1
|
Aboshama M, Abdo W, Elsawak A, Khater A. Effect of the long-term use of a NOAEL dose of acetaminophen (paracetamol) on hepatic, renal, and neural tissues of aged albino rats. Open Vet J 2024; 14:316-323. [PMID: 38633179 PMCID: PMC11018404 DOI: 10.5455/ovj.2024.v14.i1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 04/19/2024] Open
Abstract
Background Paracetamol is one of the most popular drugs; it is used daily by many people especially the elderly, without a limitation on the length of the period allowed for continuous use. Harms from long-term use are less clear, particularly in extrahepatic regions. Aim This study aimed to investigate whether using paracetamol at a non-observable adverse effect level dose, known not to cause toxic effects, for a long period can induce toxicity in aged male albino rats. Methods A daily dose of 500 mg per kg body weight of paracetamol was given to adult male albino rats for 12 weeks. During this period, rats were sacrificed at 4, 6, 8, 10, and 12 weeks to evaluate the toxic changes at several time intervals. Results Chemical analysis revealed elevated serum alanine transaminase, aspartate transaminase, alkaline phosphatase, urea, creatinine, and declined level of total protein in N-acetyl-p-aminophenol (APAP)-treated group; it also caused oxidative stress, as shown by decreased glutathione, superoxide dismutase, and elevated malondialdehyde in the liver, kidney, and brain. Histopathological examination demonstrated cytoplasmic vacuolation and sinusoidal congestion with the development of single-cell necrosis in the liver. Renal tubular necrosis, glomerular atrophy, and ischemic neuronal injury, especially in the hippocampus were observed. the deleterious effects of APAP were increased in severity with increasing the period of treatment. Conclusion Our results suggest that acetaminophen in a subtoxic dose for a long period could result in mild toxic effects on the liver but more serious lesions in the kidney and brain.
Collapse
Affiliation(s)
- Mirna Aboshama
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Walied Abdo
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Ahmed Elsawak
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Abdelrahman Khater
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
| |
Collapse
|
2
|
Carella MC, Forleo C, Stanca A, Carulli E, Basile P, Carbonara U, Amati F, Mushtaq S, Baggiano A, Pontone G, Ciccone MM, Guaricci AI. Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications. Curr Heart Fail Rep 2023; 20:530-541. [PMID: 37962749 PMCID: PMC10746762 DOI: 10.1007/s11897-023-00632-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers. RECENT FINDINGS The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.
Collapse
Affiliation(s)
- Maria Cristina Carella
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Cinzia Forleo
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Stanca
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Eugenio Carulli
- Cardiology Unit, Madonna Delle Grazie Hospital, Matera, Italy
| | - Paolo Basile
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Umberto Carbonara
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari Aldo Moro, Bari, Italy
| | - Fabio Amati
- Department of Basic Medicine Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| |
Collapse
|
3
|
Mustakim KR, Kim SM. Late side effects of bleomycin injection into the lower lip mucosa of a nine-year-old patient with venous malformation. J Korean Assoc Oral Maxillofac Surg 2023; 49:304-307. [PMID: 37907347 PMCID: PMC10618664 DOI: 10.5125/jkaoms.2023.49.5.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 11/02/2023] Open
Abstract
Venous malformation (VM) is a benign lesion of blood vessels caused by an error in vascular morphogenesis during the embryologic phase. This entity mostly affects the head and neck region, including the lips, tongue, buccal mucosa, gingiva, or palate. VM may cause functional and aesthetic impairments. The anatomical structure and shape of the lips provide an important aesthetic accent for an individual. Therefore, management of VM in the lip area without postoperative defects or scarring is challenging. In this brief communication article, we present a conservative approach to lip VM in a nine-year-old boy using a bleomycin injection that had good aesthetic and functional outcomes. Injection of 2 mL of 1/10 of 15 mg bleomycin in a saline dilution into the lip mucosa may present a drug reaction as a white plaque and reddish owl eye lesion that takes up to three weeks to resolve without a scar. It is important to recognize the characteristics and self-limiting nature of postoperative bleomycin complications to avoid unnecessary treatment.
Collapse
Affiliation(s)
- Kezia Rachellea Mustakim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| |
Collapse
|
4
|
Doane MJ, Raymond K, Saucier C, Bessonova L, O'Sullivan AK, White MK, Foster AM, LaGasse K, Carpenter-Conlin J, Sajatovic M, Velligan DI. Unmet needs with antipsychotic treatment in schizophrenia and bipolar I disorder: patient perspectives from qualitative focus groups. BMC Psychiatry 2023; 23:245. [PMID: 37046256 PMCID: PMC10091535 DOI: 10.1186/s12888-023-04746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar I disorder (BD-I) are chronic mental health disorders often treated with antipsychotic medications. This qualitative study sought to better understand disease burden and treatment experiences with oral antipsychotic medications in participants living with SZ or BD-I. METHODS Six 90-min focus groups were conducted with participants diagnosed with SZ or BD-I. Trained moderators facilitated discussions using a semistructured guide. Participants described symptoms, impacts of disease, and experiences with oral antipsychotic medications, whether favourable or unfavourable. RESULTS Among participants with SZ (n = 15; 3 groups, 5 per group), 53% were male and 33% were white, with a mean of 18.6 years since diagnosis. Of participants with BD-I (n = 24; 3 groups, 8 per group), 33% were male and 42% were white, with a mean of 13.0 years since diagnosis. Participants described numerous symptoms of their illnesses that impacted relationships and daily life, including effects on emotional health, the ability to work, and encounters with law enforcement. Previous antipsychotic medications were deemed effective by 14/15 (93%) participants with SZ and 12/16 (75%) participants with BD-I. Most participants with SZ (13/15; 87%) or with BD-I (16/24; 67%) reported discontinuing their antipsychotic medication at some point. Side effects were a common reason for discontinuing or switching medications for participants with SZ (8/15; 53%) and for those with BD-I (11/24; 46%). The most common side effects reported in both cohorts were weight gain, drowsiness, sexual problems, and neurologic symptoms. Side effects negatively affected quality of life, leading to serious health problems and issues with self-esteem. CONCLUSIONS People living with SZ or BD-I cited a range of favourable and unfavourable experiences with oral antipsychotic medications. Most participants reported that their antipsychotics were effective at controlling their symptoms, but multiple side effects impacted their quality of life, caused additional serious health problems, and often led to discontinuation of or switching antipsychotics. Findings from this study contribute to a better understanding of patients' experiences with antipsychotics and highlight a need for new medications with favourable benefit/risk profiles.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Martha Sajatovic
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Dawn I Velligan
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
5
|
Cai J, Li L, Shao T, Sun M, Wang W, Xie P, Wang X, Yang Y, Long Y, Kang D, Xiao J, Su Y, Peng X, Huang Y, Gao M, Wu Q, Song C, Liu F, Shao P, Ou J, Shen Y, Huang J, Wu R. Relapse in patients with schizophrenia and amisulpride-induced hyperprolactinemia or olanzapine-induced metabolic disturbance after switching to other antipsychotics. Psychiatry Res 2023; 322:115138. [PMID: 36871411 DOI: 10.1016/j.psychres.2023.115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
Hyperprolactinemia and metabolic disturbance are common side effects of antipsychotics that cause intolerance. Despite its potential influence on relapse, there are no established guidelines for antipsychotic switching. This naturalistic study explored the association between antipsychotic switching, baseline clinical status, metabolic changes, and relapse in patients with schizophrenia. In total, 177 patients with amisulpride-induced hyperprolactinemia and 274 with olanzapine-induced metabolic disturbance were enrolled. Relapse was determined by assessing changes in Positive and Negative Syndrome Scale (PANSS) total scores from baseline to 6 months (increased over 20% or 10% reaching 70). Metabolic indices were measured at baseline and 3 months. Patients with baseline PANSS >60 were more likely to relapse. Further, patients switching to aripiprazole had a higher risk of relapse regardless of their original medication. Participants who originally used amisulpride had reduced prolactin levels following medication change, while switching to olanzapine caused increased weight and blood glucose levels. In patients originally using olanzapine, only switching to aripiprazole reduced insulin resistance. Adverse effects on weight and lipid metabolism were observed in patients who switched to risperidone, while amisulpride improved lipid profiles. Changing schizophrenia treatment requires careful consideration of multiple variables, particularly the choice of substituted drug and the patient's baseline symptoms.
Collapse
Affiliation(s)
- Jingda Cai
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Li Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Tiannan Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Mengxi Sun
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Weiyan Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Peng Xie
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoyi Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ye Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yujun Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Dongyu Kang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jingmei Xiao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuhan Su
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xingjie Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuyan Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Menghui Gao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qiongqiong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Furu Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ping Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jing Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| |
Collapse
|
6
|
Das P, Mazumder DH. An extensive survey on the use of supervised machine learning techniques in the past two decades for prediction of drug side effects. Artif Intell Rev 2023; 56:1-28. [PMID: 36819660 PMCID: PMC9930028 DOI: 10.1007/s10462-023-10413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/19/2023]
Abstract
Approved drugs for sale must be effective and safe, implying that the drug's advantages outweigh its known harmful side effects. Side effects (SE) of drugs are one of the common reasons for drug failure that may halt the whole drug discovery pipeline. The side effects might vary from minor concerns like a runny nose to potentially life-threatening issues like liver damage, heart attack, and death. Therefore, predicting the side effects of the drug is vital in drug development, discovery, and design. Supervised machine learning-based side effects prediction task has recently received much attention since it reduces time, chemical waste, design complexity, risk of failure, and cost. The advancement of supervised learning approaches for predicting side effects have emerged as essential computational tools. Supervised machine learning technique provides early information on drug side effects to develop an effective drug based on drug properties. Still, there are several challenges to predicting drug side effects. Thus, a near-exhaustive survey is carried out in this paper on the use of supervised machine learning approaches employed in drug side effects prediction tasks in the past two decades. In addition, this paper also summarized the drug descriptor required for the side effects prediction task, commonly utilized drug properties sources, computational models, and their performances. Finally, the research gap, open problems, and challenges for the further supervised learning-based side effects prediction task have been discussed.
