bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Delivery of Nebulized and Metered-Dose Inhalers in an in vitro Infant Ventilator Lung Model
Authors: Avent Minyon L , Gal Peter , Ransom J Laurence , Brown Yvonne L , Hansen Charles J , Ricketts William A , Soza Felicia 
Published: March 2004

OBJECTIVE: To evaluate drug delivery to the lungs of nebulized and metered-dose inhalers (MDIs) in an in vitro infant lung model. METHODS: An in vitro lung model was modified to study drug delivery. A 1000 mL intravenous bag filled with 500 mL deionized water was attached to a 3.5 mm (12 cm length) endotracheal tube. An inline Marquest Whisper Jet infant circuit nebulizer system delivered 2.5 mg/3 mL albuterol sulfate inhalation solution (Ventolin nebules) at a flow rate of 5 L/min. An Aerochamber (Monaghan) was placed at the endotracheal tube for the delivery of the MDIs. Albuterol MDI (Ventolin) 10 inhalations and beclomethasone MDI (Beclovent) 20 inhalations were delivered. A Servo 900C (Siemens-Elma) was used at the following ventilator settings: positive inspiratory pressure 30 cm H2O), intermittent mandatory ventilation 40 breaths/min, positive end expiratory pressure 4 cm H2O, inspiratory time 0.4 sec. Each formulation was run at least 10 times and assayed in duplicate by HPLC. An unpaired Student's t-test was used to analyze the statistical significance of the data. RESULTS: There was a significantly greater percentage of drug delivery with MDI albuterol (1.96 ± 0.50) as compared with nebulized albuterol (1.26 ± 0.37) (p = 0.002) or beclomethasone diproprionate (0.51 ± 0.24) (p = 0.001). CONCLUSIONS: Albuterol MDI provides a more efficient delivery of drug to the lung as compared with nebulized albuterol and MDI beclomethasone diproprionate.
Drug and Environmental Factors Associated with Adverse Pregnancy Outcomes Part III: Folic Acid: Pharmacology, Therapeutic Recommendations, and Economics
Authors: Lewis Dale P , Van Dyke Don C , Stumbo Phyllis J , Berg Mary J 
Published: March 2004

OBJECTIVE: To review folic acid's mechanism of action, adverse effects, therapeutic recommendations, compliance, and cost. DATA SOURCES: A MEDLINE search was conducted through December 1997. Additional sources were obtained from Current Contents and citations from the references obtained. Search terms included folate, folic acid, neural tube defect, homocysteine, and methylenetetrahydrofolate reductase. STUDY SELECTION: Animal and human studies examining the effects of folate were reviewed. DATA EXTRACTION: Data collected included mechanism of action, safety issues, dosing recommendations, compliance with recommendations, and economics. DATA SYNTHESIS: Folic acid decreases neural tube defect risk through an effect on methionine–homocysteine metabolism. In addition, increased folate intake may reduce cardiovascular morbidity and mortality. Since toxicity is minimal, everyone can potentially benefit from increased folate consumption. To help achieve this, the Food and Drug Administration has mandated that cereal grain be fortified with 140 μg of folic acid per 100 g of grain, which will add approximately 0.1 mg of folate to the average diet. Studies recommend supplementing with 0.2 mg to promote optimal homocysteine concentrations and for preventing neural tube defects. CONCLUSIONS: Despite fortification, most women will still receive less folate than the 0.4 mg/d recommended by the Public Health Service. All population groups would benefit from increased folate intake. Current studies indicate 200 μg/d may be the minimum effective amount of fortification needed for normalizing homocysteine concentrations and preventing a significant number of neural tube defects; thus, a higher level of food fortification may be warranted.
Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters
Authors: Thompson Robert L , Yau Jonathan C , Donnelly Ronald F , Gowan Debra J , Matzinger Frederick RK 
Published: March 2004

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1–20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan–Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.
Factors Associated with Preventability, Predictability, and Severity of Adverse Drug Reactions
Authors: Gholami Kheirollah , Shalviri Gloria 
Published: March 2004

