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Biomedical subjects

J G Gums

Publications and source records attributed to J G Gums.

At least 19 recordsLinked to original sources
PubMed2001

Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins.

BACKGROUND: Fibromyalgia is a common rheumatologic disorder that is often difficult to treat effectively. CASE SUMMARY: Four patients diagnosed with fibromyalgia syndrome for two to 17 years are described. All had undergone multiple treatment modalities with limited success. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. All patients were women with multiple comorbidities prior to elimination of MSG. All have had recurrence of symptoms whenever MSG is ingested. DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate, that act as excitatory neurotransmitters, and can lead to neurotoxicity when used in excess. We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia. We suggest that identification of similar patients and research with larger numbers of patients must be performed before definitive conclusions can be made. CONCLUSIONS: The elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.

Adult↗
PubMed1999

Management of essential hypertension.

Hypertension, in spite of a very high prevalence, remains undertreated. This is not due to a lack of effective therapeutic modalities. Non-pharmacological treatments can be effective in many patients. If those treatments fail to reduce blood pressure sufficiently, the physician can choose between numerous classes of antihypertensive agents. However, interpatient variability in response to these agents is high, and use of multiple agents is frequently necessary. Thus, no single class has proven to be superior for the majority of patients. This article will review the different non-pharmacological and pharmacological methods available to treat hypertension, as well as the guidelines that are available to aid in proper selection of a treatment regimen.

Animals↗
PubMed1999

A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team.

Our aim was to identify financial and outcome benefits of therapeutic intervention by a multidisciplinary antimicrobial treatment team composed of pharmacists, a clinical microbiologist, and an infectious disease specialist. Of 252 consecutive inpatients receiving suboptimal intravenous antibiotics identified by the clinical pharmacist, 127 were prospectively randomized to intervention and 125 to a control group. The groups were similar with regard to severity of illness, infection type, and time from admission to randomization. Physicians received timely, detailed reviews of relevant microbiologic and clinical data with recommendations of possible optimal antibiotic choices, dosages, and rationales. Median length of stay after randomization for control and intervention groups was 9.0 days and 5.7 days, respectively (3.3-day difference, p=0.0001). Fifteen (12.0%) and eight patients (6.3%), respectively, died, although the time-specific mortality risk was not significantly different when length of postrandomization follow-up and time to death were taken into account. Physician acceptance of suggestions was 89%. Median patient charges for radiology, laboratory, pharmacy, and room were reduced by $4404/intervention, and median hospital costs were reduced by $2642/intervention. A multidisciplinary antimicrobial therapy team can be a useful information source for physicians, improve outcomes in hospitalized patients receiving intravenous antimicrobials, and result in substantial cost savings.

Aged↗
PubMed1998

Possible lansoprazole-induced eosinophilic syndrome.

OBJECTIVE: To report a case of myalgia with eosinophilia related to lansoprazole administration. CASE SUMMARY: A 50-year-old white woman developed severe myalgia 1 week after starting lansoprazole. During the treatment course, the patient was also found to have eosinophilia. The myalgia and eosinophilia resolved 40 days after lansoprazole was stopped and 18 days after prednisone therapy was begun. The patient was not rechallenged with lansoprazole. DISCUSSION: To our knowledge, this is the first reported case of lansoprazole-induced eosinophilic syndrome. Clinically, it is difficult to distinguish between eosinophilia-myalgia syndrome and eosinophilic fasciitis, which are probably part of a continuum of eosinophilic disorders. This patient presented with symptoms of both syndromes. Although other causes cannot be completely ruled out, the time course strongly suggests that lansoprazole was the causative agent. CONCLUSIONS: It is important to consider medications when diagnosing patients with hypereosinophilia and/or myalgia.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

"Isolated" low high-density lipoprotein cholesterol.