Collapse
Affiliation(s)
- Pranab Das
- Department of Computer Science and Engineering, National Institute of Technology Nagaland, Chumukedima, Dimapur, Nagaland 797103 India
| | - Dilwar Hussain Mazumder
- Department of Computer Science and Engineering, National Institute of Technology Nagaland, Chumukedima, Dimapur, Nagaland 797103 India
| |
Collapse
|
7
|
Hosseini H, Shafie M, Shakiba A, Ghayyem H, Mayeli M, Hassani M, Aghamollaii V. Valproic acid-induced hyperammonemia in neuropsychiatric disorders: a 2-year clinical survey. Psychopharmacology (Berl) 2023; 240:149-56. [PMID: 36459199 DOI: 10.1007/s00213-022-06289-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Valproic acid (VPA)-induced hyperammonemia (HA) is a rare adverse effect reported even at therapeutic VPA levels. The present study aimed to investigate the characteristics of VPA-induced HA and its association with the total dose, duration, and level of VPA. This study also investigated whether the use of VPA in combination with other medications has any effect on elevating serum ammonia levels. METHODS A total of 316 patients with a history of VPA prescribed for underlying neuropsychiatric disorders were found eligible for the study. Data including demographic information, medical history and diagnosis, VPA dosage, VPA treatment duration, VPA level, and ammonia serum level were extracted and reviewed from our hospital records. The history of other neuropsychiatric medications was also included. RESULTS Among 316 patients receiving VPA, HA was observed in 54 (17%) patients, and 15 patients were symptomatic among them. There was no significant difference in demographics between symptomatic and asymptomatic HA groups except for the number of co-administrated medications (p = 0.044). Besides, VPA duration and dose did not show a significant difference between the two groups. Additionally, the VPA level was significantly higher in patients who used risperidone in addition to VPA (p = 0.019). Eventually, VPA level showed a significant association with ammonia level (p = 0.025) and symptomatic HA (p = 0.033) after adjusting for possible confounders. CONCLUSION VPA level showed a significant association with ammonia level and symptomatic HA. Moreover, co-administrated medications such as risperidone might have an impact on the serum level of VPA. Further studies are recommended to confirm these findings.
Collapse
|
8
|
Khan MA, Sherbini N, Alyami S, Al-Harbi A, Al-Ghamdi M, Alrajhi S, Rajendram R, Al-Jahdali H. Nintedanib and pirfenidone for idiopathic pulmonary fibrosis in King Abdulaziz Medical City, Riyadh: Real-life data. Ann Thorac Med 2023; 18:45-51. [PMID: 36968327 PMCID: PMC10034822 DOI: 10.4103/atm.atm_206_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic progressive age-related lung disease causing relentless fibrosis of the lung parenchyma. Currently, pirfenidone and nintedanib are the two antifibrotic drugs, approved for the treatment of IPF. Both are shown to slow progression by preserving lung functions from rapid decline compared to a placebo. We are reporting a real-life patient experience using these two antifibrotic medications (AFMs) in our tertiary care hospital. METHODS A retrospective cohort study was conducted for all IPF cases diagnosed in multidisciplinary meetings between 2015 and 2020 at KAMC, Riyadh (Saudi Arabia). We are reporting patients' demographics, lung function, survival, tolerance, side effects, or death in patients taking AFMs. RESULTS A total of 81 cases were identified. The majority of patients aged 67 years (68%) were men with a median age of 68 years. Late presentation, severe disease, and definite usual interstitial pneumonia patterns were reported in 60% of our patients. The average number of hospital admissions before starting treatment was 1 (range: 0-3) in the nintedanib group and 1.4 (range: 1.2-5) in the pirfenidone group. There was an increase in the number of hospital admissions in the group started on pirfenidone 1.7 (range: 1.9-8) compared to nintedanib 0.5 (range: 0-3), P = 0.001. The observed mortality outcome in this cohort was 4 (11%) and 12 (27%) for nintedanib and pirfenidone, respectively. The predominant side effects were gastrointestinal symptoms for both the groups 18 (22%). CONCLUSIONS Pirfenidone and nintedanib are the available approved antifibrotic agents used for many years to treat IPF patients. Real-life data showed better tolerability than reported in the West, good compliance, and a manageable side effect profile in this group of elderly and severe IPF patients.
Collapse
Affiliation(s)
- Mohammed Ayaz Khan
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Pulmonary, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nahed Sherbini
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Division of Pulmonology, Prince Mohammed bin Abdulaziz Hospital, National Guard Health Affairs, Madina, Saudi Arabia
| | - Sami Alyami
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Pulmonary, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah Al-Harbi
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Pulmonary, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Majed Al-Ghamdi
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Pulmonary, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Suliman Alrajhi
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Radiology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Rajkumar Rajendram
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Internal Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Department of Medicine, College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, Division of Pulmonary, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Lee SY, Jung KI, Park MH, Lee CU. Old Age, Female Sex, and Psychotropic Medications Predict Hyposalivation But Not Heart Rate Variability. Psychiatry Investig 2023; 20:62-68. [PMID: 36721887 PMCID: PMC9890040 DOI: 10.30773/pi.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/04/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To explore risk factors for dry mouth and examine the clinical utility of the heart rate variability (HRV) test in the prediction of dry mouth. METHODS Every outpatient, who underwent tests for both unstimulated salivary flow and HRV, was retrospectively reviewed. After excluding seven subjects, the demographics and clinical factors in 70 total patients were collected. Based on objective salivary flow rates, patients were classified into normal (≥0.2 mL/min) or hyposalivation groups (<0.2 mL/min), and inter-group comparisons were performed with a two-tailed statistical significance of 0.05. RESULTS Patients with subjective dry mouth were significantly more likely to show hyposalivation. Advanced age, female sex, and current use of psychotropic medications were identified as risk factors for dry mouth. However, dry mouth was not associated with any HRV parameters. CONCLUSION HRV test did not demonstrate a clinical utility in predicting dry mouth. Because subjective dry mouth is significantly associated with objective hyposalivation, a simple probing question would be useful for early recognition of dry mouth. Clinical attention is required for patients meeting criteria of older age, female, and/or using psychotropic prescriptions. Prompt management of hyposalivation may improve quality of life and clinical outcome by enhanced treatment adherence.
Collapse
Affiliation(s)
- Seung-Yup Lee
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
10
|
Nguyen N, Jennen D, Kleinjans J. Omics technologies to understand drug toxicity mechanisms. Drug Discov Today 2022; 27:103348. [PMID: 36089240 DOI: 10.1016/j.drudis.2022.103348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/18/2022] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Drug side effects are an important study subject in pharmacology. Recent omics technologies provide a range of omics data and help to understand the biological mechanisms involved in drug effects. These modern technologies provide significant support to all biological disciplines, including drug toxicology. In this review, we provide an overview the use of omics applications to understand drug side effects at the molecular level. We discuss by available omics technologies, their possible uses, as well as their advantages and limitations.
Collapse
Affiliation(s)
- Nhan Nguyen
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University, Maastricht 6229ER, the Netherlands
| | - Danyel Jennen
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University, Maastricht 6229ER, the Netherlands.
| | - Jos Kleinjans
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University, Maastricht 6229ER, the Netherlands
| |
Collapse
|
11
|
Retzlaff T, Dörfler J, Kutschan S, Freuding M, Hübner J. The benefits of vitamin A as a complementary treatment for oncology patients: a systematic review. J Cancer Res Clin Oncol 2022. [PMID: 35972692 DOI: 10.1007/s00432-022-04224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Vitamin A and its derivatives positively influence the differentiation of epithelia and other tissues and prevent the proliferation of preneoplastic and neoplastic cells. Vitamin A is therefore taken into account as a potential supporting factor in cancer therapy. METHODS In November 2020, a systematic search was conducted searching five electronic databases (EMBASE, Cochrane, PsycINFO, CINAHL and Medline) to find studies looking at the effects of using vitamin A as a complementary therapy for cancer patients. From all 12,823 search results, 9 publications referring to 9 studies with 4296 patients were included in this systematic review. RESULTS The patients treated with vitamin A were diagnosed with various cancers and stages. Outcome variables were overall survival of cancer, progression-free survival, occurrence of second primary tumours and recurrences, improvement of chronic radiation-induced proctopathy and side effects of vitamin A. For the most part, the studies had a limited methodological quality. In summary, it can be said that due to the methodological deficiencies of the studies, no concrete statement can be made regarding the prolongation of overall survival and progression-free survival. There is also no evidence of the benefit of vitamin A in the treatment of chronic radiation-induced proctopathy, which can be attributed to methodological deficiencies in the study, as well. In the studies that report on side effects, it becomes clear that side effects, such as mucocutaneous symptoms, temporary increase in liver enzymes and gastrointestinal side effects occur more frequently in the group with vitamin A intervention. CONCLUSION The limited interpretability of the results due to the methodological deficiencies of the included studies does not allow a final statement on the benefits of vitamin A as a complementary treatment for cancer patients.
Collapse
|
12
|
Liang X, Li J, Fu Y, Qu L, Tan Y, Zhang P. A novel machine learning model based on sparse structure learning with adaptive graph regularization for predicting drug side effects. J Biomed Inform 2022; 132:104131. [PMID: 35840061 DOI: 10.1016/j.jbi.2022.104131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
Drug side effects are closely related to the success and failure of drug development. Here we present a novel machine learning method for side effect prediction. The proposed method treats side effect prediction as a multi-label learning problem and uses sparse structure learning to model the relationships between side effects. Additionally, the proposed method adopts the adaptive graph regularization strategy to explore the local structure in drug data and fuse multiple types of drug features. An alternating optimization algorithm is proposed to solve the optimization problem. We collected chemical structures and biological pathway features of drugs as the inputs of our method to predict drug side effects. The results of the cross-validation experiment showed that our method could significantly improve the prediction performance compared to the other state-of-the-art methods. Besides, our model is highly interpretable. It could learn the drug neighbourhood relationships, side effect relationships, and drug features related to side effects. We systematically validated the information extracted by the model with independent data. Some prediction results could also be supported by literature reports. The proposed method could be applied to integrate both chemical and biological data to predict side effects and helps improve drug safety.
