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At least 1,081 records · Page 60Linked to original sources
PubMed1996

[Natural history of dysthyroidism during interferon treatment of chronic hepatitis C].

Thyroid dysfunction developed in 35 patients among a series of 300 (190 men and 110 women) treated with alpha-interferon (35/300 = 12%. No relationship was observed between the type of alpha-interferon, the dose, or hepatic response, but there were more women (24/35). Antithyroid antibody levels were frequently elevated before treatment (8/35, 23%). Hypothyroidism developed in 27 patients, 7 with clinical hypothyroidism, 10 with moderate hypothyroidism and 5 with elevated TSH only. Patients with severe symptoms and highly elevated thyroid antibodies were more prone to develop sustained or irreversible hypothyroidism (10 patients). Twelve patients recovered a normal thyroid function within a few months, but antibody levels fell more slowly. Primary hyperthyroidism of variable severity appeared in 13 patients. In 8 patients, normal thyroid function was recovered within a few weeks but thyroid antibodies remained high for at least one year. In 5 others spontaneous hypothyroidism occurred within a few weeks ("biphasic" hypothyroidism). Direct toxicity appears to be less probable than an autoimmune mechanism; elevated antithyroid antibodies were observed in only 20 patients (57%). In clinical practice, TSH levels should be regularly monitored during and after alpha-interferon therapy.

Adult↗
PubMedDate not supplied

'Health-for-All' in the twenty-first century: a global perspective.

Changes in the broad determinants of health since the Alma Ata Conference in 1978 necessitate a renewed examination of the underlying principles and focus of the Primary Health Care (PHC) strategy. The PHC approach has been adopted by most countries and has led to improved access to certain basic health services. However, the health gains in other areas are less encouraging. Some elements of the PHC approach, for example, the effective implementation of equity-oriented health policies and the need to improve management principles within health services, have yet to be fully implemented. Moreover, to address the underlying determinants of health status, the World Health Organization's (WHO) renewed global health policy will have to include certain issues that were not considered at Alma Ata. For example, the health impacts of global recession and globalization and the need for human-centered sustainable development strategies were not considered at Alma Ata. A renewed global health policy will also have to consider demographic, epidemiological, environmental and technological changes that have emerged since 1978. It is important that WHO's renewed policy be based on sound evidence, a commitment to ethical principles and broad use of partnerships for health at global, national and local levels. One implication of this new context of health development for the renewed health policy will be that 'thinking globally and acting locally' will have to complemented by stronger global action to protect local and national health.

Cross-Cultural Comparison↗
PubMed1997

Occupational medicine at the verge of the twenty first century: evaluation of accomplished and expected changes in the preventive approach.

The World Bank in its document under the title 'Investing in Health' (1993) states that the health status of the population, including the working population, and working conditions in individual countries depend essentially on the value of gross national product per capita. The attitudes towards the role and objectives of occupational medicine have changed significantly over the last three decades. A high priority given to primary prevention reflects the mainstream of a new approach to preventive measures. Advancements in technology, production and services, common use of computers and flattening of work organisation structures have brought about the need for workers' active participation in planning of activities and shaping working conditions in own enterprise. At the same time, workers are required to possess much higher qualifications facilitating their participation in applying new technologies and using new information systems, which resulted in a fierce competition on the labour market. In the countries in the political, social and economic transition, the conditions for introducing a new system of sustained development, described by Gustavsen at the 25th International Congress on Occupational Health have not as yet been established. A procedure-based system involving negotiations between employers and workers' representatives failed to be successful in improving working conditions as the roles of the state, employers and trade unions had not been defined precisely. It is expected that further health promotion at the worksites in these countries will depend mainly on the economic progress and the reformed system of education.

Economic Competition↗
PubMed1997

Implementation of the WHO Global Strategy for Occupational Health for All. Plan of action: covering the specific period 1996-2001. Part I.