OBJECTIVE: To present information on the function, structure, and importance of high-density lipoprotein cholesterol (HDL-C) and to evaluate the current literature regarding the controversy of managing patients with an "isolated" low HDL-C concentration. DATA SOURCE: A MEDLINE search was performed (1966-June 1996) to identify English-language clinical and review articles pertaining to HDL-C. Some articles were identified through the bibliography of selected articles. STUDY SECTION: All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA EXTRACTION: Important historical lipid studies, recent review articles, and clinical trials involving therapy for HDL-C were evaluated. DATA SYNTHESIS: The structure, function, and measurement of HDL-C and the state of an isolated low HDL-C are discussed for background. Lifestyle modification measures to increase HDL-C, medications to avoid, estrogen replacement, and lipid-altering agents used to raise an isolated low HDL-C are presented. CONCLUSIONS: An isolated low HDL-C concentration poses a risk for coronary heart disease. The management of this state is controversial. The first step in management is in agreement with experts and includes lifestyle modification (e.g., weight reduction, diet, smoking cessation, aerobic exercise). Estrogen replacement therapy and discontinuance of drugs that secondarily lower HDL-C are additional treatment options. The use of lipid-altering agents has been used in some patients. Nicotinic acid appears to be an effective agent for an isolated low HDL-C. A large clinical trial evaluating the effect of treating an isolated low HDL-C for primary and secondary prevention of coronary events is needed.

Cholesterol, HDL↗
PubMed1997

The serum digoxin concentration: ten questions to ask.

Although the role of digoxin therapy has been the subject of debate, the drug is generally accepted as effective in the treatment of heart failure due to systolic dysfunction and as therapy for atrial fibrillation and supraventricular tachyarrhythmias. Serum digoxin concentrations are commonly used to gauge patient response to digoxin. Digoxin pharmacokinetics are complex, and many factors can confound the interpretation of digoxin concentrations. The exact therapeutic range of serum digoxin varies in the literature but should be considered to be from 0.8 to 2.0 ng per mL, on the basis of population data regarding therapeutic response and toxicity. Renal function plays a major role in digoxin pharmacokinetics and is an important factor in determining digoxin doses. Many medications, including quinidine, amiodarone and verapamil, alter digoxin pharmacokinetics and can result in two- to three-fold increases in the serum digoxin concentration. Effective interpretation of the digoxin concentration requires consideration of the patient's renal function and clinical status, possible drug interactions, time of the assay and other variables.

Algorithms↗
PubMed1996

Alpha blockers: a reassessment of their role in therapy.

Intended for the treatment of hypertension, alpha blockers offer advantages in treating patients who also have other risk factors for coronary artery disease. Alpha blockers lower blood pressure by decreasing vascular resistance and are effective for the treatment of mild to moderate hypertension. In addition, alpha blockers have beneficial effects on lipid levels; they increase high-density lipoprotein levels and decrease total cholesterol, low-density lipoprotein and triglyceride levels. Alpha blockers do not induce glucose intolerance or hyperinsulinemia. Although they appear to decrease left ventricular mass, the clinical significance of this action is unknown. Alpha blockers are also effective for improving the symptoms of benign prostatic hypertrophy, although surgery is recommended for patients with severe symptoms.

Adrenergic alpha-Antagonists↗
PubMed1994

Infectious vaginitis. Selecting therapy and preventing recurrence.

Vaginal candidiasis, trichomoniasis, and bacterial vaginosis can be difficult to manage because of predisposing factors and frequent recurrence. Thus, in addition to drug therapy, management should include attempts to minimize factors that contribute to recurrence. Both topical and oral agents are available for vaginal candidiasis and bacterial vaginosis, and both routes of administration appear equally safe and effective. Topical therapy may be used for these conditions in pregnant women. Only oral therapy is optimal for trichomoniasis. However, during pregnancy, the infection may be managed with topical clotrimazole. Currently, treatment of a woman's sexual partner is recommended in the management of trichomoniasis and is optional in cases of bacterial vaginosis. Sexual activity may also contribute to the recurrence of vaginal candidiasis; however, more studies are needed to evaluate the impact on recurrence rates of treating the male partner.

Bacterial Infections↗
PubMed1993

Tuberculosis. The primary care physician's role in eradication.

