bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged Thrombocytopenia Associated with Procainamide in an Elderly Patient
Authors: Landrum Elizabeth M. , Siegert Elisabeth A. , Hanlon Joseph T. , Currie Mark S. 
Published: January 2017

OBJECTIVE: To report a case of thrombocytopenia associated with the use of extended-release procainamide hydrochloride in a geriatric patient. CASE SUMMARY: A 77-year-old man was admitted to the hospital for four-vessel coronary artery bypass surgery. He subsequently developed new onset atrial fibrillation and was started on extended-release procainamide on hospital day 7. The patient's platelet count on admission was 229 times 109/L. The platelet count began to decrease on hospital day 22 and was 79 times 109/L by day 30 and 13 times 109/L by hospital day 37. The patient exhibited gross hematuria and lower extremity petechiae. There were no signs of splenic sequestration and other hematologic indices were normal. Procainamide was discontinued on hospital day 32. There was full recovery of the platelet count to baseline 33 days after procainamide was discontinued. DISCUSSION: Other possible medical and drug-related causes of thrombocytopenia are reviewed and ruled out. Previous reports of procainamide-associated thrombocytopenia describe an immune-mediated peripheral destruction of platelets with platelet recovery within three to eight days after drug discontinuation. However, the prolonged recovery period and the presence of antiplatelet antibodies suggest an immune-mediated process in the bone marrow of this patient. CONCLUSIONS: Clinicians should be aware of the possible adverse hematologic effects of procainamide in the elderly.
Stability of Cisapride in a Liquid Dosage form at Two Temperatures
Authors: Nahata Milap C. , Morosco Richard S. , Hippie Thomas F. 
Published: January 2017

Objective: To determine the stability of cisapride in a liquid dosage form stored in plastic bottles at 2 temperatures. Design: Cisapride tablets were used to prepare a suspension in equal volumes of methylcellulose 1% and simple syrup to yield a concentration of 1 mg/mL. The cisapride suspension was stored in 10 amber plastic prescription bottles. Five bottles were stored at room temperature (25 ± 0.1 °C) and 5 under refrigeration (4 °C). Samples were drawn from each bottle immediately after mixing (day 0), and at 7, 14, 28, 42, 56, 70, and 91 days of storage at each temperature. All samples were analyzed in duplicate on each day of analysis. Cisapride was measured by a stability-indicating HPLC method. Results: The mean concentration of cisapride exceeded 90% of its initial concentration throughout the 91-day study period at 4 °C, but only during the first 28 days at 25 °C. No significant change in pH was observed during the study period. Conclusions: Cisapride was stable in a suspension for 91 days at 4 °C and 28 days at 25 °C in amber plastic prescription bottles.
Lamotrigine: an Anhepileptic Agent for the Treatment of Partial Seizures
Authors: Gilman Jamie T. 
Published: January 2017

Objective: To review the current literature on lamotrigine and its use as an antiepileptic drug (AED). Data Sources: MEDLINE and bibliographic literature searches pertaining to lamotrigine were performed. Additionally, Burroughs Wellcome provided a comprehensive bibliography, data on file, and investigator's brochure. Data Selection: The selection of reported data for this review includes both controlled and uncontrolled studies as well as case reports and unreported data from both European and US trials. Data Synthesis: Lamotrigine is effective as an adjunctive agent in the treatment of complex and simple partial seizures with or without secondary generalization. Anecdotal reports suggest that the spectrum of activity may include other seizure types, but controlled studies substantiating these reports are needed. Lamotrigine has a favorable pharmacokinetic profile, including a long half-life, low serum protein binding, and lack of mixed-function oxidase enzyme induction. It is likely that the drug induces metabolism through the glucuronidation pathway, although probably not to a clinically significant extent. Concurrent use of enzyme-inducing AEDs increase lamotrigine's clearance, whereas valproic acid decreases it. Adverse effects are primarily central nervous system-related, with dizziness, diplopia, ataxia, and somnolence reported in at least 10% of the patients treated. The incidence of these effects is higher in patients treated concomitantly with carbamazepine and may represent a pharmacodynamic interaction. The occurrence of rash may limit lamotrigine's use and was the most common cause for discontinuation in clinical trials (2.3%). The incidence of rash is higher in patients comedicated with valproic acid. Conclusions: Lamotrigine appears to be a safe and effective new AED for patients with refractory partial seizures when used as an adjunctive agent. It has a favorable pharmacokinetic profile allowing for once- or twice-daily dosing and adverse effects appear mild and transient. Additional studies are required to confirm efficacy in other seizure types.
Fatal Hepatotoxicity Following Oral Administration of Amiodarone
Authors: Richer Monique , Robert Sylvie 
Published: January 2017

