bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Epidural Corticosteroids in Low Back Pain
Authors: Tonkovich-Quaranta Lynn A , Winkler Susan R 
Published: June 2003

OBJECTIVE: To review the literature regarding the safety and efficacy of epidural corticosteroid injections in the treatment of low back pain (LBP) of various etiologies. DATA SOURCES: A MEDLINE search (1966–February 1999) of English-language literature pertaining to the use of epidural corticosteroids in LBP was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for the review. The clinical trials included are those that enrolled a larger patient population and were primarily controlled clinical trials. The authors selected pertinent information for further discussion. DATA SYNTHESIS: Nerve root compression and inflammation are thought to be factors contributing to LBP. Corticosteroids act to decrease inflammation and may be of benefit in relieving LBP, especially if administered directly to the affected area via the epidural route. However, data on the efficacy of various corticosteroid agents administered via this route are limited. In addition, there have been reports of significant adverse reactions, thought to be due primarily to the preservative components in the corticosteroid preparations. Therefore, the role of these agents in the therapy of LBP remains to be determined. CONCLUSIONS: Based on the studies reviewed, epidural corticosteroids may be an effective treatment for LBP. Their use is warranted in patients who have failed conservative therapy. Although they contain preservatives, it appears that these agents are relatively safe and do not cause significant neurotoxicities.
The Use of Calcium Salts in the Prevention and Management of Verapamil-Induced Hypotension
Authors: Moser Lynette R , Smythe Maureen A , Tisdale James E 
Published: June 2003

OBJECTIVE: To review the available literature on the use of intravenous calcium salts for the prevention of hypotension associated with intravenous verapamil. METHODS: A MEDLINE search (1966–June 1999) identified pertinent articles; references from these articles were identified to serve as additional resources. DISCUSSION: Verapamil is effective in inhibiting atrioventricular nodal conduction, thereby controlling ventricular rate in patients with atrial fibrillation/flutter and terminating paroxysmal supraventricular tachycardia. However, hypotension may be caused by the negative inotropic and vasodilating effects of verapamil. In vitro and animal data suggest that calcium pretreatment may minimize the effects of verapamil on cardiac output and blood pressure. Case reports suggest that intravenous calcium may be useful for both prevention and reversal of the hemodynamic effects of verapamil. A number of small clinical trials have been performed, suggesting that calcium administered prior to intravenous verapamil results in a decreased incidence of hypotension. The most common adverse effect of intravenous calcium is flushing. CONCLUSIONS: Calcium pretreatment prior to intravenous calcium-channel blocker administration should be considered in patients in whom further reductions in blood pressure may precipitate hypoperfusion or worsen underlying cardiovascular status. A dose of calcium gluconate 1 g (ionized calcium 90 mg) administered over three minutes is recommended for preventing or lessening the hypotensive effect of verapamil without affecting the antiarrhythmic effects of verapamil.
Tacrolimus: An Alternative for Graft-Versus-Host Disease Prevention
Authors: Lee Traci J , Kennedy LeAnne D 
Published: June 2003

OBJECTIVE: To evaluate the efficacy of tacrolimus for prevention of graft-versus-host disease (GVHD) in patients receiving allogeneic bone marrow transplants. DATA SOURCES: Published literature was identified through MEDLINE (January 1990–December 1998) using the key words tacrolimus, FK506, graft-versus-host disease, and bone marrow transplant. DATA SYNTHESIS: GVHD associated with allogeneic bone marrow transplant is a serious life-threatening complication. An evaluation of studies using tacrolimus for prevention of GVHD was conducted. CONCLUSIONS: Tacrolimus is effective for the prevention of GVHD in allogeneic bone marrow transplant. Further studies need to be conducted to optimize the dosage schedule and to determine therapeutic ranges, efficacy, and safety.
Fluorouracil-Induced Neurotoxicity
Authors: Pirzada Noor A , Ali Imran I , Dafer Rima M 
Published: June 2003

