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2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.
Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM.
American Association of Poison Control Centers, 3201 New Mexico Avenue, Ste. 330, Washington, DC 20016, USA.
PMID: 16140178 [PubMed - indexed for MEDLINE]
Topiramate-induced psychosis.
Kober D, Gabbard GO.
Publication Types:
PMID: 16055782 [PubMed - indexed for MEDLINE]
Serotonin toxicity associated with concomitant use of linezolid.
Bergeron L, Boule M, Perreault S.
Department of Pharmacy, Centre Hospitalier de Quebec, Canada. luc.bergeron@chuq.qc.ca
OBJECTIVE: To report 2 cases of serotonin toxicity (ST) associated with concomitant use of linezolid and serotonergic drugs and review previously published case reports. CASE SUMMARIES: Case 1. A 38-year-old white female with cystic fibrosis treated with venlafaxine 300 mg/day for one year was prescribed linezolid 600 mg intravenously every 12 hours for treatment of methicillin-resistant Staphylococcus aureus (MRSA) pulmonary infection. She displayed symptoms of ST 8 days after the introduction of linezolid. The venlafaxine dosage was decreased to 150 mg/day, and symptoms gradually abated over 36 hours. Case 2. A 37-year-old male with multiple myeloma received citalopram 40 mg/day and trazodone 150 mg/day for anxiety-related disorders. Linezolid treatment with 600 mg orally twice daily was instituted for MRSA cellulitis. The following day, the patient developed anxiety, panic attacks, tremors, tachycardia, and hypertension that persisted throughout linezolid treatment. Symptoms finally waned 5 days after linezolid treatment was stopped. DISCUSSION: The symptoms observed in our patients were consistent with Sternbach's criteria for ST. A review of published case reports showed a short time to onset of symptoms following the introduction of linezolid, generally within 1-3 days. Also of note is the use of relatively high dosages of serotonergic drugs. Use of the Naranjo probability scale indicated a possible relationship between the use of linezolid and the occurrence of ST in both cases. CONCLUSIONS: Clinicians should pay special attention to patients treated with serotonergic drugs, especially those receiving dosages in the higher end of the normal range who are prescribed linezolid, and consider tapering or reducing the dosage of serotonergic drugs for the duration of antibiotic therapy.
Publication Types:
PMID: 15827071 [PubMed - indexed for MEDLINE]
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Generalized seizure and toxic epidermal necrolysis following levofloxacin exposure.
Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG.
University of Toronto, Scarborough, Ontario, Canada.
OBJECTIVE: To report the case of a ciprofloxacin-allergic patient who developed a generalized tonic-clonic seizure and toxic epidermal necrolysis (TEN) following a single dose of levofloxacin. CASE SUMMARY: An 87-year-old white woman was admitted to the hospital following a transient episode of unresponsiveness that had been accompanied by flailing of her limbs. Approximately 4 hours earlier, she had developed a pruritic rash on her trunk and limbs, and 3 hours before this had taken a first dose of levofloxacin. The fluoroquinolone had been prescribed for treatment of an upper respiratory tract infection. She had developed a skin rash approximately 3 years earlier following ciprofloxacin prescribed for a urinary tract infection. On admission, the patient had a normal neurologic examination. She was mildly hypomagnesemic (serum magnesium 1.7 mg/dL), with no other electrolyte imbalances present. Skin biopsy confirmed TEN. The lesions progressed to involve 30% of the body surface area and were managed with polymyxin B and gramicidin cream. Levofloxacin was discontinued on admission, and no anticonvulsants were prescribed. The woman remained seizure-free at discharge one week later. DISCUSSION: Generalized tonic-clonic seizures are a rare complication of levofloxacin therapy. TEN following levofloxacin use has, to our knowledge, as of March 28, 2005, been previously reported only once. The seizure and TEN were probably induced by levofloxacin as corroborated by the Naranjo probability scale. We believe that the previous adverse dermatologic reaction to ciprofloxacin sensitized our patient to levofloxacin. CONCLUSIONS: These rare adverse reactions to levofloxacin, involving disparate organ systems, can occur simultaneously. A previous dematologic adverse reaction to a fluoroquinolone can sensitize a patient to more severe adverse reactions (with onset after only a single dose of the subsequent fluoroquinolone). Further fluoroquinolone use should be avoided in such patients.
