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Reynolds V, Demarco J, Steinberg K. Better Breathing, Tougher Speaking? A Scoping Review of the Effects of Inhaled Corticosteroids on the Voice Quality of Asthmatic Children. J Voice 2024:S0892-1997(24)00003-1. [PMID: 38331703 DOI: 10.1016/j.jvoice.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are a common treatment for certain lung diseases, including chronic obstructive pulmonary disorder in adults, and asthma across the lifespan. There is a link between the use of ICS and dysphonia in adults. This scoping review aims to investigate the incidence of dysphonia, in children aged under 12, who use ICS to treat asthma. METHODS A scoping review was conducted, in accordance with the guidelines prescribed by Arksey and O'Malley (2005). ASHAWire, Science Direct, PubMed, and ProQuest databases were searched. Out of the total yield of 1471 articles, four articles met the inclusion criteria, that is, were primary studies reporting on voice quality in children who use ICS, who present with asthma and/or allergy. RESULTS The majority of papers yielded from the initial search were retrieved because of the use of the term "dysphonia" in the basic definitions of asthma and descriptors of its side effects. Only four studies presented primary data about the presence of dysphonia in asthmatic children (with or without comorbid allergic conditions). None specifically investigated the relationship between ICS and dysphonia. Research questions focused on side effects associated with allergies and asthma, which included some information about medication. Only three of the four studies conducted a comprehensive review of the voice and utilized video laryngoscopy. DISCUSSION The evidence of a relationship, between ICS and dysphonia in children, is not conclusive, and is complicated by the connection between asthma, and breath support for phonation. There is a need for more thorough and focused investigation of the relationship between ICS, with or without bronchodilator use, and any resultant effects on children's vocal quality.
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Affiliation(s)
| | - Jenalee Demarco
- Lewis University, Romeoville, Illinois; Advanced Therapy and Wellness Clinic, Crest Hill, Illinois
| | - Katie Steinberg
- Lewis University, Romeoville, Illinois; Downers Grove Grade School District 58, Downers Grove, Illinois
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Niu C, Blaylock B, Niu C, Davidson HE, DePue R, Williams GR, Steinberg K. Development of Minimum Data Set-based Individualized Care Pathways for Chronic Obstructive Pulmonary Disease Treatment in Nursing Home Residents. J Am Med Dir Assoc 2021; 22:B20. [PMID: 34287165 DOI: 10.1016/j.jamda.2021.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Coates LC, Orbai AM, Azevedo VF, Cappelleri JC, Steinberg K, Lippe R, Lim I, Eder L, Richette P, Weng MY, Queiro Silva R, Fallon L. Results of a global, patient-based survey assessing the impact of psoriatic arthritis discussed in the context of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. Health Qual Life Outcomes 2020; 18:173. [PMID: 32513190 PMCID: PMC7282161 DOI: 10.1186/s12955-020-01422-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory musculoskeletal disease, manifesting as peripheral arthritis, enthesitis, dactylitis, spondylitis, and skin and nail psoriasis. A core set of domains for measuring the impact of PsA has been developed, including pain, patient global assessment, physical function, health-related quality of life (HRQoL), and fatigue. To understand the impact of PsA on health domains from a patient’s perspective, a global survey was developed and results reported in the context of the 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire. Methods An online patient-based global survey was conducted by The Harris Poll in Australia, Brazil, Canada, France, Spain, Taiwan, the UK, and the US between November 2, 2017 and March 12, 2018. Eligible patients were ≥ 18 years old with a diagnosis of PsA for > 1 year, had visited a rheumatologist/dermatologist in the past 12 months and reported using ≥ 1 synthetic/biologic disease-modifying antirheumatic drug for PsA. Patients reported on PsA severity and symptoms, and the impact of PsA on HRQoL. After survey completion, responses were aligned with PsAID health domains. Descriptive statistics and chi-square tests were conducted. Results This analysis included 1286 patients from eight countries. Most patients (97%) reported musculoskeletal symptoms relating to PsA in the past year. Common moderate/major impacts of PsA were on physical activity (78%), ability to perform certain activities (76%), work productivity (62%), and career path (57%). Skin/nail symptoms occurred in 80% of patients. Overall, 69% of patients reported that PsA had a moderate/major impact on emotional/mental wellbeing, 56% on romantic relationships/intimacy, and 44% on relationships with family and friends. Social impacts included emotional distress (58%), social shame or disapproval (32%), and ceased participation in social activities (45%). Over half of all patients experienced unusual fatigue over the past 12 months (52%). The health domains that patients reported as being impacted by PsA aligned with life impact domains of the patient-derived PsAID health domains. Conclusion These results highlight the impact of PsA on multiple health domains from a patient perspective that should be considered during shared decision-making processes between healthcare providers and patients.
