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Publications (45)


Effects of Pioglitazone on Blood Glucose and Inflammatory Markers of Diabetic Kidney Transplant Patients
  • Article
  • Full-text available

September 2014

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163 Reads

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12 Citations

Iranian Journal of Kidney Diseases

A Randomized

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Controlled Trial

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Introduction: The aim of this study was to assess the effects of pioglitazone on blood glucose control and inflammatory biomarkers in diabetic patients receiving insulin after kidney transplantation. Materials and methods: In a randomized placebo-controlled trial, 62 diabetic kidney transplant patients were followed for 4 months after randomly assigned to placebo and pioglitazone (30 mg/d) groups. All of the patients continued their insulin therapy irrespective of the group that they were assigned to, in order to evaluate the effects of addition of pioglitazone on blood glucose and inflammation biomarkers including serum C-reactive protein, high-sensitivity C-reactive protein, and interleukin-18 levels, as well as erythrocyte sedimentation rate. Results: At baseline, there were no significant differences in laboratory studies between the two groups. After 4 months of intervention, along with significant improvement in hemoglobin A1c in the pioglitazone group, daily insulin requirements also decreased and lipid profile improved significantly. In addition, erythrocyte sedimentation rate, C-reactive protein, and high-sensitivity C-reactive protein values were significantly lower in the pioglitazone group (P = .03, P < .001, and P = .01). Interleukin-18 levels were not significantly different at the end of the study between the two groups, but it had a decreasing trend in the pioglitazone group (P = .002). Conclusions: Pioglitazone complementing insulin in diabetic kidney transplant patients not only improved glycemic control, evidenced by hemoglobin A1c, and reduced daily insulin requirement, but also decreased inflammatory markers which may have an impact on overall cardiovascular events and mortalities beyond glycemic control.

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Figure 1. Flow of Patients in the Trial. aOther includes 362 patients receiving propofol, 39 with open abdomen or chest, 33 needing ongoing deep sedation (because of a plan to return to the operating room, severe agitation, chronic pain, precarious airway, or hemodynamic instability), and 23 receiving high-frequency ventilation. For the remainder, please see the supplemental eAppendix.
Figure 2. Kaplan-Meier Curves for Time to Successful Extubation. P value calculated from log-rank statistic.
Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol A Randomized Controlled Trial

October 2012

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1,202 Reads

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461 Citations

Journal of the American Medical Association

Context Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits. Objective To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients. Design, Setting, and Patients Randomized controlled trial of 430 critically ill, mechanically ventilated adults conducted in 16 tertiary care medical and surgical ICUs in Canada and the United States between January 2008 and July 2011. Intervention Continuous opioid and/or benzodiazepine infusions and random allocation to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption (n = 214). Using validated scales, nurses titrated infusions to achieve light sedation. For patients receiving daily interruption, nurses resumed infusions, if indicated, at half of previous doses. Patients were assessed for delirium and for readiness for unassisted breathing. Main Outcome Measure Time to successful extubation. Secondary outcomes included duration of stay, doses of sedatives and opioids, unintentional device removal, delirium, and nurse and respiratory therapist clinical workload (on a 10-point visual analog scale [VAS]). Results Median time to successful extubation was 7 days in both the interruption and control groups (median [IQR], 7 [4-13] vs 7 [3-12]; interruption group hazard ratio, 1.08; 95% CI, 0.86-1.35; P = .52). Duration of ICU stay (median [IQR], 10 [5-17] days vs 10 [6-20] days; P = .36) and hospital stay (median [IQR], 20 [10-36] days vs 20 [10-48] days; P = .42) did not differ between the daily interruption and control groups, respectively. Daily interruption was associated with higher mean daily doses of midazolam (102 mg/d vs 82 mg/d; P = .04) and fentanyl (median [IQR], 550 [50-1850] vs 260 [0-1400]; P < .001) and more daily boluses of benzodiazepines (mean, 0.253 vs 0.177; P = .007) and opiates (mean, 2.18 vs 1.79; P < .001). Unintentional endotracheal tube removal occurred in 10 of 214 (4.7%) vs 12 of 207 patients (5.8%) in the interruption and control groups, respectively (relative risk, 0.82; 95% CI, 0.36-1.84; P = .64). Rates of delirium were not significantly different between groups (53.3% vs 54.1%; relative risk, 0.98; 95% CI, 0.82-1.17; P = .83). Nurse workload was greater in the interruption group (VAS score, 4.22 vs 3.80; mean difference, 0.41; 95% CI, 0.17-0.66; P = .001). Conclusion For mechanically ventilated adults managed with protocolized sedation, the addition of daily sedation interruption did not reduce the duration of mechanical ventilation or ICU stay. Trial Registration clinicaltrials.gov Identifier: NCT00675363







