bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperphagia and Weight Loss during Fluoxetine Treatment
Authors: Fichtner Christopher G. , Braun Bennett G. 
Published: January 2017

OBJECTIVE: To report the unusual coincidence of weight loss with increased appetite and food intake in a patient treated for depression on two separate occasions with fluoxetine. CASE SUMMARY: A 27-year-old woman experienced a modest weight loss during treatment for depression with fluoxetine. The weight loss was associated with a reported increase in daily caloric intake and consumption of a greater proportion of dietary fat than usual for the patient. The same patient was treated again with fluoxetine more than a year later and again experienced weight loss associated with an increase in appetite, caloric intake, and dietary fat consumption. DISCUSSION: Fluoxetine is a selective serotonin reuptake inhibitor that often is associated with a modest weight loss when used for the treatment of depression, although it also has been reported to have the opposite effects of weight gain and hyperphagia in some patients. The effects on weight usually are assumed to be the result of primary effects on appetite, but the discrepancy between the appetite and weight changes in this case challenges the applicability of that assumption in all cases. CONCLUSIONS: The effects of fluoxetine on appetite and weight may be mediated by partially distinct mechanisms and might conceivably involve a direct metabolic effect in some patients.
Knowledge of and Attitudes About Adverse Drug Reaction Reporting Among Rhode Island Pharmacists
Authors: Generali Joyce A , Danish Michele A , Rosenbaum Sara E 
Published: January 2017

Objective: To survey pharmacists' knowledge of the adverse drug reaction (ADR) reporting process, as well as the nature and seriousness of ADRs observed by pharmacists, and to determine how pharmacists perceive their role in monitoring and reporting suspected reactions. Design: A survey was mailed to 793 Rhode Island pharmacists with a 40% (318) response rate. Results: Two hundred and thirty-five surveys were reviewed for final analysis. Pharmacists in retail settings were more likely than hospital pharmacists to be aware of ADRs relating to therapeutic inequivalence and over-the-counter products, and more likely to ask the patient about ADRs (40% vs 16%). Hospital pharmacists were more likely to receive ADR information from physicians (40% vs 15%). Almost all pharmacists (97%) believed that action should be taken when a serious ADR is suspected. Younger pharmacists (<45 y) were more willing to contact the physician and refer the patient to medical attention. Conclusions: Our results show that fewer than half of the respondents (41%) claimed to have observed a serious ADR (potentially life-threatening or requiring hospitalization), although almost all (97%) believed that pharmacists should take some action when a serious ADR is suspected. The influence of the practice setting, the number of years in practice, and the number of hours worked per week influenced the reporting practices and attitudes.
Multiorgan Failure Associated with Lomusttne Overdose
Authors: Trent Kelley C , Myers Lesley , Moreb Jan 
Published: January 2017

Objective: To report a lomustine overdose in a patient with anaplastic astrocytoma. Case Summary: A 28-year-old woman with anaplastic astrocytoma was treated with partial resection and radiation therapy followed by a lomustine-containing regimen. The patient took lomustine 1400 mg po over a week, her regular dose being 200 mg on day 1 of the regimen. Pancytopenia developed within a week after the last dose of lomustine and the patient was admitted to the bone marrow transplant unit for supportive care. About 3 weeks later, the patient gradually developed a multiorgan dysfunction, including liver, brain, and lungs without evidence of infection or tumor progression, and died on day 45 of hospitalization. Discussion: This is the third reported case of lomustine overdose that resulted from supplying the patient with more tablets than needed for 1 dose. Although late hematopoietic recovery may be possible after such a high dose of lomustine, other organ toxicities might be detrimental. Conclusions: Physicians and pharmacists should avoid supplying more tablets than needed for 1 lomustine dose. High doses of lomustine may cause irreversible multiorgan toxicities.
Use of Antidiabetic and Antihypertensive Drugs in Hospital and Outpatient Settings in Hong Kong
Authors: Lau Grace SN , Chan Juliana CN , Chu Pauline LM , Tse Dylan CK , Critchley Julian AJH 
Published: January 2017

