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Setia S, Villaveces A, Dhillon P, Mueller BA. Neonatal jaundice in Asian, white, and mixed-race infants. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2002; 156:276-9. [PMID: 11876673 DOI: 10.1001/archpedi.156.3.276] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND East Asians have inherently higher bilirubin levels at birth than whites. The potential for unnecessary treatment makes jaundice a problem of public health and clinical significance. OBJECTIVES To report the occurrence of jaundice diagnoses in East Asian and mixed East Asian/white infants in Washington State in recent years, and to compare the risk of diagnosis with neonatal jaundice among these infants, relative to white infants. DESIGN Population-based cohort study in Washington state. Participants were infants of full East Asian parentage (n = 3000), maternal Asian parentage (n = 2997), paternal Asian parentage (n = 2048), and white parentage (n = 3000). Diagnoses of jaundice and "severe jaundice" were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis and procedure codes from hospital discharge records. RESULTS Infants of full East Asian parentage were more likely to be diagnosed with jaundice than were white infants (relative risk [RR], 1.37; 95% confidence interval [CI], 1.16-1.62). For infants with Asian mothers and white fathers, the RR was 1.09 (95% CI, 0.91-1.30). Infants with Asian fathers and white mothers had an RR of 1.26 (95% CI, 1.05-1.52). The risk of severe jaundice requiring phototherapy, blood transfusion, or rehospitalization, however, was significantly elevated only for infants of full East Asian parentage (RR, 1.7; 95% CI, 1.12-2.58). CONCLUSIONS Diagnoses of neonatal jaundice occurred more often among East Asian and mixed Asian/white infants than among white infants. However, the risk of jaundice requiring extended hospital stay, rehospitalization, phototherapy, or blood transfusion was elevated only for infants of full East Asian parentage.
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Mueller BA, Zhang J, Critchlow CW. Birth outcomes and need for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol 2002; 186:446-52. [PMID: 11904605 DOI: 10.1067/mob.2002.120502] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether women with multiple sclerosis who deliver singleton infants are more likely to have pregnancy or delivery complications or to have infants with low birth weight, preterm gestation, or malformations than women without multiple sclerosis and to compare their need for rehospitalization during the 2 years after delivery. STUDY DESIGN This was a population-based cohort study that used Washington State linked birth certificate-hospital discharge records for singleton births from 1987 through 1996. Pregnancy course, birth outcomes, and need for rehospitalization within 2 years after delivery were compared for 198 women with multiple sclerosis and a comparison group of 1584 women. RESULTS With the exception of maternal anemia, women with multiple sclerosis were no more likely to have pregnancy or delivery complications, nor were their infants more likely to be low birth weight or preterm or to have malformations. Affected women were, however, twice as likely to be rehospitalized during the 3 months after delivery. CONCLUSION The increased risk of rehospitalization emphasizes a need for strong support systems and close monitoring during the 3 months after delivery.
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Schulte EC, Ahmidouch A, Armstrong CS, Arrington J, Asaturyan R, Avery S, Baker OK, Beck DH, Blok HP, Bochna CW, Boeglin W, Bosted PY, Bouwhuis M, Breuer H, Brown DS, Bruell A, Cadman RV, Carlini R, Chant NS, Cochran A, Cole L, Danagoulian S, Day DB, Dunne JA, Dutta D, Ent R, Fenker HC, Fox B, Gan L, Gao H, Garrow K, Gaskell D, Gasparian A, Geesaman DF, Gilman R, Glashausser C, Gueye P, Harvey M, Holt RJ, Jackson HE, Jiang X, Keppel CE, Kinney ER, Liang Y, Lorenzon W, Lung AF, Mack DJ, Markowitz PE, Martin J, McIlhany K, McKee D, Meekins DG, Miller MA, Milner RG, Mitchell JH, Mkrtchyan H, Mueller BA, Nathan AM, Niculescu G, Niculescu I, O'Neill TG, Papavassiliou V, Pate SF, Piercey RB, Potterveld DH, Ransome RD, Reinhold J, Rollinde E, Roos P, Saha A, Sarty AJ, Sawafta R, Segbefia E, Shin T, Stepanyan S, Strauch S, Sutter MF, Tadevosyan V, Tang L, Tieulent R, Uzzle A, Vulcan WF, Wood SA, Xiong F, Yuan L, Zeier M, Zihlmann B, Ziskin V. Measurement of the high energy two-body deuteron photodisintegration differential cross section. PHYSICAL REVIEW LETTERS 2001; 87:102302. [PMID: 11531475 DOI: 10.1103/physrevlett.87.102302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2001] [Indexed: 05/23/2023]
Abstract
The first measurements of the d(gamma,p)n differential cross section at forward angles and photon energies above 4 GeV were performed at the Thomas Jefferson National Accelerator Facility (JLab). The results indicate evidence of an angular dependent scaling threshold. Results at straight theta(cm) = 37 degrees are consistent with the constituent counting rules for E(gamma) greater, similar 4 GeV, while those at 70 degrees are consistent with the constituent counting rules for E(gamma) greater, similar 1.5 GeV.
