bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of Combination Aspirin and Anticoagulation in Acute Ischemic Stroke
Authors: Fagan Susan C. , Kertland Heather R. , Tietjen Gretchen E. 
Published: January 2017

OBJECTIVE: To assess the risk of bleeding complications in patients treated with combination aspirin and heparin for cerebral ischemia. DESIGN: A retrospective, cohort study. SETTING: A large urban teaching hospital. PATIENTS: One hundred charts of stroke patients who had received anticoagulation with or without aspirin therapy were identified from the Stroke Data Bank. Bleeding rates were compared between the two groups. RESULTS: Forty-two patients who had received heparin and/or warfarin in combination with aspirin were compared with 33 patients who had received anticoagulation alone. The mean duration of anticoagulant therapy was 8.0 and 8.4 days, respectively. Bleeding rates were not different between the two groups: 23.8 percent (10/42) (p=0.78) and 24.2 percent (8/33), respectively. Although the bleeding rate was substantial, there was only one major bleed (severe epistaxis) occurring in a patient receiving anticoagulation only. No patient had an intracerebral hemorrhage. CONCLUSIONS: Our data suggest that combination antithrombotic therapy is safe in a controlled, inpatient setting.
Potential Pharmacokinetic Interaction between Felbamate and Phenobarbital
Authors: Gidal Barry E. , Zupanc Mary L. 
Published: January 2017

OBJECTIVE: TO REPORT A CASE OF A POTENTIAL PHARMACOKINETIC INTERACTION BETWEEN FELBAMATE AND PHENOBARBITAL IN A PATIENT WITH EPILEPSY. CASE SUMMARY: A patient with a history of a mixed seizure disorder and static encephalopathy who was receiving sodium valproate 750 mg/d and phenobarbital 230 mg/d was initiated on felbamate (as part of a compassionate use program). Upon instituting felbamate, valproate dosage was reduced to 500 mg/d and phenobarbital to 200 mg/d. Felbamate dosage was titrated to approximately 50 mg/kg/d over three weeks. In this patient, plasma phenobarbital concentrations increased from 48 μg/mL, to 68 μg/mL, at which point the patient was hospitalized because of clinically significant neurotoxicity. Phenobarbital dosage was subsequently reduced to 150 mg/d; this resulted in phenobarbital trough concentrations of 60 μg/mL. CONCLUSIONS: Felbamate has been shown previously to interact with multiple other anticonvulsant medications, including valproate, phenytoin, and carbamazepine. Felbamate appears to decrease the clearance of valproate, phenytoin, and carbamazepine epoxide to a significant extent, an effect that may be the result of inhibition of the metabolism of these compounds. Carbamazepine plasma concentrations have been demonstrated to decrease following administration of felbamate, suggesting metabolic induction. It is reasonable to suggest that based on these findings and the observations in our patient, felbamate comedication may result in clinically significant increases in plasma phenobarbital concentrations. It would seem prudent, therefore, when initiating or adjusting felbamate therapy in patients receiving this drug combination, to monitor phenobarbital plasma concentrations.
Agranulocytosis Associated with Etodolac
Authors: Cramer Richard L. , Aboko-Cole Vivian C. , Gualtieri Richard J. 
Published: January 2017

OBJECTIVE: To report a case of probable etodolac-induced agranulocytosis. CASE SUMMARY: A 72-year-old woman who had been taking etodolac 300 mg bid for approximately six weeks presented to the emergency department with symptoms of urosepsis. She was found to be profoundly granulocytopenic. Etodolac was discontinued and broad-spectrum intravenous antibiotic therapy was administered for the next 17 days. Results of bone marrow biopsy revealed marked hypocellularity consistent with drug-induced agranulocytosis. Following etodolac withdrawal, the total white blood cell count reached a low value of 0.9 × 109L and then returned to a preetodolac baseline after 15 days. Her hemoglobin concentration also decreased significantly during hospitalization. DISCUSSION: Agranulocytosis has rarely been reported in association with nonsteroidal antiinflammatory drugs (NSAIDs), and there are no literature reports associating etodolac with agranulocytosis. This case involving etodolac is consistent with the pattern described with other NSAIDs. Factors correlating etodolac as the causative agent are identified. Details of patient history, treatment, follow-up, and assessment are discussed. CONCLUSIONS: Detailed case assessment demonstrated probable etodolac-induced agranulocytosis in our patient. Clinicians should be aware that etodolac, like other NSAIDs, has potential to cause agranulocytosis.
Suicide Attempt by Means of Aspirin Enema
Authors: Watson Jerry E. , Tagupa Eumar T. 
Published: January 2017