OBJECTIVE: To investigate the usage patterns of antidiabetic and antihypertensive drugs and to identify any discordance between recommended management guidelines and clinical practice in two study locations. DESIGN: Prescription survey. SETTING: A government-operated general outpatient clinic (GOPC) and a medical/geriatric specialist clinic (SC) affiliated with a regional hospital in the same district. PATIENTS: Patients presenting with a prescription during the study period at the respective pharmacy were classified as having diabetes if at least one antidiabetic agent was prescribed and as having hypertension if a cardiovascular drug was prescribed in a hypotensive dosage. MAIN OUTCOME MEASURE: The pattern of use of antidiabetic and antihypertensive drugs. RESULTS: One thousand one hundred forty-four consecutive prescriptions were collected in the GOPC, and 1523 in the SC. Of these, 9.4% (n = 107) of patients were classified as having diabetes in the GOPC and 20.4% (n = 310) in the SC (ρ > 0.001). Most patients with diabetes were taking oral hypoglycemic agents (98.1% in GOPC vs. 84.5% in SC). Glibenclamide was the sulfonylurea used most often as monotherapy in both settings (50.5% in GOPC vs. 40.6% in SC). The combined use of a sulfonylurea with metformin was common in both settings (22.4% in GOPC vs. 28.4% in SC). Metformin monotherapy (1.9% in GOPC vs. 2.6% in
Evaluation of a Pharmaceutical Care Model on Diabetes Management
Authors: Jaber Linda A , Halapy Henry , Fernet Mireille , Tummalapalli Suresh , Diwakaran Hariharan 
Published: January 2017

OBJECTIVE: To assess the effectiveness of a pharmaceutical care model on the management of non-insulin-dependent diabetes mellitus (NIDDM) in urban African-American patients. DESIGN: Eligible patients were randomized to either a pharmacist intervention or control group and followed over a 4-month period. Patients in the intervention group received diabetes education, medication counseling, instructions on dietary regulation, exercise, and home blood glucose monitoring, and evaluation and adjustment of their hypoglycemic regimen. Patients in the control group continued to receive standard medical care provided by their physicians. SETTING: A university-affiliated internal medicine outpatient clinic. PARTICIPANTS: The study population consisted of urban African-American patients with NIDDM currently attending the clinic. MAIN OUTCOME MEASURES: Primary outcome measures included fasting plasma glucose and glycated hemoglobin concentrations. Secondary outcome endpoints included blood pressure, serum creatinine, creatinine clearance, microalbumin to creatinine ratio, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein concentrations. Quality-of-life assessments were performed in both groups at baseline and at the end of the study. RESULTS: Thirty-nine patients (17 intervention, 22 control) completed the study. The intervention group consisted of 12 women and 5 men with a mean ± SD age of 59 ± 12 years, total body weight (TBW) of 93 ± 22 kg, body mass index (BMI) of 34 ± 7 kg/m2, and duration of NIDDM 6.8 ± 6.5 years. The control group consisted of 15 women and 7 men with a mean age of 65 ± 12 years, TBW of 88 ± 19 kg, BMI of 33 ± 7 kg/m2, and a duration of NIDDM of 6.2 ± 4.8 y. Significant improvement in glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.015) was achieved in the intervention group. No change in glycemia was observed in the control subjects. Statistically significant differences in the final glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.022) concentrations were noted between groups. No significant changes in blood pressure control, lipid profile, renal function parameters, weight, or quality-of-life measures were noted within or between groups. CONCLUSIONS: Our data demonstrate the effectiveness of pharmaceutical care in the reduction of hyperglycemia associated with NIDDM in a group of urban African-American patients.
Suspected Neuroleptic Malignant Syndrome in a Patient Receiving Clozapine
Authors: Ganelin Luba , Lichtenberg Pesach S , Marcus Esther-Lee , Munter R Gabriel 
Published: January 2017

