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Biomedical subjects

Dan Justo

Publications and source records attributed to Dan Justo.

17 recordsLinked to original sources
PubMed2006

Torsades de pointes induced by antibiotics.

BACKGROUND: Several frequently used antibiotics are associated with an arrhythmia called "torsades de pointes" (TdP). This potentially fatal arrhythmia is considered unpredictable. METHODS: In order to investigate the prevalence of risk factors for TdP prior to initiation of antibiotic therapy, we conducted a literature search for all published reports on TdP induced by antibiotics and we asked pharmaceutical companies for additional unpublished reports. RESULTS: We studied 61 reports on 78 patients with TdP induced by antibiotics. Female gender was the most common risk factor for TdP: 66.7% (n=52) of all patients were women. Advanced heart disease and concomitant use of a QT interval-prolonging agent or an inhibitor of liver drug metabolism were also frequently present (59% and 48.7%, respectively). Most patients had at least one and 58 patients (74.3%) had two risk factors or more for TdP prior to initiation of antibiotic therapy. CONCLUSION: Contrary to common belief, TdP induced by antibiotics may be predictable by simple history-taking and by obtaining a baseline electrocardiogram. We wish to draw attention to risk factors for TdP prior to the initiation of antibiotic therapy.

Journal Article↗
PubMed2006

Methadone-associated Torsades de Pointes (polymorphic ventricular tachycardia) in opioid-dependent patients.

AIMS: We reviewed all the publications concerning methadone-associated Torsades de Pointes (TdP) (polymorphic ventricular tachycardia) in opioid-dependent patients in order to characterize the clinical circumstances leading to this serious complication. METHODS: Our literature search yielded 14 reports on 40 patients with methadone-associated TdP. We gathered and recorded the risk factors for TdP mentioned in those reports, among other clinical aspects. RESULTS: The most prevalent risk factors for TdP were high-dose methadone (n = 39, 97.5%) and concomitant use of agents that increase serum methadone levels or trigger TdP (n = 22, 55%). HIV infection (n = 16), hypokalaemia (n = 14), female sex (n = 13), liver cirrhosis or renal failure (n = 11) and heart disease (n = 9) were also described. All the patients had at least one and 34 (85%) had two or more risk factors for TdP during methadone treatment. CONCLUSIONS: We wish to raise the level of awareness of risk factors for TdP among physicians in heroin-treatment clinics who frequently prescribe methadone.

Adult↗
PubMed2006

Torsade de pointes induced by systemic antifungal agents: lessons from a retrospective analysis of published case reports.

Torsade de pointes (TdP) is a potentially fatal arrhythmia that might be associated with systemic antifungal agent (SAFAs) administration. The objective of this study was to investigate all published reports on TdP induced by SAFAs in order to characterise this association. Each original report was analysed for the presence of risk factors for TdP: female gender, structural heart disease, electrolyte imbalance, concomitant use of a QT interval prolonging agent which SAFA inhibits its liver metabolism, liver cirrhosis, renal failure and more. Naranjo probability scale for adverse drug reactions was applied for every full report. Twenty-one reports on 28 patients were analysed. All patients survived. Most patients (25/28; 89.2%) used one or more agents that might have prolonged the QT interval and their liver metabolism might have been inhibited by SAFA. Female gender was the second most common risk factor for TdP (20/28; 71.4%). All patients, including female patients, had one or more risk factors for TdP prior to SAFA administration. According to Narajno probability scale, there was no definite association between TdP and SAFA in any report. SAFA alone might seldom trigger TdP. We wish to raise the level of awareness of risk factors for TdP prior to SAFA administration and for concomitant use of other dysrhythmogenic agents in particular.

Adolescent↗
PubMed2006

The prevalence of reversible cardiovascular risk factors in Israelis aged 25-55 years.

BACKGROUND: Coronary heart disease is a major cause of morbidity and mortality worldwide. Early detection of cardiovascular risk factors and intervention may reduce consequential morbidity and mortality. OBJECTIVES: To assess the prevalence of reversible and treatable cardiovascular risk factors among 26,477 healthy Israeli adults: 23,339 men and 3138 women aged 25-55 years. METHODS: We collected data during routine examinations performed as part of a screening program for Israel Defense Force personnel. RESULTS: The three most prevalent cardiovascular risk factors were a sedentary lifestyle (64%), dyslipidemia (55.1%) and smoking (26.8%). Overall, 52.9% of the men and 48.4% of the women had two or more cardiovascular risk factors. Moreover, 52.4% of young adult men and 43.3% of young adult women, age 25-34 years, had two or more reversible cardiovascular risk factors. CONCLUSIONS: In this expectedly healthy population there was a high prevalence of reversible and treatable cardiovascular risk factors in both genders and in young ages. These observations stress the need for routine health examinations and lifestyle modification programs even in the young healthy Israeli population.

