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Bianchi S, Rossi P, Schauerte P, Elvan A, Blomström-Lundqvist C, Kornet L, Gal P, Mörtsell D, Wouters G, Gemein C. Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation. Circ Arrhythm Electrophysiol 2015; 8:562-8. [DOI: 10.1161/circep.114.002588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
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Gal P, Linnenbank AC, Adiyaman A, Smit JJJ, Ramdat Misier AR, Delnoy PPH, de Bakker JM, Elvan A. Correlation of atrial fibrillation cycle length and fractionation is associated with atrial fibrillation free survival. Int J Cardiol 2015; 187:208-15. [DOI: 10.1016/j.ijcard.2015.03.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/06/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Parlak E, Gal P, Schellings D, Beukema R, Adiyaman A, Berg JT, Van 't Hof A, Elvan A. OP-008 Serial N-terminal Pro Brain Natriuretic Peptide Assessments in The Prediction of Incident Atrial Fibrillation in ST Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2015. [DOI: 10.1016/j.amjcard.2015.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gal P, Parlak E, Schellings DAAM, Beukema R, ten Berg J, Adiyaman A, van ’t Hof AWJ, Elvan A. Association of serial high sensitivity troponin T with onset of atrial fibrillation in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:33-42. [DOI: 10.1177/2048872615570220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
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Gal P, Ooms JFW, Ottervanger JP, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPHM, Jager PL, Elvan A. Association between pulmonary vein orientation and atrial fibrillation-free survival in patients undergoing endoscopic laser balloon ablation. Eur Heart J Cardiovasc Imaging 2015; 16:799-806. [DOI: 10.1093/ehjci/jeu321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/18/2014] [Indexed: 11/14/2022] Open
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Gal P, Elvan A. [Catheter ablation for persistent atrial fibrillation: looking for the best strategy]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2015; 159:A9401. [PMID: 26395569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Drug-refractory atrial fibrillation (AF) can be highly symptomatic and warrant invasive ablation targeting the pulmonary veins. Although limited ablation for paroxysmal AF is associated with a high success rate, more extensive ablation appears to be indicated for persistent AF. The Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR AF II) showed that the addition of complex fractionated atrial electrogram (CFAE) ablation or linear ablation lesions did not result in an improved ablation outcome. However, novel techniques that allow assessment ]\of AF substrate, rotor mapping and AF trigger ablation have been associated with improved ablation outcome and randomised studies evaluating these techniques are currently being designed.
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Gal P, Aarntzen AESM, Smit JJJ, Adiyaman A, Misier ARR, Delnoy PPHM, Elvan A. Conventional radiofrequency catheter ablation compared to multi-electrode ablation for atrial fibrillation. Int J Cardiol 2014; 176:891-5. [PMID: 25156854 DOI: 10.1016/j.ijcard.2014.08.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data is available on long-term atrial fibrillation (AF) free survival after multi-electrode catheter pulmonary vein isolation (PVI). The aim of this study was to compare point-by-point PVI to multi-electrode PVI in terms of procedural characteristics and long-term AF free survival. METHODS AND RESULTS 460 consecutive patients were randomly allocated: 230 patients underwent conventional, point-by-point ablation with a radiofrequency ablation catheter (cPVI group) and 230 patients underwent multi-electrode, phased radiofrequency ablation (MER group). Median follow-up was 43 months. Mean age was 56 years, 82% of patients had paroxysmal AF. Baseline characteristics did not differ among catheter groups. Acute electrical PVI was achieved in 99.7% of pulmonary veins, with no differences among catheter groups. Procedure time and ablation time were significantly shorter in the MER group. There were significantly less complications in the MER group (4.8% vs. 1.3%, P=0.025). After a mean of 1.5 procedures, AF free survival without the use of antiarrhythmic drugs was 74% at 1 year and 46% at 5 years follow-up and did not differ among catheter groups (cPVI group 45%, MER group 48%, P=0.777). In multivariate analysis, BMI, AF duration and CHADSVASc score were predictors of AF free survival. CONCLUSION Multi-electrode ablation was superior in procedure duration and ablation time, with less complications. However, both conventional point-by-point PVI and multi-electrode PVI achieved a high acute PVI success rate and showed a comparable long-term AF free survival.
