bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of Intravenous Bolus Administration of Gentamicin in Pediatric Patients
Authors: Robinson Renee F , Nahata Milap C 
Published: June 2003

OBJECTIVE: To determine the safety of gentamicin administered intravenously as a bolus. METHODS: All patients (n = 123, ages: up to 18y, 121; 21y, 1; 31y, 1) who received gentamicin intravenously as a bolus over a four-month period were studied retrospectively. Patient demographics, type of infection, dosing regimen, length of therapy, peak and trough serum concentrations, blood urea nitrogen, serum creatinine, and urine output were reviewed. Patients were stratified into four groups and data analyzed statistically. RESULTS: Mean initial dose (5.32 ± 2.38 mg/kg/d) was consistent with established guidelines for age and kidney development, with subsequent adjustments based on serum concentrations. Susceptible organisms were eradicated with a mean length of therapy of 6.9 ± 6.9 days (range 1–35). Patients received a median of nine doses: 42% received doses every eight hours and 33% received doses every 24 hours. No relationship between dosing and abnormal serum creatinine were found (p = 0.69). The estimated cost savings mainly from less nursing time and lower equipment and supply use were $50/patient with bolus administration of gentamicin. CONCLUSIONS: Intravenous bolus administration was safe in pediatric patients and was associated with lower costs.
Ischemic Heart Disease Associated with Vincristine and Doxorubicin Chemotherapy
Authors: Calvo-Romero José M , Fernández-Soria-Pantoja Rafael , Arrebola-García Juan D , Gil-Cubero Mercedes 
Published: June 2003

OBJECTIVE: To report the ocurrence of ischemic heart disease (IHD) in a patient with multiple myeloma treated with vincristine and doxorubicin. CASE SUMMARY: A 46-year-old man developed a Q-wave inferior and right-ventricle myocardial infarction with postinfarction angina after receiving his third cycle of vincristine and doxorubicin for immunoglobulin A multiple myeloma. Angiography showed two small filling defects consistent with thrombi in the distal right coronary artery. DISCUSSION: IHD may be a serious but uncommon complication of treatment with several chemotherapeutic agents. It is likely that chemotherapy played a role in the development of IHD in our patient. Several putative mechanisms for vascular toxicity have been associated with chemotherapy. CONCLUSIONS: Chemotherapy with vincristine and doxorubicin may play a role in the ocurrence of IHD. Physicians should possess an awareness of this potentially serious complication of chemotherapy.
Seizures Associated with Fluoroquinolones
Authors: Kushner Janine M , Peckman Howard J , Snyder Clyde R 
Published: June 2003

OBJECTIVE: To report two cases of seizures following administration of levofloxacin and ciprofloxacin. CASE SUMMARY: A 75-year-old white woman admitted to the hospital was prescribed levofloxacin for ischemic toes. After receiving three doses of oral levofloxacin, the patient experienced a seizure. One month later, the patient was rechallenged with ciprofloxacin and again experienced a seizure. The patient was hypomagnesemic and had elevated serum creatinine at the time of both seizures, and was hyponatremic during the second seizure. A 74-year-old white woman admitted to the hospital was prescribed levofloxacin for bacterial pneumonia. After five doses, the patient experienced a seizure. The woman had no electrolyte imbalances at the time of the seizure and no history of a seizure disorder. DISCUSSION: Quinolone antibiotics vary in their ability to induce seizures, with trovafloxacin having the greatest potential and levofloxacin possibly having the least potential. Neither patient had a history of a previous seizure disorder. Electrolyte imbalances are common with previous reports of fluoroquinolone-induced seizures. CONCLUSIONS: Although levofloxacin monotherapy has not been implicated in inducing seizures, it appears to be the causative agent in the second case. In the first case, the quinolones may have been a necessary, but not sufficient, cause in a patient with electrolyte abnormalities. Risk factors for fluoroquinolone-induced seizures may include seizure history, electrolyte imbalances, dose unadjusted for renal insufficiency, and concomitant treatment with agents that lower the seizure threshold.
Warfarin and Ropinirole Interaction
Authors: Bair Jennifer D , Oppelt Thomas F 
Published: June 2003

