bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Valproic Acid-Associated Hepatic Failure with Orthotopic Liver Transplantation
Authors: Bell Edward A. , Shaefer Mark S. , Markin Rodney S. , Wood R. Patrick , Langnas Alan N. , Stratta Robert J. , Shaw Byers W. 
Published: January 2017

OBJECTIVE: To report a case of valproic acid (VPA)-induced hepatotoxicity and to discuss the incidence rates, risk factors, possible etiologies, preventive measures, and treatment courses for this severe reaction. DATA SOURCES: Case reports, review articles, and relevant laboratory studies identified by MEDLINE. DATA EXTRACTION: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors. DATA SYNTHESIS: The case of a 23-year-old woman with VPA-associated hepatic failure was successfully treated with orthotopic liver transplantation. Hepatic failure is a rare, often fatal, adverse effect of VPA. Most cases of VPA-associated hepatic failure have occurred within several months of initiation of therapy. Initial symptoms of presentation often include nausea and vomiting, lethargy, or loss of seizure control. Laboratory values to be monitored include serum concentrations of hepatic enzymes, and, in some patients, tests indicative of the liver's synthetic capabilities. The exact mechanism of VPA-associated hepatic failure has not been clearly established; however, it is postulated to involve the formation of toxic metabolites. Major risk factors include age less than two years and concomitant treatment with more than one anticonvulsant. Other significant risk factors include underlying metabolic or serious neurologic disorders. CONCLUSIONS: Caution should be taken when initiating VPA therapy and clinicians should be familiar with the risk factors and clinical presentation of this reaction.
Populations at Risk for Penicillin-Induced Seizures
Authors: Barrons Robert W. , Murray Kim M. , Richey Robert M. 
Published: January 2017

OBJECTIVE: This article reviews principles associated with penicillin's epileptogenic activity in an effort to alert clinicians of patients at high risk for penicillin-induced seizures. The case presentation exemplifies the most prevalent factor predisposing patients to penicillin-induced seizures—renal impairment. DATA SOURCES: References are identified from pertinent articles and books. DATA SYNTHESIS: The epileptogenic properties of penicillin are explained on the basis of the beta-lactam ring's binding to gamma aminobutyric acid receptors. Several patient populations are at risk for potentially fatal neurotoxic symptoms. Most of these patients demonstrate impaired renal function, either as the primary condition or secondary to an infectious process. The other at-risk populations include infants and the elderly, patients with meningitis, patients undergoing intraventricular antibiotic therapy, and patients with a history of seizures. Treatment remains controversial; however, benzodiazepines theoretically produce a favorable response. CONCLUSIONS: Pharmacokinetic parameters explain patient populations most at risk; a guideline equation has been recommended to allow clinicians to make appropriate dose adjustments based on creatinine clearance. Physicians and pharmacists must recognize the populations most at risk for high-dose, penicillin-induced neurotoxicities; monitor these patients at least during the first 72 hours, and reduce or discontinue therapy when appropriate.
“Brain Attack”: An Indication for Thrombolysis?
Authors: Fagan Susan C. , Zarowitz Barbara J. , Robert Sylvie 
Published: January 2017

