bluuebunny/crossref_metadata_2025 huggingface dataset:
Syphilis Serology and Human Immunodeficiency Virus Positivity in Chandigarh
Authors: Kumar B , Rajagopalan M , Sehgal S , Sharma M , Malhotra S
Published: January 2017

AIDS and other sexually transmitted diseases are interlinked. VDRL positivity may indicate that the individual has an increased risk of being HIV positive as the epidemiological risk factors for developing syphilis and AIDS are similar. We analysed 323 (5.8%) VDRL positive serum samples (out of 5592 screened) for HIV positivity. All were HIV negative. While syphilitic infection in India at present is not commonly associated with HIV infection, experience in other countries indicates caution.
Comparison of Cotton Wool Swab and Cytobrush for Detection of Chlamydial Infection in Women Attending a Genitourinary Medicine Clinic
Authors: Mandal D , Ray T K , Richmond S J , Goorney B P , Haye K R
Published: January 2017

Endocervical specimens obtained by cytobrush and conventional cotton wool swabs from 90 women attending a genitourinary medicine clinic were compared for their efficiency in detecting chlamydial infection. Isolation of Chlamydia trachomatis and detection of the chlamydial lipopolysaccharide antigen were attempted on each specimen. Antigen was detected in 18% of cytobrush and 17% of swab specimens. The cytobrush proved less suitable than swabs for isolation because 8 cytobrush specimens (9%) were toxic to the McCoy cells. Toxicity was significantly associated with an infected endocervix (2 P=0.004). Cytobrush therefore appeared to have little advantage over the much cheaper alternative, the cotton wool swab.
Genital Papillomavirus Infection in Women Treated for Chlamydial Infection
Authors: Andersson-Ellström A , Forssman L
Published: January 2017

Samples for chlamydia testing were taken from 298 and PAP smear from 284 non-pregnant sexually active young women in a midwife-run family planning service. Chlamydia was found in 36 (12.1%). Three women (1.1%) had cytological atypia corresponding to CIN I or II. Koilocytosis was seen in 9 smears (2.8%).

Thirty-two of the chlamydia-positive women were followed for a mean of 15 months by a gynaecologist with chlamydia tests, colposcopy, PAP-smears and in some cases biopsies. There were 7 reinfections with chlamydia (22%). Signs of genital papillomavirus infection (GPVI) were found in 24 of the 32 chlamydia cases during follow-up.

Twenty chlamydia-positive patients had abnormal colposcopy, 15 of them had other changes suggestive of GPVI, seven of these had CIN I or II. At follow-up 6 patients had cytologic atypia (18.8%) compared with the average 1.5% in this department during this period. Among 12 patients with normal colposcopy there were no cytological changes.

Chlamydial infection calls for increased alertness regarding abnormal vaginal cytology even among young patients not commonly included in PAP smear screening programmes.
Reactive Arthritis
Authors: Svenungsson B
Published: January 2017

Reactive arthritis (ReA) develops after an infection elsewhere in the body, generally in the genitourinary or intestinal tract. Chlamydia trachomatis, Yersinia enterocolitica, salmonella, shigella, and campylobacter are frequent triggering agents. Between 60% and 90% of patients are positive for HLA-B27. The arthritis occurs within 4 weeks of the primary infection and is oligoarticular and asymmetric. Extra-articular manifestations include mucocutaneous symptoms, ocular inflammation, and urethritis. The average duration of arthritis is 4 to 5 months but two-thirds of patients have symptoms for more than a year. Bacterial antigens have been found in synovial specimens from patients with ReA, but cultures are sterile. The treatment of ReA comprises non-steroidal anti-inflammatory drugs, intra-articular steroid injections, and physical treatment. Short-term antibiotic treatment has no effect in manifest ReA, whereas a tendency to improvement has been seen with treatment over months, at least after chlamydia infection.
A Study of the Prevalence of Male Intrameatal Warts Using Meatoscopy in a Genitourinary Medicine Department
Authors: Nathan P M , Thompson V C , Sharmacharja G , Hawkswell J , Fogarty B
Published: January 2017

A cross-sectional study is undertaken to determine the prevalence of male intrameatal and distal urethral warts, using meatoscopy. A group of 169 patients presenting for anogenital warts and a group of 74 unselected patients attending the Department for a variety of reasons during the study period, were examined. Twenty-one patients (13.5%) out of 155 patients with anogenital or related warts had external warts at the meatus. Of these 21 cases, 12 (57.1%) had further extension of their warts into the distal urethra. Fifteen other cases of intrameatal and distal urethral warts were detected in the absence of external warts at the meatus. Twenty-three cases out of 107 males with genital warts (21.5%) were found to have intrameatal or distal urethral warts, thus reflecting the common occurrence of these lesions. A highly significant association between the presence of intrameatal/distal urethral warts and the presence of male genital warts was found ( P=0.003). One hundred and fifty-three repeat meatoscopic examinations were carried out, 6 weeks after their first examination. Three new cases of intrameatal/distal urethral warts were found. Intrameatal and distal urethral warts occurred from a depth of 5 mm to 25 mm. One hundred and eighty-three female partners of the study patients were examined. An association between the presence of intrameatal/distal urethral warts and female anogenital warts was found ( P=0.028). No corroborating association between the presence of male and female anogenital warts was found ( P=0.47). This observation may have a bearing on disease transmission and control. The detection of intrameatal/distal urethral warts will be important in achieving successful treatment of male anogenital warts.
Pharyngeal Flora in a Sexually Active Population
Authors: Russell J M , Azadian B S , Roberts A P , Talboys C A
Published: January 2017

