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[CLINICAL GUIDELINES FOR DIAGNOSING, TREATING AND MONITORING OF ADULT PATIENTS WITH GLIOMAS OF CENTRAL NERVOUS SYSTEM]. - LijecÌ†nicÌ†ki vjesnik
Gliomas of the central nervous system are glial cell tumors that are divided in low and high grade group. Multidisciplinary approach to treatment consists of surgery, radiotherapy and chemotherapy. The type and order of treatment depend on the characteristics of the tumor and the patient. We present the clinical guidelines for diagnostic procedures, surgical treatment, oncological treatment and follow up of patients with this type of tumor in the Republic of Croatia.
Psychotropic medications in older adults: a review. - Psychiatria Danubina
Prevalence of prescribing psychotropic medications, particularly inappropriate prescription, is widespread in older adults, both in nursing home residents as well as community-dwelling older adults. This review describes prevalence and prevention of inappropriate prescribing and risk factors associated with psychotropic medications.MEDLINE and GOOGLE SCHOLAR data base were searched for the key words "older adults", "psychotropic drugs", "inappropriate prescribing", "nursing home residents", "community-dwelling older adults". The study was limited to the articles published in English in the period from 2007 to 2014. The list of references includes additional articles that were searched manually.The utilization of different psychotropic medications is prevalent among older adults worldwide, regardless of whether they live in nursing homes or in the community. Among older adults, nursing home residents are the most vulnerable individuals for potentially inappropriate drug prescription. The most common potentially inappropriate prescribed medications in the elderly are benzodiazepines, particularly long-acting, antipsychotics and antidepressants, particularly SSRIs. All classes of listed medications have been associated with different adverse events, particularly falls and falls-related fractures and increased risk for mortality. Many different pharmacological and non-pharmacological interventions, such as monitoring polypharmacy, reviewing medications, spending more time in the institution by a physician, reducing the number of prescribers in the institution as well as greater involvement of geriatricians, general practitioners and pharmacists should be implemented to reduce this health issue.The prevalence of prescribing psychotropic medications to older adults is high. Inappropriate prescribing of psychotropic drugs and polypharmacy are present in institutionalized and non-institutionalized older adults and can cause adverse health events, and can significantly reduce the quality of life of these vulnerable groups. Multidisciplinary approach is needed in addressing widespread problem of prevalence of psychotropic medications in older adults.
Randomized trial of acupoints herbal patching in Sanfu Days for asthma in clinical remission stage. - Clinical and translational medicine
Although China has a long history of using acupoints herbal patching (acupoints herbal patching means applying herbal patch on special acupoints to stimulate skin to form blisters, hyperemia, and even suppuration) in Sanfu Days (Sanfu Days are supposed to be the three hottest days in a year which is calculated by the ancient calendar) for the treatment of asthma, there is insufficient evidence to support its effectiveness and safety issues. This study investigated the efficacy and safety of acupoints herbal patching compared with placebo in participants with asthma in clinical remission stage.We enrolled participants with asthma in clinical remission stage, above 13Â years old and both genders in a randomized, double-blind and placebo-control trial at clinical center, School of Chinese Medicine, The University of Hong Kong to assess the effectiveness and safety of acupoints herbal patching, as compared with placebo, when added to guidelines-based therapy. The trial was conducted for three times (these three times were 19 July, 29 July and 8 August 2010), and the primary outcome was pulmonary function test. Secondary outcome was self-made questionnaire which were designed based on Traditional Chinese Medicine theory and clinical experience summary.Three hundred and twenty three eligible participants were enrolled, they were randomly assigned to acupoints herbal patching group (nÂ =Â 165), placebo control group (nÂ =Â 158). There was no significant difference in primary and secondary outcome as compared with placebo group at the end of 3rd treatment and four times follow ups. But sub-analysis of secondary outcome in four times follow ups showed that acupoints herbal patching significantly reduced the proportion of participants who didn't need medical treatment when they had a small rise in asthma-related symptoms increased from 6-15Â % at 1st follow up and 0-7Â % at 3rd follow up (PÂ <Â 0.05). It indicated that the proportion of participants who can spontaneous resolution of an asthma attack increased through acupoints herbal patching. In addition, acupoints herbal patching was significantly superior to placebo in reducing the percentage of participants who were susceptibly waken up by asthma symptoms from 27-14Â %, and the percentage of participants who had the symptom of running nose and sneezing before onset from 18-8Â % at 2nd follow up (PÂ <Â 0.05). Improvements also occurred with treatment group, it reduced the proportion of participants who were spontaneous sweating at 3rd follow up (PÂ <Â 0.05).There was no significant difference between acupoints herbal patching and placebo in pulmonary function test in this study. Self-made questionnaire showed that the lasting effect of acupoints herbal patching was significantly better than placebo in reducing the need for medications to control asthma and the proportion of susceptible symptoms in participants with asthma in clinical remission stage. It showed that the low quality of life caused by asthma-related symptoms was significantly improved through acupoints herbal patching in Sanfu Days. Besides, acupoints herbal patching was as safe as placebo for chronic stable asthma.HKUCTR-1128, Registration date 22 Jul 2010.