OBJECTIVE: To report a case of increased international normalized ratio (INR) in a geriatric patient receiving warfarin and ropinirole. CASE SUMMARY: A 63-year-old African-American man with a history of Parkinson disease, Alzheimer disease, and status postcardio-vascular accident was evaluated for symptoms of progressing stiffness and rigidity. Ropinirole was added to his current therapy for Parkinson disease, with a corresponding decrease in the dose of levodopa/carbidopa to allow levodopa sparing. On laboratory evaluation, he was noted to have an increased INR nine days after these adjustments; the INR had previously been stable. No other significant medication, social, or diet changes were noted. Warfarin was withheld for four days and restarted at approximately 75% of the previous weekly dose. The patient had no obvious signs of bleeding. Furthermore, the warfarin dose was again increased after discontinuation of ropinirole due to common gastrointestinal adverse effects. DISCUSSION: Warfarin is an oral anticoagulant whose narrow therapeutic index and potential for drug interaction is well documented. It is always possible that a change in blood coagulability can occur without an obvious contributable cause; however, an acute change in a previously stable INR with the addition of other medications always raises questions as to the possible mechanism of adverse reaction. No previously documented interaction of this precise nature has been identified. CONCLUSIONS: Ropinirole may elevate the anticoagulant effects of warfarin. Patients receiving warfarin should be considered for more frequent INR monitoring when ropinirole is added, adjusted, or discontinued from their medical regimen.
Isotretinoin-Induced Inflammatory Bowel Disease in an Adolescent
Authors: Reniers Denise E , Howard John M 
Published: June 2003

OBJECTIVE: To report a case of inflammatory bowel disease (IBD) associated with use of isotretinoin. CASE SUMMARY: A 17-year-old boy presented with new-onset rectal bleeding after completion of a five-month course of isotretinoin. A diagnosis of ulcerative colitis was made. His condition worsened despite therapy with 5-aminosalicylic acid, steroid retention enema, iron supplement, and prednisone. Five months after the onset of rectal bleeding, he had lost 11.4 kg and developed bilateral pitting edema of the hips and profound anemia. A subtotal colectomy and ileostomy was performed. DISCUSSION: Rectal bleeding has been reported to occur during or up to several years after treatment with isotretinoin. The mechanism by which isotretinoin may induce IBD is unknown. Proposed mechanisms include inhibition of epithelial cell growth resulting in ulceration and inflammation of the gut mucosa, inhibition of glycoprotein synthesis affecting the integrity of the mucosal wall, and stimulation of killer T cells, leading to epithelial cell injury and a resultant inflammatory response. CONCLUSIONS: This case of probable isotretinoin-induced IBD suggests that patients with suspected IBD should be asked about current or past use of isotretinoin to improve documentation of this serious adverse event.
Olanzapine-Induced Rhabdomyolysis
Authors: Rosebraugh Curtis J , Flockhart David A , Yasuda Sally Usdin , Woosley Raymond L 
Published: June 2003

OBJECTIVE: To report a possible case of olanzapine-induced rhabdomyolysis with concomitant lithium-induced pseudo-infarction electrocardiogram changes. CASE SUMMARY: A 13-year-old white boy was admitted to the hospital with profound weakness and electrocardiogram (ECG) changes suggestive of myocardial damage after starting olanzapine and lithium. An adverse medication effect was not considered at the time of the patient's admission. The time course of onset of weakness was coincident with administration of olanzapine. ECG abnormalities are a known manifestation of lithium therapy. DISCUSSION: This is a case description of olanzapine-induced rhabdomyolysis. Although other antipsychotic agents have been reported to cause rhabdomyolysis, an adverse drug reaction was not initially part of this patient's differential diagnosis. The patient had begun reporting myalgias six days after starting olanzapine. Fourteen days later, these symptoms forced him to bed rest; lithium was added for behavior misinterpreted as disobedience and oppositional disorder. Only when medications were considered as cause of the weakness and ECG changes, was the true nature of the patient's illness discovered. CONCLUSIONS: Olanzapine, like other neuroleptic agents, can cause rhabdomyolysis. Lithium can cause multiple ECG changes that can be misinterpreted as myocardial damage. Medication effects and adverse effects must always be considered in any disease complex.
Mirtazapine for Treatment of Depression and Comorbidities in Alzheimer Disease
Authors: Raji Mukaila A , Brady Shannon R 
Published: June 2003

