bluuebunny/crossref_metadata_2025 huggingface dataset:
Computational analysis of vortices near casing in a transonic axial compressor rotor
Authors: Wu Yanhui , An Guangyao , Chen Zhiyang , Wang Bo
Published: December 2017

Complicated flowfields near casing in a transonic axial flow compressor rotor have been numerically investigated in this paper. Two vortex identification methods, namely the Eigenvector Method and Lambda 2 Method, are introduced as important tools for the graphical representation of the concentrated vortices arising from tip leakage flow and blade boundary layer separation. The analysis of the numerical results reveals that multiple tip vortices whose development are dependent on the variation of shock wave configuration are observed at conditions around the peak efficiency point. However, with the decrease of the massflow rate, only the well-known tip leakage vortex and the second tip vortex are left in the tip region due to the disappearance of the second shock wave. Then when the massflow rate further decreases to the stall limit, an deceleration flow region emerges downstream of the shock wave due to an increasing interaction between the first shock wave and the well-known tip leakage vortex. The tip leakage vortex further experiences a bubble-type and then spiral-type breakdown at near stall flow conditions. In addition, the validity of the two vortex identification methods is also discussed in this paper. It is found that both methods are able to identify and accentuate the concentrated streamwise vortices near casing when a vortex is not disrupted. However, if the vortex breakdown occurs, only Eigenvector Method can describe the breakdown region in a deep view.
The use of NIRS in the dairy industry: New trends and applications
Authors: Holroyd SE
Published: December 2017

Near infrared spectroscopy has been widely used as an analytical tool in the dairy industry since the 1980s. NIR use has progressed as instruments have evolved over time. Today there are fleets of networked instruments using generic calibrations across broad product classes for at- and in-line applications. More recently NIR has found application for food safety applications as well, increasingly using non-targeted approaches. However the relevant strengths and weaknesses of NIR must be thoroughly understood in these challenging applications.
Sharpening randomization-based causal inference for 22 factorial designs with binary outcomes
Authors: Lu Jiannan
Published: December 2017

In medical research, a scenario often entertained is randomized controlled 22 factorial design with a binary outcome. By utilizing the concept of potential outcomes, Dasgupta et al. proposed a randomization-based causal inference framework, allowing flexible and simultaneous estimations and inferences of the factorial effects. However, a fundamental challenge that Dasgupta et al.’s proposed methodology faces is that the sampling variance of the randomization-based factorial effect estimator is unidentifiable, rendering the corresponding classic “Neymanian” variance estimator suffering from over-estimation. To address this issue, for randomized controlled 22 factorial designs with binary outcomes, we derive the sharp lower bound of the sampling variance of the factorial effect estimator, which leads to a new variance estimator that sharpens the finite-population Neymanian causal inference. We demonstrate the advantages of the new variance estimator through a series of simulation studies, and apply our newly proposed methodology to two real-life datasets from randomized clinical trials, where we gain new insights.
Natural lymphatic (“atypical”) actinobacillosis in cattle caused by Actinobacillus lignieresii
Authors: Caffarena Rubén D. , Rabaza Ana , Casaux Laura , Rioseco Melissa Macías , Schild Carlos O. , Monesiglio Cecilia , Fraga Martín , Giannitti Federico , Riet-Correa Franklin
Published: December 2017

Bovine actinobacillosis is typically characterized by pyogranulomatous glossitis (wooden tongue). The involvement of other tissues, generally the skin or lymph nodes, has been regarded as atypical or cutaneous. We describe herein 2 outbreaks of actinobacillosis affecting primarily the lymph nodes of the head and neck. The disease affected 40 of 540 lactating cows in a dairy herd, and 5 of 335 two-y-old steers in a beef herd. Multiple or single, occasionally ulcerated nodules were observed in the region of the mandible, neck, and shoulder, including the parotid, submandibular, retropharyngeal, and prescapular lymph nodes. The histologic lesions were multifocal pyogranulomatous lymphadenitis, dermatitis, and cellulitis with Splendore–Hoeppli material. One steer had an exophytic pyogranuloma in the gingiva and another died because of ruminal tympany secondary to oropharyngeal and esophageal obstruction by a pyogranulomatous mass. Actinobacillus lignieresii was isolated from the lesions and identified by amplification, sequencing, and analysis of the 16S ribosomal (r)DNA gene. Seven of 8 cows recovered after treatment with sodium iodide. Lymphatic actinobacillosis is a frequent disease in Uruguay, southern Brazil, and Argentina. Morbidity is 1–50%; mortality is <1%. A. lignieresii apparently penetrates the intact oral and pharyngeal mucosa, infecting primarily the regional lymph nodes. Later, lesions may extend to the subcutaneous tissue and the skin, causing ulceration. Affected cattle with draining pyogranulomas contaminate the environment, favoring disease transmission, and should be treated with sodium iodide or antibiotics and isolated from the herd in order to control the disease.
Enzootic calcinosis in horses grazing Solanum glaucophyllum in Argentina
Authors: Odriozola Ernesto R. , Rodríguez Alejandro M. , Micheloud Juan F. , Cantón Germán J. , Caffarena Rubén D. , Gimeno Eduardo J. , Bodega José J. , Gardey Pedro , Iseas Fortunato B. , Giannitti Federico
Published: December 2017