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Affiliation(s)
- L C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - A-M Orbai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V F Azevedo
- Universidade Federal do Paraná, Curitiba, Brazil
| | | | | | - R Lippe
- Pfizer Pharma GmbH, Berlin, Germany
| | - I Lim
- BJC Health, Sydney, NSW, Australia
| | - L Eder
- Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - P Richette
- Lariboisière Hospital, Lariboisière, University of Paris 7, Paris, France
| | - M Y Weng
- Department of Internal Medicine, Division of Allergy, Immunology and Rheumatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | | | - L Fallon
- Pfizer Inc, Montreal, QC, Canada
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Sheehan D, Zee PC, Steinberg K, Ginovker A, Atkins N, Moline M. 0485 Experience and Attitudes About Prescription Insomnia Medications: Results from an Online Survey of Individuals with Sleeping Difficulties and Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
This survey explored several topics related to living with insomnia/sleeping difficulties. Reported here are patient experience, attitudes, and perspectives about and understanding of prescription medications for insomnia.
Methods
The online survey was conducted by The Harris Poll in the U.S. between February 14 and March 8, 2019. Survey respondents (“patients”) were adults age ≥18y who had been diagnosed with insomnia (11% of respondents), or had experienced sleeping difficulties (defined as difficulty falling asleep or staying asleep for ≥3 nights/week for ≥3 months; 89% of respondents). Raw survey data were weighted by relevant factors to be representative of the total U.S. adult population with insomnia/sleeping difficulties.
Results
Among 525 patients (mean age 46y; 55% female) who completed the survey, 83 were currently using prescription medication, 45 used prescription medication previously, and 397 had no prescription medication history. The majority of all patients “somewhat” or “strongly” agreed they were “concerned about the safety risks of sleep medications currently available by prescription” (79%); felt “there have got to be better medications that help people sleep” (74%); and that they “wish there were more medications to choose from” (67%). Within the group of respondents with current/past prescription history (n=128), 63%, 23%, and 14% had tried 1-2, 3-4, or ≥5 different prescription medications, respectively. Among reasons for missing/skipping a dose, ~20% of respondents with current/past prescription history selected for each response that they “do not feel my medication is effective”; “do not like the way my medication makes me feel when I wake up the next morning”; and “prefer not to take my medication every night unless absolutely necessary.”
Conclusion
Results from this online survey provide insights into patient attitudes toward pharmacotherapy and indicate that a significant number of insomnia patients feel dissatisfied with medication treatment options, including concerns regarding safety and side effects.
Support
Eisai Inc.
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Affiliation(s)
- D Sheehan
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - P C Zee
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Zee P, Sheehan D, Steinberg K, Ginovker A, Atkins N, Moline M. Insomnia Impacts the patient and the household: perceptions of the burden of insomnia on next-day functioning. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Steinberg K. HEALTH POLICY AND BUSINESS MODELS FOR BEST PRACTICES OPERATIONALIZATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Steinberg
- California State University Institute for Palliative Care, San Marcos, California
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7
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Kaplan AL, Klein MP, Tan HJ, Setlur NP, Agarwal N, Steinberg K, Saigal CS. Use of patient ethnography to support quality improvement in benign prostatic hyperplasia. Healthc (Amst) 2015; 2:263-7. [PMID: 26250634 DOI: 10.1016/j.hjdsi.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/28/2014] [Accepted: 10/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient-centeredness is a primary aim of quality improvement (QI) but optimal strategies to achieve that goal remain elusive. Benign prostatic hyperplasia (BPH) is one of the commonest urologic diagnoses and significantly affects quality of life. Patient ethnography is an emerging qualitative method of observation and dynamic interviews to understand the context through which the patient experiences care. We implemented patient ethnography to support our QI infrastructure and improve patient-centeredness in BPH. PROBLEM Little is known about how to measure whether processes of care are patient-centered. We did not know whether the care processes our patients experienced provided value from their perspective. GOALS We sought to discover previously unrecognized components of care that patients perceived to be of low value. Our primary goal was to develop QI initiatives that targeted low-value themes identified in the ethnography. Our secondary goal was a rapid rollout of three targeted initiatives. STRATEGY We used a 4-step patient ethnography: (1) created detailed process maps to define phases of care, (2) interviewed patients, (3) synthesized transcript data in focus groups using the Crawford Slip method, and (4) targeted undesirable components of care for QI. Semi-structured interviews with seven representative patients identified low-value themes. Focus groups, comprised of primary care physicians, case coordinators, nurses, and urologists, evaluated the interview transcripts and generated improvement opportunities prioritized based on feasibility, patient value, scalability, and innovation. We used affinity mapping and priority matrix techniques to prioritize QI opportunities. RESULTS We identified five low-value themes from the patient interviews and developed corresponding QI opportunities. These included issues surrounding the referral and consultation process as well as postoperative care, especially home urinary catheter maintenance. Six months after completing the ethnography three of five targeted improvement opportunities had been implemented.
