Drugs for amnesia in the ICU

1997 ◽  
Vol 6 (3) ◽  
pp. 192-201 ◽  
Author(s):  
BK Wagner ◽  
DA O'Hara ◽  
JS Hammond
Keyword(s):  
Data Extraction ◽  
Safety Information ◽  
Plasma Concentrations ◽  
Anterograde Amnesia ◽  
Cerebral Injury ◽  
Duration Of Action ◽  
Conference Abstract ◽  
Study Selection ◽  
High Doses ◽  
Long Acting

OBJECTIVE: This review focuses on how patients' recall of their stay in the ICU can be modified pharmacologically. DATA SOURCES: Computerized MEDLINE and PAPERCHASE searches of English- and foreign-language published research from 1966 to 1995, bibliographies, pharmaceutical and personal files, and conference abstract reports. STUDY SELECTION: All abstracts from uncontrolled and controlled clinical trials were reviewed. DATA EXTRACTION: Study design, population, results, and safety information were retained. Efficacy conclusions were drawn from controlled trials. DATA SYNTHESIS: Patients without cerebral injury may recall mental and physical discomfort during their stay in the ICU. All benzodiazepines produce amnestic effects, but the short duration of action, lack of long-acting metabolites, and potent amnestic effects make lorazepam and midazolam preferable in this setting. Infusions of propofol for conscious sedation produce concentrations below those required for consistent amnesia. Opioids generally do not produce amnesia; however, end-organ failure and use of high doses of opioids may increase plasma concentrations to levels that produce impairment of learning and various degrees of amnesia. High infusion rates of ketamine may be required for satisfactory amnesia and pain control (with coadministration of benzodiazepine). Barbiturates and haloperidol do not impair memory in patients who are not critically ill. Antihistamines and anticholinergics that do not penetrate the central nervous system do not produce amnesia. Flumazenil may induce recall. CONCLUSIONS: Patients may remember their stay in the ICU, depending on the type of injury and the drug therapy. Of the drugs presented, benzodiazepines most reliably provide anterograde amnesia, whereas ketamine and propofol exhibit dose-dependent effects on memory.

Nelarabine: A Nucleoside Analog with Efficacy in T-Cell and other Leukemias

2005 ◽  
Vol 39 (6) ◽  
pp. 1056-1063 ◽  
Author(s):  
David F Kisor
Keyword(s):  
T Cell ◽  
English Language ◽  
Data Extraction ◽  
Safety Information ◽  
Hematologic Malignancies ◽  
Water Soluble ◽  
Significant Activity ◽  
Study Selection ◽  
Important Addition ◽  
Key Terms

OBJECTIVE: To present the pharmacology and pharmacokinetics of nelarabine, 9-β-D-arabinofuranosylguanine (ara-G) and intraleukemic cellular pharmacokinetics of 9-β-D-arabinofuranosylguanine triphosphate (ara-GTP) generated from the administration of nelarabine, and clinical and safety information relative to nelarabine use in the treatment of hematologic malignancies. DATA SOURCES: MEDLINE (1966—December 2004) was searched using the English-language key terms 2-amino-6-methoxypurine arabinoside, 506U78, and nelarabine. Data were also obtained from published abstracts. STUDY SELECTION AND DATA EXTRACTION: Clinical studies evaluating the pharmacokinetics of nelarabine, ara-G, and cellular ara-GTP and use of nelarabine, alone or in combination with other agents for the treatment of hematologic malignancies, were included in this review. DATA SYNTHESIS: Nelarabine is the water-soluble, 6-methoxy analog of 9-β-D-ara-G. Nelarabine is readily converted to ara-G by endogenous adenosine deaminase. The half-life of nelarabine is approximately 15 minutes compared with 2–4 hours for ara-G. The clearance of ara-G is higher in children than in adults (0.312 vs 0.213 L × h−1 × kg−1). Intracellular ara-GTP elimination is slow relative to nelarabine and ara-G. In pediatric and adult patients, neurologic toxicity is dose limiting. Severe myelosuppression was not consistently observed. Major responses were seen in patients with T-cell malignancies. Patients who responded had significantly higher intracellular ara-GTP concentrations compared with those who did not respond. CONCLUSIONS: Nelarabine is an effective ara-G prodrug. Nelarabine has significant activity against malignant T-cells and appears to be an important addition to treatments of various leukemias.

New Treatment for Chronic Obstructive Pulmonary Disease: Tiotropium Bromide

2005 ◽  
Vol 21 (3) ◽  
pp. 144-149
Author(s):  
Emily W Evans
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Data Extraction ◽  
Tiotropium Bromide ◽  
Chronic Obstructive ◽  
Duration Of Action ◽  
Obstructive Pulmonary Disease ◽  
Study Selection ◽  
New Treatment

Objective: To review chronic obstructive pulmonary disease (COPD) and evaluate the role of tiotropium bromide in its treatment. Data Sources: MEDLINE was searched for articles published between 1990 and June 2004 that contained the terms tiotropium and chronic obstructive pulmonary disease. Study Selection/Data Extraction: Selected studies documented clinical outcomes related to the use of tiotropium bromide and included a complete description of methods and results. These studies were examined to determine the extent of the effect of tiotropium on clinical outcomes involved in COPD. Data Synthesis: Tiotropium bromide has a long duration of action and thus can be dosed just once daily. It was found to improve lung function, reduce symptoms, improve health status, and decrease exacerbations compared with both placebo and other bronchodilator medications. Conclusions: Tiotropium appears to be a valuable addition to the current therapies available for COPD.