Objective: To report a case of fatal hepatotoxicity associated with the chronic use of oral amiodarone. Case Summary: Long-term administration of amiodarone for the control of intractable ventricular tachycardia was associated with fatal hepatotoxicity in a patient receiving amiodarone for 14 months. Discussion: Although most hepatic adverse effects associated with amiodarone are transient and reversible with time, deaths resulting from amiodarone-induced hepatotoxicity have been reported. The relation of hepatotoxicity to cumulative dose and duration of therapy is debated. The histopathologic features of amiodarone-induced hepatotoxicity include Mallory bodies, steatosis, intralobular inflammatory infiltrates, fibrosis, and phospholipidosis. Conclusions: Evidence pertaining to both mild and severe amiodarone toxicity indicates that cumulative dose may correlate with overall toxicity and, therefore, maintenance doses should be kept as low as possible. Patients should be followed with monitoring of liver function test results every 3–6 months.
Rebound of Plasma Free Phenytoin Concentration Following Plasmapheresis in a Patient with Thrombotic Thrombocytopenic Purpura
Authors: Mansur Lisa I , Murrow Richard W , Garrelts James C , Minns Garold O 
Published: January 2017

Objective: To measure the total and free serum phenytoin concentrations and phenytoin clearance in a patient with thrombotic thrombocytopenic purpura undergoing plasmapheresis. Case Summary: A dose of phenytoin 400 mg iv was administered daily 2.5 hours after the completion of plasmapheresis. Intravenous samples were obtained to measure the free and total phenytoin concentrations on 4 consecutive days. These samples were obtained before, at the midpoint, upon completion, and 30, 60, and 120 minutes after completion of plasmapheresis. The samples were centrifuged and stored at 4 °C until analysis using the same fluorescence polarization immunoassay kit. The free phenytoin was separated by ultracentrifugation. Discussion: Despite a decrease in total and free serum phenytoin concentrations measured during the procedure, a marked rebound in the free phenytoin concentration was noted 30 minutes after completion of the procedure. However, by 120 minutes after the procedure, the free phenytoin concentration had decreased to the preprocedure value. The total amount of phenytoin removed by the procedure was less than 5%. Conclusions: Despite the decrease in total and free serum phenytoin concentrations observed during plasmapheresis, patients undergoing plasmapheresis may not need supplemental phenytoin, as a rapid reequilibration of the therapeutically active free serum phenytoin occurs following the completion of the procedure. In addition, less than 5% of the total body phenytoin is removed. Second, if the patient experiences symptoms of phenytoin toxicity immediately after the procedure, a free serum phenytoin concentration may be obtained, as this concentration may reflect the reason for toxicity despite a decreased total phenytoin concentration.
Eosinophilia Associated with Bupropion
Authors: Malesker Mark A , Soori Gamini S , Malone Patrick M , Mahowald James A , Housel Glenda J 
Published: January 2017

Objective: To describe the first incidence of eosinophilia following administration of bupropion. Case Summary: The patient was a 72-year-old woman admitted for evaluation of chest pain. During hospitalization, the eosinophil count reached 0.60 fraction of 1.00, with absolute eosinophil count of 6693 × 109/L and a white blood cell count of 18.5 × 109/L. She had been receiving bupropion therapy for 5 days prior to this admission. Discussion: Potential causes of the eosinophilia, including disease states and medications, were reviewed comprehensively and ruled out. A review of the literature (MEDLINE 1966—1994) did not identify previous cases of eosinophilia associated with bupropion therapy. Causes of eosinophilia include parasitic infections, allergic diseases, and medication use. A proposed mechanism for the occurrence of eosinophilia in this patient is unknown. Conclusions: Considering the temporal sequence of events, drugs administered prior to the development of eosinophilia, and the rapid decline of the eosinophil count following discontinuation of the medication, bupropion appears to be the precipitating agent.
Application of International Consensus Meeting Criteria for Classifying Drug-Induced Liver Disorders
Authors: Bussières Jean-Francois , Habra Magdi 
Published: January 2017

