Biomedical subjects

Robert Berkowitz

Publications and source records attributed to Robert Berkowitz.

12 recordsLinked to original sources

PubMed2006

Once-daily evening administration of mometasone furoate in asthma treatment initiation.

BACKGROUND: In a previous study, a 200-microg once-daily evening dose of mometasone furoate dry powder inhaler (DPI) was effective in patients with asthma previously taking inhaled corticosteroids. No studies have been conducted to test the effect of a once-daily evening dose in patients previously using only short-acting beta2-adrenergic agonists (SABAs) for symptom relief. OBJECTIVE: To evaluate the effectiveness of mometasone furoate DPI administered once daily in the evening as initial controller therapy in patients previously using SABAs alone for asthma. METHODS: Patients with mild-to-moderate persistent asthma from 18 US centers participated in a 12-week, randomized, double-blind, placebo-controlled study. Patients received either mometasone furoate DPI, 200 microg, or placebo once daily in the evening. The primary efficacy variable was the change in forced expiratory volume in 1 second from baseline to the end point (last evaluable visit). Other measurements included forced vital capacity, forced expiratory flow between 25% and 75%, morning and evening peak expiratory flow, asthma symptoms, use of albuterol, nocturnal awakenings, physicians' evaluation of response to therapy, and time to asthma worsening. RESULTS: At the end point, the mean increase in forced expiratory volume in 1 second relative to baseline for the mometasone furoate DPI group of 0.43 L (16.8%) was significantly greater than that for the placebo group of 0.16 L (6.0%) (P < .01). Morning peak expiratory flow, forced vital capacity, and forced expiratory flow between 25% and 75% also significantly improved with mometasone furoate DPI treatment relative to placebo (P < .01). Once-daily dosing with mometasone furoate DPI was well tolerated. CONCLUSION: Mometasone furoate DPI (200 microg) administered once daily in the evening significantly improves pulmonary function in patients previously using SABAs alone for asthma control.

Adolescent↗

PubMed2005

Reduced nicotine reward in obesity: cross-comparison in human and mouse.

RATIONALE: Tobacco use and obesity lead to significant morbidity and mortality. OBJECTIVE: This study was conducted to investigate the factors maintaining smoking behavior in lean and obese individuals by utilizing a mouse/human cross-validation model of nicotine reward. METHODS: In humans, a cigarette choice paradigm was used to examine the relative reinforcing value of nicotine in obese and non-obese smokers. Conditioned place preference (CPP) for nicotine was assessed in mice fed standard low fat rodent chow and mice rendered obese by a high fat diet. RESULTS: In humans, obese smokers self-administered nicotine via cigarettes significantly less often than non-obese smokers and showed attenuated hedonic effects of nicotine-containing cigarettes compared to denicotinized cigarettes. Similarly, mice exposed to a high fat diet did not exhibit nicotine CPP, relative to control mice. mRNA levels for mu-opiate and leptin receptors were also downregulated in the ventral tegmental area of these mice. CONCLUSIONS: Together, these studies provide the first evidence for reduced nicotine reward in obese subjects and suggest that this may be mediated by dietary influences on the endogenous opioid system.

Animals↗

PubMed2005

Pullout strength of self-tapping screws inserted to different depths.

OBJECTIVES: The purpose of this study was to determine whether the depth of insertion through the far cortex of self-tapping screws significantly affects pullout strength. DESIGN: Fifty, Synthes, 3.5-mm, self-tapping screws were inserted into synthetic bone blocks and divided into 5 groups. Group 1 had screws with their tips inserted 1 mm short of the far cortex. Group 2 had screws inserted flush with the far cortex. Groups 3, 4, and 5 had screws inserted 1 mm, 2 mm, and 3 mm past the far cortex respectively. Pullout strength was then tested. SETTING: Institutional research laboratory. MAIN OUTCOME MEASUREMENTS: Pullout strength (peak force) was measured for each group and analyzed using a single factor analysis of variance-balanced incomplete block design. RESULTS: Peak force values presented as mean +/- SD for the 5 groups were as follows: group 1 (1380 +/- 69 N), group 2 (1566 +/- 137 N), group 3 (1956 +/- 137 N), group 4 (2013 +/- 184 N), group 5 (2044 +/- 174 N). With a P < or = 0.05, it was found that groups I and II had statistically different pullout strengths than all other groups. However, there was no significant difference in pullout strength between groups 3, 4, and 5. CONCLUSIONS: Synthes self-tapping screws exhibit their highest pullout strength when inserted 1 mm past the far cortex, and there is no significant increase in pullout strength with deeper insertion depths.

