bluuebunny/crossref_metadata_2025_split huggingface dataset:
Torsemide: A Pyridine-Sulfonylurea Loop Diuretic
Authors: Blose Jamie S , Adams Kirkwood F , Patterson J Herbert 
Published: January 2017

Objective: To review the clinical pharmacology of torsemide and to compare it with currently available loop diuretics, particularly furosemide. Data Sources: An English-language MEDLINE search, 1985 to October 1994, was used to identify pertinent literature, including review articles. Data Extraction: Data from scientific literature were extracted, evaluated, and summarized for presentation. Pivotal and representative studies are discussed relating to the pharmacology, pharmacokinetics, and use of torsemide in patients with congestive heart failure, renal disease, hepatic disease, and hypertension. Data Synthesis: Torsemide is a loop diuretic of the pyridine-sulfonylurea class. The bioavailability of torsemide is approximately 80%, with little first-pass metabolism, and torsemide can be given without regard to meals. The serum concentration reaches its peak within 1 hour after oral administration and diuresis lasts approximately 6—8 hours. Torsemide is eliminated both hepatically (80%) and renally (20%) as unchanged drug with an elimination half-life of about 3.5 hours. Because of the high bioavailability, oral and intravenous doses are therapeutically equivalent. Torsemide, and other loop diuretics such as furosemide, are indicated for the treatment of edema associated with congestive heart failure, renal disease, and hepatic disease. They also are indicated for the treatment of hypertension alone or in combination with other antihypertensive agents. Depending on the indication, the recommended initial adult dosage of torsemide is between 5 and 20 mg once daily orally or intravenously. Special dosage adjustments in the elderly are not necessary. Conclusions: Torsemide is a loop diuretic similar to furosemide, with similar indications. Torsemide is characterized by good bioavailability and once-daily dosing and, compared with furosemide, provides generally equivalent therapeutic efficacy.
Beta-Lactam Antibiotics: Is Continuous Infusion The Preferred Method of Administration?
Authors: Vondracek Thomas G 
Published: January 2017

Objective: To examine the pharmacodynamic properties of the beta-lactam class of antibiotics and the rationale for their continuous infusion (CI), and to explore reasons that this mode of administration has not replaced intermittent infusion as the standard of practice. Data Sources: A MEDLINE search of the English-language literature evaluating CI administration of beta-lactam antibiotics was conducted. Bibliographic searches of these articles also were performed. Study Selection: Because there were few human trials, all available trials were considered for review. A cross section of clinical trials, animal studies, and in vitro studies examining the impact of the route of antibiotic administration was selected for each pharmacodynamic variable addressed. Data Synthesis: The support for CI as the preferred method of beta-lactam administration comes primarily from in vitro and animal data. Most beta-lactam antibiotics do not demonstrate concentration-dependent killing and have an appreciable postantibiotic effect only against gram-positive cocci. Their efficacy appears to be optimized by maintaining suprainhibitory concentrations throughout the dosing interval. Therefore, CI of beta-lactams could potentially enhance the efficacy of treatment or allow less drug to be used on a daily basis. This has yet to be demonstrated convincingly in human clinical trials. Comparative trials need to continue to explore die impact of the method of administration on patient outcomes such as duration and cost of therapy, as well as morbidity and mortality. Conclusions: Results of many animal and in vitro studies suggest that CI may be the optimal method of beta-lactam administration. Clinical trials need to further document the impact of the method of beta-lactam administration on the incidence of adverse effects, emergence of bacterial resistance, and patient outcome. Pharmacodynamic studies defining target beta-lactam concentrations, the practicality of CI in patients requiring multiple intravenous fluids and medications, and the pertinence of this issue when beta-lactam antibiotics are used as sole agents or in combination with other antimicrobials require further exploration.
Predicting Unbound Phenytoin Concentrations in the Critically Ill Neurosurgical Patient
Authors: Mlynarek Mark E , Peterson Edward L , Zarowitz Barbara J 
Published: January 2017