OBJECTIVE: To report a case of acute neurologic adverse effects related to fluorouracil administration and to review the neurotoxicity of this agent. CASE SUMMARY: A 73-year-old white man with a history of esophageal carcinoma was treated with fluorouracil 1500 mg iv daily for four days. After completing treatment, he presented with sudden onset of confusion, cognitive disturbances, a cerebellar syndrome, and repeated seizures. A magnetic resonance image of the brain showed no structural abnormalities, and cerebrospinal fluid examination was normal; none of the other laboratory tests provided an explanation for his symptoms. The patient was treated with anticonvulsants, and the cognitive changes resolved in 72 hours. The cerebellar signs, however, did not resolve completely and persisted when the patient was examined two weeks after discharge. DISCUSSION: Fluorouracil can cause both acute and delayed neurotoxicity. Acute neurotoxicity manifests as encephalopathy or as cerebellar syndrome; seizures, as seen in our patient, have rarely been reported. Acute neurotoxicity due to fluorouracil is dose related and generally self-limiting. Various mechanisms for such toxicity have been postulated, and treatment with thiamine has been recommended. Delayed neurotoxicity has been reported when fluorouracil was given in combination with levamisole; this form of subacute multifocal leukoencephalopathy is immune mediated and responds to treatment with corticosteroids. CONCLUSIONS: Clinicians should be aware of the adverse neurologic effects of fluorouracil and should include them in the differential diagnosis when patients receiving the drug present with neurologic problems.
Medicine Information Help Lines: A Survey of Hospital Pharmacy-Based Services in the UK and Their Conformity with Guidelines
Authors: Raynor David K , Sharp Jane A , Rattenbury Hazel , Towler Rory J 
Published: June 2003

OBJECTIVE: To describe the prevalence and nature of hospital pharmacy–based medicine help lines for consumers in the UK and to compare service provision with published guidelines. BACKGROUND: Since 1992, telephone help lines for patients have proliferated in hospital pharmacies in the UK. There is no common template for such services with variations in target group, number and type of calls, and arrangements for training and audit. Data on these factors will help guide further development of such services. METHODS: All medicine help lines operating from hospital pharmacies in the UK were identified through the national Drug Information Pharmacists network. They were sent a piloted questionnaire covering many aspects of help line operation, including funding, method of advertisement, procedures, target group, number and nature of calls, and audit procedures. RESULTS: Eighty-two help lines were identified in England, Scotland, Wales, and Northern Ireland. Completed responses were received from 69 help lines (84% response rate). The pharmacy drug information center was the help line site in 57% of hospitals; all other help lines were located in the dispensary. In 55% of cases, help lines were open only to patients of the hospital. In the remainder of help lines, calls from the public were answered (although the majority of help lines only advertised to hospital patients). Calls were answered by pharmacists only in 45% of services, and additional staff training had been provided in 43%. Only 48% of services had written procedures or guidelines for operation of the help line. Forty-six percent of the services received fewer than five calls per week, 31% received between five and 10 calls per week, and 22% received 11 or more calls per week. In 59% of the sites, calls took an average of 10 minutes or less to answer; it took 11–15 minutes in 32% of the sites and >15 minutes in 9% of the sites. The most common queries related to adverse effects, dosage and administration, and interactions (including alcohol). Only 33% of help lines had any auditing or monitoring of the service in place. CONCLUSIONS: The increasing use of the telephone to provide services directly to consumers is reflected in the growth of hospital-based medicine help lines in the UK. The telephone route is likely to become more important as patients' needs for information about their medicines increase. However, the rate of calls is low when compared with the number of patients issued prescriptions; further research is needed to investigate the reasons for this low response. There is currently reason for concern because most help lines lack not only professional training in telephone counseling, but also proper documentation, monitoring, and audit procedures.
Homocysteine as a Risk Factor for Atherosclerosis
Authors: Temple Mary E , Luzier Aileen B , Kazierad David J 
Published: June 2003