Bone Screws↗

PubMed2005

Neuropsychiatric disorders at the presentation of type 2 diabetes mellitus in children.

OBJECTIVES: To estimate the frequency of neuropsychiatric disease (NPD) in an urban pediatric type 2 diabetes mellitus (T2DM) population, to compare demographic characteristics of affected patients with those unaffected with NPD, and to determine the frequency of psychotropic medication treatment. STUDY DESIGN: Retrospective chart review of patients with T2DM at the Children's Hospital of Philadelphia. RESULTS: Of 237 patients with T2DM, 46 (19.4%) were found to have NPD at the presentation of diabetes. Diagnoses by report included depression, attention-deficit hyperactivity disorder (ADHD), neurodevelopmental disorders, schizophrenia, and bipolar disorder. Those affected were 63% females and 37% males, with a mean age of 14.6 yr and body mass index (BMI) of 34.3 kg/m(2) at diagnosis of T2DM. Patients were 79% African American, 13% Caucasian, 4.3% Hispanic, and 4.3% Asian. There were no statistically significant differences in demographic characteristics or BMI between those affected and unaffected with NPD. Twenty-nine patients (63%) were on psychotropic medication and were prescribed 58 medications, most commonly mood stabilizers (n = 20) and atypical antipsychotics (n = 17). CONCLUSIONS: Our data reveal a high frequency of NPD among pediatric patients with T2DM at presentation to a tertiary care, urban medical center. Many affected patients are receiving psychotropic medication. These data have implications for screening regimens for pediatric populations at high risk for T2DM and for therapeutic interventions, including lifestyle measures.

Adolescent↗

PubMed2004

Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry.

OBJECTIVES: We conducted a prospective multicenter registry in a large metropolitan area to define the clinical characteristics, hospital course, treatment, and factors precipitating decompensation in patients hospitalized for heart failure with a normal ejection fraction (HFNEF). BACKGROUND: The clinical profile of patients hospitalized for HFNEF has been characterized by retrospective analyses of hospital records and state data banks, with few prospective single-center studies. METHODS: Patients hospitalized for heart failure (HF) at 24 medical centers in the New York metropolitan area and found to have a left ventricular (LV) ejection fraction of > or 50% within seven days of admission were included in this registry. Patient demographics, signs and symptoms of HF, coexisting and exacerbating cardiovascular and medical conditions, treatment, laboratory tests, procedures, and hospital outcomes data were collected. Analysis by gender and race was prespecified. RESULTS: Of 619 patients, 73% were women, who were on average four years older than men (72.8 +/- 14.1 years vs. 68.6 +/- 13.8 years, p < 0.001). Black non-Hispanic patients comprised 30% of the study population. They were eight years younger than other patients (66.0 +/- 14.2 years vs. 74 +/- 13.5 years p < 0.001). Co-morbid conditions and their prevalence were: hypertension, 78%; increased LV mass, 82%; diabetes, 46%; and obesity, 46%. Before clinical decompensation that precipitated hospitalization, 86% of patients had chronic symptoms compatible with New York Heart Association functional classes II to IV. Factors precipitating clinical decompensation were identified in 53% of patients. In-hospital mortality was 4.2%. CONCLUSIONS: Patients hospitalized for HFNEF are most often chronically incapacitated elderly women with a history of hypertension and increased LV mass. Reasons for clinical decompensation are identified in only one-half of patients.