Publication Types:
PMID: 15827068 [PubMed - indexed for MEDLINE]
Folic acid calls to poison centers in Texas, 1998-2003.
Forrester MB.
Epidemiology and Surveillance Disease Unit, Texas Department of State Health Services, 1100 W 49th Street, Austin, TX 78756, USA. mathias.forrester@dshs.state.tx.us
Folic acid (folacin, pteroylglutamic acid) is a monoglutamate form of the water-soluble B vitamin that is involved in the synthesis of nucleotides and amino acids and the normal maturation of red blood cells. This study describes the folic acid calls received by Texas poison centers during 1998-2003. There were 650 calls involving folic acid as a single-ingredient product, of which 55.1% were human exposures. Children age <6 years accounted for 80.1% of the human exposures. Patients were managed outside of the health care facilities in 92.1% of the cases. Of those cases with a known medical outcome, 94.8% had no clinical effects. This study found folic acid exposures reported to poison centers were unlikely to have more than minor adverse affects.
PMID: 16138734 [PubMed - indexed for MEDLINE]
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Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine.
Koski A, Vuori E, Ojanpera I.
Department of Forensic Medicine, Laboratory of Toxicology, University of Helsinki, Finland. anna.koski@iki.fi
Drugs and alcohol often occur together in fatal poisonings, complicating the process of determining the cause of death. Especially when found in concentrations generally regarded as toxic but not lethal, the question arises whether the combination of sublethal amounts was the likely cause of death. In this study, we examined poisoning deaths involving amitriptyline, propoxyphene and promazine, which are, after benzodiazepines, the most frequently occurring drugs in Finnish alcohol-related poisonings. From the forensic toxicology database, covering the years 1995-2002, we extracted 332 fatal poisonings, calculated median blood alcohol and drug concentrations, constructed concentration-concentration and concentration-response curves and evaluated the significance of the presence of therapeutic amounts of benzodiazepines. Median amitriptyline and propoxyphene concentrations were lower in alcohol-related cases than in clean drug poisonings. Correspondingly, the median blood alcohol concentrations in all drug-related poisonings were 1.5-2.2 mg/g lower than that found in clean alcohol poisonings. Alcohol concentration proved to be a more sensitive indicator of alcohol-drug interaction than drug concentration. This result suggests that when alcohol is present, relatively small overdoses of the studied drugs may result in fatal poisoning. In this context, fatal drug and alcohol concentrations and the issue of determining the most important agent in fatal drug-alcohol intoxications are discussed.
PMID: 16138729 [PubMed - indexed for MEDLINE]
Allergic reaction to depot risperidone but not to oral risperidone.
Reeves RR, Mack JE.
Publication Types:
PMID: 16013916 [PubMed - indexed for MEDLINE]
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Risperidone in psychotic combat-related posttraumatic stress disorder: an open trial.
Kozaric-Kovacic D, Pivac N, Muck-Seler D, Rothbaum BO.
National Centre for Psychotrauma, Department of Psychiatry, Dubrava University Hospital, Zagreb, Croatia.