BACKGROUND: Depression in patients with Alzheimer disease is a treatable cause of functional decline, caregiver burden, and mortality. It is often associated with severe weight loss, insomnia, and anxiety. These symptoms independently and collaboratively further worsen the prognosis of these vulnerable patients. An antidepressant medication with good adverse effect profile and salutary effects on these comorbid symptoms may be of significant therapeutic value in these patients. OBJECTIVE: To describe the role of mirtazapine in the treatment of depressed Alzheimer patients with comorbid weight loss, insomnia, and anxiety. CASE SUMMARY: Three patients with dementia and depression complicated by weight loss, insomnia, and anxiety were treated with mirtazapine at an outpatient memory loss clinic of a university hospital. DISCUSSION: Despite the persistence of memory loss, the patients experienced a prompt and sustained response to mirtazapine. There was a complete remission of poor appetite, weight loss, sleep disturbances, and anxiety. Other depression symptoms, including sad mood, anhedonia, and energy level, were also substantially improved. CONCLUSIONS: The clinical response of our patients underscores the usefulness of mirtazapine in the treatment of the comorbid symptoms of weight loss, insomnia, and anxiety. The effectiveness of mirtazapine in depressed Alzheimer patients may be a reflection of its enhancement of brain serotonergic and noradrenergic neurotransmission. The usefulness of mirtazapine in depressed Alzheimer patients merits further study in a large randomized, controlled, clinically comparative trial.
Pharmacists' Attitudes toward Diabetes and Their Involvement in Diabetes Education
Authors: Younis Wisam S , Campbell Suzanne , Slack Marion K 
Published: June 2003

OBJECTIVE: To determine the relationship between pharmacists' attitudes toward diabetes and their involvement in diabetes patient education in the community setting. METHODS: Registered pharmacists in Arizona were mailed surveys regarding their attitudes toward diabetes and their involvement in diabetes patient education. Attitudes were measured using the Diabetes Attitude Scale (DAS); the types of educational skills evaluated were based on those recommended by the American Diabetes Association's Standards of Medical Care. RESULTS: Pharmacists' attitudes were significantly positive toward the need for special training for diabetes care, the importance of tight glycemic control, the team approach to care, and the preference for diabetes education in an outpatient setting (p < 0.001). The majority of the time, pharmacists provided basic patient education (52%) rather than intermediate or advanced patient education (26% and 27%, respectively). There was a negative correlation between the attitude that diabetes is a difficult disease to treat and pharmacists' involvement in diabetes patient education (p < 0.05). This indicates that, although pharmacists believe that diabetes is a treatable disease, they infrequently provide diabetes patient education. CONCLUSIONS: Overall, pharmacists had positive attitudes toward diabetes. These attitudes did not correlate with the degree of their involvement in diabetes patient education. More diabetes patient education through community pharmacists is needed.
A Cost-Benefit Analysis of RSV Prophylaxis in High-Risk Infants
Authors: Schrand Linda M , Elliott Jane M , Ross Mary B , Bell Edward F , Mutnick Alan H 
Published: June 2003

OBJECTIVE: To determine the cost and benefit of using RSV-IG and palivizumab as prophylactic therapy against respiratory syncytial virus (RSV)–associated illness in high-risk infants. METHODS: A nonrandomized, retrospective, cohort control study was conducted comparing the outcomes of patients who received either RSV-IG or palivizumab therapy against RSV during the 1998–1999 RSV season with patients identified from the 1994–1995 RSV season who would have been eligible to receive prophylaxis had either agent been available at that time. Medical record reviews were conducted to gather data regarding the costs associated with both the administration of the prophylactic drugs and the treatment of RSV-associated hospitalizations in both groups. Decision analysis was used to determine the average cost per patient for both groups. A cost—benefit analysis was then conducted to determine the return on investment, if any, for the use of these drugs. A sensitivity analysis was also conducted to determine the robustness of the data. RESULTS: Patients who received RSV-IG or palivizumab had a hospitalization rate of 1.6% compared with 25% for the group who did not receive prophylactic drugs. The average costs for the RSV prophylaxis group were less per patient: $3733 compared with $4258 in the group who did not receive prophylaxis. The benefit is a 23.4% lower chance of hospitalization for each infant or, in dollar figures, $3985 ($17 031 × 0.234). The benefit—cost ratio is 1.15:1 ($3985:3461). The benefits, therefore, exceed the costs associated with the prophylaxis program. The prophylaxis program saved healthcare dollars by preventing RSV-related hospital-izations. CONCLUSIONS: Results demonstrate that when used according to our institution's criteria, RSV prophylaxis is of benefit to our institution.
Compliance from Self-Reported versus Pharmacy Claims Data with Metered-Dose Inhalers
Authors: Erickson Steven R , Coombs John H , Kirking Duane M , Azimi Anita R 
Published: June 2003

