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OBJECTIVE: To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV). DESIGN: Randomized controlled trial. SUBJECTS: HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight. INTERVENTION: Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day. MAIN OUTCOME MEASURES: Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test). STATISTICAL ANALYSES: Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test. RESULTS: Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance. APPLICATIONS: In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.

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The steady-state pharmacokinetic interaction between buspirone and alprazolam was evaluated in a parallel study with two groups of 12 male volunteers each. On days 1 to 7, group I subjects received a 1-mg alprazolam tablet every 8 hours (q8h) (TRT 1) and group II subjects received 2 x 5-mg buspirone tablets q8h (TRT 2). On days 8 through 14, all subjects received a combination of 1-mg alprazolam and 2 x 5-mg buspirone tablets q8h (TRT 3). Plasma samples, collected 0 to 8 hours after the morning dose on days 7 and 14, were analyzed for buspirone, alprazolam and their metabolites, 1-PP, and alpha-HO-alprazolam, respectively. Additional samples were collected before the morning dose on days 5 and 6 of each session to monitor the attainment of steady state. Steady-state pharmacokinetic parameters Cmax, Tmax, AUC0-8, and Cmin were calculated. The results indicated that for alprazolam, there was a small (< 10%) increase in Cmax and AUC when coadministered with buspirone. For buspirone, there was a 10% and 29% increase in Cmax and AUC, when coadministered with alprazolam. These values were within the normal variability observed with this class of drugs. Except for a 14% decrease in Cmin for alpha-HO-alprazolam, coadministration of buspirone and alprazolam did not affect the parameters for the metabolites. The results of this study suggest that coadministration of buspirone and alprazolam did not markedly affect the steady-state pharmacokinetics of either drug.

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This report presents the results of a retrospective analysis of pooled efficacy data from eight studies in which buspirone was compared to placebo in 520 patients with generalized anxiety disorder (GAD). In addition to evaluating overall efficacy in the composite patient data base, four criteria were used to identify subsets of patients with GAD who had coexisting depressive symptoms of at least moderate intensity: (1) a score of > or = 2 on the Hamilton Anxiety (HAM-A) Rating Scale item 6 (depressed mood), (2) a score of > or = 2 on the Hamilton Depression (HAM-D) Rating Scale item 1 (depressed mood), (3) a HAM-D total score of > or = 18, or (4) a HAM-D Retardation Factor value (items 1, 7, 8, and 14) greater than the median for the group. Overall, patients treated with buspirone demonstrated significant (p < or = 0.001) improvement over baseline in total HAM-A scores compared to patients who received placebo. Buspirone also produced significant (p < or = 0.001) global improvement compared to placebo as assessed by the attending physician. Of the GAD patients stratified according to the four criteria for coexisting depressive symptoms, a substantial percentage (44-64%) of the total patient sample exhibited significant depressive symptoms as part of their anxiety disorder. Patients with GAD and coexisting depressive symptoms of at least moderate intensity exhibited significantly greater improvement with buspirone compared to placebo treatment regardless of the stratification criterion used. They also responded at least as well or better to buspirone therapy as did those with GAD who had less intense depressive symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

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A US multicenter, double-blind, placebo-controlled study was performed to evaluate the efficacy and safety of fenofibrate in patients with type IV or V hyperlipoproteinemia. One hundred forty-seven patients entered the study and all were stabilized on a low-fat diet. Following a placebo baseline period, patients were stratified according to plasma triglyceride (TG) levels (group A, 350-499 mg/dl; group B, 500-1,500 mg/dl) and randomly assigned to treatment with either 100 mg fenofibrate or one placebo capsule three times a day with meals. Demographically, the treatment groups were similar. A dramatic reduction in total TG levels occurred in the fenofibrate-treated patients but not in the placebo-treated patients. This effect was seen in both group A (46%) and group B (55%) patients and reached near-maximum reduction in only 2 weeks of treatment. In both groups, fenofibrate treatment also decreased very low-density lipoprotein (VLDL) TG, total cholesterol and VLDL cholesterol, and increased high-density lipoprotein levels. Adverse effects of fenofibrate were minimal compared with placebo and resolved when the drug was discontinued. Overall, fenofibrate was found to be effective in patients with type IV or V hyperlipoproteinemia, and caused no clinically significant adverse effects that would preclude its use in these patients.