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Mueller BA, Newton K, Holly EA, Preston-Martin S. Residential water source and the risk of childhood brain tumors. ENVIRONMENTAL HEALTH PERSPECTIVES 2001; 109:551-6. [PMID: 11445506 PMCID: PMC1240334 DOI: 10.1289/ehp.01109551] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Gestation may represent a window of susceptibility to transplacental effects of environmental exposures, including chemicals in water. The N-nitroso compounds (NNC), a class of chemicals with demonstrated neurocarcinogenic potential, include substances detected in drinking water. We used data from a study of possible risk factors for childhood brain tumors (CBT) to investigate the association of source of residential drinking water during pregnancy and CBT occurrence among offspring. In addition, dipstick measurements were made of nitrates and nitrites in tap water for the subset of women living in the same home they had lived in during their pregnancies. Population-based CBT cases (n = 540) and controls (n = 801) were identified in three regions including Los Angeles County, and the San Francisco Bay Area of California, and the Seattle-Puget Sound area of western Washington state. Overall, we observed no increased risk of CBT in offspring associated with wells as the source of residential water. However, an increased risk of CBT [odds ratio (OR) = 2.6; 95% confidence interval (CI), = 1.3-5.2] was observed in western Washington among offspring of women who relied exclusively on well water, and a decreased risk of CBT (OR = 0.2; 95% CI, 0.1-0.8) was observed in Los Angeles County. Among the small subset of subjects for whom dipstick measurements of tap water were available, the risk of CBT associated with the presence of either measurable nitrite and/or nitrate was 1.1 (95% CI, 0.7-2.0). Given the crude measurement method employed and because measurements often were obtained years after these pregnancies occurred, the relevance of the dipstick findings is unclear. The lack of consistency in our findings related to residential water source does not support the hypothesis of increased risk related to consumption of well water; however, regional differences in well water content may exist, and the increased risk observed in western Washington deserves further evaluation.
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Sowinski KM, Mueller BA, Grabe DW, Manley HJ, Frye RF, Bailie GR, Marx MA. Cefazolin dialytic clearance by high-efficiency and high-flux hemodialyzers. Am J Kidney Dis 2001; 37:766-76. [PMID: 11273877 DOI: 10.1016/s0272-6386(01)80126-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cefazolin dialytic clearance has not been determined in patients undergoing hemodialysis with high-efficiency or high-flux dialyzers. The objective of this study is to determine the pharmacokinetics and dialytic clearance of cefazolin and develop dosing strategies in these patients. Twenty-five uninfected subjects undergoing chronic thrice-weekly hemodialysis were administered a single dose of intravenous cefazolin (15 mg/kg) after their standard hemodialysis session. Fifteen subjects underwent hemodialysis with high-efficiency hemodialyzers, and 10 subjects underwent hemodialysis with high-flux hemodialyzers. Blood and urine samples were collected serially over the interdialytic period, during the next intradialytic period, and immediately after the next hemodialysis session. Serum and urine concentrations of cefazolin were determined by high-performance liquid chromatography. Differential equations describing a two-compartment model were fit to the cefazolin serum concentration-time data over the study period, and pharmacokinetic parameters were determined. Mean dialytic clearance values for cefazolin were significantly greater in the high-flux group compared with the high-efficiency group (30.9 +/- 6.52 versus 18.0 +/- 6.26 mL/min, respectively; P: < 0.05). Cefazolin reduction ratios were significantly greater (0.62 +/- 0.08 versus 0.50 +/- 0.07; P: < 0.005) in the high-flux group compared with the high-efficiency group and correlated well with equilibrated urea reduction. The pharmacokinetic model developed from patient data was used to simulate cefazolin serum concentration data for high-efficiency and high-flux dialyzers. Cefazolin doses of 15 or 20 mg/kg after each hemodialysis session maintained adequate serum concentrations throughout a 2- or 3-day interdialytic period regardless of hemodialyzer type.
