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Biomedical subjects

D E Baker

Publications and source records attributed to D E Baker.

At least 19 recordsLinked to original sources
PubMed2001

Nateglinide therapy for type 2 diabetes mellitus.

OBJECTIVE: To review the pharmacology, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy of nateglinide. DATA SOURCES: Primary and review articles regarding nateglinide were identified by MEDLINE search (from 1966 to January 2001); abstracts were identified through the Institute for Scientific Information Web of Science (from 1995 to January 2001) and the American Diabetes Association; additional information was obtained from the nateglinide product information. STUDY SELECTION/DATA EXTRACTION: All articles and meeting abstracts identified from the data sources were evaluated and all information deemed relevant was included in this review. Much of the information was from abstracts or the product labeling, since few clinical studies have been published in the medical literature. DATA SYNTHESIS: Nateglinide is a novel nonsulfonylurea oral antidiabetic agent that stimulates insulin secretion from the pancreas. It has a rapid onset and short duration of action, allowing administration before a meal to reduce postprandial hyperglycemia. Improvement in glycemic control with nateglinide monotherapy has been demonstrated in patients not previously treated with antidiabetic medications. Greater improvement in glycemic control was observed when nateglinide was administered in combination with metformin. CONCLUSIONS: Nateglinide is similar to repaglinide, but has a quicker onset of action, quicker reversal, and does not usually require dosage titration. Based on the pharmacodynamics of nateglinide and repaglinide, nateglinide produces a more rapid postprandial increase in insulin secretion, and its duration of response is shorter than that of repaglinide. The risk of postabsorptive hypoglycemia should be lower than with either sulfonylureas or repaglinide.

Animals↗
PubMed2001

Esomeprazole magnesium (Nexium).

Esomeprazole, the S-isomer of omeprazole, is a new proton pump inhibitor. Esomeprazole provides better control of intragastric pH than omeprazole. It is more effective in treating erosive esophagitis in patients with GERD than omeprazole. Esomeprazole can maintain the healing of erosive esophagitis when used daily or on demand. It is also effective for the eradication of Helicobacter pylori infections. The incidence and type of adverse events associated with esomeprazole therapy are infrequent and likely to be similar to omeprazole.

Anti-Ulcer Agents↗
PubMed2001

Pegylated interferons.

Interferon therapy for chronic hepatitis C is not a cure, but it is able to decrease the viral load and may decrease the risk of complications (e.g., cirrhosis, liver failure, liver cancer). Pegylation of the interferon increases the amount of time the interferon remains in the body by increasing the size of the interferon molecule. Increasing molecule size slows the absorption, prolongs the half-life, and decreases the rate of interferon clearance. Thus the duration of biological activity is increased with pegylated interferon over nonpegylated interferon. The peginterferon alfa products offer an advantage over nonpegylated interferon alfa products because of less frequent administration. Tolerability of the pegylated interferons is comparable to the nonpegylated formulations. Monotherapy with these agents produces a better response in some patients than monotherapy with the nonpegylated formulation. Combination therapy with ribavirin is more effective than monotherapy. Studies comparing peginterferon alfa-2b and peginterferon alfa-2a in the treatment of chronic hepatitis C have not been performed.

Antiviral Agents↗
PubMed2001

Budesonide modified-release capsules.

Budesonide modified-release capsule is an effective form of therapy for the treatment of Crohn's disease located in the distal ileum, ileocecal region, and ascending colon. Because some of the benefit of budesonide therapy results from local effects, this agent will not be very effective in the treatment of patients with extensive colitis or left-side colitis. Budesonide is equal to less effective than prednisolone or prednisone therapy in the treatment of active Crohn's disease, but is associated with fewer glucocorticoids adverse reactions.

Administration, Oral↗
PubMed2001

Tegaserod for the treatment of constipation-predominant irritable bowel syndrome.

Tegaserod, a potent, partial serotonin 4 receptor (5-HT4) agonist, is an effective agent for the treatment of females with constipation-predominant irritable bowel syndrome. Tegaserod enhances gastric motility, stimulates peristaltic reflux and intestinal secretion, inhibits visceral sensitivity, and/or shortens colonic transit time. This agent may help women who have failed to respond to diet and exercise, laxatives, and other forms of therapy. The optimal dose of tegaserod is 6 mg twice daily and results in decreased number of days per month with pain, bloating, and days without bowel movements. Tegaserod is less effective in males than females in the treatment of constipation-predominant irritable bowel syndrome. Tegaserod is well tolerated. Diarrhea is the most frequent adverse effect. The diarrhea tends to occur most frequently during the first few months of therapy and decreases with continued administration.

Clinical Trials, Phase III as Topic↗
PubMed2000

Miglitol: assessment of its role in the treatment of patients with diabetes mellitus.

