Age Ageing. 2021 Nov 17:afab196. doi: 10.1093/ageing/afab196. Online ahead of print.

ABSTRACT

BACKGROUND: identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA).

OBJECTIVE: to assess the performance of those triggers in detecting DRA.

DESIGN: retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial.

SETTINGS: four European medical centres.

SUBJECTS: multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up.

METHODS: the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole.

RESULTS: of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 [0.62-0.69].

CONCLUSIONS: this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.

PMID:34794171 | DOI:10.1093/ageing/afab196

J Oncol Pharm Pract. 2021 Nov 18:10781552211056856. doi: 10.1177/10781552211056856. Online ahead of print.

ABSTRACT

INTRODUCTION: Capecitabine is an orally administered prodrug that converts preferentially to 5-fluorouracil within tumors, resulting in enhanced concentrations of 5-fluorouracil in tumor tissue. The use of capecitabine has shown efficacy in the metastatic setting for breast cancer, and more recently, efficacy as adjuvant therapy for triple-negative breast cancer (TNBC). Capecitabine has been shown to be well tolerated with minimal side effects, but the incidence of leukoencephalopathy is rare with a risk of less than one percent.

CASE REPORT: We report on a 34-year-old female patient with left TNBC, moderately differentiated, stage IIB that experienced symptoms of neurotoxicity following initiation of adjuvant chemotherapy with capecitabine.

MANAGEMENT AND OUTCOME: Naranjo Algorithm Assessment score of nine indicated patient had drug-induced leukoencephalopathy leading to discontinuation of capecitabine and resolution of the neurotoxicity symptoms.

DISCUSSION: Early detection of capecitabine-induced neurotoxicity by magnetic resonance imaging is crucial as symptoms may be reversible to the condition that capecitabine is immediately discontinued.

PMID:34791927 | DOI:10.1177/10781552211056856

Dermatol Ther. 2021 Nov 17:e15207. doi: 10.1111/dth.15207. Online ahead of print.

ABSTRACT

Drug induced bullous pemphigoid (DBP) associated to biologics administered for psoriasis is rare. DBP has been described especially in association with anti TNF-α drugs and anti IL12 and 23, but never in relation to guselkumab (anti IL23). We report the case of a 76-year-old male patient with severe psoriasis (PASI 20), presenting with generalized tense bullae and erosions after being recently switched to guselkumab therapy. Histology and direct immunofluorescence confirmed the suspect of bullous pemphigoid (BP). Guselkumab administration was interrupted, low-dose oral corticosteroid therapy was introduced and after only 1 month remission was obtained with no new lesions appearing. As outlined in the presented case, DBP's onset typically follows the introduction of a new drug in patients taking polypharmacy. Also, DBP may spontaneously regress after discontinuation of the triggering drug and it responds very rapidly to steroid therapy. Up to date, DBP has been described after biological therapy for psoriasis in 11 patients, following administration of ustekinumab, efalizumab, etanercept, secukinumab and adalimumab. Conversely, DBP after guselkumab therapy for psoriasis has never been reported in published studies. We highlight the need to face and document increasing, though rare, side effects of biologic therapies, as new biologic molecules are being constantly developed and administered to psoriatic patients, to promptly interrupt treatment when needed.

PMID:34791777 | DOI:10.1111/dth.15207

Eur Radiol Exp. 2021 Nov 17;5(1):49. doi: 10.1186/s41747-021-00249-7.

ABSTRACT

BACKGROUND: We investigated whether levosimendan prevents contrast medium nephrotoxicity with glycerol aggravation in rats.

