bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of rectal gonorrhoea and chlamydia on HIV viral load in the rectum: potential significance for onward transmission
Authors: Davies Olubanke , Costelloe Sinead , Cross Gemma , Dew Tracy , O’Shea Siobhan , White John , Fox Julie
Published: January 2017

The aim of this study was to investigate the effect of asymptomatic rectal bacterial sexually transmitted infections (STIs) on rectal HIV viral load (VL). A prospective cohort study of HIV-positive men who have sex with men attending a tertiary centre in London, UK, for their routine HIV care was performed. Forty-two HIV-positive men who have sex with men were recruited between January and August 2014. In participants on antiretroviral therapy (ART), there was no significant difference in rectal VL in those with and without STI ( p = 0.4). All rectal HIV VLs were below the limit of detection (<100 copies/µg of total RNA) whether an STI was present or not. In those not on ART, rectal HIV VL was on average 0.6log10 lower post STI treatment. The presence of asymptomatic rectal chlamydia and gonorrhoea was not associated with increased rectal HIV VL in those fully suppressed on ART. In the context of effective ART, the presence of rectal gonorrhoea or chlamydia does not appear to increase rectal HIV VL and the risk of increased viral infectivity.
Genital lichen sclerosus developing around ‘ectopic’ urethral orifices supports the role of occlusion and urine in its pathogenesis
Authors: Gupta Vishal , Gupta Somesh
Published: January 2017

Several factors such as genetic susceptibility, autoimmunity, hormones, infections, local trauma, urine, and occlusion have been speculated to play a role in the pathogenesis of lichen sclerosus. We report two male patients with lichen sclerosus around ‘ectopic’ urethral openings and the opposing surfaces of the penile shaft and scrotum, providing further evidence in support of urine and occlusion as contributing factors in the development of lichen sclerosus.
GPs, STDs and Life Insurance
Authors: Keane F E A , Young S M
Published: January 2017

We sought to ascertain general practitioners' (GPs) views on their patients' attendances at genitourinary medicine (GUM) departments regarding methods of referral, record keeping and supplying of information to insurance companies.

A questionnaire was sent to 429 local GPs of whom 294 (68%) responded. A written means of referral was less likely for HIV than for sexually transmitted disease (STD) ( P<0.001), and in turn less likely for STD than for other genital problems ( P<0.02). The percentage of GPs who did not keep a record of referrals were: For HIV testing—29%; STDs—13%; and for other genital problems—8%. Whilst 48% of GPs did not feel obliged to divulge lifestyle information on a patient, 21% would feel it necessary to confirm that a patient had suffered from an STD if the ‘source’ on a cytology smear was shown to be that of a GUM department. Only 23 GPs (8%) felt they had sufficient knowledge as to the use to which the information they supplied to insurance companies was put.

Many GPs acknowledged that their practice, with reference to patient attendance at a GUM department, was influenced by life insurance considerations. Bearing in mind the current policy of The Association of British Insurers which recommends that all applicants for life insurance be asked to declare any previous STD and counselling/testing for HIV, we make several suggestions which may aid GPs in this difficult area.
Attitudes towards and Experience of General Practice among HIV-Positive Patients in the Republic of Ireland
Authors: Bradley Fiona , Bury Gerard , Mulcahy Fiona , O'Kelly Fergus , Shannon William , Langton-Burke Deirdre
Published: January 2017

In order to study their attitudes to and experience of general practitioner care, 150 attenders at the only HIV specialist clinic in the Republic of Ireland were asked to complete an anonymous, self administered questionnaire. (81%) of respondents reported having a regular GP and 94% of those indicated that the GP was aware of their HIV diagnosis. The majority (64%) of patients with a regular GP reported seeing their doctor on more than 5 occasions during the previous year. Most patients were satisfied with the support which they received from their GPs. Even so, the majority of patients (72%) would go directly to the hospital clinic for any problem which they perceive to be HIV related.
Seroprevalence and Incidence of Sexually Transmitted Diseases in a Rural Ugandan Population
Authors: Wagner H U , Van Dyck E , Roggen E , Nunn A J , Kamali A , Schmid D Scott , Dobbins J G , Mulder D W
Published: January 2017

The aim of the study was to determine in a rural population the age-and sex-specific prevalence and incidence rates of serological reactivity of 5 common sexually transmitted diseases (STDs) and their association with HIV-1 antibody status.

Of the adult population of two villages (529 adults aged 15 years or more) 294 provided an adequate blood specimen both on enrolment and at 12 months. The sera were tested at 3 collaborating laboratories for antibodies against HIV-1, Treponema pallidum, Haemophilus ducreyi, Chlamydia trachomatis and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). A sample of 45 children were tested for HSV-1 and HSV-2.

Seroprevalence rates in adults on enrolment were 7.8% for HIV-1, 10.8% for active syphilis, 10.4% for H. ducreyi, 66.0% for C. trachomatis, 91.2% for HSV-1 and 67.9% for HSV-2. Males were significantly more likely than females to be seropositive for H. ducreyi (15.6% versus 6.6%), but less likely to be HSV-2 antibody positive (57.0% versus 74.4%). Reactivity to H. ducreyi, C. trachomatis and HSV-2 rose with increasing age. In contrast, active syphilis showed no age trend. All STDs tended to be more common in those HIV-1 seropositive. Incidence rates over the 12 months were nil for HIV-1, 0.5% for syphilis, 1.2% for H. ducreyi, 11.3% for C. trachomatis, and 16.7% for HSV-2.

