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Biomedical subjects

Michael C Smith

Publications and source records attributed to Michael C Smith.

13 recordsLinked to original sources
PubMed2006

Optimizing therapy of seizures in children and adolescents with developmental disabilities.

Children and adolescents with intellectual and developmental disabilities and epilepsy are a unique patient population that offers significant challenges. They are more likely to suffer lifelong intractable epilepsy with multiple seizure types than other patients with epilepsy. In addition, these patients often cannot clearly express their complaints about antiepileptic drug (AED) side effects, and the caregiver's role becomes all-important as an advocate for the patient. Finally, behavioral and psychiatric comorbidities are common and need to be considered when choosing an AED in this patient population. Our society will be judged by how we care for the most unfortunate among us.

Adolescent↗
PubMed2006

A basic guide to investing.

Today's investors have many choices. From seemingly simple investments, such as stocks, bonds and cash, to more complicated option strategies, there is a dizzying array of investment vehicles that can leave even the most seasoned investor a bit confused. In discussions with our clients, one common thread is the desire to learn more about the various types of investments available. Following is a basic guide to the most common investments and the risks inherent in those choices.

Financing, Personal↗
PubMed2005

Variants in the Wilms' tumor gene are associated with focal segmental glomerulosclerosis in the African American population.

Wilms' tumor gene (WT1) is important for nephrogenesis and gonadal growth. WT1 mutations cause Denys-Drash and Frasier syndromes, which are characterized by glomerular scarring. To test whether genetic variations in WT1 and WIT1 (gene immediately 5' to WT1) associate with focal segmental glomerulosclerosis (FSGS), patients with biopsy-proven idiopathic and HIV-1-associated FSGS were enrolled in a multicenter study. We genotyped SNP rs6508 located in WIT1 exon 1, three SNPs (rs2301250, rs2301252, rs2301254) in the promoter shared by WT1 and WIT1, rs2234590 in exon 6, rs2234591 in intron 6, rs16754 in exon 7, and rs1799937 in intron 9 of WT1. Cases (n = 218) and controls (n = 281) were compared in the African American population. Stratification by HIV-1 infection status showed that SNPs rs6508, rs2301254, and rs1799937 were significantly associated with FSGS [rs6508 odds ratio (OR) 1.82, P = 0.006; rs2301254 OR 1.65, P = 0.049; rs1799937 OR 1.91, P = 0.005] in the non-HIV-1 group and rs2234591 (OR 0.234, P = 0.011) in the HIV-1 group. Haplotype analyses in the population revealed that seven SNPs were associated with FSGS; five SNPs had the highest contingency score [-log10(P value) = 13.57] in the HIV-1 group. This association could not be explained by population substructure. We conclude that SNPs in WT1 and WIT1 genes are significantly associated with FSGS, suggesting that variants in these genes may mediate pathogenesis by altering WT1 function. Furthermore, HIV-1 infection status interacts with genetic variations in both genes to influence this phenotype. We speculate that nephropathy liability alleles in WT1 pathway genes cause podocyte dysfunction and glomerular scarring.

Black or African American↗
PubMed2004

Extended-release formulations: simplifying strategies in the management of antiepileptic drug therapy.

Advances in our understanding, diagnosis, and treatment of seizure disorders have transformed the management of epilepsy. As the number of antiepileptic drugs and their formulations increase, so do the expectations of therapy. Once limited to attaining complete control of seizures, epilepsy management now strives to enable patients to lead lifestyles consistent with their own capabilities. Extended-release antiepileptic drug formulations can help achieve the primary treatment goals for many patients with epilepsy: preventing occurrence of seizures and preventing or reducing side effects. The dosing flexibility and consistency of serum levels (without marked peak-to-trough fluctuations) conferred by extended-release formulations help achieve these goals. These same attributes of extended-release formulations may also improve compliance, quality of life, and patient satisfaction with treatment.

