bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weight Gain Associated with Cinnarizine
Authors: Navarro-Badenes Joaquin , Martínez-Mir Inocencia , Palop Vicente , Rubio Elena , Morales-Olivas Francisco J. 
Published: January 2017

OBJECTIVE: To report four cases of cinnarizine-induced weight gain. DATA SOURCES: Case reports from a local obesity center and review articles. DATA EXTRACTION: Data were abstracted from spontaneous comments made by patients to one of the authors, who was a doctor at the clinic, and reviewed by the remaining authors. DATA SYNTHESIS: We reviewed the cases of four women, aged 50–57 years without endocrine or metabolic pathologies, that showed weight gain associated with the intake of cinnarizine for one to two years. No other drugs usually were administered during the period in which the women gained weight, although in two cases cinnarizine was associated with dihydroergocristine in the same medicine (Clinadil). The mean weight increase was 6.25 kg (range 4–10). The increases do not appear to be related to whether the patients' initial weight was ideal or excessive. The weight gain was always associated with increased appetite and food intake. One patient discontinued cinnarizine treatment and her weight returned to its previous level. CONCLUSIONS: Cinnarizine is a piperazine derivative used in the treatment of vertigo and in the prophylaxis of migraine. In contrast to related drugs, data about cinnarizine are scarce because randomized trials of cinnarizine have been inconclusive. Our observations indicate that cinnarizine may cause weight gain, as observed with other drugs in the same class.
A Description of a Pharmacotherapy Curriculum in a University-Based Family Medicine Program
Authors: Bucci Kathryn K. , Frey Keith A. 
Published: January 2017

OBJECTIVE: To describe the methods by which a family medicine residency program implements a pharmacotherapy curriculum. The goal of the curriculum is to teach family medicine residents the principles of rational drug therapy. SETTING: A university-based family medicine residency program. TEACHING STRATEGIES: Specific learning objectives are discussed and the following teaching strategies are expanded upon: (1) monthly noon conferences; (2) a printed formulary and pharmacotherapy handbook; (3) a pharmacy and therapeutics committee; (4) policy statements for drug representatives and use of samples; (5) an on-site pharmacy; (6) quarterly newsletter, and (7) inpatient consultation coverage. PHARMACIST ROLE: The role and responsibilities of the pharmacy faculty and pharmacist(s) who implement this curriculum and the methods used to evaluate its effectiveness are also described. The availability and funding of the pharmacy faculty member can sometimes be arranged with local schools of pharmacy seeking clerkship sites. Interaction with pharmacy students also serves to enhance the educational experience of the family medicine residents. CONCLUSIONS: The family medicine program implements a comprehensive curriculum designed to teach family medicine residents the principles of rational drug therapy. The curriculum may be expanded upon as necessary, or, if the entire program is not feasible, certain elements may be extracted and applied in other institutions.
Controversies in the Management of Mycobacterium Avium Complex Infection in AIDS Patients
Authors: Peloquin Charles A. 
Published: January 2017

