36 results on '"Sunil S. Iyer"'
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2. A Multi-centric Bioequivalence Trial in Ph+ Chronic Myeloid Leukemia Patients to Assess Bioequivalence and Safety Evaluation of Generic Imatinib Mesylate 400 mg Tablets
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Rachna Arora, Manju Sharma, Sunil S. Iyer, and Tausif Monif
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Adult ,Male ,0301 basic medicine ,Cancer Research ,Cmax ,Administration, Oral ,Biological Availability ,Antineoplastic Agents ,Bioequivalence ,Pharmacology ,03 medical and health sciences ,0302 clinical medicine ,Pharmacokinetics ,Oral administration ,Leukemia, Myelogenous, Chronic, BCR-ABL Positive ,Drugs, Generic ,Humans ,Medicine ,Philadelphia Chromosome ,Protein Kinase Inhibitors ,Aged ,Cross-Over Studies ,Leukemia ,business.industry ,Therapeutic equivalency ,Imatinib ,Middle Aged ,Protein-Tyrosine Kinases ,Crossover study ,Confidence interval ,Imatinib mesylate ,030104 developmental biology ,Oncology ,Area Under Curve ,030220 oncology & carcinogenesis ,Female ,Original Article ,Safety ,business ,Tablets ,medicine.drug - Abstract
Purpose This study was designed to characterize the pharmacokinetic profile and to assess bioequivalence of the sponsor’s test formulation (imatinib mesylate 400 mg tablets) with an innovator product (Gleevec 400 mg tablets, Novartis Pharmaceuticals) under fed conditions, in adult patients of Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) stabilized on imatinib mesylate 400 mg. In addition, the aim of this study was to monitor the safety profile of investigational medicinal products (IMPs). Materials and Methods A multicenter, randomized, open label, two-period, crossover, single dose bioequivalence study was designed for conduct under fed conditions in 42 adult Ph+ CML patients already stabilized on imatinib 400 mg tablets. Pharmacokinetic parameters Tmax, Cmax, and AUC0-24 were calculated using a non-compartmental model on validated WinNonlin software. Validated SAS software was used for statistical evaluation of data. The safety profile of investigational products was monitored during the course of study by applying a clinical process for recording observed untoward effects postadministration of investigational products. Results The 90% confidence intervals for the test/reference mean ratios of the ln-transformed PK variables Cmax (99.0%) and AUC0-24 (99.2%) were within an acceptable range of 80%-125%, as per bioequivalence assumptions. Both formulations were well tolerated after oral administration of IMPs. Conclusion The test product was found to be bioequivalent and safe, and thus can be used interchangeably in clinical practice.
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- 2016
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3. A Phase 3, Double-Blind, Randomized Study of Arterolane Maleate–Piperaquine Phosphate vs Artemether–Lumefantrine for Falciparum Malaria in Adolescent and Adult Patients in Asia and Africa
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Victor Mwapasa, Rajinder K. Jalali, Nilanjan Saha, Neena Valecha, Sunil S. Iyer, Sanjib Mohanty, Arjun Roy, S. K. Arora, Anupkumar R. Anvikar, Bappanaidu Hoigegudde Krishnamurthy Rao, Issaka Sagara, Tarit Kumar Bose, Srivicha Krudsood, Antoinette Tshefu, Ballamudi Srinivas Rao, Oumar Gaye, Pradeep Sharma, Ricardo Thompson, Offianan Andre Toure, and Harald Noedl
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Male ,0301 basic medicine ,Artemether/lumefantrine ,chemistry.chemical_compound ,0302 clinical medicine ,030212 general & internal medicine ,Artemether ,Malaria, Falciparum ,Child ,Articles and Commentaries ,biology ,Middle Aged ,Artemisinins ,Peroxides ,Infectious Diseases ,Ethanolamines ,Quinolines ,Drug Therapy, Combination ,Female ,Half-Life ,medicine.drug ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Asia ,Adolescent ,Plasmodium falciparum ,030106 microbiology ,Fixed-dose combination ,India ,Antimalarials ,Heterocyclic Compounds, 1-Ring ,Young Adult ,03 medical and health sciences ,Double-Blind Method ,Internal medicine ,Piperaquine ,parasitic diseases ,medicine ,Humans ,Spiro Compounds ,Arterolane ,Aged ,Fluorenes ,Lumefantrine ,Intention-to-treat analysis ,business.industry ,medicine.disease ,biology.organism_classification ,chemistry ,Africa ,business ,Malaria - Abstract
Background. Artemisinins, which are derived from plants, are subject to risk of supply interruption due to climatic changes. Consequently, an effort to identify a new synthetic antimalarial was initiated. A fixed-dose combination of arterolane maleate (AM), a new synthetic trioxolane, with piperaquine phosphate (PQP), a long half-life bisquinoline, was evaluated in patients with uncomplicated Plasmodium falciparum malaria. Methods. In this multicenter, randomized, double-blind, comparative, parallel-group trial, 1072 patients aged 12–65 years with P. falciparum monoinfection received either AM–PQP (714 patients) once daily or artemether–lumefantrine (A–L; 358 patients) twice daily for 3 days. All patients were followed up until day 42. Results. Of the 714 patients in the AM–PQP group, 638 (89.4%) completed the study; of the 358 patients in the A–L group, 301(84.1%) completed the study. In both groups, the polymerase chain reaction corrected adequate clinical and parasitological response (PCR–corrected ACPR) on day 28 in intent-to-treat (ITT) and per-protocol (PP) populations was 92.86% and 92.46% and 99.25% and 99.07%, respectively. The corresponding figures on day 42 in the ITT and PP populations were 90.48% and 91.34%, respectively. After adjusting for survival ITT, the PCR-corrected ACPR on day 42 was >98% in both groups. The overall incidence of adverse events was comparable. Conclusions. AM–PQP showed comparable efficacy and safety to A–L in the treatment of uncomplicated P. falciparum malaria in adolescent and adult patients. AM–PQP demonstrated high clinical and parasitological response rates as well as rapid parasite clearance. Clinical Trials Registration. India. CTRI/2009/091/000101.
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- 2016
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4. Development, Validation and Successful Application of an In Vitro-In Vivo Correlation Model for Sustained Release Tablets of Bupropion Hydrochloride
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Rakesh K. Jain, Sunil S. Iyer, Arshad Khuroo, Sudershan Kumar, and Praveen Radhakrishnan
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Chemistry ,Bupropion hydrochloride ,General Pharmacology, Toxicology and Pharmaceutics ,In vitro in vivo ,Pharmacology - Published
- 2017
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5. Safety, tolerability and pharmacokinetic profile of single and multiple oral doses of arterolane (RBx11160) maleate in healthy subjects
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Pawandeep Kaur, Pradeep Sharma, Nilanjan Saha, Sunil S. Iyer, Joerg J. Moehrle, and Anita Zutshi
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Adult ,Male ,Adolescent ,Placebo-controlled study ,Administration, Oral ,Pharmacology ,Placebo ,Antimalarials ,Food-Drug Interactions ,Heterocyclic Compounds, 1-Ring ,Young Adult ,chemistry.chemical_compound ,Double-Blind Method ,Pharmacokinetics ,Oral administration ,Humans ,Medicine ,Spiro Compounds ,Pharmacology (medical) ,Dosing ,Arterolane ,Adverse effect ,Aged ,Cross-Over Studies ,business.industry ,Middle Aged ,Healthy Volunteers ,Peroxides ,Tolerability ,chemistry ,Female ,business - Abstract
Arterolane (RBx11160, OZ277) maleate is a rapidly acting synthetic trioxolane anti-malarial. This randomized, placebo controlled study was a phase I study to evaluate the clinical safety and tolerability as well as pharmacokinetics (PKs) of arterolane maleate including food effect. Eight single rising oral doses of arterolane (25, 50, 100, 150, 200, 300, 400, 600 mg), food effect under fed and fasting conditions at 100 mg dose and four multiple oral dose regimens (25, 50, 100, 200 mg) were administered once daily for 7 days in 64 healthy young males (Caucasian). A randomized, placebo-controlled study was also conducted in healthy elderly males and females (Caucasian) to investigate PKs, safety and tolerability of single oral dose (100 mg) of arterolane. All doses were well tolerated after oral administration. The initial peak of arterolane was apparent at 2-3 hours post-dose followed by a secondary peak at approximately 5 hours post-dose. Thereafter, plasma arterolane concentration declined with a geometric mean t1/2 of approximately 2-4 hours. The PKs of arterolane appeared to be time-invariant after repeated once-daily dosing. The incidence of adverse events was similar for placebo and active treatments. Arterolane had similar PKs and tolerability in elderly and younger subjects and between elderly males and females.
