Nonword Repetition And Sentence Repetition In Preschool Children: A Comparison Of Speech And Language Screening Measures

Nonword repetition tasks and sentence repetition tasks have been shown to accurately differentiate children with speech and/or language disorders from their typically developing peers (Dollaghan & Campbell, 1998; Archibald & Gathercole, 2006). Additionally, they provide information on semantic, syntactical, and phonological processing as well as memory and acoustic perceptual skills (Vance, Stackhouse, & Wells, 2005). Despite their utility as a screening measure, their use in clinical practice has been minimal. Instead, practicing speech-language pathologists often choose to use publisher-provided screening measures or their own developed measures, rather than using research-based screening methods that have recognized differential diagnosis ability (Nash, Leavett, & Childs, 2011). The purpose of the present study is to compare the current speech and language screening measures used by student clinicians in the UND Speech, Language, and Hearing Clinic to the Dollaghan and Campbell\u27s (1998) nonword repetition task (NRT) and the sentence repetition task (SRT) taken from the Clinical Evaluation of Language Fundamentals - Preschool Second Edition (CELF-P2) (Semel, Wiig, & Secord, 2004). In order to determine the clinical usefulness of the SRT and NRT as a speech and language screener, potential cut-off points to distinguish typically developing (TD) children and those who may have language impairment (LI) and/or speech sound disorder (SSD) were also considered. Forty-nine English-speaking, monolingual, preschool-aged children (ages 3;1 to 5;9 years) were recruited for this study. Results indicated a limited correlation was found between UND\u27s measures and the SRT and the NRT. In addition, a strong relationship was found between the SRT CELF-P2 scaled scores and the percent consonant correct (PCCs) and percent phoneme correct (PPCs) scores of the SRT and NRT. Overall, a greater number of participants performed more poorly on the SRT and NRT than on UND\u27s screening measures. These results indicate that the SRT and NRT may be detecting speech and/or language disorders that UND\u27s measures fail to detect

Managing Psychotropic Drugs with Efavirenz

Efavirenz is in the non-nucleoside reverse transcriptase inhibitor category of HIV antiretroviral medicines. It is an in vivo inducer of the CYP3A4 isoenzyme within the cytochrome P450 (CYP450) system, and an in vitro inhibitor of the system’s CYP2C9/2C19, 3A4 and 2B6 isoenzymes; as a result, concentrations of psychotropic drugs can be increased or decreased depending on the specific enzyme pathway involved in their metabolism. CYP3A4 is responsible for metabolizing many benzodiazepines and other psychotropics, as well as selective serotonin reuptake inhibitors and tricyclic antidepressants. As an inducer of CYP3A4, efavirenz can increase the rate at which these agents are metabolized, resulting in administered psychotropic drug levels that are below their therapeutic thresholds. Conversely, efavirenz is an inhibitor of CYP2B6, which metabolizes agents such as bupropion; consequently, bupropion levels in the blood can increase. Given the existing conflicting data, the clinician may find it impractical to use an evidence-based approach when concomitantly prescribing efavirenz and psychotropic drugs to their HIV patients. Instead, it may be preferable to use a more pragmatic approach that applies knowledge of the most current pharmacological and pharmacokinetic data for psychotropics and non-nucleoside reverse transcriptase inhibitors, which may help better predict their potential interactions

Optimal Use of Raltegravir (Isentress®) in the Treatment of HIV-Infected Adults – Canadian Consensus Guidelines

BACKGROUND AND OBJECTIVES: A meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV-treating physicians on the appropriate use of raltegravir (MK-0518, Isentress®, Merck Frosst Canada Inc) in HIV-infected adults.METHODS: Evidence from the published literature and conference presentations, as well as expert opinions of the group members, was considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from five other physicians and scientists across Canada with expertise in HIV treatment and antiretroviral drug resistance, and experience in the use of raltegravir. The final recommendations represent the core group’s consensus agreement once all feedback was considered.RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians in the optimal use of raltegravir. The issues considered included raltegravir’s role in overall treatment strategy, efficacy, durability of effect, rate of viral load reduction, resistance, safety/toxicity, pharmacokinetics and drug interactions.Peer Reviewe

Optimal use of raltegravir (Isentress®) in the treatment of HIV-infected adults – Canadian consensus guidelines

BACKGROUND AND OBJECTIVES: A meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV-treating physicians on the appropriate use of raltegravir (MK-0518, Isentress®, Merck Frosst Canada Inc) in HIV-infected adults

A Computational Physics-based Approach to Predict Unbound Brain-to-Plasma Partition Coefficient, Kp,uu

The blood-brain barrier (BBB) plays a critical role in preventing harmful endogenous and exogenous substances from penetrating the brain. Optimal brain penetration of small molecule CNS drugs is characterized by a high unbound brain/plasma ratio (Kp,uu). While various medicinal chemistry strategies and in silico models have been reported to improve BBB penetration, none were developed to predict Kp,uu directly. We describe a physics-based computational approach, solvation free energy calculations (energy of solvation or E-sol), to predict Kp,uu. Prospective application of this method to internal CNS drug discovery programs highlighted the utility and accuracy of this new method, which showed a categorical accuracy of 79% and a R2 of 0.61 from a linear regression model

HIV-associated Lipodystrophy Syndrome: A Review of Clinical Aspects

Approximately two years after the introduction of highly active antiretroviral therapy for the treatment of HIV infection, body shape changes and metabolic abnormalities were increasingly observed. Initially, these were ascribed to protease inhibitors, but it is now clear that nucleoside reverse transcriptase inhibitors also contribute to lipodystrophy syndrome. The syndrome groups together clinical conditions describing changes in body fat distribution that include lipoatrophy, lipoaccumulation or both. However, there does not appear to be a direct link between lipoatrophy and lipoaccumulation that would support a single mechanism for the redistribution of body fat. Currently, there is no clear definition of lipodystrophy, which explains the difficulty in determining its prevalence and etiology. There are no current guidelines for the treatment of fat distribution abnormalities that occur in the absence of other metabolic complications. The present article reviews the current state of knowledge of the definition, symptoms, risk factors, pathogenesis, diagnosis and treatment of the morphological changes associated with lipodystrophy syndrome

Management and treatment of hepatitis C virus in patients with HIV and hepatitis C virus coinfection: A practical guide for health care professionals

Concomitant HIV and hepatitis C virus (HCV) is a common yet complex coinfection. The present document is a practical guide for treating HCV infection in people coinfected with HIV. Effective antiretroviral therapies have prolonged survival rates for HIV-infected people over the past decade, which have made latent complications of HCV major causes of morbidity and mortality in these patients. Advances in the treatment of HCV (eg, combined pegylated interferon and ribavirin) offer the possibility of eradicating HCV infection in coinfected persons. The treatment of HCV must be considered in all cases. Intensive management of the adverse effects of HCV treatment is one of the factors for the success of these therapies. HCV eradication is predicted to decrease the mortality associated with coinfection and reduce the toxicity of HIV treatment