bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should Relatives Be Informed That Autopsy Is intended?
Authors: Britton Mona 
Published: July 2017

According to a recommendation of the Swedish JO (Ombudsman) relatives of deceased patients were informed that autopsy was intended. Subsequently, 278 (94%) of them were interviewed. The aim was to investigate whether the notification procedure had had positive consequences for them or whether, from their point of view, it could equally well or preferably be omitted. (1) 13% of the relatives denied that they had been informed. This was more common among those who had not commented at all when the intention was presented. It seemed that many of them had never realized that the matter had been mentioned. (2) Generally it seems that the information procedure provided an opportunity for relatives who object to autopsy to express their views. (3) Relatives had a better knowledge of the cause of death when they had been made aware that a post-mortem was intended than when they had not. (4) On the basis of their own experience, the vast majority (79%) considered that information about intended autopsy should be given to relatives of patients dying in hospitals. Finally, suggestions are offered concerning the procedure to be adopted for informing relatives of an intended autopsy.
Work and Disability at the Age of 30 Years: A Sociomedical Study of a Birth-cohort from Bergen: I. Description of Project and Methods
Authors: Kinge Finn Olav , Bjerkedal Tor 
Published: July 2017

The aim of the study was to quantify conditions of impaired or lost ability to work at the age of 30 years and to illustrate some of the possible underlying causes. The study is based on a cohort of 1570 persons, all live births in the year 1940 of mothers then residing in Bergen. The birth-cohort was followed up in the compulsory school system at the age of 14 years, and again at the age of 30 years, concluding as of 1st June 1971. Public records and registers were searched for information on living conditions, including social situation at the time of birth, school attended at the age of 14 years, income and disability at the age of 30 years. More detailed medical, psychological, educational, social and occupational histories were collected and individual medical/psychological tests were administered to a stratified random sample of the cohort. The sample was taken after stratification of the cohort according to the type of school attended in Bergen at the age of 14 years. It was supplemented with persons who had attended special schools for the educable mentally retarded and with persons who had received care from the national services for the mentally retarded. The final sample consisted of 262 persons. Results of the study will be presented in a series of articles. This article presents a description of the project and of the methods used in collecting the various data. The other articles will be published in Scand J Soc Med, Acta Neurol Scand, Acta Ophthal and Scand Audiol. They deal with the frequency of permanent, occupational disability at the age of 30 years and disability as related to medical, psychological and educational background. Also selfsupporting ability as well as earned income are discussed in an article. Some possible underlying causes of work-insufficiency are explored from a mainly social/educational and psychological point of view in two articles. Three articles deal with some specific medical conditions as related to school background and intellectual ability namely encephalopathy, visual and hearing impairments.
Mexiletine for Diabetic Peripheral Neuropathy
Authors: Nabulsi Lama H , McLendon Beth M , Vondracek Thomas G 
Published: July 2017

Objective: To evaluate the efficacy and safety of mexiletine for the treatment of painful diabetic peripheral neuropathy (DPN). Data Sources: English-language clinical studies and review articles involving human subjects were identified using MEDLINE (January 1966-January 1999). Data Synthesis: Peripheral neuropathy is a common complication of diabetes. Tricyclic antidepressants are the agents of choice for treatment of symptomatic peripheral neuropathy. However, other therapies are necessary in patients who do not respond to tricyclic antidepressants, do not tolerate their adverse effects, or have a contraindication to their use. The use of mexiletine for DPN has been evaluated in four studies. Two studies concluded that mexiletine was significantly better than placebo as treatment for DPN; another showed no difference. In the fourth study, improvement with use of mexiletine was not demonstrated, but posthoc analysis showed benefits in certain subgroups of patients, including patients with stabbing or burning pain, heat sensation, or formication. All studies excluded patients with cardiac, renal, or hepatic disease; in addition, only one study assessed quality of life, which raises questions about the safety and clinical significance of the reported benefits of mexiletine therapy. Conclusions: Four studies have evaluated the role of mexiletine in treating DPN. Although the results are not uniform, they suggest that mexiletine may be considered a potential alternative for patients unable to take tricyclic antidepressants. The long-term safety of mexiletine and its use in patients with renal, hepatic, or cardiac disease has not been established.
The Incidence and Nature of Adverse Reactions during Intravenous Acetylcysteine Therapy for Acetaminophen Overdose
Authors: Lifshitz Matitiahu , Kornmehl Perez , Reuveni Haim 
Published: July 2017

