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Biomedical subjects

B Levine

Publications and source records attributed to B Levine.

At least 37 records · Page 2Linked to original sources
PubMed2001

Palliative pain therapy at the end of life and forensic medicine issues.

An 83-year-old woman with a history of Alzheimer's disease and breast cancer died at home while receiving palliative pain therapy with oral morphine from her family for metastatic breast cancer. Allegations of mistreatment were made, and this case was ultimately referred to the Office of the Chief Medical Examiner, State of Maryland. An autopsy failed to identify any injuries or residual cancer, leaving no anatomic explanation for the pain that had been presumed to be metastatic breast carcinoma involving bone. The blood free morphine concentration was 5,200 ng/ml, and the total morphine concentration was 15,000 ng/ml. This case demonstrates the challenges and difficulties in forensic medicine when faced with the interpretation of toxicologic results at the end of life.

Administration, Oral↗
PubMed2001

Emergency department evaluation of chest pain using exercise stress echocardiography.

OBJECTIVE: Patients with a low risk of coronary artery disease (CAD) presenting to the emergency department (ED) with chest pain pose a diagnostic dilemma because a small percentage will suffer an acute myocardial infarction (MI) and sudden death. The authors conducted this study to determine whether exercise stress echocardiography (ESE) could be used to further support the safe discharge of these low-risk patients. METHODS: A convenience sample of patients > or =30 years of age without a prior cardiac history who presented to an academic community hospital with chest pain, normal initial creatine kinase, and electrocardiography without ischemic changes underwent ESE within 6 +/- 1.7 hours (mean +/- SD). Abnormal ESE was defined as regional wall motion abnormality at rest or after exercise. The ED disposition and three- and six-month follow-up for cardiac events were recorded. This was a prospective observational cohort study. RESULTS: Of a total of 149 eligible patients, 145 completed the study. The mean age (+/-SD) was 47 +/- 9 years; 56% were male. No adverse events were noted during ESE. Seven patients (5%) had abnormal ESE (2 with rest wall motion abnormalities and 5 with exercise-induced wall motion abnormalities). Five of the seven underwent cardiac catheterization; three had CAD. All patients received telephone follow-up at three months and six months. Of the 138 patients with a normal ESE, all were free of cardiac events at three months. One patient had a non-Q-wave MI at six months (negative predictive value = 99.3%, 95% CI = 97.8% to 100%). CONCLUSIONS: Exercise stress echocardiography can be used to evaluate low-risk chest pain patients in the ED. Patients with a normal ESE may be considered for discharge with minimal risk of sequelae.

Adult↗
PubMed2001

Identification of genes involved in the host response to neurovirulent alphavirus infection.

Single-amino-acid mutations in Sindbis virus proteins can convert clinically silent encephalitis into uniformly lethal disease. However, little is known about the host gene response during avirulent and virulent central nervous system (CNS) infections. To identify candidate host genes that modulate alphavirus neurovirulence, we utilized GeneChip Expression analysis to compare CNS gene expression in mice infected with two strains of Sindbis virus that differ by one amino acid in the E2 envelope glycoprotein. Infection with Sindbis virus, dsTE12H (E2-55 HIS), resulted in 100% mortality in 10-day-old mice, whereas no disease was observed in mice infected with dsTE12Q (E2-55 GLN). dsTE12H, compared with dsTE12Q, replicated to higher titers in mouse brain and induced more CNS apoptosis. Infection with the neurovirulent dsTE12H strain was associated with both a greater number of host genes with increased expression and greater changes in levels of host gene expression than was infection with the nonvirulent dsTE12Q strain. In particular, dsTE12H infection resulted in greater increases in the levels of mRNAs encoding chemokines, proteins involved in antigen presentation and protein degradation, complement proteins, interferon-regulated proteins, and mitochondrial proteins. At least some of these increases may be beneficial for the host, as evidenced by the demonstration that enforced expression of the antiapoptotic mitochondrial protein peripheral benzodiazepine receptor (PBR) protects neonatal mice against lethal Sindbis virus infection. Thus, our findings identify specific host genes that may play a role in the host protective or pathologic response to neurovirulent Sindbis virus infection.

Alphavirus Infections↗
PubMed2001

The detection of psilocin in human urine.

