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Items 1 - 13 of 13 |
One page. |
Acute hepatotoxicity caused by repaglinide.
Nan DN, Hernandez JL, Fernandez-Ayala M, Carrascosa M.
Publication Types:
PMID: 15545689 [PubMed - indexed for MEDLINE]
 
Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms.
Smalligan R, Cole J, Brito N, Laing GD, Mertz BL, Manock S, Maudlin J, Quist B, Holland G, Nelson S, Lalloo DG, Rivadeneira G, Barragan ME, Dolley D, Eddleston M, Warrell DA, Theakston RD.
Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.
OBJECTIVE: To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers. DESIGN: Randomised double blind comparative trial of three antivenoms. SETTING: Shell, Pastaza, southeastern Ecuador. PARTICIPANTS: 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. INTERVENTION: One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. MAIN OUTCOME MEASURES: Permanent restoration of blood coagulability after 6 and 24 hours. RESULTS: The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. CONCLUSIONS: All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15539665 [PubMed - indexed for MEDLINE]
Latrodectus tredecimguttatus spider bite.
Calista D, Venturelli C, Morri M.
Department of Dermatology, and Entomology Unit, 'M.Bufalini' Hospital, viale Ghirotti 286, 47023 Cesena, Italy. calista@iol.it
Publication Types:
PMID: 15327564 [PubMed - indexed for MEDLINE]
Serum IgE elevation correlates with blood lead levels in battery manufacturing workers.
Heo Y, Lee BK, Ahn KD, Lawrence DA.
Catholic University of Daegu, Department of Occupational Health, 330 Kumrak 1-ri, Hayang-eup, Kyongsan-si, Kyongbuk, Korea.
Lead (Pb), an occupational and environmental toxicant, is known to induce immunomodulatory effects resulting in lowered resistance to infectious micro-organisms and altered levels of immunoglobulins in humans. Preferential activation of type-2 helper T cells and inhibition of type-1 T-cell activation is considered a cellular mechanism for the Pb-induced immune alteration, which has not been investigated well in humans. Lead's influence on in vivo balance between type-1 and type-2 activities was assessed among workers exposed to Pb through battery manufacturing in Korea. Serum IgE levels were significantly higher in the workers with a blood Pb level (PbB) of > or = 30 microg/dL than in the workers with a PbB of < 30 microg/dL. Furthermore, the serum IgE concentrations significantly correlated with PbB although no significant relationship between PbB and serum interleukin-4 or interferon gamma levels was observed. The present study indicates that elevation of IgE levels may be an immunologic index for Pb-induced in vivo toxicities, potentially involved with progression of various allergic diseases in humans.
PMID: 15222397 [PubMed - indexed for MEDLINE]
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A case of human insulin allergy induced by short-acting and intermediate-acting insulin but not by long-acting insulin.
Adachi A, Fukunaga A, Horikawa T.
Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Japan. faadachi@dd.iij4u.or.jp
A 66-year-old woman suffering from pollinosis developed generalized urticaria after injection of intermediate-acting insulin for diabetes mellitus. She had human insulin-specific IgE, and in skin tests was positive for human recombinant insulin and negative for additives. Uniquely, she reacted to fast-acting and slow-acting insulin but not to long-acting insulin. We further confirmed that human insulin preparations could stimulate her peripheral basophils to release a significant amount of histamine. Genetically generated human insulin analogs, aspart and lispro, induced positive skin tests and histamine release from basophils. She was recommended to use a long-acting insulin preparation and was free from symptoms thereafter.
Publication Types:
PMID: 15304187 [PubMed - indexed for MEDLINE]
A case of prolonged peyote-induced psychosis resolved by sleep.
Lu BY, Woofter C, Escalona R.
Publication Types:
PMID: 15491253 [PubMed - indexed for MEDLINE]
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Neuroleptic malignant syndrome in a child treated with an atypical antipsychotic.
Abu-Kishk I, Toledano M, Reis A, Daniel D, Berkovitch M.
Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Israel.
Neuroleptic malignant syndrome (NMS) is an uncommon potentially fatal side effect of neuroleptic drugs, characterized by movement disorder, altered mental status and autonomic instability. A single dose of clotiapine was administered to an 11-year old male with acute psychosis. The previously healthy child had signs consistent with NMS including hyperthermia, hypertension, motor and mental changes. Repeat examination performed two weeks later, demonstrated that while his hyperthermia subsided, his mental status deteriorated. Olanzapine was administered, after which the child had hyperthermia, dystonia and more pronounced restlessness, once again consistent with NMS. He developed respiratory failure and was intubated and mechanically ventilated. Lorazepam, dantrolene and bromocriptine were administered as treatment of possible NMS. His mental condition, movement disorder and autonomic dysfunction improved significantly. Two weeks later, the patient was discharged in good general condition without the need for any ongoing medical treatment. There are only few case reports of NMS in children treated with olanzapine, an atypical antipsychotic. In children, caution must be exercised when prescribing antipsychotics, particularly atypical antipsychotics as these drugs may cause NMS. Because of the low incidence of NMS, a high index of suspicion is needed to identify cases so prompt treatment can be undertaken.