During a 7-week period 1141 patients attending the Genitourinary Clinic at Charing Cross Hospital completed a brief questionnaire and had pharyngeal swabs cultured for Neisseria spp, β-haemolytic streptococci, corynebacterium and yeasts. The study included 397 heterosexual men, 492 heterosexual women, 189 homosexuals, 41 lesbians and 22 bisexual men and women. Four hundred and sixty patients (40%) admitted oro-genital contact in the preceding 2 weeks.

The meningococcal carriage rate was 11.6%. Homosexuals had the highest carriage 23.8% and heterosexual females the lowest 5.9%. Significant differences in carriage rates were found between homosexual and heterosexual men ( P<0.0001), heterosexual men and women ( P<0.005) and between lesbian and heterosexual women ( P< 0.025). Recent oro-anal contact significantly increased meningococcal isolation ( P<0.001).

A significant association between β-haemolytic streptococci and concomitant meningococcal carriage was also found ( P<0.01).

Sexual orientation and oro-genital contact influences both meningococcal and pharyngeal yeast isolation and should be considered when interpreting pharyngeal culture results.
The Emergence of an Abstract Grammatical Category in Children’s Early Speech
Authors: Meylan Stephan C. , Frank Michael C. , Roy Brandon C. , Levy Roger
Published: January 2017

How do children begin to use language to say things they have never heard before? The origins of linguistic productivity have been a subject of heated debate: Whereas generativist accounts posit that children’s early language reflects the presence of syntactic abstractions, constructivist approaches instead emphasize gradual generalization derived from frequently heard forms. In the present research, we developed a Bayesian statistical model that measures the degree of abstraction implicit in children’s early use of the determiners “a” and “the.” Our work revealed that many previously used corpora are too small to allow researchers to judge between these theoretical positions. However, several data sets, including the Speechome corpus—a new ultra-dense data set for one child—showed evidence of low initial levels of productivity and higher levels later in development. These findings are consistent with the hypothesis that children lack rich grammatical knowledge at the outset of language learning but rapidly begin to generalize on the basis of structural regularities in their input.
The gap in scientific knowledge and role of science communication in South Korea
Authors: Chang Jeong-Heon , Kim Sei-Hill , Kang Myung-Hyun , Shim Jae Chul , Ma Dong Hoon
Published: January 2017

Using data from a national survey of South Koreans, this study explores the role of science communication in enhancing three different forms of scientific knowledge ( factual, procedural, and subjective). We first assess learning effects, looking at the extent to which citizens learn science from different channels of communication (interpersonal discussions, traditional newspapers, television, online newspapers, and social media). We then look into the knowledge gap hypothesis, investigating how different communication channels can either widen or narrow the gap in knowledge between social classes. Television was found to function as a “knowledge leveler,” narrowing the gap between highly and less educated South Koreans. The role of online newspapers in science learning is pronounced in our research. Reading newspapers online indicated a positive relationship to all three measures of knowledge. Contrary to the knowledge-leveling effect of television viewing, reading online newspapers was found to increase, rather than decrease, the gap in knowledge. Implications of our findings are discussed in detail.
‘No Malicious Incidents’
Authors: He Xin
Published: January 2017

Based on participant observation and in-depth interviews with judges, this article demonstrates the significant role of concern for social stability in China’s divorce law practice in highly contested and potentially explosive cases. This is evident in the current use of mediation procedures. Since the judge is held responsible for keeping the parties in check, the concern for social stability dominates proceedings. The legal criterion of ‘the breakdown of mutual affection’ is eclipsed by the political principle of ‘no malicious incidents’. This emphasis on maintaining stability, however, paradoxically reproduces social instability because it incentivizes violence in the domestic sphere. It also reinforces gender inequality. This study suggests the need to reflect upon the appropriate role of the judiciary in divorce proceedings and the tenuous boundary between law and politics in contemporary China.
Non-visualized aorta in abdominal aortic aneurysm screening: Screening outcomes and the influence of subject and programme characteristics
Authors: Bennett Damien , Stewart Diane , Kearns Deirdre , Mairs Adrian , Ellis Peter
Published: January 2017

Objectives

To compare abdominal aortic aneurysm screening outcomes of men with non-visualized aorta at original scan with subsequent scans and to determine predictors of non-visualized aorta.

Methods

In the Northern Ireland Abdominal Aortic Aneurysm screening programme, outcomes (discharge, annual surveillance, three-monthly surveillance, or vascular referral) and patient and programme characteristics (age, deprivation quintile, family history, technician experience, and screening location) for men with non-visualized aorta were investigated at original scan, and first and second rescans.