Adult↗

PubMed2004

B-type natriuretic Peptide and the diagnosis of acute heart failure.

Heart failure is a major public health problem and despite significant advances in treatment remains the only cardiovascular disease still on the rise. Because this patient population often has a number of other concomitant diseases, including hypertension, coronary artery disease, arrhythmias, diabetes, chronic obstructive pulmonary disease, and renal insufficiency, diagnosis can be difficult. Currently, diagnosis of acute decompensated heart failure (ADHF) relies largely on patient history, signs, and symptoms. Rapid and accurate diagnosis of ADHF in the emergency department (ED) is essential for timely initiation of treatment. Thus, any means for improving the speed and accuracy of ADHF diagnosis in the ED can contribute to better clinical and economic outcomes. Measurement of circulating endogenous B-type natriuretic peptide (BNP) has proven to be a sensitive and specific test for heart failure that can easily be used in the ED. Used in conjunction with standard diagnostic procedures, measurement of BNP levels can improve the accuracy of ADHF diagnosis during the critical window for optimal care.

Decision Trees↗

PubMed2003

Early childhood caries: an overview with reference to our experience in California.

Dental caries in young children frequently appears first on the maxillary primary incisors, where the liquids ingested by the infant sucking on a bottle or breast remain pooled away from salivary flow. This so-called early childhood caries can rapidly progress to result in rampant destruction of the primary dentition. ECC can affect children from all socioeconomic classes but is most often found in children of new immigrants or those with lower socioeconomic status. The treatment of ECC is costly, and treatment relapses are frequent. Prevention and treatment of ECC focus on inhibition of the growth of oral bacteria. Strategies include reducing the frequency of exposure to bacterial substrates, as well as controlling the growth of oral bacteria. Topical antibacterials such as 10 percent povidone iodine show promise for future use in the inhibition of ECC in young children.

Anti-Infective Agents, Local↗

PubMed2002

Decrements in vigilance and cognitive functioning associated with ragweed-induced allergic rhinitis.

BACKGROUND AND OBJECTIVE: The adverse effects of untreated seasonal allergic rhinitis (AR) on performance in the workplace, school, and home are poorly understood. To delineate more clearly the impact and consequences of the disease on performance, the effect of symptomatic AR on vigilance and a wide range of cognitive functions was investigated. METHODS: A battery of automated neuropsychological tests was administered to asymptomatic adult subjects with histories of AR. Subjects were randomized to either a symptomatic or to an asymptomatic group. Subjects in the symptomatic group were exposed to ragweed pollen in a controlled exposure setting until they demonstrated predetermined severities of AR symptoms. Subjects in the asymptomatic group were not exposed to ragweed pollen in the environmental unit and retained a minimum symptom profile. The battery of cognitive measures was re-administered to both groups. RESULTS: AR had major adverse impacts on measures of vigilance. Further, AR adversely affected a broad range of cognitive functions. Specifically, subjects with AR symptoms demonstrated longer response times and decreased efficiency on measures of working memory, psychomotor speed, reasoning/computation, and divided attention as compared with asymptomatic subjects. CONCLUSIONS: In addition to decreased vigilance, AR was associated with decrements in speed and efficiency across several cognitive domains. This is similar to findings in research on medications and medical conditions that cause sedation. Findings may represent a link between AR and poor productivity/personal safety among AR sufferers. This suggests that these results have implications with regard to public health.

Allergens↗

PubMedDate not supplied

Strategies to reduce hospitalization in the management of heart failure.

