bluuebunny/crossref_metadata_2025_split huggingface dataset:
Possible Case of Procainamide-Induced Intrahepatic Cholestatic Jaundice
Authors: Chuang Linda C. , Tunier Auguste P. , Akhtar Nayeem , Levine Stephen M. 
Published: January 2017

OBJECTIVE: To describe a possible case of procainamide-induced intrahepatic cholestatic jaundice that was recognized six weeks after the initiation of procainamide therapy and to summarize the five previously reported cases. CASE SUMMARY: A 77-year-old woman with a history of hypertension, insulin-dependent diabetes mellitus, temporal arteritis, and Wolff-Parkinson-White syndrome who had taken procainamide for six weeks presented to the hospital with disorientation and acute renal and hepatic dysfunction. In addition to disorientation, scleral icterus, and diffuse maculopapular rash, her physical examination was generally normal. There was no evidence of fever, nausea, vomiting, lymphadenopathy, or eosinophilia. Her liver enzyme concentrations increased significantly from baseline (beginning of procainamide therapy). Her N-acetylprocainamide (NAPA) concentration was elevated to 52 mg/L upon admission. Procainamide was discontinued and her NAPA concentration returned to within normal limits in two days. Diagnostic tests were performed to rule out active hepatitis, vasculitis, and liver malignancies. After procainamide was discontinued and prednisone treatment was started, she became more oriented and her liver enzyme concentrations slowly improved. DISCUSSION: Only five cases of procainamide-induced liver abnormalities have been previously reported; these included granulomatous hepatitis and intrahepatic cholestasis. The mechanism for liver dysfunction is not known; however, it is proposed to be a delayed hypersensitivity reaction. Clinical hallmarks of hypersensitivity include fever, eosinophilia, rash, and lymphadenopathy; nausea and vomiting also may be present. Of the five reported cases, all experienced fever and only one experienced pruritis. No patients had eosinophilia or lymphadenopathy. Because of the temporal increase in liver enzyme concentrations after six weeks of procainamide therapy, we believe that this case represents another possible procainamide-induced hypersensitivity reaction. CONCLUSIONS: Procainamide-induced liver dysfunction can occur from one day to six weeks after initiation of the drug and may subside one day to several weeks after discontinuation of therapy. Symptoms may include nausea, vomiting, rash, and fever. Liver enzyme concentrations are abnormal. It is important to recognize the possibility of such a reaction early so that procainamide therapy can be discontinued promptly to avoid further liver damage.
Prospective Surveillance of Imipenem/Cilastatin Use and Associated Seizures Using a Hospital Information System
Authors: Pestotnik Stanley L. , Classen David C. , Evans R. Scott , Stevens Lane E. , Burke John P. 
Published: January 2017

OBJECTIVE: To develop computerized methods to monitor and recommend dosage changes for patients treated with excessive dosages of imipenem/cilastatin (I/C) and to determine the incidence of I/C-associated seizures in our patient population. DESIGN: Prospective observational and interventional study of all patients admitted to LDS Hospital and treated with I/C from May 1, 1987, through June 30, 1991. SETTING: LDS Hospital, Salt Lake City, UT, a 520-bed, tertiary care center associated with the University of Utah School of Medicine. PATIENTS: Using a hospital information system we developed computerized algorithms to identify and monitor patients receiving I/C. These algorithms screened the computer-stored medical records of all inpatient admissions for I/C prescription orders. Computer-decision support algorithms estimated the renal function of each I/C-treated patient and provided suggestions when dosages were determined to be excessive. Additional computer-generated alerts identified patients who were receiving anticonvulsants concomitantly with I/C or whose therapy reflected dosage changes in the previous 24 hours. A list of all I/C-treated patients with alerts was reviewed daily by a clinical pharmacist and prescribing physicians were contacted if the computer-generated suggestions were clinically relevant. MAIN OUTCOME MEASURE: The number and characterization of I/C-associated seizures. RESULTS: From May 1, 1987, through June 30, 1991, we prospectively monitored 107 600 patients of whom 1951 were treated with I/C. The following risk factors for I/C-associated seizures were observed in the I/C-treated population: CNS disease (6 percent), seizure disorders (0.6 percent), and abnormal renal function (70 percent). The observational and interventional methods employed in this study resulted in 79 percent of the patients receiving I/C dosages appropriate for their corresponding renal function. During the 50-month study period, we detected four seizures (0.20 percent) in the I/C-treated patients. All 4 patients were receiving I/C dosages that were excessive with respect to their renal function. CONCLUSIONS: Our rate of seizure (0.2 percent) was lower than the 1–2 percent rate reported in the literature despite the fact that more than 70 percent of the patients who received I/C had risk factors for seizure. We believe that appropriate dosing of I/C results in a low rate of associated seizures. Computer-assisted monitoring of I/C dosages in relation to renal function resulted in a reduced incidence of seizures.
Prophylaxis of HIV Infection following Occupational Exposure
Authors: Fish Douglas N. 
Published: January 2017

