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Biomedical subjects

M J Romano

Publications and source records attributed to M J Romano.

13 recordsLinked to original sources
PubMed2001

Improvement in asthma symptoms and quality of life in pediatric patients through specialty care delivered via telemedicine.

Asthma is the most common chronic disease affecting children. Studies have demonstrated improvements in asthma control when care is delivered by specialists compared with generalists. We postulated that specialist care delivered by telemedicine would result in similar improvements in control of symptoms and quality of life as compared with face-to-face encounters with specialists. Seventeen patients with persistent asthma, who were cared for by pediatricians in a rural school-based health clinic, were treated over a 6-month period in an asthma specialty program. Patients had face-to-face encounters at week zero, and then telemedicine follow-up visits at weeks 4, 12, and 24. Patients maintained a symptom diary and reliever medication use log. Spirometry and patient and caregiver quality-of-life questionnaires were completed at each visit. Mean number of symptom free days increased 83% from 2.35 days at week 0 to 4.31 days at week 24 (p < 0.05). There was a 44% reduction in mean symptom scores, from 2.32 at week 0 to 1.31 at week 24 (p < 0.001). Nine patients reported having 7 symptom-free days or 7 days of symptom scores of zero in the preceding seven days at week 24 compared with one patient at week 0 (p < 0.002). FEV(1) increased by > or = 12% in seven patients during the study period. Significant improvements in quality of life were reported by patients at week 4 (p < 0.02) and week 24 (p < 0.01), and by caregivers at week 24 (p < 0.002). Specialty asthma care delivered via telemedicine resulted in improvements in asthma symptom control and quality of life similar to improvements reported in face-to-face encounters provided by specialists.

Adolescent↗
PubMed2001

A 1000-fold overdose of clonidine caused by a compounding error in a 5-year-old child with attention-deficit/hyperactivity disorder.

A 5-year-old child who weighed 17.5 kg received 50 mg of clonidine. The amount ingested was confirmed by analysis of the suspension administered (clonidine HCl 9.78 mg/mL). To our knowledge, this represents the largest ingestion in a child and the largest ingestion on a milligram per kilogram basis in the medical literature. The child's initial presentation included hyperventilation, an unusual feature of clonidine toxicity. The child was discharged without sequela 42 hours after admission. A serum concentration of clonidine 17 hours postingestion was 64 ng/mL, the highest reported to date in a pediatric patient. The intoxication was traced to a pharmacy compounding error in which milligrams were substituted for micrograms. Increased prescribing of clonidine in young children coupled with the requirement to compound clonidine in a suspension and the narrow therapeutic index suggests that the frequency of severe ingestions in children will increase in the future.

Adrenergic alpha-Agonists↗
PubMed1993

Single-dose pharmacokinetics and safety of HA-1A, a human IgM anti-lipid-A monoclonal antibody, in pediatric patients with sepsis syndrome.

The pharmacokinetics and safety of HA-1A (Nebacumab), a human IgM monoclonal antibody with specificity for the lipid A region of endotoxin, were evaluated in a multicenter trial of pediatric patients with sepsis syndrome or septic shock. Forty-two patients received a total of 44 infusions of drug, at a dose of 3 mg/kg (maximum 100 mg). The mean age was 7 years 10 months (range, 11 months to 16 years 7 months). The pharmacokinetic behavior of HA-1A during 36 hours was best described by a one-compartment open model. Clearance (6.1 +/- 2.0 ml/kg per hour) and apparent volume of distribution at steady state (0.11 +/- 0.03 L/kg) were larger than values reported previously in adults with sepsis syndrome. Elimination half-life (14.5 +/- 6.8 hours) and plasma concentration after infusion (30.7 +/- 14.5 mg/L) were similar to adults' values. In an additional three patients studied for 72 hours after administration, a biexponential function (i.e., two-compartment open model) best described the pharmacokinetic behavior of HA-1A: clearance (1.5 +/- 1.4 ml/hr per kilogram) and apparent volume of distribution at steady state (0.2 +/- 0.02 L/kg) were different (p < 0.002) from values observed in children's blood samples during 36 hours. Within the pediatric population, no age-related differences in pharmacokinetics could be detected. Drug disposition was unaffected by renal or hepatic dysfunction. Decreased blood pressure was the most frequently reported adverse event; 4 (9%) episodes in 44 infusions were considered possibly related to the study drug. Gram-negative bacteremia was documented in 23 (55%) of 42 patients. The overall mortality rate was 31%. Enterobacter cloacae was the most common pathogen isolated. Haemophilus influenzae type b was isolated from one child with sepsis syndrome. We conclude that infusion of HA-1A in children is associated with a low incidence of side effects. The pharmacokinetic-pharmacodynamic behavior of HA-1A in children requires further study to determine whether developmental differences exist and how these differences might affect drug administration. Efficacy remains to be studied.

