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British Journal of Clinical Pharmacology Jan 19791. The metabolism and plasma kinetics of chlordiazepoxide have been determined in a group of volunteers and in a group of patients with acute alcohol intoxication. 2....
1. The metabolism and plasma kinetics of chlordiazepoxide have been determined in a group of volunteers and in a group of patients with acute alcohol intoxication. 2. Using the SAAM 26 non-linear least squares fitting programme, all chlordiazepoxide plasma concentration v time data following oral administration could be analysed in terms of a one-compartment open model with metabolic conversion of chlordiazepoxide to desmethylchlordiazepoxide. 3. Acutely intoxicated patients showed a prolonged elimination of chlordiazepoxide and a reduced clearance when compared with alcohol-free volunteers. The elimination of desmethylchlordiazepoxide, on the other hand, appeared to be faster in the alcoholics. 4. Alcohol exerts significant effects on the metabolism of chlordiazepoxide in acutely intoxicated patients.
Topics: Adult; Aged; Alcoholic Intoxication; Chlordiazepoxide; Dealkylation; Half-Life; Humans; Kinetics; Male; Middle Aged; Time Factors
PubMed: 760747
DOI: 10.1111/j.1365-2125.1979.tb00903.x -
Current Eye Research 2016To analyze current understanding of the factors that contribute to raised intraocular pressure (IOP) in patients with uveitis. (Review)
Review
AIM
To analyze current understanding of the factors that contribute to raised intraocular pressure (IOP) in patients with uveitis.
METHODS
A pubmed literature review was carried out using words including "uveitic glaucoma", "IOP AND uveitis", "ocular hypertension AND uveitis", "inflammation AND glaucoma", "aqueous dynamics" AND "glaucoma/uveitis".
RESULTS
Of the two studies looking at the aqueous dynamics in experimentally induced uveitis, both found aqueous flow decreased acutely, and one found that uveoscleral outflow increased. This is likely to reflect the types of uveitis that present acutely with hypotony. A study examining patients with Fuch's heterochromic cyclitis found no difference in aqueous flow or uveoscleral outflow. No studies have examined aqueous dynamics in types of uveitis that present with acutely raised IOP. Levels of prostaglandins rise in acute uveitis, which has been shown to increase uveoscleral and trabecular outflow, without affecting aqueous flow. Studies have demonstrated that raised levels of trabecular protein reduce trabecular outflow. Steroid treatment, inflammatory cells, free radicals and enzymes are also likely to contribute to the development of raised pressure. When considering the impact of the pathogenesis of raised pressure in uveitis on its treatment, prostaglandins may provide good intraocular pressure control, but there are concerns regarding their theoretical ability to worsen the inflammatory response in uveitis. Studies have not conclusively proven this to be the case. Surgical success rates vary, but trabeculectomy plus an antimetabolite, deep sclerectomy plus an antimetabolite, and Ahmed valve surgery have been used.
CONCLUSIONS
Uveitic glaucoma is caused by a number of different diseases, some of which present with acute hypotony, others with acutely raised IOP, and others which demonstrate an increase in IOP over time. Further studies should be carried out to examine the differing pathogenesis in these types of diseases, and to establish the best treatment options.
Topics: Humans; Intraocular Pressure; Ocular Hypertension; Risk Factors; Uveitis
PubMed: 25974243
DOI: 10.3109/02713683.2015.1017650 -
The Clinical Respiratory Journal Apr 2014The clinical management of tuberculosis (TB) could be greatly improved by an affordable biomarker test to monitor treatment response. Here, we examined changes in...
BACKGROUND AND AIMS
The clinical management of tuberculosis (TB) could be greatly improved by an affordable biomarker test to monitor treatment response. Here, we examined changes in immunoglobulin M (IgM) antibody response to lipids as a potential biomarker for monitoring TB treatment in an experimental mouse model.
METHODS
We performed enzyme-linked immunosorbent assay to investigate changes in IgM antibody response against cardiolipin (CL), phosphatidylcholine (PTC), phosphatidylethanolamine (PE), phosphatidylinositol (PI) and sphingolipid (SL) in BALB/c mice that were treated after being infected with Mycobacterium tuberculosis for 4 weeks (acute infection) and 20 weeks (chronic infection). Cytokine levels [interleukin (IL)-5, IL-10, interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1)] in lung and spleen homogenates as well as in blood were also compared.
RESULTS
In both acutely and chronically infected mice, lungs were sterilised of M. tuberculosis infection after 8 weeks of treatment. The IgM response to CL, PTC, PE, PI and SL were consistently elevated throughout the course of infection in chronically infected mice compared with acutely infected mice. In acutely infected mice, the IgM antibody response against CL significantly decreased after 8 weeks of treatment, but not against other lipids. In chronically infected mice, the IgM response showed no significant changes against any of the lipids after 8 weeks of treatment. Of the cytokines examined, only MCP-1 levels in lungs decreased significantly after treatment.
