bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated with Suboptimal Analgesic use in Community-Dwelling Elderly
Authors: Hanlon Joseph T , Fillenbaum Gerda G , Studenski Stephanie A , Ziqubu-Page Thandi , Wall William E 
Published: January 2017

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred for 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk is consistently increased in those who are depressed or have impaired functional status.
Agranulocytosis, Plasmacytosis, and Thrombocytosis Followed by a Leukemoid Reaction Due to Acute Acetaminophen Toxicity
Authors: Gürsoy Murat , Haznedaroğlu Ibrahim C , Çelik Ismail , Sayinalp Nilgün , Özcebe Osman I , Dündar Semra V , Guévremont Chantal 
Published: January 2017

OBJECTIVE: To describe a patient who developed hepatotoxicity, reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction, apparently caused by acute acetaminophen toxicity. SETTING: University-affiliated hospital. CASE SUMMARY: A 19-year-old white woman who took an overdose of acetaminophen developed hepatotoxicity and reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction. Symptoms, signs, and laboratory findings regressed with symptomatic therapy during the follow-up period. CONCLUSIONS: We believe that acute acetaminophen toxicity was responsible for these hematologic abnormalities. This profile of hematologic adverse effects associated with acetaminophen toxicity has not been reported previously.
Risperidone-Induced Neuroleptic Malignant Syndrome
Authors: Sharma Roopali , Trappler Brian , Ng Yiu Kee , Leeman Cavin P 
Published: January 2017

OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995. DATA SYNTHESIS: We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management. CONCLUSIONS: Clinicians are cautioned about the possibility of NMS with risperidone.
Bruising Associated with the Use of Fluoxetine
Authors: Pai Vinita B , Kelly Michael W 
Published: January 2017

OBJECTIVE: To report a case of suspected fluoxetine-induced bruising and review the literature surrounding this rare adverse effect. CASE SUMMARY: A 31-year-old white woman was diagnosed with depression and treated with fluoxetine. After fluoxetine 20 mg/d for 6 weeks, she reported bruising that was disproportionate to any trauma incurred. Her prothrombin time, partial thromboplastin time, and complete blood cell count were within normal limits. Fluoxetine was suspected to be the cause of this bruising. The patient did not want to discontinue the medication and has continued to bruise while continuing fluoxetine therapy. DISCUSSION: Frequently encountered adverse effects caused by fluoxetine use include nausea, nervousness, and insomnia, but hematologic effects have also been reported. These include bleeding or bruising with prolonged bleeding time, increased prothrombin time and partial thromboplastin time, and thrombocytopenia. The mechanism behind these adverse effects is the prevention of serotonin-induced amplification of platelet aggregation by fluoxetine. Blockade of 5-hydroxytryptamine uptake in the platelets by fluoxetine reduces or depletes the platelet serotonin stores, thereby predisposing a patient with a mild underlying platelet disorder to a fluoxetine-induced hematologic disorder. CONCLUSIONS: Fluoxetine has been reported to produce bruising, bleeding, and other hematologic disorders. It should be used with caution when treating patients with thrombocytopenia or with proven or suspected platelet dysfunction.
Pharmacologic Management of Postdural Puncture Headache
Authors: Choi Alice , Laurito Charles E , Cunningham Francesca E 
Published: January 2017

OBJECTIVE: To discuss the pathogenesis, incidence, and clinical presentation of postdural puncture headaches (PDPHs) and to provide a comprehensive evaluation on the pharmacologic management of PDPH. DATA SOURCE: A MEDLINE search was used to identify pertinent literature published in English including review articles, case reports, letters, and abstracts. Information was also extracted from textbooks for background purposes. STUDY SELECTION: All clinical studies, case reports, abstracts, and letters were included because of the limited amount of literature available on the pharmacologic therapy for PDPH. Related research articles and review articles were also used to provide background information on PDPH. DATA EXTRACTION: Methodology and results from clinical trials and abstracts were described and evaluated. Case reports and letters were summarized and critically reviewed for the feasibility of the different treatment modalities. Information on the pathophysiology, incidence and severity, and clinical presentation of PDPH was extracted from related research articles, review articles, and textbooks. DATA SYNTHESIS: The epidural blood patch (EBP) is one of the most effective treatments for PDPH. Pharmacologic management of PDPH offers a less invasive treatment modality than the EBP. Numerous drug therapies have been presented in the literature, though few merit clinical application. Caffeine therapy, both oral and parenteral, is the most commonly used pharmacologic treatment modality. Theophylline and sumatriptan are potentially promising agents for the treatment of PDPH. Epidural administration of fluids and drugs is also effective in the treatment of PDPH. Epidural administration of NaCl 0.9% and dextran may be an alternative to the EBP when the EBP is unsuccessful or contraindicated. Epidural adrenocorticotropic hormone and epidural morphine also demonstrate some potential in the treatment of PDPH. Individual patient characteristics (i.e., HIV, sepsis) need to be considered when deciding on a treatment. More reports, especially clinical studies, are necessary before a definitive statement can be made regarding any one treatment. In the meantime, therapy will be guided by clinical judgment based on the literature reviewed in this article. CONCLUSIONS: Intravenous and oral caffeine are effective and noninvasive treatments for PDPH. Epidural NaCl 0.9% or dextran are alternatives when the EBP is unsuccessful or contraindicated. Several methods of pharmacologic management have been cited in the literature, but all require further evaluation.
Pharmacoepidemiology of Urinary Tract Infections in Iowa Medicaid Patients in Urban Long-Term-Care Facilities
Authors: Bjornson Darrel C. , Rovers John P. , Burian Julie A. , Hall Nancy L. 
Published: January 2017

