bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polypharmacy in Psychiatry: Three Case Studies and Methods for Prevention
Authors: Stewart Ronald B. , Yedinak Kimberly C. , Ware Michael R. 
Published: January 2017

OBJECTIVE: To illustrate problems of overprescribing in the elderly and to make practical suggestions for prevention of polypharmacy. DESIGN: Three cases of polypharmacy in psychiatric patients admitted to the hospital between January and March 1990 are described. Intervention to correct drug-related problems in these patients is described and methods of preventing polypharmacy are discussed. SETTING: Inpatient psychiatry service in a tertiary-care center. PATIENTS: Elderly psychiatry patients (n=3) taking an excessive number of medications. This polypharmacy was believed to contribute to decreased cognitive and/or physical function. INTERVENTIONS: Medication regimens were reviewed by the physician and pharmacist. Those considered unnecessary or believed to be adversely affecting the patient were discontinued. RESULTS: All patients were discharged on a reduced number of medications, with improvement in cognitive and/or physical function. CONCLUSIONS: Polypharmacy contributes to an increased incidence of adverse reactions in the elderly. Implementation of practical methods for reducing polypharmacy can lead to a reduction in the number of drug-related adverse effects and improved care of the elderly patient.
Status of Child Health Worldwide
Authors: Nahata Milap C. 
Published: January 2017

OBJECTIVE: The objective of this article is to summarize some of the facts about child health and goals of international health organizations. DATA SOURCES: The sources included the publications of World Health Organization's (WHO), United Nations Children Fund, and United Nations Educational, Scientific, and Cultural Organizations; and journal articles. DATA EXTRACTION: Data on areas related to child health were obtained from various publications. DATA SYNTHESIS: Although childhood mortality continues to fall worldwide, nearly 14 million children under five years of age still die annually in developing countries. Diarrhea, measles, tetanus, pertussis, pneumonia, and malnutrition are preventable and treatable and yet account for the majority of deaths. AIDS has begun to substantially affect the pediatric population. It is encouraging that the WHO's goal to immunize 80 percent of all children in the developing world has been met. The World Summit for Children, in consultation with governments of 159 countries, and the agencies of the United Nations, has adopted new goals to be attained by the year 2000. CONCLUSIONS: It is hoped that governmental and nongovernmental agencies will embrace these goals and formulate plans to markedly reduce childhood morbidity and mortality.
Didanosine Therapy in Patients Intolerant of or Failing Zidovudine Therapy
Authors: Rathbun R. Chris , Martin Emory S. 
Published: January 2017

OBJECTIVE: To examine the effect of didanosine (2′,3′-dideoxyinosine, ddI) on surrogate markers of HIV infection (CD4+ lymphocyte count, p24 antigen) and to evaluate the incidence of adverse effects from ddI. DESIGN: This study was performed as a retrospective chart review of patients who were enrolled in Bristol-Myers Squibb's expanded-access program for ddI. SETTING: Patient records were obtained from primary care physicians' offices. PATIENTS: Twenty-five HIV-infected patients diagnosed with AIDS or AIDS-related complex (ARC) who were intolerant of zidovudine (ZDV) therapy or deteriorating clinically despite ZDV therapy and were eligible for inclusion in the ddI expanded-access program. INTERVENTION: ddI was administered orally in a citrate-phosphate buffer every 12 hours. Patients were followed by their private physician on a monthly basis. MAIN OUTCOME MEASURES: Laboratory analysis at each month included CD4+ lymphocyte count, hemoglobin, hematocrit, serum amylase, uric acid, serum triglycerides, and p24 antigen. Mean CD4+ cell count, serum amylase, hemoglobin, and uric acid at each month during ddI therapy were compared with baseline concentrations for nine months. RESULTS: Patients had received prior ZDV therapy for an average of 15.5 months before starting ddI. Mean CD4+ cell counts increased from 53.9/mm3 at baseline to 72.4/mm3 after 4 months of therapy (p=0.04) but returned to concentrations comparable with those at baseline after 5 months. One case of documented pancreatitis, two cases of suspected pancreatitis, and nine cases of peripheral neuropathy occurred during ddI therapy. The estimated mean cumulative dose for the development of neuropathy was 1.16 g/kg, which is lower than previously reported. CONCLUSIONS: Patients who have received prolonged therapy with ZDV or who have low initial CD4+ counts may not have sustained increases in CD4+ counts from ddI therapy. Also, development of peripheral neuropathy may occur at lower cumulative doses in these patient populations.
Prolonged Recurrence of Pentamidine-Induced Torsades de Pointes
Authors: Cortese Linda M. , Gasser Robert A. , Bjornson Darrel C. , Dacey Michael J. , Oster Charles N. 
Published: January 2017

