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PubMedDate not supplied

Insulin pump therapy in type 1 diabetes mellitus.

OBJECTIVES: To review the current experience with insulin pump therapy in children and adolescents in order to guide pediatricians regarding indications and complications. SOURCES OF DATA: Systematic review of articles published in the literature referring to the use of insulin pump therapy, indications, complications and response to treatment. All articles published between 1995 and 2005 and appearing in the MEDLINE and LILACS databases were reviewed. The keywords were: insulin pump, type 1 diabetes mellitus and diabetes mellitus. The articles covering the subject of interest and referring to children and adolescents were selected. SUMMARY OF THE FINDINGS: Insulin pump therapy is not required for all patients with type 1 diabetes, since intensive treatments produce very similar results in terms of glycated hemoglobin and control of complications over the medium and long terms. However, the pump allows for greater comfort for patients, with less rigid meal schedules and better quality of life. The first requirement for patients intending to use the pump is getting used to having a device attached to the body and following strict glucose control; otherwise, pump therapy is not advantageous. Complications are rare due to the technologies currently available. The cost, however, is greater than with conventional treatments. CONCLUSION: The development of infusion pumps and glucose monitors, including continuous monitoring systems, will lead to "intelligent pumps," so that a true "artificial pancreas" will be available, which can even be implanted in the patient, allowing non-diabetic persons to lead a normal life.

Adolescent↗

PubMed1994

The role of technology in diabetes therapy.

This decade will bring major changes to the therapy of diabetes. New drugs are likely to include monomeric insulins, fatty-acid-oxidation inhibitors, insulin-secretion inducers, and nutrition modifiers. Likely new devices include improved insulin pens, less invasive methods of insulin administration, and noninvasive blood glucose monitoring. The use of computers will integrate this care, and artificial intelligence will provide new approaches to all of health care. An integrated system for using these new technologies, such as staged diabetes management, will ensure an orderly, cost-effective transition in therapy by the entire health-care community.

Blood Glucose↗

PubMed1990

Hypertension: cognitive and behavioral considerations.

This article reviews literature concerning functional changes resulting from elevated blood pressure, from reduction of blood pressure, and as a result of the medications used to treat high blood pressure. The research reviewed includes the areas of psychomotor speed, intelligence and cognitive processing, sensory and perceptual processes, and emotional and interpersonal behaviors. The conclusions reached are that the deficits noted to date in hypertensive individuals are not extreme nor are they specific. The greatest disadvantage, however, appears in the area of response speed.

Antihypertensive Agents↗

PubMed2000

Cognitive-behavioral therapy for medication-resistant symptoms.

Cognitive-behavioral therapy for psychosis is described. It draws on the cognitive models and therapy approach of Beck and colleagues, combined with an application of stress-vulnerability models of schizophrenia and cognitive models of psychotic symptoms. There is encouraging evidence for the efficacy of this approach. Four controlled trials have found that cognitive-behavioral therapy reduces symptoms of psychosis, and there is some evidence that it may contribute to relapse reduction. Studies that have examined factors that predict treatment response are reviewed. There is preliminary evidence that a good outcome is partially predicted by a measure of cognitive flexibility or a "chink of insight." People who present with only negative symptoms may show poorer outcome. However, there is no evidence that intelligence or symptom severity is associated with outcome. Implications for selecting patients and for optimal duration of treatment are discussed. Finally, the importance of taking account of the heterogeneity of people with psychosis, so that individual treatment goals are identified, is discussed.

Adaptation, Psychological↗

PubMed1985

Pulmonary arterial catheterization before anesthesia in patients undergoing cardiac surgery. Placement of the pulmonary arterial catheter before anesthesia for cardiac surgery: safe, intelligent, and appropriate use of invasive hemodynamic monitoring.

Should one catheterize the pulmonary artery (PA) for cardiac surgery before or after induction of anesthesia? Issues of central importance to this question include (1) the patient's preexisting hemodynamic abnormalities, (2) cardiovascular effects of anesthetic induction drugs, and (3) hemodynamic stress caused by laryngoscopy, endotracheal intubation, and PA catheter insertion. Some clinicians use the PA catheter immediately before anesthetic induction to detect and correct acute abnormalities in preload and ventricular function. This approach has been described as being partially responsible for decreased morbidity and mortality in patients with cardiovascular disease. Hemodynamic instability during induction has been reported with many of the common anesthetic induction agents, especially in patients with poor ventricular function. Since blood pressure is the product of cardiac output and systemic vascular resistance, accurate interpretation and treatment of hypotension are possible only when these variables are provided by vigorous use of the PA catheter. Early detection of myocardial ischemia is possible with examination of acute changes in the pulmonary capillary wedge pressure tracing. However, the lack of such information can restrict even the best anesthetist. Insertion of the PA catheter in the awake patient can be accomplished effectively and with minimal risk, so long as good patient rapport, adequate premedication, and continuation of antianginal medication until the time of surgery are assured. Preinduction placement of the PA catheter provides valuable, objective information for the cardiac anesthesiologist without incurring significant risk to the patient.

