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Biomedical subjects

C M Perry

Publications and source records attributed to C M Perry.

52 records · Page 3Linked to original sources
PubMed1996

Valaciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections.

Valaciclovir, the L-valyl ester of aciclovir (acyclovir), is an oral prodrug that undergoes rapid and extensive first-pass metabolism to yield aciclovir and the essential amino acid L-valine. Aciclovir, the active antiviral component of valaciclovir, shows good in vitro activity against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus. The bioavailability of aciclovir from oral valaciclovir is considerably greater than that achieved after oral aciclovir administration. Thus, valaciclovir delivers therapeutic aciclovir concentrations when administered in a less frequent oral dosage regimen than is required for aciclovir. Valaciclovir is an effective treatment for herpes zoster in immunocompetent adults. In a large comparative study that included patients > or = 50 years of age, valaciclovir (1000mg 3 times daily for 7 or 14 days) and oral aciclovir (800mg 5 times daily) were equally effective in achieving resolution of cutaneous zoster lesions. Importantly, valaciclovir was significantly more effective than aciclovir in reducing the duration of zoster-associated pain. Preliminary results of several studies indicate that valaciclovir (500 to 1000mg twice daily for 5 to 10 days) is as effective as aciclovir (200mg 5 times a day for 5 to 10 days) in the treatment of genital herpes. In patients with first or recurrent episodes of genital herpes, valaciclovir reduced the duration of viral shedding, hastened lesion healing and decreased lesion-associated pain. Valaciclovir was also effective in suppressing recurrent episodes of genital herpes and significantly prolonged the time to a recurrent episode of infection compared with placebo. Valaciclovir is a well tolerated drug; in herpes zoster and HSV studies its tolerability profile was similar to that of aciclovir or placebo. Valaciclovir represents and advance in antiherpes drug therapy and is a useful treatment option for patients with herpes zoster or genital herpes. It is at least as effective as aciclovir and is administered in a more convenient oral dosage regimen. Thus, valaciclovir may ultimately succeed aciclovir as a first-line treatment for genital herpes or herpes zoster.

Acyclovir↗
PubMed1996

Didanosine. An update on its antiviral activity, pharmacokinetic properties and therapeutic efficacy in the management of HIV disease.

Didanosine is a dideoxynucleoside analogue, which is phosphorylated to the active metabolite dideoxyadenosine triphosphate (ddATP) intracellularly. At therapeutic concentrations, ddATP inhibits HIV replication by inhibiting HIV reverse transcriptase. Didanosine is established as a first-line treatment for patients with HIV disease and has recently been shown to be superior to zidovudine monotherapy in the treatment of patients with intermediate-stage HIV infection. In clinical practice, however, combination regimens of antiretroviral drugs are generally considered preferable to monotherapy as first-line treatment for most patients with HIV disease. Importantly, 2 large multicentre studies have demonstrated that combination therapy with didanosine and zidovudine was more effective than zidovudine monotherapy in delaying disease progression and death in patients with intermediate or advanced HIV disease. In other comparative studies, improvements in surrogate markers of HIV disease were generally greater in patients who received combination therapy than in recipients of antiretroviral drug monotherapy. Improvements in surrogate markers were also observed in children who received didanosine monotherapy in several clinical trials. Although the efficacy of combination antiretroviral drug therapy has not yet been investigated extensively in children, a combination regimen of didanosine and zidovudine was well tolerated and achieved beneficial effects on surrogate markers if HIV disease. In addition, preliminary findings of a larger study have shown that disease progression was delayed in children and adolescents who received didanosine plus zidovudine combination therapy compared with those receiving zidovudine monotherapy. Didanosine has a tolerability profile that is distinctly different from that of zidovudine. In particular, didanosine exhibits only minimal haematological toxicity when administered either as a single agent or in combination with zidovudine. The most serious dose-limiting adverse effects associated with didanosine treatment are peripheral neuropathy and pancreatitis. In conclusion, didanosine monotherapy is an effective treatment of HIV infection. However, combination antiretroviral therapy is the optimal treatment strategy for most patients, and didanosine is now firmly established as a component of combination antiretroviral drug regimens for the first-line treatment of patients with HIV disease.

