bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linear Immunoglobulin a Bullous Dermatosis Induced by Gemcitabine
Authors: Pozo Jesús del , Martínez Walter , Yebra-Pimentel María T , Almagro Manuel , Peña-Penabad Carmen , Fonseca Eduardo 
Published: June 2003

OBJECTIVE: To report a case of linear immunoglobulin (Ig) A bullous dermatosis (LABD) induced by gemcitabine. CASE SUMMARY: A 59-year-old man was diagnosed with squamous-cell carcinoma of the lung in T4N2M0 stage and treated with cisplatin, vinorelbine, and gemcitabine. Twenty-four hours after the administration of gemcitabine, a symmetric, bullous, herpetiform eruption appeared on his trunk and upper limbs. Histopathologic examination and direct immunofluorescence test were consistent with IgA bullous dermatosis. Cutaneous lesions resolved two weeks after the drug was withdrawn and topical steroid treatment was instituted. DISCUSSION: Drug-induced LABD is a variant of classic or idiopathic LABD. Vancomycin is the most frequently implicated drug, but other agents have been reported to cause LABD. According to the Naranjo probability scale, the relationship of gemcitabine treatment with cutaneous eruption in our patient is possible. CONCLUSIONS: We report the first case of gemcitabine-induced LABD. Clinicians should monitor patients receiving this drug for signs of LABD.
Blood Pressure Monitoring with Home Monitors versus Mercury Sphygmomanometer
Authors: Rotch Allison L , Dean Joseph O , Kendrach Michael G , Wright Stephanie Gooch , Woolley Thomas W 
Published: June 2003

OBJECTIVE: To determine the accuracy of three automatic monitors (arm, wrist, finger) for blood pressure measurement manufactured by Omron compared with a standard mercury sphygmomanometer. PRIMARY END POINT: Difference in the mean blood pressure readings from each monitor; the secondary end point was difference in pulse readings. DESIGN: A single-visit, crossover trial tested each device twice on the left arm of each participant; the average of the two readings was recorded. The pulse readings from each monitor were also recorded. ANOVA was used to compare mean blood pressure readings and pulse readings from each device. RESULTS: A total of 55 persons (mean age 53 y; 36 women) met inclusion criteria and completed the study. The mean systolic and diastolic readings obtained from the electronic arm unit were comparable to the mercury readings (124.4/78.02 vs. 129.45/77.87 mm Hg, respectively; p > 0.05 for both readings). The mean results obtained from the wrist and finger monitors differed significantly from those of the mercury readings (145.44/89.58 and 113.94/69.07 mm Hg, respectively; p < 0.05 for both monitors compared with control). No difference was measured in the mean pulse readings between the comparisons (p = 0.72). The absolute difference in systolic and diastolic blood pressure readings from control varied the least with the arm monitor. CONCLUSIONS: Compared with the mercury sphygmomanometer, the arm monitor was the most accurate in measuring blood pressure. The wrist and finger monitors resulted in statistically significant mean systolic and diastolic differences compared with the mercury sphygmomanometer.
Newer Dopamine Agonists in the Treatment of Restless Legs Syndrome
Authors: Weimerskirch Patti R , Ernst Michael E 
Published: June 2003

OBJECTIVE: To review the use of newer dopamine agonists, pramipexole and ropinirole, in the treatment of restless legs syndrome (RLS). DATA SOURCES: Biomedical literature was accessed through MEDLINE (1990–June 2000); key terms included restless legs syndrome, pramipexole, ropinirole, and dopamine agonists. References cited in those articles were also evaluated. DATA SYNTHESIS: A number of small clinical studies of short duration have examined the use of pramipexole and ropinirole in the treatment of RLS. Patients treated with either agent demonstrated marked improvement in RLS symptoms with minimal adverse effects. Recent postmarketing surveillance of the use of these drugs for Parkinson's disease reported problems with daytime somnolence; thus, patients should be counseled appropriately. CONCLUSIONS: Although the published trials show promising results for efficacy of pramipexole and ropinirole in the treatment of RLS, they are subject to many limitations. At present, these agents can be considered a reasonable alternative after failure of traditional therapies for RLS, such as carbidopa/levodopa. The encouraging results underscore the need for a large, double-blind study comparing pramipexole and ropinirole with traditional agents.
Impact of a Limited Fluoroquinolone Reimbursement Policy on Antimicrobial Prescription Claims
Authors: MacCara Mary E , Sketris Ingrid S , Comeau Donna G , Weerasinghe Swarna DS 
Published: June 2003

