Biomedical subjects
Publications and source records attributed to J P Rindone.
Atorvastatin 15 mg/week was administered to 21 patients with hypercholesterolemia for 2 months. The mean low-density lipoprotein concentration decreased by 20% after treatment.
CONTEXT: Chronic low back pain is one of the most prevalent and costly medical conditions in the United States. Permanent magnets have become a popular treatment for various musculoskeletal conditions, including low back pain, despite little scientific support for therapeutic benefit. OBJECTIVE: To compare the effectiveness of 1 type of therapeutic magnet, a bipolar permanent magnet, with a matching placebo device for patients with chronic low back pain. DESIGN: Randomized, double-blind, placebo-controlled, crossover pilot study conducted from February 1998 to May 1999. SETTING: An ambulatory care physical medicine and rehabilitation clinic at a Veterans Affairs hospital. PATIENTS: Nineteen men and 1 woman with stable low back pain of a mean of 19 years' duration, with no past use of magnet therapy for low back pain. Twenty patients were determined to provide 80% power in the study at P<.05 to detect a difference of 2 points (the difference believed to be clinically significant) on a visual analog scale (VAS). INTERVENTIONS: For each patient, real and sham bipolar permanent magnets were applied, on alternate weeks, for 6 hours per day, 3 days per week for 1 week, with a 1-week washout period between the 2 treatment weeks. MAIN OUTCOME MEASURES: Pretreatment and posttreatment pain intensity on a VAS; sensory and affective components of pain on the Pain Rating Index (PRI) of the McGill Pain Questionnaire; and range of motion (ROM) measurements of the lumbosacral spine, compared by real vs sham treatment. RESULTS: Mean VAS scores declined by 0.49 (SD, 0.96) points for real magnet treatment and by 0.44 (SD, 1.4) points for sham treatment (P = .90). No statistically significant differences were noted in the effect between real and sham magnets with any of the other outcome measures (ROM, P = .66; PRI, P = .55). CONCLUSIONS: Application of 1 variety of permanent magnet had no effect on our small group of subjects with chronic low back pain.
PURPOSE: The objective of this study was to assess if kudzu root extract influences the drinking habits of veterans who entered a substance abuse treatment program. DESIGN: Prospective, randomized double-blind controlled clinical trial. SETTING: A nonacademic Veteran Affairs Medical Center. METHODS: Patients with the diagnosis of alcoholism were randomly assigned to receive either kudzu root extract 1.2 g twice daily or a matching placebo. Patients completed questionnaires that focused on craving for alcohol and sobriety status on a monthly basis. OUTCOME MEASURES: Sobriety level and craving for ethanol were assessed on a visual analogue scale from 0 to 10. RESULTS: Thirty-eight patients completed 1 month of the study; 21 randomly assigned kudzu, 17 to placebo. No statistically significance difference in craving and sobriety scores were noted after 1 month between kudzu and placebo, or at later stages with smaller numbers (15-19) of patients. CONCLUSION: In this small patient population, kudzu root appeared to be no better than placebo in reducing the craving for alcohol or promoting sobriety.
OBJECTIVE: To determine the effectiveness of glucosamine in reducing pain from osteoarthritis of the knee. DESIGN: Randomized, double-blind parallel trial of glucosamine 500 mg three times daily or a placebo for 2 months. SETTING: Veterans Affairs Medical Center, Prescott, AZ. PARTICIPANTS: Ninety-eight patients aged 34 to 81 being treated for osteoarthritis of the knee. MAIN OUTCOME MEASURES: Pain intensity both at rest and while walking as assessed by a visual analog scale at baseline and after 30 and 60 days of treatment. RESULTS: Forty-nine patients were randomly allocated to each group. There was no statistical difference between the two groups in scores on the visual analog scale at 30 days for resting (mean [SD] score placebo group 3.5 [2.7] vs 3.3 [2.4] glucosamine group, P = 0.66) or walking (5.1 [2.6] vs 5.3 [2.4], P = 0.69); there was also no difference at 60 days for resting (3.4 [2.5] vs 3.2 [2.5], P = 0.81) or walking (4.9 [2.2] vs 4.9 [2.8], P = 0.90). There was also no statistical difference between groups in the mean change from baseline in scores on the visual analog scale (mean [SD] change for walking at 60 days placebo group -1.5 [2.5] vs glucosamine group -1.4 [3.0], P = 0.77). Two participants taking glucosamine and 4 taking placebo withdrew from the study due to adverse side effects (P = 0.67). CONCLUSION: Glucosamine was no better than placebo in reducing pain from osteoarthritis of the knee in this group of patients.
A retrospective study evaluated the success of dosages of simvastatin lower than the 10-20 mg/day recommended by the manufacturer in patients with hypercholesterolemia. Records of 95 patients enrolled in a pharmacist-managed lipid clinic receiving stable dosages of simvastatin were reviewed. Data collected were demographics, number of simvastatin refills, dosage distribution, baseline and posttreatment lipid profiles, and proportion of patients with low-density lipoprotein (LDL) levels below target as recommended by the National Cholesterol and Education Program. Dosages for 62% of patients were less than 20 mg/day. Percentages of patients at goal LDL were 98%, 89%, and 83% for patients taking 2.5, 5, and 10 mg/day, respectively. Patients taking 40 mg/day were least likely to be below the goal. There was an even distribution of patients taking each dosage. No statistical difference in compliance was noted among dosages based on prescription refills. Most patients taking less than the recommended initial dosage of the agent had satisfactory lipid control.
