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American Family Physician Oct 2007Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis... (Review)
Review
Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three weeks to three months. Bell's palsy is more common in patients with diabetes, and although it can affect persons of any age, incidence peaks in the 40s. Bell's palsy has been traditionally defined as idiopathic; however, one possible etiology is infection with herpes simplex virus type 1. Laboratory evaluation, when indicated by history or risk factors, may include testing for diabetes mellitus and Lyme disease. A common short-term complication of Bell's palsy is incomplete eyelid closure with resultant dry eye. A less common long-term complication is permanent facial weakness with muscle contractures. Approximately 70 to 80 percent of patients will recover spontaneously; however, treatment with a seven-day course of acyclovir or valacyclovir and a tapering course of prednisone, initiated within three days of the onset of symptoms, is recommended to reduce the time to full recovery and increase the likelihood of complete recuperation.
Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Diagnosis, Differential; Humans; Prednisone; Valacyclovir; Valine
PubMed: 17956069
DOI: No ID Found -
Canadian Journal of Psychiatry. Revue... Jun 2019Tardive dyskinesia is a movement disorder characterised by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication. We aim...
BACKGROUND
Tardive dyskinesia is a movement disorder characterised by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication. We aim to provide recommendations on the treatment of tardive dyskinesia.
METHODS
We performed a systematic review of studies of the treatment of tardive dyskinesia. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. Overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework.
RESULTS
Preventing tardive dyskinesia is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimising the duration of therapy. The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible. Yet, for many patients with serious mental illness, the discontinuation of antipsychotics is not possible due to disease relapse. Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may be effective in reducing tardive dyskinesia symptoms. The strongest evidence for a suitable co-intervention to treat tardive dyskinesia comes from tests with the new VMAT inhibitors, deutetrabenazine and valbenazine. These medications have not been approved for use in Canada.
CONCLUSION
Data on tardive dyskinesia treatment are limited, and the best management strategy remains prevention. More long-term safety and efficacy data are needed for deutetrabenazine and valbenazine, and their routine availability to patients outside of the USA remains in question.
Topics: Adrenergic Uptake Inhibitors; Antipsychotic Agents; Humans; Tardive Dyskinesia; Tetrabenazine; Valine
PubMed: 30791698
DOI: 10.1177/0706743719828968 -
Journal of Clinical Hypertension... 2001In a multicenter, randomized, double-blind trial, the authors compared the antihypertensive efficacy of once-daily treatment with the new angiotensin II type 1 receptor... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
In a multicenter, randomized, double-blind trial, the authors compared the antihypertensive efficacy of once-daily treatment with the new angiotensin II type 1 receptor blocker (ARB) olmesartan (20 mg) with recommended starting doses of losartan (50 mg), valsartan (80 mg), and irbesartan (150 mg) in 588 patients with a cuff diastolic blood pressure (DBP) of greater than or equal to 100 and less than or equal to 115 mm Hg and a mean daytime DBP of greater than or equal to 90 mm Hg and less than 120 mm Hg, as measured by ambulatory blood pressure monitoring. Cuff and ambulatory blood pressures were monitored at baseline and after 8 weeks of treatment. All groups were predominantly white and approximately 62% male, and their mean age was approximately 52 years. In all groups, mean baseline DBP and systolic blood pressure (SBP) were approximately 104 and 157 mm Hg, respectively. The reduction of sitting cuff DBP with olmesartan (11.5 mm Hg), the primary efficacy variable of this study, was significantly greater than with losartan, valsartan, and irbesartan (8.2, 7.9, and 9.9 mm Hg, respectively). Reductions of cuff SBP with the four ARBs ranged from 8.4-11.3 mm Hg and were not significantly different. The reduction in mean 24-hour DBP with olmesartan (8.5 mm Hg) was significantly greater than reductions with losartan and valsartan (6.2 and 5.6 mm Hg, respectively) and showed a trend toward significance when compared to the reduction in DBP with irbesartan (7.4 mm Hg; p=0.087). The reduction in mean 24-hour SBP with olmesartan (12.5 mm Hg) was significantly greater than the reductions with losartan and valsartan (9.0 and 8.1 mm Hg, respectively) and equivalent to the reduction with irbesartan (11.3 mm Hg). All drugs were well tolerated. The authors conclude that olmesartan, at its starting dose, is more effective than the starting doses of the other ARBs tested in reducing cuff DBP in patients with essential hypertension.
Topics: Analysis of Variance; Antihypertensive Agents; Biphenyl Compounds; Chi-Square Distribution; Double-Blind Method; Female; Humans; Hypertension; Irbesartan; Losartan; Male; Middle Aged; Tetrazoles; Valine; Valsartan
PubMed: 11588406
DOI: 10.1111/j.1524-6175.2001.01136.x -
The New England Journal of Medicine Dec 2001Actions of angiotensin II may contribute to the progression of heart failure despite treatment with currently recommended drugs. We therefore evaluated the long-term... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Actions of angiotensin II may contribute to the progression of heart failure despite treatment with currently recommended drugs. We therefore evaluated the long-term effects of the addition of the angiotensin-receptor blocker valsartan to standard therapy for heart failure.
