bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluoroquinolone E-Testing against Pseudomonas Aeruginosa and Streptococcus Pneumoniae
Authors: Sahloff Eric G , Smith Benjamin P , Martin Steven J 
Published: September 2013

Objectives and Design: The use of fluoroquinolones has increased against antibiotic-resistant pathogens such as Streptococcus pneumoniae and Pseudomonas aeruginosa. The E-test (AB Biodisk, Solna, Sweden) is now commonly used for susceptibility testing of fluoroquinolones against these organisms. The purpose of the present study was to evaluate the accuracy and correlation of minimum inhibitory concentrations (MICs) determined by E-testing with a National Committee for Clinical Laboratory Standards reference standard, agar-dilution MIC testing. E-test and agar dilution MICs were compared for ciprofloxacin, levofloxacin, gatifloxacin, and moxifloxacin against clinical isolates of S. pneumoniae (n = 53) and P. aeruginosa (n = 62). Main Outcome Measures: MICs were determined by use of agar dilution and E-test methods. Essential agreement was defined as MICs from both methods within ± 1 log2 dilution. Categorical agreement compared MIC interpretations: susceptible, intermediate, or resistant. Categorical disagreement between methods was reported as very major, major, or minor errors. Results: E-tests produced lower MICs than the reference method for ciprofloxacin, gatifloxacin, and moxifloxacin versus P. aeruginosa. For S. pneumoniae, E-test MICs tended to be higher for all fluoroquinolones. The best correlation between testing methods was seen with levofloxacin. Essential agreement occurred more frequently with P. aeruginosa in the lower range of MICs and with S. pneumoniae in the higher range of MICs. Categorical agreement was greater than 90% for the 460 comparisons. Two very major errors (false-susceptible) occurred for gatifloxacin versus P. aeruginosa. Conclusions: For the determination of fluoroquinolone susceptibility against S. pneumoniae and P. aeruginosa, E-testing is a simple tool for clinical use, and few very major or major errors in susceptibility interpretation occur for either organism. For determining fluoroquinolone MICs, E-testing may overestimate drug activity against P. aeruginosa and underestimate drug activity versus S. pneumoniae compared with the agar dilution method. These differences could affect appropriate antimicrobial selection, leading to suboptimal outcomes.
Assessing Home Health Care Pharmacists' Knowledge of Cytochrome P450 Pharmacogenetics
Authors: Rogers Janyce F , Kidd Robert S 
Published: September 2013

Objective: Genetic code governs cytochrome P450 activity as a consequence, it may influence an individual's response to medications metabolized by these enzymes. Pharmacists have a prominent role in providing education concerning adverse drug reactions and variability in drug response. This investigation assessed the knowledge of a group of pharmacists regarding cytochrome P450 pharmacogenetics. Methods: This observational, cross-sectional study presented a Web–based questionnaire available for completion by pharmacists contacted via E-mail. Fifty-two pharmacists involved with a nationwide home-care facility participated in the study on a volunteer basis. The main outcome measure was percentage score on a 10-question examination. Results: Fifty-two of 171 contacted pharmacists participated in the study, yielding a response rate of 30%. The mean percentage questionnaire score ± SD was 17.5 ± 15.1. Scores were slightly higher for pharmacists with 2 or more pharmacokinetic classes in their formal education (p < 0.02). Conclusions: Understanding the principles of pharmacogenetics will allow pharmacists to appreciate that patients respond differently to certain medications as influenced by genetic variations encoding drug-metabolizing enzyme activity. As a consequence, some patients will have a normal therapeutic response, whereas others may experience drug toxicity or therapeutic inefficacy when given the same dose of a drug. This study determined, albeit with many limitations, that there is likely a need for improved availability of pharmacogenetic continuing education programs.
G-CSF and Erythropoietin Stability in Amniotic Fluid during Simulated in vitro Digestion Conditions
Authors: Calhoun Darlene A , Richards Brooke E , Gersting Jason A , Sullivan Sandra E , Christensen Robert D 
Published: September 2013

