bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Azole-Resistant Oropharyngeal Candidiasis with Topical Amphotericin B
Authors: Grim Shellee A , Smith Kelly M , Romanelli Frank , Ofotokun Ighovwerha 
Published: June 2003

OBJECTIVE: To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin B. CASE SUMMARY: A 30-year-old white woman presented with recurrent oral thrush. The patient had been exposed to azole antifungals for >20 years, and in vitro susceptibility tests revealed class resistance. The patient started taking amphotericin B 100 mg oral suspension swish-and-spit 4 × daily. After 4 weeks of topical amphotericin B treatment, the patient reported significant symptomatic improvement. The oral candidiasis worsened following a course of oral antibiotics, but improved once the antibiotic was discontinued and after receiving amphotericin B swish-and-swallow for 4 additional weeks. DISCUSSION: Current Infectious Diseases Society of America guidelines include topical amphotericin B as a potentially effective option for the treatment of oropharyngeal candidiasis. There is limited evidence to support this recommendation. Besides lack of data, an appropriate dosing regimen and consistent means of product formulation need to be determined. CONCLUSIONS: This report demonstrates the potential role for topical amphotericin B in the treatment of azole-refractory oral candidiasis. Double-blind, randomized, controlled trials are needed to define dosing, efficacy, administration, and long-term safety of oral amphotericin B.
Interferon Therapy for Acute Hepatitis C during Pregnancy
Authors: Özaslan Ersan , Yılmaz Rahmi , Simsek Halis , Tatar Gonca 
Published: June 2003

OBJECTIVE: Due to their antiproliferative activity, the probable effects of interferons on a fetus are a concern. We report on a pregnant patient who developed acute hepatitis C during pregnancy and was treated with a short course of interferon alfa therapy with a successful outcome. CASE SUMMARY: A 26-year-old woman was diagnosed with acute hepatitis C at the 16th week of pregnancy. She received a total dose of 72 million units of interferon alfa-2b during a 2 1/2 month period. Although the therapy was discontinued due to adverse effects, a complete biochemical and virologic response was obtained. Premature labor occurred and healthy, but growth-restricted, twin infants were born transvaginally. At 18 months of age, they had normal development, with a negative hepatitis C serology. DISCUSSION: The rate of transmission of hepatitis C virus from mother to infant is within the range of 1–5%. Although acute hepatitis C during pregnancy is a very rare occurrence, the mother is at a great risk for chronic infection. There is scarce literature about the probable effects of interferon use during pregnancy due to a lack of controlled studies in this special population. A total of 8 infants, including ours, exposed to interferon alfa and/or ribavirin during pregnancy showed no congenital anomalies or malformations. CONCLUSIONS: Patients with chronic hepatitis whose therapy can be delayed should not be treated with interferon due to a lack of controlled studies. However, women exposed to interferon inadvertently during pregnancy may be encouraged to continue pregnancy. In patients with acute hepatitis C during pregnancy, the use of interferon therapy should be considered with close monitoring.
Citalopram-Associated SIADH
Authors: Barclay Teresa S , Lee Audrey J 
Published: June 2003

OBJECTIVE: To report a case of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with use of citalopram in an elderly male patient and to review the English-language literature for any previous reports of SIADH or hyponatremia caused by citalopram. CASE SUMMARY: An 87-year-old Filipino man was admitted to the hospital reporting malaise, confusion, dizziness, and falls approximately 3 weeks following an increase in his citalopram dosage from 10 to 20 mg/d. On physical examination, the patient was euvolemic and had no evidence of malignancy, cardiac, renal, or hepatic disease. Pertinent laboratory test results revealed hyponatremia, serum hypoosmolality, urine hyperosmolality, and elevated urine sodium concentration, leading to a diagnosis of SIADH. Citalopram was discontinued and fluid restrictions were instituted. The patient was discharged after his serum sodium increased from 122 to 128 mEq/L and he reported increased strength and decreased confusion. Five days after discharge, the patient denied experiencing any new falls, weakness, confusion, or lethargy. His serum sodium measured that day was 131 mEq/L; 2 months later, it was 135 mEq/L. DISCUSSION: We report the seventh case of citalopram-induced hyponatremia published in the English language and the second in a man. Review of the cases demonstrated that the onset of citalopram-induced hyponatremia or SIADH ranged from 6 to 20 days. Potential risk factors for SIADH due to citalopram included advanced age, female gender, concomitant use of medications known to cause SIADH or hyponatremia, and, possibly, higher citalopram doses. CONCLUSIONS: Elderly patients receiving citalopram should be monitored for signs and symptoms of SIADH, especially in the first few weeks of therapy, in the presence of risk factors, and during dose escalation.
Interaction of Colony-Stimulating Factors and Fluorodeoxyglucose F18 Positron Emission Tomography
Authors: Mayer Dmitri , Bednarczyk Edward M 
Published: June 2003

