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Biomedical subjects

R Hoigné

Publications and source records attributed to R Hoigné.

At least 37 records · Page 2Linked to original sources
PubMed1990

Risk factors for adverse drug reactions--epidemiological approaches.

Age by itself is not an important risk factor for ADRs. Age-related changes are the consequence of a number of individual factors, for example morbidity associated with polypharmacy, decline in renal or liver function in the elderly, hypoalbuminaemia, reduced body weight, etc. The relationship between gastrointestinal bleeding and non-steroidal anti-inflammatory drugs can be assessed globally in large cohort studies with access to computerized data, but complete accuracy requires access to the original patient records. The increase in the risk of GI bleeding in users of NSAIDs and aspirin was 50% above that in non-users. About a quarter of ADRs in hospitalized patients seem not to arise from purely pharmacological mechanisms. They are mainly due to allergic, anaphylactoid, or idiosyncratic reactions and to intolerance. In such non-pharmacological reactions, the time of exposure, reaction time, and even dosage may be important factors in identification of the causal drug. The use of benzodiazepines can be optimized by taking into account potency, time of action and the different syndromes encountered after withdrawal. Following long-term use problems of relapse and rebound are being increasingly recognized, in addition to organic withdrawal symptoms. In psychiatric patients extrapyramidal disorders due to neuroleptics are common. The rates of these ADRs differ markedly between various drugs, even after dosages and co-medications are taken into account. Epidemiological screening for potentially carcinogenic drugs can only be done in large cohorts of patients with pre-recorded full information sets as may be found in an HMO (Health Maintenance Organization). The findings of several such studies have been published in specialist cancer journals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Side-effects of frequently administered hypnotics and sedatives as well as of anxiolytics. Results from a Comprehensive Hospital Drug Monitoring (CHDM) program].

The occurrence and age distribution of patients with adverse drug reactions (ADR) were studied on the basis of a total of 17,653 admissions to the medical divisions of the Zieglerspital Bern and the Anna-Seiler-Haus, Inselspital Bern, during the period 1976-1982. Among this population 12,424 patients (70.4%) happened to have been treated with hypnotics, sedatives or anxiolytics. Results are as follows: 1. The occurrence rate of psychic and neurologic symptoms (with the exception of somnolence and hangover) is 0.14% of all treatments if the casualty category "definitely or probably drug-induced" is considered. For "other ADR" (non-psychic, non-neurologic) the rate is 0.16%. For the benzodiazepine preparations, the psychic and neurologic ADR occurred at about the same rate as for the neuroleptic drugs studied, whereas "other ADR" related to benzodiazepines were observed in only 0.04% of treatments. 2. There is a marked difference in ADR symptoms between benzodiazepines and neuroleptics. With benzodiazepines the most severe reactions were two episodes of shortlived respiratory arrest immediately after intravenous administration. With neuroleptic drugs the most severe symptoms were choreoathetosis, dyskinesia, hyperkinesia and Parkinson's syndrome. There was no fatal reaction. 3. With benzodiazepines there is a slight but significant increase in the occurrence of psychic and neurologic symptoms in the older group of patients, as compared to the younger patients, whereas with neuroleptics there is no age dependence.

Anti-Anxiety Agents↗
PubMed1987

[Skin side effects of non-steroidal anti-inflammatory analgesics and so-called minor analgesics. Report from the Berne Comprehensive Hospital Monitor].

9118 of 19,653 inpatients of two internal medicine divisions were treated with analgesics and nonsteroidal antiinflammatory drugs including minor analgesics (NSAID). In the first part of the study all generalized skin reactions (gsr) considered to be probably or definitely due to a drug were evaluated clinically. In 23 out of 91 patients with a drug induced skin reaction, this was judged to be mainly related to an NSAID drug rather than any other drug (= 0.3% of patients exposed to an NSAID). The 26 reactions of the 23 patients were as follows: 15 maculo-papular exanthemas, 6 urticarias, 2 angioedema, 2 serum sickness syndromes and 1 erythema nodosum. In the second part we did statistical calculations only on the basis of the time/exposure relationship to ascertain the rate of gsr with chemotherapeutics and antibiotics (group B), with NSAID including minor analgesics (group A) and with all other drugs. 10.8% occurred with B, 1.8% with A without B and 0.9% without A and without B. The difference between 1.8% (A without B) and 0.9% (neither A nor B) is significant (p less than 0.05).

Analgesics↗
PubMed1987

[A frequent error in drug therapy: under-dosage].

Systematic studies on the occurrence and frequency of drug underdosage are rare, except in relation to noncompliance of patients and their physicians in different institutions (hospitals, outpatient divisions, practice). On the basis of four examples (digitalis preparations, diuretics, theophyllins and corticosteroids), seven rules are presented with a view to avoiding situations of relevant underdosage.

Adrenal Cortex Hormones↗
PubMed1986

[Exanthema during frequent use of antibiotics and antibacterial drugs (penicillin, especially aminopenicillin, cephalosporin and cotrimoxazole) as well as allopurinol. Results of The Berne Comprehensive Hospital Drug Monitoring Program].

Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.

Allopurinol↗
PubMed1986

Fall in systolic blood pressure due to metamizol (dipyrone, noramidopyrine, novaminsulfone). Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB).

