bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcium Channel Blockers and Treatment of Hypertension
Authors: Lam Y.W. Francis , Giard Mark J. , Warren J. Bryan
Published: May 2016

Over the past years, research efforts have been focused on the pathophysiologic role of calcium ions, and the implication for the potential role of calcium channel blockers in the management of essential hypertension. Numerous studies have shown that nifedipine and verapamil are effective antihypertensive agents, initial experience with diltiazem is also encouraging. The magnitude of blood pressure reduction with these drugs is related to the pre-treatment blood pressure. In refractory hypertension, combination with other antihypertensive agents provide additive effect. In the elderly population and in patients with ischemic heart disease, supraventricular arrhythmia, bronchospastic disease, peripheral vascular disease or diabetes mellitus, the calcium channel blockers offer potential advantages over other antihypertensive agents. Experimental studies also suggest that these drugs may reverse ventricular hypertrophy. When long-term safety with these drugs is documented from well-controlled clinical trials, the calcium channel blockers may be our first line of therapy for the management of hypertension.
Postgraduate Pharmacy Fellowships (1985–86)
Authors: Kaul Alan F. , Janosik John E. , Powell Stephen H.
Published: May 2016

During August and September 1985, the Brigham & Women's Hospital Pharmacy Services Department conducted its fifth annual nationwide survey of postgraduate pharmacy fellowships. There are 115 fellowships offered with 89 fellows at 33 sites.
Norfloxacin: A Quinoline Antibiotic
Authors: Marble Dwight A. , Bosso John A.
Published: May 2016

Norfloxacin is a quinoline (quinolinecarboxylic acid) that should prove successful in treating infections that currently require hospitalization and intravenous antibiotics. Although a nalidixic acid derivative, it possesses greater antibacterial activity against gram-positive and gram-negative bacteria. Compared with other antimicrobial agents, norfloxacin is more potent than the aminoglycosides, first-, second-, and third-generation cephalosporins, tetracycline, trimethoprim-sulfamethoxazole, carbenicillin, piperacillin, nalidixic acid, oxolinic acid, cinoxacin, and enoxacin.

In the clinical studies to date, the side effects of norfloxacin have been minimal, but include nausea, vomiting, anorexia, dizziness, headache, drowsiness, depression, and a bitter taste in the mouth. In studies with more than 4000 patients, the incidence of side effects ranged from 3.9 to 4.7 percent, with most appearing by the second day of therapy.
Drug Interactions with Oral Contraceptives
Authors: D'Arcy P. F.
Published: May 2016

In the very rare cases where a pregnancy occurs during oral contraceptive use, the blame is usually laid against the patient for having forgotten to take the pill. Evidence has started to accumulate to suggest that neither the patient nor the pill is at fault in some contraceptive failures. It may be because the patient is taking other medicines and these may be preventing the pill from suppressing ovulation. Most drug interactions reducing or negating contraceptive activity are due to concomitant use of drugs having microsomal enzyme-inducing activity (e.g., some antibiotics, especially rifampicin, and anticonvulsants, including phenobarbital, Phenytoin, and primidone. Other antibiotics (e.g., tetracycline) may also interact by interruption of the enterohepatic circulation of contraceptive steroids.

Less well appreciated, oral contraceptive steroids may themselves modify the metabolism and pharmacological activity of various other drugs (e.g., anticoagulants, benzodiazepines, β-blockers, caffeine, corticosteroids, and tricyclic antidepressants); in this respect the oral contraceptives are acting as enzyme inhibitors.

Contraceptive steroids may also interact with drugs that cause enzyme inhibition and this delays the metabolism of the hormonal agents. Interactions of this type would be expected to potentiate the action of the contraceptive steroids. It is suggested that the effects of such interaction might be presented in terms of increased incidence of side effects, including water retention, diabetogenic effects, hypertension, and an increased risk of thromboembolic disorders.

The spectrum of interactions with oral contraceptives is presented in three tables.
An Updated pKa Listing of Medicinal Compounds
Authors: Raymond Glynn G. , Born Jerry L.
Published: May 2016

A tabulated listing of pKa values is presented for 87 medicinal compounds commercially marketed since 1978. Medicinal compounds are listed alphabetically under their respective generic name. The pKa values reported are listed as either acid or base depending upon the ionization characteristics of the functional group corresponding to the respective pKa value.
Lidocaine Excretion in Breast Milk
Authors: Zeisler John A. , Gaarder Thomas D. , De Mesquita Samuel A.
Published: May 2016

Nursing mothers are occasionally treated with intravenous lidocaine for ventricular dysrhythmias. There have been no reports on the excretion of lidocaine into breast milk. This case documents the excretion of lidocaine into breast milk in small amounts and shows the validity of the TDx methodology used in the whole-milk lidocaine assay. We observed breast-milk concentrations of lidocaine at 40 percent of the serum levels. Clinical practitioners should be aware that lidocaine is excreted into breast milk in small amounts and the mother could probably continue to safely breast-feed her child while on parenteral lidocaine. Any adverse reactions in the nursing infant would probably be limited to an idiosyncratic or allergic reaction.
Induction of Hemolytic Anemia by Nonsteroidal Antiinflammatory Drugs
Authors: Sanford-Driscoll Marcia , Knodel Leroy C.
Published: May 2016

