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De Sensi, Francesco, Gennaro Miracapillo, Luigi Addonisio, Marco Breschi, Alberto Cresti, Pasquale Baratta, Francesco Paneni y Ugo Limbruno. "Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What’s the Culprit?" Medicina 55, n.º 8 (20 de agosto de 2019): 505. http://dx.doi.org/10.3390/medicina55080505.
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Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation.
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Wesley, Sarah F., Aya Haggiagi, Kiran T. Thakur y Philip L. De Jager. "Neurological Immunotoxicity from Cancer Treatment". International Journal of Molecular Sciences 22, n.º 13 (23 de junio de 2021): 6716. http://dx.doi.org/10.3390/ijms22136716.
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The emergence of immune-based treatments for cancer has led to a growing field dedicated to understanding and managing iatrogenic immunotoxicities that arise from these agents. Immune-related adverse events (irAEs) can develop as isolated events or as toxicities affecting multiple body systems. In particular, this review details the neurological irAEs from immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell immunotherapies. The recognition and treatment of neurological irAEs has variable success, depending on the severity and nature of the neurological involvement. Understanding the involved mechanisms, predicting those at higher risk for irAEs, and establishing safety parameters for resuming cancer immunotherapies after irAEs are all important fields of ongoing research.
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Soldatos, Theodoros G. y David B. Jackson. "Adverse Event Circumstances and the Case of Drug Interactions". Healthcare 7, n.º 1 (19 de marzo de 2019): 45. http://dx.doi.org/10.3390/healthcare7010045.
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Adverse events are a common and for the most part unavoidable consequence of therapeutic intervention. Nevertheless, available tomes of such data now provide us with an invaluable opportunity to study the relationship between human phenotype and drug-induced protein perturbations within a patient system. Deciphering the molecular basis of such adverse responses is not only paramount to the development of safer drugs but also presents a unique opportunity to dissect disease systems in search of novel response biomarkers, drug targets, and efficacious combination therapies. Inspired by the potential applications of this approach, we first examined adverse event circumstances reported in FAERS and then performed a molecular level interrogation of cancer patient adverse events to investigate the prevalence of drug-drug interactions in the context of patient responses. We discuss avoidable and/or preventable cases and how molecular analytics can help optimize therapeutic use of co-medications. While up to one out of three adverse events in this dataset might be explicable by iatrogenic, patient, and product/device related factors, almost half of the patients in FAERS received multiple drugs and one in four may have experienced effects attributable to drug interactions.
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Kirkpatrick, Peter J., Piotr Smielewski, Marek Czosnyka, David K. Menon y John D. Pickard. "Near-infrared spectroscopy use in patients with head injury". Journal of Neurosurgery 83, n.º 6 (diciembre de 1995): 963–70. http://dx.doi.org/10.3171/jns.1995.83.6.0963.
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✓ A multimodality recording system was used in 14 ventilated patients with closed head injury to assess the potential use of near-infrared spectroscopy (NIRS) in the neurointensive care unit. Signals of intracranial pressure, cerebral perfusion pressure, peripheral oxygen saturation, jugular venous saturation, and NIRS-derived changes in the chromophores of oxy- and deoxyhemoglobin were digitized and recorded. After a review of 886 hours of continuous monitoring, 376 hours were considered free from artifact and were entered for final analysis. In nine of the patients 38 events were recorded that demonstrated clear changes in cerebral perfusion pressure accompanied by hemodynamic changes in middle cerebral artery flow velocity (transcranial Doppler) and cortical perfusion (laser Doppler flowmetry). Near-infrared spectroscopy showed correlated changes in 37 events (97%) whereas jugular venous saturation monitoring registered only 20 (53%). There was associated peripheral oxygen desaturation in eight cases (21%), intracranial hypertension in 10 (26%), and cerebral hyperemia in eight (21%). The remaining 12 events (32%) appeared to be complex changes of uncertain origin. Iatrogenic factors were identified as causative in 14 cases (37%). The potential application of NIRS in adults and the importance of using multiple parameter recording systems in the interpretation of cerebral events are discussed.
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Burrin, Charlotte, Natasha Faye Daniels, Rudolf N. Cardinal, Catherine Hayhurst, David Christmas y Jorge Zimbron. "Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm". Case Reports in Psychiatry 2021 (27 de mayo de 2021): 1–8. http://dx.doi.org/10.1155/2021/6615723.
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Attempted suicide and deliberate self-harm are common and challenging presentations in the emergency department. A proportion of these patients refuse interventions and this presents the clinical, legal, and ethical dilemma as to whether treatment should be provided against their will. Multiple factors influence this decision. It is difficult to foresee the multitude and magnitude of complications that can arise once it has been decided to treat individuals who do not consent. This case illustrates a particularly complex chain of events that occurred after treating someone against their will who presented with self-harm and suicidal ideation. These consequences are contrasted with those of not intervening when similar situations arose with the same patient.
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Gabriel, Ciss Amadou, Dieng Papa Adama, Ba Papa Salmane, Gaye Magaye, Diatta Souleymane, Leye Mohamed, Fall Lamine et al. "A Case Report of Iatrogenic Pulmonary Artery Injury due to Chest-Tube Insertion Repaired under Cardiopulmonary Bypass". Case Reports in Medicine 2013 (2013): 1–2. http://dx.doi.org/10.1155/2013/590971.
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The authors presented a case of a 50-year-old patient with multiple trauma who suffered from the inadvertent cannulation of the main pulmonary artery at the second attempt of left chest drainage. Pulmonary artery injury has been suspected because early chest tube production was 2300 mL of blood. CT scan showed injury of the trunk of the pulmonary artery, left hemothorax, and suspect damage of the right branch of the pulmonary artery. That chest tube touched the posterior wall of ascending aorta. Surgical approach was median sternotomy. Exploration showed a perforation of the trunk of pulmonary artery without lesion of the right pulmonary branch and the posterior wall of the ascending aorta. The lesion was repaired under normothermic partial cardiopulmonary bypass. Postoperative period was free of events. Review of the literatures for this rare case report has been done.
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Jariwala, Pankaj, Gururaj Pramod Kulkarni, Dilip Gude, Hari Kishan Boorugu y Arshad Punjani. "Acute Psychological Stress, Coronary Artery Spasm, Iatrogenic Coronary Dissection, In-stent Restenosis, and Atherosclerosis: A Rare Association of Multiple Etiologies for Recurrent Acute Coronary Syndrome". Journal of the Practice of Cardiovascular Sciences 9, n.º 3 (2023): 195–99. http://dx.doi.org/10.4103/jpcs.jpcs_71_23.
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Abstract Nonobstructive coronary artery lesions are seen in two-thirds of patients with angina and verified ischemia using a stress test who undergo coronary angiography. Ischaemia with no obstructed coronary artery disease (INOCA) is becoming more well recognized as a significant medical illness due to its relationship to decreased quality of life and an increased risk of cardiac events. This association between acute coronary syndrome (ACS) and high levels of psychological stress has been thoroughly investigated, and it has been found to be substantial. The microvascular function of the coronary arteries is endothelium-dependent, and this plays a role in how the heart reacts to psychological stress. Although coronary artery spasm (CAS) is likely to play a role in the etiology of INOCA, it is frequently misdiagnosed and underreported. In this article, we discuss a case of a young woman who came with recurrent ACS related to CAS, which was exacerbated by iatrogenic coronary dissection due to the presence of arteria lusoria, an atherosclerotic coronary artery disease leading to in-stent restenosis of the previous stent.
