Clinical practices

Inactivation and Removal of Viruses. In developing methods of plasma fractionation, the possibiHty of transmitting infection from human vimses present in the starting plasma pool has been recognized (4,5). Consequentiy, studies of product stabiHty encompass investigation of heat treatment of products in both solution (100) and dried (101) states to estabHsh vimcidal procedures that could be appHed to the final product. Salts of fatty acid anions, such as sodium caprylate [1984-06-17, and the acetyl derivative of the amino acid tryptophan, sodium acetyl-tryptophanate [87-32-17, are capable of stabilizing albumin solutions to 60°C for 10 hours (100) this procedure prevents the transmission of viral hepatitis (102,103). The degree of protein stabilization obtained (104) and the safety of the product in clinical practice have been confirmed (105,106). The procedure has also been shown to inactivate the human immunodeficiency vims (HIV) (107). 

A number of inhalation anesthetics have been introduced to clinical practice, some of which are Hsted in Table 1. AH agents introduced after 1950, except ethyl vinyl ether, contain fluorine. Agents such as ether, chloroform, trichloroethylene (Tdlene), cyclopropane, and fluoroxene (Fluoromar), which were once used, have been displaced by the newer fluorinated anesthetics. 

Another clinical consideration is the abiUty of local anesthetic agents to effect differential blockade of sensory and motor fibers. In surgical procedures such as obstetrics or postoperative pain rehef, an agent which produces profound sensory block accompanied by minimal motor block is desirable. On the other hand some procedures such as limb surgery require both deep sensory and motor blockade. In clinical practice, bupivacaine ( 22,... 

Resistance to Tetracyclines. The tetracyclines stiU provide inexpensive and effective treatment for several microbial infections, but the emergence of acquired resistance to this class of antibiotic has limited their clinical usehilness. Studies to define the molecular basis of resistance are underway so that derivatives having improved antibacterial spectra and less susceptibiUty to bacterial resistance may be developed. Tetracyclines are antibiotics of choice for relatively few human infections encountered in daily clinical practice (104), largely as a result of the emergence of acquired tetracycline-resistance among clinically important bacteria (88,105,106). Acquired resistance occurs when resistant strains emerge from previously sensitive bacterial populations by acquisition of resistance genes which usually reside in plasmids and/or transposons (88,106,107). Furthermore, resistance deterrninants contained in transposons spread to, and become estabUshed in, diverse bacterial species (106). 

G. C. Cook, Parasitic Disease in Clinical Practice, Springer-Vedag, London, 1990. 

QuinidJne. Quinidine, an alkaloid obtained from cinchona bark (Sinchona sp.), is the dextrorotatory stereoisomer of quinine [130-95-0] (see Alkaloids). The first use of quinidine for the treatment of atrial fibrillation was reported in 1918 (12). The sulfate, gluconate, and polygalacturonate salts are used in clinical practice. The dmg is given mainly by the oral (po) route, rarely by the intravenous (iv) route of adniinistration. It is the most frequentiy prescribed po antiarrhythmic agent in the United States. The clinical uses of quinidine include suppression of atrial and ventricular extrasystoles and serious ventricular arrhythmias (1 3). 

In the 1970s questions were raised about certain immunological complications as a consequence of male sterilisation or vasectomy. Clinical epidemiological data do not appear to indicate that this actually occurs in clinical practice. No significant long-term side effects of male sterilisation have been demonstrated. 

Campbell, M. (ed.J (1996) Sensor System for Environmental Monitoring, Kluwer Academic Publishers, The Hague. Carson, P.A., and Dent, N.J. (ed.) (1990) Good Laboratory and Clinical Practices, Hememann Newnes, Oxford. Carson, P.A., and Mumford, C.J. (1988) The Safe Handling of Chemicals in Industry (Vols 1 and 2), Longman Scientific and Technical, Harlow. 

The relatively low potency of aspirin in overcoming the symptoms of inflammatory diseases has led to a continuing search for new antiinflammatory agents. Although many more potent agents have been introduced to clinical practice, most of these elicit some side effects that limit their use. Derivatives of iv-aryl anthra-nillic acids have provided a series of quite effective antiinflammatory drugs, the so-called fenamic acids. 

