bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparin-Induced Thrombotic Thrombocytopenia
Authors: Phillips David E. , Payne D. Keith , Mills Glenn M. 
Published: January 2017

OBJECTIVE: To report a case of heparin-induced thrombotic thrombocytopenia (HITTS) and discuss the incidence, possible mechanisms, complications, and treatment for this syndrome. DATA SOURCES: Case reports and review articles identified by MEDLINE from 1980 through 1991. Older articles located by manual searches. DATA EXTRACTION: Data were extracted and reviewed from published sources. Cases were selected on the basis of case presentation, time of disease onset, pathophysiology of disease, and therapeutic options. SETTING: A 600-bed university teaching hospital and an affiliated community hospital. PATIENT: A 36-year-old woman with insulin-dependent diabetes mellitus, sepsis, adult respiratory distress syndrome, diabetic ketoacidosis, oliguric renal failure developed HITTS and subsequent gangrene of her right arm. INTERVENTION: Immediate cessation of all heparin use and amputation of the patient's right arm. RESULTS: The patient's condition improved progressively over the following 60 days and she was discharged to outpatient care. CONCLUSIONS: Heparin has been associated with thrombocytopenia and thrombotic events. Laboratory tests for HITTS are unreliable and the diagnosis is usually suspected by the clinical presentation of the patient. Platelet counts should be monitored closely during heparin use. In the event of a marked decrease in platelet count associated with venous or arterial thrombosis, heparin therapy should be stopped immediately. If further anticoagulation is necessary, oral anticoagulants such as warfarin may be used instead. As the onset of warfarin may take several days to become therapeutic, aspirin, dipyridamole, or both may be used effectively. Healthcare workers should be aware that in these patients, the use of even small amounts of heparin can produce catastrophic results.
Probable Pentamidine-Induced Acute Pancreatitis
Authors: Sauleda Jaume , Gea Joaquim G. , Aguar M Carmen , Aran Xavier , Pastó Meritxell , Broquetas Joan M 
Published: January 2017

OBJECTIVE: To report a case of probable pentamidine-induced acute pancreatitis. CASE SUMMARY: A patient was hospitalized because of fever, dyspnea, and productive cough. Chest X-ray revealed diffuse alveolar infiltrates, and the examination of bronchoalveolar lavage demonstrated the presence of Pneumocystis carinii. Intravenous cotrimoxazole was administered but the patient's condition did not improve. As secondary leukopenia appeared, the treatment was changed to pentamidine isethionate 4 mg/kg/d iv. On day 5 of this new therapy, the patient experienced abdominal pain, and both blood and urine amylase concentrations raised to 330 U/L and 3960 U/L, respectively. The patient died 48 hours later, and signs of acute pancreatitis were observed in necropsy. DISCUSSION: With reference to a classical method for estimating the probability of adverse drug reactions, a probable relationship between pentamidine therapy and acute pancreatitis was found in this patient. Furthermore, no alternative causes of pancreatitis were present. CONCLUSIONS: It is likely that pentamidine administration in our patient resulted in an acute episode of pancreatitis. Serum and urine amylase concentrations should be monitored in patients receiving this drug.
Reassessment of Measuring Total Iron Binding Capacity in Acute Iron Overdose
Authors: Raebel Marsha A. 
Published: January 2017

OBJECTIVE: To evaluate recent data that suggest that total iron binding capacity (TIBC) is not a reliable laboratory parameter in assessing acute iron overdose. DATA SOURCES: A MEDLINE search of the literature with a fan search of relevant articles. STUDY SELECTION AND DATA EXTRACTION: Laboratory, human, and animal studies on the measurement and relevance of TIBC in acute iron poisoning were reviewed. These data were analyzed in light of the current guidelines for use of TIBC in assessing iron poisoning. DATA SYNTHESIS: There are significant data to suggest that the sensitivity of TIBC in acute iron poisoning is unacceptable. This lack of sensitivity is also reflected in the poor positive predictive value of TIBC. The specificity and negative predictive value are higher but not without error. One survey of 500 laboratories reported a coefficient of variation for TIBC of 16 percent (95 percent confidence interval), suggesting unacceptable accuracy. CONCLUSIONS: These data suggest that TIBC may not be a reliable laboratory parameter in assessing acute iron poisoning. Studies are needed to develop a reliable analytical procedure for TIBC and to correlate TIBC with clinical outcomes in acute iron poisonings.
Doesciprofloxacin Interact with Cyclosporine?
Authors: Hoey Lori L. , Lake Kathleen D. 
Published: January 2017