Objective: To determine the stability of granulocyte colony-stimulating factor (G-CSF) and erythropoietin (Epo) in human amniotic fluid and recombinant G-CSF (Neupogen) and Epo (Epogen) in simulated amniotic fluid to digestions at pH concentrations of 3.2, 4.5, and 5.8 to assess their bioavailability to the neonate. Design: A simulated amniotic fluid containing Neupogen and Epogen was subjected to in vitro conditions that mimicked preprandial and postprandial neonatal intestinal digestion. Human amniotic fluid was tested using identical digestion conditions as well as human amniotic fluid to which Epogen and Neupogen had been added. Main Outcome Measures: The percentages of G-CSF/Epo and Neupogen/Epogen remaining after 1 and 2 hours of simulated digestions were compared with those at time zero, and concentrations at 2 hours were compared with those at 1 hour and time zero. Results: In simulated amniotic fluid at pH 3.2, significant degradation of G-CSF was observed at 1 hour (p = 0.03). No differences were observed at 1 or 2 hours for either pH 4.5 (p = 0.30 and 0.11, respectively) or pH 5.8 (p = 0.20 and 0.49, respectively). Human amniotic fluid exhibited significant degradation pH 3.2 (p = 0.04) and pH 4.5 (p < 0.05) at 1 hour; no difference was noted at pH 5.8 at 1 hour (p = 0.34). When additional Neupogen was added to human amniotic fluid, significant degradation was observed at pH 3.2 (p < 0.05) and pH 4.5 (p = 0.03) at 1 hour; no difference was noted at 1 hour at pH 5.8 (p = 0.11). In simulated amniotic fluid at pH 3.2, significant degradation of Epo occurred at 1 hour (p < 0.05). There were no differences at 1 hour for pH 4.5 (p = 0.50) or pH 5.8 (p = 0.17). Human amniotic fluid exhibited significant degradation at pH 3.2 (p < 0.05) and pH 4.5 (p < 0.05) at 1 hour; no difference was noted at 1 hour at pH 5.8 (p = 0.34). When additional Epogen was added to human amniotic fluid, significant degradation was observed at pH 3.2 (p = 0.001) and pH 4.5 (p = 0.003); no difference was noted at 1 hour at pH 5.8 (p = 0.31). Conclusions: G-CSF/Epo in human amniotic fluid and Neupogen/Epogen in simulated amniotic fluid are preserved to varying degrees during simulated digestion conditions. The degree of degradation of both cytokines was time- and pH-dependent. Measurable quantities of G-CSF and Epo are biologically available when swallowed by the fetus or a preterm neonate.
Evaluation of Eptifibatide Treatment in Patients Undergoing Percutaneous Coronary Intervention
Authors: Sheikh-Taha Marwan T , Strickland Warren L 
Published: September 2013

Background: Abrupt closure and restenosis remain serious and costly consequences of coronary angioplasty procedures. Eptifibatide (Integrilin) has been shown to decrease the rate of combined endpoint of death, new myocardial infarction, or the need for urgent intervention in this setting. Platelet aggregation is inhibited by eptifibatide in a dose-dependent manner, with more than 80% receptor occupancy required to prevent thrombus formation. Objective: To evaluate the safety and efficacy of a shorter duration of treatment with eptifibatide in low-risk patients undergoing percutaneous coronary intervention. Methods: We compared low-risk patients undergoing percutaneous coronary intervention who received either conventional eptifibatide dosing or a bolus dose that was sufficient to produce more than 80% platelet inhibition. All patients were followed for major adverse cardiovascular events (MACE) for 90 days after the procedure. MACE complications included death, myocardial infarction (defined as elevation of the creatine kinase-MB fraction at least 3 times the upper limit of normal or new Q-waves in 2 electrocardiographic leads), or any treatment for recurrent angina (percutaneous transluminal coronary angioplasty, stent placement, or coronary artery bypass grafting). Safety was assessed by the incidence of bleeding and thrombocytopenia. Results and Conclusions: None of the patients in either study group had a MACE or thrombocytopenia during the follow-up period. Patients who received a conventional eptifibatide dose had a higher incidence of minor bleeding. It appears that, in low-risk patients, a shorter duration of treatment with eptifibatide may prevent the ischemic complications of percutaneous coronary intervention.
Cholestyramine Ointment Used on an Infant for Severe Buttocks Rash Resistant to Standard Therapeutic Modalities
Authors: White C Michael , Kalus James S , Caron Michael F , Suski Kelly 
Published: September 2013