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Ahmed, A. "Monitoring of blood clotting during bleeding". Infusion & Chemotherapy, n.º 3.2 (15 de diciembre de 2020): 12–13. http://dx.doi.org/10.32902/2663-0338-2020-3.2-12-13.
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Background. The risk of bleeding and thrombotic events should be weighed before, during and after surgery. To facilitate this process, it is advisable to ask yourself the following questions: if we start the operation now, will the bleeding develop? If we delay the intervention, will a thrombotic event occur? Are the patient’s antithrombotic drugs effective?
Objective. To describe the blood coagulation monitoring system.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Coagulopathy can be congenital and acquired, the latter including iatrogenic. The causes of congenital coagulopathies include hemophilia, von Willebrand factor deficiency, thrombocytopenia, and antiphospholipid syndrome. Antiplatelet drugs and direct oral anticoagulants are the main causes of iatrogenic coagulopathies. Other causes of acquired coagulopathies include hemostasis failure, disseminated intravascular coagulation syndrome, and post-surgical coagulopathies of various types. In order to treat bleeding in coagulopathies, desmopressin, tranexamic acid, coagulation factors, and protamine are administered. Laboratory tests needed to detect coagulopathies include prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, fibrinogen levels, and coagulation factors. The limitations of these tests include their non-dynamic nature, lack of ability to predict the risk of bleeding, time and financial costs, inability to understand the pathophysiological mechanism of bleeding. There may also be an error in the analysis due to the addition of citrate and calcium to the samples. Rapid tests to assess the hemostasis system include determination of activated coagulation time, Hepcon heparin monitoring system, thromboelastography and platelet mapping, platelet aggregometry using multiple electrodes, rotational thromboelastometry, and sonoreometry.
Conclusions. 1. For best results, coagulopathy should be anticipated, detected, and treated in a timely manner. 2. The strength of blood clots depends on platelets and fibrinogen. 3. It is advisable to use rapid tests to assess hemostasis and repeat them regularly, as bleeding and blood clotting are dynamic processes. 4. The effects of hemodilution, acid-base balance and temperature should be kept in mind.
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Edinoff, Amber N., Emily D. Ellis, Laura M. Nussdorf, Taylor W. Hill, Elyse M. Cornett, Adam M. Kaye y Alan D. Kaye. "Antipsychotic Polypharmacy-Related Cardiovascular Morbidity and Mortality: A Comprehensive Review". Neurology International 14, n.º 1 (17 de marzo de 2022): 294–309. http://dx.doi.org/10.3390/neurolint14010024.
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Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.
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Dong, Yimin, Belinda Sun y Achyut Bhattacharyya. "Refractory Duodenal Ulcer and Upper Gastrointestinal Bleeding Following Yttrium-90 Transarterial Radioembolization". American Journal of Clinical Pathology 152, Supplement_1 (11 de septiembre de 2019): S57. http://dx.doi.org/10.1093/ajcp/aqz113.050.
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Abstract Transarterial radioembolization (TARE) with Yttrium-90 (Y90) is widely used for management of primary or secondary liver malignancies that are not amenable to surgery. Nevertheless, complications of Y90 treatment, including rare events of gastric and duodenal ulceration and cirrhosis, may be critical. Here we report a case of a 79-year-old man who received Y90 TARE for metastatic neuroendocrine tumor to liver from bronchial primary and developed multiple iatrogenic GI complications. Following TARE, a gastroduodenal artery (GDA) coil was instituted to prevent migration of Y90 beads. One year following TARE, the patient presented with cirrhosis of unknown etiology, thrombocytopenia, and multiple episodes of upper gastrointestinal bleeding (UGB). Endoscopy demonstrated GDA coil eroding into duodenum through mucosal ulcer base. Three years following TARE, an emergent esophagogastroduodenoscopy was performed due to upper GI bleeding. The histopathologic examination of stomach and duodenum revealed mucosal hemorrhage, submucosal and serosal fibrosis, and chronic inflammation associated with Y90 intravascular beads. A cholecystectomy was performed for fibrotic gallbladder that showed chronic cholecystitis with cholelithiasis and intravascular Y90 beads. GDA coil was removed, which showed attached food material, bacterial colonies, and Candida spp. A subsequent liver biopsy showed previously treated area with Y90 beads, inflammation, and fibrosis in adjacent parenchyma. Due to rich vascularity, TARE is considered an ideal treatment choice for neuroendocrine tumor. GI ulceration is the most common complication, which occurs in less than 4% patients, and usually can be managed with proton pump inhibitor. A surgery should be performed upon failure of medical treatment. Radiation-associated fibrosis has been reported mainly in hepatocellular carcinoma patients, who often have cirrhosis before the procedure. To conclude, this is the first case report of Y90 TARE complications in multiple GI organs in a metastatic NET patient.
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Morris, Katrina A., John F. Golding, Patrick R. Axon, Shazia Afridi, Claire Blesing, Rosalie E. Ferner, Dorothy Halliday et al. "Bevacizumab in neurofibromatosis type 2 (NF2) related vestibular schwannomas: a nationally coordinated approach to delivery and prospective evaluation". Neuro-Oncology Practice 3, n.º 4 (7 de enero de 2016): 281–89. http://dx.doi.org/10.1093/nop/npv065.
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Abstract Background NF2 patients develop multiple nervous system tumors including bilateral vestibular schwannomas (VS). The tumors and their surgical treatment are associated with deafness, neurological disability, and mortality. Medical treatment with bevacizumab has been reported to reduce VS growth and to improve hearing. In addition to evaluating these effects, this study also aimed to determine other important consequences of treatment including patient-reported quality of life and the impact of treatment on surgical VS rates. Methods Patients treated with bevacizumab underwent serial prospective MRI, audiology, clinical, CTCAE-4.0 adverse events, and NFTI-QOL quality-of-life assessments. Tumor volumetrics were classified according to the REiNs criteria and annual VS surgical rates reviewed. Results Sixty-one patients (59% male), median age 25 years (range, 10–57), were reviewed. Median follow-up was 23 months (range, 3–53). Partial volumetric tumor response (all tumors) was seen in 39% and 51% had stabilization of previously growing tumors. Age and pretreatment growth rate were predictors of response. Hearing was maintained or improved in 86% of assessable patients. Mean NFTI-QOL scores improved from 12.0 to 10.7 (P < .05). Hypertension was observed in 30% and proteinuria in 16%. Twelve treatment breaks occurred due to adverse events. The rates of VS surgery decreased after the introduction of bevacizumab. Conclusion Treatment with bevacizumab in this large, UK-wide cohort decreased VS growth rates and improved hearing and quality of life. The potential risk of surgical iatrogenic damage was also reduced due to an associated reduction in VS surgical rates. Ongoing follow-up of this cohort will determine the long-term benefits and risks of bevacizumab treatment.
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Sühn, Thomas, Ajay Pandey, Michael Friebe, Alfredo Illanes, Axel Boese y Christoph Lohman. "Acoustic sensing of tissue-tool interactions – potential applications in arthroscopic surgery". Current Directions in Biomedical Engineering 6, n.º 3 (1 de septiembre de 2020): 595–98. http://dx.doi.org/10.1515/cdbme-2020-3152.