Publication Types:
PMID: 15533033 [PubMed - indexed for MEDLINE]
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Position paper: whole bowel irrigation.
[No authors listed]
Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting greater than two hours after drug ingestion. WBI should be considered for patients who have ingested substantial amounts of iron as the morbidity is high and there is a lack of other options for gastrointestinal decontamination. The use of WBI for the removal of ingested packets of illicit drugs is also a potential indication. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients or in patients with medical conditions that may be further compromised by its use. The concurrent administration of activated charcoal and WBI may decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain. A review of the literature since the preparation of the 1997 Whole Bowel Irrigation Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
Publication Types:
PMID: 15533024 [PubMed - indexed for MEDLINE]
Accumulated lead exposure and risk of age-related cataract in men.
Schaumberg DA, Mendes F, Balaram M, Dana MR, Sparrow D, Hu H.
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Mass 02215-1204, USA. dschaumberg@rics.bwh.harvard.edu
CONTEXT: Low-level lead exposure may increase the risk for a number of chronic age-related diseases. Several studies have documented the presence of lead in lenses with cataract. The intrusion of lead into the lens may alter lens redox status and cause protein conformational changes that decrease lens transparency. OBJECTIVE: To determine the relationship of cumulative lead exposure with the development of cataract. DESIGN, SETTING, AND PARTICIPANTS: Tibial (cortical) and patellar (trabecular) bone lead levels were measured by K x-ray fluorescence between 1991 and 1999 in a subset of participants in the Normative Aging Study (NAS), a Boston-based longitudinal study of aging in men. Among the first 795 NAS participants to have bone lead levels measured, we reviewed eye examination data (collected routinely every 3-5 years) for the period after the bone lead measurements were taken. We limited the population to men aged 60 years and older who had sufficient eye examination information available (n = 642). Blood lead levels were also measured. MAIN OUTCOME MEASURES: Cataract assessment was done while masked to the lead level results. A participant was considered to have cataract if there was documentation for either eye of cataract surgery or a cataract graded clinically as 3+ or higher on a 4-point scale. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as estimates of the magnitude and significance of the relationship of lead exposure with cataract, in logistic regression models. RESULTS: The mean age of the study participants was 69 years and cataract was identified in 122 men. The age-adjusted OR (95% CI) for cataract for men in the highest vs lowest quintile of tibia lead level was 2.68 (1.31-5.50). Further adjustment for pack-years of cigarette smoking, diabetes, blood lead levels, and intake of vitamin C, vitamin E, and carotenoids resulted in an OR of 3.19 (95% CI, 1.48-6.90). For patella lead level, there was an increased risk of cataract in the highest vs lowest quintile (OR, 1.88; 95% CI, 0.88-4.02), but the trend was not significant (P = .16). Blood lead levels, more indicative of short-term exposure levels, were not significantly associated with cataract (OR, 0.89; 95% CI, 0.46-1.72; P = .73). CONCLUSIONS: These epidemiological data suggest that accumulated lead exposure, such as that commonly experienced by adults in the United States, may be an important unrecognized risk factor for cataract. This research suggests that reduction of lead exposure could help decrease the global burden of cataract.
PMID: 15585735 [PubMed - indexed for MEDLINE]
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Etiology of pruritic papular eruption with HIV infection in Uganda.
Resneck JS Jr, Van Beek M, Furmanski L, Oyugi J, LeBoit PE, Katabira E, Kambugu F, Maurer T, Berger T, Pletcher MJ, Machtinger EL.
Department of Dermatology and Institute for Health Policy Studies, University of California, San Francisco, School of Medicine, CA 94143-0363, USA. resneck@itsa.ucsf.edu
CONTEXT: A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. OBJECTIVE: To determine the etiology of PPE occurring in HIV-infected individuals. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. MAIN OUTCOME MEASURES: Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. RESULTS: Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites. CONCLUSIONS: Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients.
PMID: 15572719 [PubMed - indexed for MEDLINE]
Contagious acute gastrointestinal infections.
Musher DM, Musher BL.
Medical Service, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center, and the Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA. daniel.musher@med.va.gov
Publication Types:
PMID: 15575058 [PubMed - indexed for MEDLINE]
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Medical mystery--the answer.
Wickless SC, Shwayder TA.
Publication Types:
PMID: 15564558 [PubMed - indexed for MEDLINE]
Comment on:
Venom immunotherapy.
Houliston L, Brookes I, Mallon DF.
Publication Types:
PMID: 15537914 [PubMed - indexed for MEDLINE]
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