PubMed Journal Database | American journal of therapeutics 
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Showing PubMed Articles 1–25 of 54 from American journal of therapeutics
Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Extension of a pancreatic pseudocyst into the mediastinum is rare. We present a case of a 43-year-old male with a history of pancreatitis, who presented with dysphagia and was found to have a pancreatic pseudocyst. The pseudocyst was extending to the mediastinum and compressing the esophagus. It was successfully drained externally by computed tomography-guided catheter intervention. Depending on the location and size, patients...
Morphine sulfate and naltrexone hydrochloride extended release capsules (EMBEDA®, King Pharmaceuticals®, Inc., Bristol, TN), indicated for the management of chronic, moderate to severe pain, contain extended release morphine pellets with a sequestered naltrexone core (MS-sNT). If the product is tampered with by crushing, naltrexone, a μ-opioid antagonist, is intended for release to mitigate morphine-induced subjective effects. The primary end point of this randomized 2-way crossover study in healthy fast...
To study the safety and efficacy of a new medical food (Theramine) in the treatment of low back pain, we performed a 28-day double-blind randomized controlled trial in 129 patients. Back pain was present for at least 6 weeks and was not mild. Patients were randomly assigned to receive medical food alone (n = 43), naproxen alone (250 mg/d, n = 42), or both medical food and naproxen (n = 44). All patients were assessed by using Roland-Morris Disability Questionnaire, Oswestry Low Back Pain Scale, Visual Analo...
Treatment of Stable Angina Pectoris.
Management of stable angina pectoris includes antianginal medications, medications to prevent progression of atherosclerosis, and aggressive treatment of causative risk factors. Antianginal medications commonly used include nitrates, beta-blockers, calcium channel blockers, and ranolazine. Antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors are used in patients with these problems to prevent progression of atherosclerosis and/or premature cardiovascular death. Aggressive risk factor c...
The objective of this study was to utilize a case report to review the use of physostigmine for jimsonweed intoxication. A 15-year-old girl was found at school hallucinating and incoherent. Upon presentation to the emergency department, she was found to be tachycardic and confused with dilated pupils and dry, flushed, hot skin. She was admitted to our institution. Hallucinations and symptoms resolved after the use of physostigmine. She subsequently admitted to ingesting 'moonflower seeds,' which are derived...
Pharmacotherapy of Atrial Fibrillation: A Pathophysiological Perspective and Review.
Atrial fibrillation (AF) is one of the most common arrhythmia encountered in clinical practice. Although AF is due to the structural and electrophysiological alterations in the atria, its sustainability is multifactorial, and the actual mechanisms are still not clear. Despite the recent advances in catheter ablation technology and techniques, pharmacotherapy still remains the first-line therapy for the management of AF. Current pharmacotherapy targets ion channel alterations that in fact represent only one...
Accumulation of molecular damage and increased molecular heterogeneity are hallmarks of photoaged skin and pathogenesis of human cutaneous disease. Growing evidence demonstrates the ability of molecular chaperone proteins and of pharmacologic chaperones to decrease the environmental stress and ameliorate the oxidation stress-related and glycation disease phenotypes, suggesting that the field of chaperone therapy might hold novel treatments for skin diseases and aging. In this review, we examine the evidence...
Inducible nitric oxide synthase (iNOS) plays an important role in mediating inflammation. In our studies, we found that iNOS-derived NO was significantly increased in the serum samples of 150 patients infected with influenza A virus in comparison with samples of 140 healthy individuals. In human lung epithelial cells, infection with influenza A virus or stimulation with poly(I:C) + interferon-gamma resulted in increased mRNA and protein levels of both interleukin-32 and iNOS, with subsequent release of NO....
Angioedema is a rare but life-threatening adverse effect of administration of angiotensin-converting enzyme inhibitors (ACEIs) administration. It has been classically associated with ACEIs, although angioedema has also been reported with angiotensin receptor blockers (ARBs). Angioedema is a deep swelling of tissues just below the skin and mucous membranes, characterized by non-pitting asymmetric swelling that is usually non-pruritic. ARBs may cause an increase in plasma angiotensin II levels, which may lead...