METHODS: Forty-eight Wistar albino rats were assigned to eight groups (n = 6 × 8). No medication was administered to group I (controls); glycerol (intramuscular injection of 25% glycerol, 10 mL/kg) group II; intravenous iohexol 10 mL/kg to group III; glycerol and iohexol to group IV; iohexol and intraperitoneal levosimendan 0.25 mg/kg to group V; glycerol, iohexol, and levosimendan 0.25 mg/kg to group VI; iohexol and levosimendan 0.5 mg/kg to group VII; and glycerol, iohexol, and levosimendan 0.5 mg/kg to group VIII. One-day water withdrawal and glycerol injection prompted renal damage; iohexol encouraged nephrotoxicity; levosimendan was administered 30 min after glycerol injection and continued on days 2, 3, and 4. The experiment was completed on day 5. Serum blood urea nitrogen (BUN) and creatinine levels, superoxide dismutase (SOD) activity, glutathione (GSH), malondialdehyde (MDA) levels, tumour necrosis factor-α (TNF-α), nuclear factor kappa ß (NFK-ß), interleukin 6 (IL-6), and histopathological marks were assessed. One-way analysis of variance and Duncan's multiple comparison tests were used.

RESULTS: Levosimendan changed serum BUN (p = 0.012) and creatinine (p = 0.018), SOD (p = 0.026), GSH (p = 0.012), and MDA (p = 0.011). Levosimendan significantly downregulated TNF-α (p = 0.022), NFK-ß (p = 0.008), and IL-6 (p = 0.033). Histopathological marks of hyaline and haemorrhagic cast were improved in levosimendan-injected groups.

CONCLUSION: Levosimendan showed nephroprotective properties due to its vasodilator, oxidative distress decreasing and inflammatory cytokine preventing belongings.

PMID:34786647 | DOI:10.1186/s41747-021-00249-7

Am Fam Physician. 2021 Nov 1;104(5):519-520.

NO ABSTRACT

PMID:34783508

J Assoc Physicians India. 2021 Nov;69(11):11-12.

ABSTRACT

Prescribing is always a risky proposition with a varied degree of vulnerability embedded in the act. It is therefore important to do a perfect balancing in favor of benefit against harm. Deprescribing is the planned and supervised process of dose reduction or stopping of prescribed medications, aimed at correcting inappropriate polypharmacy and improving patient outcomes. Informed reconciliation for potential deprescribing need should be a norm in all patients receiving many medications for multiple chronic comorbidities and is best done in partnership with the prescribing physician. Judicious deprescribing through clinical pharmacological review ensures better patient outcomes. We present here a case series from our experience in clinical pharmacology outpatients' department (OPD), highlighting how de-prescribing helps achieving better patient outcomes.

PMID:34781620

Am J Trop Med Hyg. 2021 Nov 15:tpmd210600. doi: 10.4269/ajtmh.21-0600. Online ahead of print.

ABSTRACT

The management of visceral leishmaniasis (VL) in HIV-infected patients is complex because of high mortality rates, toxic drug-related side effects, and a high risk of treatment failure and relapse. We report a case of active chronic VL in an HIV-1-infected woman presenting multiple secondary VL episodes over 7 years leading to massive splenomegaly and blood transfusion-dependent anemia despite several treatment courses and secondary prophylaxis. The patient was finally successfully treated with rescue treatment based on intravenous pentamidine. One year after discontinuation of pentamidine the patient presented complete clinical and parasitological response. In patients with active chronic VL, rescue treatment with intravenous pentamidine can be effective and should be considered as rescue treatment.

PMID:34781255 | DOI:10.4269/ajtmh.21-0600

Eur J Cancer. 2021 Nov 12;159:205-214. doi: 10.1016/j.ejca.2021.09.040. Online ahead of print.

ABSTRACT

BACKGROUND: Hormone-resistant HER2-negative or triple-negative advanced breast cancers (ABC) are routinely treated with paclitaxel chemotherapy. LY2780301 is a dual inhibitor of p70 ribosomal protein S6 kinase and AKT. The TAKTIC study aimed at exploring the combination of paclitaxel and LY2780301 in this population.