Adult↗
PubMed2005

Erythrocyte adhesiveness/aggregation: a novel biomarker for the detection of low-grade internal inflammation in individuals with atherothrombotic risk factors and proven vascular disease.

BACKGROUND: We have introduced a concept of using the erythrocyte as a sensor for the detection of enhanced inflammation-sensitive protein concentrations. We presently evaluated the capability of this new biomarker to detect the presence of inflammation in individuals with a history of a vascular disease as opposed to individuals with atherothrombotic risk factors but no clinically evident vascular disease. METHODS: The degree of erythrocyte adhesiveness/aggregation was determined in the peripheral venous blood by using a simple blood test. Blood was drawn into a syringe containing sodium citrate and trickled onto a slide at an angle of 30 degrees. The slides were than scanned by a blinded technician by using an image analyzer to determine the area that is covered by the erythrocytes. RESULTS: One hundred fifty-six subjects (61 women and 95 men) of 2586 (1238 women and 1348 men) met the criteria of a definite vascular disease (history of stroke, myocardial infarction, coronary artery bypass grafting, or peripheral vascular disease). The degree of erythrocyte aggregation was significantly (P = .008) higher in men, but not in women, with vascular disease as opposed to these without a vascular disease. The results of receiver operating characteristic curve analysis confirmed the diagnostic superiority of the erythrocyte aggregation biomarker over other commonly used markers of the acute phase in men. Similar results were obtained by using discriminant analysis. Finally, a significant correlation was found between the degree of erythrocyte aggregation and other markers of the acute phase suggesting its relevance for the detection and quantitation of low-grade inflammation in individuals with atherothrombosis. CONCLUSION: Erythrocyte adhesiveness/aggregation may be a useful biomarker to detect internal inflammation in individuals with atherothrombosis.

Adhesiveness↗
PubMed2005

Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men.

BACKGROUND: Erectile dysfunction (ED) is often associated with sleep disorders and sleep apnea syndrome (SAS) in mostly middle-aged and elderly men. Sleep disorders and ED are also prevalent in younger men. PURPOSE: To study the association between ED, sleep disorders, and SAS, particularly among adult men. METHODS: A health screening program is offered by the Israel Defense Force (IDF) for career servicemen older than 25 years, for the purpose of early detection of ED and sleep disorders, among other concealed morbidities. The Sexual Health Inventory for Man questionnaire (SHIM) was used to measure ED. The Sleep Quality (SQ) questionnaire, developed by the medical services of the IDF, was used to characterize SAS and other sleep disorders. RESULTS: From 2002 through 2003, 3,363 men (mean age, 36.1+/-6.8 years) replied to the SHIM and SQ questionnaires. Of these men, 337 (10%) scored high (>or=25) in the SQ questionnaire, suggesting moderate to severe sleep disorders, and 870 men (25.8%) scored low (<or=21) in the SHIM questionnaire, suggesting ED. There was a negative correlation between the scores in the SHIM questionnaire and in the SQ questionnaire (r=-0.29, P<0.0001)-even after age adjustment and after excluding men with risk factors for both ED and SAS (such as essential hypertension, diabetes mellitus, and obesity; r=-0.21, P<0.0001). This correlation was consistent with all severity levels of ED and sleep disorders. CONCLUSIONS: Sleep disorders, in particular SAS, and ED are prevalent and may be related in adult men. Either ED or sleep disorders should be considered whenever the other is suspected in adult men. Sleep disorders and ED should also be investigated for the purpose of treating underlying systemic diseases and emotional disorders, and in order to prevent late complications of atherosclerosis.

Adult↗
PubMed2005

Low scores in the sexual health inventory for men questionnaire may indicate sexual disorders other than erectile dysfunction.

