WJ. Reciprocal in vivo regulation of myocardial G protein-coupled receptor kinase expression by -adrenergic receptor stimulation and blockade. Circulation. 1998; 98: 17831789. Yamazaki T, Komuro I, Zou Y, Kudoh S, Shiojima I, Hiroi Y, Mizuno T, Aikawa R, Takano H, Yazaki Y. Norepinephrine induces the raf-1 kinase mitogen-activated protein kinase cascade through both 1 - and -adrenoceptors. Circulation. 1997; 95: 1260 Bristow MR. -Adrenergic receptor blockade in chronic heart failure. Circulation. 2000; 101: 558 Bhm M, Gierschik P, Jakobs KH, Pieske B, Schnabel P, Ungerer M, Erdmann E. Increase of Gi in human hearts with dilated but not ischemic cardiomyopathy. Circulation. 1990; 82: 1249 Choudhury L, Rosen SD, Lefroy DC, Nihoyannopoulos P, Okaley CM, Camici PG. Myocardial adrenoceptor density in primary and secondary left ventricular hypertrophy. Eur Heart J. 1996; 17: 17031709. Cho MC, Rapacciuolo A, Koch WJ, Kobayashi Y, Joens LR, Rockman HA. Defective -adrenergic receptor signaling precedes the development of dilated cardiomyopathy in transgenic mice with calsequestrin overexpression. J Biol Chem. 1999; 274: 2225122256. Choi DJ, Koch WJ, Hunter JJ, Rockman HA. Mechanism of -adrenergic receptor desensitization in cardiac hypertrophy is increased -adrenergic receptor kinase. J Biol Chem. 1997; 272: 1722317229. CIBIS-II Investigators, and Committees. The Cardiac Insufficiency Bisoprilol Study II CIBIS-II ; : randomized trial. Lancet. 1999; 353: 9 MERIT-HF Study Group. Effect of metoprolol CR XL in chronic heart failure: Metoprolol CR XL Randomized Intervention Trial in Congestive Heart Failure MERIT-HF ; . Lancet. 1999; 353: 20012007. Kim MH, Devlin WH, Das SK, Petrusha J, Montgomery D, Starling MR. Effects of -adrenergic blocking therapy on left ventricular diastolic relaxation properties in patients with dilated cardiomyopathy. Circulation. 1999; 100: 729 Haeusler G, Schliep HJ, Schelling P, Becker KH, Klockow M, Minck KO, Enenkel HJ, Schulze E, Bergmann R, Schmitges CJ, Seyfried C, Harting J. High 1-selectivity and favourable pharmacokinetics as the outstanding properties of bisoprolol. J Cardiovasc Pharmacol. 1986; 8: S2S15. 19. Anzai T, Yoshikawa T, Baba A, Nishimura H, Shiraki H, Nagami K, Suzuki M, Wainai Y, Ogawa S. Myocardial sympathetic denervation prevents chamber-specific alteration of -adrenergic transmembrane sig.
In terms of adverse events, based on one trial, patients on bisporolol had a higher incidence of bradycardia 1 2% versus 5% ; , dizziness 1 3% versus 5% ; , hypotension 1 4% versus 3% ; and fatigue 3% versus 1 and diltiazem!
24 effect of bsioprolol on perioperative complications in chronic heart failure after surgery cardiac insufficiency biso0rolol study ii cibis ii.
In a meta-analysis, there were significantly lower risks with bisoprolol compared with placebo for the following endpoints: all-cause death RR 0.71 ; , cardiovascular death RR 0.72 ; , sudden death RR 0.63 ; , hospital admission RR 0.85 ; , hospital admission and death RR 0.82 ; . Safety Adverse events reported in the clinical trials with bisoprolol included dizziness, bradycardia and hypotension. Additional Information The Summary of Product Characteristics SPC ; states that `it is recommended that the treating physician should be experienced in the management of chronic heart failure'. NICE guidelines on chronic heart failure state that `beta-blockers licensed for heart failure should be initiated in patients with heart failure due to left ventricular systolic dysfunction after diuretic and ACE inhibitor therapy regardless of whether or not symptoms persist ; '. Patients should be optimally treated with an ACE inhibitor and diuretic before treatment with bisoprolol is commenced. See SPC for dosing titration and cautions. At current prices one year's treatment costs 125 for bisoprolol 10mg once daily 327 for carvedilol 25mg twice daily and doxazosin.