METHODS: In this multicentric phase Ib/II trial, we enrolled patients with HER2-negative ABC, with (phase IB) or without (phase II) prior to cytotoxic treatment for advanced disease. Oral LY2780301 was administered once daily in combination with intravenous weekly paclitaxel. Primary endpoints were to determine the recommended phase II dose (RP2D) of the combination of LY2780301 with weekly paclitaxel (phase Ib), and to estimate a 6 months objective response rate (ORR) (phase II) in patients with HER2-negative ABC, both in the overall patient population and in cases with activation of the PI3K/AKT pathway (PI3KAKT+).

RESULTS: A total of 51 patients were enrolled; RP2D was LY2780301 500 mg QD+ paclitaxel 80 mg/m2. Main drug-related adverse events noted in phase Ib included neuropathy (75% of patients, grade 3-4 in 8%), asthenia (58% of patients, no grade 3-4), and ungual toxicity (50% of patients, grade 3-4 in 25%). They were similar in the phase II part, except that 14% of patients experienced pneumonia (grade 3-4 in 6%). In the phase II part, 6-month ORR in the overall population and in PI3KAKT+ subgroup were, respectively, 63.9% [48.8-76.8] and 55% [35-73.7].

CONCLUSION: Combining LY2780301 and weekly paclitaxel in patients with HER2-negative ABC was feasible with preliminary evidence of efficacy in both the overall population and the PI3KAKT+ subgroup.

TRIAL REGISTRATION ID: NCT01980277.

PMID:34781168 | DOI:10.1016/j.ejca.2021.09.040

Am J Ophthalmol. 2021 Nov 12:S0002-9394(21)00578-X. doi: 10.1016/j.ajo.2021.11.002. Online ahead of print.

ABSTRACT

PURPOSE: No approved therapies directly target retinal ganglion cells (RGCs) for neuroprotection or neuroenhancement in glaucoma. Recombinant human nerve growth factor (rhNGF) has been shown to promote RGC survival and function in animal models of optic neuropathy. Here we evaluate safety, tolerability, and efficacy of short-term, high-dose rhNGF eye drops versus placebo in a cohort of glaucoma patients.

METHODS: This study is a single-center, randomized, double-masked, vehicle-controlled, parallel group study designed to assess safety and tolerability as well as short-term neuroenhancement of structure and function (Clinicaltrials.gov NCT02855450). Sixty open-angle glaucoma patients were randomized 40:20 to receive either 180 μg/ml rhNGF or vehicle control eye drops in both eyes, three times daily for 8 weeks, with a 24-week post-treatment follow-up. One eye was officially selected as the study eye, although both eyes were studied and dosed. Primary endpoints were safety, as assessed through adverse events, and tolerability, as assessed through patient reported outcomes. Secondary outcome measures included best corrected visual acuity (BCVA), Humphrey visual field (HVF), electroretinogram (ERG), and optical coherence tomography (OCT) of retinal nerve fiber layer (RNFL) thickness at baseline, after 8 weeks of treatment, and at 4 and 24 weeks after treatment (12- and 32-weeks total).

RESULTS: Of the 60 randomized subjects, 23 were female (38%) and the average age was 66.1 years. Through week 32, there were no treatment-related serious adverse events, including no unexpectedly severe progression of optic neuropathy, no adverse events affecting ocular function or pressure, and no drug-related systemic toxicity. Topical high-dose rhNGF was tolerated well, with low level of symptom burden mainly eliciting periocular ache (in 52% of treated, 5% of placebo) and only 3 patients (7.5%) discontinuing treatment due to discomfort, out of whom 1 patient (2.5%) prematurely withdrawing from the study. There were no statistically significant differences in global indices of HVF, and no meaningful differences in total, quadrant, or clock-hour mean RNFL thickness between the groups, although both of these function and structure measures showed non-significant trends towards significance in favor of rhNGF. Real-world participant data was used to generate an estimate of cohort size needed to power subsequent studies.

