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Biomedical subjects

T J Craig

Publications and source records attributed to T J Craig.

At least 37 records · Page 2Linked to original sources
PubMed1999

Leukotriene modifiers in the management of asthma.

Leukotrienes play a major role in the underlying pathophysiology of asthma. Leukotriene-receptor antagonists and direct leukotriene-synthesis inhibitors may be important new agents in maintenance therapy for asthma. Their role may also extend to attenuating exercise-induced and allergen-induced bronchospasm. This article reviews the effectiveness of available leukotriene modifiers in various clinical studies, reviews their adverse effects profile, and discusses their potential roles in the management of asthma.

Asthma↗
PubMed1999

Seasonal allergic conjunctivitis: overview and treatment update.

Seasonal allergic conjunctivitis is rarely associated with permanent vision impairment; however, it is a relatively common condition that may compromise the quality of life. It may, in extreme cases, impair daily activities, including work. Numerous treatment options have become available for the relief of acute symptoms. Avoidance should always be the first line in therapy but, in most cases, is not practical, especially with pollen allergies. The use of saline eyedrops is simple and nontoxic, and it is effective in up to 30% to 35% of cases. It can and should be added to all other remedies to reduce adverse effects and cost by decreasing the need for other therapeutic options. Antihistamines and decongestants are useful treatment choices for the majority of cases. Ketorolac tromethamine may be helpful in relieving pruritus, but it offers little advantage over topical antihistamines. Corticosteroids may be used for severe cases for a limited time. If topical corticosteroids are being considered, an ophthalmologist should be consulted. Cromolyn sodium and lodoxamide ophthalmic solution may be helpful in the prophylaxis of symptoms during the allergy season, but these agents require frequent dosing. Olopatadine hydrochloride is a mast cell stabilizer and antihistamine that can be dosed twice a day. Immunotherapy is effective and should be offered to those who are intolerant or have allergic conjunctivitis refractory to medications.

Conjunctivitis, Allergic↗
PubMed1999

Efficacy and safety of azelastine nasal spray for the treatment of allergic rhinitis.

Azelastine hydrochloride is a nasally administered antihistamine that is effective and safe for the treatment of perennial and seasonal allergic rhinitis. In addition to acting as a histamine H1-receptor antagonist, azelastine also inhibits the production or release of many chemical mediators of the allergic response such as leukotrienes, free radicals, and cytokines. After nasal administration, azelastine is systemically absorbed with a bioavailability of about 40%. The side effects of azelastine are drowsiness, headache, and bitter taste. Azelastine has a rapid onset of action with a benefit in about 2 hours and a prolonged duration of activity (12 to 24 hours). Studies have shown azelastine to be more effective than placebo in terms of reduction of the major and total symptom complexes of allergic rhinitis. Comparison studies have demonstrated that azelastine is as effective as ebastine, loratadine, cetirizine hydrochloride, and terfenadine at symptom reduction, with varying results when compared with the corticosteroids budesonide and beclomethasone. Although there are conflicting studies, some have demonstrated that azelastine reduces the nasal congestion of allergic rhinitis. This feature that distinguishes it from oral antihistamines is of great interest because corticosteroids are known to be quite effective for the relief of nasal congestion, whereas the antihistamines are effective for the sneezing, itchy eyes, itchy nose, and watery eyes, but not the congestion. Azelastine nasal spray seems to be an efficacious treatment for allergic rhinitis with a rapid onset and long duration of activity, but without the systemic adverse effects of traditional sedating antihistamines.

Administration, Inhalation↗
PubMed1999

Atopic dermatitis: a clinical review for the primary care physician.

Atopic dermatitis is a common disease, causing significant morbidity. The histology and cellular mechanisms suggest that atopic dermatitis is an atopic disease similar to asthma and allergic rhinitis, with helper T type 2 lymphocytes being at least a component of the pathogenesis of the disease. Specific allergies, including food allergies, should be explored and treated. Treatment should be directed at increasing the patient's quality of life. Antihistamines, topical steroids, and lubricants are the keystones of therapy. In severe cases, oral steroids may be necessary but should be used sparingly. Interferon, cyclosporine, phototherapy, and immunosuppressive agents may be necessary in refractory cases. It appears that leukotriene inhibitors may have a future role in therapy. Clinical assessment and follow-up are important, as other atopic diseases such as asthma and allergic nasosinus disease may eventually develop in many of these patients.

Dermatitis, Atopic↗
PubMed1999

Chronic fatigue syndrome.

