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Chronic Use (chronic + use)
Selected AbstractsThymoglobulin induction and steroid avoidance in cardiac transplantation: results of a prospective, randomized, controlled studyCLINICAL TRANSPLANTATION, Issue 1 2008Mohamad H Yamani Abstract:, Background:, Chronic use of corticosteroids (CS) following transplantation is associated with significant long-term morbidities. Minimizing exposure to CS to improve long-term outcomes, without compromising allograft function, remains an important goal in transplantation. Objectives:, This single-center, prospective, randomized, open-label study was designed to evaluate the efficacy of Thymoglobulin® as part of a CS-sparing regimen in cardiac transplantation. Methods:, Thirty-two low-risk cardiac transplant patients were randomized in a 1:1 ratio to receive either a Thymoglobulin-based CS-avoidance regimen (CS-avoidance group; n = 16) or a long-term CS-based regimen with no antibody induction (control group; n = 16). Pulse CS therapy was used for the treatment of acute cellular rejection in both groups. Results:, Baseline characteristics were similar between groups. At one yr, there was no significant difference in the mean incidence of acute cellular rejection (,3A) episodes between the CS-avoidance and control groups, 0.81 ± 1.05 and 1.07 ± 1.03, respectively. Importantly, the CS-avoidance patients had significant improvement in muscle strength and less bone loss compared with the control patients during the first six months post-transplant. Conclusions:, CS-avoidance regimen with Thymoglobulin induction appeared to be safe and effective in cardiac transplantation. Further studies are required to demonstrate the long-term safety and benefits of such a regimen. [source] Self-report of memory and affective dysfunction in association with medication use in a sample of individuals with chronic sleep disturbanceHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2000Mary Pat McAndrews Abstract Benzodiazepines produce memory disturbance after acute administration. It is not clear whether chronic use of benzodiazepines is hazardous to memory processes. Epidemiological data indicate that a large proportion (10,30 per cent) of individuals with sleep dysfunction take hypnotic aids for a year or longer. The purpose of the present study was to evaluate self-reported memory dysfunction in a sample of individuals who considered their sleep disturbance sufficiently severe to seek investigation in sleep clinics. It was hypothesized that individuals taking benzodiazepines for sleep would report greater perceived everyday memory failures than individuals taking other sleep aids or no medication. Questionnaires were given to 368 individuals referred into the study by investigators in six sleep disorders clinics. All respondents completed a lengthy (700-item) questionnaire, which included scales assessing memory difficulties, affective status and sleep disturbance. Respondents also reported any medication use for sleep problems and duration of use of the current drug. Information on medication use was reported by 289 participants. Fifty-six per cent of respondents reported using some form of psychoactive medication (antidepressants, benzodiazepines, Zopiclone). Twenty-two per cent reported using no medication. Analysis of covariance showed that these medications had no detectable effect on subjective memory difficulties during chronic use, F(4,226)=1·34, p=0·25. Copyright © 2000 John Wiley & Sons, Ltd. [source] Sexual Abuse of BoysJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2005Sharon M. Valente RN TOPIC:, Sexual abuse in childhood can disable self-esteem, self-concept, relationships, and ability to trust. It can also leave psychological trauma that compromises a boy's confidence in adults. While some boys who willingly participate may adjust to sexual abuse, many others face complications, such as reduced quality of life, impaired social relationships, less than optimal daily functioning, and self-destructive behavior. These problems can respond to treatment if detected. PURPOSE:, In this paper, we examine the prevalence, characteristics, psychological consequences, treatment, and coping patterns of boys who have been sexually abused and their failure to disclose abuse unless asked during a therapeutic encounter. Nurses have a responsibility to detect the clues to sexual abuse, diagnose the psychological consequences, and advocate for protection and treatment. SOURCES USED:, Computerized literature search of the Medline and PsychInfo literature and books on sexual abuse of boys. CONCLUSIONS:, Psychological responses to abuse such as anxiety, denial, self-hypnosis, dissociation, and self-mutilation are common. Coping strategies may include being the angry avenger, the passive victim, rescuer, daredevil, or conformist. Sexual abuse may precipitate runaway behavior, chronic use of sick days, poor school or job performance, costly