Current clinical pharmacology
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Curr Clin Pharmacol · May 2009
ReviewIs propofol the perfect hypnotic agent for procedural sedation in neonates?
Following the landmark observations on the relevance of adequate analgesia and sedation in neonates, neonatologists are in search for short acting agents for procedural sedation. Propofol (2,6 di-isopropylphenol) is considered to be a short acting anaesthetic that is both rapid in onset and short in duration after cessation, but data on pharmacokinetics and metabolism in neonates were absent. ⋯ Clinicians should remain careful with propofol in neonates because of the reduced clearance and extensive interindividual variability. We strongly dissuade the use of continuous or repeated intermittent administration of propofol in the first weeks of life and suggest to study the pharmacodynamics of single bolus administration of propofol in neonates.
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Curr Clin Pharmacol · Jan 2009
Randomized Controlled Trial Comparative StudyState of the art clinical efficacy and safety evaluation of N-acetylcarnosine dipeptide ophthalmic prodrug. Principles for the delivery, self-bioactivation, molecular targets and interaction with a highly evolved histidyl-hydrazide structure in the treatment and therapeutic management of a group of sight-threatening eye diseases.
The exact biological functions of the aminoacyl-histidine dipeptides in ophthalmology are still unknown but they are the subject of intensive research activities at Innovative Vision Products, Inc. (IVP). Numerous studies have demonstrated, both at the tissue and organelle levels, that naturally occuring imidazole containing peptidomimetics possess strong and specific antioxidant properties, by preventing and reducing the accumulation of oxidised products derived from the lipid peroxidation (LPO) of biological membranes. Carnosine has been shown to act as a competitive inhibitor of the non-enzymatic glycosylation of proteins.Thus, carnosine may prevent and reverse (de-link) the formation of the advanced glycation end-products (AGEs), whose accumulation in the ocular tissues has been proposed to play a direct role in the etiology and pathogenesis of cataract and diabetic ocular complications (DOC). Besides, histidine-containing dipeptides are believed to act as cytosolic buffering agents. ⋯ Cataract is a major disease both in terms of number of people involved and economic impact. The research into causative factors and mechanisms to prevent the development of cataract is essential, particularly in developing countries where cataract surgery is often inaccessible. The results of this study provide a substantial basis for further evaluation of N-acetylcarnosine eye drops patented by IVP in the treatment and prevention of visual impairment in the temporal cross-sections of an older population several years apart. In the number of promotion studies this ophthalmic drug showed experimental and clinical potential for the non-surgical treatment of age-related cataracts. Comprehensive studies that investigate clinical, economic, and humanistic outcomes for the patient and society are conducted and will be described with different types of identified pharmacoeconomic evaluations to adequately assess the comparative value of current N-acetylcarnosine eye drops therapeutics for medical care and its place in future ophthalmic practices. Patients and the public expect that safe and cost-effective cataract medical care with N-acetylcarnosine therapeutic platform should be commissioned for them.
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Hyperglycemia in hospitalized patients has been shown to increase both morbidity and mortality, regardless of the presence of preexisting diabetes. In order to achieve recommended glycemic goals, many patients require the use of intravenous insulin therapy in the critical care setting. Following the publication of a landmark trial evaluating the benefits of intensive insulin therapy in critically ill patients, a worldwide increased effort to achieve strict glycemic control has ensued. ⋯ As demonstrated by studies which have been terminated prematurely due to increased risk for hypoglycemic episodes, the benefits versus risks of intensive insulin therapy must be weighed carefully. Patients receiving continuous infusions of insulin require close monitoring, which may increase workload for intensive care unit staff. In an effort to balance the risks and benefits of intensive insulin therapy, many hospitals are incorporating standardized protocols and using an interdisciplinary approach toward patient care.
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Curr Clin Pharmacol · Sep 2008
ReviewThe interaction between burn injury and vitamin D metabolism and consequences for the patient.
The stress and inflammatory responses to burn injury are associated with bone loss. The stress response entails production of large amounts of endogenous glucocorticoids that decrease osteoblasts on the mineralization surface of bone and decreases differentiation of marrow stromal cells into osteoblasts, thereby decreasing the amount of bone formation. Deficiency of osteoblasts also blocks osteoclastogenesis thus leading to low bone turnover and bone loss. ⋯ Moreover, the skin from burned patients cannot synthesize vitamin D normally. Thus vitamin D supplementation is the only means by which to ensure vitamin D sufficiency for burn victims. The proper requirement for vitamin D in acutely burned patients remains unknown.
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Curr Clin Pharmacol · May 2008
ReviewAmyloid beta protein and tau in cerebrospinal fluid and plasma as biomarkers for dementia: a review of recent literature.
This review addresses recent developments in amyloid beta (Abeta), total tau (t-tau), and phosporylated tau (p-tau) protein analysis, in cerebrospinal fluid (CSF) and plasma as biomarkers for dementia. Recent research focused on the protection of patients with mild cognitive impairment (MCI) into dementia and the differential diagnosis of Alzheimer's Disease (AD). A combination of Abeta42 and t-tau in CSF can discriminate between patients with stable MCI and patients with progressive MCI into AD or other types of dementia with a sufficient sensitivity and specificity. ⋯ In conclusion, progress has been made regarding Abeta and tau as biomarkers for dementia, both for differentiation between stable MCI and progressive MCI patients and for the differential diagnosis of AD. Future research should aim to validate these recently published results, preferably in pathologically confirmed AD patients. In addition, it is important to standardise research in terms of study design (longitudinal, minimal follow-up period of 5 years), type of researched parameters ( total or p-tau, type of Abeta peptides), type of matrix (CSF and plasma) and data analysis (establishment of predefined cut-off values, type of ratio, type of marker combination).