The chronic fatigue syndrome is an illness of unknown etiology characterized by severe fatigue, myalgias, lymphadenopathy, arthralgias, chills, fevers, and postexertional malaise. Recognizing chronic fatigue syndrome is primarily a method of exclusion with no definitive diagnostic test or physical findings. As research continues to delve into the many possible etiologic agents for chronic fatigue syndrome--infectious, immunologic, neurologic, or psychiatric alone or in combination--the answer remains elusive. What is known is that chronic fatigue syndrome is a heterogeneous disorder very possibly involving an interaction of biological systems. Therefore, chronic fatigue syndrome may describe a large subset of patients, each exhibiting unique symptoms and serologic profiles dependent on the nature of the onset of illness and the genetic profile of individual patients.

Clinical Trials as Topic↗
PubMed1999

Chronic sinusitis in patients with cystic fibrosis.

Cystic fibrosis is a lethal genetic disorder whose victims currently have a median life span of approximately 30 years. With this increased life span, new aspects of the disease are identified in patients with cystic fibrosis, including chronic sinusitis. Sinusitis severely affects the quality of life of patients with sinusitis. This article discusses several aspects of sinusitis in patients with cystic fibrosis, including clinical presentation, radiologic findings, and treatment options. By recognizing and treating sinusitis in patients with cystic fibrosis, physicians may improve the quality of life of these patients.

Chronic Disease↗
PubMed1999

Medications frequently used for asthma and rhinitis. Asthma Steering Committee, Penn State Geisinger Health System.

Multiple medications are available to treat asthma and other allergic diseases, making it difficult to determine which medications to use. The decision should be based on efficacy, cost, and other advantages and disadvantages. Comparative tables can help for rapid selection and can be used as a tool for enhancing prescribing practices. This article organizes this information into a tabular format, allowing for rapid review.

Anti-Asthmatic Agents↗
PubMed1998

Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids.

BACKGROUND: Allergic rhinitis (AR) is a frequent disease affecting up to 20% of the population. AR causes a hypersensitivity reaction, which results in inflamed nasal mucosa and nasal congestion. Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse, airway obstruction, and an increased number of sleep microarousals. Sleep disturbances and microarousals can detrimentally affect daytime energy levels, mood, and daytime function. It is unknown whether treatment directed to reduce congestion may reduce these microarousals, sleep problems, and, consequently, associated daytime fatigue. OBJECTIVE: We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and daytime sleepiness. METHOD: We enrolled 20 subjects in a double-blind, placebo-controlled study using Balaam's Design. Patients were treated with topical nasal corticosteroids or placebo. Subjective data were collected by use of a daily diary, which focused on nasal symptoms, sleep, and daytime sleepiness. RESULTS: The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid-treated subjects but not in the placebo group. Sleepiness improved, but not significantly (p = 0.08). CONCLUSION: Often, people with perennial allergies may attribute their daytime fatigue to causes such as the side effects of medications, when in fact, the fatigue may be a result of nasal congestion and associated sleep fragmentation. Decreasing nasal congestion with nasal steroids may improve sleep, daytime fatigue, and the quality of life of patients with AR.

Administration, Topical↗
PubMed1998

Churg-Strauss syndrome associated with zafirlukast.

In recent years, the leukotriene modifiers, a new class of drugs, have become commercially available as a promising medication for asthma. According to the 1997 National Institutes of Health guidelines, the leukotriene modifiers are indicated in mild persistent asthma as an alternative to inhaled steroids. Nonetheless, they have been used in patients with moderate and severe asthma and, in some cases, they have made it possible for patients to taper or discontinue their use of oral steroids, thereby controlling their asthma while avoiding the side effects of oral corticosteroids. Since the introduction of zafirlukast, there have been reported at least eight cases of Churg-Strauss syndrome, a granulomatous, necrotizing vasculitis with eosinophilia, associated with the use of zafirlukast. No other leukotriene modifier has yet to be associated with the syndrome. All the patients in whom Churg-Strauss syndrome developed were patients with asthma who were taking zafirlukast and were being weaned from oral corticosteroids. Reported here is a case of Churg-Strauss syndrome in a patient referred to the authors. Included is a review of the literature of the association of Churg-Strauss syndrome and zafirlukast therapy.

Adult↗
PubMed1997

Diagnosis, treatment, and six-month outcome status in first-admission psychosis.

Six-month outcome status was examined in 202 first-admission inpatients with DSM-III-R schizophrenia spectrum (N = 96), psychotic bipolar disorder (N = 64), and psychotic depression (N = 42) drawn from 10 facilities in Suffolk County, New York. Schizophrenics fared significantly worse on all outcome variables rehospitalization, which ranged from 17.7 to 23.4%. Bipolars had good psychosocial outcomes regardless of clinical outcome, while the two outcome domains were uncorrelated among schizophrenics and psychotic depressed. Schizophreniform patients had significantly better outcome than those with schizophrenia or schizoaffective disorder. Posthospital treatment was generally unrelated to outcome except that fewer rehospitalized schizophrenics received continuous treatment, and patients with psychotic depression with poorer psychosocial outcome received medication less frequently. These findings highlight the different treatment needs of these diagnostic groups, especially as regards the provision of more intensive rehabilitation for schizophrenic patients and the "poor-outcome" psychotic depressed.