Solanum glaucophyllum, a toxic plant known for its calcinogenic effects, causes enzootic calcinosis in ruminant and monogastric animals. We describe an outbreak of enzootic calcinosis that occurred in a herd of 110 horses grazing pastureland heavily contaminated with S. glaucophyllum in Buenos Aires province, Argentina. Ten horses developed clinical signs, and 6 horses died. Clinical signs included abnormal gait (stiff-legged action, short strides), stiffness, thoracolumbar kyphosis, reluctance to move, wide stance, chronic weight loss, weakness, recumbency, and difficulty standing. Autopsy of 2 horses revealed severe mineralization of the aorta, pulmonary arteries, heart, and lungs, consistent with enzootic calcinosis. Although horses usually have very selective grazing behavior, under food restriction conditions, they can ingest the toxic plants and can develop the disease. Enzootic calcinosis should be considered as a differential diagnosis in horses grazing S. glaucophyllum–invaded pasturelands with compatible clinical signs and lesions.
Determination of the diversity of astroviruses in feces from cats in Florida
Authors: Lawler Patricia E. , Cook Kirstin A. , Williams Hannah G. , Archer Linda L. , Schaedel Karen E. , Isaza Natalie M. , Wellehan James F. X.
Published: December 2017

Astroviruses are small, nonenveloped RNA viruses that have been linked to numerous diseases in a variety of species, including enteric disease in humans and cheetahs. Species Mamastrovirus 2, previously known as feline astrovirus, has been isolated from the feces of domestic cats and cheetahs. A total of 122 cat fecal samples from Alachua County, FL Animal Services and the Veterinary Community Outreach Program at the University of Florida were analyzed, and 35 contained astroviral RNA that was amplified and identified using consensus RT-PCR and sequence analysis. Using phylogenetic analysis, 19 of the astroviral sequences were identified as Mamastrovirus 2, making it the most prevalent astrovirus in this population. Three samples were identified as an astrovirus similar to viruses previously identified in foxes in The Netherlands and a cat in California, and one was similar to a bat astrovirus. One astroviral sequence was identified as an Avastrovirus. Although a causative relationship between mamastroviruses and enteric disease in cats has yet to be established, it is clear that mamastroviruses are prevalent, and an understanding of prevalence of astroviral types may help direct future test development.
A Plea for Uniform Lot Numbers
Authors: Whitney H. A. K. , Lomonte V. A.
Published: December 2017

The practicing pharmacist must have some means of determining the age of the products he purchases and dispenses in order to assist him in providing the patient with drugs which are not deteriorated. If the pharmacist could determine the date of manufacture from the lot number, this problem could be alleviated.

This paper reports a study of the lot numbering systems of 166 pharmaceutical and chemical manufacturers. The manufacturers were asked to explain the meaning of their numbers if it was not confidential. They were also asked if they would be amenable to a standard system of assigning lot numbers to be utilized by all manufacturers. Of the 138 replies, 84 (61 percent) did not consider their number information confidential. Eighty-eight (64 percent) of the manufacturers stated that the date of manufacture could be determined from the lot number. Fifty-six (41 percent) of the respondents favored a standard system of assigning lot numbers. The means of identifying the date of production from the lot number are revealed for over fifty manufacturers. It is recommended that manufacturers adopt a standard system of assigning lot numbers.
Environment for Sterile Dosage Formulation & Control
Authors: Gallelli Joseph F. , Skolaut Milton W.
Published: December 2017

The need for removal of particulates, either biological or inert, in clean rooms of hospitals involved in preparation and control of sterile dosage formulations and intravenous additive solutions, prompted an investigation of the methods used to aid in controlling contamination.

This was accomplished in large part by the use of laminar flow hoods in clean rooms. Evaluation of laminar flow hoods and clean room ultraviolet hoods, along with advantages and disadvantages of each, is reported. Selection of equipment for specific operations is discussed.
Diffusion of Drugs through the Cuprophane Membrane
Authors: Kowal Nathan H. , Sandler Alan I. , Davis Arthur J.
Published: December 2017

This paper describes the in vitro diffusion, through the cuprophane membrane, of a significant number of drugs currently being administered to patients who are undergoing hemodialysis.

The diffusion potentials of the drug molecules through the cuprophane membrane, the dialyzing membrane which separates the blood and the dialysate during the dialysis exchange must be accurately determined to establish the relationship between dosage administration and the quantities of the drug remaining in the patient during the dialysis procedure and in the immediate postdialysis period.