Results

Non-visualized aorta proportions were 2.9, 11.4, and 4.7% at original, first, and second rescan, respectively. There were no differences in screening outcomes between scanning stages (98.4, 97.6, and 97.4% <3 cm). There were 42 men (0.13%) with aortas ≥5.5 cm at original scan, but none at first and second rescan. A significantly greater proportion with non-visualized aorta were from more deprived (5.0%) than less deprived areas (1.7%). Deprivation quintile and staff role were significant independent non-visualized aorta predictors at original scan, and staff role at first rescan. Men from less deprived areas were three times as likely to have aortas visualized than those from more deprived areas (OR = 3.0, CI = 2.4–3.8) at original scan. A man scanned by screening technician compared with lead sonographer was 51% less likely to have aorta visualized at original scan and 94% less likely at first rescan.

Conclusions

The risk of abdominal aortic aneurysm in men with non-visualized aorta on first or subsequent rescans is no more than for those with visualized aorta on original scanning. Men from deprived areas are much more likely to have non-visualized aorta at original scan.
Effect of sample storage temperature and buffer formulation on faecal immunochemical test haemoglobin measurements
Authors: Symonds Erin L , Cole Stephen R , Bastin Dawn , Fraser Robert JL , Young Graeme P
Published: January 2017

Objectives

Faecal immunochemical test accuracy may be adversely affected when samples are exposed to high temperatures. This study evaluated the effect of two sample collection buffer formulations (OC-Sensor, Eiken) and storage temperatures on faecal haemoglobin readings.

Methods

Faecal immunochemical test samples returned in a screening programme and with ≥10 µg Hb/g faeces in either the original or new formulation haemoglobin stabilizing buffer were stored in the freezer, refrigerator, or at room temperature (22℃–24℃), and reanalysed after 1–14 days. Samples in the new buffer were also reanalysed after storage at 35℃ and 50℃. Results were expressed as percentage of the initial concentration, and the number of days that levels were maintained to at least 80% was calculated.

Results

Haemoglobin concentrations were maintained above 80% of their initial concentration with both freezer and refrigerator storage, regardless of buffer formulation or storage duration. Stability at room temperature was significantly better in the new buffer, with haemoglobin remaining above 80% for 20 days compared with six days in the original buffer. Storage at 35℃ or 50℃ in the new buffer maintained haemoglobin above 80% for eight and two days, respectively.

Conclusion

The new formulation buffer has enhanced haemoglobin stabilizing properties when samples are exposed to temperatures greater than 22℃.
An Evaluation of the Prevalent round of the Breast Screening Programme in South East Thames, 1988–1993: Achievement of Quality Standards and Population Impact
Authors: Garvican Linda , Littlejohns Peter
Published: January 2017

Objective

–To evaluate the impact of the prevalent round of the NHS breast screening programme on the whole population of women aged 50–64 during the period 1988–92, by comparing the numbers of cancers detected at screening with those diagnosed symptomatically, in one United Kingdom health region (population 3.5 million). To relate this impact to the achievement of national quality standards and the observed sensitivity and specificity of the programme.

Method

–The breast screening programme computer systems and the Thames Cancer Registry database were used to diagnose cancers in women aged 50–64 during the period 1988–1992, who were classified into screen detected, interval cases, eligible but not yet invited, non-attenders, and those not registered with the programme.

Results

–The programme met all national quality assurance targets for uptake, diagnostic process, and detection, but screen detected cases comprised only 48% of those diagnosed during 1991 and 1992 when the breast screening programme was fully operational. As fewer than 40% of breast cancers registered occur in the eligible age range, this limits the impact of the programme to the possible early diagnosis of only 20% of all cases. A surprisingly high proportion occurred in women unknown to the programme, especially in inner London. The high number of interval cancers led to a programme sensitivity of only 73%, but 99.7% of women screening negative were correctly reassured as a result of screening—and for them the breast screening programme is a success.

Conclusion

–Despite achievement of quality standards, the breast screening programme is apparently having a low impact on the overall diagnosis of breast cancer in South East Thames, so a large mortality reduction due to screening alone is unlikely. Population coverage will need to be improved, and it may be necessary to reduce the screening interval, or extend the age range, or both.
Reliability of Statistics on Down's Syndrome Notifications
Authors: Huang T , Watt H C , Wald N J , Morris J K , Mutton D , Emeritus E Alberman
Published: January 2017

Objectives—

To evaluate the completeness of notifications of Down's syndrome live births and terminations to the Office for National Statistics (ONS) using data from the National Down Syndrome Cytogenetic Register (NDSCR). To examine the agreement of observed birth prevalence of Down's syndrome with the expected birth prevalence derived from published maternal age specific rates.

Methods—

The number of live births (adjusted to allow for the estimated under-ascertainment) and the number of terminations due to fetal Down's syndrome from NDSCR were compared with those figures reported to the ONS. Subsequently, using the NDSCR figures, the live birth prevalence of Down's syndrome that would have occurred in the absence of antenatal diagnosis and selective termination was calculated in England and Wales in the years 1990–1993. These figures were compared with those derived by applying published age specific prevalences to the maternal age distribution in England and Wales.

