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Biomedical subjects

M Muszkat

Publications and source records attributed to M Muszkat.

At least 19 recordsLinked to original sources
PubMed2003

A common beta1-adrenergic receptor polymorphism (Arg389Gly) affects blood pressure response to beta-blockade.

BACKGROUND: A common polymorphism of the beta(1)-adrenergic receptor Arg389Gly markedly affects function in vitro, but little is known about its in vivo significance. METHODS AND RESULTS: Resting and exercise hemodynamic responses were measured in subjects homozygous for Arg389 (n = 21) or Gly389 (n = 13) alleles before and 3 hours after administration of a beta-blocker, atenolol. Demographic characteristics and atenolol concentrations were similar in the two genotypic groups. Genotype had a marked effect on resting hemodynamic responses to atenolol, with Arg389-homozygous subjects having a larger decrease in resting systolic blood pressure (8.7 +/- 1.3 mm Hg versus 0.2 +/- 1.7 mm Hg, P < .001) and mean arterial blood pressure (7.2 +/- 1.0 mm Hg versus 2.0 +/- 1.7 mm Hg, P = .009). Attenuation of exercise-induced hemodynamic responses by atenolol was not affected by genotype. CONCLUSIONS: There is reduced sensitivity of Gly389 homozygotes to a beta-adrenergic receptor antagonist, and this polymorphism may be an important determinant of variability in response to beta-blockade.

Adrenergic beta-Antagonists↗
PubMed2002

Post-partum hypocalcemia: idiopatic hypoparathyroidism manifested early in lactation.

Hypocalcemia associated with labor and lactation is a rare condition reported previously in patients with hypovitaminosis D. We here describe a case of a young woman in whom symptomatic severe hypocalcemia appeared after her second delivery, early in lactation. At the end of lactation the condition worsened. We review all previously reported cases and suggest a possible physiologic explanation for the association between pregnancy, lactation and the appearance of symptomatic hypocalcemia.

Adult↗
PubMed2002

Use of complementary alternative medicine in patients admitted to internal medicine wards.

OBJECTIVE: To evaluate rate and type of complementary alternative medicine (CAM) use in patients admitted to a medical ward. To identify demographic and disease or treatment-related factors associated with CAM use in these patients. To evaluate the awareness of physicians regarding this practice and whether CAM use had contributed to hospital admission. METHODS: This study is based on consecutive interviews and chart reviews of 180 patients admitted to the Department of Internal Medicine, Hadassah Hebrew University Hospital in Jerusalem, Israel. 29 patients were excluded due to impaired cognitive state and 2 patients refused to participate in the study. Patients were asked questions concerning sociodemographic characteristics and CAM use: type, time, duration of use, causes, outcomes and communication about CAM use with their hospital and family physicians. Information about background diseases, acute diagnoses that led to hospitalization, symptoms on admission, drugs taken at home prior to admission was provided by chart reviews. RESULTS: 26% of patients reported a lifetime history of CAM use and 11% during the month prior to admission. Younger age, higher education and Israeli, USA or European origin was associated with more frequent CAM use. Hospital physicians were informed only about 12% of the CAM courses in the month prior to admission, whereas family physicians were aware of about half of them. No direct or indirect harmful effects of CAM were noticed in this study. No essential changes in the regimen of drugs or other conventional treatments due to CAM use were found. If the condition deteriorated, patients did not defer their visit to hospital because of CAM use. CONCLUSIONS: With reservations due to small sample size, it appears that CAM use was not an important factor influencing hospital admissions to a medical ward. Awareness of the hospital physicians regarding CAM use in their patients during the month prior to admission was much lower than that of the family physicians (12% vs. 51.3%).

Adult↗
PubMed2001

The evaluation of pleural effusions in patients with heart failure.

PURPOSE: To determine the causes of pleural effusions in patients with heart failure, and the association of the characteristics of these statistics with the use of diuretics. SUBJECTS AND METHODS: Eighty-one patients with a definite diagnosis of heart failure who underwent thoracentesis were evaluated. Fluids were classified as transudates or exudates using Light's criteria. RESULTS: Forty-one effusions (in 34 patients) were transudates, and 54 (in 47 patients) were exudates. A specific cause was found for 32 of the exudates (27 patients); except for heart failure, no obvious cause was found for the remaining 22 fluids (20 patients). Exudates with a specific cause for an exudate were more likely to have at least two of Light's criteria (18 of 27 [67%]) than did exudates without a known cause (2 of 21 [10%]). Intravenous diuretic therapy in the 24 hours before thoracentesis was significantly more common among patients with exudates without a specific cause. CONCLUSIONS: Patients with heart failure may have exudative pleural effusions without an obvious cause except heart failure.