The results of this exploratory study indicate that all STDs included are common in this rural population. The high HSV-2 prevalence rate among adolescents suggests that HSV-2 may be an important risk factor for HIV-1 infection. HSV-2 serology may be a useful tool to monitor sexual behaviour interventions in young people.
Abdominal Pain in Women Attending a Genitourinary Medicine Clinic: Who Has PID?
Authors: Stacey C M , Munday P E
Published: January 2017

Eighty-one women who presented to a genitourinary medicine clinic with mild to moderate acute or chronic abdominal pain were studied in order to compare the clinical features of those who had pelvic inflammatory disease (PID) and those who did not. The diagnosis was made by laparoscopy, and PID was detected in 14%, adhesions in 11% and endometriosis in 16%. Women with PID were clinically indistinguishable from women with other diagnoses or no obvious cause.
Sexual Behaviour among London GUM Clinic Attenders: Implications for HIV Education
Authors: Filipe E M V , Strauss S B , Beck E J , Whitaker L , Wadsworth J , Renton A M , Goldmeier D , Miller D L
Published: January 2017

The aim of this study was to describe the sexual behaviour of a sample of genitourinary medicine (GUM) clinic attenders, 5 years after the launch of the UK government HIV media campaigns. A gender-specific and anonymous cross-sectional self-completion questionnaire was modified from the National Survey of Sexual Attitudes and Lifestyle and completed by 250 men and 250 women. The majority of the respondents were in their twenties, lived in London and were employed or students. Sixty-eight per cent of the men reported that one or more of their last 3 partners was not a regular partner. For those men whose last sexual encounter was with a new partner, 27% of heterosexuals and 33% of homosexuals reported using a condom. Fifty-one per cent of women reported one or more non-regular partners among their last 3 partners. For those women whose last sexual encounter was with a new partner, 43% of heterosexuals and 75% of bisexuals used a condom. Seventy-eight per cent of men and 75% of women had had a previous sexually transmitted disease (STD). These findings highlight the persistence of practices associated with the risk of contracting or transmitting HIV infection and which needs to be addressed in future educational campaigns. The GUM clinic population is an important population to monitor over time, either by longitudinal or serial cross-sectional studies. The results of this study provide a baseline against which to gauge the effects of future educational interventions.
The Road to Bribery and Corruption
Authors: Köbis Nils C. , van Prooijen Jan-Willem , Righetti Francesca , Van Lange Paul A. M.
Published: January 2017

Major forms of corruption constitute a strong threat to the functioning of societies. The most frequent explanation of how severe corruption emerges is the slippery-slope metaphor—the notion that corruption occurs gradually. While having widespread theoretical and intuitive appeal, this notion has barely been tested empirically. We used a recently developed paradigm to test whether severely corrupt acts happen gradually or abruptly. The results of four experimental studies revealed a higher likelihood of severe corruption when participants were directly given the opportunity to engage in it (abrupt) compared with when they had previously engaged in minor forms of corruption (gradual). Neither the size of the payoffs, which we kept constant, nor evaluations of the actions could account for these differences. Contrary to widely shared beliefs, sometimes the route to corruption leads over a steep cliff rather than a slippery slope.
The Development of a Cross-Modal Sense of Body Ownership
Authors: Nava Elena , Bolognini Nadia , Turati Chiara
Published: January 2017

In this study, we investigated the contribution of tactile and proprioceptive cues to the development of the sense of body ownership by testing the susceptibility of 4- to 5-year-old children, 8- to 9-year-old children, and adults to the somatic rubber-hand illusion (SRHI). We found that feelings of owning a rubber hand in the SHRI paradigm, as assessed by explicit reports (i.e., questionnaire), are already present by age 4 and do not change throughout development. In contrast, the effect of the illusion on the sense of hand position, as assessed by a pointing task, was present only in 8- to 9-year-old children and adults; the magnitude of such capture increased with age. Our findings reveal that tactile-proprioceptive interactions contributed differently to the two aspects characterizing the SRHI: Although the contribution of such interactions to an explicit sense of self was similar across age groups, their contribution to the more implicit recalibration of hand position is still developing by age 9.
In vivo protection studies of bis-quaternary 2-(hydroxyimino)-N-(pyridin-3-yl) acetamide derivatives (HNK oximes) against tabun and soman poisoning in Swiss albino mice
Authors: Kumar P , Swami D , Nagar DP , Singh KP , Acharya J , Karade HN , Yadav R
Published: January 2017

The study reports antidotal efficacy of three HNK [ bis quaternary 2-(hydroxyimino)-N-(pyridin-3yl) acetamide derivatives] and pralidoxime (2-PAM), against soman and tabun poisoning in Swiss albino mice. Protection index (PI) was determined (treatment doses: HNK oximes, ×0.20 of their median lethal dose (LD50) and 2-PAM, 30 mg/kg, intramuscularly (im)) together with atropine (10 mg/kg, intraperitoneally). Probit log doses with difference of 0.301 log of LD50 of the nerve agents administered and inhibition of acetylcholinesterase (AChE) activity by 50% (IC50) was calculated at optimized time in brain and serum. Using various doses of tabun and soman (subcutaneously (sc)), in multiples of their IC50, AChE reactivation ability of the oximes was studied. Besides, acute toxicity (0.8× LD50, im, 24 h postexposure) of HNK-102 and 2-PAM was also compared by determining biochemical, hematological variables and making histopathological observations. Protection offered by HNK-102 against tabun poisoning was found to be four times higher compared to 2-PAM. However, nearly equal protection was noted with all the four oximes against soman poisoning. HNK-102 reactivated brain AChE activity by 1.5 times more than 2-PAM at IC50 dose of soman and tabun. Acute toxicity studies of HNK-102 and 2-PAM showed sporadic changes in urea, uric acid, aspartate aminotransferase, and so on compared to control group, however, not supported by histopathological investigations. The present investigation showed superiority of newly synthesized HNK-102 oxime over standard 2-PAM, as a better antidote, against acute poisoning of tabun (4.00 times) and soman (1.04 times), in Swiss albino mice.
Development and validation of the Dark Future scale
Authors: Zaleski Zbigniew , Sobol-Kwapinska Malgorzata , Przepiorka Aneta , Meisner Michal
Published: January 2017