OBJECTIVE: To determine how well self-reported compliance with metered-dose inhalers (MDIs) agrees with compliance determined from pharmacy claims data. Additional analyses were conducted to establish psychometric properties of the questionnaire. METHODS: A cross-sectional survey was performed of all adult enrollees with asthma of a managed care organization. The overall return rate was 63.4% (696/1098). Patients with persistent asthma and at least one prescription claim for a controller MDI during the four months preceding the survey were included. Pharmacy claims data were used to calculate a compliance ratio. Self-reported compliance was based on a four-item questionnaire. The primary end points were the percent-agreement and the overall correlation between the two measures. The questionnaire's internal reliability and construct validity were assessed using Cronbach's α and Pearson's correlations, respectively. Mean item response scores for compliant patients were compared with scores of noncompliant patients using the Student's t-test. RESULTS: One hundred questionnaire respondents met the study criteria. The mean ± SD compliance ratio was 0.52 ± 0.27, the mean ± SD self-reported compliance score was 4.07 ± 1.0. The overall percent agreement and correlation between self-reported compliance score and the compliance ratio were 75.5% and r = 0.348 (p = 0.01), respectively. The percent agreement was highest (85%) when noncompliant patients (by compliance ratio <0.8) reported being noncompliant (questionnaire score <5). Cronbach's α was 0.86. CONCLUSIONS: This study demonstrated a moderate correlation between self-reported asthma compliance and the compliance ratio determined using claims data. The questionnaire may be useful as a screening tool to detect noncompliant behavior in populations or individual patients with asthma.
Antiplatelet Agents for Secondary Prevention of Ischemic Stroke
Authors: Majid Arshad , Delanty Norman , Kantor Jonathan 
Published: June 2003

OBJECTIVE: To review and summarize the efficacy, mechanisms of action, and cost of the options available when choosing antiplatelet agents for secondary stroke prevention. DATA SOURCES: This article is based on a review of the literature found with MEDLINE, CINAHL, and Cochrane Reviews (1980–June 2000) and abstracts from relevant international scientific meetings. We searched for the terms aspirin, ticlopidine, dipyridamole, antiplatelet, and clopidogrel. STUDY SELECTION: English-language articles, both reviews and original studies, were evaluated, and all information considered relevant was included in this review. In addition, guidelines from the American Heart Association are included. DATA SYNTHESIS: Aspirin is a relatively inexpensive and effective agent for secondary stroke prevention, and lower doses of aspirin appear as effective as higher doses. Ticlopidine has been used alone or in combination with aspirin, but serious adverse effects have limited its use. Clopidogrel has emerged as a safe and effective alternative to ticlopidine and lacks some of the serious adverse effects associated with ticlopidine, but is not superior to aspirin in secondary stroke prevention. Unlike previous studies, one recent trial showed that dipyridamole in combination with aspirin is superior to aspirin alone. CONCLUSIONS: Antiplatelet therapy is a key component of secondary prevention strategies in ischemic stroke. While aspirin has been the cornerstone in the management of stroke, other classes of antiplatelet drugs present new opportunities to optimize antiplatelet therapy.
Upper Gastroduodenal Ulceration in Arthritis Patients Treated with Celecoxib
Authors: Ashcroft Darren M , Chapman Stephen R , Clark Wendy K , Millson David S 
Published: June 2003