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- 2013
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6. Development and validation of a LC-ESI-MS/MS method for simultaneous quantification of olmesartan and hydrochlothiazide in human K3 EDTA plasma and its application to pharmacokinetic biostudy
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Ajay Kumar, Priya Ranjan Prasad Verma, Tausif Monif, Arshad Khuroo, and Sunil S. Iyer
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Pharmacology ,Bioanalysis ,Chromatography ,Resolution (mass spectrometry) ,Chemistry ,Formic acid ,Pharmaceutical Science ,Mass spectrometry ,chemistry.chemical_compound ,Hydrochlorothiazide ,medicine ,Pharmacology (medical) ,Solid phase extraction ,Glucuronide ,Olmesartan ,medicine.drug - Abstract
This is the first publication on a complete validated bioanalytical method for estimation of olmesartan (OLM) and hydrochlorothiazide (HCTZ) in human K3 EDTA plasma that chromatographically resolves its olmesartan glucuronide. An API 4000 mass spectrometer was employed in this method where olmesartan d4 (OLMD4) and hydrochlorothiazide −13C, d2 (HCTZD2) served as the internal standard. Sample was prepared by solid phase extraction (SPE) technique using a polymer based, MCX cartridges and chromatographic resolution achieved on Synergi MAX RP-18A, (4.6 × 150 mm, 4 μm) column using a mobile phase of 0.2% formic acid solution/acetonitrile (30:70, v/v). Negative mass transitions (m/z) of OLM, HCTZ, OLMD4, and HCTZD2 were detected in multiple reactions monitoring (MRM) mode at 445.5 → 149.3, 296.0 → 269.0, 449.2 → 149.3, and 299.1→270.0, respectively. The linearity was checked over a concentration range of 4.051–2500.912 ng/mL for OLM and 0.506–304.109 ng/mL for HCTZ. Intra- and inter-run precision of OL...
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- 2013
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7. Bioequivalence assessment for non-oral dosage forms
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Sunil S Iyer
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business.industry ,Medicine ,Bioequivalence ,Pharmacology ,business ,Dosage form - Published
- 2017
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8. CHALLENGES IN BIOANALYTICAL METHOD DEVELOPMENT FOR SIMULTANEOUS DETERMINATION OF OLMESARTAN AND HYDROCHLOROTHIAZIDE IN HUMAN PLASMA BY LIQUID CHROMATOGRAPHY COUPLED TO TANDEM MASS SPECTROMETRY
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Abhishek K. Singh, Arshad Khuroo, Sunil S. Iyer, Tausif Monif, Ajay Kumar, and Priya Ranjan Prasad Verma
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Chromatography ,Resolution (mass spectrometry) ,Clinical Biochemistry ,Analytical chemistry ,Pharmaceutical Science ,Tandem mass spectrometry ,Mass spectrometry ,Biochemistry ,Analytical Chemistry ,chemistry.chemical_compound ,Hydrochlorothiazide ,chemistry ,medicine ,Ammonium formate ,Sample preparation ,Solid phase extraction ,Olmesartan ,medicine.drug - Abstract
A bioanalytical method for simultaneous estimation of olmesartan (OLM) and hydrochlorothiazide (HCTZ) in human K3 EDTA plasma is described. An API 3000 mass spectrometer was employed in this method where olmesartan d4 (OLMD4) and hydroflumethiazide (HFTZ) served as the internal standard. Sample preparation involved solid phase extraction (SPE), a polymer based, hydrophilic-lipophilic balanced cartridges, and chromatographic resolution achieved on X Terra RP18, (4.6 × 150 mm, 5 µm) column using a mobile phase of 2 mM ammonium formate buffer, (pH 3.50 ± 0.10 with formic acid)/acetonitrile (30:70, v/v). Negative mass transitions (m/z) of OLM, HCTZ, OLMD4, and HFTZ were detected in multiple reactions monitoring (MRM) mode at 445.6 → 148.4, 295.9 → 268.9, 449.4 → 148.4, and 329.9 → 238.3, respectively. The linearity was checked over a concentration range of 0.11 × 101 to 1.06 × 103 ng/mL for OLM and 0.10 × 101 to 0.32 × 103 ng/mL for HCTZ. Intra- and inter-run precision of OLM and HCTZ assay at four concentrat...
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- 2012
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9. Evaluation of the Effect of Ammonia on Nicotine Pharmacokinetics Using Rapid Arterial Sampling
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William H. Barr, Gerd Kobal, Kelly Fisher, Diana Mckinney, W. Hans Carter, Maria Gogova, Viswanathan Ramakrishnan, Bruce D. Davies, William R. Garnett, Sunil S. Iyer, H. Thomas Karnes, and Amit A. Somani
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Adult ,Smoke ,Nicotine ,Chromatography ,Chemistry ,Smoking ,Public Health, Environmental and Occupational Health ,Area under the curve ,Arteries ,Pharmacology ,Bioequivalence ,Bolus (medicine) ,Double-Blind Method ,Pharmacokinetics ,Ammonia ,Liquid chromatography–mass spectrometry ,Tobacco ,medicine ,Humans ,Arterial blood ,medicine.drug - Abstract
INTRODUCTION: The nicotine bolus theory states that the dependence-producing potential of cigarettes relates to a rapid increase in nicotine at brain receptor sites. It has been suggested that ammonia, a compound typically found in tobacco products, further increases the amount of nicotine absorbed and its absorption rate. The aim of this study was to determine whether different ammonia yields in cigarettes affected the rate or amount of nicotine absorption from the lungs to arterial circulation. METHODS: 34 adult smokers received 3 separate puffs from each of 2 test cigarettes with different ammonia yields (ammonia in smoke: 10.1 μg per cigarette vs. 18.9 μg per cigarette), followed by rapid radial arterial blood sampling (maximum one sample per second) with 30 min between puffs. Arterial blood samples were assayed for nicotine by liquid chromatography tandem mass spectrometry. Pharmacokinetic modeling was performed and the two test cigarettes were assessed for bioequivalence. RESULTS: No significant differences were found in area under the curve, C(max), or T((max)) and the 2 test cigarettes were found to be bioequivalent based on 2 one-sided tests at a significance level of 5%. In addition, the zero-order rate constant (k(0)) obtained from the initial slope of the curves and the model-dependent first-order rate constant (k(a)) were not significantly different. CONCLUSIONS: This study provides strong evidence that the different ammonia yields of the test cigarettes had no impact on nicotine pharmacokinetics; thus, the ammonia did not increase the rate or amount of nicotine absorption from a puff of cigarette smoke.
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- 2011
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10. A pharmacokinetic drug interaction study of ceftazidime with clavulanic acid in healthy male Indian subjects
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Anil K. Patni, M.S. Tomar, Tausif Monif, Sachin Mehra, Sunil S. Iyer, Rachna Arora, Vikesh Kumar Shrivastav, Nageshwar Rao Thudi, and Arshad Khuroo
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Pharmacology ,medicine.drug_class ,business.industry ,Cephalosporin ,Fixed-dose combination ,Pharmaceutical Science ,Ceftazidime ,Drug interaction ,Pharmacokinetics ,Potassium Clavulanate ,Clavulanic acid ,medicine ,Pharmacology (medical) ,Open label ,business ,medicine.drug - Abstract
Ceftazidime is a third generation cephalosporin with a broad range of activity. Clavulanic acid is a β-lactamase inhibitor. A fixed dose combination, with the wide spectrum of action of ceftazidime and clavulanic acid’s high stability to β-lactamases has been developed by Ranbaxy Laboratories Limited (India). The present study was planned to predict any interaction between ceftazidime and clavulanic acid which could affect the safety and efficacy of the fixed dose combination. The study was an open label, balanced, randomized two-treatment, two-period, two-sequence, crossover, single-dose comparative pharmacokinetic study under fed conditions. A single intravenous injection of the test product containing a fixed dose combination of ceftazidime 2000 mg and potassium clavulanate 200 mg and the reference product containing ceftazidime 2000 mg only, was administered during each period. Serial blood samples were collected until 12 h post-dose in each period. Ceftazidime and clavulanic acid concentration in pla...