Objective: To report a patient with 2 consecutive reversible drug-induced liver disorders and the application of International Consensus Meeting Criteria for the screening and diagnosis of drug-induced liver disorders. Case Summary: An 88-year-old man in a chronic care institution developed abdominal discomfort and jaundice after finishing a 10-day course of trimethoprim/sulfamethoxazole therapy for a urinary tract infection (UTI). The jaundice and the symptoms resolved spontaneously and the final diagnosis was symptomatic drug-induced liver injury, mixed type. After 1 month, the same patient received a course of cefadroxil therapy for another UTI. He developed an asymptomatic drug-induced liver injury, mixed type. Six months later, the patient received oral penicillin therapy and then ciprofloxacin, with no change in his liver function test results. Discussion: To our knowledge, there are only a few other reports in the literature of a drug-induced liver injury with Cefadroxil therapy; more cases are reported with trimethoprim/sulfamethoxazole than with cefadroxil. The criteria of an International Consensus Meeting were helpful to evaluate both incidences of liver injury in this patient with the aim of establishing the diagnosis and causality assessment. Additionally, the criteria were used to show that the patient had 2 separate liver injuries. Conclusions: Screening and diagnosis of drug-induced liver disorders depend on careful history taking and 5 specific biochemical liver tests. The evolution of the liver disorder induced by Cefadroxil therapy probably was interrupted because of its early detection. Appropriate screening was done with the subsequent administration of new potentially hepatotoxic drugs.
Approaches to The Treatment of Hyperlipidemia in the Solid Organ Transplant Recipient
Authors: Kirk Julienne K , Dupuis Robert E 
Published: January 2017

Objective: To review the literature investigating increased lipid concentrations in transplant recipients and the use of lipid-lowering agents in this population. Data Sources: Relevant articles were identified from a MEDLINE search using the terms transplantation, hyperlipidemia, immunosuppression, and therapy including diet, gemfibrozil, bile acid sequestrants, nicotinic acid, probucol, and hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. Selected literature, including controlled studies, was used in this review. Study Selection: Articles published since 1970 pertaining to hyperlipidemia in solid organ transplant recipients. Emphasis was placed on clinical trials that investigated approaches to the treatment of hyperlipidemia in transplant recipients. Data Extraction: Original articles and reviews were obtained to select material pertinent to the objectives. Data Synthesis: Descriptions of lipid concentrations in the transplant patient and treatment approaches used, including potential complications, were reviewed. Conclusions: Hyperlipidemia is an important risk factor for coronary heart disease in the solid organ transplant patient. Treatment alternatives include diet modification and, in most cases, pharmacologic intervention that should be based on the type of hyperlipidemia. The HMG-CoA reductase inhibitors are effective agents in the treatment of hyperlipidemia in the transplant recipient and generally are used as single therapy in low dosages to minimize the risk of myositis or rhabdomyolysis.
Administration of Lipid-Emulsion Versus Conventional Amphotericin B in Patients with Neutropenia
Authors: Pascual Begoña , Ayestaran Ana , Montoro José B , Oliveras Juan , Estibalez Antero , Julia Antoni , Lopez Andres 
Published: January 2017