OBJECTIVE: To report a suicide attempt with an aspirin enema. CASE SUMMARY: A patient presented to the emergency room after self-administering, in enema form, approximately 700 aspirin tablets dissolved in water. Over the next 12hours the patient became progressively acidemic with eventual cardiac arrest and subsequent chronic hypoxic encephalopathy. DISCUSSION: This patient's poor outcome was the result of retained aspirin products in the rectal vault combined with the failure to recognize the delayed absorption properties of rectally administered aspirin. CONCLUSIONS: In rectal aspirin overdoses, aspirin absorption from the rectum may occur over a long period of time. It is important to remove as much aspirin from the rectum as possible and to closely monitor these patients so that appropriate therapy may be started quickly. Activated charcoal given both in enema and oral form may help decrease aspirin absorption. Hemodialysis should be available and performed without delay should the patient require it.
Tacrolimus, a New Immunosuppressant—A Review of the Literature
Authors: Hooks Michael A. 
Published: January 2017

OBJECTIVE: To review the clinical pharmacology, pharmacokinetics, adverse effects, therapeutic uses, and current status of tacrolimus. DATA SOURCES: Data from scientific literature were identified by a MEDLINE search. The data were extracted, evaluated, and summarized for presentation. Experiences from studies evaluating tacrolimus in the form of articles, abstracts, letters to the editor, or proceedings were considered for inclusion. STUDY SELECTION: Open and controlled clinical and animal trials were reviewed in evaluating the pharmacology, pharmacokinetics, and adverse effects of tacrolimus. DATA EXTRACTION: Data from animal and human studies published in the English literature were evaluated. DATA SYNTHESIS: Tacrolimus is an 822-kDa macrolide antibiotic that has potent immunosuppressive properties. The mechanism of action is similar to that of cyclosporine in that it ultimately blocks the production of interleukin 2, thereby inhibiting further T-lymphocyte proliferation. Tacrolimus is metabolized solely in the liver and the metabolites are primarily excreted in the bile. The elimination halflife of tacrolimus is approximately 8.5 h, and is prolonged in hepatic dysfunction. Tacrolimus has shown efficacy in the prophylaxis of allograft rejection in both animals and human clinical trials, and has been used effectively to rescue patients who have exhibited refractory rejection failing cyclosporine prophylaxis. Adverse effects requiring tacrolimus dosage adjustment include nephrotoxicity, neurotoxicity, alterations in glucose metabolism, and infection or susceptibility to malignancy. CONCLUSIONS: To date, trials comparing tacrolimus with cyclosporine are not available in the literature; however, tacrolimus appears to be useful in rescuing grafts, particularly liver grafts that fail cyclosporine-based immunosuppression. Direct comparisons with cyclosporine are needed to define the role of tacrolimus as primary transplant therapy.
Risk Factors for Acute Renal Insufficiency in Patients with Suspected or Documented Bacterial Pneumonia
Authors: Welage Lynda S. , Walawander Cynthia A. , Timm Edward G. , Grasela Thaddeus H. 
Published: January 2017

