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Biomedical subjects

M D Murray

Publications and source records attributed to M D Murray.

At least 19 recordsLinked to original sources
PubMed1992

Effects of flurbiprofen on renal function in patients with moderate renal insufficiency.

1. Renal function was assessed in eight patients with chronic renal insufficiency following the administration of flurbiprofen 50 mg as a single dose and after chronic administration of 50 mg four times daily for 8 and 27 days. Diet and fluid intake were controlled. 2. Inulin and creatinine clearances and urinary excretion of sodium were measured at baseline and every 20 min for at least 3 h after dosing. The time of the mean peak concentration of (S)-flurbiprofen was used to guide the analysis of the clearances. Creatinine clearance, urinary excretion of sodium, and serum sodium and potassium were also assessed for 24 h after the dose and on a daily basis. Body weight and blood pressure were measured on a daily basis. 3. Decrements in inulin and creatinine clearances were small and reversible within 3 h of an oral dose of flurbiprofen. Comparison of baseline clearances for the three study periods (first dose and at 8 and 27 days of chronic dosing) revealed a lack of chronic effect on glomerular filtration rate. 4. In contrast, flurbiprofen caused a substantial (73 to 86%) and progressive decrease in the urinary excretion of sodium that reached a nadir within 4-5 h after drug administration. However, comparison of baseline values did not differ, indicating that balance conditions had been re-established. 5. Results of 24 h assessments were in agreement with the clearance study results. Reduced urinary excretion of sodium appeared to be limited to the first few days of flurbiprofen administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Parallel bonded cast attachments for removable partial dentures.

The original design of a semi-precision extra-coronal attachment for partial dentures is illustrated, and its fabrication in a cast non-precious bondable alloy is described. A step-by-step method is also described of bonding multiple attachments in parallel for the retention and support of removable partial dentures. Clinical cases are illustrated. The results of trials indicate that the method is clinically viable and, in selected cases, appears to offer distinct advantages over existing retention systems.

Chromium Alloys↗
PubMed1990

Ibuprofen-associated renal impairment in a large general internal medicine practice.

The authors determined the incidence of ibuprofen-associated renal impairment and risk factors for its development in 1908 patients treated with ibuprofen using data from a computerized medical records system. Renal impairment occurred in 343 patients (18%). Multivariable analysis revealed six independent predictors of renal impairment: age, prior renal insufficiency, coronary artery disease, male gender, elevated systolic blood pressure, and diuretic use. They then tested the degree to which ibuprofen contributed to the development of renal impairment by evaluating a control group of 3933 acetaminophen recipients. Neither ibuprofen nor acetaminophen was among the independent predictors of risk when all patients were considered (adjusted odds ratio, 1.05; 95% Cl, 0.88-1.26). However, two subsets of at risk patients had an ibuprofen effect: patients greater than or equal to 65 years of age who received ibuprofen were at greater risk of renal impairment as compared to acetaminophen recipients (adjusted odds ratio, 1.34; 95% Cl, 1.05 to 1.72) as were patients with coronary artery disease (adjusted odds ratio, 2.54; 95% Cl, 1.38 to 4.68). Their results suggest that elderly patients and patients with coronary artery disease are at risk for ibuprofen-associated renal impairment and therefore should have their renal function monitored when ibuprofen and possibly other nonsteroidal anti-inflammatory drugs are prescribed.

Acetaminophen↗
PubMed1990

Nonsteroidal anti-inflammatory drugs.

Although the increased need for studies assessing the influence of age on the pharmacokinetics and pharmacodynamics of all drugs has been emphasized, relatively little is known about NSAIDs in the elderly. The pharmacokinetics of some NSAIDs have been examined in elderly subjects; unfortunately, recent data indicate that much of the earlier information may be incomplete or even misleading. Many studies report the disposition of only total NSAIDs. Since all of the NSAIDs are highly protein bound, it is the unbound, pharmacologically active, fraction that is most important. Few studies have quantified the pharmacokinetics of unbound NSAID in any age group, much less in elderly patients. Also, it is now apparent that studies of the propionic acid derivatives and other drugs with chiral centers must assess the disposition of the active S-enantiomer. Finally, studies of NSAIDs that form acylglucuronides are confounded by the reversion of these metabolites to active drug. Reduced renal elimination of these metabolites may be greater in elderly persons. Studies that account for these features of NSAIDs will provide necessary data for safe and effective use of NSAIDs in the elderly.

Age Factors↗
PubMed1988

Akabane disease in sheep.

Perinatal lamb mortality, associated with malformations of the CNS due to Akabane viral infection, occurred in 4 of 9 flocks of ewes lambing on 3 farms between 26 May and 14 November, 1976. Cases were restricted to ewes conceiving prior to the second week of March and lambing between 26 May and 19 July. As judged by seroconversion in sentinel flocks on 2 of the farms, field infection with Akabane virus occurred mainly between mid-February and mid-April. Malformations of the CNS occurred in 42.5%, 51.2%, 100% and 31.0% of the dead lambs examined in the affected flocks respectively. Prevalence in the 4 affected flocks, expressed as the proportion of ewes lambing which delivered at least one malformed foetus, was 6.1%, 8.4%, 88.9% and 5.7% respectively. Lamb mortality due to malformations of the CNS was 7.1%, 5.5%, 92.3% and 5.7% of lambs born. Age-specific prevalence was calculated for 3 of the 4 flocks and 2-year-old ewes accounted for 71.4% and 76.9% of total cases respectively in 2 flocks, whereas in one flock malformations occurred at equivalent frequencies throughout several older age groups. Birthweights of affected lambs were usually significantly lighter than those of unaffected lambs of similar sex and birth-type, and their mean duration of gestation was slightly, and significantly, prolonged. Micrencephaly (88.1% of cases) and hydrocephalus (68.7% of cases) were the outstanding pathological features of the malformations with hydranencephaly, microgyria, porencephaly and attenuation of the spinal cord occurring at much lower frequencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Attitudes of house physicians concerning various antibiotic-use control programs.