OBJECTIVE: To evaluate reports of altered diagnostic images with fluorodeoxyglucose F18 (FDG) positron emission tomography (PET) after treatment with colony-stimulating factors (CSFs). DATA SOURCES: Literature was identified by a MEDLINE search (1966–December 2001). Key search terms included granulocyte colony-stimulating factor, granulocyte—macrophage colony-stimulating factor, macrophage colony-stimulating factor, fluorodeoxyglucose, and emission-computed tomography. English language literature was reviewed. DATA SYNTHESIS: Reports have suggested altered FDG PET images following CSF treatment. Studies that assessed the effect of CSF administration on FDG PET imaging of the bone and bone marrow were reviewed. CONCLUSIONS: Administration of CSFs may interfere with accurate FDG PET imaging. Separating FDG PET imaging from CSF therapy by ≥5 days may diminish this interference.
Levofloxacin and Warfarin Interaction
Authors: Jones Cade B , Fugate Susan E 
Published: June 2003

OBJECTIVE: To report 4 cases of hypoprothrombotic response resulting from addition of levofloxacin therapy to chronic warfarin therapy and to review related literature to support or refute a warfarin—levofloxacin interaction. CASE SUMMARY: Four patients, 34–81 years old, were prescribed levofloxacin concomitantly with stable warfarin therapy. Three patients had a target international normalized ratio (INR) range of 2.0–3.0 and experienced an increase in INR to 3.5, 8.12, and 11.5 on days 11, 5, and 4 of a 10-day course of levofloxacin, respectively. The fourth patient experienced minor bleeding, with a slightly elevated INR on the second day of levofloxacin therapy that required up to a 19% warfarin dose reduction during levofloxacin treatment. DISCUSSION: An initial premarketing clinical trial concluded that levofloxacin had no effect on warfarin's pharmacokinetics and pharmacodynamic response. Two case reports have since documented an increase in INR in patients taking long-term warfarin on completion of levofloxacin therapy. Our case reports provide further evidence of a significant increase in INR observed during concomitant levofloxacin therapy. The proposed mechanism of this interaction is displacement of warfarin from protein binding sites, reduction in gut flora producing vitamin K, and decreased warfarin metabolism. CONCLUSIONS: Prolonged prothrombin response in patients undergoing chronic warfarin therapy has been well documented with many antibiotics, including fluoroquinolones. Recognition of newer antibiotics' effects on warfarin therapy is important to guide safe use and monitoring of anticoagulation therapy. Our case studies demonstrate significant elevations in INR values during and up to 1 day after levofloxacin therapy in patients undergoing stable warfarin therapy.
Citalopram in Children and Adolescents with Depression or Anxiety
Authors: Baumgartner Jennifer L , Emslie Graham J , Crismon M Lynn 
Published: June 2003