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AbstractArthroscopic surgery is a technically challenging but common minimally invasive procedure with a long learning curve and a high incidence of iatrogenic damage. These damages can occur due to the lack of feedback and supplementary information regarding tissue-instrumentcontact during surgery. Deliberately performed interactions can be used however to obtain clinically relevant information, e.g. when a surgeon uses the tactile feedback to assess the condition of articular cartilage. Yet, the perception of such events is highly subjective. We propose a novel proximally attached sensing concept applied to arthroscopic surgery to allow an objective characterization and utilization of interactions. It is based on acoustic emissions which originate from tissue-instrument-contact, that propagate naturally via the instrument shaft and that can be obtained by a transducer setup outside of the body. The setup was tested on its ability to differentiate various conditions of articular cartilage. A femoral head with varying grades of osteoarthritic cartilage was tapped multiple times ex-vivo with a conventional Veress needle with a sound transducer attached at the outpatient end. A wavelet-based processing of the obtained signals and subsequent analysis of distribution of spectral energy showed the potential of tool-tissue-interactions to characterize different cartilage conditions. The proposed concept needs further evaluation with a dedicated design of the palpation tool and should be tested in realistic arthroscopic scenarios.
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Almada, A., R. Simões, M. Constante, P. Casquinha y M. J. Heitor. "Psychogenic stuttering: A case and review". European Psychiatry 33, S1 (marzo de 2016): S386—S387. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1389.
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IntroductionStuttering is a speech disorder characterized by involuntary repetition, prolongation or cessation of a sound. This dysfluency may be developmental or acquired. Acquired dysfluency can be classified as neurogenic or psychogenic.ObjectivesThis case report aims to describe and discuss a case of psychogenic stuttering, providing an updated review on this disorder.MethodsIn and outpatient interviews were performed by Neurology and Psychiatry. Investigation to exclude organic causes included lab exams, electrocardiogram, electroencephalography, computed tomography scan and magnetic resonance imaging. A literature review in Science Direct database, with the keywords “psychogenic stuttering”, was also conducted.ResultsA 63-year-old man was admitted to the Beatriz Ângelo Hospital with an acute stuttering. Speech was characterized by the repetition of initial or stressed syllables, little affected by reading out loud or singing. Comprehension, syntaxes and semantic were not compromised, as weren’t sensory and motor abilities. During admission, stuttering characteristics changed. Multiple somatic complaints and stress prior to the onset and bizarre secondary behaviors were also detected. Work-up didn’t show an organic etiology for that sudden change. An iatrogenic etiology was considered, as sertraline and topiramate were started for depression 1 month before. However, the stuttering pattern, the negative results, the psychological and the social life events suggested a psychogenic etiology.ConclusionsPsychogenic stuttering finds its origin in psychological or emotional problems. It is best classified as a conversion reaction. The differential diagnosis between psychogenic and neurological stuttering can be challenging.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Alexander, Amanda, Michael Drumm, Jonathan Lamano, Rodrigo Javier, Kathleen McCortney, Rachel Weller Roska, Kirsten Burdett et al. "Abstract 522: Preoperative D-dimer and Tissue Factor activity predict postoperative venous thromboembolism in glioma patients". Cancer Research 82, n.º 12_Supplement (15 de junio de 2022): 522. http://dx.doi.org/10.1158/1538-7445.am2022-522.
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Abstract Background: Venous thromboembolism (VTE) is a debilitating and life-threatening condition that is common in patients with cancer, especially glioma. There are no widely-accepted antithrombotic prophylaxis guidelines for glioma patients, partly because of the risk of iatrogenic intracerebral hemorrhage. Effective VTE risk assessment models exist for other cancers, but not glioma. Our prior publications suggested a protective role of IDH1 mutations (IDHmut) against VTE, and a direct correlation between circulating Tissue Factor (TF), a procoagulant secreted by cancers, and VTE in glioma patients. Others have found a correlation between inflammatory markers and cancer-associated VTE, but this has not yet been proven in gliomas. Our objective was to evaluate glioma patients for increased VTE risk by assessing clinical, histologic, molecular, and plasma-based markers. Methods: The Northwestern University Nervous System Tumor Bank provided preoperative arterial plasma, tumor tissue, and clinical-pathological data from 165 newly diagnosed glioma patients. Molecular profiling was done by GlioSeq NGS. Twelve candidate VTE biomarkers (D-dimer, E-Selectin, ICAM-1, VCAM-1, Granzyme B, IFNγ, TNFα, IL-2, IL-4, IL-6, IL-10, and IL-13) were analyzed using the automated microfluidic multiplex Ella࣪ platform. TF procoagulant activity was measured using a FXa chromogenic assay. Results: Of these patients (n=165), 33 (20%) experienced post-operative VTE. Clinical characteristics associated with increased VTE risk included advanced patient age, high body mass index, high tumor grade, prior history of VTE, coronary artery disease, hyperlipidemia, and hypertension. Of the targeted genetic screening panel (GlioSeq) on resected tumors, only IDHmut significantly correlated with VTE, being associated with reduced risk (OR=0.28; 95% CI=0.12-0.64, P=0.001). Among the plasma biomarkers, elevated circulating TF activity and D-dimer correlated with VTE risk. Circulating TF (>2.0pg/mL) was associated with VTE (Log-rank, P=0.002). D-dimer was elevated in patients that developed VTE (1,355±2,000 vs 605±1,061 ng/mL; P=0.004). High levels of D-dimer associated with worse median overall survival (2.5 vs. 46.9 months; Log-rank P<0.0001), and high D-dimer also developed VTE events quicker (95 vs 245 days; Log-rank P=0.001). Conclusions: This study identified multiple risk factors for glioma-associated VTE and may help identify which patients would benefit the most from prophylactic anticoagulation therapy following surgery. Citation Format: Amanda Alexander, Michael Drumm, Jonathan Lamano, Rodrigo Javier, Kathleen McCortney, Rachel Weller Roska, Kirsten Burdett, Denise M. Scholtens, Nathan Steere, Amanda Kubik, Yoav Noam, Craig Horbinski, Dusten J. Unruh. Preoperative D-dimer and Tissue Factor activity predict postoperative venous thromboembolism in glioma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 522.
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Brunetti, L., J. Vekaria, P. Lipsky y N. Schlesinger. "THU0417 READMISSION RISK AND QUALITY OF CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH GOUT FLARES". Annals of the Rheumatic Diseases 79, Suppl 1 (junio de 2020): 446.2–446. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3302.