OBJECTIVE: To report a case of suspected neuroleptic malignant syndrome (NMS) associated with clozapine therapy. CASE SUMMARY: A 42-year-old schizophrenic man treated with clozapine developed a temperature of 39.5 °C, diaphoresis, tachycardia, rigidity, and leukocytosis. His serum creatine kinase concentration was 25 000 U/L. A diagnosis of NMS was made. He was treated with bromocriptine and supportive therapy, and recovered within a week. DISCUSSION: Despite earlier expectations that clozapine, with a pharmacologic profile differing from that of other antipsychotic medications, might not cause NMS, NMS remains the most likely diagnosis in this case. CONCLUSIONS: NMS may be a possible complication of clozapine therapy.
Possible Paroxetine-Induced Bruxism
Authors: Romanelli Frank , Adler David A , Bungay Kathleen M 
Published: January 2017

OBJECTIVE: To report the case of a patient with possible paroxetineinduced bruxism that was effectively treated with buspirone. CASE SUMMARY: A 20-year-old woman with no active medical conditions besides acne and no history of dental problems was seen in an outpatient psychiatry clinic for the evaluation of ongoing depression. The patient was prescribed paroxetine 10 mg every morning. After 5 days of therapy the patient reported no adverse effects, and the paroxetine dosage was increased to 20 mg every morning. Due to increased somnolence, the dosing schedule was subsequently changed to 20 mg hs. Two months later during a dental visit for a tooth extraction, the dentist noted that the patient's teeth appeared damaged in what he believed to be a pattern consistent with the grinding and clenching of teeth. Prior to this time, dental examinations had not revealed any tooth damage. The patient was thought to have paroxetine-induced bruxism and, based on earlier case reports, was treated with buspirone 5 mg hs. On day 4 of buspirone therapy the patient reported a significant reduction in the extent of gritting, tooth pain, and jaw tenderness. DISCUSSION: The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and sertraline have been associated with bruxism in previous reports. This case suggests paroxetine-induced bruxism. The exact mechanism of SSRI-induced bruxism remains unclear. Many theories have been proposed, including sleep disturbance, serotonergic-mediated inhibition of dopamine manifesting as akathisia, and SSRI-induced anxiety. According to published reports, SSRI-induced bruxism may respond to therapy with buspirone. Consistent with these reports, this patient responded favorably to buspirone therapy. CONCLUSIONS: Clinicians should be aware that the potential for paroxetine-induced bruxism exists and that buspirone may be an appropriate therapeutic intervention.
Insulin Lispro: Its Role in the Treatment of Diabetes Mellitus
Authors: Campbell R Keith , Campbell Lance K , White John R 
Published: January 2017

OBJECTIVE: To introduce a rapid-acting human insulin analog, insulin lispro; to review its pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, and drug interactions; and to summarize the clinical trials of its efficacy and safety alone and in comparison with regular human insulin in the treatment of diabetes mellitus. DATA SOURCES: A MEDLINE database search was completed to identify all relevant articles, including reviews; Eli Lilly and Co.; published articles and abstracts; and review chapters from medical textbooks. STUDY SELECTION: Due to the relatively few citations listed in MEDLINE (12 as of December 1995), most of the studies reported were found from abstracts summarizing the clinical action, adverse effects, or pharmacokinetics of insulin lispro in healthy volunteers or patients with diabetes mellitus. A few of the studies used patients with diabetes mellitus in multicenter, randomized, crossover trials of insulin lispro. DATA EXTRACTION: All clinical trials that were available prior to submission of this manuscript for publication, including unpublished reports, were reviewed. DATA SYNTHESIS: The human insulin analog, insulin lispro, which is biosynthetically made by inverting the amino acid sequence of human insulin at B-28 and B-29, is more effective than regular human insulin in improving postprandial glucose control. Subcutaneous injections of insulin lispro result in decreased blood glucose peaks following meals and a potential decreased risk of hypoglycemic episodes, including nighttime hypoglycemia in patients with type 1 diabetes. Insulin lispro in comparison with regular human insulin provides equal or slightly better blood glucose control. When compared with subcutaneous injections of regular human insulin, the peak serum insulin concentration of insulin lispro is three times higher, time to peak is 4.2 times faster, the absorption rate constant is double, and the duration of action is half as long. Insulin lispro is similar to regular human insulin with reference to dose, toxicity, adverse effects, drug interactions, and imrnunogenicity. When insulin lispro is mixed with human NPH (isophane) or Lente insulins, insulin lispro should be drawn into the syringe first, mixed with the long-acting insulin, and injected immediately after mixing. Patients using insulin lispro perceive an improvement in their well-being and quality of life due to flexible injection times and less frequent hypoglycemic reactions. Insulin lispro is believed to be suitable for patients using insulin infusion pumps. CONCLUSIONS: Insulin lispro is equipotent to human insulin and has a much more rapid onset and shorter duration of action than human insulin does, which may reduce the risk of hypoglycemia. In addition, insulin lispro improves the dosing convenience for patients with diabetes and provides a more natural control of blood glucose concentrations. Insulin lispro is a useful new agent in the treatment of diabetes mellitus.
How Can Legal Education Speak to the Discovery-enriched Curriculum?
Authors: Pascoe Daniel 
Published: January 2017