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Affiliation(s)
- A L Kaplan
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA.
| | - M P Klein
- Institute for Innovations in Health, UCLA Health System, USA
| | - H J Tan
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA
| | - N P Setlur
- Performance Excellence, UCLA Health System, USA
| | - N Agarwal
- Performance Excellence, UCLA Health System, USA
| | - K Steinberg
- Institute for Innovations in Health, UCLA Health System, USA
| | - C S Saigal
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA
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Sharma AN, Steinberg K, Nelson LS. Akathisia and prochlorperazine. Ann Emerg Med 2000; 36:169-170. [PMID: 10918114 DOI: 10.1067/mem.2000.108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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O'Grady M, Hackney AC, Schneider K, Bossen E, Steinberg K, Douglas JM, Murray WJ, Watkins WD. Diclofenac sodium (Voltaren) reduced exercise-induced injury in human skeletal muscle. Med Sci Sports Exerc 2000; 32:1191-6. [PMID: 10912880 DOI: 10.1097/00005768-200007000-00001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the effects of prolonged systemic administration of diclofenac sodium (Voltaren), a nonsteroidal anti-inflammatory drug, on objective indices of exercise-induced muscle damage in humans. METHODS Fifty-four volunteers (mean age, 26.4 yr; range, 18-35) participated in this randomized double-blind, placebo-controlled trial. To achieve steady-state tissue levels, either placebo or diclofenac was orally administered two times a day for 27 consecutive days. A strenuous 20-min stepping exercise program, about which the subjects were unfamiliar, was conducted on day 15. Creatine kinase (CK) activities were measured immediately before the exercise session and on days 16, 18, and 27. Vastus lateralis muscle samples were obtained immediately before exercise and on day 27 for subsequent histological characterization of muscle inflammation. RESULTS The preexercise muscle samples revealed no difference in muscle damage between the two groups. However, the postexercise muscle samples showed that the diclofenac-treated group demonstrated less muscle tissue damage than placebo-treated subjects (P = 0.002). The administration of diclofenac also resulted in a significant lowering of post-/pre-exercise CK ratios on days 18 (P = 0.03) and 27 (P = 0.02) compared with the placebo group, an indirect finding that supports the possibility of diclofenac reducing exercise-induced muscle damage. CONCLUSION These findings demonstrate preadministration of diclofenac (in accordance with tissue half-life pharmacokinetics) significantly reduces quantitative indices of exercise-induced skeletal muscle damage in human muscle.
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Affiliation(s)
- M O'Grady
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA.
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Abstract
OBJECTIVE To evaluate the correspondence among measures of self-reported drinking, standard biological indicators and the reports of collateral informants, and to identify patient characteristics associated with observed discrepancies among these three sources of research data. METHOD Using data collected from a large-scale clinical trial of treatment matching with alcoholics (N = 1,726), these three alternative outcome measures were compared at the time of admission to treatment and at 12 months after the end of treatment. RESULTS Patient self-reports and collateral reports agreed most (97.1%) at treatment admission when heavy drinking was unlikely to be denied. In contrast, liver function tests were relatively insensitive, with positive serum gamma-glutamyl transpeptidase (GGTP) values obtained from only 39.7% of those who admitted to heavy drinking. At 15-month follow-up the correspondence between client self-report and collateral report decreased to 84.7%, but agreement with blood chemistry values increased to 51.6%. When discrepancies occurred, they still indicated that the client' s self-report is more sensitive to the amount of drinking than the biochemical measures. Patients who presented discrepant results tended to have more severe drinking problems, more previous treatments, higher levels of pretreatment drinking and significantly greater levels of cognitive impairment, all of which could potentially interfere with accurate recall. CONCLUSIONS In clinical trials using self-selected research volunteers, biochemical tests and collateral informant reports do not add sufficiently to self-report measurement accuracy to warrant their routine use. Resources devoted to collecting these alternative sources of outcome data might be better invested in interview procedures designed to increase the validity of self-report information.