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Spangler L, Cummings P, Tencer AF, Mueller BA, Mock C. Biomechanical factors and failure of transcervical hip fracture repair. Injury 2001; 32:223-8. [PMID: 11240299 DOI: 10.1016/s0020-1383(00)00186-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the association between biomechanical measurements (bone quality of the femoral neck, comminution, fracture angle, and fracture level) and the likelihood of fixation failure among patients who have a multiple screw stabilisation of an intracapsular hip fracture. METHODS A cohort study of 139 Washington State residents greater than 60 years of age who sustained a fall-related transcervical hip fracture treated from 1990 to 1996 inclusive. Measurements of bone quality, fracture angle, fracture level, and comminution were taken from perioperative X-rays. The outcome measure was clinical failure of the internal fixation procedure within 12 months of hospital discharge, as measured by readmission for further surgery to that hip. RESULTS Of the four biomechanical aspects examined, only bone quality, as measured by presence of an ICD code for osteoporosis, was significantly associated with risk of subsequent hospitalisation for revision surgery (adjusted hazard ratio 7.7, 95% CI 1.8-32.8). CONCLUSION A diagnosis code for osteoporosis was related to the outcome of intracapsular fractures repaired with multiple pins. Other biomechanical measurements from diagnostic X-rays were not related to the need for further surgery.
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Brown CN, Awes TC, Beddo ME, Brooks ML, Bush JD, Carey TA, Chang TH, Cooper WE, Gagliardi CA, Garvey GT, Geesaman DF, Hawker EA, He XC, Isenhower LD, Kaplan DM, Kaufman SB, Kirk PN, Koetke DD, Kyle G, Lee DM, Lee WM, Leitch MJ, Makins N, McGaughey PL, Moss JM, Mueller BA, Nord PM, Papavassiliou V, Park BK, Peng JC, Petitt G, Reimer PE, Sadler ME, Sondheim WE, Stankus PW, Thompson TN, Towell RS, Tribble RE, Vasiliev MA, Webb JC, Willis JL, Wise DK, Young GR. Observation of polarization in bottomonium production at square root of s = 38.8 GeV. PHYSICAL REVIEW LETTERS 2001; 86:2529-2532. [PMID: 11289972 DOI: 10.1103/physrevlett.86.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2000] [Indexed: 05/23/2023]
Abstract
We present a measurement of the polarization observed for bottomonium states produced in p-Cu collisions at square root of s = 38.8 GeV. The angular distribution of the decay dimuons of the Upsilon(1S) state shows no polarization at small values of the fractional longitudinal momentum x(F) and transverse momentum p(T) but significant positive transverse production polarization for either p(T)>1.8 GeV/c or for x(F)>0.35. The Upsilon(2S+3S) (unresolved) states show a large transverse production polarization at all values of x(F) and p(T) measured. These observations challenge NRQCD calculations of the polarization expected in the hadronic production of bottomonium states.
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Guevara JP, Young JC, Mueller BA. Do protective factors reduce the risk of hospitalization in infants of teenaged mothers? ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2001; 155:66-72. [PMID: 11177065 DOI: 10.1001/archpedi.155.1.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the risk of hospitalization associated with prenatal care use and indicators of socioeconomic status and social support among infants of teenage mothers. DESIGN Population-based case-control study. SETTING Nonfederal hospitals in Washington State. PARTICIPANTS Infants born from 1987 to 1995 to mothers younger than 20 years were identified using linked birth certificate-state hospital discharge data. Cases consisted of 8052 infants who were hospitalized during the first year of life at least 2 days after birth hospitalization discharge. An equal number of controls, frequency matched on birth year and maternal age group, were randomly sampled from among nonhospitalized infants. MAIN OUTCOME MEASURE Hospitalization in the first year of life. RESULTS Infants with a father listed on the birth certificate or whose mothers had commercial health insurance had a decreased risk of hospitalization (adjusted odds ratios, 0.91 and 0.78, respectively; 95% confidence intervals, 0.83-0.99 and 0.71-0.85, respectively). Participation in state-funded pregnancy programs, adequacy of prenatal care, or marital status did not affect the risk of hospitalization, except among infants whose mothers received more than adequate prenatal care (adjusted odds ratio, 1.15; 95% confidence interval, 1.03-1.29). CONCLUSION Our results suggest that teenaged mothers who list a father on the birth certificate or who have insurance, indicative of higher socioeconomic status, may have a reduced risk of hospitalization for their infants. Teenaged mothers who receive more than adequate prenatal care may have pregnancy complications that place their infants at increased risk of hospitalization. The effect of these protective factors should be clarified in future studies.
