bluuebunny/crossref_metadata_2025 huggingface dataset:
Emu oil expedites small intestinal repair following 5-fluorouracil-induced mucositis in rats
Authors: Mashtoub Suzanne , Tran Cuong D , Howarth Gordon S
Published: September 2013

Mucositis resulting from cancer chemotherapy is characterized by intestinal inflammation and ulceration. Previously, emu oil (EO) improved intestinal architecture ( Br J Nutr, 2010) in a rat model of chemotherapy-induced mucositis. We investigated EO for its further potential to promote intestinal repair in this mucositis model. Female Dark Agouti rats ( n = 8/group) were gavaged with water, olive oil (OO) or EO once daily (1 mL), injected with 5-fluorouracil (5-FU) or saline on day 5 and euthanized on day 8, 9, 10 or 11. Intestinal villus height (VH) and crypt depth (CD), neutral mucin-secreting goblet cell (GC) count, myeloperoxidase (MPO) activity and selected cytokines were quantified; P < 0.05 was considered significant. In 5-FU-injected rats, only EO administration significantly increased VH in the ileum (day 8), jejunum and jejunum–ileum junction (days 8 and 9) compared to 5-FU controls ( P < 0.05). GC count was significantly reduced by 5-FU (jejunum: days 8 and 9; ileum: day 8; P < 0.05) and EO increased ileal GC on days 10 and 11 compared to 5-FU controls. MPO activity was significantly increased in jejunum (days 8 and 9) and ileum (day 8) following 5-FU injection, compared to normal controls ( P < 0.05). Both EO and OO significantly reduced jejunal MPO on days 8 and 9; however, only EO decreased ileal MPO on day 8. Cytokine levels were not significantly affected by either oil or 5-FU administration at the day 8 time point. Promotion of repair from injury could represent a new mechanism of action for EO, suggesting potential as an adjunct to conventional treatment approaches for cancer management.
Mutant PAX6 downregulates prohormone convertase 2 expression in mouse islets
Authors: Chen Yuanyuan , Cao Wenwan , Zhou Shixin , Shen Liang , Wen Jinhua
Published: September 2013

Transcriptional factor paired box 6 (PAX6) is very important for the development of the eyes, central nervous system, and pancreas. PAX6 mutations are associated with a diabetic phenotype and abnormal glucose metabolism. Our previous study showed that PAX6 directly bound to and activated the prohormone convertase 1/3 ( Pc1/3) gene promoter and subsequently regulated proinsulin processing. Prohormone convertase 2 (PC2) is the essential enzyme for pancreatic proinsulin processing. To study the regulation of PAX6 in Pc2 expression, we did research on the pancreas of Pax6 R266Stop mutant mice, where truncated mutations happened in the C-terminal of the PAX6 protein. Our studies showed that the mutant PAX6 protein was stable and regulated the activity of Pc2 promoter as shown by luciferase activity assays. We found that the wild-type PAX6 protein imparts a transcriptional effect, and the mutant PAX6 can also regulate the downstream molecules. The results provide new insights into the mechanism of truncated PAX6 in regulating the functions of the pancreas and endocrine system.
Efficacy and Feasibility of Home-Based Training for Individuals With Homonymous Visual Field Defects
Authors: Aimola Lina , Lane Alison R. , Smith Daniel T. , Kerkhoff Georg , Ford Gary A. , Schenk Thomas
Published: September 2013

Background. Homonymous visual field defects (HVFDs) are one of the most common consequences of stroke. Compensatory training encourages affected individuals to develop more efficient eye movements to improve function. However, training is typically supervised, which can be time consuming and costly. Objective. To develop and evaluate the efficacy and feasibility of an unsupervised reading and exploration computer training for individuals with HVFDs. Methods. Seventy individuals with chronic HVFDs were randomly assigned to 1 of 2 groups: intervention or control. The former received 35 hours of reading and exploration training, and the latter received 35 hours of control training. Visual and attentional abilities were assessed before and after training using perimetry, visual search, reading, activities of daily living, the Test of Everyday Attention, and a Sustained Attention to Response task. Results. Eighteen individuals failed to complete the training; analyses were conducted on the remaining 28 intervention and 24 control group participants. Individuals in the intervention group demonstrated significant improvements in the primary outcomes of exploration (12.87%, 95% confidence interval [CI] = 8.44% to 17.30%) and reading (18.45%, 95% CI = 9.93% to 26.97%), which were significantly greater than those observed following the control intervention (exploration = 4.80%, 95% CI = 0.09% to 9.51%; reading = 1.95%, 95% CI = −4.78% to 8.68%). Participants in the intervention group also reported secondary subjective improvements, although these were not matched by objective gains in tasks simulating activities of daily living. Conclusions. Home-based compensatory training is an inexpensive accessible rehabilitation option for individuals with HVFDs, which can result in objective benefits in searching and reading, as well as improving quality of life.
Antimicrobial Utilization Pattern in a Hematologic Intensive Care Unit
Authors: Krivoy Norberto , Mattalon Nurith
Published: September 2013

Background:

Recently, a new method for assessing the quality of prescription — The drug utilization 90% index (DU-90%) — Was introduced. The defined daily dose (DDD) concept is an established parameter in pharmacoepidemiologic studies.

