8 results on '"Singh, Gurkirpal"'
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2. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy
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Singh, Gurkirpal
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Gastrointestinal system ,Nonsteroidal anti-inflammatory drugs -- Adverse and side effects ,Health ,Health care industry - Abstract
Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated. The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) Post-Marketing Surveillance Program (PMS) has prospectively followed patient status and outcomes, drug side effects, and the economic impact of illness for [is greater than] 11,000 arthritis patients at 8 participating institutions in the United States and Canada. Analysis of these data indicates that: (1) osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5-5.5 times more likely than the general population to be hospitalized for NSAID-related GI events; (2) the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time; (3) there are no reliable warning signals-[is greater than] 80% of patients with serious GI complications had no prior GI symptoms; (4) independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and (5) antacids and [H.sub.2] antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications. Currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events. Ongoing ARAMIS research is aimed at developing a simple point-score system for estimating individual risks of developing serious NSAID-related GI complications. Am J Med. 1998;105(1B):31S-38S. [C] 1998 by Excerpta Medica, Inc.
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- 1998
3. Patient education and health promotion can be effective in Parkinson's disease: a randomized controlled trial
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Montgomery, Erwin B., Jr., Lieberman, Abraham, Singh, Gurkirpal, and Fries, James F.
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Parkinson's disease -- Study and teaching ,Patient education -- Evaluation ,Health promotion -- Evaluation ,Health ,Health care industry - Abstract
We performed a randomized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson's disease. The health promotion program (PROPATH) was designed to improve health confidence, provide information and support, improve physical function through exercise, and work with the physician to optimize medical treatment and compliance. The intervention was delivered by mail, with disease assessment questionnaires completed by patient or caregiver at 0, 2, 4, and 6 months, with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians. Two hundred ninety patients completed the 6-month trial, 140 patients in the intervention group and 150 in a control group of patients who received only questionnaires. The intervention group had significantly increased exercise, decreased 'time off' and percentage of time off, reduced side effects, and decreased summary Parkinson's scores by approximately 10% (P >0.05). Twelve of 13 variables showed differences favoring the intervention group. The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise sharply for controls (P >0.01). Levodopa dose rose for controls and slightly decreased for the intervention group. Doctor visits, hospital days, and sick days were reduced in the intervention group. The quality-of-life assessment demonstrated improvement in patient global, self-efficacy scores, and spouse or caregiver assessments. We conclude that a low-cost patient education program provides a useful adjunct to medical therapy of Parkinson's disease, may reduce costs, and can improve intermediate term outcomes.
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- 1994
4. Celecoxib Versus Naproxen and Diclofenac in Osteoarthritis Patients: SUCCESS-I Study
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Singh, Gurkirpal, Fort, John G., Goldstein, Jay L., Levy, Roger A., Hanrahan, Patrick S., Bello, Alfonso E., Andrade-Ortega, Lilia, Wallemark, Carl, Agrawal, Naurang M., Eisen, Glenn M., Stenson, William F., and Triadafilopoulos, George
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CELECOXIB , *ANTIARTHRITIC agents , *OSTEOARTHRITIS , *NONSTEROIDAL anti-inflammatory agents - Abstract
Abstract: Purpose: To evaluate the efficacy and upper gastrointestinal (UGI) safety of celecoxib, compared with nonspecific nonsteroidal anti-inflammatory drugs (NSAIDs), among patients with osteoarthritis. Methods: A total of 13274 osteoarthritis patients from 39 countries were randomly assigned to double-blind treatment with either celecoxib 100 mg twice daily (BID), celecoxib 200 mg BID, or nonselective NSAID therapy (diclofenac 50 mg BID or naproxen 500 mg BID) for 12 weeks. Standard validated measures were used to assess osteoarthritis efficacy. Serious UGI events were evaluated by 2 blinded, independent, gastrointestinal events committees. Results: Results from all primary efficacy assessments showed that both dosages of celecoxib were as effective as NSAIDs in treating osteoarthritis. Significantly more ulcer complications occurred within the nonselective NSAID group (0.8/100 patient-years) compared with the celecoxib group (0.1/100 patient-years) (odds ratio = 7.02; 95% confidence interval [CI], 1.46 to 33.80; P =.008). There were fewer ulcer complications in the celecoxib group compared with the NSAID group, both in patients taking concomitant aspirin and those not taking aspirin, but the difference reached statistical significance only in the latter comparison. The number of cardiovascular thromboembolic events was low and not statistically different between the groups (eg, myocardial infarction rates: celecoxib 10 events [0.55/100 patient-years] vs NSAIDs 1 event [0.11/100 patient-years], (P =.11), but the study was not powered to detect such differences. Conclusions: In the treatment of osteoarthritis, celecoxib is as effective as the nonspecific NSAIDs naproxen and diclofenac, but has significantly fewer serious upper gastrointestinal events. [Copyright &y& Elsevier]