RATIONALE: Psychotic symptoms that frequently occur in combat-related posttraumatic stress disorder (PTSD) complicate its pharmacotherapy. We hypothesized that war veterans with psychotic PTSD, resistant to prior antidepressant treatment, would respond well to 6 weeks of treatment with the atypical antipsychotic risperidone, given as a monotherapy. METHOD: Twenty-six male war veterans with psychotic PTSD (DSM-IV) completed the 6-week inpatient treatment with risperidone (2-4 mg/day) during the period from November 1999 through December 2002. The primary outcome measure was change from baseline to endpoint (6 weeks) in Positive and Negative Syndrome Scale (PANSS) total and subscale scores. Secondary outcome measures were changes in PTSD Interview (PTSD-I) and Clinical Global Impressions-Severity of Illness scale (CGI-S) total and subscale scores. Clinical improvement was assessed by CGI-S, CGI-Improvement scale, and Patient Global Impression of Improvement scale, while adverse events were recorded by Drug-Induced Extrapyramidal Symptoms Scale. RESULTS: Treatment with risperidone for either 3 or 6 weeks in an open trial significantly reduced total and subscales scores on the PANSS and on the PTSD-I and CGI-S when compared to baseline scores in patients with psychotic PTSD. CONCLUSION: Our preliminary data from the open trial indicate that risperidone decreased most of the psychotic and PTSD symptoms. Psychotic PTSD patients, unresponsive to antidepressant treatment, improved significantly after treatment for either 3 or 6 weeks with risperidone.
Publication Types:
PMID: 16013909 [PubMed - indexed for MEDLINE]
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Quality of life in schizophrenia: a multicenter, randomized, naturalistic, controlled trial comparing olanzapine to first-generation antipsychotics.
Silva de Lima M, de Jesus Mari J, Breier A, Maria Costa A, Ponde de Sena E, Hotopf M.
Eli Lilly Brazil, Sao Paulo, Brazil. limama@lilly.com
OBJECTIVE: To assess the effectiveness of olanzapine for treating schizophrenia and to assess if olanzapine promotes a better quality of life than first-generation antipsychotics (FGAs). METHOD: Multicenter, naturalistic, randomized controlled study, comparing olanzapine with FGAs, at hospitalization and during a 9-month follow-up. Outcome assessors were blind to the allocated drug. The dose of antipsychotic was determined by doctors according to their clinical practice routines. Data collection was performed from April 1999 to August 2001. RESULTS: 197 patients with DSM-IV-diagnosed schizophrenia were allocated to olanzapine (N = 104) and FGA (N = 93). Patients taking olanzapine showed greater improvements in Positive and Negative Syndrome Scale (PANSS) negative symptoms (mean difference = 2.3, 95% CI = 0.6 to 4.1) and general psychopathology (mean difference = 4.0, 95% CI = 0.8 to 7.2) sub-scales and fewer incidences of tardive dyskinesia (RR = 2.4, 95% CI = 1.4 to 4.2, p < .0001). Olanzapine was also associated with greater improvement in a number of health-related quality-of-life outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey, including physical functioning (mean difference = 6.6, 95% CI = 1.2 to 11.9), physical role limitations (mean difference = 13.7, 95% CI = 3.0 to 24.3), and emotional role limitations (mean difference = 12.1, 95% CI = 0.7 to 23.5). Patients taking olanzapine gained significantly more weight during the trial than patients taking FGAs, with a correspondent endpoint increase in the body mass index (BMI) of 28.7 versus 25.3 (p < .001). CONCLUSION: Compared with FGAs, olanzapine has advantages in terms of improvements of negative symptoms and quality of life. It is also associated with fewer incidences of tardive dyskinesia and greater increases in weight and BMI. These findings are highlighted by the naturalistic approach adopted in this trial.
Publication Types:
PMID: 16013897 [PubMed - indexed for MEDLINE]
Comment in:
Recognition and management of complications of new recreational drug use.
Ricaurte GA, McCann UD.
Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. Ricaurte@jhmi.edu
Use of illicit drugs in clubs and large dance parties (so-called raves) is a burgeoning cultural trend. Such recreational drug use is associated with several medical complications, both acute and longlasting. Although few, if any, of the drugs currently used in recreational venues are truly new, their patterns and context of use have changed (a great deal in some instances). For some of these substances, this cultural repackaging of the drug experience has resulted in various medical disorders that have previously gone undocumented. This review aims to help treating physicians recognise and manage complications associated with the use of new drugs in clubs, including methylenedioxymethamfetamine, ephedrine, gamma-hydroxybutyrate; gamma-butyrolactone, 1,4-butanediol, flunitrazepam, ketamine, and nitrites. We also alert researchers to specific toxic effects of club-drugs on which more basic information is needed.
