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Biomedical subjects

D R Shapiro

Publications and source records attributed to D R Shapiro.

29 records · Page 2Linked to original sources
PubMed1990

Hydroxymethylglutaryl coenzyme A reductase inhibitors as monotherapy in the treatment of hypercholesterolemia.

A variety of double-blind studies have compared the efficacy of hydroxymethylglutaryl coenzyme A reductase inhibitors (lovastatin and simvastatin) with that of control agents (cholestyramine, fibrates and probucol) in patients with type IIA or IIB primary hypercholesterolemia. Results have shown that both lovastatin and simvastatin are more effective than the standard therapies with regard to reducing total and low-density lipoprotein cholesterol. Decreases in triglycerides and increases in high-density lipoprotein cholesterol were generally greater with fibrates. Ongoing studies are assessing the benefits of lovastatin and simvastatin in reducing the incidence of mortality from coronary artery disease, as well as causing regression of coronary atheroma.

Bezafibrate↗
PubMed1990

Effects of simvastatin and cholestyramine in familial and nonfamilial hypercholesterolemia. Multicenter Group I.

Simvastatin, a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, was compared with cholestyramine resin in a randomized open-label 12-week multicenter study of 251 high-risk patients with familial or nonfamilial hypercholesterolemia. Simvastatin, 20 mg and 40 mg daily, produced mean reductions in total cholesterol of 26% and 33%, respectively, and reductions in low-density lipoprotein cholesterol level of 32% and 40%. Cholestyramine resin, 4 to 12 g twice daily, reduced total cholesterol and low-density lipoprotein cholesterol levels 15% and 21%, respectively. High-density lipoprotein cholesterol levels were increased 8% to 10% by all treatments. Plasma triglyceride levels were moderately decreased by simvastatin treatment, while triglyceride levels increased with cholestyramine treatment. Simvastatin was better tolerated than cholestyramine, which had numerous gastrointestinal tract side effects. No patient had a serious drug-related adverse event.

Adult↗
PubMed1989

Response to maintenance therapy in bipolar illness. Effect of index episode.

Most previous studies of long-term maintenance therapy for bipolar illness simply compared proportions of patients experiencing recurrences. This method is inadequate because the length of time until a recurrence is not taken into account and because data from patients who withdraw prematurely from the study without a recurrence are either ignored or analyzed improperly. More appropriate survival analytic techniques were applied to the data from the National Institute of Mental Health Collaborative Study of bipolar patients treated with lithium carbonate, imipramine hydrochloride, or both. An interaction between treatment and the nature of the index episode (the episode that brought the patients into the study) was found. In patients with manic index episodes, both lithium and the combination were superior to imipramine. In patients with depressive index episodes, the combination was significantly superior to imipramine, whereas lithium was indistinguishable from imipramine. The latter finding differs from the original analysis, which found the combination to be no different from the other two treatments for patients with a depressive index episode.

Actuarial Analysis↗
PubMed1985

Ultrasonic characteristics of retinopathy of prematurity presenting with leukokoria.

The B-mode ultrasonic appearance of eyes afflicted with retinopathy of prematurity exhibiting leukokoria was retrospectively investigated as an aid to increase the accuracy in assessing the patient with leukokoria. B-mode sonograms were obtained employing the immersion technique (Sonometrics 150 A/B-mode instrument). Contact A-mode confirmation was made (Kretztechnik 7200 MA instrument). Prominent B-mode characteristics included echo patterns consistent with increased corneal thickness (47%), shallow anterior chamber depth (73%), malpositioned lens (64%), cataractous lens changes (64%), fibroproliferation in the anterior vitreous (63%), total retinal detachment (53%), partial retinal detachment and/or retinal fold (30%), choroidal thickening (30%), and acoustic shadowing of orbital fat (33%). Together, these features aid in the ultrasonic differentiation from other causes of leukokoria.

Adolescent↗
PubMed1984

Sequence organization of a pea chloroplast DNA gene coding for a 34,500-dalton protein.

A gene (PGII), which codes for a 34.5-kilodalton protein, has been isolated and cloned from pea chloroplast DNA. The production of its 1.2-kilobase mRNA is photodependent. The direction of transcription has been determined, the site of initiation of transcription has been found, and an in vitro protein product has been produced. The gene, including the 5' and 3'-flanking regions, has been sequenced. It shows ca. 95% homology to the photosystem II thylakoid membrane protein, photogene 32, from spinach and tobacco. There are no intervening sequences. The 5'-flanking region suggests similarities with Escherichia coli promoters. The 5'-flanking region is remarkably conserved among pea, spinach, and tobacco DNA.

Base Sequence↗
PubMedDate not supplied

Effects of simvastatin versus gemfibrozil on lipids and glucose control in patients with non-insulin-dependent diabetes mellitus. NIDDM Study Group.

