Medicine and Health Sciences Commons^™

Perioperative Nonopioid Agents For Pain Control In Spinal Surgery., Anna Rivkin, Mark Rivkin

Mark Rivkin

PURPOSE: Commonly used nonopioid analgesic agents that are incorporated into multimodal perioperative pain management protocols in spinal surgery are reviewed. SUMMARY: Spinal procedures constitute perhaps some of most painful surgical interventions, as they often encompass extensive muscle dissection, tissue retraction, and surgical implants, as well as prolonged operative duration. Perioperative nonopioid analgesics frequently used in multimodal protocols include gabapentin, pregabalin, acetaminophen, dexamethasone, ketamine, and nonsteroidal antiinflammatory drugs (NSAIDs). There is evidence to suggest that gabapentin is safe and effective in reducing opioid consumption and pain scores at optimal doses of 600-900 mg orally administered preoperatively. Pregabalin 150-300 mg orally perioperatively …

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Reactive Oxygen Species Modulation Of Na/K-Atpase Regulates Fibrosis And Renal Proximal Tubular Sodium Handling, Jiang Liu, David J. Kennedy, Yanling Yan, Joseph I. Shapiro Md

Jiang Liu

The Na/K-ATPase is the primary force regulating renal sodium handling and plays a key role in both ion homeostasis and blood pressure regulation. Recently, cardiotonic steroids (CTS)-mediated Na/K-ATPase signaling has been shown to regulate fibrosis, renal proximal tubule (RPT) sodium reabsorption, and experimental Dahl salt-sensitive hypertension in response to a high-salt diet. Reactive oxygen species (ROS) are an important modulator of nephron ion transport. As there is limited knowledge regarding the role of ROS-mediated fibrosis and RPT sodium reabsorption through the Na/K-ATPase, the focus of this review is to examine the possible role of ROS in the regulation of Na/K-ATPase …

Peroxisome Proliferator-Activated Receptor Delta Agonist, Hpp593, Prevents Renal Necrosis Under Chronic Ischemia, Larisa V. Fedorova, Komal Sodhi, Cara Gatto-Weis, Nitin Puri, Terry D. Hinds Jr., Joseph I. Shapiro Md, Deepak Malhotra

Joseph I Shapiro MD

The Goldblatt’s 2 kidney 1 clip (2K1C) rat animal model of renovascular hypertension is characterized by ischemic nephropathy of the clipped kidney. 2K1C rats were treated with a specific peroxisome proliferator-activated receptor δ (PPARδ) agonist, HPP593. Clipped kidneys from untreated rats developed tubular and glomerular necrosis and massive interstitial, periglomerular and perivascular fibrosis. HPP593 kidneys did not exhibit any histochemical features of necrosis; fibrotic lesions were present only in perivascular areas. Necrosis in the untreated clipped kidneys was associated with an increased oxidative stress, up regulation and mitochondrial translocation of the pro-death protein BNIP3 specifically in tubules. In the kidneys …

Reactive Oxygen Species Modulation Of Na/K-Atpase Regulates Fibrosis And Renal Proximal Tubular Sodium Handling, Jiang Liu, David J. Kennedy, Yanling Yan, Joseph I. Shapiro Md

Joseph I Shapiro MD

The Na/K-ATPase is the primary force regulating renal sodium handling and plays a key role in both ion homeostasis and blood pressure regulation. Recently, cardiotonic steroids (CTS)-mediated Na/K-ATPase signaling has been shown to regulate fibrosis, renal proximal tubule (RPT) sodium reabsorption, and experimental Dahl salt-sensitive hypertension in response to a high-salt diet. Reactive oxygen species (ROS) are an important modulator of nephron ion transport. As there is limited knowledge regarding the role of ROS-mediated fibrosis and RPT sodium reabsorption through the Na/K-ATPase, the focus of this review is to examine the possible role of ROS in the regulation of Na/K-ATPase …

Physical, Thermal And Spectroscopic Studies Of Biofield Treated P-Chlorobenzonitrile, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Ragini Singh, Snehasis Jana

Mahendra Kumar Trivedi

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Chad A. Knoderer

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad Knoderer, Allison Gritzman, Kristen Nichols, Amy Wilson

Chad A. Knoderer

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Compatibility Of Vancomycin And Oxacillin During Simulated Y-Site Delivery, Hilary Teibel, Chad Knoderer, Kristen Nichols

Chad A. Knoderer

Background: Vancomycin and oxacillin may be used together as empiric coverage in patients with proven or suspected Staphylococcus aureus infections. Though vancomycin hydrochloride 20 mg/mL and oxacillin sodium 160 mg/mL are reported to be compatible via Y-site delivery, Y-site compatibility of commonly used concentrations, vancomycin 10 mg/mL and oxacillin 20 mg/mL, has not yet been reported. Objective: To determine the Y-site compatibility of vancomycin 10 mg/mL and oxacillin 20 mg/mL. Methods: One vancomycin hydrochloride 1 g vial was reconstituted with 10 mL sterile water for injection (SWFI) and diluted with 90 mL 5% dextrose in water (D5W) in an evacuated …