CONCLUSIONS: rhNGF is safe and tolerable in a topical 180 μg/ml formulation. Although no statistically significant short-term neuroenhancement was detected in this trial, given the strong effects of NGF in preclinical models and trends detected in this study, analysis for efficacy in a neuroprotection trial is warranted.

PMID:34780798 | DOI:10.1016/j.ajo.2021.11.002

Front Oncol. 2021 Oct 28;11:721764. doi: 10.3389/fonc.2021.721764. eCollection 2021.

ABSTRACT

AIM: The effect of recombinant human thrombopoietin (rhTPO) is largely unknown in lower-risk myelodysplastic syndrome (LR-MDS). This study aimed at investigating the safety and efficacy of rhTPO in patients with LR-MDS.

METHODS: LR-MDS patients receiving stanozolol (2 mg, t.i.d.) and supportive care alone (non-rhTPO) or additional rhTPO were enrolled in this study prospectively. rhTPO was given at 15,000 U (q.d.) for 7 days/month for at least 3 months. Patients stopped rhTPO if the platelet count was higher than 50 × 109/L or had no effects after 3 months of treatment. The overall response (OR), complete response (CR), platelet response, side effects, clone evolution, and clinical outcome were evaluated.

RESULT: Thirty-five patients were enrolled: 20 (57.1%) patients in the rhTPO group and 15 (42.9%) patients in the non-rhTPO group. The demographic and baseline characteristics were balanced between the two groups. Platelet response was higher at 1 and 2 months as compared with that in the non-rhTPO group (p = 0.006 and p = 0.001, respectively). Meanwhile, the rhTPO group had a shorter time to achieve a platelet transfusion-free state compared with the non-rhTPO group (p = 0.034). Hematologic response was higher at 1 and 2 months compared with that in the non-rhTPO group (p = 0.006 and p = 0.001, respectively). There was no significant difference in the overall response or complete response at 1, 2, 3, 6, and 12 months between the two groups. One patient in the rhTPO group evolved into higher-risk MDS at 9 months. No significant difference in disease progression, infection, gastrointestinal disorders, or drug-related liver/renal injuries was found between the two groups (p > 0.05).

CONCLUSION: Adding short-term rhTPO can accelerate the early platelet response and decrease platelet transfusion, with no obvious side effects.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04324060?cond=NCT04324060&draw=2, identifier NCT04324060.

PMID:34778037 | PMC:PMC8581467 | DOI:10.3389/fonc.2021.721764

BMC Health Serv Res. 2021 Nov 13;21(1):1231. doi: 10.1186/s12913-021-07260-z.

ABSTRACT

BACKGROUND: The prediction of the real-world cost of adverse drug reactions (ADRs) has historically relied on the data from randomized controlled trials (RCT). However, trial conditions do not always reflect the real-world applications of pharmaceutical products; hence, they may not accurately portray the actual risks of ADRs associated with them. The objective of this study is two-fold: (a) demonstrate whether and how post-market and RCT ADR data could lead to different conclusions for a set of drugs of interest, and (b) evaluate the potential economic impact of the post-market ADRs associated with those drugs.

METHODS: We selected two TNF-α inhibitor biologics, infliximab and adalimumab, and used the Canada Vigilance Adverse Reaction (CVAR) online database as a source of post-market ADR data. Adverse reaction data from RCTs were obtained from ClinicalTrials.gov . Direct healthcare costs associated with adverse reactions were obtained from Canadian Institute for Health Information (CIHI) or Interactive Health Data Application, Alberta. We calculated post-market ADR rates and compared them with those found in the randomized controlled trials of these two drugs. Using the post-market data, we estimated the costs associated with serious ADRs from three perspectives: patient, health system, and societal.

