bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxygen Toxicity
Authors: Stogner Steven W. , Payne D. Keith 
Published: January 2017

OBJECTIVE: The objective of this article is to provide an overview of the biochemistry of oxygen metabolism, including the formation of free radicals and the role of endogenous antioxidants. Pathophysiologic correlates underlying the clinical manifestations of oxygen toxicity are reviewed and management strategies are outlined. DATA SOURCES: References from basic science and clinical journals were selected from the authors' files and from a search of a computerized database of the biomedical literature. STUDY SELECTION: Articles selected for review included both historical and current literature concerning the biochemistry and pathophysiology of oxygen toxicity in animals and humans. DATA SYNTHESIS: The benefits of oxygen therapy have been known for many years; however, its potential toxicity has not been recognized until the last two decades. The lungs, the eyes, and, under certain conditions, the central nervous system are the organs most affected by prolonged exposure to hyperoxic environments. Free radical formation during cellular metabolism under hyperoxic conditions is recognized as the biochemical basis of oxygen injury to cells and organs. Endogenous antioxidants are a primary means of detoxifying reactive oxygen species and preventing hyperoxia-induced cellular damage. When this defense fails or is overwhelmed by the excessive production of hyperoxia-induced free-radical species, distinctive morphologic changes occur at the cellular level. The amount of hyperoxia required to cause cellular damage and the time course of these changes vary from species to species and from individual to individual within the same species. Age, nutritional status, presence of underlying diseases, and certain drugs may influence the development of oxygen toxicity. CONCLUSIONS: There is currently no reliably effective drug for preventing or delaying the development of oxygen toxicity in humans. Use of the lowest effective oxygen concentration, the avoidance of certain drugs, and attention to nutritional and metabolic factors remain the best means currently available to avoid or minimize oxygen toxicity. Research is continuing into more effective ways to prevent, diagnose, and treat this disorder.
Effect of Xanthine-Related Compounds on a Theophylline Assay Using Theophylline Oxidase
Authors: Vaughan Leigh M. , Gottehrer Andrew 
Published: January 2017

OBJECTIVE: This study investigated a new, nonimmunologic, enzymatic-based theophylline assay for the possible interference of a clinically achievable serum theophylline concentration by four xanthine-related compounds: pentoxifylline, 1-methylxanthine, allopurinol, and oxypurinol. RATIONALE: The enzyme theophylline oxidase is used in this assay kit to convert theophylline to 1,3 dimethyluric acid in the presence of cytochrome C. Cytochrome C is reduced to ferrocyte C, which is then measured by ultraviolet spectrophotometry at one minute and again at five minutes. The rate of appearance of ferrocyte C over this time is then related to a one-point 20-μg/mL (111-μmol/L) theophylline standard provided with the kit and the concentration of theophylline is calculated. Xanthine-related compounds have the potential to interact with theophylline oxidase via: (1) structural similarity, and (2) inhibition of xanthine oxidase, which increases theophylline metabolite concentrations. DESIGN: Human serum was spiked with known, therapeutically achievable concentrations of pentoxifylline, 1-methylxanthine, allopurinol, and oxypurinol, both alone and in combination with theophylline in a concentration of 15 μg/mL (83.3 μmol/L). Two controls were used: human serum and human serum spiked with theophylline. Data were analyzed statistically with ANOVA, and clinically with ±10 percent control criteria. RESULTS: Means (± SEM) for the control samples were 2.0 (0.2) μg/mL for serum alone and 15.3 (0.3) μg/mL for theophylline-spiked serum. For the test specimens, the results ranged from 2.3 to 2.8 μg/mL and from 13.9 to 16.6 μg/mL when xanthine-related compounds were added to serum without and with theophylline, respectively. CONCLUSIONS: The results were not statistically or clinically significant for the four xanthine-related compounds at the concentrations studied.
Sorbitol Content of Selected Oral Liquids
Authors: Lutomski Dave M. , Gora Mary Lea , Wright Sharon M. , Martin Jill E. 
Published: January 2017