Adolescent↗
PubMed1993

Infrared tympanic thermometry in the pediatric intensive care unit.

OBJECTIVES: To determine the performance of two different commercially available, noncontact infrared tympanic thermometers in predicting core body temperature as measured by pulmonary artery catheters in pediatric intensive care unit (ICU) patients. The performance of the tympanic thermometers was compared with the performance of an indwelling rectal probe and digital axillary temperature determinations. DESIGN: Prospective, consecutive sample, unblinded study. SETTING: Pediatric ICU of a tertiary care children's hospital. PATIENTS: Twenty patients requiring pulmonary artery catheter monitoring for clinical management. INTERVENTIONS: Temperature measurements were made using each infrared tympanic thermometer unit in the core mode. These values were compared with simultaneously obtained pulmonary arterial, digital axillary, and rectal probe temperatures. MEASUREMENTS AND MAIN RESULTS: Bias and variability of each method compared with the pulmonary arterial temperature were calculated. Bias did not vary with temperature measured or age of the patient. Indwelling rectal probes showed the least bias and variability and axillary temperature the most. Neither infrared tympanic thermometer had clinically important bias; one model had variability similar to that of the rectal probes, and the other model had significantly greater variability. CONCLUSIONS: In a pediatric ICU population, rectal probes reflect core temperature better than axillary determinations and both infrared tympanic models estimated core body temperature better than digital axillary temperature. One of the tympanic systems (Thermoscan Pro-1 infrared tympanic thermometer) performed in a similar way to the indwelling rectal probes and may be used to estimate core temperature in situations where a pulmonary artery catheter is not in place. The other test tympanic system (First Temp) had greater variability than the rectal probes.

Adolescent↗
PubMed1989

Phenotypic characterization of bovine lymphoblastoid cell lines.

Cytochemical and immunological markers were used to phenotype the bovine lymphoblastoid cell lines BL-3*, EBL-1, and EBL-2. Southern blot experiments were also performed to test these lines for the presence of proviral bovine leukemia virus (BLV). The BL-3* cell line, originally derived from a case of sporadic bovine leukosis (non BLV-associated) but later infected with BLV in vitro, was found to contain BLV provirus and expressed the BLV-encoded envelope glycoprotein BLV-gp51. BL-3* cells express surface IgM and cytoplasmic IgM as well as class II antigens, and greater than 95% were negative for the T-cell markers B26A, sheep erythrocyte (E) receptors and alpha-naphthyl butyrate esterase (alpha-NB). BL-3* thus appears to be B-cell derived. EBL-1 and EBL-2 were derived from cows with enzootic bovine lymphosarcoma; however, these cell lines were found not to be infected with BLV. Phenotypically, EBL-1 and EBL-2 are mature T-cells, as they were positive for the B26A epitope, alpha-NB, and E receptors. These cell lines also express class II major histocompatibility antigens, indicating an activated state. The T-cell phenotype of EBL-1 and EBL-2 raises interesting questions concerning the possible role of other retroviruses and non BLV-infected transformed T-cells in the development of EBL tumors.

