Long-term clinical consequence

Most diabetics are in this category. Genetic factors rather than viruses or autoimmune antibodies are apparently causal. The metabolic alterations observed are milder than those described for IDDM (for example, NIDDM patients typically are not ketotic), but the long-term clinical consequences can be just as devastating (for example, vascular complications and subsequent infection can lead to amputation of the lower limbs). 

Kleerekoper M, Sullivan JM. Osteoporosis as a model for the long-term clinical consequences of the menopause. Prog Cardiovasc Dis 1995 38 181-8. 

Potential long-term adverse consequences associated with the addition of ingredients new to infant formulas may not be detected in clinical studies. Therefore, for every new ingredient to be added to an infant formula, a plan for a systematic approach for in-market... 

In the 1970s questions were raised about certain immunological complications as a consequence of male sterilisation or vasectomy. Clinical epidemiological data do not appear to indicate that this actually occurs in clinical practice. No significant long-term side effects of male sterilisation have been demonstrated. 

Pharmacodynamic tolerance to the psychomotor effects of benzodiazepines has been demonstrated after single or multiple doses (File 1985 Greenblatt and Shader 1978 Rosenberg and Chiu 1985). Pharmacodynamic tolerance to the anxiolytic effect (over a 6-month period) has not been demonstrated (Rickels et al. 1983), and clinical experience supports the view that many patients with anxiety disorders require long-term therapy with benzodiazepines or alternative antianxiety agents. An important clinical consequence of tolerance to sedative effects is observed in benzodiazepine overdoses, when patients may initially be... 

There is a paucity of clinical trial evidence comparing the benefit of diuretics to other therapies for symptom relief or long-term outcomes. Additionally, excessive preload reduction can lead to a decrease in CO resulting in reflex increase in sympathetic activation, renin release, and the expected consequences of vasoconstriction, tachycardia, and increased myocardial oxygen demand. Careful use of diuretics is recommended to avoid overdiuresis. Monitor serum electrolytes such as potassium, sodium, and magnesium frequently to identify and correct imbalances. Monitor serum creatinine and blood urea nitrogen daily at a minimum to assess volume depletion and renal function. 

With increased success in pediatric clinical trials, the overall survival rate for pediatric cancers has increased significantly over the last 35 years. For certain disease states, the overall survival rate for specific pediatric malignancies is now up to 80%. Unfortunately, the consequences of success are that approximately two-thirds of childhood cancer survivors have at least one chronic or late-occurring complication of treatment. Long-term follow-up of survivors treated decades ago also has revealed very late sequelae.24... 

The argument is often made that African Americans and other ethnic minorities do not participate in clinical trials because they do not want to. African Americans in particular were thought to be suspicious of participation because of previous experiences of exploitation and manhandling of vulnerable minority groups (Melfi et al, 2000 Corbie-Smith et al, 1999). The Tusgekee syphilis study is often cited as a reason for mistrust (Shavers et al, 2000 Shavers et al, 2002 Corbie-Smith et al, 1999). This study was a federally funded study of the long-term consequences of syphilis on African American men initially started before antibiotics were available. 

Maintenance and prophylaxis with lithium, and perhaps other mood stabilizers, favorably alters the longitudinal course of a bipolar disorder. Thus, efforts to enhance long-term compliance are a necessary part of any overall strategy. The incidence of adverse or toxic events is relatively low, and close attention to the more clinically relevant consequences can usually prevent serious sequelae ( 198).An issue of critical importance for future research is the potential efficacy of alternative maintenance medication for those who fail to respond adequately to acute or long-term lithium therapy. 

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