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At least 631 records · Page 35Linked to original sources

Risk factors, co-medication, and concomitant diseases: their influence on the outcome of therapy with cisapride.

In a 28-day non-blinded study of 1071 patients with functional dyspeptic symptoms in a general practice setting, 666 presented with mainly typical symptoms of functional dyspepsia and received 5 mg cisapride three times daily, while 405 with predominating symptoms indicative of gastroesophageal reflux received 10 mg cisapride three times daily. On the basis of an anamnestic risk factor analysis for organic lesions, 'low-risk' patients were to be treated directly with cisapride, while for 'high-risk' patients a more thorough gastrointestinal examination was recommended before starting cisapride. Of patients in the dyspepsia group 75% reported a good or excellent response; the corresponding rate was 80% in the reflux group. Low-risk patients in both groups tended to respond better than high-risk patients (mean difference, 11%). Patients and investigators reached identical assessments of response. Concomitant antacids, calcium antagonists, beta-blockers and sedatives did not affect the results, but concomitant NSAIDs reduced the mean improvement rate by 14% (p < 0.01). Adverse effects such as abdominal cramps and loose stools were uncommon (< or = 3.4%).

Cisapride↗

Evaluation of a nonisotopic DNA assay kit for diagnosing Plasmodium falciparum malaria in Madagascar.

This study evaluated a nonisotopic DNA assay kit for diagnosing Plasmodium falciparum malaria in an area of Madagascar where all Plasmodium species of human malaria are present and where malaria is endemic. Blood samples from 440 healthy children and 20 healthy adults were processed and assayed in a single day in a blind protocol. The parasitemia levels of the four Plasmodium species were determined by microscopic examinations and by counts of numbers of malaria parasites per 1,000 white blood cells. Relative to P. falciparum infections, the DNA assay results agreed with those of microscopy for 207 positive and 239 negative samples; two samples were scored as positive by the DNA probe that were not detected by microscopy, and 12 samples were scored as positive by microscopy but were not detected by the assay. Relative to microscopy, the sensitivity of the assay was 95%, the specificity was 99%, and the effective sensitivity threshold of the DNA probe assay was approximately 30 parasites/mm3 of blood. The assay did not detect infections with either P. vivax, P. malariae, or P. ovale alone, but detected mixed infections of P. falciparum with either P. vivax or P. ovale. With this nonisotopic DNA probe assay, we were able to process large numbers of samples efficiently and to detect P. falciparum malaria infections with high sensitivity and specificity in a population that did not display overt disease symptoms.

Adolescent↗

Infectious keratoconjunctivitis in bighorn sheep, Silver Bell Mountains, Arizona, USA.

An infectious keratoconjunctivitis (IKC) epizootic in bighorn sheep (Ovis canadensis) occurred in the Silver Bell Mountains, Arizona, USA, from 1 December 2003 to 31 March 2004. We used standard culture methods and polymerase chain reaction (PCR) amplification of the 16S rRNA gene to test for the causative agents of IKC and other diseases reported to be associated with bighorn sheep populations. All bighorn sheep and domestic goat test results were negative except for Mycoplasma spp. and Branhamella spp. The culture and PCR results differed. Conjunctival swabs from four of 19 IKC-affected bighorn sheep tested by culture were positive for Mycoplasma spp., whereas 22 of 22 bighorn sheep samples tested by PCR were positive for Mycoplasma spp. None of 13 domestic goats tested positive by culture for Mycoplasma spp., whereas five of 16 tested positive by PCR. Three of 16 domestic goats and seven of 24 IKC-affected bighorn sheep tested positive for Branhamella spp. by culture. Bighorn sheep began showing clinical signs of IKC between 21 and 28 days following initial detection of domestic goats in bighorn sheep habitat. The IKC epizootic lasted 122 days, and individual bighorn sheep were blind for an average of 38.4 days. Given the clear potential for disease transmission to bighorn sheep, we recommend that land managers not allow the pasturing of domestic goats near occupied bighorn sheep habitat.

Animals↗

[Clinical study of effect of yizhi capsule on senile vascular dementia].