Objective:

To evaluate antibiotic utilization in a specialized hospital unit where the use of antibiotics in immune-compromised patients undergoing intensive chemotherapy or bone marrow transplantation may be one of the main components in the direct cost of therapy of this type of patient.

Methods:

The antibiotic utilization pattern and accompanying costs were prospectively measured for 48 patients in a hematologic intensive care unit during a 60-day period, accumulating 896 admission days of follow-up. The DU-90% level is arbitrarily chosen as a reasonable cutoff point; it concentrates on the bulk of the prescribed antibiotics.

Results:

Of 26 antimicrobial agents prescribed, 14 were included in the DU-90%. Amphotericin B was delivered to 100% of the study population, with a total of 57.99 DDD/100 admission days. Ceftriaxone was the antimicrobial least prescribed, with a total of 0.22 DDD/100 admission days. The DU-90% index showed that 53% of the prescribed medications equal 92% of the total antibiotic cost. A discrepancy between the pharmacy's report and the calculated costs based on DDDs was observed. Failure to have a real-time inventory and costs unification, the use of mean instead of median acquisition costs, and failure to use electronic prescription systems are the main elements affecting and disrupting drug utilization studies. This possibly explains, in part, the difference between the two cost reports.
Multiple NSAID Prescriptions in a Medicare Managed Care Population
Authors: Barnum Karl R , Wertheimer Albert I , Morrison Alan , Straus Walter L
Published: September 2013

Objective:

To describe the use of multiple nonsteroidal antiinflammatory drugs (NSAIDs) and the cost implications in a Medicare managed care population.

Design:

Retrospective analysis of prescription drug database records.

Setting:

Three Medicare managed care plans in the West and South.

Patients:

The population consisted of 22,544 patients who filled prescriptions for one or more different nonaspirin NSAIDs during a six-month period beginning March 1, 1998.

Main Outcome Measure:

Prescriptions for nonaspirin NSAIDs, misoprostol, proton-pump inhibitors, sucralfate, and analgesic drugs.

Results:

A total of 12.6% of individuals filled prescriptions for two different NSAIDs, and 2.3% filled prescriptions for between three and five different NSAIDs. As the number of NSAIDs increased from one to five, there was a decrease in the generic:brand-name ratio from 4.3:1 to 0.93:1, an increase in the total days' supply from 39 to 310 days (for the 180-d period), an eightfold increase in the coprescription of misoprostol, a twofold increase in coprescription of analgesics, and an increase in payments per person for all NSAIDs and listed coprescribed drugs from $51.67 to $403.00.

Conclusions:

A small subset of individuals in Medicare health plans fill prescriptions for multiple NSAIDs, concomitant with increased use of brand-name drugs, increased coprescription of misoprostol and analgesics, and increased drug costs. Healthcare providers should scrutinize this population and consider whether alternative therapeutic approaches might be appropriate.
Implementing Protocol-Based Therapy of Continuous Neuromuscular Blockade Provides Cost Minimization
Authors: MacLaren Robert , Toombs L Kent , Plamondon Johanna M , Rocker Graeme M , Patrick Ward D , Hall Richard I
Published: September 2013

Objective:

To compare empiric and protocol-based therapies of neuromuscular blockade in terms of cost and control of paralysis.

Methods:

Data were prospectively collected for nine months before and five months after a protocol was implemented in the 24-bed medical/surgical/neurologic intensive care unit as a physician-initiated, doublesided medication order form. Pancuronium was the preferred agent and vecuronium was an alternative for patients with renal dysfunction, hepatic dysfunction, or hemodynamic instability.

Results:

Twenty-nine empiric-therapy patients and 17 protocol-based therapy patients were comparatively evaluated. Length of stay in the intensive care unit and duration of neuromuscular blockade were similar between groups. Protocol adherence rate was 76.5%. Protocol-based therapy increased the hourly dose of pancuronium (0.29 ± 0.37 mg vs. 0.02 ± 0.10 mg; p < 0.005) and reduced the mean hourly cost of neuromuscular blockade compared with empiric therapy ($5.11 ± 4.76 Canadian [CDN] vs. $9.03 ± 7.03 CDN; p < 0.05). Vecuronium use did not change, but rocuronium and atracurium were not given after protocol implementation. The proportion of recorded train-of-four measurements representing adequate neuromuscular blockade increased (52.3% vs. 32.7%; p < 0.05) with protocol-based therapy.

Conclusions:

Compliance with a neuromuscular blocking protocol reduces drug costs and improves control of neuromuscular blockade.
A Review of Valproic Acid–Induced Carnitine Deficiency and Replacement
Authors: Ahluwalia Navneet S , Bernad Peter G
Published: September 2013

Objective:

To review valproic acid–induced carnitine deficiency and subsequent carnitine replacement.

