bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myxedema Coma Associated with Combination Aripiprazole and Sertraline Therapy
Authors: Church Chelsea O , Callen Erin C 
Published: November 2009

Objective: To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy. Case Summary: A 41-year-old male presented to the emergency department with confusion, right-sided numbness and tingling, slurred speech, dizziness, and facial edema. His blood pressure was 160/113 mm Hg, with a pulse of 56 beats/min and temperature of 35.4 °C, Initial abnormal laboratory values included creatine kinase (CK) 439 U/L; serum creatinine 1.6 mg/dL; aspartate aminotransferase 85 U/L; and alanine aminotransferase 35 U/L. Repeat cardiac markers revealed an elevated CK level of 3573 U/L with a CK-MB of 24 ng/mL. Thyroid function tests showed thyroid-stimulating hormone 126.4 μIU/mL and free thyroxine 0.29 ng/dL. Home medications of unknown duration were sertraline 200 mg and aripiprazole 20 mg daily. He was admitted to the intensive care unit and initially treated with intravenous levothyroxine and dexamethasone. By hospital day 4, the patient was clinically stable and discharged to home. Discussion: Myxedema coma, the most significant form of hypothyroidism (HT), is a rare but potentially fatal condition. The known precipitating causes of MC were ruled out in this patient, which left his home medications as the likely cause. Cases of HT caused by certain atypical antipsychotics and antidepressants are found in the literature, but none was reported with aripiprazole therapy. There are also no reported cases of sertraline or aripiprazole inducing MC. Use of the Naranjo probability scale indicates that the combination of aripiprazole and sertraline was a probable inducer of MC in this patient. Conclusions: Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole.
Drug-Drug Interaction Between Itraconazole and the Protease Inhibitor Lopinavir/Ritonavir
Authors: Hills-Nieminen Cara , Hughes Christine A , Houston Stan , Shafran Stephen D 
Published: November 2009

Objective: To report the results of therapeutic drug monitoring of lopinavir/ritonavir and itraconazole concentrations in an HIV-infected male who was treated for histoplasmosis. Case Summary: A 34-year-old HIV-infected man who had recently initiated efavirenz-based antiretroviral therapy was diagnosed with disseminated Histoplasma capsulatum infection. In the hospital, lopinavir/ritonavir 400 mg/100 mg twice daily replaced efavirenz to avoid etavirenz-itraconazole interactions. After 14 days of liposomal amphotericin B therapy, itraconazole solution was initiated at 150 mg twice daily for 3 days, followed by 200 mg daily. Prior to itraconazole initiation, lopinavir trough concentration was 7.4 mg/L. The lopinavir trough concentration 15 days later, after 14 days of itraconazole, was 6.8 mg/L. An itraconazole concentration measured 2 hours post-dose on day 15 of oral therapy was 1.9 pg/mL. After 2 weeks of liposomal amphotericin, urine Histoplasma antigen was 27.23 ng/mL; after 5 months of oral itraconazole therapy, it decreased to 5.24 ng/mL. Plasma HIV RNA decreased 4.26 log10 in 5 months to less than 40 copies/mL The patient has demonstrated marked clinical improvement. Discussion: In this case, dosing recommendations of itraconazole 200 mg daily with lopinavir/ritonavir were appropriate. Lopinavir trough concentrations were not significantly different following the addition of itraconazole and were above the minimum target of 1 mg/L in treatment-naive patients. The itraconazole concentration was above the recommended concentration of at least 1 μg/mL. Conclusions: The dose of itraconazole was reduced to 200 mg daily as recommended by current guidelines, and therapeutic drug monitoring of both itraconazole and lopinavir concentrations confirmed that no further dosage adjustments were necessary.
Lopinavir Cerebrospinal Fluid Steady-State Trough Concentrations in HIV-Infected Adults
Authors: DiCenzo Robert , DiFrancesco Robin , Cruttenden Kim , Donnelly Julie , Schifitto Giovanni 
Published: November 2009

