bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Macrolide Antibiotics: Usefulness in Infections Caused by Mycobacteria other Than Mycobacterium Tuberculosis
Authors: Rapp Robert P. , McCraney Scott A. , Goodman Norman L. , Shaddick David J. 
Published: January 2017

OBJECTIVE: To compare the pharmacology, in vitro activity, and clinical use of the new macrolide antibiotics, azithromycin and clarithromycin, in the treatment of infections caused by mycobacteria other than Mycobacterium tuberculosis. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1987–1994), Index Medicus (1987–1994), Program and abstracts of the 31st (1991) and 32nd (1992) Interscience Conference on Antimicrobial Agents and Chemotherapy, and bibliographic reviews of related textbooks, review articles, and professional society publications. STUDY SELECTION: 105 articles were selected. In vitro and in vivo reports on the pharmacokinetics, microbiology, pharmacology, and effectiveness of clarithromycin and azithromycin were assessed to compare their effectiveness and safety. Emphasis was placed on the use of these new drugs in treating infections caused by Mycobacterium avium complex, Mycobacterium chelonae, and Mycobacterium fortuitum infections. RESULTS: A review of the in vitro activity of the new macrolides revealed moderate to very good activity against many strains of mycobacteria other than M. tuberculosis. Early clinical trials show promising results in pulmonary infections, lymphadenitis, cutaneous infections, and disseminated infections. CONCLUSIONS: The new macrolides, azithromycin and clarithromycin, show great promise for treating infections caused by these acid-fast bacteria. Clarithromycin is recommended as a component of combination therapy for the treatment of M. avium complex infections in patients with AIDS. The development of resistance in patients, particularly when these agents are used alone, has been reported.
Autism and Associated Behavioral Disorders: Pharmacotherapeutic Intervention
Authors: Gilman Jamie T. , Tuchman Roberto F. 
Published: January 2017

Objective: To review the literature on autism and pervasive developmental disorders (PDDs) as well as their respective pharmacotherapies. Data sources: An Index Medicus, MEDLINE, and bibliographic search of the literature pertaining to autism, PDDs, and respective treatments. Study selection: Because of the paucity of literature on the treatment of autism and PDDs, the selection of reported data for this review included both controlled and uncontrolled studies, as well as case reports and any other information reported in the literature on the treatment of these disorders. Data synthesis: Autism and PDDs are severe developmental disabilities defined by behavioral criteria. These disorders are lifelong in nature and present in varying severity of clinical manifestations. Behavioral manifestations of patients with autism include core deficits in social interaction, communication, and imaginative activities, with a restricted repertoire of activities and interests. The present understanding of the neurochemical basis of the disorder is limited. The role of pharmacotherapy in the management of autism and PDDs is to ameliorate behavioral symptoms that interfere with the patient's ability to participate in educational, social, work, and family systems. Agents that have shown positive clinical effects in the treatment of children with autism and PDDs are reviewed in this article. Conclusions: Autism is a complex developmental disorder representing a heterogeneous group of individuals with similar symptomatologies and multiple biologic etiologies. Present pharmacotherapeutic intervention seeks to resolve behavioral symptoms. Treatment of autism and PDDs requires appropriate delineation of the behaviors and neurobiologic disorders associated with each patient. No single therapeutic agent, or combination thereof, is appropriate for the treatment of all children and adults with autism or PDDs.
Tobramycin-Induced Hypersensitivity Reaction
Authors: Schretlen-Doherty Janet S , Troutman William G 
Published: January 2017