OBJECTIVE: To investigate the efficacy and tolerability of citalopram in children and adolescents. METHOD: Retrospective chart review of 17 outpatients treated with citalopram at a tertiary care center. Subjects were diagnosed with a depressive or anxiety disorder with or without comorbidities and may have received concurrent medications. The primary outcome measure was the Clinical Global Impression Improvement Scale (CGI-I). Secondary outcome measures were the Children's Depression Rating Scale—Revised (CDRS-R), Inventory of Depressive Symptomatology, and Screen for Child Anxiety-Related Emotional Disorders (SCARED). Adverse effects were assessed via chart documentation. RESULTS: Patients were treated with a mean citalopram dose of 22.4 ± 7.3 mg for 12 weeks. Thirteen patients (76%) had CGI-I scores ≤2: 8 of 12 patients with depression and 5 of 5 patients with an anxiety disorder. The mean time to response was 7.6 ± 3.6 weeks. Additionally, 6 of 8 patients had ≥50% reduction from baseline CDRS-R score, with 3 patients (38%) meeting criteria for remission. Three of 4 patients had a >50% reduction for baseline SCARED-parent score. Overall, adverse effects appeared minor and transient. One patient discontinued citalopram due to intolerable adverse effects, and 1 patient required dose reduction. CONCLUSIONS: Citalopram appears to be effective and well tolerated in this group of children and adolescents with depressive or anxiety disorders and a high degree of comorbidity. Controlled studies in this patient population are indicated.
Pain and Distress from Bone Marrow Aspirations and Lumbar Punctures
Authors: Holdsworth Mark T , Raisch Dennis W , Winter Stuart S , Frost Jami D , Moro Michele A , Doran Nivine H , Phillips Joyce , Pankey Jan M , Mathew Prasad 
Published: June 2003

OBJECTIVE To compare the efficacy of 3 different pharmacologic regimens to relieve pain and distress in children with cancer undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs). DESIGN Retrospective cohort study with crossovers for some patients. PATIENTS AND METHODS The pain and distress ratings of patients undergoing BMAs (n = 73) and LPs (n = 105) were examined in a comparison of 3 different interventions: (1) a topical eutectic mixture of lidocaine and prilocaine (EMLA cream), (2) oral midazolam and EMLA cream, or (3) propofol/fentanyl general anesthesia. The choice of the intervention depended on patient/parent request. A validated faces pain scale was completed by the child or parent following each BMA or LP. The faces pain scale includes ratings of the severity of pain (from 0 = none to 5 = severe) and ratings of how frightened (from 0 = not scared to 5 = scared) the child was prior to each procedure. Comparisons of the pain and distress ratings were made among all patients for their first procedure and also within individual patients who had received >1 of the 3 interventions. Independent comparisons between the first treatments received by each patient were analyzed using Kruskal–Wallis tests. Comparisons of different crossover treatments received by individual patients were analyzed using Wilcoxon tests. RESULTS For all first procedures, mean ± SD pain and distress ratings during LPs were significantly lower when propofol/fentanyl was used (n = 43; 0.4 ± 1.0 and 1.4 ± 1.7) versus either EMLA (n = 29; 2.4 ± 1.7 and 2.9 ± 1.9) or midazolam/EMLA (n = 33; 2.4 ± 1.8 and 2.7 ± 1.8), respectively. Pain and distress ratings during BMAs were also significantly lower with propofol/fentanyl (n = 29; 0.5 ± 1.0 and 1.2 ± 1.7) versus EMLA (n = 21; 3.5 ± 1.6 and 3.3 ± 1.8) or midazolam/EMLA (n = 23; 3.3 ± 1.5 and 3.0 ± 1.9), respectively. When data were analyzed within each patient, these differences were also present. CONCLUSIONS Children receiving propofol/fentanyl general anesthesia experienced significantly less procedure-related pain and distress than did those receiving either EMLA or oral midazolam/EMLA.
Treatment of Tick-Borne Diseases
Authors: Donovan Brian J , Weber David J , Rublein John C , Raasch Ralph H 
Published: June 2003

