bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cannabinoid Analgesia as a Potential New Therapeutic Option in the Treatment of Chronic Pain
Authors: Burns Tammy L , Ineck Joseph R 
Published: February 2006

Objective:To review the literature concerning the physiology of the endocannabinoid system, current drug development of cannabinoid agonists, and current clinical research on the use of cannabinoid agonists for analgesia.Data Sources:Articles were identified through a search of MEDLINE (1966–August 2005) using the key words cannabis, cannabinoid, cannabi*, cannabidiol, nabilone, THC, pain, and analgesia. No search limits were included. Additional references were located through review of the bibliographies of the articles identified.Study Selection and Data Extraction:Studies of cannabinoid agonists for treatment of pain were selected and were not limited by pain type or etiology. Studies or reviews using animal models of pain were also included. Articles that related to the physiology and pharmacology of the endocannabinoid system were evaluated.Data Synthesis:The discovery of cannabinoid receptors and endogenous ligands for these receptors has led to increased drug development of cannabinoid agonists. New cannabimimetic agents have been associated with fewer systemic adverse effects than delta-9-tetrahydrocannabinol, including recent development of cannabis medicinal extracts for sublingual use (approved in Canada), and have had promising results for analgesia in initial human trials. Several synthetic cannabinoids have also been studied in humans, including 2 cannabinoid agonists available on the international market.Conclusions:Cannabinoids provide a potential approach to pain management with a novel therapeutic target and mechanism. Chronic pain often requires a polypharmaceutical approach to management, and cannabinoids are a potential addition to the arsenal of treatment options.
Lanthanum Carbonate
Authors: Joy Melanie S , Kshirsagar Abhijit , Candiani Corina , Brooks Tyson , Hudson Joanna Q 
Published: February 2006

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of lanthanum carbonate, a phosphate binder for chronic kidney disease (CKD). Data Sources: Information was selected from PubMed (1965–October 2005). All studies presented as scientific posters and abstracts from nephrology meetings from 1999 to 2005 were also included. Study Selection and Data Extraction: All published articles regarding lanthanum carbonate were included. In addition, abstracts and presentations from scientific meeting symposia were also considered for inclusion. Data Synthesis: Lanthanum carbonate has been recently approved as non-calcium-based therapy for phosphate reduction in patients with stage 5 CKD requiring dialysis. The recommended dose is 250–500 mg with meals, for a maximum of 1500 mg daily. Clinical studies have shown short- and long-term safety with lanthanum carbonate administration. Adverse effects were primarily gastrointestinal in nature. Clinical trials have also shown reductions in serum phosphorus to target concentrations, reductions in associated calcium-phosphorus product, and minimal effects on serum calcium and parathyroid hormone concentrations. Conclusions: Lanthanum carbonate is an effective phosphate-binding agent without significant risk of hypercalcemia or worsening metabolic acidosis. Lanthanum carbonate is a safe and effective drug for reduction of elevated serum phosphorus levels associated with stage 5 CKD. The role of lanthanum carbonate relative to other phosphate-binding drugs, such as calcium salts and sevelamer, remains to be determined.
Bivalirudin Use in Carotid Endarterectomy in a Patient with Heparin-Induced Thrombocytopenia
Authors: Finks Shannon W 
Published: February 2006