OBJECTIVE: To assess the correlation of measured unbound Phenytoin concentration (dphF) to estimated unbound concentration (dphEF) using the Sheiner-Tozer equation in critically ill patients in the neurosurgical intensive care unit. DESIGN: The dphF and total phenytoin (dphT) trough serum concentrations were measured during the first week of therapy in 17 consecutive patients with albumin concentrations less than 3.5 g/dL. Serum albumin concentrations were measured within 24 hours of serum phenytoin concentration measurement. SETTING: A university-affiliated urban teaching hospital. PARTICIPANTS: The study population consisted of 17 neurosurgical patients who were at least 18 years old. MAIN OUTCOME MEASURES: The predictability of the Sheiner-Tozer equation was tested by measuring dphF, dphT, and serum albumin concentrations. Measured phenytoin concentrations were compared with phenytoin concentrations calculated from the Sheiner-Tozer equation. To estimate correlation between variables linear regression was calculated. Mean absolute value of error and mean error were estimated to assess precision and bias between measures, respectively. RESULTS: The mean ± SD dphT was 13.05 ± 5.15 μg/mL. The measured dphF was 1.89 ± 0.80 compared with 2.00 ± 0.8 μg/mL for the dphEF (NS). Regression analysis for dphEF versus dphF revealed a significant correlation (r2 = 0.94, ρ = 0.001). The mean absolute value of error for the Sheiner-Tozer equation to predict dphEF was 0.167, which was 9% of the mean value of dphF (1.89). CONCLUSIONS: These results indicate that, in this population, the Sheiner-Tozer estimate of dphEF provides an unbiased, precise clinical estimate of dphF in patients for whom measured dphF is unavailable or impractical.
Comparison of Cefprozil, Cefpodoxime Proxetil, Loracarbef, Cefixime, and Ceftibuten
Authors: Schatz Beth S , Karavokiros Kellie Tefakis , Taeubel Mary A , Itokazu Gail S 
Published: January 2017

OBJECTIVE: To discuss the pharmacokinetics, spectrum of activity, clinical trials, and adverse effects of cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and ceftibuten, an investigational cephalosporin. DATA SOURCES: Literature was identified by a MEDLINE search from 1986 to January 1995. STUDY SELECTION: Randomized, controlled studies were selected for evaluation; however, uncontrolled studies were included when data were limited for indications approved by the Food and Drug Administration. DATA EXTRACTION: Data were evaluated with respect to in vitro activity, study design, clinical and microbiologic outcomes, and adverse drug reactions. DATA SYNTHESIS: Cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and ceftibuten are active in vitro against organisms frequently involved in community-acquired infections such as Streptococcus pneumoniae, Escherichia coli, beta-lactamase-positive or -negative Haemophilus influenzae, and Moraxella catarrhalis. Except for cefixime and ceftibuten, they all are active against methicillin-susceptible Staphylococcus aureus. Even though there were problems in study design (discussed within the text), clinical data demonstrate that these new oral beta-lactam compounds are as efficacious as conventional therapies for a variety of community-acquired infections. CONCLUSIONS: Cefprozil, cefpodoxime, cefixime, loracarbef, and ceftibuten demonstrate in vitro activity against the major organisms that cause community-acquired infections. Clinical trials confirm that these agents are as effective as traditional therapies for the management of acute otitis media, pharyngitis/tonsillitis, sinusitis, bronchitis, pneumonia, urinary tract infections, and skin and skin-structure infections. In addition, cefixime and cefpodoxime are effective therapies for uncomplicated gonococcal infections. Selection of a specific agent will be influenced by susceptibility data and safety, as well as issues of compliance and cost.
Use of Baclofen to Suppress Cough Induced by Angiotensin-Converting Enzyme Inhibitors
Authors: Dicpinigaitis Peter V 
Published: January 2017