Collapse
Affiliation(s)
- Xujun Liang
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China; National Clinical Research Center for Gerontology, Xiangya Hospital, Central South University, PR China.
| | - Jun Li
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China
| | - Ying Fu
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China
| | - Lingzhi Qu
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China
| | - Yuying Tan
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China
| | - Pengfei Zhang
- NHC Key Laboratory of Cancer Proteomics, Department of Oncology, PR China; National Clinical Research Center for Gerontology, Xiangya Hospital, Central South University, PR China
| |
Collapse
|
13
|
Shi P, Zhao T, Wang W, Peng F, Wang T, Jia Y, Zou L, Wang P, Yang S, Fan Y, Zong J, Qu X, Wang S. Protective effect of homogeneous polysaccharides of Wuguchong (HPW) on intestinal mucositis induced by 5-fluorouracil in mice. Nutr Metab (Lond) 2022; 19:36. [PMID: 35585561 PMCID: PMC9118848 DOI: 10.1186/s12986-022-00669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/04/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In hospitalized patients, drug side effects usually trigger intestinal mucositis (IM), which in turn damages intestinal absorption and reduces the efficacy of treatment. It has been discovered that natural polysaccharides can relieve IM. In this study, we extracted and purified homogenous polysaccharides of Wuguchong (HPW), a traditional Chinese medicine, and explored the protective effect of HPW on 5-fluorouracil (5-FU)-induced IM. METHODS AND RESULTS First, we identified the physical and chemical properties of the extracted homogeneous polysaccharides. The molecular weight of HPW was 616 kDa, and it was composed of 14 monosaccharides. Then, a model of small IM induced by 5-FU (50 mg/kg) was established in mice to explore the effect and mechanism of HPW. The results showed that HPW effectively increased histological indicators such as villus height, crypt depth and goblet cell count. Moreover, HPW relieved intestinal barrier indicators such as D-Lac and diamine oxidase (DAO). Subsequently, western blotting was used to measure the expression of Claudin-1, Occludin, proliferating cell nuclear antigen, and inflammatory proteins such as NF-κB (P65), tumour necrosis factor-α (TNF-α), and COX-2. The results also indicated that HPW could reduce inflammation and protect the barrier at the molecular level. Finally, we investigated the influence of HPW on the levels of short-chain fatty acids, a metabolite of intestinal flora, in the faeces of mice. CONCLUSIONS HPW, which is a bioactive polysaccharide derived from insects, has protective effects on the intestinal mucosa, can relieve intestinal inflammation caused by drug side effects, and deserves further development and research.
Collapse
Affiliation(s)
- Peng Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Tianqi Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Wendong Wang
- Department of Orthopaedics, The Second People's Hospital of Dalian, 29 Hongji Street, Dalian, China
| | - Fangli Peng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Ting Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Yong Jia
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Linxuan Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,Dalian Runxi Technology Development Co., Ltd, 3 Jinxia Street, Dalian, China
| | - Peng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China
| | - Simengge Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Yue Fan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Junwei Zong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China. .,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China.
| | - Xueling Qu
- Pelvic Floor Repair Centre, The Affiliated Dalian Maternity Hospital of Dalian Medical University, 1 Dunhuang Road, Dalian, China. .,Pelvic Floor Repair Centre, Dalian Women and Children Medical Centre (Group), No. 1 Road of Sports New Town, Dalian, China.
| | - Shouyu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China. .,College of Integrative Medicine, Dalian Medical University, 9 South Lushun Road West, Dalian, China.
| |
Collapse
|
14
|
Fillion E, Torny D. Like mother, like daughter, like granddaughter… Transgenerational ignorance engendered by a defective reproductive health technology. Reprod Biomed Soc Online 2022; 14:101-110. [PMID: 35005259 PMCID: PMC8717442 DOI: 10.1016/j.rbms.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 08/23/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
From 1941, the synthetic oestrogen diethylstilbestrol (DES) was administered to millions of women around the world to prevent miscarriages. In 1971, a clear and direct link was shown between taking DES during pregnancy and its subsequent long-term morbid effects on offspring. In the last 50 years, the list of side effects of in-utero exposure to DES has grown to include cancer, infertility, significant prematurity and urogenital malformation, amongst others. Based on qualitative sociological research conducted between 2010 and 2013, compiling archives, judicial documents and 108 interviews, this article illustrates a continuous production of ignorance in France. By focusing on DES as a reproductive health technology, three aspects are stressed. First, in terms of recognition of adverse effects, despite DES being identified as a prototype for other technologies such as the contraceptive pill or hormone replacement therapy, there remained a strong reluctance to import knowledge from the USA on its dangers and risks. Second, there was indifference to transgenerational side effects: even when the most visible effects of DES were finally acknowledged, there was a lack of consideration of the health of descendants; an inability to deem the knowledge of these repercussions as emancipatory or potentially empowering for the offspring. Third, regarding the health care of DES daughters, an important propensity to undone science is highlighted, with notable indifference to the risks of hormonalization of the female body, even on the part of activists. Thus, decades after it was last given to pregnant women, the shadow of DES still lingers as a failed reproductive health technology.
Collapse
Affiliation(s)
- Emmanuelle Fillion
- Ecole des Hautes Etudes en Santé Publique, ARENES (UMR 5160), Rennes, France
| | - Didier Torny
- CNRS, CSI, Mines ParisTech (I3, UMR 9217), PSL University, Paris, France
| |
Collapse
|
15
|
Larsen VB, Grøsland M, Telle K, Magnusson K. Utilization of health care services before and after media attention about fatal side effects of the AstraZeneca vaccine: a nation-wide register-based event study. BMC Health Serv Res 2021; 21:1229. [PMID: 34774045 PMCID: PMC8590367 DOI: 10.1186/s12913-021-07233-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Survey studies have found that vaccinated persons tend to report more side effects after being given information about side effects rather than benefits. However, the impact of high media attention about vaccine-related side effects on the utilization of health care is unknown. We aimed to assess whether utilization of health care services for newly vaccinated health care workers changed after media attention about fatal side effects of the AstraZeneca vaccine on March 11th, 2021, and whether changes differed by age, sex, or occupation. Methods We utilized individual-level data on health care use, vaccination, employment, and demographics available in the Norwegian emergency preparedness register Beredt C19. In all 99,899 health care workers in Norway who were vaccinated with AstraZeneca between February 11th and March 11th, we used an event-study design with a matched comparison group to compare the change in primary and inpatient specialist care use from 14 days before to 14 days after the information shock on March 11th, 2021. Results Primary health care use increased with 8.2 daily consultations per 1000 health care workers (95% CI 7.51 to 8.89) the week following March 11th for those vaccinated with AstraZeneca (n = 99,899), compared with no increase for the unvaccinated comparison group (n = 186,885). Utilization of inpatient care also increased with 0.8 daily hospitalizations per 1000 health care workers (95% CI 0.37 to 1.23) in week two after March 11th. The sharpest increase in daily primary health care use in the first week after March 11th was found for women aged 18–44 (10.6 consultations per 1000, 95% CI 9.52 to 11.68) and for cleaners working in the health care sector (9.8 consultations per 1000, 95% CI 3.41 to 16.19). Conclusions Health care use was higher after the media reports of a few cases of fatal or severe side effects of the AstraZeneca vaccine. Our results suggest that the reports did not only lead vaccinated individuals to contact primary health care more, but also that physicians referred and treated more cases to specialist care after the new information. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07233-2.
Collapse
Affiliation(s)
- Vilde Bergstad Larsen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, Oslo, Norway.
| | - Mari Grøsland
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, Oslo, Norway
| | - Kjetil Telle
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, Oslo, Norway
| | - Karin Magnusson
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, Oslo, Norway.,Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Faculty of Medicine, Lund, Sweden
| |
Collapse
|
16
|
Waespe N, Strebel S, Marino D, Mattiello V, Muet F, Nava T, Schindera C, Belle FN, Mader L, Spoerri A, Kuehni CE, Ansari M. Predictors for participation in DNA self-sampling of childhood cancer survivors in Switzerland. BMC Med Res Methodol 2021; 21:236. [PMID: 34717553 PMCID: PMC8557596 DOI: 10.1186/s12874-021-01428-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on germline genetic variants relies on enough eligible participants which is difficult to achieve for rare diseases such as childhood cancer. With self-collection kits, participants can contribute genetic samples conveniently from their home. Demographic and clinical factors were identified previously that influenced participation in mailed self-collection. People with pre-existing heritable diagnoses might participate differently in germline DNA collection which might render sampling biased in this group. In this nationwide cross-sectional study, we analysed predictive factors of participation in DNA self-collection including heritable diagnoses. METHODS We identified childhood cancer survivors from the Swiss Childhood Cancer Registry for invitation to germline DNA self-sampling in September 2019. Participants received saliva sampling kits by postal mail at their home, were asked to fill them, sign an informed consent, and send them back by mail. Two reminders were sent to non-participants by mail. We compared demographic, clinical, and treatment information of participants with non-participants using univariable and multivariable logistic regression models. RESULTS We invited 928 childhood cancer survivors in Switzerland with a median age of 26.5 years (interquartile range 19-37), of which 463 (50%) participated. After the initial send out of the sampling kit, 291 (63%) had participated, while reminder letters led to 172 additional participants (37%). Foreign nationality (odds ratio [OR] 0.5; 95%-confidence interval [CI] 0.4-0.7), survivors aged 30-39 years at study versus other age groups (OR 0.5; CI 0.4-0.8), and survivors with a known cancer predisposition syndrome (OR 0.5; CI 0.3-1.0) were less likely to participate in germline DNA collection. Survivors with a second primary neoplasm (OR 1.9; CI 1.0-3.8) or those living in a French or Italian speaking region (OR 1.3; CI 1.0-1.8) tended to participate more. CONCLUSIONS We showed that half of childhood cancer survivors participated in germline DNA self-sampling relying completely on mailing of sample kits. Written reminders increased the response by about one third. More targeted recruitment strategies may be advocated for people of foreign nationality, aged 30-39 years, and those with cancer predisposition syndromes. Perceptions of genetic research and potential barriers to participation of survivors need to be better understood. TRIAL REGISTRATION Biobank: https://directory.bbmri-eric.eu/#/collection/bbmri-eric:ID:CH_HopitauxUniversitairesGeneve:collection:CH_BaHOP Research project : Clinicaltrials.gov: NCT04702321 .
Collapse
Affiliation(s)
- Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Sven Strebel
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Denis Marino
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Veneranda Mattiello
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland
| | - Fanny Muet
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Tiago Nava
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabien N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Center for Primary Care and Public Health (Unisanté), Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Luzius Mader
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Adrian Spoerri
- SwissRDL - Medical Registries and Data Linkage, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Pediatrics, University Hospital of Bern, Bern, Switzerland
| | - Marc Ansari
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland. .,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland.
| |
Collapse
|
17
|
Leucht K, Foller S, Grimm MO. [Bacillus Calmette-Guérin (BCG) and alternatives : Drug treatment of high-risk non-muscle invasive bladder cancer]. Urologe A 2021; 60:1400-1408. [PMID: 34709440 DOI: 10.1007/s00120-021-01681-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intravesical instillation of bacillus Calmette-Guérin (BCG) is an accepted strategy to reduce the risk of recurrence and possibly progression of high-risk non-muscle invasive bladder cancer (NMIBC). However, side effects are not uncommon. In addition, the tumors may be BCG refractory or unresponsive. These tumors have a very high risk of recurrence and progression, so cystectomy must be weighed against conservative treatment options. OBJECTIVES We describe the current recommendations regarding treatment of NMIBC with BCG and alternatives for BCG failure. METHODS Literature search on current treatment options and their alternatives with the help of mainly primary literature and guideline recommendations. RESULTS AND CONCLUSION For high-risk NMIBC, instillation therapy with BCG remains standard-of-care, applied according to a standard regimen in terms of dose and dosing intervals (induction: weekly instillation for 6 weeks, maintenance: weekly instillation for 3 weeks, 3, 6 and 12 months after initiation of BCG therapy plus, for high-risk NMIBC, 18, 24, 30 and 36 months after initiation of BCG therapy). Potential future treatment options for BCG failure are systemic (i.v.) pembrolizumab (FDA approved) and, possibly, intravesical nadofaragene firadenovec. Ongoing randomized clinical trials are furthermore evaluating the role of PD-(L)1 immune checkpoint inhibitors in combination with BCG.
