Biomedical subjects
Publications and source records attributed to I Iqbal.
Leflunomide (Arava) was approved for the treatment of rheumatoid arthritis by the regulatory authorities in the US and Europe in 1998. This approval was based on three pivotal randomised clinical trials conducted in the US and Europe. This report will focus on the use of leflunomide in rheumatoid arthritis based on the data from these trials as well information on the efficacy and safety learned from post release clinical experience.
Manufactured by the process of injection moulding, starch capsules have been shown to be a very useful alternative delivery system for orally administered compounds. This review describes the starch capsule manufacturing and filling processes and provides an overview of the capsules' physical characteristics. In addition, investigations supporting the development of novel delivery technologies based on the starch capsules are described. Particular emphasis is given to a technology that facilitates drug delivery to specific sites in the human gastrointestinal tract.
We compared cefixime with chloramphenicol in a randomized trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally and twenty received chloramphenicol 50 mg/kg/day orally. On entry in the study, the clinical characteristics of the two groups were comparable. Duration of therapy was 14 days. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenical. Out of the 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all of them were cured. Over all 28 cases out of 30 (93.3%) P = 0.0049 were cured by cefixime.
We compared cefixime with chloramphenicol in a trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally for 14 days and twenty received chloramphenicol 50 mg/kg/day orally for 14 days. On entry the clinical characteristics of the two groups were comparable. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenicol. Of 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all were cured. Overall 28 out of 30 cases (93.3%) were cured by cefixime.
A knowledge, attitude and practices (K.A.P.) survey was conducted among doctors working as general practitioners (GP) in Multan, for diagnosis and management of acute respiratory infections (ARI) in children under five years of age. GPs in Multan were not familiar with national ARI control programme and rational drug use guidelines. They rarely asked about symptoms describing severity of disease while taking patient histories and did not look for signs of severe pneumonia during physical examinations. Most patients diagnosed as URTI (upper respiratory tract infection) received oral antibiotics and those with pneumonia received injectable antibiotics. Other drugs prescribed included cough syrups, antihistamines and antipyretics. The average number of drugs prescribed per patient was 3.4. The doctors were deficient in providing home care advice for sick children to the caretakers. Average time spent by doctors on each patient was two minutes and twenty-three seconds. A combination of biomedical and social factors help to perpetuate this irrational prescribing behaviour of the GPs. Continuing education programmes for doctors in general practice about ARI management in children and rational use of drugs and health education of the public may improve the current prescribing practices.
Chronic inflammatory demyelinating neuropathy (CIDP) is a rare disease in childhood. We reviewed the clinical characteristics, response to therapy, and long-term prognosis in 13 children (1.5 to 16 years of age) diagnosed with CIDP at Washington University Medical Center, St. Louis, and the Royal Children's Hospital, Melbourne, Australia, between 1979 and 1994. The most common presenting symptom (in 11/13 [85%]) was lower extremity weakness associated with difficulty in walking. Preceding events within 1 months of onset, mostly intercurrent infections or vaccinations, occurred in seven children (54%). The disease was monophasic in three children (23%). One relapse occurred in four (30%) and multiple relapses in six (46%). All patients had at least short-term response to steroids. Three children (23%) recovered completely during the first year. Ten children (77%) had residual weakness after an average follow-up of 6 years. There seems to be two populations of children with CIDP. One subgroup, with a favorable prognosis, progressed to peak disability over less than 3 months; these children often have a monophasic course with complete resolution of symptoms and signs and withdrawal from all medications by 1 year after onset. A second subgroup progressed for 3 months or longer; these children all required substantial does of prednisone for prolonged periods and had considerable long-term morbidity with persistent weakness.
To identify factors associated with control of human cholesterol synthesis, periodicity in cholesterogenesis, hormonal levels and food consumption behavior were examined in 5 healthy individuals at the beginning and end of 18 d in a perpetual daylight Arctic environment devoid of time cues. At d 2 (phase I) and d 16 (phase II), cholesterol fractional synthesis rate was determined at 6 h intervals over 30 h as deuterium incorporation into plasma free cholesterol. Total plasma cholesterol, insulin and glucose-dependent insulinotropic polypeptide were also measured at each timepoint. Food intake and sleeping patterns were recorded prior to and during each phase. Cholesterol fractional synthesis rate (FSR) exhibited periodicity in all subjects on each phase, but did not differ between phase I (FSR rate = 0.038 +/- 0.038 pools.d-1) and phase II (FSR rate = 0.037 +/- 0.072 pools.d-1) phases. Phase II FSR period length was associated with both the duration between first and last meals (r2 = 0.81, p = 0.037) and total hours spent awake (r2 = 0.99, p = 0.001). Insulin and glucose-dependent insulinotropic polypeptide levels were not associated with FSR periodicity. These results suggest that meal timing and sleep/wake cycles are more important factors than insulin and glucose-dependent insulinotropic polypeptide in controlling the rhythms of whole body cholesterol synthesis.
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The authors describe the surgical implantation of a left ventricular assist device (LVAD) in a patient with ischemic cardiomyopathy and recurring episodes of ventricular tachycardia with associated sudden death, as a therapeutic intervention for the recurrent ventricular arrhythmias. The clinical inference of this report demonstrates that these devices are useful as a bridge to heart transplantation, not only improving the symptoms of heart failure but also suppressing malignant ventricular arrhythmias. (c) 1999 by CHF, Inc.
The clinical characteristics as well as treatment of a patient with renal artery stenosis associated with uncontrolled hypertension and heart failure is described. Patients with similar findings should alert clinicians of this entity, since rapid diagnosis and treatment will assure a prompt relief not only of the increased blood pressure but also of the symptoms of heart failure. (c)1999 by CHF, Inc.