Factors associated to the use of insecticide treated nets and intermittent preventive treatment for malaria control during pregnancy in Cameroon. - Archives of public health = Archives belges de santeÌ publique
Malaria in pregnancy has been shown to cause both maternal and infant morbidity and mortality especially in sub Saharan Africa. The World Health Organization therefore recommends the use of insecticide treated nets (ITNs), intermittent preventive treatment (IPT) and effective management of clinical malaria. The main aim of this study was to assess the coverage of ITN and IPT among pregnant women and the factors associated with their use in the Buea Health District of Cameroon.A cross sectional study was carried out from April to July 2014, in the Buea Health District which included 292 pregnant women attending antenatal care at clinics in the area. A structured questionnaire was use to obtain demographic data of participants and information on IPT and ITN use.The Overall coverage rate of IPT was 88.7Â % and 43.8Â % for ITN while the overall non usage rate for IPT and ITN was 11.3Â % and 17.5Â % respectively. Occupation, educational level, trimester and number of ANC were statistically significant to ITN use by bivariate analyses while being a student/ unemployed (ORâ€‰=â€‰0.25, 95 % CIâ€‰=â€‰0.07-0.95)) was negatively associated to ITN use by multivariate analysis. For IPTp-SP, occupation of participants, educational level, trimester of pregnancy and number of ANC were statistically significantly by bivariate analyses while attending ANC just once (ORâ€‰=â€‰0.006, 95 % CIâ€‰=â€‰0.00-0.04) was negatively associated to IPTp-SP use by multivariate analyses.This study identified that the use of IPT was fairly good, while ITN use was still low despite their free distribution. Therefore, frequent antenatal care visits and involvement of participants in a potential income generating venture (Business or earning a salary) will increase IPT and ITN usage.
[First documented cases of systemic lupus erythematosus in Niger]. - La Tunisie meÌdicale
We describe in this first series of lupus documented in Niger, the epidemiological, diagnostic, therapeutic and prognostic aspects.This is a prospective study in internal medicine at the National Hospital of Niamey during 10 years. ACR criteria were used as diagnostic criteria.We identified only 9 cases with a frequency of 0.05 % (7 women, 2 men) with a mean age of 36.7 years [range, (26, 48)]. Frequent manifestations were prolonged fever (8 cases), malar rash (6 cases), arthritis (6 cases), alopecia (5 cases), discoid lupus (3 cases), haematological disorders (7 cases), serositis (4 cases) and renal failure (4 cases). All patients had at least 4 ACR criteria with an average of 6.11 criteria. ANA were positive in 8 patients with an average of 1/568, 68 [extremes (1/1280-1/160)]. The most commonly molecules used were Prednisone, Azathioprine and Hydroxychloroquine. The MycofÃ©nolate MofÃ©til, Cyclophosphamide and Rituximab were used in a single patient. The outcome was favorable in 8 patients and we deplore the death of one patient.Under diagnosis would be the basis of the low prevalence of lupus in Niger. Diagnostic means are necessary for epidemiological studies in order to have more representative data.
Tobacco alkaloids reduction by casings added/enzymatic hydrolysis treatments assessed through PLSR analysis. - Regulatory toxicology and pharmacology : RTP
Based on encouraged development of potential reduced-exposure products (PREPs) by the US Institute of Medicine, casings (glucose and peptides) added treatments (CAT) and enzymatic (protease and xylanase) hydrolysis treatments (EHT) were developed to study their effect on alkaloids reduction in tobacco and cigarette mainstream smoke (MS) and further investigate the correlation between sensory attributes and alkaloids. Results showed that the developed treatments reduced nicotine by 14.5% and 24.4% in tobacco and cigarette MS, respectively, indicating that both CAT and EHT are potentially effective for developing lower-risk cigarettes. Sensory and electronic nose analysis confirmed the significant influence of treatments on sensory and cigarette MS components. PLSR analysis demonstrated that tobacco alkaloids were positively correlated to the off-taste, irritation and impact attributes, and negatively correlated to the aroma and softness attributes. Additionally, nicotine and anabasine from tobacco leaves positively contributed to the impact attribute, while they negatively contributed to the aroma attribute (P<0.05). Meanwhile, most alkaloids in cigarette MS positively contributed to the impact and irritation attributes (P<0.05). Hence, this study paved a way to better understand the correlation between tobacco alkaloids and sensory attributes.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Application of Counter-propagation Artificial Neural Networks in Prediction of Topiramate Concentration in Patients with Epilepsy. - Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, SocieÌteÌ canadienne des sciences pharmaceutiques