Objective: To determine the incidence of adverse drug reactions in patients with acetaminophen overdose following administration of intravenous acetylcysteine, and to evaluate the cost-benefit ratio of intravenous compared with oral acetylcysteine therapy. Methods: The incidence of adverse drug reactions to intravenous acetylcysteine therapy was studied retrospectively in all patients with acetaminophen overdose who were admitted to Soroka University Medical Center, Beer-Sheva, Israel, from 1994 to 1998. Data were obtained from hospital records. All patients were treated with a 20-hour intravenous regimen according to the Prescott protocol. Special attention was paid to the clinical manifestations of adverse reactions, time of onset, and history of patient allergy and asthma. Cost of therapy (drug prices, hospital per diems) for intravenous versus oral acetylcysteine administration was evaluated in accordance with average rates prevailing in Israel in December 1998. Results: Ninety-two patients, 32 adolescents aged 12–18 years (mean ± SD 14.2 ± 1.9) and 60 adults aged 18–52 years (28.2 ± 3.2), were treated with intravenous acetylcysteine for acetaminophen overdose during the study period. Three patients (3.2%) developed adverse reactions: one adult presented with a maculopapular rash and pruritus, and two adolescents developed mild urticaria; no other adverse reactions were reported. All adverse reactions occurred during administration of the loading dose, 15–20 minutes after initiation of therapy. The reactions subsided a few hours after the acetylcysteine infusion was stopped and did not require antiallergy therapy. None of the three patients had a history of allergy. The 20-hour intravenous acetylcysteine protocol is approximately three times less expensive than the recommended oral regimen in terms of drug cost and length of hospitalization. Conclusions: Intravenous acetylcysteine is a relatively safe antidote for acetaminophen poisoning. The incidence rate of adverse reactions is low, and they are mild and easily controlled by termination of the infusion. We recommend intravenous acetylcysteine therapy, particularly for patients with vomiting caused by the acetaminophen overdose or by oral acetylcysteine therapy. The 20-hour intravenous acetylcysteine therapy has a cost-benefit advantage over oral therapy; however, the oral formulation is not approved by the FDA.
The Use of Finasteride in Treating Androgenetic Alopecia in Adult Men
Authors: Hobdy-Henderson Karen C , LeClair Chad , Huynh Tam , Huynh Kiet 
Published: July 2017

Objective: To review the medical literature discussing the use of finasteride in the treatment of androgenetic alopecia in adult men. Data Sources: English-language journal articles, the Internet, and the manufacturer's package insert. Study Selection: Clinical trials evaluating the efficacy and safety of finasteride in the treatment of men with mild to moderate androgenetic alopecia were selected. Of these trials, those evaluating the efficacy of finasteride were blinded, randomized, placebo-controlled studies of 12-months' duration conducted in men between 18 and 41 years of age; those evaluating the safety of finasteride were conducted in rats, mice, and rabbits. Data Extraction: Data were extracted and analyzed if the information was relevant and consistent. Study selection was based on study design and clinical end points. Data Synthesis: Male pattern hair loss is a common condition in which men experience thinning of the hair on the scalp. This often results in a receding hairline or balding on the top of the head. This type of hair loss is known as androgenetic alopecia. In men with androgenetic alopecia, the balding scalp contains miniaturized hair follicles and increased amounts of dihydrotestosterone (DHT) compared with a hairy scalp. Administration of finasteride decreases scalp and serum DHT concentrations in these men, causing an increase in the number of scalp hairs for most men and helping to fill in thin or balding areas of the scalp. Conclusions: Finasteride is the first oral drug in its class to be used in treating alopecia in men only. It maintains and regrows hair on top of the head and anterior midscalp area. Finasteride begins to block the formation of DHT almost immediately; however, because hair grows slowly, visible results from the daily use of finasteride are not seen for at least three months. This drug is not recommended for use in women and children. Finasteride demonstrates an excellent profile in treating men with hair loss.
Retrospective Evaluation of the Lipid-Lowering Effects of Atorvastatin
Authors: Buys Lucinda M , Rosenkrans Kurt A 
Published: July 2017