Data Sources:

Articles indexed in MEDLINE from 1966 to May 2000, as well as other published works and standard references.

Data Extraction:

Studies investigating clinical epidemiologic and pathologic evidence of the role of valproic acid–induced carnitine deficiency and double-blind clinical trials evaluating the effectiveness of carnitine replacement with anticonvulsant therapy are presented.

Data Synthesis:

Clinical epidemiologic and pathologic studies provide evidence of valproic acid–induced carnitine deficiency. There is no clear consensus for providing carnitine supplementation to all patients taking valproic acid — It is only indicated for children with valproic acid–induced hepatotoxicity and those with valproic acid overdose.

Conclusions:

There is evidence that implicates valproic acid in inducing carnitine deficiency. Patients should be evaluated clinically for signs and symptoms of carnitine deficiency before beginning supplementation. Currently, carnitine supplementation should be reserved for children with valproic acid–induced hepatotoxicity and valproic acid overdose until the results of further clinical studies are available.
Pharmaceutical Calculations — A Basic Review
Authors: Russo Nicole M
Published: September 2013

Objective:

To review mathematical topics used in pharmaceutical preparation, specifically ratios and proportions, percentage concentrations, and stock solutions.

Data Source:

Online pharmaceutics sources and current pharmaceutics textbooks were consulted.

Data Synthesis:

Ratios and proportions are basic tools for adjusting drug concentrations. Using proportions, medications can be provided in any concentration desired. By extending this technique to percentage concentrations, prescriptions can be interpreted and calculated. In the same manner, the ability to dilute stock solutions provides patient-specific drug delivery.

Conclusions:

The mathematical concepts of ratios and proportions, percentage concentrations, and stock dilutions are essential for correct medication administration in any setting.
Acyclovir in the Treatment of Bell's Palsy
Authors: Miller Susan M
Published: September 2013

Objective:

To examine the role of acyclovir in the treatment of Bell's palsy.

Data Sources:

A search was performed using MEDLINE (1966–September 2002) and the Cochrane Database of Systematic Reviews with the search terms acyclovir, antiviral, idiopathic facial paralysis, Bell's palsy, herpes simplex virus, and corticosteroids.

Data Synthesis:

Treatment of Bell's palsy is controversial. Recent research has indicated that herpes simplex virus type 1 may be the likely causative agent. Clinical trials and review articles focusing on the use of acyclovir in the treatment of Bell's palsy were reviewed and evaluated.

Conclusions:

More solid evidence is necessary to validate whether herpes simplex virus type 1 causes Bell's palsy. Limited published clinical studies exist that have used acyclovir for the treatment of Bell's palsy. The results of available trials are contradictory. The American Academy of Neurology's practice parameter states that acyclovir, in combination with steroids, is safe and possibly effective for Bell's palsy treatment. Further information is needed from larger prospective, randomized, placebo-controlled trials to clarify the ultimate therapeutic role of acyclovir for Bell's palsy.
Treatment of Very High Triglycerides with Fish Oils: A Review of 2 Cases
Authors: Caron Michael F , Nguyen Isabelle T , Folstad Jon E
Published: September 2013

Objective:

To report 2 cases of serum triglycerides >1000 mg/dL (i.e., very high serum triglycerides) in which fish oil was used because of treatment failure or intolerance with conventional therapeutic modalities.

Case Summary:

Two individuals with a history of serum triglycerides >1000 mg/dL were referred to a pharmacist-managed lipid clinic by their primary-care provider because of either treatment failure or intolerance to conventional therapeutic modalities. Fish oils were used in lieu of and in addition to conventional treatment modalities in cases 1 and 2, respectively. Both cases demonstrated that fish oil, at doses ranging from 1 to 6 g/d, decrease triglyceride levels to a degree similar to conventional measures. Both patients tolerated fish oil well; however, increases in liver transaminases were observed.

Discussion:

Published studies have shown that fish oil can reduce elevated plasma triglycerides by an average of 30–52% in subjects with borderline-high (150–199 mg/dL) to high (200–499 mg/dL) triglycerides. Both of our cases reflect similar results in patients with very high triglycerides. Although fish oil has not been reported to induce hepatotoxicity, both of our patients experienced an increase in transaminases while on fish oil therapy. Whether fish oil truly causes hepatic injury remains to be elucidated.

Conclusions:

Fish oil supplementation is effective and generally well tolerated in patients with very high triglycerides and can be used as either alternative or adjunctive therapy when conventional treatment modalities become ineffective or intolerable.
Evaluation of Anticoagulation Therapy in an Academic Nursing Home
Authors: Karki Shyam D , Lander Susan M
Published: September 2013

Objective:

To evaluate the warfarin management patterns in an academic nursing home and evaluate what predetermined factors are associated with variability in the international normalized ratio (INR).

Setting:

A 566-bed academic nursing home.