Background: The central nervous system may act as a sanctuary site for viral replication in the setting of low antiretroviral penetration. Data on lopinavir cerebrospinal fluid (CSF) trough concentration (Ctrough) values have yet to be reported. Objective: To describe lopinavir CSF Ctrough values and compare them with a measure of HIV susceptibility. Methods: In a prospective, open-label design, HIV-infected adults whose regimen included lopinavir/ritonavir 400/100-mg soft-gel capsules twice daily for at least 4 weeks were enrolled. Each subject had 8 plasma lopinavir concentrations determined over a 12-hour dosing interval and 1 CSF lopinavir Ctrough value determined at the end of the study. Linear regression methods tested for associations between CSF or CSF to plasma concentration ratio and covariates including pharmacokinetic parameters and CSF protein. Results: Ten patients (7 male; median [range] ± SD age 45.3 ± 2.8 y) completed the study. Median (intraquartile range [IQR]) lopinavir plasma 0- to 12-hour area under the curve (AUC0-12) and minimum concentrations were 71.3 h•μg/mL (48.4-87.6) and 3.82 /jg/mL (2.76-5.34). Median (IQR) CSF Ctrough, paired plasma concentration, and time since last dose were 11,200 pg/mL (6760–16.400), 5.42 μg/mL (3.88–5.85), and 9.9 hours (9.7-10.2), respectively. Median (IQR) CSF to plasma concentration ratio was 0.225% (0.194-0,324). Lopinavir CSF Ctrough was above the median 50% inhibitory concentration (IC50) for wild-type HIV-1 (wfHIV-1) (1900 pg/mL) in all subjects. Lopinavir plasma AUC0-12 (r2= 0.65; p = 0.009) and CSF protein (r2 = 0.26; p = 0.006) were associated with lopinavir CSF concentration, while CSF protein (r2 = 0.66; p = 0.008) was associated with CSF to plasma concentration ratio. Conclusions: Lopinavir CSF Ctrough was above the median IC50 for wfHIV-1 replication in all patients receiving lopinavir/ritonavir 400/100-mg soft-gel capsules twice daily.
Gemfibrozil-Induced Myositis in a Patient with Normal Renal Function
Authors: Hahn Martin , Sriharan Kalavally , McFarland M Shawn 
Published: November 2009

OBJECTIVE To describe a case of gemfibrozil monotherapy-induced myositis in a patient with normal renal function CASE SUMMARY A 68-year-old white man presented to his primary care clinic complaining of a 6-month history of total body pain. His past medical history was significant for hypertension, diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, benign prostatic hypertrophy, arthritis, impotence, and pancreatic cancer that required excision of part of his pancreas. His home drug regimen included bupropion 75 mg twice daily, gemfibrozil 600 mg twice daily for the past 8 months, glimiperide 1 mg daily, insulin glargine 5 units at bedtime, insulin aspart 5 units in the evening, lisinopril 10 mg daily, omeprazole 40 mg daily, pregabalin 100 mg daily, and sildenafil 100 mg as needed. Laboratory test results were significant for elevated aspartate aminotransferase (AST) 78 U/L (reference range 15–46 U/L), alanine aminotransferase (ALT) 83 U/L (13–69 U/L), and creatine kinase (CK) 3495 U/L (55–170 U/L). Serum creatinine was normal at 1.19 mg/dL. The physician determined that the elevated CK indicated myositis secondary to gemfibrozil use, and gemfibrozil was subsequently discontinued. The patient returned 1 week later to repeat the laboratory tests. Results were CK 220 U/L, AST 26 U/L, ALT 43 U/L, and serum creatinine 1.28 mg/dL. The patient was asked to return in 3 weeks to repeat the laboratory tests. At that time, CK had continued to decrease to 142 U/L, and the AST and ALT had returned to normal, at 22 and 29 U/L, respectively. The patient reported complete resolution of total body pain 3 weeks after discontinuation of gemfibrozil. Follow-up 5 weeks after discontinuation revealed no change compared to the 3-week follow-up. DISCUSSION Myositis most often produces weakness and elevated CK levels more than 10 times the upper limit of normal. The risk of developing myositis, myopathy, or rhabdomyolysis is low (1%) when fibrates such as gemfibrozil are used as monotherapy. Evaluation of the literature revealed one case of gemfibrozilrelated myositis in a patient with chronic renal failure. There is also one report of myopathy associated with gemfibrozil monotherapy in a patient with normal renal function. The present case is the first documented case of gemfibrozil monotherapy-induced myositis in a patient with normal renal function. The Naranjo probability scale indicated a probable relationship between gemfibrozil treatment and the onset of myositis in our patient. Other potential causes of myositis were ruled out by patient interview and chart review. CONCLUSIONS Although the risk of myositis appears to be low with gemfibrozil monotherapy, clinicians should be aware of the potential for this adverse event. For patients taking gemfibrozil monotherapy who present with myalgia, discontinuation of the medication may be necessary for the alleviation of pain.
A Retrospective Poison Center Review of Varenicline-Exposed Patients
Authors: Kreshak Allyson A , Clark Alycia K , Clark Richard F , Ly Binh T , Cantrell F Lee 
Published: November 2009