OBJECTIVE: To assess the efficacy of Yizhi capsule (YZC) in treating senile dementia. METHODS: Sixty-one vascular dementia (VaD) patients were randomly divided into YZC and control groups. There were 32 cases in YZC group, 4 capsules each time three times a day. In control group, there were 29 cases, 2 mg of hydergine were given each time three times a day, single-blind method was used and the treatment course was two months. RESULTS: YZC could remarkably increase mini-mental state examination (MMSE) and Hamilton Depression Scale (HDS) marks of VaD patients. YZC had the effect of improving balance and gait ability of VaD patients. YZC could improve the abnormal blood velocity (BV), as well as improve cerebral blood flow, brain electrical activity monitoring (BEAM) and hemorheological indexes especially for the abnormal case. No side-effect or toxic-effect was observed in the administration period. CONCLUSION: YZC had certain effect on senile VaD, and it was safe in application.

Aged↗

Clinical evaluation of a new 10% carbamide peroxide tooth-whitening agent.

NUPRO Gold Tooth Whitening System was evaluated for efficacy according to the proposed ADA guidelines for acceptance. Sixty participants with discolored anterior teeth participated in a 14-day, double-blind, clinical trial. The participants were matched for age, gender, and oral health status and were given either a placebo gel without the active agent or the NUPRO Gold active gel, which they wore in a custom-fabricated mouth guard for home use. The shade of each participant's maxillary anterior teeth was evaluated using a value-oriented Vita Lumin Vacuum Shade Guide before the study. The same shade guide was used to determine shade changes. Time of use of the agent and potential side effects, such as tooth and gingival hypersensitivity and tissue irritation, were assessed at all recall examinations and were recorded by participants in daily diaries. The average shade change for the placebo users was less than one shade. The average shade change for the NUPRO Gold users was 6.96 shades. Tooth hypersensitivity varied from none to severe. Tissue irritation was minimal. The results of these evaluations indicate that NUPRO Gold is effective as a tooth-whitening system, when administered properly under the supervision of a dentist, with commonly reported side effects of transient tooth sensitivity and minimal gingival sensitivity. Little or no change in tissue health was noted. This study was supported by Dentsply Preventive Care (York, Pennsylvania).

Adolescent↗

Erythromycin for chlamydiasis in pregnant women. Assessing adherence to a standard multiday, multidose course.

OBJECTIVE: To assess patient adherence among pregnant women infected with Chlamydia trachomatis given a self-administered, 10-day course of erythromycin prescribed as 500-mg tablets to be taken four times a day for the full 10-day period of treatment. STUDY DESIGN: Study participants (n = 30) were given the standard, 10-day supply of 500-mg tablets of erythromycin and instructed to take one tablet four times daily for 10 days. Patients were blinded to the fact that the Medication Event Monitoring System was being used and that their adherence to this course of drug therapy was being monitored. RESULTS: A 100% cure rate was achieved. The average percentage of therapeutic coverage actually achieved by the study participants declined with the length of erythromycin therapy. Further, as the duration of treatment increased, the longest interval between two successive doses of erythromycin also increased. CONCLUSION: This study demonstrated the importance of assessing both the quantitative and temporal aspects of self-administered oral medication when assessing patient adherence. Moreover, since the length of the course of antibiotic therapy was shown to affect patient adherence, coupled with the 100% cure rate we observed, future research geared toward maximizing adherence while minimizing duration of treatment seems warranted.

Adult↗

Adult ADHD. Controlled medication assessment.

Many adults with ADHD respond to stimulant therapy, but controlled medication assessments have not been reported. We administered an effortful working memory task in four half-day sessions, double blind, at methylphenidate levels of 0, 5, 10 and 20 mg. Dose-response curves were established individually. Fifteen of 17 patients displayed a favorable response to one or more levels of medication; that is, they achieved more correct responses and less variability than on placebo. Each dose level elicited optimal performance from some of the patients. Unlike monitoring by self-report, the objective medication assessment offers an expeditious approximation to the ultimate optimal dose, potentially saving the patient weeks on an ineffective and/or excessive dosage regime.

Association Learning↗

Degeneration of myelinated efferent fibers induces spontaneous activity in uninjured C-fiber afferents.