City University of Hong Kong’s (CityU) Discovery-enriched Curriculum (DEC) is a pedagogical approach involving discovery, innovation and creativity. With its focus on invention and experimentation, this approach lends itself naturally to the artistic and science-based disciplines; yet with an open mind, it can also be implemented within the undergraduate curriculum in law. This article discusses the DEC and its theoretical basis within the educational literature on discovery-based learning and the undergraduate research movement, before moving on to suggest the ways and means by which the undergraduate law curriculum at CityU could be changed in order to implement DEC and equally as importantly the ways in which established law-teaching practices already fit within the DEC framework. To fully implement DEC within CityU’s Bachelor of Laws curriculum, some changes to long-standing teaching practices and the list of core courses will be necessary, but perhaps fewer changes than a sceptic might first believe. Overall, DEC has the potential to become a model for other law schools to follow in adopting inductive learning methods, if these are implemented in accordance with the results of existing pedagogical research.
The Demographics of Claudication and the Aging of the American Population
Authors: Kannel William B 
Published: January 2017

Most peripheral artery disease is of ischemic atherosclerotic etiology and manifested as intermittent claudication (IC). Death and disability from atherosclerotic cardiovascular disease (CVD) is a growing problem because of the rapidly increasing elderly segment of the population. By the year 2015 the elderly will constitute 14.8% of Americans. Of the total 255 million, 13.8 million are over age 75 years and 9 million are women. On reaching age 65 years, the average remaining lifetime is 17.4 years. In the USA this 11% of the population accounts for 29% of the health costs and 70% of all deaths are attributable to cardiovascular disease. About 9.6% of cardiovascular events are due to peripheral artery disease manifested as IC requiring 777 000 office visits and 63 000 hospitalizations. Also, 17 400 deaths each year are attributed directly to this cause. The biennial incidence of IC in the Framingham Study was 7.1 per 1000 for men and 3.6% for women, increasing with age in both sexes up to age 75 years. At all ages there is a distinct male predominance. In the 35–64-year age range IC incidence is virtually identical to that of cardiac failure and stroke, but only one-third of CHD incidence. Beyond age 65 years IC incidence is only half that of other atherosclerotic cardiovascular conditions. The incidence of carotid bruits and non-palpable pedal pulses is virtually identical in the two sexes; only femoral bruits are male predominant. At time of diagnosis of IC one in three already have overt evidence of CHD, stroke or congestive heart failure (CHF). In those free of these at outset CHD and strokes occur at two to three times the general population rate and CHF 3.5–4.5 times the rate of persons without IC. Within 10 years of IC onset 43% develop CHD, 21% strokes and 24% cardiac failure. Carotid and femoral bruits are likewise harbingers of other atherosclerotic CVD. As many as 45% of IC victims lose their symptoms for extended periods. Survival following onset of IC is only two-thirds of that of the general population; after 10 years 60% died. This high mortality is largely attributable to coexistent cardiovascular impairments. A risk profile comprising the major cardiovascular risk factors predicts occurrence of IC even better than CHD. IC risk increases progressively with burden of the risk factors. With an aging population of increased size peripheral artery disease is a problem of increasing dimensions. Attention to comorbid conditions is essential if survival is to be improved. Because IC shares many of the same risk factors, measures to prevent CHD, CHF and strokes should also reduce IC risk.
Trauma in Pregnancy: Assessment and Treatment
Authors: Petrone P. , Asensio J. A. 
Published: January 2017