RESULTS: For both drugs, the post-market and RCT data exhibited significantly different adverse reaction rates for several different clinical outcomes. As a general trend, more serious adverse reactions, such as death, appeared to have a higher rate in post-market applications compared to the clinical trials. The estimated average annual economic burden of the severe adverse reaction outcomes ranged from $10 million to $20 million for infliximab and $6 million to $19 million for adalimumab.

CONCLUSIONS: The frequency and severity of post-market adverse reactions associated with pharmaceutical products may significantly differ from those detected in the clinical trials. Despite possible methodological differences, this is due to the fact that post-market data reflect the externalities of the real-world that are absent in RCTs. The economic burden of adverse reactions can be substantial, and the cost calculated using post-market data is better reflective of the cost of ADRs in the real-world.

PMID:34774053 | DOI:10.1186/s12913-021-07260-z

Int J Mol Sci. 2021 Oct 29;22(21):11786. doi: 10.3390/ijms222111786.

ABSTRACT

Amiodarone is a potent antiarrhythmic drug and displays substantial liver toxicity in humans. It has previously been demonstrated that amiodarone and its metabolite (desethylamiodarone, DEA) can inhibit mitochondrial function, particularly complexes I (CI) and II (CII) of the electron transport system in various animal tissues and cell types. The present study, performed in human peripheral blood cells, and one liver-derived human cell line, is primarily aimed at assessing the concentration-dependent effects of these drugs on mitochondrial function (respiration and cellular ATP levels). Furthermore, we explore the efficacy of a novel cell-permeable succinate prodrug in alleviating the drug-induced acute mitochondrial dysfunction. Amiodarone and DEA elicit a concentration-dependent impairment of mitochondrial respiration in both intact and permeabilized platelets via the inhibition of both CI- and CII-supported respiration. The inhibitory effect seen in human platelets is also confirmed in mononuclear cells (PBMCs) and HepG2 cells. Additionally, amiodarone elicits a severe concentration-dependent ATP depletion in PBMCs, which cannot be explained solely by mitochondrial inhibition. The succinate prodrug NV118 alleviates the respiratory deficit in platelets and HepG2 cells acutely exposed to amiodarone. In conclusion, amiodarone severely inhibits metabolism in primary human mitochondria, which can be counteracted by increasing mitochondrial function using intracellular delivery of succinate.

PMID:34769217 | PMC:PMC8583998 | DOI:10.3390/ijms222111786

J Am Board Fam Med. 2021 Nov-Dec;34(6):1246-1248. doi: 10.3122/jabfm.2021.06.210120.

ABSTRACT

BACKGROUND: Methotrexate is a folate analog prescribed for varying disease with weekly administration as opposed to daily. Dosing errors can prove clinically significant and sometimes fatal.

METHODS: We performed a retrospective poison center review of methotrexate calls between 2009 and 2019.

RESULTS: Of 111 human-related poison center calls, most patients taking methotrexate were women ages 41 to 80 years old and were prescribed methotrexate for rheumatoid arthritis. Eighty-eight (79%), and 41 (36%) were admitted to the hospital. Thirty-one (75%) of hospitalized patients received leukovorin treatment for their exposure. Two patients died from methotrexate dosing errors.

DISCUSSION: Most methotrexate accidental ingestions reported to poison centers result from dose frequency errors. However, we note a higher incidence of unintentional therapeutic errors (79% vs 13.7%) than reported in the National Poison Data System in 2019. Patients are often hospitalized for lab monitoring, and many receive leucovorin.

CONCLUSIONS: Most methotrexate calls to our poison center resulted from taking the drug more often than prescribed. Efforts may focus on patient education, physician or pharmacist monitoring during initiation, improved dispensing devices, or weekly drug dispensing.

PMID:34772781 | DOI:10.3122/jabfm.2021.06.210120

Drug Ther Bull. 2021 Nov 12:dtb-2021-000059. doi: 10.1136/dtb.2021.000059. Online ahead of print.