Collapse
Affiliation(s)
- K Leucht
- Klinik und Poliklinik für Urologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - S Foller
- Klinik und Poliklinik für Urologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Marc-Oliver Grimm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| |
Collapse
|
18
|
Torres Dios JÁ, Pérez Benítez S. Second-degree atrioventricular block after administration of methylergometrine for treatment of uterine atony during cesarean section. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:487-490. [PMID: 34521612 DOI: 10.1016/j.redare.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/16/2020] [Indexed: 06/13/2023]
Abstract
Mortality due to cardiovascular disease in pregnancy is a growing problem in developed countries, being nowadays the leading cause of maternal death. Within this group, the most common cause of death are congenital or acquired heart diseases, representing a challenge in the management of these patients, since the pregnancy-related physiological alterations can impair their basal condition and treatment. We present the case of a 34-year-old patient, without any relevant pathological antecedents, who developed a second-degree atrioventricular block, Mobitz type I, following the administration of methylergometrine during cesarean section due to failure to progress in labour. We emphasize the importance of considering the side effects of commonly used drugs in pregnant patients, despite rare possibility of some adverse reactions.
Collapse
Affiliation(s)
- J Á Torres Dios
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
| | - S Pérez Benítez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| |
Collapse
|
19
|
Kelly DL, Claxton A, Bidollari I, Du Y. Analysis of prolactin and sexual side effects in patients with schizophrenia who switched from paliperidone palmitate to aripiprazole lauroxil. Psychiatry Res 2021; 302:114030. [PMID: 34118485 DOI: 10.1016/j.psychres.2021.114030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
One strategy to address hyperprolactinemia and associated sexual side effects in patients receiving antipsychotics is switching to an antipsychotic not associated with prolactin elevation (eg, aripiprazole). This post hoc analysis assessed prolactin concentrations and sexual side effects in an open-label prospective study of switching long-acting injectable antipsychotics from paliperidone palmitate (PP) to aripiprazole lauroxil (AL). Serum prolactin was measured throughout the study. Patient-reported sexual and endocrine side effects were assessed on the UKU Side Effect Rating Scale sexual function subscale and analyzed in study completers. Prior to starting AL treatment (screening), 49/50 (98%) patients had prolactin concentrations above the upper limit of normal (ULN; >13.13 ng/mL [males]; >26.72 ng/mL [females]). Six months after beginning AL treatment, prolactin levels were above ULN in 2/32 (6.3%) patients. Among 32 study completers, 81.3% reported sexual dysfunction in ≥1 domain at screening versus 56.3% at 6 months after starting AL treatment. Diminished sexual desire was the most common patient-reported sexual complaint at screening (46.9%); at 6 months, it was reported by 18.8%. In this post hoc analysis, the high levels of prolactin observed at screening decreased during AL treatment, and modest improvements in sexual side effects were evident in patients with schizophrenia.
Collapse
Affiliation(s)
- Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
Magnesium (Mg2+) plays an essential role in many biological processes. Mg2+ deficiency is therefore associated with a wide range of clinical effects including muscle cramps, fatigue, seizures and arrhythmias. To maintain sufficient Mg2+ levels, (re)absorption of Mg2+ in the intestine and kidney is tightly regulated. Genetic defects that disturb Mg2+ uptake pathways, as well as drugs interfering with Mg2+ (re)absorption cause hypomagnesemia. The aim of this review is to provide an overview of the molecular mechanisms underlying genetic and drug-induced Mg2+ deficiencies. This leads to the identification of four main mechanisms that are affected by hypomagnesemia-causing mutations or drugs: luminal transient receptor potential melastatin type 6/7-mediated Mg2+ uptake, paracellular Mg2+ reabsorption in the thick ascending limb of Henle's loop, structural integrity of the distal convoluted tubule and Na+-dependent Mg2+ extrusion driven by the Na+/K+-ATPase. Our analysis demonstrates that genetic and drug-induced causes of hypomagnesemia share common molecular mechanisms. Targeting these shared pathways can lead to novel treatment options for patients with hypomagnesemia.
Collapse
|
21
|
Brosda J, Becker T, Richter M, Jakobs M, Hörbelt T, Bendix I, Lückemann L, Schedlowski M, Hadamitzky M. Treatment with the calcineurin inhibitor and immunosuppressant cyclosporine A impairs sensorimotor gating in Dark Agouti rats. Psychopharmacology (Berl) 2021; 238:1047-1057. [PMID: 33349900 PMCID: PMC7969700 DOI: 10.1007/s00213-020-05751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
RATIONALE Calcineurin is a protein regulating cytokine expression in T lymphocytes and calcineurin inhibitors such as cyclosporine A (CsA) are widely used for immunosuppressive therapy. It also plays a functional role in distinct neuronal processes in the central nervous system. Disturbed information processing as seen in neuropsychiatric disorders is reflected by deficient sensorimotor gating, assessed as prepulse inhibition (PPI) of the acoustic startle response (ASR). OBJECTIVE Patients who require treatment with immunosuppressive drugs frequently display neuropsychiatric alterations during treatment with calcineurin inhibitors. Importantly, knockout of calcineurin in the forebrain of mice is associated with cognitive impairments and symptoms of schizophrenia-like psychosis as seen after treatment with stimulants. METHODS The present study investigated in rats effects of systemic acute and subchronic administration of CsA on sensorimotor gating. Following a single injection with effective doses of CsA, adult healthy male Dark Agouti rats were tested for PPI. For subchronic treatment, rats were injected daily with the same doses of CsA for 1 week before PPI was assessed. Since calcineurin works as a modulator of the dopamine pathway, activity of the enzyme tyrosine hydroxylase was measured in the prefrontal cortex and striatum after accomplishment of the study. RESULTS Acute and subchronic treatment with the calcineurin inhibitor CsA disrupted PPI at a dose of 20 mg/kg. Concomitantly, following acute CsA treatment, tyrosine hydroxylase activity was reduced in the prefrontal cortex, which suggests that dopamine synthesis was downregulated, potentially reflecting a stimulatory impact of CsA on this neurotransmitter system. CONCLUSIONS The results support experimental and clinical evidence linking impaired calcineurin signaling in the central nervous system to the pathophysiology of neuropsychiatric symptoms. Moreover, these findings suggest that therapy with calcineurin inhibitors may be a risk factor for developing neurobehavioral alterations as observed after the abuse of psychomotor stimulant drugs.
Collapse
Affiliation(s)
- Jan Brosda
- Institute of Pharmacology and Toxicology, School of Veterinary Medicine, Freie Universität Berlin, 14195, Berlin, Germany
| | - Thorsten Becker
- Institute of Biology, Department of Neurophysiology, Freie Universität Berlin, 14195, Berlin, Germany
| | - Mathis Richter
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Marie Jakobs
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Tina Hörbelt
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Ivo Bendix
- Department of Pediatrics I/Experimental perinatal Neuroscience, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Laura Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.
| |
Collapse
|
22
|
Specka M, Groll M, Scherbaum N, Wiltfang J, Benninghoff J. [Identification of polypharmacy-associated risks among nursing home residents]. Z Gerontol Geriatr 2021. [PMID: 33570659 DOI: 10.1007/s00391-021-01850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
Einleitung Multimorbidität im Alter ist u. a. ein Grund für intensivierte Pharmakotherapie. Gleichzeitig kann es mit steigender Medikamentenzahl zu einer Zunahme der Multimorbidität kommen, insbesondere wenn Interaktionen zwischen den Wirkstoffen zu unerwünschten Arzneiwirkungen (UAW) führen. Ziel dieser Untersuchung war es, in einer Pilotstudie Patienten zu identifizieren, die einem erhöhten Risiko für UAW unterliegen. Methoden In einer Querschnittserhebung wurden 918 in Heimen lebende psychiatrisch behandelte Alterspatienten untersucht (Altersmittel: 79,3 (±11,6) Jahre; 31,8 % Männer). Es kamen exemplarisch verschiedene Methoden zur Identifikation von möglichen Risikopatienten zur Anwendung: eine die Interaktionen der Gesamtmedikation erfassende „Clinical-Decision-Support-Software“(CDSS)-Onlinedatenbank, mediQ, und eine Negativliste, die pauschal zu vermeidende Präparate indiziert, die PRISCUS-Liste. Ergebnis Es hatten 76,3 % aller Studienpatienten bei Betrachtung der Gesamtmedikation ein klinisch relevantes Interaktionsrisiko (IR), 2,2 % standen unter einem darüber hinausgehenden potenziell starken UAW-Risiko durch Interaktionen. Ungefähr ein Viertel der untersuchten Studienpopulation erhielt potenziell inadäquate Medikamente gemäß PRISCUS. Schlussfolgerung Diese unterschiedlichen Zahlen zeigen die Komplexität der eindeutigen Identifikation von Risikopatienten am Beispiel dieser beiden, auf unterschiedlicher Grundlage basierenden Instrumente. Trotz des technischen Fortschritts sollte der Schwerpunkt der UAW-Vermeidung unverändert darauf liegen, Medikamente erst nach besonders gründlicher Prüfung der klinischen Indikation zu verordnen und eine adäquate Verlaufskontrolle zu gewährleisten. Die neuen CDSS oder Negativlisten bieten hierbei Unterstützung.
Collapse
|
23
|
Sisman G, Barbur E, Saka D, Erdamar Cetin S. Pembrolizumab-induced immune-mediated fatal colitis with concurrent giardia infection. Cancer Immunol Immunother 2021; 70:2385-8. [PMID: 33481043 DOI: 10.1007/s00262-020-02815-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022]
Abstract
Advancements in medicine have enabled the use of monoclonal antibodies in the field of oncology. However, the new adverse effects of immunotherapeutic agents are still being reported. We present the first case of pembrolizumab-induced fatal colitis with concurrent Giardia infection in a patient with metastatic ovarian cancer. A 47-year-old woman with metastatic ovarian cancer who was being treated with pembrolizumab admitted to our clinic complaining of persisting bloody diarrhoea. Her stool antigen test was positive for Giardia. The patient received metronidazole. A colonoscopy with mucosal biopsy was performed upon no clinical or laboratory improvement. Colonoscopy detected deep exudative ulcers in sigmoid colon and rectum. The cytopathological evaluation revealed immune-mediated ischemic colitis. The treatment was rearranged with methylprednisolone. Upon an increase in bloody diarrhoea frequency and C-reactive protein levels, infliximab was started. However, the patient became refractory to infliximab therapy after the second dose and was deceased due to septic shock.