The incidence of immune hemolytic anemia (IHA) is increasing. The proliferation of pharmaceuticals is a contributing factor to this increase. IHA is an uncommon, though significant, adverse effect of a wide variety of drugs. Several recent case reports have implicated the nonsteroidal antiinflammatory drugs (NSAIDs). Because of the extensive use of this class of drugs, a review of case reports, clinical studies, and in vitro research was conducted on NSAID-induced IHA. Mefenamic acid, ibuprofen, sulindac, naproxen, tolmetin, feprazone, and aspirin are reported to cause IHA, with mefenamic acid most frequently implicated. Mefenamic acid appears to cause hemolytic anemia by an autoimmune mechanism similar to methyldopa and aspirin by an immune complex mechanism. However, there is insufficient information concerning ibuprofen, sulindac, naproxen, tolmetin, and feprazone to assign specific mechanisms of immune hemolysis. In individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, aspirin at usual therapeutic doses is not a predisposing factor to hemolysis unless other risk factors are present. Although individuals with G-6-PD deficiency are at increased risk of developing hemolytic anemia when exposed to oxidizing stresses, the use of NSAIDs does not appear to increase this risk significantly. Because NSAID-induced IHA occurs infrequently and the sensitivity of currently used tests to detect drug-dependent antibodies is limited, routine serologic testing in patients receiving NSAIDs is not justified. If hemolytic anemia occurs in a NSAID-treated patient and the history is consistent with a drug-induced etiology, the NSAID should be discontinued. With discontinuation of the offending agent, the prognosis is good. There is a rapid hematologic recovery, with a slow resolution of abnormal serologic findings.
Review of Systemic Fluoride Supplementation and Consideration of the Pharmacist's Role
Authors: Baker Karen A. , Levy Steven M.
Published: May 2016

Interprofessional contact and consultation among dentists, physicians, and pharmacists can help to optimize patient care. Because pharmacists are readily accessible to the public, their influence is essential for the appropriate prescribing and continued use of systemic fluoride supplements.

Pharmacists should be familiar with various aspects of fluoride therapy, such as mechanisms of caries inhibition, dosages associated with acute and chronic toxicity, and recommended daily dosage levels. The impact of breastfeeding, multiple sources of water intake, and changing age of the patient must be considered in determining proper systemic fluoride dosage.

Pharmacists should consult with both physicians and dentists to coordinate water fluoride assay and prescribing responsibilities. They also can help to educate both prescribers and patients. Because of frequent patient contact and access to medication records, pharmacists can encourage and monitor patient compliance. Fluoride prescriptions and results of water fluoride assays should be documented on the patients' computerized or card profiles. In addition, pharmacists can counsel patients about the fluoride ion content of various home-use products and make recommendations to ensure that an optimal level of fluoride ingestion is maintained.
Serum Sickness Associated with Cefoxitin and Pentoxifylline Therapy
Authors: Panwalker Anand P. , Gibson Keith , Glynn Martin J. , Hanson Victor A.
Published: May 2016

Human serum sickness is a syndrome characterized by fever, malaise, skin rashes, arthralgias, gastrointestinal disturbances, and lymphadenopathy. It is believed to be mediated by circulating immune complexes composed of a foreign antigen and host antibody. Several cephalosporins have been associated with serum sickness. We report the occurrence of serum sickness in a patient who received cefoxitin, a commonly used cephamycin antibiotic, and pentoxifylline, a xanthine derivative that improves the flow properties of blood by decreasing its viscosity. Serum sickness has not been previously reported with the use of cefoxitin or pentoxifylline.
Dialyzability and Pharmacokinetics of Indomethacin in Adult Patients with End-Stage Renal Disease
Authors: Skoutakis Vasilios A. , Acchiardo Sergio R. , Carter Charles A. , Wojciechowski Norbert J. , Straughn Arthur B. , Meyer Marvin C.
Published: May 2016

Indomethacin, a nonsteroidal antiinflammatory drug, has been shown to be effective for the treatment of pericarditis in chronic hemodialysis patients. Data regarding the dialyzability of indomethacin in these patients, however, is lacking. The aim of this study, therefore, was to evaluate (1) the dialyzability, and (2) the absorption and elimination kinetics of indomethacin, using six stable anephric adult patients who were maintained on chronic hemodialysis and were receiving indomethacin for the management of their uremic pericarditis. The results from this study demonstrate that indomethacin is dialyzable, but not to an appreciable extent. The mean predialysis and postdialysis indomethacin plasma levels were 3.4 and 1.6 μg/ml, respectively. The mean total amount of indomethacin removed by five hours of hemodialysis was 19.6 percent of the single dose of indomethacin 100 mg po. However, mean Cpmax, tmax, t½, and AUC0-α during and in the absence of hemodialysis were 5.4 and 5.4 μg/ml (not statistically significant [NS]), 1.9 and 2.0 h (NS), 6.1 and 5.3 h (NS), and 30.9 and 35.7 μg h ml−1 (NS), respectively. Based on these findings, it can be concluded that although indomethacin is dialyzable, no dosage adjustment is required in patients receiving indomethacin for the management of their uremic pericarditis when undergoing maintenance hemodialysis.
Continuous Intravenous Morphine Infusions for Terminal Pain Control: A Retrospective Review
Authors: Stuart Glenda J. , Davey E. Bruce , Wight Susan E.
Published: May 2016