OBJECTIVE: To evaluate miglitol, a new oral alpha-glucosidase inhibitor, and discuss its pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy. DATA SOURCES: A MEDLINE English-language only database search using the keywords miglitol, glyset, and Bay m 1099 (1985 to December 1999), was completed to identify relevant articles including reviews, recent studies, and abstracts; American Diabetes Association 1999 Annual Meeting abstracts; Pharmacia & Upjohn data on file and product information. STUDY SELECTION: The clinical trials that were selected to be reviewed in detail were randomized, double-blind studies with at least 100 patients in the intention-to-treat group. DATA EXTRACTION: All articles and abstracts were reviewed along with the product labeling from Pharmacia & Upjohn. DATA SYNTHESIS: Miglitol is an alpha-glucosidase inhibitor that exerts its effect through the delayed absorption of complex carbohydrates in the small intestine, resulting in a decrease in postprandial glucose concentrations that are directly correlated with the dietary carbohydrate content. Both small, short-term trials and large, clinical trials show a decrease in postprandial glucose concentrations and a modest decrease in glycosylated hemoglobin of approximately 0.5-1.0% as a result of miglitol's action. The adverse effects of miglitol are mild and transitory and include flatulence, diarrhea, and abdominal pain. The incidence of gastrointestinal problems may be reduced with a small initial dose, which is slowly titrated as tolerated. CONCLUSIONS: Miglitol is an effective and safe treatment option in patients with type 2 diabetes mellitus who are inadequately controlled with diet or oral sulfonylurea therapy. Miglitol is a good choice of therapy in Hispanic, African-American, and elderly patients, or any patients in whom hypoglycemia, weight gain, or lactic acidosis are risks. No published studies comparing miglitol with acarbose have been published, but there appears to be no major clinical or financial advantages to using one agent over the other.

1-Deoxynojirimycin↗
PubMed1999

Direct measurement of unfractionated heparin using a biochemical assay.

A number of investigations have noted that functional biological assays for heparin are not always reliable and may not reflect the actual biochemical level of heparin in patients receiving anticoagulant therapy. This creates the possibility that patients receiving anticoagulant treatment may have an excess or deficiency of circulating levels of heparin. To address this problem, we have developed a direct biochemical measurement of heparin. The heparin assay uses fluorophore-assisted carbohydrate electrophoresis (FACE) to directly measure the predominate disaccharide of unfractionated heparin. In this study, unfractionated heparin was measured in vitro throughout a wide range of heparin concentrations in plasma. Seven in vivo pharmacokinetic studies in five normal subjects given 3,000 USP units of unfractionated heparin intravenously showed a three-phase elimination process with higher peak plasma levels and shorter elimination times than predicted from previous studies. At these doses, heparin is largely eliminated intact through urinary excretion. Body weight has a significant effect on heparin kinetics. When we compared the direct biochemical assay with two biological clotting assays, we found the latter can overestimate biochemical heparin concentrations. The FACE assay, due to its sensitivity, is also able to measure circulating levels of endogenous heparin in plasma and urine. Direct heparin measurement using the FACE technique is practical and useful for studies of the correlation of biochemical and biological activities.

Animals↗
PubMed1997

Saphenous vein graft aneurysm after coronary artery bypass surgery.

OBJECTIVE: The purpose of this report is to show the imaging characteristics of saphenous vein graft aneurysms and pseudoaneurysms. Conventional radiographic, CT, and coronary angiography images were reviewed for three patients ranging from 64 to 69 years old who had documented saphenous vein graft aneurysms or pseudoaneurysms. CONCLUSION: Saphenous vein graft aneurysms and pseudoaneurysms appear as paracardiac, hilar, or mediastinal masses on chest radiographs. On CT, the lesions are enhancing tubular mixed-attenuation masses along the heart border. Coronary angiography confirms the graft dilatations. Knowing the imaging characteristics of these entities should lead to their diagnosis and prevent unnecessary complications.

Aged↗
PubMed1996

Interferon alfa therapy in adults with chronic idiopathic thrombocytopenic purpura.

The role of interferon alfa-2b in the treatment of chronic ITP has not been well documented. One small clinical trial indicated that 84.6% of patients failing to respond to corticosteroid therapy and splenectomy might respond to interferon alfa-2b. These results cannot be extrapolated to all patients refractory to steroids. Subsequent anecdotal reports have not demonstrated a similar response, possibly because the reports included patients who were no longer responsive to corticosteroids, splenectomy, and other agents (i.e., vinblastine, cyclophosphamide, danazol, azathioprine, immunoglobulin). This latter group of patients may have a poor prognosis and less chance of responding to interferon alfa-2b therapy. Therefore, the role of interferon alfa-2b in the treatment of patients with chronic ITP unresponsive to other forms of therapy remains to be established, but it may prove beneficial in some patients. Uncertainty remains as to the reason for lack of interferon alfa-2b efficacy. There is question of a presence of rapid development of antibodies against interferon alfa-2b. In addition, it is unknown whether interferon alfa-2a and interferon alfa-2b are capable of producing similar results in the treatment of chronic ITP.