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- 2011
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11. Comparison of pharmacokinetics of citalopram in healthy Asian Indian and Mexican volunteers
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Anil K. Patni, Sunil S. Iyer, Rakesh K. Jain, Sudershan Kumar, Tausif Monif, Nageshwar Rao Thudi, Arshad Khuroo, Sachin Rana, and M.S. Tomar
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Pharmacology ,medicine.medical_specialty ,business.industry ,Significant difference ,Cmax ,Pharmaceutical Science ,Bioequivalence ,Citalopram ,Gastroenterology ,Confidence interval ,Pharmacokinetics ,Internal medicine ,medicine ,Pharmacology (medical) ,Analysis of variance ,Dosing ,business ,medicine.drug - Abstract
Randomized, two-way crossover, bioequivalence studies were conducted separately in healthy Mexican and Asian Indian volunteers. One tablet either of test or of reference product was administered after 10 h of overnight fasting. After dosing, serial blood samples were collected for a period of 72 h and 168 h, respectively, for both the studies. Plasma samples were analyzed for citalopram by a validated liquid chromatographic and mass spectrometric method (LC-MS/MS). The pharmacokinetic parameters AUC0–t, AUC0–72, AUC0–∞, Cmax, and Tmax were determined from plasma concentration-time profiles for both the test and reference formulation of citalopram 20 mg tablets, and were compared statistically to evaluate bioequivalence between the two brands of citalopram. In both the studies, the analysis of variance (ANOVA) did not show any significant difference between the test and reference formulations and 90% confidence intervals (CI) were lying within the acceptable range for bioequivalence. The test and reference...
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- 2011
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12. A comparative bioavailability study of two formulations of itraconazole 100 mg capsule in healthy human Indian subjects under fasting conditions
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Sunil S. Iyer, Arshad Khuroo, Anil K. Patni, Ashok K. Tiwary, and Tausif Monif
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Pharmacology ,Itraconazole ,Bioavailability Study ,business.industry ,Metabolite ,Cmax ,Pharmaceutical Science ,Capsule ,Bioavailability ,chemistry.chemical_compound ,chemistry ,Pharmacokinetics ,medicine ,Pharmacology (medical) ,Dosing ,business ,medicine.drug - Abstract
The objective of the study was to evaluate the effect of time of administration of food post-dosing on the oral bioavailability of two formulations of itraconazole 100 mg capsule in 24 healthy adult Indian subjects under fasting conditions. Three different paradigms for time of administrations of food post-dose were selected: 4 h, 5 h, and 6 h. A randomized two-treatment, four-period, three-sequence, single dose bioavailability study was conducted. After dosing, serial blood samples were collected for up to 72 h. Plasma samples were analyzed for Itraconazole (ITZ) and its metabolite Hydroxy Itraconazole (OH-ITZ) by a sensitive and validated simultaneous liquid-chromatographic and mass-spectrometric (LC-MS/MS) method. A comparison of effect of post-dose fasting up to 4 h, 5 h, and 6 h on pharmacokinetic parameters of the two formulations was done, and it was found that pharmacokinetic parameters (Cmax, AUC0–t, AUC0–∞, Tmax) were consistent for both formulations in all the paradigms tested. This result sugg...
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- 2010
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13. Rapid automated blood sampling system for pharmacokinetics studies of cigarette smoking
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William M. Adams, Diana Mckinney, William H. Barr, William R. Garnett, Sunil S. Iyer, Maria Gogova, Gerd Kobal, H. Thomas Karnes, Wayne Lewis, Chad Powell, and Bruce D. Davies
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Adult ,Male ,Smoke ,Nicotine ,Inhalation ,Smoke Inhalation Injury ,business.industry ,Smoke inhalation ,Smoking ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Young Adult ,Anesthesia ,Administration, Inhalation ,Humans ,Infusion pump ,Arterial blood ,Medicine ,Female ,business ,Aged ,Blood sampling ,medicine.drug - Abstract
Introduction We developed an automated sampling system to allow multiple, discrete blood samples from a human participant to be collected rapidly and immediately following cigarette smoke exposure. We reported the details of the sampling system along with the results of a pilot study for evaluation of the system. Methods Components of the system include silastic tubing, solenoid pinch valves, a peristaltic pump, and a fraction collector. This system incorporates a smoking machine that allows precise delivery of cigarette smoke through a mouthpiece and intricate timing to correlate blood samples with smoke inhalation. All components are controlled via integration from a user interface and are fully customizable. We performed several tests to evaluate the equipment, including tubing dead volume, leakage tests, and sample reproducibility. We also performed a pilot study with 6 adult smokers, who received 6 controlled puffs of a research test cigarette. Each inhalation was followed by radial arterial blood collection (1 sample per second tapered to 1 sample every 4 s) for 1 min. Samples were evaluated for nicotine via liquid chromatography-tandem mass spectrometric methods. Results Sampling times and volumes were sufficient for nicotine analysis. No adverse effects were seen in the pilot study, and a 30-min washout period was deemed appropriate between puffs. A significant rise in plasma nicotine levels above baseline after inhalation of smoke was consistently detected in all participants. Discussion The unique advantage of this system is to allow rapid blood sampling after a puff of cigarette smoke, with the benefits of reproducibility, reduction in labor intensity, and high temporal resolution.
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- 2010
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14. Comparison of the safety and efficacy of fixed-dose combination of arterolane maleate and piperaquine phosphate with chloroquine in acute, uncomplicated Plasmodium vivax malaria: a phase III, multicentric, open-label study
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Arjun Roy, B. H. Krishnamoorthy Rao, Jitendra D Lakhani, Nilanjan Saha, Anupkumar R. Anvikar, Bina Srivastava, Pradeep Sharma, Nithya J Gogtay, Rajinder K. Jalali, Deepali Savargaonkar, Sunil S. Iyer, Neena Valecha, Bhagirath B. Solanki, Sanjay K. Kochar, Santanu Kumar Tripathi, S. K. Arora, Girish Chandra Rajadhyaksha, and Nalli Babu Vijaya Kumar
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Male ,Primaquine ,Plasmodium vivax ,Fixed dose combination ,Pharmacology ,chemistry.chemical_compound ,0302 clinical medicine ,Chloroquine ,030212 general & internal medicine ,Primary efficacy analysis ,education.field_of_study ,biology ,Middle Aged ,Peroxides ,Infectious Diseases ,Quinolines ,Drug Therapy, Combination ,Female ,Parasite clearance time ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,Fixed-dose combination ,Population ,03 medical and health sciences ,Antimalarials ,Heterocyclic Compounds, 1-Ring ,Young Adult ,Internal medicine ,Piperaquine ,Fever clearance time ,medicine ,Malaria, Vivax ,Humans ,Pharmacokinetics ,Spiro Compounds ,Arterolane ,Adverse effect ,education ,Aged ,business.industry ,Research ,Maleates ,biology.organism_classification ,Cure rate ,Arterolane maleate and piperaquine phosphate ,Malaria ,chemistry ,Parasitology ,business - Abstract
Background Chloroquine has been the treatment of choice for acute vivax malaria for more than 60 years. Malaria caused by Plasmodium vivax has recently shown resistance to chloroquine in some places. This study compared the efficacy and safety of fixed dose combination (FDC) of arterolane maleate and piperaquine phosphate (PQP) with chloroquine in the treatment of uncomplicated vivax malaria. Methods Patients aged 13–65 years with confirmed mono-infection of P. vivax along with fever or fever in the previous 48 h were included. The 317 eligible patients were randomly assigned to receive FDC of arterolane maleate and PQP (n = 159) or chloroquine (n = 158) for 3 days. Primaquine was given as an anti-relapse measure on day 3 and continued for 14 consecutive days. Primary efficacy analysis included assessment of the proportion of aparasitaemic and afebrile patients at 72 h. Safety endpoints were analysis of adverse events, vital signs, laboratory data, and abnormalities on electrocardiograph. Patients participated in the study for at least 42 days. Results In per protocol population, the proportion of aparasitaemic and afebrile patients at 72 h was 100 % (140/140) in the FDC of arterolane maleate and PQP group, and 99.3 % (145/146) in the chloroquine group (Fisher, p > 0.9999). In intent to treat population, the corresponding value was reported to be 96.9 % (154/159) in the FDC of arterolane maleate and PQP group and 98.7 % (156/158) in the chloroquine group (Fisher, p = 0.4479). The median parasite clearance time was 24 h in FDC of arterolane maleate and PQP group and 26 h in chloroquine group (Log-rank, p = 0.2264). Similarly, median fever clearance time was 24 h in both the groups (Log-rank, p = 0.7750). In PP population, day 28 cure rates were 100 % in both the groups (95 % CI (96.52, 100.0 for FDC of arterolane maleate and PQP and 96.73, 100.0 in chloroquine group)). Incidence of adverse events was 82.4 % in the FDC of arterolane maleate and PQP group and 85.4 % in the chloroquine group. Most of the adverse events were mild to moderate in intensity. The commonly reported clinical adverse events in the FDC of arterolane maleate and PQP versus chloroquine group were vomiting (5.0 vs 5.1 %), headache (1.3 vs 3.2 %) and prolonged QT (1.9 vs 3.2 %). No deaths were reported. The pharmacokinetic analysis indicates that arterolane maleate is well absorbed and has a relatively short t1/2 of 3.2 h. Piperaquine is also well absorbed after oral administration with a t1/2 of about 228.33 h. Conclusions The study showed that FDC of arterolane maleate and PQP effectively cured vivax malaria and attained acceptable level of cure up to day 28. Both the groups showed similar safety profile. Trial Registration Clinical Trial Registry India: CTRI/2011/11/002129 Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1084-1) contains supplementary material, which is available to authorized users.