OBJECTIVE: To provide the reader with a review of the literature that evaluates whether a pharmacokinetic or pharmacodynamic drug interaction exists between ciprofloxacin and cyclosporine. DATA SOURCES: A MEDLINE search was used to identify pertinent review articles, pharmacokinetic studies, and case reports. STUDY SELECTION: As both pharmacokinetic trials and case reports were few in number, all available sources were reviewed. DATA EXTRACTION: A few case reports were reviewed; however, data were extracted primarily from prospective human studies involving cyclosporine pharmacokinetic profiles. DATA SYNTHESIS: Ciprofloxacin has been reported to interact with cyclosporine during concomitant use through an interaction with the cytochrome P-450 system or by additive nephrotoxicity. Because ciprofloxacin may be used to treat a variety of infections in transplant recipients who receive cyclosporine, it is important to determine whether an interaction exists. Although cyclosporine is known to cause nephrotoxicity, only a few reports of ciprofloxacin-induced acute renal failure exist, all involving an immune-mediated interstitial nephritis. Four case reports have suggested a possible pharmacokinetic or pharmacodynamic drug interaction between cyclosporine and ciprofloxacin; however, many pharmacokinetic studies have refuted these reports. Several studies performing cyclosporine pharmacokinetic profiles have documented no increased cyclosporine concentrations, thus supporting the premise that ciprofloxacin does not interact with cyclosporine. CONCLUSIONS: Controlled studies involving cyclosporine pharmacokinetic profiles do not support a pharmacokinetic or pharmacodynamic drug interaction between ciprofloxacin and cyclosporine. Although anecdotal case reports have suggested synergistic nephrotoxicity, no clear correlation can be made. Based on our review of the literature, it can be concluded that cyclosporine and ciprofloxacin may be used together safely at the recommended dosages without increased cyclosporine monitoring.
Stability of Ceftazidime and Vancomycin Alone and in Combination in Heparinized and Nonheparinized Peritoneal Dialysis Solution
Authors: Vaughan Leigh M. , Poon Cathy Y. 
Published: January 2017

OBJECTIVE: To examine the stability of ceftazidime, vancomycin, and heparin, alone and in combination, in dialysis solution over six days at three temperatures. DESIGN: Nine 250-mL Dianeal PD-2 dextrose 1.5% bags were prepared with ceftazidime, vancomycin, and heparin alone and in combination at set concentrations of 100 μg/mL, 50 μg/mL, and 1 unit/mL, respectively. Three bags of each mixture were stored at 4, 25, and 37°C. Duplicate samples for analysis were removed from each bag at the following time points: premix, 0, 12, 24, 48, 72, 96, 120, and 144 hours. MAIN OURCOME MEASURES: Each sample was examined visually for signs of cloudiness and precipitation. Each sample was analyzed by stability-indicating HPLC assay for ceftazidime and vancomycin, with stability defined as less than 10 percent degradation of drug overtime. RESULTS: No color change or precipitation was observed in any bag. Vancomycin with or without heparin was stable for 5–6 days at 4, 25, and 37°C. Ceftazidime with and without heparin was stable for 6 days at 4°C, 4 days at 25°C, and less than 12 hours at 37 °C. Vancomycin plus ceftazidime with and without heparin was stable for 6 days at 4 °C and 25°C, and 4–5 days at 37 °C, Ceftazidime plus vancomycin with or without heparin was stable for 6 days at 4°C, 2–3 days at 25°C, and 12 hours at 37 °C. CONCLUSIONS: Bulk preparations of ceftazidime and vancomycin, alone and in combination and with or without heparin in Dianeal PD dextrose 1.5% solution, are sufficiently stable for use up to 6 days under refrigeration or 48 hours at room temperature.
Possible Red-Man Syndrome Associated with Systemic Absorption of Oral Vancomycin in a Child with Normal Renal Function
Authors: Bergeron Luc , Boucher François D. 
Published: January 2017

