Functional information on the variant is essential for justifying its clinical use order precose 25mg mastercard diabetic test strips. Discovery of new genetic variants is outstripping the generation of knowledge on the biological meanings of existing variants purchase precose 50mg visa metabolic disease group. Therefore discount precose 25mg otc diabetes insipidus peds in review, candidates for sulfasalazine ther- apy should be genotyped to identify those patients who might beneﬁt from the drug quality precose 50mg type 1 diabetes. These results offer the potential to improve the safety proﬁle of lumiracoxib by identifying indi- viduals at elevated risk for liver injury and excluding them from lumiracoxib treatment. The results from this study therefore pose a difﬁcult challenge to decision makers. Tranilast inhibits the release or production of cyclooxygenase-2 and restores cytokine-induced nitric oxide production. Pharmacogenetic studies showed that it to be Gibert’s syndrome due to polymorphism in the uridine diphosphat glucuronosyltransferase 1A1 gene − mild chronic hyperbilirubinemia that can occur in the absence of liver disease and hemolysis and is not life-threatening. Such a collaborative project would probably not be possible until companies were at the point where they had genotyped at least 100,000 patients on high-density arrays. Recommendations for the Clinical Use of Pharmacogenetics Due to the rapid development of cost-effective methods for genotyping and the need to genotype only once in the lifetime of a patient, it would be advisable to include the genotype in the patient’s record. It is also desirable to include the genotypes of trans- port proteins and drug receptors, which can reveal highly predictive genetic informa- tion. This would provide the physician with valuable information to individualize the treatment. Besides development of personalized medicines, the impact of genotyping on medical practice would shift the emphasis from present diagnosis-based treatment to detection of disease prior to clinical manifestation and preventive treatment with appropriate medicine and a dose that is most effective and safest for an individual. Predicted clinical developments from application of pharmacogenetics are: • Establishment of prescribing guidelines, based on clinical studies, for drugs that are subject to substantial polymorphic metabolism • Prescribing advice will relate dose to genotype and will highlight the possibility of drug interactions when multiple drugs are prescribed concomitantly • Establishment and recording of individual patient genotypes that is, “personal pharmacogenetic proﬁles” • Pharmacogenetic testing will substantially reduce the need for hospitalization, and its associated costs, because of adverse drug reactions • Development of new drugs for patients with speciﬁc genotypes that is, “drug stratiﬁcation” Limitations of Pharmacogenetics Inherited component of the response to drugs is often polygenic. Furthermore, the drug response is probably affected by multiple genes, each gene with multiple poly- morphisms distributed in the general population. Racial differences add further Universal Free E-Book Store Pharmacoepigenomics vs Pharmacogenetics in Drug Safety 145 confounding factors. Drug response might be predicted from a certain pattern of polymorphisms rather than only a single polymorphism, yet these patterns probably differ between ethnic groups. This could prevent predictions about drug responses across the general patient population, and it emphasizes the need to stratify clinical pharmacogenomics studies. The candidate-gene strategy has the advantage of focusing resources on a manage- able number of genes and polymorphisms that are likely to be important but the limitations are the incompleteness of knowledge of a medication’s pharmacokinet- ics and mechanisms of action. The dynamic complexity of the human genome, involvement of multiple genes in drug responses, and racial differences in the prevalence of gene variants impede effective genome-wide scanning and progress towards practical clinical applica- tions. Genomic technologies are still evolving rapidly, at an exponential pace simi- lar to the development of computer technology over the past 20 years. Gene expression proﬁling and proteomic studies are evolving strategies for identifying genes that may inﬂuence drug response. Holding sensitive information on some- one’s genetic make-up raises questions of privacy and security and ethical dilemmas in disease prognosis and treatment choices. After all, polymorphisms relevant to drug response may overlap with disease susceptibility, and divulging such informa- tion could jeopardize an individual. On the other hand, legal issues may force the inclusion of pharmacogenomics into clinical practice. Once the genetic component of a severe adverse drug effect is documented, doctors may be obliged to order the genetic test to avoid malpractice litigation. Pharmacoepigenomics vs Pharmacogenetics in Drug Safety Phamacoepigenomics refers to drug action as inﬂuenced by the epigenome, which is the overall epigenetic state of a cell, and serves as an interface between the envi- ronment and the genome. The role of epigenetic factors in drug action has been mentioned throughout this report. The epigenome is dynamic and responsive to environmental signals not only during development, but also throughout life; and it is becoming increasingly apparent that chemicals can cause changes in gene expres- sion that persist long after exposure has ceased. A hypothesis has been presented, which states that commonly-used pharmaceutical drugs can cause such persistent epigenetic changes (Csoka and Szyf 2009). An example of an indirectly acting drug is isotretinoin, which has transcription factor activity. A two-tier mechanism is Universal Free E-Book Store 146 4 Pharmacogenetics postulated for indirect effects in which acute exposure to a drug inﬂuences signaling pathways that may lead to an alteration of transcription factor