OBJECTIVE: To update readers on the clinical management of infections secondary to Mycobacterium avium complex (MAC) in patients with AIDS. A general description of the organism, culture and susceptibility testing, and clinical manifestations of the disease is provided. Several aspects of the treatment of the disease, including an historical perspective, current approaches, and future research opportunities, are described. DATA SOURCES: Current medical literature, including abstracts presented at international meetings, is reviewed. References were identified through MEDLINE, Current Contents, and published meeting abstracts. STUDY SELECTION: Data regarding the epidemiology, clinical manifestations, culture and susceptibility testing, and treatment of MAC are cited. Specific attention is given to the management of patients with MAC infection. DATA EXTRACTION: Information contributing to the discussion of the topics selected by the author is reviewed. Data supporting and disputing specific conclusions are presented. DATA SYNTHESIS: Disseminated MAC infection is diagnosed antemortem in approximately 30 percent of patients with AIDS; postmortem rates of isolation exceed 50 percent. The incidence of MAC may increase as attempts at isolating the organism become more aggressive. The traditional approach to the isolation, susceptibility testing, and treatment of MAC has been derived from the management of Mycobacterium tuberculosis, with disappointing results. Newer radiometric in vitro methods of susceptibility testing appear to show more promise. Current mouse models of MAC are not true AIDS models; new CD4-deficient mouse models are being developed. Clinical mycobacteriologic and pharmacokinetic laboratory support have been underused, with treatment generally proceeding empirically. New agents that may contribute to the management of disseminated MAC infection include the macrolide derivatives clarithromycin and azithromycin. Research also continues with new rifamycins (including rifabutin) and fluoroquinolones (ciprofloxacin, sparfloxacin). Preliminary results suggest a central role for macrolides in the treatment of disseminated MAC; effective companion drugs are needed to prevent the rapid emergence of macrolide-resistant MAC. CONCLUSIONS: Treatment results for disseminated MAC infection remain poor. Therapy may be improved by selecting drugs on the basis of susceptibility data for each isolate, rather than by using empiric regimens based on susceptibility trends. Significant antimycobacterial drug malabsorption has been documented, and may contribute to poor outcomes. More-potent agents are needed to improve the clinical outcome in AIDS patients with MAC.
Fluvoxamine-Associated Sexual Dysfunction
Authors: Dorevitch Abraham , Davis Hillel 
Published: January 2017

OBJECTIVE: To report two cases of sexual dysfunction induced by fluvoxamine, a selective serotonin reuptake inhibitor (SSRI). SETTING: University teaching hospital. PATIENTS: Two depressed patients who developed ejaculation and orgasmic difficulties after initiation of fluvoxamine therapy. DISCUSSION: The literature concerning sexual dysfunction with serotonergic antidepressants is reviewed, and speculated mechanisms for this untoward effect are discussed. CONCLUSIONS: Sexual dysfunction associated with antidepressant drugs, including SSRIs, may be underreported. This troublesome adverse effect may significantly affect patient comfort and compliance. Careful evaluation of sexual function is warranted, prior to and during drug treatment, especially as more serotonergic antidepressant agents become available.
High-Dose Clonidine in a Case of Restless Legs Syndrome
Authors: Zoe Anette , Wagner Mary L. , Walters Arthur S. 
Published: January 2017

OBJECTIVE: To describe a patient with idiopathic restless legs syndrome (RLS). CASE SUMMARY: A 37-year-old man developed severe symptoms of RLS. Treatment using combinations of levodopa, opioids, benzodiazepines, and baclofen provided only partial benefit or resulted in intolerable adverse effects. Higher dosages of clonidine than previously reported in the literature (0.9 mg/d in divided doses) were needed to completely relieve his RLS symptoms. The only prominent adverse effect was dry mouth. The RLS symptoms returned after subsequent reductions in the dosage. After the dosage of clonidine was again increased, complete relief of the symptoms was achieved again. After several months, clonidine was tapered to zero and the patient entered a period of spontaneous remission. When his symptoms returned four months after clonidine had been discontinued, clonidine therapy was restarted. DISCUSSION: Clonidine alleviated RLS symptoms in 30 of 41 patients reported in the literature, indicating that the adrenergic nervous system may playa role in RLS. CONCLUSIONS: High-dose clonidine appears to be useful in treating RLS when other therapies fail. However, well-controlled, polysomnographic studies are needed.
Pleural Effusions: Pathophysiology and Management
Authors: Andrews Carlota O. , Gora Mary Lea 
Published: January 2017