OBJECTIVE: To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes. DESIGN: Retrospective review of medical records in LTCFs of patients who had documented UTIs. METHODS: Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995. Patients with UTIs were selected from the LTCF infection control logs. Data collected on patients included demographics, concomitant diseases, type of UTI (i.e., symptomatic, asymptomatic, catheter-related), process measures for management, UTI treatment, patient outcomes, and follow-up. Patient outcome data were defined as either cure or no cure. A UTI cure was defined as a negative urine culture while taking antibiotic therapy and/or complete resolution of signs and symptoms, as well as no further treatment given within 2 weeks after the end of treatment. RESULTS: Data were collected on 310 patients who had at least one UTI over the 1-year study period. Patients were primarily elderly (mean age 82.2 ± 12.3 y), white (95.1%), and female (83.9%). Concomitant diseases were common and about one-fourth (23.0%) of the patients were catheterized. There were 536 UTI events (the unit of analysis) documented over the 1-year period, with about one-half (45.9%) being UTIs with symptoms consistent with uncomplicated lower UTI. Nearly two-thirds (62.3%) of the patients were cured, based on the study definition; there was no association between cure and type of antimicrobial therapy (p = 0.99). Over one-third (35.2%) of the UTIs were treated with a quinolone antibiotic. Others were treated with trimethoprim/sulfamethoxazole (24.4%), nitrofurantoin (13.9%), a cephalosporin (10.4%), or ampicillin/amoxicillin (9.8%). Sixty-day follow-up showed no association between type of therapy and hospital readmission, physician follow-up visits, or subsequent UTIs. CONCLUSIONS: There were no differences in cure rates when comparing LTCF UTI patients receiving various regimens. With outcomes being the same, the clinician should closely consider costs of drug therapy in selecting a treatment preference.
Paclitaxel Formulation as a Cause of Ethanol Intoxication
Authors: Wilson David B. , Beck Thomas M. , Gundlach Catherine A. 
Published: January 2017

OBJECTIVE: To report a case of ethyl alcohol intoxication associated with paclitaxel administration. CASE SUMMARY: A patient who received a 3-hour paclitaxel infusion for metastatic breast carcinoma and developed symptoms of acute alcohol intoxication. A blood ethanol concentration drawn at the end of the paclitaxel infusion was 97.8 mg/dL (0.098%). DISCUSSION: The amount of alcohol contained in paclitaxel is discussed. A review of the literature revealed one patient series where the highest blood alcohol concentration was one-third that seen in our patient. CONCLUSIONS: Clinicians should recognize the potential for alcohol intoxication with paclitaxel administration. This is especially pertinent when higher doses are given over a short period of time.
The Effect of Mesalamine and Nicotine in the Treatment of Inflammatory Bowel Disease
Authors: Bonapace Charles R. , Mays David A. 
Published: January 2017