Adult↗
PubMed1995

Personality characteristics of adult children of alcoholics.

The study examined whether eight characteristics attributed to adult children of alcoholics (ACOAs) by Woititz (1983) were supported by personality measures. The Children of Alcoholics Screening Test (CAST) and nine scales from the California Personality Inventory and the 16-PF were administered to 166 undergraduates. Forty-nine (29%) of these subjects were identified as ACOAs. ACOAs' scores on the personality measures were compared to an age- and gender-matched control group. No differences were identified between ACOA men and control men. ACOA women were found to be more flexible, impulsive, and pessimistic, with a sense of less wellbeing than control women. A significant discriminant function correctly classified 77.6% of the women subjects. This function indicated that easygoingness, independence, self-assurance, and self-directedness are associated with status as an ACOA for women.

Adult↗
PubMed1994

Selected topics in drug information access and practice: an update.

The area of drug information is broad and of increasing importance to all pharmacy practitioners. The efficient and effective use of the literature should not be limited to those individuals with specialized drug information education and training. Pharmacists must be familiar with the many sources of information available to them, including the expanding line of CD-ROM products and on-line databases. Drug information specialists should serve as consultants and facilitators in the appropriate use of these products. All pharmacists should have a baseline level of critical literature evaluation skills. Part of the responsibilities of drug information specialists should be to help educate practitioners in the acquisition and development of these skills and to assist with the actual analysis of clinical studies. Finally, pharmacists in all settings, in conjunction with drug information specialists, need to work to develop DUE and adverse event monitoring programs that will maximize positive patient outcomes.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Therapeutic advances in the prevention of hepatitis B: yeast-derived recombinant hepatitis B vaccines.

Viral hepatitis is second to gonorrhea as the most commonly reported infectious disease in the US. Hepatitis B accounts for the majority of viral hepatitis cases. Fortunately, the disease is self-limiting and frequently resolves completely with minimal complications; however, a significant number of individuals may experience long-term sequelae. Research utilizing genetic engineering has led to the development of yeast-derived recombinant DNA (YDR) hepatitis vaccines--a significant advancement in the control and prevention of hepatitis B. The recombinant process allows production of unlimited quantities of vaccine at considerably lower cost and without the potential threat of blood-borne illness. Clinical trials in various high-risk populations have demonstrated the effectiveness and safety of YDR vaccines. However, questions regarding optimal regimen and the need for periodic revaccination remain unanswered. Persons at risk should be adequately vaccinated against hepatitis B.

Age Factors↗
PubMed1991

Effects of dietary cadmium chloride throughout gestation on blood and tissue metabolites of primigravid and neonatal dairy cattle.

Thirty-six postpubertal Holstein heifers were allocated to three groups and fed the same diet, which differed only in the concentration of Cd: control group (.25 ppm of Cd), low-Cd group (1 ppm of Cd), and high-Cd group (5 ppm of Cd). Cadmium was supplemented to the low-Cd and high-Cd groups using CdCl2. Liver, kidney cortex, and abdominal muscle were biopsied for mineral analysis from one-half of the heifers of each group before Cd supplementation and again from the same animals within 5 d after parturition, 394 d later. Blood, liver, and muscle were collected from each calf within 5 h after birth. In the dam, 5 ppm of dietary Cd caused a 62-, 27-, and 4-fold increase in Cd of the kidney, liver, and muscle, respectively; kidney Zn and Fe increased (76%) and decreased (33%), respectively, whereas the serum Cu was reduced (31%). Liver Cu was reduced to 40 and 17% by dietary Cd of 1 and 5 ppm, respectively, in the dams. Calves from dams consuming 5 ppm of Cd had a 29 and 43% reduction in liver Cu and Zn, respectively. In these same calves, packed cell volume, hemoglobin concentration, and serum Cu were decreased by 17, 18, and 25%, respectively, whereas serum Zn was increased (55%). Serum sodium and potassium were reduced by 4 and 13%, respectively, and blood urea nitrogen was increased by 63% in calves from dams consuming 5 ppm of Cd. Feeding primigravid dairy cattle up to 5 ppm of Cd as CdCl2 throughout gestation did not influence the concentration of Cd in the neonate but caused reductions in liver Cu and Zn; teratogenesis was not apparent.

Animals↗
PubMed1991

Effects of long-term dietary cadmium chloride on tissue, milk, and urine mineral concentrations of lactating dairy cows.

