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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 2 year history of severe diarrhea, tiredness, and weight loss in a female patient could not be diagnosed satisfactorily despite repeated and extensive clinical investigations of various kinds. The final diagnosis of laxative abuse was arrived at after identification and quantitation of a bisacodyl metabolite in the urine from the patient. The metabolite was bisacodyl disphenol. The analytical method developed was based on liquid chromatographic determination after hydrolysis of the conjugated metabolite of bisacodyl and selective isolation from the urine. The precision of the method was 5% at the 2.3 microgram/ml level (n = 9) of bisacodyl diphenol, and the absolute recovery was estimated at 80%. The method allowed detection of 0.5 migrogram/ml of the metabolite in urine. After a single dose (10 mg) of bisacodyl to volunteers, urinary concentrations of the metabolite in the range of 1--5 microgram/ml were found. The bisacodyl diphenol recovered in the urine corresponded to 20--30% of the original dose. The urinary concentration of the diphenol derivative in the patient was estimated at 17 microgram/ml.
Ther Drug Monit 1980
PMID:Quantitation of a bisacodyl metabolite in urine for the diagnosis of laxative abuse. 722 87

Analysis of the scientific research activities of the Donetsk Research Centre of Occupational Hygiene and Prevention of Traumatism was carried out, which offered a basis for the development of technology for medicosocial assessment of morbidity involving temporary unfitness for work, occupational morbidity, invalidism and mortality among coal miners, risk for development of nonoccupational and occupational diseases, prevalence of IHD and other non-infectious diseases, functional status of the organism according to psychophysiological indices for those going to work in the mine, as well as of the state of undue fatigue and overstrain experienced by the miners. The analysis permits the above technology to be inaugurated in the health care establishments and research institutes.
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PMID:[The scientific support of public health institutions with the technology for the sociomedical assessment of the health of miners]. 760 71

This paper describes a microcomputer system for automating the process of data collection, calculation and display of anaerobic capacity tests on an air-braked ergometer. The use of the spreadsheet Excel and associated 'Dalog' program represents an advance on current software which estimates the anaerobic capacity from work performed alone. Numerous calculations are required when air-braked, rather than friction-braked erogometers are used. Each 1 s power output collected during an all-out sprint on the ergometer is corrected against the criterion of a dynamic calibration rig and adjusted for differences in barometric pressure, ambient temperature and humidity. The Excel template features a series of macros invoked by buttons imbedded in the spreadsheet. Their selection displays various dialogue boxes which request input related to the calculation of oxygen deficit and related variables. Selecting the final macro prints a summary table and charts which include: power output, fatigue index, mechanical work performed, % aerobic contribution to work, oxygen demand, oxygen consumption and anaerobic capacity as determined by the maximal accumulated oxygen deficit.
Int J Clin Monit Comput 1996 Aug
PMID:A macro-driven Excel template for determining the anaerobic capacity using an air-braked ergometer. 891 33

The search for a specific structural basis for chronic whiplash and other chronic pain and fatigue syndromes has been in progress for decades, and yet currently there remains no "structural" solution to these enigmata. In light of the failure of research to identify the chronic "damage" or pathology as lying in a muscular, bony, or "connective tissue" sites for many chronic pain syndromes like whiplash, fibromyalgia, et cetera, more recent attention has been paid to nervous system structures. Nerve irritation has been implicated as the basis for the pain and other symptoms that are common to many chronic disability syndromes. We postulate here, however, that the concept of nervous irritation has been prostituted for centuries whenever more concrete structural explanations for chronic pain and other controversial illness have been untenable. We suggest that, after each cycle of nervous irritation as a disease, and subsequent dismissal of the notion, the doctrine of irritation as a disease was too good to go away. First, with the hypersthenic and asthenic diseases of the nineteenth century, then railway spine, whiplash, thoracic outlet syndrome, and now brachial plexus irritation, we detect the same pattern: patients with symptoms, but no objective evidence of nerve disease. Nervous irritation has repeatedly served this purpose for the last 200 years. It is our intent that bringing an understanding of this trend will encourage current clinicians and researchers to appreciate the need to abandon this form of speculation without historical insight when dealing with today's controversial syndromes.
Med Sci Monit 2003 Nov
PMID:From railway spine to whiplash--the recycling of nervous irritation. 1471 39

