bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Glargine: A New Basal Insulin
Authors: Levien Terri L , Baker Danial E , White John R , Campbell R Keith 
Published: June 2003

OBJECTIVE: To review the pharmacology, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy of insulin glargine. DATA SOURCES: Primary and review articles regarding insulin glargine were identified by MEDLINE search (1966–July 2001); abstracts were identified through Institute for Scientific Information Web of Science (1995–July 2001) and the American Diabetes Association. Additional information was obtained from the insulin glargine product information. STUDY SELECTION AND DATA EXTRACTION: All of the articles and meeting abstracts identified from the data sources were evaluated, and all information deemed relevant was included in this review. Priority was placed on data from the primary medical literature. DATA SYNTHESIS: Insulin glargine is a long-acting, recombinant human insulin analog that is given once daily as a basal source of insulin in patients with type 1 or type 2 diabetes mellitus. Modification of the basic insulin structure has produced a new insulin that is soluble at an acidic pH, but precipitates in the subcutaneous tissue and is slowly released from a depot. Insulin glargine has a slower onset of action than NPH insulin and a longer duration of action with no peak activity. Once-daily administration of insulin glargine has comparable efficacy to that of NPH insulin administered once or twice daily in basal-bolus regimens when used in combination with intermittent doses of regular insulin or insulin lispro in patients with type 1 and type 2 diabetes, and in conjunction with oral antidiabetic agents in patients with type 2 diabetes. Overall, insulin glargine has an incidence of hypoglycemia comparable to or less than that of NPH insulin, with a reduced incidence of nocturnal hypoglycemia compared with NPH insulin seen in some studies. CONCLUSIONS: Insulin glargine is a long-acting insulin analog capable of providing 24-hour basal insulin coverage when administered once daily at bedtime. Its activity profile, which lacks a pronounced peak, more closely resembles that of endogenous basal insulin than that of other intermediate- or long-acting insulins and appears more likely to be associated with a reduced incidence of hypoglycemia, particularly nocturnal hypoglycemia. Insulin glargine physiologically provides basal insulin but, for most patients, the addition of a rapid-acting insulin, like insulin lispro, before or with meals will need to be included in the treatment regimen to achieve optimal management of blood glucose concentrations.
Severe Serotonin Syndrome Induced by Mirtazapine Monotherapy
Authors: Hernández José L , Ramos Francisco J , Infante Jon , Rebollo Mariano , González-Macías Jesús 
Published: June 2003

OBJECTIVE: To document a case of serotonin syndrome (SS) associated with mirtazapine monotherapy, review the previously reported cases of SS associated with this tetracyclic antidepressant, and discuss the possible pathogenic mechanisms leading to this serious adverse drug reaction. CASE SUMMARY: A 75-year-old man developed agitation, confusion, incoordination, and gait disturbance because of progressive rigidity. Mirtazapine had been started 8 days earlier to control major depression. Physical examination revealed diaphoresis, low-grade fever, hypertension, tachycardia, bilateral cogwheel rigidity, hyperreflexia, tremor, and myoclonus, symptoms and signs that are consistent with severe SS. DISCUSSION: A review of the cases of SS with implication of mirtazapine as the cause was performed. The possible pathogenic mechanisms leading to this adverse reaction in this patient are also discussed, and pathophysiologic hypotheses are formulated. CONCLUSIONS: Although mirtazapine offers clinicians a combination of strong efficacy and good safety, we suggest bearing SS in mind when prescribing this drug, especially in frail, elderly patients with underlying chronic conditions. In these patients, it might be more adequate to start mirtazapine therapy at a lower dose (<15 mg/d).
Lansoprazole-Induced Thrombocytopenia
Authors: Zlabek Jonathan A , Anderson Christopher G 
Published: June 2003