Background: Varenicline was approved by the Food and Drug Administration (FDA) as a prescription smoking cessation aid in May 2006. Varenicline is both a partial nicotine agonist and an antagonist. Recent reports by the Institute of Safe Medication Practices identified safety problems associated with varenicline use, and the FDA recently issued a boxed warning. These safety concerns regarding varenicline use prompted this study. Objective: To characterize varenicline-exposed patients as reported to a poison control system. Methods: We performed a retrospective search of the California Poison Control System electronic database from August 2006 through August 2008, using the term varenicline or Chantix. Cases matching these results were reviewed. All ages were included. Excluded were patients with coingestants and unknown outcomes. Clinical parameters and medical outcomes were extracted from the database. Results: Thirty-six cases met inclusion criteria and 17 cases were excluded, Ten cases involved nonpediatric patients; 9 cases involved patients less than 6 years old, which were defined as pediatric patients. The median duration of poison center follow-up for pediatric patients was 253 minutes; median duration of follow-up for nonpediatric patients with unintentional exposures was 28.5 minutes. The majority of exposures were unintentional and included all the pediatric patients and 6 nonpediatric patients who had unintentional medication errors, Gastrointestinal and neuropsychiatric adverse events were most frequently reported. The majority of these patients were managed at home. Among those evaluated at a healthcare facility, only 1 pediatric patient was admitted. Of the remaining patients, 1 nonpediatric patient reported a deliberate exposure and 3 nonpediatric patients experienced adverse effects at therapeutic doses. Median duration of follow-up for these patients was 308 minutes. Conclusions: Patients exposed to varenicline in our study had favorable outcomes. Gastrointestinal and neuropsychiatric effects were the most commonly reported adverse events. A dose-response relationship could not be determined and triage criteria to a healthcare facility remain undetermined.
Defenses of polar macroalgae against herbivores and biofoulers
Authors: Amsler Charles D. , Iken Katrin , McClintock James B. , Baker Bill J. 
Published: November 2009

Abstract
Chemical defenses against herbivores are common in macroalgae from Antarctica, particularly in those species that typically dominate benthic communities. Conversely, although little studied, chemical defenses do not appear to be as important in the ecological relationships of Arctic macroalgae. Mesoherbivory may be particularly heavy in Antarctic macroalgal communities, but Antarctic macroalgae produce chemical defenses against both mesoherbivores and macroherbivores. Antarctic macroalgae have been useful in testing and extending chemical defense theories. While physical defenses may also be important in some Antarctic macroalgal-herbivore relationships, particularly with respect to mesoherbivores, physical defenses do not appear to have wide-spread importance against macroherbivores. In Arctic macroalgae, physical defenses may be of more overall importance in reducing mesoherbivory. Antarctic macroalgae also produce compounds with the potential to control biofouling by sympatric microalgae.
Biodiversity, biogeography and zonation of marine benthic micro- and macroalgae in the Arctic and Antarctic
Authors: Wulff Angela , Iken Katrin , Quartino María Liliana , Al-Handal Adil , Wiencke Christian , Clayton Margaret N. 
Published: November 2009