OBJECTIVE: To determine the rate of adverse drug reactions (ADRs) in hospitalized patients in an Iranian hospital and to assess factors associated with preventability, predictability, and severity of ADRs. DESIGN AND PARTICIPANTS: A prospective, randomized study was conducted on 370 patients in a hospital at the Tehran Medical Sciences University, from March to December 1996. Patients who experienced at least one ADR (n = 62) were entered into the database. Preventability, predictability, and severity of reactions were determined, based on the available algorithms developed by other investigators. SETTING: A 1200-bed tertiary care university teaching hospital in Tehran, Iran. RESULTS: Approximately 16.8% (n = 62) of the 370 patients who were included in this study had at least one ADR. One hundred two ADRs were reported during this study. Approximately 58.8% of the ADRs (60 reactions) were identified as preventable reactions and 96.1% as predictable reactions. The severity of 9.8% of the ADRs was identified as mild, 86.3% as moderate, 1% as severe, and 2.9% as lethal. The length of hospitalization increased with the severity of the ADRs. Preventable ADRs were more severe than those that were nonpreventable. In addition, the incidence of preventable ADRs increased with the patients' age and caused longer hospitalization than did nonpreventable ones. The most predictable ADRs were hematologic. CONCLUSIONS: This study noted that the rate of ADRs in Iran is probably as high as the rate in other parts of the world. These results indicate a need for a strong national ADR program that detects and reports adverse drug events in Iran.
Successful Desensitization to Dapsone for Pneumocystis Carinii Prophylaxis in an HIV-Positive Patient
Authors: Cook Donna E , Kossey Joyce L 
Published: March 2004

OBJECTIVE: To report a case of successful desensitization to dapsone for Pneumocystis carinii pneumonia (PCP) prophylaxis in a patient unable to tolerate trimethoprim/sulfamethoxazole (TMP/SMX) desensitization or dapsone at standard doses. CASE SUMMARY: A 37-year-old HIV-positive African-American man was treated for pneumonia with TMP/SMX and then continued on the drug for PCP prophylaxis. After experiencing a pruritic maculopapular rash with TMP/SMX, both at standard doses and after attempting a desensitization regimen to the drug, he was started on dapsone for PCP prophylaxis. He experienced a rash and fever after taking dapsone at standard PCP prophylactic doses. At this time, an 18-day oral dapsone rechallenge by dose escalation was attempted, and it was well tolerated. CONCLUSIONS: This case suggests that utilization of a dapsone desensitization regimen may permit a viable treatment option in patients previously thought to be intolerant to the agent. More regimens of this type should be attempted and the results published, using both dapsone and TMP/SMX, so that standard desensitization treatment guidelines may eventually be adopted.
Concomitant Rash and Blood Dyscrasias in Geriatric Psychiatry Patients Treated with Carbamazepine
Authors: Cates Marshall , Powers Richard 
Published: March 2004

BACKGROUND: Rashes and blood dyscrasias are disconcerting adverse effects associated with carbamazepine therapy. Rashes are quite common, as are mild blood dyscrasias, such as mild leukopenias. Fortunately, severe rashes and blood dyscrasias are rare. There are few reports on the relationship between carbamazepine-induced rashes and blood dyscrasias, including a prospective study in which rash appeared concomitantly with leukopenia and/or thrombocytopenia in 10 patients, two case reports in which simultaneous rash and agranulocytosis occurred, and two case reports in which rashes served as harbingers of fatal aplastic anemia. CASE REPORTS: We report two cases of concomitant rashes and blood dyscrasias in geriatric psychiatry patients receiving carbamazepine therapy for bipolar disorder. One patient was found to have a severe leukopenia within several days after rash onset. The other patient was discovered to have a severe leukopenia and thrombocytopenia within about a month after rash onset. DISCUSSION: Current hematologic monitoring guidelines for carbamazepine rely heavily on the recognition of signs and symptoms of blood dyscrasias by clinicians and patients. We believe that our cases support the suggestion that patients who develop rashes receive more vigilant monitoring of the complete blood count, should carbamazepine therapy be continued. Given the currently available case reports and the fact that the incidence of drug-induced blood dyscrasias increases with advanced age, this recommendation may be particularly relevant for geriatric patients. CONCLUSIONS: Further study is required to establish whether carbamazepine-induced concomitant rashes and blood dyscrasias are valid associations insofar as monitoring is concerned.
Vancomycin-Induced Acute Interstitial Nephritis
Authors: Wai Amy O , Lo Agnes MS , Abdo Ayman , Marra Fawziah 
Published: March 2004