CONCLUSION
These findings demonstrate that antilipid IgM antibody can remain elevated in chronically infected mice, but with treatment, only anti-CL IgM antibody levels decreased together with M. tuberculosis bacterial burden in acutely infected mice. Treatment did not affect antilipid IgM levels in chronically infected mice.
Topics: Acute Disease; Animals; Antibodies, Antiphospholipid; Antitubercular Agents; Chronic Disease; Disease Models, Animal; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Immunity, Innate; Immunoglobulin M; Mice; Mice, Inbred BALB C; Tuberculosis
PubMed: 23910993
DOI: 10.1111/crj.12049 -
Neurourology and Urodynamics 2002To evaluate the acute and chronic urodynamic effects of electrically stimulated detrusor myoplasty in dogs. (Comparative Study)
Comparative Study
AIMS
To evaluate the acute and chronic urodynamic effects of electrically stimulated detrusor myoplasty in dogs.
METHODS
Eight female mongrel dogs were studied acutely and six dogs chronically (0 to 12 weeks postoperatively). Bladders were wrapped with the rectus abdominis muscle, keeping an intact blood supply and at least two intercostal nerves of the flap preserved. Bladders were electrically stimulated with bipolar electrodes inserted into the muscle. Urodynamics and post void residual were measured post operatively in the acute studies and every 2 weeks for 3 months in chronic studies.
RESULTS
Acutely, the increase in intravesical pressure was 45+/-7 cm H(2)O, which resulted in a postvoid residual of 26+/-3%. In the chronic study, increases of intravesical pressure sufficient to empty the bladder during myoplasty electrical stimulation were not sustained, although detrusor compliance and flap viability were preserved.
CONCLUSIONS
The electrically stimulated detrusor myoplasty worked well acutely to increase vesical pressure sufficient to empty the bladder, but the chronically stimulated myoplasty did not maintain efficient bladder emptying primarily due to electrode problems. Further studies with improved electrode material and placement are required before clinical application of the electrically stimulated detrusor myoplasty can be assessed.
Topics: Animals; Compliance; Dogs; Electric Stimulation; Female; Muscle Contraction; Pressure; Rectus Abdominis; Surgical Flaps; Time Factors; Urinary Bladder; Urodynamics
PubMed: 12232891
DOI: 10.1002/nau.10035 -
Cureus Nov 2017The two main treatment modalities of acute intracranial aneurysm rupture are endovascular embolization and surgical clipping, each with its own benefits and risks....
The two main treatment modalities of acute intracranial aneurysm rupture are endovascular embolization and surgical clipping, each with its own benefits and risks. Endovascular treatment is associated with better outcomes compared to surgical clipping, but is also associated with high recurrence rates. We present the case of a patient with an acutely ruptured intracranial aneurysm, who subsequently underwent partial endovascular coiling acutely, and later underwent flow diversion therapy with the Pipeline Embolization Device. We also review the literature on this topic for further recommendations on treatment options of acute intracranial aneurysm rupture.
PubMed: 29487765
DOI: 10.7759/cureus.1876 -
Journal of Thoracic Imaging Jul 2015Acute dyspnea is a common presenting complaint in the Emergency Room. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse... (Review)
Review
Acute dyspnea is a common presenting complaint in the Emergency Room. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities that require further assessment with computed tomography (CT). The aim of this review is to outline a pattern-based approach for the analysis of diffuse pulmonary abnormalities in an acutely dyspneic patient with emphasis on CT appearances. Specific disease entities may be differentiated by their distribution in the lungs and by their radiologic findings. Recognition of the predominant finding and its distribution can generate an appropriate differential diagnosis that is further refined by the presence or absence of ancillary findings. Incorporation of the clinical history, laboratory data, and prior studies narrows the differential diagnosis, indicates the optimum modality for further evaluation, and, in some situations, provides important prognostic data.
Topics: Acute Disease; Dyspnea; Humans; Lung; Lung Diseases; Tomography, X-Ray Computed
PubMed: 25730554
DOI: 10.1097/RTI.0000000000000133 -
World Journal of Critical Care Medicine Feb 2014Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety... (Review)
Review
Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ''crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity (fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy based on functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity (fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ''default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.
PubMed: 24834399
DOI: 10.5492/wjccm.v3.i1.24 -
Journal of Clinical Microbiology Feb 2019This study evaluated the usefulness of adding the IgA antibody enzyme-linked immunosorbent assay (ELISA) to the serologic panel of tests done for the diagnosis of acute...