Medical and surgical house physicians at three teaching hospitals with different antibiotic control programs (ACPs) were surveyed to determine their attitudes about and preferences for these programs. Questionnaires were mailed to resident physicians who had trained at all three hospitals. One hospital had no antibiotic prescribing policy (open prescribing), one employed an infectious-disease physician consultant who discussed antibiotic orders for certain reserved drugs with prescribing physicians but did not otherwise restrict access to the drugs (educational ACP), and the third hospital required approval of an infectious-disease physician for dispensing of reserved drugs by the pharmacy department (restrictive ACP). The survey response was 77% after one follow-up mailing to nonrespondents. Regardless of hospital type, physicians preferred the educational ACP to either open prescribing or the restrictive ACP. Based on personal experiences, significantly fewer physicians encountered patient-care problems with the educational ACP than with either open antibiotic prescribing or the restrictive ACP. Significantly more physicians perceived that the educational ACP was more beneficial for patient antibiotic therapy and will be more beneficial for future antibiotic prescribing than the restrictive ACP. Most respondents believed that ACPs save hospitals money, that ACPs can be implemented without compromising either patient care or physician performance, and that they would encounter similar ACPs in the future. Educational ACPs should be considered at teaching hospitals with interested infectious-disease consultants.

Anti-Bacterial Agents↗
PubMed1987

Epidemiology of bovine ephemeral fever in Australia 1981-1985.

Bovine ephemeral fever is an important viral disease of cattle in Australia. The disease occurred each year, principally in summer and autumn, between 1981 and 1985. Queensland and the northern half of New South Wales were areas of greatest activity with only sporadic cases being reported from the Northern Territory and the northern third of Western Australia. Since 1981, the disease has been endemic in an extensive area of eastern Australia and has tended to occur in widely scattered outbreaks rather than the north-south advancing wave form of the epidemics of 1936-37, 1967-68, 1970-71 and 1972-74. The southernmost outbreaks between 1981 and 1985 were well within the limits of these earlier epidemics. The pattern of disease appears to have become seasonally endemic rather than periodically endemic in the northern two-thirds of eastern Australia. Ephemeral fever was not recorded in Victoria, Tasmania, South Australia or the southern part of Western Australia between 1981 and 1985. The disease was most frequently reported in cattle under 3 years of age, but also occurred in older cattle.

Animals↗
PubMed1987

Akabane epizootics in New South Wales: evidence for long-distance dispersal of the biting midge Culicoides brevitarsis.

In 1983 an outbreak of Akabane disease occurred in calves in New South Wales between Coolah and Dunedoo at the foothills of the Liverpool Range, from Molong to Oberon in the Blue Mountains and in the Bylong Valley. These areas, at the time of infection of the dams, were in a drought and conditions were unsuitable for the multiplication of C. brevitarsis. In late March meteorological phenomena developed producing air movements favourable for transporting infected midges from the Hunter Valley. A re-examination of the data from the epizootics of 1974 and 1955 showed that similar weather systems had developed. It is possible that the source of infected midges in these epizootics was also the Hunter Valley.

Animals↗
PubMed1986

Medication use by ambulatory elderly. An in-home survey.

The elderly residents of an urban subsidized apartment building were interviewed in their apartments to determine a comprehensive medication profile. The interviews were conducted by doctor of pharmacy candidates, and 155 residents (81.2%) participated. Compliance was similar to rates previously reported (49.3%), and adverse drug reactions were common (29.1%). Other findings included: compliance did not decrease with advancing age; most elderly individuals could open child-resistant containers (83.4%), read standard container labels (79.7%), and identify teaspoon (97.3%) and tablespoon (88.5%) quantities; inability to open easy-open (flip-off) containers decreased compliance (P = .03); men were more compliant than women (68.4 v 42.4%, P = .006) but were taking fewer medications (3.3 per male v 5.0 per female); only 12.6% of respondents thought they were taking too much medication but when they did compliance diminished (P = .003); medications were infrequently shared (5.6% of respondents reported sharing); and only 6.4% of respondents reported medication expense as a concern.

Adult↗
PubMed1986

Factors contributing to medication noncompliance in elderly public housing tenants.

A study examined the extent and correlates of noncompliance in 155 predominantly elderly public housing tenants. Data were gathered through in-home interviews; only data from tenants taking prescribed medications on a regularly scheduled basis (n = 140) were analyzed. Noncompliance was significantly (p less than 0.05) associated with taking more than five prescribed medications, an inability to read prescription and auxiliary labels, and difficulty opening flip-off type medication container lids. The results indicate that attempts to reduce the total number of prescription drug products used in these elderly residents by carefully scrutinizing the need for each prescription drug may enhance compliance. Pharmacists could assist in the detection of elderly patients at risk for medication noncompliance (five or more total prescription medications) by assessing the patients' ability to read labels on prescription containers for all new drug additions and refills, and by having them try to open a flip-off container lid.

Aged↗