OBJECTIVE: To determine whether baclofen can suppress the cough induced by angiotensin-converting enzyme (ACE) inhibitors. DESIGN: Prospective, open-label, clinical trial of a 4-week course of low-dose oral baclofen (5 mg tid days 1–7, 10 mg tid days 8–28). SUBJECTS: Seven patients with severe, persistent ACE inhibitor-induced cough. SETTING: University-affiliated teaching hospital. MAIN OUTCOME MEASURES: Study participants kept daily diaries monitoring the frequency of cough during and after completion of baclofen therapy. RESULTS: All subjects demonstrated diminution of cough after initiation of baclofen. Initial improvement was noted by a mean of 4.0 days (range 3–6), and maximal improvement during treatment was achieved by a mean of 10.7 days (range 5–15). In addition, all subjects demonstrated persistent suppression of cough (range 25–74 d) after discontinuation of the study drug. CONCLUSIONS: Low-dose oral baclofen therapy caused a prolonged antitussive effect in all subjects without inducing any adverse reactions. Baclofen may offer an alternative to the discontinuation of ACE inhibitor therapy in patients for whom these drugs are required.
Acarbose: Its Role in the Treatment of Diabetes Mellitus
Authors: Campbell Lance K , White John R , Campbell R Keith 
Published: January 2017

OBJECTIVES: To review the clinical pharmacology of acarbose, an alpha-glucosidase inhibitor, and to summarize its role in the pharmacotherapy of diabetes mellitus. DATA SOURCES: A MEDLINE search identified all relevant articles, including reviews; Bayer Pharmaceuticals. STUDY SELECTION: Due to the large number of clinical trials available, specific criteria were used to narrow the focus of this review: (1) randomized, double-blind, placebo-controlled, parallel-group study design; (2) a minimum of 25 patients enrolled per treatment arm; (3) a treatment duration of 90 days or more; and (4) adherence to Food and Drug Administration Good Clinical Practice guidelines. DATA EXTRACTION: All clinical trials that were available up to December 1995 were reviewed. Preliminary trials and unpublished reports were not reviewed. DATA SYNTHESIS: Acarbose is effective in reducing postprandial hyperglycemia. It does not stimulate endogenous insulin secretion and, therefore, will not cause hypoglycemia when used as monotherapy. The enhanced glycemic control achieved with acarbose is additive to that of sulfonylureas. It lowers postprandial serum glucose and insulin concentrations and does not promote weight gain. Acarbose can be used as first-line therapy with diet and exercise, or it can be used in combination with sulfonylureas to lower hemoglobin Alc concentrations an additional 0.5–0.9%. Acarbose is not a cure for diabetes, nor is it a substitute for diet, exercise, oral hypoglycemic agents, or insulin. Adverse effects are gastrointestinal and can be diminished by starting with an initial dosage of 25 mg tid. Depending on patient response, the dosage can be increased up to a maximum of 100 mg tid over time. CONCLUSIONS: Acarbose, through its unique mechanism of action, appears to be a safe and effective adjunctive agent to diet/exercise therapy or sulfonylurea therapy for treatment of non-insulin-dependent diabetes mellitus.
No evidence of disease activity in patients receiving daclizumab versus intramuscular interferon beta-1a for relapsing-remitting multiple sclerosis in the DECIDE study
Authors: Kappos Ludwig , Havrdova Eva , Giovannoni Gavin , Khatri Bhupendra O , Gauthier Susan A , Greenberg Steven J , You Xiaojun , Wang Ping , Giannattasio Giorgio 
Published: January 2017

Background: No evidence of disease activity (NEDA) is a composite endpoint being increasingly applied as an outcome measure in clinical trials as well as proposed for individual therapeutic decisions in multiple sclerosis (MS). Objective: Assess the proportion of patients with relapsing-remitting MS achieving NEDA in the DECIDE study of daclizumab 150 mg subcutaneous versus intramuscular interferon beta-1a 30 µg for 96–144 weeks. Methods: NEDA was defined as no relapses, no onset of 12-week confirmed disability progression (CDP), no new/newly enlarging T2 hyperintense lesions (NET2), and no gadolinium-enhancing (Gd+) lesions. Logistic regression models adjusted for baseline covariates compared treatment groups for baseline to week 96, weeks 0–24, and weeks 24–96. Results: From baseline to week 96, more daclizumab versus intramuscular interferon beta-1a patients achieved NEDA (24.6% vs 14.2%; odds ratio (OR; 95% confidence interval): 2.059 (1.592−2.661); p < 0.0001). ORs for clinical NEDA (no relapses, no CDP) and magnetic resonance imaging (MRI) NEDA (no NET2, no Gd+ lesions) were 1.651 (1.357−2.007; p < 0.0001) and 2.051 (1.628−2.582; p < 0.0001), respectively. ORs in favor of daclizumab for weeks 24–96 were consistently higher than for weeks 0–24. Conclusion: More daclizumab versus intramuscular interferon beta-1a patients achieved NEDA early in DECIDE, with effects increasing over time.
Temperature dependence of multiple sclerosis mortality rates in the United States
Authors: Sun Hongbing 
Published: January 2017