Objective: To describe a case of severe buttocks rash refractory to standard therapy that was treated successfully with cholestyramine 5% in Aquaphor. Case Summary: An infant developed a rash that worsened to a severe and very painful buttocks rash refractory to other therapies. When cholestyramine ointment was applied after every stooling, the rash was markedly improved within 2 days and completely resolved 7 days after therapy was initiated. Discussion: Fecal expulsion of bile acids may be the reason for treatment-refractory severe buttocks rashes in infants. The use of topical cholestyramine ointment may lead to the resolution of problems even among previously determined treatment-refractory cases. This was shown elsewhere in a child on a promotility drug. Conclusions: Cholestyramine ointment can be compounded and may provide benefit for infants who have a severe buttocks rash that is refractory to traditional therapies.
Phenelzine–Opiate–Induced Delirium Complicated by Phenelzine Withdrawal
Authors: Gold Douglas G , Fatemi S Hossein 
Published: September 2013

Objective: To report a case of delirium involving a drug interaction of the antidepressant phenelzine in combination with an opiate and to discuss the exacerbation of delirium secondary to a withdrawal syndrome caused by the abrupt discontinuation of phenelzine. Case Summary: A 67-year-old white woman with a history of major depression and chronic anxiety developed delirium shortly after the postsurgical administration of opioid analgesics. In addition, she was taking the antidepressant phenelzine and had been maintained on this medication for approximately 20 years. Her presenting symptoms included combativeness, auditory and visual hallucinations, and persecutory delusions. After development of the delirium, the patient's phenelzine medication was abruptly discontinued, introducing a withdrawal syndrome that further aggravated her condition. Discussion: This case emphasizes the importance of the potentially fatal drug interaction involving phenelzine and opiates and addresses the adverse consequences of abruptly discontinuing phenelzine during phenelzine–opiate–induced delirium. Phenelzine–opiate interactions and phenelzine withdrawal should be considered as possible etiologies of delirium in patients with a history of phenelzine use. Conclusions: Less widely prescribed antidepressants such as phenelzine may be unfamiliar to contemporary clinicians, resulting in adverse consequences for patients, such as phenelzine–opiate drug interactions and phenelzine withdrawal.
Seizures: An Unusual Complication of Intrapleural Povidone–Iodine Irrigation
Authors: Azzam Zaher S , Farhat Diab , Braun Eyal , Krivoy Norberto 
Published: September 2013

Objective: To report a case of seizures that probably developed because of the disinfectant and antiseptic agent povidone iodine (PVI). Case Summary: A 67-year-old healthy white man developed pleural empyema that was treated with drainage and intrapleural PVI irrigation. Within 10 minutes, complex partial seizures with secondary generalization lasting several minutes were documented. Several hours later, the patient developed a similar episode. Both events resolved spontaneously and, in 10 months of follow-up, there was no recurrence. Discussion: The adverse effects of iodine are known; however, little has been reported about seizures following the administration of PVI. This complication is thought to be due to either the osmotic and hydrophilic qualities or the presence of ionic changes and lipid solubility of PVI. Conclusions: Intracavitary PVI should be considered in the differential diagnosis of localized and generalized seizures.
Voriconazole: A Novel Antifungal
Authors: Gunderson Shana M , Jain Rupali , Danziger Larry H 
Published: September 2013

Objective: To review the published in vitro, in vivo, and clinical data and FDA background documents that led to the approval of voriconazole. Data Sources: Articles were identified by the referenced package insert and by a MEDLINE search (1966–October 2002) using the terms voriconazole, azole antifungal, aspergillosis, and UK-109, 496. Additionally, journal Web sites and abstracts from major infectious disease meetings were researched to obtain newly published data. Study Selection: All animal and human data published in journals, abstracts, and FDA background documentation were used. The only in vitro susceptibility testing studies used were those that incorporated a large number of fungal isolates. Data Synthesis: Voriconazole is a novel monotriazole antifungal agent that inhibits the fungal cytochrome P450–mediated 14 α-lanosterol demethylation. In vitro susceptibility studies, in vivo clinical trials, and case reports have shown potent activity against various Aspergillus spp., Scedosporium, and Fusarium. Additionally, voriconazole has shown in vitro activity against dimorphic fungi and yeast, including Candida spp. and Cryptococcus neoformans. The efficacy of voriconazole has been evaluated in 4 clinical trials. The clinical studies indicate that it is at least as effective as amphotericin B for the treatment of acute invasive aspergillus infection. The most common adverse effects in clinical trials included visual disturbances, rash, and elevated liver function tests. Voriconazole is metabolized by CYP2C19, CYP2C9, and CYP3A4 and thus causes multiple serious drug–drug interactions. Conclusions: Voriconazole provides an advance in therapy for the treatment of acute invasive aspergillus infection.
Rhabdomyolysis Due to Combined Therapy with Cerivastatin and Diclofenac
Authors: Schechner Vered , Hershcovici Tiberiu , Beigel Yitzhak 
Published: September 2013