medical, emergency and or mental health visits. In worst cases, the boy may decide that life is not worth living and plan suicide. The nurse has a key role to play in screening, assessing, and treating sexual abuse children. [source] Pediatric primary cutaneous marginal zone lymphoma: in association with chronic antihistamine useJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2006Novie Sroa There have been no prior reports of this lymphoma occurring in American children. We present a case of a 15-year-old male with a history of atopic diathesis and chronic use of antihistamine agents who presented with an asymptomatic lesion on his left forearm of 6 months duration. Because histopathological and immunohistochemical studies were compatible with marginal zone lymphoma, and the patient had no associated extracutaneous disease, the diagnosis of primary cutaneous marginal zone lymphoma was rendered. Based on the patient's past medical history prior to appearance of lesion, it was postulated that the development of lymphoma was associated with the ingestion of antihistamines and further propagated by his underlying atopic diathesis. [source] Neuropathological changes in vibration injury: An experimental studyMICROSURGERY, Issue 1 2005Hani S. Matloub M.D. Vibration syndrome, a clinical condition arising from chronic use of vibrating tools, is associated with a spectrum of neurovascular symptoms. To date, only its vascular pathology has been extensively studied; we sought to determine what direct neurologic injury, if any, is caused by vibration. Hindlimbs of anesthetized rats were affixed to a vibrating platform 4 h a day for 7 days. Study animals were vibrated with set parameters for frequency, acceleration, velocity, and amplitude; control animals were not vibrated. On day 7, nerves were studied by light and electron microscopy. While light microscopy showed minimal histologic differences between vibrated (n = 12) and control (n = 12) nerves, electron microscopic changes were dramatic. Splitting of the myelin sheath and axonal damage (e.g., myelin balls and "finger ring") were consistently seen in both myelinated and nonmyelinated axons. Despite relatively short vibration, definite pathology was demonstrated, suggesting that vibration syndrome has a direct neurologic component. © 2005 Wiley-Liss, Inc. Microsurgery 25:71,75, 2005. [source] Major depression: emerging therapeuticsMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2008Srijan Sen MD Abstract The first effective antidepressants, monoamine oxidase inhibitors and tricyclic antidepressants, were identified 50 years ago, largely through serendipity. These medications were found to improve mood in a little more than half of depressed patients after a few weeks of chronic use. Almost all antidepressants prescribed today were developed through minor modifications of these original antidepressants and, like monoamine oxidase inhibitors and tricyclic antidepressants, act primarily through monoaminergic mechanisms. Although there have been improvements in side-effect profiles and overdose toxicity, these newer medications have not provided substantial advances in the efficacy and speed of the antidepressant effect for patients. Over the last 2 decades, our understanding of the neurobiology underlying depression has expanded exponentially. Given this expansion, we may be nearing an inflection point in antidepressant drug development, at which useful medicines will be designed through a rational understanding of the biological systems. In this review, we discuss the biological basis and preclinical and clinical evidence for a series of promising classes of antidepressants developed primarily out of a pathophysiologically informed approach. Mt Sinai J Med 75:203,224, 2008. © 2008 Mount Sinai School of Medicine [source] Evidence For and Against the Use of Opioid Analgesics for Chronic Nonmalignant Low Back Pain: A ReviewPAIN MEDICINE, Issue 3 2002J. D. Bartleson MD Abstract Introduction., Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. Methods., A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. Results., There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. Conclusions., There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP. [source] Influence of ,2-adrenoceptor polymorphisms on the response to chronic use of albuterol in asthmatic childrenPEDIATRIC PULMONOLOGY, Issue 5 2008Verónica Giubergia MD Abstract Background Several studies have suggested that after regular use of short acting ,2-agonists the bronchodilator effect of the drug may decline and this condition would be related to polymorphisms of the ,2-adrenergic receptor (,2-AR). Objective To assess the frequency of ,2-AR polymorphisms in asthmatic children from Argentina, and to evaluate their influence on bronchodilator desensitization to albuterol over a 4-week treatment. Methods ,2-AR genotypes were determined in 117 children with asthma and 101 of them were