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Gillard KK, Bloedon L, Grady-Benson JC, Edwards A, Fahy S, Sasiela WJ, Louie MJ, Thompson PD. Prevalence of Tendon Rupture and Tendinopathies Among Patients with Atherosclerotic Cardiovascular Disease Derived From United States Administrative Claims Data. Cardiol Ther 2024; 13:575-591. [PMID: 39003659 PMCID: PMC11333683 DOI: 10.1007/s40119-024-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/06/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION The prevalence of tendon rupture and tendinopathies (TRT) has not been determined in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). We investigated TRT prevalence among patients with ASCVD and in the general population, using data from the Symphony Health Integrated Dataverse, a large US medical and pharmacy claims database. METHODS This retrospective, observational study included patients aged ≥ 19 years from the claims database during the identification period (January 2019 to December 2020) and 12 months of continuous enrollment. The primary outcome was evidence of TRT in the 12 months following the index date (first ASCVD diagnosis in the ASCVD cohort; first claim in the claims database in the overall population). Diagnostic codes (ICD-10 and/or CPT) were used to define ASCVD and TRT diagnosis. RESULTS The ASCVD cohort and overall population included 5,589,273 and 61,715,843 patients, respectively. In the ASCVD cohort, use of medications with a potential or known association with TRT was identified in 67.9% (statins), 17.7% (corticosteroids), and 16.7% (fluoroquinolones) of patients. Bempedoic acid use was reported in 1556 (< 0.1%) patients. TRT prevalence during 12-month follow-up was 3.4% (ASCVD cohort) and 1.9% (overall population). Among patients with ASCVD, 83.5% experienced TRT in only one region of the body. Factors most associated with TRT in the ASCVD cohort were increasing age, most notably in those aged 45-64 years (odds ratio [OR] 2.19; 95% confidence interval [CI] 2.07-2.32), obesity (OR 1.51; 95% CI 1.50-1.53), and rheumatoid arthritis (OR 1.47; 95% CI 1.45-1.79). Use of statins or bempedoic acid was not associated with increased TRT risk. CONCLUSION Patients with ASCVD may have greater risk of TRT than the general population, which may be driven by an increased prevalence of comorbidities and use of medications with a potential or known association with TRT.
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Affiliation(s)
- Kristin K Gillard
- Esperion Therapeutics Inc., Ann Arbor, MI, USA.
- , 245 Lindero Avenue, Long Beach, CA, 90803, USA.
| | | | - John C Grady-Benson
- Orthopedic Associates of Hartford PC, Hartford, CT, USA
- Department of Orthopedic Surgery, The Bone and Joint Institute at Hartford HealthCare, Hartford, CT, USA
| | | | - Sean Fahy
- Symphony Health, ICON Plc Company, Blue Bell, PA, USA
| | | | | | - Paul D Thompson
- Cardiovascular Institute, Hartford HealthCare, Hartford, CT, USA
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Zou P, Chen Z, Tu J, Chen X, Liu X. Comparison of Mutant Prevention Concentrations of Fluoroquinolones Against ESBL-Positive and ESBL-Negative Klebsiella pneumoniae Isolates from Orthopedic Patients. Microb Drug Resist 2024. [PMID: 39019029 DOI: 10.1089/mdr.2024.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
The majority of Klebsiella pneumonia isolates possess the extended-spectrum beta-lactamase (ESBL) enzymes. Therefore, K. pneumoniae can easily develop drug resistance. How to effectively overcome the problem of drug resistance in K. pneumoniae is still a research hotspot. This study aimed to compare the mutant prevention concentration (MPC) of ESBL-positive and ESBL-negative K. pneumoniae isolated from orthopedic patients, which may provide a basis for the effective use of drugs to control the enrichment of resistance mutants of K. pneumoniae. The MPC90 values of 55 isolates of ESBL-positive K. pneumoniae against 4 fluoroquinolones were 32 µg/mL for levofloxacin and gatifloxacin, 16 µg/mL for ciprofloxacin, and 4 µg/mL for gemifloxacin. The selection index value was 8 for levofloxacin and ciprofloxacin and 2 for gemifloxacin and gatifloxacin, respectively. For ESBL-negative K. pneumoniae isolates, the MPC90 values were 16 µg/mL for levofloxacin and ciprofloxacin, 4 µg/mL for gemifloxacin, and 32 µg/mL for gatifloxacin. The selection index value was 8 for levofloxacin and ciprofloxacin, 2 for gemifloxacin, and 4 for gatifloxacin. For the ESBL-positive K. pneumoniae, the %T>MIC90 order was gemifloxacin > levofloxacin > ciprofloxacin > gatifloxacin. For the ESBL-negative K. pneumoniae, the %T>MIC90 order was levofloxacin > gemifloxacin > ciprofloxacin > gatifloxacin. The mutant-preventing ability of gatifloxacin and gemifloxacin was the strongest among the 4 fluoroquinolones. So gemifloxacin may be the first choice of drug to treat K. pneumoniae infection.
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Affiliation(s)
- Peng Zou
- The Department of Orthopedics, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Zhiquan Chen
- The Department of Orthopedics, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Jijun Tu
- The Department of Orthopedics, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Xinfeng Chen
- The Department of Orthopedics, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Xuejian Liu
- The Department of Orthopedics, Zhengzhou Seventh People's Hospital, Zhengzhou, China
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Lin S, Sproul D, Agarwal A, Harris AB, Golladay GJ, Thakkar SC. Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:1840-1844.e1. [PMID: 38331356 DOI: 10.1016/j.arth.2024.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Quadriceps tendon extensor mechanism disruption is an infrequent but devastating complication after total knee arthroplasty (TKA). Our knowledge of specific risk factors for this complication is limited by the current literature. Thus, this study aimed to identify potential risk factors for quadriceps tendon extensor mechanism disruption following TKA. METHODS A retrospective cohort analysis was performed using the PearlDiver Administrative Claims Database. Patients undergoing TKA without a prior history of quadriceps tendon extensor mechanism disruption were identified. Quadriceps tendon extensor mechanism disruption included rupture of the quadriceps tendon, patellar tendon, or fracture of the patella. Patients who had a minimum of 5 years of follow-up after TKA were included. A total of 126,819 patients were included. Among them, 517 cases of quadriceps tendon extensor mechanism disruption occurred (incidence 0.41%). Hypothesized risk factors were compared between those who had postoperative quadriceps tendon extensor mechanism disruption and those who did not. RESULTS On multivariate analysis, increased Charlson Comorbidity Index (odds ratio (OR): 1.10, 95% confidence interval (CI) [1.07 to 1.13]; P < .001), obesity (OR: 1.49, 95% CI [1.24 to 1.79]; P < .001), and fluoroquinolone use any time after TKA (OR: 1.24, 95% CI [1.01 to 1.52]; P = .036) were significantly associated with quadriceps tendon extensor mechanism disruption. CONCLUSIONS Our study identified the incidence of quadriceps tendon extensor mechanism disruption following TKA as 0.41%. Identified risk factors for quadriceps tendon extensor mechanism disruption after TKA include an increased Charlson Comorbidity Index, obesity, and use of fluoroquinolones postoperatively.
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Affiliation(s)
- Shu Lin
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - David Sproul
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Andrew B Harris
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
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Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatol Adv Pract 2024; 8:rkae022. [PMID: 38601140 PMCID: PMC11003818 DOI: 10.1093/rap/rkae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/25/2024] [Indexed: 04/12/2024] Open
Abstract
Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.
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Affiliation(s)
- Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- PhysioTec, Tarragindi, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Gallipoli Medical Research, Greenslopes, Queensland, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Ožegić O, Bedenić B, Sternak SL, Sviben M, Talapko J, Pažur I, Škrlec I, Segedi I, Meštrović T. Antimicrobial Resistance and Sports: The Scope of the Problem, Implications for Athletes' Health and Avenues for Collaborative Public Health Action. Antibiotics (Basel) 2024; 13:232. [PMID: 38534667 DOI: 10.3390/antibiotics13030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial resistance (AMR) poses a global threat, leading to increased mortality and necessitating urgent action-however, its impact on athletes and the world of sports has hitherto been neglected. Sports environments (including athletic and aquatic) exhibit high levels of microbial contamination, potentially contributing to the spread of resistant microorganisms during physical activities. Moreover, the literature suggests that travel for sports events may lead to changes in athletes' gut microbiomes and potentially impact their antibiotic resistance profiles, raising questions about the broader implications for individual and public/global health. The prevalence of Staphylococcus aureus (S. aureus) among athletes (particularly those engaged in contact or collision sports) ranges between 22.4% and 68.6%, with MRSA strains being isolated in up to 34.9% of tested individuals. Factors such as training frequency, equipment sharing, delayed post-training showers, and a history of certain medical conditions are linked to higher colonization rates. Moreover, MRSA outbreaks have been documented in sports teams previously, highlighting the importance of implementing preventive measures and hygiene protocols in athletic settings. In light of the growing threat of AMR, there is a critical need for evidence-based treatment guidelines tailored to athletes' unique physiological demands to ensure responsible antibiotic use and mitigate potential health risks. While various initiatives-such as incorporating AMR awareness into major sporting events-aim to leverage the broad audience of sports to communicate the importance of addressing AMR, proactive measures (including improved AMR surveillance during large sporting events) will be indispensable for enhancing preparedness and safeguarding both athletes' and the general public's health. This narrative review thoroughly assesses the existing literature on AMR and antibiotic usage in the context of sports, aiming to illuminate areas where information may be lacking and underscoring the significance of promoting global awareness about AMR through sports.