The continuous intravenous infusion of morphine may control terminal cancer pain unrelieved by conventional narcotic therapy. A retrospective review was conducted of the medical records of 79 terminal cancer patients who received a total of 84 intravenous morphine infusions. Data were recorded on morphine dosage, pain control, adverse effects, duration of infusion, and concomitant medication requirements. Infusion duration varied from less than 24 hours to 162 days (median: 7 days). Morphine dosage ranged from 0.5 to 300 mg/h. All patients experienced an improvement in baseline pain control; however, 54 percent required additional medication to enhance analgesia. Serious adverse effects, including marked sedation, hallucinations, diaphoresis, and respiratory depression, were recorded in 14 patients. These effects may be a reason for reducing the dose. Guidelines for the use of continuous intravenous morphine infusions are presented. Accurate pain assessment, morphine dosage calculation, and monitoring of adverse effects are essential to insure the safe and effective use of these infusions.
Drug Utilization Study Methodologies: National and International Perspectives
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Serradell Joaquima , Bjornson Darrel C. , Hartzema Abraham G.
Published: May 2016

This paper in the series on pharmacoepidemiology describes the history, development, and present status of drug utilization activities. The various methodologies employed in drug utilization studies are evaluated and presented along with a listing of the principal drug databases available for drug utilization research. An analysis is presented comparing the validity of drug consumption rates based on individual patient usage or drug cost data as adopted in North America and the defined daily dose unit as developed in Europe. Drug utilization derives its importance in pharmacoepidemiology from the fact that it provides the methodological rigor for defining the denominator data needed in pharmacoepidemiological research.
Lisinopril: A New Angiotensin-Converting Enzyme Inhibitor
Authors: Armayor Graciela M. , Lopez Larry M.
Published: May 2016

Lisinopril is a new, nonsulfhydryl angiotensin-converting enzyme inhibitor approved for the treatment of hypertension. After oral administration, 25–29 percent of the dose is absorbed intact; biotransformation is not required for pharmacological activity. Onset of action occurs one to two hours after administration, with effects still present 24 hours later. The major route of elimination is through renal excretion and an elimination half-life of 12.6 hours has been reported in normotensive individuals. In patients with impaired renal function (creatinine clearance ≤ 30 ml/min) a longer half-life and accumulation have been observed. Lisinopril 20–80 mg/d has been shown to be as effective as hydrochlorothiazide, nifedipine, and beta-blocking agents in the treatment of essential hypertension. Its efficacy in renovascular hypertension has also been demonstrated. In congestive heart failure (CHF) doses of 2.5–20 mg/d appear to provide hemodynamic effects comparable to those of captopril. Dizziness and cough have been the most frequently reported side effects; rash and proteinuria have also been reported in a small number of patients. Interactions with diuretics, potassium supplements, and possibly with nonsteroidal antiinflammatory agents may occur.

Lisinopril appears to be similar in efficacy to other antihypertensive agents in the treatment of essential hypertension and to captopril in the treatment of CHF. Whether lisinopril is safer or more effective than captopril or enalapril in the treatment of hypertension or CHF requires further investigation. Prolonged duration of action of lisinopril allows once daily dosing, unlike captopril for which dosing is required every 8–12 hours or enalapril which may necessitate twice daily dosing.
Individualized Aminoglycoside Dosage Regimens in Patients with Cystic Fibrosis
Authors: Delage Gilles , Desautels Lucie , Legault Sylvie , Lasalle Roger , Lapierre Jean-Guy , Lamarre André , Masson Pierre , Spier Sheldon
Published: May 2016

Individualized dosage regimens have recently been recommended for patients treated with aminoglycoside antibiotics. We have developed a calculator-based program for our patients with cystic fibrosis and have studied 93 courses of intravenous aminoglycoside treatment, comparing predicted and measured values in 45 courses. Pharmacokinetic parameters differed notably among subjects: This was reflected by widely variable total daily aminglycoside dosage requirements. The mean daily dosage requirements (± SD) for tobramycin (62 treatment courses) was 13.0 ± 3.74 mg/kg, and for gentamicin (26 treatment courses) was 11.5 ± 2.6 mg/kg. The accuracy of the program was evaluated by its ability to predict peak and trough values in individuals: 84 percent of measured peaks were within 2 μg/ml of predicted peaks and 93 percent of trough levels were within 1 μg/ml of the predicted level. Nephrotoxicity was observed in one patient, ototoxicity in three. This program provides a simple, safe, and effective method of tailoring an aminoglycoside regimen to the patient's needs.
Treatment of Adult Respiratory Distress Syndrome
Authors: Dull William L.
Published: May 2016

Adult respiratory distress syndrome (ARDS) culminates in inadequate oxygen delivery to the tissues. There are numerous inciting factors for this syndrome. Several therapies including the prophylactic use of antibiotics and steroids are controversial; even mechanical ventilatory support has controversial elements. The cornerstone of treatment remains supportive care until the cause of ARDS has resolved.
Flexible Classification for the Clinical Potency of Topical Corticosteroid Proprietaries
Authors: Fusaro Ramon M.
Published: May 2016