Objective: To evaluate the usefulness of a 20% lipid emulsion as a delivery system for amphotericin B (1 mg/mL) administered over 1 hour to patients with neutropenia with hematologic malignancies compared with amphotericin B (0.1 mg/mL) administered in dextrose 5% solution over the same time. Design: A prospective, comparative, randomized, labeled study. Setting: Hematology unit, pharmacy service, university general hospital. Participants: Twenty patients with neutropenia with hematologic malignancies and proven or suspected fungal infections, 10 in the fat emulsion group (group 1) and 10 in the dextrose 5% group (group 2). Main Outcome Measures: Clinical tolerance (i.e., fever, shaking chills, nausea, blood pressure, pulse rate) and biologic tolerance (i.e., urea, creatinine, sodium, potassium). Results: Clinical tolerance was comparable in both groups although amphotericin B in fat emulsion was better tolerated. Medication for symptoms related to the administration of amphotericin B was given in 6 cases in group 1 and in 8 cases in group 2. There was a statistically significant difference in the urea concentrations between the 2 groups (p = 0.023); there was an observed increase between the initial and the final serum urea (56.8 mg/d in group 1, 79.8 mg/dL in group 2). Statistically significant differences in creatinine serum concentrations (84.9 μmol/L in group 1, 123.8 μmol/L in group 2) (p = 0.047) were found. No differences were found in the antifungal efficacy of the treatment. However, as amphotericin B was started in the majority of cases (75%) as empiric treatment for fever unresponsive to antibiotic therapy, it is difficult to compare the efficacy of both preparations. Conclusions: The clinical tolerance of lipid-emulsion infusions is similar to that of conventionally administered amphotericin B therapy. Renal toxicity appears to be decreased when the drug is administered in a fat emulsion. This type of preparation permits the reduction of the volume and the time of administration for amphotericin B therapy.
Ifosfamide-Induced Nonconvulsive Status Epilepticus
Authors: Bhardwaj Ashwani , Badesha Pritam S 
Published: January 2017

Objective: To describe a patient with ifosfamide-induced nonconvulsive status epilepticus. Case Summary: A 71-year-old woman with a history of malignant mixed mesodermal tumor involving the uterus, cervix, and vagina was admitted because of local recurrence. After receiving 3 doses of ifosfamide/mesna, she was found to be unresponsive. Physical examination and laboratory data revealed no significant changes. An electroencephalogram was consistent with the diagnosis of nonconvulsive status epilepticus. The patient's mental status returned to baseline after treatment with intravenous phenytoin and discontinuation of ifosfamide therapy. Discussion: Central nervous system (CNS) toxicity has been described with ifosfamide, with most cases reported in the pediatric population. Among CNS toxicities, generalized tonic-clonic seizures have been reported in both children and adults. This represents the first report of nonconvulsive status epilepticus induced by ifosfamide. Conclusions: There was a temporal relationship between the onset of nonconvulsive status epilepticus and initiation of ifosfamide infusion. No other identifiable factor contributed to the unresponsiveness.
Comparative Role of Omeprazole in The Treatment of Gastroesophageal Reflux Disease
Authors: Skoutakis Vasilios A , Joe Ronald H , Hara Dimitri S 
Published: January 2017

Objective: To review gastroesophageal reflux disease (GERD) and its treatment, with emphasis on the use and place of omeprazole, a proton pump inhibitor. Data Sources: A compilation prepared by the National Library of Medicine's Interactive Retrieval Services (Medlars II) for the period 1987 to 1994 was used as the data source. Study Selection: Focus was placed on human comparative clinical studies with well-accepted measures of esophageal healing (endoscopy) and symptom resolution. Safety data were compiled from the clinical trials literature and large postmarketing data studies. Pharmacoeconomic studies selected were judged to meet the criteria of good design, presence of sensitivity testing, and statement of perspective. Data Extraction: Data were obtained from double-blind, controlled clinical studies. Other data were extracted from pertinent literature of good design and significant results. Data Synthesis: Overall, the clinical trials of omeprazole for the treatment of patients with erosive GERD demonstrate that omeprazole provides superior therapy in terms of esophageal healing symptom resolution and patient compliance when compared with histamine2-receptor antagonists (H2RAs) and antacids. In addition, studies also indicate that omeprazole is the most effective agent for the treatment of patients with GERD refractory to other treatments. Dosage adjustment is not necessary in patients with impaired renal or hepatic function or in the elderly. Finally, although the acquisition drug cost for daily treatment of patients with GERD is highest with the use of omeprazole, pharmacoeconomic studies indicate that treatment is more cost-effective with the use of omeprazole than with H2RA or antacid treatment alone or combined with nonpharmacologic approaches. Conclusions: Based on efficacy, safety, and cost-effectiveness, omeprazole is the drug of choice for the treatment of patients with endoscopically confirmed erosive GERD.
Anaphylactic Shock following Povidone
Authors: Garijo Ma Angeles Gonzalo , Quintana José A Durán , González Pedro Bobadilla , Asuero Pilar Máiquez 
Published: January 2017

