Current Issue : April - June Volume : 2014 Issue Number : 2 Articles : 6 Articles
Background. Stroke commonly affects upper extremity motor abilities, yet there has been very limited success in developing effective\r\nrehabilitation interventions to remediate motor impairments, particularly for the upper extremity. Objective. To determine if taskoriented\r\npractice administered soon after stroke is more effective than usual care in improving poststroke upper extremity motor\r\nrecovery and to explore the optimal amount of practice. Methods. A systematic review of the literature was performed from 1950 to\r\nNovember 2012, to identify randomized controlled trials of task-oriented practice compared to usual care, or to different amounts\r\nof task-oriented practice to improve motor impairment and activity. Studies were excluded if specific types of interventions were\r\nused as comparators or if they were of poor methodological quality. Results. Six studies met the review criteria. Three of the six\r\nstudies demonstrated a statistically significant effect of task-oriented practice. Study results could not be pooled because of a lack of\r\nhomogeneity in populations and intervention. Conclusions.The results demonstrate that an increase in the amount of task-oriented\r\npractice after stroke may result in less upper extremity impairment; further research on both effect and required dosage is needed\r\nas results are inconsistent....
Objective. This study uses the acute otitis media clinical practice guideline proposed in 2004 as a reference to evaluate whether\r\nantibiotics doses that are in line with the recommendations lead to better prognosis. The study also attempts to clarify possible\r\nfactors that influence the outcome. Study Design. Retrospective cohort study. Subjects and Methods. A total of 400 children with\r\nacute otitis media were enrolled.The dosage of amoxicillin was considered to be appropriate when in accord with clinical practice\r\nguidelines, that is, 80ââ?¬â??90mg/kg/day. The outcome was defined according to the description of tympanic membrane on medical\r\nrecords.Multivariate logistic regressionwas used to analyze the relationship between antibiotic dosage and prognosis after adjusting\r\nfor baseline factors. Results. The majority of prescriptions were under dosage (89.1%) but it was not noticeably associated with\r\noutcome (P= 0.41).Thecorrelation between under dosage and poor prognosis was significant in children below20 kgwith bilateral\r\nacute otitis media (odds ratio 1.63; 95% CI 1.02ââ?¬â??2.59,P = 0.04). Conclusion. Treating acute otitis media in children, high-dose\r\namoxicillin with clavulanate as recommended in the clinical practice guideline was superior to conventional doses only in children\r\nunder 20 kg with bilateral diseases....
Background: Long-term administration of low-dose aspirin (LDA) is associated with a greater risk of adverse events,\r\nincluding gastroduodenal ulcers. The purpose of this study was to identify the risk factors for and assess the role of\r\nmedication use in the development of peptic ulcer disease in Japanese patients with no history of peptic ulcers.\r\nMethods: Consecutive outpatients receiving LDA (75 mg/day) who underwent esophagogastroduodenoscopy\r\nbetween January and December 2010 were enrolled. Clinical parameters, peptic ulcer history, concomitant drugs,\r\nthe presence of Helicobacter pylori infection, reason for endoscopy, and endoscopic findings were analysed.\r\nResults: Of 226 total patients, 14 (6.2%) were endoscopically diagnosed with peptic ulcer. Age, sex, current\r\nsmoking status, current alcohol consumption, endoscopic gastric mucosal atrophy, and abdominal symptoms\r\nwere not significantly associated with peptic ulcers. Diabetes mellitus was more frequent (42.9% vs. 16.5%; P = 0.024) in\r\npatients with peptic ulcers than in those without peptic ulcers. Using multiple logistic regression analysis, co-treatment\r\nwith anticoagulants or proton pump inhibitors (PPIs) was significantly associated with increased and decreased risk for\r\npeptic ulcer, respectively (odds ratio [OR], 5.88; 95% confidence interval [CI], 1.19 - 28.99; P = 0.03 and OR, 0.13; 95% CI,\r\n0.02 - 0.73; P = 0.02, respectively). Co-treatment with additional antiplatelet agents, H2-receptor antagonists, angiotensin\r\nII Type 1 receptor blockers, angiotensin-converting enzyme inhibitor, 3-hydroxy-3-methylglutaryl-CoA reductase\r\ninhibitor, or nonsteroidal anti-inflammatory drugs was not associated with peptic ulcer development.\r\nConclusion: The use of PPIs reduces the risk of developing gastric or duodenal ulcers in Japanese patients taking\r\nLDA without pre-existing gastroduodenal ulcers. However, this risk is significantly increased in both patients ingesting\r\nanticoagulants and patients with diabetes. These results may help identify patients who require intensive prophylaxis\r\nagainst aspirin-induced peptic ulcers....