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Affiliation(s)
- Ognjen Ožegić
- Department of Anaesthesiology, Intensive Medicine and Pain Management, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
| | - Branka Bedenić
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- BIMIS-Biomedical Research Center Šalata, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Sunčanica Ljubin Sternak
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
| | - Mario Sviben
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Parasitology Department, Microbiology Service, Croatian National Institute of Public Health, 10000 Zagreb, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Iva Pažur
- Department of Anaesthesiology, Intensive Medicine and Pain Management, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Segedi
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department for Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA
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Rodrigues da Silva Barros B, Dal’Ava Augusto D, de Medeiros Neto JF, Michener LA, Silva RS, Sousa CDO. Isometric versus isotonic exercise in individuals with rotator cuff tendinopathy-Effects on shoulder pain, functioning, muscle strength, and electromyographic activity: A protocol for randomized clinical trial. PLoS One 2023; 18:e0293457. [PMID: 37956135 PMCID: PMC10642785 DOI: 10.1371/journal.pone.0293457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Rotator cuff tendinopathy is a common shoulder disorder in which the primary treatment is resistance exercises. Isometric exercises are being studied for lower limb tendinopathies but not for rotator cuff tendinopathy. This protocol for a randomized clinical trial aims to compare the effects of two types of exercise (isometric and isotonic) on shoulder pain, functioning, muscle strength, and electromyographic activity in individuals with rotator cuff tendinopathy. METHODS Forty-six individuals (18 to 60 years old) with shoulder pain for more than three months and unilateral supraspinatus and/or infraspinatus tendinopathy will participate in this trial. Individuals will be randomized into two exercise groups: isometric or isotonic. The following outcomes will be evaluated before and after the first session and after six weeks of intervention: shoulder pain and functioning; isometric strength of shoulder elevation and lateral and medial rotation; and electromyographic activity of medial deltoid, infraspinatus, serratus anterior, and lower trapezius. Groups will perform stretching and strengthening of periscapular muscles. The isometric group will perform three sets of 32 s, at 70% of maximal isometric strength. The isotonic group will perform concentric and eccentric exercises (2 s for each phase) in three sets of eight repetitions at a load of eight repetition maximum. The total time under tension of 96 s will be equal for both groups, and load will be adjusted in weeks three and five of the protocol. Treatment effect between groups will be analyzed using linear mixed model. TRIAL REGISTRATION Trial registration number: Universal Trial Number (UTN) code U1111-1284-7528 and Brazilian Clinical Trials Registry platform-RBR-3pvdvfk.
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Affiliation(s)
- Bianca Rodrigues da Silva Barros
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | - Denise Dal’Ava Augusto
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | | | - Lori Ann Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, State of Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
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Dias M, Chapagain T, Leng F. A Fluorescence-Based, T5 Exonuclease-Amplified DNA Cleavage Assay for Discovering Bacterial DNA Gyrase Poisons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.16.562555. [PMID: 37904923 PMCID: PMC10614890 DOI: 10.1101/2023.10.16.562555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Fluoroquinolones (FQs) are potent antibiotics of clinical significance, known for their unique mechanism of action as gyrase poisons, which stabilize gyrase-DNA cleavage complexes and convert gyrase into a DNA-damaging machinery. Unfortunately, FQ resistance has emerged, and these antibiotics can cause severe side effects. Therefore, discovering novel gyrase poisons with different chemical scaffolds is essential. The challenge lies in efficiently identifying them from compound libraries containing thousands or millions of drug-like compounds, as high-throughput screening (HTS) assays are currently unavailable. Here we report a novel fluorescence-based, T5 exonuclease-amplified DNA cleavage assay for gyrase poison discovery. This assay capitalizes on recent findings showing that multiple gyrase molecules can simultaneously bind to a plasmid DNA molecule, forming multiple gyrase-DNA cleavage complexes on the same plasmid. These gyrase-DNA cleavage complexes, stabilized by a gyrase poison, can be captured using sarkosyl. Proteinase K digestion results in producing small DNA fragments. T5 exonuclease, selectively digesting linear and nicked DNA, can fully digest the fragmented linear DNA molecules and, thus, "amplify" the decrease in fluorescence signal of the DNA cleavage products after SYBR Green staining. This fluorescence-based, T5 exonuclease-amplified DNA cleavage HTS assay is validated using a 50-compound library, making it suitable for screening large compound libraries.
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Chongboonwatana J, Terbsiri V, Suwanpimolkul G. Prevalence, risk factors and treatment outcomes of fluoroquinolones-associated tendinopathy in tuberculosis patients at university hospital, Thailand. Heliyon 2023; 9:e20331. [PMID: 37810827 PMCID: PMC10550594 DOI: 10.1016/j.heliyon.2023.e20331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Tuberculosis (TB) is an epidemic disease in Thailand. Fluoroquinolones are used to treat TB and have a lengthy treatment course. Therefore, many patients may have adverse effects from these medications. Tendinopathy has been reported as a significant adverse effect of fluoroquinolones. Although the mechanism of tendinopathy from fluoroquinolones is not fully understood, it can progress to a more serious consequence such as a ruptured tendon which can result in morbidity if not treated effectively. Methods This study was a single-centered, retrospective descriptive study conducted in patients at a tertiary-level university hospital in Thailand. TB patients who received fluoroquinolones for the treatment of TB from January 2017 to December 2019 were enrolled. This study assessed the prevalence, clinical characteristics, treatment, treatment outcomes for fluoroquinolones-associated tendinopathy, and treatment outcomes of TB. Results During the study period, 184 participants that were diagnosed with TB and used fluoroquinolones were enrolled in the study. 34 (18.5%) participants developed tendinopathy. The risk factors that were associated with fluoroquinolones-associated tendinopathy were younger age (<60 years) (Odd ratio (OR) 3.61; 95% CI 1.16-11.23), female (OR 3.54; 95% CI 1.58-7.90), and prolonged usage of levofloxacin (>180 days) (OR 2.61; 95%CI 1.12-6.08). All participants who developed tendinopathy received conservative treatment; the dose of fluoroquinolones was reduced in 9 (26.4%) participants, fluoroquinolones were discontinued in 7 (20.6%) participants and the rest of the participants (n = 18; 52.9%) had conservative treatment. After conservative treatment, 25 (73.5%) participants recovered from tendinopathy. For the TB treatment, 27 (79.4%) participants in the tendinopathy group completed TB treatment and none of them experienced treatment failure. On the other hand, 89 (59.3%) participants in the no tendinopathy group had completed their TB treatment and 3 (2%) of them experienced treatment failure. Conclusions The prevalence of fluoroquinolones-associated tendinopathy was not uncommon, and the risk of fluoroquinolones-associated tendinopathy was high in young and female patients. Levofloxacin use was related to an elevated risk of developing tendinopathy, which was dose- and duration-dependent. Conservative treatment, reducing the dose or discontinuation of fluoroquinolones successfully improved the symptoms of tendinopathy. Fluoroquinolones-associated tendinopathy did not affect the treatment of TB.
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Affiliation(s)
- Jirarat Chongboonwatana
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Varalee Terbsiri
- Division of Infectious Diseases, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Gompol Suwanpimolkul
- Division of Infectious Diseases, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Emerging Infectious Diseases Clinical Center, Thai Red Cross Society, Bangkok, Thailand
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Waters TL, Ross BJ, Wilder JH, Cole MW, Collins LK, Sherman WF. Is Fluoroquinolone Exposure after Primary Tendon Repair Associated with Higher Rates of Reoperations? A Matched Cohort Study. Orthop Rev (Pavia) 2023; 15:67914. [PMID: 36843858 PMCID: PMC9946796 DOI: 10.52965/001c.67914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Background The association between tendon damage and fluoroquinolone (FQ) antibiotics has been well documented. However, there is limited data evaluating the impact of postoperative FQ use on outcomes of primary tendon repairs. The purpose of this study was to compare rates of reoperation for patients with FQ exposure after primary tendon repair versus controls. Methods A retrospective cohort study was conducted using the PearlDiver database. All patients who underwent primary repair of distal biceps ruptures, Achilles tendon ruptures, and rotator cuff tears were identified. For each tendon, patients who were prescribed FQs within 90 days postoperatively were propensity score matched at a 1:3 ratio with controls without postoperative FQ prescriptions across age, sex, and several comorbidities. Rates of reoperation were compared at two years postoperatively with multivariable logistic regression. Results A total of 124,322 patients who underwent primary tendon procedures were identified, including 3,982 (3.2%) patients with FQ prescriptions within 90 days postoperatively: 448 with distal biceps repair, 2,538 with rotator cuff repair, and 996 with Achilles tendon repair. These cohorts were matched with 1,344, 7,614, and 2,988 controls, respectively. Patients with postoperative FQ prescriptions exhibited significantly higher rates of revision surgery after primary repair of distal biceps ruptures (3.6% vs. 1.7%; OR 2.13; 95% CI, 1.09-4.04), rotator cuff tears (7.1% vs. 4.1%; OR 1.77; 95% CI, 1.48-2.15), and Achilles tendon ruptures (3.8% vs. 1.8%; OR 2.15; 95% CI, 1.40-3.27). Conclusion Patients with FQ prescriptions within 90 days after primary tendon repair demonstrated significantly higher rates of reoperations for distal biceps, rotator cuff, and Achilles tendon repair at two years postoperatively. To achieve optimal outcomes and avoid complications in patients following primary tendon repair procedures, physicians should consider prescribing alternative non-FQ antibiotics and counsel patients on the risk of reoperation associated with postoperative FQ use.
