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Search Results: 1 - 10 of 11145 matches for " Smith HS "
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Considerations in selecting rapid-onset opioids for the management of breakthrough pain
Smith HS
Journal of Pain Research , 2013, DOI: http://dx.doi.org/10.2147/JPR.S40745
Abstract: nsiderations in selecting rapid-onset opioids for the management of breakthrough pain Review (492) Total Article Views Authors: Smith HS Published Date March 2013 Volume 2013:6 Pages 189 - 200 DOI: http://dx.doi.org/10.2147/JPR.S40745 Received: 26 November 2012 Accepted: 17 January 2013 Published: 06 March 2013 Howard S Smith Departments of Anesthesiology, Medicine, and Physical Medicine and Rehabilitation Albany Medical College, Albany, NY, USA Abstract: Breakthrough pain (BTP) is a transitory pain that occurs despite the use of long-term, around-the-clock analgesia. It is highly prevalent in certain populations and places a significant burden on patients, their families, caregivers, and health-care systems. Despite its prevalence and impact, BTP is sometimes unrecognized and often undertreated. Various formulations of fentanyl – a rapid-onset opioid with short duration of action – are available for the management of BTP. The efficacy of formulations using transmucosal, transbuccal, sublingual, and intranasal administration routes has been demonstrated for BTP treatment in clinical trials. However, a lack of head-to-head trials evaluating their relative efficacy makes it challenging for physicians to reach informed decisions on the most efficacious intervention for individual patients. In the absence of clear data on the relative efficacy of fentanyl formulations, prescribing decisions need to be based on physician understanding and experience and product cost and availability, taking into account the individual patient's needs, the ability of the patient or caregivers to administer medication, and the patient's wishes. This review evaluates current pharmacologic methods of alleviating BTP and discusses factors that should be considered when selecting the most appropriate formulation for individual patients. With the range of fentanyl formulations available, it is now possible to successfully address BTP in the majority of patients.
Considerations in selecting rapid-onset opioids for the management of breakthrough pain
Smith HS
Journal of Pain Research , 2013,
Abstract: Howard S SmithDepartments of Anesthesiology, Medicine, and Physical Medicine and Rehabilitation Albany Medical College, Albany, NY, USAAbstract: Breakthrough pain (BTP) is a transitory pain that occurs despite the use of long-term, around-the-clock analgesia. It is highly prevalent in certain populations and places a significant burden on patients, their families, caregivers, and health-care systems. Despite its prevalence and impact, BTP is sometimes unrecognized and often undertreated. Various formulations of fentanyl – a rapid-onset opioid with short duration of action – are available for the management of BTP. The efficacy of formulations using transmucosal, transbuccal, sublingual, and intranasal administration routes has been demonstrated for BTP treatment in clinical trials. However, a lack of head-to-head trials evaluating their relative efficacy makes it challenging for physicians to reach informed decisions on the most efficacious intervention for individual patients. In the absence of clear data on the relative efficacy of fentanyl formulations, prescribing decisions need to be based on physician understanding and experience and product cost and availability, taking into account the individual patient's needs, the ability of the patient or caregivers to administer medication, and the patient's wishes. This review evaluates current pharmacologic methods of alleviating BTP and discusses factors that should be considered when selecting the most appropriate formulation for individual patients. With the range of fentanyl formulations available, it is now possible to successfully address BTP in the majority of patients.Keywords: rapid-onset opioid, breakthrough pain, pain, fentanyl
Duloxetine in the management of chronic musculoskeletal pain
Smith HS, Smith EJ, Smith BR
Therapeutics and Clinical Risk Management , 2012, DOI: http://dx.doi.org/10.2147/TCRM.S17428
Abstract: loxetine in the management of chronic musculoskeletal pain Review (1962) Total Article Views Authors: Smith HS, Smith EJ, Smith BR Published Date June 2012 Volume 2012:8 Pages 267 - 277 DOI: http://dx.doi.org/10.2147/TCRM.S17428 Received: 14 February 2012 Accepted: 03 March 2012 Published: 19 June 2012 Howard S Smith,1 Eric J Smith,2 Benjamin R Smith2 1Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA Abstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy) and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.
