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Park P.,VA Connecticut Healthcare | Caballero J.,Nova Southeastern University | Omidian H.,Nova Southeastern University
Annals of Pharmacotherapy | Year: 2014

Objective: To review the current literature on the efficacy and safety of serotonin norepinephrine reuptake inhibitors in the treatment of attention-deficit hyperactivity disorder (ADHD) in the pediatric population. Data Sources: A literature search from 1996 to August 2013 was conducted using MEDLINE, CINAHL, and EMBASE databases. Search terms included attention-deficit hyperactivity disorder, serotonin norepinephrine reuptake inhibitor, pediatric attention-deficit hyperactivity disorder, venlafaxine, duloxetine, desvenlafaxine, milnacipran, and nefazodone. Study Selection and Data Extraction: Relevant articles on duloxetine and venlafaxine for the treatment of pediatric ADHD were reviewed; 5 studies on venlafaxine and 1 study on duloxetine were evaluated. Studies included open-label and randomized, double-blind trials. Case studies in pediatric populations and all studies in adult populations were excluded. Data Synthesis: Patients 6 to 17 years old were evaluated in the venlafaxine and duloxetine studies. Trials on venlafaxine, ranging from 2 to 6 weeks, showed patient improvement as measured by the Conners Rating Scale and ADHD Rating Scale. Venlafaxine was initiated at 12.5 to 25 mg/d and titrated up to 1.4 to 3.8 mg/kg/d to a maximum of 150 mg/d. Duloxetine showed minimal efficacy in treating ADHD symptoms at doses of 60 mg/d at 6 weeks. The most common side effects for venlafaxine and duloxetine included drowsiness and decreased appetite, respectively. Conclusions: Data for venlafaxine and duloxetine are limited. However, venlafaxine may be considered as an alternative agent when patients cannot tolerate or fail stimulants, tricyclic antidepressants, or bupropion. Duloxetine has been studied in children; however, with only 1 study available, it is difficult to recommend. © The Author(s) 2013. Source

Kulas J.F.,VA Connecticut Healthcare | Kulas J.F.,Yale University | Axelrod B.N.,John D. Dingell VAMC | Rinaldi A.R.,VA Connecticut Healthcare
Psychological Injury and Law | Year: 2014

Assessment of the validity of neuropsychological test data has become an ensconced aspect of the assessment process. Among the more popular free-standing performance validity measures (PVMs) is the Test of Memory Malingering (Tombaugh 1996). Given the popularity of this measure, a number of researchers (i.e., Trial 1 (Denning, 2012); TOMMe10 (Denning, 2012); Albany Consistency Index (Gunner, Miele, Lynch, & McCaffrey, 2012)) have sought to expand its utility by increasing the number of scoring approaches associated with its administration. This paper aimed to cross-validate prior work by examining the performance of these measures in a mixed clinical sample of veterans referred for neuropsychological evaluation. All five examined measures provided good to excellent discrimination of patients determined to be putting forth poor effort based on failure of two or three alternate measures of performance validity. Traditional scoring approaches revealed high rates of specificity, with lower rates of sensitivity. The newer measures performed well for both sensitivity and specificity at higher base rates. However, predicted performance in low base rate populations (i.e., 0.10) using the newly derived scoring failed to reach predetermined cutoffs for specificity (0.90). Further examination of the cumulative performance of the scoring approaches indicated that administration of only two initial scoring indices was necessary to obtain a high rate of classification. © 2014, Springer Science+Business Media New York (outside the USA). Source

Wallis R.S.,Pfizer | Jakubiec W.,VA Connecticut Healthcare | Mitton-Fry M.,Pfizer | Ladutko L.,VA Connecticut Healthcare | And 5 more authors.
PLoS ONE | Year: 2012

There presently is no rapid method to assess the bactericidal activity of new regimens for tuberculosis. This study examined PNU-100480, TMC207, PA-824, SQ109, and pyrazinamide, singly and in various combinations, against intracellular M. tuberculosis, using whole blood culture (WBA). The addition of 1,25-dihydroxy vitamin D facilitated detection of the activity of TMC207 in the 3-day cultures. Pyrazinamide failed to show significant activity against a PZA-resistant strain (M. bovis BCG), and was not further considered. Low, mid, and high therapeutic concentrations of each remaining drug were tested individually and in a paired checkerboard fashion. Observed bactericidal activity was compared to that predicted by the sum of the effects of individual drugs. Combinations of PNU-100480, TMC207, and SQ109 were fully additive, whereas those including PA-824 were less than additive or antagonistic. The cumulative activities of 2, 3, and 4 drug combinations were predicted based on the observed concentration-activity relationship, published pharmacokinetic data, and, for PNU-100480, published WBA data after oral dosing. The most active regimens, including PNU-100480, TMC207, and SQ109, were predicted to have cumulative activity comparable to standard TB therapy. Further testing of regimens including these compounds is warranted. Measurement of whole blood bactericidal activity can accelerate the development of novel TB regimens. © 2012 Wallis et al. Source

Paniz-Mondolfi A.,Yale University | Ladutko L.,VA Connecticut Healthcare | Brown-Elliott B.A.,University of Texas Health Science Center at Tyler | Vasireddy R.,University of Texas Health Science Center at Tyler | And 6 more authors.
Journal of Clinical Microbiology | Year: 2014

Mycobacterium canariasense is a recently described late-pigmenting, rapidly growing mycobacterium linked to bacteremia in patients with underlying malignant diseases. We report a case of M. canariasense infection in a patient from Massachusetts with underlying diffuse B cell lymphoma, which was identified both by multilocus sequence typing and matrix-assisted laser desorption ionization?time of flight mass spectrometry (MALDI-TOF MS). To our knowledge, this is the first description after its original identification in Spain and the first report of this opportunistic pathogen in the Americas. Copyright © 2014, American Society for Microbiology. All Rights Reserved. Source

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