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Johnston BD, Britt J, D'Ambrosio L, Mueller BA, Rivara FP. A preschool program for safety and injury prevention delivered by home visitors. Inj Prev 2000; 6:305-9. [PMID: 11144634 PMCID: PMC1730673 DOI: 10.1136/ip.6.4.305] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State. STUDY SAMPLE The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial. INTERVENTION Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were offered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection. EVALUATION METHODS At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed. RESULTS Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention. CONCLUSIONS Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up.
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Scott MK, Kim MA, Kraus MA, Mueller BA, Sehra RA, Altemose GT, Sowinski KM. Effect of cisapride on QT interval in patients with end-stage renal disease. Am J Cardiol 2000; 86:873-5. [PMID: 11024404 DOI: 10.1016/s0002-9149(00)01109-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McKean-Cowdin R, Preston-Martin S, Pogoda JM, Mueller BA, Holly EA. Reliability of demographic, smoking and occupational data provided by mothers vs. fathers in a childhood cancer study. Paediatr Perinat Epidemiol 2000; 14:257-62. [PMID: 10949218 DOI: 10.1046/j.1365-3016.2000.00277.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A large case-control study of children was used to test mothers' reporting of information on fathers' background, lifestyle and occupational factors. For a subset (104) of 1341 enrolled families, both parents were interviewed about fathers' characteristics. Reliability of reporting was determined for fathers' race, education, smoking status, non-recent job history and use of occupational agents. The ability of mothers to report fathers' race, education and smoking status was high (kappa > 0.70). Mothers were generally able to report jobs held by the fathers in the 5 years preceding the birth of the child, but reliability was higher for jobs held for longer (kappa typically above 0.70), rather than shorter periods (kappa above 0.40). The finding that mothers' reporting on fathers' background, lifestyle and non-recent job history was reliable is encouraging, because many studies on childhood health rely exclusively on information from interviews with mothers. However, mothers were not reliably able to describe exposure to specific occupational agents.
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Kingery JR, Sowinski KM, Kraus MA, Klaunig JE, Mueller BA. Vancomycin assay performance in patients with end-stage renal disease receiving hemodialysis. Pharmacotherapy 2000; 20:653-6. [PMID: 10853620 DOI: 10.1592/phco.20.7.653.35177] [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: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare the performance of polyclonal fluorescence polarization immunoassay (pFPIA) with that of enzyme-multiplied immunoassay technique (EMIT) in patients receiving vancomycin and hemodialysis. SETTING Outpatient hemodialysis center. PATIENTS Seven subjects with end-stage renal disease treated with hemodialysis 3 times/week with a cellulose triacetate hemodialyzer. INTERVENTION Subjects received vancomycin 1000 mg intradialytically during the first study session and 750 mg every other hemodialysis session thereafter for 4 weeks. MEASUREMENTS AND MAIN RESULTS Blood samples were obtained throughout the study, and vancomycin serum concentrations were determined by pFPIA and EMIT. The mean +/- SD difference (estimate of bias) between assays was -1.10 +/- 1.35 mg/L. The limits of agreement (mean difference +/- 1.96 x SD) between them were -3.80-1.60 mg/L. CONCLUSION Our data suggest that the manufacturer's changes in the vancomycin pFPIA eliminated overestimation of drug concentrations in patients undergoing high-permeability hemodialysis.
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Leitch MJ, Lee WM, Beddo ME, Brown CN, Carey TA, Chang TH, Cooper WE, Gagliardi CA, Garvey GT, Geesaman DF, Hawker EA, He XC, Isenhower LD, Kaplan DM, Kaufman SB, Koetke DD, McGaughey PL, Moss JM, Mueller BA, Papavassiliou V, Peng JC, Petitt G, Reimer PE, Sadler ME, Sondheim WE, Stankus PW. Measurement of differences between J/psi and psi(') suppression in p-A collisions. PHYSICAL REVIEW LETTERS 2000; 84:3256-3260. [PMID: 11019064 DOI: 10.1103/physrevlett.84.3256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/1999] [Revised: 12/17/1999] [Indexed: 05/23/2023]
Abstract
Measurements of the suppression of the yield per nucleon of J/psi and psi(') production for 800 GeV/ c protons incident on heavy nuclear targets, relative to light nuclear targets, have been made with very broad coverage in x(F) and p(T). The observed suppression is smallest at x(F) values of 0.25 and below, and increases at larger values of x(F). It is also strongest at small p(T). Substantial differences between psi(') and J/psi production are observed for the first time in p-A collisions. The suppression for psi(') production is stronger than that for J/psi for x(F) near zero, but becomes comparable to that for J/psi for x(F)>0.6.