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Objective. Although acute complications of diabetes account for approximately 3% of all emergency calls, clinically relevant indicators of structural and process quality in the management of diabetic emergencies have not yet been studied. The purpose of this investigation was, therefore, to collect representative data on these indicators for the whole of Germany. Methods. Standardized questionnaires comprising 20 items were sent to all 312 emergency medical services in Germany. Apart from demographic data, information was obtained about the diagnostic materials and drugs carried by the ambulances, methods of blood glucose measurement, the level of qualification of the emergency teams, the frequency of diabetic emergencies, and the need for further training. Results. The return rate of the questionnaires was 55%, corresponding to 172 emergency medical service districts serving a total population of 45.3 million. The data revealed deficits with regard to structural and process quality. Thus, only 6% of ambulances carried glucagon and only 11% ketone test strips. In 57% capillary blood was used for glucose determination, in 17% visually read test strips were still used. While in some districts hospital admission after hypoglycaemic episodes was mandatory even for patients well educated about their diabetes, in other districts multimorbid patients on oral antidiabetics were sometimes only treated at the emergency scene. Emergency medical technicians increasingly carried out both the diagnosis and treatment of diabetic emergencies. Conclusions. The structural and process quality of the management of diabetic emergencies in Germany is in need of improvement. The most important factor is continuing education of the entire emergency team. Keywords: diabetes, diabetic coma, emergency medicine, hypoglycaemia, process quality, structural quality and mesylate.
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References will be checked, and assessed against the following criteria: client's overall satisfaction with quality of work, and adherence to deliverables, timelines and budget. River Valley Health will not enter into contract negotiations with any Bidder whose references are found to be unsatisfactory. 11.2 Research and Evaluation Proposal Introduction: Provide a brief overview, which demonstrates the Bidder's understanding of the purpose and objectives of the Telehomecare Initiative-EMPcare home, as well as their knowledge and experience with the subject matter. Overall Approach: Describe the overall approach to achieve the evaluation objectives. Include the time lines, and potential challenges and strategies to overcome these challenges.
The department intends to complete the promulgation of the revised Chapter 65E-14, F.A.C. Based on the outcome, the Mental Health and Substance Abuse programs will then modify the model contracts and other associated documents to ensure compliance with the rule and catapres.
Results Drug related adverse events were 16% for the bisoprolol and HCTZ patients, 21% for the amlodipine patients, and 23% for the enalapril patients. There was no significant difference between the groups no p value reported ; . DBP reduction p 0.01 ; was comparable in the two groups. Decrease of SBP in the metoprolol and HCTZ combination group was significant p 0.01 ; . Decrease in SBP from the metoprolol 400 mg day to the combination metoprolol and HCTZ was significant p 0.05.
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| The plan covers certain health care services when provided either by a physician or another type of health care professional. All health care professionals must be licensed by the state in which the services are performed and must be acting within the scope of that license. In the absence of licensing requirements, appropriate certification is required. Covered health care professionals include Physician assistants for services that would have been covered if performed by a physician licensed as an M.D. Registered nurses for services that would have been covered if performed by a physician licensed as an M.D. The plan also covers intermittent visits of a registered nurse if skilled care in place of hospitalization is not available through an alternative provider at a lesser cost. Clinical psychologists and master's level therapists for the treatment of mental illness or substance abuse conditions covered under the plan. For the coverage terms related to mental health and substance abuse treatment, see Exhibit 7 on pages 37 through 39. ; Physical, occupational, and speech therapists for the services described on pages 29 and 30. Dentists for dental work or surgery covered under the Traditional Medical Plan. Optometrists providing covered vision care services. For coverage of routine vision care services, see the vision care payment levels and other terms described in Exhibit 6 on page 35. ; Podiatrists providing covered podiatric services. Chiropractors for necessary spinal manipulation by hand, including initial examination and spinal X-rays. For benefit limitations, see "Spinal Manipulations" on page 30. ; Christian Science practitioners listed in the current Christian Science Journal at the time they provide a service.
Tooth decay is a common nutritional health problem in the United States today. Cavities can be painful and expensive to repair. They can cause infection, chewing difficulties, and malnutrition. Almost half of all children have some tooth decay by age 4 and 90% by age 12. Finding a dentist capable of working with a child with special health care needs is often difficult. Cavities are caused by the acid destruction of tooth enamel. Acid comes from fermentation of sugars in the mouth. All natural or refined sugar including white sugar, honey, molasses, brown sugar, and raw sugar can cause decay. Carbohydrate foods, such as bread, rice, potatoes, and pasta, may also cause cavities. The rate of cavity formation is influenced by when the food is eaten. Sugared foods between meals are more harmful than when eaten at mealtime. Sticky foods and candies are more likely to produce cavities. Mannitol, xylitol, and sorbitol have lower tooth decay producing potential, but large amounts of these sugars can cause diarrhea, gas, bloating, or cramps. As few as six pieces of sugar-free gum made with sorbitol could cause diarrhea in a child weighing 40 pounds. Children with developmental delays may have a high rate of cavities because of poor brushing habits or techniques, frequent snacking instead of regular meals, and a preference for sweets that is often supported by overindulgent parents.