We demonstrated recently that uninjured C-fiber nociceptors in the L4 spinal nerve develop spontaneous activity after transection of the L5 spinal nerve. We postulated that Wallerian degeneration leads to an alteration in the properties of the neighboring, uninjured afferents from adjacent spinal nerves. To explore the role of degeneration of myelinated versus unmyelinated fibers, we investigated the effects of an L5 ventral rhizotomy in rat. This lesion leads to degeneration predominantly in myelinated fibers. Mechanical paw-withdrawal thresholds were assessed with von Frey hairs, and teased-fiber techniques were used to record from single C-fiber afferents in the L4 spinal nerve. Behavioral and electrophysiological data were collected in a blinded manner. Seven days after surgery, a marked decrease in withdrawal thresholds was observed after the ventral rhizotomy but not after the sham operation. Single fiber recordings revealed low-frequency spontaneous activity in 25% of the C-fiber afferents 8-10 d after the lesion compared with only 11% after sham operation. Paw-withdrawal thresholds were inversely correlated with the incidence of spontaneous activity in high-threshold C-fiber afferents. In normal animals, low-frequency electrocutaneous stimulation at C-fiber, but not A-fiber, strength produced behavioral signs of secondary mechanical hyperalgesia on the paw. These results suggest that degeneration in myelinated efferent fibers is sufficient to induce spontaneous activity in C-fiber afferents and behavioral signs of mechanical hyperalgesia. Ectopic spontaneous activity from injured afferents was not required for the development of the neuropathic pain behavior. These results provide additional evidence for a role of Wallerian degeneration in neuropathic pain.

Action Potentials↗

Schizophrenia and valproate.

Valproate (the active moiety of both valproic acid and divalproex sodium) is commonly used as an adjunctive agent for the treatment of schizophrenia. Among the anticonvulsants, valproate is the most extensively studied in patients with schizophrenia. Theoretical underpinnings for valproate in schizophrenia include its effect on voltage-gated ion channels and on the g-aminobutyric acid (GABA) system, thus modulating mesolimbic dopaminergic activity. Case reports, retrospective studies, and randomized clinical trials support the use of valproate combined with antipsychotics in managing schizophrenia. A recently completed 28-day, double-blind, randomized clinical trial of 249 patients with schizophrenia demonstrated faster improvement in psychopathology with a combination therapy of divalproex and risperidone or olanzapine, compared to monotherapy with risperidone or olanzapine. Additional research is needed to assess the utility of valproate in specialized populations such as those with treatment-refractory schizophrenia or agitation in schizophrenia. Regarding the latter, positive double-blind, randomized clinical trials have already been conducted in patients with borderline personality disorder, dementia, and with disruptive adolescents. It is anticipated that future research will focus on the new extended-release formulation of divalproex that can be administered on a once-daily basis.

Affect↗

Loracarbef (LY 163892) vs amoxicillin/clavulanate in bacterial maxillary sinusitis.

Loracarbef (LY 163892), a beta-lactam antibiotic (carbacephem), was compared with amoxicillin/clavulanate potassium in a 10-day, single-blind, randomized parallel trial in the treatment of acute bacterial maxillary sinusitis. Based on posttherapy aspirate and culture, there was a 95.2% bacteriologic cure rate in patients receiving loracarbef (400 mg twice daily) and an 86.7% cure rate in patients receiving amoxicillin/clavulanate (500/125 mg three times daily) (p = 0.359). Loracarbef was comparable in efficacy to amoxicillin/clavulanate with a more desirable safety profile.

Adolescent↗

Lack of burning and stinging from a novel first-aid formulation applied to experimental wounds.

Antiseptic-anesthetic first aid formulations typically produce a burning or stinging sensation when used on wounds. The aim of this study was to assess the lack of sting/burn potential of a prototype first-aid wipe when applied to superficial wounds. This was a one-day, double-blind, randomized study, evaluating the stinging/burning sensation from a prototype first-aid wipe with a cellulose base containing 1.0% pramoxine HCL and 0.13% benzalkonium chloride. The study followed a direct comparison test design of four test formulations. The remaining three articles were: (a) sterile 0.9% sodium chloride (no-sting/no-burn control), (b) 3% hydrogen peroxide (first-aid sting/burn control), and (c) 70% isopropyl alcohol (second sting/burn control). The test was performed on 24 subjects. The tape stripping method was used to create four standardized wounds on the volar forearms, reaching the glistening layer. Each test article was applied to the wound for 15 seconds. The subjects were asked to report the intensity of the stinging/burning sensation during the application. The prototype pramoxine-benzalkonium chloride wipe produced significantly less stinging/burning than both 70% isopropyl alcohol and 3% hydrogen peroxide. Also, the prototype wipe did not produce more stinging and burning in superficial wounds compared to the saline control.