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- 2016
15. A LC-Electrospray Tandem MS Method for the Analysis of Naltrexone in Canine Plasma Employing a Molecular Model to Demonstrate the Absence of Internal Standard Deuterium Isotope Effects
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Sunil S. Iyer, Glen E. Kellogg, and H. Thomas Karnes
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Spectrometry, Mass, Electrospray Ionization ,Analyte ,Electrospray ,Chromatography ,Narcotic antagonist ,Calibration curve ,Chemistry ,Narcotic Antagonists ,Analytical chemistry ,General Medicine ,Reference Standards ,Mass spectrometry ,High-performance liquid chromatography ,Naltrexone ,Analytical Chemistry ,Dogs ,Deuterium ,Tandem Mass Spectrometry ,Animals ,Quantitative analysis (chemistry) ,Chromatography, Liquid - Abstract
A simple and sensitive method is described for the determination of naltrexone (NAL), an opioid antagonist, in dog plasma. Sample processing involved a single step liquid-liquid extraction, followed by evaporation of the supernatant, and reconstitution of the residue prior to injection into the liquid chromatograph. The peak height ratio of NAL to [15,15,16-(2)H] naltrexone (NAL-d(3)) was used for quantitation. Observation of the chromatograms for NAL and NAL-d(3) revealed that the mean retention times of the compounds were 1.32 and 1.31 min, respectively. The almost identical retention times possibly accounted for the absence of matrix effects influencing quantitation. Molecular mechanics calculations using SYBYL software were carried out to qualitatively and quantitatively assess analyte and isotopic internal standard stationary phase interactions. Binding energy values of -10.22 and -10.26 kcal/mole were obtained for NAL and NAL-d(3), respectively. These data predict, semi-quantitatively, the absence of deuterium isotope effects that may influence quantitation. Calibration curves were linear from 10 pg/mL to 5014 pg/mL with a weighting factor of 1/x. Precision and accuracy and reverse predicted concentration residuals were within 15%. The method has been used successfully for the analysis of plasma samples from a pilot subcutaneous implantation study in dog.
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- 2007
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16. A ‘biorelevant’ system to investigate in vitro drug released from a naltrexone implant
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William H. Barr, Sunil S. Iyer, Peter R. Coleman, Mario E. Dance, and H. Thomas Karnes
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Surface Properties ,Chemistry, Pharmaceutical ,Drug Compounding ,Narcotic Antagonists ,Drug Evaluation, Preclinical ,Pharmaceutical Science ,Pharmacology ,Models, Biological ,Diffusion ,Bioreactors ,Dogs ,Subcutaneous Tissue ,Pharmacokinetics ,In vivo ,Animals ,Technology, Pharmaceutical ,Drug Implants ,Chemistry ,Narcotic antagonist ,Foreign-Body Reaction ,Reproducibility of Results ,Equipment Design ,Penetration (firestop) ,Naltrexone ,In vitro ,Kinetics ,Solubility ,Toxicity ,Liberation ,Implant ,Biomedical engineering - Abstract
This research is based on the recognized need for an in vitro release method for drug implants that better simulate physiological conditions at the site of implantation ('biorelevance'). In this paper, we describe the evaluation of a 'biorelevant' approach for in vitro drug release testing of a biodegradable implant of naltrexone in a pre-clinical stage of development. A miniature, capillary cell culture device was modified and tested as a biorelevant alternative for a standard commercially available flow-through cell. The real-time data generated through 90 days indicated a 48% lower rate of release for the capillary system. The profiles using both systems followed zero-order kinetics after an initial period of burst release. In vitro release data from the capillary device resulted in a 1-to-1 correlation with dog plasma pharmacokinetic data, and furthermore, the capillary device potentially simulated the lag-time in absorption more effectively than the flow-through cell. Scanning electron micrographs revealed that the sheath was continuous with no signs of cracks at the end of in vitro and in vivo studies. However, at the interface of the sheath and the core, intercalating, "finger-like" projections were observed consistent with penetration of the medium. No macroscopic or clinical toxicity signs were observed during the in vivo implantation study.
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- 2007
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17. A ‘biorelevant’ approach to accelerated in vitro drug release testing of a biodegradable, naltrexone implant
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William H. Barr, H. Thomas Karnes, and Sunil S. Iyer
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Chemistry, Pharmaceutical ,Drug Compounding ,Narcotic Antagonists ,Kinetics ,Drug Evaluation, Preclinical ,Pharmaceutical Science ,Pharmacology ,Naltrexone ,symbols.namesake ,Bioreactors ,medicine ,Technology, Pharmaceutical ,Drug Implants ,Arrhenius equation ,Chemistry ,Narcotic antagonist ,Temperature ,Reproducibility of Results ,Equipment Design ,Biodegradation ,In vitro ,Models, Chemical ,Solubility ,symbols ,Liberation ,Implant ,medicine.drug ,Biomedical engineering - Abstract
The development of a 'biorelevant' approach for accelerating drug release from an implant is described. A miniature, capillary system has been shown previously to be suitable for real-time release tests for a biodegradable, naltrexone implant. Whereas the real-time study under physiological condition was essential for evaluation of the system, the accelerated (short-term) method provides for a faster assessment of in vitro drug release that would be useful in product development and quality control. Increased temperature was employed as the mechanism for accelerating drug release. Release rates were investigated and compared using modifications of two devices: the flow-through cell and the new, potentially more 'biorelevant' capillary device. The data generated for accelerated release using both devices through 45 days indicated approximately two-fold and four-fold increases in release rates at 45 and 55 degrees C, respectively, as compared to the real-time release rate. The similar activation energy values for both devices obtained from Arrhenius plots demonstrated that the release mechanism had been consistent; and that the rates of release could be used for long-term prediction. The rate of release reverted to that observed in real-time data, however, upon a reduction of temperature to 38 degrees C. The results demonstrated that temperature was the sole factor involved in modification of the release rate in vitro. The profiles using both systems followed zero-order kinetics after an initial period of burst release.
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- 2007
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18. Quantification of Cyclosporin A in Human Cerebrospinal Fluid by Liquid Chromatography‐Mass Spectrometry using Atmospheric Pressure Chemical Ionization
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H. Thomas Karnes, Sunil S. Iyer, Gretchen M. Brophy, M. Ross Bullock, and Leslie Edinboro
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Chemical ionization ,Chromatography ,Chemistry ,Clinical Biochemistry ,Analytical chemistry ,Pharmaceutical Science ,Atmospheric-pressure chemical ionization ,Reversed-phase chromatography ,Mass spectrometry ,Biochemistry ,High-performance liquid chromatography ,Ion source ,Analytical Chemistry ,Liquid chromatography–mass spectrometry ,Cyclosporin a - Abstract
Cyclosporin A (CsA) is widely used as an immunosuppressant in organ transplantation, and the treatment of autoimmune disorders. This is the first publication describing a rapid, sensitive, and selective liquid chromatography‐mass spectrometry (LC‐MS) method for analysis of CsA in cerebrospinal fluid (CSF). Chromatographic separation was achieved using a reversed‐phase column with a linear gradient mobile phase. A column switching procedure was incorporated to minimize contamination in the ion source of the mass spectrometer. The sample volume requirement was 50 µL and no internal standard was employed. Quantification was carried out with selected ion reaction (SIR) monitoring of the protonated sodium ion adduct (m/z=1224.7). Calibration curves were linear from 0.5 ng/mL to 20 ng/mL with a weighting factor of 1/x. Precision and accuracy, and reverse predicted concentration residuals were within 15%. The method has been used successfully for the analysis of CSF samples from a clinical study.