OBJECTIVE: To examine the influence on administrative pharmacy claims of a policy that limited the reimbursement of the fluoroquinolones and other antimicrobials in the senior population within Nova Scotia, Canada. METHODS: The administrative claims database of the Nova Scotia Seniors' Pharmacare Program was used to identify all prescription claims for orally administered antibiotics and urinary antiinfectives. The number of beneficiaries receiving antimicrobials and the number, duration, and cost of prescriptions for antimicrobials were measured monthly. Descriptive time-series plots were used to compare antimicrobial use for two 12-month periods before the institution of the policy (December 1, 1994–November 30, 1995, and December 1, 1995–November 30, 1996) and the 12 months after the policy took effect (January 1, 1997–December 31, 1997). RESULTS: Following the implementation of the fluoroquinolone reimbursement policy, the number of patients using antimicrobials decreased by 2.2% and the number of prescriptions for antimicrobials decreased by 3.4%. Fluoroquinolone prescriptions decreased by 80.2%; prescriptions for sulfonamides and trimethoprim increased by 34.9%, cephalosporins by 17.0%, and macrolides and lincosamides by 16.5%. The only prescription duration to change was the fluoroquinolones, which increased by 25%. The average cost per antimicrobial user/year decreased from $35.24 during prepolicy period 2 to $27.51 during the postpolicy period. CONCLUSIONS: Prescription claims for fluoroquinolones in seniors decreased following the introduction of the policy. Total antimicrobial use also decreased, although this may be related to other factors. The effect of this policy change on patient outcomes requires further study.
Gynecomastia Associated with Highly Active Antiretroviral Therapy
Authors: Manfredi Roberto , Calza Leonardo , Chiodo Francesco 
Published: June 2003

OBJECTIVE: To report four cases of HIV-associated gynecomastia diagnosed during treatment with nucleoside analogs with or without protease inhibitors. CASE SUMMARY: Four HIV-infected patients developed gynecomastia while taking two nucleoside analogs (stavudine combined with lamivudine in 3 patients, stavudine with didanosine in 1 patient) and protease inhibitors (indinavir, nelfinavir, ritonavir—saquinavir in 3 patients) all patients had received prior treatment with single or associated nucleoside analogs for ≥21 months. Gynecomastia occurred three to seven months after the start of a triple regimen in the first three patients, and 17 months after initiating the last dual nucleoside analog therapy in the remaining patient. Liver, kidney, and thyroid function were normal; a routine endocrinologic workup showed slight follicle-stimulating hormone and luteinizing hormone abnormalities in one patient only. Other possible causes of drug-or disease-induced gynecomastia were excluded. A concurrent fat redistribution syndrome was present in three patients (including the patient who received nucleoside analogs only), while serum lipid and/or glucose concentration abnormalities were present in all patients. Gynecomastia remained unchanged during the subsequent seven- to 16-month follow-up, even after modification of antiretroviral therapy. DISCUSSION: Gynecomastia has been recently associated with antiretroviral therapy, and all reported cases but one occurred two to 17 months after the start of a protease inhibitor—based regimen. Our experience underlines the possible occurrence of gynecomastia in the absence of protease inhibitor administration, its persistence despite changes of antiretroviral regimen (thus resembling some signs related to lipodystrophy syndrome), and the apparently constant association with prolonged nucleoside analog administration (especially stavudine). CONCLUSIONS: Gynecomastia should be included among emerging adverse effects of antiretroviral therapy, although its etiopathogenesis deserves further investigation.
Linezolid for the Treatment of Resistant Gram-Positive Cocci
Authors: Bain Kevin T , Wittbrodt Eric T 
Published: June 2003