OBJECTIVE: To describe the incidence of acute renal insufficiency and identify potential risk factors associated with this adverse medical event. DESIGN: A cohort analytic study of patients with documentedor suspected bacterial pneumonia. SETTING: Nationwide survey of 74 acute care hospitals across the US. INCLUSION AND EXCLUSION CRITERIA: A total of 1822 adult patients with documented or suspected bacterial pneumonia who were receiving a cephalosporin, penicillin, or an aminoglycoside were enrolled. Patients were excluded if the duration of antimicrobial therapy was <3 days or if the pneumoniawas judged to be nonbacterial. DATA COLLECTION: Clinical pharmacists completed standardized data collection forms on all patients enrolled in the study. Information regarding patient demographics, concurrent illnesses and medications, antibiotic administration, representative laboratory data, and the occurrenceof any adverse clinical event was specifically captured. Information regardingthe development of acute renal insufficiency was targetedas an event to be captured. MAIN OUT COME MEASURES: Univariateand multivariate analyseswere performed to identify significant risk factors for acute renal insufficiency. A subset analysis was similar lyperformed to identify risk factors associated with aminoglycoside-related acute renal insufficiency. RESULTS: Of the patients enrolled in this study, 8.2 percent developed acute renal insufficiency. Risk factors for acute renal insufficiency included renal disease, aminoglycoside therapy, nosocomial pneumonia, elevated estimated creatinine clearance prior to study entry, cardiac arrest/shock, congestive heart failure, total duration of antibiotics >7 days, clindamycin therapy, liver disease, and first-generation cephalosporin usage. Risk factors for aminoglycoside-related acute renal insufficiency identified via multiple logistic regression included amphotericin B, congestive heart failure, aminoglycoside trough concentration >1.5 mg/L, and clindamycin therapy. CONCLUSIONS: The risk factors identified for acute renal insufficiency suggest that severity of illness strongly influences the development of renal insufficiency. Theoretically, the results of this study could serve as a framework for developing risk prevention programs within individual hospitals. Specific risk factors could be identified for a patient population and risk factors that could be modified could then be targeted for intervention. This type of information can also assist cliniciansin predictingthe probability of the adverseevent for a particular patient and subsequently minimizing this risk by initiating intense monitoring or modifying the drug regimen.
Adult Height in Girls with Turner Syndrome Treated with Low-Dose Estrogens and Androgens
Authors: Lin Tsu H. , Kirkland Rebecca T. , Kirkland John L. 
Published: January 2017

OBJECTIVE: To determine if low dosages of estrogens and androgens administered to girls with Turner syndrome adversely affected their adult height. DESIGN: A nonrandomized control trial of nine girls. SETTING: The endocrine clinic at Texas Children's Hospital in Houston, Texas, an academic referral center. PARTICIPANTS: Participants had chromosomal defects consistent with Turner syndrome. Informed consent was obtained in accordance with institutional review board procedures. Eligibility criteria included an absence of previous hormone treatment. No one withdrew from this study because of adverse effects. INTERVENTIONS: Hormonal replacement therapy was initiated with conjugated estrogen 0.15 mg and tluoxymesterone 1 mg administered daily. MAIN OUTCOME MEASURES: Outcome measurements were a comparison of the final heights following treatment versus the predicted adult heights prior 10 treatment. RESULTS: The predicted adult height in these children prior to treatment was 140.0 ± 4.4 cm (mean ± SD); the actual adult height was 139.63 ± 4.1 cm. The difference was 0.37 ± 3.54 cm, which was not statistically significant by Wilcoxon signed-rank test (p=0.23). The 95% confidence interval on this difference ranged from −3.1 to 2.3 cm, which indicates a true mean height loss of no more than 3.1 cm or a true mean gain of no more than 2.3 cm. CONCLUSIONS: Our results indicate that hormone replacement therapy with low dosages of conjugated estrogens and androgens starting at 10–11 years of age in children with Turner syndrome does not adversely affect actual adult height.
Update on Childhood Immunizations
Authors: de Clavijo Irene V. , Weart C. Wayne 
Published: January 2017