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Schroeder V, Hess K, Phoenix F, Dobo J, Gal P, Ajjan R. Complement MBL-associated serine protease-1 (MASP-1) interacts with plasma clot formation - a novel link between inflammation and thrombosis? Mol Immunol 2011. [DOI: 10.1016/j.molimm.2011.06.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Joeris A, Ondrus S, Planka L, Gal P, Slongo T. ChronOS inject in children with benign bone lesions--does it increase the healing rate? Eur J Pediatr Surg 2010; 20:24-8. [PMID: 19899039 DOI: 10.1055/s-0029-1241866] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Benign bone lesions in children although rare, can result in a pathological fracture. Although their etiology and pathogenesis are not yet entirely clear, the phenomenon of spontaneous healing is well known. Nevertheless, some benign bone lesions are unlikely to heal spontaneously due to the patient's age or high risk of fracture and deformity due to the lesion's location or size. The following study presents our results after treatment of these bone cysts with chronOS Inject. METHODS From June 2004 to May 2007 23 patients with 24 benign bone cysts were treated with chronOS Inject, an injectable tricalcium phosphate, using a minimally invasive technique at two pediatric surgery departments. Postoperative follow-up examined bone healing, remodeling, chronOS Inject resorption and adverse effects. RESULTS 15 males and 9 females, mean age 11 years at time of diagnosis, were treated with chronOS Inject. The humerus was affected 13 times, the femur 7 times, the tibia twice and the radius, the fibula and talus once each. Except for one case, all pathological fractures healed within five weeks post-injection. Two children had cystic residues. No severe adverse effects were seen. CONCLUSIONS These preliminary results indicate that chronOS Inject could provide an alternative treatment for benign bone cysts that are unlikely to heal spontaneously due to the patient's age, high risk of instability or pathological fracture due to the lesion's size or location, or lesions that have already been treated several times using other methods without success.
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Harmat V, Kardos J, Gal P, Barabas O, Graf L, Naray-Szabo G, Zavodszky P. Structure of the active form of the catalytic region of the complement protease C1r. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302096198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Glover ML, Shaffer CL, Rubino CM, Cuthrell C, Schoening S, Cole E, Potter D, Ransom JL, Gal P. A multicenter evaluation of gentamicin therapy in the neonatal intensive care unit. Pharmacotherapy 2001; 21:7-10. [PMID: 11191739 DOI: 10.1592/phco.21.1.7.34441] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate traditional nomogram (TN) versus individualized pharmacokinetic gentamicin dosing practices in neonatal intensive care units, focusing on achieving target therapeutic concentrations (peak > 8 microg/ml, trough < 2 microg/ml), number of dosing changes, number of concentrations obtained, and evidence of nephrotoxicity. DESIGN Retrospective chart review. SETTING Three neonatal intensive care units. PATIENTS Three hundred nine infants prescribed gentamicin. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Sixty-seven percent of patients receiving pharmacokinetic dosing had initial peak concentrations of 8 microg/ml or greater compared with 7% of patients receiving TN dosing (p<0.001). Trough concentrations exceeding 2 microg/ml were reported in 23% of patients receiving TN dosing compared with 2% of pharmacokinetic-dosed patients (p<0.001). Forty-two percent and 6%, respectively, required dosage adjustments (p<0.01). The mean number of concentrations obtained per patient was 2.8 and 2.1, respectively (p<0.01). Neither group had evidence of gentamicin-related nephrotoxicity. CONCLUSION Compared with TN dosing, administering gentamicin loading doses and performing initial pharmacokinetic analysis resulted in rapid attainment of desired concentrations and fewer dosage adjustments, and allowed for a decrease in the number of gentamicin concentrations.