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Background:Gout is the most common form of inflammatory arthritis and its economic burden is substantial, with estimates for the overall cost exceeding $20 billion (US) annually. Contributing to the economic burden are hospital admissions and iatrogenic events associated with pharmacotherapy. Identification of modifiable risk factors would be an important contribution to clinical practice.Objectives:The aim of this study was to identify opportunities for enhancing gout care in patients presenting to the Emergency Department (ED) with gout flares.Methods:This retrospective cohort study used data from electronic medical records (EMR) at a large community hospital. All consecutive patients visiting the medical center ED with a primary diagnosis of gout from 1/1/2016 to 7/1/2019 were included. Patients were then followed for 90 days to determine whether they were readmitted to the ED for any reason. A chart review identified whether they were on appropriate medications in terms of gout flare management. All data were summarized using descriptive statistics. A multiple logistic regression was constructed to identify risk factors for ED utilization within 90 days of the index visit.Results:A total of 214 patients were included in the analysis. Most patients were male (79%), mean age was 59.4 ± 15.6 years, and mean Charlson comorbidity index was 0.5 ± 1.14. The most common medications prescribed during the ED visit included NSAIDs (41.6%), opioids (28%), corticosteroids (26.6%), and colchicine (21%). Allopurinol and febuxostat were initiated in the ED in 4.7% and 0.9%, respectively. Discharge medications for the management of gout included NSAIDs (37%), corticosteroids (34.6%), opioids (23.8%), colchicine (14%), febuxostat (7%), and allopurinol (6.5%). Of the patients sent home with an opioid, 40% were newly prescribed. An anti-inflammatory medication was not prescribed in 29.6% of patients discharged from the ED. Readmission within 90 days was recorded in 16.8% of patients. Of these readmissions, 33.3% were gout-related and 11.1% were cardiac related.After adjusting for age and comorbidity index, patients receiving colchicine were 2.8 times more likely (OR, 2.81; 95% CI, 1.12 to 7.02; p=0.027) to return to the ED within 90 days. The most common cause of readmission in this subset was gout-related (54.5%).Conclusion:Nearly 30% of patients were discharged from the ED without an anti-inflammatory medication, whereas initiation of urate lowering therapy was rare. Opiates were used frequently, but the indication was uncertain. Only 5.6% of subjects revisited the ED for gout-related diagnoses in the subsequent 3 months. Colchicine prescription was associated with an increased risk of gout-related ED utilization within 90 days. Treatment of gout in the ED is sub-optimal and often does not follow established guidelines.Disclosure of Interests: :Luigi Brunetti Grant/research support from: Astellas Pharma, CSL Behring, Consultant of: Horizon Foundation of New Jersey, Janaki Vekaria: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon
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Li, Xia, Haikun Lin, Boxiang Wu, Xinyi Lai, Yinnan Tong, Jinyan Huang, Pengxu Qian, Yongxian Hu y He Huang. "A Single-Cell Transcriptomic Atlas of Cytokine Storm in CAR-T Therapy, COVID-19, and SLE". Blood 144, Supplement 1 (5 de noviembre de 2024): 420. https://doi.org/10.1182/blood-2024-201300.
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Introduction: Cytokine storm (CS) is a severe hyperinflammatory disorder characterized by the overproduction of diverse inflammatory cytokines, manifesting as high fever, vascular leakage, nausea, hypotension, and even multi-organ failure. CS can occur as a complication in various conditions, primarily chimeric antigen receptor (CAR)-T therapy, coronavirus 2019 (COVID-19), and systemic lupus erythematosus (SLE). These represent the three major triggers of CS: iatrogenic causes, infections, and autoimmune conditions. Given the heterogeneity of CS triggers, the clinical features and immune landscapes of CS vary widely, necessitating tailored management strategies. However, the detailed immune profiles of CS across these diverse settings are not well characterized, hindering the identification of common and distinct mechanisms underlying this hyperinflammatory complication. Methods and Results: Here, we constructed a large-scale single-cell transcriptomic atlas of peripheral blood mononuclear cells (PBMC) in CS with data from three representative disease settings: CAR-T cell therapy, COVID-19, and SLE. The total sample count is 416, encompassing 2,304,606 cells. We collected 111 samples from multiple myeloma (MM) patients who received anti-BCMA CAR-T treatment and experienced CS events at our center, with ethical approval and informed consent from all participants. The scRNA-seq data for COVID-19 (n=221), SLE (n=40), and healthy donor controls (n=44) were retrieved from online open-access publications. Samples from the progression stage of each disease showed significantly elevated expression of CS-related genes, indicating an inflammatory status. We further analyzed the enriched cellular subclusters and expression profiles of these samples to reveal the unique CS landscape of each disease. The results showed that CS following CAR-T therapy was strongly associated with actively proliferating CD8+ T cells, with gene expressions enriched in T cell function-related pathways, such as MAPK and NLR signaling pathways. We also identified an increased percentage of CD8+ exhausted T cells in CS following CAR-T therapy, which might significantly contribute to the abnormal inflammatory responses. Moreover, COVID-19 progression was characterized by unique dynamics of myeloid immune cells, particularly CD14+ monocytes with S100A8 expression and neutrophils with enhanced interferon signaling. Interestingly, in myeloid immune cells from the COVID-19 progression stage, KEGG analysis revealed significantly enriched expressions of genes involved in neuronal transduction, suggesting the potential crosstalk between systemic inflammation and neuronal functions. In SLE, translation activities and ribosome functions were significantly elevated in B cells and plasma cells. Additionally, myeloid immune cells in SLE were enriched for genes involved in phagocytosis, antigen processing, and antigen presentation, showing the over-active status of phagocytotic monocytes/macrophages, which contributes to systemic inflammation. Significance: Our large-scale single-cell transcriptomic analysis of CS in three distinct disease contexts uncovered the unique and shared immune landscapes underlying CS across different conditions. Our findings highlight the distinct contributions of specific immune cell subclusters and signaling pathways in each disease context, suggesting potential targets for tailored therapeutic strategies and advancing our understanding of this complex hyperinflammatory complication.
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Gurnari, Carmelo, Simona Pagliuca, Pedro H. Prata, Luiz Fernando Bazzo Catto, Lise Larcher, Marie Sebert, Vincent Allain et al. "Immunogenetic, Molecular and Clinical Determinants of Clonal Evolution in Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria". Blood 138, Supplement 1 (5 de noviembre de 2021): 602. http://dx.doi.org/10.1182/blood-2021-147556.