Anti-Bacterial Agents↗
PubMed1995

Estramustine phosphate sodium. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in prostate cancer.

Estramustine phosphate sodium (estramustine phosphate), a unique antitumour agent, is selectively taken up by prostate cells and exerts antineoplastic effects by interfering with microtubule of dynamics and by reducing plasma levels of testosterone. In noncomparative studies of estramustine phosphate in patients with hormone-refractory disease, objective response rates ranging from 19 to 69% have been reported. Preliminary clinical investigations indicate that combining estramustine phosphate with vinblastine, etoposide or paclitaxel improves objective response rates over single-agent treatment, although no survival benefit over single-agent treatment has been demonstrated to date. In comparative studies, estramustine phosphate produces similar objective response rates to conventional antineoplastic agents in patients with hormone-refractory prostate cancer. In previously untreated patients with advanced metastatic hormone-responsive prostate cancer, objective responses are achieved in approximately 80% of patients. Estramustine phosphate appears to be at least as effective as estrogen or flutamide therapy in these patients. Nausea and vomiting are the most frequently observed adverse effects of treatment with estramustine phosphate. While these symptoms are usually mild to moderate in nature, they may occasionally be more troublesome to the patient and necessitate withdrawal of treatment. Cardiovascular complications are a more serious, though less frequently encountered, adverse effect of the drug. However, these complications may be avoided by careful patient selection and prophylactic treatment measures. Unlike some other antineoplastic agents, estramustine phosphate is rarely associated with myelosuppression. In addition to producing similar objective response rates to other established agents, estramustine phosphate improves the subjective status of many patients and has been shown to reduce the intensity of pain and improve the performance status of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1995

Fluconazole. An update of its antimicrobial activity, pharmacokinetic properties, and therapeutic use in vaginal candidiasis.

Fluconazole is a bis-triazole antifungal drug which has a pharmacokinetic profile characterised by its high water solubility, low affinity for plasma proteins, and metabolic stability. After a single 150 mg oral dose, therapeutic concentrations in vaginal secretions are rapidly achieved and are sustained for a duration sufficient to produce high clinical and mycological responses in nonimmunocompromised patients with vaginal candidiasis (candidosis). At this dosage, clinical and mycological responses have compared favourably with responses achieved after multiple dose regimens of other oral and intravaginal antifungal agents. Clinical efficacy rates have ranged between 92 and 99% at short term evaluation (5 days post-treatment). At 80 to 100 days post-treatment clinical efficacy rates of 91% have been reported. In addition, limited data indicate that fluconazole is more effective than placebo as prophylactic treatment of frequently recurring vaginal candidiasis. Single oral doses of fluconazole 150 mg are well tolerated. Most frequently observed adverse events are gastrointestinal symptoms, which are generally mild and transient in nature. Thus, fluconazole is a valuable alternative to established systemic and intravaginal azole antifungal drugs which are used to treat vaginal candidiasis. Moreover, in view of its favourable patient acceptability and compliance profile compared with alternative treatments, single-dose oral fluconazole should be considered as a first-line therapeutic choice for the treatment of women with vaginal candidiasis.

Administration, Oral↗
PubMed1995

Famciclovir. A review of its pharmacological properties and therapeutic efficacy in herpesvirus infections.