AbstractThis paper reviews the composition, biogeography and zonation of benthic algae in Arctic and Antarctic polar regions. There is a marked contrast in the literature between the amount of information on microalgae vs. macroalgae. Perhaps not surprising in view of their size and conspicuous nature, the macroalgae are better known than the microalgae and they have been studied more intensively. Macroalgal biodiversity is greater in Antarctica than in the Arctic, as is the number of endemic species. Both these characteristics of the Antarctic marine macroalgal flora can be explained by the biogeographical histories of the regions. In contrast, endemism amongst Arctic and Antarctic benthic microalgae is generally considered to be low; however, there is very little evidence to support this and further molecular research is needed to document and clarify the biodiversity of marine benthic microalgae of both polar regions. The zonation or local distribution of polar macroalgae and microalgae is influenced by physiological, morphological, chemical and ecological characteristics that determine responses to a range of environmental factors, including the ability to resist and survive algal grazing. Typically, the lower depth distribution limit elevates with increasing latitude.
Light and temperature demands of marine benthic microalgae and seaweeds in polar regions
Authors: Gómez Iván , Wulff Angela , Roleda Michael Y. , Huovinen Pirjo , Karsten Ulf , Quartino María Liliana , Dunton Ken , Wiencke Christian 
Published: November 2009

Abstract
Polar algae have a striking ability to photosynthesize and grow under very low light and temperatures. In seaweeds, minimum light demands for photosynthetic saturation and compensation can be as low as 10 and 2 μmol photons m-2 s-1, respectively. For benthic microalgae, these values can be even lower because of the limited irradiance reaching deep sea floors. The extreme shade adaptation of these organisms sets their distributional limits at depths close to 40 m and enables them to tolerate long periods of extended darkness. In addition to their capability for efficient photosynthesis at extremely low light levels, polar algae possess metabolic adaptations to persist at low temperatures, which permit them to complete their life cycles at year-round temperatures close to 0°C. Seaweeds with the lowest temperature demands are the species endemic to the Antarctic while Arctic algae are comparatively less cold-adapted. These adaptive characteristics allow benthic marine algae to make high contributions to high latitude coastal primary productivity and energy fluxes, exceeding or equaling the production of primary producers in more temperate systems. The studies summarized here give important insights into the major physiological adaptations allowing marine benthic microalgae and seaweeds to colonize these extreme habitats.
Impact of oceanic warming on the distribution of seaweeds in polar and cold-temperate waters
Authors: Müller Ruth , Laepple Thomas , Bartsch Inka , Wiencke Christian 
Published: November 2009

Abstract
Temperature is one of the most important factors controlling the biogeographic distribution of seaweeds and is expected to increase due to the rise in anthropogenic greenhouse gas concentrations, especially in polar and cold-temperate regions. To estimate prospective distributional shifts in cold-water key structural seaweeds from both hemispheres, we related temperature requirements and recent distributions of seaweeds to observed mean sea surface temperature (SST) isotherms for the periods 1980–1999 (Meteorological Office Hadley Centre's SST data set; HadISST) and to modelled temperatures for 2080–2099 [Coupled Model Intercomparison Project 3 (CMIP3) database prepared for the Intergovernmental Panel on Climate Change Fourth Assessment Report (IPCC AR4) report] based on moderate greenhouse gas emissions Special Report on Emission Scenarios – Scenario B1 (SRESA1B). Under this scenario, North Atlantic polar to cold-temperate seaweeds investigated will extend their distribution into the High Arctic until the end of the 21st century, but retreat along the northeastern Atlantic coastline. In contrast, selected Antarctic seaweeds will probably not significantly alter their latitudinal distributions, as deduced from our presently incomplete knowledge of their temperature requirements. We identified several cold-temperate regions where seaweed composition and abundance will certainly change with elevated temperatures. The results are discussed in the context of local temperature conditions, effects of multifactorial abiotic and biotic interactions and expected ecological consequences for seaweed-dominated ecosystems.
Biological variation of free plasma amino acids in healthy individuals
Authors: Corte Zoraida , Venta Rafael 
Published: November 2009

Abstract

Background: Biological variation data for free plasma amino acids are lacking from the more comprehensive databases. Therefore, we determined the intra- and inter-individual components of variation in healthy subjects. These data were used to define desirable goals for imprecision, bias and total error, indices of individuality and reference change values.

Methods: Plasma samples were collected from 11 volunteers at weekly intervals over 5 weeks. Free plasma amino acids were analyzed by reversed-phase HPLC and analytical and biological variation data were derived using ANOVA.