OBJECTIVE: To report a case of acute interstitial nephritis (AIN) related to administration of vancomycin for the treatment of Staphylococcus aureus sternal wound infection, osteomyelitis, and infective endocarditis. CASE SUMMARY: Reports in the literature regarding vancomycin-induced AIN are scarce. We describe the fifth known case of AIN, in a 64-year-old white man who developed fever, maculopapular rash, acute renal failure, eosinophilia, and eosinophiluria after approximately 1 month of vancomycin treatment. The results of the renal biopsy were consistent with an allergic drug reaction. Four months after his initial episode of AIN, the patient was rechallenged with vancomycin for the treatment of S. aureus septic arthritis. One day after initiation of vancomycin, serum eosinophils started to rise, his urine tested positive for eosinophils, but his serum creatinine remained stable. CONCLUSIONS: Our case report and others from the literature suggest vancomycin causes allergic AIN. Clinicians should be aware of this adverse effect in an era of increasing use of vancomycin for treatment of resistant gram-positive organisms.
Iritis Associated with Intravenous Cidofovir
Authors: Tseng Alice L , Mortimer Clive B , Salit Irving E 
Published: March 2004

OBJECTIVE: To report two patients with AIDS and cytomegalovirus retinitis who developed iritis after receiving intravenous cidofovir. Both experienced recurrent symptoms upon rechallenge. CASE SUMMARIES: Two HIV-positive patients with cytomegalovirus retinitis infections previously controlled with intravenous ganciclovir or foscarnet were treated with intravenous cidofovir. Symptoms of iritis developed after the second or third dose of cidofovir. One patient experienced symptoms unilaterally, while the other patient had bilateral symptoms. In both patients, the iritis resolved with topical ophthalmic therapy, but recurred following subsequent infusions of cidofovir. Therapy with cidofovir was discontinued, and no further recurrences of iritis were noted. One patient had post-inflammatory fixed dilated pupils. CONCLUSIONS: Iritis can uncommonly occur in patients receiving intravenous cidofovir and oral probenecid. With prompt drug discontinuation and administration of topical corticosteroids and/or mydriatic agents, symptoms are usually reversible.
Trovafloxacin: A New Fluoroquinolone
Authors: Alghasham Abdullah A , Nahata Milap C 
Published: March 2004

OBJECTIVE: To review the pharmacology, antimicrobial activity, pharmacokinetics, clinical efficacy, and safety of trovafloxacin. DATA SOURCES: A MEDLINE search (January 1966–April 1998) was conducted for relevant literature using the terms CP-99,219, CP-116,519, trovafloxacin, and alatrofloxacin. Abstracts published by the American Society of Microbiology during 1995–1997 meetings were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All in vitro, animal, and human studies were reviewed for the antimicrobial activity, pharmacokinetics, efficacy, and safety of trovafloxacin. DATA SYNTHESIS: Trovafloxacin is a new fluoroquinolone with enhanced activity against gram-positive and anaerobic microorganisms. The oral bioavailability under fasting conditions is approximately 88%. The elimination half-life of trovafloxacin is approximately 10 hours. Less than 10% of trovafloxacin is eliminated unchanged in the urine. Trovafloxacin is effective in the treatment of community-acquired pneumonia and nosocomial pneumonia with cure rates of >90% and 77%, respectively. Trovafloxacin is comparable with ceftriaxone in the treatment of meningococcal meningitis in children; each produces a cure rate of ∼90%. In treatment of uncomplicated urinary tract infection, both ciprofloxacin and trovafloxacin achieve an eradication rate of ≥93%. Trovafloxacin is similar to ofloxacin in the treatment of urogenital Chlamydia trachomatis and acute exacerbations of chronic bronchitis, with clinical success in 97% of patients with each drug. The common adverse effects of trovafloxacin include dizziness, headache, and gastrointestinal intolerance. CONCLUSIONS: The advantages of once-daily dosing and enhanced activity of trovafloxacin against gram-positive and anaerobic organisms may expand its use over available fluoroquinolones. Further studies are needed to define its role in the treatment of various infectious diseases.
Relative Bioavailability of Atovaquone Suspension When Administered with an Enteral Nutrition Supplement
Authors: Freeman Collin D , Klutman Neil E , Lamp Kenneth C , Dall Lawrence H , Strayer Andrew H 
Published: March 2004