Famciclovir, a synthetic acyclic guanine derivative, is a prodrug which, after oral administration, is rapidly metabolised to the highly bioavailable antiviral compound penciclovir. Penciclovir is active in vitro against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus (VZV). Famciclovir is an effective treatment of immunocompetent patients with acute herpes zoster (shingles) caused by VZV. Comparative studies have demonstrated that famciclovir has therapeutic efficacy similar to that of oral aciclovir (acyclovir) in attenuating the acute signs and symptoms of infection (including pain during the acute phase of infection). In a placebo-controlled study, famciclovir significantly reduced the duration of postherpetic neuralgia; this effect was more pronounced (almost a 3-fold reduction) in patients aged > or = 50 years. In immunocompetent patients with recurrent genital herpes infection, suppressive treatment with oral famciclovir effectively prolonged the time to recurrence of symptomatic episodes of infection compared with placebo. In addition, famciclovir significantly reduced the duration of viral shedding, accelerated healing of genital herpes lesions and reduced the duration of symptoms. Famciclovir is reported to be the first antiviral agent to significantly reduce symptoms associated with multiple genital herpes lesions. Famciclovir is a well-tolerated drug with a tolerability profile similar to that of placebo and aciclovir. Thus, famciclovir is now established as an effective treatment of immunocompetent patients with herpes zoster or genital herpes infection, particularly as famciclovir is administered in a convenient dosage regimen that may improve compliance compared with aciclovir.

2-Aminopurine↗
PubMed1995

Modes of moral judgment among early adolescents.

Early adolescence is an important definitional stage during which a value system and behavior code are largely shaped (Levy, 1988). Since one's value system and behavior code govern moral reasoning and resultant behavior, how early adolescents reason about moral/value issues has implications for schools, parents, and society as a whole. This study found that early adolescents use a variety of modes to make moral decisions. These include care--where they wish others not to suffer; justice--where decisions are made according to principles (golden rule), and narrowly concerned or selfish. All three modes were used by males and females; however, males were much more likely to choose the narrowly concerned mode than were females.

Adolescent↗
PubMed1995

A study of underlying variables affecting aspirations of rural adolescents.

Aspirations are comprised of two major components--inspiration and ambition. Ambitions represents the ability to look ahead and invest in the future. Inspiration can be described as the ability to invest the time, energy, and effort to reach those ambitions. Variables such as how and why students spend their time illustrate the dynamics of these two components. The data in this report are based on the responses to the Aspirations Survey of 2,677 eighth- to twelfth-grade students from seven rural schools in Maine. The data suggest that many students have no understanding of why they engage in certain activities. If students are to be responsible for their education and more importantly for themselves, they must see purpose in their pursuits.

Adolescent↗
PubMed1994

Families and support networks among African American oldest-old.

This article examines the demographic profile of oldest-old African-Americans who reside in the San Francisco Bay Area. Family life and social support available from adult children, relatives, and friends are explored as they vary by gender. Bivariate analyses indicate that females receive more help from relatives and friends, and males receive more help from immediate family members. Parent and childless respondents were compared for instrumental supports. The childless received support from a variety of helpers, whereas, the parents received help from family or the formal sector. Overall, fewer family members were available to assist the oldest-old with community living, although many were able to redefine relationships and increase the numbers of helpers available to assist them. These findings indicate that the principle of substitution operates among some segments of the older African American population, primarily those who are childless. This pattern was more evident among females than among males.

Black or African American↗
PubMed1987

The influence of age on prognosis in carcinoma of the cervix.

Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB-IV treated between 1970-1984 inclusive, 11% (43 patients) were aged less than or equal to 35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970-1972 to 18% for 1982-1984. In women aged less than or equal to 35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients (P greater than 0.1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival (P greater than 0.1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.

Actuarial Analysis↗
PubMed1987

The role of combined surgery and radiotherapy in the management of stage I and II carcinoma of the cervix.

The results are presented of 100 patients with stage I B, II A or II B carcinoma of the cervix treated by combined surgery and radiotherapy. The actuarial five year survival rates for FIGO stage I B (74 patients) was 85%, for selected stage II A (8 patients) 100%, and for selected early stage II B (18 patients) 72%. Within FIGO stage I B the five year survival for patients with negative nodes was 93% and for those with positive nodes 36%. The radiotherapy complication rate for patients treated with pre-operative radiotherapy followed by Wertheim's hysterectomy was 5%. However, when additional post-operative radiotherapy was given, the complication rate was 60%. It is concluded that pre-operative intracavitary radiotherapy followed by Wertheim's hysterectomy is suitable treatment for early-stage disease with negative nodes, but is unsatisfactory treatment for poor risk patients requiring additional post-operative radiotherapy, as their survival rate is poor and the complication rate is high.

