bluuebunny/crossref_metadata_2025 huggingface dataset:
α-Tocopherol (vitamin-E) ameliorates ferric nitrilotriacetate (Fe-NTA)-dependent renal proliferative response and toxicity: diminution of oxidative stress
Authors: Iqbal Mohammad , Rezazadeh Hassan , Ansar Sabah , Athar Mohammad
Published: July 2017

Ferric nitrilotriacetate (Fe-NTA) is a potent nephrotoxic agent. In this communication, we show the modulatory effect of DL-a-tocopherol (Vitamin-E) on ferric nitrilotriacetate (Fe-NTA)-induced renal oxidative stress, toxicity and hyperproliferative response in rats. Fe-NTA-treatment enhances the susceptibility of renal microsomal membrane for iron-ascorbate-induced lipid peroxidation and hydrogen peroxide generation which are accompanied by a decrease in the activities of renal antioxidant enzymes, catalase, glutathione peroxidase, glutathione reductase and glutathione-S-transferase and depletion in the level of renal glutathione. Parallel to these changes, a sharp increase in blood urea nitrogen and serum creatinine has been observed. In addition, Fe-NTA-treatment also enhances renal ornithine decarboxylase activity (ODC) and increases [3H]thymidine incorporation in renal DNA. Prophylactic treatment of animals with Vit.E daily for 1 week prior to the administration of Fe-NTA resulted in the diminution of Fe-NTA-mediated damage. Enhanced susceptibility of renal microsomal membrane for lipid peroxidation induced by iron-ascorbate and hydrogen peroxide generation were significantly reduced (P50.05). In addition, the depleted level of glutathione and inhibited activities of antioxidant enzymes recovered to significant levels (P50.05). Similarly, the enhanced blood urea nitrogen and serum creatinine levels which are indicative of renal injury showed a reduction of about 50% at a higher dose of Vit.E. The pretreatment of rats with Vit.E reduced the Fe-NTA-mediated induction in ODC activity and enhancement in [3H]thymidine incorporation in DNA. The protective effect of Vit.E was dose dependent. In summary, our data suggest that Vit.E is an effective chemopreventive agent in kidney and may suppress Fe-NTA-induced renal toxicity.
Immunoglobulin levels in workers exposed to hexachlorobenzene
Authors: Queiroz M LS , Bincoletto C , Perlingeiro R CR , Quadros M R , Souza C A
Published: July 2017

The serum immunoglobulin (IgG, IgM and IgA) concentrations of 52 chlorinated-exposed workers were examined and compared with those of non-exposed, age- and sex-matched individuals. At the time of testing, the exposed population had mean hexachlorobenzene (HCB) blood levels of 3.84 mg/dl with a range of 0.1 to 16 mg/dl. Increased IgG and IgM levels were found in the HCB- exposed workers (P50.05 and P50.01, respectively). Hepatic function was evaluated by serum aspartate (AST) and alanine aminotransferase (ALT) activities, as well as by bilirubin levels. IgM concentrations were positively correlated with three of the studied parameters, namely, length of exposure (r=0.367) and the activities of both AST (r=0.367) and ALT (r=0.507).
Sites of lead and nickel accumulation in the placental tissue
Authors: Reichrtová Eva , Dorociak František , Palkovičová Lubica
Published: July 2017

1 There is a variety of quantitative analytical data regarding the total concentrations of heavy metals in human placentae. However, little is known about sites of metal accumulation in the placental tissue structural zones in relation to the environment. In this study, the lead and the nickel particulate deposits in the placental chorionic plate, the chorionic villous tree and the basal plate, using tissue histochemical reactions for lead and nickel, have been estimated. The degree of metal contamination of placentae was assessed according to an arbitrary scale. Both metals have shown a common mode of accumulation in the placental tissue structural zones. Among the observed contaminated structures in the placental tissue, the syncytiotrophoblast was the most frequent site for lead and nickel particulate deposits.

2 The frequency distribution of both metals within the mentioned placental zones, using four metal contamination degrees, was determined. A heavily contaminated zone was found to be the chorionic villous tree, especially in samples from the industrial region.

3 A comparison between two Slovak regions (an industrial and a rural one) using statistical tests was performed. The frequency of samples without any lead occurrence in the chorionic villous tree was found to be 10% in the industrial region, and 16% in the rural region. Regarding the nickel deposits, the frequency of non-contaminated samples in the industrial region was 2%, whereas in the rural region 6%. A relationship between traffic related pollution and human placenta contamination was found in both investigated regions.
Captopril as an antioxidant in lead-exposed Fischer 344 rats
Authors: Gurer Hande , Neal Rachel , Yang Ping , Oztezcan Serdar , Ercal Nuran
Published: July 2017

1 Recent studies suggest that lead induces oxidative stress in various tissues.

2 Captopril ([2S]-1-[3-mercapto-2-methylpropionyl]-L-proline), an angiotensin-converting enzyme inhibitor, is a well-known antihypertensive agent and is also believed to function as an antioxidant.

