bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute treatment of bipolar depression with adjunctive zonisamide: a retrospective chart review
Authors: Baldassano Claudia F , Nassir Ghaemi S , Chang Alice , Lyman Alan , Lipari Melissa 
Published: September 2004

Background:  This retrospective chart review evaluated the use of zonisamide as adjunctive treatment in patients with bipolar depression.Method:  The charts of outpatients with bipolar I or II disorder treated with adjunctive zonisamide were reviewed. The efficacy of zonisamide was assessed via comparison of physician‐rated Global Assessment of Functioning (GAF) and Clinical Global Impression of Severity (CGI‐S) Scale scores at baseline and after 6 weeks of therapy using paired t‐tests. Patients who scored ≤2 on the CGI‐S after 6 weeks of zonisamide therapy were considered good responders to zonisamide.Results:  Charts for 12 patients (four men and eight women) with a mean (±SD) age of 39.6 (±7.6) years were evaluated. Patients received a mean (±SD) zonisamide dosage of 236 (±68) mg/day. Mean GAF scores significantly improved from 44.0 at baseline to 59.3 at week 6 (P = 0.05). Mean CGI‐S scores improved from 4.54 at baseline to 3.42 at week 6, but the change was not statistically significant. Six patients (50.0%) were considered responders to zonisamide. Four patients discontinued zonisamide therapy, two for an adverse event (sedation) and two for lack of efficacy.Conclusions:  Zonisamide may be a useful adjunctive treatment for some patients with bipolar depression. Conclusions from this study are limited due to its retrospective design. Further investigation of zonisamide in the treatment of bipolar depression is warranted.
A prospective 4–5 year follow‐up of juvenile onset bipolar disorder
Authors: Jairam Rajeev , Srinath Shoba , Girimaji Satish C , Seshadri Shekhar P 
Published: September 2004

Objective:  Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4–5 year period.Method:  Twenty‐five consecutively ascertained subjects (9–16 years) with a diagnosis of mania (mean duration at intake of 4.6 ± 3.9 weeks), were comprehensively assessed at baseline and at 6‐month intervals using the Diagnostic Interview for Children and Adolescents (revised) (DICA‐R), the Missouri Assessment for Genetic Interview in Children (MAGIC), the Young's Mania Rating Scale (YMRS) and the Children's Global Assessment (CGAS). The study phenotype required DSM‐IV criteria of mania with elation and/or grandiosity as a criterion to distinguish them from those with attention deficit hyperactivity disorder. Subjects received the standard treatment as prescribed by their primary treating team.Results:  During the course of the study period, all 25 subjects (100%) recovered from the index episode. The mean time to recovery was 44 ± 46 days. The mean duration of follow‐up was 51.6 ± 4.1 months. Sixteen subjects (64%) relapsed after a mean period of 18 ± 16.4 months. A majority of the relapses (72.4%) were while the subjects were on treatment.Conclusions:  Acute juvenile onset mania has a high rate of recovery and low chronicity. The relapse rate was high and most of these occurred in the first 3 years despite aggressive prophylactic treatment. The effectiveness of currently used thymoleptics, in particular lithium, in the prophylaxis of juvenile bipolar disorder needs to be evaluated in controlled studies.
The anesthetic management of an intrabronchial escape of a hydatid's ruptured laminated membrane during rigid bronchoscopy
Authors: Dabir Shideh , Boloursaz Mohammad‐Reza , Javaherzadeh Mojtaba , Radpay Badiozaman , Parsa Tahereh 
Published: September 2004

SummaryWe describe the anesthetic management of a case in whom a previously undiagnosed pulmonary hydatid cyst manifested as a large amount of intrabronchial fragmented pieces of laminated membrane suddenly and unexpectedly during diagnostic rigid bronchoscopy.
Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging
Authors: Tomatir Erkan , Atalay Habip , Gurses Ercan , Erbay Hakan , Bozkurt Pervin 
Published: September 2004

