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Biomedical subjects

James R Taylor

Publications and source records attributed to James R Taylor.

9 recordsLinked to original sources
PubMed2006

The envelope gene is a cytopathic determinant of CCR5 tropic HIV-1.

Late stage AIDS associated CCR5 tropic HIV-1 clones (R5-AIDS HIV-1) exhibit greater cytopathic effects (CPE) than earlier isolates from the same patients. In this study, envelopes from a series of three biological clones derived from the same patient were evaluated as a cytopathic determinant of R5-AIDS HIV-1 for thymocytes. In a single round of replication in thymocytes, the AIDS associated clone mediated greater initiation of reverse transcription. This enhancement was not due to broadened coreceptor tropism, as all clones studied were exclusively R5 tropic. The full-length R5-AIDS env mediated greater infectivity than R5 pre-AIDS env when used to pseudotype a reporter virus. R5-AIDS env pseudotypes were more resistant to TAK-779 and showed more rapid infection kinetics but similar resistance to a CD4 blocking mAb. We conclude that the enhanced thymic replication and CPE shown by the R5-AIDS clone is due to enhanced efficiency of Env-mediated entry via CCR5.

Amides↗
PubMed2006

Efficacy and safety of oral conivaptan: a V1A/V2 vasopressin receptor antagonist, assessed in a randomized, placebo-controlled trial in patients with euvolemic or hypervolemic hyponatremia.

CONTEXT: Hyponatremia [serum sodium concentration ([Na(+)]), <135 mEq/liter] is the most common fluid and electrolyte abnormality among hospitalized patients. It is frequently caused by the inappropriate release of arginine vasopressin. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of oral conivaptan, a vasopressin V(1A)/V(2) receptor antagonist, in patients with euvolemic or hypervolemic hyponatremia. DESIGN: The study design was a 5-d placebo-controlled, randomized, double-blind study. SETTING: The study was performed at a hospital. INTERVENTION: Oral conivaptan (40 or 80 mg/d) or placebo was given in two divided doses. PATIENTS: Seventy-four patients (average baseline serum [Na(+)], 115 to <130 mEq/liter) were studied. MAIN OUTCOME MEASURE: The main outcome measure was the change from baseline in serum [Na(+)] area under the curve. RESULTS: The least-squares mean change from baseline in the serum [Na(+)] area under the curve with conivaptan (40 and 80 mg/d) was 2.0-fold (P = 0.03) and 2.5-fold (P < 0.001) greater, respectively, than that with placebo. The median time to achieve a confirmed increase in serum [Na(+)] of 4 mEq/liter or more from baseline was 71.7 h for placebo, 27.5 h for 40 mg/d conivaptan (P = 0.044), and 12.1 h for 80 mg/d conivaptan (P = 0.002). The mean total times during which patients had a serum [Na(+)] level of 4 mEq/liter or more above baseline were 46.5, 69.8, and 88.8 h (P = 0.001), respectively. The least-squares mean change in serum [Na(+)] from baseline to end of treatment was 3.4 mEq/liter for placebo, 6.4 mEq/liter for 40 mg/d conivaptan, and 8.2 mEq/liter for 80 mg/d conivaptan (P = 0.002). A confirmed normal serum [Na(+)] (>/=135 mEq/liter) or increase of 6 mEq/liter or more was observed in 48% of patients given placebo, 71% given 40 mg/d conivaptan, and 82% given 80 mg/d conivaptan (P = 0.014). Headache, hypotension, nausea, constipation, and postural hypotension were the most common adverse events. CONCLUSION: Oral conivaptan (40 and 80 mg/d) was well tolerated and efficacious in correcting serum [Na(+)] in hyponatremia.

Administration, Oral↗
PubMed2006

Pharmacologic management of chronic insomnia.

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia present, its severity, and can consequently guide therapy. Behavioral therapy has been shown to be equivalent to or superior to pharmacologic therapy, at least in some patients. It is a reasonable initial approach, although there are barriers to its use. There are several pharmacologic agents available, some of which are more effective at reducing time to fall asleep and others for maintaining sleep. There is some evidence to indicate that combining the approaches may impair outcomes. There is little data on the long-term use of pharmacologic agents.

Humans↗
PubMed2006

Probable interaction between tolterodine and warfarin.

53-year-old woman with a history of deep vein thrombosis and pulmonary embolism was receiving warfarin to prevent thromboembolic complications; her international normalized ratio (INR) had been stable for 1 month. Extended-release tolterodine 4 mg/day was then prescribed to manage overactive bladder. On her next anticoagulation clinic visit, the patient's INR had increased, although the dosage of warfarin had been reduced when the tolterodine had been prescribed. Due to the absence of other contributing factors and the temporal relationship between tolterodine and prolonged INR, the event was determined to be a probable drug interaction. When patients are prescribed tolterodine and warfarin concurrently, clinicians should monitor INR carefully, and a reduction in warfarin dosage may be required.

Anticoagulants↗
PubMed2005

Comparison of point-of-care HbA1c test versus standardized laboratory testing.