3 In the present study the antioxidant effect of captopril on lead-induced oxidative stress was studied in Fischer 344 rats. Their liver, brain and kidneys were assayed for glutathione (GSH), glutathione disulfide (GSSG), malondialdehyde concentrations, and catalase activities. The results from animals treated with captopril were compared to results of control and lead-exposed non-treated groups.

4 The captopril-treated samples showed higher GSH:GSSG ratios in the liver, brain and kidneys, as well as slightly decreased malondialdehyde concentrations. The catalase activity was not significantly affected.
Airway epithelial damage and release of inflammatory mediators in human lung parenchyma after sulfur mustard exposure
Authors: Calvet J H , Gascard J-P , Delamanche S , Brink C
Published: July 2017

This study was performed to evaluate the morphological effects of sulfur mustard on human lung parenchyma in vitro and to measure the metabolites of arachidonic acid which are released during acute exposure to the alkylating agent. Histological analysis of the tissue following exposure to sulfur mustard for a period of 45 min at 10 mM revealed the presence of paranuclear vacuoles in the epithelium, specifically, in the ciliated cells. The release of metabolites of arachidonic acid were determined in the bath fluids by an enzymo-immunoassay. The basal release of prostaglandin E2 (PGE2:1.36±0.33 ng/g tissue) and 6- keto prostaglandin F1α (6-keto PGF1α: 8.83±1.17 ng/g tissue) were not modified during tissue exposure to sulfur mustard (45 min, 0.1 mM). In addition, the basal release of cysteinyl-leukotriene E4 (LTE4: 1.55±0.44 ng/g tissue) was also not altered by challenge of the tissues with sulfur mustard. In contrast, when the human lung parenchyma was stimulated with anti human IgE (anti-IgE) only the basal release of the metabolite of the 5-lipoxygenase pathway was significantly increased (LTE4: 6.84±1.57 ng/g tissue).

These data suggest that sulfur mustard may produce morphological alterations in epithelial cells and at the time point studied (45 min exposure), this effect is not associated with a release of arachidonic acid metabolites. However, the increased release of LTE4 by anti-IgE suggests that the target cells for sulfur mustard and anti-IgE in the human lung may be different.
Population and Welfare in Industrial Societies
Authors: Davis Kingsley
Published: July 2017

This is the Fourth Annual Dorothy Nyswander Lecture. It was delivered in Berkeley, April 6, 1960. The lectureship was established in honor of Dr. Nyswander upon her retirement as Professor of Health Education at the University of California.
An evaluation of tumor necrosis factor microsatellite alleles in genetic susceptibility to multiple sclerosis
Authors: Sandberg-Wollheim M , Ciusani E , Salmaggi A , Pociot F
Published: July 2017

We have analyzed the distribution of tumor necrosis factor (TNF) a and-b microsatellite alleles in HLA-DQ and-DR typed Swedish patients with multiple sclerosis (MS) (n=l22) and ethnically matched control subjects (n=l78). We found significant differences in the frequencies of TNFa and TNFb alleles between patients and controls. TNFal I was significantly associated with MS. This was also the case for the combination of TNFal I with TNFb4. However, TNFal I (alone or in combination with TNFb4) did not show any disease association independent of DQA 1*01021 DQBI*0602/DR2, whereas the previously reported strong association with HLA-DQAI*0102/DQBI*0602/DR2 in Scandinavian populations was confirmed. Therefore the association of TNFal I (and TNFb4) is most likely secondary to the increase of DQAI*0102/DQBl*0602/DR2 in MS patients. The proportion of TNFa6 positive individuals was lower among DR2-negative MS patients than among DR2-negative controls (p=0.08). Since the presence of the TNFab allele correlates with low TNFα production in response to lipopolysaccharide, it could be speculated that DR2-negative MS patients have an increased risk of being high TNFα producers in response to exogenous stimuli.
Causal Analysis and Ecological Fallacy in Cross-national Epidemiological Research
Authors: Kalimo Esko , Bice Thomas W.
Published: July 2017

This paper has two interrelated purposes. First, we examine the usefulness of a statistical technique derived from a causal model, i.e., path analysis, in the analysis of cross-national epidemiological data. With this method, the data analysis can be conducted according to the causal relations among the variables specified by the theory. In this way, the statistical analysis of the data and the testing of causal hypotheses are tied together more closely than when using other statistical techniques. Second, we scrutinize the importance of the analytical unit in the interpretation of the results, by comparing within-area results, based on individuals, with results calculated across the areas, using aggregate data. Because of the “ecological fallacy”, interpretations on individuals cannot usually be made on the basis of area level results. The results are demonstrated by using data from a cross-national study incorporating 48 subpopulations in seven countries.
Socio-medical Aspects on Previously Hospitalized Psoriatics in a Metropolitan Area
Authors: Molin Lars
Published: July 2017