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Mueller BA, Scott MK, Sowinski KM, Prag KA. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis 2000; 35:310-2. [PMID: 10676732 DOI: 10.1016/s0272-6386(00)70342-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report the case of a man with chronic renal insufficiency who self-medicated with an alternative medicine product known as noni juice (Morinda citrifolia). The patient presented to the clinic with hyperkalemia despite claiming adherence to a low-potassium diet. The potassium concentration in noni juice samples was determined and found to be 56.3 mEq/L, similar to that in orange juice and tomato juice. Herbal remedies and alternative medicine products may be surreptitious sources of potassium in patients with renal disease.
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Mueller BA, Carlstedt BC. Pharmacy-buzzword bingo. Am J Health Syst Pharm 1999; 56:2464. [PMID: 10595809 DOI: 10.1093/ajhp/56.23.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Trujillo TN, Sowinski KM, Venezia RA, Scott MK, Mueller BA. Vancomycin assay performance in patients with acute renal failure. Intensive Care Med 1999; 25:1291-6. [PMID: 10654216 DOI: 10.1007/s001340051060] [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: 10/28/2022]
Abstract
OBJECTIVE Fluorescence polarization immunoassays (FPIA) have been reported to overestimate vancomycin serum concentrations compared to high-performance liquid chromatography (HPLC) or enzyme multiplied immunoassay technique (EMIT) in patients with chronic renal disease. The assay manufacturer has modified the FPIA to remedy this overestimation. The purpose of this study was to compare the assay performance of two FPIAs to EMIT in acute renal failure patients receiving vancomycin and continuous venovenous hemofiltration. DESIGN Open-label trial. SETTING Intensive care unit in a university affiliated hospital. PATIENTS AND PARTICIPANTS 15 serum and ultrafiltrate samples were obtained from 14 critically ill patients (mean +/- SD; 57 +/- 12 years; 8 males/6 females). MEASUREMENTS AND RESULTS Vancomycin concentrations were determined by a polyclonal FPIA (pFPIA) performed on the TDx system, a monoclonal FPIA (mFPIA) performed on the AxSYM system and EMIT. The coefficient of variation for all assays was < 5%. The mean difference +/- SDd between mFPIA vs EMIT and pFPIA vs EMIT assays in serum were: -0.08 +/- 1.55 and 1.24 +/- 2.11 mg/l, respectively. The limits of agreement between the mFPIA vs EMIT and pFPIA vs EMIT assays in serum were: -3.18 to 3.03 and -2.99 to 5.46 mg/l, respectively. CONCLUSIONS Our data demonstrate that the manufacturer's changes to the pFPIA have reduced overestimation. The mFPIA appears to be an acceptable assay for measuring vancomycin serum concentrations in acute renal failure patients and does not significantly overestimate these concentrations.
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Brophy DF, Sowinski KM, Kraus MA, Moe SM, Klaunig JE, Mueller BA. Small and middle molecular weight solute clearance in nocturnal intermittent peritoneal dialysis. Perit Dial Int 1999; 19:534-9. [PMID: 10641773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES To determine the dialysate-to-plasma (D/P) concentration ratios and peritoneal dialytic clearance (CI(D)) of substances with a wide range of molecular weights in subjects receiving a simulated nocturnal intermittent peritoneal dialysis (NIPD) session. DESIGN Open-label single-dose study. SUBJECTS Six end-stage renal disease patients undergoing peritoneal dialysis (PD). SETTING Clinical research center of a university-affiliated hospital. INTERVENTIONS Subjects received intravenous gentamicin and vancomycin on the first day of the study. Subjects received no PD until their return on the following day, when subjects underwent a simulated NIPD session utilizing four 2- to 2.5-L peritoneal dialysate dwells of 2 hours. Blood and dialysate samples were collected immediately before the session and after each dialysate dwell for determination of urea, creatinine, gentamicin, vancomycin, and beta2-microglobulin (beta2M) concentrations. Each solute's D/P concentration ratio and peritoneal CI(D) were calculated. MEASUREMENTS AND MAIN RESULTS The (mean +/- SD) 2-hour D/P concentration ratios were 0.78 +/- 0.05 (urea), 0.49 +/- 0.11 (creatinine), 0.38 +/- 0.08 (gentamicin), 0.11 +/- 0.06 (vancomycin), and 0.07 +/- 0.03 (beta2M). Peritoneal CI(D) values (mL/min of dialysis) were 19.0 +/- 2.8 (urea), 12.1 +/- 3.5 (creatinine), 8.4 +/- 2.8 (gentamicin), 2.7 +/- 1.5 (vancomycin), and 1.7 +/- 0.8 (beta2M). The D/P concentration ratios and peritoneal CI(D) values for urea, creatinine, and gentamicin were significantly different from vancomycin and beta2M (repeated measures ANOVA, p < 0.05). Beta2-microglobulin peritoneal CI(D) was strongly related to gentamicin peritoneal CI(D) (r = 0.96, p < 0.05). CONCLUSION Small molecular weight solutes have significantly greater D/P and peritoneal CI(D) than middle molecular weight solutes in NIPD. In NIPD, daily peritoneal CI(D) of beta2M is lower than that reported in continuous ambulatory PD. NIPD also results in lower drug CI(D) than that reported in continuous ambulatory PD studies.