SummaryBackground : We aimed to investigate effects of low dose ketamine before induction on propofol anesthesia for children undergoing magnetic resonance imaging (MRI).Methods : Forty‐three children aged 9 days to 7 years, undergoing elective MRI were randomly assigned to receive intravenously either a 2.5 mg·kg−1 bolus of propofol followed by an infusion of 100 μg·kg−1·min−1 or a 1.5 mg·kg−1 bolus of propofol immediately after a 0.5 mg·kg−1 bolus of ketamine followed by an infusion of 75 μg·kg−1·min−1. If a child moved during the imaging sequence, a 0.5–1 mg·kg−1 bolus of propofol was given. Systolic and diastolic blood pressures, heart rate, peripheral oxygen saturation and respiratory rates were monitored. Apnea, the requirement for airway opening maneuvers, secretions, nausea, vomiting and movement during the imaging sequence were noted. Recovery times were also recorded.Results : Systolic blood pressure and heart rate decreased significantly in the propofol group, while blood pressure did not change and heart rate decreased less in the propofol‐ketamine group. Apnea associated with desaturation was observed in three patients of the propofol group. The two groups were similar with respect to requirements for airway opening maneuvers, secretions, nausea‐vomiting, movement during the imaging sequence and recovery time.Conclusions : Intravenous administration of low dose ketamine before induction and maintenance with propofol preserves hemodynamic stability without changing the duration and the quality of recovery compared with propofol alone.
Postoperative behavioral changes following anesthesia with sevoflurane
Authors: Keaney Aideen , Diviney Dara , Harte Sinead , Lyons Barry 
Published: September 2004

SummaryBackground : Behavioral disturbance following hospitalization is a relatively frequent event, some children still having negative behavioral changes (NBC) 1 month following their operation. Sevoflurane has a propensity to induce ‘excitement’ during induction of anaesthesia, and delirium in the immediate postoperative phase. The aim of this study was to evaluate whether this translates into prolonged behavioral change.Methods : A total of 120 children presenting for daycase surgical procedures under anesthesia were included in the study. Children were randomized to induction and maintenance of anesthesia with sevoflurane or halothane. No additional sedative drugs were administered. Postoperative behavioral change was assessed using the Post‐Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 7 and 30.Results : The Sevoflurane group (n = 63) were more distressed on emergence of anesthesia than the Halothane group (n = 57) (P < 0.05). About 58.3, 46.8 and 38.3% of all children exhibited NBC on postoperative days 1, 7 and 30, respectively. There was no association between anesthetic agent and behavior. There was a significant relationship between decreasing age and NBC (P < 0.005).Conclusions : Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age.
Early intravenous cannulation in children during sevoflurane induction
Authors: Schwartz Donald , Connelly Neil Roy , Gutta Srinivasa , Freeman Katharine , Gibson Charles 
Published: September 2004

SummaryBackground : It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known.Methods : Pediatric patients, age 1–18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded.Results : Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement.Conclusion : Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.
Droperidol for perioperative sedation causes a transient prolongation of the QTc time in children under volatile anesthesia1
Authors: Stuth Eckehard A.E. , Stucke Astrid G. , Cava Joseph R. , Hoffman George M. , Berens Richard J. 
Published: September 2004

SummaryBackground : Droperidol is useful for postoperative sedation in infants and children after cardiac surgery because it provides sedation and akinesia with minimal respiratory depression. However, droperidol has been associated with QT prolongation and ventricular arrhythmias. We investigated, if neuroleptanalgesic doses of droperidol led to QT prolongation and cardiac arrhythmias in children undergoing cardiac surgery.Methods : We retrospectively analysed electrocardiogram rhythm strips that were obtained before and in time increments after a 100 μg·kg−1 intravenous bolus of droperidol in 20 children undergoing cardiac surgery. The longest QT interval was determined in each ECG and corrected for heart rate (QTc). All arrhythmias were recorded.Results : Droperidol led to a significant increase in QTc time that was still present at 15 min but had resolved within 30 min after the bolus. No associated arrhythmias were observed.Conclusions : The statistically significant prolongation of QTc time after a sedative dose of droperidol is of concern because it may increase the risk for malignant cardiac arrhythmias. A large, prospective study is necessary to identify the true risk for arrhythmias after droperidol in this patient population, but our study suggests that any arrhythmogenic risk, if present, will be very transient, since the increase in QTc time was limited to a period of less than 30 min after the bolus.
Health‐related quality of life in the first year following diagnosis of Type 2 diabetes: newly diagnosed patients in general practice compared with screening‐detected patients. The Hoorn Screening Study
Authors: Adriaanse M. C. , Dekker J. M. , Spijkerman A. M. W. , Twisk J. W. R. , Nijpels G. , Van Der Ploeg H. M. , Heine R. J. , Snoek F. J. 
Published: September 2004