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Abstract Despite therapeutic successes, AA patients (pts) exhibit a much higher risk of leukemic evolution than the general population. Secondary myeloid neoplasia (sMN) remains the most serious AA complication with major therapeutic and prognostic implications. Historically, multiple theories have been proposed as to the origin of leukemic evolution. For instance, sMN may be the consequence of a relentless autoimmune attack producing a maladaptive response to immunosuppression (IST). Alternatively, occurrence of leukemogenic drivers may be an event setting in motion initially successful and overshooting tumor surveillance reactions. Finally, sMN pathogenesis may be related to either CHIP evolution or acceleration of its progression. Each of these theories is supported by clinical-molecular features (e.g. HLA mutations, secondary PNH evolution, somatic mutations at presentation etc.). Here, we took advantage of a multicentric cohort of pts with AA (n=1010; to our knowledge the largest yet explored) and primary MN (n=3599) to define immunogenetic, iatrogenic and molecular determinants of MN progression. Among AA pts (M:F ratio 0.98; median age 34 years, IQR 20-54, median follow-up 89 months), the 5 and 10 years cumulative incidences of sMN were 6% and 11% respectively, with a median time to progression of 56 months (IQR 23-96). Analysis of available data showed that younger pts (<40 years, HR=0.27 [95%CI 0.1-0.5] p<.001), IST responders (HR=0.36 [95%CI 0.1-0.8] p=.01) and moderate AA (HR=0.33 [95%CI 0.1-0.8] p=.02) had lower risk of malignant evolution. MDS was the most frequent diagnosis at progression (80%), followed by AML (17%, of which 71% MRC subtype) and MPN (3%). Whereas only 27% of MDS pts were classified as EB-1/2, high-risk R-IPSS scores (>3.5) were observed in 59% (vs 43% in pMDS, p=.02) due to the enrichment in poor/very poor cytogenetic risk groups. In particular, chr.7 abnormalities were the most frequent (54%, of which 88% were del7). By comparison, del7/7q was present in 8% of pMN cases (p<.001). Among treated pts, chemotherapy was administered to 37%, HMA to 63% and, overall 36% received HSCT. Disease progression was the main cause of death (42%). When compared to pMN, sMN had poorer survival outcomes (p=.01) especially among del7/7q carriers (p=.004). At the time of AA onset only 18% of pts harbored somatic myeloid mutations with their presence/absence not influencing evolution, whereas mutations were found in 81% of sMN (1.7 mutations/patient, n=86/101). No difference in mutational burden was observed according to presence/absence of del7/7q, which constituted the founder lesion in 60% of cases, when the analysis was possible. ASXL1 (24% vs 14%, p=.01), RUNX1 (21% vs 11%, p=.008), SETBP1 (14% vs 3%, p<.001) and U2AF1 (13% vs 6%, p=.01) mutations were more frequent in sMN, while TET2 (8% vs 26%, p<.001) and SF3B1 (1% vs 12%, p<.001) were less common as compared to pMN. Del7/7q pts were enriched in SETBP1 (22% vs 4% in pMN, p<.001), ASXL1 (29% vs 12%, p=.007) and RUNX1 (29% vs 12%, p=.003) lesions while TP53 mutations were by far less common (5% vs 31%, p<.001).Remarkably, CUX1 hits at AA onset heralded malignant progression (p<.001) and longitudinal analysis showed their loss in patients who eventually acquired del7/7q. In aggregate, the low CUX1 expression in 70% of primary del7/7q MDS and its function in DNA repair, may argue for a role of CUX1/chr.7 during AA to MN progression. 1 When we studied immune-selected somatic events, PIGA mutations were the most frequent lesions at AA onset (33%). However, only 5% of cases at MN evolution (p<.001) had PNH clones, consistent with a reciprocal expansion of PNH clones/evolution to secondary PNH in non-progressors, and clonal sweeping in sMN. HLA class I/II mutations or loss were instead identified at a similar rate in AA and sMN (~27%) pts. No HLA alleles were identified as harbingers of malignant evolution, which instead associated with a lower HLA class II evolutionary divergence (HR=2 [95%CI 1-4] p=.03) possibly hampering efficacious surveillance responses. 2 AA malignant evolution is characterized by an orchestra of molecular events with an invariant genomic signature (e.g. CUX1, SETBP1, ASXL1). Immunogenetic and immune escape mechanisms may also play a role in shaping the fate of individual patients' trajectories towards PNH vs sMN progression, which may be considered a maladaptive escape event resulting from a bottlenecked hematopoiesis. Disclosures Sebert: BMS: Consultancy; Abbvie: Consultancy. Patel: Apellis: Consultancy, Other: educational talks, Speakers Bureau; Alexion: Consultancy, Other: educational talks, Speakers Bureau. Voso: Celgene: Consultancy, Research Funding, Speakers Bureau; Novartis: Speakers Bureau. Calado: Novartis Brasil: Honoraria; Alexion Brasil: Consultancy; AA&MDS International Foundation: Research Funding; Agios: Membership on an entity's Board of Directors or advisory committees; Instituto Butantan: Consultancy; Team Telomere, Inc.: Membership on an entity's Board of Directors or advisory committees. Peffault De Latour: Novartis: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Amgen: Research Funding; Alexion Pharmaceuticals: Consultancy, Honoraria, Research Funding; Apellis Pharmaceuticals Inc: Consultancy, Honoraria; Swedish Orphan Biovitrum AB: Consultancy, Honoraria. Maciejewski: Regeneron: Consultancy; Alexion: Consultancy; Novartis: Consultancy; Bristol Myers Squibb/Celgene: Consultancy.
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Satish, Sneha, Kiran, Ramesh M. Bhat y Annabel Jose. "Iatrogenic Cushing’s syndrome, cataract, and metabolic syndrome in an adult following topical steroid abuse for dermatophytosis". Journal of Skin and Sexually Transmitted Diseases, 6 de noviembre de 2024, 1–3. http://dx.doi.org/10.25259/jsstd_46_2024.
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A much is known about the cutaneous side effects of topical corticosteroids (TCs) often neglecting their potential systemic adverse events, including Cushing’s syndrome (CS). Although cases of CS following TCs abuse are a well-documented entity in the pediatric population, similar instances in adults are less common and less discussed. Here, we describe a case of dermatophytosis where the patient developed multiple systemic adverse effects, including significant weight gain, numerous skin striations, and blurred vision, as a result of TCs misuse complicating the otherwise non-significant disease. Hence, it is crucial to emphasize the importance of consulting a dermatologist instead of relying on easily accessible over-the-counter medications from pharmacies, which many people in the general population often resort to.
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Mac Donald, Benjamin, Sanna A. Gustafsson, Cynthia M. Bulik y Loa Clausen. "Living and leaving a life of coercion: a qualitative interview study of patients with anorexia nervosa and multiple involuntary treatment events". Journal of Eating Disorders 11, n.º 1 (13 de marzo de 2023). http://dx.doi.org/10.1186/s40337-023-00765-4.
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Abstract Background A small but significant group of patients with anorexia nervosa (AN) undergo multiple involuntary treatment (IT) events. To enhance our understanding of IT and potentially inform treatment, we explored experiences and perspectives on IT of these patients. Methods We designed a qualitative semi-structured interview study and used reflexive thematic analysis. Participants were at least 18 years of age, had multiple past IT events (≥ 5) related to AN over a period of at least one month of which the last IT event happened within the preceding five years. Participants had no current IT, intellectual disability, acute psychosis, or severe developmental disorder. We adopted an inductive approach and constructed meaning-based themes. Results We interviewed seven participants. The data portrayed a process of living and leaving a life of coercion with a timeline covering three broad themes: living with internal coercion, coercive treatment, and leaving coercion; and five subthemes: helping an internal battle, augmenting suffering, feeling trapped, a lasting imprint, and changing perspectives. We highlighted that patients with AN and multiple IT events usually experienced internal coercion from the AN prior to external coercion from the health care system. IT evoked significant negative affect when experienced, and often left an adverse imprint. Moreover, IT could help an internal battle against AN and perspectives on IT could change over time. Conclusions Our study suggests that feeling internally coerced by AN itself sets the stage for IT. Clinicians should be conscious of the potential iatrogenic effects of IT, and reserve IT for potentially life-threatening situations.
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Fusaroli, Michele, Emanuel Raschi, Milo Gatti, Fabrizio De Ponti y Elisabetta Poluzzi. "Development of a Network-Based Signal Detection Tool: The COVID-19 Adversome in the FDA Adverse Event Reporting System". Frontiers in Pharmacology 12 (8 de diciembre de 2021). http://dx.doi.org/10.3389/fphar.2021.740707.