Anticonvulsants↗
PubMed2004

Medication management by the person with epilepsy: perception versus reality.

PURPOSE: In an attempt to understand if perception of medication management matched actual medication management, we examined epilepsy patients' perceptions of their overall medication management and their actual management. METHODS: The investigators interviewed 25 adults with refractory epilepsy regarding perceptions of their past overall medication management. Following the interview, each subject received the Medication Event Monitoring System (MEMS) and was asked to use it for 1 month. For the 21 persons who used and returned the caps, a score for compliance was calculated by dividing the number of compliant days by the total number of days. RESULTS: Four participants stated that they may sometimes forget to take their medications, and three patients said that they self-regulated their medications to fit their lifestyle. The self-regulation was not reflected in the MEMS cap data. Fourteen participants reported that it was not difficult to manage their medication regimen. MEMS cap data showed that 11 participants had a compliance score greater than 80% and 10 had a compliance score lower than 34%, but patients' perceptions of their past overall compliance did not differ between these groups. CONCLUSION: Although 14 of the participants reported that managing their medications was not a problem, MEMS cap data suggested that 10 of the participants did have difficulties managing their medication.

Attitude to Health↗
PubMed2004

Clinical comparison of extended-release divalproex versus delayed-release divalproex: pooled data analyses from nine trials.

Divalproex sodium is an effective anticonvulsant, antimanic, and migraine prophylaxis agent. Recently, a new extended-release (ER) formulation of divalproex sodium has become available, which allows for once-daily dosing and provides prolonged therapeutic serum levels. Using data pooled from nine open-label trials involving 321 epilepsy and psychiatry patients, we compared the efficacy and tolerability of divalproex ER with preceding treatment with the older delayed-release (DR) formulation, based on patient reports and analysis by McNemar's test for within-subject paired data. Divalproex ER was associated with superior tolerability with less frequent tremor, weight gain, and gastrointestinal complaints (all P<0.001), but not less hair loss. Divalproex ER also yielded improved seizure control and greater improvement of psychiatric symptoms, and was greatly preferred by patients over divalproex DR. Although the results of the current analyses must be considered highly tentative due to the open-label nature of the trials included, the findings do suggest broad clinical superiority of the new ER preparation.

Adolescent↗
PubMed2003

The efficacy of divalproex for partial epilepsies.

Valproic acid has clear efficacy in the treatment of partial epilepsies. Its multiple mechanisms predicted its broad spectrum of efficacy and preclinical experimental data prompted its clinical use. Valproic acid's efficacy has been repeatedly demonstrated in clinical trials over the past 25 years. Its efficacy in the treatment of partial epilepsies is similar or better than both the traditional and new antiepileptic drugs. Its side effect profile is well known and manageable, especially with extended-release formulations.

Anticonvulsants↗
PubMed2002

Successful blood pressure control in the African American Study of Kidney Disease and Hypertension.

BACKGROUND: The African American Study of Kidney Disease and Hypertension (AASK) is an ongoing trial to evaluate the effect of blood pressure and choice of antihypertensive drug on the rate of decline of renal function. OBJECTIVE: To present the success of the AASK in achieving the trial's rigorous blood pressure goals in an extremely challenging patient population. METHODS: The AASK participants included African American patients with hypertension (n = 1094), aged 18 to 70 years, with glomerular filtration rates between 20 and 65 mL/min per 1.73 m(2) and no other identified causes of renal insufficiency. Participants were randomized to a goal mean arterial blood pressure (MAP) of either 102 to 107 mm Hg (usual MAP goal) or 92 mm Hg or less (low MAP goal). Participants in each of these groups were also randomized (double-blind) to a regimen containing metoprolol succinate, ramipril, or amlodipine besylate. Additional agents were added, if required, in the following recommended order: furosemide, doxazosin mesylate, clonidine hydrochloride, or hydralazine hydrochloride (or minoxidil, if needed). RESULTS: In participants randomized to the low MAP goal, the percentage of participants who achieved a blood pressure of less than 140/90 mm Hg increased from a baseline of 20.0% to 78.9% by 14 months after randomization. For usual MAP goal participants, the corresponding percentages increased from 21.5% to 41.8%. The difference in median levels of MAP between the 2 MAP goal groups increased and remained at approximately 12 mm Hg. Blood pressure reduction was similar regardless of age, sex, body mass index, education, insurance or employment status, income, or marital status. CONCLUSION: The blood pressure goals set and achieved in AASK participants clearly demonstrate that adequate blood pressure control can be achieved even in hypertensive populations whose blood pressure is the most difficult to control.