Optimized Antimicrobial Dosing Strategies: A Survey Of Pediatric Hospitals, Chad Knoderer, Kristen Nichols, Elaine Cox

Chad A. Knoderer

Background Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. Objective The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and Participants A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome Measure The main outcome measure was the percentage utilization of the dosing …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Kristen R. Nichols

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad A. Knoderer, Allison L. Gritzman, Kristen R. Nichols, Amy C. Wilson

Kristen R. Nichols

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Compatibility Of Vancomycin And Oxacillin During Simulated Y-Site Delivery, Hilary Teibel, Chad Knoderer, Kristen Nichols

Kristen R. Nichols

Background: Vancomycin and oxacillin may be used together as empiric coverage in patients with proven or suspected Staphylococcus aureus infections. Though vancomycin hydrochloride 20 mg/mL and oxacillin sodium 160 mg/mL are reported to be compatible via Y-site delivery, Y-site compatibility of commonly used concentrations, vancomycin 10 mg/mL and oxacillin 20 mg/mL, has not yet been reported. Objective: To determine the Y-site compatibility of vancomycin 10 mg/mL and oxacillin 20 mg/mL. Methods: One vancomycin hydrochloride 1 g vial was reconstituted with 10 mL sterile water for injection (SWFI) and diluted with 90 mL 5% dextrose in water (D5W) in an evacuated …

Optimized Antimicrobial Dosing Strategies: A Survey Of Pediatric Hospitals, Chad A. Knoderer, Kristen R. Nichols, Elaine G. Cox

Kristen R. Nichols

Background Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. Objective The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and Participants A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome Measure The main outcome measure was the percentage utilization of the dosing …

Physical, Thermal And Spectral Properties Of Biofield Treated 1,2,3-Trimethoxybenzene, Mahendra Kumar Trivedi, Rama Mohan Tallapragada, Alice Branton, Dahryn Trivedi, Gopal Nayak, Rakesh K. Mishra, Snehasis Jana

Mahendra Kumar Trivedi

Physicochemical And Spectroscopic Characterization Of Biofield Treated Butylated Hydroxytoluene, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Ragini Singh, Snehasis Jana

Mahendra Kumar Trivedi

The Medicine Shoppe V. Loretta Lynch: Pharmacists’ Corresponding Responsibility With Physicians Under Dea Interpretation Of The “Legitimate Medical Purpose” Standard, Jeffrey C. Grass Jd, Ms, Aclm

Jeffrey C. Grass JD, MS, ACLM

The Medicine Shoppe v. Loretta Lynch et al. 14-1223 will assist pharmacists and pharmacy owners in understanding their duties “corresponding responsibility to assure that its prescriptions for controlled substances are issued for a legitimate medical purpose” and “in the practitioner's usual course of professional practice.” In the meantime, pharmacists need to know that they are not immune from administrative, regulatory or criminal prosecution under the CSA solely due to their status. Rather, they are expected to dispense drugs for the bona fide treatment of a patient's disease. Under this regime, he or she must exercise sound professional judgment when evaluating …

Physical, Thermal And Spectral Properties Of Biofield Energy Treated 2,4-Dihydroxybenzophenone, Mahendra Kumar Trivedi, Rama Mohan Tallapragada, Alice Branton, Dahryn Trivedi, Gopal Nayak, Rakesh K. Mishra, Snehasis Jana

Mahendra Kumar Trivedi

Investigation Of Isotopic Abundance Ratio Of Biofield Treated Phenol Derivatives Using Gas Chromatography-Mass Spectrometry, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Gunin Saikia, Snehasis Jana

Mahendra Kumar Trivedi

Cd36 And Na/K-Atpase- Α 1 Form A Proinflammatory Signaling Loop In Kidney, David Kennedy, Yiliang Chen, Wenxin Huang, Jamie Viterna, Jiang Liu, Kristen Westfall, Jian Tian, David Bartlett, W.H. Tang, Zijian Xie, Joseph Shapiro, Roy Silverstein

Jiang Liu

Proatherogenic, hyperlipidemic states demonstrate increases in circulating ligands for scavenger receptor CD36 (eg, oxidized low-density lipoprotein [oxLDL]) and the Na/K-ATPase (eg, cardiotonic steroids). These factors increase inflammation, oxidative stress, and progression of chronic kidney disease. We hypothesized that diet-induced obesity and hyperlipidemia potentiate a CD36/Na/K-ATPase–dependent inflammatory paracrine loop between proximal tubule cells (PTCs) and their associated macrophages and thereby facilitate development of chronic inflammation and tubulointerstitial fibrosis. ApoE^-/- and apoE^-/-/cd36^-/- mice were fed a high-fat diet for ≤32 weeks and examined for physiologic and histologic changes in renal function. Compared with apoE^-/-, apoE^{-/- …}