OBJECTIVE: To report possible red-man syndrome (RMS) associated with oral administration of vancomycin. CASE SUMMARY: A 23-month-old child with acute myeloblastic leukemia developed symptoms compatible with RMS while receiving oral vancomycin for suspected Clostridium difficile colitis. Serum concentrations of vancomycin, measured at the time of the clinical episode, demonstrated significant oral absorption of the drug. Serum concentrations of vancomycin decreased later, implying a possible decrease in absorption, after the patient's neutrophil count returned to normal. The child later experienced another clinical episode compatible with RMS while vancomycin was being administered intravenously for suspected sepsis. DISCUSSION: There is no published report of RMS following oral administration of vancomycin. The reaction described took place while the child was neutropenic. Because of the absence of any significant renal function alteration that could explain the importance of the serum concentrations observed, we assume that C. difficile, neutropenia-, and chemotherapy-associated colitis may have resulted in extensive intestinal lesions, leading to an increased amount of vancomycin being systemically absorbed. This increased absorption during profound neutropenia may have been sufficient to exceed a purported threshold, leading to RMS. CONCLUSIONS: This case demonstrates that significant absorption of vancomycin may occur in neutropenic patients with normal renal function, and that it may be accompanied by RMS, usually associated with rapid infusions or large parenteral doses of the drug.
Acyclovir Excretion in Human Breast Milk
Authors: Taddio Anna , Klein Julia , Koren Gideon 
Published: January 2017

OBJECTIVE: To measure acyclovir concentrations in the breast milk of a lactating woman using the drug for herpes zoster while nursing her 7-month-old infant. METHODS: The maternal dosage of acyclovir was 800 mg five times daily for seven days. Three random breast milk samples collected on the fifth and sixth days of therapy were analyzed for acyclovir concentrations with radioimmunoassay (RIA). RESULTS: Acyclovir concentrations in breast milk ranged from 18.5 μmol (4.16 μg/mL) to 25.8 μmol (5.81 μg/mL). An estimate of the infant's dosage ingested through nursing was 0.73 mg/kg/d, or approximately 1 percent of the maternal dose in milligrams/kilograms/day. The baby was nursed without any signs of adverse effects. CONCLUSIONS: Acyclovir was measured in clinically insignificant concentrations in the milk of a woman receiving large dosages for herpes zoster. Breast feeding continued without adverse effects to the nursing infant.
Pleural Effusion Associated with Chronic Dantrolene Administration
Authors: Mahoney Janelle M. , Bachtel Michelle D. 
Published: January 2017

OBJECTIVE: To report a case of pleural effusion associated with chronic dantrolene administration. DESIGN: Case report. SETTING: Private, university-affiliated, teaching hospital. RESULTS: Twelve years after the initiation of low-dose dantrolene therapy for chronic spasticity, a 35-year-old man developed a pleural effusion with pleural and peripheral eosinophilia. This reaction gradually resolved over several months after discontinuation of the dantrolene therapy. CONCLUSIONS: In patients treated with chronic dantrolene therapy, the presence of pleural effusions should raise the suspicion of dantrolene-induced disease. Withdrawal of dantrolene therapy has generally been associated with an alleviation of signs and symptoms within several months.
Should All Patients with Dilated Cardiomyopathy Receive Chronic Anticoagulation?
Authors: Cheng Judy W.M. , Spinier Sarah A. 
Published: January 2017

OBJECTIVE: To review the mechanism of intracardiac thrombus formation, describe the risk of systemic thromboembolization, critically evaluate the literature regarding the use of oral anticoagulation, review the American College of Chest Physicians (ACCP) guidelines, and provide recommendations for oral anticoagulation in patients with dilated cardiomyopathy (DCM). DATA SOURCES: English language clinical studies, abstracts, and review articles pertaining to oral anticoagulation and DCM. STUDY SELECTION AND DATA EXTRACTION: Relevant human studies examining the role of anticoagulation for preventing systemic thromboembolism in patients with DCM. DATA SYNTHESIS: Potential mechanisms and risk factors for systemic thromboembolization in patients with DCM are discussed. Studies evaluating the benefits and risks of chronic oral anticoagulation to prevent systemic thromboembolization are critiqued. Recommendations for oral anticoagulation in patients with DCM from the second and third ACCP Consensus Conferences are reviewed. Suggestions for study design of a new clinical trial are presented. CONCLUSIONS: The second ACCP Consensus Conference recommended chronic anticoagulation for all patients with DCM, but the third conference did not address this issue. Review of demographic data from clinical trials demonstrates reluctance to use anticoagulation in all patients with DCM because of lack of support from prospective, controlled trials. Recent data from large clinical trials suggest that the risk of systemic embolization may be lower than previously believed. We recommend the use of chronic anticoagulation with warfarin in patients for whom the risk of embolism is greater than the risk of major bleeding, such as those with atrial fibrillation or previous systemic embolization. Lack of compliance with ACCP guidelines suggests that clinicians require additional information regarding the bleeding risk and systemic embolization rate reduction of chronic anticoagulation in patients with DCM who remain in normal sinus rhythm. It is only through prospective, controlled trials that this risk/benefit ratio to prevent systemic embolism in patients with DCM can be established.
Interferon Beta for Multiple Sclerosis
Authors: Connelly Julie F. 
Published: January 2017