Memantine Treatment in Patients With Moderate to Severe Alzheimer Disease Already Receiving Donepezil

January 2004

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171 Reads

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728 Citations

A LZHEIMER DISEASE (AD) IS A neurodegenerative disorder characterized by cognitive decline , impaired performance of activities of daily living, and behav-ioral and psychiatric signs and symptoms. Pathological features of AD include intraneuronal neurofibrillary tangles containing abnormally phos-phorylated tau protein, extracellular amyloid plaques containing the pep-tide amyloid, neuronal cell death, and anatomic as well as functional impairment of neurotransmitter systems. 1,2 Alzheimer disease affects approximately 4.5 million people in the United States. 3 Treatments approved by the Food and Drug Administration were previously limited to monotherapy with cholinesterase inhibitors in patients with mild to moderate AD. 2 In Octo-ber 2003, the Food and Drug Administration approved memantine for the treatment of moderate to severe AD; memantine is now available in more than 40 countries worldwide. Memantine, a low-to moderate-affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist , represents the first member of a new class of medications showing clinical benefit and good tolerability in AD. Although other NMDA receptor modula-tors (eg, milacemide and D-cycloser-ine) have failed in development as Context Memantine is a low-to moderate-affinity, uncompetitive N-methyl-D-aspartate receptor antagonist. Controlled trials have demonstrated the safety and efficacy of memantine monotherapy for patients with moderate to severe Alzheimer disease (AD) but no controlled trials of memantine in patients receiving a cholinesterase inhibitor have been performed. Objective To compare the efficacy and safety of memantine vs placebo in patients with moderate to severe AD already receiving stable treatment with donepezil.




Citations (43)


... There is insufficient data to assess the similarities of labor companion training associated with the included studies. Only some papers gave short descriptions of how the training was conducted [34,35,37,39]. Also, healthcare workers with different levels of training and experience were employed as labor companions in the included studies [5,25,28,29]. ...

Reference:

Impact of continuous labor companion- who is the best: A systematic review and meta-analysis of randomized controlled trials
Continuous Emotional Support During Labor in a US Hospital
  • Citing Article

... There is growing attention to its importance (Black et al., 2017;McEwen & McEwen, 2017). We learned so much from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial (Ball et al., 2002;Rebok et al., 2014;Willis et al., 2006), in part because it grew out of a National Institute of Aging funding mechanism that engendered substantive and sustained interaction among individuals with divergent perspectives. The time is ripe for a large-scale study comparable to the ACTIVE trial to test mechanistic explanations of how engagement may impact cognition (Onken et al., 2014). ...

Effects of Cognitive Training Interventions With Older Adults

... There are reports that ipriflavone reduces bone loss in rats (Cecchini et al., 1997) and humans (Gennari et al., 1997). A 4-y multicenter trial, however, showed that ipriflavone had no effect on BMD in postmenopausal women (Alexandersen et al., 2001). Despite these conflicting observations, Ipriflavone is approved for the treatment of involutional osteoporosis in some European countries and in Japan with the trade names Iprosten, Osteofix, and Osten (Kelly et al., 2006). ...

Ipriflavone in the Treatment of Postmenopausal Osteoporosis
  • Citing Article

... In an attempt to minimize the use of physical restraints in LTC homes, many jurisdictions have regulated their use through changes in legislation and have implemented market-based approaches, such as public reporting, to enhance the quality of care and influence provider and consumer choice (3,(12)(13)(14)(15). Studies evaluating the effectiveness of policy tools have reported lower physical restraint use as a result of regulation, but also concomitant worsening of other quality indicators (3,10,(16)(17)(18)(19), including the use of antipsychotic medications. ...