The results of this study will provide the prescribing physician with the information that will be useful in selecting the proper therapeutic agent and the dosage needed to assure adequate blood levels while the patient is undergoing hemodialysis.
A Practical Method of Sterility Monitoring of IV Admixtures and a Method of Implementing a Routine Sterility Monitoring Program
Authors: Buth J.A. , Coberly R.W. , Eckel F.M.
Published: December 2017

A practical procedure for sterility testing of intravenous admixtures contained in plastic bags using membrane filtration was developed. This technique was then evaluated in a pilot study involving 140 (18 percent) of the large volume intravenous admixtures prepared during June, 1972, by a central pharmacy admixture program. The technique was effective in detecting all of the positive controls, intentionally contaminated, in the pilot study.

The pilot study furnished the necessary data to statistically determine a monthly sample size of intravenous admixtures to be cultured, which would represent the entire population at a 95 percent confidence level with a 5 percent allowable error of the mean, and to implement a program of routine sterility monitoring by the hospital's Epidemiology Department.

Procedures involved in maintaining sterility in a centralized intravenous admixture program were also implemented and are discussed.

Results of this study indicate that a program of routine sterility monitoring of a hospital pharmacy intravenous admixture program can be implemented simply and practically. The program would monitor potential contamination from both the pharmacy and pharmaceutical manufacturers.
Factors Involved in Monitoring IV Therapy — a Study of Microbial Growth in IV Fluids
Authors: Pierpaoli Paul G. , Palmer Henry A. , Codino Rudolph J.
Published: December 2017

A Study of Microbial Growth in Intravenous Solutions A study of the growth potential of five microorganisms in 18 different intravenous fluids was made. It has been shown that with the exception of 2 organisms (Enterobacter cloacae and Erwinia species) growth after 24-hours is suppressed in solutions which do not contain nitrogen supplied by amino acids.

These data indicate that microbial monitoring studies of intravenous fluids should be carried out by running sterility test procedures immediately after the likelihood of contamination occurs, (i.e. admixture preparation, administration set insertion, and administration to patient). Negative results obtained from surveillance samples more than 24-hours old may not be truly indicative of the initial level of microbial contamination. Such monitoring could therefore lead to a false sense of security relative to in-house techniques for intravenous solution preparation, handling and administration.
The Effect of Packaging and Instruction on Outpatient Compliance with Medication Regimens
Authors: Linkewich Joseph A. , Catalano Robert B. , Flack Herbert L.
Published: December 2017

The effect of packaging and instruction on outpatient compliance with medication regimens was evaluated. Data derived from pill count assessments of patient prescriptions demonstrated marked differences in compliance of different patient populations receiving instruction and special packaging.
Clinical Pharmacy Case Studies
Authors: McCarron Margaret M.
Published: December 2017

This series of case studies has been prepared by the faculty of the Department of Clinical Education and Services at U.S.C. School of Pharmacy as a continuing education course for pharmacists. The cases are meant to be studied in sequence; concepts and laboratory test evaluations presented in one case will be used in subsequent cases. All normal laboratory test values will be those used at the Los Angeles County/U.S.C. Medical Center; values may differ at other hospitals depending on the method used. Medical material is presented to give the pharmacist an understanding of the case, it is not meant to teach' the pharmacist diagnosis. The cases have been altered for teaching purposes so that they do not represent actual cases.
Acute Brain Syndrome in an Elderly Patient
Authors: McCarron Margaret M. , Kayne Ronald C.
Published: December 2017

This case was presented to acquaint the reader with (1) manifestations of acute brain syndrome, (2) clinical situations frequently associated with acute brain syndrome, and (3) drug frequently used in the geriatric patient that that have been associated with acute brain syndrome.
Maturing of Pharmaceutical Education
Authors: Swintosky Joseph V.
Published: December 2017

In this paper the author recommends that American pharmaceutical education should move rapidly in the direction of a single terminal professional doctor of pharmacy degree for all of its graduates. An attempt is made to review for the reader: (1) some of the historical events of the twentieth century that influenced the direction of education in pharmaceutical, medical and related health professions,1,2,3,4(2) the Pharmaceutical Survey of 19485,6which was the last major introspective study prior to the present work underway by the Millis Commission, (3) the report of the Citizens Commission On Graduate Medical Education7which appeared in 1966, (4) several tracts of the past few decades2,3,8,9,10which have focused on the changing scene in American pharmaceutical education, (5) the development7,10in medical education which have provided important precedents for pharmacy and (6) several recent papers11,12which have espoused the professional doctor of pharmacy degree. The author particularly calls upon direct quotes and recommendations from the Findings And Recommendations of the Pharmaceutical Survey of 1948. Also, he draws upon and paraphrases remarks of The Report of the Citizens Commission and Graduate Medical Education, chaired by John S. Millis, and which appeared in 1966.
The Treatment of Hypertension in Pregnancy
Authors: Wilson A.L. , Matzke Gary R.
Published: December 2017