OBJECTIVE: To introducereaders to the use of a new agent, interferon beta-1b (IFNser), in the treatment of relapsing-remitting multiple sclerosis(RRMS). Therapeuticand economic issues surrounding IFNβser are discussed, as are its pharmacology, clinical efficacy, adverse effects, and dosage guidelines. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including clinical trials and reviews. STUDY SELECTIONS: All available trials were reviewed. DATA EXTRACTION: Since trials evaluating subcutaneously administered interferon beta are sparse, clinical trials evaluating intrathecal IFNβser were included, as was toxicology information from the oncology population. DATA SYNTHESIS: IFNβser has recently been approved by the Food and Drug Administration for the treatmentof RRMS. Its exact mechanism of action is unknown, but it may downregulate interferon gamma (IFNγ) production and the IFNγ-stimulated major histocompatibility complex antigen expression, and/or augment T-suppressor cell function. Primary adverse effects include flu-like symptoms, fever, chills, myalgia, sweating, and injection-site reactions. Clinical efficacy has been investigated in 372 ambulatory patients with RRMS. IFNβser treatment resulted in a reduction in the annual exacerbationrate and a greater proportionof exacerbation-free patients. Burden of central nervous system disease was also significantly reduced in treated patients. However, no reductions were detected on the Scripps Neurologic Rating Scale or with confirmed endpoint scoreson the Kurtzke Expanded Disability Status Scale. Although many questions remain concerning IFNβser's long-term efficacy, its benefits in patients with other types of multiple sclerosis (MS), and its effect on progressionof disease and ultimate disability, IFNβser is the first treatment modality that has substantially altered the natural course of MS in a controlled clinical trial. CONCLUSIONS: IFNβser is not a cure for MS, but it is well tolerated and patients with RRMS have shown significant improvements in exacerbation rates and burden of central nervous system disease. IFNβser should be considered a definite improvementin RRMS treatment, although many therapeutic issues remain unanswered. Additional clinical trials are needed.
Identification of Patient-Controlled Analgesia Overdoses in Hospitalized Patients: A Computerized Method of Monitoring Adverse Events
Authors: Whipple Julianne K. , Quebbeman Edward J. , Lewis Kelly S. , Gaughan Linda M. , Gallup Edward L. , Ausman Robert K. 
Published: January 2017

OBJECTIVE: To describe and validate a computer-based quality assurance method that detects narcotic overdoses associated with patient-controlled analgesia (PCA) use. SETTING: Two acute care teaching hospitals. PATIENTS: 4669 patients who received PCA. INTERVENTIONS: The following patient lists were obtained during a two-year period from both hospital information systems: those who received PCA and (1) received naloxone, a narcotic antagonist, (2) were transferred to an intensive care unit, (3) had a cardiac or respiratory arrest, or (4) died. Possible overdoses were defined as patients who appeared on the PCA list and one of the other lists. Charts were reviewed if the patient's name appeared on the PCA and one of the other lists. Patients were judged to have experienced a narcotic overdose if there was an immediate improvement in blood pressure, respiratory rate, or mental status after the administration of naloxone. RESULTS: The search strategy identified 294 possible overdoses in 1499 patients who received PCA. Ten charts were unavailable for review. An actual overdose occurred in 11 patients. The accuracy of the new method was compared with that of the hospitals' present reporting methods. Eleven overdoses were identified by the computer search, but only 6 overdoses were identified in incident and adverse drug reaction reports. CONCLUSIONS: The systematic computer search identified almost twice as many adverse incidents than were reported by the traditional hospital methods.
Healthcare Resource Use and Costs Associated with Migraine in a Managed Healthcare Setting
Authors: Clouse Jon C. , Osterhaus Jane T. 
Published: January 2017

