bluuebunny/crossref_metadata_2025_split huggingface dataset:
Verapamil-Induced Hyperprolactememia Complicated by a Pituitary Incidentaloma
Authors: Dombrowski Robert C , Romeo June H , Aron David C 
Published: July 2017

Objective: To describe a patient with an incidental pituitary lesion who experienced verapamil-induced hyperprolactinemia. Case Summary: A patient experiencing impotence was found to have increased prolactin and low testosterone concentrations. Verapamil as a cause for his increased prolactin concentration was not considered initially. The patient underwent extensive testing to rule out a pituitary tumor. Magnetic resonance imaging showed a 6-mm lesion consistent with a pituitary microadenoma that had remained unchanged for 6 months. Verapamil therapy was discontinued and within 1 month the patient's prolactin concentration decreased from 46.8 to 14.4 μg/L, and has remained within normal limits. Discussion: We reviewed reports of verapamil-induced hyperprolactinemia. This case was unique as this patient had an incidental pituitary lesion that was not responsible for increasing the prolactin concentration in our patient, but rather complicated the identification of a drug-induced disorder. Conclusions: The failure to identify the hyperprolactinemic effect of verapamil may have resulted in performing unnecessary radiologic procedures in this patient This case highlights the importance of obtaining a medication history in patients with hyperprolactinemia.
Activated Clotting Time Versus Activated Partial Thromboplastin Time for Therapeutic Monitoring of Heparin
Authors: Simko Robert J , Tsung Faye FW , Stanek Eric J 
Published: July 2017

Objective: To compare and contrast the activated partial thromboplastin time (aPTT) and the activated clotting time (ACT) for the therapeutic monitoring of heparin therapy. Data Sources: Relevant articles were identified through an English-language MEDLINE search from 1966 to 1995. Additional sources were identified from the reference lists of these articles. Study Selection: Studies that investigated the use and limitations of the individual assays and those offering direct comparisons were chosen for review. Data Extraction: Features demonstrating clinical applications and limitations of the aPTT and the ACT were extracted. Where possible, data suggesting preferential application of either assay also were extracted. Data Synthesis: Both the aPTT and ACT are clinically useful for the monitoring of heparin therapy. The aPTT is used more frequently for routine monitoring; the ACT is used in specialized situations requiring large heparin doses. The ACT is typically performed at bedside and is capable of yielding results rapidly and perhaps at a lower cost than an aPTT performed by a central laboratory. Most practitioners are familiar with the central laboratory aPTT. A bedside aPTT device is available, but is not yet in widespread clinical use. Both assay techniques are subject to various limitations. Conclusions: The ACT is theoretically equally as useful as the aPTT for the routine monitoring of heparin therapy, but has not been well-studied. The ACT appears more useful in situations in which high serum concentrations of heparin are required. Further cost-effectiveness and clinical outcome studies directly comparing the ACT and the aPTT in specific clinical situations are needed.
Quinupristin/Dalfopristin (RP 59500): A New Streptogramin Antibiotic
Authors: Chant Clarence , Rybak Michael J 
Published: July 2017