Clozapine, an atypical antipsychotic, depends mainly on cytochrome P4501A2 (CYP1A2) for its metabolic clearance. CYP1A2 is inducible by smoking, and lower plasma concentrations of clozapine are measured in smokers than in nonsmokers. Case reports have been published on the effects of discontinuing smoking in patients receiving clozapine, which might lead to elevated plasma concentrations and severe side effects. We present 2 cases on the consequences of smoking cessation in patients receiving this drug. In the first patient, smoking cessation resulted, within 2 weeks, in severe sedation and fatigue, with an approximately 3-fold increase of plasma clozapine concentrations. In the second patient, a very high plasma concentration of clozapine (3004 ng/mL) was measured 6 days following a 16-day stay in a general hospital, during which smoking was prohibited. In the latter patient, the replacement of omeprazole, a strong CYP1A2 inducer, by pantoprazole, a weaker CYP1A2 inducer, could have contributed, in addition to smoking cessation, to the observed strong increase of plasma clozapine concentrations. Genotyping of the 2 patients revealed that they were carriers of the AA genotype for the -164C>A polymorphism (CYP1A2*1F) in intron 1 of CYP1A2 gene, which has previously been shown to confer a high inducibility of CYP1A2 by smoking. Thus, at the initiation of clozapine treatment, smoking patients should be informed that, if they decide to stop smoking, they are encouraged to do so but must inform their prescriber beforehand. Also, because of the increased use of no-smoking policies in many hospitals, studies examining the consequences of such policies on the pharmacokinetics/pharmacodynamics of drugs metabolized by CYP1A2, taking into account different CYP1A2 genotypes, are needed.
Ther Drug Monit 2005 Aug
PMID:Increased clozapine plasma concentrations and side effects induced by smoking cessation in 2 CYP1A2 genotyped patients. 1604 15

Exercise induced hemodynamic stress has been studied extensively using a wide range of physiological sensors. While athletes can modulate their training intensity using EKG-based heart rate monitors, there are currently no noninvasive monitors that can be used to ascertain with a high degree of certainty the hemodynamic stress an individual is experiencing because of fatigue or an underlying pathology. We propose that cardiac stress will result in detectable changes in skin blood flow. In a clinical trial with eleven healthy subjects performing the Bruce Protocol treadmill test low frequency waves were observed in the blood flow to both the forehead and ear, but not the finger, using photople- thysmographs (PPG) measured by a pulse oximeter. As volitional fatigue approached, the low frequency (f = 0.05-0.2 Hz) amplitude modulation observed in the PPG became more pronounced; then, within several seconds of the cessa- tion of the protocol, they disappeared. Using a software-based detector, these distinct waves are reliably detected, with a low incidence of false positives, in all subjects before the onset of volitional fatigue. We hypothesize that the low frequency waves observed in the PPG of individuals exercising to volitional fatigue provide a mechanism for noninvasively detecting hemodynamic stress to the human vascular system.
J Clin Monit Comput 2008 Aug
PMID:Noninvasive detection of the hemodynamic stress of exercise using the photoplethysmogram. 1858 96