OBJECTIVE: The primary objective of this article is to introduce the reader to the use of thrombolytics in the acute treatment of ischemic stroke. Theory and experimental evidence to support this approach are emphasized in addition to potential adverse effects of thrombolysis. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including reviews. STUDY SELECTION: Studies were selected for detailed review if they involved stroke patients and addressed possible toxicities of therapy. Any abstracts concerning ongoing clinical trials also were reviewed. DATA EXTRACTION: Data from animal investigations using tissue plasminogen activator for the acute treatment of several models of cerebral ischemia were used to support the importance of early treatment (within six hours of symptom onset). Also, studies performed in animal models of stroke revealed that thrombolysis could be accomplished safely in acute ischemic stroke. All human studies published to date are anecdotal case reports, but point to the safety of thrombolysis if administered early. Reviews of ongoing multicenter trials are taken from published abstracts and proceedings. DATA SYNTHESIS: Thrombolysis holds promise as a hyperacute therapy for acute stroke; however, the risk of intracerebral hemorrhage remains. Crucial to the success of this and any other therapy for acute stroke is the ability to treat patients within hours of symptom onset. Also, the importance of concomitant medications such as heparin and aspirin has not yet been addressed. CONCLUSIONS: Pharmacists need to be knowledgeable of new treatments of stroke and the risks associated with them. As patient educators, pharmacists can contribute to public awareness by promoting the early recognition of stroke symptoms. As pharmacotherapists, pharmacists need to understand the risks and the important monitoring parameters related to thrombolysis. The results of ongoing multicenter clinical trials are awaited before making a final judgment on the usefulness of thrombolysis in acute ischemic stroke.
Central Nervous System Toxicity after Abrupt Monoamine Oxidase Inhibitor Switch: A Case Report
Authors: Safferman Allan Z. , Masiar Stephen J. 
Published: January 2017

DESCRIPTION: There have been numerous case reports of adverse reactions involving monoamine oxidase inhibitors (MAOIs), including reactions that developed when one MAOI was substituted for another. Although most reports have usually described a switch from isocarboxazid or phenelzine to tranylcypromine, we report a case of acute central nervous system toxicity possibly associated with a switch from phenelzine to isocarboxazid. SYMPTOMATOLOGY: Predominant symptoms included stuporous sensorium, hypertension, tachycardia, tremor, and urinary retention. Onset of symptoms began within 48 hours after the abrupt MAOI switch. CONCLUSIONS: Clinicians must allow a sufficient washout period before adding any agent that has a known potential to interact adversely with MAOIs. In addition, patients who are unusually sensitive to one type of MAOI may also be at increased risk for developing problems with a different MAOI secondary to unforeseen pharmacokinetic or pharmacodynamic effects, even at doses that are usually considered subtherapeutic.
Effects of Heat Treatment on Selected Plasma Therapeutic Drug Concentrations
Authors: Delaney Robert A. , Mikkelsen Stephen L. , Jackson Margaret B. 
Published: January 2017

OBJECTIVE: We investigated the heat stability of six common therapeutic drugs routinely assayed in pharmacokinetic and clinical laboratories. DESIGN: Serum samples were spiked at three concentrations (subtherapeutic, therapeutic, and potentially toxic) with amikacin, gentamicin, tobramycin, phenytoin, theophylline, and phenobarbital. The samples were then heated at 56 ° and assayed by fluorescence polarization immunoassay at 15-minute intervals for one hour. SETTING: The study was conducted at a clinical research laboratory using standard laboratory methods. MAIN OUTCOME MEASURES: Drug concentrations of heated samples were compared with unheated controls using ANOVA to determine if degradation occurred over time with heating. RESULTS: Analysis of data revealed no degradation of any of the samples. CONCLUSIONS: Heat treatment of samples from high-risk individuals may be a mechanism to protect healthcare workers from exposure to the human immunodeficiency virus.
Is There a Role for Fluconazole in the Treatment of Vulvovaginal Candidiasis?
Authors: Thompson Dennis F. , Raebel Marsha A. , Patel Hina S. , Peters Mark D. , Smith Curtis L. 
Published: January 2017