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Affiliation(s)
- T F Babor
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington 06030-1910, USA
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11
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Sampson EJ, Barr JR, Cordovado SK, Hannon WH, Henderson LO, Johnson AB, Miller D, Mueller PW, Myers GL, Pirkle JL, Schleicher RL, Steinberg K, Sussman D, Vogt RF. Current activities at the Centers for Disease Control and Prevention's National Diabetes Laboratory. Diabetes Technol Ther 1999; 1:403-9. [PMID: 11474824 DOI: 10.1089/152091599316919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In 1997, the Centers for Disease Control and Prevention established the National Diabetes Laboratory in order to help prevent and treat type 1 diabetes. This state-of-the-art laboratory collaborates with research scientists and key national and international organizations throughout the world to identify and study risk factors for type 1 diabetes by developing measurements for glycosylated proteins, developing and evaluating technology for measuring genetic risk factors for the disease, and working to standardize autoantibody measurements. Developing improved technologies for diagnosing and managing diabetes and developing reference materials for properly calibrating and standardizing blood glucose meters are also critical aspects of the laboratory's work. In addition, the laboratory provides quality storage for valuable collections of biologics and other materials and facilitates sharing of specimens, associated epidemiologic data, and test results. Working with our partners in diabetes research, we are improving the diagnosis, treatment, and prevention of type 1 diabetes.
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Affiliation(s)
- E J Sampson
- National Center for Environmental Health, National Diabetes Laboratory, Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, Georgia, USA.
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East TD, Heermann LK, Bradshaw RL, Lugo A, Sailors RM, Ershler L, Wallace CJ, Morris AH, McKinley B, Marquez A, Tonnesen A, Parmley L, Shoemaker W, Meade P, Thaut P, Hill T, Young M, Baughman J, Olterman M, Gooder V, Quinn B, Summer W, Valentine V, Carlson J, Steinberg K. Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial. Proc AMIA Symp 1999:251-5. [PMID: 10566359 PMCID: PMC2232746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.
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Affiliation(s)
- T D East
- Department of Medical Informatics, Cottonwood Hospital, Salt Lake City, Utah 84107, USA
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Como PG, Rubin AJ, O'Brien CF, Lawler K, Hickey C, Rubin AE, Henderson R, McDermott MP, McDermott M, Steinberg K, Shoulson I. A controlled trial of fluoxetine in nondepressed patients with Huntington's disease. Mov Disord 1997; 12:397-401. [PMID: 9159735 DOI: 10.1002/mds.870120319] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To examine the antidepressant specificity of fluoxetine in Huntington's disease (HD), we carried out a randomized, double-blind, placebo-controlled trial of this medication in nondepressed HD patients. Thirty patients with early HD who were depressed (Hamilton Depression Inventory < 16) were randomized to placebo (N = 13) or fluoxetine 20 mg/day (N = 17) and were followed up for 4 months. Outcome measures included changes in total functional capacity (TFC) and in standardized neurological, cognitive, and behavioral ratings. After adjustment for the higher education level found in the placebo group at baseline, no differences between the treatment groups were found in TFC, neurological, or cognitive ratings. Fluoxetine-treated patients did show a slight reduction in agitation and in the need for routine. Although fluoxetine may be a useful antidepressant in depressed HD patients, it failed to exert substantial clinical benefits in nondepressed HD patients.