OBJECTIVE: Excipients in pharmaceuticals usually are considered inert, and may be overlooked in the differential diagnosis of diarrhea. Sorbitol-containing medicinal liquids are capable of inducing osmotic diarrhea. We reviewed the oral liquids in our formulary to determine their sorbitol content and to evaluate the availability of this information. DESIGN: The oral liquids stocked by our hospital were determined through a computer search and manual inspection of the pharmacy storeroom. Three common sources of drug information were consulted to determine each product's sorbitol content: Manufacturers' product information, American Hospital Formulary Service (AHFS) Drug Information 91, and Facts and Comparisons Drug Information. We then contacted each manufacturer by mail or telephone to verify the information. SETTING: The study was conducted at the University of Cincinnati Hospital, a tertiary-care, teaching hospital. RESULTS: A total of 129 products (98 chemical entities) were reviewed. Fifty-four (42 percent) of the products examined contained sorbitol. The frequency of sorbitol presence by liquid type was: Solutions (33 percent), suspensions (43 percent), syrups (59 percent), elixirs (43 percent), concentrates (67 percent), drops (33 percent), tinctures (0 percent), and emulsions (0 percent). The percentage of listings indicating the presence of sorbitol was: Manufacturer's product information (79 percent), Facts and Comparisons (52 percent), and AHFS Drug Information 91(13 percent). Only three of the 54 products had the exact sorbitol content stated in any source. CONCLUSIONS: Based on literature data, single doses greater than 10 g and total daily doses greater than 50 g of sorbitol would produce adverse gastrointestinal effects in a sizable number of adults. Many of the marketed products reviewed could deliver an adult laxative dose. Current labeling is insufficient for healthcare providers to assess the risk for individual patients.
Foscarnet-Induced Severe Hypomagnesemia and other Electrolyte Disorders
Authors: Gearhart Maureen O. , Sorg Timothy B. 
Published: January 2017

OBJECTIVE: To report a case of possible foscarnet-induced severe Hypomagnesemia and other electrolyte disorders. CASE SUMMARY: An AIDS patient experienced an exacerbation of cytomegalovirus retinitis and was treated with foscarnet. The patient experienced muscle twitches, tremulousness, and anxiety on day 17 of foscarnet therapy. Laboratory results indicated hypomagnesemia, hypocalcemia, hypokalemia, and hypophosphatemia. After electrolyte supplementation and discontinuation of foscarnet, the symptoms resolved and laboratory indices returned to normal. DISCUSSION: Electrolyte disorders associated with foscarnet are reviewed. Severe hypomagnesemia occurred in this patient and published literature is highlighted. In addition, known and/or possible mechanisms of the disorders are discussed. CONCLUSIONS: It is probable that foscarnet contributed to the electrolyte disorders and symptomatology in this patient. Electrolytes must be monitored frequently during foscarnet therapy. Also, concomitant therapy with antianxiety medications that may mask the symptoms of electrolyte disorders should be undertaken with caution.
Insect Repellent (N,N-Diethyl-m-Toluamide) Cardiovascular Toxicity in an Adult
Authors: Clem James R. , Havemann David F. , Raebel Marsha A. 
Published: January 2017

OBJECTIVE: To describe a case of N,N-diethyl- m-toluamide (DEET)-induced cardiovascular toxicity in an adult and reviews other cases that have been reported in the published literature. Human and animal data available on DEET pharmacokinetics are reviewed and factors that predispose an individual to DEET toxicity are identified. DATA SOURCES: Case report information was obtained through personal contact with the patient during hospitalization and by telephone, and also from the patient's medical records. Computerized literature searches were conducted with the following systems to obtain medical literature on DEET toxicity: TOXLINE, International Pharmaceutical Abstracts, and MEDLINE. Index Medicus was searched manually. STUDY SELECTION: All reported cases of DEET toxicity in children and adults were reviewed. DATA EXTRACTION: Case reports were evaluated for the quantity of the DEET exposure (topical or oral), the clinical manifestations of the exposure, and the outcome of the exposure. DATA SYNTHESIS: This case is similar in some aspects to those already in the literature; however, very few cases of DEET toxicity in adults have been reported. Cardiovascular toxicity in humans related to DEET application has not been previously reported in the published medical literature. DEET exposure (topical or oral) results in a highly variable clinical course. Whether the outcome is death or recovery without sequelae is difficult to predict. CONCLUSIONS: Adults, as well as children, are at risk for toxicity from insect repellents. The use of highly concentrated DEET-containing insect repellents should be avoided to reduce the risk of toxicity in both children and adults. The consequences of DEET toxicity are variable and unpredictable.
Capsaicin: Identification, Nomenclature, and Pharmacotherapy
Authors: Cordell Geoffrey A. , Araujo Oscar E. 
Published: January 2017