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Affiliation(s)
- Timothy L Waters
- Department of Orthopaedic SurgeryTulane University School of Medicine
| | - Bailey J Ross
- Department of Orthopaedic SurgeryEmory University School of Medicine
| | - J. Heath Wilder
- Department of Orthopaedic SurgeryTulane University School of Medicine
| | - Matthew W Cole
- Department of Orthopaedic SurgeryTulane University School of Medicine
| | - Lacee K Collins
- Department of Orthopaedic SurgeryTulane University School of Medicine
| | - William F Sherman
- Department of Orthopaedic SurgeryTulane University School of Medicine
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Furuta H, Yamada M, Nagashima T, Matsuda S, Nagayasu K, Shirakawa H, Kaneko S. Increased expression of glutathione peroxidase 3 prevents tendinopathy by suppressing oxidative stress. Front Pharmacol 2023; 14:1137952. [PMID: 37021050 PMCID: PMC10067742 DOI: 10.3389/fphar.2023.1137952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Abstract
Tendinopathy, a degenerative disease, is characterized by pain, loss of tendon strength, or rupture. Previous studies have identified multiple risk factors for tendinopathy, including aging and fluoroquinolone use; however, its therapeutic target remains unclear. We analyzed self-reported adverse events and the US commercial claims data and found that the short-term use of dexamethasone prevented both fluoroquinolone-induced and age-related tendinopathy. Rat tendons treated systemically with fluoroquinolone exhibited mechanical fragility, histological change, and DNA damage; co-treatment with dexamethasone attenuated these effects and increased the expression of the antioxidant enzyme glutathione peroxidase 3 (GPX3), as revealed via RNA-sequencing. The primary role of GPX3 was validated in primary cultured rat tenocytes treated with fluoroquinolone or H2O2, which accelerates senescence, in combination with dexamethasone or viral overexpression of GPX3. These results suggest that dexamethasone prevents tendinopathy by suppressing oxidative stress through the upregulation of GPX3. This steroid-free approach for upregulation or activation of GPX3 can serve as a novel therapeutic strategy for tendinopathy.
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Affiliation(s)
- Haruka Furuta
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Mari Yamada
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Takuya Nagashima
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuki Nagayasu
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Hisashi Shirakawa
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Shuji Kaneko
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
- *Correspondence: Shuji Kaneko,
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James S, Daffy J, Cook J, Samiric T. Short-Term Exposure to Ciprofloxacin Reduces Proteoglycan Loss in Tendon Explants. Genes (Basel) 2022; 13:genes13122210. [PMID: 36553476 PMCID: PMC9777606 DOI: 10.3390/genes13122210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Fluoroquinolone antibiotics are associated with increased risk of tendinopathy and tendon rupture, which can occur well after cessation of treatment. We have previously reported that the fluoroquinolone ciprofloxacin (CPX) reduced proteoglycan synthesis in equine tendon explants. This study aimed to determine the effects of CPX on proteoglycan catabolism and whether any observed effects are reversible. Equine superficial digital flexor tendon explant cultures were treated for 4 days with 1, 10, 100 or 300 µg/mL CPX followed by 8 days without CPX. The loss of [35S]-labelled proteoglycans and chemical pool of aggrecan and versican was studied as well as the gene expression levels of matrix-degrading enzymes responsible for proteoglycan catabolism. CPX suppressed [35S]-labelled proteoglycan and total aggrecan loss from the explants, although not in a dose-dependent manner, which coincided with downregulation of mRNA expression of MMP-9, -13, ADAMTS-4, -5. The suppressed loss of proteoglycans was reversed upon removal of the fluoroquinolone with concurrent recovery of MMP and ADAMTS mRNA expression, and downregulated TIMP-2 and upregulated TIMP-1 expression. No changes in MMP-3 expression by CPX was observed at any stage. These findings suggest that CPX suppresses proteoglycan catabolism in tendon, and this is partially attributable to downregulation of matrix-degrading enzymes.
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Affiliation(s)
- Stuart James
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Melbourne, VIC 3086, Australia
| | - John Daffy
- Department of Infectious Diseases, St Vincent’s Hospital, Melbourne, VIC 3065, Australia
| | - Jill Cook
- Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086, Australia
| | - Tom Samiric
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
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12
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Bove C, Baldock RA, Champigneulle O, Martin L, Bennett CL. Fluoroquinolones - Old drugs, putative new toxicities. Expert Opin Drug Saf 2022; 21:1365-1378. [DOI: 10.1080/14740338.2022.2147924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cecilia Bove
- Department of Biological Sciences, York College of Pennsylvania, 441 Country Club Road, York, PA, USA
| | - Robert A. Baldock
- School of Pharmacy and Biomedical Science, University of Portsmouth, St. Michael’s Building, White Swan Road, Portsmouth, PO1 2DT, UK
| | - Oscar Champigneulle
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
| | - Linda Martin
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
| | - Charles L Bennett
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
- Beckman Research Institute (BRI) of City of Hope and the Department of Comparative Medicine and Evidence Based Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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13
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Lee CC, Chang SN, Tehrani B, Liu SSH, Chan CY, Hsu WT, Huang TY, Huang PS, Hwang JJ, Chen JJ, Tsai CT. Use of nicorandil is associated with increased risk of incident atrial fibrillation. Aging (Albany NY) 2022; 14:6975-6992. [PMID: 36084950 PMCID: PMC9512508 DOI: 10.18632/aging.204259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Background: Nicorandil will activate ATP-sensitive potassium channel (KATP). However, activation of potassium channels plays an important role in the mechanism of atrial fibrillation (AF) or atrial flutter (AFL). Whether use of nicorandil might contribute to initiation and/or perpetuation of AF/AFL remained unknown. We determined the relationship between use of nicorandil and risk of atrial fibrillation and determined its molecular mechanism. Methods: We performed a nested case-control study using a cohort from the National Health Insurance Research Database (NHIRD) of Taiwan. The association between nicorandil use and risk of atrial fibrillation/flutter was estimated by logistic regression model. We also performed molecular, cellular and animal studies to explain the association. Results: A total of 715 individuals who experienced AF/atrial flutter were matched to 72,215 controls. New use of nicorandil was found to be associated with increased risk for AF/AFL (odds ratio [OR], 2.34; 95% CI 1.07–5.13) compared to nitrate use. We found the expression of KATP subunits Kir6.2 and SUR2A in human and rat left atrial tissues. Furthermore, nicorandil directly shortened action potential duration (APD) in rat left atrium and shortened the QT interval of cultured human induced pluripotent stem cell (iPSC) derived cardiomyocytes (iPSC-CMs). Conclusions: Use of nicorandil was found to be associated with increased risk of AF/AFL. We also showed the expression of KATP subunits in human atria, and a possible mechanism that use of nicorandil increases the risk of AF through activation of KATP and shortening of atrial APD.
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Affiliation(s)
- Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Nan Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Babak Tehrani
- Department of Medicine, Brown University/Rhode Island Hospital, Providence, RI 02912, USA
| | - Sot Shih-Hung Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ying Chan
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tzu-Yun Huang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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14
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Antibiotic Therapy and Athletes: Is the Mitochondrial Dysfunction the Real Achilles’ Heel? Sports (Basel) 2022; 10:sports10090131. [PMID: 36136386 PMCID: PMC9504712 DOI: 10.3390/sports10090131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
It is widely recognized that athletes consume oral antibiotics almost twice as often as observed in the non-sports population in order to reduce as much as possible the period of inactivity due to bacterial diseases. However, increasing evidences have demonstrated the ability of some classes of antibiotics to induce muscle weakness, pain, and a feeling of fatigue upon resuming physical activity conditions that considerably limit the athletic performance of athletes, ascribable to alterations in the biochemical mechanisms underlying normal musculoskeletal activity, such as mitochondrial respiration. For this reason, tailoring a treatment plan for effective antibiotics that limit an athlete’s risk is paramount to their safety and ability to maintain adequate athletic performance. The present review illustrates and critically analyzes the evidence on the use of antibiotics in sports, deepening the molecular mechanisms underlying the onset and development of muscle–tendon alterations in athletes as well as delineating the pharmacological strategies aimed at counteracting such adverse events.
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15
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Shahbazi F, Shojaei L, Farvadi F, Kadivarian S. Antimicrobial safety considerations in critically ill patients: part II: focused on anti-microbial toxicities. Expert Rev Clin Pharmacol 2022; 15:563-573. [PMID: 35734938 DOI: 10.1080/17512433.2022.2093716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics. AREAS COVERED In the current article we searched PubMed, Scopus and Google Scholar for neurotoxicities, hematologic toxicity and fluid stewardship in intensive care units. EXPERT OPINION Critically ill patients who receive antimicrobial agents should be monitored for neurological, hematologic toxicities especially seizure, thrombocytopenia, and clostridioides infections. Other toxicities including QTc prolongation, electrolyte disturbances, liver enzyme elevation, and infusion-related reactions were being considered. Other changes, including fluid overload, hypoalbuminemia, augmented renal clearance, increased cardiac outputs in septic shock, and acute kidney injury, may influence treatment efficiency and patient outcome.
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Affiliation(s)
- Foroud Shahbazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fakhrossadat Farvadi
- Center for nanotechnology in drug delivery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Kadivarian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
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16
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Salimiaghdam N, Singh L, Singh MK, Chwa M, Atilano SR, Mohtashami Z, Nesburn AB, Kuppermann BD, Lu SY, Kenney MC. Impacts of Bacteriostatic and Bactericidal Antibiotics on the Mitochondria of the Age-Related Macular Degeneration Cybrid Cell Lines. Biomolecules 2022; 12:675. [PMID: 35625603 PMCID: PMC9138285 DOI: 10.3390/biom12050675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 12/07/2022] Open
Abstract
We assessed the potential negative effects of bacteriostatic and bactericidal antibiotics on the AMD cybrid cell lines (K, U and J haplogroups). AMD cybrid cells were created and cultured in 96-well plates and treated with tetracycline (TETRA) and ciprofloxacin (CPFX) for 24 h. Reactive oxygen species (ROS) levels, mitochondrial membrane potential (ΔψM), cellular metabolism and ratio of apoptotic cells were measured using H2DCFDA, JC1, MTT and flow cytometry assays, respectively. Expression of genes of antioxidant enzymes, and pro-inflammatory and pro-apoptotic pathways were evaluated by quantitative real-time PCR (qRT-PCR). Higher ROS levels were found in U haplogroup cybrids when treated with CPFX 60 µg/mL concentrations, lower ΔψM of all haplogroups by CPFX 120 µg/mL, diminished cellular metabolism in all cybrids with CPFX 120 µg/mL, and higher ratio of dead cells in K and J cybrids. CPFX 120 µg/mL induced overexpression of IL-33, CASP-3 and CASP-9 in all cybrids, upregulation of TGF-β1 and SOD2 in U and J cybrids, respectively, along with decreased expression of IL-6 in J cybrids. TETRA 120 µg/mL induced decreased ROS levels in U and J cybrids, increased cellular metabolism of treated U cybrids, higher ratio of dead cells in K and J cybrids and declined ΔψM via all TETRA concentrations in all haplogroups. TETRA 120 µg/mL caused upregulation of IL-6 and CASP-3 genes in all cybrids, higher CASP-7 gene expression in K and U cybrids and downregulation of the SOD3 gene in K and U cybrids. Clinically relevant dosages of ciprofloxacin and tetracycline have potential adverse impacts on AMD cybrids possessing K, J and U mtDNA haplogroups in vitro.