The effects of long-term consumption of 1 and 5 ppm of Cd on Cd, Cu, Fe, and Zn concentrations in milk and a variety of tissues of first-lactation dairy cows was investigated. Thirty-six Holstein heifers were allocated to three groups and fed similar diets differing only in the concentration of Cd (.25, 1, and 5 ppm) for a 394-d period before calving. One- and 5-ppm Cd concentrations were achieved using CdCl2. Liver, kidney cortex, and muscle were biopsied from one-half of the heifers of each group before Cd supplementation and again from the same heifers within 5 d after parturition. Colostrum and milk were sampled throughout the 150 d of lactation. Urine was sampled after an average of 450 d of Cd exposure. At slaughter (after an average of 554 d), 11 tissues were sampled from 12 cows representing all treatment groups. During the first 394 d, Cd accumulated in kidney and liver with increasing dietary concentrations of Cd but did not further increase by 554 d. However, by 554 d Cd had also accumulated in the adrenal glands, ovaries, spleen, and uteri of cows consuming 5 ppm of Cd. Dietary Cd did not influence the concentration of Cd, Cu, Fe, or Zn in colostrum or milk. However, urine pH, Zn, and K were lower in cows consuming 5 ppm of Cd. Liver Cu was reduced by 1 and 5 ppm of Cd at both 394 and 554 d.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Radiographically guided fine-needle aspiration of nonpalpable breast lesions.

Radiographically guided fine-needle aspiration (X-FNA) in 215 nonpalpable, mammographically detected breast lesions was performed by means of a coordinate-grid localization system. Aspirates were categorized either into four cytologic groups or as simple cysts. Based on the most stringent cytologic criteria, the maximum sensitivity for detection of carcinoma was 97% and the specificity was 94%. However, according to these strict cytologic criteria, only 46% of aspirates contained representative material. Based on less stringent cytologic criteria, the maximum sensitivity was 68% and the specificity was 97%. Forty-one of 74 lesions proved to be malignant at biopsy. Thirty-four patients did not complete adequate mammographic follow-up. High sensitivity and specificity can be achieved with X-FNA. However, management decisions ultimately require integration of mammographic findings with cytologic results. Close cooperation among mammographer, surgeon, cytopathologist, and patient is mandatory for successful results.

Biopsy, Needle↗
PubMed1989

Pharmacists' self-medication for the travelers' diarrhea.

Visitors to developing areas of the world are at high risk for contracting travelers' diarrhea (TD). Despite proven effectiveness in the prevention of TD, prophylactic use of anti-diarrheal agents is controversial. Most authorities recommend against the routine use of drugs for the prevention of TD. This article presents data from surveys of pharmacists and their spouses participating in vacation-study tours to countries associated with a high risk of TD. Patterns of antidiarrheal drug use are compared with the recommended practices regarding both prophylactic and symptomatic therapy. Generally, the subjects in this study adhered closely to recommended practices. Nevertheless, although a majority employed dietary restrictions for TD prevention, 22.8 percent took antidiarrheal drugs prophylactically. Nearly half took antidiarrheal agents for symptomatic use. The ingredients most frequently mentioned matched current recommendations. Inappropriate practices included the use of prophylactic agents without dietary restrictions, and the use of antimotility agents prophylactically. Patterns of dietary and antidiarrheal drug use are compared, including intended versus actual, prophylactic versus symptomatic, and prescription versus nonprescription product use. The controversy regarding the use of prophylactic drug therapy for TD is discussed.

Diarrhea↗
PubMed1988

Adrenal magnetic resonance imaging in Addison's disease.

Magnetic resonance imaging of the adrenal glands was performed in 9 patients with Addison's disease to evaluate the role of magnetic resonance (MR) in this entity. All patients had bilateral adrenal masses demonstrated by computed tomography (CT); etiologies included adrenal hemorrhage (2 patients), granulomatous disease (1 patient), adrenal lymphoma (3 patients), and adrenal metastases (3 patients). Spin-echo axial images were obtained at repetition times (TR) 0.5, 2.0 s and TE 28, 56 ms, using a Diasonics superconducting magnet operating at 0.35 T. In the patients with lymphoma, metastases, and granulomatous disease, the adrenal masses appeared hypointense or isointense with liver on the T1-weighted images (TR 0.5 s, TE 28 ms). In cases of adrenal hemorrhage, areas of hyperintensity were seen on TR 0.5, TE 56 ms sequences, due to shortening of T1 values. In both groups of patients the masses were hyperintense on T2 weighted sequences. Mean calculated T1 of the hemorrhagic glands was 449 ms, compared with a mean of 782 ms for metastases and lymphoma. While MR is not capable of distinguishing between acute inflammatory and metastatic diseases of the adrenal glands, it may be equally efficacious as CT in suggesting the diagnosis of adrenal hemorrhage in patients with Addison's disease.

Addison Disease↗