under 4 weeks treatment with albuterol. Spirometric changes in FEV1 were recorded at the beginning (day 1) and at the end of the study (day 30) and compared to genotypes at position 16 and 27 of the receptor. The frequency of the polymorphisms was calculated in all population. Results The presence of glutamine at position 27 (Gln27) was significantly more frequent in this Argentinean study population than in other Caucasian populations. The homozygosity for Gln27 polymorphism was associated to a desensitization of the receptor with a decline in the bronchodilator response to albuterol after chronic use. Conclusion Gln27 polymorphism might be a marker for adverse clinical outcomes with chronic ,2-agonist exposure in children with asthma from Argentina. Pediatr Pulmonol. 2008; 43:421,425. © 2008 Wiley-Liss, Inc. [source] Chronic inhaled corticosteroids do not affect the course of acute severe asthma exacerbations in children,PEDIATRIC PULMONOLOGY, Issue 12 2006Christopher L. Carroll MD Abstract Chronic therapy with inhaled corticosteroids (ICS) suppresses airway inflammation and increases airway responsiveness to ,2 -adrenergic receptor agonists. We hypothesized that the chronic use of ICS would be associated with shorter duration of hospitalization in severely ill children with status asthmaticus. An 8-year retrospective chart review was conducted of all children admitted to the ICU with status asthmaticus. During the study period, 241 children were admitted, and 44% reported the use of chronic ICS. ICS use was associated with increased baseline asthma severity, previous hospitalization for asthma, and public insurance status. However, ICS use had no effect on hospital or ICU length of stay, type, and duration of treatments received, or the rate of recovery determined by a standard severity of illness scoring system. In the subsets of patients including children with persistent asthma and those who received intravenous terbutaline, there was also no improvement in outcomes with the use of chronic ICS showing that the chronic use of ICS did not improve response to ,2 -adrenergic receptor agonists in severely ill children with status asthmaticus. Although useful as a preventive therapy, the chronic use of ICS does not appear to affect the course of severe acute asthma exacerbations in pediatric patients once hospitalized. Pediatr Pulmonol. 2006; 41: 1213,1217. © 2006 Wiley-Liss, Inc. [source] NSAID switching and short-term gastrointestinal outcome rates after the withdrawal of rofecoxibPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2009Sebastian Schneeweiss MD Abstract Objective The consequences of the rofecoxib withdrawal on upper GI toxicity are largely unknown. We sought to estimate the effect of switching from selective Cox-2 inhibitors to non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) on the incidence of upper GI adverse events following the withdrawal of rofecoxib on 30 September 2004. Methods We identified a cohort of 33,045 patients with arthritis and chronic use of any selective Cox-2 inhibitor during the 6 months before the withdrawal of rofecoxib in claims data from several US health plans. We calculated monthly rates of hospitalization for upper GI adverse events or upper GI endoscopy for the 6 months before and 3 months after the switching and compared the time trends in outcomes. Results In the subgroup of 15,916 patients using rofecoxib immediately before its withdrawal, 2626 (17%) switched to nsNSAIDs without co-prescribing of a gastroprotective drug, 146 (1%) with a gastroprotective drug, and 5246 (33%) switched to either celecoxib or valdecoxib. Among those switching to nsNSAID without gastroprotection, time trends of upper GI hospitalization rates and endoscopies did not significantly increase compared with those switching to celecoxib or valdecoxib (+0.3 per 1000 per month; 95%CI ,3.0 to 3.5). The visit rate for peptic ulcer disease (PUD) increased more in the group switching to nsNSAIDs without gastroprotection (+5.2 visits per 1000 per month; 1.2,9.2) compared with the group switching to another coxib. Conclusions Short-term follow-up data suggest that the sudden shift from rofecoxib to nsNSAIDs without gastroprotection did not increase the rate of hospitalization for GI complications but increased outpatient visits for PUD. Copyright © 2009 John Wiley & Sons, Ltd. [source] ORIGINAL RESEARCH,ENDOCRINOLOGY: Transdermal Testosterone Gel prn Application for Hypoactive Sexual Desire Disorder in Premenopausal Women: A Controlled Pilot Study of the Effects on the Arizona Sexual Experiences Scale for Females and Sexual Function QuestionnaireTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2007Bella Chudakov MD ABSTRACT Introduction., Several studies suggest that increased plasma testosterone can improve sexual function and desire in post-oophorectomy or postmenopausal women. However, side effects of chronic daily testosterone raise questions about the generalizability