Anesthesia↗

PubMed2005

Ichthyosis follicularis, alopecia and photophobia (IFAP) syndrome treated with acitretin.

We describe a 3-year-old male patient with the ichthyosis follicularis, alopecia and photophobia (IFAP) syndrome, who developed cutaneous and ocular involvement in infancy. In addition, he had growth retardation and borderline intelligence; no other systemic involvement was found on detailed investigation. A moderate response to acitretin therapy (1 mg/kg) administered for 6 months was observed, with improvement in cutaneous features and corneal erosions and no change in alopecia or photophobia.

Abnormalities, Multiple↗

PubMed1992

Cerebral consequences of hypothermic circulatory arrest in adults.

Despite widespread use of hypothermic circulatory arrest (HCA) in aneurysm surgery and for repair of congenital heart defects, there is continued concern about possible adverse cerebral sequelae. The search for ways to improve implementation of HCA has inspired retrospective clinical studies to try to identify risk factors for cerebral injury, and clinical and laboratory investigations to explore the physiology of HCA. At present, risk factors associated with less favorable cerebral outcome after HCA include: prolonged duration of HCA (usually greater than 60 min); advanced patient age; rapid cooling (less than 20 min); hyperglycemia either before HCA or during reperfusion; preoperative cyanosis or lack of adequate hemodilution; evidence of increased oxygen extraction before HCA or during reperfusion; and delayed reappearance of electroencephalogram (EEG) or marked EEG abnormality. Strategies advocated to increase safety of HCA include: pretreatment with barbiturates and steroids; use of alpha-stat pH regulation during cooling and rewarming; intraoperative monitoring of EEG; slow and adequate cooling, including packing of the head in ice; monitoring of jugular venous oxygen content; hemodilution; and avoidance of hyperglycemia. Current investigation focuses on delineating the relationship of cerebral blood flow (CBF) to cerebral oxygen consumption and glucose metabolism during cooling, HCA, rewarming, and later recovery, and identifying changes in acute intraoperative parameters, including the presence of intracerebral enzymes in cerebral spinal fluid, with cerebral outcome as assessed by neurological evaluation, quantitative EEG, and postmortem histology. Clinically, intraoperative monitoring of EEG and measurement of CBF by tracer washout or Doppler flows are contributing to better understanding of the physiology of HCA, and in the laboratory, nuclear magnetic resonance (NMR) spectroscopy has provided valuable insights into the kinetics of intracerebral energy metabolism. Promising strategies for the future include investigation of other pharmacological agents to increase cerebral protection, and use of "cerebroplegia" or intermittent perfusion between intervals of HCA to improve cerebral tolerance for longer durations of HCA.

Animals↗

PubMed2004

A hybrid model for improving response time in distributed data mining.

This paper presents a hybrid distributed data mining (DDM) model for optimization of response time. The model combines a mobile agent approach with client server strategies to reduce the overall response time. The hybrid model proposes and develops accurate a priori estimates of the computation and communication components of response time as the costing strategy to support optimization. Experimental evaluation of the hybrid model is presented.

Algorithms↗

PubMedDate not supplied

Signaling protein networks as targets of new antineoplastic drugs.

In-depth analysis of molecular regulatory networks in cancer holds the promise of improved knowledge of the pathophysiology of tumor cells so that it will become possible to design a detailed molecular tumor taxonomy. This knowledge will also offer new opportunities for the identification and validation of key molecular tumor targets to be exploited for novel therapeutic approaches. Some signaling proteins have already been identified as such, e.g. c-Myc, Cyclin D1, Bcl-XL, kinases and some nuclear receptors. This has led to the successful development of a few function-modulatory drugs (Glivec, SERM, Iressa), providing proof-of-principle of the validity of this approach. Further developments are likely to derive from "-omic" approaches, aimed at the understanding of signaling networks and of the mechanism of action of newfound lead molecules. High-throughput screening of small drug-like molecules from combinatorial chemical libraries or from microbial extracts will identify novel, "intelligent" drug candidates. An additional medicinal chemistry strategy (via 40-50 unit rosary-bead chains) has the potential to be much more effective than small molecules in interfering with protein-protein interactions. This may lead to considerably higher selectivity and effectiveness compared with historical approaches in drug discovery.