The resurgence of tuberculosis in the United States presents a challenge for primary care physicians. The disease remains concentrated in the growing population of socioeconomically disadvantaged persons, immigrants from areas where drug resistance is common, certain racial groups, persons in extended-care facilities, alcohol and drug abusers, and persons infected with the human immunodeficiency virus. Because people in these groups are much less likely than others to seek regular medical care, it is difficult to identify and treat active tuberculosis in these populations. Contacts of patients with tuberculosis are equally difficult to identify. Active intervention by primary care physicians--including tuberculin screening, prophylactic therapy, treatment of active disease, and follow-up--is needed to help achieve the goal of eradicating tuberculosis.

Adolescent↗
PubMed1993

Carisoprodol as a drug of abuse.

Carisoprodol (available as Soma and in other commercial forms) is a commonly prescribed muscle relaxant. A small group of patients was recently discovered colluding to obtain the drug under false pretenses for the purposes of substance abuse. Animal and human studies have previously shown limited potential for tolerance or abuse, while the evidence for therapeutic efficacy is inadequate. There are two previous case reports of human carisoprodol abuse or dependence, one in which a patient showed signs of a true withdrawal syndrome. A third case involved a fatality linked to carisoprodol abuse. Data from the National Institute on Drug Abuse reveal that overdose and abuse of carisoprodol may be more common than previously suspected. Carisoprodol use should be limited to short-term treatment of acute musculoskeletal conditions involving significant muscle spasm. Suspicions of abuse should be raised by patients requesting the drug by name, "losing" prescriptions, using carisoprodol chronically, or denying the efficacy of less mind-altering alternatives.

Behavior, Addictive↗
PubMed1993

Therapeutic drug monitoring in ambulatory care.

There is a growing emphasis on developing ambulatory care services in an attempt to minimize healthcare costs through preventive medicine and outpatient therapeutic management. This creates an environment that can greatly benefit from a pharmacist-managed ambulatory TDM service. The implementation of a pharmacist-managed TDM service can improve patient care, contain the cost of healthcare, and enhance the education of pharmacy/medical students and physicians. The opportunity exists for further development of clinical pharmacy services to positively influence patient care in the ambulatory care setting. This development, however, may be hindered by inadequate reimbursement for services and lack of documentation to support the beneficial impact of clinical pharmacy services on patient outcome. Methods of documenting clinical pharmacists' interventions and outcome must be developed in order to obtain reimbursement for these services.

Ambulatory Care↗
PubMed1992

Use of ACE inhibitors in the treatment of cardiovascular disease.

ACE inhibitors have been available by prescription since the marketing of captopril in the early 1980s. Since that time, six additional ACE inhibitors have been marketed, four of which received approval from the Food and Drug Association in 1991. All but one of the new ACE inhibitors are carboxylic-acid compounds, and all of them maintain a pro-drug metabolic pathway. Initially, ACE inhibitors were approved only for the control of high blood pressure. More recently, captopril and enalapril have been approved for use in congestive heart failure. In 1988, ACE inhibitors were one of the recommended first-line therapies for mild-to-moderate hypertension. Their use in patients with hypertension has steadily increased, most likely because of their minimal effect on coexistent cardiovascular risk factors. In CHF, ACE inhibitors are the only single drug class that has been shown to reduce mortality and hospitalizations due to the disease without concomitant administration of another drug. ACE inhibitors are clearly drugs that should be used early in the treatment of most patients with CHF. Differences between ACE inhibitors are often difficult to define. As information regarding the clinical utility of tissue ACE inhibition is unveiled, the ability to use a selected ACE inhibitor based on individual patient characteristics may increase. The future for ACE inhibition looks promising and the cumulative clinical value of ACE inhibition appears to be just beginning.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Treatment of type I diabetes with a combination of glyburide and insulin.