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Affiliation(s)
- Nasim Salimiaghdam
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Lata Singh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Mithalesh K. Singh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Marilyn Chwa
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Shari R. Atilano
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Zahra Mohtashami
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Anthony B. Nesburn
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Baruch D. Kuppermann
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - Stephanie Y. Lu
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
| | - M. Cristina Kenney
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA; (N.S.); (L.S.); (M.K.S.); (M.C.); (S.R.A.); (Z.M.); (A.B.N.); (B.D.K.); (S.Y.L.)
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA 92697, USA
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17
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Badawy S, Yang Y, Liu Y, Marawan MA, Ares I, Martinez MA, Martínez-Larrañaga MR, Wang X, Anadón A, Martínez M. Toxicity induced by ciprofloxacin and enrofloxacin: oxidative stress and metabolism. Crit Rev Toxicol 2022; 51:754-787. [PMID: 35274591 DOI: 10.1080/10408444.2021.2024496] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ciprofloxacin (CIP) (human use) and enrofloxacin (ENR) (veterinary use) are synthetic anti-infectious medications that belong to the second generation of fluoroquinolones. They have a wide antimicrobial spectrum and strong bactericidal effects at very low concentrations via enzymatic inhibition of DNA gyrase and topoisomerase IV, which are required for DNA replication. They also have high bioavailability, rapid absorption with favorable pharmacokinetics and excellent tissue penetration, including cerebral spinal fluid. These features have made them the most applied antibiotics in both human and veterinary medicine. ENR is marketed exclusively for animal medicine and has been widely used as a therapeutic veterinary antibiotic, resulting in its residue in edible tissues and aquatic environments, as well as the development of resistance and toxicity. Estimation of the risks to humans due to antimicrobial resistance produced by CIP and ENR is important and of great interest. Moreover, in rare cases due to their overdose and/or prolonged administration, the development of CIP and ENR toxicity may occur. The toxicity of these fluoroquinolones antimicrobials is mainly related to reactive oxygen species (ROS) and oxidative stress (OS) generation, besides metabolism-related toxicity. Therefore, CIP is restricted in pregnant and lactating women, pediatrics and elderly similarly ENR do in the veterinary field. This review manuscript aims to identify the toxicity induced by ROS and OS as a common sequel of CIP and ENR. Furthermore, their metabolism and the role of metabolizing enzymes were reported.
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Affiliation(s)
- Sara Badawy
- National Reference Laboratory of Veterinary Drug Residues (HZAU) and MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, China.,Pathology Department of Animal Medicine, Faculty of Veterinary Medicine, Benha University, Benha, Egypt
| | - YaQin Yang
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, China
| | - Yanan Liu
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, China
| | - Marawan A Marawan
- The State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Infectious Diseases, Animal Medicine Department, Faculty of Veterinary Medicine, Benha University, Benha, Egypt
| | - Irma Ares
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Universidad Complutense de Madrid (UCM), and Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain
| | - María-Aránzazu Martinez
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Universidad Complutense de Madrid (UCM), and Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain
| | - María-Rosa Martínez-Larrañaga
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Universidad Complutense de Madrid (UCM), and Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain
| | - Xu Wang
- National Reference Laboratory of Veterinary Drug Residues (HZAU) and MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, China.,MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, China
| | - Arturo Anadón
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Universidad Complutense de Madrid (UCM), and Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain
| | - Marta Martínez
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Universidad Complutense de Madrid (UCM), and Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain
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18
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Dorph K, Haughan J, Robinson M, Redding LE. Critically important antimicrobials are frequently used on equine racetracks. J Am Vet Med Assoc 2022; 260:774-779. [PMID: 35239509 DOI: 10.2460/javma.22.01.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize antimicrobial use on four racetracks in the eastern US during the peak racing 2017-2018 seasons. PROCEDURES Handwritten daily treatment sheets provided by attending veterinarians who listed treatments administered to horses stabled at the racetrack were obtained. Information contained in the treatment sheets included the date, name of the horse and its trainer, type of treatment, and a brief (usually 1-word) indication for treatment. The handwritten data listed on the racetrack treatment sheets were manually transcribed and analyzed. RESULTS A total of 2,684 antimicrobial prescriptions were recorded, representing 6.8% of all drug treatments. The most frequently prescribed antimicrobials were enrofloxacin, with 854 prescriptions (31.8% of antimicrobial treatments), followed by gentamicin (570 [21.2%] prescriptions), ceftiofur (388 [14.5%] prescriptions,), and penicillin (220 [8.2%] prescriptions). The relative frequencies of antimicrobial class and indication for treatment varied significantly by racetrack and by prescribing veterinarian. Limitations associated with the data precluded ascertainment of the proportion of horses treated or exact indications for treatment. CLINICAL RELEVANCE Antimicrobials appeared to be prescribed relatively infrequently at racetracks relative to other drugs, but highly or critically important antimicrobials were most often used. The appropriateness of use of these drugs remains unknown.
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19
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Abass S, Parveen R, Irfan M, Jan B, Husain SA, Ahmad S. Synergy based extracts of medicinal plants: Future antimicrobials to combat multidrug resistance. Curr Pharm Biotechnol 2022; 23:1527-1540. [PMID: 35081888 DOI: 10.2174/1389201023666220126115656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
Abstract
The use of herbal medicines and supplements in the last thirty years has increased enormously. Herbal medication has demonstrated promising and effective potential against various diseases. Herbal and phytoconstituent medications are gaining popularity globally and many people are adopting herbal remedies to deal with different health issues. The indiscriminate use of antibiotics, due to the development of antimicrobial resistance, poses an unprecedented problem for human civilization. Bacterial infections are difficult to cure because of the propensity of microbes to acquire resistance to a wide range of antimicrobial drugs. New compounds are being explored and quantified for possible antibacterial activity with little or no side effects. Researchers are investigating the range of therapeutic plants mentioned in Unani, Ayurveda, and Siddha around the globe. Known and commonly acclaimed global databases such as PubMed, Research Gate, Science Direct, Google Scholar, were searched using different search strings such as Indian medicinal plants, multidrug resistance (MDR), thin layer chromatography (TLC), antimicrobials, and Synergism were used in diverse combinations to reclaim numerous citations associated with this area. Thus, the current review aims to shed a light on the information of medicinal plants as a potential foundation of herbal drugs and elucidate how synergism and TLC bioautography plays a crucial role in finding antimicrobial compounds.
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Affiliation(s)
- Sageer Abass
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Rabea Parveen
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohammad Irfan
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Bisma Jan
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Syed Akhtar Husain
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Sayeed Ahmad
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
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20
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Cannizzaro DN, Naughton LF, Freeman MZ, Martin L, Bennett CL, Bove C. A New Criterion for Fluoroquinolone-Associated Disability Diagnosis: Functional Gastrointestinal Disorders. Medicina (B Aires) 2021; 57:medicina57121371. [PMID: 34946316 PMCID: PMC8706438 DOI: 10.3390/medicina57121371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Fluoroquinolones (FQs) are a broad-spectrum class of antibiotics routinely prescribed for common bacterial infections despite recent recommendations to use them only for life-threatening cases. In addition to their antimicrobial properties, FQs act in the central nervous system as GABAA receptor inhibitors, which could potentially affect functionality of the vagus nerve at the forefront of gastrointestinal (GI) tract function. Alterations in neural control of digestion have been shown to be linked to Functional Gastrointestinal Disorders (FGIDs), which are usually diagnosed based on self-reported symptoms. The aim of this study was to assess the incidence of FGIDs following FQ use. Materials and Methods: Self-reports from the FDA Adverse Event Reporting System were analyzed together with ~300 survey responses from a social network derived sample to the Bowel Disease Questionnaire. Results: The results of this study suggested that six different FQs are associated with a wide range of GI symptoms not currently reported in the drugs’ labels. The responses from the survey suggested that ~70% of FQ users scored positive for FGID, with no positive correlation between drug type, duration of administration, dosage and frequency of administration. Conclusions: This study showed that GI disorders other than nausea, vomiting and diarrhea are more common than currently reported on the drug labels, and that FGIDs are possibly a common consequence of FQ use even after single use.
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Affiliation(s)
- Deanna N. Cannizzaro
- Department of Biology, Bucknell University, Lewisburg, PA 17387, USA; (D.N.C.); (L.F.N.); (M.Z.F.)
| | - Lydia F. Naughton
- Department of Biology, Bucknell University, Lewisburg, PA 17387, USA; (D.N.C.); (L.F.N.); (M.Z.F.)
| | - Maya Z. Freeman
- Department of Biology, Bucknell University, Lewisburg, PA 17387, USA; (D.N.C.); (L.F.N.); (M.Z.F.)
| | - Linda Martin
- SONAR (Southern Network on Adverse Reactions) Program, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (L.M.); (C.L.B.)
| | - Charles L. Bennett
- SONAR (Southern Network on Adverse Reactions) Program, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (L.M.); (C.L.B.)
| | - Cecilia Bove
- Department of Biology, Bucknell University, Lewisburg, PA 17387, USA; (D.N.C.); (L.F.N.); (M.Z.F.)
- Correspondence:
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21
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Elshaier YAMM, Aly AA, El-Aziz MA, Fathy HM, Brown AB, Ramadan M. A review on the synthesis of heteroannulated quinolones and their biological activities. Mol Divers 2021; 26:2341-2370. [PMID: 34698911 DOI: 10.1007/s11030-021-10332-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
The quinoline scaffold has become an important construction motif for the development of new drugs. The quinolones and their heteroannulated derivatives have high importance due to their diverse spectrum of biological activities as antifungal, anti-inflammatory, anti-diabetes, anti-Alzheimer's disease, antioxidant and diuretic activities. This review summarizes the various new, efficient and convenient synthetic approaches to synthesize diverse quinolone-based scaffolds and their biological activities. We also dealt with the important mechanism, the route and type of reactions of the obtained products. The biological activities of some heteroannulated quinolones were also discussed.