OBJECTIVE: To describe a case of thrombocytopenia associated with the administration of lansoprazole. CASE SUMMARY: An 85-year-old white man presented with an upper gastrointestinal hemorrhage from a gastric ulcer. His platelet count was normal on admission. He was started on oral lansoprazole 60 mg twice daily and, on hospital day 2, his platelet count decreased to 102 × 103/mm3; on hospital day 3, the platelet count was 36 × 103/mm3. Lansoprazole was discontinued, and the platelet count returned to normal. He has not had any further episodes of thrombocytopenia to date. DISCUSSION: After exclusion of other causes, the onset of thrombocytopenia after administration of lansoprazole, the resolution of the adverse reaction after discontinuation of the drug, and the fact that no other medicines were introduced during this time frame lead us to believe that this was most likely an idiosyncratic thrombocytopenic response to lansoprazole. To date, this is the first reported case of what appears to be isolated thrombocytopenia associated with lansoprazole. CONCLUSIONS: Clinicians should be aware of the possible association of thrombocytopenia with lansoprazole and discontinue the drug if thrombocytopenia becomes apparent.
Hepatitis B Vaccination Safety
Authors: Geier Mark R , Geier David A 
Published: June 2003

BACKGROUND: Recent studies have suggested that adult hepatitis B vaccination may be associated with adverse reactions. OBJECTIVE: To further examine the relative risk, percentage association, and statistical significance of arthritic, immunologic, and gastrointestinal adverse reactions reported after adult hepatitis B vaccination compared with control vaccines. DESIGN: The Vaccine Adverse Events Reporting System (VAERS) database was analyzed for the incidence of adverse reactions after adult hepatitis B immunization compared with the incidence of adverse reactions reported to VAERS about vaccine control groups. SETTING: The medical and scientific communities have generally accepted that hepatitis B vaccine, a highly purified, genetically engineered single-antigen vaccine, is a safe vaccine. METHODS: The VAERS database was analyzed from 1997 to 2000 for adverse reactions associated with adult hepatitis B vaccination and from 1991 to 2000 for adverse reactions reported about vaccine control groups. RESULTS: The results showed a statistically significant increase in the incidence of adverse reactions reported after adult hepatitis B vaccination when compared with the incidence of adverse reactions reported to VAERS about control vaccines. CONCLUSIONS: Patients and physicians need to be fully informed of the potential adverse reactions associated with hepatitis B vaccination so that together they can make an informed consent decision about the risk versus the benefit. Patients who may have had an associated adverse reaction to hepatitis B vaccine should be made aware that they may be eligible for compensation from the no-fault Vaccine Compensation Act, administered by the US Court of Claims. TRASFONDO: Estudios recientes sugieren que la vacunación para hepatitis B en adultos podría estar asociada con reacciones adversas.
Lipid-Lowering Drug Use and Cardiovascular Events after Myocardial Infarction
Authors: Klungel Olaf H , Heckbert Susan R , de Boer Anthonius , Leufkens Hubert GM , Sullivan Sean D , Fishman Paul A , Veenstra David L , Psaty Bruce M 
Published: June 2003

BACKGROUND: The benefits of lipid-lowering drug treatment for the secondary prevention of coronary heart disease have been well established by randomized, controlled trials. Nonetheless, the risk of events has not been compared directly for inhibitors of hydroxymethylglutaryl coenzyme A reductase (statins) and non-statin lipid-lowering drugs. Further, it remains uncertain whether patients in usual practice who are treated with lipid-lowering drugs after myocardial infarction (MI) gain a similar benefit with regard to the risk of cardiovascular events compared with patients in randomized, controlled trials. OBJECTIVE: To assess the association between lipid-lowering drug therapies in usual clinical practice and the risk of cardiovascular events in patients with a first MI who were discharged alive from the hospital. METHODS: An inception-cohort study was performed among 1956 enrollees of Group Health Cooperative who sustained an incident MI between July 1986 and December 1996 and survived for at least 6 months after hospitalization. Subjects with untreated low-density-lipoprotein cholesterol concentrations >130 mg/dL or untreated total cholesterol concentrations >200 mg/dL were included. The median duration of follow-up after the first MI was 3.3 years. Medical record review was used to collect information on cardiovascular risk factors. Computerized pharmacy records were used to assess antihyperlipidemic drug use during the first 6 months after hospitalization. RESULTS: Compared with 1263 subjects who did not receive lipid-lowering drug treatment, 373 subjects who received statins had a lower risk of recurrent coronary events (relative risk [RR] 0.59; 95% CI 0.39 to 0.89), stroke (RR 0.82; 95% CI 0.35 to 1.95), atherosclerotic cardiovascular mortality (RR 0.49; 95% CI 0.21 to 1.13), and any atherosclerotic cardiovascular event (RR 0.63; 95% CI 0.40 to 0.98). Among 320 subjects who used non-statin drug therapies, the RRs were 0.66 (95% CI 0.45 to 0.97) for recurrent coronary events, 0.95 (95% CI 0.46 to 1.95) for stroke, 0.68 (95% CI 0.35 to 1.32) for cardiovascular mortality, and 0.77 (95% CI 0.53 to 1.11) for any atherosclerotic cardiovascular event, compared with untreated hyperlipidemic patients. CONCLUSIONS: In this study of MI survivors, the use of lipid-lowering drug therapies after hospitalization was associated with a reduced risk of cardiovascular events. These results emphasize the importance of lipid-lowering drug treatment in patients with hyperlipidemia who survive a first MI.
The Economic Burden of Barrett's Esophagus in a Medicaid Population
Authors: Amonkar Mayur M , Kalsekar Iftekhar D , Boyer J Gregory 
Published: June 2003