OBJECTIVE: To report a case of recurrent pentamidine-induced torsades de pointes (TdP) and to review previously reported cases in the literature. DATA SOURCES: Medical records of the subject patient, case reports, and relevant studies identified by MEDLINE. DATA EXTRACTION: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors. DATA SYNTHESIS: A 43-year-old woman with AIDS experienced pentamidine-induced TdP. TdP and other cardiac arrhythmias recurred repeatedly for 13 days after pentamidine therapy was discontinued and in the presence of normal magnesium and potassium serum concentrations. Infusions of magnesium, lidocaine, and isoproterenol were used to treat the arrhythmias. The exact mechanism of pentamidine-induced TdP has not been clearly established. It is postulated, however, that the similarity of pentamidine's structure to procainamide may contribute to its proarrhythmic effects. The tissue-binding capacity of pentamidine may result in a prolongation of its effects. No distinctive characteristic appears to predispose people to the development of cardiac arrhythmias. Laboratory values that should be monitored include serum magnesium, potassium, and creatinine. The corrected QT interval also should be monitored. CONCLUSIONS: Recurrent arrhythmias may be seen for many days after intravenous administration of pentamidine has been discontinued. Clinicians should consider this phenomenon as they decide how to monitor patients who have received this drug.
Verapamil Overdose: Case Report and Review of the Literature
Authors: Watling Sharon M. , Crain Judy L. , Edwards Todd D. , Stiller Ronald A. 
Published: January 2017

OBJECTIVE: To report the presentation and controversies regarding therapy of an 18-year-old man following a life-threatening ingestion of verapamil. CASE SUMMARY: An 18-year-old man ingested large quantities of dipyridamole, trimethoprim/sulfamethoxazole, amoxicillin, and verapamil. He presented to an outlying hospital and was initially conscious. Soon thereafter, the patient had a seizure; he required intubation, developed cardiac conduction abnormalities, and became hypotensive. The patient required pharmacologic pressors and a pacemaker for transfer to our institution. At our institution, vigorous fluid resuscitation, cardiac pacing, and careful attention to acid/base and electrolyte management provided the basis of therapy. The patient recovered without deficit and was discharged from the intensive care unit five days later. DISCUSSION: Current controversies regarding the management of verapamil overdose are reviewed. Removal of the drug by gastric lavage is a mainstay of therapy. Administration of syrup of ipecac is contraindicated. Although specific recommendations for calcium dosing in the overdose situation have not been rigorously studied, maintenance of a normal serum ionized calcium concentration is suggested. An exogenous catecholamine, rather than dopamine, may be the drug of choice for treating hypotension. Cardiopulmonary bypass provides a method for drug removal in cases of severe toxicity; however, this invasive method requires further study. Management of fluid/electrolyte, acid/base, and ventilation abnormalities is required to treat large ingestions of verapamil. Treatment guidelines for critical care clinicians are provided.
Lisinopril-Induced “Scalded Mouth Syndrome”
Authors: Savino Lee B. , Haushalter Nikki M. 
Published: January 2017

OBJECTIVE: To report a case of “scalded mouth syndrome” (SMS) caused by lisinopril. PATIENT: A woman being treated with lisinopril for hypertension developed a burning sensation of her lips and buccal mucosa. The condition persisted with continued use of lisinopril and subsided when the medication was discontinued. CONCLUSIONS: The symptoms described by our patient were similar to those reported in previous cases of SMS associated with the use of enalapril and captopril, two other angiotensin-converting enzyme (ACE) inhibitors. This reaction to ACE inhibitors appears to be dose related, and subsides with a decreased dosage or discontinuation of the medication.
Haemophilus Influenzae Type B Conjugate Vaccines
Authors: Force Rex W. , Lugo Ralph A. , Nahata Milap C. 
Published: January 2017