OBJECTIVE: To review the pathophysiology and management of pleural effusions, including available agents for pleural sclerosis. DATA SOURCES: A MEDLINE search (1966 to present) was performed that included clinical studies in the English language involving the pathophysiology and management of pleural effusions; references used in those articles were screened for additional published information. STUDY SELECTION: All clinical trials were considered for potential inclusion in the review. DATA SYNTHESIS: Pleural effusion is an accumulation of fluid in the pleural space that results when homeostatic forces that control the flow into and out of the area are disrupted. The management of transudative pleural effusions is primarily directed at treatment of the underlying disease. There are several treatment options for pleural effusions, including chemical pleurodesis. Many of the trials that examine the use of talc, bleomycin, and doxycycline have poorly described study designs and end points, with inconsistent evaluation of patients. Each agent is considered to be generally effective and safe, with fever and pain as the most frequently reported adverse effects. The use of talc requires sterilization, and many clinicians use general anesthesia with instillation, which increases the risk associated with the procedure. Bleomycin is generally safe; however, it should not be used in doses exceeding 40 mg/m2. Only uncontrolled trials support the use of doxycycline; however, it provides an effective, safe, and relatively inexpensive alternative. CONCLUSIONS: Pleural effusions are defined as an accumulation of fluid in the pleural space. Treatment is generally palliative. Intrapleural administration of talc, bleomycin, and doxycycline are effective sclerosing agents for treatment of recurrent, symptomatic pleural effusions. Although the most cost-effective agent has not been determined, doxycycline is an inexpensive alternative to bleomycin, and may have fewer adverse effects than talc.
Amphotericin B-Associated Hypertension
Authors: Le Ysa , Rana Khurram Z , Dudley Michael N 
Published: January 2017

OBJECTIVE: To report two cases of hypertension related to amphotericin B infusion. CASE SUMMARY: A 63-year-old woman with Candida albicans bacteremia and an 84-year-old man with Aspergillus fumigatus pneumonia developed hypertension within minutes of amphotericin B administration. Both patients' blood pressure returned to baseline soon after the infusion of amphotericin B was stopped. Neither patient was rechallenged. DISCUSSION: A causal relationship may exist between the administration of amphotericin B and these hypertensive episodes. Blood pressure in both patients normalized without treatment on discontinuation of the infusion. The mechanism of amphotericin B-associated hypertension is unclear but could include vasoconstricting properties of the drug or the administration of intravenous NaCl 0.9% prior to amphotericin B infusion. We recommend that intravenous NaCl 0.9% be administered following amphotericin B infusion and that the infusion be stopped if hypertensive episodes arise. CONCLUSIONS: Both acute hypertension and hypotension can occur in patients receiving amphotericin B for systemic fungal infections. OBJETIVO: Reportar dos casos de hipertensión relacionados a la infusión de anfotericina B. RESUMEN DEL CASO: Una paciente de 63 años de edad con bacteremia debida a la Candida albicans y un paciente de 84 años de edad con neumonía debida al Aspergillus fumigatus desarrollaron hipertensión a los pocos minutos de comenzar la administración de anfotericina B. La presión sanguínea de ambos pacientes retornó a la línea de base tan pronto como se detuvo la infusión de anfortericina B. Ninguno de los dos pacientes fue reexpuesto a la anfotericina B para determinar si el evento se repeatía. DISCUSIÓN: Puede existir una relación causal entre la adminstración de anfotericina B y estos episodios de hipertensión reportados, ya que la presión sanguínea se normalizó en ambos pacientes sin necesidad de tratamiento adicional después de que se suspendió la infusión de anfotericina B. El mecanismo por el cual anfotericina está asociada al desarrollo de hipertensión no está claro pero se especula que se debe a las propiedades vasoconstrictoras del medicamento o a la administración de cloruro de sodio intravenosamente antes de comenzar la infusión de anfotericina B. Por consiguiente, los autores recomiendan que el cloruro de sodio sea administrado después de que se haya concluido la infusión de anfotericina B. En el caso de que se reporten episodios hipertensivos, la infusión de anfotericina B debería ser suspendida inmediatamente. CONCLUSIONES: Casos de hipertensión o hipotensión pueden ocurrir en pacientes que reciben anfotericina B para el tratamiento de infecciones fungosas sistémicas.
Dibenzepin Overdose Causing Pulmonary Edema
Authors: Wirtheim Eytan , Bloch Yuval 
Published: January 2017