Objective: To evaluate the lipid-lowering effects, particularly changes in high-density lipoprotein (HDL) cholesterol, associated with atorvastatin use in a typical outpatient family medicine practice. Design: Retrospective case series. Setting: A community-based family medicine residency program. Patients: One hundred twenty-three patients with hyperlipidemia. Interventions: Treatment with atorvastatin to meet National Cholesterol Education Program (Adult Treatment Program) II goals. Main Outcome Measures: Fasting lipid profiles, including total cholesterol, low-density lipoprotein (LDL) cholesterol, HDL cholesterol, and triglycerides. Results: Atorvastatin lowered total cholesterol, LDL cholesterol, and triglycerides. HDL cholesterol was essentially unchanged from baseline to follow-up. In a subset of patients (∼50%), HDL cholesterol decreased by 13.1%. In the remainder of patients, HDL cholesterol increased by 10.7%. The decrease of HDL cholesterol was as much as 24 mg/dL. Conclusions: Atorvastatin is an effective agent for lowering total cholesterol, LDL cholesterol, and triglycerides. In a subset of patients, atorvastatin appeared to lower HDL cholesterol. Close monitoring of HDL cholesterol concentrations while patients are receiving atorvastatin is important.
Infectious Vulvovaginitis: Current Trends and Management
Authors: Ponte Charles D 
Published: July 2017

Objective: To review the clinical presentation, diagnosis, and contemporary management of infectious vulvovaginitis. Data Sources: A MEDLINE search on English-language literature was performed, with emphasis on 1999 publications. Search terms included trichomoniasis, candida vaginitis, and bacterial vaginosis (BV). Personal files containing relevant published reviews and original research were also reviewed. Results: Vulvovaginitis is a common gynecologic disorder. The three most prevalent types of infectious vulvovaginitis are BV, candidiasis, and trichomoniasis. Patients typically report discharge, odor, itching, dysuria, or dyspareunia. The healthy vagina is resistant to pathogenic organisms due to an acidic pH and the production of hydrogen peroxide. Any disruption of the healthy vaginal ecosystem can result in infection. Candidiasis is an opportunistic infection that can be sexually transmitted and is diagnosed by presence of fungal hyphae or pseudohyphae in vaginal secretions. Treatment is usually initiated with topical imidazoles or triazoles, which are highly effective against Candida albicans; however, drug-resistant nonalbicans species (e.g., Candida glabrata) are becoming more prevalent and pose treatment challenges. Trichomoniasis is a sexually transmitted disease caused by Trichomonas vaginalis, a protozoan that invades the paraurethral structures of both sexes and is diagnosed by presence of motile trichomonads in vaginal secretions. Oral metronidazole is the only drug recommended for treatment; however, the incidence of metronidazoleresistant trichomoniasis is increasing and poses therapeutic challenges for the clinician. BV is characterized by an overgrowth of aerobic and anaerobic organisms that replace normal lactobacilli. Amsel's criteria are useful in making the diagnosis of BV. Effective treatment is necessary since BV is associated with various gynecologic and obstetric complications. Recommended therapies include oral or topical metronidazole or clindamycin. Conclusions: Patient history and physical examination findings are paramount in diagnosing infectious vulvovaginitis. Despite effective oral and topical treatments, resistant organisms are becoming more prevalent, necessitating a search for more effective management of this disorder.
Efficacy of d-Penicillamine in Reducing Lead Concentrations in Children: A Prospective, Uncontrolled Study
Authors: Lifshitz Matitiahu , Levy Jacov 
Published: July 2017