OBJECTIVE: To estimate the overall healthcare expenditures of patients with Barrett's esophagus in the West Virginia Medicaid population. METHODS: West Virginia Medicaid—paid claims data for the period January 1, 1995, to December 31, 1999, were used for the study. The population included all individuals eligible for West Virginia Medicaid during the study period except for Medicare eligible– And Medicaid managed—care recipients. A prevalence-based approach was used to determine the cost of illness for Barrett's esophagus. RESULTS: The total cost of illness for Barrett's esophagus more than tripled, from $182 399 in 1995 to $623 864 in 1999, with approximately a 4 1/2-fold increase in medical and more than a threefold increase in pharmacy costs. The average cost of treating Barrett's esophagus was found to be approximately $1207 per patient in 1999. Overall, pharmacy costs accounted for >66% of the total costs. Controlling for age, gender, and number of comorbidities, patients with Barrett's esophagus incur 21.2% higher overall costs than patients with gastroesophageal reflux disease and 62.4% higher overall costs than the general Medicaid population. CONCLUSIONS: The increasing prevalence of and resource utilization for Barrett's esophagus provide a framework for further analysis and implementation of policies aimed at appropriate allocation of resources for the state's Medicaid program.
Evidence for the Cardioprotective Effects of Omega-3 Fatty Acids
Authors: Carroll Douglas N , Roth Mary T 
Published: June 2003

OBJECTIVE: To review available literature regarding the cardiovascular effects of marine-derived ω-3 fatty acids and evaluate the benefit of these fatty acids in the prevention of coronary heart disease. DATA SOURCES: Biomedical literature accessed through a MEDLINE search (1966–April 2002). Search terms included fish oil, omega-3 fatty acid, sudden death, hypertriglyceridemia, myocardial infarction, and mortality. DATA SYNTHESIS: Following an early 1970's observational investigation that ω-3 fatty acids may reduce the occurrence of myocardial infarction—related deaths in Greenland Eskimos, additional trials have been conducted that support this finding. Epidemiologic and clinical trial data suggest that ω-3 fatty acids may reduce the risk of cardiovascular-related death by 29–52%. In addition, the risk of sudden cardiac death was found to be reduced by 45–81%. Possible mechanisms for these beneficial effects include antiarrhythmic properties, improved endothelial function, antiinflammatory action, and reductions in serum triglyceride concentrations. ω-3 Fatty acids are fairly well tolerated; potential adverse effects include bloating and gastrointestinal distress, “fishy taste” in the mouth, hyperglycemia, increased risk of bleeding, and a slight increase in low-density-lipoprotein cholesterol. CONCLUSIONS: ω-3 Fatty acids may be beneficial and should be considered in patients with documented coronary heart disease. They may be particularly beneficial for patients with risk factors for sudden cardiac death.
Clinical Outcomes of Ambulatory Acute Exacerbations of Chronic Bronchitis with Older versus Newer Antimicrobials
Authors: Madaras-Kelly Karl J , Magdanz Stephanie B , Johnson Christopher K , Jue Sandra G 
Published: June 2003