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Abstract
OBJECTIVE To describe the use of enoxaparin to treat suspected thrombosis in a preterm neonate. CASE DESCRIPTION A 29-week-gestation white infant with a family history of protein S deficiency lost color and blood flow to the right hand several hours after removal of the umbilical artery catheter. Although normal color returned to all except the distal first, second, and third fingers after warming, Doppler flow showed a radial artery defect, indicating a lack of blood flow. Enoxaparin 1 mg/kg intravenously every eight hours was then started. Heparin concentrations measured via anti-Xa assay drawn four and eight hours after a dose were 0.78 and 0.39 units/mL, respectively. Pharmacokinetic parameters calculated from these concentrations using a one-compartment model were elimination half-life four hours, volume of distribution 0.13 L/kg, and clearance 0.022 L/kg/h. No adverse effects were noted. Blood flow eventually returned, leaving only the third fingertip chronically injured. DISCUSSION Differences between the neonatal and adult hemostatic systems contribute to an increased risk of thromboembolic events and an altered sensitivity to heparin anticoagulation in the neonate. Although heparin is currently the anticoagulant of choice, it may produce several adverse effects, such as hemorrhage and thrombocytopenia, which may be avoided by use of low-molecular-weight heparins (LMWHs). However, despite the efficacy and improved safety profile of LMWHs in adults, data regarding their use in children and neonates are scarce. This case demonstrates that enoxaparin can be used safely and effectively in a preterm infant through appropriate monitoring of heparin concentrations to adjust dosages. A larger volume of distribution of enoxaparin was noted in this neonate than in adults. CONCLUSIONS Enoxaparin 1 mg/kg intravenously every eight hours was used safely in this preterm infant with suspected thrombosis, suggesting that more than one dosing regimen may be appropriate in this population.
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Rubino C, Ransom JL, Gal P, Shaffer C. Preventing medication errors in the intensive care unit. JAMA 2000; 283:1288; author reply 1288-9. [PMID: 10714721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Avent ML, Gal P, Ransom JL, Brown YL, Hansen CJ. Comparing the delivery of albuterol metered-dose inhaler via an adapter and spacer device in an in vitro infant ventilator lung model. Ann Pharmacother 1999; 33:141-3. [PMID: 10084406 DOI: 10.1345/aph.17425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the delivery of an albuterol metered-dose inhaler (MDI) (Ventolin) via an Aerochamber (Monaghan) with an inline adapter (Medicomp Straight Swivel) in an in vitro infant lung model. METHODS An in vitro infant lung model was modified to compare the delivery of albuterol MDI 10 inhalations via an Aerochamber with an inline adapter. The adapter and Aerochamber were placed at the endotracheal tube. A 1000 mL intravenous bag filled with 500 mL deionized water was attached to a 3.5 mm endotracheal tube (10 cm length). An Infant Bear Cub ventilator was used at the following settings: positive inspiratory pressure 20 cm H2O, intermittent mandatory ventilation 40 breaths/min, positive end expiratory pressure 4 cm H2O, and inspiratory time 0.5 second. Each device was run at least 10 times and assayed in duplicate by HPLC. An unpaired Student's t-test was used to analyze the statistical significance of the data. RESULTS There was significantly greater delivery of albuterol with the Aerochamber (19.49 +/- 7.23 microg; 2.17% +/- 0.8%) as compared with an inline adapter (1.0625 +/- 1.36 microg; 0.12% +/- 0.15%) (p = 0.001). CONCLUSIONS The Aerochamber provides a greater delivery of albuterol metered-dose inhalations to the lung than the inline adapter in an in vitro infant lung model.
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Avent ML, Gal P, Ransom JL, Brown YL, Hansen CJ, Ricketts WA, Soza F. Evaluating the delivery of nebulized and metered-dose inhalers in an in vitro infant ventilator lung model. Ann Pharmacother 1999; 33:144-8. [PMID: 10084407 DOI: 10.1345/aph.17426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate drug delivery to the lungs of nebulized and metered-dose inhalers (MDIs) in an in vitro infant lung model. METHODS An in vitro lung model was modified to study drug delivery. A 1000 mL intravenous bag filled with 500 mL deionized water was attached to a 3.5 mm (12 cm length) endotracheal tube. An inline Marquest Whisper Jet infant circuit nebulizer system delivered 2.5 mg/3 mL albuterol sulfate inhalation solution (Ventolin nebules) at a flow rate of 5 L/min. An Aerochamber (Monaghan) was placed at the endotracheal tube for the delivery of the MDIs. Albuterol MDI (Ventolin) 10 inhalations and beclomethasone MDI (Beclovent) 20 inhalations were delivered. A Servo 900C (Siemens-Elma) was used at the following ventilator settings: positive inspiratory pressure 30 cm H2O), intermittent mandatory ventilation 40 breaths/min, positive end expiratory pressure 4 cm H2O, inspiratory time 0.4 sec. Each formulation was run at least 10 times and assayed in duplicate by HPLC. An unpaired Student's t-test was used to analyze the statistical significance of the data. RESULTS There was a significantly greater percentage of drug delivery with MDI albuterol (1.96 +/- 0.50) as compared with nebulized albuterol (1.26 +/- 0.37) (p = 0.002) or beclomethasone diproprionate (0.51 +/- 0.24) (p = 0.001). CONCLUSIONS Albuterol MDI provides a more efficient delivery of drug to the lung as compared with nebulized albuterol and MDI beclomethasone diproprionate.