Aged↗
PubMed2001

Glucose-6-phosphate dehydrogenase deficiency is associated with increased initial clinical severity of acute viral hepatitis A.

BACKGROUND AND AIM: In glucose-6-phosphate dehydrogenase (G6PD) deficiency, the enzyme is deficient in liver cells as well as in erythrocytes. It has been suggested that this may be associated with a more severe clinical presentation of acute viral hepatitis A. The aim of this study is to determine the severity of liver disease in patients with viral hepatitis and G6PD deficiency. METHODS: Eighteen patients with diagnosed G6PD deficiency and acute hepatitis A were compared with 18 matched control patients with hepatitis A in a university hospital for liver disease severity and clinical outcome. RESULTS: Two of 18 patients with G6PD deficiency had neurological deterioration. Patients with G6PD deficiency had a mean peak prothrombin time (PT) that was significantly prolonged as compared with the control group (15.5 +/- 3.7 vs 12.9 +/- 2.0 s, respectively, P < 0.02), and a significantly higher proportion had an abnormal PT (PT > 13.3 s): 61 versus 11% (P < 0.0001). Hemolysis occurred in 44% of the G6PD deficiency patients. Total and direct bilirubin were significantly higher in all patients with G6PD deficiency, including patients without hemolysis. There was no significant difference in liver enzyme levels between the two groups. Patients with G6PD deficiency had a longer average hospital stay (9.5 +/- 4.8 vs 3.4 +/- 0.8 days, respectively, P < 0.001). There was no difference in the final clinical outcome between the two groups, and recovery of liver function was seen in all patients. CONCLUSIONS: Glucose-6-phosphate dehydrogenase deficiency in patients with hepatitis A causes a more severe initial clinical presentation, but does not alter the final clinical outcome.

Acute Disease↗
PubMed2001

Co-occurrence of hepatocellular carcinoma and lymphoma in patients with hepatitis C virus cirrhosis.

The association of hepatitis C virus (HCV) with neoplasia is not completely understood. Hepatitis C virus is hepatolymphotrophic. It is considered an inducing factor of hepatocellular carcinoma (HCC) and is associated with various types of lymphomas. We describe a patient with HCV cirrhosis who developed gastric lymphoma and HCC, and we review the current data and theories about the oncogenesis of HCV.

Aged↗
PubMed2001

Phenytoin metabolic ratio: a putative marker of CYP2C9 activity in vivo.

CYP2C9 mediates the oxidative metabolism of approximately 10% of drugs, some of which are characterized by a narrow therapeutic index. We aimed to validate genotype method and phenotype methodology, for evaluation of CYP2C9 activity in vivo. Thirty-one healthy subjects (22 male) received a single 300 mg dose of phenytoin. Blood was drawn periodically and urine was collected at intervals for 96 h. Plasma phenytoin and 5-(4-hydroxyphenyl)-5-phenylhydantoin (p-HPPH) and urine S and R enantiomers of p-HPPH were determined by high-performance liquid chromatography. CYP2C9 genotyping was obtained by polymerase chain reaction followed by digestion with Sau96I and StyI for the identification of CYP2C9*2 and CYP2C9*3, respectively. Eighteen subjects were CYP2C9*1 homozygous, seven were CYP2C9*2 heterozygous, four were CYP2C9*3 heterozygous, one was CYP2C9*2 homozygous and one was compound CYP2C9*2/CYP2C9*3 heterozygous. The allele frequencies of CYP2C9*1, CYP2C9*2 and CYP2C9*3 were 0.76 [95% confidence interval (CI) 0.73-0.79], 0.16 (95% CI 0.13-0.19) and 0.08 (95% CI 0.05-0.11), respectively. The CYP2C9-mediated production of (S)-p-HPPH represented the major metabolic pathway of phenytoin biotransformation as its excretion accounted for 95.6 + 0.9% of 'total' p-HPPH excretion over the 96 h collection interval. Phenytoin metabolic clearance to produce (S)-p-HPPH (PMC), correlated significantly with (S)-p-HPPH (or 'total' p-HPPH) content in 0-8, 0-12 and 0-24 urine collections (r = 0.88, 0.85 and 0.89, respectively) and with phenytoin metabolic ratio (PMR) defined as the ratio of urine (S)-p-HPPH (or 'total' p-HPPH) to mid-interval plasma phenytoin (r = 0.90, 0.88 and 0.94, respectively). PMC and PMR exhibited a gene-dose effect so that the highest and lowest values were noted in homozygous subjects CYP2C9*1 and subjects carrying two defective alleles, respectively, whereas heterozygous subjects had intermediate values. CYP2C9 genotyping and several phenytoin metabolic indices are correlated with CYP2C9 activity in vivo. The utility of phenytoin to predict the metabolism of other CYP2C9 substrates justifies further evaluation.