METHODS
A total of 5010 patients with heart failure of New York Heart Association (NYHA) class II, III, or IV were randomly assigned to receive 160 mg of valsartan or placebo twice daily. The primary outcomes were mortality and the combined end point of mortality and morbidity, defined as the incidence of cardiac arrest with resuscitation, hospitalization for heart failure, or receipt of intravenous inotropic or vasodilator therapy for at least four hours.
RESULTS
Overall mortality was similar in the two groups. The incidence of the combined end point, however, was 13.2 percent lower with valsartan than with placebo (relative risk, 0.87; 97.5 percent confidence interval, 0.77 to 0.97; P=0.009), predominantly because of a lower number of patients hospitalized for heart failure; 455 (18.2 percent) in the placebo group and 346 (13.8 percent) in the valsartan group (P<0.001). Treatment with valsartan also resulted in significant improvements in NYHA class, ejection fraction, signs and symptoms of heart failure, and quality of life as compared with placebo (P<0.01). In a post hoc analysis of the combined end point and mortality in subgroups defined according to base-line treatment with angiotensin-converting-enzyme (ACE) inhibitors or beta-blockers, valsartan had a favorable effect in patients receiving neither or one of these types of drugs but an adverse effect in patients receiving both types of drugs.
CONCLUSIONS
Valsartan significantly reduces the combined end point of mortality and morbidity and improves clinical signs and symptoms in patients with heart failure, when added to prescribed therapy. However, the post hoc observation of an adverse effect on mortality and morbidity in the subgroup receiving valsartan, an ACE inhibitor, and a beta-blocker raises concern about the potential safety of this specific combination.
Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Probability; Quality of Life; Stroke Volume; Survival Analysis; Tetrazoles; Valine; Valsartan
PubMed: 11759645
DOI: 10.1056/NEJMoa010713 -
Medicina (Kaunas, Lithuania) Mar 2021Considering atherosclerosis as one of the more challenging threats to healthcare worldwide, any novel therapy that counteracts the risks for developing it, provides new...
Considering atherosclerosis as one of the more challenging threats to healthcare worldwide, any novel therapy that counteracts the risks for developing it, provides new opportunities for the management of this process. We performed an experimental research in which we induced a hypercholesterolemia via a cholesterol-rich diet. Our aim was to demonstrate the antiatherogenic potential of two essential amino acids (valine and leucine). The experimental study was carried out over a period of 60 days. Male Wistar rats weighing between 250-280 g were used and divided into 4 groups, each group including 8 animals. Group I-control was fed with a standard diet. Group II received cholesterol, group III cholesterol and valine and group IV cholesterol and leucine. Blood samples were collected from the retro-orbital plexus, under anesthesia with 75 mg/kg of intraperitoneal ketamine, in three different moments (R0-1st day, R1-the 30th day, R2-the 60th day) in order to measure the levels of triglycerides. In R0, there were no significant differences between the average levels of triglycerides across all the groups ( < 0.05). Compared to the group I, in R1 and R2, the average levels of triglycerides were significantly higher in all groups ( < 0.001). Also, in R1 and R2, the average triglycerides in group II receiving cholesterol (C) were significantly higher than those in group III receiving valine (C + V) as well as in group IV receiving leucine (C + L) ( < 0.001; < 0.05). In R2, the average triglycerides in group III were significantly lower than in group IV ( < 0.001). Our data provides evidence that valine and leucine have a direct impact on the lipid metabolism parameters by lowering the level of triglycerides. The comparison of the two essential amino acids indicates that valine acts more promptly and rapidly than leucine.
Topics: Animals; Cholesterol; Hypercholesterolemia; Leucine; Male; Rats; Rats, Wistar; Valine
PubMed: 33807510
DOI: 10.3390/medicina57030239 -
Microbial Cell Factories Aug 2021L-valine is an essential amino acid that has wide and expanding applications with a suspected growing market demand. Its applicability ranges from animal feed additive,... (Review)
Review
L-valine is an essential amino acid that has wide and expanding applications with a suspected growing market demand. Its applicability ranges from animal feed additive, ingredient in cosmetic and special nutrients in pharmaceutical and agriculture fields. Currently, fermentation with the aid of model organisms, is a major method for the production of L-valine. However, achieving the optimal production has often been limited because of the metabolic imbalance in recombinant strains. In this review, the constrains in L-valine biosynthesis are discussed first. Then, we summarize the current advances in engineering of microbial cell factories that have been developed to address and overcome major challenges in the L-valine production process. Future prospects for enhancing the current L-valine production strategies are also discussed.