The drug treatment of hypertension occurring during pregnancy is described. Diagnostic problems and management are outlined, and the available literature regarding the use of standard hypotensive agents in pregnancy is reviewed by drug class. Based on currently published literature and opinion, the following drugs are recommended when needed during pregnancy (with proper monitoring): methyldopa, hydralazine, and furosemide. Caution is recommended when the following drugs are used during pregnancy: propranolol, and thiazide diuretics. The following drugs are not recommended for use during pregnancy based on currently available information: reserpine, clonidine, chlorthalidone, prazosin, minoxidil, spironolactone, ethacrynic acid, metoprolol, nadolol, and guanethidine.
Number and Type of Psychotropic Drugs on the Scandinavian Market in 1950-1977
Authors: Hemminki Elina , Pesonen Terttu , Hansen Ebba Holme
Published: December 2017

This article describes the number and types of psychotropic drugs on the market in Denmark, Finland, Norway, and Sweden from 1950-1977. The total number of drugs on the market in each country depended greatly on how psychotropic drugs were defined, but trends with time and differences between the countries were less affected by this definition. The number of drugs was highest in Finland and lowest in Norway. In all countries, the number of drugs increased from 1950 to the mid-1960s, most abruptly in Finland. They then quickly decreased in Finland and Sweden, but remained fairly constant in Denmark and Norway. The number of different active substances was much smaller than the number of drugs, and the differences between the countries were also smaller. The proportions of combination and hidden psychotropic drugs in relation to all psychotropics were considerable in Finland and Sweden, and the varying numbers of combination drugs contributed greatly to the wide differences in the numbers of drugs. From the medical point of view, far too many drugs were on the market in that period.
Critical Care Therapeutics: The Management of Septic Shock
Authors: Dasta Joseph F. , Eskridge Roger A.
Published: December 2017

Septic shock is a common emergency, most often caused by gram-negative bacteremia. Appearance of gram-negative endotoxin in the systemic circulation sets off a complex reaction involving many physiologic systems. The resultant reduction in microcirculation and subsequent organ dysfunction often lead to death. Early therapy to support the cardiovascular system and rational antibiotic therapy may improve the chance of survival. Careful monitoring of disease and drug effect parameters is essential to therapy.
Amiodarone for Tachyarrhythmias: Pharmacology, Kinetics, and Efficacy
Authors: Canada Andrew T. , Lesko Lawrence J. , Haffajee Charles I. , Johnson Brian , Asdourian George K.
Published: December 2017

Amiodarone, although widely studied in Europe, is a recent addition to the investigational antiarrhythmics being used in the U.S. Pharmacologically, its primary cardiac effects are to increase coronary artery blood flow, increase the effective refractory period, and produce an atropine-resistant bradycardia.

Amiodarone is incompletely (~ 50 percent) and slowly (peak serum concentration ~ 6 h) absorbed. With chronic administration, it deposits both in adipose tissue and in organs with high blood perfusion. It has an apparent elimination half-life of 15–45 days, which presents unique dosing problems. The apparent therapeutic range is 0.6-3 μg/ml.

Amiodarone is 85–95 percent effective in the treatment of atrial tachyarrhythmias and 70–80 percent effective in ventricular tachyarrhythmias. It appears to be of particular value in chronic atrial fibrillation/flutter because it may be able to maintain sinus rhythm after cardioversion.

Side effects, although uncommon, may prevent the drug from becoming a standard of therapy. Drug interactions, particularly with warfarin and digoxin, as well as pulmonary fibrosis are of concern.
Clinical Pharmacy Case Reports: Recurrence of Intravenous-Diazepam-Induced Phlebitis from Oral Diazepam
Authors: Brandstetter Robert D. , Gotz Vincent P.
Published: December 2017

A patient who developed phlebitis from the intravenous administration of diazepam is described. This episode resolved in two days after treatment with moist heat packs. Three days after complete resolution, the phlebitis recurred approximately eight hours after a single oral dose of diazepam. This recurrence of phlebitis resolved slowly over seven days, with warm soaks and aspirin therapy. Oral diazepam may have exacerbated the initial phlebitis by interfering with a subclinical healing process.
Therapy with Monoclonal Antibodies
Authors: Conner Christopher S.
Published: December 2017

Monoclonal antibodies (MABs) are an exciting development in the field of clinical immunology. Secreted in large amounts from hybrid myeloma (hybridoma) cell lines, MABs are directed at a specific antigen, such as tumor cell antigens, providing a major advantage over conventional, heterogeneous antisera. MABs have shown promise in the treatment of cancer, producing remission in some patients with leukemia and lymphoma. The future uses of MABs are enormous, including passive immunization against infections and allergies, treatment of autoimmune disease, and specific antibody treatment of drug intoxications. The impact of MAB technology on clinical medicine will be felt in the years to come.
The Feasibility of Barcode-Based Dispensing Quality Assurance Programs
Authors: Hokanson James A. , Guernsey Brock G. , Bryant Stephen G. , Doutré William H. , Ingrim Naomi B. , Grant J. Andrew , Galvan Eustacio
Published: December 2017