Methods:

A retrospective chart review of all residents receiving warfarin therapy for >3 consecutive months in a calendar year was conducted. Data were collected regarding the number of times the INR fluctuated during the follow-up period and the degree of fluctuation between each blood sampling. An INR that changed by 0.5–0.99 between samplings was classified as a small fluctuation; a change >0.99 was defined as a large fluctuation. The sample was divided into 2 groups, easy management and difficult management, based on variability in the INR. The easy-management group consisted of residents who had small fluctuations in the INR and who had INRs outside of the therapeutic range ≤10% of the time. The difficult- management group had large fluctuations in the INR, with the ratio outside of the therapeutic range >10% of the time.

Results:

Thirty-seven patients were taking warfarin (mean ± SD age 71 ± 14 y; mean number of medical illnesses 7.6 ± 3). The mean length of time of warfarin therapy was 10.6 ± 3.2 months. The average dose and INR were 4.0 ± 1.9 mg and 2.0 ± 0.3, respectively. No statistically significant differences were found between age, dose, or INR. For patients who had INR values exceeding the therapeutic range, there was no significant difference between the management groups in length of treatment, age, number of medical illnesses, number of high-risk factors, dose, average monthly INR, number of medication adjustments per year, albumin and creatinine levels, total number of medications, or number of routine medications known to interact with warfarin. The difficult-management group received more medications known to interact with warfarin than the easy-management group. These medications may have caused the INR to increase above the normal range (p = 0.003), as well as producing a large (p = 0.001) or small fluctuation (p = 0.0007) in the INR. Of all the interacting medications, 55% were antibiotics and 28% were analgesics. No statistically significant differences in outcome were seen between groups.

Conclusions:

Results of this study indicate that large variations (>0.99) in the INR may be due to newly prescribed medications that enhance the anticoagulant effect of warfarin. These variations may be minimized by closely monitoring the INR when a drug known to interact with warfarin is prescribed.
Bioequivalence of Carpine Tablets Containing Carbamazepine
Authors: Hassan Yahaya , Tan Yvonne T , Peh Kok-Khiang , Aziz Noorizan Abd , Rahman Ab Fatah Ab , Mohamed Nornisah , Ismail Omar
Published: September 2013

Objective:

To develop a suitable assay method for carbamazepine and to use this method in the evaluation of a Malaysian-made generic tablet and a commercially available tablet containing carbamazepine for bioequivalence after a single-dose, randomized, 2-period, 2-treatment, 2-sequence crossover study.

Method:

Eighteen healthy men participated in the bioequivalence study. Each treatment was given as a single 2 × 200-mg dose. Plasma concentrations of carbamazepine were collected for up to 168 hours and assayed using HPLC.

Results:

The test to reference ratios were found to be 1.05 for maximum concentration (Cmax), 1.02 for AUC(0-t), 0.96 for AUC(t-∞), 1.01 for AUC(0-∞), and 0.99 for elimination half-life. The 90% confidence intervals of the AUC and Cmax parameters were within the range of 0.80–1.25. Wilcoxon signed-rank test for paired samples showed no statistically significant difference between the tmax results.

Conclusions:

All of the parameters evaluated showed bioequivalence between the 2 formulations.
Moxifloxacin-Induced Seizures in an Epileptic Patient
Authors: Unzurrunzaga Ainhoa , Ruiz Javier , Garcia Monserrat , Aguirre Carmelo , Garcia-Monco Juan C
Published: September 2013

Objective:

To report a patient with seizures probably related to the use of moxifloxacin, a fourth-generation quinolone.

Case Summary:

A 79-year-old white man developed status epilepticus after a 4-day course of moxifloxacin for respiratory infection. He had experienced seizures 2 years before presentation. The patient was currently receiving warfarin, theophylline 400 mg/d, albuterol; furosemide, potassium, and digoxin; and omeprazole for chronic obstructive pulmonary disease, atrial fibrillation with mild heart failure, and heartburn, respectively. He also had moderate renal failure. Despite aggressive therapy, the patient developed progressive respiratory insufficiency and died.

Discussion:

Quinolone use is associated with a variety of central nervous system (CNS) adverse effects in approximately 1–2% of patients. In fact, CNS adverse effects represent the second most frequently encountered form of quinolone toxicity after gastrointestinal involvement. Occasionally, quinolones induce seizures, but, as of October 17, 2003, none have been reported in the literature. Use of the Naranjo probability scale indicated a probable relationship between seizures and moxifloxacin administration in this patient. Seizures may be mediated by CNS stimulation secondary to quinolone binding to γ-aminobutyric acid receptors. Coexisting medical conditions and concurrent medications also facilitate seizure appearance. Risk factors include seizure history, hypokalemia, alkalosis, renal failure, and concomitant treatment with agents that lower the seizure threshold. These factors were not present in this patient except for a prior history of seizures and mild renal failure.