OBJECTIVE: To report a case of pulmonary edema due to dibenzepin overdose. CASE SUMMARY: A 39-year-old woman was hospitalized 24 hours after she ingested eight tablets of dibenzepin hydrochloride delayed-release 240 mg/tablet (∼35 mg/kg body weight). On admission the patient was confused, and physical examination revealed sinus tachycardia (HR 130 beats/min). Forty-five hours after ingestion of the dibenzepin she developed pulmonary edema and was treated with furosemide, morphine, and mechanical ventilation through an endotracheal tube for 48 hours. Repeated echocardiography revealed left ventricular dysfunction that resolved as the medical condition of the patient improved. Appropriate studies excluded pneumonia, pneumonitis, adult respiratory distress syndrome, myocardial infarction, and pulmonary emboli as contributing factors to this patient's condition. DISCUSSION: Tricyclic antidepressant overdose is known to cause cardiopulmonary complications, including pulmonary edema. To the best of our knowledge, this is the first reported case of pulmonary edema as a result of dibenzepin overdose. The most probable mechanism for this complication is depression of left ventricular function. CONCLUSIONS: As with other tricyclic antidepressants, dibenzepin toxicity may cause pulmonary edema. Close patient monitoring is essential for at least 48-72 hours after the overdose.
Understanding Allergic Reactions to Local Anesthetics
Authors: Eggleston Steven T , Lush Lori W 
Published: January 2017

OBJECTIVE: To review the pharmacology and mechanisms by which local anesthetics cause allergic reactions. Recommendations concerning appropriate use of local anesthetics and alternative therapies in patients with documented local anesthetic allergies are given. DATA SOURCE: A MEDLINE search of the English-language literature identified pertinent clinical studies, case reports, and reviews. The periods of review were Med1, 1990-present; and Med2, 1985-1989, using the MeSH terms drug hypersensitivity and anesthetics. References from the selected studies, case reports, and reviews were reviewed. STUDY SELECTION: Controlled and uncontrolled prospective studies and case reports pertaining to local anesthetic allergies were reviewed. The selection focused on information pertaining to the etiology and diagnosis of allergic reactions to local anesthetics and alternative therapies for patients with local anesthetic allergies. DATA SYNTHESIS: Local anesthetics are classified as either ester or amide compounds. Esters are associated with a higher incidence of allergic reactions, due to a p-aminobenzoic acid (PABA) metabolite. Amide agents do not undergo such metabolism. However, preservative compounds (methylparaben) used in the preparation of amide-type agents are metabolized to PABA. Patients who are allergic to ester local anesthetics should be treated with a preservative-free amide local anesthetic. If the patient is not allergic to ester local anesthetics, these agents may be used in amide-sensitive patients. In the rare instance that hypersensitivity to both ester and amide local anesthetics occurs, or if skin testing cannot be performed, then alternative therapies including diphenhydramine, opioids, general analgesia, or hypnosis can be used. CONCLUSIONS: A true immunologic reaction to a local anesthetic is rare. Intradermal skin testing of local anesthetic compounds, methylparaben, and metabisulfite should be performed in patients when a thorough history does not rule out a possible allergic reaction to local anesthetics and future local anesthesia is necessary. Skin testing enables the clinician to identify autonomic responses to minor surgical procedures and toxic reactions to anesthetics so that patients are not incorrectly labeled as “caine” allergic. Diphenhydramine can be used as an alternative to ester and amide local anesthetics in minor procedures of short duration.
Inappropriate Medication Prescribing for the Elderly by Office-Based Physicians
Authors: Aparasu Rajender R. , Fliginger Shana E. 
Published: January 2017

OBJECTIVE: To estimate the prevalence of inappropriate medications prescribed by office-based physicians for patients 65 years or older. DESIGN: A nationwide cross-sectional survey of office visits by the elderly. SETTING: The National Ambulatory Medical Care Survey (NAMCS) 1992, a national probability sample survey of office visits by ambulatory patients within the continental US. SUBJECTS: A national probability sample of patients 65 years or older visiting office-based physicians. National estimates are based on the National Center for Health Statistics weighting procedure for the NAMCS sample. MAIN OUTCOME MEASURES: Prevalence of 20 inappropriate medications that should be entirely avoided in the elderly, using criteria developed by a panel of national experts in geriatric medicine and geriatric pharmacology. RESULTS: In the US during 1992, an estimated 8.47 million (95% CI 7.66 million to 9.28 million) office visits by the elderly indicated prescribing of at least 1 of the 20 inappropriate medications. Approximately 7.75 million (95% CI 6.98 million to 8.52 million) visits by the elderly involved 1 inappropriate medication and 0.72 million (95% CI 0.51 million to 0.93 million) visits included 2 inappropriate medications. According to the NAMCS, office-based physicians prescribed at least 1 inappropriate medication to 7.58% of the elderly who received prescriptions. The most frequently prescribed inappropriate medications were propoxyphene, amitriptyline, dipyridamole, diazepam, and chlorpropamide. Elderly patients rarely received prescriptions from office-based physicians for drugs such as secobarbital, isoxsuprine, trimethobenzamide, and carisoprodol. Furthermore, office-based physicians did not prescribe cyclandelate, pentobarbital, or phenylbutazone for the elderly. CONCLUSIONS: The prescribing of inappropriate medications by office-based physicians raises concerns regarding the quality of care for the elderly in ambulatory settings. The crux of improving patient care in ambulatory settings rests with collaborative efforts between physicians and pharmacists.
Fatal Cardiac Event following Initiation of Risperidone Therapy
Authors: Ravin Donna S. , Levenson James W. 
Published: January 2017