OBJECTIVE: To compare the relative bioavailability of a single atovaquone 750 mg suspension oral dose when administered in the fasting state, after a normal breakfast, and after an enteral nutrition supplement. DESIGN: Ten healthy volunteers received a single dose of atovaquone suspension 750 mg/5 mL while fasting. At 2-week intervals, the subjects were then randomized in a crossover design to receive the atovaquone dose within 1 hour of consuming a normal breakfast (fat content 21 g) and 16 oz. of Sustacal Plus (fat content 28 g). Blood samples were collected at seven time points after each atovaquone dose. HPLC was used to determine the atovaquone concentrations in plasma. RESULTS: Administering atovaquone suspension with either a normal breakfast or an enteral nutrition supplement, such as Sustacal Plus, significantly increased the oral relative bioavailability. The mean AUC0–24 after the fasting dose was 43.4 μg · h/mL. The mean AUC0–24 values with breakfast (103.8 μg · h/mL) and Sustacal Plus (118.8 μg · h/mL) were significantly greater compared with fasting (p < 0.0001). CONCLUSIONS: This study has shown that the new atovaquone oral suspension also has significantly greater bioavailability when administered after food or a nutrition supplement that has a moderate fat content. Patients who require atovaquone therapy can use Sustacal Plus without risk of reduced absorption.
Domperidone: A Peripherally Acting Dopamine2-Receptor Antagonist
Authors: Barone Joseph A 
Published: March 2004

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of domperidone in the treatment of gastrointestinal motility disorders and emesis. DATA SOURCES: MEDLINE and Excerpta Medica online databases were searched to identify published reports. STUDY SELECTION: Domperidone has been marketed worldwide outside the US since 1978, and extensive clinical data for this drug are available. This review focuses on the clinical experience from controlled studies of domperidone in the treatment of motility disorders, particularly diabetic gastroparesis. Also, case reports are used in summarizing safety. The control comparator groups included placebo or other prokinetic drugs (metoclopramide and cisapride). Controlled clinical trials of domperidone's efficacy and safety as an antiemetic are also briefly examined. Although a variety of domperidone dosage forms have been marketed, data generated from trials using the 10-mg tablet are highlighted because this is the only dosage form available in Canada and is under investigation in the US. DATA EXTRACTION: Because symptoms do not correlate with objective measures of gastrointestinal motility and they are the primary reason that patients with motility disorders seek treatment, the primary outcome extracted from the clinical studies was symptomatic response to treatment. Safety and efficacy between domperidone and placebo, metoclopramide, or cisapride were compared. DATA SYNTHESIS: Domperidone, a peripheral dopamine2-receptor antagonist, regulates the motility of gastric and small intestinal smooth muscle and has been shown to have some effects on the motor function of the esophagus. It also has antiemetic activity as a result of blockade of dopamine receptors in the chemoreceptor trigger zone. In controlled clinical trials, domperidone provided better relief of symptoms (anorexia, nausea, vomiting, abdominal pain, early satiety, bloating, distension) than placebo in patients with symptoms of diabetic gastropathy; symptomatic improvement was similar with domperidone and metoclopramide or cisapride. Domperidone also provided short-term relief of symptoms in patients with dyspepsia or gastroesophageal reflux, prevented nausea and vomiting associated with emetogenic chemotherapy, and prevented the gastrointestinal and emetic adverse effects of antiparkinsonian drugs. Because very little domperidone crosses the blood–brain barrier, reports of central nervous system adverse effects, such as dystonic reactions, are rare. CONCLUSIONS: Domperidone is a unique gastrokinetic and antiemetic drug. Because of its favorable safety profile, domperidone appears to be an attractive alternative to metoclopramide. In the management of diabetic gastropathy, domperidone's antiemetic activity distinguishes it from cisapride.
Respiratory Failure following Oral Administration of Metoclopramide
Authors: MacLaren Robert , Shields Catherine A 
Published: March 2004