Collapse
|
24
|
Abstract
Schwere Arzneimittelnebenwirkungen stellen mit 5–7 % einen häufigen Grund für eine Krankenhauseinweisung dar. Die Prävalenz von unerwünschten Arzneimittelwirkungen (UAW) während eines stationären Aufenthaltes liegt sogar bei etwa 11,5 %. Die Ursache sind oftmals Medikamentenwechselwirkungen, bedingt durch die Polypharmazie der multimorbiden älteren Patienten. So nimmt ein 65-jähriger Patient im Durchschnitt 5 Medikamente gleichzeitig ein. Aufgrund des zunehmenden Einsatzes von Systemtherapeutika in der Dermatologie und der gleichzeitig zunehmenden Polypharmazie ist das Wissen um Medikamenteninteraktionen für den Dermatologen zur Vermeidung schwerer Arzneimittelnebenwirkungen wesentlich. Dieser Beitrag soll eine Hilfestellung bieten, Patienten und Medikamente mit einem hohen Risiko für schwerwiegende Interaktionen zu identifizieren und dadurch das Auftreten unerwünschter Wirkungen oder auch die Verminderung des therapeutischen Effektes von Wirkstoffen zu vermeiden. Wir möchten darauf hinweisen, dass die folgende Arbeit einzelne Aspekte behandelt und nicht von der Überprüfung einzelner Arzneimittelinteraktionen mittels Interaktionsprogrammen entbindet. Nicht außer Acht gelassen werden sollte, dass neben verschreibungspflichtigen Medikamenten auch Nahrungsmittel, Nahrungsergänzungsmittel und Kräuter zu Interaktionen mit Medikamenten führen können.
Collapse
Affiliation(s)
- Kristina Krause
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Jahn
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Bernhard Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| |
Collapse
|
25
|
Jekel K, Wagner P. [Neuropsychological diagnostics of cognitive deficits : Focus on dementia]. Z Gerontol Geriatr 2020; 53:797-806. [PMID: 33146740 DOI: 10.1007/s00391-020-01800-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
Older people often report a decline in their cognitive functions - memory problems and difficulty finding words are frequently mentioned. In this context it is essential to differentiate between age-related cognitive decline and pathological processes as they occur in the context of dementia. Neuropsychological diagnostics make an important contribution to this distinction. Using cognitive tests, the quality and quantity of cognitive deficits can be determined. Moreover, the cognitive profile can be used to generate hypotheses about the etiology of the cognitive impairment. In order to avoid a misdiagnosis, factors such as drug side effects, loss of vision and hearing, the presence of depressive symptoms or states of delirium should be taken into account.
Collapse
Affiliation(s)
- Katrin Jekel
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
| | - Peter Wagner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
| |
Collapse
|
26
|
van Kessel SP, de Jong HR, Winkel SL, van Leeuwen SS, Nelemans SA, Permentier H, Keshavarzian A, El Aidy S. Gut bacterial deamination of residual levodopa medication for Parkinson's disease. BMC Biol 2020; 18:137. [PMID: 33076930 PMCID: PMC7574542 DOI: 10.1186/s12915-020-00876-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by both motor and non-motor symptoms. Gastrointestinal tract dysfunction is one of the non-motor features, where constipation is reported as the most common gastrointestinal symptom. Aromatic bacterial metabolites are attracting considerable attention due to their impact on gut homeostasis and host’s physiology. In particular, Clostridium sporogenes is a key contributor to the production of these bioactive metabolites in the human gut. Results Here, we show that C. sporogenes deaminates levodopa, the main treatment in Parkinson’s disease, and identify the aromatic aminotransferase responsible for the initiation of the deamination pathway. The deaminated metabolite from levodopa, 3-(3,4-dihydroxyphenyl)propionic acid, elicits an inhibitory effect on ileal motility in an ex vivo model. We detected 3-(3,4-dihydroxyphenyl)propionic acid in fecal samples of Parkinson’s disease patients on levodopa medication and found that this metabolite is actively produced by the gut microbiota in those stool samples. Conclusions Levodopa is deaminated by the gut bacterium C. sporogenes producing a metabolite that inhibits ileal motility ex vivo. Overall, this study underpins the importance of the metabolic pathways of the gut microbiome involved in drug metabolism not only to preserve drug effectiveness, but also to avoid potential side effects of bacterial breakdown products of the unabsorbed residue of medication.
Collapse
Affiliation(s)
- Sebastiaan P van Kessel
- Department of Molecular Immunology and Microbiology, Groningen Biomolecular Sciences and Biotechnology Institute (GBB), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands
| | - Hiltje R de Jong
- Department of Molecular Immunology and Microbiology, Groningen Biomolecular Sciences and Biotechnology Institute (GBB), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands
| | - Simon L Winkel
- Department of Molecular Immunology and Microbiology, Groningen Biomolecular Sciences and Biotechnology Institute (GBB), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands
| | - Sander S van Leeuwen
- Department of Molecular Immunology and Microbiology, Groningen Biomolecular Sciences and Biotechnology Institute (GBB), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands.,Current Address: Department of Laboratory Medicine, Cluster Human Nutrition & Health, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sieger A Nelemans
- Department of Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands
| | - Hjalmar Permentier
- Interfaculty Mass Spectrometry Center, University of Groningen, Groningen, The Netherlands
| | - Ali Keshavarzian
- Division of Digestive Disease and Nutrition, Section of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, USA
| | - Sahar El Aidy
- Department of Molecular Immunology and Microbiology, Groningen Biomolecular Sciences and Biotechnology Institute (GBB), University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands.
| |
Collapse
|
27
|
Kinduryte Schorling O, Clark D, Zwiener I, Kaspers S, Lee J, Iliev H. Pooled Safety and Tolerability Analysis of Empagliflozin in Patients with Type 2 Diabetes Mellitus. Adv Ther 2020; 37:3463-3484. [PMID: 32372290 PMCID: PMC7370973 DOI: 10.1007/s12325-020-01329-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this analysis was to characterize the safety and tolerability of empagliflozin in patients with type 2 diabetes mellitus (T2DM) who were randomized to empagliflozin (10/25 mg) or placebo in clinical trials. METHODS Pooled data from 20 trials were analyzed for patients with T2DM treated with empagliflozin 10 mg (n = 4858), empagliflozin 25 mg (n = 5057), or placebo (n = 4904). The dataset comprised 15 randomized phase I-III trials, an extension trial and dose escalation studies. Adverse events (AEs) were assessed descriptively in participants who took ≥ 1 dose of study drug. AE incidence rates per 100 patient-years were calculated to adjust for differences in drug exposure between trials. RESULTS Total exposure was 16,480 and 7857 patient-years in the pooled empagliflozin 10/25 mg and placebo groups, respectively. The incidence of any AEs, AEs leading to treatment discontinuation, severe AEs, and serious AEs was similar across groups. The frequency of serious AEs requiring hospitalization was 18.6% for the empagliflozin 10/25 mg group and 21.3% for the placebo group. The empagliflozin 10/25 mg group was not associated with a higher rate of confirmed hypoglycemia versus placebo, except in patients co-administered insulin and/or a sulfonylurea (31.5% vs. 30.2%, respectively). The incidence of events consistent with urinary tract infections (UTI) was also similar for the empagliflozin 10/25 mg group versus placebo (9.27 vs. 9.70/100 patient-years, respectively). History of UTI was identified as a risk factor for UTI during treatment. Events consistent with genital infections occurred more frequently with empagliflozin 10/25 mg than placebo (3.54 vs. 0.95/100 patient-years, respectively). The frequency of AEs consistent with volume depletion was similar across groups, but higher with empagliflozin 10/25 mg than placebo in patients aged 75 to < 85 years and those on loop diuretics at baseline. CONCLUSION This comprehensive analysis confirms that both empagliflozin 10 mg and 25 mg are well tolerated in patients with T2DM, reinforcing the established clinical safety profile of empagliflozin.
Collapse
|
28
|
Millea TP. Smoke and Mirrors: The Recreational Marijuana Debate. Linacre Q 2020; 87:254-258. [PMID: 32699434 DOI: 10.1177/0024363920916284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasingly widespread legalization of recreational marijuana should raise concerns regarding the societal and medical impact of its use. The relative cultural acceptance for its use should be counterbalanced with an honest and scientific review of the adverse impacts. This article provides a synopsis of recent studies that point to significant concerns from medical and psychiatric viewpoints. Summary With the increasing number of states that have legalized the use of recreational marijuana, concerns regarding its negative effects are necessary. There is growing scientific evidence that the use of marijuana for recreational purposes has a wide variety of negative health effects, both physical and psychiatric.
Collapse
|
29
|
Panza F, Lozupone M, Bellomo A, Imbimbo BP. Do anti-amyloid-β drugs affect neuropsychiatric status in Alzheimer's disease patients? Ageing Res Rev 2019; 55:100948. [PMID: 31454563 DOI: 10.1016/j.arr.2019.100948] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022]
Abstract
In the Alzheimer's disease (AD) brain, accumulation of the amyloid-β (Aβ) peptide starts 15-20 years before clinical symptoms become apparent and is believed to be the initial event of the pathological process. Unfortunately, candidate drugs targeting production, clearance and deposition of Aβ have failed to show clinical benefit in patients with established or prodromal disease, or in cognitively normal subjects with high risk of developing AD. Surprisingly, several potent anti-Aβ drugs accelerated cognitive decline of AD and, in some cases, worsened neuropsychiatric symptoms (NPS) and triggered suicidal ideation. Clarifying the relationships between the AD-related pathology and NPS of AD patients may be useful for elucidating the underlying pathophysiological process. We believe that steady overproduction of Aβ in AD may represent an attempt of the brain to mitigate or repair neuronal damage/insult. Sudden reductions of brain Aβ levels with potent anti-Aβ drugs may worsen cognition and exacerbate NPS.
Collapse
|
30
|
Abstract
Chronic heart and lung diseases are very common in the elderly population. The combination of chronic heart failure and chronic obstructive pulmonary disease (COPD) is also common and, according to current guidelines, these patients should be treated for both diseases. In patients with heart failure, beta-blockers are very important drugs because their use is associated with significantly improved morbidity and mortality. These beneficial effects were documented in patients with and without COPD, although theoretically there is a risk for bronchoconstriction, particularly with non-beta1 selective blockers. In COPD patients, long-acting sympathomimetics (LABA) improve lung function, dyspnea, and quality of life and their combination with a beta-blocker makes sense from a pharmacological and a clinical point of view, because any potential arrhythmogenic effects of the LABA will be ameliorated by the beta-blocker. Inhaled tiotropium, a long-acting muscarinic antagonist (LAMA), has been extensively investigated and no safety concerns were reported in terms of cardiac adverse effects. The same applies for the other approved LAMA preparations and LAMA-LABA combinations. Severe COPD causes air-trapping with increasing pressures in the thorax, leading to limitations in blood return into the thorax from the periphery of the body. This causes a decrease in stroke volume and cardiac index and is associated with dyspnea. All these adverse effects can be ameliorated by potent anti-obstructive therapy as recently shown by means of a LABA-LAMA combination.