The WHO Executive Board, at its Ninety-Seventh Session, in January 1996, recognized the vital role of occupational health in sustainable development and public health as a whole, endorsed the WHO Global Strategy for Occupational Health for All (Resolution EB97.R6). In May 1996, the World Health Assembly discussed occupational health and adopted a resolution on the WHO Global Strategy for Occupational Health for All (WHA49.12), requesting the Director-General to promote the implementation of the Global Strategy for Occupational Health for All within the framework of the Ninth General Programme of Work. Member States were urged to devise national programmes on occupational health for all, based on the global strategy, with special attention to pull occupational health services for the working population, including migrant workers, workers in small enterprises, in the informal sector, and for other occupational groups at high risk and with special needs, including children at work. Therefore, the draft Plan of Action for the Implementation of the WHO Global Strategy for Occupational Health for All has been prepared. The description of all 10 objectives of the global strategy, at both the international and national levels, are merged with appropriate activities of WHO and other contributing organizations. The Global Network of the WHO Collaborating Centres in Occupational Health is given a special role in the implementation of the global strategy.

Computer Communication Networks↗
PubMed1997

Evidence for endothelin involvement in the pulmonary vasoconstrictor response to systemic hypoxia in the isolated rat lung.

We investigated the effect of systemic hypoxia (Krebs-Henseleit solution gassed with 5% CO2/95% N2) on an isolated, perfused rat lung. Hypoxia resulted in a slowly developing sustained increase in pulmonary perfusion pressure (PPP) accompanied by an increase in lung weight (LW). The endothelin (ET) receptor antagonists BQ123 (3 and 10 microM), BQ788 (3 microM) and bosentan (1.5 and 5 microM) all attenuated the hypoxia-induced increases in LW and PPP. In addition, phosphoramidon (1 microM), an ET-converting enzyme inhibitor, also significantly attenuated the hypoxia-induced increases in PPP and LW. The use of two agents that alter peptide secretion, phalloidin (10 and 50 nM) and colchicine (100 nM), and the peptide synthesis inhibitor cycloheximide (5 microM) all significantly attenuated the hypoxia-induced increases in PPP and LW. The increase in PPP and LW after the onset of hypoxia was accompanied by an increase in perfusate levels of ET-1 compared with normoxic time-matched controls. The results show that in this model, systemic hypoxia is capable of causing a sustained vasoconstriction and increased LW. The fact that these increases can be attenuated by an ET-converting enzyme inhibitor, ET receptor antagonists and agents that block peptide synthesis and secretion, together with the increase in perfusate levels of ET-1, suggests that ET production and release contribute to the changes seen.

Animals↗
PubMed1997

[Pharmacologic treatment for ventricular arrhythmias].

Pharmacologic management of patients with ventricular arrhythmias remains in a state of considerable flux. New findings from controlled clinical trials, suggest that use of the principles of risk stratification permits identification of patients at very high risk for developing sustained ventricular tachyarrhythmias or ventricular fibrillation. Available data suggest that patients with sustained ventricular tachyarrhythmias require treatment. Patients with frequent ventricular ectopy or nonsustained ventricular tachycardia in the absence structural heart disease do not require treatment except when relief of symptoms is warranted. The indication for treatment of patients with underlying structural heart disease, particularly coronary artery disease and a previous myocardial infarction, who manifest frequent ventricular ectopy or more particular nonsustained ventricular tachycardia remain uncertain. From meta-analytic studies, it has become clear that beta-blockers reduce sudden death and total cardiac mortality. Data also suggest that amiodarone appears to be the safest antiarrhythmic drug for treatment sustained and nonsustained arrhythmias, and improved survival in patients with advanced heart failure.

Amiodarone↗
PubMed1998

Cyclosporine, but not FK506, selectively induces renal and coronary artery smooth muscle contraction.