OBJECTIVE: To report a case of respiratory failure, possibly due to anaphylaxis or asthma exacerbation, following the administration of metoclopramide. CASE SUMMARY: A 32-year-old white woman with a history of severe asthma and short-bowel syndrome was admitted for Hickman catheter line sepsis. Two doses of oral metoclopramide 10 mg in solution were administered for nausea and vomiting. Transient dyspnea followed the first dose of metoclopramide, but respiratory failure requiring intubation followed the second dose. DISCUSSION: Respiratory failure has been reported with metoclopramide-induced movement disorders. Three other cases of respiratory failure from anaphylaxis or asthma exacerbation following metoclopramide administration have been reported. Respiratory failure in our patient may be due to anaphylaxis or bronchoconstriction from metoclopramide-induced cholinergic activity of the vagus nerve, possibly through inhibition of acetylcholinesterase. CONCLUSIONS: The use of metoclopramide in patients with pulmonary dysfunction may warrant caution.
Toxicity Management in Patients Receiving Low-Dose Aldesleukin Therapy
Authors: Sundin David J , Wolin Maurice J 
Published: March 2004

OBJECTIVE: To review the pathophysiology and subsequent treatment options for low-dose aldesleukin-induced toxicity when administered via intravenous bolus infusion, continuous intravenous infusion, or subcutaneous injection. BACKGROUND: The adverse events associated with high-dose aldesleukin therapy (600 000 IU per kg iv every 8 h for a maximum of 14 doses) are well documented in the literature; however, the adverse event profile of lower doses and alternative administration routes are less well described. An understanding of the adverse event profile associated with these alternative regimens can enhance management of toxicity. DATA SOURCES: English-language clinical studies, abstracts, and review articles pertaining to low-dose intravenous, continuous intravenous infusion, or subcutaneous injection of aldesleukin, as well as aldesleukin-induced adverse events. STUDY SELECTION AND DATA EXTRACTION: Relevant studies were selected that assist with understanding the pathophysiology, clinical management, diagnosis, and management of aldesleukin-induced adverse events. CONCLUSIONS: Aldesleukin therapy initiates a cytokine-mediated proinflammatory process resulting in a toxicity profile that is different from traditional nonbiologic chemotherapeutic agents. The frequency and severity of adverse events associated with aldesleukin administration are dependent upon dose, route, and administration schedule. In addition, most adverse reactions are self-limiting. Alleviation of aldesleukin-induced adverse effects can usually be achieved on an outpatient basis with agents such as antiemetics, antipyretics, and topical creams or lotions, as well as nonmedication interventions. Aggressive and proactive management of aldesleukin associated toxicities can help facilitate completion of therapy.
High Anion Gap Metabolic Acidosis Associated with Aminocaproic Acid
Authors: Budris William A , Roxe David M , Duvel James M 
Published: March 2004

OBJECTIVE: To report a case of high anion gap metabolic acidosis related to infusion of aminocaproic acid (ACA) that temporarily corrected during hemodialysis and resolved upon ACA discontinuation. CASE SUMMARY: A 65-year-old white woman with staphylococcal sepsis complicated by acute renal failure was treated with ACA to control a hemorrhagic coagulopathy. After receiving an initial 5-g bolus of ACA, she received a continuous intravenous infusion of 500 mg/h for just over 5 days, then 250 mg/h for a final 12 hours. Immediately after beginning ACA therapy, she developed a severe anion gap metabolic acidosis that briefly improved after hemodialysis. The condition resolved completely only after the discontinuation of ACA and therapy with a systemic alkalinizer. DISCUSSION: ACA is not among the previously identified causes of high anion gap metabolic acidosis. The temporal profile relating anion gap to ACA initiation, hemodialysis treatment, and ACA discontinuation supports causality in this case. The magnitude of increase in the anion gap appears to have been proportional to the dose of ACA. CONCLUSIONS: In patients with renal impairment, ACA administration may produce a dose-related, high anion gap metabolic acidosis that might be reversible during hemodialysis. Insufficient data are available, but when ACA must be used in such patients, a more conservative dosing of ACA should be coupled with close monitoring.