Results—

It is estimated that only 48% and 46% respectively of Down's syndrome live births and terminations of pregnancy were notified to ONS between 1990 and 1993. The annual expected birth prevalences of Down's syndrome obtained by applying maternal age specific prevalences to the maternal age distribution were in close agreement with observed rates from NDSCR.

Conclusions—

There is considerable underreporting of Down's syndrome births and terminations to ONS. The NDSCR data are more complete and therefore the effects of screening should be monitored using data from this source, or using estimates derived from the age specific rates of Down's syndrome.
Use of Two View Mammography Compared with One View in the Detection of Small Invasive Cancers: Further Results from the National Health Service Breast Screening Programme
Authors: Blanks R G , Moss S M , Wallis M G
Published: January 2017

Objective—

To examine further the effect of using two view mammography in comparison with one view mammography in the detection of small (<15 mm) invasive cancers for programmes in the National Health Service breast screening programme (NHSBSP). The study is in two parts: First the effect on the small invasive cancer detection rate for programmes that changed from using one view to two views for first (prevalent) screens, and secondly the effect on the small invasive cancer detection rate for programmes that used two views for subsequent (incident) screens compared with programmes that used one view.

Setting—

Screening programme data from the NHSBSP.

Methods—

Data were collated from all screening programmes in the United Kingdom on standard “Korner” returns (KC62 forms) for the screening years 1 April 1994 to 31 March 1995 and 1 April 199S to 31 March 1996. The comparison between one and two view mammography was made using indirectly age standardised invasive cancer detection rates.

Results—

For prevalent (first) screens, programmes changing from one view mammography in 1994/95 to two views in 1995/96 reported a 45% (95% confidence interval (CI) 25% to 68%) increase in the detection of invasive cancers of <15 mm. In comparison, programmes that were already using two views in 1994/95 showed no change in 1995/96. For incident (subsequent) screens the small number of programmes that have opted to use two views reported 25% (95% CI 1% to 55%) more invasive cancers of <15 mm than programmes using one view in 1995/96, and 42% (95% CI 11% to 81%) more in 1994/95.

Conclusions—

These results confirm the benefit of using two view mammography in the detection of small invasive cancers, and provide evidence that this effect is seen in subsequent screens as well as the first screen.
The Impact of Commodity Terms of Trade in Africa
Authors: Loser Claudio , Vilkelyte Ieva
Published: January 2017

The sharp increase in commodity prices that began in the early 2000s resulted in a marked improvement in terms of trade for Africa. Since then, commodity exporters’ terms of trade have declined despite a very moderate recovery in mid-2016. Terms of trade still remain higher than they were at the turn of the century, giving the false impression that conditions still favor Africa. The evidence, however, suggests that the commodity-driven prosperity has ended or, at best, has been interrupted for a long time to come. Some of these losses have not been realized fully because of unsustainable macroeconomic and foreign borrowing policies. These policies cannot be sustained, and the actual losses will catch up even if terms of trade do not deteriorate further. The complacency engendered by the relatively high gross domestic product (GDP) growth rates is misplaced, given the very rapid rate of population growth in Africa both in absolute terms and as compared to most other regions of the world. On the basis of the analysis presented in this article, a further decline or even stable terms of trade can be expected to have a significant negative effect on African economies. Many policymakers believe they are choosing between continued growth on the basis of present policies, or painful adjustment, usually imposed from outside. However, adjustment is inevitable. The real choice is between orderly and internationally supported correction and disorderly and disruptive crisis if current policies continue. It is imperative for the African countries, both highly concentrated exporters and more diversified economies, to focus on macroeconomic sustainability. In today’s adverse circumstances, and particularly given the fragile fiscal positions and mounting debts of many African countries, these policies are only possible if the economy adjusts to a sustainable path. Time is of the essence, and a conscious break with a policy of short-sighted comfort is required.
Harbin Power Equipment Company and the Battle for the Chinese Market: Sub-Contractor to the Multinationals or Integrated, Globally Competitive Firm?
Authors: Nolan Peter , Xiaoqiang Wang , Yan Liu
Published: January 2017

The manufacture of power generating equipment is characterised by high technology, rapid technical progress and powerful economies of scale and scope. Only a few firms dominate the industry globally. Rapid growth of demand for power generating equipment in China provides a big opportunity for its indigenous power equipment suppliers. However, the Chinese market has become a battleground for the multinationals. Despite large progress, China's leading power equipment manufacturer, Harbin, still is far behind the leading multinationals in terms of both scale and technology. If China's major power equipment manufacturers are to establish internationally competitive firms, they need to make the transition from autonomous plants within a national ‘quasi-firm’, to a true, large-scale, multi-plant firm benefiting from economies of scale and scope. To achieve this requires extensive assistance from state industrial policy, especially to ensure technology transfer from the multinationals, and to orchestrate a merger of leading domestic companies. Powerful forces, both domestic and international, are working against this outcome, wishing instead to transform China's leading firms into sub-branches of the multinationals. The industry is in the middle of a tense battle, of great significance for China's industrial evolution in the epoch of high globalisation.
Oncocytic carcinoma of the salivary gland in a dog
Authors: Nakahira Rei , Michishita Masaki , Kato Misaki , Okuno Yuki , Hatakeyama Hitoshi , Yoshimura Hisashi , Azakami Daigo , Ochiai Kazuhiko , Bonkobara Makoto , Takahashi Kimimasa
Published: January 2017