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Rubino CM, Gal P, Ransom JL. A review of the pharmacokinetic and pharmacodynamic characteristics of beta-lactam/beta-lactamase inhibitor combination antibiotics in premature infants. Pediatr Infect Dis J 1998; 17:1200-10. [PMID: 9877383 DOI: 10.1097/00006454-199812000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frick PA, Gal P, Lane TW, Sewell PC. Antiretroviral medication compliance in patients with AIDS. AIDS Patient Care STDS 1998; 12:463-70. [PMID: 11361994 DOI: 10.1089/apc.1998.12.463] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The paradigm of AIDS patient care has evolved to that of a chronic disease that is manageable with combination antiretroviral therapy. Intermittent adherence to antiretroviral regimens, however, has been associated with the selection of HIV mutations, resulting in drug-resistant virus. Medication compliance has become a vital component in the care of HIV-infected patients. This study was designed to assess the degree of medication compliance with zidovudine (ZDV) over a 2-month period among a convenience sample of 23 ambulatory patients with HIV infection. Enrollment took place during February to March 1995, when monotherapy with ZDV was considered the standard of care. Medication compliance was assessed by three methods: patient self-report determined by questionnaire, pharmacy refill records from the 3 months immediately before entry in the study, and an electronic monitoring system (Medication Event Management Systems [MEMS], Aprex Corp., Fremont, CA), which records the date and time of each opening of the medication vials. MEMS was utilized among a subgroup of eight participants over a 2-month period. Despite greater than 95% (22 of 23) of the subjects reporting that they believed ZDV was life prolonging, a majority took < or = 75% of the prescribed doses of ZDV as identified by both refill and MEMS methods. The mean percentage compliance over a 2-month period of observation for MEMS and pharmacy refill record review methods was 66% and 78%, respectively (p = 0.294). Among the subgroup of eight in the MEMS evaluation, 88% reported taking their ZDV according to the directions, all of the time. These results demonstrate that reliance upon patient self-report of medication compliance is less accurate than MEMS or pharmacy refill records, and that reliance on self-reporting could lead to erroneous assumptions of the patient's true drug compliance. In addition, the study suggests that pharmacy refill records may provide a method of assessing compliance that is equivalent to MEMS but is less experimental, and can easily be followed and interpreted by pharmacists and other clinicians caring for patients infected with HIV. Most importantly, relatively poor compliance rates demonstrated by MEMS raises serious concern for widespread development of HIV resistance to the more complicated, multiple-drug regimens in present use.
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Thielens N, Lacroix M, Dobo J, Gal P, Zavodsky P, Arlaud G. Expression and characterization of the proenzyme and activated forms of the catalytic regions of human C1r. Mol Immunol 1998. [DOI: 10.1016/s0161-5890(98)90538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shaffer CL, Davey AM, Ransom JL, Brown YL, Gal P. Ampicillin-induced neurotoxicity in very-low-birth-weight neonates. Ann Pharmacother 1998; 32:482-4. [PMID: 9562146 DOI: 10.1345/aph.17228] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Burstein AH, Gal P, Forrest A. Evaluation of a sparse sampling strategy for determining vancomycin pharmacokinetics in preterm neonates: application of optimal sampling theory. Ann Pharmacother 1997; 31:980-3. [PMID: 9296235 DOI: 10.1177/106002809703100904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To use optimal sampling theory to determine the fewest vancomycin concentrations required and the appropriate sampling times to calculate vancomycin pharmacokinetic parameters in neonates. DESIGN Unblinded evaluation in neonates with presumed sepsis. SETTING Level 3 community-based neonatal intensive care unit. PATIENTS Eleven neonates with presumed sepsis. INTERVENTIONS Twelve courses of intravenous vancomycin 20 mg/kg were administered. Blood samples were collected 3 and 9 hours after initiation of a 1-hour infusion of the first dose. MEASUREMENTS AND MAIN RESULTS A two-compartment model was fit to vancomycin concentrations using iterative two-stage analysis. Pharmacokinetic parameter estimates were used for determination of optimal sampling times for two-, three-, and four-sample strategies with subsequent generation of two-, three-, and four-sample concentration data for 100 cases. Relative performance of strategies was compared through calculation and comparison of D efficiency for the determined strategies. Bias (median percent error) and precision (median percent absolute error) of pharmacokinetic parameter estimates for each strategy in the 100 simulated cases were determined. CONCLUSIONS For estimation of total clearance and volume in the central and peripheral compartments, all strategies performed similarly with no difference in efficiency or bias and precision of estimates. Our results suggest that for clinical evaluations two appropriately timed samples (0.5 h after a 1-h infusion, trough concentration) are adequate for estimation of vancomycin clearance in neonates.
