bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multicenter Case Series of Pediatric Metformin Ingestion
Authors: Spiller Henry A , Weber Julie A , Winter Mark L , Klein-Schwartz Wendy , Hofman Maryann , Gorman Susan E , Stork Christine M , Krenzelok Edward P 
Published: June 2003

OBJECTIVE: There are no large studies, case series, or case reports of metformin ingestion in children. This study summarizes the clinical course and outcomes of metformin ingestion in children reported to the American Association of Poison Control Centers– Certified regional poison centers. METHODS: This was a case series of all metformin ingestions in patients <18 years of age reported to eight regional poison centers. Data collection included age, gender, dose ingested, co-ingestants, symptoms, vital signs, laboratory values, length of hospital stay, and medical outcome. Entrance into the study required at least 24 hours of follow-up. RESULTS: Fifty-five cases were collected. Ages ranged from 15 months to 17 years, with a mean (±SD) of 4.2 ± 4.4 years. The dose ingested, by history, ranged from 250 mg to 16.5 g, with a mean and median of 1710 ± 3391 and 500 mg, respectively. Forty-one children (76%) ingested a maximum of two tablets (=1700 mg). In the children younger than six years, dosage ranged from 9 to 196 mg/kg, with a mean and median of 60 ± 41.1 and 40 mg/kg, respectively. Thirty-seven children were evaluated in a healthcare facility. Clinical effects were limited to nausea (2), diarrhea (2), and dizziness (1). None of the 38 children who had serial glucose measurements experienced hypoglycemia. Arterial blood gas and electrolyte measurements were performed in three and 19 children, respectively. No evidence of acidosis was demonstrated. Two children had lactate concentrations measured and were determined to be in the normal range. Twenty-nine patients received activated charcoal. Five patients received parenteral glucose and one adolescent with a history of diabetes received insulin for hyperglycemia. CONCLUSIONS: Unintentional ingestion of ≤1700 mg of metformin in the healthy pediatric population does not appear to pose a significant health risk of hypoglycemia or detrimental outcome. In the 21 children who were tested for either blood glucose, electrolyte, or lactate concentrations, no evidence of lactic acidosis was seen.
Use of Sucralfate in Renal Failure
Authors: Hemstreet Brian A 
Published: June 2003

OBJECTIVE: To assess the potential for the development of aluminum toxicity in patients with renal insufficiency or chronic renal failure who are taking sucralfate. DATA SOURCES: Clinical literature accessed through MEDLINE (1966–December 1999) and International Pharmaceutical Abstracts (1970–December 1999). Key search terms included sucralfate, renal failure, renal insufficiency, and end-stage renal disease. DATA SYNTHESIS: Urinary excretion is an important route of elimination for systemically absorbed aluminum. Accumulation of aluminum in patients with impaired renal function may lead to significant toxicity. A potential source of aluminum is the antiulcer medication sucralfate. Studies and case reports evaluating the use and toxicity of sucralfate in patients with normal renal function, as well as those with renal failure or renal insufficiency, were reviewed. CONCLUSIONS: Aluminum accumulation and toxicity have been reported with the use of sucralfate in patients with compromised renal function. The risk of toxicity most likely represents a long-term complication of sucralfate use in this patient population. Toxicity may be enhanced by concurrent use of other aluminum-containing medications, such as phosphate binders or antidiarrheal preparations. These medications, in addition to sucralfate, should be avoided if possible in patients with end-stage renal disease. Patients with renal failure or renal insufficiency who are undergoing prolonged sucralfate therapy should be monitored for potential signs of aluminum toxicity.
Neuraminidase Inhibitors: Zanamivir and Oseltamivir
Authors: McNicholl Ian R , McNicholl Joan Jovero 
Published: June 2003