Antineoplastic Agents↗

PubMedDate not supplied

Female university students in Sweden: sex, contraception and STDs.

Female university students (n = 241) visiting the Student Health Center participated in a study concerning sexual behavior (study I). A randomized postal survey (study II) with similar questions was also performed to verify the findings in the first study (n = 137). The mean age was 23 years in both studies. Sexual experience was reported by 96% in study I and 87% in study II. Mean age at first intercourse and mean number of partners were similar; 17.6 years and 6 partners, respectively. Change of contraceptive type was frequent, and about one third had done so within the past two years. A common reason for adopting a new method was a change in social life. More than half the women were afraid of using oral contraceptives. Twenty-six percent of the students in study I and 29% in study II had had at least one sexually transmitted disease (STD). Forty-three percent claimed to have changed their sexual behavior as a result of AIDS publicity but condoms were used by less than 50% at the first intercourse with a new partner. Although this group of intelligent young people have access to information, many of them were risk-takers with respect to both unwanted pregnancies and STD. Misconceptions were frequent concerning the safety of OCs. It is clear that new approaches must be made to educate them about safe sexual practices.

Adult↗

PubMed2002

Polymerized crystalline colloidal array chemical-sensing materials for detection of lead in body fluids.

We have developed intelligent polymerized crystalline colloidal array (IPCCA) chemical-sensing materials for detection of Pb(2+) in high ionic-strength environments such as body fluids with a detection limit of <500 nmol L(-1) Pb(2+) (100 ppb). This IPCCA lead sensor consists of a mesoscopically periodic array of colloidal particles polymerized into an acrylamide hydrogel. The array Bragg-diffracts light in the visible spectral region because of the periodic spacing of the colloidal particles. This material also contains a crown ether chelating agent for Pb(2+). Chelation of Pb(2+) by the IPCCA in low-ionic-strength solutions results in a Donnan potential that swells the gel, which red-shifts the diffracted light in proportion to the Pb(2+) concentration. At high ionic strength the Donnan potential is, unfortunately, swamped and no static response occurs for these sensors. We demonstrate, however, that we can determine Pb(2+) at high ionic strength by incubating these IPCCA in a sample solution and then measuring their transient response on exposure to pure water. The non-complexed ions diffuse from the IPCCA faster than the bound Pb(2+). The resulting transient IPCCA diffraction red-shift is proportional to the concentration of Pb(2+) in the sample. These IPCCA sensors can thus be used as sensing materials in optrodes to determine Pb(2+) in high-ionic-strength solutions such as body fluids.

Acrylamide↗

PubMed1987

Infectious morbidity in gynecologic cancer.

A retrospective investigation of infectious morbidity in gynecologic oncology patients documented that 54 (11%) of 494 patients and 68 (6%) of 1204 patient admissions were complicated by a serious infection. The highest rate of infectious morbidity by admission was 21%, occurring in patients admitted for cancer of the vulva. The highest surgical infectious morbidity, 22%, occurred in patients admitted for cervical cancer. Important factors in determining infection risk include multiple host factors, radical surgical procedures, factors inherent in the tumor itself, and additional irradiation and chemotherapy. These serious polymicrobial infections dictate intelligent selection of antimicrobials and appropriate monitoring to anticipate complications inherent in antimicrobial therapy. beta-Lactamase induction, superinfection, nephrotoxicity, and necrotizing enterocolitis are documented problems in these patients.

Adult↗

PubMed1980

Autism: definition, diagnosis, and management.

Recent investigations have exploded a number of misconceptions about autism. It is not a disease of the upper middle class; nor are parents etiologic agents; the children do not "tune out" but rather they never "tune in"; most important, autism is not childhood schizophrenia, and the diagnostic criteria are discriminating. Management of autism mandates close physician-family-community interactions.

Affective Symptoms↗

PubMed2006

Improvement of cognitive functioning in mood disorder patients with depressive symptomatic recovery during treatment: an exploratory analysis.

Depressive symptoms have a large impact on cognitive test performance of mood disorder patients. After remission, some improvement of cognitive functioning has been observed, but also stable deficits have been reported both during depression and remission. In the present study, the authors aimed to investigate the cognitive functioning of mood disorder patients in relation to early symptomatic recovery, by comparing performances at the Wechsler Adult Intelligence Scale-Revised (WAIS-R) of responders and non-responders to the antidepressant treatment. The sample was composed of 51 hospitalized patients for a major depressive episode (major depressives/bipolars = 37/14). All patients were treated with fluvoxamine and evaluated at baseline and after 4 weeks using the 21-item Hamilton Rating Scale for Depression. All subjects were once assessed for their cognitive functioning with the WAIS-R, at the end of the fourth week of treatment. In the current sample, patients who showed a significant symptomatic remission after 4 weeks of treatment showed higher total WAIS-R scores and a lower incidence of cognitive impairment, compared to non-responders to treatment. No major differences could be observed on any particular subtest, but rather a global improving of scores in responders compared to non-responders to pharmacotherapy. Pre-treatment illness severity, that was significantly higher among non-responders, was significantly associated with patients' intelligence quotient scores. Despite a number of limitations, present data support a strong effect of depressive symptoms on patients WAIS-R performances and an early global improvement of cognitive functioning concurrent with symptomathology recovery during pharmacological treatment.