OBJECTIVE: To review the role of homocysteine as a risk factor in the pathogenesis of atherosclerosis and to provide recommendations for the treatment of hyperhomocysteinemia. DATA SOURCES: A MEDLINE search using key terms such as homocysteine, atherosclerosis, folic acid, vitamin B6, and vitamin B12 was conducted for the time period 1966 through January 1999. STUDY SELECTION: An article was selected for inclusion in this review if it assessed the relationship and proposed mechanisms of hyperhomocysteinemia on the vasculature, physiologic changes due to hyperhomocysteinemia, and outcomes due to hyperhomocysteinemia, such as morbidity and mortality. In addition, studies that assessed the treatment outcomes of hyperhomocysteinemia were evaluated. DATA SYNTHESIS: Studies of patients with cerebral vascular disease reveal elevated homocysteine concentrations in 30–40% of patients compared with controls. Many studies demonstrate a correlation between elevated homocysteine concentrations, risk of myocardial infarction, and mortality. In addition, hyperhomocysteinemia and decreased folic acid concentrations have been identified in end-stage renal disease (ESRD) and type 2 diabetic patients, while both concentrations remained normal in healthy controls. Studies using folic acid 650 μg/d reduced homocysteine concentrations to within normal therapeutic range after two weeks of treatment. Studies with vitamins B6 and B12 have demonstrated that the use of either alone is ineffective, but when combined or administered with folic acid, homocysteine concentrations return to normal. All therapies must be given for the lifetime of the patient. In addition, patients must use discretion in their diet, as common beverages, such as coffee, have a strong correlation with hyperhomocysteinemia, while foods high in folic acid, vitamin B6 and vitamin B12 may reduce homocysteine concentrations. Additional prospective studies are needed to determine effects of treatment of hyperhomocysteinemia and various diets on atherosclerotic morbidity and mortality. CONCLUSIONS: Studies demonstrate a positive correlation between hyperhomocysteinemia and atherosclerosis. The treatment of choice for hyperhomocysteinemia is folic acid. Although the optimal dose is not known, 650 μg/d is the minimum effective dose. To date, no studies have assessed the effects on morbidity and mortality when treating high homocysteine concentrations in atherosclerotic patients.
Systemic Adverse Effects of Ophthalmic β-Blockers
Authors: Zanden Jeanne A Vander , Valuck Robert J , Bunch Cheryl L , Perlman Jay I , Anderson Carolyn , Wortman George I 
Published: June 2003

OBJECTIVE: To review published clinical information on the systemic adverse effects of ophthalmic β-blockers for the purpose of developing a pilot contraindication/warning system for active prescriptions in the Veterans Affairs dispensing database. DATA SOURCES: Articles were identified by searching MEDLINE (1966–October 2000) and International Pharmaceutical Abstracts (1970–October 2000). STUDY SELECTION AND DATA EXTRACTION: Article relevance was determined by review of titles, abstracts, and key words. DATA SYNTHESIS: The preponderance of the evidence suggests that ophthalmic β-blockers may be associated with bronchospasm and adverse cardiovascular effects including bradycardia. Depression and other central nervous system effects are reported less commonly. Data are inadequate to suggest that ophthalmic β-blocker use is routinely associated with adverse metabolic effects. CONCLUSIONS: The strongest level of evidence (grade A1) supports a contraindication for use of ophthalmic β-blockers for respiratory disease, with a moderate level of evidence (grade B1) for cardiovascular disease. Data are insufficient to support or refute contraindications for other disease states. The search technique and classification scheme described in this article provide a methodology for evaluating, grading, and applying evidence on potential adverse effects of drug therapy.
Zuclopenthixol-Associated Neutropenia and Thrombocytopenia
Authors: Hirshberg Boaz , Gural Alexander , Caraco Yoseph 
Published: June 2003

OBJECTIVE: To report a case of neutropenia and thrombocytopenia secondary to use of zuclopenthixol in a schizophrenic patient. CASE SUMMARY: A 66-year-old white man with chronic schizophrenia was referred to the hospital due to neutropenia and thrombocytopenia that developed shortly after initiation of zuclopenthixol therapy. Prior to zuclopenthixol administration, his white blood cell and platelet counts were 8.5 times 109 cells/L3 and 305 cells x 109/L, respectively. Progressive reduction in leukocyte and platelet counts occurred, reaching a nadir of 2.9 times 109 cells/L3 (granulocytes 18.9%) and 109 cells x 109/L, respectively. Zuclopenthixol was discontinued on admission, resulting in complete recovery within the next five days. DISCUSSION: Neutropenia and thrombocytopenia are well-known complications of antipsychotic drug therapy. Zuclopenthixol, a well-established antipsychotic agent, has relatively few adverse effects. The rapid decrease of white blood cell and platelet counts following the initiation of zuclopenthixol, as well as the rapid recovery, implicate zuclopenthixol as the predominant cause for neutropenia and thrombocytopenia in this patient. CONCLUSIONS: Although neutropenia and thrombocytopenia are rare complications of zuclopenthixol therapy, monitoring blood counts in patients receiving this agent seems to be justified.
Hydroxyurea in the Treatment of HIV-1
Authors: Gibbs Matthew A , Sorensen Suellyn J 
Published: June 2003