OBJECTIVE: To review the epidemiology of Haemophilus influenzae type b (Hib) disease, the first Hib vaccine and its limitations, the characteristics and clinical efficacy of the newer conjugate vaccines, and the current recommendations for administration of Hib vaccines. DATA SOURCES: Pertinent literature was identified via a MEDLINE search. Additionally, references cited in published articles were used as data sources. STUDY SELECTION: Studies describing the epidemiology of Hib disease and the efficacy and/or immunogenicity of the Hib vaccines are reviewed. DATA SYNTHESIS: Serious invasive disease secondary to Hib infection causes significant morbidity and mortality in children between the ages of three months and five years. The original Hib vaccine was found to be ineffective in stimulating an adequate immune response in children younger than two years of age. The new Hib conjugate vaccines provide superior efficacy and immunogenicity compared with the original unconjugated vaccine. They stimulate an immune response that is distinctly different from that elicited by the original vaccine. Two vaccine products are currently licensed for use in children as young as two months of age, thus conferring immunity to those children at highest risk for Hib disease. CONCLUSIONS: The new Hib conjugate vaccines provide excellent efficacy and, when used as recommended, may significantly reduce the incidence of invasive Hib disease and its sequelae.
Current Treatment Recommendations for Leishmaniasis
Authors: Moss Jeffrey T. , Wilson James P. 
Published: January 2017

OBJECTIVE: To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease. DATA SOURCES/DATA SELECTION: We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia. DATA EXTRACTION: Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options. DATA SYNTHESIS: The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy. CONCLUSIONS: Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.
Value of Community Pharmacists' Interventions to Correct Prescribing Errors
Authors: Rupp Michael T. 
Published: January 2017

OBJECTIVE: The purpose of this analysis was to estimate the economic value created by community pharmacists who routinely screen for and correct prescribing-related problems during the course of their dispensing activities. DESIGN: Three expert judges evaluated the documented interventions of community pharmacists practicing in five states. RESULTS: The judges agreed that 28.3 percent of the identified problems could have resulted in patient harm had the pharmacist not intervened to correct the problem. The direct cost of medical care that was avoided as a result of pharmacists' intervention activities was estimated to be $122.98 per problematic prescription, or $2.32 per each new prescription order that was screened during the study. CONCLUSIONS: Clinical pharmacy services can and do create significant value by enhancing the achievement of positive patient outcomes and by avoiding negative outcomes. Research to develop reliable methods for measuring and monitoring the value of clinical pharmacy services must continue. Mechanisms must be created to encourage and reward pharmacists who consistently provide services that add measurable value to patient care.
Pain Management with Intravenous Ketorolac
Authors: Miller Lisa J. , Kramer Mark A. 
Published: January 2017

OBJECTIVE: To report a case in which intravenous ketorolac was used successfully on a chronic basis to treat cancer pain. DATA SOURCES: Clinical and compatibility studies obtained through a computer literature search. STUDY SELECTION: We identified five reports that specifically addressed intravenous dosing of ketorolac. DATA SYNTHESIS: A 41-year-old man received pain relief from intravenous injections of ketorolac for 11 months. As far as we know, there are no other reports in the literature in which intravenous ketorolac has been used on a chronic basis. CONCLUSIONS: Experience at our institution indicates that intravenous ketorolac is a useful, well-tolerated nonsteroidal antiinflammatory drug that should be investigated further for use in selected pain models.
Ciprofloxacin-Resistant Haemophilus Influenzae Infection in a Patient with Chronic Lung Disease
Authors: Barriere Steven L. , Hindler Janet A. 
Published: January 2017