Socio-medical circumstances have been studied in previously hospitalized psoriatics living in a metropolitan area. The patterns seen in male and female psoriatics differed. The males were less often gainfully employed, belonged to a lower social class, and had lower incomes than their contrasts. The differences were mostly small, however. The females, on the other hand, were more often gainfully employed, belonged to a higher social class, and had higher incomes than their contrasts. The differences were relatively large and were of statistical significance. In the material studied there was also a marked difference according to sex as regards the severity of psoriasis. The severity of the course of the disease was more severe in the males than in the females. The subjective complaints, however, were assessed almost equal in males and females. The social variables studied could not be convincingly related to the severity of psoriasis or to the subjective assessment of complaints due to the skin disease. Factors other than psoriasis per se were considered more significant, such as primarily varying ability amongst psoriatics to utilize the available medical facilities. Apart from psoriasis itself, the greater morbidity in the psoriatics as compared with their contrasts indicated that psoriatics were more likely to seek hospital treatment for psoriasis if they also had other diseases.
The Patient-centred, Family Working Group—a Medium for Collaboration with the “Unmotivated” Family Members
Authors: Vaglum Per
Published: July 2017

One vital factor which must be changed if a hospitalized mental patient is to stand a chance of staying out of hospital is often the problem-solving capacity of the nuclear family. It is a characteristic of the families of many of our patients that, at the time of hospitalization, they have almost given up hope of solving the problems of the patient concerned and show few signs of ability to adapt or of motivation to define themselves as patients. This paper describes a model and one way of increasing the problem-solving capacity of such a family by inviting the family members to take part in group work where the development and treatment of said patient is the primary goal. The family member is then offered the role of a “co-worker” instead of “patient” or “co-therapist”.
Cooperation between Medical and Social Services
Authors: Westrin Claes-Göran
Published: July 2017

Three basic questions can be posed regarding the coordination between medical and social services:

1. What will be gained by coordination?

2. What does the concept of coordination imply?

3. How is cooperation in the field (objectives, direction and form) to be organised?

This paper deals mainly with the third question, as illustrated by the planning and experiences of the health centre in Skara, a town in the west of Sweden. In this health centre there is a co-localization of the health and medical services and the social services of the municipality. The cooperation is also structured through different types of consultative groups at the political level as well as in the practical work in the field.

The paper also discusses some general principles regarding the cooperation between medical and social services and presents results from some screening studies regarding the need for such cooperation.
Dangerous Alcoholics
Authors: Hagnell Olle , Nyman Eberhard , Tunving Kerstin
Published: July 2017

Alcoholics registered as dangerous to others were compared, by means of a health questionnaire and individual testing, with a suicidally inclined group and non-dangerous alcoholic controls. Dangerous subjects reported conspicuously few nervous complaints, whereas the suicidal group was characterized by a broad spectrum of symptoms including paranoid, depressive and aggressive feelings as well as tiredness and irritability. Intellectually they were found to be rather verbal. The controls formed an intermediate group as to the variables applied. The results tend to confirm a hypothesis of a psychopathic-neurotic continuum as a major differentiating factor between the groups.
On Factors Complicating Rehabilitation of Psychiatric Patients
Authors: Sakki Pekka , Sorri Pentti , Virkkunen Matti
Published: July 2017

Judging by previous studies, the factors most seriously complicating the rehabilitation of psychiatric patients include the underdeveloped state of society, the symptoms and detrimental consequences of the patients' disorders, the harmful consequences of prolonged institutionalization and the problems associated with home and family.

The sample of this study consisted of 104 patients who were under treatment at the University Psychiatric Clinic, Helsinki, on November 30, 1971. No old people or children were included. The subjects' educational and intellectual levels were above average, and the proportion of patients with grave disorders in the sample was smaller than in psychiatric hospitals in general. The sample included no addicts.

The attending doctor filled out, for each subject, a questionnaire, on which information was provided about the subject's psychosocial background, recommendations made for his treatment and rehabilitation, and the most serious obstacles to his rehabilitation were assessed. A number of “recommendation” and “obstacle” alternatives were listed in the form, from which 4 and 5 respectively of the most important were chosen.

The patients' psychic disorders, problems associated with their families and homes, unrealistic hopes and expectations, and lack of motivation proved the most serious obstacles to rehabilitation. Typical of all these is their somewhat individual-centred nature. They were apparently linked with the reasons why the patients had come to hospital for treatment and with the rehabilitational goals the respondents had had in mind. Obstacles that can be characterized as social were of little significance, housing problems being the only exception here. The authors feel that caution should be observed in drawing generalized conclusions from these results, because the results of studies on rehabilitation are in general closely tied up with the population or sample studied as well as the environment and society.
Mortality among Finnish Doctors, 1953–1972
Authors: Asp Sisko , Hernberg Sven , Collan Yrjö
Published: July 2017