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Affiliation(s)
- P G Como
- Department of Neurology, University of Rochester School of Medicine and Dentistry, New York, USA
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Deutsch SI, Rosse RB, Steinberg K, Morn C, Koetzner L, Riggs R, Mastropaolo J. Evaluation of in vivo interactions in mice between flurazepam and two neuroactive steroids. Pharmacol Biochem Behav 1996; 55:323-6. [PMID: 8951972 DOI: 10.1016/s0091-3057(96)00100-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The development of neuroactive steroids as anticonvulsant medications may be useful both as a primary treatment and as an adjuvant to other anticonvulsants. They may be limited, however, by sedative and ataxic side effects. In the current study, 3 alpha-hydroxy-5 beta-pregnan-20-one and alfaxalone, two prototypic neuroactive steroids, were shown to potentiate the ability of flurazepam to antagonize electrically precipitated tonic hindlimb extension in mice at doses that by themselves had little antiseizure efficacy. While alfaxalone alone lacked motor incoordinating effects at a dose (18.0 mg/kg) that potentiated the antiseizure efficacy of flurazepam, the same dose of 3 alpha-hydroxy-5 beta-pregnan-20-one possessed both the ability to potentiate flurazepam's anticonvulsant effect and disrupt mouse rotorod performance. The data suggest that allosteric interactions that have been described in vitro between neuroactive steroids and other modulators of the GABAA receptor complex may have relevance for the intact animal. Finally, the data also suggest that neuroactive steroids could be developed as short-lived adjuvant antiseizure medications in certain critical situations (e.g., medication-refractory status epilepticus). However, the motor incoordinating effects resulting from the combination of neuroactive steroids and flurazepam suggest that their usefulness as adjuvant medications in the chronic therapy of seizure disorders may be limited.
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Affiliation(s)
- S I Deutsch
- Psychiatry Service (116A), Department of Veterans Affairs Medical Center, Washington, DC 20422, USA
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Rubio A, Steinberg K, Figlewicz DA, MacDonald ME, Greenamyre T, Hamill R, Shoulson I, Powers JM. Coexistence of Huntington's disease and familial amyotrophic lateral sclerosis: case presentation. Acta Neuropathol 1996; 92:421-7. [PMID: 8891076 DOI: 10.1007/s004010050539] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present the clinical, molecular genetic and neuropathological findings of an 81-year-old man with concurrent Huntington's disease (HD) and familial amyotrophic lateral sclerosis (FALS). His mother had been diagnosed clinically as having ALS. There was no known family history of HD, but a maternal uncle had died in a chronic care psychiatric hospital. The diagnosis of HD in the patient was suspected at age 66, after 8 years of personality change, hallucinations, agitation, cognitive decline and choreoathetosis. No symptoms of motor neuron disease were noticed at that time, but progressive weakness developed later. Postmortem examination revealed cerebral atrophy, marked atrophy of basal ganglia (grade 3), and atrophy of brain stem and spinal cord. The neostriatum displayed massive neuronal loss and gliosis. The neocortex showed changes characteristic of Alzheimer's disease. Pathological lesions also included loss of neurons and gliosis in the anterior horns, Clarke's columns and the hypoglossal nuclei; degeneration of the lateral corticospinal tracts, dorsal spinocerebellar tracts and fasciculus gracilis; and rare Bunina bodies and ubiquitin-positive filamentous skeins in motor-neuron perikarya. Molecular analysis demonstrated chromosome 4p16.3 expansion of trinucleotide repeats characteristic of HD. Analysis of Cu,Zn superoxide dismutase gene and heavy neurofilament subunit gene failed to demonstrate mutations. The concurrence of HD and FALS in our patient and three previously reported cases did not appear to be associated with cosegregation in other family members.
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Affiliation(s)
- A Rubio
- Department of Pathology, University of Rochester, NY 14642, USA.
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Feigin A, Kieburtz K, Como P, Hickey C, Claude K, Abwender D, Zimmerman C, Steinberg K, Shoulson I. Assessment of coenzyme Q10 tolerability in Huntington's disease. Mov Disord 1996; 11:321-3. [PMID: 8723151 DOI: 10.1002/mds.870110317] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We performed a 6-month open-label trial to evaluate the tolerability and efficacy of coenzyme Q10 (CoQ) in 10 patients with Huntington's disease (HD). Subjects were evaluated at baseline, 3 months, and 6 months using the HD Rating Scale (HDRS), the HD Functional Capacity Scale (HDFCS), and standardized neuropsychological measures. Adverse events (AEs) were assessed by telephone interview every month. CoQ doses ranged from 600 to 1,200 mg per day. All subjects completed the study, although four subjects reported mild AEs, including headache, heartburn, fatigue, and increased involuntary movements. There was no significant effect of the treatment on the clinical ratings. The good tolerability of CoQ suggests that it is a good candidate for evaluation in long-term clinical trials designed to slow the progression of HD.