Women between the ages of 10 and 50 year-old have the potential for pregnancy; therefore this condition must be taken into consideration when a woman is examined in the Emergency Room after sustaining a traumatic event. Pregnancy produces significant physiologic and anatomic changes in every system of the female body. The evaluation of the traumatized pregnant patient, the approach, and the interpretation of the diagnostic tests results must be accompanied by the full knowledge of all changes that take place during pregnancy. In the same context, although the physician treating a pregnant trauma victim must remember that there are two patients, the treatment priorities are the same as for the non-pregnant trauma patient. The best initial treatment for the fetus is the optimum resuscitation of the mother. A thorough exam should take place to discover unique conditions that might be present in any pregnant patient such as blunt or penetrating injury to the uterus, placental abruption, amniotic fluid embolism, isoimmunization, and premature rupture of membranes. The obstetrician should be present at all times and be considered a part of the trauma team in the evaluation and treatment of apregnant trauma patient.
Long-Term Results of Laparoscopic Nissen Fundoplication Due to Gastroesophageal Reflux Disease. A Ten Year Follow-Up in a Low Volume Center
Authors: Kornmo T. S. , Ruud T. E. 
Published: January 2017

Background and Aims: Laparoscopic 360° Nissen fundoplication has been our routine surgical procedure since 1995, in the treatment of gastroesophageal reflux disease (GERD). We have reviewed our results of patients treated with laparoscopic Nissen fundoplication (LNF) during 1995–1998. Material and Methods: 170 patients have undergone LNF in our hospital since 1995. During the period of 1995–1998, 33 patients were treated. All patients were asked to return a structured follow-up questionnaire, using a Visick grading scale, after an average of 69 months (2003) and 117 months (2007). 29 questionnaires (90%) were answered in 2003, and 31 questionnaires (97%) were answered in 2007. One patient died at home before the first questionnaire in 2003, and is therefore not included. We present our results on LNF after an observation time of 117 months (range 99–144 months). Results: Patient satisfaction after LNF is rated as very good or good (Visick 1–2) in 93% in 2003 and 97% in 2007. 97% of the patients would recommend the same treatment to other patients with similar symptoms at ten year follow up. One patient has undergone resurgery during follow up. Daily gas bloat and flatulence is reported in 52% in 2003 and 39% in 2007, and is the most common reason for reduced satisfaction. Five patients report of reflux symptoms, one patient daily and four patients sometimes, where the first patient still uses proton pump inhibitor (PPI) daily and three patients use PPI occasionally. Conclusions: Patient satisfaction after LNF treatment for GERD is high at long-term (10 years) follow-up. Bloating and flatulence persistently occurred to a great extent and the need for preoperative information regarding these symptoms is important.
An Evaluation of Mitral Valve Procedures Using the European System for Cardiac Operative Risk Evaluation
Authors: Kaartama T. , Heikkinen L. , Vento A. 
Published: January 2017

Background and Aims: This study was undertaken in order to evaluate the usefulness of the Euroscore in the choice and outcome of mitral valve procedures undertaken at the Helsinki University Central Hospital. Material and Methods: Data from 378 patients was collected. Predicted mortalities were calculated for all patients using the European System for Cardiac Operative Risk Evaluation and different mitral valve procedures were compared with 30-day mortality, length of hospital care and rate of post-operative complications. Results: The mortality rate in the mitral valve repair (MVP) group decreased gradually from 5.9% (in 1999) to 2.2% (2003). The variation of annual mortality was higher in the mitral valve replacement (MVR) group. The predicted mortality given by EuroSCORE increased over the years in both groups. The mortality in the MVR group was nearly four times higher than in the MVP group. The length of both intensive and overall hospital stay decreased in patients with mvp procedures. Post-operative survival was 89% in the MVP patients and 74% in MVR patients after three years. Discussion: The results of mitral valve operations have improved. This is observed as decreased mortality rates and lengths of hospital care in the MVP group, although the predicted mortality rate was increased.