OBJECTIVE: To provide a brief overview of the chemical history, analysis, nomenclature, biology, pharmacology, and pharmacotherapy of capsaicin. DATA SOURCES: Chemical Abstracts, Biological Abstracts, and a MEDLINE search were used to identify pertinent literature; selected literature was used in this review. DATA EXTRACTION: Original articles, reviews, and abstracts of articles were used to select material pertinent to the objectives of the review. The volume of material available prohibits comprehensive data extraction. CONCLUSIONS: A history of the use of Capsicum spp. and the predominant active ingredient, capsaicin, the parent compound of a group of vanillyl fatty acid amides, is presented. Distinct structural differences are noted between this compound and the capsaicinoids, especially the synthetic analog nonivamide, which has appeared as an adulterant in capsaicin-labeled products. Analysis shows that although some of these synthetic analogs eventually may prove to be true natural products, conclusive evidence based on isolation and structure elucidation is still absent after decades of attempted isolation from several potential natural sources. Although the crude, dark oleoresin extract of capsicum contains over 100 distinct volatile compounds and therefore may function in many ways dissimilar to capsaicin, the oleoresin continues to be marketed in products with a high degree of variability in efficacy. Capsaicin as a pure white crystalline material, however, acts specifically by depleting stores of substance P from sensory neurons, and has been successful in the treatment of several painful conditions (e.g., rheumatoid arthritis, osteoarthritis, peripheral neuropathies).
Allopurinol Hypersensitivity Syndrome: A Review
Authors: Arellano Félix , Sacristán José A. 
Published: January 2017

OBJECTIVE: To review the pathophysiology, pathology, and clinical findings of allopurinol hypersensitivity syndrome (AHS), an infrequent but life-threatening adverse effect of allopurinol therapy. DATA SOURCES: A MEDLINE search (key terms hepatitis, interstitial nephritis, severe hypersensitivity, severe toxicity, vasculitis, toxic epidermal necrolysis, Lyell's syndrome, erythema multiforme, and Stevens-Johnson syndrome) was used to identify cases reported in the literature through the end of 1990. STUDY SELECTION: All cases evaluated met Singer and Wallace's diagnostic criteria for AHS. DATA EXTRACTION: We extracted data from 101 cases of AHS reported in the literature. The following information, when available, was analyzed: (1) patient data (age, gender, medical history), (2) treatment data (daily dosage of allopurinol, duration of treatment, indications, concomitant medications, and (3) adverse-event data. DATA SYNTHESIS: Patients were mostly middle-aged men with hypertension and/or renal failure receiving excessive doses of allopurinol primarily for asymptomatic hyperuricemia. Cutaneous rash and fever were the most common clinical findings. CONCLUSIONS: Although the pathophysiologic pathway leading to the development of AHS is unknown, it probably involves an immunologic mechanism following allopurinol accumulation in patients with poor renal function. Our findings suggest that the accepted diagnostic criteria for AHS may be too broad, and we recommend the application of more restrictive criteria. There is no effective treatment for AHS. The use of allopurinol only for accepted indications and in dosages adjusted for a patient's renal function may be the only means of minimizing the incidence of AHS.
Angiotensin-Converting Enzyme Inhibitors in Diabetic Nephropathy
Authors: Melchior Wayne R. , Bindlish Vinita , Jaber Linda A. 
Published: January 2017