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Affiliation(s)
- A Feigin
- Department of Neurology, University of Rochester School of Medicine and Dentistry, New York, USA
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Feigin A, Kieburtz K, Bordwell K, Como P, Steinberg K, Sotack J, Zimmerman C, Hickey C, Orme C, Shoulson I. Functional decline in Huntington's disease. Mov Disord 1995; 10:211-4. [PMID: 7753064 DOI: 10.1002/mds.870100213] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We prospectively evaluated 129 patients with manifest Huntington's disease (HD) to determine the rate of illness progression and the clinical features that correlate with functional decline. A single examiner evaluated each patient using the HD Functional Capacity Scale. Standardized motor performance was also assessed in 94 of the patients (73%) using the HD Rating Scale. Total Functional Capacity declined at a rate of 0.63 +/- 0.75 U per year. As functional capacity worsened, chorea lessened, and dystonia intensified. There was no correlation between rate of functional decline and age at onset of HD, body weight, gender of affected parent, or history of neuroleptic use.
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Affiliation(s)
- A Feigin
- Department of Neurology, University of Rochester Medical Center, NY 14642-8673, USA
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Kieburtz K, MacDonald M, Shih C, Feigin A, Steinberg K, Bordwell K, Zimmerman C, Srinidhi J, Sotack J, Gusella J. Trinucleotide repeat length and progression of illness in Huntington's disease. J Med Genet 1994; 31:872-4. [PMID: 7853373 PMCID: PMC1016662 DOI: 10.1136/jmg.31.11.872] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The genetic defect causing Huntington's disease (HD) has been identified as an unstable expansion of a trinucleotide (CAG) repeat sequence within the coding region of the IT15 gene on chromosome 4. In 50 patients with manifest HD who were evaluated prospectively and uniformly, we examined the relationship between the extent of the DNA expansion and the rate of illness progression. Although the length of CAG repeats showed a strong inverse correlation with the age at onset of HD, there was no such relationship between the number of CAG repeats and the rate of clinical decline. These findings suggest that the CAG repeat length may influence or trigger the onset of HD, but other genetic, neurobiological, or environmental factors contribute to the progression of illness and the underlying pace of neuronal degeneration.
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Affiliation(s)
- K Kieburtz
- Department of Neurology, University of Rochester Medical Center, New York 14642
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Thacker SB, Hoffman DA, Smith J, Steinberg K, Zack M. Five longitudinal studies designed to measure the effect of low-level body burdens of lead. Arch Environ Health 1994; 49:204-5. [PMID: 8018200 DOI: 10.1080/00039896.1994.9940384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
An automated subpicomole sequencing method is described. It is based on a chemistry that generates easily detectable amino acid derivatives from the postcleavage products of the classical Edman degradation. These products, which include the amino acid anilinothiazolinone (ATZ), phenylthiocarbamyl (PTC), and phenylthiohydantoin (PTH), are converted to a homogeneous preparation of ATZ that can react with sensitivity-enhancing compounds such as fluorescent amines. The method is demonstrated with a protein of known sequence (alpha-lactalbumin) and appears to offer a significant improvement over current high-sensitivity protein sequencing strategies. Modifications to the sequencer hardware or to the Edman degradation chemistry are not required.
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Affiliation(s)
- V Farnsworth
- Beckman Instruments, Inc., Fullerton, California 92634
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Farnsworth V, Steinberg K. The generation of phenylthiocarbamyl or anilinothiazolinone amino acids from the postcleavage products of the Edman degradation. Anal Biochem 1993; 215:200-10. [PMID: 8122779 DOI: 10.1006/abio.1993.1576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A method is described for the generation of phenylthiocarbamyl (PTC) amino acids from phenylthiohydrantoin (PTH) or anilinothiazolinone (ATZ) amino acids. An aqueous base containing a reducing agent promotes the opening of the PTH or ATZ ring to form a stable PTC amino acid. The new reaction is essentially quantitative for all of the amino acids and may be used instead of the established Edman conversion with an aqueous acid. The PTC amino acids may be analyzed directly or used for generating other analytes. A further method is described for the generation of ATZ amino acids from either the PTH or PTC derivatives. This chemistry involves a Lewis acid-catalyzed dehydration of the PTC. The resulting ATZ may be combined with labels that permit high-sensitivity detection. This reaction is also essentially quantitative for all of the amino acids except aspartic acid, which exhibits a strong preference for the PTH form under these conditions. Taken together, these chemistries allow the preparation of homogeneous PTC or ATZ amino acids from any mixture of amino acid derivatives resulting from the Edman degradation and promise to greatly facilitate the high-sensitivity analysis of protein.