Objective: To review the current knowledge on RP 59500 (quinupristin/dalfopristin, Synercid), a new streptogramin antibiotic, with respect to its pharmacology, pharmacokinetics, pharmacodynamics, mechanism of resistance, and in vitro inhibitory and bactericidal activity. Data Sources: A MEDLINE search using the keywords RP 59500, pristinamycin, virginiamycin, and streptogramin was performed. Relevant abstracts presented at recent scientific conferences also were consulted. Study Selection: Because RP 59500 is a relatively new investigational agent, relevant in vitro and animal studies were selected. All available human studies were included as well. Data Extraction: Data from in vitro and in vivo studies were included, with particular emphasis on human studies. Data Synthesis: RP 59500 is a new injectable streptogramin antibiotic consisting of a mixture of 2 synergistic pristinamycin compounds. RP 59500 possesses in vitro inhibitory and bactericidal activity against most isolates of gram-positive organisms including vancomycin-resistant Enterococcus faecium, selected gram-negative bacteria, and most anaerobic organisms. Based on preliminary data, the drug appears to be metabolized rapidly and extensively while exhibiting a significant postantibiotic effect. Data from ongoing clinical trials suggest that RP 59500 is well-tolerated except for mild injection site irritations. However, before the role of RP 59500 within the vast armamentarium of antimicrobials can be elucidated, additional studies need to be conducted to document its clinical efficacy. Conclusions: Based on in vitro susceptibility testing, in vivo studies, and preliminary clinical data, RP 59500 may be an alternative to the glycopeptides, especially for inherently resistant organisms. Further studies are needed to confirm this agent's in vitro activity and to establish its clinical efficacy.
Necrolytic Migratory Erythema: A Forgotten Paraneoplastic Condition
Authors: Tremblay Catherine , Marcil Isabelle 
Published: July 2017

Background: Necrolytic migratory erythema (NME) is most commonly a paraneoplastic condition. It is the dermatologic manifestation classically associated with glucagonoma pancreatic neuroendocrine tumour. Glucagonoma syndrome has been defined by the constellation of secreting tumour associated with overproduction by the α-cells in the pancreatic islets of Langerhans, abnormally elevated blood level of glucagon, and skin findings of NME. Objective: Although rare, all dermatologists must know and recognise NME promptly to request useful investigations for the diagnosis of this characteristic neuroendocrine tumour. Methods and Results: We report a case of a middle-aged woman seen in our dermatology clinic with longstanding skin findings suggestive of NME revealing a glucagonoma. Surgical removal was associated with complete resolution of the cutaneous and systemic features. Conclusion: NME is often the first clinical finding of an occult neuroendocrine pancreatic neoplasia. Dermatologists must be aware of this condition since they can be the first physician to suspect it and allow multidisciplinary management, which influences the prognostic value. Surgical removal is the first-line therapy if early diagnosis is done before liver metastases occur.
Characteristics of school-based health services associated with students’ mental health
Authors: Denny Simon , Howie Hamish , Grant Sue , Galbreath Ross , Utter Jennifer , Fleming Theresa , Clark Terryann 
Published: July 2017

Objective School-based health services (SBHS) have been shown to improve access to mental health services but the evidence of their effectiveness on students’ mental health is lacking. Our objective was to examine associations between variation in the provision of SBHS and students’ mental health. Methods A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted in March–November 2012. Students’ mental health is related to data on school health services obtained from clinic leaders and clinicians from 90 participating high schools. Results After adjustment for socio-demographic differences in students between schools, increasing levels of services were associated with progressively lower levels of student-reported depressive symptoms (p = 0.002), emotional and behavioural difficulties (p = 0.004) and suicidality (p = 0.008). Services with greater levels of nursing hours (p = 0.02) and those that performed routine, comprehensive psychosocial assessments (p = 0.01) were both associated with lower levels of student-reported depressive symptoms. Greater levels of nursing hours and doctor hours were associated with lower self-reported suicidality among students. Conclusions Although a causal association between school-based health services and students’ mental health cannot be demonstrated, these findings support the benefit of such services and the need for a cluster randomized trial.
Social Differences in Reproductive Health
Authors: Olsen Jørn , Frische Grethe 
Published: July 2017