OBJECTIVE: To describe the role of hydroxyurea in the treatment of HIV-1. DATA SOURCES: Published clinical studies using hydroxyurea in HIV treatment were accessed through MEDLINE (January 1994–March 1999) and conference abstracts. All relevant studies were evaluated. DATA SYNTHESIS: Adherence, expense, and resistance limit the pharmacotherapeutic options in the management of patients with HIV. Hydroxyurea may be an alternative to conventional HIV treatments. CONCLUSIONS: Several potential advantages of adding hydroxyurea to antiretroviral treatment regimens include the drug's well-documented toxicity, convenient dosing, good tolerability and low cost, and its unique mechanism of action. Hydroxyurea may have synergistic effects that prove promising in initial and salvage therapy antiretroviral regimens. Larger, well-controlled clinical studies are needed to adequately define the role of hydroxyurea in the treatment of HIV.
Sorbitol Compared with Xylitol in Prevention of Dental Caries
Authors: Gales Mark A , Nguyen To-Mai 
Published: June 2003

OBJECTIVE: To summarize published data on the comparative efficacy of sorbitol and xylitol for prevention of dental caries. DATA SOURCES: Published double-blind comparative trials, using sorbitol and xylitol products, identified by MEDLINE (January 1966–December 1998) and International Pharmaceutical Abstracts (January 1970–December 1998) searches. DATA SYNTHESIS: Clinical trials generally used sorbitol and xylitol gums, which patients chewed three to five times daily for 20–40 months. Xylitol was superior to sorbitol in two longer, secondary dentition trials (30–63% reductions), but not in two primary dentition trials. CONCLUSIONS: The data suggest that xylitol-containing gums may provide superior efficacy in reducing caries rates in high-risk populations.
Interaction between Warfarin and Danshen (Salvia Miltiorrhiza)
Authors: Chan Thomas YK 
Published: June 2003

OBJECTIVE: To discuss the potential for an adverse interaction between the Chinese herb danshen, the dry root and rhizome of Salvia miltiorrhizaBge, and warfarin. DATA SOURCES: A MEDLINE search was performed (from January 1966 through October 2000) using the key words danshen and Salvia miltiorrhiza. All articles written in English or with an English extract were considered for review. STUDY SELECTION AND DATA EXTRACTION: All studies of antithrombotic effects of danshen or interaction between danshen and warfarin were evaluated. Previous case reports of an adverse interaction between danshen and warfarin were reviewed. DATA SYNTHESIS: Danshen is commonly used in mainland China for the treatment of atherosclerosis-related disorders such as cardiovascular and cerebrovascular diseases. Danshen can affect hemostasis in several ways, including inhibition of platelet aggregation, interference with the extrinsic blood coagulation, antithrombin III—like activity, and promotion of fibrinolytic activity. Single-dose and steady-state studies in rats indicated that danshen increased the absorption rate constants, AUCs, maximum concentrations, and elimination half-lives, but decreased the clearances and apparent volume of distribution of both R- and S-warfarin. Consequently, the anticoagulant response to warfarin was exaggerated. Three cases have previously been published reporting gross overanticoagulation and bleeding complications when patients receiving chronic warfarin therapy also took danshen. CONCLUSIONS: Because of both pharmacokinetic and pharmacodynamic interactions, danshen should be avoided in patients taking warfarin.
Newer Antithrombotic Strategies in the Initial Management of Non–ST-Segment Elevation Acute Coronary Syndromes
Authors: Mathis A Scott 
Published: June 2003