OBJECTIVE: To review the data regarding the pharmacotherapy of Lyme disease, Rocky Mountain spotted fever (RMSF), and the human ehrlichioses. DATA SOURCES: English-language literature was identified via MEDLINE (1966–January 2002) using the keywords Lyme disease, Rocky Mountain spotted fever, and ehrlichiosis. Textbooks and other pertinent resources were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles identified through the data sources above were evaluated and reviewed if pertinent to the objective. DATA SYNTHESIS: Tick-borne diseases are the most common vector-transmitted diseases in North America. Each disease causes significant morbidity and, in the case of RMSF, mortality if patients go untreated. If the disease syndromes are recognized early and treatment is initiated, complications are greatly reduced. Doxycycline is active against each of the causative organisms, simplifying empiric treatment. CONCLUSIONS: Effective pharmacotherapy exists to treat each of these diseases, assuming diagnosis is made quickly. The β-lactam and tetracycline antibiotics appear to be the most effective therapy for Lyme disease. The tetracyclines, but not the β-lactams, are effective for RMSF and the human ehrlichioses. Since Borrelia burgdorferi and the human granulocytic ehrlichiosis agent are becoming more common coinfecting pathogens, tetracycline or doxycycline should be considered the drugs of choice for patients from endemic areas where exposure to both pathogens may have occurred. Doxycycline is the preferred agent because of decreased frequency of administration and adverse effects.
Steroid-Induced Myopathy in the ICU
Authors: Polsonetti Bryan W , Joy Saju D , Laos Luis F 
Published: June 2003

OBJECTIVE: To report a case of steroid-induced myopathy resulting from prolonged administration of corticosteroids in an asthmatic patient in a medical intensive care unit. CASE SUMMARY: A 30-year-old white man presented with status asthmaticus requiring intubation for respiratory failure. His hospital course was complicated by the need for reintubation and the development of “quadriplegia.” Electromyography does not identify neuropathy. After rapid tapering of systemic steroids, the patient quickly regained muscle strength, was extubated, and was transferred to a rehabilitation facility for prolonged physical therapy. DISCUSSION: Steroid-induced myopathy is a rare occurrence in the intensive care setting. Cases of myopathy that have been reported have been associated with prolonged and combined use of corticosteroids with neuromuscular blocking agents or aminoglycosides. Corticosteroids are thought to produce deleterious effects through 1 or all of 3 main pathways: altered electrical excitability of muscle fibers, loss of thick filaments, and/or inhibition of protein synthesis. All of these pathways are believed to increase the rate of muscle catabolism and result in loss of muscle movement. CONCLUSIONS: Steroid-induced myopathy is a complication of high-dose steroid use. Unfortunately, in this patient, initial treatment of status asthmaticus required intravenous steroids in high doses to adequately treat the presenting illness. Clinicians should be aware of neuromuscular findings and act aggressively to appropriately eliminate systemic steroids from the treatment regimen.
Myopathy Due to Statin/Fibrate Use in the Netherlands
Authors: Mantel-Teeuwisse Aukje K , Klungel Olaf H , Herings Ron MC , van Puijenbroek Eugène P , Porsius Arijan J , de Boer Anthonius 
Published: June 2003

OBJECTIVE: To estimate the number of expected cases of myopathy based on the prevalence of lipid-lowering drug use, and to compare this number with the observed number of cases of myopathy due to lipid-lowering drug use in the Netherlands. METHODS: Prevalence of lipid-lowering drug use in 1998 was estimated by using data from the PHARMO record linkage system comprising pharmacy records linked to hospital admission data. The expected number of cases of myopathy was calculated by multiplying the total number of person-years of lipid-lowering drug use by the excess incidence rates of myopathy due to those drugs as reported in the literature. The observed number of cases was obtained from PHARMO and the Dutch Pharmacovigilance Foundation Lareb. RESULTS: Based on the estimated prevalence of lipid-lowering drug use in the Netherlands in 1998 (n = 520 800), we expected 60 cases of idiopathic myopathy due to hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) or fibric acid derivatives (fibrates). This low number was confirmed by data from PHARMO (n = 11; none of these were related to current use of lipid-lowering drugs) and Lareb (n = 43). CONCLUSIONS: The expected number of statin- or fibrate-related idiopathic myopathy is low and observed numbers are even lower in the Netherlands. This should, therefore, not compromise continued use of lipid-lowering drugs.
Readability of Printed Patient Information for Epileptic Patients
Authors: Foster David R , Rhoney Denise H 
Published: June 2003