A flexible system of classifying topical corticosteroid proprietaries is proposed to help the clinician understand the relative antiinflammatory potency of these products. This system has the advantage of indicating not only the relative potency of a specific proprietary preparation but also noting the number of divisions in the classification. It allows for new product development and keeps the clinician informed of the change by the number of divisions being used. The system also has the potential for the classification of relative severity of both local and systemic side effects of corticosteroids.
Postgraduate Academic Desires: Senior Doctor of Pharmacy Students
Authors: McNulty Robert M. , Mirtallo Jay M.
Published: May 2016

Senior Doctor of Pharmacy (Pharm.D.) students were surveyed by questionnaire to glean information about academic training, and residency, fellowship, or practice positions sought after graduation. There were 227 (27 percent of total surveys) responses. Of those responding, 71 percent were Bachelor of Science graduates, 29 percent were Pharm.D. primary degree students, and 18 percent completed a residency either before or during Pharm.D. training. Fifty percent had an average of three years of clinical services work experience prior to their Pharm.D. education. There was strong interest in postgraduate education by respondents: 41 percent for residencies and 26 percent for fellowships. Of resident candidates, 18 percent and 49 percent, respectively, considered research essential and important to the program. Areas of greatest interest in residencies were general medicine, infectious disease, and pharmacokinetics. Important to the selection of a fellowship was the research proposal and concurrent clinical practice.

Pharm.D. students are interested in postgraduate training as residents (60 percent), fellows (38 percent), or both (2 percent). Desired activities are research and clinical practice independent of residency or fellowship interest.
Rebound Hypertension during Initiation of Transdermal Clonidine
Authors: Stewart Maren , Burris James F.
Published: May 2016

Rebound hypertension with a neurological complication occurred during an attempt to substitute transdermal for oral clonidine in a patient with severe hypertension. Published studies have not established an unequivocal correlation between previous oral clonidine dose and the dose of transdermal clonidine required for equally effective antihypertensive therapy. Close observation of blood pressure may be advisable for at least one week following substitution of transdermal for oral clonidine, especially in patients with severe hypertension.
Verapamil Preceded by Calcium in Supraventricular Tachycardia
Authors: Stringer Kathleen A. , Hicks Paul , Royal Stephen H. , Branconi Joseph M. , Sloan Rita
Published: May 2016

Verapamil has been shown to be effective in the management of supraventricular tachycardia (SVT). However, the utility of verapamil may be limited because of adverse effects, specifically hypotension. Several clinical observations have shown that the intravenous administration of calcium is effective in reversing the myocardial depressant effects of verapamil. We report the case of a patient with SVT and a systolic blood pressure of 80 mm Hg in which the administration of calcium chloride prior to that of verapamil may have negated verapamil-induced hypotension.
Differentiation of Cocaine Toxicity: Role of the Toxicology Drug Screen
Authors: Quandt Christine M. , Sommi Roger W. , Pipkin Travis , McCallum M.H.
Published: May 2016

Fifteen cases of presumed cocaine intoxication were evaluated in the emergency room (ER) at a city hospital over a four-day period. This series is unique in that many of these patients were from a similar area of the city, in some cases had the same street address, were regular abusers of cocaine, and presented to the ER with similar symptoms of tachycardia, dilated pupils, marked confusion, bizarre and sometimes violent behavior, psychosis, and hallucinations. Many of these symptoms were present several hours after drug use. Samples of a white powder presumed by the patients to be cocaine were obtained from two patients and analyzed by gas-liquid chromatography. Neither sample contained cocaine, but rather revealed atropine, benzocaine, and procaine. The signs and symptoms of cocaine, amphetamine, and atropine intoxication are reviewed and the problems of drug analysis and differential diagnosis of drug intoxication are discussed.
Calcium-Channel Blocking Agents and Chest Pain
Authors: Gaginella Timothy S. , Maxfield Dane L.
Published: May 2016

Calcium-channel blocking agents can relieve anginal and chest pain associated with hypermotility of the esophagus. Although calcium-channel antagonists differ in their effects on the esophageal body and the lower esophageal sphincter, reduction of lower esophageal sphincter pressure theoretically could result in gastroesophageal reflux and pain. This pain may be difficult to differentiate from chest pain of cardiac origin. An association between calcium-channel blocking agents and chest pain is speculative at this time. However, the possibility of such an effect should be considered by clinicians in the total management of patients. Future clinical studies are warranted to address the issue of the incidence of such an effect and to define more precisely the potential interrelationship among the calcium-channel antagonists, their efficacy in relieving cardiac pain, and their potential liability in inducing chest pain of noncardiac origin.
Cost Comparison of Ceftazidime versus Tobramycin/Ticarcillin Therapy in Three Hospitals
Authors: Parr Michael D. , Hansen Lea Ann , Rapp Robert P.
Published: May 2016