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Affiliation(s)
- V Farnsworth
- Beckman Instruments, Inc., Fullerton, California 92634
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Glaesener JJ, Maske A, Petersen W, Steinberg K. [Traumatic paraplegia with injury of the upper extremity--effects on the success of rehabilitation]. Rehabilitation (Stuttg) 1992; 31:224-30. [PMID: 1484996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The evaluation of a greater number of patients with traumatic paraplegia and tetraplegia showed more than 20% of associated injuries of the upper limbs. In view of the fact that arms and shoulders of the paraplegic person take over a decisive weight-bearing function, we were interested in the effects of these special injuries on rehabilitation outcome. Injuries of the distal arm were found to have more serious repercussions for achievement of the rehabilitation aim than the relatively more impressing injuries of the shoulder girdle and the upper arm. Serious limitations were found in the range of motion of the affected joints. Compensation was due only to the skill of the paraplegics in dealing with these deficits in motion and in using the uninjured extremity. This is the main reason why the functional deficits in independence were relatively minor.
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Affiliation(s)
- J J Glaesener
- Querschnittgelähmten-Zentrum, Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg
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Thacker SB, Hoffman DA, Smith J, Steinberg K, Zack M. Effect of low-level body burdens of lead on the mental development of children: limitations of meta-analysis in a review of longitudinal data. Arch Environ Health 1992; 47:336-46. [PMID: 1444595 DOI: 10.1080/00039896.1992.9938372] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of low-level body burdens of lead on the intelligence of children, as measured by intelligence quotient (IQ), was assessed. We reviewed 35 reports from five longitudinal studies conducted in the United States and Australia. In each of these studies, infants were followed for 58 mo or less. The study populations consisted of low- and middle-socioeconomic-class infants who had low-level exposure to environmental lead. Blood-lead levels were measured in a standard fashion at various times, beginning in the prenatal period, and intelligence was first measured at 6 mo of age and was followed by subsequent assessments. Studies were assessed for quality by a review panel blinded to the identity of the investigators and their affiliations. Efforts were made to pool the data with meta-analytic techniques, but efforts were unsuccessful because the methods used to analyze and report data were inconsistent. Inconsistencies were as follows: (a) there were few instances in which IQ and blood-lead levels were measured at comparable times in different studies; (b) incompatibilities existed among the studies, including differences in independent variables, data transformations, and statistical parameters reported; (c) results conflicted when measurement intervals were comparable (i.e., heterogeneity); (d) patterns of regression and correlation coefficients were inconsistent; and (e) data were insufficient to interconvert the parameters reported. Consequently, definitive conclusions regarding the effect of low-level body burdens of lead on IQ could not be determined from the longitudinal data. Examination of the weight of the evidence from this and other studies, however, suggests an adverse relationship of lead on the intelligence of children.
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Affiliation(s)
- S B Thacker
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333
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Abstract
To obtain information on the prevalence and clinical and laboratory correlates of osteopenia in patients with chronic liver disease, we measured bone densities and 30 selected laboratory variables in 133 subjects (70 men, 63 women) with liver disease. Thirty-two had alcoholic liver disease, 18 had primary biliary cirrhosis, 16 had primary sclerosing cholangitis, 48 had other forms of cirrhosis (cryptogenic, posthepatic) and 19 had chronic hepatitis or fibrosis without cirrhosis. Bone densities of the lumbar spine and three sites of the proximal femur (neck, Ward's triangle, greater trochanter) were estimated by dual-photon absorptiometry. Bone densities at all sites were significantly correlated to one another (r = 0.4 to 0.9; 95% confidence intervals = 0.24-0.54 to 0.81-0.90; p less than 0.0001 for all). Compared with an age- and gender-matched reference group, patients with liver disease had highly significant decreases in bone densities (greater than 2 standard deviations below control values; p less than 0.0008 at all sites). Decreases were particularly marked (24% to 42%) at Ward's triangle, the site of the femoral neck particularly prone to fracture. The prevalence of decreased bone densities ranged from 10% to 56%, depending on the site studied and the nature of the liver disease. Among 30 laboratory variables studied, there were significant (p less than 0.05) correlations with bone densities at more than one site for urinary creatinine (r = 0.21, 0.25), urinary calcium (r = -0.18, -0.23), serum total alkaline phosphatase (r = -0.18, -0.27) and the liver-1 isozyme of serum alkaline phosphatase (r = -0.19, -0.26).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H L Bonkovsky
- Department of Biochemistry, Emory University, Atlanta, Georgia 30322
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Abstract
The relationship between selected psychosocial variables and compliance was studied in 71 adolescents prescribed medication for iron deficiency. The mean compliance rate in the study group was 67%. Home pill counts were highly correlated with the other methods of measuring compliance, ie, change in serum ferritin level and urinary assay for tracer riboflavin. Statistically significant predictors of compliance included adverse side effects, initial estimate by the adolescent as to his probable level of compliance, and frequency of family reminders to take the medication. There was no significant correlation between self-esteem, locus of control, or most variables of the Health Belief Model and the level of patient compliance. Our findings suggest that home pill counts are an accurate method of assessing compliance and that instituting family reminders may be helpful in those adolescents who are potentially non-compliant.