Effect of Vitamin D Supplementation on the Incidence of Diabetes Mellitus

2020 ◽  
Vol 105 (8) ◽  
pp. 2857-2868 ◽  
Author(s):  
Mahmoud Barbarawi ◽  
Yazan Zayed ◽  
Owais Barbarawi ◽  
Areeg Bala ◽  
Ahmad Alabdouh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vitamin D ◽  
Data Extraction ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Cochrane Library ◽  
Study Selection ◽  
Incidence Risk ◽  
High Doses ◽  
The Cochrane Library

Abstract Context The effect of vitamin D supplementation on the risk of type 2 diabetes mellitus (T2DM) remains controversial because most randomized controlled trials (RCTs) have been small or have reported low doses of vitamin D. Objective To conduct a meta-analysis of RCTs testing vitamin D supplementation in the prevention of T2DM. Data Sources Database search of PubMed/MEDLINE, EMBASE, and the Cochrane Library was performed by 2 reviewers from inception through September 15, 2019. Study Selection We included RCTs that reported the effect of vitamin D supplementation for at least 1 year on T2DM prevention. Data Extraction Two independent reviewers extracted the data. The risk ratios (RRs) and 95% confidence intervals (CIs) were reported. Primary outcome of the meta-analysis was the incidence of T2DM. Data Synthesis Nine RCTs were included (43 559 participants). The mean age (standard deviation) was 63.5 (6.7) years. The RR for vitamin D compared with placebo was 0.96 (95% CI, 0.90-1.03); P = 0.30. In trials testing moderate to high doses of supplementation (≥1000 IU/day), all conducted among participants with prediabetes, the RR for vitamin D compared with placebo was 0.88 (95% CI, 0.79-0.99). In contrast, the trials testing lower doses, which were conducted in general population samples, showed no risk reduction (RR, 1.02; 95% CI, 0.94-1.10; P, interaction by dose = 0.04). Conclusion In patients with prediabetes, vitamin D supplementation at moderate to high doses (≥1000 IU/day), significantly reduced the incidence risk of T2DM, compared with placebo.

High-Dose Daptomycin and Clinical Applications

2021 ◽  
pp. 106002802199194
Author(s):  
Timothy W. Jones ◽  
Ah Hyun Jun ◽  
Jessica L. Michal ◽  
William J. Olney
Keyword(s):  
Data Extraction ◽  
High Dose ◽  
Burn Patients ◽  
Gram Positive ◽  
Data Synthesis ◽  
First Line Therapy ◽  
Search Terms ◽  
Study Selection ◽  
High Doses ◽  
Meta Analyses

Objective: To evaluate evidence for high-dose daptomycin (doses ≥ 8 mg/kg/d). Data Sources: A PubMed/MEDLINE literature search was performed (January 2000 to December 2020) using the search terms daptomycin, high dose, and dosing. Review article references and society guidelines were reviewed. Study Selection and Data Extraction: Clinical trials, observational studies, retrospective studies, meta-analyses, and systematic reviews reporting on high-dose daptomycin were included. Data Synthesis: Experimentally, daptomycin outperforms other antimicrobials for high inoculum and biofilm-associated infections. Clinically, high-dose daptomycin is supported as salvage and first-line therapy for endocarditis and bacteremia, primarily when caused by methicillin-resistant Staphylococcus aureus (when vancomycin minimum inhibitory concentration is >1 mg/L) and Enterococcus. High-dose daptomycin appears effective for osteomyelitis and central nervous system infections, although comparative studies are lacking. High dosing in renal replacement therapy requires considering clearance modality to achieve exposures like normal renal function. Weight-based dosing in obesity draws concern for elevated exposures, although high doses have not been evaluated kinetically in obesity. Some data show benefits of high doses in overweight populations. Burn patients clear daptomycin more rapidly, and high doses may only achieve drug exposures similar to standard doses (6 mg/kg). Relevance to Patient Care and Clinical Practice: This review analyzes the efficacy and safety of high-dose daptomycin in serious gram-positive infections. Discussion of specific infectious etiologies and patient populations should encourage clinicians to evaluate their daptomycin dosing standards. Conclusions: The efficacy of high-dose daptomycin and limited safety concerns encourage clinicians to consider high-dose daptomycin more liberally in severe gram-positive infections.