OBJECTIVE: To characterize the usefulness of mesalamine and nicotine in the treatment of active ulcerative colitis and inactive Crohn's disease. DATA SOURCES: Citations were selected from the MEDLINE database. Only those involving human subjects, inflammatory bowel disease, and available in English were selected. STUDY SELECTION: Selection criteria consisted of clinical trials and review articles assessing the effects of mesalamine and nicotine in active ulcerative colitis or inactive Crohn's disease and the utility of reducing steroid dependence or relapse rate. Less than 20% of the articles identified met the selection criteria. DATA SYNTHESIS: In patients with inactive Crohn's disease, mesalamine 2 g/d significantly reduced the risk of relapse in high-relapse-risk patients compared with placebo, reducing the relapse rate from 71% to 55%, but was ineffective in preventing recurrence of inactive Crohn's disease following surgical resection. Mesalamine 4 g/d was effective in decreasing weaning failure due to steroid dependence by 67%, although the relapse rate was not significant compared with placebo at the end of 12 months. Following surgical resection, mesalamine was unable to significantly reduce the incidence of recurrence compared with placebo at the end of 1 year. In patients with active ulcerative colitis, oral mesalamine 2 and 4 g/d was superior to placebo in inducing remission compared with placebo. Among patients with prior steroid or sulfasalazine treatment, rectal mesalamine 4 g hs achieved a remission rate of 78% in more than 12 weeks of therapy. Other studies have not found a dose—response relationship with lower dosages of mesalamine. Whereas nicotine 15–25 mg/d administered as a transdermal patch produced greater symptomatic improvement in active ulcerative colitis compared with placebo, nicotine 15 mg/16 h produced results no different from those with placebo in maintaining remission in inactive ulcerative colitis. Nicotine appears to have an adverse effect on the course of Crohn's disease and is not recommended. CONCLUSIONS: Mesalamine has demonstrated clinical effectiveness as a therapeutic agent in the treatment of active ulcerative colitis and inactive Crohn's disease. Although its relationship to inflammatory bowel disease has been known for many years, the usefulness of nicotine for the treatment of active ulcerative colitis requires further exploration before it can be recommended as a therapeutic agent.
Prenatal Alcohol Exposure and Fetal Programming: Effects on Neuroendocrine and Immune Function
Authors: Zhang Xingqi , Sliwowska Joanna H. , Weinberg Joanne 
Published: January 2017

Alcohol abuse is known to result in clinical abnormalities of endocrine function and neuroendocrine regulation. However, most studies have been conducted on males. Only recently have studies begun to investigate the influence of alcohol on endocrine function in females and, more specifically, endocrine function during pregnancy. Alcohol-induced endocrine imbalances may contribute to the etiology of fetal alcohol syndrome. Alcohol crosses the placenta and can directly affect developing fetal cells and tissues. Alcohol-induced changes in maternal endocrine function can disrupt maternal-fetal hormonal interactions and affect the female’s ability to maintain a successful pregnancy, thus indirectly affecting the fetus.In this review, we focus on the adverse effects of prenatal alcohol exposure on neuroendocrine and immune function, with particular emphasis on the hypothalamic-pituitary-adrenal (HPA) axis and the concept of fetal programming. The HPA axis is highly susceptible to programming during fetal development. Early environmental experiences, including exposure to alcohol, can reprogram the HPA axis such that HPA tone is increased throughout life. We present data that demonstrate that maternal alcohol consumption increases HPA activity in both the maternal female and the offspring. Increased exposure to endogenous glucocorticoids throughout the lifespan can alter behavioral and physiologic responsiveness and increase vulnerability to illnesses or disorders later in life. Alterations in immune function may be one of the long-term consequences of fetal HPA programming. We discuss studies that demonstrate the adverse effects of alcohol on immune competence and the increased vulnerability of ethanol-exposed offspring to the immunosuppressive effects of stress. Fetal programming of HPA activity may underlie some of the long-term behavioral, cognitive, and immune deficits that are observed following prenatal alcohol exposure.
Bioavailability of Carotenoids and Tocopherols from Broccoli: In Vivo and in Vitro Assessment
Authors: Granado F. , Olmedilla B. , Herrero C. , Pérez-SacristáN B. , Blanco I. , BláZquez S. 
Published: January 2017