OBJECTIVE: To provide an overview of childhood immunizations with emphasis in new recommendations, as well as recent vaccine developments and special populations. DATA SOURCES: English language literature identified via a MEDLINE search. Additional references were obtained from cited references. STUDY SELECTION AND DATA EXTRACTION: Original articles, reviews, and official publications were used to obtain the most accurate data on safety and efficacy of available pediatric vaccines, as well as current recommendations for their use. DATA SYNTHESIS: Immunizations have been an area of vigorous research for several years. New vaccines have been developed by improving older products to maximize immunogenicity and minimize adverse effects. Some of these novel vaccines, like the Haemophilus influenzae type b conjugate vaccines (HibCV), have already contributed significantly to the prevention of diseases in childhood. New recommendations have been issued to help speed this process. Adverse effects of routine immunizations are generally mild and transient. CONCLUSIONS: The development of new effective and safe vaccines for children is an important step in the global eradication of contagious diseases. A new generation of combination vaccines has started with the combination of the diphtheria-tetanus-pertussis vaccine and HibCV. Some other combined products are yet to come that would eventually make immunization schedules more costeffective and improve compliance rates. Our colleagues in the community and in the ambulatory care setting must actively participate in the implementation of vaccination programs and provide education to parents regarding all aspects of the immunization process.
Vancomycin-Induced Neutropenia during Treatment of Endocarditis in a Pediatric Patient
Authors: Shinohara Y. Todd , Colbert James 
Published: January 2017

OBJECTIVE: To report a case of reversible vancomycin-associated neutropenia occurring during long-term therapy with vancomycin using weight and age-adjusted dosing. CASE SUMMARY: A 2-year-old boy was started on vancomycin therapy for presumed endocarditis resulting from his ventriculoseptal defect. After 18 days of treatment, neutropenia with an absolute neutrophil count (ANC) of 990 × 106 cells/L was noted. The neutropenia progressed over the next 3 days and reached a nadir concentration of 459 × 106 cells/L. Vancomycin therapy was discontinued after 17 days (antibiotic day 20). A rise in the ANC occurred within 2 days of discontinuation. An improved ANC of 1672 × 106 cells/L occurred within 5 days. Vancomycin serum concentrations remained within an acceptable range: a peak of 30 μg/mL and a trough of 9 μg/mL. DISCUSSION: Case reports in the literature of vancomycin-associated neutropenia in adults were briefly reviewed and compared. The onset and resolution and mechanism of vancomycin-induced neutropenia were studied. The potential relationship between vancomycin, weight-, and age-adjusted dosing and the occurrence of neutropenia in our pediatric patient was postulated. CONCLUSIONS: Vancomycin is identified as a possible cause of drug-induced neutropenia. More data are needed that clearly indicate vancomycin as the offending agent in children. The vancomycin-induced neutropenia is believed to be immunologically based and independent of drug concentrations.
Once-Daily Administration of Aminoglycosides
Authors: Bates Richard D. , Nahata Milap C. 
Published: January 2017

OBJECTIVE: To provide an overview of the efficacy and adverse effects associated with once-daily administration of aminoglycosides. DATA SOURCES: An extensive MEDLINE search and review of journals was conducted to identify information for this review. DATA SYNTHESIS: Aminoglycosides alone or in combination with beta-lactams are commonly used for their activity against gram-negative microorganisms. Numerous studies have been performed comparing efficacy and toxicity of once-daily administration of aminoglycosides with multiple-daily dosing. Two studies have found a significant difference in clinical efficacy between once-daily and multiple-daily dosing of aminoglycosides. Several studies have observed a lower incidence of toxicity with once-daily than multiple-daily dosing, but others have found no difference. CONCLUSIONS: Review of the literature suggests that once-daily administration of aminoglycosides may be as safe and effective as multiple-daily dosing regimens for the treatment of certain infections caused by gram-negative bacteria.
Gabapentin: A New Agent for the Management of Epilepsy
Authors: Andrews Carlota O. , Fischer James H. 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of gabapentin, a new antiepileptic drug (AED). Gabapentin's potential role in the treatment of epilepsy also was assessed. DATA SOURCE: A MEDLINE search was performed to identify all published literature (manuscripts and abstracts). Abstracts presented at the American Epilepsy Society, International Epilepsy Congress, and American Academy of Neurology meetings from 1991 to 1993 also were reviewed. A copy of the proceedings from the Food and Drug Administration Peripheral and Central Nervous System Advisory Committee meeting and package insert were obtained from Parke Davis. STUDY SELECTION: All pertinent literature was reviewed. Emphasis was placed on published information, particularly placebo-controlled clinical trials. DATA SYNTHESIS: Gabapentin is effective as adjunctive treatment for patients with partial seizures with or without secondary generalization refractory to the standard AEDs. It has a unique pharmacokinetic profile for an AED, including no binding to plasma proteins, primary elimination by the kidney, and dose-dependent oral absorption at high dosages. No drug interactions occur with the other AEDs. The most frequent adverse reactions noted in patients receiving gabapentin have been mild and transient central nervous system effects. No serious hypersensitivity or systemic reactions have been observed. CONCLUSIONS: Gabapentin appears to be a useful new AED. Further studies evaluating its use as monotherapy, in higher dosages, and in pediatric and elderly patients are required to better delineate its therapeutic role relative to that of other AEDs.
Pharmacokinetics of Once-Dally Dosing of Gentamicin in Surgical Intensive Care Unitpatients with Openfractures
Authors: Sangha Kiranpal S. , Miyagawa Clyde I. , Healy Daniel P. , Bjornson H. Stephen 
Published: January 2017

