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Biomedical subjects

A D Woolf

Publications and source records attributed to A D Woolf.

At least 55 records · Page 3Linked to original sources
PubMed1999

Effect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose.

OBJECTIVE: To determine the effect of the metoclopramide dose on the prevention of vomiting of N-acetylcysteine in acetaminophen overdose. METHODS: Patients with acetaminophen ingestions receiving metoclopramide prior to emergency department administration of N-acetylcysteine were included. Emergency Department and poison center records were reviewed for administration of metoclopramide pre-N-acetylcysteine and incidence of subsequent vomiting. The treatment group was defined as patients receiving high-dose metoclopramide (20-50 mg intravenously) prior to the loading dose of N-acetylcysteine. Controls were patients receiving standard-dose (< 20 mg intravenously) metoclopramide prior to loading dose of N-acetylcysteine. Outcome was vomiting within 60 minutes of N-acetylcysteine administration. RESULTS: Twelve of 19 patients (63%) receiving standard-dose metoclopramide vomited N-acetylcysteine. Only 5 of 23 patients (22%) receiving high-dose metoclopramide vomited N-acetylcysteine (crude odds ratio: 6.2; 95% CI [1.3-30.3]). After controlling for confounding in the logistic regression model, the effect of high-dose metoclopramide in preventing vomiting of N-acetylcysteine remained significant (adjusted odds ratio: 17.0; 95% CI [2.6-110.0]). CONCLUSION: This study supports the efficacy of high-dose metoclopramide to prevent emesis after the oral loading dose of N-acetylcysteine.

Acetaminophen↗
PubMed1999

Nail primer cosmetics: correlations between product pH and adequacy of labeling.

BACKGROUND: We have previously reported on injuries suffered by young children exposed to methacrylic acid-containing nail primers and the need for public education efforts concerning this potential household hazard. However, some primers contain alternative ingredients, which may or may not pose the same risk; product labeling information is variable and may be confusing to consumers. OBJECTIVE: To investigate the relationship between pH of different primer products, product contents, and appropriateness of product labeling and packaging. METHODS: Twenty-three commercially available primers were grouped by product contents: (methacrylic acid vs others). Product pH was measured and product labels were scored on 7 warning points: "poison and/or corrosive," a "caution to avoid contact and/or to use a barrier when handling the product," a "skin first aid," and "eye first aid," an "ingestion first aid," a caution to "keep out of reach of children," and a "in emergency, contact a poison center." A summative "global hazard notification score" was calculated for each product. Data were analyzed using correlations and the two-sample t-test. RESULTS: None of 23 products tested were contained in a child-resistant container and none included all 7 label items. Product pH ranged from 1.90-8.55 (mean pH 4.59 +/- 1.99); 20 products had pH < 7.0. Only 1 product advised, in the event of a poisoning, that a poison center be contacted. Of 20 acidic products, only 7 alerted users that the contents could cause burns. The mean global hazard notification score (MAX = 7) was 3.6; global hazard notification score did not correlate with pH. Methacrylic acid-containing products had a lower pH (mean 3.43 +/- 0.78) than those without methacrylic acid (mean 5.34 +/- 2.18), p = 0.008. When the primer bottle was separated from the rest of the packaging which comprised the artificial nail "kit," 50% of products lost all of their warning information. CONCLUSIONS: Most, but not all, artificial nail primers analyzed in this study were highly acidic. Labeling and packaging of many nail primers are inadequate, given the potential of methacrylic acid in these products to cause burns and the toxicity of most nail primers. We agree with the Consumer Product Safety Commission's recently proposed rule to require cosmetic manufacturers to repackage methacrylic acid-containing household products in child-resistant containers. We also urge manufacturers to alert consumers to the hazards of nail primers by better labeling. Manufacturers should also investigate the feasibility of either substituting other chemicals or lowering the concentration of methacrylic acid.

Cosmetics↗
PubMed1999

Use of phenothiazines as sedatives in children: what are the risks?

Phenothiazines have been widely used for their antiemetic, antipsychotic and sedative properties for many years. The introduction of alternative agents for paediatric sedation has led to the re-evaluation of phenothiazines as paediatric sedatives. Newer agents, such as fentanyl and midazolam, have short half-lives and reversal agents are available. Therefore these agents may offer comparable therapeutic efficacy with a better safety profile in young children. Reports of sudden infant death syndrome in children receiving a phenothiazine-containing syrup for symptoms of upper respiratory infection means that the outpatient use of these compounds in very young infants is not recommended.

Child↗
PubMed1999

The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey.