Objective: To describe the occurrence of severe rhabdomyolysis and acute renal failure in a patient treated concomitantly with cerivastatin and diclofenac. Case Summary: A 73-year-old white man with mild chronic renal failure, treated with cerivastatin for hypercholesterolemia, received intramuscular injections of diclofenac for low-back pain. A few days later, severe muscle weakness and acute renal failure developed. Laboratory tests confirmed severe rhabdomyolysis. Diclofenac and cerivastatin were discontinued, and treatment with forced diuresis and urine alkalinization was started. Twenty-four days later, serum creatine phosphokinase and urinary function returned to baseline, and the muscle weakness improved. Discussion: Rhabdomyolysis is a well-known adverse effect of statins. According to recent reports, it occurs more frequently with cerivastatin than with other statins. Nevertheless, the interaction between cerivastatin (or other statins) and diclofenac as a trigger for rhabdomyolysis has never been reported. Conclusions: Coadministration of diclofenac (and perhaps other nonsteroidal antiinflammatory drugs) with cerivastatin (and perhaps other statins) should be done cautiously, especially in the presence of renal failure, under close monitoring of renal function and muscle enzyme levels.
An Unusual Case of Thrombocytopenia and Leukopenia Associated with Diltiazem and Acyclovir
Authors: Cersosimo Robert J , Hankins Michelle A , Hamrah Sanaz D 
Published: September 2013

Objective: To describe the case of a patient who developed thrombocytopenia associated with diltiazem and leukopenia associated with diltiazem or acyclovir. Case Summary: An 81-year-old white man was admitted for management of chronic obstructive pulmonary disease (COPD). On admission, his white blood cell (WBC) count and platelet count were within normal limits. Admission medications included metoprolol, which was replaced on day 3 with diltiazem due to concern that it might exacerbate the COPD. The patient's platelet count at the initiation of diltiazem therapy was 180 × 103/mm3. The next day the platelet count was 232 × 103/mm3, but decreased to 182 × 103/mm3 on day 5 and continued to decline through day 30, at which time it reached a nadir of 10 × 103/mm3. By then, several causes of thrombocytopenia, including disseminated intravascular coagulation and thrombotic thrombocytopenic purpura, had been ruled out. A hematology consult suggested diltiazem as the cause of thrombocytopenia, and it was discontinued. The platelet count began to rise 8 days after discontinuation of diltiazem and returned to normal values over a period of 5 days. On day 15, acyclovir was initiated for an oral herpes simplex virus–1 infection. The WBC count on day 20 was 8.7 × 103/mm3, and it continued to decline daily. On day 24, the value was 2.5 × 103/mm3, at which time acyclovir was discontinued. The WBC count continued to decline for 6 days, reaching a nadir of 0.6 × 103/mm3, at which point filgrastim was initiated; the WBC count gradually returned to normal over the next 5 days. Conclusions: Myelosuppression is a rare complication of diltiazem and acyclovir therapy. Patients using these medications should be monitored for signs and symptoms of myelosuppression.
Possible Lovastatin-Induced Fatal Necrotizing Pancreatitis
Authors: de A Nishioka Sérgio , Guedes Liliane Q 
Published: September 2013

