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Ziprasidone-related tardive dyskinesia.
Keck ME, Muller MB, Binder EB, Sonntag A, Holsboer F.
Publication Types:
PMID: 14702272 [PubMed - indexed for MEDLINE]
Comment on:
Comment: combination risperidone and SSRI-induced serotonin syndrome.
Isbister GK.
Publication Types:
PMID: 14519058 [PubMed - indexed for MEDLINE]
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Seizure secondary to citalopram overdose.
Cuenca PJ, Holt KR, Hoefle JD.
Madigan-University of Washington Emergency Medicine Residency, Madigan Army Medical Center, Fort Lewis, Washington, USA.
Selective serotonin reuptake inhibitors (SSRIs) are widely used in the community for treating many forms of mental illness. Citalopram, a newer generation SSRI, is commonly prescribed but, despite its low toxicity profile, has a danger of seizure and dysrhythmias in overdose. This case report documents the key aspects in treatment of a citalopram overdose resulting in a seizure and an episode of supraventricular tachycardia (SVT). The seizure was successfully treated with benzodiazepines. The SVT was terminated with administration of adenosine. We review the literature and make recommendations on treatment of citalopram overdose.
PMID: 14980340 [PubMed - in process]
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The effect of Cyclosporine A on survival time in salicylate-poisoned rats.
Katz KD, Curry SC, Brooks DE, Gerkin RD.
Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, Arizona, USA.
Salicylate (SAL) produces mitochondrial membrane permeability transition (MPT) with resultant oxidative phosphorylation uncoupling. Cyclosporine A (CSA) inhibits SAL-induced MPT. This study determined if CSA pretreatment prolonged survival time in SAL-poisoned rats. Twenty-nine rats were randomized to receive pre-treatment with either 30 mg/kg CSA or equal volume of control diluent intraperitoneally (i.p.). Four hours later, all rats received 1700 mg/kg sodium salicylate i.p. Survival time, whole blood CSA ([CSA]), and serum sodium ([Na]), glucose and SAL ([SAL]) concentrations were determined. The results showed median survival time for controls was 18 min (95% CI 14-22 min) and for CSA animals was 14 min (95% CI 13-15 min). Univariate and multivariate analyses and Cox proportional hazard regression revealed CSA treatment was associated with higher [SAL], which was associated with shortened survival times. The CSA group also demonstrated shorter survival times for a given [SAL]. In conclusion, CSA pre-treatment shortened survival in SAL-poisoned rats.
PMID: 14980335 [PubMed - in process]
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Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose.
Martyres RF, Clode D, Burns JM.
841 Rathdowne Street, North Carlton, VIC 3054, Australia. raymond.martyres@mdgp.com.au
OBJECTIVE: To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. DESIGN: Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. SUBJECTS: Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. MAIN OUTCOME MEASURES: Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. RESULTS: Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death. CONCLUSIONS: An apparent increase in "doctor shopping" in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.
PMID: 14984339 [PubMed - in process]
An outbreak of Plasmodium vivax malaria in Far North Queensland, 2002.
Hanna JN, Ritchie SA, Eisen DP, Cooper RD, Brookes DL, Montgomery BL.
Tropical Public Health Unit, Queensland Health, PO Box 1103, Cairns, QLD 4870, Australia. Jeffrey_hanna@health.qld.gov.au
OBJECTIVE: To describe an outbreak of Plasmodium vivax malaria in Far North Queensland in 2002. DESIGN: Epidemiological and entomological investigations; molecular analyses of the infecting parasites. MAIN OUTCOME MEASURES: Case characteristics, adult and larval mosquito counts at the outbreak location, haplotyping of parasites in blood samples from different cases determined through sequencing of AMA1 and MSP1 genes. RESULTS: A man with imported P. vivax malaria stayed at a camping ground 95 km north of Cairns in late September 2002. This led to an outbreak of P. vivax malaria in 10 adults who stayed at the camping ground in October. Large numbers of Anopheles farauti sensu lato larvae were present in stagnant pools in a creek at the camping ground, and many adult mosquitoes were collected nearby. Not only had most of the infected patients been exposed to mosquitoes at night, they were also less likely than other campers to have used insect repellents appropriately (odds ratio, 0.01; P < 0.001). Two different haplotypes of P. vivax, only one of which was detected in the imported case, were involved in the outbreak. CONCLUSIONS: Although local transmission of malaria is rare in Far North Queensland, the risk is probably higher in the dry season (September to December). Campers need to be aware of the increased risk of mosquito-borne diseases. Sexual recombination of multiple gametocytes in mosquitoes infected by the imported case may have resulted in the two haplotypes of P. vivax involved in the outbreak.
PMID: 14709124 [PubMed - indexed for MEDLINE]
Comment in:
Parallel infusion of hydrocortisone +/- chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites.
Gawarammana IB, Kularatne SA, Dissanayake WP, Kumarasiri RP, Senanayake N, Ariyasena H.
Faculty of Medicine, Peradeniya University, Sri Lanka.
OBJECTIVE: To investigate the efficacy of continuous infusion of hydrocortisone with or without chlorpheniramine bolus against early adverse reactions to polyspecific antivenom. DESIGN AND SETTING: Prospective, double-blind, randomised, placebo-controlled trial at General Hospital, Anuradhapura, Sri Lanka. SUBJECTS: 52 patients with snake envenoming were randomised to receive infusion of hydrocortisone (Group A), hydrocortisone with chlorpheniramine bolus (Group B) or placebo (Group C) during the administration of antivenom. INTERVENTION: Hydrocortisone 1000 mg in 300 mL of normal saline infusion was started 5 min before and continued for 30 min after antivenom. Chlorpheniramine 10 mg intravenous bolus dose was given 5 min after commencement of antivenom. MAIN OUTCOME MEASURES: Occurrence and severity of adverse reactions to antivenom. RESULTS: Adverse reactions were observed in 80% (12/15) of Group A, 52% (11/21) of Group B, and 81% (13/16) of Group C. Reactions were mild or moderate except in two patients. A significant reduction in the number of adverse reactions was seen in Group B compared with the placebo group (difference, 29 percentage points; 95% CI, 0.2 to 58 percentage points). There was no significant difference between Group A and the placebo group. CONCLUSION: Prophylaxis with a parallel hydrocortisone infusion alone is ineffective in reducing the occurrence of acute adverse reaction to antivenom serum, but combining it with chlorpheniramine seems efficacious.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14709123 [PubMed - indexed for MEDLINE]
Comment on:
Antivenom efficacy, safety and availability: measuring smoke.
Cheng AC, Winkel KD.
Improving safety is important, but in many regions antivenoms are not available.
Publication Types:
PMID: 14709119 [PubMed - indexed for MEDLINE]
Acute chemical emergencies.
Kales SN, Christiani DC.
Cambridge Health Alliance, Department of Medicine, Occupational and Environmental Health, Harvard Medical School, Cambridge, Mass 02139, USA. skales@challiance.org
Publication Types:
PMID: 14973213 [PubMed - indexed for MEDLINE]
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