Aim: To describe differences in life style variables according to socioeconomic groupings and to analyse the association between birth weight, stillbirth and congenital malformation according to the socioeconomic grouping for the father as well as the mother. Method: Follow-up of 11 888 pregnant women in Odense and Aalborg, Denmark who were consecutively enrolled in the study from April 1984 to April 1987 as part of a community trial. Data: Information on socioeconomic group and life-style factors were collected by means of self-administered questionnaires in the 36th week of gestation. Data on pregnancy outcomes were collected from birth certificates and medical records according to standardized search routines. Results: Women in the lower socioeconomic groups were younger, smaller, had a higher prepregnancy weight, smoked more and had a higher intake of coffee during pregnancy than women in higher socioeconomic groups. Better off women, on the other hand, had a higher consumption of alcohol, fish, and vegetables. Low birth weight was found to be negatively correlated with socioeconomic grouping. The lowest birth weights were found among babies born to unskilled and unemployed women even after adjustment for smoking habits, prepregnancy height and weight and a number of other potential confounders. Stillbirth and the prevalence of congenital malformations was not associated with socioeconomic grouping, but the amount of information was very limited regarding these outcomes.
Fibromyalgia
Authors: Bruusgaard Dag , Evensen Åsa Rytter , Bjerkedal Tor 
Published: July 2017

Fibromyalgia is a condition under dispute. Accepted by some as a major step forward in understanding some of the patients with widespread muscular pain, looked upon as a confusing side step by others. In 1988 fibromyalgia was by far the most frequent single diagnosis as a reason for disability pension in Norway. Disability statistics however show big differences between counties. Two neighbouring counties had among the lowest and the highest incidence of disability pensioners with the diagnosis fibromyalgia. New pensioners with fibromyalgia and some closely related diagnoses have been studied during the year 1988 by means of reading the insurance records. It became apparent that the difference between the two counties with respect to the incidence of fibromyalgia as a cause of disability pension could be explained by differences in diagnostic setting by the doctors and difference in the assessment from the insurance system, rather than real differences in morbidity pattern. Complaints from the musculoskeletal system is frequent and increasing in the population both as a reason for sick leave and disability pension. Whether this complicated and challenging situation is made more easy to handle by defining a subgroup of those persons as having “fibromyalgia” is questioned.
Maternal chromium restriction modulates miRNA profiles related to lipid metabolism disorder in mice offspring
Authors: Zhang Qian , Xiao Xinhua , Zheng Jia , Li Ming , Yu Miao , Ping Fan , Wang Zhixin , Qi Cuijuan , Wang Tong , Wang Xiaojing 
Published: July 2017

Increasing evidence shows that maternal nutrition status has a vital effect on offspring susceptibility to obesity. MicroRNAs are related to lipid metabolism processes. This study aimed to evaluate whether maternal chromium restriction could affect miRNA expression involved in lipid metabolism in offspring. Weaning C57BL/6J mice born from mothers fed with normal control diet or chromium-restricted diet were fed for 13 weeks. The adipose miRNA expression profile was analyzed by miRNA array analysis. At 16 weeks old, pups from dams fed with chromium-restricted diet exhibit higher body weight, fat weight, and serum TC, TG levels. Six miRNAs were identified as upregulated in the RC group compared with the CC group, whereas eight miRNAs were lower than the threshold level set in the RC group. In the validated target genes of these differentially expressed miRNA, the MAPK signaling pathway serves an important role in the influence of early life chromium-restricted diet on lipid metabolism through miRNA. Long-term programming on various specific miRNA and MAPK signaling pathway may be involved in maternal chromium restriction in the adipose of female offspring. Impact statement For the first time, our study demonstrates important miRNA differences in the effect of maternal chromium restriction in offspring. These miRNAs may serve as “bridges” between the mother and the offspring by affecting the MAPK pathway.
Post-obstructive pulmonary edema from aspirated nuts
Authors: Bashir Ahsan , Ahmad Sabina Qureshi , Silverman Joshua , Concepcion Emily , Lee Haesoon 
Published: July 2017

Objectives: Post-obstructive pulmonary edema is thought to occur from hemodynamic changes secondary to forced inspiration against the closed airway due to acute or chronic airway obstruction. We report a case of a 13 month-old boy who developed pulmonary edema from aspirated foreign body, nuts. Methods: He underwent emergency bronchoscopy to confirm the clinical diagnosis of aspirated nuts in the trachea and nuts were removed endoscopically. His trachea was then intubated and he was mechanically ventilated with oxygen. Results: He developed florid pulmonary edema early in the course with tracheal obstruction and during endoscopic removal of nuts. After removal of obstruction he was ventilated mechanically and pulmonary edema cleared rapidly. Conclusions: Aspirated nuts obstructing trachea can induce obstructive pulmonary edema. Early recognition of foreign body obstruction based on clinical history and its removal resolved pulmonary edema.
The feasibility of delivering constraint-induced language therapy via the Internet
Authors: Pitt Rachelle , Theodoros Deborah , Hill Anne J , Rodriguez Amy D , Russell Trevor 
Published: July 2017