Automated physiologic alarms are available in most commercial physiologic monitors. However, due to the variability of data coming from the physiologic sensors describing the state of patients, false positive alarms frequently occur. Each alarm requires review and documentation, which consumes clinicians' time, may reduce patient safety through 'alert fatigue' and makes automated physician paging infeasible. To address these issues a computerized architecture based on simple reactive intelligent agent technology has been developed and implemented in a live critical care unit to facilitate the investigation of deterministic algorithms for the improvement of the sensitivity and specificity of physiologic alarms. The initial proposed algorithm uses a combination of median filters and production rules to make decisions about what alarms to generate. The alarms are used to classify the state of patients and alerts can be easily viewed and distributed using standard network, SQL database and Internet technologies. To evaluate the proposed algorithm, a 28 day study was conducted in the University of Michigan Medical Center's 14 bed Cardiothoracic Intensive Care Unit. Alarms generated by patient monitors, the intelligent agent and alerts documented on patient flow sheets were compared. Significant improvements in the specificity of the physiologic alarms based on systolic and mean blood pressure was found on average to be 99% and 88% respectively. Even through significant improvements were noted based on this algorithm much work still needs to be done to ensure the sensitivity of alarms and methods to handle spurious sensor data due to patient or sensor movement and other influences.
J Clin Monit Comput 2009 Feb
PMID:Specificity improvement for network distributed physiologic alarms based on a simple deterministic reactive intelligent agent in the critical care environment. 1916 35

The intensive care unit (ICU) environment is rich in both medical device and electronic medical record (EMR) data. The ICU patient population is particularly vulnerable to medical error or delayed medical intervention both of which are associated with excess morbidity, mortality and cost. The development and deployment of smart alarms, computerized decision support systems (DSS) and "sniffers" within ICU clinical information systems has the potential to improve the safety and outcomes of critically ill hospitalized patients. However, the current generations of alerts, run largely through bedside monitors, are far from ideal and rarely support the clinician in the early recognition of complex physiologic syndromes or deviations from expected care pathways. False alerts and alert fatigue remain prevalent. In the coming era of widespread EMR implementation novel medical informatics methods may be adaptable to the development of next generation, rule-based DSS.
J Clin Monit Comput 2013 Aug
PMID:Connecting the dots: rule-based decision support systems in the modern EMR era. 2345 93

Background Many natural compounds were tested for the ability to suppress viral replication. The present manuscript details an analysis of high dose vitamin C therapy on patients with EBV infection. Material and Methods The data were obtained from the patient history database at the Riordan Clinic. Among people in our database who were treated with intravenous vitamin C (7.5 g to 50 g infusions) between 1997 and 2006, 178 patients showed elevated levels of EBV EA IgG (range 25 to 211 AU) and 40 showed elevated levels of EBV VCA IgM (range 25 to 140 AU). Most of these patients had a diagnosis of chronic fatigue syndrome, with the rest being diagnosed as having mononucleosis, fatigue, or EBV infection. Results Our data provide evidence that high dose intravenous vitamin C therapy has a positive effect on disease duration and reduction of viral antibody levels. Plasma levels of ascorbic acid and vitamin D were correlated with levels of antibodies to EBV. We found an inverse correlation between EBV VCA IgM and vitamin C in plasma in patients with mononucleosis and CFS meaning that patients with high levels of vitamin C tended to have lower levels of antigens in the acute state of disease. In addition, a relation was found between vitamin D levels and EBV EA IgG with lower levels of EBV early antigen IgG for higher levels of vitamin D. Conclusions The clinical study of ascorbic acid and EBV infection showed the reduction in EBV EA IgG and EBV VCA IgM antibody levels over time during IVC therapy that is consistent with observations from the literature that millimolar levels of ascorbate hinder viral infection and replication in vitro.
Med Sci Monit 2014 May 03
PMID:Effect of high dose vitamin C on Epstein-Barr viral infection. 2479 92

We describe a patient who developed symptoms of headache, fatigue, and dizziness after administration of terbinafine (Lamisil). Laboratory tests revealed that he is heterozygous for the C677T variation of the methylenetetrahydrofolate reductase genetic mutation. The prescription of Deplin (L-methylfolate) greatly reduced the symptoms. It was later noted that Lamisil's mechanism of action interferes with cells' methylation cycle, which we suspect compromises cellular function in people with the methylenetetrahydrofolate reductase genetic mutation.
Ther Drug Monit 2015 Dec
PMID:Antifolates and MTHFR. 2592 15


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