OBJECTIVE: To review the data describing the use of fluconazole in the treatment of vulvovaginal candidiasis (VVC). DATA IDENTIFICATION: A MEDLINE search of the English-language literature and a bibliographic review of pertinent articles examining the use of fluconazole in the treatment of VVC. STUDY SELECTION AND DATA EXTRACTION: Relevant open and controlled studies reporting on the efficacy, associated adverse effects, or both of fluconazole for the treatment of VVC are reviewed. Appropriate conclusions and/or data are extracted from each article and described. DATA SYNTHESIS: Studies comparing fluconazole with ketoconazole and topical antifungal agents such as clotrimazole and miconazole have shown fluconazole to be equally efficacious with minimal adverse effects. Most of these trials used single-dose fluconazole, which would theoretically lead to a high degree of medication compliance. Fluconazole also has shown promise at diminishing VVC relapse or recurrence, possibly because of more complete vaginal and rectal eradication of Candida species. Pharmacoeconomically, single-dose fluconazole therapy is cost-effective; however, the recent approval of miconazole and clotrimazole by the Food and Drug Administration for over-the-counter use may limit this potential advantage. CONCLUSIONS: Until additional data are available, fluconazole may be considered a treatment alternative for women with VVC who experience frequent relapses or recurrences, or for those who are noncompliant with standard therapy.
A Review of Cyclic Antidepressant-Induced Blood Dyscrasias
Authors: Hartshorn Edward A. , Levin Gary M. , DeVane C. Lindsay 
Published: January 2017

OBJECTIVE: To review the literature for cases of blood dyscrasias associated with cyclic antidepressants. Several types of blood dyscrasias are discussed. DATA SOURCES: All references were selected through the use of MEDLINE. Indexing terms were blood, abnormalities, dyscrasias, antidepressants, agranulocytosis, and eosinophilia. The only constraints were English language and human subjects. STUDY SELECTION: All cases were included except for letters to the editor of various journals when pertinent data such as doses and additional medications were omitted. DATA SYNTHESIS: The review provides a table listing the different blood dyscrasias and the drug the patient was receiving. The table also includes time of onset, time to recovery, and several symptoms for each patient. CONCLUSIONS: Common symptoms of various blood dyscrasias are discussed. The chemical structures of the antidepressants are related to phenothiazines, which are also implicated in causing blood dyscrasias. Recommendations for treatment of both the dyscrasia and depression are discussed.
Relationship Between Calf Muscle Size and Strength after Achilles Rupture Repair
Authors: Leppilahti J. , Lähde S. , Forsman K. , Kangas J. , Kauranen K. , Orava S. 
Published: January 2017

The object was to study the relationships between calf muscle size and strength in 85 patients an average of 3.1 years after repair of achilles tendon rupture. The isokinetic calf muscle strength results were excellent or good for 73 % of the patients, whereas calf muscle size was normal in only 30 %. The average plantar flexion peak torque per unit muscle cross-sectional area was higher on the injured side than on the uninjured side. The average calf muscle cross-sectional area deficit was 15±9% (p<0.001) of that on the unaffected side, while the average plantar flexion peak torque deficit was speed-dependent, being 9±18%, 10±18 and 2±13% of that on the unaffected side at 30, 90, and 2407sec (p<0.001). The correlation between cross-sectional area and peak torque varied in the range 0.52–0.61 at 30, 90 and 2407sec (p<0.001).
Prospective Study of Topical 5-Aminolevulinic Acid Photodynamic Therapy for the Treatment of Moderate to Severe Acne Vulgaris in Chinese Patients
Authors: Wang Hong-Wei , Lv Ting , Zhang Ling-Lin , Guo Ming-Xia , Stepp Herbert , Yang Kui , Huang Zheng , Wang Xiu-Li 
Published: January 2017