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Affiliation(s)
- B A Cromer
- Department of Pediatrics, Ohio State University, Columbus
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Guinan ME, Steinberg K, Freni-Titulaer L. Osteoporosis and ERT--the jury is still out. J Am Med Womens Assoc (1972) 1987; 42:92-3. [PMID: 3584786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Stehr-Green PA, Welty E, Steele G, Steinberg K. Evaluation of potential health effects associated with serum polychlorinated biphenyl levels. Environ Health Perspect 1986; 70:255-9. [PMID: 3104024 PMCID: PMC1474290 DOI: 10.1289/ehp.8670255] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In late 1983, we conducted a cross-sectional epidemiologic study to evaluate persons at risk of exposure to three chemical waste sites by comparing clinical disease end points and clinical chemistry parameters with serum polychlorinated biphenyls (PCB) levels. A total of 106 individuals participated in the study. The only statistically significant finding in regard to self-reported, physician-diagnosed health problems was a dose-response relationship between serum PCB levels and the occurrence of high blood pressure; however, this association failed to achieve statistical significance (p = 0.08) when we controlled for possible confounding effects of both age and smoking. Serum triglyceride and cholesterol levels were also higher in the group with elevated serum PCBs; additionally, there were isolated statistically significant correlations of serum aspartate aminotransferase (SGOT) with serum lipid fraction-adjusted PCB level (r = -0.21) and serum albumin (r = -0.24) and total bilirubin (r = 0.30) with serum PCB level. Although the ranges of serum levels reported herein from exposures to PCBs in the general environment are lower than those that have been associated with acute symptoms or illness in other studies, whether these levels are associated with long-term health risks is not known. Associations of such chronic, low-dose exposures with observable health effects as suggested by this study must be evaluated further before any final conclusions can be drawn.
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Stehr-Green PA, Welty E, Steele G, Steinberg K. Evaluation of potential health effects associated with serum polychlorinated biphenyl levels. Environ Health Perspect 1986. [PMID: 3104024 DOI: 10.2307/3430362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In late 1983, we conducted a cross-sectional epidemiologic study to evaluate persons at risk of exposure to three chemical waste sites by comparing clinical disease end points and clinical chemistry parameters with serum polychlorinated biphenyls (PCB) levels. A total of 106 individuals participated in the study. The only statistically significant finding in regard to self-reported, physician-diagnosed health problems was a dose-response relationship between serum PCB levels and the occurrence of high blood pressure; however, this association failed to achieve statistical significance (p = 0.08) when we controlled for possible confounding effects of both age and smoking. Serum triglyceride and cholesterol levels were also higher in the group with elevated serum PCBs; additionally, there were isolated statistically significant correlations of serum aspartate aminotransferase (SGOT) with serum lipid fraction-adjusted PCB level (r = -0.21) and serum albumin (r = -0.24) and total bilirubin (r = 0.30) with serum PCB level. Although the ranges of serum levels reported herein from exposures to PCBs in the general environment are lower than those that have been associated with acute symptoms or illness in other studies, whether these levels are associated with long-term health risks is not known. Associations of such chronic, low-dose exposures with observable health effects as suggested by this study must be evaluated further before any final conclusions can be drawn.
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Epstein SS, Arnold E, Steinberg K, Mackintosh D, Shafner H, Bishop Y. Mutagenic and antifertility effects of TEPA and METEPA in mice. Toxicol Appl Pharmacol 1970; 17:23-40. [PMID: 5456640 DOI: 10.1016/0041-008x(70)90128-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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