AbstractAims  To determine health‐related quality of life (HRQoL) in the first year following diagnosis of Type 2 diabetes among newly diagnosed patients in general practice compared with patients detected by targeted population screening.Methods  The study population consisted of 49 newly diagnosed patients in general practice and 116 screening‐detected patients. HRQoL was operationalized as symptom distress, perceived health status and emotional well‐being, that were assessed prospectively ∼2 weeks, 6 months and 12 months after the diagnosis of Type 2 diabetes, with the Type 2 Diabetes Symptom Checklist (DSC‐type 2), the Short Form 36 (SF‐36) and the Well‐Being Questionnaire (W‐BQ12), respectively.Results  The DSC‐type 2 total score (range 0–4) improved significantly within newly diagnosed patients in general practice (median at ∼2 weeks, 6 months and 12 months; 0.56, 0.21, 0.26; P = 0.000) and not within screening‐detected patients (0.24, 0.24, 0.29; P = 0.093). Descriptives showed that newly diagnosed patients in general practice compared with screening‐detected patients had consistently worse mean scores on all SF‐36 mental health subscales Social Functioning, Role Emotional, Mental Health, Vitality, and all W‐BQ12 scales at each time point. The differences were statistically significant for Role Emotional, Mental Health, Vitality (SF‐36), and General well‐being (W‐BQ12). The SF‐36 General Health (F = 3.7, P = 0.028) and Vitality (F = 4.5, P = 0.012) scores of newly diagnosed patients in general practice improved significantly over time, compared with screening‐detected patients.Conclusions  Newly diagnosed patients in general practice compared with screening‐detected patients reported more diabetes‐related symptom distress shortly after the diagnosis, and a consistently worse mental health status at each time point. Improved Vitality scores in newly diagnosed patients in general practice in the first year following diagnosis of Type 2 diabetes suggest a positive effect of diabetes treatment on HRQoL.
The combination oral and nutritional treatment of late‐onset diabetes mellitus (CONTROL DM) trial results
Authors: Reboussin D. M. , Goff D. C. , Lipkin E. W. , Herrington D. M. , Summerson J. , Steffes M. , Crouse R. J. , Jovanovic L. , Feinglos M. N. , Probstfield J. L. , Banerji M. A. , Pettitt D. J. , Williamson J. 
Published: September 2004

AbstractObjective  To examine the effect of short‐term improvements in glycaemic control on brachial artery endothelial function as a marker of cardiovascular health.Methods  Persons with Type 2 diabetes who were poorly controlled on oral therapy were randomly assigned to monotherapy with repaglinide or combination therapy with repaglinide plus metformin. Brachial artery flow‐mediated vasodilation was assessed by ultrasonography at randomization and following 16 weeks of therapy. The primary outcome was change in brachial artery endothelial function from baseline. Comparison of randomized groups was a secondary aim.Results  Eighty‐six participants were randomized, and 83 were followed to study completion. Post occlusion brachial artery vasodilation was 3.74% at baseline and 3.82% following 16 weeks of therapy (P = 0.77). The treatment effect was 0.08% (95% CI: −0.48%, 0.64%). No difference was seen between treatment groups (P = 0.69). Overall, A1C was reduced from 8.3% to 7.0%, with a greater reduction in the combination therapy group (from 8.4% to 6.7%) than in the monotherapy group (from 8.3% to 7.3%, p for difference between groups = 0.01). Statistically significant reductions were observed in fasting glucose, and plasminogen activator inhibitor‐1. Statistically significant increases were observed for fasting insulin, uric acid, weight and BMI.Conclusions  Brachial artery endothelial function was not influenced by short‐term improvements in glycaemic control. The CONTROL DM group was successful in lowering A1C. Future research should explore more intensive and longer‐lasting improvements in glycaemic control on endothelial function. Some data previously published in abstract form (Diabetes 2001; 50 (Suppl. 2): A217).
Risk factors for development of impaired renal function in Type 2 diabetes mellitus patients in primary care
Authors: Naushahi M. J. , De Grauw W. J. C. , Avery A. J. , Van Gerwen W. H. E. M. , Van De Lisdonk E. H. , Van Weel C. 
Published: September 2004

