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Biomedical subjects

G E Francisco

Publications and source records attributed to G E Francisco.

At least 19 recordsLinked to original sources
PubMed2005

Efficacy of early use of intrathecal baclofen therapy for treating spastic hypertonia due to acquired brain injury.

OBJECTIVE: To determine the efficacy and safety of early (<1 year post-disease onset) use of intrathecal baclofen (ITB). DESIGN: Consecutive case series of 14 individuals with spastic hypertonia due to trauma (5), anoxia (6) and stroke (3). MAIN OUTCOME MEASURES: Modified Ashworth (MAS) and Disability Rating (DRS) scales. INTERVENTIONS: ITB pump placement within 1 year of onset, after inadequate response to other previous treatment modalities. RESULTS: At follow-up after ITB pump implantation (mean = 13.9 months; mean daily dose = 591.5 microg per day), mean MAS scores improved from baseline by 1.0 and 2.1 points in the upper and lower limbs, respectively. DRS scores did not change significantly. Functional gains included decreased pain and improved gait speed and motor skills. The only complication was spinal leak in one subject. CONCLUSIONS: ITB therapy within 1 year of onset of acquired brain injury appears effective and safe in decreasing spastic hypertonia and does not appear to adversely affect recovery.

Adolescent↗
PubMed2004

The role of intrathecal baclofen therapy in the upper motor neuron syndrome.

This review article will discuss the application of intrathecal baclofen (ITB) therapy in the upper motor neuron syndrome (UMNS). While the UMNS consists of a variety of signs and symptoms, spasticity appears to be the most widely discussed in research and clinical practice. Thus, while a variety of motor disorders result from spasticity and the other components of the UMNS, such as dystonia, rigidity, and co-contraction of agonists and antagonists, we will refer to spasticity as the representative pathology of the UMNS. The term spasticity will be used in this discussion as if it were synonymous to the UMNS, because it is the term used in most published research and papers. This does not necessarily mean that the other features of the UMNS are less important. Publications in the use of ITB in the pediatric population, especially cerebral palsy, abound, but this paper will focus on UMNS in adults. In addition to reviewing the process of ITB management, from patient selection to rehabilitation, topics of practical interest to clinicians will be discussed.

Journal Article↗
PubMed2001

Intrathecal baclofen therapy for stroke-related spasticity.

Intrathecal baclofen (ITB) therapy is a widely recognized management technique for severe, disabling spasticity in individuals with cerebral palsy and spinal and brain injuries. Its utility in the stroke population has only been recognized recently. Unlike the aforementioned patient populations, many stroke survivors are ambulatory and are able to maintain a certain degree of functional independence through compensatory use of the uninvolved limbs. Clinicians often fail to recognize the potential enhancement in the function of these individuals if they gain better control of their spastic limbs. Other spasticity treatments, such as oral medications and neurolytic procedures, offer the advantage of being nonsurgical; however, not every stroke patient will respond well to them. Some patients may not tolerate the systemic side effects of oral medications, such as drowsiness and sedation. In patients with severe multilimb spasticity, phenol and even high doses of botulinum toxin may not adequately control spasticity. ITB therapy offers the advantage of effectively decreasing severe, diffuse spasticity without causing untoward effects on arousal and cognition. This article will review the efficacy of ITB therapy in treating spasticity and enhancing function in stroke survivors.

Journal Article↗
PubMed2001

GABA agonists and gabapentin for spastic hypertonia.

Spasticity is a result of an imbalance between the afferent excitatory and descending inhibitory pathways after central nervous system damage. Its pharmacologic control is believed to result from the antagonism of inhibitory mechanisms (gamma-aminobutyric acid [GABA] or glycine-mediated antagonism of excitatory mechanisms), or both. Because GABA receptor sites are widely present in the central nervous system, it is amenable to pharmacologic manipulation.

Acetates↗
PubMed2001

Intrathecal baclofen therapy for spastic hypertonia.

Intrathecal baclofen is perhaps the most effective treatment for significant spasticity regardless of the origin. For appropriately selected patients, it can provide qualitative and quantitative improvements in quality of life. This article discusses the practical aspects and patient selection, trial, implant, and ongoing management of patients with intrathecal baclofen pump therapy.

Baclofen↗
PubMed1997

Bruxism after brain injury: successful treatment with botulinum toxin-A.