A fall in systolic blood pressure which was not accompanied by any other symptoms of anaphylactic shock was first observed in 1972 and 1973 by our team in four patients after they had received metamizol-containing drugs parenterally. Of the 17,407 patients monitored from 1974-1981, ten further cases exhibited a fall in systolic blood pressure within minutes up to six hours after intravenous administration of metamizol. In all of these cases, a causal relationship between drug administration (0.5-2.5 g) and the reaction described was considered 'likely' or even 'definite'. During the same period, 67 arterial hypotensive incidents were registered in connection with other drugs. Between 1976 and 1981, 7 out of 15,678 patients monitored in the Comprehensive Hospital Drug Monitoring Berne (CHDMB) showed this adverse reaction. In relative figures, this represents 0.34% of the 2,053 patients who received parenteral treatment with a metamizol preparation.

Adult↗
PubMed1985

A double blind study on immunotherapy with chemically modified honey bee venom: monomethoxy polyethylene glycol-coupled versus crude honey bee venom.

24 patients with honey bee sting allergy were treated with either honey bee venom (HBV) or monomethoxy polyethylene glycol-coupled HBV (PEG-HBV) in a double blind trial. Both treatments induced a strong increase in HBV-specific IgG antibodies in most patients. Immunotherapy with PEG-HBV was much better tolerated than that with HBV. Conversely, patients on HBV did considerably better during a sting challenge with a living honey bee. Only 4 developed a large local and one a mild systemic reaction compared to 7 large local and 3 moderate to severe systemic reactions in the PEG-HBV-group. A higher maintenance dose of PEG-HBV may still be well tolerated but prove more effective at reexposure.

Adult↗
PubMed1984

[Significance of age, sex, kidney function, atopy and number of prescriptions for the occurrence of adverse drug reactions, studied by multivariate statistical methods. Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB)].

UNLABELLED: The influence of five factors (age, sex, renal function, atopy and number of drugs) on the incidence of adverse drug reactions (ADRs) is analysed by multivariate statistical methods (loglinear models for contingency tables). The study is based on a total of 19,653 inpatients in the "Comprehensive Hospital Drug Monitoring Berne (CHDMB)". RESULTS: 1. The risk of ADRs mainly increases with the number of drugs. 2. Increasing age and female sex are also confirmed as risk factors by these statistical methods. Reduced renal function (increased serum creatinine) is strongly correlated with advancing age. Renal function, however, yields more pertinent information on ADR risk than does age. 3. In atopic and non-atopic patients, the ADR risk is identical. In both groups of patients the same number of drugs was given. If the pathogenetic mechanisms of the ADRs (allergic or pharmacologic in the broad sense) are considered, it is found that atopic patients show a ratio of about 2:1 pharmacologic to allergic reactions, compared to about 3:1 in non-atopic subjects. A reduction in the incidence of ADRs is best attained by even more restricted use of drugs and better and earlier adaptation of drug dosage to diminished renal function.

Adolescent↗
PubMed1983

[Atopy and generalized allergic reactions to insect stings].

458 patients with systemic allergic reactions following hymenoptera stings were investigated with regard to the incidence of atopic disease. Personal atopy (13.7%) and a family history of atopy (26.4%) were not found more frequently than in a normal population. The age of the first manifestation of hymenoptera sting allergy was however significantly lower in atopic than in non-atopic patients, sensitization occurred following a smaller number of stings and there was a preponderance of respiratory symptoms.

Age Factors↗
PubMed1983

[Reducing blood pressure with Dipyron (novaminsulfone sodium)].

A fall in systolic blood pressure without other symptoms of anaphylactic shock has been described following the administration of drugs containing dipyrone. This adverse reaction was first observed in 4 patients by the same team in 1972-1973. Ten further cases with a fall in systolic blood pressure by at least 20 mm Hg occurring within minutes to 6 hours after intravenous administration of dipyrone are presented in this paper. In each of them this adverse reaction was considered to be probable or even definite. During the years 1976-1981 drug exposure was registered for all 15 678 patients of the two medical divisions of Comprehensive Hospital Drug Monitoring Berne. This adverse reaction was found in 7, representing 0.34% of the 2053 patients who received intravenous treatment with a dipyrone preparation.

Aged↗
PubMed1983

Venom immunotherapy in hymenoptera sting allergy. Comparison of rush and conventional hyposensitization and observations during long-term treatment.

42 patients with confirmed hypersensitivity to honey bee (HBV) and/or yellow jacket (YJV) were treated with the respective venoms (7 with HBV, 5 with VJV and 30 with both venoms). Treatment tolerance, skin tests (ST), specific IgE- and specific IgG-antibodies were monitored before, after 3, 6, 12, 24 and 36 months. 21 patients had a rush and 21 a conventional treatment schedule. Maintenance dose was 100 micrograms. Adverse effects occurred as large local (8 patients), slight systemic (12 patients) and moderate to severe systemic reactions (4 patients). Of 24 re-exposed patients 17 had no reaction at all, six a markedly decreased and one an unchanged reaction. After 3 years of treatment ST became negative in nine of 31 patients on HBV and in seven of 26 patients on YJV. RAST became negative in three of 30 patients on HBV and 17 of 29 patients on YJV treatment. Both ST and RAST became negative in five HBV- and 10 YJV-treated patients. Loss of venom hypersensitivity according to diagnostic tests may correspond to actual desensitization and enable discontinuation of immunotherapy.

Adolescent↗