The first drugs in this class to be introduced into clinical practice are simple derivatives of 5-nitrofurfural (18). Thus, the oxime is known as nitrofuroxime (19) while the semicarbazone is called nitrofurazone (20). In order to maintain better control over the distribution and metabolism of these antibacterial agents, increasingly complex side chains and rings have been grafted onto the hydrazone. 

Norfloxacin (41), the substance which triggered this avalanche of activity, has recently been introduced into clinical practice in the United States. Its synthesis parallels closely that of its N-methyl analogue, pefloxacin, except that the nucleophilic aromatic displacement reaction of 32 is carried out with mono-N-carboethoxypiperazine instead and the final step encompasses deblocking of this carbamoyl ester moiety [8]. 

The phenomenon of bacterial resistance to antibiotics was already known by the pioneers of the era of antibiotics, like Paul Ehrlich, who coined the term selective toxicity as the basic principle of antimicrobial therapeutics, as well as Gerhard Domagk, the inventor of the sulfonamide drugs, and Sir Alexander Fleming, the discoverer of the penicillins. When penicillin G was introduced into clinical practice in 1944, as many as 5% of the isolates of Staphylococcus aureus were resistant to penicillin, while 5 years later the percentage was 50%. 

Arepally GM, Ortel TL (2006) Clinical practice. Heparin-induced thrombocytopenia. N Engl JMed 355 809-817... 

Canadian Clinical Practice Guidelines for the Treatment of Schizophrenia. Can J Psychiatry 1998 1-CPG... 

Initial daily doses of 10-40 and 100-600 mg are recommended in clinical practice for MMI and PTU, respectively [1, 2]. Several studies have shown that treatment of hyperthyroidism with single daily doses of 10-40 mg of MMI is effective in the induction of euthyroidism in 80-90% of patients within 6 weeks [2]. The aim of the further antithyroid therapy is to maintain euthyroidism with the lowest necessary diug dose. Intrathyroidal diug accumulation is one cause for the efficiency of a single daily dose regimen. Moreover, a once daily dose yields better patients compliance. Single daily doses of PTU have been shown to be less effective in achieving euthyroidism than administration of three divided doses a day. If a once daily... 

Our new appreciation of the role of inflammation in atherosclerosis shows the way for translation of these novel biological insights to clinical practice, for example by aiding the identification of individuals at risk of adverse cardiovascular events [5]. In this context, inflammatory biomarkers such as CRP merit rigorous consideration for inclusion in risk assessment strategies. In addition, these scientific advances provide a framework... 

Libby P, Ridker PM (2006) Inflammation and athero-thrombosis from population biology and bench research to clinical practice. J Am Coll Cardiol 48(9 Suppl) A33-A46... 

Plasmin cleaves fibrin at different positions. Of high clinically practical relevance is the cleavage of the fibrin y-chain that results in D-Dimers (Fig. 11). D-Dimers are specific for fibrin cleavage by plasmin. They can easily be detected by commercially available assays and are used to exclude thrombosis. A negative test for D-Dimer has a high negative predictive value for a thrombosis. 

Dtug interactions can cause serious problems in clinical practice especially when the affected dmg has the potential to be highly toxic. Furthermore, pharmacokinetic interactions are clinically important if the affected dmg has a narrow therapeutic range (i.e. small difference between the minimum effective concentration and the toxic concentration Fig. 1) and a steep concentration-response curve (i.e. significant alterations in pharmacological and/or adverse effects caused by small changes in blood concentration). 

The presence of a specific resistance mechanism in a bacterial isolate does not necessarily implicate that this isolate is resistant in clinical terms. However, an isolate expressing a resistance mechanism possibly will be eliminated less easily as compared to a susceptible one. In clinical practice, resistance mechanisms will be rarely identified. Usually the sensitivity of isolates will be determined and reported to the clinician by using the interpretive criteria which is sensitive, intermediate or resistant. Some bacteria harbouring resistance... 

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