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Biomedical subjects

S M Gordon

Publications and source records attributed to S M Gordon.

117 records · Page 7Linked to original sources
PubMedDate not supplied

Protease-sparing regimen in a real-life practice with naïve patients: an equal opportunity approach?

PURPOSE: Proven clinical efficacy of protease-sparing regimens (PSR) has been shown. Concerns exist about broad applicability of these regimens in advanced naïve patients. Recent reports have associated a rise in liver enzymes with nevi rapine; however, no data exist with efavirenz. METHOD: 17 consecutive antiretroviral-naïve HIV patients were started on a PSR with efavirenz plus two nucleoside reverse transcriptase inhibitors. Baseline liver enzymes, serum CD38, CD4, and HIV viral load data were collected. Correlation between change in viral load and immune reconstitution on therapy were compared to baseline laboratory values. RESULTS: All patients had a mean viral load decrease of >2 logs, including patients with low initial CD4% or high viral load, and there was no increase of liver enzymes observed at a median follow-up of 42 weeks (range 17-78). There was a perfect correlation between the change in viral load and the initial viral load (p <.0001, r = 1.00) including patients with viral load > or =100,000 copies/mL and CD4 count< or =50 (n = 5). Even patients with low initial CD4 had a significant percentage increase in CD4 count (p <.0002, r = 0.7880). CD38% showed a positive correlation with change in viral load (p =.046, r = 0.522). CONCLUSION: All patients experienced a mean viral load decrease of >2 logs (88% less than 400 copies/mL and 35% less than 20 copies/mL). There were no observed increases in liver enzymes. Patients with low CD4 counts, high initial viral load, or high CD38 expression still experienced a significant change in viral load.

Adult↗
PubMedDate not supplied

New surgical techniques and surgical site infections.

Technologic advances in surgery include a trend toward less invasive procedures, driven by potential benefits to patients and by health-care economics. These less invasive procedures provide infection control personnel opportunities for direct involvement in outcomes measurement.

Cardiac Surgical Procedures↗
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Vancomycin-resistant Staphylococcus aureus: an emerging public health threat.

Three reported cases of infection with strains of Staphylococcus aureus that had only intermediate susceptibility to vancomycin raise fears that high-level vancomycin resistance may soon be seen. To forestall this occurrence, physicians need to limit their use of vancomycin, and hospitals need to intensify their infection-control efforts. We review treatment options and the recommendations from the Centers for Disease Control and Prevention to identify and slow the spread of resistant strains.

Adult↗
PubMedDate not supplied

The threat of bioterrorism: a reason to learn more about anthrax and smallpox.

Threats of domestic terrorism and international news about germ warfare research have forced us to recognize the potential menace of biological weapons. Both smallpox and anthrax could be used as biological weapons. It is important for physicians to reacquaint themselves with these diseases, because if a domestic attack were to occur, it might first be recognized when patients with unusual symptoms began presenting to hospitals and primary care physicians. In this article, we discuss symptoms and treatments for smallpox and anthrax, and suggest resources for physicians who wish to learn more about the subject.

Anthrax↗
PubMedDate not supplied

Analgesia and COX-2 inhibition.

While non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy for the management of acute pain and rheumatoid arthritis, toxicity associated with chronic administration limits their benefit-to-risk relationship in many patients. A series of studies is reviewed that assesses the relationship between cytokines released at the site of tissue injury and NSAID analgesia, and the in vivo selectivity of a selective cyclooxygenase (COX)-2 inhibitor (celecoxib) in comparison to a dual COX-1/COX-2 inhibitor (ketorolac). Three replicate studies in the oral surgery model of acute pain used submucosal microdialysis sample collection for the measurement of prostaglandin E2 (PGE2; a product of both COX-1 and COX-2) and thromboxane B2 (as a biomarker for COX-1 activity) with parallel assessments of pain. The time course of PGE2 production was consistent with early release due to COX-1 activity followed by increased production 2-3 hours after surgery, consistent with COX-2 expression. Ketorolac 30 mg at pain onset suppressed both pain and peripheral PGE2 levels. Ketorolac 1 mg either at the site of injury or intramuscularly also produced analgesia but without any effect on peripheral PGE2 levels. Celecoxib selectively suppressed PGE2 but not TxB2 at time points consistent with COX-2 activity, while producing analgesia. These studies demonstrate the ability to assess the time course and selective effects of COX-2 inhibitors in vivo and suggest that suppression of COX-2 mediated PGE2 is temporally related to NSAID analgesia.

Acute Disease↗
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Elimination kinetics of volatile organics in humans using breath measurements.

During the past decade significant strides have been made toward understanding the sources and factors which lead to volatile organic chemical (VOC) exposure in the general population. Less is known, however, about the impact of low-level environmental exposure on human health. Investigations are underway in a number of laboratories in an effort to determine the uptake, distribution, metabolism, and elimination kinetics for VOCs in humans. We examined the elimination kinetics for the third phase for ten VOCs--1,1,-trichloroethane, trichloroethylene, tetrachloroethylene, benzene, toluene, m,p-xylenes, o-xylene, ethylbenzene, p-dichlorobenzene, and limonene--in human subjects. Subjects were exposed to a variety of common consumer products and breath samples were collected post-exposure while the subjects spent up to 10 hr in a clean air environment. VOCs from breath samples were collected into canisters or onto Tenax GC cartridges and analyzed by gas chromatography-mass spectrometry. Exponential modeling of the decay data was performed to obtain kinetic parameters. The half-lives for trichloroethylene and 1,1,1-trichloroethane were approximately 5 to 8 hr for the four subjects. In general, the magnitude and range of variability was larger for toluene, limonene, and p-dichlorobenzene than for the other VOCs; the elimination rate spanning a few hours to a day or two. Thus, VOCs exhibit relatively short residence times in the body relative to other halo-carbons, such as polychlorinated biphenyls and dioxins.

Adult↗
PubMedDate not supplied

Enhancing provider effectiveness in treating pregnant women with addictions.

Prenatal care providers can play an important role in identifying, intervening in, and making referrals for substance abuse problems among pregnant women. Although studies suggest that most addicted persons who need treatment do not receive it, innovative methods such as the one described here can help increase the number of pregnant women who engage in treatment, with likely benefits to the client, her unborn baby, and other children whom she may parent. A qualitative study of the implementation of an innovative model to prevent and treat substance abuse among pregnant women is presented. The study took place in a prenatal clinic staffed by nurse-midwives in a dense suburb serving a population largely covered by Medical Assistance. Results indicate that education, training, and structural changes in care delivery led to changes in the attitudes and behaviors of nurse-midwives toward pregnant addicted women and increased their effectiveness.

Adolescent↗