The application of artificial neural networks in the pharmaceutical sciences is broad, ranging from drug discovery to clinical pharmacy. In this study, we explored the applicability of counter-propagation artificial neural networks (CPANNs), combined with genetic algorithm (GA) for prediction of topiramate (TPM) serum levels based on identified factors important for its prediction.The study was performed on 118 TPM measurements obtained from 78 adult epileptic patients. Patients were on stable TPM dosing regimen for at least 7 days; therefore, steady-state was assumed. TPM serum concentration was determined by high performance liquid chromatography with fluorescence detection. The influence of demographic, biochemical parameters and therapy characteristics of the patients on TPM levels were tested. Data analysis was performed by CPANNs. GA was used for optimal CPANN parameters, variable selection and adjustment of relative importance.Data for training included 88 measured TPM concentrations, while remaining were used for validation. Among all factors tested, TPM dose, renal function (eGFR) and carbamazepine dose significantly influenced TPM level and their relative importance were 0.7500, 0.2813, 0.0625, respectively. Relative error and root mean squared relative error (%) and their corresponding 95% confidence intervals for training set were 2.14 [(-2.41) - 6.70] and 21.5 [18.5 - 24.1]; and for test set were -6.21 [(-21.2) - 8.77] and 39.9 [31.7 - 46.7], respectively.Statistical parameters showed acceptable predictive performance. Results indicate the feasibility of CPANNs combined with GA to predict TPM concentrations and to adjust relative importance of identified variability factors in population of adult epileptic patients.
Investigation into the phenomena affecting the retention behavior of basic analytes in chaotropic chromatography: Joint effects of the most relevant chromatographic factors and analytes' molecular properties. - Journal of chromatography. A
The aim of this study was to systematically investigate the phenomena affecting the retention behavior of structurally diverse basic drugs in ion-interaction chromatographic systems with chaotropic additives. To this end, the influence of three factors was studied: pH value of the aqueous phase, concentration of sodium hexafluorophosphate, and content of acetonitrile in the mobile phase. Mobile phase pH was found to affect the thermodynamic equilibria in the studied system beyond its effects on the analytes' ionization state. Specifically, increasing pH from 2 to 4 led to longer retention times, even with analytes which remain completely protonated. An explanation for this phenomenon was sought by studying the adsorption behavior of acetonitrile and chaotropic additive onto stationary phase. It was shown that the magnitude of the developed surface potential, which significantly affects retention - increases with pH, and that this can be attributed to the larger surface excess of acetonitrile. To study how analytes' structural properties influence their retention, quantitative structure-retention modeling was performed next. A support vector machine regression model was developed, relating mobile phase constituents and structural descriptors with retention data. While the ETA_EtaP_B_RC and XlogP can be considered as molecular descriptors which describe factors affecting retention in any RP-HPLC system, TDB9p and RDF45p are molecular descriptors which account for spatial arrangement of polarizable atoms and they can clearly relate to analytes' behavior on the stationary phase surface, where the electrostatic potential develops. Complementarity of analytes' structure with that of the electric double layer can be seen as a key factor influencing their retention behavior. Structural diversity of analytes and good predictive capabilities over a range of experimental conditions make the established model a useful tool in predicting retention behavior in the studied chromatographic system.Copyright Â© 2015 Elsevier B.V. All rights reserved.
Theoretical Models and QSRR in Retention Modeling of Eight Aminopyridines. - Journal of chromatographic science
In this article, retention modeling of eight aminopyridines (synthesized and characterized at the Faculty of Pharmacy) in reversed-phase high performance liquid chromatography (RP-HPLC) was performed. No data related to their retention in the RP-HPLC system were found. Knowing that, it was recognized as very important to describe their retention behavior. The influences of pH of the mobile phase and the organic modifier content on the retention factors were investigated. Two theoretical models for the dependence of retention factor of organic modifier content were tested. Then, the most reliable and accurate prediction of log k was created, testing multiple linear regression model-quantitative structure-retention relationships (MLR-QSRR) and support vector regression machine-quantitative structure-retention relationships (SVM-QSRR). Initially, 400 descriptors were calculated, but four of them (POM, log D, M-SZX/RZX and m-RPCG) were included in the models. SVM-QSRR performed significantly better than the MLR model. Apart from aminopyridines, four structurally similar substances (indapamide, gliclazide, sulfamethoxazole and furosemide) were followed in the same chromatographic system. They were used as external validation set for the QSRR model (it performed well within its applicability domain, which was defined using a bounding box approach). After having described retention of eight aminopyridines with both theoretical and QSRR models, further investigations in this field can be conducted.Â© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country. - PloS one
A relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.We collected information on SES (education, employment status and household's relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index.According to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29-0.85 and b = 0.27; CI = 0.10-0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS.This study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.
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