OBJECTIVE: To determine whether the cure rate was similar between traditional and newer antibiotics in the treatment of acute exacerbations of chronic bronchitis (AECB), to determine whether antibiotic selection during the first AECB of the season influences the frequency of subsequent AECB, and to identify variables associated with poor short- and long-term treatment outcome. METHODS: A retrospective analysis of subjects seen for management of their first seasonal AECB was conducted. Subjects were stratified into traditional therapies (n = 95) or newer therapies (n = 101) by antibiotic prescription. RESULTS: There was no difference in initial cure rates between older versus newer antibiotics (93% vs. 95%; p = 0.48). There was no difference in the number of subjects that remained AECB-free for 6 months after initial treatment with older versus newer antibiotic regimens (34% vs. 28%; p = 0.37). Oxygen initiation or increased dose (OR 10.9; 95% CI 1.4 to 84.2; p = 0.02) was the only variable independently associated with lack of AECB resolution. Nonsmoking status trended toward an association with remaining AECB-free at 180 days (OR 0.39; 95% CI 0.15 to 1.01; p = 0.053). CONCLUSIONS: The use of older versus newer antibiotics did not independently predict short-term outcome or future AECB.
Assessment of an Online Consumer “Ask Your Pharmacist” Service
Authors: Assemi Mitra , Torres Nina M , Tsourounis Candy , Kroon Lisa A , McCart Gary M 
Published: June 2003

OBJECTIVE: To describe consumer demographics and the types of questions submitted to an online Ask Your Pharmacist (AYP) drug information service. METHODS: This is a retrospective review of a sample of consecutive queries submitted online to an AYP service between 1999 and 2000. All data were coded, transcribed, and evaluated in a Microsoft Excel spreadsheet. Data regarding gender, age, patient relationship to consumer, allergies, medical conditions, products, and question types were evaluated. RESULTS: One thousand eighty-seven queries involving drug information or health-related questions were evaluated: 65% of the queries were from consumers requesting information for themselves; 55.2% of queries originated from women; 61% of consumers were between 19 and 55 years of age. The 5 most listed medical conditions were depression-related, hypertension, allergies, pain, and infectious disease. More than 60% of the questions involved prescription or over-the-counter (OTC) medications; another 10% targeted herbal products or dietary supplements. Consumers were most interested in drug efficacy, safety, and drug interactions. CONCLUSIONS: An AYP online service is a relatively new, unique way for consumers to receive medication information. Consumers of all ages use AYP services for both acute and chronic conditions. Most consumers asked questions related to their own health or medications. Consumers were more likely to ask questions related to prescription and OTC medications than to botanical and dietary supplements. Consumers were primarily interested in drug efficacy and adverse effects.
Propofol Infusion Syndrome in Critically Ill Patients
Authors: Kang Tep M 
Published: June 2003

OBJECTIVE: To describe the clinical presentation of propofol infusion syndrome in critically ill adults. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966 — March 2001). Key search terms included Diprivan, propofol, and propofol infusion syndrome. Case reports and small case series evaluating the use and toxicity of propofol in sedating critically ill adults were reviewed. DATA SYNTHESIS: The association between propofol infusion syndrome and death in children secondary to myocardial failure is well documented. However, few data are available regarding the syndrome in critically ill adults. Based on a review of those data, it appears that propofol infusion syndrome can occur in both children and adults. Common clinical features of propofol infusion syndrome may include hyperkalemia, hepatomegaly, lipemia, metabolic acidosis, myocardial failure, and rhabdomyolysis. Although the premise has not been proven, recent published cases appear to demonstrate an association between propofol infusion and death secondary to myocardial failure. CONCLUSIONS: Until further safety data become available, caution should be exercised when using high-dose (>5 mg/kg/h) and long-term (>48 h) propofol infusion in sedating critically ill adults.
Recombinant Human Erythropoietin Use in Intensive Care
Authors: Darveau Martin , Notebaert Éric , Denault André Y , Bélisle Sylvain 
Published: June 2003