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Rubino CM, Shaffer CL, Gal P, Ransom JL, Kissling GE. Postnatal pharmacologic prevention of intraventricular hemorrhage: meta-analysis of phenobarbital and indomethacin. PEDIATRIC NURSING 1997; 23:196-204. [PMID: 9165939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Williams BS, Ransom JL, Gal P, Carlos RQ, Smith M, Schall SA. Gentamicin pharmacokinetics in neonates with patent ductus arteriosus. Crit Care Med 1997; 25:273-5. [PMID: 9034263 DOI: 10.1097/00003246-199702000-00013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the effect of patent ductus arteriosus on the pharmacokinetics of gentamicin in neonates and to examine whether any particular pharmacokinetic parameter is of value as a marker of patent ductus arteriosus. DESIGN Cohort study of neonates treated with gentamicin, according to a standard dosing protocol. SETTING A 24-bed, Level III, neonatal intensive care unit. PATIENTS Neonates treated with gentamicin at the time of admission to the neonatal intensive care unit, using a standard protocol, and who were < 36 wks of gestational age. INTERVENTIONS All patients received a gentamicin loading dose, and had gentamicin concentrations measured at 2 and 12 hrs after this dose, in order to determine pharmacokinetic parameters and calculate the optimum maintenance dose. Those neonates subsequently diagnosed to have patent ductus arteriosus, based on clinical suspicion and echocardiographic confirmation, were compared with those neonates without clinically suspected patent ductus arteriosus. Gentamicin pharmacokinetic parameters were calculated using a one-compartment model. MEASUREMENTS AND MAIN RESULTS A total of 322 courses of gentamicin were administered (patent ductus arteriosus, n = 106; control, n = 216). Gentamicin clearance was decreased in the patent ductus arteriosus group vs. the control group (40.02 vs. 44.73 mL/kg/hr; p < .0108). Volume of distribution was greater for patent ductus arteriosus patients (0.61 L/kg) than for controls (0.54 L/kg) (p < .0002). Also, volume of distribution was a useful marker for presence of patent ductus arteriosus, with a 92% specificity for patent ductus arteriosus. CONCLUSIONS Gentamicin dosing should be altered in neonates with patent ductus arteriosus to reflect the impact of higher volume of distribution and lower clearance. When the gentamicin volume of distribution exceeds 0.7 L/kg, it may be of predictive value for the presence of patent ductus arteriosus.
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Gal P, Ransom JL, Shaffer CL, Smith MS, Carlos RQ, Brown Y, Schall S. Reopening of the ductus arteriosus after closure with indomethacin: importance of sustained effective indomethacin serum concentrations. J Pediatr 1996; 128:719. [PMID: 8627452 DOI: 10.1016/s0022-3476(96)80149-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Avent ML, Gal P, Ransom JL, Fulp J. Colored deposit left in endotracheal tubes by ipratropium bromide. Am J Health Syst Pharm 1995; 52:421. [PMID: 7757872 DOI: 10.1093/ajhp/52.4.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
The challenging issues in pediatric pharmacotherapy are both profound and exciting. Microtechnologies for evaluating the impact of genetics in disease (e.g., using polymerase chain reactions) and the possibilities of therapeutic interventions create major clinical and ethical dilemmas that remain to be resolved. Inclusion of pediatric patients in drug development and marketing trials also remains a point of contention. Finally, well-established therapies should not be overlooked in favor of new but unestablished treatment approaches. Future columns will continue to use the current format, in which a few selected topics of high therapeutic importance are discussed. The research technologies, discussion of new drug therapy interventions, and preventive strategies most likely to benefit the health care of infants, children, and adolescents will remain the scope of this column.
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