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- 2007
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19. Characterization of a potential medium for ‘biorelevant’ in vitro release testing of a naltrexone implant, employing a validated stability-indicating HPLC method
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William H. Barr, Sunil S. Iyer, and H. Thomas Karnes
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Quality Control ,Calibration curve ,Chemistry, Pharmaceutical ,Drug Storage ,Narcotic Antagonists ,Clinical Biochemistry ,Pharmaceutical Science ,Buffers ,High-performance liquid chromatography ,Dosage form ,Naltrexone ,Analytical Chemistry ,Drug Stability ,Drug Discovery ,medicine ,Chromatography, High Pressure Liquid ,Spectroscopy ,Drug Implants ,Chromatography ,Chemistry ,Narcotic antagonist ,Osmolar Concentration ,Temperature ,Reproducibility of Results ,Hydrogen-Ion Concentration ,Reference Standards ,In vitro ,Pharmaceutical Solutions ,Solubility ,Liberation ,Indicators and Reagents ,Spectrophotometry, Ultraviolet ,Implant ,medicine.drug - Abstract
A variety of factors have been recognized that influence media optimization for drug release studies of implant dosage forms. Of primary importance is selection of a medium that physiologically mimics the milieu at the site of administration (a condition termed ‘biorelevance’). We describe in this paper, the characterization of Hanks’ balanced salts solution, with necessary modification, for application as a ‘biorelevant’ medium for in vitro release studies of a biodegradable, subcutaneous implant of naltrexone. A detailed investigation of changes in pH, osmolality and ultraviolet (UV) spectrum as a function of time and temperature was conducted. Variation in the parameters evaluated was found to be within acceptable limits. Validation of a simple and selective, high performance liquid chromatography (HPLC) assay method for naltrexone was carried out to evaluate stability. The calibration curves were linear from 0.16 to 20.00 μg ml −1 . Imprecision and inaccuracy were less than 2% and no interference was observed from degradation peaks. Stability studies of naltrexone indicated the media should be replaced every 7–8 days for real-time testing. This was applied to an investigation of in vitro drug release. The method has been proven to be suitable for investigation of naltrexone released from the implant.
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- 2007
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20. A molecular model to explain paclitaxel and docetaxel sensitivity changes through adduct formation with primary amines in electrospray ionization mass spectrometry
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Sunil S. Iyer, Glen E. Kellogg, Songmei Gao, Zong-Ping Zhang, and H. Thomas Karnes
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Models, Molecular ,Spectrometry, Mass, Electrospray Ionization ,Electrospray ,Paclitaxel ,Molecular model ,Electrospray ionization ,Docetaxel ,Sensitivity and Specificity ,Analytical Chemistry ,Adduct ,chemistry.chemical_compound ,medicine ,Molecule ,Amines ,Spectroscopy ,Chromatography ,Molecular Structure ,Chemistry ,Organic Chemistry ,Models, Chemical ,Taxoids ,Amine gas treating ,Chromatography, Liquid ,medicine.drug - Abstract
The objective of this study was to adopt a molecular modeling approach to understand changes in signal intensity due to adduct formation with short-chain alkylamines for two anticancer agents, paclitaxel and docetaxel, during electrospray mass spectrometric analysis. We describe a simple and intuitive modeling procedure using a comparison of hydropathic interaction (HINT) scores to explain differences in responses of amine adducts formed with the two analytes. The responses of paclitaxel and docetaxel were generally enhanced considerably (up to approximately 500% in some instances) on adding the amines. However, for the docetaxel adduct formed with added decylamine in the mobile phase, the response dropped by 32%. A mechanistic understanding for this behavior is proposed, and binding scores calculated from corresponding molecular models were found to be consistent with the trend obtained from mass spectrometric data.
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- 2005
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21. Controlled Transdermal Delivery of Propranolol Using HPMC Matrices: Design and In-vitro and In-vivo Evaluation
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Sunil S. Iyer and Priya Ranjan Prasad Verma
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Adult ,Male ,Biological Availability ,Pharmaceutical Science ,Absorption (skin) ,Methylcellulose ,Pharmacology ,Administration, Cutaneous ,Excipients ,Drug Delivery Systems ,Hypromellose Derivatives ,Reaction rate constant ,Elimination rate constant ,Pharmacokinetics ,Humans ,Antihypertensive Agents ,Transdermal ,Chromatography ,Chemistry ,Area under the curve ,Propranolol ,Bioavailability ,Kinetics ,Area Under Curve ,Female ,Drug carrier ,Half-Life - Abstract
To improve bioavailability and achieve a smoother plasma-concentration profile as compared with oral administration, a matrix-dispersion-type transdermal delivery system was designed and developed for propranolol using different ratios of hydroxypropyl-methylcellulose (HPMC) K4M, K15M and K100M. Formulations were evaluated for in-vitro dissolution characteristics using a Cygnus' sandwich-patch holder. Drug release followed Higuchi rather than zero-order or first-order kinetics. In-vivo evaluation was carried out on healthy volunteers (21 ± 1.41 years; 60.89 ± 5.35 kg) following the balanced incomplete block design. The dissolution rate constant (k) and data generated from plasma and urine (Cmax, maximum plasma concentration; tmax, time to reach peak plasma concentration; AUC, area under the curve; ke, elimination rate constant; t½e, elimination half-life; ka, absorption rate constant; t½a, absorption half-life) were evaluated statistically by two-way analysis of variance. Statistically excellent correlation was found between the percentage of drug absorbed and Cmax, AUC0–24 and AUC0-∞. A highly significant difference (P < 0.001) was observed when Cmax and AUC0-∞ generated from plasma and urine were compared, but ke, t½e, ka and t½a did not differ significantly (P > 0.1). We conclude that urinary excretion data may be used as a simpler alternative to blood level data in studying the kinetics of absorption and deriving the absorption parameters.
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- 2000
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22. Transdermal Delivery of Propranolol Using Mixed Grades of Eudragit: Design and in Vitro and In Vivo Evaluation
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Sunil S. Iyer and Priya Ranjan Prasad Verma
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Adult ,Pharmacology ,Active ingredient ,Polymers ,Chemistry ,Chemistry, Pharmaceutical ,Organic Chemistry ,Biological Availability ,Pharmaceutical Science ,Absorption (skin) ,Administration, Cutaneous ,Propranolol ,Dosage form ,Bioavailability ,Drug Delivery Systems ,Pharmacokinetics ,In vivo ,Area Under Curve ,Drug Discovery ,Humans ,Drug carrier ,Antihypertensive Agents ,Biomedical engineering ,Transdermal - Abstract
A matrix-dispersion-type transdermal drug delivery system of propranol was developed using different ratios of mixed polymeric grades of Eudragit. Formulations were evaluated for in vitro dissolution characteristics using a Cygnus' sandwich patch holder. Selected formulations followed zero-order release kinetics. In vivo evaluation was carried out on healthy human volunteers following a balanced incomplete block design (BIBD). In vitro dissolution rate constant k and pharmacokinetic parameters generated from plasma and urine were evaluated statistically. Statistically excellent correlation was found between percentages of drug absorbed from patch versus Cmax, AUC0-24, and AUC0-alpha. A highly significant difference was observed when Cmax and AUC0-alpha generated from plasma and urine data were compared, but when ke, t1/2e, ka, and t1/2a were compared, the difference was not significant. Urinary excretion data are suggested as a simpler alternative to blood-level data in studying the kinetics of absorption and deriving the absorption parameter.