Adult↗
PubMed2001

Compound cardiac toxicity of oral erythromycin and verapamil.

OBJECTIVE: To report a case of complete atrioventricular (AV) block and QTc prolongation following coadministration of high-dose verapamil and erythromycin. CASE SUMMARY: A 79-year-old white woman was admitted to the hospital due to extreme fatigue and dizziness. On admission, heart rate was 40 beats/min and blood pressure was 80/40 mm Hg. An electrocardiogram showed complete atrioventricular (AV) block, escape rhythm of 50 beats/min, and QTc prolongation 583 msec. This event was attributed to concomitant treatment with verapamil 480 mg/d and erythromycin 2,000 mg/d, which was prescribed one week before admission. DISCUSSION: This is the first case published describing complete AV block and prolongation of QTc following coadministration of erythromycin and verapamil. CYP3A4 is the main isoenzyme responsible for metabolism of erythromycin and verapamil. Both drugs are potent inhibitors of CYP3A4 and of P-glycoprotein; this may be the basis for the pharmacokinetic interaction between erythromycin and verapamil. In addition to being a woman, our patient had other risk factors for QT prolongation: slow baseline heart rate (probably induced by verapamil), left-ventricular hypertrophy, and possibly ischemic heart disease. CONCLUSIONS: This life-threatening arrhythmia was probably the result of a pharmacokinetic and/or pharmacodynamic interaction of high-dose verapamil and erythromycin.

Aged↗
PubMed2001

[Eletroencephalographic ambulatory monitoring in refractory epilepsies in childhood].

The objective of our study was, by means of continuous prolonged ambulatory electroencephalographic monitoring, to analyze the temporal distribution of paroxysmal discharges during sleep and awake in children and adolescents with refractory epilepsies. Twenty-one patients in the 4-to-17 year age bracket with refractory epilepsies, with 52.3% (n=11) male and 47.6% (n=10) female from the Discipline of Neurology of the Universidade Federal de São Paulo (Federal University of São Paulo). Cerebral Holter was carried out with Bioware EEG-2008 of prolonged ambulatory electroencephalographic monitoring equipment. We observed greater frequency of isolated and grouped epileptic discharges in day and in night sleep in relation to awake; day and night sleep led to activation of epileptic discharges, both isolated and grouped. The cerebral Holter was more effective in detecting epileptiform discharges than the routine EEG in 33.33% of the patients. The cerebral Holter proved a useful and precise method in detecting epileptic discharges, as an aid in the assessment of the fluctuations in frequency of paroxysmal activity in children with refractory epilepsies, both in relation to activities in daily life, and to the relation to the biological cycle of sleep and awake.

Adolescent↗
PubMed2000

Local SIgA response following administration of a novel intranasal inactivated influenza virus vaccine in community residing elderly.

Community-residing elderly were immunized twice intranasally three weeks apart with a new inactivated whole influenza vaccine. A control group was immunized intramuscularly with conventional influenza vaccine. Local antibody response was detected in about 50% of intranasally immunized subjects compared to about 20% of intramuscularly immunized subjects, to the three viral strains. Increasing the incidence of elevated IgA response may prevent influenza at its early stages thus reducing complications in the elderly.

Administration, Intranasal↗
PubMed2000

Natural course of insulin edema.

Generalized edema due to water retention is a very rare complication of insulin therapy. It affects mainly patients with newly diagnosed diabetes or patients with chronic hyperglycemia following initiation of insulin therapy. When it occurs, it is treated effectively with diuretics. This case report describes a female patient, who developed severe insulin edema following initiation of insulin. Diuretics were not given due to severe side effects, thus the natural outcome of insulin edema was observed. Edema was gradually replaced by fat tissue with persistent weight gain. Physicians treating diabetic patients should be aware of "insulin edema" in the differential diagnosis of weight gain in patients treated with insulin.