INTRODUCTION: A screening program aimed at early detection of erectile dysfunction, among other hidden morbidities, is offered by the medical services of the Israel Defense Force for career servicemen. Men apparently with erectile dysfunction can turn to a sexual rehabilitation specialist for consultation. AIM: To present our experience in sexual evaluation of men with low scores in the Sexual Health Inventory for Men (SHIM) questionnaire. METHODS: Men aged 25-50 years go through a routine check-up at the Staff Periodic Examination Center. The SHIM questionnaire was used to characterize erectile dysfunction. Men who had scored low in the SHIM questionnaire were referred to a sexual consultation and evaluation. RESULTS: During 2001-2003, 11,914 men reported to the Staff Periodic Examination Center (mean age 34.8 +/- 7.1 years). Among 5,836 men who filled out the SHIM questionnaire (compliance of 48.9%), 1,570 (26.9%) men scored low. Of those men with low SHIM scores, 7.2% (114/1,570) underwent a sexual dysfunction evaluation. Only 50% (57/114) of the men in fact had erectile dysfunction, of whom 15.7% (9/57) also had premature ejaculation. In addition, 38.5% (44/114) of the men were found to have premature ejaculation only, and the rest (14/114, 9.7%) had other sexual dysfunctions or lack of sexual knowledge. CONCLUSION: The SHIM questionnaire is a valuable tool for detecting various sexual dysfunctions other than erectile dysfunction. Incorporating the SHIM questionnaire in a routine check-up encourages men to seek consultation and treatment for sexual disorders. In addition, the SHIM questionnaire encourages men to seek sexual education and increase their awareness of issues concerning sexual health.

Adult↗
PubMed2004

Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug.

OBJECTIVES: The goal of this study was to determine how often atrioventricular (AV) block is really caused by medications. BACKGROUND: Beta-blockers, verapamil, and diltiazem are considered a cause of AV block for which pacemaker implantation is not indicated. However, it is not known if such patients can expect a benign course after discontinuation of the culprit medication. METHODS: Consecutive patients with II or III degree AV block not related to acute myocardial infarction, digitalis toxicity, or vasovagal syncope were studied. The level of AV block (AV-nodal or infranodal) was defined by electrocardiographic criteria. The cause and effect relation between AV block and drugs was defined according to the response to drug discontinuation. RESULTS: Of 169 patients with AV block, 92 (54%) were receiving beta-blockers and/or verapamil or diltiazem. Patients receiving medications had similar clinical and electrocardiographic characteristics with patients who had AV block in the absence of drugs. Drug discontinuation was followed by resolution of AV block in 41% of cases, whereas spontaneous improvement of AV conduction occurred in 23% of patients who had AV block in the absence of drugs. However, 56% of the patients for whom drug discontinuation led to resolution of AV block had recurrence of AV block in the absence of therapy. Atrioventricular block that was "truly caused by drugs" was found in only 15% of patients who had II or III degree AV block during therapy with beta-blockers, verapamil, or diltiazem. CONCLUSIONS: Atrioventricular block is commonly "related to drugs" but is rarely "caused by drugs."

Adrenergic beta-Antagonists↗
PubMed2004

Roxithromycin-induced torsades de pointes.

Roxithromycin is an oral macrolide antibiotic agent frequently used in the clinical setting. The risk of pro-arrhythmia during roxithromycin use has always been considered extremely remote. We describe a patient who developed prolongation of the QT interval and torsades de pointes under roxithromycin treatment.

Journal Article↗
PubMed2004

Is idiopathic ventricular fibrillation a short QT syndrome? Comparison of QT intervals of patients with idiopathic ventricular fibrillation and healthy controls.

OBJECTIVE: The purpose of this study was to determine if patients with idiopathic ventricular fibrillation (VF) have shorter QT intervals than comparable healthy controls. BACKGROUND: The upper limit of the normal QT is well defined. Less is known about the lower limit of the normal QT. Patients with the recently described "short QT syndrome" have characteristics resembling those of patients with idiopathic VF. METHODS: The ECGs of 28 consecutive patients with idiopathic VF (17 men and 11 women, age 31 +/- 17 years) were compared to those of 270 age- and gender- matched healthy controls. Based on published literature, we defined "short QT" as QTc < or = 360 ms for males and < or = 370 ms for females. RESULTS: Despite significant overlapping, the QTc of males with idiopathic VF was shorter than the QTc of healthy males (371 +/- 22 ms vs 385 +/- 19 ms, P = .034). Short QT intervals were found more frequently among males with idiopathic VF (35% vs 10%, P = .003). No such differences were apparent among women. Short QTc intervals were more commonly seen during bradycardia. However, the correlation between short QT and a history of VF was independent of heart rate. CONCLUSIONS: "Short" QTc values are commonly seen in male patients with idiopathic VF. However, "short" QTc values are not rare among healthy adults, especially at slow heart rates. Further studies are needed to define when a given QT is really "too short."