activity at gene promoters. This stimulation results in the altered expression of receptors, signaling molecules, and other proteins necessary to alter genetic regulatory circuits. Therefore, any epigen- etic side-effect caused by a drug may persist after the drug is discontinued. It is further proposed that some iatrogenic diseases such as tardive dyskinesia and drug- induced systemic lupus erythematosus are epigenetic in nature. If this hypothesis is correct the consequences for modern medicine are profound, since it would imply that our current understanding of pharmacology is an oversimpliﬁcation. Thus epi- genetic side-effects of pharmaceuticals may be involved in the etiology of heart disease, cancer, neurological and cognitive disorders, obesity, diabetes, infertility, and sexual dysfunction. It is suggested that a systems biology approach employing microarray analyses of gene expression and methylation patterns can lead to a better understanding of long-term side-effects of drugs, and that in the future, epigenetic assays should be incorporated into the safety assessment of all pharmaceutical drugs. The impact of pharmacoepigenomics may be equal to or greater than that of pharmacogenetics. Future Role of Pharmacogenetics in Personalized Medicine The number of polymorphisms identiﬁed in genes encoding drug metabolizing enzymes, drug transporters, and receptors is rapidly increasing. In many cases, these genetic factors have a major impact on the pharmacokinetics and pharmaco- dynamics of a particular drug and thereby inﬂuence the sensitivity to such drug in an individual patient with a certain genotype. Many of the genes examined in early studies were linked to highly penetrant, single-gene traits, but future advances hinge on the more difﬁcult challenge of elucidating multi-gene determinants of drug response. In order to apply the increasing amount of pharmacogenetic knowledge to clini- cal practice, speciﬁc dosage recommendations based on genotypes will have to be developed to guide the clinician, and these recommendations will have to be evalu- ated in prospective clinical studies. Such development will lead to personalized medicines, which hopefully would be more efﬁcient and will result in fewer adverse drug reactions. Epigenetic side-effects of common pharmaceuticals: a potential new ﬁeld in medicine and pharmacology. Pharmacogenomic biomarker information in drug labels approved by the United States food and drug administration: prevalence of related drug use. Inﬂuence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects. Investigating drug-induced mitochondrial toxicity: a biosensor to increase drug safety? A preliminary pharmacogenetic investigation of adverse events from topiramate in heavy drinkers. Association of cytochrome P450 2C19 genotype with the antiplatelet effect and clinical efﬁcacy of clopidogrel therapy. Cytochrome 2C19*17 allelic variant, platelet aggregation, bleeding events, and stent thrombosis in clopidogrel-treated patients with coronary stent place- ment. Establishing the characteristics of an effective pharmaco- genetic test for clozapine induced agranulocytosis. Currently, it is estimated that there are approximately 19,000 genes in the human organism. Several new technologies have been devel- oped to study the genome and new terms have been derived from genomics, the best known of which is pharmacogenomics. Completion of sequencing of the human genome has opened a new era for improved understanding of the genetic basis of human diseases and to provide new targets for drug discovery. Pharmacogenomics is an important basis for the development of personalized medicines. Pharmacogenomics implies the use of genetic sequence and genomics informa- tion in patient management to enable therapy decisions.
Abdul Latif 1University Malaya purchase precose 25 mg fast delivery diabetes signs and symptoms ppt, Rehabilitation Medicine- Faculty of Medicine discount 50mg precose amex diabetes gene test, dysfunction and strong predictors for mortality of cardiovascular disease buy 25 mg precose metabolic disease list. Material and Methods: In a prospec- sess the autonomic response to graded physiological stress purchase precose 25 mg with mastercard diabetes mellitus type 2 algorithm. There was no signif- J Rehabil Med Suppl 55 Poster Abstracts 183 icant difference with regards to mortality or major adverse cardiac nal chest wall might provide autonomy and greater compliance. Conclusion: This cardiac rehabilitation program proved to compared safety and effcacy of a mechanical chest percussor de- be effective in improving patient’s exercise capacity. There Department of Rehabilitation Medicine, The Second Affliated Hos- were no signifcant difference in adverse events and majority of pital of Chongqing Medical University, Chongqing, China patients were willing to use the device by themselves. A random effects analysis was applied on account element of care for people with cystic fbrosis. There was no techniques, physical exercise and inhalation therapy are part of evidence of signifcant publication bias (Begg’s p=0. Our objective was to evaluate the effciency of aerobic exercises combined with airway clearance techniques. Material and Meth- tation Centre Hospital, Jakarta, Indonesia ods: 34 individuals with kyphotic posture (20 individuals without respiratory problems and 14 individuals with respiratory problems) Introduction/Background: Chronic obstructive pulmonary disease who has the average of 49. Many factors contribute to the reduction of functional tion tests, the datas recorded prior to kinesiologic taping, after and exercise capacity and balance impairment. The obtained datas were compared to appropriate of physical activity, lower extremity muscle weakness and inspira- statistical analysis. Results: When pulmonary function parameters tory muscle weakness have been associated with both problems. So, that obtained prior to kinesiologic taping and after kinesiologic tap- purpose this study To analyse the relationship