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Introduction: The analysis of pharmacovigilance databases is crucial for the safety profiling of new and repurposed drugs, especially in the COVID-19 era. Traditional pharmacovigilance analyses–based on disproportionality approaches–cannot usually account for the complexity of spontaneous reports often with multiple concomitant drugs and events. We propose a network-based approach on co-reported events to help assessing disproportionalities and to effectively and timely identify disease-, comorbidity- and drug-related syndromes, especially in a rapidly changing low-resources environment such as that of COVID-19.Materials and Methods: Reports on medications administered for COVID-19 were extracted from the FDA Adverse Event Reporting System quarterly data (January–September 2020) and queried for disproportionalities (Reporting Odds Ratio corrected for multiple comparisons). A network (the Adversome) was estimated considering events as nodes and conditional co-reporting as links. Communities of significantly co-reported events were identified. All data and scripts employed are available in a public repository.Results: Among the 7,082 COVID-19 reports extracted, the seven most frequently suspected drugs (remdesivir, hydroxychloroquine, azithromycin, tocilizumab, lopinavir/ritonavir, sarilumab, and ethanol) have shown disproportionalities with 54 events. Of interest, myasthenia gravis with hydroxychloroquine, and cerebrovascular vein thrombosis with azithromycin. Automatic clustering identified 13 communities, including a methanol-related neurotoxicity associated with alcohol-based hand-sanitizers and a long QT/hepatotoxicity cluster associated with azithromycin, hydroxychloroquine and lopinavir-ritonavir interactions.Conclusion: Findings from the Adversome detect plausible new signals and iatrogenic syndromes. Our network approach complements traditional pharmacovigilance analyses, and may represent a more effective signal detection technique to guide clinical recommendations by regulators and specific follow-up confirmatory studies.
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Brook, Karolina, Alexandra Tcherepanova, Flavio Gilio Andrade de Meneses, R. Mauricio Gonzalez, William Vincent y Mohamed T. Sarg. "Use of 400 µg/mL Peripheral Phenylephrine Infusions During Anesthesia: A Safety Initiative". Hospital Pharmacy, 29 de septiembre de 2024. http://dx.doi.org/10.1177/00185787241286764.
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During a general anesthetic case, a patient was administered a 400 µg/mL infusion of phenylephrine as opposed to the 40 µg/mL solution typically used in most operating rooms. The patient experienced iatrogenic hypertension, which resolved once the cause was discovered and the phenylephrine was discontinued. A root cause analysis was performed, with multiple factors contributing to the error. The Department of Pharmacy advocated switching to one concentration of phenylephrine hospital-wide. After performing a literature review regarding the safety of using 400 µg/mL phenylephrine peripherally, the decision was made to switch the operating room to this concentration of phenylephrine. The switch has been successful, with only one known medication error and no adverse events occurring since implementation. This quality improvement initiative demonstrates that 400 µg/mL phenylephrine can be used as an infusion in the operating room, which has potential implications for patient safety and efficiency. This safety initiative may serve as an example for other operating rooms.
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Zappulo, Emanuela, Antonio Riccardo Buonomo, Francesco Saccà, Cinzia Valeria Russo, Riccardo Scotto, Giulia Scalia, Agostino Nozzolillo, Roberta Lanzillo, Grazia Tosone y Ivan Gentile. "Incidence and Predictive Risk Factors of Infective Events in Patients With Multiple Sclerosis Treated With Agents Targeting CD20 and CD52 Surface Antigens". Open Forum Infectious Diseases 6, n.º 11 (21 de octubre de 2019). http://dx.doi.org/10.1093/ofid/ofz445.
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Abstract Objective Monoclonal antibodies (MAbs) directed against the CD20 and CD52 antigens are used increasingly in patients with multiple sclerosis (MS). Several life-threatening opportunistic infections have been reported in postmarketing case series. The aim of this study was to investigate the incidence of infections and associated prognostic factors during the first year of treatment in patients receiving anti-CD20 (ocrelizumab or rituximab) or anti-CD52 MAbs (alemtuzumab). Methods A retrospective study was conducted in patients with MS referring to the Neurodegenerative Diseases Center at the University of Naples Federico II who received MAbs between November 2015 and June 2018. Results A total of 163 patients were enrolled. Approximately 40% of patients experienced lymphocytopenia during treatment. Eighty-six infective events were reported in 67 patients (41%). Bacterial infections were significantly more frequent with anti-CD20, whereas viral infections prevailed with alemtuzumab. Cytomegalovirus reactivation rates were significantly higher in the alemtuzumab group than in patients on anti-CD20 (51% vs 6%, P < .001). The overall annualized infection rate was 1.1 per patient-year, higher in patients on anti-CD52 versus those on anti-CD20 regimens (1.5 vs 0.8 per patient-year). Alemtuzumab treatment, prior exposure to ≥2 MS drugs, and iatrogenic immune impairment significantly and independently predicted an infection event (adjusted hazard ratio [aHR], 2.7; P = .013; aHR, 1.7; P = .052; and aHR, 2.9; P = .004; respectively). Conclusions Given their considerable infection risk, MS patients receiving MAbs should undergo timely follow up and tailored preventive interventions. Anti-CD52–based treatment, prior exposure to MS drugs, and on-treatment immune impairment are significant predictive factors of infection and their evaluation could help clinicians to stratify a patient’s risk of infection.
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Berthier, Alexandre, Céline Gheeraert, Manuel Johanns, Manjula Vinod, Bart Staels, Jérôme Eeckhoute y Philippe Lefebvre. "The Molecular Circadian Clock Is a Target of Anti-cancer Translation Inhibitors". Journal of Biological Rhythms, 23 de octubre de 2023. http://dx.doi.org/10.1177/07487304231202561.
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Circadian-paced biological processes are key to physiology and required for metabolic, immunologic, and cardiovascular homeostasis. Core circadian clock components are transcription factors whose half-life is precisely regulated, thereby controlling the intrinsic cellular circadian clock. Genetic disruption of molecular clock components generally leads to marked pathological events phenotypically affecting behavior and multiple aspects of physiology. Using a transcriptional signature similarity approach, we identified anti-cancer protein synthesis inhibitors as potent modulators of the cardiomyocyte molecular clock. Eukaryotic protein translation inhibitors, ranging from translation initiation (rocaglates, 4-EGI1, etc.) to ribosomal elongation inhibitors (homoharringtonine, puromycin, etc.), were found to potently ablate protein abundance of REV-ERBα, a repressive nuclear receptor and component of the molecular clock. These inhibitory effects were observed both in vitro and in vivo and could be extended to PER2, another component of the molecular clock. Taken together, our observations suggest that the activity spectrum of protein synthesis inhibitors, whose clinical use is contemplated not only in cancers but also in viral infections, must be extended to circadian rhythm disruption, with potential beneficial or iatrogenic effects upon acute or prolonged administration.
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Leker, Kristy, Arti Patel y Annam Zahid. "Papillary Muscle Rupture in the Setting of Streptococcus lutetiensis Endocarditis". Journal of Investigative Medicine High Impact Case Reports 12 (enero de 2024). http://dx.doi.org/10.1177/23247096241300912.