OBJECTIVE: To review the place in therapy of currently available antithrombotic agents in the non–ST-segment elevation acute coronary syndromes, that is, unstable angina and non–Q-wave myocardial infarction (MI). Recommendations are made based on currently available data. DATA SOURCE: English-language clinical studies, position statements, and review articles pertaining to the management of unstable angina and non–Q-wave MI with currently available products. STUDY SELECTION: Selection of prospective clinical studies was limited to those focusing on the management of the non–ST-segment elevation acute coronary syndromes, unstable angina, and non–Q-wave MI. DATA SYNTHESIS: It has yet to be determined which combination of agents (dalteparin, enoxaparin, lepirudin, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban) and procedural strategies most significantly reduces mortality and serious events in these patients. The relevant pathophysiology, diagnostic criteria, and risk-stratifying procedures are reviewed in context with information from clinical studies regarding currently available agents for the management of non–ST-segment elevation acute coronary syndromes. CONCLUSIONS: A large number of new therapeutic classes and agents are available for the treatment of unstable angina and non–Q-wave MI. Although the diagnoses of unstable angina or non–Q-wave MI identify risk, treatment decisions are often based on the presence or absence of ST-segment elevations. Limited prospective evidence delineates the proper utilization of resources to best manage these patients. Efforts should be aimed at identifying particular patients who will best benefit from recently available therapies.
Relationship between Clinical and Biologic Variables and Chloramphenicol Pharmacokinetic Parameters in Pediatric Patients with Sepsis
Authors: Goytia Gustavo Lugo , Lares-Asseff Ismael , Guillé María Gabriela Pérez , Pérez Adrián Guillé , Mejía Cynthia Larios 
Published: June 2003

OBJECTIVE: To evaluate the influence of several clinical and biologic factors on the disposition kinetics of oral chloramphenicol in pediatric patients and to determine the usefulness of this information to predict chloramphenicol serum concentrations. STUDY DESIGN: The clinical, biologic, and pharmacokinetic data of 30 consecutive pediatric patients diagnosed with sepsis and admitted to a tertiary care center were analyzed retrospectively. The patients were randomly assigned to a study group and a validation group. The model was developed by a three-step approach involving Bayesian estimation of pharmacokinetic parameters, selection of covariates by principal component analysis, and final selection by stepwise multiple linear regression. The model was tested in the study group and compared with a general population model using a prediction error analysis. RESULTS: Regression analysis revealed that weight, albumin, and white blood cell (WBC) count were the most important determinants for chloramphenicol distribution volume, whereas age, WBC count, and serum creatinine were the most important determinants for chloramphenicol clearance. The performance of the constructed population model improved significantly in terms of both bias and precision compared with the general model when tested in the validation group. CONCLUSIONS: Clinical and biologic factors may significantly influence chloramphenicol's disposition in pediatric patients with sepsis and therefore should be considered in programming dosage regimens.
Aerosolized Furosemide in the Treatment of Acute Respiratory Distress and Possible Bronchopulmonary Dysplasia in Preterm Neonates
Authors: Pai Vinita B , Nahata Milap C 
Published: June 2003

OBJECTIVE: To review the efficacy and safety of inhaled furosemide in the treatment of acute respiratory distress and possible bronchopulmonary dysplasia (BPD) in preterm neonates receiving ventilator and oxygen support. DATA SOURCES: A MEDLINE search was performed from January 1966 to December 1998 using the key words inhaled or aerosolized furosemide, BPD, preterm, neonate, and infant newborn. STUDY SELECTION AND DATA EXTRACTION: All clinical trials involving the use of inhaled furosemide in ventilator- and oxygen-dependent preterm neonates with acute respiratory distress and possible BPD were evaluated. DATA SYNTHESIS: Inhaled furosemide 1 and 2 mg/kg has improved pulmonary function in preterm neonates without significant adverse effects. However, only a single dose of inhaled furosemide was used in these trials, and pulmonary functions were monitored for only two or four hours after administration. CONCLUSIONS: Inhaled furosemide may be effective, but studies are needed to determine the optimal dosage regimen and long-term risks and benefits of its use in these patients.