OBJECTIVE: To describe a patient who developed fatal pulseless electrical activity following treatment with risperidone. CASE SUMMARY: A 34-year-old white woman with no history of cardiac disease was initiated on risperidone therapy for an acute exacerbation of chronic schizophrenia. The patient developed postural hypotension and the risperidone dosage was held at 2 mg bid. On day 5 of risperidone therapy, the patient developed cardiac arrest and was treated for pulseless electrical activity. Her electrocardiogram revealed a prolonged QRS interval of 160 msec and an abnormal QTc interval of 480 msec. Despite resuscitative efforts, the patient became asystolic and was pronounced dead. DISCUSSION: Adverse cardiac events are rarely associated with risperidone therapy. Prolongation of the QRS and QTc intervals have been reported to occur following two cases of presumed risperidone overdose and also in 8 of 380 patients in a double-blind study reported by the manufacturer. Although other possibilities exist, risperidone cannot be ruled out as the cause of this patient's fatal episode of pulseless electrical activity. CONCLUSIONS: Prolongation of the QTc interval with severe adverse effects remains a possibility with the use of risperidone.
Hypothalamic Neuronal Histamine Modulates Febrile Response but Not Anorexia Induced by Lipopolysaccharide
Authors: Chiba Seiichi , Itateyama Emi , Oka Kyoko , Masaki Takayuki , Sakata Toshiie , Yoshimatsu Hironobu 
Published: January 2017

This study examined the contribution of hypothalamic neuronal histamine (HA) to the anorectic and febrlle responses induced by lipopolysaccharide (LPS), an exogenous pyrogen, and the endogenous pyrogens interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). Intraperitoneal (ip) Injection of LPS, IL-1β, or TNF-α suppressed 24-hr cumulative food intake and increased rectal temperature in rats. To analyze the histamlnergic contribution, rats were pre-treated with intracerebroventricular (icv) injection of 2.44 mmol/ kg or ip injection of 244 mmol/kg of α-fluoromethylhistidine (FMH), a suicide inhibitor of histidine decarboxylase (HDC), to deplete Neural HA. The depletion of neural HA augmented the febrile response to ip Injection of LPS and IL-1ß and alleviated the anorectic response to ip injection of IL-1ß. However, the depletion of neural HA did not modify the LPS-lnduced anorectic response or TNF-α-induced febrile and anorectic responses. Consistent with these results, the rate of hypothalamic HA turnover, assessed by the accumulation of tele-methylhistamine (t-MH), was elevated with ip injections of LPS and IL-1ß, but unaffected by TNF-α at equivalent doses. This suggests that (I) LPS and IL-1ß activate hypothalamic neural HA turnover; (II) hypothalamic neural HA suppresses the LPS- and IL-1β-induced febrile responses and accelerates the IL-1ß-induced anorectic response; and (iii) TNF-α modulates the febrile and anorectic responses via a neural HA-independent pathway. Therefore, hypothalamic neural HA is Involved in the IL-1ß-dominant pathway, rather than the TNF-α-dominant pathway, preceding the systemic Inflammatory response induced by exogenous pyrogens, such as LPS. Further research on this is needed.