OBJECTIVE: To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis. DATA SOURCES: English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis. STUDY SELECTION: Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included. DATA EXTRACTION: In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed. DATA SYNTHESIS: Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain. CONCLUSIONS: Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.
Pharmacy in Iceland
Authors: Cleary John D. , Gunnarsdottir Rannveig , Loftsson Thorsteinn , Magnusson Einar 
Published: January 2017

OBJECTIVE: To summarize the practice of pharmacy in Iceland. DATA SOURCES: Human resources were the primary sources of data for this publication. Personal observation by Cleary is the basis of this publication. DATA EXTRACTION AND SYNTHESIS: Data on areas related to Icelandic history, practice of pharmacy, Icelandic health system, and the European Economic Community and Education were obtained through interviews. Information is presented to give an appreciation of pharmacy practice in a Nordic country. CONCLUSIONS: Pharmacy education and practice is progressive and flourishing in Iceland's National Health Service. Clinical pharmacy services are in their infancy; however, the potential for growth is immense. The Fulbright experience was educational and beneficial for all parties involved.
Treatment of Bacterial Vaginosis
Authors: Schlicht John R. 
Published: January 2017

OBJECTIVE: The purposeof this articleis to review the treatment options for bacterial vaginosis, including the newer topical antibiotics, metronidazole gel and clindamycin cream. The article also examines the controversies over whether bacterial vaginosis is a sexually transmined disease and whether asymptomatic women should be treated. DATA SOURCE: A MEDLINE search was conducted to identify pertinent literature, including review articles. STUDY SELECTION: Emphasiswas placed on those clinical trials using metronidazole gel or clindamycin cream. Studies addressing the complications of bacterial vaginosis in pregnancy, the risk of treatment in pregnancy, and the method of transmission of the disease also were reviewed. DATA EXTRACTION: Clinical studies evaluating clindamycin cream and metronidazole gel were scarce; therefore, data from all available trials were reviewed. The objectives, methodology, and results from other studies werer eviewed; thoseaddressing complications of the disease and risksand benefits of treatment wereincluded. DATA SYNTHESIS: There is evidence both for and against bacterial vaginosis being a sexually transmined disease. Potential complications of the disease may warrant treatment of certain asymptomatic women, especially during pregnancy. Treatment options include oral or vaginal metronidazole or clindamycin, all of which provide high cure rates. Vaginal antibiotics result in minimal risk to the fetus in pregnant patients. CONCLUSIONS: Complications of bacterial vaginosis maybe associated with significant morbidity, especially among pregnant women. Treatment of asymptomatic women with the disease is controversial, but may be justified in certain high-risk populations. The topical agents, clindamycin vaginal cream 2% and metronidazole vaginal gel 0.75% provide a safe, effective, but expensive alternative to oral antibiotic regimens for the treatment of bacterial vaginosis.
Ticlopidine and Fatal Aplastic Anemia in an Elderly Woman
Authors: Mallet Louise , Mallet Jacques 
Published: January 2017

OBJECTIVE: To report a case of aplastic anemia that developed during ticlopidine treatment. CASE SUMMARY: An 84-year-old woman was started on ticlopidine for secondary stroke prevention. Within six weeks of initiating ticlopidine therapy she developed aplastic anemia. She was hospitalized and received empiric antibiotics, antifungal agents, blood transfusions, platelets, and granulocyte colony-stimulating factor. The patient died on day 76 after beginning ticlopidine. DISCUSSION: Hematologic effects such as neutropenia, thrombocytopenia, agranulocytosis, thrombotic thrombocytopenic purpura, and pancytopenia have been described with the use of ticlopidine. Previous case reports have associated ticlopidine with the development of aplastic anemia. CONCLUSIONS: Ticlopidine can produce fatal hematologic adverse effects, and its use should be reserved as second-line therapy.
Severe, Disabling Neurologic Toxicity Following Cisplatin Retreatment
Authors: Higa Gerald M. , Wise Tamara C. , Crowell Edward B. 
Published: January 2017