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Affiliation(s)
- Yaseen A M M Elshaier
- Organic & Medicinal Chemistry Department, Faculty of Pharmacy, University of Sadat City, Menoufia, 32958, Egypt
| | - Ashraf A Aly
- Chemistry Department, Faculty of Science, Minia University, El-Minia, 61519, Egypt.
| | - Mohamed Abd El-Aziz
- Medicinal Chemistry Department, Faculty of Pharmacy, Minia University, El-Minia, 61519, Egypt
| | - Hazem M Fathy
- Organic Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, 71524, Egypt
| | - Alan B Brown
- Chemistry Department, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Mohamed Ramadan
- Organic Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, 71524, Egypt
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22
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Majalekar PP, Shirote PJ. Fluoroquinolones: Blessings Or Curses. Curr Drug Targets 2021; 21:1354-1370. [PMID: 32564750 DOI: 10.2174/1389450121666200621193355] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
Fluoroquinolones are one of the world's most valuable and popularly used categories of antimicrobial agents. This paper attempts to review the substantial progress of fluoroquinolones from their discovery to black box warning. Antibiotic drug choice will remain difficult in the presence of increasing resistance, but the introduction of fluoroquinolones has created a new and exciting era in antimicrobial treatment. These are a synthetic heterogeneous group of compounds used in both hospital and community practices to treat numerous severe infections. The era of quinolone antibiotics began with the serendipitous discovery of the quinolone prototype in 1962. The chronological development of fluoroquinolone reported that nalidixic acid was the first quinolone that gained popular choice for the treatment of urinary tract infection. The subsequent agents like levofloxacin, ofloxacin, norfloxacin, gatifloxacin, moxifloxacin, clinafloxacin, sparfloxacin, and ciprofloxacin were derived through side chain and nuclear manipulation from basic pharmacophore. The fluoroquinolone motifs have been found as a milestone, effective in certain infections that are respiratory tract infection, urinary tract infection, bone disorders, meningococcal and mycobacterial infections, sexually transmitted diseases, skin infections, etc. Fluoroquinolones are first entirely man-made antibiotics that exhibit antibacterial activity through the inhibition of topoisomerase II, topoisomerase IV and deoxyribonucleic acid gyrase, which is vital for chromosome replication and function. The post-marketing surveillance pointed out the favorable side effects associated with fluoroquinolones such as phototoxicity, QT interval prolongation and anaphylaxis. The discovery, development and clinical use of fluoroquinolone antibiotics in the last century contributed to a decline in morbidity and mortality rates.
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Affiliation(s)
- Priyanka P Majalekar
- Department of Pharmaceutical Chemistry, Appasaheb Birnale College of Pharmacy, Sangli. Shivaji University, Sangli - 416416, India
| | - Pramodkumar J Shirote
- Department of Pharmaceutical Chemistry, Arvind Gavali College of Pharmacy, Satara Shivaji University, Satara- 415015, India
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23
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James S, Schuijers J, Daffy J, Cook J, Samiric T. Ciprofloxacin reduces tenocyte viability and proteoglycan synthesis in short-term explant cultures of equine tendon. PeerJ 2021; 9:e12003. [PMID: 34540363 PMCID: PMC8411937 DOI: 10.7717/peerj.12003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolones are an effective, broad-spectrum antibiotic used to treat an array of bacterial infections. However, they are associated with an increased risk of tendinopathy and tendon rupture even after discontinuation of treatment. This condition is known as fluoroquinolone-associated tendinopathy, the underlying mechanisms of which are poorly understood. While many factors may be involved in the pathophysiology of tendinopathies in general, changes in tenocyte metabolism and viability, as well as alteration of proteoglycan metabolism are prominent findings in the scientific literature. This study investigated the effects of ciprofloxacin, a common fluoroquinolone, on cell viability, proteoglycan synthesis, and proteoglycan mRNA expression in equine superficial digital flexor tendon explants after 96 h treatment with between 1–300 µg/mL ciprofloxacin, and again after 8 days discontinuation of treatment. Ciprofloxacin caused significant reductions in cell viability by between 25–33% at all dosages except 10 µg/mL, and viability decreased further after 8 days discontinuation of treatment. Proteoglycan synthesis significantly decreased by approximately 50% in explants treated with 100 µg/mL and 300 µg/mL, however this effect reversed after 8 days in the absence of treatment. No significant mRNA expression changes were observed after the treatment period with the exception of versican which was down-regulated at the highest concentration of ciprofloxacin. After the recovery period, aggrecan, biglycan and versican genes were all significantly downregulated in explants initially treated with 1–100 µg/mL. Results from this study corroborate previously reported findings of reduced cell viability and proteoglycan synthesis in a whole tissue explant model and provide further insight into the mechanisms underlying fluoroquinolone-associated tendinopathy and rupture. This study further demonstrates that certain ciprofloxacin induced cellular changes are not rapidly reversed upon cessation of treatment which is a novel finding in the literature.
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Affiliation(s)
- Stuart James
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
| | - Johannes Schuijers
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
| | - John Daffy
- Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jill Cook
- Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tom Samiric
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
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24
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Rusu A, Lungu IA, Moldovan OL, Tanase C, Hancu G. Structural Characterization of the Millennial Antibacterial (Fluoro)Quinolones-Shaping the Fifth Generation. Pharmaceutics 2021; 13:pharmaceutics13081289. [PMID: 34452252 PMCID: PMC8399897 DOI: 10.3390/pharmaceutics13081289] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022] Open
Abstract
The evolution of the class of antibacterial quinolones includes the introduction in therapy of highly successful compounds. Although many representatives were withdrawn due to severe adverse reactions, a few representatives have proven their therapeutical value over time. The classification of antibacterial quinolones into generations is a valuable tool for physicians, pharmacists, and researchers. In addition, the transition from one generation to another has brought new representatives with improved properties. In the last two decades, several representatives of antibacterial quinolones received approval for therapy. This review sets out to chronologically outline the group of approved antibacterial quinolones since 2000. Special attention is given to eight representatives: besifloxacin, delafoxacin, finafloxacin, lascufloxacin, nadifloxacin and levonadifloxacin, nemonoxacin, and zabofloxacin. These compounds have been characterized regarding physicochemical properties, formulations, antibacterial activity spectrum and advantageous structural characteristics related to antibacterial efficiency. At present these new compounds (with the exception of nadifloxacin) are reported differently, most often in the fourth generation and less frequently in a new generation (the fifth). Although these new compounds' mechanism does not contain essential new elements, the question of shaping a new generation (the fifth) arises, based on higher potency and broad spectrum of activity, including resistant bacterial strains. The functional groups that ensured the biological activity, good pharmacokinetic properties and a safety profile were highlighted. In addition, these new representatives have a low risk of determining bacterial resistance. Several positive aspects are added to the fourth fluoroquinolones generation, characteristics that can be the basis of the fifth generation. Antibacterial quinolones class continues to acquire new compounds with antibacterial potential, among other effects. Numerous derivatives, hybrids or conjugates are currently in various stages of research.
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Affiliation(s)
- Aura Rusu
- Pharmaceutical and Therapeutical Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.R.); (G.H.)
| | - Ioana-Andreea Lungu
- The Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.-A.L.); (O.-L.M.)
| | - Octavia-Laura Moldovan
- The Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.-A.L.); (O.-L.M.)
| | - Corneliu Tanase
- Pharmaceutical Botany Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Correspondence: ; Tel.: +40-744-215-543
| | - Gabriel Hancu
- Pharmaceutical and Therapeutical Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.R.); (G.H.)
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25
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Abstract
Fluoroquinolones (FQs) are a broad class of antibiotics typically prescribed for bacterial infections, including infections for which their use is discouraged. The FDA has proposed the existence of a permanent disability (Fluoroquinolone Associated Disability; FQAD), which is yet to be formally recognized. Previous studies suggest that FQs act as selective GABAA receptor inhibitors, preventing the binding of GABA in the central nervous system. GABA is a key regulator of the vagus nerve, involved in the control of gastrointestinal (GI) function. Indeed, GABA is released from the Nucleus of the Tractus Solitarius (NTS) to the Dorsal Motor Nucleus of the vagus (DMV) to tonically regulate vagal activity. The purpose of this review is to summarize the current knowledge on FQs in the context of the vagus nerve and examine how these drugs could lead to dysregulated signaling to the GI tract. Since there is sufficient evidence to suggest that GABA transmission is hindered by FQs, it is reasonable to postulate that the vagal circuit could be compromised at the NTS-DMV synapse after FQ use, possibly leading to the development of permanent GI disorders in FQAD.
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26
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Young K, Koshi EJ, Mostales JC, Saha B, Burgess LP. Medicolegal Considerations Regarding Steroid Use in Otolaryngology: A Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:544-550. [PMID: 34151596 DOI: 10.1177/00034894211026737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review the literature on corticosteroid use and provide recommendations on patient counseling and/or consent to promote judicious prescribing and reduce the incidence of corticosteroid-related lawsuits. METHOD A conventional literature search of PubMed on corticosteroid-related medicolegal cases was undertaken. Search terms included "medicolegal," "otolaryngology," and "adrenocorticosteroids." A medical subjects headings search with the keywords "adrenal cortex hormones" and "jurisprudence" was also performed. RESULTS Corticosteroids have been reported as the third most frequent medication involved in malpractice claims, oftentimes leading to disproportionately costly payments. The most common specialties found to be involved in corticosteroid related medicolegal cases included dermatology (12%), primary care (10%), and neurologists or neurosurgeons (6%). The most common complications encountered were avascular necrosis (39%), changes in mood (16%), infection (14%), and vision changes (14%). Only a few cases corticosteroid-related litigation regarding otolaryngologists were identified. More frequent causes for otolaryngology claims were intraoperative complications, deficits in diagnoses, and failures or delays in treatment. Three medicolegal pitfalls regarding corticosteroid use were identified from this review included: (1) insufficient advising, (2) lack of or incomplete informed consent, and (3) the significance of the patient-physician relationship. CONCLUSION Despite the scarcity of corticosteroid-related medicolegal literature pertaining to otolaryngologists, corticosteroids are one of the most widely prescribed medications in the field of otolaryngology and have been shown to have a high rate of medical malpractice claims in medicine. Counseling and consenting the patient, as well as developing a strong physician-patient relationship, are integral processes in addressing any adverse effects occurring during therapy, and may also help to decrease the incidence and success of litigation against otolaryngologists.