Pharmacokinetic studies of psilocybin in humans have shown the rapid dephosphorylation of psilocybin to psilocin with further conversion to 4-hydroxy-tryptophole (4HT) and 4-hydroxyindole-3-acetic acid (4HIAA) in plasma. Our study shows that psilocin also undergoes conjugation and can be found in the urine as the psilocin-glucuronide conjugate. Recoveries after enzymatic hydrolysis of the urine with beta-glucuronidase (Helix Pomatia or E. Coli) when compared to non-hydrolyzed urine confirmed the presence of the glucuronide. Detection of psilocin from hydrolyzed and extracted samples was optimized for GC/MS by derivatization with MSTFA. The method developed allows for the detection of psilocin in urine with a limit of quantitation of 10 ng/mL, based on 5 mL of spiked urine. Using this method, our laboratory has confirmed the presence of psilocin in 6 out of 8 urine samples, with concentrations ranging from 10 ng/mL to greater than 200 ng/mL. Before implementation of the hydrolysis and derivatization steps, our limit of detection was 200 ng/mL, based on spiked urine standards. No case samples were positive without hydrolysis and derivatization.

Forensic Medicine↗
PubMed2001

The Trail Making Test: a study in focal lesion patients.

The relationship of the Trail Making Test (TMT) to the frontal lobes was tested by comparing patients with damage to the frontal and nonfrontal regions to control participants. Although the analysis of time measurements, both raw and transformed, showed notable slowing of frontal groups, error analysis proved to be a more useful method of categorizing performance. Analysis of errors on Part B indicated that all patients who made more than 1 error had frontal lesions. Dividing the frontal damaged patients into subgroups on the basis of the number of errors yielded specificity of brain-behavior relations within the frontal lobes. Patients with damage in dorsolateral frontal areas were most impaired. Those with inferior medial damage to the frontal lobes were not significantly affected in TMT Part B performance.

Adult↗
PubMed2001

Water quality assessment for indirect potable reuse: a new methodology for controlling trace organic compounds at the West Basin Water Recycling Plant (California, USA).

The West Basin Water Recycling plant (California; USA) was built to increase the region's water resource availability. The plant influent is produced at Los Angeles Hyperion wastewater treatment plant and is treated through two parallel treatment processes depending on the end use: (1) Title 22 water for industrial and urban use, and (2) barrier treatment for groundwater recharge. A new methodology was applied to monitor the fate of base neutral compounds in the water barrier treatment train. The methodology included large sample volumes coupled with integrated chromatographic analysis (ICA). Data indicated a 25% increase in concentration of base neutral compounds after RO pretreatment, followed by a 70% removal efficiency after RO. The increase in concentration after RO pretreatment appears to be linked to the use of lime clarification.

Calcium Compounds↗
PubMed2001

Role of water reuse for enhancing integrated water management in Europe and Mediterranean countries.

Recycling water is an important aspect of water resource and environment management policies, ensuring reliable alternative water resources, reducing environmental pollution and achieving a more sustainable form of development. This paper focuses on wastewater reuse as a strategy for integrated water management. Key economic, financial, regulatory, social and technical factors that help to make water reuse projects successful are reviewed. Selected examples from Northern and Western Europe and arid and semi-arid Mediterranean regions illustrate the contribution of wastewater reuse to integrated management of water resources.

City Planning↗
PubMed2001

Eprosartan provides safe and effective long-term maintenance of blood pressure control in patients with mild to moderate essential hypertension.