Degradation Kinetics of Methionine5-Enkephalin by Cerebrospinal Fluid: In Vitro Studies.
Changes in the levels or biochemistry of cerebrospinal fluid (CSF) neuropeptides with opioid-like properties have been suggested to reflect alterations in specific biological processes. We have determined various kinetic parameters for methionine-enkephalin (MET) degradation by CSF samples from nonneurological patients. Study subjects included 9 males (51-67 years of age) and 5 females (47-61 years of age). Aliquots, removed from an incubation vessel containing buffer, CSF, and peptide [tyr-3',5'-H(N)MET],...
Addressing Barriers to Insulin Therapy: The Role of Insulin Pens.
Despite the fundamental role of insulin therapy in diabetes management, many patients and some clinicians may resist insulin initiation due to concerns about its complexity or a general resistance to injections. Many patients' concerns about insulin initiation may stem from perceptions about the pain and inconvenience of using vials and syringes for delivering insulin. However, insulin pen devices offer an easier method for insulin administration that is more accurate, less painful, and more discreet compar...
Disseminated Tuberculosis Secondary to Adalimumab.
A 62-year-old woman with rheumatoid arthritis presented with fever (T-103.9°F). Vital signs and physical examination were normal. She was taking adalimumab, methotrexate, and prednisone for the past 9 months. Blood and urine cultures, human immunodeficiency virus, rapid plasma reagin, purified protein derivative, and cerebrospinal fluid test findings were negative. Computed tomography showed scattered 0.2-cm nodules in the lungs and innumerable subcentimeter lesions in the liver and spleen. Broad-spectrum...
Evaluation of Cardiovascular Morbidity Associated with Adherence to Atorvastatin Therapy.
Long-term adherence to statins is poor. We assessed the relationship between cardiovascular (CV) risk and atorvastatin adherence in primary- and secondary-prevention patients, adjusting for healthy-adherer bias by incorporating preventive service use into the model. Medical and pharmacy claims from employee-based plans from 2002 to 2008 were analyzed for patients who initiated atorvastatin in 2003-2004. Adherent patients were defined as having ≥60% of days covered in the year after atorvastatin initiation...
Diffuse Alveolar Damage and Recurrent Respiratory Failure Secondary to Sertraline.
Sertraline is one of the most commonly used antidepression medications. In this case report, we present a 52-year-old male, smoker, who presented with respiratory failure, 6 months after starting Sertraline. We noticed an improvement in the clinical course after decreasing the dose of Sertraline and recurrent respiratory failure upon inadvertent rechallenge. Open-lung biopsy showed a picture of diffuse alveolar damage. Eventually, the patient improved after stopping Sertraline. This case demonstrates the re...
Nearly 285 million people worldwide, with 10% being Americans, suffer from diabetes mellitus and its associated comorbidities. This is projected to increase by 6.5% per year, with 439 million inflicted by year 2030. Both morbidity and mortality from diabetes stem from the consequences of microvascular and macrovascular complications. Of the 285 million with diabetes, over a quarter of a million die per year from related complications, making diabetes the fifth leading cause of death in high-income countries...
Erythropoietin in the Treatment of Postural Orthostatic Tachycardia Syndrome.
Erythropoietin has been reported to improve symptoms of orthostatic intolerance in patients suffering from orthostatic hypotension. Previous reports on the use of erythropoietin in patients with postural orthostatic tachycardia (POTS) have included only a very small number of patients. In the current study, we report on the use of erythropoietin in patients with refractory POTS. The study was approved by the institutional review board. A retrospective nonrandomized analysis was performed on 39 patients eval...
Carboplatin-Induced Hematuria in a Patient of Breast Carcinoma. A Case Report.
Platinum-based antineoplastic drugs are widely used in the treatment of solid tumors. Carboplatin, a second generation platinum compound, was developed to have less nonhematologic toxicity, in comparison with cisplatin. We report on a 34-year-old woman with breast cancer who developed gross hematuria after initiation of carboplatin-based chemotherapy. To our knowledge, there are very few cases reports of carboplatin-associated gross hematuria.