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Papillary muscle rupture is commonly linked to ischemic events, occurring typically postmyocardial infarction. However, iatrogenic and nonischemic etiologies can play a role in papillary muscle rupture, including infective endocarditis. The case presented herein is an 85-year-old female with a history of heart failure with preserved ejection fraction (HFpEF), who presented with progressive dyspnea despite furosemide therapy, and was discovered to have a flail posterior mitral valve leaflet secondary to papillary muscle rupture associated with Streptococcus lutetiensis endocarditis. Transthoracic echocardiography revealed flail posterior mitral valve leaflet with newly appreciated severe wide-open mitral regurgitation. Emergent mitral valve repair was performed with a successful MitraClip placement. Patient had an atypical presentation without ischemic symptomology or electrocardiogram (EKG) changes indicative of ischemia. Despite transesophageal echocardiography, not revealing vegetations, infective endocarditis was presumed due to presence of Streptococcus lutetiensis bacteremia, osteomyelitis, elevated inflammatory markers, and clinical presentation. Papillary muscle rupture results in severe mitral regurgitation that is a medical emergency that requires prompt diagnosis and management from a multidisciplinary team. Therefore, it is imperative to ensure clinical insight into the multiple etiologies of papillary muscle rupture to provide timely treatment.
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Beidel, Deborah C., Clint A. Bowers, Amie R. Newins, Christine Seaver, David Rozek, Carole McDaniel y Daniel R. Horning. "Virtual-reality exposure treatment for first responder PTSD: a pilot investigation". Frontiers in Virtual Reality 5 (30 de julio de 2024). http://dx.doi.org/10.3389/frvir.2024.1336523.
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Introduction: There is increasing recognition that first responders’ exposure to multiple traumatic events puts them at risk for the development of emotional distress, including depression, substance misuse, posttraumatic stress disorder (PTSD), and suicide. Despite this increased risk and higher prevalence of PTSD and other trauma-related disorders, there are few data on treatment for first responders.Method: This investigation describes the outcome of an intensive outpatient program (IOP), initially developed for military trauma, as applied to the treatment of first responders with PTSD. This treatment is unique in that it utilizes virtual reality to enhance the immersion into the exposure scene. Furthermore, we assessed the utility of both fixed-length and unbounded-length exposure sessions.Results: The results indicate that the intervention was feasible to implement and did not produce iatrogenic effects. Participants reported significantly reduced symptoms of PTSD and related emotional distress, reduced disability, and improved daily functioning. These positive outcomes were maintained at 3-month follow-up. There was no difference in outcomes between the fixed- and unbounded-length sessions.Discussion: These results suggest that an efficacious, short-term intervention incorporating virtual reality has the potential to quickly return first responders to their profession.
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Humphrey, Jamie L., Clyde Schwab, Nicholas J. Richardson, Barrot H. Lambdin, Alex H. Kral y Bradley Ray. "Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market". Journal of Epidemiology and Community Health, 10 de octubre de 2024, jech—2024–222263. http://dx.doi.org/10.1136/jech-2024-222263.
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BackgroundThe opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency.MethodsCross-sectional study using point-level information on law enforcement opioid-related drug seizures from property room data, opioid-related non-fatal overdose events from emergency medical services and block group-level social determinants of health data from multiple sources. Using an endemic-epidemic spatiotemporal regression model, we estimated the degree to which exposure to drug supply disruptions triggers future overdose events within small space-time distances in Indianapolis, Indiana.ResultsNeighbourhoods with more structural racism, economic deprivation or urban blight were associated with higher rates of non-fatal overdose. Exposure to an opioid-related drug seizure event had a significant and positive effect on the epidemic probability of non-fatal overdose. An opioid seizure that occurred within 250 m and 3 days, 250 m and 7 days, and 250 m and 14 days of an overdose event increased the risk of a new non-fatal overdose by 2.62 (rate ratio (RR)=2.62, 95% CI 1.87 to 3.67), 2.17 (RR=2.17, 95% CI 1.87 to 2.59) and 1.83 (RR=1.83, 95% CI 1.66 to 2.02), respectively. Similar spatiotemporal patterns were observed in a smaller spatial bandwidth.ConclusionsResults demonstrated that overdoses exhibit a community spread process, which is exacerbated following law enforcement strategies to disrupt the unregulated drug market. We discuss decriminalisation and increasing resources that promote safer drug use to combat this public health crisis.
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Singh, Deepshikha, Minakshi Malhotra y Sneh Agarwal. "Variations in the Axillary Artery Branching Pattern". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2020. http://dx.doi.org/10.7860/jcdr/2020/44533.13887.
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Variations in axillary artery branching pattern can lead to iatrogenic injuries during invasive procedures. Knowledge of the same is critical to prevent such events. Multiple bilateral variations were observed in the branching pattern of axillary artery. These variations were noted in a female cadaver, during routine undergraduate dissection in September 2019 in Lady Hardinge Medical College, New Delhi. On the left side, an anomalous branch running with the medial pectoral nerve was found. A common stem arising from the 2nd part of left axillary artery divided to give the lateral thoracic artery, the subscapular artery and an alar artery. Another alar branch arose from the left subscapular artery before it bifurcated into thoraco-dorsal and circumflex scapular arteries. The right axillary artery gave an aberrant branch proximal to the lateral thoracic artery. A common trunk arising from the 2nd part of right axillary branched out to give the posterior circumflex humeral artery, the subscapular artery and an alar artery. The brachial artery divided 13.5 cm proximal to the intercondylar line of humerus on the left and 14.4 cm on the right side. On both sides, the ulnar artery arose proximally and the radial and common inter-osseous arteries continued as a common trunk and divided distally. This case study reports multiple bilateral axillary artery anomalies and complements to the existing knowledge of vascular anomalies. Comprehensive knowledge of these variations is essential from anatomical, radiological and surgical point of view. During surgeries involving axillary and pectoral group of lymph nodes, such variations should be kept in mind.
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Kryshen, K. L., N. M. Faustova, M. N. Makarova y V. G. Makarov. "Endocrine disorders associated with medicinal products: approaches to preclinical safety assessment". Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products. Regulatory Research and Medicine Evaluation, 2 de junio de 2022. http://dx.doi.org/10.30895/1991-2919-2022-12-401.
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The endocrine system coordinates almost all organs and other systems in vertebrates. In particular, it regulates such important biological functions as metabolism, development, reproduction, and behaviour. To date, a significant amount of information has accumulated on endocrine disorders associated with chemical compounds (endocrine disruptors) used in various fields of human activity. The aim of this work was to evaluate the possibility of preclinical risk assessment for the endocrine function disorders attributable to new medicinal products. Endocrine disruptors are associated with a wide range of adverse events, including developmental problems arising from functional abnormalities of the endocrine system. Endocrine disorders caused by endocrine-disrupting chemicals are characterised by a long latency period between exposure and manifestation of a dysfunction; a nonlinear dose–response relationship; and a linear correlation of damage severity to exposure timing and duration. The chemicals influence the endocrine system through multiple mechanisms, the main of which being the interaction with cellular receptors sensitive to certain hormones and the influence on gene expression, intracellular signalling, and hormone transport, etc. This paper discusses the possibility of using hormone levels as indicators of endocrine disruption and presents the literature and authors’ own data on normal levels of relevant hormones in the blood of animals. An analysis of animal blood hormone levels in preclinical programmes will provide an opportunity to evaluate potential iatrogenic risks.