Objective: To compare the first-dose pharmacokinetic parameters of gentamicin 6 mg/kg and 2 mg/kg in stable, nonobese surgical intensive care unit patients with open extremity fractures receiving gentamicin prophylactically. Methods: Serial blood samples were obtained over 8 or 24 hours following the first dose of gentamicin. Serum concentrations of gentamicin were measured using fluorescence polarization immunoassay and analyzed by noncompartmental means. Results: Eleven patients were enrolled, 7 in the 6 mg/kg group and 4 in the 2 mg/kg group. The median (6 vs. 2 mg/kg) age was 29 versus 28 years; serum creatinine 80 versus 88 μmol/L; and APACHE H score 13 versus 10. The mean ± SD (μg/mL) of concentration at the end of the 30-minute infusion (Cmax), concentration 30 minutes after the end of the infusion (Cpk), and concentration at the end of the dosing interval for 6 versus 2 mg/kg were: 35.0 ± 19.0 versus 10.1 ± 1.77; 17.0 ± 2.7 versus 5.4 ± 0.4, and 0.45 ± 0.31 versus 0.69 ± 0.11, respectively. Area under the curves0-∞ (AUC0-∞), apparent volume of distribution, and half-life were: 89.0 ± 28.9 versus 26.1 ± 1.2 mg·h/L, 0.40 ± 0.10 versus 0.47 ± 0.14 L/kg, and 4.0 ± 1.1 versus 4.3 ± 1.5 h, respectively. Conclusions: The first-dose pharmacokinetics of gentamicin 6 mg/kg resulted in a proportional rise in Cmax, Cpk, and AUC0-∞, compared with gentamicin 2 mg/kg in patients with open fractures, but with greater variability.
Ifosfamtoe-Induced Fanconi Syndrome
Authors: Garcia Agustin A 
Published: January 2017

Objective: To report a case of possible ifosfamide-induced Fanconi syndrome in an adult with cancer. Case Summary: A 20-year-old man was treated for an osteosarcoma with a chemotherapy regimen that included ifosfamide, methotrexate, and doxorubicin. Three months after completing therapy he developed polyuria, polydypsia, and bilateral ankle pain. Laboratory findings showed decreased serum concentrations of phosphorus, uric acid, calcium, potassium, and bicarbonate; elevated blood urea nitrogen and creatinine; and increased urinary excretion of phosphorus, potassium, calcium, citrate, and protein. The patient was diagnosed with Fanconi syndrome and osteomalacia. Treatment with oral supplements of potassium, sodium, citric acid, calcium, and calcitriol corrected the electrolyte abnormalities. Discussion: The adverse effect most frequently associated with ifosfamide is hemorrhagic cystitis. The incidence of hemorrhagic cystitis is decreased with the concomitant administration of the uroprotective agent mesna. The development of Fanconi syndrome after ifosfamide therapy has been described previously, although it occurs more frequently in children than adults. The mechanism by which ifosfamide causes renal tubular damage is not well understood, but it appears to involve metabolites of the drug. Conclusions: The development of renal tubular defects and renal failure should be considered in patients receiving ifosfamide. Although this complication appears more frequently in children, adults also can be affected. Renal function should be monitored closely to detect the appearance of this adverse effect. Renal tubular dysfunction can, as this case illustrates, develop months after completing chemotherapy.