Conclusions:

Seizures with quinolones, albeit rare, need to be considered in certain populations, particularly patients who have had prior seizures, the elderly, patients with renal dysfunction, and patients on multiple medications.
Paralytic Ileus Possibly Associated with Nebulized Ipratropium Bromide
Authors: Poquet-Jornet Jaime E , Hosta-Mateu Victor , Misis-Del-Campo Maite
Published: September 2013

Objective:

To report a case of paralytic ileus possibly associated with nebulized ipratropium bromide.

Case Summary:

A 43-year-old man fell from a wall and was admitted to the intensive care unit (ICU) for the resulting thoracic trauma. An epidural thoracic catheter was placed for pain control using bupivacaine 0.25% and methadone 0.2 mg/mL. On hospital day 4, he developed purulent bronchiole constriction, and treatment with nebulized mesna and ipratropium bromide was started. Six hours after the first nebulization, the patient developed abdominal pain and bowel distension. An abdominal X-ray showed intestinal gas retention and dilated loops of large bowel. Paralytic ileus was diagnosed. Nebulized ipratropium bromide treatment was stopped and, during the following 24 hours, the patient gradually improved.

Discussion:

Nebulized ipratropium bromide–induced paralytic ileus is an uncommon adverse event that may be of considerable clinical relevance. Nebulized ipratropium bromide is predominantly deposited in the oropharynx, but some amount of the drug may be swallowed with resultant systemic adverse effects. Ipratropium bromide is a nonselective muscarinic antagonist and may inhibit contraction of the gastrointestinal tract. Paralytic ileus could not be attributed to an electrolyte disturbance or abdominal injury. The patient's paralytic ileus resolved when nebulized ipratropium bromide was stopped. An objective causality assessment showed that the paralytic ileus was possibly associated with this drug.

Conclusions:

This case report indicates that ipratropium bromide should be considered capable of inducing paralytic ileus.
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part II
Authors: Nice Frank J , DeEugenio Deborah , DiMino Traci A , Freeny Ingrid C , Rovnack Marissa B , Gromelski Joseph S
Published: September 2013

Objective:

To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common cardiology and general medications during breast-feeding.

Data Sources:

Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004).

Study Selection/Data Extraction:

Multiple sources were used wherever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast-feeding, lactation, nursing, and medications, as well as specific drug names.

Data Synthesis:

Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are drugs that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm.

Conclusions:

Having objective and reliable information on medications enables pharmacists, pharmacy technicians, healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
Defining “Pharmacy Technician”
Authors: Wilson Debbie L
Published: September 2013

Background:

Legal definitions of “pharmacy technician” vary by state. Also, many pharmacy organizations have definitions of “pharmacy technician.” There is no consensus on the definition.

Objective:

To explore the legal definitions of a pharmacy technician and use of the term “professional judgment” in those definitions and develop an empirically and theoretically based definition of a pharmacy technician.

Methods:

Definitions of a pharmacy technician from the state statutes and regulations were found using LexisNexis State Capital and entered into an N-4 Classic database. The database was then coded through an iterative process of content analysis. A definition was developed using the content analysis and literature-based theory.

Results:

Definitions were found for 42 states (84%). Five main concepts were found to exist in the definitions: credentialing, designation, functions, practice site, and supervision. An empiric and theoretically based definition of a pharmacy technician was developed.

Conclusions:

Statutory and regulatory definitions of a pharmacy technician tend to define technicians in terms that preserve the dispensing role for pharmacists. Definitions of a pharmacy technician should focus on the types of services pharmacy technicians provide and the types of credentials they must have, rather than what they may not do and who they are not. The use of the term “professional judgment” in defining a pharmacy technician lacks precision and is therefore not helpful in defining “pharmacy technician.”
Topiramate Effective in the Treatment of Intractable Glossodynia
Authors: Lampl Yair , Gilad Ronit
Published: September 2013

Objective:

To report effective treatment with topiramate in 2 cases of glossodynia (burning tongue and mouth syndrome).

Case Summaries:

Two women, 52 and 53 years old, suffered from intractable unilateral burning mouth syndrome. In both cases, the activities of daily living were severely restricted. Previous treatment with diverse medications had failed. Administration of topiramate 200–350 mg/day stopped the attacks completely in one patient and reduced the frequency by 50–60% in the second.

Discussion:

Glossodynia may present as unilateral intractable pain syndrome with characteristics of neuralgic pain. It is defined as a burning pain in the tongue and mucous membranes of the mouth. There is some research on possible effective medications for treatment, but few data on the beneficial effects of this therapy have been reported. Topiramate has been previously shown to have an antineuralgic effect in trigeminal neuralgia. In the cases of intractable glossodynia presented here, this medication led to significant improvement in the symptoms of this uncommon neuralgic pain.

Conclusions:

Topiramate has a beneficial effect in intractable burning mouth and tongue syndrome. Taking these positive results into consideration, the practitioner can give hope to disabled patients for returning to acceptable activities of daily living.
Octreotide for Refractory Diarrhea Associated with Capecitabine
Authors: Tanvetyanon Tawee , Gaynor Ellen R
Published: September 2013

Objective:

To describe the effect of low-dose subcutaneous octreotide on refractory diarrhea associated with capecitabine.