BACKGROUND: Cyclosporine immunosuppression for organ transplantation is associated with hypertension and nephrotoxicity. Because the effects of cyclosporine as an immunosuppressant are mediated by the effect of cyclosporine as a phosphatase inhibitor, and phosphatase inhibitors are potent vascular smooth muscle contractile agents, we hypothesized that cyclosporine might induce contraction of the renal artery vascular smooth muscle directly. METHODS: Strips of bovine renal, carotid, superior mesenteric, or coronary arteries were obtained fresh from an abattoir. The strips were equilibrated in a muscle bath, and the contractile responses to cyclosporine and FK506 were determined. RESULTS: Cyclosporine (50 to 5000 micrograms/ml), but not FK506, induced rapidly developing, sustained contractions of renal and coronary artery smooth muscle. The magnitude of the cyclosporine-induced contractions of carotid and superior mesenteric artery smooth muscles was significantly less. The magnitude of renal artery smooth muscle contractions induced by cyclosporine was enhanced in the presence of an intact endothelium. CONCLUSIONS: Although these effects occurred in vitro to relatively high doses of cyclosporine, these data suggest that cyclosporine may selectively induce renal artery smooth muscle contraction through activation of the Ca(2+)-dependent phosphatase (calcineurin) in the smooth muscle, and these contractions may be enhanced by the release of endothelial-derived contracting factors.

Animals↗
PubMed1997

[Coordination of surgical relief concepts in the international community].

Concerned by the increasing number and extent of disasters, the international community declared the period from 1990-2000 an international decade for natural disaster reduction (IDNDR). The "United Nations Disaster Relief Organisation" (UNDRO) was restructured into the "Department of Humanitarian Affairs" (DHA) to study ways and means of improving the co-ordination of international relief operations at the site of a disaster. This included the establishment of the "United Nations Disaster Assessment and Co-ordination Stand-by Team" (UNDAC) and the "On-site Operations Co-ordination Centre" (OSOCC) concept. Surgical relief teams had to implement new concepts regarding mission indication, guidelines, ethical code of conduct and measures of improved prevention, rehabilitation, reconstruction and sustainable development.

Altruism↗
PubMed1998

Is there a relationship between hypertension and lower-extremity contracture release in cerebral palsy?

Recent reports have suggested a relationship between release of lower-extremity contractures and the development of hypertension in cerebral palsy and poliomyelitis patients. A retrospective study was performed on 119 cerebral palsy patients who had undergone lower-extremity contracture releases. Temporary elevation of systolic blood pressure in the perioperative and intraoperative periods occurred in 46 patients (39%), and temporary elevation of diastolic blood pressure occurred in 14 patients (12%). Type of cerebral palsy, patient age, patient sex, type of anesthesia, and type of procedure were not significantly correlated with the temporary blood pressure elevations. No patient developed sustained elevation of systolic and diastolic blood pressure. We conclude that lower-extremity contracture release in pediatric patients is not associated with an increased incidence of postoperative hypertension.

Adolescent↗
PubMed1998

Priorities for medium-term development in the health sector of Bosnia and Herzegovina.

In the medium term, the World Bank will work with the Government of Bosnia and Herzegovina, non-government organizations, and international development agencies to complete the reconstruction work already begun. There will be an increased emphasis on developing sustainable health finance regime and establishing a basic health system.

Bosnia and Herzegovina↗
PubMedDate not supplied

[The radiofrequency ablation of a left lateral accessory pathway during pre-excitation atrial fibrillation].