Animals↗
PubMed1985

Cost savings associated with use of gentamicin versus tobramycin.

A hospital's use and costs of tobramycin sulfate versus gentamicin sulfate before and after a tobramycin use review were compared. Retrospective audits of 100 charts of adult patients in a 515-bed hospital were performed for two six-month periods in 1983-84. Tobramycin use was considered appropriate in patients with serum creatinine concentrations greater than 1.5 mg/dL or pre-existing renal disease, in any patient over 70 years of age, and in patients with neutropenia, documented pseudomonas infection, or infection with an organism shown to be resistant to gentamicin but sensitive to tobramycin. Tobramycin use was not justifiable in 37 (18.7%) of 198 patients whose charts were evaluable. Use of gentamicin in these 37 patients would have saved $14,300. The infection control committee was notified of the audit results; the audit results and recommendations for tobramycin use were included in a letter to all physicians; and the infectious disease service held educational conferences on tobramycin use. In the first six months after the corrective measures, mean monthly tobramycin use decreased by 38% and gentamicin use increased by 48.9%. Total aminoglycoside costs decreased 30.2% and total aminoglycoside use decreased 12.5%. In the second six months after intervention, mean monthly tobramycin use was 11% less than before intervention, and mean monthly gentamicin use was 13% greater than before intervention. Total aminoglycoside costs were 3.6% less and total aminoglycoside use was 4% less than before the audit. The tobramycin use audit and subsequent interventions with prescribers were effective in reducing tobramycin use and costs for approximately six months; decreases in tobramycin use and costs were smaller during the second six months after intervention.

Aged↗
PubMed1981

Cost containment through restriction of cephalosporins.

The effect of a program designed to reduce hospital drug costs by limiting the selection of injectable cephalosporins and promoting the rational use of the selected agents was studied. Cefazolin sodium was chosen as the primary injectable cephalosporin, and guidelines for proper dosing were approved. Strict guidelines for the use of cephapirin sodium, cefamandole nafate, and cefoxitin sodium were also adopted; cephalothin sodium was deleted from the formulary. Clinical pharmacists reviewed all cephalosporin orders and consulted with prescribers whose orders did not conform to the guidelines. Total cephalosporin purchases for the first fiscal year of the program were $64,914, a decrease of $55,715 or 46.2% from the previous year's total of $120,629. Cost per patient day for cephalosporins decreased from $0.921 to $0.519 (43.6%) over the same period. The number of milligrams of cephalosporins used per patient day decreased from 398.16 to 178.77 (55.1%), while the number of patient days decreased by only 4.45% during the same interval. The estimated annual cost of monitoring the program was $1500. This program demonstrates that substantial cost savings can be achieved if guidelines for the use of injectable cephalosporins are clearly outlined and strictly enforced.

Cefazolin↗
PubMed1980

Transport of methylamine by Pseudomonas sp. MA.

Pseudomonas sp. MA grows on methylamines as a sole source of carbon, nitrogen, and energy. The transport of methylamine into the organism was investigated. It was found that this organism possesses an inducible transport system for methylamine having the following physical parameters: pH optimum, 7.2; temperature optimum, 30 to 35 degrees C; Km, 1 to 30 mM; Vmax, 90 to 120 nmol/min per mg (dry weight) of cells. Methylamine uptake was curtailed by azide, cyanide, and carbonyl cyanide-m-chlorophenylhydrazone; osmotic shock treatment reduced the uptake by 50%. The uptake was not effectively inhibited by ammonium ion, amino acids, or amides, but was competitively inhibited by short-chain alkylamines. Cells grown on succinate-ammonium chloride did not possess the transport system, but it could be induced in such cells by methylamine in 20 h. Cells grown with methylamine as a sole nitrogen, but not carbon, source transported methylamine at a reduced rate.

Amines↗