The objective of this study was to compare the lipid-altering efficacy and safety of simvastatin with that of gemfibrozil in hypercholesterolemic patients with non-insulin-dependent diabetes mellitus (NIDDM). The study was a 24-week, double-blind, randomized, multicenter trial conducted at clinics and hospitals in the United States, Austria, Germany, Brazil, and New Zealand. The study population included 168 men and women aged 34 to 78 years with NIDDM and primary hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] level at screening was > or = 4.9 mmol/L with no other risk factor or > or = 4.1 mmol/L with one or more other risk factors). All patients had been under moderate-to-good diabetic control (hemoglobin A1c [HbA1c] < or = 10.0%) for at least 6 months with diet alone, oral hypoglycemic agents, or insulin therapy. Patients meeting eligibility criteria were randomized to receive either simvastatin 10 mg (titrated up to 40 mg to achieve an LDL-C level < 3.4 mmol/L) once in the evening or gemfibrozil 600 mg twice daily. There were 81 patients in the simvastatin group and 87 patients in the gemfibrozil group. After 17 weeks of treatment, simvastatin significantly reduced levels of total cholesterol, LDL-C, and very-low-density lipoprotein cholesterol (VLDL-C) by approximately 25%, 33%, and 20%, respectively (P < or = 0.001), and triglycerides by about 9% (P < or = 0.05). The drug increased high-density lipoprotein cholesterol (HDL-C) levels by about 6% (P < 0.01). Gemfibrozil significantly reduced total cholesterol, VLDL-C, and triglyceride levels by approximately 8%, 38%, and 27%, respectively (P < 0.001); it significantly increased HDL-C values by about 12% (P < 0.001). Gemfibrozil lowered LDL-C levels by 4% but not significantly. The decreases in total cholesterol and LDL-C were significantly greater (P < 0.001) in the simvastatin group, and decreases in VLDL-C and triglycerides were significantly greater in the gemfibrozil group (P < 0.01). The changes in HDL-C were not significantly different between groups. LDL-C values of < 3.4 mmol/L were achieved in 60% of the simvastatin patients and 14% of the gemfibrozil patients. There were no significant between-group differences in fasting serum glucose or HbA1c at any time point. Glycemic profiles (performed at baseline and after 17 weeks of treatment) and glucose area under the curve (at baseline and after 17 weeks of treatment) were not significantly different between treatment groups. Both drugs were generally well tolerated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Comparative effects of simvastatin and lovastatin in patients with hypercholesterolemia. The Simvastatin and Lovastatin Multicenter Study Participants.

The efficacy, safety profile, and tolerability of the HMG-CoA reductase inhibitors simvastatin and lovastatin were compared in a multicenter, randomized, double-blind study in patients with moderate hypercholesterolemia. Commonly prescribed doses of these two drugs were used by 544 men and women, who followed an American Heart Association phase I diet during a 6-week baseline period and for the 24 weeks of active treatment. Simvastatin 10 mg and lovastatin 20 mg produced statistically significant reductions in total and low-density lipoprotein cholesterol (LDL-C). Patients receiving simvastatin 10 mg once daily and lovastatin 20 mg once daily experienced similar reductions in LDL-C and total cholesterol; however, simvastatin 20 mg was statistically superior to lovastatin 40 mg in decreasing these lipid fractions. For all treatment groups, increases in high-density lipoprotein cholesterol were inversely related to baseline levels. Moderate decreases in triglycerides occurred with all doses. Lipoprotein(a) levels, measured in a subset of patients, were similar before and after treatment. Both drugs were well tolerated.

Adult↗
PubMedDate not supplied

Severe ocular trauma without corneal rupture after radial keratotomy: case reports.

The vulnerability of the ocular coat to trauma following radial keratotomy is an issue of concern to both patients and physicians. Herein, we report two cases of eyes which were exposed to severe trauma after previously undergoing radial keratotomy procedures. In the first case, a woman sustained multiple facial bone fractures in a fatal airplane crash. In the second case, a man was involved in a case of blunt ocular trauma involving a high velocity racquetball. Rupture of the ocular coat did not occur in either case.

Accidents, Aviation↗
PubMedDate not supplied

Radial keratotomy in intact epikeratoplasty graft.

BACKGROUND: Epikeratoplasty can be used to flatten the cornea in keratoconus but is not a satisfactory tool to correct refractive errors in this setting. Radial and astigmatic keratotomy are unpredictable in keratoconus but can be used in an eye which has previously undergone epikeratoplasty for keratoconus. METHODS: We report a case of a pseudophakic eye with Keratoconus which received epikeratoplasty and subsequently underwent radial and astigmatic keratotomy in the graft. RESULTS: Before the refractive keratotomy, the patient had a refraction of -8.00 + 3.25 x 25. At 5 months after radial and astigmatic keratotomy, the patient had an uncorrected visual acuity of 20/60+ with a refraction of -0.50 + 2.00 x 28. CONCLUSIONS: This case demonstrates how different types of refractive corneal surgery can be combined to improve visual acuity in an individual patient. Whether the specific combination of epikeratoplasty and refractive keratotomy can be advocated in the treatment of keratoconus requires more experience with a greater number of patients.

Corneal Transplantation↗