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Scott MK, Mueller BA, Sowinski KM. The effects of peracetic acid-hydrogen peroxide reprocessing on dialyzer solute and water permeability. Pharmacotherapy 1999; 19:1042-9. [PMID: 10610010 DOI: 10.1592/phco.19.13.1042.31587] [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: 11/23/2022]
Abstract
We characterized the effects of peracetic acid-hydrogen peroxide (PAHP) reprocessing on hemodialyzer permeability to water and solutes of various molecular weights and compared these effects within and between dialyzers. An aqueous-based solution containing urea, creatinine, vancomycin, inulin, myoglobin, and albumin was dialyzed for 60 minutes with a hemodialyzer after undergoing 0, 1 , 5, 10, and 15 reuse cycles. Solute clearance, sieving coefficient (SC), and ultrafiltration coefficient were determined. We found that PAHP reprocessing significantly decreased water and solute removal (urea, creatinine, vancomycin, inulin) by cellulose triacetate dialyzers (CT190) over 15 reuses (p<0.05) but did not affect the permeability of polysulfone dialyzers (F80A). Inulin removal was significantly lower for F80A than for CT190 (p<0.0001 and p<0.001 for clearance and SC values, respectively). Myoglobin and albumin removal by CT190 significantly decreased over 15 reuses (p<0.05), but no protein was detected in dialysate or ultrafiltrate at any reuse number for F80A. Reprocessing with PAHP alters dialyzer permeability; the effect is more pronounced for the CT190 dialyzer, but removal of solutes with molecular weight above 1500 Da is significantly lower with F80A dialyzers than with CT190. These changes in dialyzer permeability should be considered when determining optimal reuse procedures.
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Velentgas P, Daling JR, Malone KE, Weiss NS, Williams MA, Self SG, Mueller BA. Pregnancy after breast carcinoma: outcomes and influence on mortality. Cancer 1999; 85:2424-32. [PMID: 10357413 DOI: 10.1002/(sici)1097-0142(19990601)85:11<2424::aid-cncr17>3.0.co;2-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To the authors' knowledge, no previous studies have identified an adverse effect of pregnancy on patient survival after breast carcinoma. However, results are difficult to interpret because of failure to control for stage of disease at the time the pregnancy occurred. METHODS Study participants were women diagnosed with invasive breast carcinoma between 1983-1992 who previously had participated in a population-based case-control study or, if deceased, proxy respondents. Information regarding subsequent pregnancies was obtained by self-administered questionnaire or telephone interview. Information regarding breast carcinoma recurrences was obtained by questionnaire and from cancer registry abstracts. Women who became pregnant after a diagnosis of breast carcinoma (n = 53) were matched with women without subsequent pregnancies based on stage of disease at diagnosis and a recurrence free survival time in the comparison women greater than or equal to the interval between breast carcinoma diagnosis and onset of pregnancy in the women with a subsequent pregnancy. RESULTS Sixty-eight percent of women who became pregnant after being diagnosed with breast carcinoma delivered one or more live-born infants. Miscarriages occurred in 24% of the patients who became pregnant compared with 18% of the controls (women without breast carcinoma) of similar ages from the case-control study. Five of the 53 women who had been pregnant after breast carcinoma died of the disease. The age-adjusted relative risk (RR) of death associated with any subsequent pregnancy was 0.8 (95% confidence interval [95% CI], 0.3-2.3). All five deaths occurred among the 36 women who had a live birth (age-adjusted RR = 1.1; 95% CI, 0.4-3.7). CONCLUSIONS The findings of the current study are based on a small number of deaths but do not suggest that pregnancy after a diagnosis of breast carcinoma has an adverse effect on survival.