OBJECTIVE: Diabetic nephropathy (DN) is a leading cause of kidney disease in the US. At least four factors influence whether people with diabetes will develop DN: (1) hypertension, (2) hyperglycemia, (3) dietary protein intake, and (4) intrarenal hemodynamics. The angiotensin-converting enzyme (ACE) inhibitors are known to affect blood pressure (BP) and intrarenal hemodynamics; thus, they may prevent the onset of DN or slow the decline in renal function once DN has been diagnosed. DATA SOURCES: English-language, controlled, and crossover studies published between 1973 and 1991 and indexed in MEDLINE under the headings diabetic nephropathies and angiotensin-converting enzyme inhibitors. MAIN OUTCOME MEASURES: The primary outcome indicators of interest were the effects of the ACE inhibitors captopril, enalapril, and lisinopril on BP control and urinary albumin excretion rate. CONCLUSIONS: ACE inhibitors delay the onset and slow the progression of DN in people with diabetes independent of BP effects. They also slow the progression of DN in people with diabetes who have poorly controlled hyperglycemia. The proper dose and time at which to initiate ACE inhibitor therapy to prevent the appearance of DN is not known. It is also not known how long the beneficial effects of ACE-inhibitor therapy persists as only two studies have followed patients for more than one year. Finally, large, long-term, controlled clinical trials are needed before ACE inhibitors can be considered for prophylactic use to prevent the onset and/or progression of DN.
Lack of Effect of Influenza Vaccine on Anticoagulation by Acenocoumarol
Authors: Souto Joan C. , Oliver Artur , Montserrat Isabel , Mateo José , Sureda Anna , Fontcuberta Jordi 
Published: January 2017

OBJECTIVE: To analyze the effects of influenza vaccine on patients receiving chronic anticoagulant therapy with acenocoumarol. DESIGN: A prospective trial. SETTING: Hospital de la Santa Creu i Sant Pau, Barcelona. PATIENTS: Forty-three patients who received acenocoumarol, had stable levels of International Normalized Ratio (INR), and did not need dosage modification for four months before entering the study. INTERVENTION: A study of anticoagulation levels measured by INR at 7, 15, and 30 days from administration of the trivalent vaccine from the 91–92 campaign was conducted. MAIN OUTCOME MEASURES: Comparison was made between basal values (day 0) and anticoagulation levels at 7, 15, and 30 days from vaccine administration by means of a repeated-measures ANOVA. RESULTS: Nine patients (21 percent) had INR levels out of the therapeutic range during the study period. INR increased in three of these patients and decreased in six. There were no significant intraindividual changes in INR values during the time period analyzed (p=0.125). No hemorrhagic or thrombotic manifestations occurred and no significant changes in renal or hepatic biochemistry were observed. CONCLUSIONS: Influenza vaccine does not modify acenocoumarol activity in patients receiving long-term anticoagulant therapy.
Nabumetone: A “Nonacidic” Nonsteroidal Antiinflammatory Drug
Authors: Dahl Stephen L. 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetic disposition, dosage recommendations, adverse effects, drug interactions, and efficacy of nabumetone in patients with selected rheumatic disorders and soft-tissue injuries. DATA SOURCES: Data from scientific literature were extracted, evaluated, and summarized for presentation. A MEDLINE search was conducted using the following indexing terms: antiinflammatory agents, nonsteroidal, nabumetone, rheumatoid arthritis (RA), and osteoarthritis (OA). Studies evaluating nabumetone reported in articles, abstracts, or proceedings involving human subjects were considered for inclusion. STUDY SELECTION: Special consideration was given to clinical studies using double-blind, randomized, parallel, controlled designs. Studies comparing the effectiveness and safety of nabumetone with placebo and other nonsteroidal antiinflammatory drugs (NSAIDs) were included. DATA EXTRACTION: Data from human studies published in the English language were evaluated. Trials were assessed according to study design, sample size, and description of outcomes. DATA SYNTHESIS: Nabumetone is a nonacidic prodrug that is metabolized to an active nonsteroidal antiinflammatory moiety, 6-methoxy-2-naphthylacetic acid (6-MNA). 6-MNA is a structural analog of naproxen. Like naproxen and other NSAIDs, 6-MNA possesses analgesic, antipyretic, and antiinflammatory activity. 6-MNA has a prolonged elimination half-life, ranging from 17 to 74 hours, which allows for once-daily dosing. The efficacy of nabumetone for treating symptoms of RA and OA has been established in controlled clinical trials. Nabumetone also has been studied in ankylosing spondylitis and soft-tissue injuries. Adverse effects associated with nabumetone are similar to those associated with other NSAIDs. Gastrointestinal reactions occur most frequently in the form of abdominal pain or indigestion, nausea, or vomiting. Central nervous system adverse effects occur less frequently, and are followed in order of occurrence by rashes. CONCLUSIONS: Nabumetone is a prodrug metabolized to an active metabolite structurally related to naproxen. Studies have demonstrated the efficacy of nabumetone, but no advantages over the many other NSAIDs now available.
Treatment of Clozapine- and Molindone-Induced Agranulocytosis with Granulocyte Colony-Stimulating Factor
Authors: Geibig Charles B. , Marks Louis W. 
Published: January 2017