Administration, Topical↗

Comparison of the parasitologic efficacy of amodiaquine and sulfadoxine-pyrimethamine in the treatment of Plasmodium falciparum malaria in the Bungoma District of western Kenya.

The efficacy of amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) was assessed in 310 symptomatic children from western Kenya with uncomplicated Plasmodium falciparum malaria. A non-blinded, randomized, 14-day study was performed and parasitologic criteria were used. Of 310 patients included, 238 (77%) completed the study: 120 received AQ and 118 received SP. In those treated with AQ, there were sensitive (S) infections in 107 patients (89.2%, 95% confidence interval [CI] = 82.2, 94.1%), RI resistance in 10 (8.3%, 95% CI = 4.1, 14.8%), RII resistance in 1 (0.8%, 95% CI = 0, 4.6%), and RIII resistance in 2 (1.7%, 95% CI = 0.2, 5.9%). In those treated with SP, there were S infections in 74 patients (62.7%, 95% CI = 53.3, 71.4%), RI resistance in 21 (17.8%, 95% CI = 11.4, 25.9%), RII resistance in 11 (9.3%, 95% CI = 4.7, 16.1%), and RIII resistance in 12 (10.2%, 95% CI = 5.4, 17.1%). Resistance rates were consistently higher in the SP-treated patients (P < 0.001). Resistance to SP in this area has reached such levels that it should no longer be the first-line treatment. Alternative treatment, such as SP plus AQ combination treatment or artemisinin combination treatment, is urgently needed.

Amodiaquine↗

Clinical evaluation of the contact sensitization potential of a transdermal nicotine system (Nicoderm)

BACKGROUND: Transdermal nicotine therapy has shown promise as a smoking cessation aid, but questions about its contact sensitization potential and long-term topical safety have been raised. The purpose of this study was to determine the contact sensitization potential of one nicotine transdermal system (Nicoderm, Marion Merrell Dow Inc, Kansas City, Mo, and ALZA Corporation, Palo Alto, Calif) in a population who were allowed to continue smoking. METHODS: This study comprised two phases separated by a 2-week rest interval. During phase 1, a 42-day open-label induction period, subjects wore only active transdermal nicotine systems. During phase 2, a 4-day double-blind challenge period, subjects wore active and placebo systems concurrently. Upon removal of each patch, skin sites were evaluated for signs of irritation, and subjective complaints such as itching or burning were recorded. RESULTS: Of the 186 subjects completing the study, 3 (1.6%) exhibited evidence of delayed contact sensitization manifested as erythema with or without infiltration and confined solely to sites of active transdermal nicotine system application. Nonallergic skin irritation was observed in less than 3% of all applications. All reactions resolved without incident. No subjects developed systemic reactions. CONCLUSIONS: The transdermal nicotine system used in this trial had a low contact sensitization incidence and was well tolerated topically with minimal irritation.

Adhesives↗

Rapeseed oil and sunflower oil diets enhance platelet in vitro aggregation and thromboxane production in healthy men when compared with milk fat or habitual diets.

In this highly controlled trial, 26 normolipidemic men (average age 28 years, range 18 to 60) were fed a baseline diet high in milk fat (MF) (fat 36% of energy, saturates 19%, monounsaturates 11%, polyunsaturates 4%), followed by a diet high in sunflower oil (SO) (fat 38% of energy, saturates 13%, monounsaturates 10%, polyunsaturates 13%) and another diet high in low erucic-acid rapeseed oil (RO) (fat 38% of energy, saturates 12%, monounsaturates 16%, polyunsaturates 8%). All diets were mixed natural diets with the same cholesterol contents. The baseline milk fat diet was given for 14 days and the oil diets for 24 days in a blind cross-over design. The platelet in vitro aggregation (slope %/min) induced by 1, 2 and 3 microM ADP and collagen (25 micrograms/ml PRP) was highly significantly (p less than 0.001) increased after both oil diets when compared with the results from the milk fat diet. The aggregation pattern determined by threshold collagen concentration confirmed increased collagen sensitivity of the platelets after the rapeseed oil diet (p less than 0.001). The enhancement of platelet aggregation was associated with increased in vitro platelet thromboxane production after the oil diets vs. the milk fat diet (p less than 0.05 after the sunflower oil diet and p less than 0.001 after the rapeseed oil diet).