Case Summary:

A 67-year-old white woman with recurrent metastatic breast cancer received monotherapy with capecitabine after failing docetaxel. The first 2 consecutive capecitabine cycles were well tolerated. The patient, however, developed severe watery diarrhea after the third cycle. Diphenoxylate, atropine, loperamide, and attapulgite, along with conventional supportive measures, did not significantly improve the diarrhea, resulting in prolonged hospitalization. Octreotide 100 μg every 8 hours was administered subcutaneously. Immediate relief in stool frequency was observed during the first day. The stool became more formed on the next day. The patient was ready for discharge after learning how to perform subcutaneous injections. Octreotide was continued at home for 3 more days. After discontinuation of octreotide, no recurrent diarrhea occurred. Capecitabine was not reinitiated.

Discussion:

Diarrhea is a potentially life-threatening complication from treatment with capecitabine, an oral fluoropyrimidine analog. Octreotide has shown efficacy for diarrhea from many conditions, including chemotherapy with irinotecan and intravenous fluoropyrimidines such as fluorouracil. Our report suggests that octreotide also is effective for diarrhea associated with capecitabine. The patient's rapid response shortened her hospital stay and improved her quality of life.

Conclusions:

In our patient, subcutaneous octreotide, along with other conventional antidiarrheal therapies, was associated with rapid resolution of refractory diarrhea attributed to capecitabine.
The Effects of β-Adrenergic Blockers in African Americans with Chronic Heart Failure
Authors: Veverka Angie , Carter D Brent , Crouch Michael A
Published: September 2013

Objective:

To review the available literature regarding the use of β-adrenergic blockers in African Americans with heart failure.

Data Sources:

Primary literature was located via MEDLINE (1966–January 2004). Key search terms were β-adrenergic blockers; heart failure, congestive; carvedilol; metoprolol; bisoprolol; and bucindolol.

Data Synthesis:

In African Americans, the prevalence of chronic heart failure (CHF) is nearly twice that of white people. African Americans exhibit symptoms of CHF at an earlier age, develop more marked functional decline after hospitalization for CHF, and have almost a twofold higher mortality rate compared with white patients. Sympathetic nervous system activation is a key pathophysiologic response in CHF; by attenuating this system, β-blockers have been shown to decrease mortality. Unfortunately, minority populations have been underrepresented in many of the trials evaluating β-blockers. Of the 4 β-blockers assessed in CHF, bucindolol has shown detrimental effects when used in African Americans. Metoprolol and bisoprolol have not been sufficiently evaluated to determine if response varies by race. Carvedilol has the best documented benefit in this population.

Conclusions:

Response to β-adrenergic blockers in CHF varies by race. Bucindolol has shown detrimental effects when used in African Americans. Further investigation is warranted to determine if metoprolol and bisoprolol are equally efficacious to carvedilol in African American patients with CHF.
Management of Cardiac Failure—Do Practitioners Follow Guidelines?
Authors: Suisted Philip , Seneviratne Sujith , Burgess Carl
Published: September 2013

Objective:

To assess the use of β-blockers, spironolactone, and the dose of angiotensin-converting enzyme (ACE) inhibitors in patients with congestive cardiac failure.

Methods:

The medical records of patients discharged with a diagnosis of congestive cardiac failure between January 1, 2001, and June 30, 2001, from the internal medicine and cardiology services at Capital and Coast District Health Board, Wellington, New Zealand, were identified and analyzed for cardiac drugs on admission and discharge. These records were also reviewed for New York Heart Association status and left-ventricular ejection fraction.

Results:

Two hundred ninety-two patients (146 from each service) were identified as having congestive cardiac failure; 84 were excluded due to death, admission being procedure related, notes being unavailable, or transfers from other services. The patients' mean age was 73 years. Four of 74 eligible patients were started on β-blockers, while 11 of 30 eligible patients were started on spironolactone. Sixteen patients were prescribed spironolactone inappropriately, and 27 were prescribed target recommended doses of ACE inhibitors.

Conclusions:

This study has shown that guidelines for the treatment of cardiac failure are difficult to follow in clinical practice. Adequate studies in older individuals with congestive cardiac failure are indicated.
Neuroleptic Malignant Syndrome: No Longer Exclusively a “Neuroleptic” Phenomenon
Authors: Wargo Kurt A , Gupta Rahul
Published: September 2013

Objective:

To review the literature concerning the incidence of neuroleptic malignant syndrome (NMS) associated with the use of atypical antipsychotics.

Data Sources:

Cases were identified through a search of MEDLINE (1986–March 2004) using the terms neuroleptic malignant syndrome, antipsychotic, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole.

Study Selection and Data Extraction:

Case reports of possible NMS secondary to second-generation antipsychotics were selected for review. Reports meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for NMS were considered. Case reports in which 1 of the 2 major diagnostic criteria was met were also included in the analysis. Furthermore, at least one minor criterion was met. Case reports in which patients received traditional antipsychotics were excluded.