OBJECTIVE: To review the literature concerning the role of recombinant human erythropoietin (rHuEPO) in reducing the need for transfusion in critically ill patients. DATA SOURCES: Articles were obtained through searches of the MEDLINE database (from 1990 to June 2001) using the key words erythropoietin, epoetin alfa, anemia, reticulocytes, hemoglobin, critical care, intensive care, critical illness, and blood transfusion. Additional references were found in the bibliographies of the articles cited. The Cochrane library was also consulted. STUDY SELECTION AND DATA EXTRACTION: Controlled, prospective, and randomized studies on the use of rHuEPO in critically ill adults were selected. DATA SYNTHESIS: Anemia is a common complication in patients requiring intensive care. It is caused, in part, by abnormally low concentrations of endogenous erythropoietin and is mainly seen in patients with sepsis and multiple organ dysfunction syndrome, in whom inflammation mediator concentrations are often elevated. High doses of rHuEPO produce a rapid response in these patients, despite elevated cytokine concentrations. There have been 3 studies on rHuEPO administration in intensive care and 1 trial in acutely burned patients. Only 2 of these studies looked at the impact of rHuEPO administration on the need for transfusion. CONCLUSIONS: Few randomized, controlled trials explore the role of rHuEPO in critical care. Only 1 was a large, randomized clinical trial, but it presents many limitations. Future outcome and safety studies comparing rHuEPO with placebo must include clinical endpoints such as end-organ morbidity, mortality, transfusion criteria, and pharmacoeconomic analysis. rHuEPO appears to provide an erythropoietic response. Optimal dosage and the real impact of rHuEPO on the need for transfusion in intensive care remain to be determined. Currently, based on the evidence available from the literature, rHuEPO cannot be recommended to reduce the need for red blood cell transfusions in anemic, critically ill patients.
Antihypertensive Medication Compliance in a Veterans Affairs Healthcare System
Authors: Wannemacher Amy J , Schepers Gregory P , Townsend Kevin A 
Published: June 2003

OBJECTIVE: To compare compliance rates associated with categories of antihypertensive medications in a Veteran's Affairs (VA) Healthcare System by use of readily available data and standard software. METHODS: Prescriptions from the Veteran's Health Information System Technology Architecture (VISTA) database for angiotension-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), β-blockers, calcium-channel blockers (CCBs), diuretics, and a miscellaneous group of antihypertensives filled or refilled during a 12-month period were included in the analysis. Claims data for each prescription were exported from the VISTA database to Microsoft Excel, and compliance rates were calculated by use of a methodology reported elsewhere. Mean compliance rates for each antihypertensive category were compared. RESULTS: A total of 26 201 prescription records accounting for 51 927 separate prescription fills or refills were included. The majority of prescriptions (77%) were associated with calculated compliance rates >80%. The CCB category was associated with a significantly higher compliance rate (p < 0.001) than the β-blockers (95% CI 1.3% to 3.7%), diuretics (95% CI 1.4% to 3.8%), and miscellaneous agents (95% CI 1.7% to 7.5%). The ACE inhibitor category was associated with a significantly higher rate (p < 0.001) than the β-blockers (95% CI 0.7% to 3.0%), diuretics (95% CI 0.7% to 3.0%), and miscellaneous agents (95% CI 1.1% to 6.8%). The ARB category had a higher compliance rate (p < 0.001) than the miscellaneous category (95% CI 1.2% to 11.9%). There were no significant differences in compliance rates among ACE inhibitors, CCBs, or ARBs. CONCLUSIONS: VA outpatients are relatively compliant when taking their antihypertensive medications as measured by prescription refill rates. Compliance rates for CCBs and ACE inhibitors are higher than those for β-blockers, diuretics, and agents such as clonidine, methyldopa, hydralazine, and reserpine. Compliance for ARBs compared favorably with those of CCBs and ACE inhibitors. The methods used in this evaluation can be easily implemented at other institutions as part of ongoing medication compliance improvement efforts.