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- 2000
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23. A Validated High-Performance Liquid Chromatography-Tandem Mass Spectrometric (Lc-Ms/Ms) Method for Simultaneous Determination of R(+)-Ketorolac and S(−)-Ketorolac in Human Plasma and Its Application to a Bioequivalence Study
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Sabyasachi Patri, Sunil S. Iyer, Sachin Rana, Sudershan Kumar, Tausif Monif, Rakesh K. Jain, Arshad Khuroo, and Anil K. Patni
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Chromatography ,Resolution (mass spectrometry) ,Tandem ,Article Subject ,Chemistry ,Analytical chemistry ,General Medicine ,Mass spectrometric ,High-performance liquid chromatography ,Ketorolac ,Human plasma ,medicine ,Solid phase extraction ,Enantiomer ,medicine.drug - Abstract
We report a selective, accurate, and reproducible liquid chromatography-tandem mass spectrometric (LC-MS/MS) method that employs solid phase extraction for quantification of ketorolac enantiomers in human plasma. Resolution of R(+)-ketorolac and S(−)-ketorolac was achieved using a Chiral-AGP column and a mobile phase of ammonium formate buffer (10 mM, pH ):acetonitrile (85 : 15, v/v and 70 : 30, v/v) in a gradient time program. S(+)-etodolac was used as the internal standard (IS). Quantification was achieved using a positive electrospray ionization (ESI+) interface under multiple reaction monitoring (MRM) condition. The method was validated over the concentration range of 9.36–1198.69 ng/ml for R(+)-ketorolac and 6.07–776.74 ng/ml for S(−)-ketorolac. Matrix effect was found negligible and the method showed good performances in terms of accuracy (89.6–102.7%) and precision (1.7–6.7%) for both enantiomers. Extraction recoveries of R(+)-ketorolac, S(−)-ketorolac, and S(+)-etodolac were 82.04, 70.94, and 93.90%, respectively. Results of all stability exercises in human plasma were within acceptable limits. The method was successfully applied to a single dose cross over bioequivalence study in healthy human male volunteers. Incurred Sample Reanalysis (ISR) was performed by randomly selecting 10% of total subject samples of the study using Statistical Analysis Software (SAS). Values of 91.1% for R (+)-ketorolac and 83.5% for S(−)-ketorolac indicated good acceptance for ISR.
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- 2011
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24. Profiling in vitro drug release from subcutaneous implants: a review of current status and potential implications on drug product development
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William H. Barr, H. Thomas Karnes, and Sunil S. Iyer
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Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Drug Evaluation, Preclinical ,Pharmaceutical Science ,Pharmacology ,In Vitro Techniques ,Dosage form ,IVIVC ,Subcutaneous Tissue ,Medicine ,Technology, Pharmaceutical ,Pharmacology (medical) ,Dissolution testing ,Intensive care medicine ,media_common ,Hypodermic needle ,Drug Implants ,business.industry ,General Medicine ,Controlled release ,Pharmaceutical Preparations ,Drug Design ,Drug product ,Implant ,business - Abstract
This review presents current methods and strategies for studying the release characteristics of drugs from subcutaneous implant dosage forms. Implants are dosage forms that are subcutaneously placed with the aid of surgery or a hypodermic needle, and are designed to release drugs over a prolonged period of time. In most cases, the objective of a release test is to identify sufficiently discriminatory procedures that in turn would provide data to set meaningful specifications. Additional information obtained from successful in vitro-in vivo correlations (IVIVC) and accelerated drug release tests are extremely useful during drug product development. Although several workers have employed different methods to monitor drug release from these dosage forms, the use of the compendial Apparatus 4 (flow-through) device has been recommended in a publication on FIP/AAPS Guidelines for drug release testing of modified release dosage forms. However, most of method development with this device has focused on oral immediate or controlled release dosage forms and little published information is available on implants. Two recent reports on workshops provide useful information on methods to evaluate drug release from controlled-release parenterals such as implants, including IVIVC and accelerated release testing. Details on such studies, however, are generally not found in the literature; possibly because of the high proprietary value of methodologies for establishing release specifications of implant dosage forms. This article reviews the current status of methodologies used in the investigation of drug release from subcutaneous implants with an emphasis on mechanistic, product development and regulatory perspectives.
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- 2006
25. Development and validation of a LC-ESI-MS/MS method in human plasma for quantification of fenofibric acid, involving chromatographic resolution of fenofibric acid acyl-β-d-glucuronide
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Abhishek K. Singh, Debashis Kar, Arshad Khuroo, Sunil S. Iyer, Ajay Kumar, and Tausif Monif
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Bioanalysis ,Chromatography ,Resolution (mass spectrometry) ,Formic acid ,General Chemical Engineering ,General Engineering ,Mass spectrometry ,Analytical Chemistry ,chemistry.chemical_compound ,chemistry ,Sample preparation ,Solid phase extraction ,Acetonitrile ,Glucuronide - Abstract
This is the first publication on a validated bioanalytical method for estimation of fenofibric acid in human EDTA plasma that chromatographically resolves its acyl glucuronide. An API 3000 mass spectrometer was employed in this method, and fenofibric acid-d6 served as the internal standard. Sample preparation involved solid phase extraction (SPE) using a polymer based, hydrophilic-lipophilic balanced cartridges and samples were chromatographed on a Discovery C18, (4.6 × 50 mm, 5 μm) column using a mobile phase of 0.2% formic acid solution/acetonitrile (35 : 65, v/v). Negative mass transitions (m/z) of fenofibric acid and fenofibric acid-d6 were detected in multiple reactions monitoring (MRM) mode at 317.1 → 230.9 and 322.9 → 230.8, respectively. The method was validated over a concentration range of 0.150 μg mL−1 to 20.383 μg mL−1. Intra- and inter-run imprecision of fenofibric acid assay at four concentration levels was below 2.5%, and inaccuracy was within ±2.8%. Analytical recoveries for fenofibric acid and internal standard were 73.8–75.4%, and 85.9%, respectively. All other validation parameters were within acceptable limits. The back conversion of fenofibric acid from its acyl glucuronide was minimized by processing samples in an ice cold water bath under low light.
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- 2010
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26. Evaluation of Deuterium Isotope Effects in Normal-Phase LC-MS-MS Separations Using a Molecular Modeling Approach.
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Sunil S. Iyer, Zong-Ping Zhang, Glen E. Kellogg, and H. Thomas Karnes
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Molecular modeling of stationary phases presents a unique challenge because there is little available experimentally derived structural information. Verified interaction mechanisms at a molecular level with analytes are also rare. Molecular mechanics calculations using the Tripos force field were carried out to qualitatively and quantitatively assess stationary phase interactions. Binding energy values of –15.40, 15.28, –12.53, and –12.34 kcal/mol, respectively, are obtained for olanzapine (OLZ), OLZ-D3, des-methyl olanzapine (DES), and DES-D8 that corresponded to the retention behavior of the four compounds observed using liquid chromatography–mass spectrometry (MS)–MS. The model explains, semiquantitatively, the deuterium isotope effect in the normal-phase chromatographic separation of these compounds. [ABSTRACT FROM AUTHOR]
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- 2004
27. Efficacy and safety of fixed dose combination of arterolane maleate and piperaquine phosphate dispersible tablets in paediatric patients with acute uncomplicated Plasmodium falciparum malaria: a phase II, multicentric, open-label study
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Offianan Andre Toure, Arjun Roy, Rajinder K. Jalali, S. K. Arora, Nilanjan Saha, Anupkumar R. Anvikar, Pitabas Mishra, Stephen Rulisa, Neena Valecha, Ballamudi Srinivas Rao, Pradeep Sharma, and Sunil S. Iyer
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Male ,Fixed dose combination ,chemistry.chemical_compound ,Artemisinin ,Malaria, Falciparum ,Child ,education.field_of_study ,FCT ,Peroxides ,Drug Combinations ,Infectious Diseases ,Paediatric ,Child, Preschool ,Quinolines ,Female ,PCT ,medicine.drug ,Tablets ,medicine.medical_specialty ,Population ,Fixed-dose combination ,Plasmodium falciparum ,India ,Piperaquine phosphate ,Antimalarials ,Heterocyclic Compounds, 1-Ring ,Piperaquine ,Internal medicine ,Artemisinin combination therapy ,medicine ,Humans ,Spiro Compounds ,Arterolane maleate ,Arterolane ,education ,Adverse effect ,PCR-corrected ACPR ,Intention-to-treat analysis ,business.industry ,Research ,Infant, Newborn ,Rwanda ,Infant ,Surgery ,Malaria ,Clinical trial ,Cote d'Ivoire ,chemistry ,Parasitology ,business - Abstract