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of zanamivir and oseltamivir for the prophylaxis and treatment of influenza. DATA SOURCES: A MEDLINE search restricted to English-language journals was conducted (1980–May 2000). STUDY SELECTION AND DATA EXTRACTION: All efficacy and safety trials were included if conducted in humans and published in a journal. Abstracts were included if no other data source was available. DATA SYNTHESIS: Zanamivir and oseltamivir block influenza neuraminidase and prevent the cleavage of sialic acid residues, thus interfering with progeny virus dispersement within the mucosal secretions and reducing viral infectivity. The neuraminidase trials for prophylaxis and treatment of influenza enrolled predominantly young (mean age 29–37 y), healthy, mostly unvaccinated individuals who were at the lowest risk of influenza and its complications. When zanamivir 10 mg inhaled twice daily or oseltamivir 75 mg orally twice daily were used for treatment, systemic symptoms such as myalgias, fever, and headache were reduced by approximately 0.7–1.5 days. Greater efficacy (symptom reduction by 1.5–2.0 d) was noted in proven cases of influenza infection, in febrile patients, and in patients who received the treatment medication within 30 hours of symptom onset. Clinical efficacy did not increase when doses higher than the treatment dose approved by the Food and Drug Administration were used. When given for prophylaxis, zanamivir 10 mg inhaled once daily or oseltamivir 75 mg orally once daily was used for four to six weeks and achieved protective clinical efficacy for laboratory-confirmed influenza ranging from 67% to 74%, depending on whether culture or serologic tests were performed. The most common adverse effects (usually <5%) included upper respiratory tract symptoms. Patients with asthma or chronic obstructive pulmonary disease who received zanamivir had an increased incidence of a >20% decline in forced expiratory volume in one second or peak expiratory flow rates. Headaches, nausea, and vomiting were more frequent in the oseltamivir groups than in placebo groups. The most common gastrointestinal adverse effects, nausea and vomiting, were reduced to approximately 10% by administering the medication with food. CONCLUSIONS: Zanamivir and oseltamivir are more effective in preventing culture-positive influenza or for treatment of culture-positive influenza in febrile (⩾37.8 °C) individuals. Treatment is more effective if initiated within 30 hours of symptom onset in febrile individuals; however, it is difficult to meet these criteria. More realistically, clinical efficacy is closer to 60–70% and, for treatment started within 48 hours for laboratory-confirmed influenza, symptom reduction is approximately 0.7–1.5 days. If used appropriately to minimize the development of resistance, the neuraminidase inhibitors represent a new and unique class of antiinfluenza agents that can potentially reduce the morbidity associated with influenza.
Treatment of Bipolar Depression with Twice-Weekly Fluoxetine: Management of Antidepressant-Induced Mania
Authors: Megna James L , Devitt Patrick J 
Published: June 2003

OBJECTIVE: To report a case of treatment of bipolar depression and management of antidepressant-induced mania with a low-dose fluoxetine regimen. CASE SUMMARY: A 59-year-old white woman was admitted involuntarily to a New York State psychiatric center with a diagnosis of bipolar (type I) disorder, mixed, with psychotic features. Initial treatment with lithium, olanzapine, and clonazepam produced a remission of manic and psychotic symptoms. However, the patient remained clinically depressed. Addition of oral fluoxetine 10 mg every morning to her medication regimen was followed 22 days later by the development of a manic state. Reduction of the fluoxetine dosage to 10 mg twice weekly was associated with the attainment of euthymia in 18 days. Thirteen days after the fluoxetine dosage reduction, the patients fluoxetine blood concentration was 20 μg/L and the norfluoxetine concentration was reported as 53 μg/L. DISCUSSION: To our knowledge, this is the first published case that describes the association between a low-dose fluoxetine regimen and the evolution of a bipolar affective state from depression to euthymia via manic switching. The temporal synchrony of this switching with initial implementation of fluoxetine 10 mg every morning, followed by a dose reduction to 10 mg twice weekly, suggests that bipolar depressed patients are extremely sensitive to low doses of antidepressants and to incremental changes in these doses. However, it also suggests that they can respond clinically to such treatment. Furthermore, our laboratory data indicate that antidepressant blood concentrations may play a contributory role in maintaining the balance between euthymia and mania in these patients. CONCLUSIONS: Manic switching is always a concern when treating a bipolar depressed patient. Utilization of a low-dose antidepressant drug regimen may be a clinically prudent approach in such an individual.
Opioid Antagonists in the Treatment of Opioid-Induced Constipation and Pruritus
Authors: Friedman Jill D , Buono Felicia A Dello 
Published: June 2003