OBJECTIVE: To report a case of ciprofloxacin-resistant Haemophilus influenzae infection in a patient with chronic lung disease who was exposed to multiple courses of antimicrobial therapy. CASE SUMMARY: The patient suffered recurrent pulmonary infections and developed bronchiectasis as a consequence of longstanding, severe, combined immunodeficiency disease. He had received ciprofloxacin on several occasions for treatment and prophylaxis of recurrent pulmonary infections. On a recent admission his usual H. influenzae isolate, which had been highly susceptible to ciprofloxacin (minimum inhibitory concentration [MIC] ≤0.06 mg/L) on previous admissions, was resistant to ciprofloxacin and ofloxacin (MIC 8 and 16 mg/L, respectively). The patient responded to treatment with ceftizoxime and was discharged with oral cefixime, which was to be taken for a total of two weeks. DISCUSSION: Rare isolates of H. influenzae resistant to ofloxacin and lomefloxacin have been noted in Europe and Asia; however, none resistant to the fluoroquinolones have been previously reported in the US, and no resistance has been reported to ciprofloxacin. We believe that repetitive, cycling exposure to ciprofloxacin may have induced the resistance that developed in this patient's flora. CONCLUSIONS: Fluoroquinolones may be added to the list of drugs to which H. influenzae have become resistant. Only judicious use of these drugs will preserve their activity against important pathogens in community-acquired infections.
Pharmacotherapy of Sexual Offenders
Authors: Richer Monique , Crismon M. Lynn 
Published: January 2017

OBJECTIVE: To review the definition, sociology, pathogenesis, diagnosis, medicolegal aspects, and pharmacologic treatment of sexual offenders, with emphasis on the antiandrogens, the luteinizing hormone-releasing hormone (LHRH) antagonists, and the serotonergics. DATA SOURCES: An English-language literature search using MEDLINE (1966–1991) yielded clinical trials, case reports, editorials, and review articles. STUDY SELECTION: Emphasis was placed on comparative trials and case reports discussing pedophilia, rape, and exhibitionism. DATA EXTRACTION: Data from controlled human studies were evaluated. The trials were assessed for sample size, duration of therapy, therapeutic response, and incidence of recidivism. CONCLUSIONS: The pharmacologic management of sexual offenders is controversial, and treatment is presently focused on psychotherapy and the use of antiandrogenic medications. Few well-controlled, blinded, efficacy trials with adequate sample sizes have been conducted. The populations studied are heterogeneous, and the subjects enrolled present with different sexually coercive behaviors. Consequently, the results of these studies are difficult to extrapolate to the treatment of other sexual offenders. No convincing evidence exists that pharmacologic treatment decreases the recidivism rate. Case reports describing the use of serotonergic drugs and LHRH antagonists hopefully will promote controlled clinical trials. A social consensus must be reached concerning the ethics of using these agents as a part of the treatment of sexual offenders.
Selection of Activated Charcoal Products for the Treatment of Poisonings
Authors: McFarland Arthur Karl , Chyka Peter A. 
Published: January 2017

OBJECTIVE: To determine if differences exist among currently available activated charcoal products, and if an evaluation of risk versus benefit provides a guide to product selection. DESIGN: National survey by mail. PARTICIPANTS: US manufacturers of activated charcoal products. RESULTS: Six companies market activated charcoal products in ready-to-use containers. The products differ in surface area of charcoal, sorbitol content, and packaging (aqueous or powdered form). No significant differences were noted in the cost of 25- to 30-g units or efficacy based on surface area of activated charcoal. The addition of sorbitol to activated charcoal, particularly at high concentrations, increases the incidence of adverse effects, especially in children. CONCLUSIONS: Although differences do exist among currently marketed activated charcoal products, the clinical significance of these variations is unknown. Based on an evaluation of risks and benefits, any activated charcoal product that does not contain sorbitol appears to be a suitable choice for treating poisoning victims.
Single-Dose Effect of Enteric-Coated Aspirin on Platelet Function and Thromboxane Generation in Middle-Aged Men
Authors: Mohri Hiroshi , Ohkubo Takao 
Published: January 2017