Objective: To report a case of a hypersensitivity reaction associated with the use of intravenous tobramycin in a patient with cystic fibrosis. Case Summary: An 18-year-old man was hospitalized for exacerbation of his cystic fibrosis. Tobramycin 125 mg iv q6h and ceftazidime 2 g iv q8h were administered through the patient's implantable access system in the left chest. Within seconds of receiving the third dose of tobramycin, the patient experienced shaking, his left arm turned white, and urticaria and pruritus were noted on the left side of the patient's chest. The patient had experienced a similar incident, accompanied by breathing difficulty, with intravenous tobramycin 4 years príor to this incident. The patient had been skin-tested for tobramycin allergy and had been desensitized and was receiving tobramycin since that time without incident. The patient's desensitization was maintained with tobramycin 160 mg/d hs by nebulization, but the drug had been discontinued by the patient 6 months prior to the latest event. Discussion: Hypersensitivity reactions to aminoglycosides are unusual. Hypersensitivity to 1 aminoglycoside antibiotic frequently is associated with hypersensitivity to at least 1 other aminoglycoside. In patients who develop hypersensitivity to an aminoglycoside antibiotic, desensitization may be an effective alternative to changing therapy. Conclusions: Tobramycin is very important in the drug regimen for Pseudomonas aeruginosa infections in patients with cystic fibrosis. Effective desensitization can be maintained by daily administration of nebulized tobramycin.
Dissolution of Phenytoin Precipitate with Sodium Bicarbonate in an Occluded Central Venous Access Device
Authors: Akinwande Kayode I , Keehn Diane M 
Published: January 2017

Objective: To report a case of restored patency of a central venous access device occluded by precipitate of phenytoin sodium injection. Case Summary: A patient experienced total occlusion of an implanted subcutaneous port caused by precipitation of phenytoin. Phenytoin sodium injection was mixed inadvertently with dextrose 5% in NaCl 0.45% injection during intravenous administration. Dextrose 5% in NaCl 0.45% injection, which is acidic (pH 4.0), caused the phenytoin sodium injection, a basic solution (pH 12.0), to precipitate. Local instillation of sodium bicarbonate 8.4% injection to decrease the pH of the medium restored patency of the occluded port. Discussion: There are reports of local instillation of solvent restoring central ports occluded by lipid-containing parenteral nutrient admixture, calcium phosphate salt precipitate, and coagulated blood. No report of local instillation into an occluded port to dissolve precipitate of phenytoin could be found. Several factors are involved in the precipitation and dissolution of phenytoin. The key factor in this case was the hydrogen ion concentration (pH) of the solution. Decreased pH caused the precipitation, but increased pH caused the dissolution of the precipitate of phenytoin. Conclusions: Sodium bicarbonate injection was a suitable agent for clearing precipitate of phenytoin in this case of an occluded implanted central venous access device.
Peripheral Diabetic Neuropathy: Current Concepts in Treatment
Authors: Calissi Piera T , Jaber Linda A 
Published: January 2017

Objective: To review pathophysiology and current concepts in the treatment of diabetic peripheral neuropathy (PN). Data Sources: References were identified through a MEDLINE search of the English-language literature from 1976 through 1994. Additional references were obtained from reference lists of articles identified through the search. Study Selection and Data Extraction: All articles were considered for possible inclusion in the review. Clinical trials that involved an adequate number of patients and review articles were selected. Information from articles that was judged by the authors to be significant was selected for discussion. Data Synthesis: PN affects 5-50% of people with diabetes in the US and most commonly is characterized by tingling or burning sensations, particularly in the calves, ankles, and feet, with a loss of vibratory sense. Treatment of PN, for the most part, has been unsatisfactory. Therapy has been directed toward either improving nerve function or alleviating symptoms of PN, including pain and paresthesia. Glycemic control may slow the progression of PN. Hyperglycemia also is associated with decreased pain threshold in patients with diabetes mellitus. The aldose reductase inhibitors, particularly tolrestat, have been shown to improve objective and subjective neurologic function. Pain or paresthesia has been treated effectively with antidepressants, lidocaine, mexiletine, and capsaicin. The anticonvulsants phenytoin and carbamazepine may be effective, but are associated with a greater degree of adverse effects. Experimental treatments, such as gamma-linolenic acid, gangliosides, uridine, and the corticotropin4-9 analog ORG 2766, have been effective in improving neurologic function. Conclusions: Treatment of PN remains unsatisfactory. Therapy should be directed toward prevention with glycemic control and symptomatic treatment of existing PN.
Extrapyramidal Symptoms following Accidental Ingestion of Risperidone in a Child
Authors: Cheslik Tamara A , Erramouspe John 
Published: January 2017