A study was conducted to evaluate the feasibility of using barcodes in an outpatient pharmacy quality assurance program. In the first step of this study, adhesive labels containing a barcode representation of the National Drug Code (NDC) identification for the hospital's formulary medications were printed for each stock bottle or drug package used in dispensing. When an outpatient prescription was presented to the pharmacist, a label containing a barcode representation of the NDC identification for the prescribed medication was generated on-line and attached to the back of the prescription form. After the prescription item was filled by the pharmacist, an automated check was performed with a scanning wand by comparing the barcode on the prescription with the previously generated barcode on the stock bottle or drug packaging. A. match indicated that the correct medication had been dispensed. Elaborations on this basic automated system for a barcode-based dispensing quality assurance program are suggested.
Cyclosporine Pharmacokinetics and Blood Level Monitoring
Authors: Burkle Wayne S.
Published: December 2017

Although monitoring plasma or whole blood concentrations of cyclosporine has been promoted as a means of limiting toxicity while ensuring adequate immunosuppression, no consensus has been reached with regard to the assay, the specimen to be assayed, the frequency of monitoring, the therapeutic range, or even the necessity of monitoring cyclosporine concentrations. The failure to reach such a consensus can be attributed to a great extent to the complex pharmacokinetic profile of cyclosporine and the inconsistencies in the assay methodology and results used to generate its pharmacokinetic profile. This article places the subject of monitoring cyclosporine concentrations in perspective by reviewing the pharmacokinetics of cyclosporine, the assay methodology, and the published clinical experience with blood level monitoring.
Use of Essential AMINO ACID/DEXTROSE Solutions in the Nutritional Management of Patients with Acute Renal Failure
Authors: Thompson Michael
Published: December 2017

A review of the literature on the effectiveness of essential amino acid and hypertonic dextrose in the nutritional management of patients with acute renal failure is evaluated critically. Earlier case reports and studies published indicated that the administration of these solutions could lead to lower blood urea nitrogen concentrations, positive nitrogen balance, and various other clinical and metabolic improvements. Recent studies, however, show that various combinations of essential and nonessential amino acids can provide similar results. Some investigators have suggested increasing the concentration of branched-chain amino acids in these solutions to decrease protein catabolism in muscle. Unfortunately, patients with complications such as sepsis, burns, and shock may not benefit from any of these therapies. Further research is needed to elucidate fully the optimal composition of these solutions in severely stressed hypercatabolic patients with this disorder.
β-Blockers and Glucose Control
Authors: Mills Gregory A. , Horn John R.
Published: December 2017

Literature on the effects of β-blockers on blood glucose is reviewed. Data are presented regarding the adrenergic influences on glucose regulation and the effects of β-blockade during hypo- and hyperglycemia in normal and diabetic individuals.

β-adrenergic stimulation enhances insulin and glucagon secretion, as well as glycogenosis, gluconeogenesis, and lipolysis. α-adrenergic stimulation inhibits insulin secretion and may inhibit glucagon secretion and enhance liver glycogenolysis. In nondiabetics, β-blockers represent minimal risk of affecting glucose control. In insulin-dependent diabetics, β-blockers can prolong, enhance, or alter the symptoms of hypoglycemia, while hyperglycemia appears to be the major risk in noninsulin-dependent diabetics. β-blockers can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycemic drugs.
The Role of the Pharmacist in Home Health Care
Authors: McAllister James C.
Published: December 2017

Home infusion services, a new facet of home health care (HHC) delivery, have created many new opportunities for hospital pharmacists to participate more actively in patient care. These opportunities can create new roles for the pharmacist as an educator, clinician, and administrator.

Early efforts must be made to educate hospital administrators, physicians, and other allied health personnel regarding the advantages and disadvantages of providing HHC—from the perspective of both patients and institutions. The pharmacist can also collect data to assist in determining the extent to which the institution should participate in HHC delivery, and should coordinate the hospital's efforts to initiate home infusion services.

Pharmacists should play an active role in screening, selecting, and training patients for HHC before discharge. The input of pharmacists in drug product selection and assistance in product compounding can ensure optimal patient outcomes and minimize costs. Clinical monitoring activities conducted by the pharmacist can include telephone interviews with patients at home and assessment of clinical progress during scheduled return visits to the clinic.
Health Care Cost-Containment in a Changing Health Care World
Authors: Tanner David J.
Published: December 2017

Home health care, particularly antibiotic home health care, must be studied against a background of change. Hospitals are changing their structure as one way of coping with health care costs. The Health Care Financing Administration is making its impact with the DRG program. As a result, hospitals are seeking various means of cost containment, and home health care is seen as one possible answer. Much of the potential benefit to be derived from home health care will depend on how thoroughly it is based on good modern technology, and how carefully it is planned to reduce hospital length of stay and to decrease the costs of hospital personnel and supplies. Another answer may be found in the administration of parenteral antibiotics by once-daily doses.
Pitfalls in the Delivery of Outpatient Intravenous Therapy
Authors: Goldenberg Robin I.
Published: December 2017

Recent articles promoting the advantages of intravenous antibiotic therapy and total parenteral nutrition for use in home health care patients have spawned a multitude of commercial and hospital-based programs dedicated to providing such therapies in outpatient settings. Only since the establishment of these programs has there evolved an increasing familiarity with adverse experiences and pitfalls in the provision of outpatient care. Significant errors have been made in the areas of patient and disease admission criteria, antibiotic regimens, medicolegal concepts, medical and hospital politics, and financial reimbursement.