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The following describes a patient on a stable regimen of warfarin who developed severe hypoprothrombinemia and bleeding 4 weeks after starting gemfibrozil. Despite a warning by the manufacturer, only one report of this interaction has been published in the literature. This interaction may be overlooked by clinicians, which may result in a serious bleeding risk for patients on warfarin.
To assess the effects of implementing a standardized order form on the prescribing and monitoring of gentamicin sulfate at a nonteaching Veterans Affairs Medical Center, we prospectively evaluated the prescribing and monitoring of gentamicin for 14 months after the use of such a form was implemented. The data collected included dosing, initial serum gentamicin concentrations, and serum creatinine measurements. These data were compared with similar data obtained during a period of 6 months before the order form was used. A total of 76 patient records were reviewed, 39 before the use of the order form and 47 after the order form was implemented. Gentamicin peak concentrations were statistically higher in the group treated after the order form was implemented. No differences were seen in gentamicin trough concentrations. The timely measurement of serum gentamicin concentrations and serum creatinine levels was improved in the group for whom the order form was used. The order form was completed satisfactorily in 44 patients (94%). We conclude that implementing a standardized order form improved the use of gentamicin.
This study evaluated changes in serum lipids when fluvastatin was substituted for lovastatin using equivalent doses. Results showed that serum lipids, especially low-density lipoprotein cholesterol, significantly increase with this substitution.
The purpose of this study was to assess the effect of fluoxetine on the hypoprothrombinemic response of warfarin in patients chronically anticoagulated. Patients receiving low-intensity anticoagulation with warfarin were recruited. All patients were taking stable dosages of warfarin and had two baseline prothrombin times (PTs) within 10% of each other. Each patient received fluoxetine (20 mg daily) for 21 days. PTs were measured on days 2, 5, 8, 12, 15, 19, and 22 of fluoxetine administration. Six patients completed the study. There was no significant difference in mean PTs before and during fluoxetine administration. Fluoxetine at the dosage studied does not predictably effect the hypoprothrombinemic response of warfarin.
The purpose of the study was to determine whether blood glucose monitoring strips influence the management of patients with non-insulin dependent diabetes (NIDDM) in the primary care setting. The medical records of 115 patients with NIDDM taking a sulfonylurea drug (oral hypoglycemic agent) during the review period were randomly selected for review. Patients were divided into two groups: those who did not receive a prescription for blood glucose monitoring strips during 1995 and 1996 and those who did for the same 2 years. The main outcome measures were hemoglobin A1c, blood sugar, number of laboratory tests ordered, and number and type of treatment interventions. No statistically significant differences between groups were noted for any measured parameter. Glucose control was independent of number of strips dispensed. Home glucose monitoring strips did not affect the management of patients with NIDDM taking a sulfonylurea agent in the primary care setting.
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We undertook a pilot study examining the efficacy of lovastatin 20 mg every other day in patients with hypercholesterolemia, and found lovastatin to be effective in lowering low-density lipoprotein (LDL) levels in patients with serum LDL > 160 mg/dl.
BACKGROUND: Fluconazole has been reported to interact with many medications. This study examined the effect of low-dose fluconazole therapy on the hypoprothrombinemic response of warfarin sodium in patients. METHODS: Patients receiving low-intensity anticoagulation therapy with warfarin were recruited. All patients were taking stable doses of warfarin and had two baseline prothrombin times (PTs) within 10% of each other. Each patient received 100 mg of fluconazole daily for 7 days. Prothrombin times were measured on days 2, 5, and 8 during fluconazole administration. RESULTS: All patients had a progressive increase in PTs. Mean (+/- SD) of PTs increased from 15.8 +/- 1 seconds before the administration of fluconazole to 18.9 +/- 1.9 seconds on day 5 and 21.9 +/- 2.2 seconds on day 8. Fluconazole therapy was stopped early in the three patients due to high PTs. The largest change in PT was 9.7 seconds. No bleeding was noted during the study. CONCLUSION: Fluconazole predictably potentiates the hypoprothrombinemic response of warfarin. Prothrombin times must be monitored when fluconazole is administered to patients taking warfarin.
OBJECTIVE: To review the risks, manifestations, and treatment of cyanide toxicity from nitroprusside therapy. DATA SOURCES: All English case reports identified in Index Medicus (MEDLINE) of cyanide intoxication related to nitroprusside from 1970 to the present were reviewed. In addition, literature regarding the incidence, risks, and treatment of cyanide toxicity from nitroprusside is presented. CONCLUSIONS: Numerous cases of cyanide toxicity associated with nitroprusside have been reported. The overall incidence appears to be infrequent; however, certain patients may be at high risk. Risk factors may include hypoalbuminemia, cardiopulmonary bypass procedures, or the administration of moderate to high doses of nitroprusside. Treatment of cyanide toxicity requires the cessation of nitroprusside and, for severe toxicity, use of the cyanide antidote kit. Cyanide toxicity from nitroprusside may be prevented by concomitant administration of sodium thiosulfate infusions.
The use of psyllium has been associated with various allergic reactions. Three nurses at the Prescott Veterans Affairs Medical Center had differing degrees of psyllium allergy. The reactions ranged from sneezing to chest congestion and wheezing. Two nurses were available for skin testing, and both had a positive wheal reaction. Psyllium allergic reactions have been reported rarely in the literature; however, they may be more prevalent than previously realized.
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