Objective This study is designed to determine the feasibility of the provision of an evidenced-based aphasia therapy, constraint-induced language therapy, via telerehabilitation. It describes the computer software that was developed specifically for the delivery of constraint-induced language therapy in the online environment and presents two case studies. Methods Two participants with chronic aphasia were assessed before and after a two-week intensive treatment block of constraint-induced language therapy delivered via Web-based videoconferencing. The group-based, dual card request game utilized in face-to-face constraint-induced language therapy was transformed into an innovative and user-friendly Web-based game – Internet constraint-induced language therapy (iCILT). Participants accessed iCILT via the Internet from their own home every weekday for two weeks. Language and quality of life measures were administered pre- and post-therapy in order to detect treatment effects. Participant satisfaction information was also recorded. Results Online delivery of iCILT was technically feasible and participant satisfaction was high with a number of benefits associated with telerehabilitation identified by participants. Post-treatment performance for language functioning and communication-related quality of life was variable for each participant, however improvements in naming were noted. Conclusions Constraint-induced language therapy delivered via telerehabilitation may be a feasible alternative to traditional face-to-face therapy for people with chronic aphasia.
Cephalosporin-Associated Hypoprothrombinemia: Case and Review of the Literature
Authors: Stork Christine , Etzel Joseph V. , Brocavich Joseph M. , Forlenza Susan 
Published: July 2017

Objective: To present a case of cefotetan-associated hypoprothrombinemia and to review the literature concerning cephalosporin-associated hypoprothrombinemia. Data Sources: Information was collected by conducting a MEDLINE search for cases, clinical trials, reviews, and other articles pertaining to cephalosporin use and the development of hypoprothrombinemia. Study Selection: Studies, cases, and letters were selected if they addressed the development of hypoprothrombinemia in cephalosporin-treated patients. Data Synthesis: A case of hypoprothrombinemia is described in an 82-year-old woman who received cefotetan for the treatment of a urinary tract infection. A review of the literature revealed more than 50 reported cases and multiple clinical studies evaluating this adverse effect. The postulated mechanism behind this occurrence is the inhibition of the synthesis of vitamin K-dependent clotting factors by the N-methyl-thiotetrazole (NMTT) moiety found in certain cephalosporin side chains. Risk factors associated with the development of this adverse effect include advanced age, renal and hepatic impairment, recent surgical procedures, malnutrition, and the use of H2-antagonists. Conclusions: Cephalosporins containing the NMTT side chain are associated with the development of hypoprothrombinemia and possibly bleeding, especially in high-risk patients.
Gentamicin Pharmacokinetics in Elderly Patients with Normal Renal Function
Authors: Koo Ji M. , Miller Donald R. , Peterson Charles D. 
Published: July 2017

Objective: To establish the pharmacokinetic parameters of gentamicin in elderly patients and to compare predicted concentrations based on the Dettli method, with actual concentrations. Design: Measurement of gentamicin concentrations and pharmacokinetic parameters in a consecutive patient sample with comparison to ones predicted by the Dettli method. Setting: Medical and surgical units in a Veterans Affairs Medical Center. Patients: Forty-six consecutive elderly men treated with gentamicin for documented or presumed infection and had stable, normal renal function. Main Outcome Measures: The following information was calculated or measured: elimination rate constant (kel), elimination half-life, volume of distribution (Vd), and peak and trough concentrations. Results: The mean kel (0.16 ± 0.05 h−1) was not significantly different (p=0.2) from the Dettli method prediction, and the mean Vd (0.36 ± 0.1 L/kg) was 37 percent higher than that usually reported. Actual peak and trough concentrations were significantly lower (both p<0.01) than predicted concentrations. Conclusions: Based on our findings, higher than recommended loading doses and longer dosage intervals may be required in the elderly. The Dettli method is useful to estimate kel in the elderly.
Nonsterile Extemporaneous Compounding: A Bibliography for the Pharmacy Practitioner
Authors: Raymond Glynn G. 
Published: July 2017