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Sowinski KM, Abel SR, Clark WR, Mueller BA. Effect of gender on the pharmacokinetics of ofloxacin. Pharmacotherapy 1999; 19:442-6. [PMID: 10212016 DOI: 10.1592/phco.19.6.442.31044] [Citation(s) in RCA: 16] [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 OBJECTIVES To assess the influence of gender on the pharmacokinetics of ofloxacin. DESIGN Open-label study. SETTING Academic medical center. PATIENTS Five healthy men and seven healthy women volunteers. INTERVENTIONS Subjects received a single oral dose of ofloxacin 400 mg, and serial blood samples were collected for 24 hours. Plasma concentrations of ofloxacin were determined by high-performance liquid chromatography and pharmacokinetic parameters were determined. Statistical comparisons between genders were made with the Wilcoxon rank sum test. MEASUREMENTS AND MAIN RESULTS Median volume of distribution at steady state/systemic bioavailability (V(ss)/F) was significantly smaller in women than in men, although when normalized for total body weight there were no differences. Except for terminal elimination half-life, which was 10% shorter in women, no other pharmacokinetic values were significantly different between genders. Median peak concentrations, although not statistically different, were 28% higher in women. CONCLUSION Ofloxacin V(ss)/F values were smaller in women than in men, explained by gender-related differences in weight.
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Clark WR, Leypoldt JK, Henderson LW, Mueller BA, Scott MK, Vonesh EF. Quantifying the effect of changes in the hemodialysis prescription on effective solute removal with a mathematical model. J Am Soc Nephrol 1999; 10:601-9. [PMID: 10073611 DOI: 10.1681/asn.v103601] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
One potential benefit of chronic hemodialysis (HD) regimens of longer duration or greater frequency than typical three-times-weekly schedules is enhanced solute removal over a relatively wide molecular weight spectrum of uremic toxins. This study assesses the effect of variations in HD frequency (F: per week), duration (T: min per treatment), and blood/dialysate flow rates (QB/QD: ml/min) on steady-state concentration profiles of five surrogates: urea (U), creatinine (Cr), vancomycin (V), inulin (I), and beta2-microglobulin (beta2M). The regimens assessed for an anephric 70-kg patient were: A (standard): F = 3, T = 240, QB = 350, QD = 600; B (daily/short-time): F = 7, T = 100, QB = 350, QD = 600; C/D/E (low-flow/long-time): F = 3/5/7, T = 480, QB = 300, QD = 100. HD was simulated with a variable-volume double-pool model, which was solved by numerical integration (Runge-Kutta method). Endogenous generation rates (G) for U, Cr, and beta2M were 6.25, 1.0, and 0.17 mg/min, respectively; constant infusion rates for V and I of 0.2 and 0.3 mg/min, respectively, were used to simulate middle molecule (MM) G values. Intercompartment clearances of 600, 275, 125, 90, and 40 ml/min were used for U, Cr, V, I, and beta2M, respectively, For each solute/regimen combination, the equivalent renal clearance (EKR: ml/min) was calculated as a dimensionless value normalized to the regimen A EKR, which was 13.4, 10.8, 6.6, 3.7, and 4.8 ml/min for U, Cr, V, I, and beta2M, respectively. For regimens B, C, D, and E, respectively, these normalized EKR values were U: 1.04, 0.96, 1.58, and 2.22; Cr: 1.03, 1.08, 1.80, and 2.55; V: 1.06, 1.32, 2.21, and 3.12; I: 1.05, 1.54, 2.57, and 3.62; beta2M: 1.00, 1.27, 1.73, and 2.19. The extent of post-HD rebound (%) was highest for regimens A and B, ranging from 16% (urea) to 50% (inulin), and lowest for regimen E, ranging from 6% (urea) to 28% (beta2M). The following conclusions can be made: (1) Relative to a standard three-times-weekly HD regimen of approximately the same total (weekly) treatment duration, a daily/short-time regimen results in modest (3 to 6%) increases in effective small solute and MM removal. (2) Relative to a standard three-times-weekly HD regimen, a three-times-weekly low-flow/long-time regimen results in comparable effective small solute removal and progressive increases in MM and beta2M removal. A daily low-flow/long-time regimen substantially increases the effective removal of all solutes.
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Crump C, Lipsky S, Mueller BA. Adverse birth outcomes among Mexican-Americans: are US-born women at greater risk than Mexico-born women? ETHNICITY & HEALTH 1999; 4:29-34. [PMID: 10887459 DOI: 10.1080/13557859998164] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We examined adverse birth outcomes among Mexican-Americans to determine the effect of country of maternal birth, a measure of acculturation. DESIGN We conducted a retrospective cohort analysis of birth outcomes among 4800 Mexico-born and 4800 US-born Mexican-American women using Washington State birth certificate data from 1989 to 1994. Length of residence at current address was used to help refine our measure of acculturation. RESULTS US-born women had a slightly increased risk of preterm birth relative to Mexico-born women [relative risk (RR) 1.18, 95% confidence interval (CI) 1.04-1.33]. Among Mexico-born women, the risk of preterm birth increased with greater duration of current residence. CONCLUSIONS US-born Mexican-American women had a slightly increased risk of preterm birth despite having more adequate prenatal care, more education, and higher socioeconomic indicators. This may be due to acculturation factors, such as earlier pregnancy, loss of social support systems, and increased smoking or alcohol use. Reducing this risk depends on recognition among health care workers and policy-makers of the potential influence of acculturation on health in this population.