A retrospective review of 114 patient charts was conducted at three geographically different hospitals to compare the costs of ceftazidime (CTZ) with the combination of tobramycin and ticarcillin (T/T) in the treatment of hospital-acquired pneumonias and/or septicemias. Variables analyzed to determine the cost of the therapy included duration of treatment, dosage and number of doses administered, side effects, and laboratory tests. Time and motion studies were also performed and the results included in the algorithm. In two of the three hospitals, the computer-calculated cost of CTZ therapy was significantly less than for T/T therapy ($1194 vs. $1668 and $493 vs. $629). In the third hospital there was no significant difference in the costs of the two treatments ($1079 for CTZ vs. $1066 for T/T). The cost of each regimen per patient day followed a similar pattern, with CTZ therapy being significantly less expensive in the same two hospitals. Patients receiving CTZ therapy realized an average cost savings of $29.70 per day at the three institutions. These savings appeared to be due to a reduction in laboratory and administration costs resulting from the decreased frequency of CTZ administration. We conclude that CTZ therapy was less costly than T/T therapy at three geographically different institutions when the cost of supplies, laboratory tests, and personnel time were taken into account.
A Fatal Case of Propranolol Poisoning
Authors: Amundson Dennis E. , Brodine Stephanie K.
Published: May 2016

Propranolol hydrochloride is a beta-adrenergic blocking drug used in a variety of clinical conditions. Overdoses can result in severe hypotensive states usually associated with bradycardia or asystole or with profound myocardial depression. We report on an 18-year-old man who ingested a massive dose of propranolol HCl in a suicide attempt. The patient was brought to the hospital in an unresponsive state within 30 minutes of ingestion. He was initially stabilized but subsequently died nine hours after the drug was ingested. Invasive monitoring during this period revealed the shock to be secondary to marked depression of his systemic vascular resistance. Cardiac rhythm and left ventricular output were maintained throughout the attempted resuscitation. This hemodynamic picture suggests that decreased systemic vascular resistance may be another mechanism of shock in significant propranolol HCl overdoses.
Carbamazepine-Induced Severe Systemic Hypersensitivity Reaction with Eosinophilia
Authors: Robbie Melissa J. , Scurry James P. , Stevenson Peter
Published: May 2016

Skin rash, fever, and eosinophilia developed in a previously healthy 35-year-old woman three weeks after starting carbamazepine. Fulminant respiratory and renal failure ensued. Autopsy showed pneumonitis, nephritis, serositis, pancreatitis, hepatitis, and carditis, characterized by an infiltrate of eosinophils and lymphocytes. The severity, duration, and extensive organ involvement of the reaction make this case unique.
Management of Congestive Heart Failure in the Elderly
Authors: Malloy Michael J. , Lopez Larry M.
Published: May 2016

A universally accepted description of appropriate therapy for treatment of congestive heart failure (CHF) has yet to be agreed upon, especially in the elderly. Numerous studies have provided data that question use of a digitalis glycoside as the agent of choice in treatment of chronic CHF. Several clinicians have suggested that diuretics, particularly thiazide diuretics, be used as initial agents in the treatment of this condition. Evidence now demonstrates that drug therapy with enalapril or the combination of hydralazine and isosorbide dinitrate reduces the mortality related to chronic CHF. Additional studies are required to clarify respective roles of diuretics, digitalis glycosides, and vasodilators in the management of chronic CHF.
Subcutaneous Administration of Nifedipine
Authors: Krichbaum Daniel W. , Malone Patrick M.
Published: May 2016

Contents of a 10 mg nifedipine capsule (0.33 ml) were withdrawn by syringe and administered subcutaneously to a patient with hypertensive urgency due to misinterpretation of a physician's order. The drug apparently had its desired hypotensive effect and no adverse effects were noted. The literature on use of nifedipine in hypertensive urgency is reviewed. Subcutaneous administration is not recommended because of a lack of suitable controlled studies and the potential for adverse effects.
Ursodiol: A Cholesterol Gallstone Solubilizing Agent
Authors: Rosenbaum Cathy L. , Cluxton Robert J.
Published: May 2016

Ursodiol, a naturally occurring bile acid, has gained Food and Drug Administration approval for the dissolution of cholesterol gallstones. Ursodiol inhibits hepatic cholesterol synthesis and secretion. Lithocholic acid, a potentially hepatotoxic metabolite of ursodiol and chenodiol, may accumulate to a lesser extent with ursodiol than with chenodiol. Enterohepatic recirculation of ursodiol and its metabolites occurs and is essential to the dissolution of cholesterol gallstones. Complete dissolution has been achieved in 17 percent of patients with noncalcified, radiolucent, floating, cholesterol gallstones. Recurrence of cholesterol gallstones may occur in over one-half of initial responders. Diarrhea reported in up to 50 percent of the patients on chenodiol has been reported in only 4 percent of patients treated with ursodiol. Increased mean aspartate aminotransferase levels to more than twice the pretreatment level seen with chenodiol therapy have not been reported with ursodiol. Reportedly fewer adverse reactions may give ursodiol a major advantage over chenodiol in hospital formulary considerations.
Famotidine-Associated Mental Confusion in Elderly Patients
Authors: Henann Neil E. , Carpenter Deborah U. , Janda Sue M.
Published: May 2016

Central nervous system effects, such as mental confusion and hallucinations, have been reported with both cimetidine and ranitidine. Elderly patients with renal or hepatic dysfunction are more susceptible to these adverse reactions. We report two cases of reversible mental confusion in elderly patients with mild renal insufficiency following intravenous famotidine therapy, possibly explained by an increased permeability of the blood-brain barrier in patients with decreased renal function.
Assessment and Management of Post-Intubation Airway Injuries
Authors: Jones Teresa S. , Sullivan Andrew , Damle Sagar , Weyant Michael J. , Mitchell John D. , Weitzel Nathaen S. , Meguid Robert A.
Published: May 2016