This article explores the pitfalls intrinsic to the delivery of outpatient parenteral therapies and focuses on the need for diligence in program coordination, multidisciplinary involvement, and education in averting those pitfalls.
Quality Control in Antiepileptic Drug Monitoring in Italy
Authors: Taylor William J. , Bonati Maurizio , Castelli Donata , Leone Nello , Perucca Emilio , Tognoni Gianni , Demers Denyse , Burgos Glenda Sobrino
Published: December 2017

Measurement of drug concentrations in physiological fluids is increasingly becoming part of the routine management of drug therapy, thus calling for particular care to ensure reliability and avoid misguided management. As part of a long-term national project to set up a network of hospitals where clinical chemists, pharmacists, and physicians could interact and evaluate their activities in connection with therapeutic drug monitoring, the results of a quality control scheme for antiepileptic drugs, which included 50 national hospital laboratories, are described here.
Stress Ulcers: Current Understanding of Pathogenesis and Prophylaxis
Authors: Kleiman Rachel L. , Adair Colin G. , Ephgrave Kimberly S.
Published: December 2017

Stress-related gastrointestinal bleeding is known to occur in approximately 25 percent of untreated seriously ill patients, but with appropriate prophylaxis is largely preventable. Since the treatment of stress bleeding is generally unsatisfactory and has a high mortality, routine prophylaxis should be instituted for susceptible patients. Multiple mechanisms contribute to stress ulcer formation, the most important of which appear to be mucosal ischemia and the inability to control back-diffused hydrogen. Antacids and histamine2-blocking agents are presently the cornerstone of effective prophylaxis, but because they have been implicated as contributors to nosocomial pneumonias due to bacterial overgrowth in the stomach, investigation is ongoing into such alternative prophylactic agents as sucralfate and prostaglandins that do not alter the normal gastric acidity. This article presents a review of the literature on the development and prevention of stress ulcer disease.
Gentamicin Bioavailability and Single-Dose Pharmacokinetics in Spinal Cord Injury
Authors: Segal Jack L. , Brunnemann Sherry R. , Gray David R.
Published: December 2017

The rate and completeness of absorption of gentamicin from muscle (healthy and paralyzed) and gentamicin disposition kinetics following a single intravenous infusion were studied in nonobese, healthy male volunteers with functionally complete, chronic (greater than one year duration) spinal cord injury (SCI) and in able-bodied controls. Pharmacokinetic parameters were derived using compartmental and model-independent analyses. The absolute bioavailability of gentamicin was complete and did not differ from control values using both model-independent (LAGRAN) and model-dependent (ADAPT) analyses. The rate of gentamicin absorption in patients with SCI was, however, significantly slower, with a mean absorption time of 2.55 h compared with 0.96 h in able-bodied controls (p ≤ 0.05). Mean volume of distribution steady-state (Vdss) of gentamicin was demonstrated to be 33–47 percent greater in spinal cord injury than in controls (p < 0.05). We conclude that the absorption of gentamicin from paralyzed muscle is significantly impaired, and in conjunction with an increase in Vdss results in delayed, decreased peak serum levels in patients with SCI.
Short- and Long-Term Effects of Auxiliary Labels on Patient Knowledge of Precautionary Drug Information
Authors: Brown Candace S. , Solovitz Brenda L. , Bryant Stephen G. , Guernsey Brock G. , Fisher Seymour
Published: December 2017

The purpose of this study was to determine the efficacy of auxiliary prescription labels in educating outpatients about medicines at two different time periods. Five hundred fifty-nine patients were randomly assigned either to an experimental group or a control group; each person in the experimental group received a prescription bottle to which one study auxiliary label (“sticker”) had been affixed, and those in the control group received bottles with no study sticker attached. Patients were interviewed by telephone approximately one week or two months after prescription pick up. Patients who had the study sticker affixed to their prescription bottle were significantly more knowledgeable after one week about precautionary information than those patients who did not receive stickers; however, sticker-group patients receiving the delayed interview incorrectly attributed many precautions to their medication. This is the first controlled study to document that auxiliary labels increase short-term knowledge about medications, and to suggest that the same labels may result in an inappropriate generalization over time.
Neuroleptic Rechallenge after Neuroleptic Malignant Syndrome: Case Report and Literature Review
Authors: Wells Amy J. , Sommi Roger W. , Crismon M. Lynn
Published: December 2017