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Kunioku, Yuki, Rie Minoshima, Yutaro Chida y Shinichi Nishibe. "Causes, risk factors, and complications of accidental intra-arterial administration of medications in a children’s hospital: a case series". JA Clinical Reports 10, n.º 1 (2 de septiembre de 2024). http://dx.doi.org/10.1186/s40981-024-00728-x.
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Abstract Background Accidental intra-arterial administration of a medication can lead to serious iatrogenic harm. Most studies have discussed single cases of accidental intra-arterial administration of a medication, but only a few have described multiple cases occurring in a single, pediatric hospital setting. Methods The subjects were pediatric patients with an accidental intra-arterial administration of a medication. After obtaining approval from the institutional review board, the relevant cases were extracted from incident reports submitted to the patient safety office of the study center between November 2016 and April 2023. Results A review of 18,204 incident reports yielded 10 cases (patient age: 27 days to 13 years) of accidental intra-arterial administration of a medication. The most common site of the cannulation was the dorsum of the foot followed by the dorsum of the hand. The medications administered were narcotics, sedatives, muscle relaxants, antibiotics, and crystalloids. No serious adverse events occurred after injection. In some cases, the accidental arterial cannulation was not discovered immediately (53 min to 26 days). Seven patients had difficult intravenous access; in two of these, ultrasound-guided peripheral venous cannulation was used. Conclusions We experienced 10 cases of accidental intra-arterial administration of a medication. The dorsalis pedis artery and the radial artery around the anatomical tobacco socket were common sites of unintentional arterial cannulation. Difficult intravenous (IV) access may be associated with unintentional arterial cannulation. If IV access is difficult or the free IV drip is sluggish, strict vigilance and repeated confirmation are needed to prevent unintentional arterial cannulation.
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Costa, Eliana Auxiliadora Magalhães, William Mendes Lobão, Camila Lapa Matos Riba y Nathália Muraiviechi Passos. "Segurança do paciente em hospitais de grande porte". Revista de Enfermagem UFPE on line 14 (18 de mayo de 2020). http://dx.doi.org/10.5205/1981-8963.2020.243324.
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Objetivo: analisar a implementação da política nacional de segurança do paciente. Método: trata-se de um estudo quantitativo, descritivo e avaliativo de casos múltiplos em hospitais de grande porte. Informa-se que a coleta de dados constou de uma entrevista com o profissional responsável pelos Núcleos de Segurança do Paciente por meio de um formulário semiestruturado. Analisaram-se os dados pela estatística simples. Resultados: detalha-se que, dos 20 hospitais elegíveis, 12 (60%) participaram do estudo; todos os hospitais (100%) possuem núcleos constituídos, (91,7%) com Plano de Segurança do Paciente e (50%) contam com profissional com dedicação exclusiva. Implementaram-se, por mais da metade dos núcleos (58,3%), todos os protocolos obrigatórios, sendo identificação do paciente (83,3%) e higienização das mãos (83,3%) os mais frequentes. Revela-se que os percentuais de eventos adversos notificados foram: lesão por pressão (88,9%); queda do leito (77,8%) e erros de medicamentos (75%). Conclusão: conclui-se que os núcleos estudados não atendem totalmente às políticas regulatórias vigentes no país, merecendo, portanto, de adequações e de controle sanitário efetivo. Descritores: Segurança do Paciente; Legislação Hospitalar; Dano ao Paciente; Doença Iatrogênica; Política Pública; Assistência à Saúde.AbstractObjective: to analyze the implementation of the national patient safety policy. Method: this is a quantitative, descriptive and evaluative study of multiple cases in large hospitals. Please be informed that the data collection consisted of an interview with the professional responsible for the Patient Safety Centers using a semi-structured form. Data were analyzed using simple statistics. Results: it is detailed that, of the 20 eligible hospitals, 12 (60%) participated in the study; all hospitals (100%) have centers, (91.7%) have a Patient Safety Plan and (50%) have a professional with exclusive dedication. All mandatory protocols were implemented in more than half of the centers (58.3%), with patient identification (83.3%) and hand hygiene (83.3%) being the most frequent. It is revealed that the percentages of adverse events reported were: pressure injury (88.9%); bed falls (77.8%) and medication errors (75%). Conclusion: it is concluded that the centers studied do not fully comply with the regulatory policies in force in the country, therefore deserving adjustments and effective sanitary control. Descriptors: Patient Safety; Hospital Legislation; Patient Harm; Iatrogenic Disease; Public Policy; Delivery of Health Care.ResumenObjetivo: analizar la implementación de la política nacional de seguridad del paciente. Método: se trata de un estudio cuantitativo, descriptivo y evaluativo de casos múltiples en grandes hospitales. Tenga en cuenta que la recopilación de datos consistió en una entrevista con el profesional responsable de los Centros de Seguridad del Paciente utilizando un formulario semiestructurado. Los datos se analizaron mediante estadísticas simples. Resultados: se observa que de los 20 hospitales elegibles, 12 (60%) participaron en el estudio. Se dice que todos los hospitales (100%) tienen centros constituidos, (91.7%) con un Plan de Seguridad del Paciente y (50%) tienen un profesional con dedicación exclusiva. Es de destacar que más de la mitad de los centros (58.3%) implementan todos los protocolos obligatorios, siendo la identificación del paciente (83.3%) y la higiene de manos (83.3%) las más frecuentes. Se observa que los porcentajes de eventos adversos informados fueron: lesión por presión (88,9%), caída de la cama (77,8%) y errores de medicación (75%). Conclusión: se informa que los centros estudiados no cumplen plenamente con las políticas regulatorias vigentes en el país, por lo que merecen ajustes y un control sanitario efectivo. Descriptores: Seguridad del Paciente; Legislación Hospitalaria; Daño del Paciente; Enfermedad Iatrogénica; Política Pública; Prestación de Atención de Salud.
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Marinelli, Lisa M., Olivia M. Arballo, Giselle Guerrero y Wendi E. Wohltmann. "Perforating Calcinosis Cutis as a Complication of Intraosseous Fluid Infusion in the Setting of a Near-Drowning Event". Military Medicine, 3 de diciembre de 2022. http://dx.doi.org/10.1093/milmed/usac385.
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ABSTRACT Iatrogenic calcinosis cutis represents a subset of calcinosis cutis resulting secondary to treatments or procedures. We present the first report of calcinosis cutis resulting from the intraosseous infusion and one of a few cases with associated transepidermal elimination. A previously healthy 2-year-old female presented with a new-onset unilateral shin rash 1 week following hospitalization for a near-drowning event. A dermatologic exam revealed multiple small, tender, firm, chalky-white papules with surrounding erythema, in addition to two erythematous macules superior and medial to the papular lesions, corresponding to prior intraosseous access sites. The rash persisted despite trials of topical mupirocin and acyclovir cream, prompting a referral to a dermatologist. An excisional biopsy was performed, revealing circumscribed dermal deposits of acellular basophilic material connected to the overlying epidermis through an invaginated keratin plug. A von Kossa silver stain highlighted the deposits, confirming the diagnosis of perforating calcinosis cutis. The lesions did not recur following the excisional biopsy. Iatrogenic calcinosis cutis may be seen as a complication of the infusion of calcium-containing fluids via intraosseous access, in addition to the more commonly observed peripheral intravenous access. Awareness of this disorder is important in order to distinguish it from an infectious mimic and guide the selection of therapy.