OBJECTIVE: To describe the development of extrapyramidal symptoms (EPS) precipitated by an accidental overdose of risperidone in a 3.5-year-old boy. CASE SUMMARY: The boy presented to the emergency department with bilateral upward eye gaze, jerky movements of his extremities, and motor restlessness following an accidental ingestion of a single 4-mg risperidone tablet. Decontamination with NaCl 0.9% lavage and activated charcoal with sorbitol was performed. His symptoms responded immediately to intravenous diphenhydramine (on 3 different occasions) during his first 9.5 hours of hospitalization. He experienced no additional EPS, and was discharged home approximately 33 hours following initial presentation. At home, he received three oral doses of diphenhydramine in the 24 hours following hospital discharge because of hand tremor, total body shivering, and eye wandering. These signs resolved without further complications. DISCUSSION: Although the incidence of EPS associated with therapeutic risperidone use is low, its occurrence following overdose is less clearly defined. This represents the first published case, to our knowledge, of risperidone overdose in a child and highlights the potential for dystonic reactions at low doses in this population. Seven intentional overdoses of risperidone in adults (aged 21–68 y) have been reported in the literature and are reviewed. Amounts ingested ranged from 5 to 270 mg. All adult patients appeared to have a relatively benign course. Reported symptoms included drowsiness, slurred speech, altered levels of consciousness, hypertension, tachycardia, electrocardiogram abnormalities, atypical motor behavior, tremors, and other EPS (not specified). CONCLUSIONS: Accidental ingestion of low doses of risperidone can cause EPS in children that may respond well to an anticholinergic agent. Overdose management includes gastrointestinal lavage, activated charcoal with cathartic, cardiovascular monitoring, and supportive therapy.
Possible Pharmacokinetic Interaction with Quinidine: Ciprofloxacin or Metronidazole?
Authors: Cooke Catherine E , Sklar Grant E , Nappi Jean M 
Published: January 2017

OBJECTIVE: To discuss a potential pharmacokinetic interaction between quinidine, ciprofloxacin, and metronidazole. CASE SUMMARY: A 51-year-old black woman was admitted for shortness of breath, abdominal pain, and atrial fibrillation. Procainamide and diltiazem were begun for the atrial fibrillation and ciprofloxacin and metronidazole for suspected diverticulitis. The therapy was switched to quinidine on day 5 because of adverse events associated with procainamide. A trough serum quinidine concentration (SQC) on day 7 was 6.3 μg/mL (normal 2–5) with normal QT and QTc intervals. On day 8, the patient was discharged in normal sinus rhythm. She took her last doses of antibiotics on day 15 and a follow-up SQC on day 18 was 2.3 μg/mL. DISCUSSION: The possible explanations for the changes in SQCs include: (1) laboratory error, (2) compliance with medication regimen, and (3) altered hepatic metabolism. The first two are not likely in this case. The laboratory verified the elevated SQC and the patient had her prescriptions refilled within appropriate time limits. The third explanation seems more plausible. Quinidine is metabolized by the hepatic mixed-function oxidase system, specifically cytochrome P450 (CYP) 3A4. We found that metronidazole has been shown to inhibit CYP3A activity and ciprofloxacin has been shown to inhibit certain isozymes in the cytochrome P450 system as well. CONCLUSIONS: When metronidazole and ciprofloxacin are administered concomitantly with quinidine, clinicians should be aware of this potential interaction. Quinidine concentrations should be monitored and patients should be assessed for signs and symptoms of quinidine toxicity.
Combining Event Rates from Clinical Trials: Comparison of Bayesian and Classical Methods
Authors: Su Xiang Y , Po Alain Li Wan 
Published: January 2017