BACKGROUND: Written information can be a valuable tool in patient education. Studies evaluating written information for various disease states have frequently demonstrated that the majority of literature is written at a readability level that exceeds that of the average patient, and it has been recommended that written communications for adult patients should be provided at a fifth-grade level or lower. OBJECTIVE: To assess the readability of printed patient information available to patients with epilepsy. METHODS: Samples of written patient information (n = 101) were obtained from various sources. The information was classified based on source, content, and intended audience, and readability was assessed using the Flesch Reading Ease Score (FRES) and Flesch—Kincaid Grade Level (FKGL) score. RESULTS: The mean FRES and FKGL score for all samples were 50.2 and 9.4, respectively. Significant differences were observed in both the FRES and FKGL score of material obtained from different sources; however, no differences were observed when material was analyzed according to content. The mean FRES and FKGL score for materials intended for adults were 49.6 and 9.5, respectively. In comparison, mean FRES and FKGL scores for materials intended for children/adolescents were 78.9 and 5.3, respectively. CONCLUSIONS: The majority of information tested was written at a level that exceeds the reading ability of many patients. The information intended for children is actually written at the appropriate level for an adult. Efforts should be taken to develop written teaching tools that target low-level readers, especially for a disease state that affects many children.
Acute Pancreatitis Associated with Angiotensin II Receptor Antagonists
Authors: Fisher Alexander A , Bassett Mark L 
Published: June 2003

OBJECTIVE: To report a case of acute pancreatitis in a patient receiving a combination formulation of irbesartan and hydrochlorothiazide (HCTZ). CASE SUMMARY: A 33-year-old white woman developed acute pancreatitis 10 days after starting irbesartan 300 mg and hydrochlorothiazide 12.5 mg for treatment of hypertension. Her symptoms disappeared and serum concentrations of lipase and amylase returned to normal 2 days after irbesartan/HCTZ was discontinued. A search of MEDLINE (1990–September 2002) and the Australian Adverse Drug Reaction Advisory Committee database revealed 1 additional case of pancreatitis associated with irbesartan/HCTZ and 3 cases of pancreatitis associated with losartan. DISCUSSION: An objective causality assessment indicates that it is probable that pancreatitis was caused by the angiotensin II receptor antagonist irbesartan (and the same is probably true for losartan). It is less likely that the hydrochlorothiazide in irbesartan/HCTZ caused pancreatitis in our patient since the dose was lower than that usually associated with thiazide-induced pancreatitis. Angiotensin II receptors are thought to be important in regulation of pancreatic secretion and microcirculation, but the mechanism of pancreatitis induced by angiotensin II receptor antagonists remains unclear. CONCLUSIONS: Clinicians should be aware that irbesartan/HCTZ or losartan may cause acute pancreatitis. If abdominal pain develops, the medication should be discontinued and the patient investigated for acute pancreatitis.
Aspirin Dose for Prevention of Cardiovascular Disease in Diabetics
Authors: Nowak Sandra N , Jaber Linda A 
Published: June 2003

OBJECTIVE To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE Biomedical literature was accessed through MEDLINE (1990–February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS Pharmacologic and clinical studies focusing on the dose–response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81–325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.
Amlodipine versus Angiotensin-Receptor Blockers for Nonhypertension Indications
Authors: Kalus James S , White C Michael 
Published: June 2003

OBJECTIVE: To review the efficacy and safety data of amlodipine and the angiotensin-receptor blockers (ARBs), focusing on heart failure, angina, percutaneous coronary intervention (PCI), and renal protection. DATA SOURCE: A MEDLINE search (1966–December 2001) was completed using amlodipine, angiotensin-receptor antagonist, losartan, valsartan, candesartan, and telmisartan as key words. English-language articles were identified and included. STUDY SELECTION AND DATA EXTRACTION: All identified articles were evaluated. Articles representative of the subject matter of our review were included. DATA SYNTHESIS: Amlodipine and the ARBs lower blood pressure to a similar extent. Amlodipine is an effective antianginal agent, whereas ARBs are not. However, amlodipine is not effective in the treatment of heart failure; ARBs may be useful in this setting. ARBs are also effective in preserving renal function and may provide some protection from restenosis in patients who have had a PCI. The ARBs may also be useful in preventing both diabetic and nondiabetic nephropathy. CONCLUSIONS: Concomitant disease states should be considered when choosing between an ARB and amlodipine for the management of hypertension.