Background: Topical photodynamic therapy (PDT) mediated with 5-aminolevulinic acid (ALA) offers an alternative option for the treatment of acne vulgaris. Objective: To study the effects of ALA dose, incubation time, and lesion type on protoporphyrin IX (PpIX) production and treatment outcomes. Methods: To examine the time course of PpIX production, 10% ALA was applied to inflammatory papules for 1 to 5 hours and followed by in situ fluorescence examination. To determine the effects of ALA dose and lesion type, 3, 5, and 10% ALA was applied to acne lesions in split-face fashion for 3 hours followed by whole-face light irradiation at 633 nm and 30 to 70 J/cm2. Treatment was repeated twice at 2-week intervals. Results: PpIX reached a stable level after 3 hours of incubation. Similar PpIX levels were seen in areas receiving 3, 5, and 10% ALA. Poisson regression analyses indicated that lesion counts decreased by 0.791 times for a one-unit increase in treatment times (95% CI 0.782–0.799, p< .0001) but only by 0.999 times for a one-unit increase in ALA dose (95% CI 0.998–1.000, p = .22). Conclusion: The combination of low-dose ALA and a red light is a safe and effective option for the treatment of moderate to severe acne. Renseignements de base: La thérapie photodynamique topique (TPD) suivant l'administration de l'acide 5-aminolévulinique (ALA) représente une autre possibilité pour le traitement de l'acné vulgaire. Objectif: Étudier les effets de la dose d'ALA, la durée d'incubation, le type de lésion sur la production de PpIX, et les résultats du traitement. Méthodes: Pour examiner l'évolution temporelle de la production de PpIX, de l'ALA 10 % a été appliqué sur des papules inflammatoires pendant 1 à 5 heures et a été suivi d'un examen in situ en fluorescence. Afin de déterminer les effets de la dose d'ALA et le type de lésion, de l'ALA 3, 5, et 10 % a été appliqué sur les lésions d'acné sur une moitié du visage pendant 3 heures, suivi d'une irradiation de lumière de tout le visage à 633 nm et 30 à 70 J/cm2. Le traitement a été répété deux fois à 2 semaines d'intervalle. Résultats: La PpIX a atteint un niveau stable après 3 heures d'incubation. Des taux de PpIX semblables ont été observés dans les parties ayant reçu de l'ALA 3, 5, et 10 %. Des analyses de régression de Poisson ont indiqué que le nombre de lésions a diminué de 0,791 fois pour une augmentation d'une unité de temps de traitement (IC 95 % 0,782 à 0,799, p <,0001), mais seulement par 0,999 fois pour un accroissement d'une unité de dose d'ALA (CI 95 % 0,998 à 1,000, p =, 22). Conclusion: La combinaison d'une faible dose d'ALA et de la lumière rouge est une option sûre et efficace pour traiter l'acné modérée à sévère.
Allergic Contact Dermatitis from Dimethyl Fumarate after Contact with a Chinese Sofa
Authors: Doumit Joseph , Gavigan Geneviève , Pratt Melanie 
Published: January 2017

Background: Dimethyl fumarate has been successfully used in the treatment of psoriasis in the past. Despite its clinical use, cutaneous contact with this molecule may cause contact dermatitis. Objective: We report a case in which skin exposure to a synthetic fabric sofa containing dimethyl fumarate made by a Chinese furniture manufacturer resulted in a severe, pruritic, papulovesicular, eczematous dermatitis to the sites of contact with the sofa. Methods: The patient was patch-tested with serial dilutions of dimethyl fumarate. Results: Patch testing results revealed strong positive reactions to dimethyl fumarate at different concentrations. Conclusion: Dimethyl fumarate is a potent contact sensitizer and is commonly found in sachets inside furniture and footwear boxes. Contexte: Le fumarate de diméthyle a été utilisé avec succès, dans le passé, dans le traitement du psoriasis. Malgré cet usage clinique, les contacts cutanés avec la molécule peuvent causer une dermatite de contact. Objectif: Nous faisons état ici d'un cas d'exposition de la peau à du fumarate de diméthyle présent dans le tissu synthétique d'un sofa fabriqué en Chine, qui a entraîné un eczéma grave, prurigineux, et papulovésiculaire aux sièges de contact avec le sofa. Méthode: Le patient a été soumis à des tests épicutanés, avec dilutions successives du fumarate de diméthyle. Résultats: Les résultats des tests épicutanés ont révélé une forte réaction positive au fumarate de diméthyle, à différentes concentrations. Conclusion: Le fumarate de diméthyle est un puissant sensibilisant de contact, qu'on trouve souvent dans les sachets placés dans les meubles et dans les boîtes à chaussures.
Atypical Lupus Erythematosus Panniculitis Progressing to Antinuclear Antibody–Negative Systemic Lupus Erythematosus
Authors: Pandhi Deepika , Verma Prashant , Singal Archana , Sharma Sonal , Tondon Anupama 
Published: January 2017