OBJECTIVE: TO compare an empirical Bayesian, a fully Bayesian, and a classical fixed-effect (Peto) method for pooling event rates from separate epidemiologic studies or clinical trials. DESIGN: Four data sets used in meta-analyses by previous authors were evaluated. The first data set concerned death rates observed in clinical trials of beta-blockers, the second to lung cancer and smoking in 14 case-control studies, the third to drowsiness induced by the antihistamine compound chlorpheniramine, and the fourth to the use of intravenous magnesium in patients with suspected myocardial infarction. Randomly chosen data points were made more extreme to test the methods further. MAIN OUTCOME MEASURES: Pooled estimates of effect expressed as odds ratios and their associated 95% confidence intervals. RESULTS: All three methods gave comparable results with respect to the 95% confidence interval, although the Bayesian methods gave generally wider interval estimates. However, the point estimates for the individual studies were substantially different, particularly for small studies. CONCLUSIONS: For the data sets considered, Bayesian methods, which are computer intensive but intuitively appealing, provided results that were consistent with the classic fixed-effect Peto method. Introduction of the more extreme data points did not alter this conclusion.
Apoptosis: Its Role in the Development of Malignancies and its Potential as a Novel Therapeutic Target
Authors: Dixon Shannon C , Soriano Barbara J , Lush Richard M , Borner Markus M , Figg William D 
Published: January 2017

OBJECTIVE: To review the current literature regarding the role of apoptosis in the development of malignant cells and how the induction of this pathway could be used in cancer therapy. DATA SOURCE: A MEDLINE search of basic science articles pertinent to the understanding of the normal physiologic process of apoptosis was conducted. STUDY SELECTION: Because of the rapidly growing literature regarding apoptosis, only articles describing key processes in the biology of the cell and the genetic control of apoptosis were included. DATA SYNTHESIS: Apoptosis is imperative for host survival since it discards unwanted, damaged, and atypical cells. The process is therefore implicated in the continuous regulation of development, differentiation, and homeostasis. Furthermore, apoptosis is a response to physiologic and pathologic stresses that disrupt the balanced rates of cell generation and elimination. In a disease such as cancer, there is a lack of equilibrium between the rates of cell division and cell death; agents that promote or suppress apoptosis can manipulate these rates, influencing the anomalous accumulation of neoplastic cells. Pharmacologic manipulation of apoptosis represents a novel approach in targeting malignant cells and has far-reaching implications for new directions in cancer therapy. CONCLUSIONS: Apoptosis is a highly organized physiologic mechanism of destroying injured and abnormal cells as well as maintaining homeostasis in multicellular organisms. Both the activation and inhibition of apoptosis are tightly controlled. Pharmacologic manipulation of this pathway is a novel therapeutic target in cancer therapy.
Respiratory Syncytial Virus Immune Globulin Intravenous
Authors: Wandstrat Todd L 
Published: January 2017

OBJECTIVE: To review the clinical data detailing the use of respiratory syncytial virus immune globulin intravenous (RSV—IGIV) in infants and children. DATA SOURCES: A MEDLINE search (1990–1996) was used to identify all publications that dealt with RSV—IGIV clinical trials, pharmacology, and pharmacokinetics in infants and children. Bibliographies of articles were also used. STUDY SELECTION: All abstracts and clinical trials were reviewed. DATA EXTRACTION: Study design, population, efficacy, and safety data were retained. DATA SYNTHESIS: RSV—IGIV is an immunoglobulin product with serum neutralizing titers against RSV. It has been shown to reduce hospital stay, admissions, intensive care unit admissions, and mechanical ventilation days in infants and children with RSV pneumonia or bronchiolitis who are younger than 24 months of age and were born prematurely, or have bronchopulmonary dysplasia. RSV—IGIV is well tolerated by infants and children. CONCLUSIONS: RSV—IGIV is an effective prophylactic agent against serious RSV disease in select groups of infants and children.
Lipoprotein Disorders in Women: Which Women are the Best Candidates for Hormone Replacement Therapy?
Authors: Plushner Susyn L 
Published: January 2017