Collapse
Affiliation(s)
- H Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - M Canepa
- Cardiovascular Unit, Department of Internal Medicine, University of Genova, Genova, Italy
| | - G Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| |
Collapse
|
31
|
Abstract
We report about a 52-year-old woman with onset of drug-induced lupus erythematosus (DILE) in sun-exposed areas, under therapy with secukinumab. Topical therapy with a steroid class 3 for 4 weeks showed substantial improvement. The systemic therapy was switched to ustekinumab. DILE is a rare but notable side effect of biologicals in 0.5-1% of the patients and also possible under therapy with IL-17 inhibition. Switch of the biological agent is necessary in most cases.
Collapse
Affiliation(s)
- C Wehrmann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - W Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - A Körber
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| |
Collapse
|
32
|
Simoons M, Mulder H, Doornbos B, Raats PCC, Bruggeman R, Cath DC, Schoevers RA, Ruhé HG, van Roon EN. Metabolic Syndrome at an Outpatient Clinic for Bipolar Disorders: A Case for Systematic Somatic Monitoring. Psychiatr Serv 2019; 70:143-146. [PMID: 30526344 DOI: 10.1176/appi.ps.201800121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The primary objective of the study was to determine whether the Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR) program improved somatic monitoring practices at an outpatient clinic for bipolar disorders in the Netherlands. The secondary objective was to determine in MOPHAR the frequency of metabolic syndrome (compared with its measurability before MOPHAR) and treatment thereof. METHODS Frequencies of physical examinations and laboratory tests before (retrospectively) and after (prospectively) the active introduction of MOPHAR were compared among adult patients (N=155). RESULTS A median of three measurements (range 0-19) per patient were performed before MOPHAR, compared with 24 measurements (range 3-24) after MOPHAR (p<0.001). MOPHAR revealed somatic abnormalities previously unknown to treating physicians. Metabolic syndrome was present in 53% of patients; of these, 98% were not known to have metabolic syndrome before MOPHAR. CONCLUSIONS Introducing a monitoring program largely improved knowledge regarding metabolic abnormalities, which are frequently present among patients with bipolar disorder.
Collapse
Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Bennard Doornbos
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Pascal C C Raats
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Richard Bruggeman
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Daniëlle C Cath
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Robert A Schoevers
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Henricus G Ruhé
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Eric N van Roon
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| |
Collapse
|
33
|
Schreiber J, Müller-Ladner U. [Treatment of rheumatic diseases and pulmonary toxicity]. Pneumologe (Berl) 2018; 15:404-412. [PMID: 32288712 PMCID: PMC7101753 DOI: 10.1007/s10405-018-0209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Rheumatic diseases are treated with manifold different drugs that can potentially be pneumotoxic. Adverse effects of drug therapy may induce a wide variety of bronchopulmonary and pleural disorders, which can have a life-threatening course. These side effects rarely have pathognomonic features; therefore, drug-induced diseases are relevant differential diagnoses of pulmonary manifestations of rheumatic diseases, infections, and other independent genuine pulmonary diseases. Diagnosis is based mainly on verification of a compatible disease pattern and exclusion of differential diagnoses, as well as on assessment of the temporal relationship and the consequences of drug abstention.
Collapse
Affiliation(s)
- J. Schreiber
- Klinik für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Deutschland
| | - U. Müller-Ladner
- Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Deutschland
| |
Collapse
|
34
|
DeFronzo RA, Lee C, Kohler S. Safety and Tolerability of Combinations of Empagliflozin and Linagliptin in Patients with Type 2 Diabetes: Pooled Data from Two Randomized Controlled Trials. Adv Ther 2018; 35:1009-1022. [PMID: 29949041 DOI: 10.1007/s12325-018-0724-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Two 52-week Phase III studies evaluated the efficacy and safety of once-daily combinations of empagliflozin/linagliptin as monotherapy or add-on to metformin in patients with type 2 diabetes (T2DM). The aim of this analysis was to further assess the safety and tolerability of empagliflozin/linagliptin compared with their individual components in patients with T2DM, using pooled data from these trials. METHODS A total of 1363 patients were treated with empagliflozin 25 mg/linagliptin 5 mg (n = 273), empagliflozin 10 mg/linagliptin 5 mg (n = 272), empagliflozin 25 mg (n = 276), empagliflozin 10 mg (n = 275), or linagliptin 5 mg (n = 267). Adverse events (AEs) were assessed descriptively in patients who took ≥ 1 dose of study drug. RESULTS Total exposure was 251, 255, 256, 249, and 243 patient-years in the empagliflozin 25 mg/linagliptin 5 mg, empagliflozin 10 mg/linagliptin 5 mg, empagliflozin 25 mg, empagliflozin 10 mg, and linagliptin 5 mg groups, respectively. The proportion of patients with ≥ 1 AE was similar across groups (70.4-74.9%). The percentage of patients with confirmed hypoglycemic AEs (plasma glucose ≤ 70 mg/dL and/or requiring assistance) was low in all groups (1.1-2.2%); none required assistance. Events consistent with urinary tract infection were reported in similar percentages of patients in all groups (11.4-13.8%), and in a greater proportion of female than male patients. Events consistent with genital infection were reported in higher percentages of patients on empagliflozin/linagliptin or empagliflozin (4.0-6.5%) than linagliptin 5 mg (2.6%), and in a greater proportion of females than males. The risks of hypersensitivity reactions and events consistent with volume depletion were low across treatment groups. CONCLUSION Empagliflozin/linagliptin as monotherapy or add-on to metformin for 52 weeks was well tolerated in patients with T2DM, with safety profiles similar to individual components, including a low risk of hypoglycemia. FUNDING The Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT01422876 & NCT01422876.
Collapse
Affiliation(s)
- Ralph A DeFronzo
- University of Texas Health Science Center, San Antonio, TX, USA.
| | | | - Sven Kohler
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| |
Collapse
|
35
|
Roach-Fox E, Welisch E, Sarpal A. Autonomic instability in a dehydrated child on guanfacine: Case report and literature review. Paediatr Child Health 2018; 23:89-91. [PMID: 29686490 DOI: 10.1093/pch/pxx172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An 8-year-old girl on guanfacine extended-release (GXR) for attention-deficit/hyperactivity disorder presented with somnolence, bradycardia and hypotension during a heat wave. No overdose was suspected. She was admitted to the intensive care unit for monitoring and ongoing fluid resuscitation for hypotension. Electrocardiogram showed intermittent atrioventricular dissociation. Upon restarting the drug post-discharge, blood pressures were normal, and follow-up electrocardiograms documented asymptomatic bradycardia but no dissociation. GXR is used as monotherapy or adjunct therapy in the treatment of inattention and hyperactivity in children. No published paediatric or adult study has documented atrioventricular dissociation, bradycardia or hypotension significant enough to warrant hospital admission. This case suggests that GXR can pose a hemodynamic risk to children in the context of elevated environmental temperatures and dehydration. Clinicians should be aware of this potential complication and should counsel patients about signs and symptoms of hypotension, bradycardia, bradypnea and somnolence.
Collapse
Affiliation(s)
| | - Eva Welisch
- Children's Hospital of Western Ontario, London, Ontario
| | - Amrita Sarpal
- Children's Hospital of Western Ontario, London, Ontario
| |
Collapse
|
36
|
Abstract
BACKGROUND Drug side effects are one of main concerns in the drug discovery, which gains wide attentions. Investigating drug side effects is of great importance, and the computational prediction can help to guide wet experiments. As far as we known, a great number of computational methods have been proposed for the side effect predictions. The assumption that similar drugs may induce same side effects is usually employed for modeling, and how to calculate the drug-drug similarity is critical in the side effect predictions. RESULTS In this paper, we present a novel measure of drug-drug similarity named "linear neighborhood similarity", which is calculated in a drug feature space by exploring linear neighborhood relationship. Then, we transfer the similarity from the feature space into the side effect space, and predict drug side effects by propagating known side effect information through a similarity-based graph. Under a unified frame based on the linear neighborhood similarity, we propose method "LNSM" and its extension "LNSM-SMI" to predict side effects of new drugs, and propose the method "LNSM-MSE" to predict unobserved side effect of approved drugs. CONCLUSIONS We evaluate the performances of LNSM and LNSM-SMI in predicting side effects of new drugs, and evaluate the performances of LNSM-MSE in predicting missing side effects of approved drugs. The results demonstrate that the linear neighborhood similarity can improve the performances of side effect prediction, and the linear neighborhood similarity-based methods can outperform existing side effect prediction methods. More importantly, the proposed methods can predict side effects of new drugs as well as unobserved side effects of approved drugs under a unified frame.
Collapse
Affiliation(s)
- Wen Zhang
- School of Computer, Wuhan University, Wuhan, 430072, China
| | - Xiang Yue
- International School of Software, Wuhan University, Wuhan, 430072, China
| | - Feng Liu
- International School of Software, Wuhan University, Wuhan, 430072, China
| | - Yanlin Chen
- School of Mathematics and Statistics, Wuhan University, Wuhan, 430072, China
| | - Shikui Tu
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xining Zhang
- School of Computer, Wuhan University, Wuhan, 430072, China.
| |
Collapse
|
37
|
Green CE, Mojtabai R, Cullen BA, Spivak A, Mitchell M, Spivak S. Exposure to Direct-to-Consumer Pharmaceutical Advertising and Medication Nonadherence Among Patients With Serious Mental Illness. Psychiatr Serv 2017; 68:1299-1302. [PMID: 28945185 DOI: 10.1176/appi.ps.201700035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the association of exposure to direct-to-consumer advertising (DTCA) with medication nonadherence among individuals with serious mental disorders. METHODS Results of an anonymous survey administered at an inner-city mental health clinic were examined by using logistic regression. Nonadherence was defined as not taking prescribed medications for at least two out of seven days. RESULTS Of 246 respondents, 48% reported DTCA exposure and 43% reported nonadherence. Sixty-one percent of those exposed to DTCA reported nonadherence, compared with 26% of those not exposed (adjusted odds ratio=4.96, 95% confidence interval=2.64-9.33, p<.001). Among those exposed to advertisements and reporting nonadherence, 59% reported changing medication-taking behaviors or stopping prescribed medications because of side effect information in advertisements. Only a minority communicated with providers before becoming nonadherent. CONCLUSIONS This study found an association between self-report of DTCA exposure and self-reported nonadherence. These results support further research on DTCA as a possible risk factor for nonadherence.