OBJECTIVE: To describe the role of opioid antagonists in the treatment of opioid-induced constipation and pruritus. DATA SOURCES: A MEDLINE search was performed (1966–February 2000) for narcotics and opioid antagonists. Results were limited to English-language and clinical trials. Background information was obtained from pharmacology and pharmacotherapy references and review articles. Hand searching of selected bibliographies yielded several references. STUDY SELECTION AND DATA EXTRACTION: Studies were reviewed that examined the use of naloxone, naltrexone, and methylnaltrexone for opioid-related constipation and pruritus. Selected citations included various clinical trials and case series. DATA SYNTHESIS: Opioid agents are used for cancer and nonmalignant pain. Peripheral opioid receptor stimulation due to endogenous (i.e., endorphins) or exogenous (i.e., morphine) stimulants may result in negative adverse effects, including constipation and pruritus. Adjuvant agents, such as laxatives and antihistamines, are often used to treat these adverse effects, but are themselves associated with adverse effects and are sometimes ineffective. Opioid antagonists have demonstrated reversal of peripheral opioid receptor stimulation. Clinical trials show adequate maintenance of pain control, as well as decreases in opioid-induced constipation and pruritus. CONCLUSIONS: Opioid antagonists offer a therapeutic alternative to conventional adjuvant agents, with the risk of loss of analgesia at higher doses. Methylnaltrexone offers the advantage of peripheral action only, therefore not reversing analgesia. Results are promising; however, larger clinical trials are necessary before opioid antagonists become the standard of care for opioid-induced constipation and pruritus.
Etanercept in Juvenile Rheumatoid Arthritis
Authors: Johnson Carrie J , Reilly Kathleen M , Murray Kim M 
Published: June 2003

OBJECTIVE: To review the classification, pathophysiology, safety, and efficacy of treatment options for juvenile rheumatoid arthritis (JRA). Etanercept, the agent most recently approved by the Food and Drug Administration for use in JRA, is featured. DATA SOURCES: Articles were identified from a search of the MEDLINE database (1966 to January 2000) and through secondary sources. Meeting abstracts and posters were also evaluated. STUDY SELECTION AND DATA EXTRACTION: Articles identified and retrieved from data sources were evaluated and, if determined to be relevant, were included in this review. DATA SYNTHESIS: JRA represents a major cause of functional disability in children. In contrast to traditional therapeutic agents for JRA, which act through generalized antiinflammatory activity or generalized immunosuppression, new therapeutic modalities have been developed that target specific molecules involved in the pathophysiology of JRA. Etanercept inhibits the activity of tumor necrosis factor and lymphotoxin-α. In a clinical trial of patients with polyarticular-course JRA, etanercept-treated patients experienced less pain and swelling in their joints, decreased incidence of disease activity, less frequent flare, and a longer time to flare than patients receiving placebo. Treatment with etanercept was generally well-tolerated. CONCLUSIONS: Etanercept represents an exciting new therapeutic option for the treatment of JRA. The positioning of etanercept among other therapeutic options for JRA will be more clearly established as additional safety and efficacy data are made available.
Beneficial Effects of Statins in Coronary Artery Disease — Beyond Lowering Cholesterol
Authors: Sotiriou Christopher G , Cheng Judy WM 
Published: June 2003