ABSTRACT

Overview of: Ghannad M, Yang B, Leeflang M, et al A randomized trial of an editorial intervention to reduce spin in the abstract's conclusion of manuscripts showed no significant effect. J Clin Epidemiol 2021;130:69-77.

PMID:34772742 | DOI:10.1136/dtb.2021.000059

Curr Med Res Opin. 2021 Nov 12:1-34. doi: 10.1080/03007995.2021.2003105. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the 4-week effectiveness and tolerability of an add-on treatment with oral high dose methocarbamol (MET) vs long-acting oral opioid analgesics (LAO) in patients with non-specific low back pain (nsLBP) poorly responsive to recommended 1st line treatments.

METHODS: Analysis of anonymized, propensity score-matched real-world data from the German Pain e-Registry, using a sequential non-inferiority superiority approach, for adult outpatients with nsLBP who had initiated treatment with MET or LAO between January 1st, 2018, and December 31st, 2019 (EUPAS identifier: 38484). The primary effectiveness variable was the absolute change of the average 24-hr. pain intensity index (PIX). Safety was assessed by incidence of physician-confirmed drug-related adverse events (DRAEs), and DRAEs leading to discontinuation.

RESULTS: Propensity score-matched data were analyzed for 374 patients treated with MET and 374 patients treated with LAO. Mean ± SD (median) MET dose over the 4-week evaluation period was 2390.4 ± 1980 (3000) mg and 69.6 ± 25.9 (60) mg morphine equivalent for LAO. With 25.8 ± 11.4 (median 26, 95%-CI: 24.5-27.1) vs. 11.4 ± 6.8 (median 11; 95%-CI: 10.6-12.2) mm VAS, absolute 4-week improvement vs. baseline was superior for MET vs. LAO [p < 0.001; effect size 1.6; least square mean difference 14.4 (95%-CI: 13.4-15.3)]. Percentages of patients with a PIX improvement ≥ MCID was 81.8 vs. 24.6% [p < 0.001; OR: 13.8 (9.7-19.6), RR: 4.0 (3.2-5.0), NNT: 1.7]. A significantly lower number of patients treated with MET vs. LAO reported DRAEs in response to study medication: 36 (9.6%) vs. 139 (37.2%; p < 0.001; NNT 4), and 9 patients treated with MET (2.4%) vs. 86 (23.0%) treated with LAO discontinued treatment in response to these DRAEs (p < 0.001; NNT: 5).

CONCLUSION: 4-week add-on treatment with MET in patients with nsLBP who showed an inadequate response to recommended 1st line treatments is superior effective to LAO and significantly better tolerated.

PMID:34767467 | DOI:10.1080/03007995.2021.2003105

Curr Pain Headache Rep. 2021 Nov 11;25(11):72. doi: 10.1007/s11916-021-00986-9.

ABSTRACT

PURPOSE OF REVIEW: Indomethacin is an important medication in the headache medicine toolbox given its utility for both of the diagnosis and treatment of several primary headache disorders. Despite its prevalence in earlier rheumatologic studies, the possibility of drug-induced headache is a not commonly discussed in headache literature.

RECENT FINDINGS: Herein, we describe a case of drug-induced headache after indomethacin trial for the treatment of an undifferentiated trigeminal autonomic cephalgia. Recognition of indomethacin-induced headache has important implications for patient education and interpreting the response to indomethacin when used both as a therapeutic and as a diagnostic tool.

PMID:34766203 | DOI:10.1007/s11916-021-00986-9

OTA Int. 2021 Sep 15;4(4):e147. doi: 10.1097/OI9.0000000000000147. eCollection 2021 Dec.

ABSTRACT

OBJECTIVES: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients.

DESIGN: Retrospective cohort study.

SETTING: Academic Tertiary Care Center.

PATIENTS/PARTICIPANTS: Series of 209 patients with fragility hip fractures treated operatively from April 1, 2019 to September 30, 2019.