OBJECTIVE: To review the data examining hormone replacement therapy (HRT) in the treatment of lipoprotein disorders in women. DATA SOURCE: A MEDLINE search (1975–1995) of the English-language literature was performed to identify pertinent primary literature and review articles. Articles were also identified through bibliographies of selected articles. DATA EXTRACTION: Controlled and uncontrolled studies evaluating the effects of lipoprotein concentrations on coronary risk and the effects of estrogen and HRT on coronary heart disease and lipoprotein concentrations in women were evaluated. Trials pertaining to adverse effects of therapy were also examined. Emphasis was placed on recent clinical trials. DATA SYNTHESIS: The National Cholesterol Education Program's (NCEP's) 1993 report recommends estrogen replacement therapy as a treatment option in postmenopausal women with hyperlipidemia. Recent trials suggesting that triglycerides and high-density lipoproteins are more closely related to coronary risks in women necessitate an improved understanding of estrogen and progestin's effects on lipoprotein concentrations. A recent trial has clarified the lipoprotein effects of HRT in women with normal lipid concentrations and suggests that beneficial effects on low-density lipoproteins are maintained, although progestins attenuate beneficial changes in high-density lipoproteins and triglyceride elevations persist. The few trials evaluating estrogen use in women with hyperlipidemia suggest a beneficial effect as well. CONCLUSIONS: In the absence of contraindications, postmenopausal women with hyperlipidemia should be offered estrogen replacement therapy as conjugated equine estrogen 0.625 mg/d. Pending further information, NCEP's recommendations should be followed regarding goals of therapy.
Scarf Osteotomy for Hallux Valgus Repair: The Dark Side
Authors: Coetzee J. Chris 
Published: January 2017

Hypothesis/Purpose: The Scarf osteotomy has gained popularity as treatment of choice in parts of Europe and is based on sound structural principles. The excellent results reported by others could not, however, be reproduced by the author and the results are presented. Methods: From January 1997 to June 1997 the Scarf osteotomy was selected in 20 consecutive patients (12 female and eight male patients, ages 18 to 60, mean: 41 years) with moderate metatarsus primus varus (IMA 13 to 20°) and hallux valgus deformities (less than 40°). The AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, visual analog scale and patient satisfaction were monitored prior to surgery, six and 12 months post-op. The patients were treated in a short leg cast, non-WB for two weeks followed by four weeks partial WB in a cast shoe. Routine post-bunion rehabilitation followed once the radiological and clinical diagnosis of healing was made. Results: Multiple complications were encountered. The most common was “troughing” of the metatarsal with loss of height. This occurred in seven patients (35%). Other complications include delayed union (5%), rotational malunion (30%), proximal fracture (10%), infection (5%) and early recurrence of deformity in 25%. All 20 patients were available for follow-up at six months, and 19 of 20 at 12 months. The AOFAS score pre-op was a mean of 53. At six months a mean of 54 (19 to 69) and at 12 months 62 (24–100). Forty-five percent (9/20) were unsatisfied at one year and would not recommend the surgery to a friend. Conclusions/Significance: The Scarf osteotomy has multiple potential pitfalls and should probably be reserved for moderate bunions in young people with good bone quality. There are multiple potential problems and the salvage of a failed Scarf osteotomy is difficult.
A Biomechanical Evaluation of Clinical Stress Tests for Syndesmotic Ankle Instability
Authors: Beumer Annechien , van Hemert Wouter L.W. , Swierstra Bart A. , Jasper Louis E. , Belkoff Stephen M. 
Published: January 2017

Displacement transducers were placed across the anterior and posterior tibiofibular ligaments of 17 fresh cadaver (78.4±6.7 years old at death) lower extremities. Displacements induced by various clinical tests (squeeze, fibula translation, Cotton, external rotation, and anterior drawer) were measured with the ankle ligaments intact and after sequential sectioning of the anterior tibiofibular ligament, anterior deltoid ligament, and posterior tibiofibular ligament. None of the syndesmotic stress tests could distinguish which ligaments were sectioned. Furthermore, the small displacements measured during the stress tests (with the exception of the external rotation test) suggest it is unlikely that the displacement induced in injured syndesmoses can be clinically differentiated from normal syndesmoses. Therefore, pain, rather than increased displacement, should be considered the outcome measure of these tests.