Oxytocin is recommended by the World Health Organisation as the most effective uterotonic for the prevention and\r\ntreatment of postpartum haemorrhage. The requirement for parenteral administration by trained healthcare providers\r\nand the need for the drug solution to be maintained under cold-chain storage limit the use of oxytocin in the\r\ndeveloping world. In this study, a spray-dried ultrafine formulation of oxytocin was developed with an optimal particle\r\nsize diameter (1-5 �µm) to facilitate aerosolised delivery via the lungs. A powder formulation of oxytocin, using\r\nmannitol, glycine and leucine as carriers, was prepared with a volume-based median particle diameter of 1.9 �µm.\r\nOxytocin content in the formulation was assayed using high-performance liquid chromatography-mass spectroscopy\r\nand was found to be unchanged after spray-drying. Ex vivo contractility studies utilising human and ovine uterine\r\ntissue indicated no difference in the bioactivity of oxytocin before and after spray-drying. Uterine electromyographic\r\n(EMG) activity in postpartum ewes following pulmonary (in vivo) administration of oxytocin closely mimicked that\r\nobserved immediately postpartum (0-12 h following normal vaginal delivery of the lamb). In comparison to the\r\nintramuscular injection, pulmonary administration of an oxytocin dry powder formulation to postpartum ewes resulted\r\nin generally similar EMG responses, however a more rapid onset of uterine EMG activity was observed following\r\npulmonary administration (129 �± 18 s) than intramuscular injection (275 �± 22 s). This is the first study to demonstrate\r\nthe potential for oxytocin to elicit uterine activity after systemic absorption as an aerosolised powder from the lungs.\r\nAerosolised oxytocin has the potential to provide a stable and easy to administer delivery system for effective\r\nprevention and treatment of postpartum haemorrhage in resource-poor settings in the developing world.\r\nCitation: Prankerd RJ, Nguyen T-H, Ibrahim JP, Bischof RJ, Nassta GC, et al. (2013) Pulmonary Delivery of an Ultra-Fine Oxytocin Dry Powder...
Micro dosing (Phase 0 trials) approach has potential to reduce the number of volunteers used in research involved in the new drug development. Micro dosing is designed to speed up the development of promising drugs /imaging agents by establishing very early on whether the drug or agent behaves in human subjects as was expected from preclinical studies. It is a technique for studying the behaviour of drugs in humans through the administration of low doses (\"sub-therapeutic\") which does not produce whole-body effects, but high enough to allow study of cellular response, pharmacokinetics of the drug with almost no risk of side effects. It is a relatively recent innovation and there remains a degree of uncertainty as to whether such a small dose will adequately predict the pharmacokinetics of the therapeutically active dose. It provides early Pharmacokinetic and Pharmacodynamic information and avoids moving those drugs onto Phase 1-3. It allows selection of drug candidates more likely to be developed successfully with wide therapeutic indexes and also helps in determination of the first dose for the subsequent phase I clinical studies. The basic approach is to label a candidate drug using the radioisotope C-14 or analysis by Accelerated mass spectroscopy (AMS), Positron emission tomography (PET) and Liquid chromatography Mass spectroscopy (LC-MS)....
The effectiveness of Okra gum in sustaining the release of propranolol hydrochloride in a tablet was studied. Okra gum was\r\nextracted from the pods of Hibiscus esculentus using acetone as a drying agent. Dried Okra gum was made into powder form and\r\nits physical and chemical characteristics such as solubility, pH, moisture content, viscosity, morphology study using SEM, infrared\r\nstudy using FTIR, crystallinity study using XRD, and thermal study using DSC and TGA were carried out. The powder was used\r\nin the preparation of tablet using granulation and compression methods. Propranolol hydrochloride was used as a model drug and\r\nthe activity of Okra gum as a binder was compared by preparing tablets using a synthetic and a semisynthetic binder which are\r\nhydroxylmethylpropyl cellulose (HPMC) and sodium alginate, respectively. Evaluation of drug release kinetics that was attained\r\nfromdissolution studies showed that Okra gum retarded the release up to 24 hours and exhibited the longest release as compared to\r\nHPMC and sodium alginate. The tensile and crushing strength of tablets was also evaluated by conducting hardness and friability\r\ntests. Okra gum was observed to produce tablets with the highest hardness value and lowest friability.Hence,Okra gum was testified\r\nas an effective adjuvant to produce favourable sustained release tablets with strong tensile and crushing strength....
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