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Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Elliott J Koshi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Joshua C Mostales
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Bibek Saha
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Lawrence P Burgess
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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27
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Ross RK, Kinlaw AC, Herzog MM, Jonsson Funk M, Gerber JS. Fluoroquinolone Antibiotics and Tendon Injury in Adolescents. Pediatrics 2021; 147:e2020033316. [PMID: 33990459 PMCID: PMC8168605 DOI: 10.1542/peds.2020-033316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the association between fluoroquinolone use and tendon injury in adolescents. METHODS We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents (aged 12-18 years) with an outpatient prescription fill for an oral fluoroquinolone or comparator broad-spectrum antibiotic. The primary outcome was Achilles, quadricep, patellar, or tibial tendon rupture identified by diagnosis and procedure codes. Tendinitis was a secondary outcome. We used weighting to adjust for measured confounding and a negative control outcome to assess residual confounding. RESULTS The cohort included 4.4 million adolescents with 7.6 million fills for fluoroquinolone (275 767 fills) or comparator (7 365 684) antibiotics. In the 90 days after the index antibiotic prescription, there were 842 tendon ruptures and 16 750 tendinitis diagnoses (crude rates 0.47 and 9.34 per 1000 person-years, respectively). The weighted 90-day tendon rupture risks were 13.6 per 100 000 fluoroquinolone-treated adolescents and 11.6 per 100 000 comparator-treated adolescents (fluoroquinolone-associated excess risk: 1.9 per 100 000 adolescents; 95% confidence interval -2.6 to 6.4); the corresponding number needed to treat to harm was 52 632. For tendinitis, the weighted 90-day risks were 200.8 per 100 000 fluoroquinolone-treated adolescents and 178.1 per 100 000 comparator-treated adolescents (excess risk: 22.7 per 100 000; 95% confidence interval 4.1 to 41.3); the number needed to treat to harm was 4405. CONCLUSIONS The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare. The excess risk of tendinitis associated with fluoroquinolone treatment was also small. Other more common potential adverse drug effects may be more important to consider for treatment decision-making, particularly in adolescents without other risk factors for tendon injury.
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Affiliation(s)
- Rachael K Ross
- Department of Epidemiology, Gillings School of Global Public Health,
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy
- The Cecil G. Sheps Center for Health Services Research, and
| | - Mackenzie M Herzog
- IQVIA, Durham, North Carolina
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Bedi PS, Kuriakose K, Kim J, Lewis PB, Singh VK. A rare case of Levofloxacin-related Iliopsoas and Achilles tendon rupture. Clin Case Rep 2021; 9:e04335. [PMID: 34136248 PMCID: PMC8190535 DOI: 10.1002/ccr3.4335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022] Open
Abstract
Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.
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Affiliation(s)
| | | | - Jay Kim
- Department of MedicineUPMC EastMonroevillePAUSA
| | - Paul B Lewis
- Department of RadiologyUPMC EastMonroevillePAUSA
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29
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The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis. Sci Rep 2021; 11:11073. [PMID: 34040146 PMCID: PMC8154986 DOI: 10.1038/s41598-021-90692-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/17/2021] [Indexed: 01/05/2023] Open
Abstract
Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71-3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59-2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13-1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the "number needed-to-harm" analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.
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30
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Chinen T, Sasabuchi Y, Matsui H, Yasunaga H. Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis. Ann Fam Med 2021; 19:212-216. [PMID: 34180840 PMCID: PMC8118488 DOI: 10.1370/afm.2673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated whether use of third-generation fluoroquinolones is associated with occurrence of Achilles tendon rupture using a case series analysis in which patients served as their own control. METHODS We used administrative claims data to identify residents in a single Japanese prefecture who were enrolled in National Health Insurance and Elderly Health Insurance from April 2012 to March 2017 and experienced Achilles tendon rupture after receiving an antibiotic prescription. Antibiotics were categorized into 3 groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and nonfluoroquinolones. We used a conditional Poisson regression model to estimate the incidence rate ratio (IRR) of Achilles tendon rupture during the antibiotic exposure period relative to the nonexposure period for each patient. An exposure period was defined as 30 days from start of the prescription. RESULTS Analyses were based on 504 patients with Achilles tendon rupture who had received antibiotic prescriptions. Risk of rupture was not significantly elevated during exposure to third-generation fluoroquinolones (IRR = 1.05; 95% CI, 0.33-3.37) and nonfluoroquinolones (IRR = 1.08; 95% CI, 0.80-1.47). In contrast, risk was significantly elevated during exposure to first- and second-generation fluoroquinolones (IRR = 2.94; 95% CI, 1.90-4.54). Findings were similar across subgroups stratified by sex and by recent corticosteroid use. CONCLUSIONS Our analysis showed that third-generation fluoroquinolone use was not associated with an increased risk of Achilles tendon rupture. These antibiotics may be a safer option for patients in whom this risk is elevated, such as athletes.
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Affiliation(s)
- Takashi Chinen
- Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan .,Data Science Center, Jichi Medical University, Tochigi, Japan
| | | | - Hiroki Matsui
- Data Science Center, Jichi Medical University, Tochigi, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Data Science Center, Jichi Medical University, Tochigi, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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31
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Matoi A, Taguchi M, Nishi S. Fatal hypoglycemia with ciprofloxacin in a dialysis patient: A case report. Clin Case Rep 2021; 9:1902-1904. [PMID: 33936612 PMCID: PMC8077382 DOI: 10.1002/ccr3.3871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/07/2022] Open
Abstract
In patients with renal dysfunction, it is important to avoid prescribing fluoroquinolones including ciprofloxacin.
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Affiliation(s)
- Aisa Matoi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
| | - Mana Taguchi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
| | - Shinichi Nishi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
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32
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Longo UG, Stelitano G, Berton A, Candela V, Barneschi G, Marescalchi M, Grasso A, Papalia R, Denaro V. 2019 Marathon of Rome. Hamstring injuries in long distance runners: influence of age, gender, weight, height, numbers of marathon and impact profile. J Sports Med Phys Fitness 2021; 61:1653-1660. [PMID: 33586934 DOI: 10.23736/s0022-4707.21.12027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hamstring diseases are one of the most widespread diseases in athletes, especially in runners, sprinters, and endurance athletes. Notwithstanding the importance of the problem, risk factors are still marginally known. This transversal study analyzes the correlation between Hamstring tendinopathy and hamstring strains and age, gender, weight, height, number of marathons, and impact profile in athletes who took part in the 2019 Rome Marathon. METHODS At the 2019 Marathon of Rome, 700 runners (484 males and 216 females; mean age: 43.6 years, range 17-80 years) filled the VISA-H and FASH questionnaires. An adequately skilled orthopedic surgeon made a diagnosis of Hamstring tendinopathy and Hamstring strain injuries in line with clinical criteria. RESULTS A diagnosis of Hamstring tendinopathy was made in 537 participants while in 624 of hamstring strains. There was evidence of a positive correlation statistically significant between age, weight and impact profile with Hamstring strain injuries, while there was no association between sex and number of marathons and the Hamstring strains. No statistically significant positive correlation was found between all of the parameters analyzed and VISA-H. The association between VISA-H score and FASH score has resulted statistically significant. CONCLUSIONS In marathon athletes, there was not found evidence of a statistically significant correlation between gender, weight, height, number of marathons, impact profile and Hamstring tendinopathy. Nonetheless, age, weight and impact profile were associated with Hamstring strains, while sex and number of marathons had not shown statistically significant positive association with Hamstring strain injuries.
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Affiliation(s)
- Umile G Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy -
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Gianfilippo Barneschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Marina Marescalchi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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33
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Getov I. Safety limitations of fluoroquinolones’ use. MAKEDONSKO FARMACEVTSKI BILTEN 2020. [DOI: 10.33320/maced.pharm.bull.2020.66.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ilko Getov
- Faculty of Pharmacy, Medical University Sofia, 2 Dunav str., 1303 Sofia, Bulgaria
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34
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Vosoughi AR, Heyes G, Molloy AP, Mason LW, Hoveidaei AH. Management of tibialis anterior tendon rupture: Recommendations based on the literature review. Foot Ankle Surg 2020; 26:487-493. [PMID: 31501017 DOI: 10.1016/j.fas.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/05/2019] [Indexed: 02/04/2023]
Abstract
Tibialis anterior tendon (TAT) rupture is a rare injury that commonly diagnosed late due to mild clinical signs and symptoms. Management of TAT rupture is a topic without a clear consensus in the literature. This current concept review tries to shed some light on the data and treatment. Our extensive literature review identified 81 case reports and case series from 1905 to 2018. Several reported management techniques with their advantages and disadvantages were analyzed and our treatment recommendations are given based on current available evidences. LEVELS OF EVIDENCE: IV.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Gavin Heyes
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Andrew P Molloy
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Lyndon W Mason
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Amir Human Hoveidaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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35
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Ptaszyńska N, Gucwa K, Olkiewicz K, Łȩgowska A, Okońska J, Ruczyński J, Gitlin-Domagalska A, Dȩbowski D, Milewski S, Rolka K. Antibiotic-Based Conjugates Containing Antimicrobial HLopt2 Peptide: Design, Synthesis, Antimicrobial and Cytotoxic Activities. ACS Chem Biol 2019; 14:2233-2242. [PMID: 31513374 DOI: 10.1021/acschembio.9b00538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Recent studies have shown that modified human lactoferrin 20-31 fragment, named HLopt2, possesses antibacterial and antifungal activity. Thus, we decided to synthesize and evaluate the biological activity of a series of conjugates based on this peptide and one of the antimicrobials with proven antibacterial (ciprofloxacin, CIP, and levofloxacin, LVX) or antifungal (fluconazole, FLC) activity. The drugs were covalently connected to the peptide via amide, methylenecarbonyl moieties, or a disulfide bridge. The antibacterial and antifungal activities were evaluated under Clinical and Laboratory Standard Institute (CLSI) recommended conditions or in a low-salt brain-heart infusion diluted medium (BHI1/100). Results showed that conjugation of the peptide with the drug increased its antimicrobial activity up to 4-fold. Under CLSI-recommended conditions, all the compounds revealed rather low efficiency. Among conjugates, the highest antibacterial activity was recorded for the CIP-Cys-S-S-HLopt2-NH2 (III). In BHI1/100, which had lower differentiating properties, all of the conjugates revealed low MIC and MMC (minimum inhibitory and microbicidal concentrations) values. The disulfide bridge used as a linker in the most active conjugate (III) upon incubation with S. aureus cells is reduced, releasing constituent peptide and CIP-Cys. In addition, we showed that its fluorescently labeled analogue and constituent peptide are able to be internalized into both C. albicans and S. aureus cells. Moreover, the invaluable advantage of the presented conjugates was their low toxicity to mammalian cells and very low hemolytic activity. The current research can form a solid basis for further in vivo studies and drug development.