Principles Of Management Of Severe Hyponatremia, Antonios H. Tzamaloukas Md, Deepak Malhorta Md, Phd, Bradley H. Rosen Do, Dominic S. C. Raj S. C. Raj Md, Glen H. Murata Md, Joseph I. Shapiro Md

Joseph I Shapiro MD

Hyponatremia represents a serious health hazard.1 Hospitalized patients,2 nursing home residents,3 women,4,5 and children6 exhibit high frequency and/or severity of hyponatremia. Hyponatremia developing during the course of other morbid conditions increases their severity.7–10 Estimates of direct costs for treating hyponatremia in the United States ranged between $1.61 and $3.6 billion.11 Clinical manifestations of hyponatremia are universal12,13 and range from subtle (disturbances of balance, problems in cognition detected only during specific testing) to life-threatening manifestations of increased intracranial pressure with life-threatening hypoxia14–16 and noncardiac pulmonary edema.17 Although the treating physicians must make an accurate diagnosis based on well-established and described clinical …

Characterisation Of Physical, Spectral And Thermal Properties Of Biofield Treated Resorcinol, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Ragini Singh, Snehasis Jana

Mahendra Kumar Trivedi

Not In My Backyard: A Systematic Review Of Clinicians’ Knowledge And Beliefs About Antibiotic Resistance, Amanda Mccullough, John Rathbone, Sarah Parekh, Tammy Hoffmann, Chris Del Mar

Amanda McCullough

Exercise and physical activity are important components in both the management and treatment of type 2 diabetes. Exercise promotes multiple beneficial effects for diabetics; however, some studies have shown that when some individuals undergo an exercise program, this can cause behavioural compensatory responses. Therefore, we investigated whether an aerobic exercise program influences sedentary behavior (SB) and moderate-vigorous physical activity (MVPA) in type 2 diabetics. Eight volunteers (51.1±8.2 years; 4 men) underwent an exercise program (3 d.wk-1, 50– 60% of VO2 peak, 30–60 min) for 8 weeks. SB and MVPA were measured by triaxial accelerometers pre- and post-exercise intervention. Cardiorespiratory fitness, …

Physical, Spectroscopic And Thermal Characterization Of Biofield Treated Myristic Acid, Mahendra Kumar Trivedi, Rama Mohan Tallapragada, Alice Branton, Dahryn Trivedi, Gopal Nayak, Rakesh K. Mishra, Snehasis Jana

Mahendra Kumar Trivedi

Physical And Structural Characterization Of Biofield Treated Imidazole Derivatives, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Gunin Saikia, Snehasis Jana

Mahendra Kumar Trivedi

Spectroscopic Characterization Of Disulfiram And Nicotinic Acid After Biofield Treatment, Mahendra Kumar Trivedi, Alice Branton, Dahryn Trivedi, Gopal Nayak, Khemraj Bairwa, Snehasis Jana

Mahendra Kumar Trivedi

An Impact Of Biofield Treatment On Spectroscopic Characterization Of Pharmaceutical Compounds, Mahendra Kumar Trivedi, Shrikant Patil, Harish Shettigar, Ragini Singh, Snehasis Jana

Mahendra Kumar Trivedi

Use Of Medications Of Questionable Benefit In Advanced Dementia, Jennifer Tjia, Becky Briesacher, Daniel Peterson, Qin Liu, Susan Andrade, Susan Mitchell

Jennifer Tjia

IMPORTANCE: Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. OBJECTIVES: To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data …

The Efficacy Of Three Types Of Analgesic Drugs In Reducing Pain In The Rainbow Trout, Oncorhynchus Mykiss, Jessica J. Mettam, Lois J. Oulton, Catherine R. Mccrohan, Lynne U. Sneddon

Lynne Sneddon, PhD

Recent research has shown the possibility of pain perception in fish; therefore, the use of analgesia or “painkillers” should be considered for invasive procedures. However, there is relatively little information on the effectiveness of analgesic drugs nor on the appropriate dose for fish. This study assessed the efficacy of three types of drug: an opioid, buprenorphine, a non-steroidal anti-inflammatory drug (NSAID), carprofen and a local anaesthetic, lidocaine. Each drug was tested at three doses on rainbow trout that were noxiously stimulated and the most effective dose was also given to fish experiencing no pain to investigate side-effects. Ventilation rate and …

Spectroscopic Characterization Of Biofield Treated Metronidazole And Tinidazole, Mahendra Kumar Trivedi, Shrikant Patil, Harish Shettigar, Khemraj Bairwa, Snehasis Jana

Mahendra Kumar Trivedi