OBJECTIVE: To review the benefits of statins in coronary artery disease management beyond their cholesterol-lowering effects. DATA SOURCES: A MEDLINE search (1966–May 2000) was conducted using the following terms: lovastatin, pravastatin, simvastatin, atorvastatin, fluvastatin, cerivastatin, endothelium, plaque stabilization, antithrombotic effects. STUDY SELECTION: English-language human studies and case reports. DATA EXTRACTION: Studies published demonstrating other mechanisms of statins' clinical beneficial effects were evaluated and reviewed. DATA SYNTHESIS: The understanding of the pharmacologic effects of statins has led to the realization that the benefits of these agents extend beyond simply lowering cholesterol. These properties include beneficial effects on vessel endothelial tissue; decreased low-density lipoprotein oxidation and inflammation; ability to stabilize atherosclerotic plaques and perhaps promote regression; proliferative effects on smooth-muscle growths, possibly strengthening atherosclerotic plaques; antithrombotic effects by inhibiting platelet aggregation and stimulation of fibrinolytic factors; and improvement of blood viscosity and flow. With these actions, statins may benefit the situation of long-term atherosclerotic plaque formation and the setting of acute coronary syndrome. CONCLUSIONS: Further large-scale studies are needed to determine the clinical importance and validity of these postulated beneficial effects of statins.
Seizure Possibly Associated with Fluvoxamine
Authors: Kim Kye Y , Craig Janet M , Hawley Joanne M 
Published: June 2003

OBJECTIVE: To inform clinicians of the possibility that seizures due to therapeutic doses of fluvoxamine may not be as rare as previously considered. CASE SUMMARY: A 49-year-old white man with schizoaffective disorder and a past history of seizures secondary to head trauma had been seizure-free for approximately 10 years. Fluvoxamine therapy was begun due to increasing obsessive—compulsive behavior. Despite receiving anticonvulsants for his mood disorder, the patient had a breakthrough seizure. There were no underlying medical conditions that might have induced this seizure. No further seizures occurred after he was placed on a higher dosage of the anticonvulsants. The obsessive—compulsive behavior improved considerably as a result of fluvoxamine treatment. DISCUSSION: The patient presented here developed a seizure with a therapeutic dosage of fluvoxamine; seizures associated with this agent have occurred more often with overdose. Multiple factors such as a prior history of seizures, head trauma, and concurrent treatment with other psychotropic agents are considered in this case report. CONCLUSIONS: Despite the relatively safe and benign adverse effect profile of the selective serotonin-reuptake inhibitors such as fluvoxamine, clinicians should be cautious about seizures as an adverse effect, especially when the patient has even a remote history of seizure or head trauma.
Neuroleptic Malignant Syndrome during a Change from Haloperidol to Risperidone
Authors: Reeves Roy R , Mack James E , Torres Rafael A 
Published: June 2003

OBJECTIVE: To report a case of neuroleptic malignant syndrome (NMS) in a patient whose therapy was being switched from haloperidol to risperidone. CASE REPORT: A 57-year-old African-American man, treated for schizophrenia with haloperidol for several years, developed NMS within 48 hours of the addition of low doses of risperidone and mirtazapine to his regimen. Symptoms, which included fever, generalized rigidity, and altered mental status, resolved after discontinuation of psychotropics, supportive management, and several weeks of treatment with bromocriptine and dantrolene. He was subsequently treated with olanzapine without adverse effects. DISCUSSION: Several cases of NMS have been reported with risperidone, but none under these circumstances. NMS most likely occurred in this patient as a result of the additive dopamine2 receptor blocking of haloperidol and risperidone. Sympathetic hyperactivity secondary to mirtazapine may also have been a contributing factor. If NMS may be induced by the simultaneous use of older, high-potency antipsychotics and newer, atypical antipsychotics such as risperidone, switching patients from older to newer antipsychotics may at × be difficult, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse. CONCLUSIONS: Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.
Postpartum Alopecia
Authors: Eastham John H 
Published: June 2003

OBJECTIVE: To determine whether there are effective treatments for postpartum alopecia. DATA SOURCES: Clinical literature identified through MEDLINE (January 1966–May 2000), EMBASE (June 1980–March 2000), and International Pharmaceutical Abstracts(January 1970–March 2000). Key search terms included alopecia, puerperium, and postpartum. DATA SYNTHESIS: Postpartum alopecia is a diffuse shedding of scalp hair that can begin two to five months following parturition. Few articles examine the treatment of this condition. Treatments in the form of thyroid supplementation, topical progesterone and estradiol lotions, and an oral contraceptive have been studied. All available studies on this subject have significant limitations, such as small sample size, absence of a control group, or subjective measurement of treatment response. Nondrug therapy for a related type of hair loss has been recommended and includes education about hair cycles and reassurance to minimize anxiety. CONCLUSIONS: From the available studies, no specific treatment has been studied well enough with sufficient treatment response to justify recommendation or to be termed effective.
Impact of an Intravenous Fluconazole Restriction Policy on Patient Outcomes
Authors: Burkiewicz Jill S , Kostiuk Karen A , Jacobs Richard A , Guglielmo B Joseph 
Published: June 2003