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Affiliation(s)
- Natalia Ptaszyńska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Katarzyna Gucwa
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland
| | - Katarzyna Olkiewicz
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Anna Łȩgowska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Joanna Okońska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Jarosław Ruczyński
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Agata Gitlin-Domagalska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Dawid Dȩbowski
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
| | - Sławomir Milewski
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland
| | - Krzysztof Rolka
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308 Gdańsk, Poland
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Fernández-Cuadros ME, Casique-Bocanegra LO, Albaladejo-Florín MJ, Gómez-Dueñas S, Ramos-Gonzalez C, Pérez-Moro OS. Bilateral Levofloxacin-Induced Achilles Tendon Rupture: An Uncommon Case Report and Review of the Literature. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119835222. [PMID: 30858744 PMCID: PMC6402071 DOI: 10.1177/1179544119835222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 11/17/2022]
Abstract
Since the introduction of Fluoroquinolones (FQ) in 1960s, these antibiotics have been used in airway and urinary tract infections, due to absorption, biodisponibility, posology and long half-life time properties. However, several reports state that FQ can cause tendinopathy and rupture. These adverse effects can occur within hours after initial treatment to up to 6 months after withdrawal. FQ-induced tendinopathy was first reported in 1983; since then more than 100 cases have been published. FQ usage can lead to complete tendon rupture and no more than 8 to 15 cases are reported worldwide. Most of rupture cases have been associated to corticoid use and rheumatic, vascular or renal disease. The purpose of this case report is to present the challenging diagnosis of a bilateral rupture of Achilles tendon in an old patient, because of the uncommon of the presentation and to review the current literature on such a debilitating condition.
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Affiliation(s)
- Marcos Edgar Fernández-Cuadros
- Physical Medicine and Rehabilitation Department, Hospital Universitario Santa Cristina, Madrid, Spain.,Physical Medicine and Rehabilitation Department, Fundación Hospital General de la Santísima Trinidad, Salamanca, Spain
| | | | | | - Sheila Gómez-Dueñas
- Physical Medicine and Rehabilitation Department, Fundación Hospital General de la Santísima Trinidad, Salamanca, Spain
| | - Carmen Ramos-Gonzalez
- Physical Medicine and Rehabilitation Department, Fundación Hospital General de la Santísima Trinidad, Salamanca, Spain
| | - Olga Susana Pérez-Moro
- Physical Medicine and Rehabilitation Department, Hospital Universitario Santa Cristina, Madrid, Spain
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Abstract
The Master runner (age 35 y and above) represents a unique athletic patient. Lifelong participation in endurance running slows the inevitable age-related decline in aerobic function and muscular strength. Still, the Master runner does not escape the inevitable effects of aging. Master runners experience a steady decline in running performance, that is, typical and maximal running speeds, after the age of 50 years of age. Age-related declines in running performance are driven by a host of factors, including declining cardiovascular function, reduced muscular capacity, altered biomechanics, and greater susceptibility to running-related injury. This review discusses age-related changes in physiology, biomechanics, and running injury susceptibility and practical strategies to maximize running participation in the Master runner.
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Acute Achilles tendon rupture after treatment with levofloxacin in a patient with giant cell arteritis. Reumatologia 2019; 57:343-346. [PMID: 32226168 PMCID: PMC7091484 DOI: 10.5114/reum.2019.91277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022] Open
Abstract
The authors report a case of a 67-year-old woman with giant cell arteritis with acute Achilles tendon rupture, which occurred after 3 days of levofloxacin therapy introduced because of newly diagnosed erosive gastritis associated with Helicobacter pylori infection. The Achilles tendon rupture was surgically treated and the patient made a complete recovery. In view of the widespread use of levofloxacin in practice, this case report raises important clinical implications. Tendinopathies are a known complication, quite rare in the healthy population, but the risk of rupture significantly increases in the population of patients over 60 years of age, with chronic usage of glucocorticosteroids, impaired renal function and recipients of organ transplants. What needs underlining, there are also described differences between individual fluoroquinolones as a cause of tendon damage in this group. Considering the widespread use of this group of drugs in patients, knowledge about the risk of adverse events including tendinopathy promotes safe use of fluoroquinolones.
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Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med 2018; 52:1497. [PMID: 30072398 PMCID: PMC6241620 DOI: 10.1136/bjsports-2018-099308] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 01/10/2023]
Abstract
The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.
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Affiliation(s)
- Martina Zügel
- Division of Sports Medicine, Ulm University, Ulm, Germany
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | | | - Werner Klingler
- Department of Anesthesiology, BKH Günzburg, Günzburg, Germany
| | - Scott C Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Thomas Findley
- Department of Physical Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Medical University Ghent, Ghent, Belgium
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Robert Schleip
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Paul William Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29:1483-1501.e2. [DOI: 10.1016/j.jvir.2018.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
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Valisena S, Petri GJ, Ferrero A. Zancolli Technique for Delayed Repair of Tibialis Anterior Tendon Rupture: A Case Report and Literature Review. Foot Ankle Spec 2018; 11:372-377. [PMID: 29307230 DOI: 10.1177/1938640017751539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several techniques for repair of tibialis anterior tendon ruptures (TATRs) are reported, although it is a rare lesion. We describe a case of TATR, discuss our treatment, and review the criteria for the choice of treatment. METHODS In November 2015, a 61-year-old woman presented to our department 13 days after an injury to her left ankle, with avulsion of TAT. Because of the stump retraction, we performed a Zancolli-like plasty, anchoring the tendon to the navicular bone. Evidence about the timing and type of surgery has been reviewed. RESULTS The patient was followed up for 16 months before being discharged. The American Orthopaedic Foot and Ankle Society score improved from an initial value of 32 to a final score of 90. CONCLUSIONS The choice of treatment depends on several factors. Patients' physical demands and the type of rupture guide the choice of surgical technique. LEVELS OF EVIDENCE Therapeutic, Level IV: Retrospective.
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Affiliation(s)
- Silvia Valisena
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
| | - Gianfranco John Petri
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
| | - Andrea Ferrero
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
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Mosca MJ, Rashid MS, Snelling SJ, Kirtley S, Carr AJ, Dakin SG. Trends in the theory that inflammation plays a causal role in tendinopathy: a systematic review and quantitative analysis of published reviews. BMJ Open Sport Exerc Med 2018; 4:e000332. [PMID: 30018785 PMCID: PMC6045756 DOI: 10.1136/bmjsem-2017-000332] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS The contribution of inflammation to tendinopathy has been debated in the scientific literature. Several factors may contribute to this lack of clarity, including inconsistent definitions of inflammation. We hypothesised that the adoption and/or rejection of a causal link between inflammation and tendinopathy varied as a function of the 'inflammatory component' (eg, immune cell and molecular mediators included in published reviews). METHODS Twenty data items were collected from each review to determine conclusions about the role of inflammation in tendinopathy, specific definitions of the 'inflammatory component,' quality of the review and other potential correlates. Associations between correlates and a review's conclusion about the role of inflammation in tendinopathy were tested using binomial logistic regression. The database searches retrieved 2261 unique publications: 137 fulfilled inclusion criteria after full text screenings. RESULTS There has been little support for an inflammatory component to tendinopathy until recently (2012-2015). Prior to 2012, the majority of published reviews did not discuss monocytes, macrophages or lymphocytes in tendinopathy; rather they focused on the lack of neutrophils, often referred to as 'the inflammatory infiltrate', or immune cells were not discussed. Reviews including monocytes and lymphocytes in their discussions were 5.23 times more likely to conclude inflammation was important than reviews that did not, p<0.001. CONCLUSIONS Data collected show growing support for an inflammatory component to tendinopathy, particularly among high-quality reviews and those that used more robust definitions of inflammation. This finding may have implications for explaining dissonance in the literature regarding a causal role for inflammation in the pathogenesis of tendinopathy.