The mortality with respect to the total population of Finnish physicians during the period 1953 to 1972 has been analysed and compared with the corresponding statistics for the general Finnish population, for Finnish foundry workers, and for American physicians. It was found that the overall mortality was lower for male physicians than that for the general population or for foundry workers, but was clearly higher than that for American physicians. Male physicians did not exhibit any major differences from the general population with regard to cardiovascular diseases and suicide, but had a lower mortality from malignant neoplasms, accidents and “other diseases” (including infectious diseases). The explanation of cancer mortality being lower than expected among male physicians was mainly to be found in a deficit in lung cancer. Although female physicians had higher life expectancy than male physicians and the female general Finnish population, they did not show any clear deficit for cancer. In respect of all specialists, surgical specialists had the lowest mortality; general practitioners had the highest mortality. Most of these variations were attributable to differences in coronary mortality, but mortality from lung cancer was also remarkably low among surgeons. Differences of a similar type were also found between occupational sub-categories; private practitioners had the highest, and research workers and central hospital physicians the lowest mortality figures. The lower cancer mortality among male physicians, as contrasted with the general population, is probably attributable to differences in smoking habits; about 22% of male physicians smoked in 1973, whereas earlier studies by others have indicated that the corresponding proportion was about 50% in the general population. In contrast, the differences in mortality between different specialist categories probably arises from other factors, since Finnish physicians reportedly display a relatively homogeneous smoking pattern.
The Dynamics of Perinatal Mortality: Maternal Age, Parity and Legitimacy
Authors: Edouard Lindsay
Published: July 2017

The perinatal mortality rates according to maternal age, parity and legitimacy in England and Wales in 1977 were applied to the distribution of the obstetric population of 1968. Demographic changes contributed about 7% of the improvement in perinatal mortality rate
Grounds for Disability Pension
Authors: Elton Martin , Hörnquist Jan Olof
Published: July 2017

Current social legislation in Sweden prescribes a great degree of restrictivity in the granting of disability pensions to young abusers of alcohol. In order to test whether his prescription is really applied, a comparison between 29 abuser applicants up to age 46 and 32 over the age of 6 years was carried out. The total of 61 abusers represented all 78 first-time applicants with an abuse over a period of 1 1/2 years who were living in a geographically defined, mixed urban–rural region in the Swedish county of Östergötland. The period lasted from 1st January 978 until 1st July 1979. The participants' quality of life was examined in a multidisciplinary fashion. In line with the prescribed restrictivity, the younger group proved to the fundamentally worse, primarily in socio-psychological and psychiatric respects. In addition, they also demontrated a greater degree of alcohol injury. Besides the legislative situation, even situational conditions were proposed as explanatory factors for the empirical findings. This is the fourth report from the research project “Abuse of alcohol – Disability pension – Quality of life”.
Medico-legal Aspects of Malignant Mesothelioma
Authors: Mowé Gunnar , Gylseth Bjørn
Published: July 2017

The object of this investigation was to discuss medico-legal aspects of malignant mesothelioma in relation to social insurance legislation for occupational injuries and diseases in Norway. During the period 1960–79 the Cancer Registry of Norway recorded a total of 155 men and 35 women with malignant mesothelioma. However, only 21 men and no women were notified to the National Insurance Institution as occupational disease cases before 31 December 1979, in spite of the well established causal association between occupational asbestos exposure and the disease. The investigation is based on these 21 patients. The long latency period from first asbestos exposure until appearance of the disease and the short survival were evident in this study. Furthermore, the legislation and provisions for occupational injuries and diseases in Norway are obviously intended for occupational accidents, and consequently the legal assessment of patients with malignant mesothelioma was complicated. For those notified, the delay in notification was considerable, and only 50% were notified before death. Delay in the claim procedure was also substantial, and few patients survived the claim procedure period. The decisions were not consistent, particularly decisions regarding “the year of injury” and appeared to have been more restrictive during recent years. One of the 21 cases was not accepted as occupational disease, because domestic exposure was considered more probable than occupational exposure.
Predictors of Mortality in a Disabled and Elderly Population Receiving Domiciliarly Based Services
Authors: Kivelä Sirkka-Liisa
Published: July 2017

Predictors of mortality were evaluated after a period of 26 months for 218 persons receiving domiciliary nursing and/or domiciliary assistance. They were living in Posio, a rural commune in northern Finland. Twenty-six (12%) persons died during the follow-up of 26 months. The prospects for survival were slightly poorer among the persons with a poor physical mobility and among those living together with their spouse, and slightly better for those persons who lived alone as compared with persons living with another person or persons. The predictions of mortality among long-term home-care patients seemed not to be the same as those of the institutionalized aged population. The findings warrant further research in this respect.
Smoking habits in East Denmark at October 1979
Authors: Roed-Petersen Bjarne
Published: July 2017

In October 1979 an Omnibus Interview Survey was carried out covering 2308 persons living in Denmark east of the Great Belt. Type and amount of tobacco consumption were registered. The multivariate structure of the data was examined by the use of a log linear model for the pinpointing of sufficient marginals among multiple contingency tables. An important finding was that among today's teenagers, more have started smoking before the age of 14 than ever before, viz. 64% of males and 77% of females. The outlines for a person-oriented antitobacco intervention program mediated by medical and dental doctors is outlined. Apart from humanitarian aspects, a cost benefit analysis may well show that an intervention program may save money in the long run.
Predictability of School Absence for Rate of Sick Leave
Authors: Bremberg Sven , Mikaelsson Bo
Published: July 2017