OBJECTIVE: To report a patient with an anaphylactic reaction related to povidone administration. CASE SUMMARY: A 37-year-old man with a history of allergic rhinitis presented with urticaria, dyspnea, wheezing, rhinorrhea, and dysphonia 20 minutes after the intraarticular administration of mepivacaine hydrochloride and paramethasone acetate in his right knee. Two months after this episode, he was admitted for controlled provocation tests. Tests on mepivacaine were negative. The preparation of paramethasone contained the excipients benzalkonium chloride, polysorbate 80, and povidone. In vitro tests and provocation were negative with polysorbate 80 and benzalkonium chloride, but positive with povidone. DISCUSSION: Povidone, a mixture of synthetic polymers, is commonly used as an excipient in pharmaceutical products, an additive in food products, and a dispersant and stabilizer in hairsprays. Although it is well tolerated when used topically or parenterally, local and systemic effects have been reported. Furthermore, multiorgan involvement resulting from accumulation of the drug in the reticuloendothelial system has been described. The immunologic properties of povidone have not been explored in humans, but have been in animals. In fact, the capacity of povidone to release histamine and its immunogenicity are proportional to its molecular weight. An immunoglobulin (Ig) E-mediated hypersensitivity reaction in asthma has been reported. In our case, povidone was responsible for the syndrome. However, we cannot determine the exact mechanism. An unspecific histamine release and/or an IgE-mediated hypersensitivity could be involved. CONCLUSIONS: Povidone was responsible for a severe anaphylactic reaction in our patient. The possibility of an iatrogenic adverse effect caused by the excipient but not by the active ingredient should be considered in patients exhibiting similar symptoms. We believe that the excipients used in the preparation of all medicines should be disclosed.
Immune-Based Therapies for Treatment of HIV Infection
Authors: Piscitelli Stephen C , Minor James R , Saville M Wayne , Davey Richard T 
Published: January 2017

OBJECTIVE: To review the in vitro, animal, and clinical data on immune-based therapies for treatment of HIV infection. DATA SOURCES: An extensive MEDLINE search was performed for interleukins, interferons, immunotoxins, tumor necrosis factor (TNF)-directed agents, vaccines, and gene therapy. STUDY SELECTION: In vitro experiments with immune-based agents in cell lines infected with HIV were included. In addition, all human studies and case reports that used these agents in patients infected with HIV were selected. Additional literature included abstracts from international meetings on HIV and AIDS. DATA EXTRACTION: Data regarding activity, efficacy, and toxicity were extracted from in vitro and in vivo studies. When conflicting data were observed, both viewpoints were stated to give an unbiased analysis. Because HIV research involves multiple social, ethical, and scientific issues, perspectives on these problems were addressed, where appropriate. DATA SYNTHESIS: Current antiretroviral therapy is limited to shortterm responses and has minimal effect on overall survival. Because the human immune response to HIV infection is effective at keeping the virus suppressed for a number of years, a focus of HIV research has been to examine immune-based therapies for treatment of HIV infection that attempt to augment, enhance, or boost the patient's immune system. Interleukins, interferons, immunotoxins, TNF-directed therapies, vaccines, and gene therapy have been studied in patients infected with HIV. Properties shared among these therapeutic modalities include adverse effect profiles, response rates dependent on baseline immunocompetence, the potential to activate viral replication, the need for supportive care, and sensitive laboratory tests required for monitoring. CONCLUSIONS: Immune-based agents represent a new approach to the treatment of HIV infection. Whereas antiretrovirals only inhibit viral replication, these agents are designed to enhance the immune system of the patient. Future attempts to manage HIV infection may combine standard nucleoside analogs with immune-based therapies.