Background The World Health Organization (WHO) recommends artemisinin combination therapy (ACT) for the treatment of uncomplicated Plasmodium falciparum malaria. The present study investigated the efficacy and safety of fixed dose combination (FDC) of arterolane maleate 37.5 mg and piperaquine phosphate (PQP) 187.5 mg dispersible tablets in paediatric patients aged 6 months to 12 years. Methods Male and female patients aged 6 months to 12 years who were confirmed cases of P. falciparum mono-infection with fever or documented history of fever in the previous 24 h were included. The patients were administered FDC of arterolane maleate and PQP as single daily doses for three consecutive days based on their age. The primary efficacy outcome was proportion of patients with polymerase chain reaction (PCR)-corrected adequate clinical and parasitological response (ACPR) on day 28. Safety was analysed based on adverse events (AE), laboratory abnormalities and abnormalities on electrocardiograph. Results A total of 141 eligible paediatric patients received FDC of arterolane maleate and PQP in a 42-day follow-up study. All the enrolled patients (141) were included in intention to treat (ITT) and safety analyses, and 126 patients were considered in per protocol (PP) population. The PCR-corrected ACPR on day 28 was achieved in all patients (100 %; 95 % CI 97.11–100) included in PP population. The median parasite clearance time (PCT) and fever clearance time (FCT) were 24 h (95 % CI 18.0–24.0) and 10 h (95 % CI 4.0–18.0), respectively. The most frequently reported clinical AE was vomiting. Majority of the AEs were mild to moderate in severity and resolved without sequelae. No patient was discontinued for any QTc (corrected QT interval) prolongation. No deaths or serious AEs were reported during the study. Conclusion The findings from this study showed that FDC of arterolane maleate and PQP effectively cures P. falciparum malaria and attains acceptable level of cure by day 28 in paediatric patients. The efficacy and safety results observed in children warrants further studies on FDC of arterolane maleate and PQP dispersible tablets. Trial Registration: Clinical Trial Registry India: CTRI/2009/091/000531
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28. 2007 highlights of advance in the pharmaceutical sciences: An American Association of Pharmaceutical Scientists (AAPS) perspective
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Amita Joshi, Vishal Gupta, Phillip Ramsey, Anne S. De Groot, Kenneth J. Norris, Craig E. Lunte, Peter L. Bonate, Sanjay Sehgal, Robert L. Chapman, Manuel Zahn, Mansoor A. Khan, Vivian Gray, Christopher R. McCurdy, Marilyn E. Morris, Susan D’Souza, Arya Jayatilaka, H. Thomas Karnes, Patrick Liu, Marilyn N. Martinez, Kim Huynh-Ba, Sunil S. Iyer, and Naushad Ghilazi
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medicine.medical_specialty ,Operations research ,business.industry ,Pharmacology toxicology ,Alternative medicine ,Pharmaceutical Science ,Pharmacy ,Article ,Dose individualization ,Quantitative pharmacology ,Population kinetics ,medicine ,Engineering ethics ,Pharmaceutical sciences ,business - Abstract
The American Association of Pharmaceutical Scientists (AAPS) covers the full range of areas of expertise associated with the resolution of concerns pertaining to drugs and drug products. This editorial highlights the initiatives, issues, and challenges that are the forefront of the pharmaceutical sciences in 2007. It also provides an overview of how these difficult questions are being addressed through the programs and events associated with the AAPS 2007 Annual Meeting that will be held at the San Diego, California, Convention Center from November 11 to 15, 2007.
29. Measurable Residual IDH1 before Allogeneic Transplant for Acute Myeloid Leukemia.
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Gui G, Dillon LW, Ravindra N, Hegde PS, Andrew G, Mukherjee D, Wong Z, Auletta J, El Chaer F, Chen E, Chen YB, Corner A, Devine SM, Iyer S, Jimenez Jimenez AM, De Lima MJG, Litzow MR, Kebriaei P, Spellman SR, Zeger SL, Page KM, and Hourigan CS
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Measurable residual disease (MRD) in adults with acute myeloid leukemia (AML) in complete remission is an important prognostic marker, but detection methodology requires optimization. The persistence of mutated NPM1 or FLT3 -ITD in the blood of adult patients with AML in first complete remission (CR1) prior to allogeneic hematopoetic cell transplant (alloHCT) has been established as associated with increased relapse and death after transplant. The prognostic implications of persistence of other common AML-associated mutations, such as IDH1 , at this treatment landmark however remains incompletely defined. We performed testing for residual IDH1 variants ( IDH1 m) in pre-transplant CR1 blood of 148 adult patients undergoing alloHCT for IDH1 -mutated AML at a CIBMTR site between 2013-2019. No post-transplant differences were observed between those testing IDH1 m positive (n=53, 36%) and negative pre-transplant (overall survival: p = 0.4; relapse: p = 0.5). For patients with IDH1 mutated AML co-mutated with NPM1 and/or FLT3 -ITD, only detection of persistent mutated NPM1 and/or FLT3 -ITD was associated with significantly higher rates of relapse (p = 0.01). These data, from the largest study to date, do not support the detection of IDH1 mutation in CR1 blood prior to alloHCT as evidence of AML MRD or increased post-transplant relapse risk., Competing Interests: Conflicts of Interest Statements Hourigan: The National Heart, Lung, and Blood Institute receives research funding for the laboratory of Dr. Hourigan from the Foundation of the NIH AML MRD Biomarkers Consortium. Auletta: Advisory Committee: AscellaHealth and Takeda El Chaer: Consultant: SPD Oncology, Amgen, Association of Community Cancer Centers; Clinical Trial Grant Support (PI) to the University of Virginia: Amgen, BMS, Celgene, SPD Oncology, Sanofi, Bristol Myers Squibb, FibroGen, PharmaEssentia, BioSight, MEI Pharma, Novartis, Arog pharmaceuticals; Travel grant: DAVA Oncology E Chen: Consultant: Rigel Pharmaceuticals and AbbVie Corner: Employment: Bio-Rad Laboratories Jimenez Jimenez: Funding: Abbvie De Lima: Advisory Board: Pfizer, Bristol Myers Squibb; Data Safety Monitoring Board: Novartis, Abbvie; Research Funding: Miltenyi Biotec Kebriaei: Consultant: Pfizer, Jazz Pharmaceuticals
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- 2023
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30. Pneumocystis jirovecii pneumonia as a complication of etoposide therapy.
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Mendoza MA, Iyer S, Camargo JF, and Benedetto PW
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- CD4-Positive T-Lymphocytes, Etoposide adverse effects, Humans, Lymphopenia, Pneumocystis carinii, Pneumonia, Pneumocystis chemically induced, Pneumonia, Pneumocystis diagnosis
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Two patients receiving oral etoposide therapy developed Pneumocystis jirovecii pneumonia during chemotherapy with significant lymphopenia without corticosteroid use. In this commentary we discuss cellular mechanisms by which etoposide induced CD4+ T lymphocyte dysfunction and reduced survival may lead to predisposition to P. jirovecii infection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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31. Prevalence of Targetable Mutations in Black Patients With Lung Cancer: A Systematic Review and Meta-Analysis.
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Costa PA, Saul EE, Paul Y, Iyer S, da Silva LL, Tamariz L, and Lopes G
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- Humans, Mutation, Prevalence, Turkey, Black or African American, Lung Neoplasms epidemiology, Lung Neoplasms genetics
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Purpose: Inferior outcomes of Black patients with lung cancer compared with other racial groups are often linked to socioeconomic factors. It is crucial to determine whether a varying prevalence of targetable mutations limits treatments and contributes to disparities., Materials and Methods: We conducted a meta-analysis on the prevalence of lung cancer EGFR , ALK , ROS-1 , and BRAF mutations in Black patients compared with White, Hispanic, and Asian patients. We searched PubMed/MEDLINE, Cochrane Library, EMBASE, CENTRAL, Google Scholar, and clinicaltrials.gov databases. We selected studies reporting the prevalence of at least one mutation in the Black population. We calculated the pooled prevalence of mutations using fixed effects, exact binomial distributions, and Freeman-Turkey double arcsine transformation to stabilize the variances., Results: Twenty studies with 11,867 patients were included. In Black patients, EGFR was the most prevalent mutation (6%; 95% CI, 5 to 7), followed by BRAF (1%; 95% CI, 0 to 2), ALK (1%; 95% CI, 0 to 2), and ROS-1 (0%; 95% CI, 0 to 1). Black patients had a lower prevalence of EGFR mutations than White, Hispanic, and Asian patients ( P < .01). BRAF mutations were less prevalent in Black compared with White patients ( P < .05), and ALK mutations were less prevalent when compared with Hispanic patients ( P < .05)., Conclusion: EGFR is the most frequent mutation found in Black patients, although its prevalence is lower than that in other races. Black patients have a low overall prevalence of ALK , ROS-1 , and BRAF mutations. Given that disproportional eligibility for targeted therapies may be contributing to inferior outcomes, research focused on the Black population is needed to evaluate specific tumor characteristics and therapeutic strategies., Competing Interests: Gilberto LopesHonoraria: Boehringer IngelheimConsulting or Advisory Role: Pfizer, AstraZenecaResearch Funding: Merck Sharp & Dohme, EMD Serono, AstraZeneca, Blueprint Medicines, Tesaro, Bavarian Nordic, Novartis, G1 Therapeutics, Adaptimmune, BMS, GlaxoSmithKline, Abbvie, Rgenix, Pfizer, Roche, Genentech, Lilly, Janssen, LucenceTravel, Accommodations, Expenses: Boehringer Ingelheim, Pfizer, E.R. Squibb Sons, LLC, JanssenNo other potential conflicts of interest were reported.