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Affiliation(s)
- Michael J Mosca
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Mustafa S Rashid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Sarah J Snelling
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Andrew Jonathan Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Stephanie Georgina Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
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Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
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44
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Picaut L, Trichet L, Ronsin O, Haye B, Génois I, Baumberger T, Mosser G. Pure dense collagen threads from extrusion to fibrillogenesis stability. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aaab78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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45
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Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:8023935. [PMID: 29147464 PMCID: PMC5632915 DOI: 10.1155/2017/8023935] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/20/2017] [Indexed: 12/24/2022]
Abstract
Long-term fluoroquinolone-associated disability (FQAD) after fluoroquinolone (FQ) antibiotic therapy appears in recent years as a significant medical and social problem, because patients suffer for many years after prescribed antimicrobial FQ treatment from tiredness, concentration problems, neuropathies, tendinopathies, and other symptoms. The knowledge about the molecular activity of FQs in the cells remains unclear in many details. The effective treatment of this chronic state remains difficult and not effective. The current paper reviews the pathobiochemical properties of FQs, hints the directions for further research, and reviews the research concerning the proposed treatment of patients. Based on the analysis of literature, the main directions of possible effective treatment of FQAD are proposed: (a) reduction of the oxidative stress, (b) restoring reduced mitochondrion potential ΔΨm, (c) supplementation of uni- and bivalent cations that are chelated by FQs and probably ineffectively transported to the cell (caution must be paid to Fe and Cu because they may generate Fenton reaction), (d) stimulating the mitochondrial proliferation, (e) removing FQs permanently accumulated in the cells (if this phenomenon takes place), and (f) regulating the disturbed gene expression and enzyme activity.
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Two Unique Cases of Ciprofloxacin-Associated Avulsion of Ligament and Tendon. Am J Phys Med Rehabil 2017; 97:e33-e36. [PMID: 28857901 DOI: 10.1097/phm.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ciprofloxacin is recognized to have a deleterious relationship with tendons, particularly Achilles tendinopathy, which makes up most case reports. Tendinopathy seems to occur because of induction of collagen-degrading enzymes causing damage and ischemia of the poorly vascularized regions preventing repair. The focus on the relationship of ciprofloxacin and the Achilles tendon leaves patients on fluoroquinolones with non-Achilles tendinopathy symptoms at risk of misdiagnosis. There have not been any documented instances of ligament damage with ciprofloxacin administration in the literature, although ligament and tendon compositions are similar and should have similar susceptibility. This report includes two cases, one presenting with right lateral thumb pain and a medical history of gastroenteritis treated with ciprofloxacin. Physical examination showed swelling of the right metacarpophalangeal joint and ultrasound confirmed disruption of the radial collateral ligament at insertion on first metacarpal; the second case is of a woman presenting with right hip pain in setting of chronic recurrent diverticulitis treated with ciprofloxacin. She received work-up for lumbar disc disease and spondylosis. After standard therapy with pharmacotherapy and physical therapy for radiculopathy failed, magnetic resonance imaging was performed showing near complete avulsion of the right hamstring tendons from the ischial tuberosity.
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47
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Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med 2017; 45:2034-2043. [PMID: 28530451 DOI: 10.1177/0363546517702862] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injection therapies are often considered alongside exercise for chronic midportion Achilles tendinopathy (AT), although evidence of their efficacy is sparse. PURPOSE To determine whether eccentric training in combination with high-volume injection (HVI) or platelet-rich plasma (PRP) injections improves outcomes in AT. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 60 men (age, 18-59 years) with chronic (>3 months) AT were included and followed for 6 months (n = 57). All participants performed eccentric training combined with either (1) one HVI (steroid, saline, and local anesthetic), (2) four PRP injections each 14 days apart, or (3) placebo (a few drops of saline under the skin). Randomization was stratified for age, function, and symptom severity (Victorian Institute of Sports Assessment-Achilles [VISA-A]). Outcomes included function and symptoms (VISA-A), self-reported tendon pain during activity (visual analog pain scale [VAS]), tendon thickness and intratendinous vascularity (ultrasonographic imaging and Doppler signal), and muscle function (heel-rise test). Outcomes were assessed at baseline and at 6, 12, and 24 weeks of follow-up. RESULTS VISA-A scores improved in all groups at all time points ( P < .05), with greater improvement in the HVI group (mean ± SEM, 6 weeks = 27 ± 3 points; 12 weeks = 29 ± 4 points) versus PRP (6 weeks = 14 ± 4; 12 weeks = 15 ± 3) and placebo (6 weeks = 10 ± 3; 12 weeks = 11 ± 3) at 6 and 12 weeks ( P < .01) and in the HVI (22 ± 5) and PRP (20 ± 5) groups versus placebo (9 ± 3) at 24 weeks ( P < .01). VAS scores improved in all groups at all time points ( P < .05), with greater decrease in HVI (6 weeks = 49 ± 4 mm; 12 weeks = 45 ± 6 mm; 24 weeks = 34 ± 6 mm) and PRP (6 weeks = 37 ± 7 mm; 12 weeks = 41 ± 7 mm; 24 weeks = 37 ± 6 mm) versus placebo (6 weeks = 23 ± 6 mm; 12 weeks = 30 ± 5 mm; 24 weeks = 18 ± 6 mm) at all time points ( P < .05) and in HVI versus PRP at 6 weeks ( P < .05). Tendon thickness showed a significant decrease only in HVI and PRP groups during the intervention, and this was greater in the HVI versus PRP and placebo groups at 6 and 12 weeks ( P < .05) and in the HVI and PRP groups versus the placebo group at 24 weeks ( P < .05). Muscle function improved in the entire cohort with no difference between the groups. CONCLUSION Treatment with HVI or PRP in combination with eccentric training in chronic AT seems more effective in reducing pain, improving activity level, and reducing tendon thickness and intratendinous vascularity than eccentric training alone. HVI may be more effective in improving outcomes of chronic AT than PRP in the short term. Registration: NCT02417987 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Anders Ploug Boesen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Hvidovre Hospital, Hvidovre, Denmark
| | - Rudi Hansen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Malliaras
- Department of Physiotherapy, School of Primary Health Care Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Victoria, Australia
| | - Henning Langberg
- CopenRehab, Institute of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
Rupture of the triceps brachii tendon is exceedingly rare, and surgical repair is generally indicated. Fluoroquinolone antibiotics have been implicated in tendon pathology, including tendon ruptures. Triceps rupture has not been previously reported in the setting of fluoroquinolone antibiotic therapy. We present 2 cases of triceps tendon rupture after treatment with fluoroquinolones. In both cases, triceps repair was performed with good outcomes. These cases highlight a risk of fluoroquinolone-induced tendinopathy to athletes. The sports medicine team should be aware of this risk and consider it when choosing antibiotics to treat athletes.
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Affiliation(s)
- Theodore B. Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
- Theodore B. Shybut, MD, Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030 ()
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Kozlovskaia M, Vlahovich N, Ashton KJ, Hughes DC. Biomedical Risk Factors of Achilles Tendinopathy in Physically Active People: a Systematic Review. SPORTS MEDICINE-OPEN 2017; 3:20. [PMID: 28523640 PMCID: PMC5436990 DOI: 10.1186/s40798-017-0087-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
Background Achilles tendinopathy is the most prevalent tendon disorder in people engaged in running and jumping sports. Aetiology of Achilles tendinopathy is complex and requires comprehensive research of contributing risk factors. There is relatively little research focussing on potential biomedical risk factors for Achilles tendinopathy. The purpose of this systematic review is to identify studies and summarise current knowledge of biomedical risk factors of Achilles tendinopathy in physically active people. Methods Research databases were searched for relevant articles followed by assessment in accordance with PRISMA statement and standards of Cochrane collaboration. Levels of evidence and quality assessment designation were implemented in accordance with OCEBM levels of evidence and Newcastle-Ottawa Quality Assessment Scale, respectively. Results A systematic review of the literature identified 22 suitable articles. All included studies had moderate level of evidence (2b) with the Newcastle-Ottawa score varying between 6 and 9. The majority (17) investigated genetic polymorphisms involved in tendon structure and homeostasis and apoptosis and inflammation pathways. Overweight as a risk factor of Achilles tendinopathy was described in five included studies that investigated non-genetic factors. COL5A1 genetic variants were the most extensively studied, particularly in association with genetic variants in the genes involved in regulation of cell-matrix interaction in tendon and matrix homeostasis. It is important to investigate connections and pathways whose interactions might be disrupted and therefore alter collagen structure and lead to the development of pathology. Polymorphisms in genes involved in apoptosis and inflammation, and Achilles tendinopathy did not show strong association and, however, should be considered for further investigation. Conclusions This systematic review suggests that biomedical risk factors are an important consideration in the future study of propensity to the development of Achilles tendinopathy. The presence of certain medical comorbidities and genetic markers should be considered when contemplating the aetiology of Achilles tendinopathy. Further elucidation of biomedical risk factors will aid in the understanding of tendon pathology and patient risk, thereby informing prevention and management strategies for Achilles tendinopathy. Trial Registration PROSPERO CRD42016036558
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Affiliation(s)
- Maria Kozlovskaia
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia. .,Department of Sports Medicine, Australian Institute of Sport, 1 Leverrier Street, Bruce, ACT, 2617, Australia.
| | - Nicole Vlahovich
- Department of Sports Medicine, Australian Institute of Sport, 1 Leverrier Street, Bruce, ACT, 2617, Australia
| | - Kevin J Ashton
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia
| | - David C Hughes
- Department of Sports Medicine, Australian Institute of Sport, 1 Leverrier Street, Bruce, ACT, 2617, Australia
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50
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Smith N, Fackrell R, Henderson E. Ciprofloxacin-associated bilateral iliopsoas tendon rupture: a case report. Age Ageing 2016; 45:737-8. [PMID: 27220702 DOI: 10.1093/ageing/afw092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/13/2016] [Indexed: 11/14/2022] Open
Abstract
Fluoroquinolone use is associated with the development of tendinopathy, most commonly affecting the Achilles tendon. Here we present the first reported case of bilateral iliopsoas tendon rupture associated with prolonged ciprofloxacin use. This older woman presented with non-traumatic, sudden onset hip pain which was diagnosed as a right iliopsoas rupture on MRI. Despite stopping ciprofloxacin, she went on to develop rupture of the contralateral iliopsoas tendon. This case highlights the time lag between fluoroquinolone use and susceptibility to this rare but important complication.
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Affiliation(s)
- Natalie Smith
- Royal United Hospital Bath NHS Trust, Bath BA1 3NG, UK
| | | | - Emily Henderson
- Royal United Hospital Bath NHS Trust, Bath BA1 3NG, UK School of Social and Community Medicine, University of Bristol, Bristol, UK
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