Objective: For the pharmacist to be able to practice good professional and scientific procedures, appropriate literature sources are provided to enable rational, appropriate decisions for extemporaneous compounding. Data Sources: The bibliography consists of articles listed from the key word “compounding” in International Pharmaceutical Abstracts. Study Selection: The list of references are compiled in alphabetical order according to the title of the reference in terms of generic name, the clinical condition, or the subject heading. Data Extraction: Many of the extemporaneous formulations are published in accessible professional pharmacy journals, including American Druggist, American Journal of Hospital Pharmacy, The Annals of Pharmacotherapy, and US Pharmacist. Data Synthesis: The pharmacist must determine if the referenced expiration date was determined either by chemical stability or by successful clinical experience. The assignment of an expiration date by chemical stability is the accepted standard of the pharmaceutical industry. Assigning an expiration date by clinical response does not give the clinician any quantification of chemical potency or an indication of the absence or presence of degradation products in a formulation. Conclusions: With extemporaneous compounding, there must not be any careless formulation of prescription products without adequate scientific and professional judgment. For this reason, pharmacists are encouraged to use the current pharmaceutical literature to enhance their professional judgment. To make pharmacists' searches of the pharmaceutical literature for extemporaneous formulations a time-efficient procedure, a bibliography is presented.
Legal Justification for Licensure of Pharmacy Technicians
Authors: Brushwood David B. 
Published: July 2017

Objective: To review the facts and legal rationale of a lawsuit in which a hospital was held liable for discharging a pharmacy technician from employment. Summary: The hospital and the pharmacy technician previously had disagreed about several matters. The technician believed he was being discriminated against based on his need to be away from work to serve in the National Guard. On one occasion, the technician reported to work in what appeared to be a drug-impaired state. The technician subsequently was discharged from employment. He sued, contending that the discharge was in retaliation for his asserting his rights as a National Guard member. The technician won the lawsuit. Conclusions: Employment law bends over backward to protect employees. When an employee is not licensed, the only effective peer review is within the employment relationship. The public may not be effectively protected from harm that might be caused by employees who are not competent. Strong laws that protect employees restrict the ability of employers to oversee employee conduct. Therefore, for employees whose incompetence may pose a threat to the public, licensure provides a necessary additional level of protection.
Treatment of Cyanide and Thiocyanate Toxicity Secondary to Sodium Nitroprusside
Authors: Burke Timothy G. , Mutnick Alan H. 
Published: July 2017

Objective: To provide the reader with an update on the disposition of nitroprusside in the body and the current therapy in managing cyanide and thiocyanate toxicity. Data Sources: Currently available literature reports were used to provide readers with a comprehensive framework that will enable them to monitor for, prevent, and if needed, treat patients with cyanide and/or thiocyanate toxicity. Additional sources were used to provide risk factors, which enable practitioners to identify patients predisposed to such toxicities while receiving nitroprusside. Conclusions: The continuously changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease have increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective and at the same time result in minimal adverse reactions. Members of the healthcare professions must be able to identify situations that warrant close therapeutic monitoring to prevent extended hospital stays caused by iatrogenic diseases. Nitroprusside is a frequently used agent that can result in extended hospital stays, increased resource use, and even death caused by cyanide and/or thiocyanate toxicity. The identification of patients at risk, methods to monitor therapy, and treatments for toxicity will help reduce such reactions and provide maximal therapeutic response with minimal toxic consequences when using nitroprusside.