OBJECTIVE: To report a case of clozapine- and molindone-induced agranulocytosis and to discuss treatment using filgrastim, a granulocyte colony-stimulating factor. CASE SUMMARY: A 64-year-old woman who had been on long-term clozapine therapy for schizophrenia was hospitalized with presumed drug-induced agranulocytosis. She had also been on short-term molindone therapy. A bone marrow biopsy and the initial white blood cell (WBC) count were consistent with drug-induced agranulocytosis. Following seven days of treatment with subcutaneous filgrastim 300 μg/d, her absolute neutrophil count was above 500 × 106/L. DISCUSSION: Reports in the literature discussing antipsychotic drug-induced agranulocytosis are reviewed. A relationship between treatment with filgrastim and WBC response is postulated. CONCLUSIONS: Filgrastim may be useful in ameliorating the effects of clozapine- and molindone-induced agranulocytosis.
Pharmacy Practice and Education in the People's Republic of China
Authors: Wang Hong-Chen , Chen Lan-Ying , Lau Alan H. 
Published: January 2017

OBJECTIVE: To describe the pharmacy profession and the education programs available to train pharmacists in the People's Republic of China (PRC). The practice of pharmacy in the hospital setting and the current development of clinical services are also described. BACKGROUND: There are two streams of medical practices in the PRC: traditional Chinese medicine and Western medicine. Hospital and community pharmacies are responsible for the dispensing of medicinals used for both streams of medical practices. Forty-two colleges of pharmacy offer pharmacy education, half of which provide a Western medicine approach and the other half traditional Chinese medicine. Both types of colleges offer a four-year curriculum with options for specialization. Opportunities for graduate study are also available. Most of the graduates work in hospital pharmacies. Hospital pharmacies participate in the bulk manufacture of drugs and parenteral fluids. A bulk dispensing system is used by some hospitals; individual patient doses are dispensed in others. Recently, the need to develop clinical pharmacy services in PRC was recognized and training courses were begun. Curricula with specialization in clinical pharmacy are being considered by colleges of pharmacy. CONCLUSIONS: It is anticipated that through increased awareness of the potential contribution of pharmacists in the PRC healthcare system, more opportunities for educating pharmacists will be made available to satisfy the vast need of the country. Development of clinical pharmacy services also will be expected to improve the quality of care provided.
Strategy of Treatment of Pruritus during Pregnancy
Authors:   The Drugs and Pregnancy Study Group, Haramburu F. , Lindoulsi T. , Bavoux F. , Boyer M. , Bégaud B. , Barat C. , Magne F. , Delage F. , Péré J.C. 
Published: January 2017

OBJECTIVE: To present a procedure for establishing treatment guidelines during pregnancy and, as an application of the method, the recommendations for treatment of pruritus. DESIGN: A preliminary survey was carried out among participants of the study group to determine drug choices for treatment of pruritus during pregnancy. Literature data on the selected drugs were analyzed. Recommendations for treatment were proposed, taking into account the most efficient agents and the least toxic for the fetus. This draft was submitted to all participants of the study group; criticism and suggestions were gathered. A new draft was evolved and repeatedly submitted to participants until consensus was reached. SETTING: Study group set up in southwestern France, with the help of national experts. PARTICIPANTS: Forty-three general practitioners, six gynecologists and/or obstetricians, five pharmacologists, two dermatologists, and an embryologist. RESULTS: The main recommendations for treatment of pruritus during pregnancy are to begin with topical treatment: emollient bath additives, moisturizing cream, talc. If insufficient, a systemic treatment should be added. Antihistamines are prescribed first: hydroxyzine or dexchlorpheniramine is used during the first 2 months. From the third month, the same agents can be used, as can mequitazine. The duration of treatment can be up to 10 days. The group's second choice was benzodiazepine (oxazepam) as second-line treatment. CONCLUSIONS: Strategies for treatment of diseases during pregnancy are not always well defined. For many common diseases, very few data are available concerning drug use in pregnant women. The study group, based on consensus among participants, proposed treatment guidelines.