OBJECTIVE: To compare healthcare use and associated costs in patients with migraine and patients without migraine headache. DESIGN: Retrospective review of a managed care organization's medical and pharmacy claims databases for claims filed between January 1, 1989 and June 30, 1990. PATIENTS: Patients between 18 and 64 years old with a 12-month minimum enrollment in the health plan, including enrollment for the prescription drug benefit. Migraine group (n=1336) inclusion required a medical claim with the diagnosis of migraine headache and a pharmacy claim for a medication potentially used for migraine treatment. Comparison group (n=1336) inclusion required at least one medical claim with no diagnosis of migraine; a pharmacy claim was not required. Comparison group patients were matched to migraine group patients by age, gender, enrollment status, and subscriber or dependent enrollment status. OUTCOME MEASURES: Total health services use, diagnosis-specific use of services, diagnostic procedures performed, comorbid conditions, medication use, and associated costs were tallied. RESULTS: Migraineurs generated nearly twice as many medical claims as comparison group patients, and nearly 2.5 times as many pharmacy claims. Number of claims generated and numbers of patients who generated claims within each of 19 diagnostic categories indicated greater comorbidity in the migraine group. Migraineurs used emergency services more than did patients in the comparison group. Total medical and pharmacy claims costs were $3.4 million for the migraine group and $2.1 million for the comparison group. The average amount paid per member-month of enrollment was significantly greater in the migraine group than in the comparison group. Comorbid conditions were responsible for a significant portion of costs in the migraine group. The migraine group incurred $83 537 for diagnostic procedures compared with $13 140 incurred by the comparison group.
Safety of Esmolol in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy Who Had Relative Contraindications to Beta-Blocker Therapy
Authors: Mooss Aryan N. , Hilleman Daniel E. , Mohiuddin Syed M. , Hunter Claire B. 
Published: January 2017

OBJECTIVE: This study was conducted to evaluate the safety of esmolol in 114 patients treated with thrombolytic therapy for acute myocardial infarction who also had relative contraindications to beta-blockade, and the predictive value of patient tolerance to esmolol and subsequent patient tolerance of oral beta-blocker therapy. PATIENTS: One hundred and fourteen patients with myocardial infarction documented by enzyme concentrations and electrocardiographic changes who also had relative contraindications to beta-blockade. METHODS: Esmolol was initiated during acute myocardial infarction for myocardial ischemia (n=88), hypertension (n=13), or supraventricular tachycardia (n=13). Relative contraindications to beta-blocker therapy included either active signs/symptoms of left ventricular dysfunction or a history of congestive heart failure (n=40), a history of chronic obstructive pulmonary disease or asthma (n=31), bradycardia (HR <60 beats/min; n=18), peripheral vascular disease (n=15), or hypotension (systolic BP <100 mm Hg; n=14). RESULTS: During initial esmolol dose titration, 69 patients tolerated 300 μg/kg/min, 12 patients tolerated 200 μg/kg/min, 17 patients tolerated 100 μg/kg/min, and 16 patients tolerated 50 μg/kg/min. Twenty-eight patients (25 percent) developed dose-limiting adverse effects during esmolol maintenance infusions. Sixteen patients required esmolol dose reduction and 12 required esmolol discontinuation. Adverse effects reversed within 30–45 minutes following dose reduction or discontinuation. The 86 patients who tolerated esmolol infusions without dose reduction or drug discontinuation were subsequently treated with oral beta-blockers. Eleven of these patients (13 percent) developed adverse effects requiring oral beta-blocker discontinuation. Nine of these patients had tolerated only 50 μg/kg/min of esmolol, and the other 2 patients had tolerated only 100 μg/kg/min. CONCLUSIONS: Esmolol can be used safely in most patients treated with thrombolytic therapy for acute myocardial infarction who have relative contraindications to beta-blockers. Tolerance to higher maintenance doses of esmolol is a good predictor of subsequent outcome with oral beta-blocker therapy.