OBJECTIVE: To assess the ability of a combination of insulin and an oral hypoglycemic agent (glyburide) to improve the overall glycemic control in a population of patients with type I diabetes. DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Community-based, university-affiliated, family medicine group. PATIENTS: Men and women between 18 and 68 years of age with type I diabetes. INTERVENTIONS: Subjects were observed and titrated on an insulin-only regimen for 12 weeks (phase I). Subjects were then randomized to receive either placebo or glyburide 10 mg/d for an additional 12 weeks (phase II). MAIN OUTCOME MEASURES: Glucose measurements were taken at breakfast, lunch, supper, and bedtime. Each patient also was followed sequentially for serum lipids, glycosylated hemoglobin, (Hb A1c) and daily insulin utilization. RESULTS: Average fasting blood glucose (FBG) measurements were significantly lower in the glyburide-treated group during phase II (9.22 +/- 0.55 mmol/L) compared with baseline (10.27 +/- 0.93 mmol/L) and phase I (10.41 +/- 0.55 mmol/L). A decrease in the average Hb A1c concentration in the glyburide group was evident by week 4 and was sustained for the duration of the study. The average daily insulin dose rose significantly in the glyburide but not the placebo group compared with baseline. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol did not change significantly in either group over the course of the study. High-density lipoprotein cholesterol increased significantly over baseline in the glyburide group during phase II. Several patients experienced dramatic improvements in glycemic parameters after the addition of glyburide to their insulin regimens. CONCLUSIONS: Improvements were observed in the FBG and Hb A1c measurements of this heterogeneous population of patients with type I diabetes after the addition of glyburide to their insulin regimens. The study failed to find consistent trends in glycemic control when evaluating mean changes in FBG measurements.

Adolescent↗
PubMed1991

Newer antihypertensive agents.

Three recent additions to the list of antihypertensive agents have been approved for use as monotherapy or in combination with other drugs. Betaxolol hydrochloride (Kerlone) maintains its effect for 24 hours, making it a true once-a-day beta blocker. Penbutolol sulfate (Levatol) is as effective as other beta blockers and diuretics. Doxazosin mesylate (Cardura), a selective alpha 1 blocker, also allows once-a-day dosing and has produced favorable changes in lipid profiles. Two new drug delivery systems, one for verapamil hydrochloride (Verelan) and one for extended-release nifedipine (Procardia XL), allow less frequent dosing and may offer other advantages, such as greater compliance and a more tolerable side-effect profile.

Antihypertensive Agents↗
PubMed1990

The new antimicrobial agents. When they're the best choice and when they're not.

The number of antibiotics available to the clinician for treatment of infectious diseases continues to increase. However, choosing an agent just because it is new is not always cost-effective and may encourage the development of bacterial resistance. The site of infection, pharmacokinetic data, minimum inhibitory concentration, and cost must all be considered in selecting the optimal antimicrobial agent for a particular clinical situation.

Anti-Bacterial Agents↗
PubMed1990

Spironolactone: a re-examination.

A review of the aldosterone antagonist spironolactone is presented. It is effective both as monotherapy and in combination with other hypotensive agents in the control of both essential and hyperaldosterone-induced hypertension. It is useful as a diuretic in conditions such as cirrhosis and congestive heart failure, and is most commonly employed because of its potassium- and magnesium-sparing qualities. Spironolactone also has been used as an antiandrogenic agent in managing hirsutism. Its adverse effect profile, considered somewhat prohibitive in the past, is generally not significant when reasonably low doses (less than 150 mg/d) are used.

Humans↗
PubMed1989

Effects of magnesium oxide on the lipid profile of healthy volunteers.

Elevated serum cholesterol is a risk factor in the development of coronary artery disease. Magnesium has been reported to decrease total serum cholesterol, low density lipoprotein, and very low density lipoprotein, and increase high density lipoprotein. A randomized, double-blind, placebo-controlled, crossover study was completed to determine if supplemented magnesium, in the form of magnesium oxide, would produce changes in the lipid profile. Fifty normal volunteers received placebo or magnesium oxide, 400 mg capsules, twice a day for 60 days, then switched to the alternate treatment. Weight, height, blood pressure, serum potassium, serum magnesium, and a lipid profile were determined initially and after each treatment. Analysis of variance (ANOVA), comparing the mean of each component of the lipid profile at baseline and after each treatment, showed no significant difference. In conclusion, supplemental magnesium oxide did not produce statistically significant changes in the lipid profile in this group of healthy volunteers.

Adolescent↗