OBJECTIVE: Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. There are, however, few population data concerning the occurrence of and clinico-biological correlates of vertebral osteophytes in both the dorsal and lumbar spine. Our purpose was to determine the frequency and distribution of anterior osteophytes in the thoracic and lumbar spine, and their relationship with both various putative risk factors, including physical activity and obesity, and self-reported back pain. METHODS: Men and women aged 50 years and over were recruited from primary care based registers in 5 UK centers. They were invited to attend for an interviewer administered lifestyle questionnaire, assessment of height and weight, and lateral spinal radiographs. Lateral spinal radiographs were evaluated by a single observer for the presence of osteophytes from T4 to L5 using a semiquantitative score (grade): 0 = none, 1 = doubtful, 2 = mild, 3 = moderate, 4 = severe. Based on these data 2 summary statistics were derived: the maximum osteophyte grade at any vertebral level (MAX), and the sum of the osteophyte grades at the individual vertebral levels (TOT). RESULTS: In total, 681 women, mean age 63.3 years, and 499 men, mean age 63.7 years, were studied; 84% of men and 74% of women had at least one vertebral level with a grade 1 or higher osteophyte. Both the sum of the individual grades (TOT) and the proportion of subjects with MAX > or =2 were greater in men than in women in both the dorsal and lumbar spine, and both increased with age. The pattern of spinal involvement was similar in the sexes, with osteophytes occurring most frequently at T9-10 and L3. Increasing body mass index was associated with more frequent osteophytes at both dorsal and lumbar spine, although the relationship was stronger at the dorsal spine. Heavy physical activity, particularly in young adult life, was associated with osteophytosis in men. Self-reported back pain, both ever and in the past year, was linked with lumbar osteophytes in men. CONCLUSION: The distribution within the spine in our study and the relationship with heavy physical activity points to mechanical factors being important in pathogenesis of vertebral osteophytosis. Prospective studies are needed to explore the types of physical activity that increase susceptibility to vertebral osteophytosis. In men, osteophytes affecting the lumbar spine are associated with back pain.

Aged↗
PubMed1998

N-acetylcysteine reduces methemoglobin in an in-vitro model of glucose-6-phosphate dehydrogenase deficiency.

OBJECTIVE: To determine whether N-acetylcysteine (NAC) reduces methemoglobin (MHB) in an in-vitro model of glucose-6-phosphate dehydrogenase (G6PD) deficiency, given that methylene blue is an ineffective MHB antidote in G6PD deficiency. METHODS: Five volunteers donated blood, which was divided equally into 2 test tubes, centrifuged, and washed with Tris-Mopps buffer (pH 7.4, 15 mmol/L glucose). Both tubes were incubated with epiandrosterone (EA) (400 micromol), a specific inhibitor of G6PD. After 75 microL of 0.18 mol hydroxylamine (HA) was added to induce MHB formation, 150 microL of NAC (20 mg/mL) was added to tube 1 and 150 microL of phosphate-buffered saline (PBS) was added to tube 2 as a volume control. Serial MHB levels are reported as a percentage of total hemoglobin (Hb). G6PD activity was measured at baseline, 15 minutes after EA, and at 5 hours. RESULTS: Mean G6PD activity at baseline was 9.2+/-2.9 U/g Hb (normal >4.6 U/g Hb); 15 minutes after EA was 3.0+/-1.0 U/g Hb; and at experiment's end was 2.3+/-0.7 U/g Hb. The mean (+/-SD) areas under the concentration-time curves (AUCs) of NAC-EA-HA and PBS-EA-HA samples were compared using an unpaired t-test and were significantly different: PBS-EA-HA, 20,400+/-1,100 % min, vs NAC-EA-HA, 10,400+/-1,000 % min, respectively (p < 0.05). CONCLUSION: In this in-vitro model of G6PD deficiency, NAC efficiently reduced MHB.

Acetylcysteine↗
PubMed1998

Baclofen overdose: drug experimentation in a group of adolescents.