OBJECTIVE: To evaluate both the economic and clinical impact of an intravenous fluconazole restriction policy in a university teaching hospital. METHODS: Intravenous fluconazole was restricted to patients unable to take oral medications due to significant nausea or to patients whose oral intake was restricted. A retrospective chart review and computerized record review was conducted in patients receiving intravenous or oral fluconazole from January 1 to June 30, 1997, and again from January 1 to June 30, 1998, after implementation of the policy. RESULTS: Six-month institutional expenditures for intravenous fluconazole decreased following policy implementation, from $81 900 to $45 400, an estimated annual institutional savings of $73 000. A 47% reduction in the number of patients treated with intravenous fluconazole was observed over the six-month period after policy implementation. During this time, the rate of successful clinical outcomes for documented or suspected disseminated Candida albicansinfection or febrile neutropenia remained the same (66.6% prepolicy and 65.9% postpolicy; p = 0.95). Similarly, the number of deaths in patients receiving fluconazole remained unchanged (p = 0.31). CONCLUSIONS: A restriction policy for intravenous fluconazole results in significant cost savings, with no significant decrease in successful outcomes or change in mortality.
Alternate-Day Dosing of HMG-CoA Reductase Inhibitors for Cholesterol Reduction
Authors: Metz Charity A , Lucas Kristy H 
Published: June 2003

OBJECTIVE: Assess efficacy, safety, and cost of alternate-day dosing with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (HRIs). DATA: International Pharmaceutical Abstracts and MEDLINE (English-language clinical trials, 1966–April 2000) were searched. DATA SYNTHESIS: Established efficacy of HRIs is based on daily administration. Many patients who could benefit from these agents are unable to afford them; therefore, alternate-day dosing may be a solution for reducing expense without decreasing therapy benefits. Studies addressing alternate-day HRI therapy are evaluated to determine the usefulness of this option for cholesterol reduction. CONCLUSIONS: Although limited studies imply a trend toward benefit with alternate-day HRI therapy, large, controlled, randomized trials are needed before making this a standard recommendation.
Anticoagulation Therapy for Radiation-Induced Myelopathy
Authors: Liu Chin Y , Yim Barbara T , Wozniak Antoninette J 
Published: June 2003

OBJECTIVE: To report the use of heparin and enoxaparin for radiation-induced myelopathy. CASE SUMMARY: A 46-year-old white woman with presumed metastatic lung cancer presented with worsening numbness and weakness of both legs. The neurooncology service was consulted and determined that the symptoms were consistent with radiation-induced myelopathy. The patient briefly responded to steroid treatment. A trial of intravenous heparin therapy was initiated by the primary team and managed by the clinical pharmacy services. Her symptoms improved when heparin was begun. She was able to walk and was subsequently discharged home on enoxaparin. DISCUSSION: Spinal cord injury is one of the known adverse effects of radiation. The onset of symptoms can be acute or delayed. The clinical signs and symptoms of delayed neurologic injury are related to the narrowing and occlusion of the vessel lumen, ischemia, edema, and cell death in the surrounding nervous tissue. Treatment often consists of corticosteroids and/or hyperbaric oxygen; however, the outcomes are often disappointing. In addition to the inhibition of serum protein—mediated coagulation, heparin inactivates or prevents the release of mediators of vascular injury, inflammation, permeability, and edema. Therefore, patients with radiation-induced spinal cord injury may benefit from anticoagulant therapy. CONCLUSIONS: Heparin and/or enoxaparin may be considered as potential treatments for patients with radiation-induced myelopathy.