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Tiprinast [(3,4-dihydro-5-methyl-6-(2-methylpropyl)-4-oxothieno[2,3-d]- pyrimidine-2-carboxylic acid] is a new antiallergy compound which shares many of the pharmacological actions of disodium cromoglycate (DSCG). Both compounds inhibit passive cutaneous anaphylaxis in the rat, histamine release from rat peritoneal mast cells and nasal constriction due to antigen in the rat. In all cases tiprinast is more potent than DSCG and also longer acting.

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A short series of the title compounds was prepared and evaluated for both antiallergic and bronchodilator activity. Members of the series exhibit good oral activity in the rat PCA test, the most potent being the parent compound, 3-(1H-tetrazol-5-yl)-4H-pyrimido[2,1-b]benzothiazol-4-one, and its 8-chloro derivative. The latter two compounds are considerably more potent than either disodium chromoglycate or theophylline as antiallergic agents and also show significant bronchodilator activity.

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The synthesis of a series of substituted 6,7-dihydroimidazo[1,2-a]purin-9(4H)-ones is described. Several members of the series exhibit enhanced antiallergic and bronchodilator activity and reduced side effects as compared to theophylline. Structure-activity relationships and metabolic considerations are discussed for the series. Analogues substituted with a 4-(4-chlorobenzyl) moiety, such as 33 and 40, shown an optimal balance of antiallergic and bronchodilator activity and are of particular interest. Compound 33 is significantly more potent than theophylline against both metacholine- and antigen-induced bronchospasms, does not affect spontaneous motor activity, and shows minimal cardiovascular effects in the rat.

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A series of novel 3,4-dihydro-4-oxothieno[2,3-d]pyrimidine-2-carboxylic acid derivatives has been prepared and tested for antiallergenic activity. Members of the series, including both carboxylic acid salts and esters, have been found to exhibit oral activity in the rat passive cutaneous anaphylaxis (PCA) test. Activity is optimized by H or CH3 substitution at the 5 position and lower alkyl groups at the 6 position. Ethyl 6-ethyl-3,4-dihydro-4-oxothieno-[2,3-d]pyrimidine-2-carboxylate and 3,4-dihydro-5-methyl-6-(2-methylpropyl)-4-oxothieno[2,3-d]pyrimidine-2-carboxylic acid dipotassium salt were the most potent of the esters and salts, respectively. Such compounds have been shown to have a duration of action of up to 4 h in the PCA test and to inhibit both histamine release from rat peritoneal mast cells in vitro and allergen-induced bronchospasm in the rat lung.

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d-Isoproterenol (ISO) applied topically to the rabbit eye specifically lowered intraocular pressure. Thus, it effectively reduced normal intraocular pressure and inhibited intraocular pressure elevation induced by water load without causing other obvious local or systemic pharmacologic effects. By comparison, dl-ISO was pharmacologically nonspecific in that amounts required to reduce intraocular pressure also produced significant and marked tachycardia. Furthermore, maximal intraocular pressure reduction was less with dl-than with d-ISO. Accordingly, and in consideration of reported clinical experience with dl-ISO in glaucomatous man, the d-isomer should be the preferred form of ISO for treating glaucoma. d-ISO should offer advantages over any other topical medication used currently in the treatment of this condition. Toxicity studies employing large, topical doses of drug in rabbit eyes showed that d-ISO was free from ocular irritation as well as systemic toxicologic effects and should be safe for controlled studies in man.

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