AbstractAims  To evaluate risk factors for the development of an impaired renal function, defined as a glomerular filtration rate (GFR) by Cockcroft‐Gault formula < 50.5 ml/min, in primary care patients with Type 2 diabetes mellitus.Methods  A case–control study of Type 2 diabetes mellitus patients with impaired renal function and age, sex and practice matched controls with Type 2 diabetes mellitus without impaired renal function in 10 Dutch family practices performing the Nijmegen Monitoring Project. Main outcome measure was the independent risk factors of impaired renal function.Results  Eighty‐seven individuals with impaired renal function were identified. The point prevalence of impaired renal function in the sample population on 31 March 2001 was 87/873 (10.0%; 95% confidence interval 7.0–15.1%). Of 87 cases, 23 (26.5%; 17.3–30.9%) were found to have impaired renal function at diagnosis. Conditional multiple logistic regression analysis revealed the following independent risk factors for the development of impaired renal function: duration of diabetes ≥ 8 years (adjusted odds ratio 5.6 (2.5–12.5); P < 0.001), glomerular filtration rate by Cockcroft‐Gault formula 50.5–80.5 ml/min at diagnosis [3.5 (1.5–8.1); P < 0.01] and existing macrovascular complications at diagnosis [2.6 (1.1–6.3); P < 0.01].Conclusion  Duration of diabetes ≥ 8 years, mild renal impairment at the time of diagnosis and existing macrovascular complications at the time of diagnosis are independent risk factors for the development of impaired renal function in white patients with Type 2 diabetes mellitus.
The effects of high glucose and atorvastatin on endothelial cell matrix production
Authors: McGinn S. , Poronnik P. , Gallery E. D. M. , Pollock C. A. 
Published: September 2004

AbstractBackground  Statins are known to enhance atherosclerotic plaque stability through influences on extracellular matrix homeostasis. Net matrix production reflects the relative balance of matrix production and degradation through enzymes such as matrix metalloproteinases (MMPs) and their inhibitors, tissue inhibitor of MMP (TIMPs). The effects of statins on endothelial cell production of these parameters following co‐exposure with a proatherogenic stimulus such as high glucose are not known.Methods  Human endothelial cells were exposed for 72 h to 5 mm (control) or 25 mm (high) glucose ± atorvastatin (1 µmol/l). Extracellular matrix homeostasis was assessed by measuring matrix metalloproteinase (MMP)‐2 secretion, tissue inhibitor of MMP (TIMP)‐1 and ‐2 secretion and net collagen IV production. Results were expressed as percentage ± sem of control values.Results  Exposure to high glucose increased cellular collagen IV expression to 190.1 ± 11.7% (P < 0.0001) of control levels. No change in MMP‐2 secretion (111.6 ± 5.2%; P > 0.05) was observed but both TIMP‐1 and TIMP‐2 expression were increased to 136.3 ± 6.4% and 144.0 ± 27.5%, respectively (both P < 0.05). The presence of atorvastatin in high glucose conditions reduced collagen IV expression to 136.1 ± 20.6%. This was paralleled by increased secretion of MMP‐2 to 145.8 ± 7.8% (P < 0.01), increased TIMP‐2 expression to 208.0 ± 21.3% (P < 0.005 compared with high glucose) but no change in TIMP‐1 expression (155.1 ± 14.6%) compared with high glucose alone. The presence of atorvastatin in control conditions did not affect levels of collagen IV expression (114.5 ± 13.2%).Conclusions  Endothelial cell exposure to high glucose was associated with a MMP/TIMP profile that increased extracellular matrix production which was attenuated by concurrent exposure to atorvastatin. Consequently, a mechanism by which the atherosclerotic plaque regression that is observed in patients taking these drugs has been demonstrated.
Presentation and course of Type 2 diabetes in youth in a large multi‐ethnic city
Authors: Zdravkovic V. , Daneman D. , Hamilton J. 
Published: September 2004