Topics: Bacteria; Metabolic Engineering; Valine
PubMed: 34461907
DOI: 10.1186/s12934-021-01665-5 -
Pediatrics Feb 2013Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal...
Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV. Women with primary genital HSV infections who are shedding HSV at delivery are 10 to 30 times more likely to transmit the virus to their newborn infants than are women with recurrent HSV infection who are shedding virus at delivery. With the availability of commercial serological tests that reliably can distinguish type-specific HSV antibodies, it is now possible to determine the type of maternal infection and, thus, further refine management of infants delivered to women who have active genital HSV lesions. The management algorithm presented herein uses both serological and virological studies to determine the risk of HSV transmission to the neonate who is delivered to a mother with active herpetic genital lesions and tailors management accordingly. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery.
Topics: Acyclovir; Algorithms; Antiviral Agents; Asymptomatic Infections; Cesarean Section; Drug Administration Schedule; Female; Guideline Adherence; Herpes Genitalis; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Pregnancy; Pregnancy Complications, Infectious; Risk; Secondary Prevention; Valacyclovir; Valine; Virus Activation
PubMed: 23359576
DOI: 10.1542/peds.2012-3216 -
Discovery Medicine 2019Sickle cell disease (SCD), the most common severe monogenic disease in the world, is known for the hallmark vaso-occlusive crises that cause great suffering and... (Review)
Review
Sickle cell disease (SCD), the most common severe monogenic disease in the world, is known for the hallmark vaso-occlusive crises that cause great suffering and degradation of health for these patients. In 1949, the discovery of the abnormal sickle cell hemoglobin protein (HbS) β-globin chain revealed a mutation where glutamic acid is replaced with a valine (β6Glu→Val). From this discovery came the pathophysiological mechanism based on the abnormal polymerization of deoxy-HbS. While an important discovery, this initial mechanism has yet been able to account for the cascade of events that trigger these crises and has therefore offered few treatment options for these patients. In red blood cells, alterations to membrane structure lead to changes in their biomechanical behaviors. A literature review has been conducted and a possible sickle cell pathophysiological mechanism that involves the potential for abnormal polymerization of the critical actin protein (in the spectrin-actin complex) within the red blood cell cytoskeleton has been identified. This review will discuss the interaction of valine and glucose on the HbS molecule and how it may lead to a destabilization of the HbS red blood cell cytoskeleton and SCD crises.
Topics: Actins; Anemia, Sickle Cell; Animals; Erythrocytes; Glucose; Humans; Spectrin; Valine
PubMed: 32053762
DOI: No ID Found -
Molecules (Basel, Switzerland) Jan 2021Adsorption kinetic studies are conducted to investigate the potential to use chiral mesoporous materials nanoporous guanosine monophosphate material-1 (NGM-1) and...
Adsorption kinetic studies are conducted to investigate the potential to use chiral mesoporous materials nanoporous guanosine monophosphate material-1 (NGM-1) and nanoporous folic acid material-1 (NFM-1) for the enantiomeric separation of l- and d-valine. A pseudo-second-order (PSO) kinetic model is applied to test the experimental adsorption equilibrium isotherms, according to both the Langmuir and Freundlich models and the characteristic parameters for each model are determined. The calcined versions of both NGM-1 and NFM-1 fit the Langmuir model with maximum sorption capacities of 0.36 and 0.26 g/g for the preferred adsorption enantiomers, d-valine and l-valine, respectively. Experimental results and the analysis of adsorption models suggest a strong adsorbate-adsorbent interaction, and the formation of a monolayer of tightly packed amino acid on the internal mesopore surface for the preferred enantiomers.
Topics: Adsorption; Folic Acid; Guanosine Monophosphate; Kinetics; Nanopores; Nanostructures; Porosity; Silicon Dioxide; Stereoisomerism; Valine
PubMed: 33440748
DOI: 10.3390/molecules26020338 -
The Journal of Clinical Psychiatry Dec 2019Tardive dyskinesia (TD), a condition characterized by involuntary movements, is found in patients taking antipsychotics or other agents that block dopamine receptors.... (Review)
Review
Tardive dyskinesia (TD), a condition characterized by involuntary movements, is found in patients taking antipsychotics or other agents that block dopamine receptors. Symptoms of TD are associated with reduced quality of life, psychosocial problems, and medication nonadherence. Few agents tested in the treatment of TD had sufficient data to support or refute their use, until recently. A review of new evidence was combined with the existing guideline to provide new treatment recommendations. This activity provides an overview of treatments for patients with TD, including valbenazine and deutetrabenazine, which both received FDA approval for the treatment of TD.
Topics: Humans; Medication Adherence; Practice Guidelines as Topic; Tardive Dyskinesia; Tetrabenazine; Valine
PubMed: 31851437
DOI: 10.4088/JCP.NU18041BR3C