Objective: To describe the successful use of bivalirudin as the primary procedural anticoagulant in a patient with suspected heparin-induced thrombocytopenia (HIT) undergoing carotid endarterectomy (CEA). Case Summary: A 73-year-old white man presented for an elective CEA 3 weeks after emergent, on-pump coronary artery bypass grafting. Bivalirudin was used for procedural anticoagulation because of seropositivity for heparin-PF4 antibodies and a clinical history consistent with HIT. The dose was administered as a 0.75 mg/kg bolus and 1.75 mg/kg/h infusion as reported in percutaneous coronary intervention, based on review of the available bivalirudin literature. The dosage was adjusted for the patient's renal dysfunction. The outcome was successful, with the patient discharged home in 8 days without significant complications. Discussion: During active HIT, when thrombocytopenia and heparin-PF4 antibodies are present, heparin therapy must be avoided. In patients with subacute HIT, when platelet counts have recovered but HIT antibodies are still present, it is also prudent to avoid heparin administration. In the case of a patient in whom anticoagulation is necessary but heparin use is contraindicated, a direct thrombin inhibitor, such as bivalirudin, may offer a viable alternative. Bivalirudin is not immunogenic and does not cross-react with the heparin-PF4 antibodies associated with HIT. To our knowledge, as of January 20, 2006, this is the first report of the use of bivalirudin for procedural anticoagulation during CEA in a patient with HIT antibodies and recent exposure to heparin. Conclusions: Further investigation is warranted to clarify the clinical benefits of bivalirudin for patients undergoing vascular surgery of the carotids, including potential advantages for vulnerable patient populations such as those with diagnosed or suspected HIT as well as those with renal dysfunction.
Drug-Gene Interaction Between the Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and Antihypertensive Therapy
Authors: Schelleman Hedi , Klungel Olaf H , van Duijn Cornelia M , Witteman Jacqueline CM , Hofman Albert , Boer Anthonius de , Stricker Bruno HCh 
Published: February 2006

Background: Despite the availability of a variety of effective drugs, inadequate control of blood pressure is common. There are some indications that the angiotensin-converting enzyme (ACE) gene modifies the response to antihypertensive drugs, but the results have been inconclusive. Objective: To investigate whether the insertion/deletion polymorphism of the ACE gene modifies blood pressure differences among subjects using diuretics, β-blockers, calcium-channel antagonists, or ACE inhibitors. Methods: Data were used from the Rotterdam Study, a population-based, prospective, cohort study in the Netherlands, which started in 1990 and included 7983 subjects aged 55 years or older. Data from 3 subsequent cross-sectional investigations were used, as well. Subjects were included if they had high blood pressure during one or more examinations and/or used monotherapy with a diuretic, β-blocker, calcium-channel antagonist, or ACE inhibitor. A marginal, generalized, linear model was used to assess the association between the mean difference in systolic/diastolic blood pressure and antihypertensive classes stratified by the 3 genotypes. Results: In total, 3025 hypertensive individuals were included, and 6500 measurements of blood pressure were taken. The percentages of DD, ID, and II genotypes were 28.3%, 51.4%, and 20.3%, respectively. The mean differences in systolic blood pressure between the II and DD genotypes were 0.23 mm Hg (95% Cl −5.48 to 5.94) for diuretics, −2.41 mm Hg (95% Cl −6.72 to 1.90) for β-blockers, 2.12 mm Hg (95% Cl −4.64 to 8.89) for calcium-channel antagonists, and −2.01 mm Hg (95% Cl −9.82 to 5.79) for ACE inhibitors. Conclusions: The adjusted mean difference in diastolic and systolic blood pressure among diuretic, β-blocker, calcium-channel antagonist, or ACE inhibitor users was not modified by the ACE insertion/deletion polymorphism.
Successful Clearance of Catheter-Related Bloodstream Infection by Antibiotic Lock Therapy Using Ampicillin
Authors: Elwood Robert L , Spencer Steven E 
Published: February 2006

Objective: To report a case in which ampicillin was used successfully as lock therapy for a central venous intravascular catheter and to discuss the implications of ampicillin used in this modality. Case Summary: A 14-month-old girl with a long-term central venous catheter acquired a polymicrobial (Escherichia coli and Enterococcus durans) bloodstream infection. The central venous catheter was suspected as the source for the bacteremia based on the timing and number of positive blood cultures in relation to therapy with antibiotics. Antibiotic sensitivity testing revealed ampicillin monotherapy to be an ideal choice to treat both organisms. A combination of systemic therapy via a temporary catheter and antibiotic lock therapy of the central venous catheter was then instituted using ampicillin without anticoagulants. The patient tolerated this therapy without complications, and follow-up cultures demonstrated effective clearance of the bacteria. Discussion: Antibiotic lock therapy has been shown to be useful in the treatment of catheter-related bloodstream infections. However, many antibiotics have yet to be tested with this modality. Ampicillin, which is frequently used in the treatment of Enterococcus and E. coli infections, has not previously been reported as a single agent for lock therapy. Conclusions: Ampicillin may be a useful agent with the relatively new modality of lock therapy for central venous catheters. Further studies are needed to demonstrate possible compatibility of this agent with anticoagulants, such as heparin, as well as its efficacy in treating catheter-related bloodstream infections.
Emerging Role of Epidemiologic Literacy
Authors: Draugalis JoLaine Reierson , Plaza Cecilia M 
Published: February 2006