Data Synthesis:

NMS is a rare and sometimes fatal disease. Several theories exist as to how NMS develops, and an equally large amount of diagnostic criteria are available. However, the majority of available data are based on the first-generation neuroleptics and very few exist with regard to the second-generation antipsychotics.

Conclusions:

Although there are numerous case reports of NMS occurring secondary to the use of second-generation antipsychotics, the incidence has never been fully elucidated. While the reasons for this remain uncertain, not all cases of second-generation–induced NMS fulfill the diagnostic criteria established for traditional neuroleptics and therefore may not be reported as such.
The Need for a More Stringent LDL-C Goal in Patients with Diabetes
Authors: Altman Julie S , Kerr Jessica L , Thrower Margaret R
Published: September 2013

Objective:

To review relevant literature supporting the need for intensive lipid management in patients with diabetes mellitus.

Data Sources:

A literature search using MEDLINE (1975–March 2005) was conducted. The search terms coronary disease, diabetes mellitus, hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins), lipoproteins, and low-density lipoprotein cholesterol (LDL-C) were used to identify published trials comparing the effects of intensive LDL-C lowering and cardiovascular morbidity and mortality.

Study Selection and Data Extraction:

Primary literature was evaluated and included in this review if the study was a large randomized trial containing a significant number of diabetic patients receiving primary prevention. For trials including patients without diabetes, an available sub-analysis of the diabetic population in that trial must have been available.

Data Synthesis:

The incidence of diabetes mellitus is rising in dramatic proportions throughout the nation. In addition to the diagnosis of diabetes, many of these patients also have preexisting risk factors that increase their risk for cardiovascular morbidity and mortality. In 2004, the National Cholesterol Education Program issued a scientific statement proposing a newer and lower optimal LDL-C goal for high-risk populations. This article reviews pertinent findings from recent clinical trials and guidelines discussing the need to integrate more stringent LDL-C goals into clinical practice.

Conclusions:

Although data are limited, all patients with diabetes mellitus, regardless of cardiovascular status, may benefit from lipid-lowering therapy with an optimal LDL-C goal of < 70 mg/dL.
The Pharmacist's Role in Continuity of Care in Type 2 Diabetes: An Evaluation of a Model
Authors: Krass Ines , Taylor Susan J , McInman Adrian D , Armour Carol L
Published: September 2013

Background:

Evidence suggests that many patients with type 2 diabetes are not achieving current evidence-based therapeutic targets.

Objective:

To compare the impact of a clinic-only versus continuity-of-care model on clinical and humanistic outcomes of patients with type 2 diabetes.

Methods:

One hundred eighteen patients were recruited from 2 diabetes clinics and assigned to a clinic-only or continuity-of-care group. The clinic-only patients were assessed by the clinic pharmacist at the initial visit and attended their usual pharmacy until the follow-up clinic visit 6 months later. The continuity-of-care patients were referred to one of 20 participating pharmacies for ongoing care over 6 months. The evaluation used a repeated measures design and compared the clinic-only with the continuity-of-care groups.

Results:

Within the continuity-of-care group, there was a significant reduction in mean blood glucose over the 6 months (p = 0.04). Compared with the clinic-only group, the continuity-of-care model demonstrated a trend toward a greater improvement in glycemic control. The net benefit of the intervention was an additional 0.27% (95% CI −0.63% to 0.009%) reduction in hemoglobin A1c (p = 0.15). Improvements in negative attitude and understanding of diabetes were seen in both groups; however, improvements in positive attitude to diabetes were seen only in the continuity-of-care group.

Conclusions:

The continuity-of-care model had a significant impact on clinical and humanistic outcomes. Community pharmacists may enhance the care of patients with type 2 diabetes.
Two Approaches to Treatment of Complicated Candida Glabrata Urinary Tract Infection in Renal Failure
Authors: Kishel Joseph J , Arunkumar Punitha
Published: September 2013

Objective:

To report the treatment of 2 cases of Candida glabrata urinary tract infection (UTI) in the setting of renal failure.

Case Summaries:

A 37-year-old female in acute renal failure developed a complicated UTI due to C. glabrata. The organism was eradicated after treatment with caspofungin. The second patient, a 58-year-old woman also in acute renal failure, developed a complicated UTI due to C. glabrata. This patient failed to eradicate the organism after repeated courses of voriconazole.

Discussion:

UTI caused by non-albicans Candida in the setting of renal failure presents few therapeutic options for management. Caspofungin and voriconazole have excellent activity against Candida spp., but have poor elimination as active drug in the urine. Amphotericin B is less feasible in the setting of acute renal failure, in which return of renal function is expected. Lipid-associated amphotericin products poorly penetrate the kidney. Despite these facts, one patient cleared the organism after treatment with caspofungin and one patient had persistent positive cultures after receiving voriconazole.