Adolescent↗
PubMed2002

A comparison of standardized versus "usual" blood pressure measurements in hemodialysis patients.

Hypertension is very common and contributes to the high cardiovascular morbidity in patients undergoing chronic hemodialysis therapy. However, the accuracy of blood pressure measurement in this population has not been well studied. We conducted a cross-sectional study of 270 patients at seven outpatient hemodialysis units. Predialysis and postdialysis seated blood pressure readings obtained by the dialysis unit using automated blood pressure monitors were significantly higher than readings obtained by a research nurse following standard procedures for blood pressure measurement (14.3/7 mm Hg higher predialysis; P < 0.01; 13.6/4.4 mm Hg higher postdialysis; P < 0.05). In 55% of patients, the postdialysis systolic blood pressure measured in the dialysis unit was at least 10 mm Hg higher than the standard reading. Bland-Altman analyses indicated poor agreement between the two readings. This study shows a marked discrepancy between routine dialysis unit and standardized blood pressure measurements. Blood pressure is frequently overestimated by routine dialysis unit readings. In light of these findings, efforts should be made to standardize blood pressure readings in hemodialysis units based on American Heart Association recommendations for blood pressure measurement.

Blood Pressure Determination↗
PubMedDate not supplied

Epileptic encephalopathy of late childhood: Landau-Kleffner syndrome and the syndrome of continuous spikes and waves during slow-wave sleep.

Landau-Kleffner syndrome (LKS) and the syndrome of continuous spikes and waves during slow wave sleep (CSWS) are two points on the spectrum of functional childhood epileptic encephalopathies. They are characterized by a severe paroxysmal EEG disturbance that may permanently alter the critical synaptogenesis by strengthening synaptic contacts that should have been naturally "pruned." The much more common benign epilepsy with centrotemporal spikes is also related to LKS and CSWS by a common pathophysiology. Although prognosis in LKS and CSWS for seizure control is good, cognitive function declines and permanent neuropsychologic dysfunction is seen in many cases. This permanent damage is most evident in those patients who had early-onset EEG abnormality and a prolonged active phase of continuous spike-and-wave discharges during sleep. If the active phase of paroxysmal activity persists for over 2 to 3 years, even successful treatment does not resolve neuropsychologic sequelae. In LKS, the paroxysmal activity permanently affects the posterior temporal area and results in auditory agnosia and language deficits; in CSWS, the frontal lobes are more involved and other cognitive disturbances predominate. Aggressive treatment should include high-dose antiepileptic drugs, corticosteroids, and surgery in specific cases.

Brain Mapping↗
PubMedDate not supplied

Blood pressure measurement in hemodialysis patients.

Measurement of blood pressure (BP) poses some unique challenges in hemodialysis patients. Timing of BP measurement in relation to dialysis, changes in interdialytic weight gain, and inconsistent BP measurement technique in dialysis units contribute to the variability of BP readings in this population. This may contribute to the equivocal relationship between hypertension and cardiovascular outcomes documented in several epidemiologic studies in this population. Home BP readings are promising, but need to be validated as a measure of the burden of hypertension in this population. It is important to standardize BP measurement in all hemodialysis units according to published guidelines to improve the management of hypertension. Future research studies should carefully validate the technique used to measure BP.

Blood Pressure Determination↗