School absence was studied in all children in grade 8 (mean age 15 years) in the municipality of Linköping during the school year 1969–70. The mean absence rate was 51 lessons per year. At the mean age of 27 years, 11–13 years later, information from the Swedish Social Insurance Office was collected in a 25% random sample. The median rate of sick leave was 5.3 days per year, the median number of sickness spells, 1.7 per year, the median number of days per sickness spells, 3.0 and the median income 77 000 SEK per year. Spearman rank correlation coefficients were calculated, separately for women and men, between absence rate in grade 8 on the one hand and different rates of sick leave and income on the other. For women, rs ranged between −0.06 and 0.14, for men, −0.16 to 0.21. Thus the predictive ability of school absence for rate of sick leave was found to be very low.
Relative survival of terminal cancer patients in home versus hospital care
Authors: Tsamandouraki Kiki , Tountas Yannis , Trichopoulos Dimitrios
Published: July 2017

A non-randomized study was undertaken in 1980–1982 to compare the effectiveness of home care versus hospital care for patients suffering from terminal stages of malignant diseases at a large cancer hospital in Pireaus, Greece and in the surrounding community. The survival pattern of 101 patients with malignant disease at various stages enrolled in a home care program for terminal patients was compared with the survival pattern of a matched comparison group of an equal number of hospital treated cancer patients. The two groups were matched for age, sex, time of initial diagnosis, primary tumor and stage of the disease at the time of diagnosis. The comparison of the survival curves was done using the logrank test taking into account censored observations. The results indicate that, under the conditions prevailing while this study was undertaken, home care was less effective compared to hospital care when survival was used as the only outcome criterion.
Pharmacy Technician Educators' Attitudes toward Education and Training Requirements for Pharmacy Technicians
Authors: Moscou Kathy D
Published: July 2017

Objective:

To poll members of the Pharmacy Technician Educators Council (PTEC) to determine their attitudes toward the level of education and training necessary for pharmacy technicians to perform current and expanded duties.

Methods:

A convenience survey was developed and sent to 130 PTEC member training programs. PTEC members include directors of college, vocational, and on-the-job training programs.

Results:

Thirty-seven PTEC members responded, yielding a response rate of 28.5%. Responses reflected the opinions of directors of pharmacy technician programs from 19 states. All respondents agreed that the length of training for pharmacy technicians should be standardized. They also agreed that minimum competencies should be established for pharmacy technicians and that examination should be required to obtain certification or licensure that would then enable the technician to be employed in the field.

Conclusions:

The use of pharmacy technicians will likely increase, as will the duties pharmacy technicians perform. Expansion of the role of pharmacy technicians, however, must be in tandem with standardizing training and establishment of competencies for pharmacy technicians. Increased responsibilities should be commensurate with increased education and national examination should be required to determine competency.
Sustained Manic Delirium
Authors: Schwartz Thomas L , Dewan Mantosh J , Armenta Wendy A
Published: July 2017

Objective:

To report a case of bipolar I disorder with psychotic features that resembled a sustained episode of delirium.

Case Summary:

A 54-year-old white woman with bipolar I disorder developed severe, sustained psychosis resembling delirium. These symptoms resolved following several pharmacologic interventions.

Discussion:

Manic delirium is an extreme manifestation of bipolar disorder. The primary symptoms of manic delirium are confusion, agitation, altered levels of consciousness, and perceptual disturbances. Our patient developed typical symptoms of manic delirium; however, this case differed in terms of increased duration of symptoms and decreased treatment efficacy.

Conclusions:

Bipolar disorder with psychotic features may present as a delirious episode. Combination therapy may be an appropriate intervention when pharmacologic monotherapy fails.
Inhaled Corticosteroids in Young Asthmatic Children: Association with Hypercalciuria
Authors: Bentur Lea , Bibi Haim , Bentur Yedidia
Published: July 2017

Introduction:

The use of inhaled corticosteroids (ICS) via infant aerochamber in young, asthmatic children is increasing. However, concern has been raised about its long-term impact. Hypercalciuria is a known adverse effect of systemic corticosteroids.

Objective:

To determine whether ICS-induced hypercalciuria occurs in young, asthmatic children.

Setting:

Two outpatient clinics.

Methods:

Urinary calcium/creatinine ratio (UCa/Cr) was determined in 32 asthmatic children (age 6–36 mo) who were receiving inhaled budesonide or beclomethasone 200–600 μg/d for two to three months. A control group of asthmatic children within the same age range (n = 23) who did not receive ICS was included. None of the children were receiving oral corticosteroids, diuretics, antibiotics, or theophylline.

Statistics:

Student's t-test and χ2 analysis.

Results:

The treated and control groups were similar with regard to age and male/female ratio. Mean ± SD UCa/Cr was significantly higher in the asthmatic children receiving ICS (0.23 ± 0.19 vs. 0.09 ± 0.07, respectively; p = 0.002). Fourteen (43.75%) of the treated patients had hypercalciuria (UCa/Cr >0.2) compared with only one (4.35%) in the control group (p = 0.002). Renal ultrasonography failed to demonstrate nephrocalcinosis in eight of the treated hypercalciuric patients.