Objective: To describe a severe neurotoxic reaction following the second cycle of cisplatin-based chemotherapy. Case Summary: A patient with unresectable non–small-cell lung cancer was treated with combined chemotherapy and radiotherapy. Thirty-six hours after the second course of chemotherapy, the patient developed severe mental status changes consisting of aphasia, confusion, and agitation. Complete neurologic workup was most consistent with an acute vascular event. Discussion: Reports of acute cisplatin-induced neurologic toxicity involving the central nervous system are rare. Potential risk factors are described. Mechanisms of chemotherapy-induced vascular damage are discussed. Conclusions: Total dosage and administration schedule of cisplatin are associated with an increased incidence of neuropathy. However, factors predicting the development of early, acute neurotoxicity are limited by the rarity of these events. It is probable that acute neurotoxic reactions in cancer patients are caused by an unknown complex of interactions involving drugs, tumor, and host factors.
Thrombocytopenia in Intensive Care Patients: A Comprehensive Analysis of Risk Factors in 314 Patients
Authors: Bonfiglio Mark F , Traeger Sheldon M , Kier Karen L , Martin Bradley R , Hulisz Darrell T , Verbeck Stephen R 
Published: January 2017

Objective: To define the incidence and severity of thrombocytopenia in a mixed medical-surgical population of critically ill patients and to examine factors that may be related to the development of thrombocytopenia. Design: Retrospective chart review of 314 critically ill patients requiring at least 3 days of critical care. Setting: A 17-bed combined medical-surgical intensive care unit (ICU) in a 560-bed tertiary care community hospital. Patients: Medical and surgical patients admitted to the ICU. Interventions: All medical records over the duration of the ICU stay were reviewed. All scheduled medications, including dosage and start/stop dates, were recorded. All platelet counts, placement of pulmonary artery catheters, liver function test results, and admission serum creatinine concentrations were collected. Measurement and Main Results: Thrombocytopenia (platelet count less than 200 × 109L) was observed frequently, but rarely reached a severe stage (7 patients). No single diagnostic category was significantly associated with thrombocytopenia alone, although the combination of sepsis syndrome/septic shock and respiratory failure was strongly correlated (p < 0.0001) with thrombocytopenia. Liver function abnormalities were correlated strongly with thrombocytopenia, and the majority of patients (5 of 7) with severe thrombocytopenia (less than 20 × 109/L) were found to have concurrent severe alterations in liver function test results. Pulmonary artery catheter placement and heparin exposure were associated strongly with thrombocytopenia (p < 0.0001). Drug therapies that were correlated with thrombocytopenia included heparin and vancomycin (p < 0.05). Hemodynamic instability was correlated strongly with the presence and severity of thrombocytopenia. In a stepwise linear regression model, the admission platelet count accounted for the largest proportion of the variance (43%), followed by hemodynamic instability (8%) and the requirement for inotropic agents (2%). Conclusions: Thrombocytopenia in the critically ill occurs frequently, rarely reaches severely depressed concentrations, and primarily represents a manifestation of disease processes initiated prior to admission. Hemodynamic instability and/or heparin exposure appear to be the strongest identifiable correlates with thrombocytopenia. Although these may cause infrequent isolated cases, other specific drug causes of thrombocytopenia are not responsible for the majority of cases of thrombocytopenia in the critically ill.
Aerosolized Beta2-Agonists Do Not Induce Bronchial Hyperreactivity in Healthy Adults
Authors: Kelly H William , McWilliams Bennie C , Murphy Shirley 
Published: January 2017

Objective: To determine whether regular administration of beta2 agonists could induce bronchial hyperreactivity in nonasthmatic volunteers. Design: A prospective, randomized, double-blind, placebo-controlled, crossover clinical trial of 2 weeks therapy with a 2-week washout period between each treatment period. Treatments were albuterol or matching placebo as 2 inhalations 4 times daily. Subjects: Ten healthy, nonsmoking women 27—37 years old. Setting: General clinical research center of a tertiary care university hospital. Main Outcome Measures: Baseline spirometry and methacholine bronchoprovocation studies were performed immediately prior to, 12 hours following, and 1 and 2 weeks following each treatment period. Results: No change was detected in either baseline spirometry or methacholine responsiveness. Conclusions: This suggests that if beta2-agonists induce a rebound bronchial hyperreactivity, it is not the result of the production of tolerance or a direct effect on bronchial smooth muscle.
Invasive Aspergillosis: A Life-Threatening Complication of Short-Term Steroid Treatment
Authors: Conesa Dolors , Rello Jordi , Vallés Jordi , Mariscal Dolors , Ferreres Joan Carles 
Published: January 2017