Tracheal laceration is a known complication of endotracheal intubation. This rare complication remains a diagnostic and management challenge for today’s practitioners. This clinical challenge report highlights current surgical and anesthetic management strategies.
Do As I Say
Authors: Mercer Kollar Laura M. , Davis Teaniese L. , Monahan Jennifer L. , Samp Jennifer A. , Coles Valerie B. , Bradley Erin L. P. , Sales Jessica McDermott , Comer Sarah K. , Worley Timothy , Rose Eve , DiClemente Ralph J.
Published: May 2016

Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women ( N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET’s efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one’s sexual partner as an assertive communication behavior within sexual health contexts.
A systematic review of the sensitivity and specificity of the toe–brachial index for detecting peripheral artery disease
Authors: Tehan Peta Ellen , Santos Derek , Chuter Vivienne Helaine
Published: May 2016

The toe–brachial index (TBI) is used as an adjunct to the ankle–brachial index (ABI) for non-invasive lower limb vascular screening. With increasing evidence suggesting limitations of the ABI for diagnosis of vascular complications, particularly in specific populations including diabetes cohorts, the TBI is being used more widely. The aim of this review was to determine the sensitivity and specificity of the TBI for detecting peripheral artery disease (PAD) in populations at risk of this disease. A database search was conducted to identify current work relating to the sensitivity and specificity of toe–brachial indices up to July 2015. Only studies using valid diagnostic imaging as a reference standard were included. The QUADAS-2 tool was used to critically appraise included articles. Seven studies met the inclusion criteria. Sensitivity of the TBI for PAD was reported in all seven studies and ranged from 45% to 100%; specificity was reported by five studies only and ranged from 16% to 100%. In conclusion, this review suggests that the TBI has variable diagnostic accuracy for the presence of PAD in specific populations at risk of developing the disease. There was a notable lack of large-scale diagnostic accuracy studies determining the diagnostic accuracy of the TBI in detecting PAD in different at-risk cohorts. However, standardised normal values need to be established for the TBI to conclusively determine the diagnostic accuracy of this test.
Not just ‘small potatoes’: Knowledge of the idiomatic meanings of collocations
Authors: Macis Marijana , Schmitt Norbert
Published: May 2016

This study investigated learner knowledge of the figurative meanings of 30 collocations that can be both literal and figurative. One hundred and seven Chilean Spanish-speaking university students of English were asked to complete a meaning-recall collocation test in which the target items were embedded in non-defining sentences. Results showed limited collocation knowledge, with a mean score of 33% correct. The study also examined the effects of frequency, semantic transparency, year at university, and everyday engagement with the second language (L2) outside the classroom on this collocation knowledge. Mixed-effects modelling indicated that there was no relationship between frequency and semantic transparency and the knowledge of the figurative meanings. However, a positive relationship was found between this knowledge and year at university, time spent in an English-speaking country, and time spent reading.
An uncommon potentially lethal injury: Traumatic pericardial rupture with herniation of the heart
Authors: Davidson TA Yuvaraj , Nand Parma
Published: May 2016

Traumatic rupture of the pericardium with herniation of the heart can be a potentially lethal injury that can be easily overlooked. Prompt diagnosis and repair can be lifesaving. We report such a case with successful repair of this injury in a 45-year-old male who sustained multiple injuries following a motor vehicle accident. CT scan revealed rupture of the pericardium with herniation of the heart. The pericardial tear was promptly repaired by primary closure. This report gives an insight into this life threatening, yet promptly treatable condition, which can be easily missed resulting in a fatal outcome. Having a high index of suspicion while treating thoracic trauma patients can prevent fatalities. Immediate referral to a cardiothoracic service or closure of the tear through a thoracotomy, if the expertise is available, can be lifesaving.
Citizenship, human rights, and dementia: Towards a new embodied relational ethic of sexuality
Authors: Kontos Pia , Grigorovich Alisa , Kontos Alexis P , Miller Karen-Lee
Published: May 2016

Sexual citizenship and sexual rights scholarship have made important contributions to broadening citizenship and more fully accommodating rights related to sexuality. However, this scholarship has concentrated primarily on the sexuality and intimacy-related needs of younger people and those who are not cognitively impaired. Consequently, it has inadvertently served to marginalize persons living with dementia who reside in long-term residential care settings. We argue that supporting sexual rights for persons with dementia requires a particular human rights ontology for citizenship—one that recognizes that corporeality is a fundamental source of self-expression, interdependence, and reciprocal engagement. This is an ontology that underpins our model of relational citizenship and that grounds our articulation of an ethic of embodied relational sexuality. In our view, this ethic offers important direction for the development of policy, legislation, and clinical guidelines to support sexual rights for persons with dementia in long-term residential care.
Re-claiming citizenship through the arts
Authors: Dupuis Sherry L , Kontos Pia , Mitchell Gail , Jonas-Simpson Christine , Gray Julia
Published: May 2016