Effect of a Guideline-Based Multicomponent Intervention on Use of Physical Restraints in Nursing Homes
  • Citing Article

... Although numerous studies have been published in Japan and worldwide on the therapeutic effects of omalizumab for cedar seasonal allergic rhinitis [4][5][6][7], most of these studies reported results after only up to 4 weeks of follow-up, and the sample sizes were often limited. ...

Effect of Omalizumab on Symptoms of Seasonal Allergic Rhinitis
  • Citing Article

... As mentioned earlier, the weight loss agent sibutramine is a centrally acting NE and serotonin reuptake inhibitor (Lean 1997;Wirth and Krause 2001). Since these neurotransmitters (NE and serotonin) activate G protein-coupled receptors, variants in this family of genes are potential candidate genes for pharmacogenetics exploration. ...

Long-term Weight Loss With Sibutramine
  • Citing Article
  • September 2001

JAMA The Journal of the American Medical Association

... Or is it only in terms of the number of injections reduced? Scientific literature show that in general, the safety and efficacy aspects of combination vaccines are not proven beyond doubt (Beeching et al., 2004;Beri & Ojha, 2002;Comenge & Girard, 2006;Girard, 2005;Vesikari et al, 1991;WHO 2012 andKlein et al., 2010), and it is reported that they are less protective when compared to their individual components (AAP, 1999;Buttery et al., 2005;FDA, 1997;Greenberg et al., 2000;Kalies et al., 2004;White et al., 1997). In pentavalent vaccine (DTP-HB-Hib), lower immunological responses to Hep-B and Hib were observed when compared to their separate administration ( Bar-On et al., 2009;Edwards & Decker, 1997;Jones et al., 1998;Pichicheo et al., 1997: WHO, 2005. ...

Immunogenicity and Safety of a Combination Pneumococcal-Meningococcal Vaccine in Infants

... A randomised trial demonstrated a small, significant reduction of new pigmented moles (the strongest predictors of melanoma risk) in Canadian schoolchildren with summer sunscreen use (Gallagher et al. 2000) and recent follow-up of a community-based trial conducted in Queensland-Australia suggests that long-term daily sunscreen use can prevent primary cutaneous melanoma in Caucasian adults (Green et al. 2011). Despite its apparent efficacy in preventing SCC (van der Pols et al. 2006), pigmented moles (Gallagher et al. 2000) and melanoma (Green et al. 2011), sunscreen is more prone to incorrect use than clothing (Harrison, Buettner, and MacLennan 2005). ...

Broad-Spectrum Sunscreen Use and the Development of New Nevi in White Children
  • Citing Article

... Compared to glipizide, PIO therapy suppressed IL-6 levels in T2D patients with overt diabetic nephropathy, an activity that was not solely attributed to its glycaemic control [121]. High-sensitivity C-reactive protein (hs-CRP) levels and erythrocyte sedimentation rate were also reduced in diabetic kidney transplant patients, receiving PIO therapy, compared to placebo [122,123]. Furthermore, recent evidence suggests that PIO administration ameliorated the peri-renal adipose tissue inflammation in prediabetic rats and reversed their structural, functional and renovascular defects [124]. ...

Effects of Pioglitazone on Blood Glucose and Inflammatory Markers of Diabetic Kidney Transplant Patients

Iranian Journal of Kidney Diseases

... 65 However, in a long-term randomized controlled trial involving over 20 000 participants, supplementation with β-Carotene did not result in a reduction in the incidence of T2DM. 66 Moreover, diminished serum carotenoid levels constitute a risk factor for obesity, and supplementation has been linked to a reduction in body weight, thereby reinforcing its potential efficacy in individuals with T2DM. 67 Increasing dietary carotenoids in general, and β-carotene specifically, might be useful in the prevention and treatment of T2D to some degree, perhaps due to its antioxidant effects. ...

Long-term -Carotene Supplementation and Risk of Type 2 Diabetes Mellitus
  • Citing Article