Adolescent↗

Daily monitored cardiovascular effects of carbamazepine in chronic crack cocaine users.

During a 20-day, double-blind, placebo-controlled, fixed-dose outpatient trial of carbamazepine (either 200 mg or 400 mg) for potential anticocaine treatment effects in volunteers who were unmotivated for treatment and who lacked any external coercion for cocaine abstinence, we monitored cardiovascular effects in 30 subjects on a daily basis. All individual cardiovascular measures obtained were within clinically normal limits. Corrected QT interval under carbamazepine was shorter than under placebo condition, although both were in the normal range. Systolic pressure was elevated by 2.1 mm Hg. No differences in pulse rate were found. With carbamazepine and concurrent ad lib cocaine use, heart rate was significantly, although not clinically, elevated (mean increase = 2.3 beats/minute). The analysis of these approximately 600 observations indicates that carbamazepine in cocaine users, alone and in combination with ad lib street crack use, causes no clinically significant cardiovascular effects.

Carbamazepine↗

A technique for isolating turkey respiratory adenoviruses.

Several turkey respiratory adenoviruses were isolated in turkey embryonic liver cells from nasal turbinate filtrate collected from clinically ill turkey poults during postmortem examination. Suspect adenovirus inoculum had to remain in cell culture for 5 to 7 days, and 9 blind passages were required before a sample was declared negative. Once isolated, the turkey adenoviruses adapted rapidly to turkey kidney cells.

Adenoviridae↗

Over-the-counter dentifrices in the treatment of tooth hypersensitivity. Review of clinical studies.

Dentinal hypersensitivity is a common condition. Most cases, after professional diagnosis, can be treated simply and inexpensively by home use of a desensitizing dentifrice. Because the habit of toothbrushing with a dentifrice for cosmetic reasons is well established in the population, compliance with this regimen is not a problem. Dentifrices incorporating potassium nitrate, strontium chloride, and dibasic sodium citrate have all been clinically determined to be effective desensitizers, and several brands have been critically evaluated and accepted by the Council on Dental Therapeutics of the ADA. During the years, clinical methodology has evolved from monadically designed, subjective investigator reports to present-day, double-blind, placebo-controlled clinical trials employing stimuli that are quantifiable in physical units. Future development of more effective desensitizing dentifrices will depend on standardization in clinical design, especially regarding stimulus choice and mode of application.

Clinical Trials as Topic↗

Use of single internal mammary artery grafts in older patients.

The indications for use of the internal mammary artery as a coronary bypass conduit in older patients are not clearly established. Between January 1985 and December 1988, 786 patients received single internal mammary artery grafts alone (717) or in conjunction with other procedures (69). Of these patients, 341 were 65 years of age or older (mean, 69.3 years). This group was compared with those patients less than 65 years of age (mean, 56.2 years). There were no significant differences between the two groups in the incidence of diabetes mellitus; the number of distal coronary anastomoses; left ventricular wall motion score; the frequency of isolated bypass procedures, reoperations, or emergent operations; or the durations of aortic clamping and cardiopulmonary bypass. The older group contained more women (34.9% versus 20.7%) and more patients with left main coronary artery disease (15.5% versus 9.4%) (p less than 0.01). No significant differences in the frequency of reoperation for hemorrhage, perioperative infarction, neurological deficits, requirements for intra-aortic balloon pumping, sternal wound infections, necessity for prolonged ventilatory support, or 30-day mortality (2.7% versus 3.2%) were observed. The length of postoperative hospitalization was greater in the older group (11.8 versus 10.2 days) (p = 0.02). Blinded histological examination of biopsies from 61 internal mammary artery grafts (34 patients less than 65 years, 27 patients greater than or equal to 65 years) showed no significant differences in luminal area or wall thickness. No significant degenerative changes were observed in either group. We conclude that the use of the internal mammary artery for bypass grafting in older patients is safe and may provide long-term benefit.

Age Factors↗