Background: It is well known that multiple sclerosis (MS) patients are very sensitive to heat events. However, how MS patients respond to the significant temperature difference between the high- and low-latitude regions is not understood. Objective: The goal is to identify the primary factor responsible for the fact that MS mortality rates of the United States is more than three times higher in the northern states than in the southern states. Methods: Correlation coefficients between the age-adjusted mortality rate of MS as the underlying cause of death and the state average temperature, altitude, latitude, duration of sunshine hours, and solar radiation in the 48 contiguous states were compared. Results: MS mortality rates correlate significantly and inversely with temperatures in the 48 states (correlation coefficient r = −0.812 and significance p = 0.00). Durations of sunshine hours and solar radiation do not correlate significantly with MS mortality rates ( r = −0.245, −0.14, and p = 0.101, 0.342, respectively). Conclusion: High environmental temperature is the primary reason for the low MS mortality rates and likely the low MS prevalence in low-latitude regions. Implication of the study result is that benefits of long-term heat acclimation through gradual and prolonged exposure to environmental heat for MS patients may be greatly underappreciated.
Does Rapid Intraoperative Parathyroid Hormone Analysis Predict Cure in Patients Undergoing Surgery for Primary Hyperparathyroidism?
Authors: Nilsen F. S. , Haug E. , Heidemann M. , Karlsen S. J. 
Published: January 2017

Background and Aims: Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia. Material and Methods: One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results. Results: The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively. Conclusions: A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.
Hip Fracture Treatment in Oulu — One-Year Survey with Four-Month Follow-Up
Authors: Saarenpää I. , Heikkinen T. , Partanen J. , Jalovaara P. 
Published: January 2017

Backgrounds and Aims: The standardized forms of the Standardized Audit of Hip Fractures in Europe (SAHFE) are aimed for the evaluation of hip fracture treatment in different hospitals and countries. The purpose was to evaluate and characterize a cohort of hip fracture patients with these forms and to evaluate their value in quality control. Material and Methods: The non-pathological hip fractures in patients over 49 years of age treated in the Oulu University Hospital were prospectively recorded during a one-year period using SAHFE forms. Results: There were 238 (52 male and 186 female) patients with a mean age of 78 (50–102) years. Fifty-nine percent of the patients were admitted from their own homes. Fifty-seven percent were able to walk alone outdoors and 48% could walk without walking aids before the fracture. A hundred and fifty patients had cervical fractures and 88 trochanteric fractures. The most frequent treatment of cervical fractures was Austin-Moore hemiarthroplasty (68%) and that of trochanteric fractures Gamma nail fixation (86%). At four months after the fracture, 50% lived in their own homes, 33% could walk alone out-doors and 13% could walk without any aids. Thirty-two percent had no pain in the hip. The overall mortality at four months was 17.6% and that of the operated patients 16.2%. The reoperation rate was 8.5%. Conclusion: SAHFE forms were very useful in the evaluation of the quality of the hip fracture treatment.
Pancreatic Injuries in the United Arab Emirates
Authors: Ahmad I. , Branicki F. J. , Ramadhan K. , El-Ashaal Y. , Abu-Zidan F. M. 
Published: January 2017