Actuarial Analysis↗
PubMed1986

The value of lymphography in the management of carcinoma of the cervix.

Lymphography has been used to evaluate the pelvic and para-aortic nodes in 205 patients with carcinoma of the cervix treated between 1970 and 1979. The incidence of positive nodes was found to be 17% for Stage I, 24% for Stage II, 52% for Stage III and 100% for Stage IV. Of 73 patients who had lymphograms before Wertheim's hysterectomy, four out of 59 patients (7%) with negative lymphograms had histologically positive nodes; four out of 14 (28%) with positive lymphograms had negative nodes. Within each FIGO stage a positive lymphogram indicated a poor prognosis. The actuarial 5-year survival rates for patients with negative and positive lymphograms were 94% and 55% respectively for Stage I, 72% and 64% for Stage II, and 34% and 17% for Stage III. Of 39 patients with positive lymphograms who died of tumour, 31 out of 39 (80%) had distant metastases, compared with nine out of 29 patients (31%) with negative lymphograms. It is concluded that lymphography is a valuable method of evaluating lymph node status in carcinoma of the cervix.

Adult↗
PubMedDate not supplied

Nevirapine: a review of its use in the prevention and treatment of paediatric HIV infection.

UNLABELLED: Nevirapine is a highly specific inhibitor of HIV-1 reverse transcriptase (RT), an important therapeutic target for the treatment of HIV infection. It was the first non-nucleoside RT inhibitor (NNRTI) to be approved for use in HIV-infected individuals, including children. Nevirapine inhibits replication of multiple HIV-1 strains and clinical isolates in cultured human T cells, but has no activity against other retroviral RTs (including HIV-2 RT) or endogenous human DNA polymerases. Monotherapy with nevirapine rapidly selects for high level drug resistance conferred by a single amino acid substitution in the HIV RT gene. The pattern of resistance mutations selected by nevirapine overlaps with those of other NNRTIs, but is distinct from those of nucleoside analogue RT inhibitors and protease inhibitors. The pharmacokinetics of nevirapine are characterised by rapid and nearly complete oral absorption, an apparently even distribution throughout all organs and tissues in the body, and a long elimination half-life. Nevirapine is both metabolised by and induces the activity of cytochrome P450 isoenzymes. Caution is required when coadministering nevirapine with other drugs metabolised by this system, including HIV protease inhibitors. As a single dose therapy given to pregnant women in labour and to neonates shortly after birth, nevirapine reduced the rate of perinatal HIV transmission by 47% compared with a short course of intrapartum and neonatal zidovudine in a randomised trial in breastfeeding women in Uganda. Nevirapine was more cost effective than zidovudine-based regimens for the prevention of perinatal HIV transmission in a cost-effectiveness model in sub-Saharan Africa. Nevirapine has shown antiretroviral efficacy as part of combination therapy with zidovudine and either didanosine or lamivudine in small numbers of paediatric patients in phase I/II trials. Triple therapy of nevirapine, zidovudine and didanosine was moderately effective in a randomised, nonblind trial in patients with advanced disease. The most frequent adverse event associated with nevirapine is rash, which occasionally develops into severe rash or Stevens-Johnson syndrome. Elevations in liver enzyme levels can occasionally lead to severe complications in patients receiving multiple dose nevirapine. CONCLUSION: Single dose nevirapine appears to be the most cost-effective of available options for the prevention of perinatal HIV transmission suitable for use in developing countries. In addition, preliminary clinical trial data suggest that nevirapine adds to the efficacy of combination therapy for the treatment of HIV infection in infants and children, and is reasonably well tolerated.

Anti-HIV Agents↗