The purpose of studies presented in this article was to develop and validate a short version of the Future Anxiety scale. The Future Anxiety scale consists of 29 items; it measures the tendency to think about the future with anxiety and uncertainty and to anticipate disasters in the future. We developed a short form of this scale—the Dark Future scale—on a total sample of 2285 Polish adults across two studies. In Study 1, we examined the reliability and factor structure of the Future Anxiety scale. In Study 2, we cross-validated the reliability, factor structure, and validity of the Dark Future scale. The validity of the Dark Future scale was assessed based on the correlations of this instrument with the Future Negative scale, the Future Time Perspective scale, the Zimbardo Time Perspective Inventory, and the Carpe Diem scale.
Analysing the ‘migrant work ethic’ – Comparing managers’ perceptions of local workers and Central and Eastern European migrants in the United Kingdom
Authors: Hopkins Benjamin
Published: January 2017

The 2004 expansion of the European Union saw over one million people from Central and Eastern Europe register to work in the United Kingdom. Early studies into this phenomenon found a highly qualified migrant workforce taking low skilled roles, and research in regions of high unemployment saw migrant workers viewed favourably by managers as compared with locals. Using a qualitative case study approach, this paper significantly adds to regional studies of migration to investigate comparisons of migrant and local workers in regions of low unemployment, where managerial views towards locals are not as negative. The paper finds that, owing to low levels of labour market power as a result of basic English language skills and problems of transferability of qualifications, migrants are finding new ways of signalling their higher productivity. These are low levels of absence and a willingness to work longer hours, frequently termed a ‘good work ethic’ by managers, and used to positively distinguish migrant workers even in regions of low unemployment. The paper then investigates what happens to the demonstration of this ‘work ethic’ over time, finding that these behaviours are less likely to be used as labour market power increases.
Breaking the Chains? A Sector Matrix for Motoring
Authors: Froud Julie , Haslam Colin , Johal Sukhdev , Williams Karel
Published: January 2017

This paper challenges the productionist chain concept of economic activity. It also provides a constructive alternative in the form of sector matrix analysis which considers the two non-corresponding webs of demand and supply side relations around the production, distribution and use of goods and services. Sector matrix analysis constructs the demand side in terms of the complementary and competing demands made by end users, and the supply side in terms of the corporate consolidation of surplus from different activities inside and outside a specific demand matrix. The scope and potential for this new kind of analysis is illustrated with material on motoring and the article uses a range of evidence, including car assembler accounts and United Kingdom (UK) data on household demand, to show how a motoring sector matrix can be used to pose new questions and provide different answers to old ones about the car industry.
Development and modeling of a new ionogel based actuator
Authors: Wang Zhipeng , He Bin , Liu Xinhua , Wang Qigang
Published: January 2017

Ionic electroactive polymer actuators are expected to be one of the most promising driving mechanisms in the future due to their extraordinary features such as their lightweight, flexibility, and low-energy consumption. Traditional ionic electroactive polymer actuators for example, ionic-polymer metal composites have a problem with durability in open air due to the evaporation of water contained in the polymer electrolytes, resulting in a corresponding loss of performance. Electrolysis of the water at relatively low operating voltages may cause deterioration of these materials. Ionic liquids are more thermally and electrochemically stable than water, with unique advantages including negligible volatility, low melting point and high ionic conductivity, therefore they can be used in the application of ionic electroactive polymer actuators. In this work, a new ionic electroactive polymer actuator based on ionogel is developed, which can be operated at low driving voltage with high electrochemical stability. In order to investigate the actuation mechanism of the actuator, a general model consisting of an equivalent electrical circuit, an electromechanical coupling term and a mechanical beam model is built up to characterize its interrelated electrical, mechanical, and chemical properties. This model explains the relationship between input voltage and bending displacement of the actuator. Theoretical and experimental results are demonstrated and documented to validate the conclusion that the model can effectively predict the actuation response of the material. The geometric scalability of the model is also investigated, giving support to the design of the soft mechanism based on ionogel.
Flexoelectric energy harvesters based on Timoshenko laminated beam theory
Authors: Liang Xu , Zhang Runzhi , Hu Shuling , Shen Shengping
Published: January 2017

Different from piezoelectricity which is restricted to certain materials, flexoelectricity is a universal electromechanical coupling in all dielectrics. In this work, mechanical energy harvester models were developed based on Timoshenko laminated beam theory, in which the flexoelectric and piezoelectric mechanisms were discussed. For a three-layered energy harvester in parallel configuration, the mechanical vibration energy can be converted into electrical energy due to flexoelectricity, and for the three-layered energy harvester in series configuration, the energy conversion is enhanced by the flexoelectricity. Resonance frequency shifts were observed in the calculations due to flexoelectricity and external circuit resistance. It is found that the electromechanical coupling displayed from the electrical responses versus resonance frequency and resistance. The energy conversion for the three-layered energy harvester system was found to be increased with the decrease in the laminated beam thickness. The energy conversion calculated for different numbers of layers also indicates that laminated energy harvester systems excel single-layered energy harvesters. This work therefore might help in designing flexoelectricity-based energy harvesters.
Experimental characterizations of bimorph piezoelectric actuator for robotic assembly
Authors: Ghosh Bhaskar , Jain Ravi K , Majumder S , Roy SS , Mukhopadhyay Sumit
Published: January 2017