Objective: To evaluate the efficacy of oral d-penicillamine therapy in children with high blood lead concentrations. Design: A prospective, uncontrolled study. Methods and Patients: Seven children (2–16 y old; mean 8.7) with elevated blood lead concentrations but no symptoms of lead poisoning were treated with oral d-penicillamine. Lead-contaminated homemade flour as found to be the source of poisoning. Mean ± SD blood lead concentrations prior to therapy were 60.3 ± 12.9 μg/dL (range 47.8–83). Mean blood zinc protoporphyrin (ZPP) was 337.86 ± 58.55 μmol/mol hemoglobin (Hb) (range 247–394). Results: Ninety days of treatment with d-penicillamine lowered the mean blood lead concentration by 31.7% to a mean of 40.7 ± 8.6 μg/dL (range 30–53) and lowered mean ZPP blood concentrations by 40% to a mean of 201.14 ± 14 μmol/mol Hb (range 150–278). Three patients with blood lead concentrations >45 μg/mL at the end of this therapy were subsequently treated with succimer, an alternative oral chelator; the blood lead concentrations were further reduced to <45 μg/mL. Conclusions: d-Penicillamine therapy significantly reduced blood lead concentrations but did not achieve acceptable lead and ZPP concentrations for young children. Therefore, we conclude that 90 days of d-penicillamine treatment is of limited effectiveness in young children who have high blood lead concentrations and also show symptoms of lead poisoning.
Pharmacologic Regulation of the Renin—Angiotensin System: Physiologic and Pathologic Effects
Authors: Jutte Sara B , Sprague Jon E 
Published: July 2017

Objective: To review the physiologic and pathologic roles of the renin-angiotensin system in maintaining blood pressure, glomerular filtration rate, and myocardial tissue growth. The pharmacologic regulations of the pathologic effects of the renin-angiotensin system are emphasized, with a comparison between angiotensin-converting enzyme (ACE) inhibitors and angiotensin1 receptor (AT1) antagonists. Data Sources: English-language basic science, clinical studies, and review articles were identified using MEDLINE, IOWA, and a manual search from January 1966 through September 1999. References were also obtained from the reference section of relevant published articles. Study Selection and Data Extraction: All articles identified were evaluated for possible inclusion in this review. Evaluative and comparative data from basic science and controlled clinical studies were reviewed. Data Synthesis: The renin-angiotensin system has a plethora of physiologic and pathologic roles in the regulation of blood pressure, renal function, and cell growth. The cellular mechanisms involved in eliciting the responses to the renin-angiotensin system are discussed in detail, with an emphasis on the pharmacologic regulation of the cellular responses. The role of angiotensin II in maintaining blood pressure, glomerular filtration rate, and in regulating myocardial cell growth secondary to myocardial infarction or as a complication of congestive heart failure are all reviewed. The ACE inhibitors and AT1 antagonists have comparable pharmacologic effects that can influence their therapeutic application. The ACE inhibitors and AT, antagonists are compared regarding clinically and experimentally observed differences that may affect their therapeutic application. Conclusions: The physiologic and pathologic roles of the renin-angiotensin system make the ACE inhibitors and AT1 antagonists ideal candidates in treating many conditions. Presently, few studies have been conducted that directly compare ACE inhibitors and AT, antagonists. An understanding of the basic underlying pharmacologic principles is essential when attempting to apply the scientific and clinical information of the ACE inhibitors and AT1 antagonists with the intention of extrapolating to therapeutic utility.
Serum and Cerebrospinal Fluid Vancomycin and Gentamicin Concentrations during Ventriculoperitoneal Shunt Surgery: An Observational Study
Authors: Faillace Walter J , Tan Paul 
Published: July 2017