AbstractAim  To review the clinical experience of children and teens diagnosed with Type 2 diabetes (T2DM) at a paediatric hospital serving a large urban multi‐ethnic population.Methods  Retrospective chart review of patients with T2DM followed in the diabetes clinic at the Hospital for Sick Children (HSC) over an 8‐year period. Patients who were included were younger than 18, referred at the onset of diabetes, and where presentation and/or clinical course was ‘typical’ of T2DM.Results  Of 1020 children with diabetes followed at HSC, 4% were identified as having T2DM in 2002. There was a sixfold increase in new cases from 1994 to 2002. The mean age at diagnosis was 13.5 ± 2.2 years (range 8.8–17.5) with a female‐to‐male ratio of 1.7. Most had a first‐ or second‐degree relative with T2DM. There was an overrepresentation of children with T2DM from Asian and African Canadian ethnic groups relative to the regional population. The majority of teens were asymptomatic at presentation, with a smaller number in diabetic ketoacidosis (DKA) at diagnosis. Mean HbA1c at diagnosis was 10 ± 3.4%. Approximately one half of patients were initially treated by diet and exercise with many requiring intensification of therapy over a short period of time.Conclusions  We report a similar increase in T2DM incidence and clinical presentation at HSC to other clinic reports in large North American urban centres. Of note is the high prevalence of children of South/South‐East Asian descent.
IRIS II study: the IRIS II score—assessment of a new clinical algorithm for the classification of insulin resistance in patients with Type 2 diabetes
Authors: Forst T. , Standl E. , Hohberg C. , Konrad T. , Schulze J. , Strotmann H. J. , Lübben G. , Pahler S. , Bachinger A. , Langenfeld M. , Pfützner A. 
Published: September 2004

AbstractAims  With the increasing availability of new drugs for the treatment of insulin resistance in patients with Type 2 diabetes, simple methods for their identification is an important challenge. The aim of our study was to compute a new algorithm for estimating insulin resistance in a routine clinical setting.Methods  Clinical data and blood samples were collected from 4265 Type 2 diabetic patients from 149 clinical sites. A clinical algorithm to estimate insulin resistance was developed by stepwise multiple regression analysis. The new generated score was compared with the HOMAIR‐score, calculated from fasting insulin and glucose levels measured in a central laboratory. In a subgroup of 48 patients, the score was verified against a frequently sampled intravenous glucose tolerance test with subsequent modified minimal model analysis according to Bergman.Results  Multiple regression analysis revealed fasting blood glucose, BMI, triglycerides and HDL as the most powerful predictors of insulin resistance which were used for further computation of the IRIS II score. A significant overall correlation was found between the HOMAIR‐score and the new clinical IRIS II score (r = 0.42; P < 0.0001). Compared with HOMAIR, the new score revealed a specificity of 0.95, a sensitivity of 0.34 and a positive predictive value of 0.95. This was in good agreement with the subset analysis of the intravenous glucose tolerance test, where a sensitivity of 0.37 and a specificity of 0.85 of the IRIS II score was calculated. Patients with insulin resistance according to the IRIS II score revealed an increased odds ratio for overall vascular complications (1.28; 1.11–1.46; P < 0.001).Conclusions  The new IRIS II score can identify insulin resistance in Type 2 diabetic patients with high predictive value and high specificity.