A 3-y-old male miniature Dachshund was presented with an ~0.8 cm diameter mass in the right mandibular region. Fourteen months later, the mass was 5 × 4 × 3 cm. Grossly, the mass was encapsulated and was homogeneously gray-white on cut surface. Microscopically, the mass was composed of large, round to polygonal tumor cells that were arranged in solid nests and cords separated by a fibrovascular stroma. Tumor cells had large, round, hypochromatic nuclei containing large prominent nucleoli and abundant eosinophilic cytoplasm containing dark blue granules visible with phosphotungstic acid–hematoxylin stain. Metastasis was observed in the mandibular lymph node. Immunohistochemically, tumor cells were positive for CK AE1/AE3, low-molecular-weight CK (CAM5.2), E-cadherin, mitochondria ATPase beta subunit, and S100, but were negative for vimentin, carcinoembryonic antigen, p63, CK14, CD10, and chromogranin A. Ultrastructurally, tumor cells contained numerous mitochondria. Therefore, the tumor was diagnosed as an oncocytic carcinoma of the mandibular gland.
Can End of Life Care for the Pediatric Patient Suffering With Escalating and Intractable Symptoms Be Improved?
Authors: Houlahan Kathleen E. , Branowicki Patricia A. , Mack Jennifer W. , Dinning Constance , McCabe Margaret
Published: January 2017

Over twelve thousand children are diagnosed each year with cancer, and approximately 2200 children die each year from the disease. A percentage of these patients experiences escalating and intractable distress with symptoms that include pain, dyspnea, and agitation. These symptoms may continue for hours to days. Intractable symptoms of pain, agitation, and dyspnea can be very distressing to the patient, family, and staff and often a challenge for the physicians and nursing staff to treat. To meet this challenge, The Dana-Farber Cancer Institute/Children's Hospital Cancer Care Program has made it a priority to create a process of care that includes identifying barriers to care and the development of an end-of-life (EOL) rapid response model that includes guidelines and physiciantemplated orders for rapid escalation of opioids. The goal of this quality-improvement initiative was to develop a model of care that would enable the caregivers to provide effective comfort care to any patient experiencing symptoms of rapid escalation of pain, dyspnea, and agitation. A model of care was created to overcome barriers to care. The model includes role clarification, “Guidelines for the Management of Escalating Pain/Dyspnea/Agitation at the End of Life,” and “Rapid Titration-Templated Physician Orders.” Staff feedback was solicited relative to the content, format, and usability of the guidelines and templated orders. The physician and nursing staff reported that they found the templated orders and guidelines very helpful and effective and suggested only a few edits. A retrospective chart review is currently under way. The purpose of this chart review is to systematically document and compare the record of management of rapidly escalating symptoms of pain and/or dyspnea and/or agitation prior to and after instituting the EOL Rapid Response Model of Care. Care of the EOL patient experiencing symptoms of pain, dyspnea, and agitation is challenging. The EOL Rapid Response Model of Care outlines a process of care and provides recommendations and templated physician orders for rapid titration of opioids.
Understanding the Clinical Implications of Minimal Residual Disease in Childhood Leukemia
Authors: Mandrell Belinda N. , Pritchard Michele
Published: January 2017

Improved laboratory techniques now allow a more sensitive detection of leukemia cells at designated intervals throughout therapy. Using flow cytometry and polymerase chain reaction, it is possible to detect 1 leukemic cell among 10 4 normal cells (1 leukemia cell in 10,000 normal cells), representing a 100-fold greater sensitivity than morphological examination in acute lymphoblastic leukemia (ALL). Recently, it has been shown that the molecular presence of persistent acute lymphoblastic leukemia at the end of remission therapy is a poor indicator of clinical outcome. Now similar studies are being performed in acute myeloid leukemia (AML). While the sensitivity using flow cytometry is less in AML than in ALL (able to detect 1 leukemic cell among 1000 normal cells in AML), persistent or minimal residual AML provides the clinician guidance with future treatment recommendations. Minimal residual disease (MRD) is now considered an important indicator response of disease response to treatment. As such, MRD once considered a research variable is now influencing treatment decisions. Therefore, it is imperative that the nurse have an understanding of the newer techniques to study residual leukemia and their clinical implications for patients and their families.
Enhanced Anticoagulant Effect of Coumarin Derivatives Induced by Doxycycline Coadministration
Authors: Caraco Yoseph , Rubinow Alan
Published: January 2017

OBJECTIVE:

To report two cases of enhanced oral anticoagulant effect induced by doxycycline coadministration.

DESIGN:

Case report.

SETTING:

University teaching hospital.

PATIENTS:

Two patients on chronic oral anticoagulation therapy who presented with severe bleeding and marked impairment in blood coagulation tests shortly after the initiation of doxycycline therapy.

DISCUSSION:

The literature concerning the possible effects of tetracyclines on hemostasis with or without antecedent anticoagulation therapy is reviewed and the speculated mechanisms for such an interaction are discussed.