Conclusions:

Treatment of young, asthmatic children with ICS may be associated with hypercalciuria. More studies are needed to evaluate the clinical significance of this finding.
Methemoglobinemia: A Recurring Complication of Topical Benzocaine Spray
Authors: Shaw Robert F , Mathew Anitha
Published: July 2017

Objective:

To report a case of acute methemoglobinemia in a patient undergoing a transesophageal echocardiogram (TEE) after administration of topical benzocaine spray.

Case Summary:

An 80-year-old white man with a history of coronary heart disease developed severe cyanosis one hour after a TTE. The patient was taken to the intensive care unit where he was diagnosed with acute methemoglobinemia. The patient was treated with methylene blue and successfully resuscitated. He recovered and was transferred out of the intensive care unit.

Discussion:

Acute methemoglobinemia is a problem that is infrequently encountered in clinical practice and, unless the practitioner is alert to the possible diagnosis, methemoglobinemia is capable of producing a potentially fatal outcome. The rise in bronchoscopies, endoscopies, and TEEs has resulted in an accompanying increase in reporting of acquired methemoglobinemia from benzocaine spray as well as other local anesthetics and medications. The drug of choice for treatment of methemoglobinemia is methylene blue administered at 1–2 mg/kg.

Conclusions:

Quick recognition, diagnosis, and prompt treatment with methylene blue are keys to a successful outcome.
Demystifying the Cardiopulmonary Code Team Response
Authors: Bardas Sandra L.
Published: July 2017

Objective:

To familiarize the reader with the sequence of events in a hospital-based cardiopulmonary resuscitation.

Data Sources:

The American Heart Association's Textbook of Advanced Cardiac Life Support and the Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care.

Data Extraction:

The roles and responsibilities of members of the cardiopulmonary code team are discussed.

Data Synthesis:

A typical code sequence is described, with emphasis on drug therapy.

Conclusions:

This information will provide a better understanding of the cardiopulmonary resuscitation team response and, in particular, the role of the pharmacist as an integral team member.
A Primer of Drug Safety Surveillance: An Industry Perspective
Authors: Allan Marjorie C.
Published: July 2017

Objective:

To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part I of this series provides a background for the discussion of drug safety by defining the basic terms and showing the flow of safety information through a pharmaceutical company. The customers for adverse drug event data are identified to provide a basis for providing quality service. The development of a drug product is briefly reviewed to show the evolution of safety data. Drug development and safety are defined by federal regulations. These regulations are developed by the FDA with information from pharmaceutical manufacturers. The intent of the regulations and the accompanying guidelines is described. An illustration from the news media is cited to show an alternative, positive approach to handling an adverse event report.

Data Sources:

This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text and additional readings are presented in an appendix. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention.

Study Selection:

The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance.

Data Synthesis:

The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Database management is subdivided into the functions of receipt, retention, retrieval, and review of adverse event reports. Emphasis is placed on the dynamic interaction of the components of the process. Suggestions are offered to facilitate communication of a review of adverse event data for various audiences.

Conclusions:

Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of the manufacturer. Attention to basic principles is essential and, as illustrated, may be sufficient to resolve some problems.
Variability in Drug Administration Times among Patients with Coronary Artery Disease
Authors: Bleske Barry E. , Cornish Laura A. , Boyd Eddie L. , Shimp Leslie A. , Shea Michael J.
Published: July 2017

Objective:

Previous studies have shown that cardiac disease is influenced by circadian rhythms, resulting in a high incidence of cardiac events occurring in the morning hours. Before determining if adjusting drug administration times will influence the effect of these circadian rhythms, it is necessary to know when patients take their medication. Therefore, the objective of this study was to determine when patients take their anti-ischemic medication in relationship to their sleep/wake cycle.

Design:

Patients with a history of coronary artery disease were identified by screening consecutive medical charts from a cardiology outpatient clinic at a university teaching hospital. Data were collected by telephone interview with a survey instrument.

Participants:

A total of 57 patients were included in the study (41 men, mean age 61.8 ± 10 years; and 16 women, mean age 62.8 ± 10.4 years).

Outcome Measures:

The survey addressed the relationship between sleep/wake cycle and medication administration times, along with activities performed prior to taking morning medication.

Results:

Approximately 46 percent of the patients took their anti-ischemic medication upon awakening and 28 percent of the patients took their anti-ischemic medication more than 30 minutes after awakening. Of the 31 patients requiring evening dosing of their anti-ischemic medication, 45 percent took their medication at bedtime and 39 percent of the patients took their medication more than three hours before bedtime. Major activities patients undertook prior to taking their morning medications included urination/defecation, eating breakfast, and getting dressed.

Conclusions:

This study showed that there is variability in the time of drug administration among cardiac patients, which may be important regarding circadian variation and cardiac disease. Additional counseling by pharmacists in regard to drug administration times and circadian rhythms may be warranted following further studies.
Apparent Hemolysis in an AIDS Patient Receiving Trimethoprim/Sulfamethoxazole: Case Report and Literature Review
Authors: Reinke C Michael , Thomas Jennifer K , Graves Allen H
Published: July 2017

Objective:

To describe a case of acute hemolysis associated temporally with administration of trimethoprim/ sulfamethoxazole (TMP/SMX) in a patient with AIDS, review the available literature on TMP/SMX-induced hemolytic anemia, and discuss possible drug- and disease-related factors that may have contributed to the episode of hemolysis.