between functional ing are compared with the parameters that obtained after a week, in exercise capacity and balance. Pearson’s nesiologic taping that applied on thoracic spine with functional cor- correlations examined relationships between functional exercise rection taping method in individuals with kyphotic posture reduces capacity and balance. There were negative correlations between predicted problems and in individuals with respiratory problems. Conclusion: There is a signifcant relation- ship between functional exercise capacity and balance. Material and Methods: A retrospec- ability such as mobility in bed and in sitting were limited. Physical therapy intervention may improve the mobility months pulmonary rehabilitation program between Jan to Jun 2015. Tambunan1 1 634 Faculty of Medicine, Physical Medicine and Rehabilitation De- partment of Dr. Results: A to- mum expiratory and inspiratory pressure, mobility of the diaphragm tal of 12 patients, mean age of 53 years with a female predomi- and diaphragmatic thickness were evaluated by ultrasound. Urodynamic studies have revealed abnormalities in 8 tory pressure, diaphragm thickness rate, and mobility increased by patients. Inappropriate used of antibiotic in the treatment admitted to our clinic complaining of drop foot for two weeks. Also, he complaint This study was to determine the common pathogen associated with the nausea and vomiting in this time. Material and Methods: This retrospective the sprain of him right foot two weeks ago. After this injury, he observational study was conducted from Sep 2012 to Sep 2014. How- cal examination, they were determined that minimal steppage gait, ever patient with other concurrent infection has been excluded. The weakness of the right foot and toe dorsifexors, and paresthesia of target sample size calculated using was 63 subjects. The fnal sample size was 22 in the tibialis anterior and extensor digitorum brevis and gastrocne- patients. The high- and electroneuromyographic fndings were consistent with a right est isolated bacteria in these patient were E. Gynecology Department and pelvic foor muscle exercise training This study showed our practice in antibiotic usage concordance to at the Rehabilitation Medicine outpatient clinic in the frst visit. The pelvic foor muscle endurance after 6 weeks biofeedback method of pelvic foor muscle exercise between Network, Rehabilitation Medicine, Liverpool, United Kingdom groups were the same and not signifcantly different (10 second, Introduction/Background: Urinary tract infections are a common p=0. Conclusion: Biofeedback method of pelvic foor muscle problem in rehabilitation units as many patients have impaired exercise for 6 weeks can improve pelvic foor muscle endurance in mobility, neurologically conditions, catheterised and constipated. Circumferential measurements were performed 639 from specifc anatomic landmarks before and after the treatment (wrist, mid forearm, elbow, mid upper arm, axilla). Each participant underwent physi- life by reducing pain and sensation of heaviness. J Rehabil Med Suppl 55 Poster Abstracts 187 641 quent metastatic sites include the pleura, brain, and skin. The aim of this study was to evaluate the these impairments and their effect on the life quality. Material and Meth- 1Baskent University, Physical Medicine and Rehabilitation, Adana, ods: The study included 100 patients (age:55±10. Patients were screened and examined for the presence of upper extremity Introduction/Background: In this study, it was aimed to determine impairments such as motion restrictions, lymphedema, pain, numb- whether there is a correlation between the serum level of vitamin D ness and loss of strength. Lymphedema was noted as in three stages and lymphedema in patients with malignancy. Fifty-fve patients had moder- affected and unaffected extremities, the volumetric differences be- ate to severe upper extremity lymphedema. Weight gain after the tween affected and unaffected extremities, range of motion and mo- disease was common and forty-six patients were obese. It was evaluated the correlations patients reported moderate-severe deconditioning. Beck Depression Scale scores showed that 59 one patient had endometrial carcinoma. Only, seven patients tients had stage 1 lymphedema while fve patients had stage 2, the did not report fatigue. There was low statistically in patients with moderate to severe fatigue or lymphedema. Also, low level of this vitamin can be precipitate the pain and decreased of the quality of life. Doruk Analan1 Introduction/Background: Etiologies of traumatic, compressive, 1Baskent University, Physical Medicine and Rehabilitation, Adana, ischemic, neoplastic, or idiopathic etiologies may cause sciatica. Turkey Most common cause of sciatica is spinal disc herniation pressing on the lumbar or sacral nerve roots. Spondylolisthesis, spinal stenosis, Introduction/Background: The aim of this study was to evaluate the piriformis syndrome and pelvic tumors are also causes sciataal- demographic and clinical characteristics of patients with lymphedema gia. Material and Methods: A 45-year-old male presented with severe persistent pain in the up- total of 95 female patients were included in the study. It was record- per thigh–lower buttock region, swelling in the left lower extremity ed type of malignancy, side of lymphedema, stage of lymphedema, and had diffculty walking for 15 days. The tumor was diagnosed as non-mus- Results: The mean age of the study population was found 52. His muscle strength in the lower extremities was 5/5 malignancies were recorded as endometrial carcinoma (3 patients), bilaterally with an antalgic gait. Side of lymphedema was right not reduce the pain and it was resistant even fentanyl. Magnetic resonance imaging showed a le- main precipitating factor of lymphedema was exhausting work (28 sion of about 29×8 cm in diameter around the priformis muscle in patients). Other factors were surgery, chemotherapy, radiotherapy, the left pelvis that compresses left sciatic nerve.