of this treatment approach. Sublingual testosterone was reported to cause testosterone levels to peak after 15 minutes and then decline to baseline levels within 90 minutes. Three to 4 hours after reaching testosterone peak, increased genital sensations and sexual lust were reported. Aim., We hypothesized that a singe dose of testosterone given 4,8 hours prior to planned intercourse in women with hypoactive sexual desire disorder (HSDD) might increase desire without side effects associated with chronic use. Methods., The design was randomized double-blind crossover. Premenstrual women with HSDD received eight packets of gel or identical placebo for use before intercourse twice weekly for 1 month. For a second month, the alternate treatment was given. Main Outcome Measures., Ratings were performed using the patient-rated Arizona Sexual Experiences Scale for females and the clinician-rated Sexual Function Questionnaire (SFQ-V1). Results., Ten patients completed the study. On the five-item self-report Arizona, the item "How easily are you aroused?" was significantly improved on testosterone gel vs. placebo, P = 0.03. There were similar trends on the physician-rated SFQ-V1 "arousal,sensation" cluster. Conclusions., These preliminary results suggest that testosterone gel given prn before intercourse has effects on sexual arousal, and further research is needed to define dosage and time schedule to optimize this effect and determine its clinical relevance. Chudakov B, Ben Zion IZ, and Belmaker RH. Transdermal testosterone gel prn application for hypoactive sexual desire disorder in premenopausal women: A controlled pilot study of the effects on the Arizona Sexual Experiences Scale for females and Sexual Function Questionnaire. J Sex Med 2007;4:204,208. [source] Gabapentin withdrawal syndrome in the presence of a taperBIPOLAR DISORDERS, Issue 3 2005Kien T Tran Objective:, To report a case report of a geriatric patient with a 5-year history of gabapentin use for enhanced bipolar control, who was tapered off of gabapentin over 1 week. The patient displayed unique withdrawal symptoms after the taper of gabapentin. Methods:, The patient is an 81-year-old white female with a life-long history of schizoaffective disorder with bipolar type I tendencies who had been prescribed gabapentin for 5 years. Results:, The patient displayed moderate upper respiratory tract infection symptoms and somatic complaints 1 day after termination of gabapentin. These symptoms gradually worsened until 10 days after, at which time she acutely developed severe mental status changes, severe somatic chest pain, and hypertension. Physical examination, electrolytes, electrocardiogram, computerized tomography, magnetic resonance imaging, and magnetic resonance angiography were all normal. Upon reintroduction of gabapentin, the patient returned to baseline within 1,2 days. Conclusions:, Gabapentin is widely utilized currently for the chronic treatment of recalcitrant migraines, bipolar illness, pain, and epilepsy. It has a wide therapeutic index with few side effects and drug interactions, is not hepatically metabolized, and is excreted by the kidneys. Past reports have suggested that some withdrawal symptoms can present after 1,2 days upon abrupt discontinuation of gabapentin after chronic use within young to middle-aged patients. These symptoms mimic that of alcohol and benzodiazepine withdrawal purportedly due to a similar mechanism of action. Unique to this case is that this geriatric patient developed debilitating withdrawal symptoms after a gradual, week-long taper of gabapentin along with flu-like symptoms. It is proposed herein that a gabapentin taper should follow a course similar to that of a benzodiazepine taper , slowly and over a period of weeks to months. [source] The effects of chronic administration of sumatriptan and dipyrone on serotonergic system in the rat brain: an immunohistochemical studyACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009E. Genç Objective,,, To investigate the effects of chronic high dose sumatriptan and dipyrone treatment on central serotonergic system in rats. Materials and methods,,, Male Sprague,Dawley rats (seven per group) were daily injected with sumatriptan (3 mg/kg), dipyrone (400 mg/kg) or saline for 30 days. The brains of animals were surgically removed and immunohistochemically stained for serotonin. Serotonin-positive stained cells were counted automatically by using a computerized image analysis program. Statistical analysis carried out using one-way ANOVA followed by post hoc Tukey test. Results,,, A significant decrease in serotonin-positive cells in the brainstem was observed after chronic sumatriptan administration while chronic use of dipyrone induced a significant increase in serotonin-positive cells both in the cortex and midbrain. Conclusion,,, Our data suggest that central serotonergic system might be modified by chronic use of sumatriptan and dipyrone. [source] | ||||||||||