Results: Intra-individual coefficients of variation ranged from 9.5% to 46.4%, with lower values among the essential amino acids. The mean inter-individual coefficient of variation was 46.6% and was higher than intra-individual values for all amino acids. Thus, indices of individuality were below 0.8. Reference change values ranged from 30.9% to 128.4% and total error values ranged from 15.2% to 61.0%.

Conclusions: Plasma amino acids exhibit relatively low intra-individual coefficients of variation, with essential amino acids showing tighter homeostatic control. Analytical quality goals can be reasonably achieved with current methods. Reference intervals are of limited value in the detection of unusual results in an individual. Therefore, comparison of serial results by means of the reference change values is recommended.
Clin Chem Lab Med 2010;48:99–104.
ADMA concentration changes across the menstrual cycle and during oral contraceptive use: the Cardiovascular Risk in Young Finns Study
Authors: Valtonen Pirjo , Punnonen Kari , Saarelainen Heli , Heiskanen Nonna , Raitakari Olli T , Juonala Markus , Viikari Jorma S A , Alfthan Georg , Kähönen Mika , Laaksonen Reijo , Lyyra-Laitinen Tiina , Laitinen Tomi , Heinonen Seppo 
Published: November 2009

ObjectiveThe aim of this study was to evaluate changes in the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) levels during different menstrual cycle phases in young adult women with or without oral contraceptive (OC) use.Design and methodsThe subjects (n=1079) originated from a large population-based, prospective cohort study conducted in Finland. Plasma ADMA, symmetric dimethylarginine (SDMA), l-arginine, C-reactive protein, creatinine, and brachial artery flow-mediated dilatation (FMD) were measured. The use of OCs and menstrual cycle phase were determined from a questionnaire.ResultsIn non-OC users, ADMA (P=0.017), l-arginine (P=0.002), and ADMA/SDMA ratio (P<0.001) were significantly lower in the luteal phase than in the follicular phase of the menstrual cycle. Non-OC users also had significantly higher ADMA and SDMA concentrations (P<0.001) and lower l-arginine concentrations (P<0.001) compared to OC users of estrogen-containing pills. Progestin-only contraceptive pills (POPs) did not lower the ADMA level, but maintained it at the same level as in non-OC users. In OC users, there were no significant differences found in ADMA, FMD, or FMD% across menstrual cycle, whereas brachial artery diameter was significantly more decreased in the luteal phase (P=0.013) than in the follicular phase.ConclusionWe observed that the circulating ADMA concentration varies across the menstrual cycle in young women not using OCs, and women on OCs displayed significantly lower circulating ADMA concentrations than non-OC users, though this was not the case with POP contraception.
Circulating white blood cell count and measures of adipose tissue inflammation predict higher 24-h energy expenditure
Authors: He Jianying , Le Duc Son , Xu Xiaoyuan , Scalise Michael , Ferrante Anthony W , Krakoff Jonathan 
Published: November 2009

ObjectiveEnergy expenditure (EE) and measures of inflammation increase with adiposity, and this obesity-induced chronic and subclinical inflammation was extensively reported to be a cause of insulin resistance. However, whether subclinical inflammation has a role in increasing EE, which may be at the cost of developing insulin resistance, is not clear.MethodsWe investigated the association between circulating white blood cell count (WBC) in a population of Native Americans (n=243) with measurement of EE in a respiratory chamber, and in a subset of the same population (n=34), with gene expression measures of inflammation in subcutaneous abdominal adipose tissue (SAAT). All subjects were healthy on oral glucose tolerance test. Statistically, nonnormally distributed variables were logarithmically transformed before analyses to approximate normal distributions.ResultsWBC was associated with 24-h EE adjusted for age, sex, fat-free mass, and fat mass (r=0.13, P=0.04). In SAAT, tumor necrosis factor-α (TNF-α), shown as log10-transformed TNF-α (r=0.36, P=0.05), and plasminogen activator inhibitor-1 (PAI-1), shown as log10-transformed PAI-1 (lPAI-1; r=0.41, P=0.02), expressions were also positively correlated with adjusted 24-h EE. lPAI-1 was also correlated with adjusted sleep EE (r=0.34, P=0.07).ConclusionsIn conclusion, circulating markers of inflammation (WBC) and markers of inflammation within adipose tissue (TNF-α and PAI-1) are positively associated with EE, indicating a role of chronic subclinical inflammation in the regulation of metabolic rate.