Piezoelectric actuator is one of the most versatile types of smart actuators, extensively used in different industrial applications like robotics, microelectromechanical systems, micro-assembly, biological cell handling, self-assembly, and optical component handling in photonics. By applying potential to a piezoelectric actuator, it can produce micro level deflection with large force generation, very fast response, and long-term actuation as compared to other actuators. The design and analysis of the bimorph piezoelectric cantilever using proportional–integral controller are carried out where the bimorph piezoelectric actuator is used as an active actuator for providing the dexterous behavior during robotic assembly. Characterization of bimorph piezoelectric actuator carried out by controlling voltage signal provides steady-state behavior which is verified by conducting experiments. A prototype of micro gripper is also developed which shows the potential of handling small lightweight objects for robotic assembly.
Comparative Methylprednisolone Pharmacokinetics in Renal Transplant Patients Receiving Double- or Triple-Drug Immunosuppression
Authors: Tornatore Kathleen M. , Walshe J. Joseph , Reed Kris A. , Holdsworth Mark T. , Venuto Rocco C.
Published: January 2017

OBJECTIVE:

To assess the pharmacokinetics of chronic methylprednisolone therapy in renal transplant patients receiving double-drug (methylprednisolone and azathioprine) and triple-drug (methylprednisolone, azathioprine, and cyclosporine) immunosuppression.

DESIGN:

Parallel, randomized trial.

PATIENTS:

Fourteen renal transplant recipients (aged 29–65 y) evaluated in a public, university-affiliated hospital clinic.

INTERVENTIONS:

All patients received their chronic oral dose of methylprednisolone via a 10–20-minute intravenous infusion.

MAIN OUTCOME MEASURES:

Serum methylprednisolone concentrations were determined by HPLC and were used to generate pharmacokinetic parameters for this drug.

RESULTS:

The mean daily methylprednisolone dosage was 19 ± 19 mg in the double-drug group and 9 ± 2 mg in the triple-drug group. Mean serum creatinine concentrations were 124 ± 44 and 124 ± 27 μmol/L, respectively. Mean methylprednisolone clearances were similar in both groups: 405 ± 205 (double-drug) and 373 ± 365 mL/h/kg (triple-drug) (p>0.05). Mean steady-state volume of distribution was 1.5 ± 0.8 L/kg in the double-drug group and 1.3 ± 0.8 L/kg in the triple-drug group (p>0.05). Plasma half-life ranged from 1.7 to 4.3 h (mean 2.7) in the double-drug group versus 1.4 to 3.4 h (mean 2.6) in the triple-drug group (p>0.05).

CONCLUSIONS:

These data indicate that cyclosporine had no definitive influence on methylprednisolone disposition. The results reveal a wide variation in methylprednisolone metabolism in renal transplant recipients receiving either a double- or triple-drug immunosuppressive regimen. Typically, methylprednisolone is prescribed according to a standardized dosing protocol that assumes minimal interpatient variation. Therefore, the pharmacokinetic variability noted in this study may have important clinical implications regarding the development of chronic toxicity (e.g., osteoporosis, hypothalamic-pituitary-adrenal suppression) and the attainment of successful immunosuppression.
Pharmacy Practice Acts: A Five-Year Follow-up
Authors: Munger Mark A. , Stilling William J. , Gardner Stephanie F.
Published: January 2017

OBJECTIVE:

To rereview the status of state pharmacy practice acts since 1987. Additionally, this report discusses adoption of the 1992 National Association of Boards of Pharmacy Model State Pharmacy Practice Act as the standard state pharmacy practice statute.

DATA SOURCES:

State codes for 50 states and the District of Columbia, with attention focused on the pharmacy practice acts; Puerto Rico and the Virgin Islands were excluded.

CASE LAW SELECTION:

Case law utilizing state pharmacy statutes was selected to demonstrate pharmacists' liability.

DATA EXTRACTION:

The focus on each statute was the statutory definition of the “practice of pharmacy.”

DATA SYNTHESIS:

Twelve pharmacy laws (24 percent) contain no definition of the practice of pharmacy. Compounding (92 percent), dispensing (100 percent), interpretation and evaluation of prescriptions (72 percent), consultation (85 percent), drug utilization review (69 percent), drug product selection (54 percent), drug administration (21 percent), pharmacokinetic consultation and patient assessment (13 percent) were noted in the laws for the remaining 38 states and the District of Columbia. Significant pharmacy activities codified since 1987 include consultation, drug administration, pharmacokinetic consultation, and patient assessment. Statutes defining pharmacy practice impact the profession by affecting liability and by mirroring society's view of the role of the profession.