CONCLUSIONS:

The administration of tetracyclines such as doxycycline to patients on chronic oral anticoagulation therapy may be associated with a marked enhancement in anticoagulant effect. In such patients the prothrombin ratio should be closely monitored and the anticoagulant dosage adjusted accordingly.
Adjuvant Corticosteroid Therapy for Pneumocystis Carinii Pneumonia in Aids Patients
Authors: Sistek Catherine J. , Wordell Cindy J. , Hauptman Stephen P.
Published: January 2017

OBJECTIVE:

To review published abstracts, case reports, and journal articles and evaluate data examining the use of systemic corticosteroids as adjuvant treatment for Pneumocystis carinii pneumonia (PCP) in patients with AIDS.

DATA SOURCES:

Computerized online databases, peer-reviewed journals from January 1986 through September 1991, and personal communication with a National Institutes of Health correspondent.

STUDY SELECTION:

The authors identified 13 reports pertinent to this review. By author consensus, five studies were selected for analysis based on sample size, controlled study design, and clinical outcome measures. Recommendations of an expert panel from the National Institutes of Health and the University of California also are discussed.

DATA EXTRACTION:

Data are presented based on the methodologic strength of the studies reviewed. Studies are assessed on sample size, inclusion criteria, comparative cohort populations, specific patient outcome measures, and statistical analysis.

DATA SYNTHESIS:

Results of the study analysis support the use of systemic corticosteroids as early adjunctive therapy for AIDS patients with moderate-to-severe PCP who have an initial arterial oxygen partial pressure of <70 mm Hg or an alveolar-arterial gradient >35 mm Hg on room air. Improved outcomes included decreased mortality, respiratory failure, and deterioration of oxygenation. Data evaluated have shown that adjuvant corticosteroid therapy is most effective when initiated within 72 hours of beginning specific antipneumocystis therapy. A small, but sometimes significant, increased rate of infection in steroid-treated patients was noted.

CONCLUSIONS:

Based on the literature reviewed, early systemic adjuvant corticosteroid therapy can benefit patients with moderate-to-severe AIDS-related PCP. The steroid regimen used in the largest controlled trial and recommended by the expert panel is prednisone 40 mg bid (days 1–5), then 40 mg/d (days 6–10), then 20 mg/d (days 1–21).
Sulfur Compounds in Therapy: Radiation-Protective Agents, Amphetamines, and Mucopolysaccharide Sulfation
Authors: Foye William O.
Published: January 2017

OBJECTIVE:

Sulfur-containing compounds have been used in the search for whole-body radiation-protective compounds, in the design of amphetamine derivatives that retain appetite-suppressive effects but lack most behavioral effects characteristic of amphetamines, and in the search for the cause of kidney stone formation in recurrently stoneforming patients.

METHODS:

Organic synthetic procedures were used to prepare radiation-protective compounds having a variety of sulfur-containing functional groups, and to prepare amphetamine derivatives having electron-attracting sulfur functions. In the case of the kidney stone causation research, isolation of urinary mucopolysaccharides (MPS) from recurrently stoneforming patients was carried out and the extent of sulfation of the MPS was determined by electrophoresis.

RESULTS:

Whole-body radiation-protective agents with a high degree of protection against lethal doses of gamma-radiation in mice were found in a series of quinolinium and pyridinium bis(methylthio) and methylthio amino derivatives. Mechanism studies showed that the copper complexes of these agents mimicked the beneficial action of superoxide dismutase. Electron-attracting sulfur-containing functions on amphetamine nitrogen, as well as 4'-amino nitrogen provided amphetamine derivatives with good appetite-suppressant effects and few or no adverse behavioral effects. Higher than normal levels of sulfation of the urinary MPS of stone formers suggested a cause for recurrent kidney stone formation. A sulfation inhibitor was found to prevent recurrence of stone formation and inhibit growth of existing stones.

CONCLUSIONS:

The inclusion of various sulfur-containing functions in organic molecules yielded compounds having whole-body radiation protection from lethal doses of gamma-radiation in animals. The presence of electron-attracting sulfur functions in amphetamine gave derivatives that retained appetite-suppressant effects and eliminated most adverse behavioral effects. A therapy for recurrent urolithiasis resulted from inhibition of MPS sulfation, after the finding that stoneforming patients had abnormally high levels of MPS sulfation.
Critical Analysis of the Content and Enforcement of Mandatory Consultation and Patient Profile Laws
Authors: Nichol Michael B. , Michael Lucy W.
Published: January 2017

OBJECTIVE:

This study evaluates the experience of 12 states that mandate that pharmacists provide consult services to patients and maintain drug profiles.

DATA SOURCES:

An analysis of each state's statutes and regulations was complemented by telephone interviews of state licensing board staff.

RESULTS:

Nine states specify the information to be provided during consultations, but only one (Florida) requires a comprehensive list of drug information, including adverse drug reactions, drug—drug interactions, directions for use, and necessary warnings. Eleven of the 12 states also require pharmacists to maintain patient drug profiles, but only 6 states specify the type of information to be included in profiles. State efforts to inform consumers about the pharmacist consultation requirement are limited, with only 7 states undertaking minimal promotional programs. The fact that no states reported any consumer consultation complaints or disciplinary actions against pharmacists for failure to consult illustrates the limited nature of mandatory consultation statutes and regulations.