Duloxetine in the management of chronic musculoskeletal pain
Smith HS,Smith EJ,Smith BR
Therapeutics and Clinical Risk Management , 2012,
Abstract: Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy) and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor
Kynurenine and serotonin pathways: A review
HS Adegbusi
Bayero Journal of Pure and Applied Sciences , 2012,
Abstract: This paper seeks to elucidate the two-key pathways involving tryptophan matabolism, namely, kynurenine and serotonin pathways. In the kynurenine pathway (KP), the discussion considers the steps of the oxidative degradation of tryptophan to yield nicotinate mononucleotide, a precursors for the biosynthesis of nicotinate nucleotides ( NAD+ and NADP+), while serotonin pathway (SP) considers the biosynthesis of serotonin from tryptophan. Two different isoforms of tryptophan hydroxylase (TPH) are involved in SP: Tryptophan hydroxylase -1 (TPH1) catalysis SP in enterochromaffin cells of the gut, while Tryptophan hydroxylase-2 (TPH2) catalysis SP in the nerve cells of the central nervous system, the brain. Emphasis is given to the relevance of pyridoxal phosphate (PLP) in KP and also identified in the pathway of KP is the liberation of alanine as a biproduct, a basis for the gluconeogenecity of tryptophan. Serotonin, a major bioactive end-product of SP is a potent neurotransmitter, vasoconstrictor, regulation of intestinal motility and a player in cognitive function. Foods that give an increased ratio of tryptophan to phenylalanine and leucine such as nuts of walnut, plantains, bananas, dates, pineapples and tomatoes are good sources of serotonin. Research suggests a diet rich in carbohydrates and low protein is also a good source. Owning to the significance of some the major bioactive end-products, intermediates and byproducts of these pathways for the well-being and happiness of human beings, more research should be carried out therein not only to unravel some of the disorders they may be associated with but to also help in the development and production of; therapeutic drugs for psychiatric and sexual disorders, and intestinal antidote.
Pregnancy complicated by morbidly adherent placenta in a patient with bilateral ovarian agenesis: a case report
Wong HS
International Journal of Women's Health , 2013, DOI: http://dx.doi.org/10.2147/IJWH.S37380
Abstract: egnancy complicated by morbidly adherent placenta in a patient with bilateral ovarian agenesis: a case report Case report (500) Total Article Views Authors: Wong HS Published Date February 2013 Volume 2013:5 Pages 53 - 55 DOI: http://dx.doi.org/10.2147/IJWH.S37380 Received: 27 August 2012 Accepted: 25 September 2012 Published: 05 February 2013 Hong Soo Wong Australian Women's Ultrasound Centre, Brisbane, Australia Abstract: The author presents a case of in vitro fertilization pregnancy complicated by morbidly adherent placenta in a patient with congenital bilateral ovarian agenesis. A 31-year-old woman with congenital bilateral ovarian agenesis who had undergone two previous dilatation and curettage procedures conceived following in vitro fertilization with a donor egg. Spontaneous labor occurred at 38 weeks and 5 days' gestation. The labor was augmented in the active phase and resulted in instrumental vaginal delivery. The third stage was complicated by hemorrhage and retained placenta. Morbidly adherent placenta was diagnosed on attempt at manual removal of the placenta, and the adherent part of the placenta was left in situ. This was removed uneventfully at 5 weeks following childbirth when there was no blood flow observed between the placenta and the myometrium on Doppler ultrasound examination. In conclusion, successful parturition is possible in patients with congenital bilateral ovarian agenesis. When morbidly adherent placenta is managed conservatively, the placenta may be safely removed if there is no vascularity between the placenta and the myometrium.
Surgical approach to the cerebellopontine angle and dissection of the temporal bone: a continuing medical education course at Hacettepe University
Surucu HS
Neuroanatomy , 2004,
Abstract: When two complex structures like cerebellum and pons build up anangle, the one formed is not simple like the ones formed by twointersecting lines in geometry, but one, difficult to understand even by thepeople who see and cut it every day. To get close to a tumor here, onewill have to cut the complex temporal bone but from which direction andhow? Answering to a question like this and many difficult others in oneday was the aim of this meeting. Diverging the attention to the surgicaltechniques and anatomy, rather than the indications of surgery made thisgoal accomplished successfully.There were 30 participants, of almost equal numbers of anatomists,otolaryngologists and neurosurgeons, by coincidence. Even this was givinga good clue about how the chosen field was in the center of clinical andbasic science cooperation. The plenary session started and chaired byRuhgun Basar. The first presentation by Nuran Yener was giving everydetail of clinical anatomy of the temporal bone. Following, Sarp Saracpresented mastoidectomy and facial nerve decompression techniques withbeautiful schematic slides and real operation movies. The movies werecleverly montaged focusing on the important moments and landmarks andcropping out the intervals in between. Otherwise the movies of these longoperations can be more difficult to watch than doing the operation.After a fifteen minute coffee break, the second session started with thebeautiful presentation of Levent