Healthcare literature, public discourse, and policy documents continue to represent persons with dementia as “doomed” and “socially dead.” This tragedy meta-narrative produces and reproduces misunderstandings about dementia and causes stigma, oppression, and discrimination for persons living with dementia. With few opportunities to challenge the dominant discourse, persons with dementia continue to be denied their citizenship rights. Drawing on the concept of narrative citizenship, we describe a community-based, critical arts-based project where persons with dementia, family members, visual and performance artists, and researchers came together to interrogate the tragedy discourse and construct an alternative narrative of dementia using the arts. Our research demonstrates the power of the arts to create transformative spaces in which to challenge dominant assumptions, foster critical reflection, and envision new possibilities for mutual support, caring, and relating. This alternative narrative supports the reclamation of citizenship for persons living with dementia and fosters the relational citizenship of all.
Original Research: Orexins A and B stimulate proliferation and differentiation of porcine preadipocytes
Authors: Wojciechowicz Tatiana , Skrzypski Marek , Szczepankiewicz Dawid , Hertig Iwona , Kołodziejski Paweł A , Billert Maria , Strowski Mathias Z , Nowak Krzysztof W
Published: May 2016

Orexin A (OXA) and B (OXB) are neuropeptides which regulate appetite, energy expenditure, and arousal via G-protein coupled receptors termed as OXR1 and OXR2. The aim of this study was to characterize the effects of OXA and OXB on proliferation and differentiation of porcine preadipocytes. Porcine preadipocytes express both OXRs. OXA and OXB enhance porcine preadipocyte proliferation by 54.8% or 63.2 %, respectively. OXA and OXB potentiate differentiation of porcine preadipocytes, as judged by the increased lipid accumulation and expression of proadipogenic genes. Cellular lipid content after exposure of preadipocytes for six days to 100 nM OXA or OXB increased by 82.2% or 59.2%, respectively. OXA and OXB suppressed glycerol release by 23.9% or 24.9% in preadipocytes differentiated for six days. OXA (100 nM) increased peroxisome proliferator-activated receptor gamma ( PPARγ) expression in cells differentiated for 24 h by 100.5%. PPARγ expression was also stimulated in preadipocytes differentiated in the presence of 10 nM (58.3%) or 100 nM OXA (50.6%) for three days. OXB potentiated PPARγ mRNA expression at 1 nM (59%), 10 nM (53.2%), and 100 nM (73.9%) in cells differentiated for three days. OXA increased CCAAT/enhancer binding protein alpha expression in preadipocytes differentiated for six days by 65%. OXB stimulated CCAAT/enhancer binding protein beta expression in preadipocytes differentiated for three days at 10 nM (149.5%) as well as 100 nM (207.2%). Lipoprotein lipase mRNA expression increased in cells treated with 10 nM OXA by 152.6% and 100 nM OXA by 162%. Lipoprotein lipase expression increased by 134% at 100 nM OXB. Furthermore, OXA (100 nM) and OXB (100 nM) increased leptin mRNA expression in preadipocytes differentiated for three days by 49.9% or 71.3%, respectively. These data indicate that orexin receptors may be relevant in the context of white adipose tissue formation.
Rupture of internal pudendal artery aneurysm following spontaneous vaginal delivery: An uncommon cause of post-partum bleeding
Authors: Martingano Daniel , Martingano Francis X , Ruggiero-DeCarlo Rosemary
Published: May 2016

Pregnancy-related rupture of an arterial aneurysm is an unusual occurrence associated with increased risk of morbidity and mortality. Various pregnancy-related physiologic changes appear to make pregnancy a high-risk situation for rupture of either preexisting arterial aneurysms or those that develop throughout the course of pregnancy. Splenic artery aneurysms are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%), celiac (4%), ovarian, uterine, and renal (<2%) artery. Even rarer are aneurysms involving the internal iliac artery and its branches, to which there is only one published case report. In this report, we present a case of a 34-year-old pregnant gravida1 para0 who, following a normal vaginal delivery, had a severe rupture of the right internal pudendal artery and subsequently developed a massive hematoma which ultimately required embolization treatment.
Operative Treatment for Osteochondral Lesions of the Talus
Authors: Yasui Youichi , Wollstein Adi , Murawski Christopher D. , Kennedy John G.
Published: May 2016

Objective

Numerous basic science articles have published evidence supporting the use of biologic augmentation in the treatment of osteochondral lesions of the talus (OLT). However, a comprehensive evaluation of the clinical outcomes of those treatment modalities in OLT has yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following biologic augmentation to surgical treatments for OLT.

Design

A comprehensive literature review was performed. Two commonly used surgical techniques for the treatment of OLT—bone marrow stimulation and osteochondral autograft transfer—are first introduced. The review describes the operative indications, step-by- step operative procedure, clinical outcomes, and concerns associated with each treatment. A review of the currently published basic science and clinical evidence on biologic augmentation in the surgical treatments for OLT, including platelet-rich plasma, concentrated bone marrow aspirate, and scaffold-based therapy follows.

Results

Biologic agents and scaffold-based therapies appear to be promising agents, capable of improving both clinical and radiological outcomes in OLT. Nevertheless, variable production methods of these biologic augmentations confound the interpretation of clinical outcomes of cases treated with these agents.