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature > 38°C; extreme muscle rigidity, with or without elevated creatine Phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.
Generalized Convulsions in a Patient Receiving Ultrashort-Acting Beta-Blocker Infusion
Authors: Das Gopal , Ferris Janine C.
Published: December 2017

Beta-receptor blocking agents are commonly used to treat patients with heart disease, and generalized seizures due to therapy with these agents are rare. All reported cases of seizures due to beta blocking agents have occurred only in those subjects who ingested large doses of the drugs. We observed generalized convulsions in a patient who was receiving therapeutic doses of an ultrashort-acting beta-blocking agent (esmolol hydrochloride) intravenously. A literature survey and possible mechanisms by which these agents induce seizures are presented.
Cefuroxime Axetil
Authors: Marx Michael A. , Fant William K.
Published: December 2017

Cefuroxime axetil is a orally active prodrug formulation of cefuroxime, which upon absorption undergoes immediate deesterification to free cefuroxime. Cefuroxime axetil offers an in vitro antibacterial spectrum against many gram-positive and some gram-negative organisms. Its beta-lactamase stability makes it useful in treating a variety of infections caused by beta-lactamase-producing strains of Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus. Cefuroxime axetil has good activity against the Enterobacteriaceae and moderate activity against non-Bacteroides fragilis anaerobes. Clinical studies suggest it is at least as effective as ampicillin, amoxicillin, amoxicillin/clavulanic acid, penicillin V, or cefaclor in the treatment of uncomplicated urinary tract infections, acute otitis media, upper respiratory infections, skin and soft tissue infections, and uncomplicated gonorrhea.
Calcium Metabolism, Calcium-Channel Blocking Agents, and Hypertension Management
Authors: Lam Y.W. Francis
Published: December 2017

Increasing evidence has suggested that a disturbance of cellular calcium metabolism may have a role in initiating and maintaining elevated systemic vascular resistance in essential hypertension. Controversy exists over whether calcium can alleviate or exacerbate the hypertensive process, and diversity of calcium metabolism in hypertensive patients has been proposed. Calcium-channel blocking agents are potent vasodilators capable of correcting the elevated systemic vascular resistance. Clinical studies have shown that these drugs have antihypertensive efficacy comparable to established agents. The elderly, blacks, and patients with low renin activity respond well to calcium-channel blockers. These drugs may also offer potential advantages over established antihypertensive agents in patients with other coexisting diseases. Sustained release formulations have been developed, and initial experience with long-term efficacy and tolerability is encouraging. The calcium-channel blockers may become first-line therapy for treatment of hypertension in selected patients.
Comparative Evaluation of Enalapril and Hydrochlorothiazide in Elderly Patients with Mild to Moderate Hypertension
Authors: Gums John G. , Lopez Larry M. , Quay Gary P. , Stein Gerald H. , McCarley Dean L.
Published: December 2017

Initial treatment of elderly hypertensive patients with an angiotensin-converting enzyme inhibitor is currently discouraged due to such patients' typical low-renin profile. To validate this principle, we studied 38 elderly males (aged ≥ 65 years) with mild to moderate hypertension, comparing hemodynamic responses to and subjective impressions of enalapril or hydrochlorothiazide (HCTZ). After gradual withdrawal of existing antihypertensive therapy and a four-week, single-blind placebo period, each patient was randomized in a double-blind fashion to receive either enalapril 10-20 mg/d or HCTZ 12.5-25 mg/d for two to four weeks. Combination therapy with both agents was employed if either alone failed to reduce seated diastolic BP to ≤ 90 mm Hg. Equivalent proportions of patients receiving enalapril or HCTZ (8 of 19 and 10 of 19, respectively; p = ns) responded with significant reductions in systolic and diastolic BP in seated and standing positions. Combination therapy was most effective in patients receiving HCTZ prior to enalapril. In patients receiving enalapril before HCTZ, BP changes were minimal. No adverse effects were observed in the enalapril group but occurred in an equivalent fraction of patients in the other groups (4 of 10 HCTZ alone, 6 of 20 enalapril + HCTZ; p = ns). We conclude that enalapril may be considered a reasonable monotherapeutic antihypertensive agent in some elderly patients. Combination with HCTZ is beneficial in patients who fail to respond adequately to HCTZ alone.
Extreme Warfarin Intoxication Secondary to Possible Covert Drug Ingestion
Authors: Richmond Rodney G. , Sawyer William T. , Aiello Patrick D. , Lindley Celeste M.
Published: December 2017

A young adult male patient presented with an excessively prolonged prothrombin time (>90 sec) following approximately two weeks of therapy with oral warfarin sodium, in doses between 2.5 and 5 mg/d. Repeated administration of vitamin K and fresh frozen plasma was required to reverse the anticoagulation and maintain a normalized prothrombin time. Serial warfarin plasma concentration measurements were used to interpret the apparently unusual prothrombin time response profile and to detect the possibility of covert drug ingestion.
Marked Digoxin-Likeimmunoreactive Factor Interference with an Enzyme Immunoassay
Authors: Karboski James A. , Godley Paul J. , Frohna Paul A. , Horton Michael W. , Reitmeyer William J.
Published: December 2017