INTERVENTION: Eligible patients received 4 intravenous doses of TXA. Some patients missed doses and only received between 1 and 3 doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture > 48 hours prior to presentation.

MAIN OUTCOME MEASURES: Red blood cell transfusion; major adverse vascular events; minor drug related adverse events.

RESULTS: Patients who received all 4 doses of TXA (n = 70) had a significantly lower transfusion rate compared to those who did not receive any TXA (7.1% vs 28.1%, P = .003). There were no significant differences in the number of major or minor adverse events between the 2 groups.

CONCLUSIONS: The use of a standardized TXA protocol of 4 doses significantly decreases transfusion rates in eligible patients undergoing operative intervention for fragility hip fracture without an increase in major or minor adverse events. These findings are even more pronounced in patients with decreased preoperative hemoglobin.Level of Evidence: Prognostic Level III.

PMID:34765898 | PMC:PMC8575430 | DOI:10.1097/OI9.0000000000000147

BMJ Case Rep. 2021 Nov 11;14(11):e246788. doi: 10.1136/bcr-2021-246788.

ABSTRACT

Idiosyncratic drug-induced agranulocytosis is a rare life-threatening adverse reaction characterised by an absolute neutrophil count <500 cells/μL of blood. Nitrofurantoin has been associated with haematological adverse events, but few agranulocytosis cases worldwide have been reported. We present a case of a 68-year-old woman who presented with fever and agranulocytosis following treatment with nitrofurantoin. Extensive workup for agranulocytosis, including a bone marrow aspirate, was unremarkable. Treatment with nitrofurantoin was discontinued, which led to a complete recovery of the complete blood count. This case stresses the importance of monitoring treatments, given that widely used drugs are not free from severe adverse reactions.

PMID:34764131 | DOI:10.1136/bcr-2021-246788

J Clin Res Pediatr Endocrinol. 2021 Nov 12. doi: 10.4274/jcrpe.galenos.2021.2021.0205. Online ahead of print.

ABSTRACT

Central precocious puberty (CPP) is defined by the appearance of secondary sexual signs in girls younger than 8 years of age or the onset of menarche before the age of 10. Gonadotropin-releasing hormone analogs (GnRHa) are the most effective therapy in CPP. Drug-induced hypersensitivity vasculitis is an inflammation of blood vessels due to the use of several pharmacologic agents. We present the first pediatric case of vasculitis induced by Decapeptyl. 7 years and 3 months old girl admitted to Pediatric Endocrinology outpatient clinic with a complaint of premature breast development. The patient diagnosed CPP with her physical examination and laboratory findings and tripoteline acetate (Decapeptyl) treatment initiated. She experienced multiple rushes on her body with a mild abdominal pain and high temperature after 8 hours from the second dose of Decapeptyl administration. She hospitalized with the diagnosis of drug-induced vasculitis and single dose of iv metyl-prednisolone 1 mg/kg treatment and oral cetirizine initiated. Her blood and urine analysis revealed no other organ involvement rather than skin. On the third day, all the purpuric lesions started to resolve and completely disappeared on the 6th day. Hereby, we described first pediatric case of CPP experiencing vasculitis due to tripotelin injection. Her treatment for PCC was switched to Depot Leuprolide acetate and she continued her treatment for 2 years uneventfully. It should be kept in mind that in pediatric PCC patients who develop side effects like cutaneous vasculitis, the treatment may be continued by changing the preparation.

PMID:34763385 | DOI:10.4274/jcrpe.galenos.2021.2021.0205

Drug Ther Bull. 2021 Nov 10:dtb-2021-000060. doi: 10.1136/dtb.2021.000060. Online ahead of print.

ABSTRACT

Overview of: Veazie S, Peterson K, Ansari Y, et al. Fludrocortisone for orthostatic hypotension. Cochrane Database of Syst Revs 2021;5:10.1002/14651858.CD012868.pub2.

PMID:34758971 | DOI:10.1136/dtb.2021.000060