OBJECTIVE: To evaluate the effect of a single dose of enteric-coated aspirin (ECA) in three different dosages on platelet function and thromboxane generation in middle-aged men. DESIGN AND METHODS: In a nonblind, nonplacebo-controlled, crossover study, a single dose of ECA (50, 250, or 1000 mg) was given in a tablet form to a group of healthy, middle-aged men. Ten subjects, aged 50–67 years, volunteered to participate in this study. Platelet functions including bleeding time, platelet aggregation, adenine nucleotides, beta-thromboglobulin, platelet factor 4, thromboxane generation, and aspirin measurement were determined. RESULTS: Before ECA ingestion, the intracellular adenine nucleotides (adenosine triphosphate, adenosine diphosphate) were decreased, and both beta-thromboglobulin and platelet factor 4 were increased. These observations suggested that platelets were activated in vivo in middle-aged men. These findings returned to normal within 8 hours after the ingestion of ECA, and maintained normal for at least two days. Bleeding time was significantly prolonged at 8 and 24 hours compared with that before ingestion of ECA 1000 mg (p<0.05). The generation of platelet thromboxane was maximally inhibited by approximately 40 percent in the samples 8 hours after ECA ingestion. Abnormal values of adenine nucleotides, beta-thromboglobulin, and platelet factor 4 returned to normal within 8 hours. Arachidonic acid-induced platelet aggregation was inhibited compared with that before treatment (p<0.01) and the inhibitory effect was maintained for at least three days. Adenosine diphosphate- and epinephrine-induced aggregations were less inhibited than those induced by arachidonic acid. Inhibitory effects of ECA on platelet aggregation were dose dependent. CONCLUSIONS: Our study indicates that platelets are activated in middle-aged men and that a single dose of ECA 50 mg is safe and can inhibit thromboxane synthesis and platelet aggregation. These results suggest that a daily dose of ECA 50 mg may be useful for blocking platelet activation and preventing thrombosis.
Subcutaneous Absorption Kinetics of Two Highly Concentrated Preparations of Recombinant Human Growth Hormone
Authors: Laursen Torben , Jørgensen Jens O.L. , Susgaard Søren , Møller Jens , Christiansen Jens S. 
Published: January 2017

OBJECTIVE: The relative bioavailability of two highly concentrated (12 IU/mL) formulations of biosynthetic human growth hormone (GH) administered subcutaneously was compared. DESIGN: A randomized, crossover study. Conventional GH therapy was withdrawn 72 hours before each study period. There was a washout period of at least four weeks between the study periods. SETTING: Participants were recruited from an outpatient clinic and were hospitalized during the two study periods. PATIENTS: Fourteen GH-deficient patients (mean age 25.2 y, range 14–54). One patient was excluded from data analysis because of signs of endogenous GH secretion. INTERVENTIONS: At the start of each study period, GH 3 IU/m2 was injected subcutaneously. The two formulations, PenFill and PenSet, differ in the buffers used and in the relative content of mannitol and glycine. Serum profiles of GH were monitored frequently for 24 hours. Samples were taken every 30 minutes for 6 hours and then hourly. MAIN OUTCOME MEASURES: Bioavailability (F) and absorption dynamics of human GH were measured. The relative absorption fractions estimated from the areas under the individual serum concentration curves from 0 to 24 hours, and the observed time (Tmax) to reach the maximum concentration (Cmax) were determined. Short-term metabolic effects of GH on insulin-like growth factor (IGF-I), glucose, and insulin were determined. RESULTS: The geometric mean (SD) of F was 0.910 (1.236). The 90 percent confidence interval was 0.819–1.010. Mean (± SD) of Cmax was 12.65 ± 5.89 and 12.58 ± 4.40 ng/mL for PenFill and PenSet, respectively. Corresponding values for Tmax were 5.49 ± 1.55 and 5.89 ± 1.79 hours for PenFill and PenSet, respectively. There was a considerable interindividual variation, but the relative absorption fraction did not significantly differ from 1 (p=0.13). Neither Cmax (p=0.74) nor Tmax (p=0.58) of the two formulations was significantly different. Injection of the two formulations induced similar increments in serum IFG-I (p=0.48). Serum insulin and blood glucose concentrations were not significantly different. CONCLUSIONS: There is no significant difference between the absorption kinetics and short-term metabolic effects of these two highly concentrated formulations of biosynthetic GH. The two formulations are bioequivalent.