Background: The ability to understand and apply epidemiology methods is a growing part of pharmacy practice, pharmacy accreditation standards, and evidence-based practice. Objective: TO examine the trends in epidemiology-related terminology used in the literature over the past 20 years. Methods: The frequency of the use of epidemiology-related terminology in 3 representative pharmacy Journals, 2 representative medical journals, and 1 public health journal from January through December 1984, 1994, and 2004 was recorded. The 3 pharmacy journals were the American Journal of Health-System Pharmacy (formerly American Journal of Hospital Pharmacy), The Annals of Pharmacotherapy (formerly Drug Intelligence and Clinical Pharmacy), and Pharmacotherapy. The 2 medical journals were the New England Journal of Medicine and The Journal of the American Medical Association (JAMA), and the public health journal was the American Journal of Public Health. The number of times an epidemiology-related term was used was summed for each year and each journal. Results: For all the journals examined in this study combined, the proportion of epidemiologic terms used in the literature has increased over the past 20 years. In 1984, of the total articles published in the 6 journals, 7.02% contained epidemiologic terms increasing to 12.27% and 15.46% in 1994 and 2004, respectively. The most dramatic differences in the 20-year comparisons were noted for Pharmacotherapy (0 to 17.75%) and JAMA (7.32 to 26.72%). Conclusions: The increase in the use of epidemiology-related terms has implications for both curricular planning in schools and colleges of pharmacy, as well as for continuing education programs and effective interprofessional communication.
Meropenem by Continuous Versus Intermittent Infusion in Ventilator-Associated Pneumonia due to Gram-Negative Bacilli
Authors: Lorente Leonardo , Lorenzo Lisset , Martín María M , Jiménez Alejandro , Mora María L 
Published: February 2006

Background: It is known that β-lactam antibiotics exhibit time-dependent bactericidal activity. Several studies have found continuous infusion of meropenem more effective than intermittent infusion in maintaining constant serum concentrations in excess of the minimum inhibitory concentration. However, limited data exist on the clinical efficacy of meropenem administered by continuous infusion. Objective: To evaluate the clinical efficacy of continuous versus intermittent infusion of meropenem for the treatment of ventilator-associated pneumonia (VAP) due to gram-negative bacilli. Methods: A retrospective cohort study was conducted of patients with VAP caused by gram-negative bacilli who received initial empiric antibiotic therapy with meropenem. We analyzed 2 contemporary cohorts: one group received meropenem by continuous infusion (1 g over 360 min every 6 h), the other by intermittent infusion (1 g over 30 min every 6 h). The administration method was prescribed according to the physician's discretion. Patients received meropenem plus tobramycin for 14 days. Results: There were no significant differences between patient groups with regard to gender, age, APACHE-II at intensive care unit admission, diagnosis, microorganism responsible for VAP, or organ dysfunction severity at the time VAP was suspected. The group receiving medication by continuous infusion showed a greater clinical cure rate than the group treated with intermittent infusion (38 of 42, 90.47%, vs 28 of 47, 59.57%, respectively, with OR 6.44 [95% Cl 1.97 to 21.05; p < 0.001]). Conclusions: Meropenem administered by continuous infusion may have more clinical efficacy than intermittent infusion.
Successful Recovery After an Overdose of Argatroban
Authors: Yee Andrew J , Kuter David J 
Published: February 2006