CONCLUSIONS:

The wide variety of requirements demonstrates that these laws do not represent a uniform standard of practice. The lack of documented evidence regarding implementation invites questions regarding their usefulness and reinforces the need for enhanced monitoring activities.
Adverse Reactions to Human Serum Albumin
Authors: Gales Barry J. , Erstad Brian L.
Published: January 2017

OBJECTIVE:

To describe the adverse effects associated with human serum albumin (HSA) administration.

DATA SOURCES:

A MEDLINE search and bibliography scanning were used to identify pertinent review articles, clinical studies, and case reports.

STUDY SELECTION:

Emphasis was placed on reporting the results of human studies with the primary objective of investigating adverse effects attributable to HSA administration. Clinical trials that reported the occurrence of adverse effects possibly associated with HSA were also reviewed. Animal data were included where pertinent.

DATA EXTRACTION:

Although isolated case reports were reviewed, data were primarily extracted from human studies involving large series of patients or studies that were randomized and prospective in nature.

DATA SYNTHESIS:

Alterations in coagulation, renal, cardiovascular, and pulmonary functions were identified as potential adverse effects following the administration of HSA. Occurrences of hypersensitivity reactions, trace metal loading, and serum amino acid alterations associated with these infusions were also noted and are described here. Pulmonary and cardiovascular systems appear to be particularly prone to complications from excessive HSA administration. Adverse effects such as HSA-induced hypersensitivity reactions may be severe, but occur infrequently.

CONCLUSIONS:

Controlled studies involving large numbers of patients are not currently available for an accurate assessment of the incidence of adverse effects attributable to HSA administration. Many of the reported reactions appear to be extensions of albumin's pharmacologic activities and would be expected to worsen following large doses of HSA.
Use of Nifedipine in the Hypertensive Diseases of Pregnancy
Authors: Levin Anne C. , Doering Paul L. , Hatton Randy C.
Published: January 2017

OBJECTIVE:

To review the available data about the use of nifedipine to treat hypertension in pregnancy.

DATA SOURCES:

All English language cases and studies published after 1984 and indexed in MEDLINE, Excerpta Medica, and BIOSIS PREVIEWS under the headings nifedipine, hypertension in pregnancy, uteroplacental blood flow, maternal/fetal hemodynamics, preeclampsia, and pregnancy outcome.

MAIN OUTCOME MEASURES:

The primary outcome indicators included the safety and antihypertensive efficacy of nifedipine in pregnancy; the effects of nifedipine on maternal/fetal hemodynamics; and the effect, if any, of nifedipine on perinatal outcome.

CONCLUSIONS:

Traditional drug therapy choices for hypertension in pregnancy continue to be hydralazine for acute reduction of blood pressure and methyldopa for the management of chronic hypertension. Current data indicate that nifedipine is an appropriate second-line antihypertensive medication in pregnancy, but more clinical trials are needed before it can be considered an appropriate choice for initial therapy. As do other antihypertensive agents, nifedipine provides maternal benefit by lowering blood pressure and reducing the risk of cerebral hemorrhage and end-organ damage. However, perinatal benefit of nifedipine remains to be established.
Relationship Between the Administration of Selected Medications and Falls in Hospitalized Elderly Patients
Authors: Gales Barry J , Menard Susan M
Published: January 2017

Objective:

To examine the relationship between administration of selected medications and falls experienced by hospitalized elderly patients. Benzodiazepines and other medications previously associated with falls in elderly patients residing in the community and nursing homes were the primary focus.

Design:

Retrospective case control.

Setting:

Private, not-for-profit, 575-bed acute care hospital.

Participants:

A total of 100 patients who had fallen and 100 control patients, aged at least 70 years, admitted during the same 17-month time period.

Main Outcome Measures:

We examined the relationship between falls and patient demographics, underlying disease states, number of concurrent disease states, and length of hospitalization. Possible associations between the administration of narcotics, benzodiazepines, antidepressants, antipsychotics, other sedating agents, antihypertensives, diuretics, nitrates, and digoxin 48 hours prior to the fall or reference day were explored. The relationships between benzodiazepine half-life, dosage, administration frequency, cumulative dose, and falls were also examined.

Results:

Demographically the groups were similar except that patients who had fallen were hospitalized significantly longer (mean 18.8 vs 12.2 d; p < 0.00001) than control patients. Benzodiazepines were received by more (40% vs 20%, odds ratio = 2.67) patients who had fallen than control patients. The use of long (>24 h) half-life benzodiazepines was similar in patients who had fallen (48%) and control patients (45%). Long half-life benzodiazepines were commonly administered (65%) to patients who had fallen in doses greater than that recommended for the elderly. Benzodiazepine use, expressed as milligrams of diazepam equivalents received during the 48-hour study, was higher in patients who had fallen than in control patients (15.00 ± 17.80 vs 9.73 ± 6.58 mg), but this was not statistically significant (p = 0.1030). Congestive heart failure (37% vs 24%), digoxin therapy (35% vs 22%), or administration of 3 or more psychoactive agents (17% vs 4%) were all more common in patients who had fallen than in control patients.