Bruxism, the rhythmic grinding of teeth--usually during sleep--is not an infrequent complication of traumatic brain injury. Its prevalence in the general population is 21%, but its incidence after brain injury is unknown. Untreated, bruxism causes masseter hypertrophy, headache, temporomandibular joint destruction, and total dental wear. We report a case of complete resolution of postanoxic bruxism after treatment with botulinum toxin-A (BTX-A). The patient was a 28-year-old man with no history of bruxism who sustained an anoxic brain injury secondary to cardiac arrest of unknown etiology. On admission to our rehabilitation unit 2 months after the injury, the patient presented with severe bruxism and heavy dental wear. The patient was injected with a total of 200 units of BTX-A to each masseter and temporalis. There was total resolution of bruxism 2 days after injection, with no complications. On follow-up 3 months after injection, the patient remained free of bruxism. We propose that botulinum toxin be considered as a treatment for bruxism secondary to anoxic brain injury. Further studies regarding muscle selection and medication dosage are warranted to elucidate the toxin's efficacy in this condition.

Adult↗
PubMed1997

Diversion colitis: a cause of abdominal discomfort in spinal cord injury patients with colostomy.

Diversion colitis is thought to result from nutritional deficiencies secondary to fecal diversion. Symptoms include hemorrhagic purulent rectal discharge, abdominal pain, and tenesmus. 5-Aminosalicylic acid (5-ASA) and N-butyrate enemas have been reported to help this condition non-spinal cord injury (SCI) patients. We report the case of a 49-year-old C6 ASIA B tetraplegic man who had received colostomy because of intractable ileus 10 years earlier. He presented with a 2-week history of rectal pain and bleeding. Abdominal and rectal examination on admission were unremarkable. Colonoscopy showed a partial stricture 70cm proximally to the rectum. The colonic mucosa appeared granular and friable with evidence of linear ulceration. Histopathologic study was consistent with colitis. The patient developed fever, abdominal distention, and extensive retroperitoneal air after endoscopy, suggesting colonic perforation. He was treated with daily 5-ASA suppository and total parenteral nutrition for the presumed diagnosis of diversion colitis, and intravenous antibiotics for perforated colon. After 6 weeks of treatment with 5-ASA, the patient had decreased rectal pain and bleeding. This experience suggests that diversion colitis may be a cause of abdominal discomfort in SCI patients and that 5-ASA may be used in the management of diversion colitis.

Abdominal Pain↗
PubMed1992

Drug therapy of diabetic neuropathy.

Neuropathy is the most common and perhaps the most devastating complication associated with diabetes. Although many theories regarding the pathogenesis of diabetic neuropathies have been proposed, the most popular theory focuses on the accumulation of sorbitol in the nerve cell through the "polyol pathway." Treatment for diabetic neuropathy remains inadequate. Newer agents such as the aldose reductase inhibitors show some promise in halting and perhaps reversing the pathogenesis of this complication; however, these agents remain investigational. Currently, the most reasonable approach involves the use of agents to control pain and other symptoms associated with this progressive disease.

Aldehyde Reductase↗
PubMed1990

Antidiabetic agents.

Although either insulin or oral hypoglycemics may be used in conjunction with diet and exercise in the management of type II diabetes, drug therapy for type I diabetes involves only insulin. C-peptide levels can be tested to assess whether the patient has remaining pancreatic endocrine function. Patients being started on insulin for the first time should receive a single injection of an intermediate-acting insulin of "human" origin at a dose of approximately 0.5 U/kg. Thereafter, fasting, mid-morning, mid-afternoon, bedtime, and possibly early morning blood sugars should be examined periodically to determine if the insulin dose needs to be increased, decreased, split, or if the patient needs to be on a two-insulin regimen. Intensive insulin therapy has become commonplace to control plasma glucose levels in the majority of patients receiving insulin therapy. Proper patient education regarding the insulin regimen, injection techniques, blood glucose monitoring, as well as diet, exercise, and foot care are essential if the patient's diabetes is to be controlled adequately. Guidelines for "adequate" glycemic control are outlined in Table 6. Recent evidence suggests that tight control of plasma glucose levels may decrease the macrovascular complications of diabetes. Although there is also evidence to suggest that the onset of microvascular complications might be delayed with strict glycemic control, the data are conflicting. The benefits of strict control must be weighted against the problems of hypoglycemia experienced by many patients who attempt tight control of their blood glucose levels. Biguanide compounds are available in Europe, but the sulfonylureas comprise the only class of oral agents in the United States commercially available for the treatment of type II diabetes. The two generations of these drugs reflect their potency and possible side-effect profiles. Of the first-generation agents, tolbutamide and chlorpropamide are the most widely prescribed. Tolbutamide is the weakest of the sulfonylureas, possibly making it a good drug for initiating oral therapy in the elderly. Chlorpropamide is becoming a less popular agent because of its long duration of action and its increased incidence of side effects. Of the second-generation agents, glyburide offers a better dosing schedule (once daily compared with twice daily for glipizide); however, glyburide may produce a greater incidence of hypoglycemia, particularly in the elderly or in patients with significant renal impairment. There are few good studies comparing these two drugs so that recommending one over the other is difficult. Drug interactions are numerous with the first-generation drugs, but less so with the newer second-generation agents.(ABSTRACT TRUNCATED AT 400 WORDS)