Adolescent↗
PubMed1997

Outcome in schizophrenia and related disorders compared between developing and developed countries. A recursive partitioning re-analysis of the WHO DOSMD data.

BACKGROUND: Data on the two-year pattern of course of illness have been collected in the WHO study of the Determinants of Outcomes of Severe Mental Disorder (DOSMD). These data are reanalysed using recursive partitioning, a method not yet applied to psychiatric data to test the hypothesis that subjects from participating centres in developing countries had better outcomes than those in developed countries. METHOD: Subjects were those from the DOSMD study for whom two-year follow-up data were available (n = 1056). The classification and regression trees recursive partitioning technique was used to examine the predictor variables associated with the outcome variable two year pattern of course. RESULTS: Pattern of course was best predicted by centre, but two developed centres (Prague and Nottingham) grouped with the developing country centres excluding Cali, having better outcomes than in the remaining developed country centres and Cali. Type of onset (insidious v. non-insidious) was the next strongest predictor, but its effect differed across these two centre groupings. Effects for some groups were modified by other predictor variables, including age, child and/or adolescent problems, and gender. CONCLUSIONS: The predominant predictor effects on two-year pattern of course continued to be centre and type of onset, but complex interactions between these variables and other predictor variables are seen in specific centre groupings not strictly defined by 'developing' and 'developed'.

Developed Countries↗
PubMed1997

Adverse reactions to fluconazole: illustrative case with focus on desensitization.

Fluconazole is an azole antifungal agent. Because it can be taken orally, it is preferred over amphotericin B for long-term treatment. Indications for fluconazole are increasing. Reports of hypersensitivity have been described. If adequate alternative therapy is not available, desensitization may be necessary. Desensitization with fluconazole has not been described. The patient described in this report required fluconazole and was successfully desensitized after manifesting a type 1 hypersensitivity reaction. The patient underwent desensitization during a 15-day period. The starting dose was less than 0.001 dose, with doubling each day. During desensitization, the patient experienced a slight transient rash that resolved with continued therapy. After desensitization, he has continued using fluconazole daily without adverse effects. This report indicates that desensitization to fluconazole can be accomplished safely in selected patients. A suggested desensitization protocol is provided.

AIDS-Related Opportunistic Infections↗
PubMed1997

Predictors of successful vs. unsuccessful outcome of a 12-step inpatient alcohol rehabilitation program.

Comparison of successful vs. unsuccessful outcome at 1-year follow-up for 101 patients treated in a VAMC inpatient alcohol rehabilitation unit, which used a combined 12-step facilitation/relapse prevention treatment model, revealed remarkably few predictors of outcome. However, one variable (self-reported absence of a mainstream Christian religious preference) strongly predicted poor outcome, whereas absence of a family history of alcoholism or a positive history of combat experience predicted a successful outcome. These results are among the first to examine the characteristics of patients who do well or poorly in this type of program and may, if replicated, begin to provide a basis on which to develop clinical algorithms for patient-treatment matching.

Alcoholism↗
PubMed1996

Insight in first-admission psychotic patients.

BACKGROUND: The prevalence of insight was examined longitudinally in psychotic patients with schizophrenia (n = 86), bipolar disorder (n = 52), major depressive disorder (n = 35) and other psychoses (n = 16). METHOD: Before discharge and at 6-month follow-up, insight in first-admission patients from 10 facilities in Suffolk County, New York was rated as part of a modified Hamilton Depression Scale. RESULTS: Initially, 80% of depressives but approximately half with other diagnoses manifested insight. At follow-up, most patients demonstrated insight except for the schizophrenic patients. After controlling for diagnosis, significant correlates of baseline insight were being married, hospitalized in a community or academic facility, intelligence and negative symptoms. At follow-up, after controlling for diagnosis and baseline insight, prior treatment was predictive. This finding held for schizophrenic patients separately. CONCLUSION: Lack of insight is more prevalent in schizophrenia and improves over time. The components of prior treatment leading to better insight should be explored.

Adult↗
PubMed1996

Tardive dyskinesia and pregnancy and delivery complications.

Twelve children and adolescents with movements suggestive of tardive dyskinesia (TD) were compared to 49 non-TD patients while receiving neuroleptic treatment. A multiple regression analysis revealed the diagnosis of TD to be significantly associated with a history of pregnancy and delivery complications (PDCs), suggesting that these events may increase the risk of the development of treatment emergent TD.

Adolescent↗