Effect of a Long-Acting Octapeptide Analogue of Somatostatin on Growth Hormone and Pancreatic and Gastrointestinal Hormones in Man

1981 ◽  
Vol 61 (5) ◽  
pp. 653-656 ◽  
Author(s):  
A. J. Barnes ◽  
R. G. Long ◽  
T. E. Adrian ◽  
W. Vale ◽  
M. R. Brown ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Plasma Concentrations ◽  
Gastrointestinal Hormones ◽  
Gastric Inhibitory Polypeptide ◽  
Duration Of Action ◽  
Disease States ◽  
Subcutaneous Dose ◽  
Prolonged Duration ◽  
Pancreatic Endocrine Tumours ◽  
Long Acting

1. The biochemical specificity and duration of action of a single 5 mg subcutaneous dose of des-AA1,2,4,5,12,13-d-Trp8-somatostatin were evaluated in eight patients with symptomatic pancreatic endocrine tumours. 2. There was a reduction by more than 50% for at least 10 h in plasma concentrations of growth hormone, glucagon, gastrin and motilin and for 4–5 h in plasma insulin, pancreatic polypeptide, gastric inhibitory polypeptide and enteroglucagon. 3. This study shows that this octapeptide analogue of somatostatin, like somatostatin itself, lacks specificity in the hormones it suppresses. However, its prolonged duration of action against several hormones when given subcutaneously suggests that it may be of therapeutic use in a number of disease states where excessive plasma concentrations of one or more of these hormones occur.

Tiotropium: A Bronchodilator for Chronic Obstructive Pulmonary Disease

2005 ◽  
Vol 39 (9) ◽  
pp. 1467-1475 ◽  
Author(s):  
Heather Somand ◽  
Tami L Remington
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Data Extraction ◽  
Tiotropium Bromide ◽  
Chronic Obstructive ◽  
Anticholinergic Agent ◽  
Obstructive Pulmonary Disease ◽  
Study Selection ◽  
Long Acting

OBJECTIVE: To review the scientific literature evaluating the efficacy and tolerability of tiotropium bromide, a new bronchodilator indicated for treatment of chronic obstructive pulmonary disease (COPD). DATA SOURCES: Articles were identified through searches of MEDLINE (1966–January 2005) using the key words tiotropium, BA 679 BR, chronic obstructive pulmonary disease, and anticholinergic agents. Additional citations were identified from bibliographies of publications cited. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of tiotropium bromide were selected. Trials of the efficacy of the drug in humans were the focus of the review. DATA SYNTHESIS: Tiotropium bromide is an effective bronchodilator for patients with COPD. It produces clinically important improvements in lung function, symptoms of dyspnea, quality of life, and exacerbation rates compared with placebo. In comparative studies, tiotropium does not appear to be more efficacious than salmeterol or ipratropium. CONCLUSIONS: Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD. Although similar to ipratropium in efficacy and tolerability, it has the advantage of once-daily dosing.

CLINICAL INVESTIGATIONS OF A LONG-ACTING OESTRIOL (POLYOESTRIOL PHOSPHATE)

1961 ◽  
Vol 38 (1) ◽  
pp. 73-87 ◽  
Author(s):  
Christian Lauritzen ◽  
Semih Velibese
Keyword(s):  
Side Effects ◽  
Phosphoric Acid ◽  
Quantitative Data ◽  
Water Soluble ◽  
Cholesterol Concentration ◽  
Experimental Investigations ◽  
Clinical Investigations ◽  
Prolonged Duration ◽  
High Doses ◽  
Long Acting

ABSTRACT A description is given of experimental investigations and preliminary clinical experience with the long-acting oestriol compound polyoestriol phosphate – a water-soluble polymere of oestriol and phosphoric acid. The compound seems to exert all the physiologically important effects of oestriol. Even with high doses the hormone causes no proliferation of the endometrium and no withdrawal bleeding. It has no untoward effect on metabolism. It decreases slightly the cholesterol concentration (to the extent of ⅓–⅕ of the effect produced by long-acting oestradiol esters). The compound has a wide therapeutic range. No side-effects have been observed. Doses of 10 mg or more have a prolonged duration. Additional prolongation of the effect is largely dependent on dosage. To ensure an effect lasting for 4 weeks 40 mg polyoestriol phosphate (corresponding with 30 mg oestriol) is required – an amount which roughly corresponds with physiological quantitative data. The compound, which involves an interesting new principle of prolongation, was most effectively used in the treatment of menopausal symptoms and genital organic disorders. For these indications it can be recommended without reservation.

scholarly journals Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Abdou Fatawou Modiyinji ◽  
Jean Joel Bigna ◽  
Sebastien Kenmoe ◽  
Fredy Brice N. Simo ◽  
Marie A. Amougou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis E Virus ◽  
Data Extraction ◽  
Meta Analysis ◽  
Hepatitis E ◽  
Epidemiological Studies ◽  
Cross Sectional ◽  
Resource Limited ◽  
Study Selection ◽  
Language Restriction

Abstract Background Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. Methods In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. Results Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0–37.2) for anti-HEV immunoglobulins G, 13.1% (3.1–28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2–4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9–65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). Conclusions We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.

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