OBJECTIVE: To provide a comprehensive review of linezolid, the first of a new class of antibiotics, the oxazolidinones. Therapeutic issues regarding the emergence of multidrug-resistant bacteria and a brief history of the oxazolidinones are also discussed. DATA SOURCES: A MEDLINE search (1966–March 2001) was conducted to identify pertinent literature, including preclinical trials, clinical trials, and reviews. Unpublished clinical data, adverse effects, and dosing information were abstracted from product labeling. STUDY SELECTION: Clinical efficacy data were extracted from clinical trials, case reports, and abstracts that mentioned linezolid. Additional information concerning antibiotic resistance, the oxazolidinones, in vitro susceptibility, and the pharmacokinetic profile of linezolid also was reviewed. DATA SYNTHESIS: Linezolid exhibits activity against many gram-positive organisms, including vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, and penicillin-resistant Streptococcus pneumoniae. Linezolid inhibits bacterial protein synthesis at an early step in translation and is rapidly and completely absorbed from the gastrointestinal tract following oral administration. Efficacy has been demonstrated in a number of unpublished clinical trials in adults with pneumonia, skin and skin structure infections, and vancomycin-resistant E. faeciuminfections. The adverse effect profile is similar to that of comparator agents (β-lactams, clarithromycin, vancomycin). CONCLUSIONS: Linezolid is the first oral antimicrobial agent approved for the treatment of vancomycin-resistant enterococci. Since the oxazolidinones have a unique mechanism of action and expanded spectrum of activity against virulent and highly resistant gram-positive pathogens, linezolid is a valuable alternative to currently available treatment options. Clinical trials evaluating linezolid and other oxazolidinones for antibiotic-resistant gram-positive infections, as well as comparator studies comparing linezolid with other candidate drugs, such as quinupristin/dalfopristin and chloramphenicol, will further define the role of linezolid.
Olanzapine-Induced Diabetes Mellitus
Authors: Bonanno Danielle Graci , Davydov Liya , Botts Sheila R 
Published: June 2003

OBJECTIVE: To report two cases of new-onset diabetes mellitus resulting after the initiation of olanzapine treatment. CASE SUMMARY: A 31-year-old African American man and a 44-year-old white man, both with schizoaffective disorder, developed diabetes mellitus within weeks or months of olanzapine initiation. DISCUSSION: Our reports of new-onset diabetes due to olanzapine are consistent with those in the literature. Although the mechanism is not yet known, it has been hypothesized that perhaps damage to the pancreatic islet cells, weight gain, dysregulation of the sympathetic system, and insulin resistance are contributing factors. CONCLUSIONS: Diabetes mellitus secondary to olanzapine use seems to be a rare occurrence. However, certain risk factors such as obesity, family history, and concomitant medications may predispose an individual to development of diabetes mellitus while taking olanzapine. An increased awareness of this reaction is essential in the treatment of patients at risk. Periodic serum glucose monitoring in these individuals may be warranted.
Use of Lepirudin in Patients with Heparin-Induced Thrombocytopenia and Renal Failure Requiring Hemodialysis
Authors: Dager William E , White Richard H 
Published: June 2003

OBJECTIVE: To report two cases of successful lepirudin use in two patients with heparin-induced thrombocytopenia (HIT) and renal failure. CASE SUMMARY: Two patients with renal failure requiring hemodialysis developed HIT syndrome during intravenous heparin therapy. Anticoagulation was necessary to prevent recurrent, acute venous thrombosis in one patient and to prevent arterial thrombosis associated with the use of an intraaortic balloon pump in the second. Intravenous lepirudin was initiated at doses of 0.01 mg/kg/h and 0.005 mg/kg/h, respectively, and titrated based on the activated partial thromboplastin time (aPTT). Steady-state doses were 0.015 mg/kg/h to maintain aPTT values of approximately 60 seconds in one patient, and 0.005–0.008 mg/kg/h to achieve an aPTT of approximately 45 seconds in the other patient. DISCUSSION: Lepirudin is one of few anticoagulants that can be safely used in patients with HIT. Because it is eliminated through the kidneys, great care must be taken when administering lepirudin to patients with renal failure; in fact, its use is currently not recommended in patients requiring hemodialysis. Lepirudin effectively prevented acute thrombosis in both of our patients with documented HIT, with no bleeding complications. We describe how we selected the initial doses and report results of aPTT monitoring. CONCLUSIONS: In patients with renal failure who develop HIT, lepirudin is one available alternative to heparin despite its poor renal elimination pattern and subsequently prolonged half-life.
Effect of Levothyroxine Administration Time on Serum TSH in Elderly Patients
Authors: Elliott David P 
Published: June 2003