CONCLUSIONS:

States have enacted new statutes principally in the areas of progressive pharmacy practice functions since 1987. Enactment of the definition of professional practice contained in the National Association of Boards of Pharmacy Model State Pharmacy Practice Act would serve the pharmacy profession by: (1) creating a uniform professional purpose; (2) creating legal responsibility that reflects contemporary practice; (3) allowing pharmacists to enlarge the scope of their practice as the profession's societal role evolves; and (4) conserving revenues normally consumed by lobbying for constant legislative revisions.
Benzodiazepine Withdrawal Reaction in Two Children following Discontinuation of Sedation with Midazolam
Authors: van Engelen Baziel G.M. , Gimbrere Jules S. , Booy Leo H.
Published: January 2017

OBJECTIVE:

To report the occurrence of recurrent benzodiazepine withdrawal reactions in two very young children following discontinuation of sedation with midazolam.

CASE SUMMARY:

A 15-month-old boy with apneic episodes was sedated with midazolam for 12 days with constant infusion. Half a day after discontinuation of the midazolam the boy became restless, tachycardic, and hyperpyrexia. When midazolam was readministered, all symptoms disappeared. Four days later midazolam was again discontinued and within 12 hours the same signs and symptoms reappeared. Midazolam infusion was restarted, and the signs and symptoms disappeared for the second time. After thoracotomy, a 14-day-old boy received intravenous midazolam for sedation for 29 days. Within 12 hours after discontinuation of midazolam he became restless, developed a bulging stomach secondary to aerophagia, and was vomiting. Midazolam therapy was reinstituted and continued for another 2 months by constant infusion. Thereafter, the boy was successfully weaned from artificial ventilation in 5 days under sedation with midazolam. About 12 hours after discontinuation of midazolam the boy became restless, tachycardic, again developed a bulging stomach because of aerophagia, and vomited. When the child was sedated with clorazepate by continuous infusion, the signs and symptoms disappeared.

DISCUSSION:

Case reports describing benzodiazepine withdrawal reaction upon discontinuation of midazolam were reviewed and compared. The symptoms observed in the children we present resemble those mentioned in the three children and two adults reported previously. Unique in the very young children in this article is the occurrence of gastrointestinal symptoms, which most likely are the result of air being swallowed secondary to severe agitation.

CONCLUSIONS:

Midazolam withdrawal reactions in adults and children, particularly in an intensive care unit, can be significant. Considerable caution must be taken with relatively long-term administration and abrupt discontinuation of midazolam.
Nedocromil Sodium
Authors: Parish Roy C. , Miller Lisa J.
Published: January 2017

OBJECTIVE:

To summarize the available pharmacokinetic and pharmacologic data on nedocromil sodium and to present representative clinical trials of this new agent in both mild-to-moderate and severe chronic asthma and allergic rhinitis. Adverse effects are reviewed.

DATA SOURCES:

A MEDLINE search was used to identify pertinent literature, excluding reviews and foreign-language articles. All available English-language studies were reviewed.

DATA EXTRACTION:

Pivotal and representative studies are discussed relating to the following issues: Pharmacology and pharmacokinetics, management of patients with non-steroid-dependent and steroid-dependent asthma, comparison with sodium cromoglycate (cromolyn), comparison with inhaled beclomethasone dipropionate, management of exercise-induced asthma, use in children with asthma, and use in allergic rhinitis.

DATA SYNTHESIS:

Nedocromil sodium is chemically grossly unrelated to cromolyn but has similar pharmacology, pharmacokinetics, and therapeutic benefits. Although ineffective in relieving acute asthma attacks, nedocromil appears to be superior to placebo in lessening the severity of chronic asthma and protecting against allergen-induced asthma when taken as chronic prophylaxis. Single doses attenuate exercise-induced asthma. It is also effective in the management of allergic rhinitis. Results have varied when nedocromil has been compared with cromolyn or inhaled beclomethasone. Studies to date indicate that, overall, nedocromil is not significantly better than cromolyn and is no better than or is inferior to inhaled beclomethasone, although individual response appears to be variable, with no identifiable predictive factors.

CONCLUSIONS:

Individual patients may receive marked improvement from nedocromil therapy, but there are no factors that identify which patients will respond. Nedocromil may be particularly useful in adults who frequently fail to respond to cromolyn.
Drug-Induced Alterations in Serum Creatinine Concentrations
Authors: Hartshorn Edward A. , Ducharme Murray P. , Smythe Maureen , Strohs Greg
Published: January 2017

OBJECTIVE:

To provide a comprehensive review of drug-induced alterations in serum creatinine concentrations (SCrs).

DATA SOURCES:

Information was obtained from a MEDLINE search, reference lists from articles identified in the search, review articles, and abstracts.

STUDY SELECTION:

Emphasis was placed on clinical studies of direct relevance to clinical practitioners.

DATA EXTRACTION:

Literature was assessed for its methodology, results, discussion, and conclusion.

DATA SYNTHESIS:

Two analytical systems to assay SCr are commonly employed in clinical practice—the Jaffé-based and enzymatic methods. Several drugs have been reported to interfere with SCr results obtained with both analytical systems by producing assay interference. In addition, trimethoprim, cimetidine, and salicylates produce elevations in the SCr by altering the normal elimination pathways of creatinine. Phenacemide has been reported to increase creatinine elimination, but the mechanism of this effect is unknown.

CONCLUSIONS:

Pharmacists should recognize the clinical significance of drug-induced interference with SCr and propose alternative methods of determining concentrations in selected patients.
Crossover Comparison of Drug Information Online Database Vendors: Dialog and Medlars
Authors: Rovers John P. , Janosik John E. , Souney Paul F.
Published: January 2017

OBJECTIVE:

To compare Dialog EMBASE with the National Library of Medicine's (NLM's) MEDLARS MEDLINE, TOXLINE, and TOXLIT to evaluate differences among the databases and vendors in a method consistent with routine drug information practice.