BACKGROUND: Baclofen, a lipophilic analog of gamma-aminobutyric acid, is clinically used to control spasticity. We report a mass exposure to baclofen in adolescents seeking intoxication; toxicokinetic data are included. CASE SERIES: A group of adolescents became symptomatic after ingesting 3 to 30 20-mg tablets of baclofen during a party at a suburban Boys' Club. Several children were noted to be very lethargic by chaperones, ingestion was suspected, and paramedics were called. Some white tablets were found in a couch at the site of the party. The Massachusetts Poison Control Center was called, and the tablets were identified as baclofen (20 mg). Fourteen patients were taken to local hospitals; 9 required intubation. Eight adolescents were transferred to our institution. In these 8 patients, symptoms were noted within 1 to 2 hours after overdose. The most common clinical findings included coma (7), hypothermia (6), bradycardia (5), hypertension (4), and hyporeflexia (8). Mean length of mechanical ventilation was 40 hours. Three patients had unifocal premature ventricular contractions. Two patients had tonic-clonic seizures. A single dose of activated charcoal was given to all patients. Drugs administered included nifedipine (1), flumazenil (1), naloxone (1), lorazepam (2), and phosphenytion (2). All patients recovered and were discharged home within 5 days of ingestion. Serial serum baclofen levels were obtained in all intubated patients (range, 0.049 to 6.0; normal, 0.08 to .40 microgram/mL). Levels obtained 14 hours after ingestion showed a linear correlation with length of mechanical ventilation (R2 = 0.9863). Persistent symptoms were noted in some patients, despite nondetectable baclofen levels. Toxicologic screening for drugs of abuse was negative except in 2 patients with ethanol levels, both < 5 mg/dL. CONCLUSION: Baclofen overdose may result in coma, apnea, autonomic disturbances, cardiac conduction abnormalities, and seizures. Levels obtained shortly after overdose correlate with length of mechanical ventilation.

Adolescent↗
PubMed1998

Choice of NSAID and management strategy in rheumatoid arthritis and osteoarthritis. The impact on costs and outcomes in the UK.

OBJECTIVE: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective therapy for rheumatoid arthritis, they are associated with significant adverse effects, the management of which imposes additional costs on the healthcare system. Prescribing NSAIDs which have a lower risk of major adverse effects as the first-line NSAID for patients with rheumatoid arthritis and osteoarthritis may be expected to lead to an improvement in clinical outcomes and reduce overall treatment costs. This analysis examines data from a published randomised controlled trial of 5 NSAIDs to explore these hypotheses. DESIGN AND SETTING: Data from a clinical trial comparing 5 NSAIDs were combined with published cost data to construct 2 clinical decision models, reflecting alternative approaches to the management of major and minor adverse effects in the UK. INTERVENTIONS: The 5 NSAIDs evaluated in the analysis were nabumetone, diclofenac, ibuprofen, piroxicam and naproxen, although only the results for ibuprofen and nabumetone are reported. MAIN OUTCOME MEASURES AND RESULTS: The total cost of care per patient receiving nabumetone was estimated to be between 25 pounds sterling (Pound) and 41 Pounds more expensive than ibuprofen. In a hypothetical cohort of 100,000 patients, there were between 690 and 821 more major adverse effects using ibuprofen than nabumetone. The cost per life-year gained (LYG) from using nabumetone rather than ibuprofen ranged between 1880 Pounds and 2517 Pounds (1995 values), depending upon the management of adverse effects. CONCLUSIONS: These results indicate that: (i) prescribing the newer, currently more expensive, NSAIDs will not necessarily lead to cost savings; (ii) the management of adverse effects can have a significant impact on costs; and (iii) the additional cost may be justifiable in terms of the mortality and morbidity gains associated with the new lower-risk NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

On-site availability of selected antidotes: results of a survey of Massachusetts hospitals.

Hospital pharmacies in Massachusetts were surveyed to determine their patterns of stocking antidotes. Mailed questionnaires were completed by hospital pharmacy directors at 82 of 93 acute care institutions (87% response rate). Results confirmed great variability in on-site accessibility of antidotes. Only 8 of the 82 hospitals (9.8%) stocked all of 14 common antidotes inventoried by the survey. Even fewer hospital pharmacies stocked specific antidotes (eg, Crotalid anti-venin, digoxin-specific Fab antibodies, pyridoxine) in an adequate quantity to treat one poisoned adult. Larger hospitals and those with a 24-hour pharmacy were more likely to have certain antidotes than smaller institutions. We conclude that Massachusetts hospitals do not carry complete inventories of 14 common antidotes. It is important that poisoned patients be referred to medical centers with adequate toxicological care. Improved guidelines for the accessibility of antidotes need to be developed and made available to hospital pharmacies and emergency departments.

Antidotes↗
PubMed1997

Osteoporosis: outstanding issues.

Major advances have occurred in our knowledge of osteoporosis and its treatment in the past 10 years. This paper reviews aspects of the epidemiology, pathogenesis, and diagnosis of the disease that deserve further investigation. Although anti-resorption treatments such as hormone replacement therapy and bisphosphonates have been shown to reduce the incidence of osteoporotic fractures, there is room for improving available treatments. Today, there is no bone-forming agent that has been shown to decrease fracture rate, and several agents are under clinical investigation. The potential value of combined therapy will also be discussed.

Bone Remodeling↗