Body Weight↗
PubMed2000

Coronary vasospasm associated with uncontrolled carcinoid tumour.

We report on a 74-year-old carcinoid patient who, following acute myocardial infarction (MI) and percutaneous transluminal coronary angioplasty, suffered recurrent episodes of chest pain and ST-segment elevation on ECG. This was accompanied by elevation of urinary 5-hydroxy-indole acetic acid. A review of the patient's file revealed that during the 3 weeks prior to the MI, she had been treated inadvertently with a fivefold lower dosage of octreotide. Following the correction of octreotide dosage, episodes of chest pain resolved immediately. We therefore suggest that this patient suffered from recurrent coronary vasospasm due to uncontrolled carcinoid tumour.

Aged↗
PubMed2000

Safety of low dose methotrexate in elderly patients with rheumatoid arthritis.

Weekly low dose methotrexate is an established treatment for rheumatoid arthritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheumatoid arthritis. A retrospective review of the clinical records of rheumatoid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and treated with methotrexate in a dose of 7.5 mg/week while being maintained on concurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. After two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was significantly reduced from 7.9 (1.8) x 10(9)/l to 6.8 (1.7) x 10(9)/l (r = 0.184, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a non-significant decrease in platelet count. The erythrocyte sedimentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r = 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appears to be safe. Routine determination of serum liver enzymes and renal function may reduce individual risk.

Aged↗
PubMed2000

Mefloquine-induced acute hepatitis.

Mefloquine is an effective drug for prophylaxis and treatment of malaria caused by Plasmodium falciparum. It is generally well tolerated with few side effects. Minimal elevation of liver function tests has been reported after exposure to mefloquine, especially in susceptible individuals with prior abnormal liver function tests. Our patient, who had had elevated liver function tests attributed to heart failure, experienced an acute elevation of liver transaminases 6 weeks after exposure to mefloquine 250 mg/week. Cessation of the drug caused test results to return to normal. Mefloquine should be prescribed cautiously in patients with liver disease.

Acute Disease↗
PubMed2000

Local and systemic immune response in community-dwelling elderly after intranasal or intramuscular immunization with inactivated influenza vaccine.

Intramuscular (IM) influenza vaccines are about 50% effective in preventing clinical illness among the elderly and their effectiveness in eliciting mucosal response may be even lower. The aim of the present study was to evaluate the immunological effect of a novel inactivated intranasal (IN) trivalent whole influenza virus vaccine among community-dwelling elderly. Sixty-one subjects were vaccinated with two doses of an IN vaccine and a control group of 31 subjects was vaccinated with a commercial IM vaccine. Viral strains in the 1997/8 vaccine used were A/Nanchang/933/95(H3N2), A/Johannesburg/82/96(H1N1) and B/Harbin/7/94. Serum IgG and nasal IgA were determined by HI and ELISA, respectively. Only a few minor local adverse events were reported after vaccination. Seroconversion for the three antigens tested was higher after IM vaccination, although not statistically significant. Local antibody response to the three antigens tested was detected in 50-53% and 19-26% of IN and IM immunized subjects, respectively. The IN vaccine tested was significantly more effective than the IM vaccine in inducing mucosal IgA response. This may prevent influenza at its early stages and thus contribute to the reduction of complications in the elderly.

Administration, Intranasal↗
PubMed1999

Corticosteroid-induced glaucoma attributable to an adrenocorticotropin-secreting malignant carcinoid tumor of the thymus.

PURPOSE: To describe the clinical and histopathologic findings in a patient with corticosteroid-induced open-angle glaucoma attributable to an adrenocorticotropin-secreting malignant carcinoid of the thymus. METHODS: Case report. In a 33-year-old man, the clinical course, laboratory findings, and imaging results as well as the histopathologic findings are described. RESULTS: Increased intraocular pressure in this patient represented a manifestation of severe hypercortisolism attributable to a malignant adrenocorticotropin-secreting carcinoid tumor. Surgical removal resulted in return of the intraocular pressure values to normal levels. CONCLUSION: Thymic carcinoid is a rare cause of Cushing syndrome, which can lead to increased intraocular pressure.

Adrenocortical Hyperfunction↗
PubMed1998

[Laterality of musical functions in partial epilepsy].

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

Adult↗