The occurrence of atrial fibrillation during an electrophysiologic study in patients with Wolff-Parkinson-White syndrome is a common problem and it is time-consuming to terminate it either with the use of drugs or by electrical cardioversion. The purpose of this report is to assess the feasibility of successful radiofrequency catheter ablation of and mapping for overt left-sided accessory pathway during atrial fibrillation. During an electrophysiologic study, pre-excitation was lost and the patient developed sustained atrial fibrillation either spontaneously or during catheter manipulation. We decided to map during this arrhythmia because we noted that the patient had maximally pre-excited beats which might increase the possibility of accessory pathway potential recording and a successful ablation site. With the ablation catheter in the left-lateral region we recorded an early ventricular electrogram and a rapid deflection preceding the onset of ventricular activation that was not observed in non pre-excited beats and we considered it the Kent potential. At this site we applied one pulse of radiofrequency current with temperature control at 70 degrees C and eliminated anterograde conduction over the accessory pathway during the first 3 seconds and continue the radiofrequency current for a total of 2 minutes. The procedure time was 60 minutes. We conclude that mapping and radiofrequency catheter ablation can be successfully performed during pre-excited atrial fibrillation and this could shorten the procedure and obviate the need for several electrical cardioversions.

Adult↗
PubMed1998

Occupational health and safety in small enterprises.

Health and work are two central components of sustainable development. A total of 2.6 billion people constitute the global labour force, 80% of which is in the developing world. A significant part of the working population in both developed and developing countries is employed in so-called small-scale enterprises (SSEs). This is the under-served working population which does not fully benefit from available knowledge and experience related to health and safety at work. The focus of this paper includes common features of SSEs, with some key WHO documents and publications on chemical hazards, safety, and emergency measures, as well as the WHO concept on Occupational Health for All, and the WHO Global Strategy.

Global Health↗
PubMed2006

Development of sustained-release tablets containing sodium valproate: in vitro and in vivo correlation.

We have developed a 200 mg and 400 mg sustained-release sodium valproate tablet that allows effective blood concentration of the active drug with once-a-day dosing. The controlled dissolution or sustained release of the drug was attained by a membrane-controlled system. A single-coating system did not adequately control the dissolution rate, and therefore double-coated tablets were prepared and a human pharmacokinetic study was conducted. With the 200 mg VPA-Na tablets, the nonfasting C(max) was only 20% higher than the fasting C(max). An in vitro dissolution test was conducted to predict the effects of food on drug dissolution after administration of this tablet. A relatively good correlation was observed between the absorption profiles and the dissolution profiles of the drug.

Acrylic Resins↗
PubMed2004

Characteristics of patients with chronic hepatitis C who develop hepatocellular carcinoma after a sustained response to interferon therapy.

BACKGROUND: The objective of the current study was to determine the characteristic features of sustained responders who develop hepatocellular carcinoma after treatment with interferon for chronic hepatitis C. METHODS: This study included 3626 patients with chronic hepatitis C who had received interferon monotherapy. Cox proportional hazards analysis was used to compare sustained responders who did and did not develop hepatocellular carcinoma, and nonsustained responders who developed hepatocellular carcinoma in a multicenter, retrospective cohort study. RESULTS: Among 1197 sustained responders, 27 patients developed hepatocellular carcinoma (2.3%). Compared with sustained responders who did not develop hepatocellular carcinoma, patients who developed disease more often were male (P = 0.0212), were older (P = 0.0068), and had advanced-stage histologic disease before interferon therapy (P = 0.0345). Conversely, compared with patients with hepatocellular carcinoma who were not sustained responders, patients who were sustained responders tended to be older at the time of the initiation of interferon therapy (P = 0.0552) and at the time hepatocellular carcinoma was detected (P = 0.0593), and they also were predominantly male (P = 0.0507). The histologic staging and serum aminotransferase levels at the initiation of interferon therapy, the interval to the detection of tumor, and the tumor size showed no significant differences between the two groups. CONCLUSIONS: Sustained responders in the group at high risk for developing hepatocellular carcinoma after interferon therapy were older, more often were male, and had more advanced histologic disease stage. Such patients should be followed carefully periodically for > 10 years after they complete interferon therapy.

Age Factors↗
PubMed1997

Formulation development of sustained-release hydrophilic matrix tablets of zileuton.