BACKGROUND: Glycosylated hemoglobin (HbA1c) evaluation is an accepted standard of care for assessing diabetes control. Point-of-care HbA1c monitors are relatively new, and there are few published data on their accuracy. OBJECTIVE: To compare a point-of-care HbA1c monitor with standardized laboratory testing. METHODS: Twenty-three patients who had type 1 or 2 diabetes were identified from our pharmacy-run diabetes clinic at a primary care clinic as needing HbA1c evaluation based on the American Diabetes Association guidelines. All patients with diabetes who attended our clinic were invited to participate in the study. Patients were required to obtain both a standardized laboratory HbA1c evaluation and a point-of-care A1c Now value within a week of each other. An analysis evaluating both clinical and statistical significance was completed at the end of the study. RESULTS: The A1c Now monitor showed good correlation (r = 0.758) to the standardized laboratory test. We found that the most accurate A1c Now values were within a range of 6-8%. One patient's value would have resulted in a different clinical decision if the decision were based on the A1c Now value. CONCLUSIONS: It appears that A1c Now may provide adequate accuracy and be useful for some patients. The monitor would be most beneficial for patients who cannot obtain standardized laboratory values secondary to either financial or transportation constraints. However, the decision to make adjustments in therapy should not be based solely on the A1c Now point-of-care result.

Blood Glucose Self-Monitoring↗
PubMed2004

Cholesterol: point-of-care testing.

OBJECTIVE: To review the literature regarding point-of-care (POC) cholesterol monitors and describe their role in pharmacy practice. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-May 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from this search were reviewed, and all information deemed relevant was included. DATA SYNTHESIS: Hyperlipidemia is a well-established risk factor for coronary artery disease, which is the leading cause of death in the US. The use of POC cholesterol monitors may help to improve the identification and management of this disease. Pharmacists may use many of these devices in their practice and are also in an ideal position to provide patient education on selection and use of these monitors and interpretation of the results. CONCLUSIONS: The availability of POC cholesterol monitors has increased in recent years. Based on currently available data, these monitors are best suited for screening purposes and to assist in the management of hyperlipidemia. There is not enough evidence to support the notion that POC cholesterol monitors can replace laboratory or office monitoring. Their application in the diagnosis of hyperlipidemia is also currently limited.

Cholesterol↗
PubMed2004

Home blood pressure monitoring: point-of-care testing.

OBJECTIVE: To review the literature regarding point-of-care blood pressure monitoring and describe its role in pharmacy practice. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-May 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All articles identified from this search were reviewed and all information deemed relevant was included in this article. DATA SYNTHESIS: Hypertension is a well-established risk factor for coronary heart disease, the leading cause of death in the US. The use of at-home blood pressure monitors may help improve identification and management of this disorder. Pharmacists may use many of these devices in their practice and are also in an ideal position to provide patient education on the selection and use of these monitors, as well as interpretation of results. CONCLUSIONS: The availability of at-home blood pressure devices has considerably increased in recent years and likely will continue to do so. Based on currently available but limited data, fully automated or semiautomated upper-arm devices are preferred over wrist- or finger-cuff devices. These devices are best suited for screening and monitoring only and should not be used for diagnosis. Although such devices are potentially cost-effective, there is presently insufficient evidence to support the notion that their use can replace routine office monitoring.

Blood Pressure Determination↗
PubMed2002

Clear cell atypical fibroxanthoma:a clinicopathologic study.

INTRODUCTION: The atypical fibroxanthoma (AFX) is considered by most authorities to represent a superficial or minimally invasive variant of malignant fibrous histiocytoma that most often presents as a solitary nodule on the sun-exposed skin of the elderly. Among the rarest variants is the clear cell AFX, a lesion which raises consideration to a differential diagnosis encompassing a variety of neoplastic and non-neoplastic clear cell proliferations. METHODS: We describe three cases of a distinctive cutaneous neoplasm arising in the sun-exposed skin of elderly patients. In all cases, formalin-fixed, paraffin-embedded tissue was available for analysis. The histology in concert with the immunophenotype was held to be diagnostic of the clear cell variant of AFX. RESULTS: All tumors comprised sheets of large cells with foamy cytoplasms and hyperchromatic, polyploid nuclei manifesting frequent and atypical mitoses. The critical cells in our cases expressed CD68 but none of CD3, CD20, CD34, S-100 protein, muscle-specific actin, factor XIIIa, Melan-A, carcinoembryonic antigen, or cytokeratin. CONCLUSION: Although typical examples of AFX provoke diagnostic consideration of spindle cell cancers of the skin (most often spindle cell melanoma, spindle cell squamous cell carcinoma, and leiomyosarcoma), the clear cell variant raises other differential diagnostic considerations instead. These include balloon cell melanoma, sebaceous carcinoma, pleomorphic liposarcoma, chordoma, parachordoma, tricholemmal carcinoma and clear cell squamous cell carcinoma. A diagnosis of AFX is one of exclusion; one must employ immunohistochemical markers to rule out the aforementioned differential diagnostic considerations. By reporting the fifth, sixth and seventh cases of clear cell AFX, we hope to alert dermatopathologists to this distinctive and unusual neoplasm, recognition of which is essential to avoid under- or over-diagnosis and inappropriate therapy.

Aged↗