Adverse drug events associated with vitamin K antagonists: factors of therapeutic imbalance

Nancy El-Helou, Amal Al-Hajje, Rola Ajrouche, Sanaa Awada, Samar Rachidi, Salam Zein, Pascale SalamehClinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, LebanonBackground: Adverse drug events (ADE) occur frequently during treatment with vitamin K antagonists (AVK) and contribute to increase hemorrhagic risks.Methods: A retrospective study was conducted over a period of 2 years. Patients treated with AVK and admitted to the emergency room of a tertiary care hospital in Beirut were included. The aim of the study was to identify ADE characterized by a high international normalized ratio (INR) and to determine the predictive factors responsible for these events. Statistical analysis was performed with the SPSS statistical package.Results: We included 148 patients. Sixty-seven patients (47.3%) with an INR above the therapeutic range were identified as cases. The control group consisted of 81 patients (54.7%) with an INR within the therapeutic range. Hemorrhagic complications were observed in 53.7% of cases versus 6.2% of controls (P < 0.0001). No significant difference was noticed between cases and controls regarding the indication and the dose of AVK. Patients aged over 75 years were more likely to present an INR above the therapeutic range (58.2%, P = 0.049). Recent infection was present in 40.3% of cases versus 6.2% of controls (P < 0.0001) and hypoalbuminemia in 37.3% of cases versus 6.1% of controls (P < 0.0001). Treatment with antibiotics, amiodarone, and anti-inflammatory drugs were also factors of imbalance (P < 0.0001).Conclusion: Many factors may be associated with ADE related to AVK. Monitoring of INR and its stabilization in the therapeutic range are important for preventing these events.Keywords: adverse drug events, vitamin K antagonists, bleeding risks, therapeutic imbalanc

Holography in asymptotically flat space-times and the BMS group

In a previous paper (hep-th/0306142) we have started to explore the holographic principle in the case of asymptotically flat space-times and analyzed in particular different aspects of the Bondi-Metzner-Sachs (BMS) group, namely the asymptotic symmetry group of any asymptotically flat space-time. We continue this investigation in this paper. Having in mind a S-matrix approach with future and past null infinity playing the role of holographic screens on which the BMS group acts, we connect the IR sectors of the gravitational field with the representation theory of the BMS group. We analyze the (complicated) mapping between bulk and boundary symmetries pointing out differences with respect to the AdS/CFT set up. Finally we construct a BMS phase space and a free hamiltonian for fields transforming w.r.t BMS representations. The last step is supposed to be an explorative investigation of the boundary data living on the degenerate null manifold at infinity.Comment: 31 pages, several changes in section 3 and 7 and references update

Couplings of self-dual tensor multiplet in six dimensions

The (1,0) supersymmetry in six dimensions admits a tensor multiplet which contains a second-rank antisymmetric tensor field with a self-dual field strength and a dilaton. We describe the fully supersymmetric coupling of this multiplet to Yang-Mills multiplet, in the absence of supergravity. The self-duality equation for the tensor field involves a Chern-Simons modified field strength, the gauge fermions, and an arbitrary dimensionful parameter.Comment: 17 pages, latex, no figure

Consistent truncation of d = 11 supergravity on AdS_4 x S^7

We study the system of equations derived twenty five years ago by B. de Wit and the first author [Nucl. Phys. B281 (1987) 211] as conditions for the consistent truncation of eleven-dimensional supergravity on AdS_4 x S^7 to gauged N = 8 supergravity in four dimensions. By exploiting the E_7(7) symmetry, we determine the most general solution to this system at each point on the coset space E_7(7)/SU(8). We show that invariants of the general solution are given by the fluxes in eleven-dimensional supergravity. This allows us to both clarify the explicit non-linear ansatze for the fluxes given previously and to fill a gap in the original proof of the consistent truncation. These results are illustrated with several examples.Comment: 41 pages, typos corrected, published versio