Case Summary:

A precipitous decrease in red blood cell count, hemoglobin, and hematocrit occurred shortly after a black woman with AIDS received a single intravenous dose of TMP/SMX for Pneumocystis carinii pneumonia. Following drug discontinuation and repeated transfusions, the patient's hematologic indices returned to baseline.

Literature Sources:

References were obtained using MEDLINE searches, the bibliographies of articles identified during the searches, review articles, and standard textbooks.

Data Synthesis:

Of the two different mechanisms of TMP/SMX-induced hemolytic anemia, the reaction is most likely to occur via dose-related oxidative disruption of the erythrocyte membrane in subpopulations deficient in glucose-6-phosphate dehydrogenase (G6PD) activity. In the US, G6PD deficiency most frequently is encountered among blacks. The potential for hemolysis may be further increased in G6PD-deficient AIDS patients, who also appear to lack adequate intracellular glutathione, which is essential for protecting the erythrocyte membrane from oxidative damage. Although an assay for G6PD activity was not conducted, the case circumstances were consistent with TMP/SMX-induced hemolysis in a G6PD-deficient patient.

Conclusions:

Black patients with AIDS who are receiving relatively high (≥50 mg/kg/d) dosages of TMP/SMX should be monitored closely for signs and symptoms of hemolytic anemia.
Effect of Low-Dose Fluconazole on Theophylline Serum Concentrations in Healthy Volunteers
Authors: Feil Rebecca A , Rindone Joseph P , Morrill Gregory B , Habib Michael P
Published: July 2017

Objective:

To determine whether fluconazole alters theophylline serum concentrations at steady-state in healthy volunteers.

Design:

Ten healthy subjects were administered controlled-release theophylline 150 mg bid for 10 days. Theophylline serum concentrations were measured at steady-state on day 4 to establish a baseline concentration. Fluconazole 100 mg/d was then administered beginning on day 4 through day 10. Theophylline serum concentrations also were measured on days 7, 9, and 11 of the study. Mean theophylline serum concentrations were compared before and during fluconazole administration. Statistical analysis was performed using repeated measures ANOVA.

Setting:

This study was undertaken in the outpatient department at the Tucson Veterans Affairs Medical Center.

Results:

No statistically significant differences in mean theophylline serum concentrations were noted on days 7, 9, and 11 compared with baseline.

Conclusions:

These data show that fluconazole 100 mg/d had no significant effect on theophylline serum concentrations in healthy volunteers.
Phenytoin Prophylaxis in Posttraumatic Head Injury
Authors: Ohimor Stephen O , Falcone Robert E
Published: July 2017

Objective:

To identify the effectiveness of prophylactic phenytoin in preventing posttraumatic epilepsy.

Design:

Retrospective cohort study.

Setting:

Urban tertiary-care hospital and trauma center.

Subjects:

Patients admitted to the trauma service in 1989 with moderate to severe head injury surviving to discharge.

Interventions:

Divided into two groups based on prophylaxis with phenytoin.

Measurements and Main Results:

Ninety-one patients with moderate to severe head injury were admitted during the study period; 6 were excluded from analysis for prehospital seizure activity. Forty-one patients received no anticonvulsants; 44 received phenytoin alone or in combination with other agents. None of the patients experienced a seizure during hospitalization. Seventy-four percent of all phenytoin concentrations were subtherapeutic (serum phenytoin 10–20 μg/mL).

Conclusions:

The lack of seizure activity in the face of absent or subtherapeutic phenytoin concentrations brings into question the benefit of prophylactic therapy.
Vitamin K1-Induced Anaphylactic Shock
Authors: Aziz Noorizan Abdul , Kamaruddin Zaitun , Hassan Yahaya , Jaalam Kamarudin
Published: July 2017

Objective:

To report a case of anaphylactic shock induced by the rapid intravenous administration of vitamin K1 in a patient in the intensive care unit (ICU).

Case Summary:

A 9-year-old Malay girl was admitted to the ICU and was diagnosed with Guillain-Barré syndrome. She developed an allergy to atropine that was manifested by a symmetric generalized transient macular rash over the trunk; it subsided 10 minutes after the drug was stopped. About 7 hours later, vitamin K1 10 mg iv was administered over 3 minutes due to the slight prolongation of prothrombin time and activated partial thromboplastin time. Immediately after the drug was administered, the patient developed a generalized transient macular rash, cyanosis, and shock. Her blood pressure and heart rate could not be detected. She responded well, however, after resuscitation.

Discussion:

Anaphylactic shock in this patient was most probably caused by the intravenous administration of vitamin K1, because this event occurred immediately after its administration. There have also been a few reported cases of severe reaction and death associated with intravenous administration of vitamin K1. The likelihood that the incident was drug-related could be classified as “probable” based on Naranjo's causal relationship algorithm.