Conclusions:

Falls experienced by the elderly patients in our acute care institution were associated with the presence of congestive heart failure along with digoxin therapy, benzodiazepine use, or the use of at least 3 psychoactive agents.
Patient-Controlled Analgesia versus Patient-Controlled Analgesia plus Continuous Infusion after Hip Replacement Surgery
Authors: Smythe Maureen A , Zak Margie B , O'Donnell Maureen P , Schad Randy F , Dmuchowski Carl F
Published: January 2017

OBJECTIVE:

To compare the efficacy and adverse effect profile of patient-controlled analgesia (PCA) versus PCA plus continuous infusion (PCACI) after hip replacement surgery.

DESIGN:

Prospective, randomized, open pilot study.

SETTING:

Large teaching institution.

PARTICIPANTS:

Thirty-four patients undergoing hip replacement or revision of hip replacement surgery.

INTERVENTIONS:

Patients were randomized to receive PCA morphine: 1 mg with 6-minute lockout, or PCACI, using the same dose, with a 0.5–1 mg/h continuous infusion. Pain intensity, sedation, narcotic use, injection/attempt ratio (I/A), and adverse effects were assessed.

RESULTS:

No significant differences in pain intensity were identified. Morphine use was not different between groups: PCA 61.8 ± 35.0 and PCACI 74.2 ± 54.9 mg (p = 0.394). A trend toward an increased 12-hour I/A ratio was evident in the PCACI group: PCA 0.73 ± 0.18 and PCACI 0.86 ± 0.17 (p = 0.073). Patient-reported adverse effects, sedation, and inability to sleep secondary to pain occurred similarly. Eight of 18 PCACI patients required discontinuation of either the continuous infusion mode or of PCA therapy entirely secondary to adverse effects.

CONCLUSIONS:

When compared with PCA therapy, PCACI was not associated with improved pain control and more patients receiving PCACI required discontinuation of therapy secondary to adverse effects.
Pseudomonas Bacteremia Precipitated by Ticlopidine-Induced Neutropenia
Authors: Geletko Sandra M , Melbourne Kathleen M , Mikolich Dennis J
Published: January 2017

OBJECTIVE:

To report a case of ticlopidine-induced neutropenia resulting in Pseudomonas bacteremia.

CASE SUMMARY:

An 83-year-old white man developed febrile neutropenia 5 days after initiation of ticlopidine therapy. At presentation, the patient's white blood cell count was 1.1 × 109/L with an absolute neutrophil count (ANC) of 0. Ticlopidine was discontinued and the patient was treated empirically with ceftazidime, gentamicin, and filgrastim. The patient's blood cultures were positive for Pseudomonas aeruginosa. By day 6 of antibiotic and filgrastim therapy, he was clinically improved and the ANC was 17 040 × 106 cells/L. The filgrastim and intravenous antibiotics were discontinued and oral ciprofloxacin was started.

CONCLUSIONS:

Ticlopidine-induced neutropenia can occur suddenly and may result in a serious infection, such as bacteremia.
Abciximab: A New Antiaggregant Used in Angioplasty
Authors: Genetta Tina B , Mauro Vincent F
Published: January 2017

OBJECTIVE:

To review the scientific literature on the pharmacology and clinical uses of abciximab.

DATA SOURCES:

MEDLINE, Index Medicus, and bibliographic literature searches of English-language articles pertaining to abciximab, 7E3, m7E3, and c7E3 were performed. Eli Lilly also provided unpublished results of the Evaluation of 7E3 for the Prevention of Ischemic Complications trial.

DATA SELECTION:

The selection of data presented focused on controlled trials using abciximab at doses currently approved by the Food and Drug Administration.

DATA SYNTHESIS:

Abciximab is a humanized chimeric Fab fragment of 7E3.7E3 is a murine antibody directed against the integrin glycoprotein IIb/IIIa receptor (GPIIb/IIIa) located on platelets. These receptors play an integral part in platelet aggregation by allowing fibrinogen to bind to them and interconnect platelets. When administered intravenously, abciximab binds to GPIIb/IIIa and hinders platelet aggregation. Bleeding times and activated clotting times are increased and the platelets' response to adenosine diphosphate is reduced with the use of abciximab. Clinical trials have indicated that abciximab can reduce the incidence of abrupt closure and restenosis associated with percutaneous transluminal coronary angioplasty (PTCA) performed in high-risk patients. Clinical trials also suggest that abciximab may have a role in the treatment of unstable angina and the acute therapy of myocardial infarctions. Complications associated with abciximab include bleeding and thrombocytopenia. The thrombocytopenia is likely related to immunologic mechanisms. In addition, the production of antimurine antibodies has been demonstrated with abciximab use. Abciximab is currently approved for the prevention of abrupt coronary closure associated with PTCA in patients at high risk for this event.

CONCLUSIONS:

Abciximab is effective in preventing platelet aggregation and has been proven to be of clinical benefit in selected high-risk patients receiving PTCA.