Collapse
Affiliation(s)
- Charee E Green
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| | - Ramin Mojtabai
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| | - Bernadette A Cullen
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| | - Amethyst Spivak
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| | - Melissa Mitchell
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| | - Stanislav Spivak
- Ms. Green, Dr. Mojtabai, Dr. Cullen, Ms. Mitchell, and Dr. Spivak are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore. Dr. Mojtabai and Dr. Cullen are also with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Ms. Spivak is with The Samaritan Women, Baltimore
| |
Collapse
|
38
|
Renzulli M, Buonfiglioli F, Conti F, Brocchi S, Serio I, Foschi FG, Caraceni P, Mazzella G, Verucchi G, Golfieri R, Andreone P, Brillanti S. Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis. Eur Radiol 2017; 28:506-513. [DOI: 10.1007/s00330-017-5033-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
|
39
|
Lamberti M, Di Rosa G, Cucinotta F, Pironti E, Galati C, Gagliano A. Aripiprazole-induced Tardive Dyskinesia in 13 Years Old Girl Successfully Treated with Biperiden: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:285-287. [PMID: 28783940 PMCID: PMC5565075 DOI: 10.9758/cpn.2017.15.3.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/25/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
In the last years second-generation antipsychotics are increasingly prescribed in the pediatric population for the treatment of several psychiatric disorders. Among the long term adverse effects, extrapyramidal symptoms (EPS) are less reported compared to first-generation antipsychotics. Tardive dyskinesia (TD) is a iatrogenic rare syndrome characterized by persistent slow writhing and sudden involuntary movements mainly involving the oral-buccal-lingual area with masticatory movements. We report a young girl with mood disorders accompanied by mild intellectual disability and behavioral problems who had TD after treatment with Aripiprazole, which responded to Biperiden therapy.
Collapse
Affiliation(s)
- Marco Lamberti
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Di Rosa
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy
| | - Francesca Cucinotta
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy
| | - Erica Pironti
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy
| | - Cecilia Galati
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy
| | - Antonella Gagliano
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Messina, Italy
| |
Collapse
|
40
|
Ransohoff JD, Kwong BY. Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies. Clin Lymphoma Myeloma Leuk 2017; 17:834-851. [PMID: 28918995 DOI: 10.1016/j.clml.2017.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
The identification of oncogenic drivers of liquid tumors has led to the rapid development of targeted agents with distinct cutaneous adverse event (AE) profiles. The diagnosis and management of these skin toxicities has motivated a novel partnership between dermatologists and oncologists in developing supportive oncodermatology clinics. In this article we review the current state of knowledge of clinical presentation, mechanisms, and management of the most common and significant cutaneous AEs observed during treatment with targeted therapies for hematologic and lymphoid malignancies. We systematically review according to drug-targeting pathway the cutaneous AE profiles of these drugs, and offer insight when possible into whether pharmacologic target versus immunologic modulation primarily underlie presentation. We include discussion of tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib), blinatumomab, ibrutinib, idelalisib, anti-B cell antibodies (rituximab, ibritumomab, obinutuzumab, ofatumumab, tositumomab), immune checkpoint inhibitors (nivolumab, pembrolizumab), alemtuzumab, brentuximab, and proteasome inhibitors (bortezomib, carfilzomib, ixazomib). We highlight skin reactions seen with antiliquid but not solid tumor agents, draw attention to serious cutaneous AEs that might require therapy modification or cessation, and offer management strategies to permit treatment tolerability. We emphasize the importance of early diagnosis and treatment to minimize disruptions to care, optimize prognosis and quality of life, and promptly address life-threatening skin or infectious events. This evolving partnership between oncologists and dermatologists in the iterative characterization and management of skin toxicities will contribute to a better understanding of these drugs' cutaneous targets and improved patient care.
Collapse
Affiliation(s)
- Julia D Ransohoff
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
41
|
Abstract
Introduction We characterized the safety and tolerability of empagliflozin in patients with type 2 diabetes (T2DM) randomized 1:1:1 to placebo, empagliflozin 10 mg, or empagliflozin 25 mg in clinical trials. Methods Pooled data were analyzed from patients with T2DM treated with placebo (N = 4203), empagliflozin 10 mg (N = 4221), or empagliflozin 25 mg (N = 4196) in 15 randomized phase I–III trials plus four extension studies. Adverse events (AEs) were assessed descriptively in participants who took at least one dose of study drug. AE incidence rates per 100 patient-years were calculated to adjust for differences in drug exposure between trials. Results Total exposure was 7369, 7782, and 7754 patient-years in the placebo, empagliflozin 10 mg, and 25 mg groups, respectively. The incidence of any AEs, severe AEs, serious AEs, and AEs leading to discontinuation was no higher in participants treated with empagliflozin vs. placebo. Empagliflozin was not associated with an increased risk of hypoglycemia vs. placebo, except in participants on background sulfonylurea. The incidence of events consistent with urinary tract infection was similar across treatment groups (8.7–9.5/100 patient-years). Events consistent with genital infection occurred more frequently in participants treated with empagliflozin 10 and 25 mg (3.5 and 3.4/100 patient-years, respectively) than placebo (0.9/100 patient-years). The incidence of AEs consistent with volume depletion was similar across treatment groups (1.7–1.9/100 patient-years) but was higher with empagliflozin 10 mg and 25 mg vs. placebo in participants aged 75 years or older (3.2 and 3.0 vs. 2.3/100 patient-years, respectively). The rates of bone fractures, cancer events, renal AEs, venous thromboembolic events, hepatic injury, acute pancreatitis, lower limb amputations, and diabetic ketoacidosis were similar across treatment groups. Conclusion This analysis of pooled safety data based on more than 15,000 patient-years’ exposure supports a favorable benefit–risk profile of empagliflozin in patients with T2DM. Funding Boehringer Ingelheim Pharma GmbH. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0573-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sven Kohler
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, 55216, Ingelheim, Germany.
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH, Birkendorfer Strasse 65, 88400, Biberach an der Riss, Germany
| | - Hristo Iliev
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, 55216, Ingelheim, Germany
| | - Stefan Kaspers
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, 55216, Ingelheim, Germany
| |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW There are currently over 40 different drugs in 12 distinct classes approved in the USA to treat patients with type 2 diabetes mellitus. This review summarizes our current knowledge about potential side effects of antidiabetic therapy and attempts to apply it to a clinical practice setting. RECENT FINDINGS Given the heterogeneity of both the patients and the disease, it is mathematically impossible to test every available drug combination in long-term outcome, prospective, randomized blinded fashion before a clinician decides which agent(s) to prescribe to a specific patient in a given situation. To complicate the clinician's dilemma, there is lack of available tests to predict an individual's response or propensity to side effects. Further, the data available are derived from small, short-term registration trials and typically focus on relative rather than absolute risks of any given drug and do not address the potential adverse outcomes if a patient's diabetes remains untreated. Clinicians have to personalize their choice of antidiabetic therapy based both on the specific characteristics of the patient in front of them (stage of diabetes and its complications, overall health status, socioeconomic situation, other medications present, desire to improve control of diabetes, etc.) and the current knowledge about the relative and absolute balance of benefits and risks of any individual medication in that specific patient. It has to be recognized that this requires constant re-evaluation as database of our experience with antidiabetic therapy expands.
Collapse
Affiliation(s)
- George Grunberger
- Grunberger Diabetes Institute, 43494 Woodward Avenue, suite 208, Bloomfield Hills, MI, 48302, USA.
- Internal Medicine and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA.
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
- Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| |
Collapse
|
43
|
Kim J, Chun J, Park JY, Hong SW, Lee JY, Kang JW, Hwang S, Ko SB, Im JP, Kim JS. Metronidazole-induced encephalopathy in a patient with Crohn's disease. Intest Res 2017; 15:124-129. [PMID: 28239323 PMCID: PMC5323302 DOI: 10.5217/ir.2017.15.1.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/02/2015] [Accepted: 07/22/2015] [Indexed: 12/27/2022] Open
Abstract
Metronidazole is a widely used antibiotic for the treatment of anaerobic bacterial infections. Metronidazole-induced encephalopathy (MIEP) is a rare but potentially reversible disease. The mechanism of MIEP remains unclear, and differences in the neurotoxic effects of oral versus intravenous (IV) metronidazole administration have not yet been determined. We report the case of a Crohn's disease (CD) patient who experienced encephalopathy immediately after a single IV dose of metronidazole following long-term exposure to the oral form of the drug. The 64-year-old man with intractable CD experienced a sudden change in mental status, aphasia, and muscle weakness after IV administration of metronidazole. He had previously taken metronidazole orally for 13 years and received intermittent IV metronidazole treatments for CD exacerbation. Brain magnetic resonance imaging (MRI) showed high-intensity signals in the bilateral medial thalamus and the midbrain and pontine tegmentum on fluid-attenuated inversion recovery images. After discontinuation of metronidazole, the high-intensity brain MRI signals resolved and the patient's mental status dramatically improved; however, the patient exhibited mild cognitive dysfunction 2 months after the onset of encephalopathy.
Collapse
Affiliation(s)
- Jihye Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yong Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Wook Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Young Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Woo Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
44
|
Abstract
OBJECTIVE To determine the frequency of medical problems, reason for referral/primary complaint, products used, medication-related problems, and polypharmacy in patients with spinal cord injury (SCI) seen at an interprofessional primary care mobility clinic. DESIGN Retrospective review of medical records of patients with SCI for patient visits between August 2012 and March 2013. METHODS Data were abstracted from medical records of patients with SCI. RESULTS Of 74 patients who presented to the clinic, 19 had an SCI. Mean age was 46.7 years and 74% were male. Most frequent medical problems were depression/anxiety (37%), osteoporosis/osteopenia (26%), hypertension (21%), dyslipidemia (21%), and osteoarthritis (21%). Most common presenting complaints were pain (23%) and bowel/bladder issues (13%). Most common medication-related problems were untreated conditions (41%), ineffective medications (21%), adverse drug reactions (18%), and under- and over-dosage (each 9%). Patients with SCI most frequently used products to treat pain (68%), constipation (42%), muscle spasm (42%), hypertension (42%), and depression (37%). When including natural health products, vitamins and minerals, polypharmacy was seen in 74% of patients with SCI (63% when limited to prescription and over-the-counter medications). For patients with SCI in whose care a pharmacist collaborated, a mean of 3.2 medication-related problems per patient were identified compared with 1 per patient when the pharmacist was not involved. CONCLUSION This study is the first to describe medication use, polypharmacy and medication-related problems in patients with SCI seen at an interprofessional primary care clinic. Use of high-risk medications, polypharmacy, and medication-related problems in patients with SCI suggest the need for collaborative interprofessional care that includes a pharmacist.