DESIGN:

Crossover comparison.

METHODS:

NLM MEDLARS databases MEDLINE, TOXLINE, and TOXLIT were searched directly. EMBASE was searched via Dialog Information Services. MEDLINE was searched back to 1980; TOXLINE and TOXLIT were searched back to 1981, reflecting the different database structures. EMBASE was searched back to 1980. To control bias, searches were randomized; identical strategies were used during the same session and were performed by the same trained searcher.

RESULTS:

Twenty-six drug information requests were compared. The MEDLARS and Dialog databases were generally similar, with no significant differences in the number of potentially relevant references, English references, clinically relevant references, available abstracts, unique citations, time online, and number of questions answered. EMBASE searches were more costly (p=0.0005). TOXLIT was costlier than TOXLINE and MEDLINE (p=0.0018).

CONCLUSIONS:

NLM MEDLARS databases were comparable to Dialog EMBASE. Although MEDLARS provided more total and English-language citations, the differences were small and did not influence the proportion of questions answered. The greatest difference between the vendors was the significantly lower cost of searching on MEDLARS. Although this difference may be partially offset by the significantly shorter search times on EMBASE, the mean 1.9 minutes saved would not recoup the mean $7.89 difference in cost. MEDLARS databases are less expensive for routine drug information requests.
Physical and Chemical Compatibility of Intravenous Ciprofloxacin with other Drugs
Authors: Jim Lucia K.
Published: January 2017

OBJECTIVE:

To determine the physical and chemical compatibilities of ciprofloxacin lactate infusion with other commonly used intravenously administered drugs.

DESIGN:

Ciprofloxacin lactate injection in a commercially available concentration of 2 mg/mL was mixed with 15 intravenous drugs during simulated Y-site injection. Ciprofloxacin was mixed with usually employed concentrations of other drugs in a 1:1 ratio and examined physically by visual inspection and chemically by HPLC analysis. Adsorption of ciprofloxacin to intravenous administration sets with or without inline filters was also studied.

SETTING:

The study was carried out at ambient temperature (25 °C) under fluorescent lighting except for vitamin B complex, which was protected from light. All samples were prepared in a laminar airflow hood.

MAIN OUTCOME MEASURES:

Physical incompatibility was determined by visual inspection against a black-and-white background, and chemical incompatibility was measured by a stability-indicating HPLC assay for ciprofloxacin. Concentrations determined at time zero (before mixing) were defined as 100 percent. Values estimated for each sample at subsequent time points were calculated as percentages of the initial concentration. Recovery below 90 percent of the initial concentration is defined as significant loss.

RESULTS:

Of the 15 drugs studied, only heparin, furosemide, and teicoplanin were found to be incompatible with ciprofloxacin. Adsorption of ciprofloxacin to administration sets with and without inline filters was minimal. Metronidazole was also found to decrease to 90 percent of its initial concentration immediately upon mixing.

CONCLUSIONS:

Ciprofloxacin ready-to-infuse solution is compatible with most of the drugs studied except heparin, furosemide, teicoplanin, and, perhaps, metronidazole. Because only the stability and potency of ciprofloxacin were studied, further testing is needed to confirm if any chemical deterioration of the other drugs occurred when combined with ciprofloxacin.
Intravenous Streptomycin Use in a Patient Infected with High-Level, Gentamicin-Resistant Streptococcus Faecalis
Authors: Kim-Sing Angela , Kays Michael B. , James Vivien E. , Weart C. Wayne
Published: January 2017

OBJECTIVE:

To report a case of intravenous streptomycin sulfate use in a patient infected with high-level, gentamicin-resistant Streptococcus faecalis.

CASE SUMMARY:

A 37-year-old woman with a history of schizoaffective disorder, diabetes insipidus possibly induced by lithium, chronic renal insufficiency, and anemia presented with a two-day history of decreased responsiveness, decreased verbalization, and tremulousness. Her hospital course was complicated by polymicrobial sepsis ( S. faecalis, coagulase-negative staphylococci, Citrobacter diversus, Enterobacter aerogenes, and unidentified gram-negative bacilli #2) requiring vancomycin and gentamicin therapy. Gentamicin was discontinued after two doses because she developed acute-on-chronic renal insufficiency. Subsequent susceptibility data showed the enterococcus to be highly resistant to gentamicin. The patient deteriorated clinically when treated only with vancomycin. She remained septic with a blood pressure of 80/40 mm Hg; streptomycin was added to her regimen. We were concerned that streptomycin concentrations obtained following intramuscular administration would not be adequate because of possible hypoperfusion. Based on limited published literature, streptomycin was administered intravenously via a central intravenous catheter.

DISCUSSION:

A review of high-level aminoglycoside-resistant S. faecalis and treatment with intravenous streptomycin therapy are discussed. The availability and monitoring of streptomycin therapy are also described.

CONCLUSIONS:

Streptomycin is an antimicrobial agent that must be used with vancomycin in serious infections to eradicate high-level, gentamicin-resistant S. faecalis. Its unique administration and monitoring concerns require individual patient assessment.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone Secondary to Fluoxetine
Authors: Blacksten Joleen V. , Birt Julie A.
Published: January 2017

OBJECTIVE:

To report a case of possible fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH).

CASE SUMMARY:

A 92-year-old patient was prescribed oral fluoxetine 20 mg daily for depression. After 13 days of therapy, she developed severe weakness and was found to have hyponatremia. Fluoxetine was discontinued. Treatment included fluid restriction and sodium chloride and potassium supplementation. Eight days after admission, the hyponatremia resolved and the patient was discharged without any pharmacologic treatment for depression.