BACKGROUND: Standard drug information resources recommend that levothyroxine be taken on an empty stomach due to the potential for interaction with food or medications. Due to concern about unpredictable response to levothyroxine in patients receiving morning doses in a skilled nursing facility, the standard administration time for the drug was changed from 0900 to midnight. OBJECTIVE: To determine if a change in response to levothyroxine as determined by the serum ultrasensitive thyroid-stimulating hormone (TSH) concentration occurred when the time of administration was changed from early morning to midnight. DESIGN: Retrospective chart review. SETTING: A 187-bed skilled nursing facility. PARTICIPANTS: Fifteen nursing home residents receiving levothyroxine during the change of administration time with a mean age of 84 years met inclusion criteria, with at least one TSH concentration reported prior to and at least one serum TSH concentration reported after the change in administration time to midnight. MEASUREMENTS: Serum TSH concentrations. RESULTS: There was a decrease in serum TSH of 0.286 ± 1.722 mU/mL (mean ± SD) after changing the administration time to midnight that was not statistically significant (t = 0.643; p = 0.532). CONCLUSIONS: Based on the results of the study, we conclude that levothyroxine could be routinely administered after breakfast.
Medication Adherence in Elderly Patients Receiving Home Health Services following Hospital Discharge
Authors: Gray Shelly L , Mahoney Jane E , Blough Dave K 
Published: June 2003

OBJECTIVE: To assess prevalence and risk factors for medication under- and overadherence in a two-week period following hospital discharge in adults ⩾ 65 years. DESIGN: Prospective, cohort study. SETTING: Three home healthcare agencies in Madison, Wisconsin, and surrounding vicinity. PARTICIPANTS: One hundred forty-seven older participants taking three or more medications who were hospitalized for medical illness, received home nursing after discharge, and completed the two-week interview. MEASUREMENTS: The main outcome measures were having at least one medication with less than 70% adherence (underadherence) and having at least one medication with more than 120% adherence (overadherence) based on pill counts. RESULTS: Forty-five (30.6%) participants were underadherent and 27 (18.4%) participants were overadherent with at least one medication. In a multivariate model, underadherence was predicted by poor cognition (OR 2.5; 95% CI 1.02 to 6.10) and higher medication use (OR 1.16; 95% CI 1.03 to 1.31, for each 1-unit increase in number of medications). Both poor cognition and low education were significantly associated with overadherence in univariate analysis; however, neither variable was significant once included in the multivariate model. CONCLUSIONS: Under- and overadherence to medications is common after hospital discharge. Poor cognition and a greater number of medications were associated with underadherence. Poor cognition and lower education were markers for overadherence; however, further study is needed to determine whether these are independent predictors. Patients who have impaired cognition or are taking a greater number of medications after hospitalization may benefit from targeted interventions to monitor and improve medication compliance.
Eradication of Severe Neonatal Systemic Candidiasis with Amphotericin B Lipid Complex
Authors: Knoppert David C , Salama Husam EM , Lee David SC 
Published: June 2003

OBJECTIVE: To report the successful use of amphotericin B lipid complex in treating severe systemic candidiasis in a very-low-birth-weight infant. CASE SUMMARY: A preterm female infant, born at 25 weeks' gestational age with a birth weight of 870 g, had received full supportive care in the neonatal intensive care unit (NICU), including mechanical ventilation, total parenteral nutrition, and placement of central venous catheters. At seven weeks of age, she developed severe disseminated candidiasis, which failed to respond to conventional amphotericin B and fluconazole therapy. Her progressive deterioration was reversed only after amphotericin B lipid complex (A-complex) was substituted for conventional amphotericin B. The improvement in her condition was impressive, and she made a full recovery without any adverse effect. DISCUSSION: With increased reliance on invasive technologies for life support, systemic candida infections have become increasingly common among premature infants in the NICU. Such infections are potentially fatal for the high-risk neonate. A literature review shows limited documentation of the use of lipid-based formulations of amphotericin B, especially A-complex, in preterm infants. However, the collective experience with these products appears to show that they are effective and cause fewer adverse effects than conventional amphotericin B. The infant reported here had shown progressive deterioration from disseminated candidiasis until conventional amphotericin B therapy was replaced with A-complex. Her recovery corresponded to the clearance of the candidemia. CONCLUSIONS: With favorable results and increasing experience with lipid-based formulations of amphotericin B, it is reasonable to consider these new formulations as therapy for candidemia in preterm infants who are at a high risk of nephrotoxicity or who have failed conventional therapy.
Argatroban for Prevention and Treatment of Thromboembolism in Heparin-Induced Thrombocytopenia
Authors: Kondo L Midori , Wittkowsky Ann K , Wiggins Barbara S 
Published: June 2003