Objective: To report the case of a critically ill man with heparin-induced thrombocytopenia (HIT) who received a 125 mg overdose of the direct thrombin inhibitor argatroban. Case Summary: A 74-year-old man with a history of Crohn's disease underwent takedown of an ileorectal fistula. He developed HIT postoperatively and was treated with argatroban. He became critically ill and was transferred to the intensive care unit. On postoperative day 24, he accidentally received argatroban 125 mg over 1 hour (26 μg/kg/min). Treatment with fresh frozen plasma (FFP) was effective, and there were no significant complications. The partial thromboplastin time, however, continued to be prolonged 48 hours after the overdose. Discussion: Medication errors with direct thrombin inhibitors are common. However, there is no known reversal agent for this class of anticoagulants. This patient was treated with FFP and did well, with no bleeding complications. However, the clearance of argatroban was prolonged. Conclusions: This case illustrates that supratherapeutic doses of argatroban can be managed with FFP and tolerated without significant complications.
Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury
Authors: Schneider H J , Schneider M , Saller B , Petersenn S , Uhr M , Husemann B , von Rosen F , Stalla G K 
Published: February 2006

Objective: Cross-sectional studies report a high prevalence of hypopituitarism after traumatic brain injury (TBI); however, no longitudinal studies on time of manifestation and reversibility exist. This study was conducted to assess hypopituitarism 3 and 12 months after TBI.
Design: This was a prospective, longitudinal, diagnostic study.
Methods: Seventy-eight patients (52 men, 26 women, mean age 36.0 years) with TBI grades I–III and 38 healthy subjects (25 men, 13 women, mean age 36.4 years) as a control group for the GHRH + arginine test were studied. The prevalence ofhypopituitarism was assessed 3 and 12 months after TBI by GHRH + arginine test, short adrenocorticotropic hormone (ACTH) test, and basal hormone measurements in patients.
Results: After 3 months, 56% of all patients had impairments of at least one pituitary axis with axes being affected as follows: gonadotropic 32%, corticotropic 19%, somatotropic 9% and thyrotropic 8%. After 12 months, fewer patients were affected, but in some cases new impairments occurred; 36% still had impairments. The axes were affected as follows after 12 months: gonadotropic 21%, somatotropic 10%, corticotropic 9% and thyrotropic 3%.
Conclusions: Hypopituitarism occurs often in the post-acute phase after TBI and may normalize later, but may also develop after the post-acute phase of TBI.
Detection of BRAF mutation in thyroid papillary carcinomas by mutant allele-specific PCR amplification (MASA)
Authors: Sapio Maria Rosaria , Posca Daniela , Troncone Giancarlo , Pettinato Guido , Palombini Lucio , Rossi Guido , Fenzi Gianfranco , Vitale Mario 
Published: February 2006

Objective: The somatic point mutation in the BRAF gene, which results in a valine-to-glutamate substitution at residue 600 (BRAFV600E), is an ideal hallmark of papillary thyroid carcinoma (PTC). However, its prevalence is varyingly reported in different studies, and its expression in the follicular variant PTC is controversial, reducing its potential usefulness as diagnostic marker.
Design and methods: We developed an assay based on mutant allele-specific PCR amplification (MASA) to detect BRAF mutation. We compared the sensitivity of MASA, single-strand conformation polymorphism (SSCP) and direct DNA sequencing of PCR products. Then, we used MASA 78 to analyze 78 archival thyroid tissues, including normal samples, follicular adenomas, follicular carcinomas and PTC.
Results: The MASA assay proved to be a more sensitive method than SSCP and DNA sequencing of PCR products. BRAF mutation was found by MASA in 19/43 (44.2%) of PTC, including 14/31 (45.2%) classic forms and 5/12 (41.7%) follicular variants. No mutations of BRAF were detected in the normal thyroid tissues, nor in follicular adenomas or follicular carcinomas. No correlation was found between BRAF mutation and clinicopathologic features nor with recurrence during a postoperative follow-up period of 4–11 years. BRAFV600E significantly correlated with absence of node metastasis.
Conclusions: BRAFV600E is present in PTC, both in the classic form and in follicular variant with similar prevalence. No correlation was found between BRAF mutation and aggressive clinical behavior. MASA-PCR proved to be a specific, sensitive and reliable method to detect BRAF T1799A in DNA extracted from different sources, including cytologic samples obtained either fresh or from archival glass slides. We propose this method as a useful tool to improve accuracy of preoperative diagnosis identifying PTC from biopsies with indeterminate cytologic findings.
Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients
Authors: Oltmanns Kerstin M , Dodt Baerbel , Schultes Bernd , Raspe Hans H , Schweiger Ulrich , Born Jan , Fehm Horst L , Peters Achim 
Published: February 2006