Purpose: To study the mechanism, management and outcome of patients who had sustained pancreatic trauma. Methodology: Patients who were treated for pancreatic trauma in Al-Ain hospital between October 2002 and August 2007 were retrospectively studied. Results: All eleven patients were males having a median age of 30 years (range 24–52 years). Nine had blunt trauma while two had suffered penetrating injury. Three presented with shock. Associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury. Early serum amylase was elevated in six patients. CT abdomen was diagnostic for pancreatic injury in seven patients. Two cases were missed by early CT scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater. All patients underwent laparotomy. Five patients were treated by drainage alone, four had distal pancreatectomy, abdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. Median hospital stay was 25 days (range 12–152 days). Two patients (18%) died. Conclusions: Blunt trauma is the main cause of pancreatic injury in our country. Early CT scan may miss pancreatic injury in almost a quarter of the patients. Thin sliced CT scan, with special views in a dedicated abdominal pancreatic study, is recommended. A high index of clinical suspicion, depending on the mechanism of injury, is important for diagnosis of pancreatic injury. Mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury, especially in haemodynamically unstable patients.
Haemodynamics and Acid-Base Equilibrium after Cardiac Surgery: Comparison of Rapidly Degradable Hydroxythyl Starch Solutions and Albumin
Authors: Niemi T. , Schramko A. , Kuitunen A. , Kukkonen S. , Suojaranta-Ylinen R. 
Published: January 2017

Background: Stable haemodynamics is often achieved by administration of colloids after cardiac surgery. We conducted a prospective, randomized, open-label study comparing haemodynamics and acid-base equilibrium after infusion of two rapidly degradable hydroxyethyl starch (HES) solutions or human albumin (HA) to cardiac surgical patients. Materials and Methods: 45 patients received a predetermined fixed dose of 15 ml kg−1 of either 6% HES (MW 130 kDa, n=15), 6% HES (MW 200 kDa, n=15) or 4% HA (MW 69 kDa, n=15) after on-pump cardiac surgery. Results: Left ventricular filling pressures assessed using pulmonary artery catheter responded similarly in all groups. Mean (SD) cardiac index was higher in HES130 [3.5 1 min−1 m−2 (0.7)] and HES200 [3.5 1 min−1 m−2 (0.5)] than in HA [2.8 1 min−1 m−2 (0.6)] group after completion of infusion (P=0.002) but no differences were detected at 2 and 18 hours. Oxygen delivery increased in both HES groups but not in HA group. After cessation of infusion base excess was the most negative in HA group. At 2 hours mean (SD) base excess was higher in HWS130 [0 (1.32)] than in HES200 [-1.32 (2.27)] and HA [-2.3 (1.3)] group (P=0.002, between the groups). Conclusions: We conclude that the effect of albumin on cardiac performance is inferior than that of HES130 or HES200 in early postoperative phase after cardiac surgery. HES130 induces no alterations in acid-base equilibrium whereas a negative base excess was observed after HA infusion.
The Impact of Proximal Femur Geometry on Fracture Type — A Comparison between Cervical and Trochanteric Fractures with Two Parameters
Authors: Panula J. , Sävelä M. , Jaatinen P. T. , Aarnio P. , Kivelä S.-L. 
Published: January 2017

Introduction: Only a few studies have tested the ability of proximal femur geometry parameters to discriminate between cervical hip fractures and those of the trochanter. The main objective of this study was to evaluate the geometrical differences between these two fracture types by measuring the neck shaft angle (NSA) and the femoral neck axis length (FNAL). We also compared the distributions of these parameters and the distributions of fracture type by gender. Material and Methods: A retrospective analysis was made in a population-based material of 428 hip fractures collected during a two-year period from 1999 to 2000 (323 women and 105 men aged 65 years or older). NSA and FNAL were manually measured from pelvic radiographs. Results: No significant differences in NSA or FNAL were found between cervical and trochanteric hip fractures in women or in men. Men had significantly higher NSA and FNAL than women. Age was not related to these geometrical parameters. The distributions by fracture type were similar in both genders. Conclusions: The different pathogenesis of cervical and trochanteric hip fractures cannot be explained by NSA or FNAL. A standardized measurement setup is needed when evaluating the role of hip geometry in fracture patients.