Control of hypertension is hindered by the incidence of adverse events associated with therapy, which can result in low patient compliance. Specific angiotensin II receptor subtype AT1 blockers offer an alternative to the angiotensin converting enzyme inhibitors in the treatment of hypertension, as the incidence of side-effects may be lower. This open-label study was designed to investigate the long-term safety and efficacy of the AT1 receptor blocker, eprosartan, in patients with mild to moderate essential hypertension (sitting diastolic blood pressure > or = 95 mmHg and < or = 114 mmHg). 706 patients from 55 centres in the USA and three centres in Canada were randomised to receive once-daily eprosartan (400-800 mg) alone or in combination with hydrochlorothiazide (HCTZ). The study consisted of five periods: screening (day 1), run-in (2-4 weeks), titration (3-15 weeks), maintenance (12-24 months) and follow-up (5-7 days). Safety evaluations included incidences of adverse events and changes in laboratory tests, vital signs and electrocardiograms. Efficacy assessments included effects on blood pressure (BP) and fasting concentrations of lipids and glucose. The maintenance period was completed at 12 months by 583 (83.3%) patients and at 24 months by 311 (44.4%) patients. In total, 396 (56.1%) patients completed the study according to protocol. Once-daily eprosartan was well tolerated either alone or in combination with HCTZ, irrespective of the study dose administered. Patients treated with eprosartan had a safety profile similar to that reported in short-term placebo-controlled studies. The most frequently reported adverse event was upper respiratory tract infection. The incidence of adverse events was not affected by age or race, and, although events increased with the addition of HCTZ, they were generally not severe. The beneficial effect on BP was maintained throughout treatment. For the majority of patients, HDL cholesterol, triglyceride and glucose levels remained within the reference levels at all doses and timepoints. In summary, eprosartan provides reliable blood pressure control in a high proportion of patients, with a safety profile similar to that seen with placebo in short-term, placebo-controlled trials. By providing long-term safety and efficacy, eprosartan may have the potential to increase patient compliance, a significant issue in the treatment of hypertension in all patient types.

Acrylates↗
PubMed2000

Prediction of recovery of continuous memory after traumatic brain injury.

OBJECTIVE: To evaluate the ability of measures of initial severity, tests of attention, and demographic characteristics to predict recovery of continuous memory for words over a 24-hour period in patients with acute traumatic brain injury. METHODS: Recovery of continuous memory was assessed prospectively in 94 patients with nonpenetrating traumatic brain injury. A classification and regression tree analysis identified a hierarchical subset of variables that may be used as a simple guideline for predicting recovery of continuous memory. Weibull regression models evaluated and compared the predictive ability of multiple variables. RESULTS: Four groups of patients were identified based on measures of severity of injury and demographic characteristics. These four groups had recovery profiles that were more precise than could be obtained by using the Glasgow Coma Scale alone: mild, about 1 week to recovery of continuous memory; moderate, 1 to 4 weeks; severe, 2 to 6 weeks; and extremely severe, 4 to 8 weeks. Regression analysis confirmed that measures of capacity (inherent resources such as indicated by age) and compromise (general functional brain state measured neuropsychologically) improved prediction over models based only on injury severity measures, such as the Glasgow Coma Scale. CONCLUSIONS: Approaches to predicting recovery of continuous memory in the acute period after traumatic brain injury that take into account multiple measures provide a more sensitive predictive index.

Adult↗
PubMed2000

Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes.

Forty-six patients with single focal lesions (35 frontal, 11 nonfrontal) were administered the Wisconsin Card Sorting Test (WCST) under three conditions of test administration. The three conditions varied in the amount of external support provided via specificity of instructions. The WCST, while a multifactorial test, is specifically sensitive to the effects of frontal lobe damage if deficits in language comprehension and visual-spatial search are controlled. There is also specificity of functioning within the frontal lobes: patients with inferior medial frontal lesions, unilateral or bilateral, were not impaired on the standard measures although they had increased loss of set when informed of the sorting categories. Verbal instructions may provide a probe to improve diagnosis and prognosis, assessment of the potential efficacy of treatment, and the time frame of plasticity of specific cognitive operations.

Brain Injuries↗
PubMed2000

Acquired aphasia in children after surgical resection of left-thalamic tumors.

Five children (three males, two females; four right-, one left-handed; age range 6 to 14 years) who developed aphasia after gross-total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the importance of the thalamus and other subcortical structures in developing cognition.

Adolescent↗
PubMed2000

Rehabilitation of executive functioning: an experimental-clinical validation of goal management training.

Two studies assessed the effects of a training procedure (Goal Management Training, GMT), derived from Duncan's theory of goal neglect, on disorganized behavior following TBI. In Study 1, patients with traumatic brain injury (TBI) were randomly assigned to brief trials of GMT or motor skills training. GMT, but not motor skills training, was associated with significant gains on everyday paper-and-pencil tasks designed to mimic tasks that are problematic for patients with goal neglect. In Study 2, GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities. Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT. These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage.

Adult↗