Publication Types:
PMID: 15964451 [PubMed - indexed for MEDLINE]
Unintentional deaths from drug poisoning by urbanization of area--New Mexico, 1994-2003.
Centers for Disease Control and Prevention (CDC).
New Mexico experienced an increase in poisoning deaths during the 1990s and in 2002 was the state with the highest death rate (14.1 per 100,000 population) from unintentional poisoning, more than twice the national rate (6.1). The majority of these unintentional poisoning deaths were caused by ingestion of drugs, including illicit, prescription, and over-the-counter drugs. New Mexico is geographically diverse, with communities ranging from urban centers to sparsely populated counties. To examine the relationship between the types of drugs causing poisoning deaths and the levels of urbanization where the decedents resided, the New Mexico Department of Health analyzed data provided by the New Mexico Office of the Medical Investigator (OMI) for 1994-2003. All counties in New Mexico were classified as metropolitan or micropolitan statistical areas, or as nonstatistical areas, by using 2001-2002 population estimates in accordance with 2003 Office of Management and Budget (OMB) classifications. This report summarizes the results of that analysis, which indicated that deaths from illicit-drug poisoning were twice as likely to occur in metropolitan areas as nonmetropolitan areas (i.e., micropolitan and nonstatistical areas combined). However, deaths from prescription-drug poisoning were most likely to occur in micropolitan and nonstatistical areas. Investigation of drug-poisoning deaths by level of urbanization can be useful to public health programs to prevent unintentional drug-poisoning deaths.
PMID: 16151371 [PubMed - indexed for MEDLINE]
Comment on:
Hepatitis A--the price of progress.
Di Giammarino L, Dienstag JL.
Publication Types:
PMID: 16135841 [PubMed - indexed for MEDLINE]
Comment in:
An outbreak of hepatitis A associated with green onions.
Wheeler C, Vogt TM, Armstrong GL, Vaughan G, Weltman A, Nainan OV, Dato V, Xia G, Waller K, Amon J, Lee TM, Highbaugh-Battle A, Hembree C, Evenson S, Ruta MA, Williams IT, Fiore AE, Bell BP.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
BACKGROUND: In November 2003, a large hepatitis A outbreak was identified among patrons of a single Pennsylvania restaurant. We investigated the cause of the outbreak and factors that contributed to its unprecedented size. METHODS: Demographic and clinical outcome data were collected from patients with laboratory confirmation of hepatitis A, and restaurant workers were tested for hepatitis A. A case-control study was conducted among patrons who dined at the restaurant between October 3 and October 6, 2003. Sequence analysis was performed on a 315-nucleotide region of viral RNA extracted from serum specimens. RESULTS: Of 601 patients identified, 3 died; at least 124 were hospitalized. Of 425 patients who recalled a single dining date at the restaurant, 356 (84 percent) had dined there between October 3 and October 6. Among 240 patients in the case-control study, 218 had eaten mild salsa (91 percent), as compared with 45 of 130 controls (35 percent) (odds ratio, 19.6; 95 percent confidence interval, 11.0 to 34.9) for whom data were available. A total of 98 percent of patients and 58 percent of controls reported having eaten a menu item containing green onions (odds ratio, 33.3; 95 percent confidence interval, 12.8 to 86.2). All restaurant workers were tested, but none were identified who could have been the source of the outbreak. Sequences of hepatitis A virus from all 170 patients who were tested were identical. Mild salsa, which contained green onions grown in Mexico, was prepared in large batches at the restaurant and provided to all patrons. CONCLUSIONS: Green onions that were apparently contaminated before arrival at the restaurant caused this unusually large foodborne outbreak of hepatitis A. The inclusion of contaminated green onions in large batches that were served to all customers contributed to the size of the outbreak. Copyright 2005 Massachusetts Medical Society.
PMID: 16135833 [PubMed - indexed for MEDLINE]
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