Fruits and vegetables are the major sources of biologically active compounds, and carotenoids and tocopherols constitute important groups in human diets. Bioavailability is a critical feature in the assessment of the role of micronutrients in human health, and the approaches to this issue include in vitro and in vivo methods. Our aim was to evaluate the bioavailability of carotenoids and tocopherols present in broccoli and to compare in vitro and in vivo approaches. Fourteen apparently healthy volunteers consumed 200 g broccoli once a day for seven days. Blood samples were drawn at baseline and after intervention to determine changes in lutein, β-carotene, and Α- and γ-tocopherol as relevant phytochemicals provided with this vegetable. Broccoli also was subjected to simulated gastrointestinal digestion to assess changes related to preabsorptive processes. Analytes in serum and at each phase of the digestion were assayed by high-performance liquid chromatography. During the intervention, the amounts supplied dally ranged from 2.4 to 3.1 mg lutein, 1.4 to 1.8 mg β-carotene, 4.5 to 6.8 mg Α-tocopherol, and 0.8 to 1.8 mg γ-tocopherol. Significant changes in serum in both men and women were observed only for lutein, whereas for γ-tocopherol a significant change was detected in women. No changes were observed for Α-tocopherol, β-carotene, retinol, the Α-tocopherol-to-cholesterol ratio, or serum lipids. Using the in vitro model, more than 75% of lutein, β-carotene, γ-tocopherol, and Α-tocopherol remained at the duodenal phase, whereas Incorporation Into the supernatants accounted for <20% of the initial content in food. Regular consumption of broccoli at dietary levels increased serum concentrations of lutein and γ-tocopherol without affecting Α-tocopherol or β-carotene status in serum. The behavior of these phytochemicals under in vitro gastrointestinal conditions does not fully explain the changes observed in vivo.
Synthesis of multi ring-fused imidazo [1,2-a]isoquinoline-based fluorescent scaffold as anti-Herpetic agent
Authors: Chakravarty Harapriya , Ojha Durbadal , Konreddy Ananda K , Bal Chandralata , Chandra Nidhi S , Sharon Ashoke , Chattopadhyay Debprasad 
Published: January 2017

Background Natural product-inspired synthesis is a key incorporation in modern diversity-oriented synthesis to yield biologically novel scaffold. Inspired by β-carboline fused system, we have designed molecules with multi ring fused scaffold by modifying the tricyclic pyrido[3,4- b]indole ring with imidazo[1,2- a]isoquinoline. Methods A highly convergent approach with new C–N and C–C bond formation to synthesize multiring fused complex scaffold imidazo[1,2- a]isoquinolinies as fluorophores. N-nucleophile-induced ring transformation of 2 H-pyran-2-one followed by in situ cis-stilbene-type oxidative photocyclization yielded new C–C bond formation without additional oxidant. The cytotoxicity, effective concentrations, and the mode of action of the synthesized analogs were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),, plaque reduction, time of addition, and reverse transcriptase Polymerase Chain Reaction (PCR). Results Novel imidazo[1,2- a]isoquinoline analogs were prepared, and the results revealed that trans isomer of cyclopropyl analog (EC50 35 and 37.5 µg/ml) and trans isomer of citric acid salt of phenyl analog (EC50 38.2 and 39.8 µg/ml) possess significant anti-Herpes Simplex Virus (HSV) activity with selectivity index of >10. The kinetic study demonstrated that both the analogs inhibited HSV-1F and HSV-2G at 2–4 h postinfection. Finally, western blot and reverse transcriptase PCR assays revealed that both the analogs suppressed viral immediate early transcription. Conclusion Novel imidazo[1,2- a]isoquinoline analogs were synthesized from pyranone with appropriate amines. Two compounds showed better antiviral profile on HSV-infected Vero cells, compared to the standard drug acyclovir (ACV). Overall, we discovered a promising scaffold to develop a nonnucleoside lead targeting the viral immediate early transcription for the management of HSV infections.
Murine systemic thrombophilia and hemolytic uremic syndrome from a factor H point mutation
Authors: Ueda Yoshiyasu , Mohammed Imran , Song Delu , Gullipalli Damodar , Zhou Lin , Sato Sayaka , Wang Yuan , Gupta Shuchi , Cheng Zhongjian , Wang Hong , Bao Jialing , Mao Yingying , Brass Lawrence , Zheng X. Long , Miwa Takashi , Palmer Matthew , Dunaief Joshua , Song Wen-Chao 
Published: January 2017

Key PointsA point mutation in murine factor H (W1206R) impairs its interaction with host cells but does not affect its complement-regulating activity. W1206R mutant mice develop complement-mediated systemic thrombotic angiopathy leading to renal failure, stroke, and retinopathy.
Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a randomised controlled trial
Authors: Martinez F. Eduardo , Anstey Matthew , Ford Andrew , Roberts Brigit , Hardie Miranda , Palmer Robert , Choo Lynn , Hillman David , Hensley Michael , Kelty Erin , Murray Kevin , Singh Bhajan , Wibrow Bradley 
Published: January 2017

Abstract
Background
Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium.

Methods
This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72 h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4 mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14 days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep.

Discussion
Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU.

Trial registration
Australian New Zealand Clinical Trial Registry (ANZCTR) number: ACTRN12616000436471. Registered on 20 December 2015.