Orbifolds and Flows from Gauged Supergravity

We examine orbifolds of the IIB string via gauged supergravity. For the gravity duals of the A_{n-1} quiver gauge theories, we extract the massless degrees of freedom and assemble them into multiplets of N=4 gauged supergravity in five dimensions. We examine the embedding of the gauge group into the isometry group of the scalar manifold, as well as the symmetries of the scalar potential. From this we find that there is a large SU(1,n) symmetry group which relates different RG flows in the dual quiver gauge theory. We find that this symmetry implies an extension of the usual duality between ten-dimensional IIB solutions which involves exchanging geometric moduli with background fluxes.Comment: 37 pages, harvma

Six-dimensional Supergravity and Projective Superfields

We propose a superspace formulation of N=(1,0) conformal supergravity in six dimensions. The corresponding superspace constraints are invariant under super-Weyl transformations generated by a real scalar parameter. The known variant Weyl super-multiplet is recovered by coupling the geometry to a super-3-form tensor multiplet. Isotwistor variables are introduced and used to define projective superfields. We formulate a locally supersymmetric and super-Weyl invariant action principle in projective superspace. Some families of dynamical supergravity-matter systems are presented.Comment: 39 pages; v3: some modifications in section 2; equations (2.3), (2.14b), (2.16) and (2.17) correcte

Unified Maxwell-Einstein and Yang-Mills-Einstein Supergravity Theories in Five Dimensions

Unified N=2 Maxwell-Einstein supergravity theories (MESGTs) are supergravity theories in which all the vector fields, including the graviphoton, transform in an irreducible representation of a simple global symmetry group of the Lagrangian. As was established long time ago, in five dimensions there exist only four unified Maxwell-Einstein supergravity theories whose target manifolds are symmetric spaces. These theories are defined by the four simple Euclidean Jordan algebras of degree three. In this paper, we show that, in addition to these four unified MESGTs with symmetric target spaces, there exist three infinite families of unified MESGTs as well as another exceptional one. These novel unified MESGTs are defined by non-compact (Minkowskian) Jordan algebras, and their target spaces are in general neither symmetric nor homogeneous. The members of one of these three infinite families can be gauged in such a way as to obtain an infinite family of unified N=2 Yang-Mills-Einstein supergravity theories, in which all vector fields transform in the adjoint representation of a simple gauge group of the type SU(N,1). The corresponding gaugings in the other two infinite families lead to Yang-Mills-Einstein supergravity theories coupled to tensor multiplets.Comment: Latex 2e, 28 pages. v2: reference added, footnote 14 enlarge

Ecophysiology of seedlings of three Mediterranean pine species in contrasting light regimes

Seasonal dynamics of net photosynthesis (Anet) in 2-year-old seedlings of Pinus brutia Ten., Pinus pinea L. and Pinus pinaster Ait. were investigated. Seedlings were grown in the field in two light regimes: sun (ambient light) and shade (25% of photosynthetically active radiation (PAR)). Repeated measures analyses over a 12-month period showed that Anet varied significantly among species and from season to season. Maximum Anet in sun-acclimated seedlings was low in winter (yet remained positive) and peaked during summer. Maximum Anet was observed in June in P. pinea (12 μmol m–2 s–1), July in P. pinaster (23 μmol m–2 s–1) and August in P. brutia (20 μmol m–2 s–1). Photosynthetic light response curves saturated at a PAR of 200–300 μmol m–2 s–1 in winter and in shade-acclimated seedlings in summer. Net photosynthesis in sun-acclimated seedlings did not saturate at PAR up to 1900 μmol m–2 s–1 in P. brutia and P. pinaster. Minimum air temperature of the preceding night was apparently one of the main factors controlling Anet during the day. In shade-acclimated seedlings, photosynthetic rates were reduced by 50% in P. brutia and P. pinaster and by 20% in P. pinea compared with those in sun-acclimated seedlings. Stomatal conductance was generally lower in shaded seedlings than in seedlings grown in the sun, except on days with a high vapor pressure deficit. Total chlorophyll concentration per unit leaf area, specific leaf area (SLA) and height significantly increased in P. pinea in response to shade, but not in P. pinaster or P. brutia. In response to shade, P. brutia showed a significant increase in total chlorophyll concentration but not SLA. Photosynthetic and growth data indicate that P. pinaster and P. brutia are more light-demanding than P. pinea