DISCUSSION:

Case reports on fluoxetine-induced SIADH were reviewed. Fluoxetine-associated SIADH appears to occur most commonly after short-term therapy in elderly patients. Resolution of hyponatremia occurs six days to two weeks after discontinuation of fluoxetine.

CONCLUSIONS:

Geriatric patients receiving fluoxetine should be monitored regularly to detect abnormal electrolyte values.
Vasopressor-Resistant Hypotension following a Massive Ingestion of Theophylline
Authors: Dasta Joseph F. , Dettloff Richard W. , Touchette Mark A. , Zarowitz Barbara J.
Published: January 2017

OBJECTIVE:

To report the unusual and poorly understood occurrence of vasopressor-resistant hypotension following a suicidal ingestion of theophylline.

DESIGN:

Single case report.

SETTING:

Eight-bed, respiratory intensive care unit in a 937-bed teaching hospital.

PATIENT:

A 52-year-old man with a past medical history significant only for hypertension.

RESULTS:

The additive influence of markedly elevated theophylline serum concentrations, status epilepticus, and vasopressor-resistant hypotension was associated with the patient's death. Intravenous dosages of epinephrine, norepinephrine, and phenylephrine (ranges 160–210, 32–105, and 200–250 μg/min, respectively) were ineffective in controlling the patient's dramatic hypotension.

CONCLUSIONS:

In addition to the usual metabolic abnormalities and central nervous system effects seen in theophylline poisoning, severe hypotension can occur and prove resistant to commonly used vasopressors. Early identification and treatment of theophylline poisoning is warranted to prevent the development of severe sequelae.
Comparative Clinical, Microbiologic, and Economic Audit of the Use of Oral Ciprofloxacin and Parenteral Antimicrobials
Authors: McGhan William F. , Bootman J. Lyle , Townsend Raymond J. , Cooke Jonathan , Cairns Christopher J. , Tillotson Glenn S. , Conner Susan , Lewin Sharron K.M. , Nicholls Jane , Tredree Roger L. , Willis Jackie V. , Hitchings Colin R.
Published: January 2017

OBJECTIVE:

To examine the use of oral ciprofloxacin and parenteral antimicrobials in the treatment of acute infection (respiratory tract, urinary tract, blood) in hospitalized patients, with particular reference to severity of infection, outcome, and associated economic implications of each treatment.

DESIGN:

A prospective, multicenter comparative audit was conducted in the UK over an 18-month period. The audit was undertaken by clinical pharmacists who reviewed the antimicrobial treatment of patients with infective episodes, who were receiving or could have received oral therapy.

PARTICIPANTS:

Clinical pharmacists who collated the data all are employed in teaching hospitals.

MAIN OUTCOME MEASURES:

Patients were identified for analysis by their type of infection, severity of illness, antimicrobial prescribed, route of administration, and response to therapy. Additionally, data on costs of the antimicrobials prescribed and the supplementary costs of drug administration were calculated.

RESULTS:

Four hundred eighty-five patients were enrolled for analysis; 208 of the patients had respiratory tract infection, 112 had urinary tract infection, 138 had septicemia, and 27 had mixed infections. Sepsis scores were applied to 152 patients receiving oral ciprofloxacin and 333 patients receiving parenteral antimicrobials and yielded mean scores of 5.9 (SD 3.1, range 1–13) and 8.7 (SD 4.2, range 1–22), respectively. of 485 patients, 188 were paired according to sepsis score results and route of administration. Resolution occurred in 133 patients (79 receiving oral and 54 receiving parenteral therapy), further therapy was required in 49 (11 oral and 38 parenteral), and treatment was withdrawn in 6 (4 oral and 2 parenteral). Microbiologic assessment yielded positive results in 227 patients (47 percent). Drug acquisition costs (based on 1 UK £ = 1.80 US $) per course of treatment were $47.23 (SD $38.32, range 5.40–218.70) for the oral group and $173.70 (SD $209.77, range 2.11–1021.40) for the parenteral group. Overall costs for treatment courses were $74.00 (SD $52.81, range 8.10–309.17) and $305.59 (SD $304.70, range 14.69–1345.00) for the two groups, respectively (p<0.001).

CONCLUSIONS:

This study suggests that, in patients with moderate infective episodes, oral ciprofloxacin may reduce overall treatment costs compared with the use of parenteral antimicrobial agents.
Rhodococcus Equi Pneumonia: Case Report and Literature Review
Authors: Frame Bill C. , Petkus Alan F.
Published: January 2017

OBJECTIVE:

To present a case of Rhodococcus equi (RE) pneumonia and discuss its pathophysiology and treatment.

CASE SUMMARY:

An HIV-positive patient presented with pneumonia. A lung biopsy was performed after sputum and thoracentesis cultures failed to identify a pathogen. The lung biopsy revealed an unidentifiable, diphtheroid-like, gram-positive rod. A bronchoscopy performed five days after the lung biopsy produced the same diphtheroid-like, gram-positive rod. The patient was treated with several injectable antibiotics, but emergence of resistance to two of the antibiotics was suspected. Two weeks after the bacterial isolate was sent to a reference laboratory, it was identified as RE. The patient was discharged on oral antibiotics and experienced no recurrence of RE pneumonia.