Background: Ventriculoperitoneal shunts become infected predominantly during surgery. Optimal antibiotic prophylaxis during cerebrospinal fluid (CSF) shunt surgery has not been fully determined. Objective: To quantitate the concentrations of vancomycin and gentamicin in the serum and CSF during 100 ventriculoperitoneal shunt surgeries at the time of shunt manipulation. Design: Descriptive, prospective, observational study with a 27- to 76-month postoperative follow-up period range. Setting: University hospital. Patients: Eighty-three hydrocephalic patients ranging from premature to adult ages. Interventions: Intraoperatively, children received intravenous vancomycin 15 mg/kg/dose and gentamicin 2.5 mg/kg/dose; adults received vancomycin 1 g/dose and gentamicin 1.5 mg/kg/dose. Antibiotics were continued for 24 hours postoperatively, with dosage and schedule adjusted for age. Antibiotic serum and CSF concentrations were sampled one hour after infusion, and measured via fluorescence polarization immunoassay. Meticulous surgical infection control measures were followed. Main Outcome Measures: Correlation of intraoperative serum and CSF antibiotic concentrations with postoperative infection rate. Results: Intraoperative vancomycin serum concentrations ranged from 10.8 to 53.8 μg/mL (28.0 ± 9.5 μg/mL, mean ± SD). Intraoperative gentamicin serum concentrations ranged from 3.9 to 9.4 μg/mL (4.8 ± 2.0 μg/mL). In all surgeries, intraoperative CSF vancomycin and gentamicin concentrations were low (vancomycin <5 μg/mL, gentamicin <2 μg/mL). The infection rate among surgeries was 2.0%, and the infection rate among patients was 2.4%. Two shunt infections occurred, one with Candida albicans and one with Citrobacter freundii. Conclusions: Serum concentrations of vancomycin and gentamicin were above the minimum inhibitory concentrations for likely pathogens in 84% and 74% of surgeries, respectively. Intraoperative bacteriostatic and bactericidal CSF antibiotic concentrations may not be necessary to achieve a low postoperative shunt infection rate. Larger confirmatory studies are needed.
Impact of Monitoring Vancomycin Peak and Trough Concentrations versus Trough Concentrations Alone on Dose Adjustments: An Outcomes Analysis
Authors: Benkert Steven C , Sinnett Mark J , Amodio-Groton Maria 
Published: July 2017

Objective: To determine whether monitoring both steady-state peak and trough serum vancomycin concentrations or steady-state trough serum vancomycin concentrations alone resulted in differences between two groups of patients in terms of dose adjustment, clinical outcome, and toxicity. Design: The study was a retrospective chart review of patients treated with vancomycin during two time periods. Group 1 represented patients hospitalized between July 1, 1996, and January 31, 1997. These patients routinely had vancomycin peak and trough concentrations measured. Group 2 represented patients hospitalized from July 1, 1997, to January 31, 1998, who were monitored with trough vancomycin concentrations only. Setting: A university teaching hospital. Patients: Adults at least 18 years of age who received a constant dose of intravenous vancomycin for at least three consecutive days were eligible for inclusion in the study. Patients were selected from lists generated by the Microbiology Department. The lists contained vancomycin serum concentrations measured during those time frames. Main Outcome Measures: The main outcome measure was to assess whether dose adjustments by prescribers were influenced by both vancomycin peak and trough concentrations or by the trough concentration alone. Results: Forty-nine and 37 patients met the criteria for inclusion into group 1 and group 2, respectively. The mean duration of therapy in group 1 (15 ± 10 d) was not statistically different from that of group 2 (14 ± 12 d). Patients in both groups received a mean daily vancomycin dose of approximately 1,500 mg. In analyzing treatment decisions, trough concentration was the only significant factor influencing a change in total daily dose of vancomycin (p = 0.038). Furthermore, although the method of vancomycin serum concentration monitoring varied between the two groups, the mean clinical outcome parameters were comparable. Conclusions: Prescribers tended to adjust vancomycin regimens based only on trough serum concentrations; monitoring peak serum vancomycin concentrations did not enhance patient care. Mean outcome parameters in the two groups were comparable.
Visual Hallucination in Craniometaphyseal Dysplasia Successfully Treated with Olanzapine
Authors: Alao Adekola O , Armenta Wendy A , Yolles Jennifer C , Naprawa Steven A 
Published: July 2017

Objective: To report the successful treatment of visual hallucinations in a patient with craniometaphyseal dysplasia (CMD) with olanzapine. Case Summary: A 15-year-old girl with CMD presenting with transient episodes of total blindness and complex visual hallucinations was successfully treated with olanzapine. Discussion: The co-occurrence of visual hallucination and blindness in this patient suggests a variety of the Charles Bonnet syndrome, a diagnosis made almost exclusively in the older population. Compared with traditional antipsychotics, the reduced propensity of olanzapine to produce extrapyramidal side effects may make it more favorable in specific situations. Conclusions: More experience with olanzapine in treating visual hallucinations is needed to determine whether it is more effective than typical antipsychotics in treating visual hallucinations associated with CMD or Charles Bonnet syndrome.