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- 2021
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32. Venous Compression Syndromes: a Review.
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Iyer S, Angle JF, Uflacker A, and Sharma AM
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Opinion Statement: Venous compression syndromes present a diagnostic and therapeutic challenge as the clinical presentation can be vague, diagnostic criteria are often not present, and high quality standardization of when and how to treat is not available in part due to the limited number of cases reported and also due to the limited literature available. Significant venous compression should be considered when clinical symptoms correlate to location of compression and there is evidence of hemodynamic changes including venous hypertension, collateral/variceal formation, and/or thrombus formation. In general, treatment of venous compression should address the etiology of the compression as opposed to just treating symptoms associated with it such as significant varices or anticoagulation for thrombus to avoid recurrence of symptoms.
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- 2017
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33. A heart team and multi-modality imaging approach to percutaneous closure of a post-myocardial infarction ventricular septal defect.
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Iyer S, Bauer T, Yeung M, Ramm C, Kiser AC, Caranasos TG, and Vavalle JP
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Post-infarction ventricular septal defect (PI-VSD) is a devastating complication that carries a high mortality with or without surgical repair. Percutaneous closure is an attractive alternative in select patients though requires appropriate characterization of the PI-VSD as well as careful device and patient selection. We describe a multidisciplinary and multi-modality imaging approach to successful percutaneous closure of a PI-VSD.
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- 2016
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34. Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study.
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Yang D, Iyer S, Gardener H, Della-Morte D, Crisby M, Dong C, Cheung K, Mora-McLaughlin C, Wright CB, Elkind MS, Sacco RL, and Rundek T
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- Adult, Black or African American, Aged, Aged, 80 and over, Black People, Carotid Artery Diseases diagnosis, Female, Humans, Male, Middle Aged, Plaque, Atherosclerotic diagnosis, Risk Factors, Carotid Arteries physiopathology, Carotid Artery Diseases complications, Carotid Stenosis complications, Plaque, Atherosclerotic complications, Smoking adverse effects, Stroke complications
- Abstract
Background: We sought to determine the association between cigarette smoking and carotid plaque ultrasound morphology in a multiethnic cohort., Methods: We analyzed 1,743 stroke-free participants (mean age 65.5 ± 8.9 years; 60% women; 18% white, 63% Hispanic, 19% black; 14% current and 38% former smokers, 48% never smoked) from the Northern Manhattan Study using an ultrasound index of plaque echodensity, the Gray-Scale Median (GSM). Echolucent plaque (low GSM) represents soft plaque and echodense (high GSM) more calcified plaque. The mean GSM weighted by plaque area for each plaque was calculated for those with multiple plaques. Quintiles of GSM were compared to no plaque. Multinomial logistic regression models were used to assess associations of cigarette smoking with GSM, adjusting for demographics and vascular risk factors., Results: Among subjects with carotid plaque (58%), the mean GSM scores for quintiles 1-5 were 48, 72, 90, 105, and 128, respectively. Current smokers had over a two fold increased risk of having GSM in quintile 1 (odds ratio (OR) = 2.17; 95% confidence interval (CI), 1.34-3.52), quintile 2 (OR = 2.33; 95% CI, 1.42-3.83), quintile 4 (OR = 2.05; 95% CI, 1.19-3.51), and quintile 5 (OR = 2.13; 95% CI, 1.27-3.56) but not in quintile 3 (OR = 1.18; 95% CI, 0.67-2.10) as compared to never smokers in fully adjusted models. Former smokers had increased risk in quintile 2 (OR = 1.46; 95% CI, 1.00-2.12), quintile 3 (OR = 1.56; 95% CI, 1.09-2.24), quintile 4 (OR = 1.66; 95% CI, 1.13-2.42), and quintile 5 (OR = 1.73; 95% CI, 1.19-2.51), but not in quintile 1 (OR = 1.05; 95% CI, 0.72-1.55)., Conclusions: A nonlinear, V-shaped-like relationship between current cigarette smoking and plaque echodensity was observed. Former smokers were at the highest risk for plaques in high GSM quintiles. Thus, current smokers were more likely to have either soft or calcified plaques and former smokers were at greater risk of having only echodense plaques when compared to those who have never smoked. Further research is needed to determine if plaque morphology mediates an association between smoking and clinical vascular events., (© 2015 S. Karger AG, Basel.)
- Published
- 2015
- Full Text
- View/download PDF
35. Role of baseline echocardiography in the preoperative management of liver transplant candidates.
- Author
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Harinstein ME, Iyer S, Mathier MA, Flaherty JD, Fontes P, Planinsic RM, Edelman K, Katz WE, and Lopez-Candales A
- Subjects
- Echocardiography methods, End Stage Liver Disease mortality, End Stage Liver Disease surgery, Female, Humans, Liver Transplantation mortality, Male, Middle Aged, Preoperative Care, Retrospective Studies, Risk Factors, Stroke etiology, Treatment Outcome, End Stage Liver Disease diagnostic imaging, Liver diagnostic imaging, Liver Transplantation diagnostic imaging
- Abstract
Liver transplantation (LT) has not traditionally been offered to patients with intracardiac shunts (ICSs) or pulmonary hypertension (PH). There is a paucity of data regarding cardiac structural characteristics in LT candidates. We examined echocardiographic characteristics and their role in managing LT candidates diagnosed with ICS and PH. We identified 502 consecutive patients (318 men, mean age 55 ± 11 years) who underwent LT and had preoperative echocardiogram. Demographics, cardiovascular risk factors, and echocardiographic variables were recorded and data were analyzed for end-stage liver disease diagnosis. ICSs were diagnosed with contrast echocardiography and PH was defined as estimated pulmonary artery systolic pressure >40 mm Hg. Primary end points included short-term (30-day) and long-term (mean 41-month) mortalities and the correlation between pre- and perioperative stroke. In our studied population >50% had >2 cardiovascular risk factors and with increasing frequency ICSs were diagnosed in 16%, PH in 25%, and intrapulmonary shunts in 41% of LT candidates. There was no correlation between short- and long-term mortality and ICS (p = 0.71 and 0.76, respectively) or PH (p = 0.79 and 0.71). Importantly, in those with ICS, no strokes occurred. In conclusion, structural differences exist between various end-stage liver disease diagnoses. ICSs diagnosed by echocardiography are not associated with an increased risk of perioperative stroke or increased mortality. A diagnosis of mild or moderate PH on baseline echocardiogram is not associated with worse outcomes and requires further assessment. Based on these findings, patients should not be excluded from consideration for LT based solely on the presence of an ICS or PH., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
36. Number of foods available at a meal determines the amount consumed.
- Author
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Levitsky DA, Iyer S, and Pacanowski CR
- Subjects
- Adolescent, Eating psychology, Feeding Behavior psychology, Female, Humans, Male, Young Adult, Choice Behavior physiology, Eating physiology, Feeding Behavior physiology
- Abstract
The number of foods available at a meal has been suggested as a major determinant of the amount consumed. Two studies conducted in humans test this idea by altering the number of foods available at a meal where participants eat the available foods ad libitum. In Study 1, dinner intake of twenty-seven young adults was measured. The amount consumed was measured when subjects were served either: (a) a composite meal (a protein rich food, a carbohydrate rich food, and a vegetable), (b) a low carbohydrate meal (protein rich food and vegetable), or (c) a vegetarian meal (carbohydrate rich food and vegetable). In Study 2, twenty-four subjects were given two different meals presented either as individual foods or as a composite meal (stir-fry or stew). Both studies show that the greater the number of foods offered at a meal, the greater the total intake. Study 2 demonstrated that the effects observed in Study 1 could not be attributed to different nutrient compositions, but was rather due to the presentation of the individual foods because the same foods that were offered as individual foods were combined to make the composite meal. The results demonstrate that the greater the number of foods offered at a meal, the greater the spontaneous intake of those foods. This finding is important because not only does it expand the concept of variety from the kinds of foods to the number of foods, but it presents an environmental variable that might contribute to overeating and obesity., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
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