OBJECTIVE: To evaluate the comparative incidence of endoscopic gastroduodenal ulcers in patients with rheumatoid arthritis or osteoarthritis treated with celecoxib. DESIGN: Quantitative systematic review of randomized controlled trials. SUBJECTS: Patients (n = 4632) with rheumatoid arthritis or osteoarthritis reported in five trials. MAIN OUTCOME MEASURES: Rate ratios, rate differences, and the number needed to harm were calculated for the incidence of endoscopically documented gastroduodenal ulcers. RESULTS: Pooled rate ratios (RRs) relative to placebo for endoscopic ulcers at 12 weeks were 1.96 (95% CI 0.85 to 4.55) for celecoxib 100 mg twice daily and 2.35 (95% CI 1.02 to 5.38) for celecoxib 200 mg twice daily. There was no significant difference in gastroduodenal ulcers at 12 weeks between celecoxib 200 mg twice daily and celecoxib 100 mg twice daily; the corresponding pooled RR was 1.21 (95% CI 0.62 to 2.38). In contrast, celecoxib 200 mg twice daily was associated with a significantly lower rate of gastroduodenal ulcers than was naproxen 500 mg twice daily at 12 weeks (RR 0.24; 95% CI 0.17 to 0.33). On average, for every seven patients treated with naproxen, one more had an endoscopic ulcer than if they were treated with celecoxib. Celecoxib 200 mg twice daily also had a significantly lower risk of endoscopic ulcers than did either modified-release diclofenac 75 mg twice daily at 24 weeks (RR 0.24; 95% CI 0.11 to 0.52) or ibuprofen 800 mg three × daily at 12 weeks (RR 0.30; 95% CI 0.20 to 0.46). CONCLUSIONS: Endoscopic studies have shown that celecoxib, at a wide range of doses, is associated with a lower incidence of gastroduodenal ulcers than are diclofenac, ibuprofen, or naproxen. The incidence rates of gastroduodenal ulcers associated with celecoxib were similar, although not equivalent, to placebo. Head-to-head comparisons suggest that, at the wide range of doses studied (100–800 mg/d), there are no dose-related increases in endoscopic gastroduodenal ulcers with celecoxib. The results of longer term comparative trials of celecoxib based on clinical outcomes are needed to determine celecoxib's ultimate risk—benefit profile.
Delirium Associated with Zolpidem
Authors: Brodeur Michael R , Stirling Alexandra L 
Published: June 2003

OBJECTIVE: To report a case of an elderly woman sustaining an episode of delirium after one dose of zolpidem. CASE SUMMARY: An 86-year-old white woman was admitted to the hospital for headaches and diplopia. On hospital day 3, the patient received zolpidem 5 mg and, approximately two hours later, became restless, disoriented, and physically agitated. She was treated with haloperidol and was restrained for her safety. The patient's symptoms resolved by day 5, and she had no recollection of the incident. No rechallenge was attempted. DISCUSSION: Pharmacokinetic factors may play an important role in zolpidem-induced adverse drug reactions. Elderly women can achieve up to a 63% higher serum concentration than men. The patient in our report had factors such as age, gender, and hypoalbuminemia, which may have increased the maximum concentration and the AUC of zolpidem and possibly increased her risk of an adverse reaction. CONCLUSIONS: This case, along with previous reports, warrants the cautious use of zolpidem. Clinicians should be aware that a majority of these reactions occur in women. It appears that the reactions are concentration dependent; therefore, dosage reductions should be made in elderly patients and those with hepatic insufficiency.
Recurrent Ingrown Toenails Secondary to Indinavir/Ritonavir Combination Therapy
Authors: James Christopher W , McNelis Kelly C , Cohen David M , Szabo Susan , Bincsik Arlene K 
Published: June 2003

OBJECTIVE: To report five cases of ingrown toenails (IGTN) associated with indinavir/ritonavir (IDV/RTV) combination therapy. CASE SUMMARY: The median onset of IGTN from initiation of IDV/RTV therapy was 18.4 weeks. Four patients previously received IDV, with one of these experiencing prior IGTN. All patients required surgical management of IGTN. All patients received virologic benefit from ongoing antiretroviral therapy, and the majority of patients elected to maintain IDV/RTV combination therapy. Two patients experienced recurrent IGTN while receiving ongoing IDV/RTV combination therapy. DISCUSSION: IGTN and paronychia have previously been reported with IDV and lamivudine. IGTN in patients with HIV infection is more likely to present acutely, involve more digits, and require surgical management. IDV increases retinoic acid signaling and, based on elevated IDV concentrations from concomitant RTV therapy, the risk of IGTN may be increased in patients receiving IDV/RTV combination therapy. CONCLUSIONS: With the increasing popularity of IDV/RTV combination therapy, clinicians should be aware of the potential increase in frequency of dose-related toxicities including IGTN. Evaluation of hands and feet on physical examination should be recommended for all patients being treated with lamivudine and IDV, especially when used in combination with RTV.