Background: Lupus erythematosus panniculitis (LEp) is an uncommon but distinctive subset of lupus erythematosus (LE). It may develop in patients with discoid or systemic LE or may occur as an isolated phenomenon. Case Report: We describe a case of LEp affecting unusual sites: the parotid gland, eyelid, and scalp. Subsequently, the patient progressed to antinuclear antibody–negative systemic LE. Contexte: Le lupus érythémateux compliqué d'une panniculite (LEp) est une forme rare mais particulière de lupus érythémateux (LE). Il peut se manifester dans le contexte du LE discoïde ou du LE disséminé, ou encore n'être qu'un phénomène isolé. Exposé de cas: Il sera question ici d'un cas de LEp touchant des sièges inhabituels: la glande parotide, les paupières, et le cuir chevelu. L'état du patient a évolué, par la suite, vers un LE disséminé négatif à l'égard des anticorps antinucléaires.
Basaloid Squamous Cell Carcinoma of the Nasal Septum Presenting as a Primary Cutaneous Lesion
Authors: Hoy Nathan , Wong Joyce , Mahmood Muhammad , Brassard Alain 
Published: January 2017

Background: Basaloid squamous cell carcinoma is a rare aggressive variant of squamous cell carcinoma, with a predilection for the head and neck region. There are only two case reports in the literature documenting a nasal cavity squamous cell carcinoma presenting as a primary cutaneous lesion. Objective: We report a rare case of nasal cavity basaloid squamous cell carcinoma presenting initially as a nasal bridge mass. Two initial biopsies revealed features consistent with basal cell carcinoma and basosquamous cell carcinoma, respectively. Result: Final surgical pathology showed extensive invasive squamous cell carcinoma with basaloid differentiation arising from the nasal septal mucosa with extension to the overlying skin. The clinicopathologic features were interpreted as basaloid squamous cell carcinoma. Conclusion: We discuss the difficulties in pathologic diagnosis of this condition given its varied phenotypical expression. As well, this case emphasizes the necessity for diagnostic vigilance when assessing a primary cutaneous lesion as it may be a rare presentation of an underlying malignancy extending to the skin. Contexte: Le carcinome squameux basaloïde est une variante rare et très maligne du carcinome squameux, qui touche le plus souvent la tête et le cou. La documentation médicale ne compte que deux exposés de cas sur le carcinome squameux de la cavité nasale se présentant sous forme de lésion cutanée primitive. Objectif: Nous faisons état ici d'un rare cas de carcinome squameux basaloïde de la cavité nasale, se présentant au départ comme une masse dans la voûte des fosses nasales. Deux biopsies ont été pratiquées au départ, et les résultats se sont montrés compatibles avec les caractéristiques du carcinome basocellulaire et du carcinome basospinocellulaire, respectivement. Résultat: L'examen histopathologique définitif de la pièce opératoire a révélé la présence d'un carcinome squameux invasif, étendu, accompagnée d'une différenciation basaloïde prenant naissance dans la muqueuse de la cloison nasale et se prolongeant jusqu'à la peau sus-jacente. Les manifestations clinicopathologiques laissaient croire à un carcinome squameux basaloïde. Conclusion: Il sera question ici des difficultés que pose le diagnostic histopathologique de cette affection compte tenu de son expression phénotypique variée. De plus, le cas met en évidence la nécessité de faire preuve de vigilance dans l'établissement du diagnostic lorsqu'on évalue des lésions cutanées primitives étant donné que celles-ci peuvent être une manifestation rare d'une tumeur maligne sous-jacente, qui s'étend jusqu'à la peau.
The Influence of Health Needs Assessment on Health Care Decision-Making in London Health Authorities
Authors: Hensher Martin , Fulop Naomi 
Published: January 2017

Objectives: Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making. Methods: A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority. Results: The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build ‘ownership’ of subsequent decisions. Conclusions: The survey suggests that needs assessment is, in practice, consistent with a ‘mixed scanning’ model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.