Biomedical subjects
M Grouhi
Publications and source records attributed to M Grouhi.
Anaphylaxis and epinephrine auto-injector training: who will teach the teachers?
BACKGROUND: Anaphylaxis is the most urgent clinical immunologic event. Effective treatment is best achieved by administration of epinephrine. Accidental exposure to the responsible allergen is the most common cause of anaphylaxis, and because it could be fatal within minutes, epinephrine in preloaded syringes and auto-injectors has been introduced. In our experience patients and medical personnel are not familiar with the use of this device. OBJECTIVE: We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients. METHODS: Study participants consisted of a medical convention's delegates and emergency department personnel in metropolitan Toronto, as well as pharmacists of the target hospitals and retail pharmacists. Research assistants approached eligible professionals to fill out a questionnaire and demonstrate their ability to use a standard placebo auto-injector trainer. RESULTS: A total of 122 professionals (composed of emergency physicians, family practitioners, and pediatricians) consented to participate in this study. The majority of participants (81%) did not have a placebo trainer to educate their patients; 76% did not know the 2 available dose strengths. To provide instructions and reinforcement, physicians clearly must have the necessary skills and knowledge, yet only 25% of the study participants were able to demonstrate the 3 steps of injection correctly. CONCLUSION: Our study highlights a specific and important deficiency in medical professionals' care of patients at risk for anaphylaxis. The results challenge the current methods of educating professionals, as well as patients, when prescribing or using epinephrine auto-injectors. Clearly a new approach to educating and maintaining such skills is required.
Long-term remission for disseminated Mycobacterium avium-intracellulare complex associated with antibody deficiency.
Mycobacterium avium-intracellulare (MAI) is a ubiquitous organism with limited virulence in the immunocompetent host. Disseminated disease is associated with a high mortality rate. Except for localized cervical adenitis, MAI disease is rare in immunocompetent children. We report a child with antibody deficiency (dysgammaglobulinemia) and disseminated MAI infection, in whom complete, long-term remission was attained with multiple antimycobacterial therapy. The patient presented with progressive cervical lymphadenopathy and hepatomegaly at 7 years of age. A lymph node biopsy showed acid-fast bacilli and granulomas. Despite a transient response to conventional antituberculous therapy, including isoniazid and rifampin, his symptoms progressed. Cultures from blood, bone marrow, spleen, and cervical lymph node tissues revealed an MAI organism. Subsequent treatment using a combination of clarithromycin, amikacin, and ethambutol for 16 months resolved clinical symptoms, and subsequent blood culture results became negative. By the time of this report, the patient has been disease-free for 4 years. Multiple-drug therapy is promising for the treatment of MAI in children with antibody deficiency; however, the selection of antiinfective drugs should include a member of the newer macrolide family. acquired immunodeficiency syndrome, clarithromycin, dysgammaglobulinemia, Mycobacterium avium-intracellulare, treatment.
Anaphylactic reaction to oral cefaclor in a child.
Adverse drug reactions are a common clinical problem. It has been estimated that 6% to 15% of hospitalized patients experience some sort of adverse drug reaction. Clinical manifestations of adverse drug reactions include skin rash; a serum sickness-like reaction; drug fever; pulmonary, hepatic, and renal involvement; and systemic anaphylaxis. Many of these adverse events are not immunologically mediated. Actual allergic or immunologic drug reactions probably account for <25% of adverse drug reactions overall. Antibiotics are one of the major contributors to drug hypersensitivity. Cefaclor, an oral second-generation cephalosporin with a beta-lactam ring, is used against various infectious diseases of the respiratory tract, especially in children. Several cases of cefaclor hypersensitivity have been reported. The most common presentations are either erythematous or papular eruptions, although serum sickness-like reactions have also been described. Anaphylactic reactions, although rare, have been observed in adults. Here we report a case of anaphylactic reaction to cefaclor in a 21/2-year-old patient.
Cerebral vasculitis associated with chronic mucocutaneous candidiasis.
Chronic mucocutaneous candidiasis is a heterogenous group of disorders, associated with a variety of autoimmune disorders and a broad spectrum of immune aberrations. We describe 2 patients with chronic mucocutaneous candidiasis who had cerebrovascular disease with severe neurologic sequelae. Results of angiography of cerebral vessels and brain biopsy in one were consistent with the diagnosis of cerebral vasculitis.
[Thromboangiitis obliterans and distal gangrene in a 5-year-old child].
Distal gangrene associated with arterial hypertension but without systemic manifestations or muco-cutaneous eruptions was noted in a 5 years old child. Gangrene first appeared in toes and then in fingers. Progression in a 7 months period led to bilateral midleg amputation and amputation of several fingers. Angiography revealed complete obliteration of popliteal and humeral arteries by thrombi and histologic examination of amputated material showed organized thrombi with phlebothrombosis and without vasculitis. Biopsies of liver, lung, kidneys and skin were unremarkable and immunofluorescence studies with various antisera were negative. Also no contributing factor or etiologic agents were found, similarities to adult type Buerger's disease are striking. Vasodilators were of no help and bilateral lumbar and cervical sympathectomy could only demarcate the already present gangrene.
Medication errors in paediatrics: a case report and systematic review of risk factors.
Explore the source record for details and available documents.