Diabetes Mellitus↗
PubMed1986

Recovery of phenytoin from an enteral nutrient formula.

The recovery of phenytoin from phenytoin oral suspension dispersed in an enteral nutrient formula was determined. The study was conducted in two phases. In phase 1, diluted phenytoin oral suspension was added to 10 1-mL samples of full-strength Osmolite and 10 1-mL samples of a distilled water control solution to produce a theoretical concentration of 10 micrograms/mL. The samples were filtered through an ultrafiltration membrane and assayed for phenytoin concentration by a homogeneous enzyme-multiplied immunoassay technique. In phase 2, varying amounts of diluted phenytoin oral suspension were added to 30-mL quantities of half-strength Osmolite or control solution to determine the effect of phenytoin concentration on recovery of phenytoin; also, a constant amount of diluted phenytoin oral suspension was added to 30-, 60-, and 90-mL quantities of half-strength Osmolite or control solution to determine the effect of solvent volume on recovery of phenytoin. Duplicate samples of each phase 2 mixture were filtered and assayed in the same manner as phase 1 samples. The mean concentration of phenytoin in phase 1 samples was 3.70 +/- 0.28 microgram/mL for Osmolite and 9.87 +/- 0.27 microgram/mL for control solution; this difference was significant. The percentage of phenytoin recovered from phase 2 samples of Osmolite increased with increasing phenytoin concentration and decreased with increasing volumes of Osmolite. The decreased recovery of phenytoin from the enteral nutrient formula used in this study has potential clinical importance, but further research in humans is needed to substantiate these in vitro observations.

Enteral Nutrition↗
PubMed1985

Home health care: drug-related problems detected by consultant pharmacist participation.

Consultant pharmacists conducted a drug history and regimen review on one-fourth of the patient population served by a community hospital-based home health department. About one-third of study patients had inappropriately stopped taking their medications; over one-fourth of the study patients had changed their schedule or dose without health professional consultation. Fifteen percent of all medications were duplications, and only 8% of prescription medications were correctly identified by name. Consultant pharmacist activities that could reduce drug-related problems were identified as drug therapy consultation with patients and staff, drug regimen review, drug information, and patient medication education.

Consultants↗
PubMed1985

Intravenous nitroglycerin delivery: dynamics and cost considerations.

After determining initial nitroglycerin (NTG) concentrations, NTG solutions were infused through polyvinylchloride (PVC) and polyethylene intravenous (IV) administration sets at rates of 6, 12, and 24 ml/hour. Delivered NTG concentrations were determined using a high-performance liquid chromatographic technique at predetermined and fixed time intervals during a 24-hour infusion. The relative availability of NTG with each infusion was determined by dividing the area under the time concentration curve for delivered NTG by the area under the curve, assuming that the initial NTG concentration was delivered constantly over the 24-hour infusion period. For the PVC administration set, the relative availabilities of NTG were 41.5%, 62.9%, and 76.0% for the 6, 12, and 24 ml/hour infusions, respectively. Additionally, the concentration of NTG delivered varied considerably with time and infusion rate. For the polyethylene administration set, the relative availabilities of NTG were 97.3%, 96.8%, and 96.3% for the 6, 12, and 24 ml/hour infusions, respectively. Considerably less NTG solution was required to deliver the same amount of drug when polyethylene administration sets were used to infuse NTG. Polyethylene IV administration sets can be used to accurately deliver the labeled NTG concentration without resulting in increased cost.

Drug Utilization↗
PubMed1985

In vitro inactivation of tobramycin by cephalosporins.