Conclusions

Current clinical evidence supports the use of biologic agents in OLT cases. Nonetheless, well-designed clinical trials with patient-specific, validated and objective outcome measurements are warranted to develop standardized clinical guidelines for the use of biologic augmentation for the treatment of OLT in clinical practice.
Magnesio-ferri-fluoro-hornblende from Portoscuso, Sardinia, Italy: description of a newly approved member of the amphibole supergroup
Authors: Oberti Roberta , Boiocchi Massimo , Hawthorne Frank C. , Ball Neil A. , Chiappino Luigi
Published: May 2016

Magnesio-ferri-fluoro-hornblende has the ideal formula A□B Ca2C(Mg4Fe3+)T(Si7Al)O22WF2(Hawthorne et al., 2012). The holotype sample described in this work occurs as prismatic crystals in vugs of volcanic rocks (Seruci ignimbrites), found along the coast road ∼5.5 km northeast of Portoscuso, Cagliari, Sardinia; associated minerals are tridymite, todorokite, magnetite, and hematite. The name and the mineral were approved by the IMA CNMNC (2014-091). Holotype magnesio-ferri-fluoro-hornblende is monoclinic, space group C2/m, a = 9.839(5), b = 18.078(9), c = 5.319(3) Å, β = 104.99(3)°, V = 913.9(9) Å3, Z = 2. The density calculated from the empirical formula is 3.315 g cm–3. In plane-polarized light, magnesio-ferri-fluoro-hornblende is pleochroic, X = pale grey (least), Y = dark grey (most), Z = pale brownish grey (intermediate); X^a= 47.6° (β obtuse), Y // b, Z^c= 33.4° (β acute). It is biaxial negative, α = 1.669, β = 1.676, γ = 1.678, all ±0.002; 2Vobs= 74(1)°, 2Vcalc= 56°. The strongest eight lines in the powder X-ray diffraction pattern are [d in Å (I)(hkl)]: 2.711 (100)(151), 8.412 (89)(110), 3.121 (64)(310), 2.553 (61)(2̄02), 3.389 (55)(131), 2.599 (45)(061), 2.164 (36)(261), and 2.738 (34)(3̄31). Electron-microprobe analysis of the refined crystal gave SiO245.34, Al2O36.18, TiO21.22, FeO 15.24, Fe2O36.27, MgO 9.71, MnO 0.78, ZnO 0.06, CaO 10.18, Na2O 1.35, K2O 1.15, F 3.22, Cl 0.30, H2Ocalc 0.37, sum 99.95 wt.%. The empirical formula unit, calculated on the basis of 24 (O, OH, F, Cl) apfu with (OH + F + Cl) = 2 apfu is: (Na0.15K0.22)∑0.37(Na0.25Ca1.66Mn0.09)∑2.00(Mg2.20Fe2+1.94Mn0.01Zn0.01Fe3+0.72Ti0.13)∑5.01(Al1.11Si6.89)∑8.00O22[F1.55(OH)0.37Cl0.08)∑2.00.
Joint analysis of histopathology image features and gene expression in breast cancer
Authors: Popovici Vlad , Budinská Eva , Čápková Lenka , Schwarz Daniel , Dušek Ladislav , Feit Josef , Jaggi Rolf
Published: May 2016

Background

Genomics and proteomics are nowadays the dominant techniques for novel biomarker discovery. However, histopathology images contain a wealth of information related to the tumor histology, morphology and tumor-host interactions that is not accessible through these techniques. Thus, integrating the histopathology images in the biomarker discovery workflow could potentially lead to the identification of new image-based biomarkers and the refinement or even replacement of the existing genomic and proteomic signatures. However, extracting meaningful and robust image features to be mined jointly with genomic (and clinical, etc.) data represents a real challenge due to the complexity of the images.

Results

We developed a framework for integrating the histopathology images in the biomarker discovery workflow based on the bag-of-features approach – a method that has the advantage of being assumption-free and data-driven. The images were reduced to a set of salient patterns and additional measurements of their spatial distribution, with the resulting features being directly used in a standard biomarker discovery application. We demonstrated this framework in a search for prognostic biomarkers in breast cancer which resulted in the identification of several prognostic image features and a promising multimodal (imaging and genomic) prognostic signature. The source code for the image analysis procedures is freely available.

Conclusions

The framework proposed allows for a joint analysis of images and gene expression data. Its application to a set of breast cancer cases resulted in image-based and combined (image and genomic) prognostic scores for relapse-free survival.
Salvage Therapy for Patients With Germ Cell Tumor
Authors: Rashdan Sawsan , Einhorn Lawrence H.
Published: May 2016

The introduction of cisplatin combination chemotherapy, 40 years ago, transformed metastatic testicular germ cell tumors from an almost uniformly fatal disease into a model for a curable neoplasm. Before the era of platinum combination chemotherapy, the 5-year survival rate among men with metastatic testicular germ cell tumors was 5% to 10%. Currently, the 5-year survival rate is 80% for patients with metastatic disease and 95% overall. Despite the substantial advances in the treatment of germ cell tumors, 20% to 30% of patients will relapse after first-line chemotherapy and will require additional salvage therapies. Standard-dose or high-dose chemotherapy can cure ≤ 50% of these patients. Relapses after high-dose chemotherapy generally carry a poor prognosis; however, cure is still possible in a small percentage of patients by using further salvage chemotherapy or salvage surgery.