Adult↗
PubMed2004

Prevalence of erectile dysfunction among young adults: results of a large-scale survey.

INTRODUCTION: Erectile dysfunction (ED) can be an early and first sign of an underlying systemic disease. A screening program is offered by the Medical services of the Israel Defense Force for career servicemen at the Staff Periodic Examination Center (SPEC) aimed at early detection of morbidity. The Sexual Human Inventory for Males (SHIM) questionnaire was introduced to these men in order to identify ED, to offer men with ED suitable treatment options, and to investigate underlying systemic diseases. AIM: To provide epidemiological data regarding the prevalence of ED among a large-scale young adult population. METHODS: Subjects aged 25-50 years are undergoing a routine check-up at SPEC. Blood samples, physiological measures, demographic variables, information on health status and smoking habits are recorded and documented. The SHIM self-administrated questionnaire was used to characterize ED. RESULTS: During 2001-2003, 11,914 males reported to SPEC (average age 34.8 +/- 7.1 years). Five thousand eight hundred thirty-six of them chose to answer the SHIM questionnaire (compliance of 48.9%). According to the SHIM scores, at least one out of three men (26.9%) suffered from ED (19%, 7%, and 1% had mild, moderate, and severe ED, respectively). ED was prevalent also among young adults: 22.1% of males under-40 had low SHIM scores (<21). Severity of ED correlated with age and diabetes mellitus. CONCLUSION: In light of these results, we conclude that ED is a major health concern among young men as well. Incorporating questions regarding sexual health in a routine check-up may encourage more men to seek treatment, not only for ED, but also for underlying diseases.

Adult↗
PubMed2003

Torsade de pointes due to noncardiac drugs: most patients have easily identifiable risk factors.

Numerous medications, including drugs prescribed for noncardiac indications, can lead to QT prolongation and trigger torsade de pointes. Although this complication occurs only rarely, it may have lethal consequences. It is therefore important to know if patients with torsade de pointes associated with noncardiac drugs have risk factors that are easy to identify. We reviewed reports of drug-induced torsade de pointes and analyzed each case of torsade de pointes associated with a noncardiac drug for the presence of risk factors for the long QT syndrome that can be easily identified from the medical history or clinical evaluation (female gender, heart disease, electrolyte disturbances, excessive dosing, drug interactions, and history of familial long QT syndrome). We identified 249 patients with torsade de pointes caused by noncardiac drugs. The most commonly identified risk factor was female gender (71%). Other risk factors were frequently present (18%-41%). Virtually all patients had at least 1 of these risk factors, and 71% of patients had 2 or more risk factors. Our study suggests that almost all patients with torsade de pointes secondary to noncardiac drugs have risk factors that can be easily identified from the medical history before the initiation of therapy with the culprit drug.

Anti-Bacterial Agents↗
PubMedDate not supplied

Long QT syndrome caused by noncardiac drugs.

Numerous medications not intended for cardiac use (including antibiotics, histamine blockers, and antipsychotic medications) incidentally block potassium channels in myocardial cells, prolong the QT interval, and may trigger malignant arrhythmias. Although the odds for a given patient for developing arrhythmias are small, the number of patients receiving such drugs is enormous. Most patients developing proarrhythmia have additional risk factors that could be easily identified from their medical history. The list of risk factors includes female gender, organic heart disease, hypokalemia, and a history of long QT or drug-induced arrhythmias. Patients without risk factors are at very low risk. For these patients, it is neither practical nor necessary to record an electrocardiogram before therapy is initiated and the most important preventive measure is to avoid concurrent administration of 2 or more drugs that prolong the QT interval or administration of a medication that impairs the metabolism of a QT-prolonging drug. We performed a computerized literature search using the key words "long QT," "torsade," "drug-adverse effects," and "drug-ventricular arrhythmias," searching for published reports of drug-induced torsade de pointes. The references in each of these reports also were reviewed to identify additional publications. In addition, we reviewed the published reviews and the Internet sites dealing with drug-induced arrhythmias. All the original articles quoted in these reviews and Web sites were examined critically.

Anti-Bacterial Agents↗