The purpose of this paper was to develop a hydrophilic matrix system for extended oral delivery of zileuton, and study the effects of certain formulation, processing, and dissolution variables on in vitro drug release. Tablet formulations with 60-70% drug and varying release rates were prepared by wet granulation using low and medium viscosity grades of hydroxypropylmethocellulose. In vitro drug release was evaluated using USP apparatus 1. The in vitro drug release from all formulations followed zero-order kinetics and was independent of compression force. In general, the release rate decreased with increasing drug load and higher polymer concentration or viscosity. High-shear granulation also resulted in lower release rate. Accelerated release was observed with increased agitation as well as in the dissolution media with higher surfactant concentration and/or ionic strength. No stereoselective release from the matrix system was observed. The hydrophilic matrix system effectively controlled the in vitro release of zileuton. Matrix tablets with desired release rates can be prepared by adjusting various formulation and processing parameters. The matrix system also has the advantage of simple processing and relatively low cost.

Biological Availability↗
PubMed1985

Development of sustained-release antimicrobial dental varnishes effective against Streptococcus mutans in vitro.

Two antimicrobial varnishes were developed to be applied to the teeth for the eradication of Streptococcus mutans infections. One of them contained chlorhexidine acetate as the antimicrobial agent and the other, erythromycin base. Both varnishes contained Sumatra benzoin. Each of the two antimicrobial agents was shown to be highly effective against S. mutans and to be compatible with the benzoin vehicle. When applied to extracted teeth, both varnishes dried to form a tough, adherent, and colorless transparent layer. Dried samples of the varnishes, when suspended in frequently-changed buffer, released their microbial agents at low but bactericidal levels for at least 12 days. After the first day, drug release from the chlorhexidine varnish showed approximately zero-order kinetics, while the erythromycin varnish showed a combination of zero-order and first-order kinetics.

Amines↗
PubMed1992

New developments in sustained-release antihypertensive therapy: formulation and pharmacokinetic considerations.

In order to achieve a consistently absorbed form of nifedipine over 24 hours, a novel formulation approach, INDAS, was used to develop a once-daily, sustained-release (SR) form of nifedipine that could provide effective control of blood pressure at a low total daily dose. The pharmacokinetic characteristics of this new formulation of nifedipine-SR were compared with those of divided doses of conventional nifedipine. The SR formulation was shown to achieve a lower peak plasma nifedipine level but with a prolonged plasma profile characterized by an extended time to peak plasma levels (Tmax), a higher trough plasma level, a longer apparent half-life, and a markedly lower peak-to-trough fluctuation in plasma nifedipine concentrations. In a separate study, the gastrointestinal transit parameters and physical characteristics of the SR tablet were evaluated. This study established that the large intestine is the major site of residence and absorption for this dosage form. The physical erosion and disintegration characteristics of the SR formulation are such that a well-maintained absorption of nifedipine is consistently achieved over the 24 hour dosing interval.

Adult↗
PubMed2002

Role of poly [DL-lactide-co-glycolide] in development of a sustained oral delivery system for antitubercular drug(s).

An oral formulation based on poly (DL-lactide-co-glycolide) (PLG) microparticles was developed for delivery of antituberculous drugs. PLG entrapped antitubercular drugs when administered orally, were found to release the drugs in a sustained manner. This formulation was found to be stable in the acidic environment of gastric fluid whereas, in the intestinal fluid the drug release was obtained up to 20 days as indicated by in vitro studies. Pharmacokinetic analysis of the data revealed changes in C(max); AUC(o-alpha); t(1/2) (a) and t(1/2) (e) when drugs were given entrapped in PLG microparticles. Higher peak concentration, area under the concentration time curve and delayed elimination rate of entrapped drugs indicated the potential of PLG for effective treatment of tuberculosis. Further, work is being carried out to evaluate the chemotherapeutic efficacy of the antitubercular drugs encapsulated in PLG microspheres.

Administration, Oral↗