Conclusions:

Despite poor penetration into the urine, caspofungin may be an option in the management of UTI when other modalities are not feasible or desired.
Impact of β-Blocker Dosage Changes during Heart Failure Exacerbation
Authors: Brouse Sara D , Hafezi Shideh
Published: September 2013

Background:

Although β-blockers are important life-saving medications in heart failure patients, studies evaluating β-blocker dosing in decompensated heart failure are limited.

Objective:

To determine the clinical outcomes in patients with severe decompensated heart failure receiving the same dose of β-blockers as well as those whose outpatient regimen was altered.

Methods:

A retrospective chart analysis was conducted in patients with severe decompensated heart failure receiving chronic β-blocker therapy who were admitted to the hospital for decompensated heart failure. Of 245 patients identified, 76 were included in the study: same dose (n = 26), decreased dose (n = 19), discontinued dose (n = 21), or increased dose (n = 10). χ2 Analysis for K-independent samples evaluated the incidence of proarrhythmic events, mortality, and the number of recurrent hospitalizations after the index admission. Stepwise forward linear regression analysis determined the variables correlated with morbidity and mortality in these patients.

Results:

New arrhythmias during hospital admission occurred in 19 (25%) patients. The discontinued dose group had the most proarrhythmic events (47.6%; n = 10) and the most deaths (50%) in 6 months. Arrhythmias developed 1.8 and 3 days following β-blocker discontinuation or dosage reduction, respectively.

Conclusions:

Patients who remained on their outpatient β-blocker dose upon admission for decompensated heart failure had better clinical outcomes than others whose β-blocker dose was changed. A prospective, randomized, controlled clinical trial is warranted to further explore the implications of this drug–disease state interaction.
Ursodeoxycholic Acid for the Treatment of Parenteral Nutrition–Associated Cholestasis in Pediatric Patients
Authors: Tejani Aaron M , Arbo Trudy C
Published: September 2013

Objective:

To determine the relative safety and efficacy of ursodeoxycholic acid (UDCA) in children and neonates with parenteral nutrition–associated cholestasis (PNAC).

Data Sources:

A comprehensive search (up to May 29, 2006) of the following databases was conducted to identify relevant prospective, randomized, double-blind clinical trials and systematic reviews: Ovid–MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, and the Centre for Reviews and Dissemination. In addition, reference lists from retrieved articles were searched to identify trials or systematic reviews not identified in the search of electronic databases. Also, the manufacturer of UDCA was contacted regarding access to any other unpublished trials that could be included in this review.

Study Selection and Data Extraction:

Prospective, double-blind, randomized, controlled trials of neonates (<36 wk gestational age) and/or children (0–18 y) who developed PNAC while receiving parenteral nutrition were included in the analysis. Articles were evaluated with specific focus placed on the following hierarchy of outcomes: mortality, nonfatal serious adverse events, liver failure, infection, sepsis, return of liver function test results to within normal ranges, and relief of pruritus.

Data Synthesis:

No prospective, double-blind, randomized, controlled trials assessing the efficacy and safety of UDCA for the treatment of PNAC in children and/or neonates were identified. Five retrospective chart reviews and/or case series were identified; however, the results of these studies were conflicting and do not provide sufficient evidence of the safety and efficacy of UDCA for the treatment of PNAC.

Conclusions:

There is no evidence from prospective, double-blind, randomized, controlled trials in neonates and/or children with PNAC regarding the relative safety and efficacy of UDCA therapy.
Physician Acceptance of a Hyperlipidemia Program's Adaptation of the National Cholesterol Education Program's Adult Treatment Panel III Update
Authors: Palmieri James
Published: September 2013

Background:

Physician acceptance of a disease management program is paramount to that program's success, particularly in a voluntary referral system. Physician satisfaction assessment is necessary as programs adapt to updated national guidelines that change the practice of care.

Objective:

To assess the level of knowledge and acceptance of the principles behind the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III update among physicians who refer to our telephone surveillance hyperlipidemia risk management program, assess their satisfaction with our program's educational efforts regarding clinical hyperlipidemia management, and ascertain the physicians' ongoing willingness to refer their patients to our program.

Methods:

Surveys were mailed to all physicians (n = 81) who had patients actively enrolled in our program at the time of the study. The survey consisted of 7 questions designed to discern the physicians' awareness and acceptance of the trend toward more aggressive cholesterol-lowering therapy in certain high-risk patient populations, as well as their future willingness to refer patients to our program now that more aggressive treatment targets have been established.

Results:

Of the 21 (26%) physicians who responded to our survey, all indicated that they were aware of the latest NCEP update. Most physicians (94%) received their knowledge of the update outside of our program's efforts to inform them, yet most (90%; p < 0.001) thought that our program kept them informed on the best practices for dyslipidemia management. Respondents were overwhelmingly in favor of the more aggressive targets (95% [p < 0.001 for highest-risk patients]; 100% [p < 0.001 for moderately high-risk patients]).

Conclusions:

Our referring physicians are aware of and support the NCEP ATP III update recommendations and the revisions to our standardized procedure that came as a result of these recommendations.