This study evaluated the usefulness of adding the IgA antibody enzyme-linked immunosorbent assay (ELISA) to the serologic panel of tests done for the diagnosis of acute toxoplasmosis in pregnant women in a reference laboratory in the United States. We conducted a retrospective study of 690 consecutive pregnant women with positive IgG antibody test results who also had IgA and IgM antibody tests performed. Patients were defined as acutely or chronically infected with based on a panel of serologic tests performed at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL). Among the 81 women who were positive by IgA antibody ELISA testing, 61 (75.3%) were acutely infected with , while of the 547 who were negative by IgA testing, only 24 (4.4%) were acutely infected ( < 0.001). Among the 71 women who were positive by both IgA and IgM antibody tests, 61 (85.9%) were acutely infected, whereas 24 (19.2%) of the 125 women who were positive by only the IgM ELISA were acutely infected ( < 0.001). These results demonstrate that pregnant women with IgA antibodies are more likely than pregnant women without IgA antibodies to have had a recent infection with IgA antibody testing can therefore improve the accuracy of a serologic panel for the diagnosis of acute toxoplasmosis during pregnancy. Physicians who ordered testing only for IgG and IgM should also request additional testing for IgA and IgG avidity, if both IgG and IgM are positive. This further testing should, ideally, be performed in a reference laboratory.
Topics: Adolescent; Adult; Antibodies, Protozoan; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin A; Immunoglobulin M; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Serologic Tests; Toxoplasma; Toxoplasmosis; United States; Young Adult
PubMed: 30463899
DOI: 10.1128/JCM.01357-18 -
Academic Pediatrics 2018Shared decision-making (SDM) has mostly been used with adults and parents in the primary care setting, and there is limited knowledge on the use of SDM with parents of... (Review)
Review
BACKGROUND
Shared decision-making (SDM) has mostly been used with adults and parents in the primary care setting, and there is limited knowledge on the use of SDM with parents of acutely ill children. The objective of this study was to review the literature on SDM with parents in the management of acutely ill children.
METHODS
We searched MEDLINE, SCOPUS, PsycINFO, the Cochrane Library, and ClinicalTrials.gov for English language studies published from the time of database inception to February, 2017. Study eligibility criterion was use of SDM with parents for children aged 18 years or younger with an acute medical problem.
RESULTS
We identified 2 ongoing clinical trials and 10 published studies that met inclusion criteria: 2 using hypothetical SDM scenarios, 1 mixed methods study, and 7 intervention studies. Only 1 study compared an SDM intervention with usual care in a randomized controlled trial. The limited literature shows that parents of acutely ill children have differing preferences for testing and/or treatment, and that they generally want the opportunity to express those preferences through an SDM process. Use of SDM often results in acutely ill children undergoing fewer and/or less intensive testing or treatment, although the effect on outcomes is unclear.
CONCLUSIONS
Parents welcome participation in SDM for management decisions with their acutely ill child. Further investigation is needed to determine how best to implement SDM with parents of acutely ill children and to assess the effect of SDM on outcomes.
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Decision Making; Humans; Infant; Infant, Newborn; Parents; Patient Participation
PubMed: 28723588
DOI: 10.1016/j.acap.2017.06.009 -
Spine Nov 1998Seventy thoracolumbar spines from cadavers of individuals killed in motor vehicle accidents were examined pathologically and radiologically, particularly for the...
STUDY DESIGN
Seventy thoracolumbar spines from cadavers of individuals killed in motor vehicle accidents were examined pathologically and radiologically, particularly for the occurrence of acute Schmorl's nodes.
OBJECTIVES
To document whether Schmorl's nodes occur acutely as a result of trauma.
SUMMARY OF BACKGROUND DATA
Theories proposed to explain the pathogenesis of Schmorl's nodes include developmental, degenerative, traumatic, and disease influences. Few studies show a direct causal relation between a traumatic episode and acute Schmorl's node formation.
METHODS
Thoracolumbar spines were removed at autopsy, underwent radiography in the anteroposterior and lateral planes, fixed, sagittally cut, and underwent radiography a second time. Pathologic and radiographic examinations were performed.
RESULTS
Nine acute Schmorl's nodes were detected, most in association with other acute injuries to the spine. Most acute Schmorl's nodes were present in spines from individuals aged 11-30 years, with a male to female ratio of 9:1, and were localized to the T8-L1 region. Spines from motorcyclists showed the highest percentage of acute Schmorl's nodes. No acute Schmorl's nodes were detected radiologically.
CONCLUSION
Schmorl's nodes do occur acutely as the result of a single traumatic episode, and are almost always associated with other acute spinal injury. The frequency and occurrence of acute Schmorl's nodes in motorcyclists suggest that axial loading is an important mechanism. Their predominance in the T8-L1 region suggests that this region is particularly susceptible to stress.
Topics: Acute Disease; Adolescent; Adult; Aged; Cadaver; Child; Female; Humans; Intervertebral Disc Displacement; Joint Dislocations; Lumbar Vertebrae; Male; Middle Aged; Spinal Fractures; Spinal Injuries; Thoracic Vertebrae
PubMed: 9820905
DOI: 10.1097/00007632-199811010-00004