Progressive and debilitating heart failure (HF) affects almost 5 million, mostly elderly, individuals in the United States. As the elderly population grows in coming decades, the prevalence of HF is expected to increase substantially. In addition to its human toll, HF yields a substantial economic burden, with direct and indirect cost estimates ranging from $27 to $56 billion annually. It is associated with an unacceptably high rehospitalization rate--50% within 6 months--which not only drives burgeoning costs but also provides a signal that current management approaches to HF are less than optimal. Evidence-based treatment approaches, which include the use of beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, and nesiritide, may offer opportunities for reducing mortality and rehospitalization rates in HF. Yet, because of inadequate discharge guidance and follow-up, many patients with HF are caught in a "revolving door" process that ultimately culminates in exacerbation and rehospitalization. Hospital-based disease management programs have consistently been shown to optimize care and reduce rehospitalization rates in patients with HF. The Hackensack University Medical Center HF program is discussed as an example of a successful HF program. This program represents a multidisciplinary, multifaceted approach to care that emphasizes case management. The core goal of this program is to provide a continuum of care that extends through hospitalization and into the patients' home environment.

Aftercare↗

PubMedDate not supplied

Current and emerging issues with B-type natriuretic peptide. Roundtable discussion.

A brief panel discussion was held on March 23, 2005, in New York City following a live symposium for primary care physicians discussing the roles of B-type natriuretic peptide in a variety of cardiovascular diseases. The participants were Dr. Marc A. Silver, Advocate Christ Medical Center, Oak Lawn, IL; Dr. Clive Rosendorff, Mount Sinai School of Medicine, New York, NY and VA Medical Center, Bronx, NY; Dr. Robert Berkowitz, Hackensack University Medical Center, Hackensack, NJ; and Dr. W. Franklin Peacock IV, The Cleveland Clinic Department of Emergency Medicine, Cleveland, OH. Dr. Silver moderated the discussion. The panel gathered to review some of the questions that emerged from the symposium and the questions raised by the attendees. These are of interest and importance to all interested in heart failure and B-type natriuretic peptide.

Heart Failure↗

PubMedDate not supplied

Application of continuous positive airway pressure in hypoxemic acute respiratory failure associated with diastolic dysfunction in pregnancy.

Diastolic heart failure with hypoxemia is a dangerous condition in pregnancy for both the mother and the fetus. Continuous positive airway pressure may help to decrease afterload and reduce venous return and ventricular filling, but its use in diastolic dysfunction has not yet been established. The authors report a case of a patient with pregnancy-induced hypertension and oligohydramnios who developed acute decompensated diastolic heart failure. The addition of continuous positive airway pressure, diuretics, and neurohormonal-blocking agents lead to a dramatic clinical and physiologic improvement. The authors recommend consideration of the use of positive pressure ventilation in these patients.

Acute Disease↗

PubMedDate not supplied

Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report.

PURPOSE: The purpose of this study was to assess the efficacy of antimicrobial therapy in the prevention of early childhood caries (ECC). METHODS: The study population consisted of 83 subjects (age: 12 to 19 months (x= 15.6); gender: 40 females and 43 males). Inclusion criteria included: (1) unremarkable medical history; (2) presence of 4 maxillary primary incisors (MPI) with no visible defects; (3) clinically caries free; (4) use of a nursing bottle at naptime and/or bedtime which contained a cariogenic substrate; (5) 2 consecutive ms positive cultures from pooled MPI plaque. The subjects were randomized into 2 groups. The 39 subjects in the experimental group and the 44 subjects in the control group were evaluated every 2 months during the study period. At each evaluation, the subjects had 10% povidone iodine (experimental group) or placebo (control group) applied to their dentition. Treatment failure was defined as the appearance of a white spot lesion(s) on any of the MPI during the study period. RESULTS: Using the Kaplan-Meier procedure, the estimated percents (+/- SES) of participants to experience 12 months of disease-free survival were 91 +/- 5% for those receiving treatment and 54 +/- 9% for those in the control group. Via the log-rank test, the hazard of treatment failure is statistically significantly higher in the placebo group (log-rank statistic 10.28, two-sided P=0.0013). CONCLUSIONS: These observations indicate that topical antimicrobial therapy increases disease-free survival in children at high risk for ECC.

Anti-Infective Agents, Local↗