Background: A few cases of statin-associated pancreatitis have been reported in the literature, mostly related to the use of simvastatin. Only 3 cases of pancreatitis associated with lovastatin have been recognized, with 2 of them possibly due to its interaction with gemfibrozil and erythromycin. Case Report: A 49-year-old woman, who had been receiving treatment for hypercholesterolemia with lovastatin 20 mg/d for about a month, was admitted to a hospital with a diagnosis of diarrhea and septic shock. She was later referred to another hospital where surgical diagnosis of necrotizing pancreatitis was made and died after prolonged hospitalization. This patient had no evidence of common risk factors to acute pancreatitis, such as biliary tract disease or alcohol use, but had moderate hyperlipidemia. Assessment of the likelihood of a causal relationship using the Naranjo probability scale suggested that the association between lovastatin and necrotizing pancreatitis in this case was probable or possible, depending on the rejection or acceptance of shock or use of ranitidine and ceftriaxone as alternative causes of pancreatitis. Discussion: There is some evidence that statins are rarely associated with acute edematous and necrotizing pancreatitis, by unknown mechanisms. This case report adds to the evidence that lovastatin is possibly 1 of such statins. Conclusions: Lovastatin is a possible cause of pancreatitis. Prescribers of statins (particularly simvastatin and lovastatin) should take into account the possibility of acute pancreatitis in patients who develop abdominal pain within the first weeks of treatment with these drugs.
A Comparison of Orlistat Use in a Veteran Population: A Pharmacist-Managed Pharmacotherapy Weight-Loss Clinic versus Standard Medical Care
Authors: Graham Maqual R , Landgraf Chelsea G , Lindsey Cameron C 
Published: September 2013

Objective: To determine whether a pharmacist-managed pharmacotherapy weight-loss clinic using orlistat is beneficial in promoting weight loss and reducing cardiovascular risk. Methods: A retrospective review of the records of all veterans receiving orlistat was conducted. Patients were assigned to 1 of 2 treatment groups: those enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic (intervention) or those receiving standard medical care (control). Changes in weight and body mass index (BMI) at 6 months were compared with baseline measures. Treatment success, defined as a weight loss of ≥5% of initial body weight, was determined. The impact of weight loss on cardiovascular risk factor reduction was compared within each group. The prevalence of adverse drug reactions was also assessed and compared. Results: Forty-seven patients were included in the analysis: 18 and 29 in the intervention and control groups, respectively. Intervention patients lost a mean ± SD of 5.0 ± 6.0 kg by 6 months compared with 2.2 ± 4.7 kg for the controls (p = 0.109). BMI significantly decreased for all patients independent of group assignment (intervention, p = 0.006; control, p = 0.026), yet a between-group comparison revealed no difference (p = 0.140). Five patients (28%) in the intervention group were considered treatment successes versus 4 (14%) in the control group; however, this was not a significant difference (p = 0.274). Total cholesterol and glycosylated hemoglobin were significantly decreased in intervention patients, while control patients demonstrated significant improvement only in total cholesterol. There was no difference in adverse reaction occurrence between groups (p = 0.995). Conclusions: Patients enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic lost twice as much weight, and twice as many were considered treatment successes compared with control patients. Intervention patients demonstrated improvement in several cardiovascular risk factors.
Effectiveness of an Amiodarone Protocol and Management Clinic in Improving Adherence to Amiodarone Monitoring Guidelines
Authors: Graham Maqual R , Wright Marcia A , Manley Harold J 
Published: September 2013

Objective: To determine whether adherence to suggested monitoring parameters improved as a result of the development and implementation of an amiodarone protocol and management clinic. Adverse effects from amiodarone therapy were also evaluated to ascertain whether the Amiodarone Management Clinic (AMC) better identified adverse events as a result of improved monitoring. Methods: A retrospective review of charts of patients with an active amiodarone prescription was conducted. Patients were identified as enrolled in the AMC (intervention) or as receiving standard medical care (control) by nonpharmacist practitioners. Compliance with recommended monitoring parameters, including the presence of interacting medications and associated drug concentration or international normalized ratio (INR), was assessed for all patients and then compared between groups. Type and frequency of adverse effects were determined for both groups. Results: Two hundred twenty-five charts were reviewed; 154 and 71 patients were assigned to the intervention and control groups, respectively. One hundred one (66%) patients in the intervention group were considered compliant with thyroid function monitoring compared with 26 patients (37%) in the control group (p < 0.0001). One hundred six (69%) and 27 (38%) patients in the intervention and control groups, respectively, were deemed compliant with liver function monitoring (p < 0.0001). Intervention patients taking warfarin were more likely to have blood drawn for INR assessment; however, there was no difference in values between groups. Seventy-six patients had a documented adverse effect from amiodarone, 68 of whom were from the intervention group (p < 0.0001). Conclusions: Many patients receiving amiodarone are not managed according to published guidelines. Implementation of a pharmacist-managed protocol and clinic significantly improved compliance with 2 of the 3 parameters needing continuous monitoring. Although more adverse effects were documented for intervention patients, it is unclear whether the AMC actually improved the event detection rate.