A case in which digoxin-like immunoreactive factors (DLIF) interfered with an enzyme immunoassay in a patient with renal insufficiency is reported. A 79-year-old woman was found to have a serum digoxin concentration (SDC) determined by enzyme immunoassay of 5.0 ng/ml. Although all subsequent SDC determined by the enzyme immunoassay system were elevated, identical samples run on a fluorescence polarization immunoassay revealed SDC within the therapeutic range. Marked DLIF-related assay interference has been reported to occur with some digoxin assays; however, the enzyme immunoassay methods have never been reported to cross-react to the magnitude seen in this case.
Sedation in Pediatric Patients Undergoing Diagnostic Procedures
Authors: Nahata Milap C.
Published: December 2017

Sedation is routinely used in pediatric patients undergoing diagnostic procedures. Meperidine with promethazine and chlorpromazine; meperidine with pentobarbital; and meperidine, morphine, pentobarbital, thiopental, methohexital, chloral hydrate, and benzodiazepines as single agents have been used at different doses in patients for various procedures including computed tomography, endoscopy, electroencephalography, and bone marrow biopsies. Most available studies, however, have not compared these drugs in a controlled and blind manner, and the data have often been collected retrospectively. In addition, the degree and duration of sedation required may depend on the procedure. Thus, it is difficult to recommend the drug of choice for producing sedation. Serious cardiac and respiratory effects and excessive sedation have been associated with these drugs, even when normal doses were used. Controlled studies and specific guidelines are needed for optimal use and monitoring of these drugs in pediatric patients.
Risk of Cerebral Hypoperfusion with Antihypertensive Therapy
Authors: Eagan Susan C. , Payne Lance W. , Houtekier Susan C.
Published: December 2017

The effective treatment of hypertension is a major factor in the declining incidence of stroke in North America. There are subsets of patients, however, in which antihypertensive therapy may actually cause cerebral ischemia and infarction. Elderly patients and those with malignant hypertension, acute stroke, and occlusive cerebrovascular disease appear to be the populations at greatest risk of iatrogenic stroke. This article reviews the effect of beta-blockers, angiotensin-converting enzyme inhibitors, direct vasodilators, and calcium-channel blockers on cerebral blood flow in various populations. Although many investigations have been performed, it remains difficult to predict the risk of cerebral hypoperfusion due to antihypertensive medication in an individual patient. It is best for practitioners to be aware of the patient populations at risk and treat high blood pressure cautiously in these patients.
Medical Management of Inflammatory Bowel Disease
Authors: Sottile Roseann F. , Quandt Christine M. , Present Daniel H. , Mehl Bernard
Published: December 2017

Inflammatory bowel disease is a serious ailment that afflicts nearly one million people in the U.S. alone. The medical management of this disorder currently includes salicylates, corticosteroids, immunosuppressive therapy, and symptomatic treatment with antidiarrheal agents, although several promising new drugs have been developed. The epidemiology, etiology, pathogenesis, and medical management of the disease are discussed in this article.
Formulary Conversion of Cefoxitin Usage to Cefotetan: Experience at a Large Teaching Hospital
Authors: Smith Karen S. , Briceland Laurie L. , Nightingale Charles H. , Quintiliani Richard
Published: December 2017

The pharmacy and therapeutics committee at Hartford Hospital recommended replacement of cefoxitin with cefotetan, based on data reported in the literature regarding antimicrobial activity, pharmacokinetic profile, and adverse reactions. Once the recommendation was approved by the medical staff, an intense educational program was instituted, and all orders for cefoxitin were converted to cefotetan with appropriate dosage modifications. A total of 960 patients were treated in the first year; no major patterns of ineffectual therapy or adverse events associated with cefotetan usage have emerged. The mean cost of cefotetan therapy was $180.59, which is $130.26 less per patient than a comparable regimen of cefoxitin (mean cost of therapy $310.85). Based on the data analysis of cefotetan usage for a 12-month period, the actual annual savings due to therapeutic substitution of cefotetan for cefoxitin was $124 961. To further evaluate the clinical efficacy, safety, and savings of this therapeutic interchange, two separate retrospective reviews of patient medical records were performed. The first audit has been previously published in its entirety. In the subsequent audit, 284 additional patient medical charts have been reviewed. These patients received either cefotetan therapy or concomitant therapy of an aminoglycoside combined with either clindamycin or mezlocillin. Clinical outcomes were classified as an empiric cure or improvement for 99.4, 98.5, and 92.9 percent of patients, respectively. In this audit, elevated prothrombin time/partial thromboplastin time values and bleeding episodes were noted infrequently, as were other adverse reactions. The decreased cost of daily cefotetan therapy combined with a significantly shorter duration of therapy lead to a significantly lower overall cost of therapy compared with the other two treatment groups ($187.94 vs. $308.61 and $329.06, respectively).