Objective: To describe a patient with invasive pulmonary aspergillosis related to short-term steroid treatment. Case Summary: A 78-year-old man with chronic obstructive pulmonary disease (COPD) developed an invasive pulmonary aspergillosis after short-term (less than 1 week) intravenous steroid therapy. The diagnosis was established by recovering Aspergillus fumigatus from a bronchoalveolar lavage and was confirmed by autopsy, with the additional finding of an aspergilloma. Discussion: This case is of interest for 3 reasons: (1) it illustrates that invasive aspergillosis may be followed by a rapidly progressive respiratory failure, even in the absence of a fever; (2) this patient had simultaneously an aspergilloma and an invasive aspergillosis; and (3) it confirms reports indicating that short-term steroid therapy for COPD represents a significant risk factor for opportunistic lung infections. Conclusions: In patients with COPD who receive even short-term steroid therapy and who have progressive respiratory failure caused by pneumonia, invasive aspergillosis should be suspected early and acted upon accordingly.
Opiate-Induced Respiratory Depression in Pediatric Patients
Authors: Gill Andrea M , Cousins Alison , Nunn Anthony J , Choonara Imti A 
Published: January 2017

OBJECTIVE: To describe 15 pediatric patients with opiate-induced respiratory depression. DESIGN: In-house adverse drug reaction (ADR) report forms were reviewed to identify any patients with suspected opiate-induced respiratory depression. Case review was then performed. SETTING: Large pediatric teaching hospital with regional specialties. PATIENTS: Fifteen patients aged 2 days to 17 years (median 14 mo). MAIN OUTCOME MEASURES: Respiratory depression resulting in apnea, hypoxia, cyanosis, reduced respiratory rate, or the need for naloxone following or during opiate administration was recorded. RESULTS: Fifteen patients experienced some degree of respiratory depression over the 3 years of surveillance. Treatment included naloxone (12 patients), admission to the pediatric intensive care unit (8), ventilation (5), and reduction in dosage (1). Predisposing factors for respiratory depression included an age of less than 1 year, excessive dosage, concurrent medical problems, concurrent drugs, and medication errors. CONCLUSIONS: Opiate-induced respiratory depression in pediatric patients occurs infrequently, but may have serious consequences. Opiates are potent analgesics that children require and should receive. Safe use of opiates in pediatric patients, however, depends on the dosage, route and method of administration, consideration of any predisposing factors, and adequate monitoring. This article highlights some of the problems with opiate use in children and gives some recommendations on how these problems may be prevented.
Fluvoxamine for Stereotypic Behavior in Patients with Dementia
Authors: Trappler Brian , Vinuela Luis M 
Published: January 2017

OBJECTIVE: To describe the effects of treatment with the selective serotonin reuptake inhibitor fluvoxamine on three patients with advanced dementia who developed a stereotypic movement disorder. CASE SUMMARY: Three patients in a skilled nursing facility were referred by their primary physicians for psychiatric consultation to assist with the management of stereotypic behaviors. The patients received a standard medical, neurologic, and psychiatric workup for dementia. Two of the patients were diagnosed with dementia of the Alzheimer type and the other patient was diagnosed with vascular dementia. All three patients were started on fluvoxamine 25 mg/d; behaviors were monitored daily by the nursing staff and their primary care physicians and weekly by their psychiatrist using the Abnormal Involuntary Movement Scales. The dosage was titrated upward weekly to a maximum dosage of 150 mg/d. RESULTS: Two patients showed complete resolution of their stereotypic behaviors by week 6. The third patient showed noticeable improvement with some residual movements after 8 weeks of treatment. CONCLUSIONS: Fluvoxamine appeared effective in the control of stereotypic behaviors in three patients with advanced dementia.
Effect on Dissolution from Halving Methylphenidate Extended-Release Tablets
Authors: Erramouspe John , Jarvi Eric J 
Published: January 2017

OBJECTIVE: To determine the effect on in vitro dissolution from cutting methylphenidate extended-release tablets in half. DESIGN: Ritalin-SR (Ciba Pharmaceutical Co.) and generic methylphenidate extended-release (MD Pharmaceutical Inc.) tablets were dissolved in water according to the method prescribed by the US Pharmacopeia under two conditions: whole and halved. Samples were collected at 15, 30, and 45 minutes and at 1, 2, 3, 3.5, 4, 5, 6, and 7 hours. Methylphenidate content was determined by HPLC. RESULTS: Halving the tablets caused a statistically significant increase in cumulative dissolution as early as 15 minutes. The difference in cumulative dissolution reached its maximum for both Ritalin-SR and generic methylphenidate extended-release tablets at 2 hours. At this time point, the percent dissolution of the whole versus halved tablets was 57% versus 74% (Ritalin-SR), respectively, and 49% versus 67% (generic), respectively. The dissolution profiles of halved and whole extended-release methylphenidate tablets were parallel from this point through the 7-hour collection period. At 7 hours, however, there was no difference in the cumulative dissolution of halved versus whole tablets. CONCLUSIONS: While statistical differences during in vitro dissolution do exist and pharmacokinetic ramifications have not yet been determined, the absolute differences in dissolution between halved and whole tablets are not great. Halving methylphenidate extended-release tablets may be a clinically acceptable means of achieving a small increment/decrement in dose without converting to a regular-release tablet.