Conclusions:

Rapid intravenous administration of vitamin K1 may induce anaphylactic shock in a critically ill patient with hemodynamic instability. If vitamin K1 is required, oral administration is preferred because it is rarely associated with severe reactions. Intravenous administration of vitamin K1 should be considered only in an emergency situation and the rate of administration should not exceed 1 mg/min.
Copper Deficieny in a Patient with AIDS Cholangiopathy and Cryptosporidium Diarrhea
Authors: Odell Timothy W , Cerveny Joli D
Published: July 2017

Objective:

To report a case of leukopenia caused by copper deficiency in a patient with AIDS cholangiopathy and Cryptosporidium diarrhea who required total parenteral nutrition (TPN).

Case Summary:

A 36-year-old white man with AIDS had Cryptosporidium diarrhea, and produced a daily stool volume of 3–5 L. He also had AIDS cholangiopathy, with intra- and extrahepatic biliary dilation and an alkaline phosphatase concentration of 3,000 U/L. He required TPN. Since copper is excreted primarily through the bile, it was omitted from his TPN. The patient then developed progressive leukopenia. His plasma copper concentration dropped to 10.2 μg/dL. Copper was subsequently added to the TPN, and the white blood cell count returned to normal.

Discussion:

A review of the literature showed that neither HIV infection nor AIDS is associated with copper deficiency. Copper deficiency has been reported as a rare complication of TPN or malabsorption, but it was not expected as a result of AIDS cholangiopathy.

Conclusions:

Copper supplementation is required in TPN in patients with chronic diarrhea and AIDS cholangiopathy. Additionally, copper deficiency is a potential cause of leukopenia in patients with AIDS who are receiving TPN or who have chronic diarrhea.
Risperidone for Treatment-Resistant Schizophrenia: Initial Clinical Experience in a State Hospital
Authors: Buckley Peter F , Donenwirth Karl , Bayer Kenneth E , Lys Christine , Ibrahim Zafar , Schulz S Charles
Published: July 2017

Objective:

To examine the efficacy of risperidone, a new antipsychotic with combined serotonergic-dopaminergic antagonism, in patients with treatment-resistant schizophrenia in state facilities.

Methods:

Brief Psychiatric Rating Scale (BPRS) evaluations were performed on 21 patients with schizophrenia who had received risperidone therapy for 10 weeks in a state facility.

Results:

Five patients showed a 20% reduction on their pretreatment BPRS score. A corresponding number of patients showed an increased BPRS score during treatment, and the remainder attained a modest reduction (2–17%) in symptoms on the BPRS.

Conclusions:

Although risperidone was an effective antipsychotic for patients with chronic treatment-resistant schizophrenia, only a subgroup of these patients achieved substantial clinical improvement over a 10-week period.
Suggested Transition from Oral to Intravenous Amiodarone Therapy
Authors: Korth-Bradley Joan M
Published: July 2017

Objective:

To provide clinicians with a basis from which to decide the appropriate intravenous dosage of amiodarone in patients who are currently taking oral amiodarone.

Data Sources:

English-language articles describing the pharmacokinetics of amiodarone were collected through literature searches of the Index Medicus database over a period of approximately 4 years. Reference lists from the publications were reviewed to search further for original articles.

Study Selection:

Data were rejected only if there was reason to doubt the validity of the pharmacokinetic parameters reported. For example, dose administration, sample collection times, and pharmacokinetic analysis procedures had to be clearly stated.

Data Extraction:

Data describing the pharmacokinetics, particularly the half-life, of amiodarone after discontinuation of long-term oral treatment were extracted from the articles.

Data Synthesis:

No formal methods were used to combine the data.

Conclusions:

Based on pharmacokinetic considerations, no intravenous replacement treatment is necessary in patients for whom oral administration is contraindicated for less than 2 weeks and who have received adequate loading doses of amiodarone. Intravenous amiodarone may be administered at half the dosage of oral amiodarone, assuming a bioavailability of 50%, to patients for whom oral administration is contraindicated for an undetermined time or in whom a steady-state concentration is unlikely to have been reached.
Topical Aminophylline: Is it Safe and Effective in Causing Regional Fat Loss?
Authors: Tong Lisa M , Gericke Kristin R
Published: July 2017

Objective:

To provide a better understanding of the efficacy and possible adverse effects of topical aminophylline in causing regional fat loss.

Data Source:

Pertinent English-language literature (1958–1995).

Study Selection:

Representative articles documenting mechanisms of action and types of drug-induced reactions, as well as treatment options.

Data Extraction:

Data were extracted only from articles that documented relevant and substantive information backed by clinical studies.

Data Synthesis:

Topical aminophylline 2% thigh cream has been introduced as a method of treating cellulite, or dimpled thighs and buttocks. The proposed method of action is by increasing local concentration, thereby stimulating lipolysis. Data from two small clinical trials showed that the cream reduced thigh girth and had no known adverse effects. However, adverse dermatologic effects caused by aminophylline have been reported in the past.

Conclusions:

Topical aminophylline cream appears to be a reasonable option for regional reduction of thigh girth for some people and has not shown any adverse effects. Nevertheless, larger, long-term studies need to be done.