Collapse
Affiliation(s)
- Tejal Patel
- University of Waterloo, School of Pharmacy, Waterloo, ON, Canada,The Centre for Family Medicine, Kitchener, ON, Canada,Correspondence to: Tejal Patel, School of Pharmacy, University of Waterloo, 10A Victoria St. South, Kitchener, ON Canada N2G 1C5.
| | - Jamie Milligan
- The Centre for Family Medicine, Kitchener, ON, Canada,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Joseph Lee
- The Centre for Family Medicine, Kitchener, ON, Canada,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
45
|
Pranić S, Marušić A. Changes to registration elements and results in a cohort of Clinicaltrials.gov trials were not reflected in published articles. J Clin Epidemiol 2016; 70:26-37. [PMID: 26226103 DOI: 10.1016/j.jclinepi.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess effectiveness of legislative initiatives to stimulate public registration of trial results, we assessed adherence to protocol and results reporting, changes to registry, and publication data for randomized controlled trials (RCTs) after introduction of Food and Drug Administration Amendment Act (FDAAA). STUDY DESIGN AND SETTING Observational study of a cohort of ClinicalTrials.gov registered FDAAA-covered RCTs found through ClinicalTrials.gov between 2009 and 2012 and data from corresponding publications. WHO Minimum Data Set items were abstracted by one author and verified by the other author. RESULTS Among 81 eligible trials, most were industry-funded, with a drug intervention in parallel assignment. Secondary outcomes at the initial and last registration were omitted for 17% and 19.7% of RCTs, respectively. RCT registration changes mostly involved scientific title (18.8%). Inclusion criteria omission was most common (88%) in publications. Inferential statistical methods for primary and secondary outcomes matched between registry and publication for 53.4% and 28.6% of RCTs, respectively. Serious and other adverse events (AEs) that were absent for 23.8% and 4.8% of RCTs, respectively, were published as nonoccurring. CONCLUSION Discrepancies remain relatively high between registered and published outcomes, particularly regarding registered omissions in publications and concomitant reporting, nature of statistical method used, and reporting of AEs. This seriously undermines transparency of clinical trials and needs immediate attention of all stakeholders in health research.
Collapse
|
46
|
Kang X, Chen K, Li Y, Li J, D'Amico TA, Chen X. Personalized targeted therapy for esophageal squamous cell carcinoma. World J Gastroenterol 2015; 21:7648-58. [PMID: 26167067 PMCID: PMC4491954 DOI: 10.3748/wjg.v21.i25.7648] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/19/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
Esophageal squamous cell carcinoma continues to heavily burden clinicians worldwide. Researchers have discovered the genomic landscape of esophageal squamous cell carcinoma, which holds promise for an era of personalized oncology care. One of the most pressing problems facing this issue is to improve the understanding of the newly available genomic data, and identify the driver-gene mutations, pathways, and networks. The emergence of a legion of novel targeted agents has generated much hope and hype regarding more potent treatment regimens, but the accuracy of drug selection is still arguable. Other problems, such as cancer heterogeneity, drug resistance, exceptional responders, and side effects, have to be surmounted. Evolving topics in personalized oncology, such as interpretation of genomics data, issues in targeted therapy, research approaches for targeted therapy, and future perspectives, will be discussed in this editorial.
Collapse
|
47
|
Xu R, Wang Q. Large-scale automatic extraction of side effects associated with targeted anticancer drugs from full-text oncological articles. J Biomed Inform 2015; 55:64-72. [PMID: 25817969 DOI: 10.1016/j.jbi.2015.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/12/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Targeted anticancer drugs such as imatinib, trastuzumab and erlotinib dramatically improved treatment outcomes in cancer patients, however, these innovative agents are often associated with unexpected side effects. The pathophysiological mechanisms underlying these side effects are not well understood. The availability of a comprehensive knowledge base of side effects associated with targeted anticancer drugs has the potential to illuminate complex pathways underlying toxicities induced by these innovative drugs. While side effect association knowledge for targeted drugs exists in multiple heterogeneous data sources, published full-text oncological articles represent an important source of pivotal, investigational, and even failed trials in a variety of patient populations. In this study, we present an automatic process to extract targeted anticancer drug-associated side effects (drug-SE pairs) from a large number of high profile full-text oncological articles. We downloaded 13,855 full-text articles from the Journal of Oncology (JCO) published between 1983 and 2013. We developed text classification, relationship extraction, signaling filtering, and signal prioritization algorithms to extract drug-SE pairs from downloaded articles. We extracted a total of 26,264 drug-SE pairs with an average precision of 0.405, a recall of 0.899, and an F1 score of 0.465. We show that side effect knowledge from JCO articles is largely complementary to that from the US Food and Drug Administration (FDA) drug labels. Through integrative correlation analysis, we show that targeted drug-associated side effects positively correlate with their gene targets and disease indications. In conclusion, this unique database that we built from a large number of high-profile oncological articles could facilitate the development of computational models to understand toxic effects associated with targeted anticancer drugs.
Collapse
Affiliation(s)
- Rong Xu
- Medical Informatics Program, Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH 44106, United States.
| | - QuanQiu Wang
- ThinTek, LLC, Palo Alto, CA 94306, United States.
| |
Collapse
|
48
|
Skolnick J, Gao M, Roy A, Srinivasan B, Zhou H. Implications of the small number of distinct ligand binding pockets in proteins for drug discovery, evolution and biochemical function. Bioorg Med Chem Lett 2015; 25:1163-70. [PMID: 25690787 DOI: 10.1016/j.bmcl.2015.01.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 01/05/2023]
Abstract
Coincidence of the properties of ligand binding pockets in native proteins with those in proteins generated by computer simulations without selection for function shows that pockets are a generic protein feature and the number of distinct pockets is small. Similar pockets occur in unrelated protein structures, an observation successfully employed in pocket-based virtual ligand screening. The small number of pockets suggests that off-target interactions among diverse proteins are inherent; kinases, proteases and phosphatases show this prototypical behavior. The ability to repurpose FDA approved drugs is general, and minor side effects cannot be avoided. Finally, the implications to drug discovery are explored.
Collapse
Affiliation(s)
- Jeffrey Skolnick
- Center for the Study of Systems Biology, Georgia Institute of Technology, 250 14th St NW, Atlanta, GA 30318, USA.
| | - Mu Gao
- Center for the Study of Systems Biology, Georgia Institute of Technology, 250 14th St NW, Atlanta, GA 30318, USA
| | - Ambrish Roy
- Center for the Study of Systems Biology, Georgia Institute of Technology, 250 14th St NW, Atlanta, GA 30318, USA
| | - Bharath Srinivasan
- Center for the Study of Systems Biology, Georgia Institute of Technology, 250 14th St NW, Atlanta, GA 30318, USA
| | - Hongyi Zhou
- Center for the Study of Systems Biology, Georgia Institute of Technology, 250 14th St NW, Atlanta, GA 30318, USA
| |
Collapse
|
49
|
Lipscombe LL, Austin PC, Alessi-Severini S, Blackburn DF, Blais L, Bresee L, Filion KB, Kawasumi Y, Kurdyak P, Platt RW, Tamim H, Paterson JM. Atypical antipsychotics and hyperglycemic emergencies: multicentre, retrospective cohort study of administrative data. Schizophr Res 2014; 154:54-60. [PMID: 24581419 DOI: 10.1016/j.schres.2014.01.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/28/2014] [Accepted: 01/30/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies. METHOD We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian provinces and the UK Clinical Practice Research Datalink. Hospitalizations for hyperglycemic emergencies (hyperglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state) were compared between new users of risperidone (reference), and new users of olanzapine, other atypical antipsychotics, and typical antipsychotics. We used propensity scores with inverse probability of treatment weighting and proportional hazard models to estimate the site-specific hazard ratios of hyperglycemic emergencies in the year following drug initiation separately for adults under and over age 66 years. Site-level results were pooled using meta-analytic methods. RESULTS Among 725,489 patients, 55% were aged 66+years; 5% of younger and 19% of older patients had pre-existing diabetes. Hyperglycemic emergencies were rare (1-2 per 1000 person years), but more frequent in patients with pre-existing diabetes (6-12 per 1000 person years). We did not find a significant difference in risk of hyperglycemic emergencies with initiation of olanzapine versus risperidone; however heterogeneity existed between sites. The risk of an event was significantly lower with other atypical (99% quetiapine) compared to risperidone use in older patients [adjusted hazard ratio, 95% confidence interval (CI): 0.69, 0.53-0.90]. CONCLUSIONS Risk for hyperglycemic emergencies is low after initiation of antipsychotics, but patients with pre-existing diabetes may be at greater risk. The risk appeared lower with the use of quetiapine in older patients, but the clinical significance of the findings requires further study.
Collapse
Affiliation(s)
- Lorraine L Lipscombe
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; Women's College Hospital, Women's College Research Institute, Department of Medicine, University of Toronto, 790 Bay St, Toronto, ON M5G 1N8, Canada.
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Silvia Alessi-Severini
- Faculty of Pharmacy, Apotex Centre, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada
| | - David F Blackburn
- College of Pharmacy & Nutrition, University of Saskatchewan, 110 Science Place, Saskatoon, SK S7N 5C9, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC H3T 1J4, Canada
| | - Lauren Bresee
- Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, McGill University, Ross Pavillion, 687 avenue des Pins Ouest, Montreal, QC H3A 1A1, Canada; Lady Davis Research Institute at the Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Yuko Kawasumi
- Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, 217-2176 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, ON M5T 1R8, Canada
| | - Robert W Platt
- Departments of Epidemiology, Biostatistics, and Occupational Health, and of Pediatrics, McGill University, Purvis Hall, 1020 Pine Ave. West, Montreal, QC H3A 1A2, Canada
| | - Hala Tamim
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada; School of Kinesiology and Health Science, York University, 341-4700 Keele St, Toronto, ON M3J 1P3, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| |
Collapse
|
50
|
Pardal PK, John TR, Rathee SP. Venlafaxine induced hypertension:a case report. Indian J Psychiatry 2001; 43:360-1. [PMID: 21407890 PMCID: PMC2956251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Venlafaxine is a newly introduced antidepressant that is clinically different from other antidepressants, possesses a slightly different mechanism of action and may have unique efficacy properties and a faster onset of action. A case of venlafaxine induced severe hypertension is reported to highlight the need for caution while using this drug.
Collapse
Affiliation(s)
- P K Pardal
- LT. COL. P.K. PARDAL, MD., Psychiatrist, Department of Psychiatry, Command Hospital (WC), Chandimandir-134107
| | | | | |
Collapse
|