The relative effects of atorvastatin and simvastatin among higher- and lower-risk patients are not well characterized. This study compared cardiovascular (CV) risk and direct and indirect costs among higher- and lower-risk employees initiating atorvastatin vs. simvastatin. Using a large employer claims database (1999-2006), employees were stratified as 1) high-risk employees with prior CV events, diabetes, or renal disorders; and 2) low- to intermediate-risk employees without these conditions. Propensity sc...
Recurrent Lower Extremity Pseudocellulitis.
The term "Pseudocellulitis" can be used to describe an uncomplicated nonnecrotizing inflammation of the dermis and hypodermis from a noninfectious etiology. Chemotherapeutic agents have been associated with a variety of cutaneous reactions, including radiation recall dermatitis, hypersensitivity reactions, and erysipeloid reactions. Gemcitabine (2,2-difluorodeoxycytidine) is currently being used for treatment of a variety of solid malignancies, including carcinoma of the lung. The dermatitis involved with g...
Management of F/P+/- Hypereosinophilic Syndromes: Case Report and Treatment Review.
Eosinophilia in clinical practice can occur due to various pathologic processes. Causes of eosinophilia include idiopathic eosinophilia, reactive eosinophilia, idiopathic hypereosinophilic syndrome (HES), chronic eosinophilic leukemia, and other hematopoietic neoplasms (myeloid, lymphatic, or mast cell). We present a case of a 22-year-old man with HES with remarkable clinical manifestations and treatment challenges. A 22-year-old male with a nonsignificant medical history presented with left arm swelling fo...
Hydralazine-Induced Pulmonary-Renal Syndrome: A Case Report.
Drug-induced lupus erythematosus differs in its manifestation from drug-induced vasculitis. The former is associated with characteristic symptoms that improve following discontinuation, whereas the latter is predominantly an antineutrophil cytoplasmic antibody (ANCA) positive small vessel vasculitis involving the kidneys, skin, and lungs. We present a case of advanced disease in an elderly Caucasian woman requiring corticosteroids, and immunosuppressive therapy, who was on hydralazine for >2 years. A 75-yea...
Delayed Onset of Clozapine-Induced Leucopenia.
Clozapine has been reported to cause agranulocytosis, neutropenia, and leucopenia that usually occur within 18 weeks of initiation of treatment. We report a case of delayed onset leucopenia after 11 years of treatment with clozapine, which reversed within a few days after discontinuation of medication.
Effect of Cyclodextrin Infusion in a Rat Model of Verapamil Toxicity.
Sulfobutylether-beta-cyclodextrin (SBE-CD) is a pharmaceutical excipient known to bind verapamil. After intravenous administration, clearance of SBE-CD approximates glomerular filtration rate. We hypothesized that SBE-CD would complex with verapamil in vivo, enhance renal elimination, and increase time to death in a rat model of verapamil toxicity. Ten Wistar rats were allocated to control or intervention groups. All received isoflurane anesthesia followed by verapamil infusion (32 mg/kg) over 1 hour. The c...
Effect of Bicarbonate on Neonatal Serum Ionized Magnesium In Vivo.
Sodium bicarbonate is used to treat metabolic acidosis or to induce metabolic alkalosis in sick neonates. The aim of this study was to quantify the decrease in serum concentration of ionized magnesium ([Mg]) when sodium bicarbonate is administered in vivo. We administered 1 mEq/kg body weight sodium bicarbonate 4.2% for correction of metabolic acidosis (n = 11) for management of persistent pulmonary hypertension (n = 3). After sodium bicarbonate treatment, serum pH increased by an average of 0.046 (P < 0.00...
Infection is a well-recognized complication that can occur after the implantation of cardiac devices such as pacemakers and implantable cardioverter defibrillators (ICDs). Reported infection rates after new device implantation are reported to be around 1%, while infection rates after device generator replacements are higher with a reported average of up to 4-5% per year. Here we report our experience using a modified plastic surgical technique for cardiac device wound closure designed to both reduce infecti...
