ABSTRACT
Topical fluoroquinolones are now available for use in the eye and ear. Their broad spectrum of activity includes the common eye and ear pathogens Staphylococcus aureus and Pseudomonas aeruginosa. For the treatment of acute otitis externa, these agents are as effective as previously available otic preparations. For the treatment of otitis media with tympanic membrane perforation, topical fluoroquinolones are effective and safe. These preparations are approved for use in children, and lack of ototoxicity permits prolonged administration when necessary. Topical fluoroquinolones are not appropriate for the treatment of uncomplicated conjunctivitis where narrower spectrum agents suffice; they represent a simplified regimen for the treatment of bacterial keratitis (corneal ulcers). When administered topically, fluoroquinolones are well tolerated and offer convenient dosing schedules. Currently, bacterial resistance appears limited.
Subject(s)
Anti-Infective Agents/administration & dosage , Ear Diseases/drug therapy , Eye Diseases/drug therapy , Acute Disease , Administration, Topical , Anti-Infective Agents/adverse effects , Bacterial Infections/drug therapy , Conjunctivitis/drug therapy , Conjunctivitis/microbiology , Ear Diseases/microbiology , Eye Diseases/microbiology , Fluoroquinolones , Humans , Keratitis/drug therapy , Keratitis/microbiology , Otitis Externa/drug therapy , Otitis Media/drug therapyABSTRACT
Obesity is one of the most common medical problems in the United States and a risk factor for illnesses such as hypertension, diabetes, degenerative arthritis and myocardial infarction. It is a cause of significant morbidity and mortality and generates great social and financial costs. Obesity is defined as a body mass index greater than 30. Many patients accomplish weight loss with diet, exercise and lifestyle modification. Others require more aggressive therapy. Weight loss medications may be appropriate for use in selected patients who meet the definition of obesity or who are overweight with comorbid conditions. Medications are formulated to reduce energy intake, increase energy output or decrease the absorption of nutrients. Drugs cannot replace diet, exercise and lifestyle modification, which remain the cornerstones of obesity treatment. Two new agents, sibutramine and orlistat, exhibit novel mechanisms of action and avoid some of the side effects that occurred with earlier drugs. Sibutramine acts to block uptake of serotonin, norepinephrine and dopamine, while orlistat decreases fat absorption in the intestines.
Subject(s)
Anti-Obesity Agents/therapeutic use , Appetite Depressants/therapeutic use , Energy Intake , Exercise , Feeding Behavior , Life Style , Obesity/diagnosis , Obesity/therapy , Algorithms , Basal Metabolism , Body Mass Index , Cyclobutanes/therapeutic use , Decision Trees , Diagnosis, Differential , Humans , Lactones/therapeutic use , Lipase/antagonists & inhibitors , Obesity/complications , Obesity/drug therapy , Obesity/etiology , Obesity/metabolism , Orlistat , Risk FactorsABSTRACT
It has been suggested that changes in fat-free weight may not fully explain the decline of resting metabolic rate (RMR) that occurs with aging. We therefore examined the hypothesis that a reduction in maximal aerobic capacity (VO2max) may partially explain the lower RMR in older men, after accounting for differences in fat-free weight and fat weight. We also considered differences in energy intake and plasma thyroid hormones as possible modulators of the age-related decline in RMR in men. Three-hundred healthy men (aged 17 to 78 years) were characterized for: (1) RMR (kcal/min) from indirect calorimetry; (2) body composition from underwater weighing; (3) maximal aerobic capacity from a test of VO2max; (4) plasma thyroid hormones (total triiodothyronine [T3], free T3, total thyroxine [T4], and free T4); and (5) estimated energy intake (kcal/d) from a 3-day food diary. A curvilinear decline of RMR with age was found (P less than .01), in which no relationship was found in men less than 40 years of age (r = .10, slope = 0.002 kcal/min/yr), whereas in men older than 40 years, RMR was negatively related to age (r = -.52, slope = -0.008 kcal/min/yr). After statistical control for differences in fat-free weight and fat weight, a negative relationship between age and RMR persisted (partial r = -.30, P less than .01). It was only after control for fat-free weight, fat weight, and VO2max (partial r = -.10, P greater than .05) that no association between age and RMR was noted.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Aging/metabolism , Basal Metabolism , Body Composition , Physical Endurance , Thyroid Hormones/blood , Adolescent , Adult , Aerobiosis , Aged , Cohort Studies , Energy Intake , Humans , Male , Middle Aged , Oxygen Consumption , Statistics as TopicABSTRACT
We examined the effect of pretesting environment on measurement of resting metabolic rate (RMR). RMR was measured in 18 older (66.1 +/- 1.4 y) individuals after an overnight stay in the Clinical Research Center (ie, inpatient) and after subjects transported themselves to the laboratory (ie, outpatient). Similar measurements were also performed after an 8-wk endurance-training program. RMR was higher (P less than 0.01) before exercise training in subjects who transported themselves to the laboratory (ie, outpatients; 4.9 +/- 0.13 kJ/min) than in inpatients (4.6 +/- 0.13 kJ/min) and after exercise training in outpatients (5.4 +/- 0.08 kJ/min) vs inpatients (5.0 +/- 0.13 kJ/min). Training increased RMR under both inpatient (10%; P less than 0.01) and outpatient (11%; P less than 0.01) conditions. We conclude that RMR is higher when measured under outpatient conditions in older volunteers. Therefore, when daily energy requirements based on the assessment of RMR are being estimated, the pretesting environment should be considered. However, the exercise-training-induced increase in RMR can be detected by using either an inpatient or an outpatient protocol.