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adverse events, and cost of argatroban in the prevention and treatment of thromboembolism in patients with heparin-induced thrombocytopenia (HIT). DATA SOURCES: A MEDLINE search (1980 to August 2000) of English-language literature was conducted using the search term argatroban to identify pertinent case reports, clinical trials, abstracts, and review articles. Additional reports were identified from the reference lists compiled in the literature reviewed, as well as from the manufacturer. DATA SYNTHESIS: Argatroban is a synthetic direct thrombin inhibitor indicated for parenteral use in the prevention and treatment of thromboembolism in patients with HIT. Its elimination half-life is approximately 40–50 minutes, and it is primarily eliminated by hepatic metabolism and biliary secretion. Compared with historical controls, argatroban-treated patients with HIT or HIT with thrombosis (HITTS) experienced lower rates of the composite end point of death, amputation, and new thrombosis. Dosing is initiated at 2 μg/kg/min and adjusted to maintain the activated partial thromboplastin time at 1.5–3 × the patient's baseline. In Japan, argatroban is approved for use in acute ischemic stroke and chronic peripheral occlusive disease. It has also been used as an alternative to unfractionated heparin (UFH) in patients with a history of HIT or HITTS undergoing percutaneous coronary intervention and other procedures. Additionally, argatroban has been compared with UFH in patients with acute myocardial infarction who were receiving thrombolytic therapy. Hemorrhage is the primary adverse event associated with argatroban. Argatroban increases the prothrombin time, making assessment of the intensity of warfarin therapy during concurrent administration more complex. CONCLUSIONS: The use of argatroban in patients with HIT and HITTS is associated with improvement in clinical outcomes compared with historical controls. Argatroban offers several practical advantages over other available agents with respect to dosing, monitoring, reversibility of effect with discontinuation of the drug, and cost.
Effect of Common Over-the-Counter Medications on Blood Alcohol Levels
Authors: Monroe Michelle L , Doering Paul L 
Published: June 2003

OBJECTIVE: T o assess the clinical and legal significance of the potential pharmacokinetic interaction between common over-the-counter (OTC) medications and alcohol that may result in increased blood alcohol levels (BALs). DATA SOURCES: A MEDLINE search (1966–February 2000) of English-language articles was performed using the terms aspirin, acetaminophen, histamine (H2)-receptor antagonist, ethanol, and blood alcohol level and then supplemented by a bibliographic review of relevant articles. STUDY SELECTION AND DATA EXTRACTION: Two H2-receptor antagonist studies using methodologies representative of other published trials and a meta-analysis of 24 H2-receptor antagonist trials were chosen for detailed review. All identified studies examining aspirin and acetaminophen were addressed. DATA SYNTHESIS: More than 30 studies have examined the potential interaction between OTC drugs and blood alcohol. Because this issue has important medical and legal implications for patients, prescribing physicians, and pharmaceutical manufacturers, a critical analysis of the literature addressing this potential interaction is presented. CONCLUSIONS: Numerous factors arguing against a clinically significant interaction were identified. First, data from the relevant studies cannot be extrapolated to the general population because of the multitude of variables that determine an individual's BAL. Also, a publication bias for small studies (=10 subjects) finding a statistically significant increase in peak BAL was observed. In addition, study results supporting an increase in BAL were often irreproducible when these trials were repeated under similar conditions. Finally, although some studies detected statistically significant increases in peak BAL, these changes were often clinically irrelevant.