Objective: The prevalence of type 2 diabetes mellitus is increasing rapidly in industrialized countries, and adrenal glucocorticoids may intensify this disease. We sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with type 2 diabetes.
Design: We investigated 190 type 2 diabetic patients who volunteered from a population study of 12 430 people in Luebeck and its suburbs. The target population comprised men and women born between 1939 and 1958 who initially received a postal questionnaire about their health status. We identified 346 subjects with confirmed diabetes mellitus and 216 patients participated in the study. Patients with type 1 diabetes were excluded.
Methods: Five salivary cortisol samples were collected before and after lunch, in the evening and then the next morning before and after standing. Clinical variables associated with diabetes were measured and correlated with cortisol concentrations.
Results: None of the cohort had salivary cortisol concentrations that exceeded the normally accepted range. Based on cortisol samples collected just prior to a standard lunch, the cohort was divided into tertiles. Cortisol was positively related to: fasting blood, urinary and postprandial glucose; glycosylated hemoglobin; and systolic and diastolic blood pressures (all P < 0.05). Cortisol concentrations also correlated with the relative abdominal mass (P < 0.05) when patients with marked glucosuria were excluded.
Conclusions: The degree of severity of several clinical measures of type 2 diabetes correlates with cortisol concentrations. Moreover, the results provide evidence for a positive relationship between metabolic disturbances and cortisol concentrations that are within the accepted normal range.
The role of thiocyanate in the etiology of goiter in an industrial metropolitan area
Authors: Brauer V F H , Below H , Kramer A , Führer D , Paschke R 
Published: February 2006

Objective: Thiocyanate (SCN−) has concentration dependent antithyroid properties and a role in the etiology of goiter has been suggested in several studies. In 1991 an epidemiological survey conducted in the region of Halle/Leipzig (Saxony), an area with significant air pollution, suggested an inverse relationship between urinary iodine (I−)/SCN− excretion and goiter prevalence. 10 years later, we reinvestigated the same industrial area to clarify if the situation has changed after the elimination of most industrial waste products and moreover, if SCN− excretion levels alone or in combination with air pollution or smoking as a SCN− source are critical for thyroid function.
Design and methods: We investigated a cohort of 708 probands for I−, SCN− and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules by high resolution ultrasonography.
Results: Probands with goiter (n = 79, 11%) had significantly higher urinary SCN− excretions than probands without (3.9 ± 2.8 vs 3.1 ± 3.4 mg SCN−/g creatinine) and significantly lower urinary I−/SCN− ratios than patients without thyroid disorders (41 ± 38 vs 61 ± 71 μg I−/mg SCN−/l). Mean urinary I− excretions were not different between probands with or without goiter. Smokers showed significantly elevated urinary SCN−/creatinine ratios in comparison to non-smokers (4.3 ± 4.3 vs 2.4 ± 2.1 mg SCN−/g creatinine). ANOVA revealed a prediction of thyroid volume through age (P < 0.001), gender (P < 0.001), body weight (P < 0.05) and smoking (P < 0.05).
Conclusions: In our investigation, age, gender and smoking (raising SCN− levels by CN− inhalation) were predictive for thyroid volume and the urinary I−/SCN− ratios were able to detect probands with an increased risk of developing goiter in contrast to urinary I− excretion levels alone. These data suggest, that in an era and area of decreased cyanide pollution, SCN− may remain a cofactor in the multifactorial aetiology of goiter.