CONCLUSIONS:

RE can be difficult to identify in the microbiology laboratory, or it may be assumed to be a colonizing diphtheroid. The isolation of difficult-to-identify, gram-positive rods, or diphtheroids, from a pulmonary source in a patient with decreased cell-mediated immunity should cause one to suspect RE. RE has been noted to develop resistance to beta-lactam antibiotics during therapy. A prolonged course of combination antibiotic therapy directed at the intracellular component of infection is necessary.
Placebo-Controlled Trial of Intravaginal Clindamycin 2% Cream for the Treatment of Bacterial Vaginosis
Authors: Stein Gary E. , Christensen Sharon L. , Mummaw Nancy L. , Soper David E.
Published: January 2017

OBJECTIVE:

To compare the safety and efficacy of intravaginal clindamycin 2% cream with placebo in nonpregnant women with bacterial vaginosis.

DESIGN:

A randomized, double-blind, placebo-controlled clinical trial.

SETTING:

Ambulatory patients in the general community.

PATIENTS:

Two hundred fifteen nonpregnant outpatients with a diagnosis of bacterial vaginosis were entered into this study. Of the 134 evaluable patients, 65 received clindamycin and 69 placebo. Demographic parameters were comparable between the two treatment groups.

INTERVENTION:

Study subjects were equally randomized to receive either 5 g of clindamycin 2% vaginal cream or placebo cream for seven nights.

MAIN OUTCOME MEASURES:

Clinical and microbiologic follow-up evaluations were scheduled for 5–10 days and 25–39 days posttreatment. Patients were interviewed about signs and symptoms, adverse events, and compliance. Diagnostic examinations were performed.

RESULTS:

Clinical success rates (cure and improvement) occurred in 50 of 65 patients who received clindamycin (77 percent) and 17 of 69 patients who received placebo (25 percent) by the first posttreatment visit (p<0.001). Microbiologic cures or improvement were observed in 59 of the 65 patients treated with clindamycin (91 percent) compared with 20 of 69 placebo-treated patients (29 percent) (p<0.001). At the end of the study, clinical and microbiologic cures or improvement were evident in 45 of 57 (79 percent) and 37 of 57 clindamycin-treated patients (65 percent), respectively, and 18 of 51 (35 percent) and 14 of 51 (28 percent) of the placebo-treated patients, respectively. The success rates with clindamycin 2% cream were statistically higher than those with placebo. The adverse-effect profiles in the two groups were similar and no serious adverse effects were reported. Patients who received clindamycin had a statistically higher incidence of nonbacterial vaginitis/cervicitis (18.5 vs. 7.5 percent, p=0.003).

CONCLUSIONS:

Intravaginal clindamycin 2% cream appears to be an effective and safe treatment of symptomatic bacterial vaginosis in nonpregnant women.
Influence of Beta Carotene, Vitamin E, and Vitamin C on Endogenous Antioxidant Defenses in Erythrocytes
Authors: Regnault Corinne , Postaire Eric R.R. , Rousset Gérard J.P. , Bejot Marie , Hazebroucq Georges F.
Published: January 2017

OBJECTIVE:

To evaluate the in vivo radical scavenger activity of vitamin E, vitamin C, and beta carotene on erythrocyte membranes.

DESIGN:

A prospective, open trial without placebo.

SETTING:

Department of Clinical Pharmacy.

PATIENTS:

Ten healthy volunteers being supplemented with beta carotene, vitamin E, and vitamin C.

MEASUREMENTS:

Erythrocytes were incubated in water bath with 2,2′ azobis (2 amidinopropane) hydrochloride (AAPH). AAPH decomposes spontaneously at 37 °C to generate free radicals inducing membrane cellular damage and hemolysis. The absorbance was measured at 405 nm at 0, 30, and 60 min, and then every 20 minutes for four hours. The time for 50 percent of maximal hemolysis (T50%), which expresses the radical scavenger activity of erythrocytes, was determined.

RESULTS:

The physiologic T50% value determined in 52 healthy volunteers is 117 ± 12 min. Patients receiving these supplements have a higher value of T50% (143.2 ± 11.6 min at 30 d and 145.7 ± 10.5 min at 60 d) than the physiologic value (p<0.001).

CONCLUSIONS:

These data suggest that vitamin C, vitamin E, and beta carotene stimulate the radical scavenger activity of erythrocyte membranes after 30 days.
Reassessing the Lower end of the Phenytoin Therapeutic Range: A Review of the Literature
Authors: Hayes Grace , Kootsikas Maria E.
Published: January 2017

OBJECTIVE:

To critically review available data on the effective lower end of the phenytoin therapeutic range for the treatment of seizure disorders.

DATA SOURCES:

Relevant articles were identified from an English-language search of MEDLINE 1982-1992. Additional references were found in bibliographies of these articles.

STUDY SELECTION/DATA EXTRACTION:

We reviewed articles that included data on serum phenytoin concentrations (SPCs) and seizure control. Data on concurrent anticonvulsants, seizure diagnosis, and seizure severity were extracted when available.

DATA SYNTHESIS:

The original study defining the phenytoin therapeutic range as 10–20 mg/L is analyzed; it was based on a small, homogeneous sample that cannot be generalized to a more diverse epileptic population. Many studies report patients obtaining seizure control with SPCs below 10 mg/L. Studies including a range of seizure diagnoses and severity have a larger variability in effective SPCs; however, effective SPCs are reproducible.

CONCLUSIONS:

The therapeutic range of phenytoin is defined on an individual basis. Some patients, especially those with infrequent, primary tonic-clonic seizures, may be controlled with phenytoin concentrations below the recognized reference range of 10–20 mg/L.