The in vitro inactivation of tobramycin when combined with each of six cephalosporins in samples of human serum was investigated. Each of six cephalosporins (cefazolin sodium, cefoxitin sodium, cefamandole nafate, moxalactam disodium, cefoperazone sodium, and cefotaxime sodium) was added to human serum samples containing tobramycin sulfate 8 micrograms/mL to produce final cephalosporin concentrations of approximately 250 and 1000 micrograms/mL. Duplicate solutions were prepared and stored at either 0 or 21 degrees C. Solutions containing tobramycin 8 micrograms/mL alone and with carbenicillin disodium in four concentrations were prepared as controls. Samples were assayed using a fluorescence polarization immunoassay (TDX) at 0, 2, 4, 8, 12, 24, and 48 hours to determine tobramycin concentration; two of the carbenicillin-tobramycin solutions were frozen immediately for assay 53 hours later. Tobramycin concentrations in the admixtures were compared with those in tobramycin reference samples. At both temperatures, samples containing tobramycin with cefamandole 250 micrograms/mL or cefotaxime 250 micrograms/mL showed less than 10% inactivation of tobramycin for at least 48 hours. At 0 degrees C, tobramycin retained greater than 90% activity when combined with cefoperazone 250 and 1000 micrograms/mL. In samples containing cefazolin 250 micrograms/mL at 0 degrees C and cefoperazone 250 micrograms/mL at 21 degrees C, tobramycin was stable for 24 hours. Only samples containing moxalactam stored at 21 degrees C showed greater than 16% inactivation of tobramycin at 48 hours. Under these study conditions, tobramycin is only moderately inactivated in vitro when combined with clinically achievable concentrations of the tested cephalosporins (excluding moxalactam) and then stored for up to 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Cephalosporins↗
PubMed1983

Teaching principles of geriatrics through a home health care rotation.

To provide pharmacy students with ambulatory geriatric training, the University of Georgia School of Pharmacy developed a clinical rotation in home health care. This one-week experience in which students encounter patients in the home environment is offered as part of the four-week required clinical clerkship. While in the home setting the student is exposed to the various medical, social, and economic problems of the elderly and in turn provides the patient with nondispensing pharmaceutical services such as drug use review, drug histories, and patient education. The patients' medication regimens are discussed prospectively and retrospectively at daily conferences with the clinical preceptor and student peers. Students have evaluated the program as valuable in improving their communication skills and their knowledge of drugs and diseases of the geriatric patient.

Education, Pharmacy↗
PubMedDate not supplied

In vitro and in vivo bioequivalence of commercial prednisone tablets.

The purpose of the study was to examine the bioequivalence of five commercially available oral prednisone products. The in vivo study utilized 18 healthy males, each of whom was administered 20 mg of prednisone as a reference solution or as a tablet in a 6-week, six-way crossover design. Blood was collected and serum was assayed, using an HPLC procedure specific for prednisone and prednisolone. Mean pharmacokinetic parameters (t 1/2, ke, Cmax, tmax, and AUC) were determined. ANOVA was performed on the prednisone and prednisolone data (F-test, p less than 0.05) as well as Duncan's multiple range analysis. Dissolution tests were also performed on each of the five products in order to test the relationship between dissolution and bioequivalence among prednisone products. The in vitro study consisted of a standard USP dissolution test which included tablets from the same lots as the tablets used in the in vivo study. The data showed no statistical difference in any of the pharmacokinetic parameters among tableted products, subjects, or dosing periods in the study. There was also no statistical difference in the dissolution study among the five commercial tablet forms.

Adolescent↗
PubMedDate not supplied

Bioequivalency and dose proportionality of three tableted promethazine products.

Data from a five-way crossover study in human subjects using four talented promethazine products and a promethazine solution are presented. All products were administered as a single oral dose. The five objectives of the study were to investigate bioequivalency, to estimate dose proportionality at two dose levels, to establish validity of a reference production solution for future bioequivalency studies, to estimate intersubject variation, and to compare bioavailability/tablet dissolution data. Blood samples were collected at given intervals over a 24-hour period and analysed for promethazine using an HPLC technique. Pharmacokinetic parameters were calculated using standard procedures and a two-way analysis of variance (ANOVAR) was used to assess whether the differences were statistically significant. The AUC0----infinity data from the ANOVAR analysis showed that the 50 mg innovator and generic products and the 50 mg solution were not significantly different. However, the innovator product had a significantly lower Cmax and longer tmax than the solution. The generic product did not differ significantly from the solution. Promethazine was found to exhibit linear dose proportionality in the range and product studied. Intersubject variation was high for all parameters (23 to 63 per cent) and the in vivo and in vitro data showed a positive relationship.

Adolescent↗