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- 2006
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5. Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam
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Singh, Gurkirpal, Lanes, Stephan, and Triadafilopoulos, George
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CLINICAL trials , *DICLOFENAC , *MEDICAL experimentation on humans , *CLINICAL medicine research - Abstract
Purpose: To assess the risk of serious gastrointestinal and thromboembolic complications with approved doses of meloxicam.Methods: We pooled data from clinical trials of meloxicam at doses of 7.5 or 15 mg/d. A blinded gastrointestinal adjudication committee used prespecified criteria to identify gastric or duodenal perforation, gastric outlet obstruction, or hemodynamically important upper gastrointestinal bleeding. For analysis of thromboembolic complications, investigator-reported events were analyzed without adjudication.Results: We analyzed data from 24,196 patients from 28 trials, most of whom had been followed for up to 60 days. Of these patients, 13,118 received meloxicam (10,158 received a daily dose of 7.5 mg and 2960 received 15 mg), 5283 were treated with diclofenac 100 mg, 181 received diclofenac 150 mg, 5371 were treated with piroxicam 20 mg, and 243 received naproxen 500 mg twice daily. Patients who received 7.5 mg of meloxicam daily had a 0.03% risk of serious upper gastrointestinal events, which was significantly lower than the risk in those who received diclofenac, naproxen, or piroxicam (P <0.02). With the 15 mg daily dose of meloxicam, this risk was significantly different only when compared with piroxicam (P = 0.03). The risk of thromboembolic events in patients treated with meloxicam at either dose was lower than with diclofenac, but similar to that observed with piroxicam and naproxen.Conclusion: This pooled analysis of 24,196 patients demonstrates that meloxicam has a favorable gastrointestinal and thromboembolic safety profile. However, only a small number of patients were followed for more than 60 days, and meaningful comparisons were not possible in this subgroup. [ABSTRACT FROM AUTHOR]- Published
- 2004
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6. Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in US Adults: 1988 to 2010.
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Ladabaum, Uri, Mannalithara, Ajitha, Myer, Parvathi A., and Singh, Gurkirpal
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PHYSICAL activity , *OBESITY , *MORTALITY , *BODY mass index , *PUBLIC health research , *DATA analysis ,DISEASES in adults - Abstract
Background Obesity and abdominal obesity are associated independently with morbidity and mortality. Physical activity attenuates these risks. We examined trends in obesity, abdominal obesity, physical activity, and caloric intake in US adults from 1988 to 2010. Methods Univariate and multivariate analyses were performed using National Health and Nutrition Examination Survey data. Results Average body mass index (BMI) increased by 0.37% (95% confidence interval [CI], 0.30-0.44) per year in both women and men. Average waist circumference increased by 0.37% (95% CI, 0.30-0.43) and 0.27% (95% CI, 0.22-0.32) per year in women and men, respectively. The prevalence of obesity and abdominal obesity increased substantially, as did the prevalence of abdominal obesity among overweight adults. Younger women experienced the greatest increases. The proportion of adults who reported no leisure-time physical activity increased from 19.1% (95% CI, 17.3-21.0) to 51.7% (95% CI, 48.9-54.5) in women, and from 11.4% (95% CI, 10.0-12.8) to 43.5% (95% CI, 40.7-46.3) in men. Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level but not caloric intake. The associated changes in adjusted BMIs were 8.3% (95% CI, 6.9-9.6) higher among women and 1.7% (95% CI, 0.68-2.8) higher among men with no leisure-time physical activity compared with those with an ideal level of leisure-time physical activity. Conclusions Our analyses highlight important dimensions of the public health problem of obesity, including trends in younger women and in abdominal obesity, and lend support to the emphasis placed on physical activity by the Institute of Medicine. [ABSTRACT FROM AUTHOR]
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- 2014
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7. The Reply.
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Ladabaum, Uri, Mannalithara, Ajitha, Myer, Parvathi A., and Singh, Gurkirpal
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PHYSICAL activity , *NATIONAL health services , *NUTRITIONAL assessment , *DISEASE prevalence , *GUT microbiome , *HEALTH surveys - Published
- 2015
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8. The Reply.
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Ladabaum, Uri, Mannalithara, Ajitha, Myer, Parvathi A., and Singh, Gurkirpal
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CARDIAC radionuclide imaging , *SINGLE photon emission computerized tomography centers , *MYOCARDIAL perfusion imaging , *CARDIAC volume , *MEDICAL care - Published
- 2014
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