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Fewer deaths among the metoprolol-treated patients.10 In the CIBIS 1994 randomized multicenter European trial of bisoprolol on patients with severe CHF all receiving digitalis, ACE inhibitors, and diuretics ; , the observed difference in mortality did not reach statistical significance Table 4 ; . However, there was suggestive evidence that patients with class 4 CHF and those with idiopathic CHF did show a significant survival benefit.15, 18 Unfortunately, to our knowledge, there have been no studies pitting ACE inhibitors alone vs -blockers. A 1996 report by Packer et al19 on a multicenter study on patients receiving digitalis, diuretics, and an ACE inhibitor showed that carvedilol, a nonselective -blocker with some -blocking activity, resulted in a 60% reduction in mortality over placebo. They also found that it was effective in both ischemic and idiopathic DCM.19 Bristow, a participant in the same study, reported that the decrease in mortality was dose related, and Colucci reported that it was effective in patients in class II as well as class III and IV New York Heart Association classification.19-21 The results on carvedilol are not considered definitive because they were not designed as survival studies, there were too few deaths, and the placebo group mortality was low so that the absolute decrease in mortality was quite small, ie, not enough class IV patients, and the studies have not had a long enough duration Table 5 ; .4 Also, the trial design of giving a test period before randomization to document tolerance may have had an adverse effect on the placebo cohort. Mechanisms of Benefits Heart Rates Because the first trials of -blockers were inspired by the tachycardias found in many patients with CHF, and since those with the fastest pretreated heart rates had the most dramatic response, it was assumed that slowing of the heart rate may allow more energy to be used for contractile work and renew a favorable balance between cellular anabolic.
Despite 20% to 30% improvements in left ventricular end-diastolic volume, left ventricular end-systolic volume, ejection fraction, and measures of exercise capacity after 1 year of bisoprolol fumarate therapy, these changes were not statistically significant between groups, which suggests that the study was underpowered. Beta-blockade significantly reduced resting and exercise heart rates, showing the expected diminution of sympathetic drive. Although the between-group differences were not significant, the magnitude of our observations on left ventricular size and function are similar to a number of studies with the beta-blockers metoprolol and carvedilol.9, 16-21 Although the CIBIS trial, from which we based our study criteria and treatment regimen, did not measure exercise tolerance, improvements in New York Heart Association functional classification, fewer hospitalizations, and an improvement in left ventricular fractional shortening was observed.13 Although our study was comparatively and zebeta.
A 42-yr-old male, 170 cm tall, weighing 60 kg, was scheduled for elective debridement and split thickness skin grafting of both feet. He had been in a road traffic accident three months earlier and had undergone debridement under general anaesthesia, which was uneventful. He was known to have hypertension for the past 2 yr that was treated with bisoprolol 2.5 mg once a day. Before surgery, his blood pressure was well-controlled 130 80 mm Hg ; and his pulse rate was 84 beats min1. There was no evidence of end-organ damage. The electrocardiogram ECG ; did not show any evidence of ischaemic heart disease or left ventricular hypertrophy. Echocardiogram showed normal left ventricular function. He gave no history of gastrooesophageal reflux. He tested positive for hepatitis B surface antigen, but there was no evidence of chronic active hepatitis or other known co-existing illnesses. Subarachnoid block was planned and the procedure was explained to the patient. He was kept fasting from midnight solids ; and was allowed water up to 7 a.m. on the day of surgery. The surgery was unexpectedly delayed by 3 h. The premedication, 1 h before the anaesthetic, consisted of diazepam 10 mg, metoclopramide 10 mg and his scheduled dose of bisoprolol. He had not taken the water that.
This paper wrongly states that carvedilol is the only beta-blocker with a licence for initiation out of the hospital setting. Bis9prolol is the only betablocker with such a licence.
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Table 4. Multivariate analysis for prognostic factors of LTLS and CTLS. CTLS Prognostic factor LDH Uric Acid Creatinine WBC Exp B ; 2.06 1.52 1.56 P value 0.001 0.005 LTLS Exp B ; 1.6 1.8 2.32 P value 0.009 0.001 Table 6. Accuracy of the predictive model in the study population. SCORE points ; 0-1 2-3 4-5 6 All Patients CTLS n % ; 1 0.3 ; 2 2.5 ; 7 9.6 ; 16 25 ; 26 Patients n % ; 306 59 ; 81 15 ; 524 100 ; LTLS n % ; Patients n.
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