Sennaroglu about labyrnthectomy andtranslabyrenthal approach to the cerebellopontine angle. He describedmedial, lateral and inferior approaches which are used for different purposes.The next presentation was about anatomy of the neurovascular structures ofthe cerebellopontine angle by Beliz Tascioglu. Her presentation was mostlyby real photographs and their explanory drawings at each slide. This typeof presentation supplied extreme good orientation to the surgeons besidesteaching the complex anatomy of the region.Ibrahim Ziyal presented the middle cranial and retrosigmoid approach ofthe neurosurgeons. He also demonstrated some operational movies andgave important clues to the surgeons. The discussion became interesting byparticipation of Dr Gokhan Akdemir and his experiences from his studieswith the famous surgeon Dr Mecit Sami.At the lunch everybody was fascinated with the presentations of the morningand waiting impatiently for the practical part which would be held in theanatomy dissection laboratory. The practicals were not less successful. Theanatomy laboratory has almost turned to an operation hall or even betterwith
Pregnancy complicated by morbidly adherent placenta in a patient with bilateral ovarian agenesis: a case report
Wong HS
International Journal of Women's Health , 2013,
Abstract: Hong Soo WongAustralian Women's Ultrasound Centre, Brisbane, AustraliaAbstract: The author presents a case of in vitro fertilization pregnancy complicated by morbidly adherent placenta in a patient with congenital bilateral ovarian agenesis. A 31-year-old woman with congenital bilateral ovarian agenesis who had undergone two previous dilatation and curettage procedures conceived following in vitro fertilization with a donor egg. Spontaneous labor occurred at 38 weeks and 5 days' gestation. The labor was augmented in the active phase and resulted in instrumental vaginal delivery. The third stage was complicated by hemorrhage and retained placenta. Morbidly adherent placenta was diagnosed on attempt at manual removal of the placenta, and the adherent part of the placenta was left in situ. This was removed uneventfully at 5 weeks following childbirth when there was no blood flow observed between the placenta and the myometrium on Doppler ultrasound examination. In conclusion, successful parturition is possible in patients with congenital bilateral ovarian agenesis. When morbidly adherent placenta is managed conservatively, the placenta may be safely removed if there is no vascularity between the placenta and the myometrium.Keywords: IVF, placenta accreta, parturition, myometrium
Updated status of Nepal’s wetland birds
HS Baral
Banko Janakari , 2009, DOI: 10.3126/banko.v19i3.2209
Abstract: Wetland birds in Nepal comprise significant portion of avian fauna of Nepal. However, they are also highly threatened because of several factors. A thorough study on wetland bird communities is lacking which is hampering conservation of wetlands and bird communities dependent on them. Proper management of the wetland beyond the protected areas is essential to conserve wetland birds in Nepal. Key words: Wetlands, birds, threatened, management ? doi: 10.3126/banko.v19i3.2209 Banko Janakari , Special Issue February 2009, 30-35
The genome sequence of the protostome Daphnia pulex encodes respective orthologues of a neurotrophin, a Trk and a p75NTR: Evolution of neurotrophin signaling components and related proteins in the bilateria
Karen HS Wilson
BMC Evolutionary Biology , 2009, DOI: 10.1186/1471-2148-9-243
Abstract: The Daphnia genome encodes a neurotrophin, p75NTR and Trk orthologue together with Trkl, ROR, and NRK-RTKs. Drosophila Spz1, 2, 3, 5, 6 orthologues as well as two new groups of Spz proteins (Spz7 and 8) are also found in the Daphnia genome. Searching genbank and the genomes of Capitella, Helobdella and Lottia reveals neurotrophin signaling components in other protostomes.It appears that a neurotrophin, Trk and p75NTR existed at the protostome/deuterostome split. In protostomes, a "neurotrophin superfamily" includes Spzs and neurotrophins which respectively form two paralogous families. Trks and Trkl proteins also form closely related paralogous families within the protostomian RTKs, whereby Trkls are absent in deuterostomes. The finding of p75NTR in several protostomes suggests that death domain TNFR superfamily proteins appeared early in evolution.In mammals, four paralogous neurotrophins play a role in embryonic neural development[1], adult neuroplasticity[2,3] and regeneration[4] of the nervous system: Nerve Growth Factor (NGF), Brain Derived Neurotrophic Factor (BDNF), Neurotrophin 3 (NT3) and Neurotrophin 4/5 (NT4/5). The neurotrophin signaling system is also involved in the immune system[5]. The biological effects of the neurotrophins are mediated by three paralogous Trks (TrkA, TrkB, TrkC) belonging to the Trk family of Receptor Tyrosine Kinases (RTK) as well as by the 75 kDa neurotrophin receptor p75NTR. Each Trk receptor preferably binds to a different neurotrophin, whereby TrkA, TrkB and TrkC can be activated by NGF, BDNF/NT4/5 and NT3 respectively. In contrast, the p75NTR receptor is non selective and has a similar affinity for all neurotrophins. Additional functional complexity results from formation of heterodimeric complexes between p75NTR and TrkA, TrkB or TrkC. These complexes alter the signaling properties of both partners of the complex[6]. Paralogues of p75NTR, known as neurotrophin receptor homologue NRH1 in fish, birds and amphibians, and NRH2 i
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