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Preston-Martin S, Pogoda JM, Mueller BA, Lubin F, Holly EA, Filippini G, Cordier S, Peris-Bonet R, Choi W, Little J, Arslan A. Prenatal vitamin supplementation and risk of childhood brain tumors. INTERNATIONAL JOURNAL OF CANCER. SUPPLEMENT = JOURNAL INTERNATIONAL DU CANCER. SUPPLEMENT 1999; 11:17-22. [PMID: 9876471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
An international case-control study of primary pediatric brain tumors included interviews with mothers of cases diagnosed from 1976 to 1994 and mothers of population controls. Data are available on maternal vitamin use during pregnancy for 1,051 cases and for 1,919 controls from 8 geographic areas in North America, Europe and Israel. While risk estimates varied by study center, combined results suggest that maternal supplementation for 2 trimesters decreased risk of brain tumor [odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5, 0.9], with a trend of less risk with longer duration of use (p trend = 0.0007). The greatest risk reduction was among children diagnosed under 5 years of age whose mothers used supplements during all 3 trimesters (OR = 0.5; CI = 0.3, 0.8). This effect did not vary by histology and was seen for supplementation during pregnancy rather than during the month before pregnancy or while breastfeeding. Our findings are largely driven by data from the United States, where most mothers took vitamins. The proportion of control mothers who took vitamins during pregnancy varied markedly from 3% in Israel and in France, 21% in Italy, 33% in Canada and 52% in Spain to 86-92% at the 3 U.S. centers. The composition of the various multivitamin compounds taken also varied: daily dose of vitamin C ranged from 0 to 600 mg; vitamin E from 0 to 70 mg; vitamin A from 0 to 30,000 IU; and folate from 0 to 2,000 micrograms. Mothers also took individual micronutrient supplements (e.g., vitamin C tablets), but most mothers who took these also took multivitamins, making it impossible to determine the potential independent effects of these micronutrients.
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Scott MK, Mueller BA, Sowinski KM, Clark WR. Dialyzer-dependent changes in solute and water permeability with bleach reprocessing. Am J Kidney Dis 1999; 33:87-96. [PMID: 9915272 DOI: 10.1016/s0272-6386(99)70262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effects of bleach reprocessing on the performance of high-flux dialyzers have not been comprehensively characterized. We compared the effects of automated bleach/formaldehyde reprocessing on solute and hydraulic permeability for cellulose triacetate (CT190) and polysulfone (F80B) dialyzers using an in vitro model. Dialyzers were studied after initial blood exposure (R0) and after 1 (R1), 5 (R5), 10 (R10), and 15 (R15) reuse cycles. Ultrafiltration coefficient (K(uf)), serial clearances, and/or sieving coefficients (SCs) of urea, creatinine, vancomycin, inulin, myoglobin, and albumin were determined. Urea, creatinine, and vancomycin clearances and SCs did not significantly differ from R0 to R15 with either dialyzer. Inulin clearances and SC also did not significantly change from R0 to R15 for the CT190. However, these same values for the F80B significantly increased (P < 0.05). The inulin clearance and SC values for the CT190 dialyzer were significantly higher than those for the F80B at all stages except R15. Myoglobin clearances significantly increased over 15 reuses for both dialyzers (P < 0.01). However, CT190 myoglobin clearances were significantly higher at all stages (R0 = 37.7 +/- 9.7; R15 = 52.5 +/- 8.8 mL/min) than the F80B (R0 = negligible; R15 = 41.3 +/- 16.5 mL/min; P < 0.01). Albumin pre- and postdialysis SCs significantly increased for both dialyzers (P < 0.01). K(uf) for R0 and R15 were 52.3 +/- 3.3 and 52.6 +/- 7.6 mL/h/mm Hg for CT190 (P = not significant) and 48.8 +/- 4.4 and 87.3 +/- 7.0 mL/h/mm Hg for F80B (P < 0.0001). We conclude that bleach reprocessing significantly increases larger solute and hydraulic permeability of high-flux cellulosic and polysulfone dialyzers. This effect is more pronounced for the polysulfone membrane. Until 10 reuses or greater, the removal of solutes greater than 1,500 d is significantly compromised with the polysulfone dialyzer used in this study.
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