Adult↗

PubMedDate not supplied

The work of the Drugs Intelligence Laboratory, Home Office Forensic Science Service.

The primary purpose of the Drugs Intelligence Laboratory is to help the police identify sources of supply and manufacture of illicit drugs. This is done by providing scientific support to the Central Drugs and Illegal Immigration Intelligence Unit, a national police unit based at New Scotland Yard, London. The Laboratory provides detailed information on United Kingdom drug seizures and data obtained from a programme of comparison and characterization of seized samples. This intelligence information is then used to supplement that obtained through normal police channels in the search for illicit drug sources, manufacturers or distributors. This paper describes the techniques used for comparing and characterizing various drug preparations and outlines the type of information that can be gained from such studies.

Amphetamines↗

PubMed2001

Evaluation and application of liquid chromatographic columns coated with "intelligent" ligands. (III). Immobilized phospholipid column.

Immobilized enzyme columns have been developed for use as high-performance liquid chromatographic enzyme reactors. Enzyme reactors were prepared by immobilizing trypsin or cytochrome-c on phospholipid columns. Dynamic coating was employed to prepare the reactors by recycling a buffer solution containing trypsin or cytochrome-c through a phospholipid-coated column, on which the enzymes were immobilized by hydrophobic binding. The immobilized trypsin column displayed hydrolytic activity which catalyzed the hydrolysis of L-amino acid esters to amino acid. The immobilized cytochrome-c column exhibited oxidation activity which catalyzed N-demethylation of N,N-dimethylaniline, codeine, and dihydrocodeine in the presence of hydrogen peroxide as an oxygenating agent. The enzyme reaction proceeded rapidly in the column; both product and substrate could be separated and detected simultaneously. The immobilized enzyme columns could be readily regenerated using the original phospholipid column by repeating the dynamic coating. These immobilized enzyme columns could be utilized as enzyme reactors in the high-performance liquid chromatographic mode. Complete hydrolysis of amino acid ester was observed with the trypsin column. Demethylation of codeine and of dihydrocodeine were observed with the cytochrome-c column.

Aniline Compounds↗

PubMed1998

Adult and two children with fetal methotrexate syndrome.

The folic acid antagonists, methotrexate and aminopterin, are known to be teratogenic in humans. The critical period for their teratogenecity is suspected to be between 6 to 8 weeks post-conception. Fetal exposure from 10 to 32 weeks weeks post-conception to methotrexate alone or in combination with other anti-cancer drugs has not resulted in obvious teratogenic effects. Methotrexate is often used to treat cancers but is occasionally used as an abortifacient. The long-term outcome of the fetal aminopterin syndrome has been published in only four adults. We report on a 28-year-old man with fetal methotrexate syndrome and two children with mild manifestations of the syndrome. One child was inadvertently exposed to methotrexate from 7 1/2 through 30 weeks post-conception because his mother was receiving it for treatment of breast cancer. The other was exposed from 11 weeks and 5 days through 25 weeks in an attempt to induce abortion. The 28-year-old man has craniofacial and digital anomalies, growth retardation but normal intelligence as noted in the previously reported cases. These cases remind us of the teratogenicity of methotrexate and should serve as a warning that if methotrexate is used as an abortifaciant and an abortion does not ensue, there is a teratogenic risk.

Abnormalities, Drug-Induced↗

PubMed1976

Methylphenidate effects in learning disabilities. Psychometric changes.

Sixty-one children of average intelligence with appreciable learning lags, but no behaviour disorders, received placedo or methylphenidate hydrochloride for a 12-week period. Methylphenidate was instrumental in improving performance on many psychological tests, but did not affect performance on standardized achievement tests. None of the patient characteristics investigated was stringly predictive of drug effect. Methylphenidate seems to have a specific effect on visualmotor processes, which in turn positively affect performance tasks, but not verbal tasks. Under the conditions of this study, methylphenidate treatment alone did not emerge as a useful agent for the amelioration of reading performance, although the data provide evidence for stimulation effects on children's cognitive functions.

Adolescent↗