Biomedical subjects

Raymond G Schlienger

Publications and source records attributed to Raymond G Schlienger.

23 records · Page 2Linked to original sources

PubMed2002

Appropriateness of digoxin level monitoring.

AIM: To evaluate the proportion of inappropriate digoxin level determinations. METHODS: We performed a retrospective analysis of 210 randomly selected digoxin plasma level determinations in inpatients. Appropriateness criteria were defined combining existing criteria from the literature. The main outcome measure was the proportion of digoxin levels assessed as inappropriate using a priori defined criteria. RESULTS: Of the 210 digoxin levels assessed, 125 (59%; 95% confidence interval [CI] 52-66%) were considered inappropriate, 81 (39%; 95% CI: 32-45%) were appropriate, and 4 (2%) determinations could not be evaluated. Of the 125 levels assessed as inappropriate, the majority (79%) was performed as routine monitoring. Extrapolating the results to all digoxin level determinations in inpatients at our institution resulted in estimated yearly costs of CHF 28,025 (approximately B 18,995) for inappropriate digoxin level determinations. CONCLUSIONS: The majority of digoxin plasma levels determinations were assessed as inappropriate. This was mainly due to the lack of an adequate indication and due to incorrect timing of drawing the blood samples. With regard to indication, routine monitoring was the reason for the majority of levels assessed as inappropriate.

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PubMed2002

Association between body mass index and liver disorders: an epidemiological study.

BACKGROUND/AIMS: Cross-sectional studies showed an association between obesity and liver disorders. Information on incidence rates from epidemiological studies is scarce. METHODS: To explore the association between body mass index (BMI) and incident liver disorders, we conducted a follow-up study with a nested case-control analysis using the UK-based General Practice Research Database. The study population encompassed normal weight (BMI <25 kg/m(2)), pre-obese (BMI 25-29.9 kg/m(2)) or obese (BMI > or =30 kg/m(2)) subjects aged 20-79 years, matched on age, sex and general practice attended. RESULTS: Within the study population of 207,630 subjects, we identified 2718 cases of newly diagnosed liver disorder, of whom 1524 (56.1%) had known predisposing conditions. The incidence rates were 2.48 (95% CI 2.31-2.66)/1000 person-years (py) in normal weight, 2.91 (95% CI 2.72-3.11)/1000 py in pre-obese, and 3.83 (95% CI 3.62-4.07)/1000 py in obese subjects. In the nested case-control analysis, the adjusted odds ratio (OR) for obese, as compared to normal weight subjects, was 1.2 (95% CI 1.1-1.4). The OR for idiopathic cases (without known risk factors for liver disorders) was 1.3 (95% CI 1.1-1.6). CONCLUSIONS: The study indicates that obesity is associated with a modest increase in the incidence of newly diagnosed liver disorder.

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PubMed2002

Use of nonsteroidal anti-inflammatory drugs and the risk of first-time acute myocardial infarction.

AIMS: Aspirin decreases the risk of clinical manifestations of atherothrombosis. This effect is mainly due to inhibition of platelet aggregation and potentially due to anti-inflammatory properties of aspirin. To evaluate whether use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) may also be associated with a decreased risk of first-time acute myocardial infarction (AMI), we performed a population-based case-control analysis using the United Kingdom-based General Practice Research Database (GPRD) METHODS: We identified first-time AMI-patients free of preexisting diagnosed cardiovascular or metabolic diseases. We compared use of NSAIDs prior to the index date between cases and control patients who were matched to cases on age, gender, practice and calendar time. RESULTS: A total of 3319 cases ( or=30 prescriptions) yielded an adjusted odds ratio (OR) of 1.20 (95% CI 0.94, 1.55). Stratification by age (<65 years vs>or=65 years) and sex did not materially change the results. CONCLUSIONS: Our findings indicate that current NSAID exposure in patients free of diagnosed cardiovascular or metabolic conditions predisposing to cardiovascular diseases does not decrease the risk of AMI.

Adult↗

PubMed2002

Tolterodine-associated acute mixed liver injury.

OBJECTIVE: To report a patient with an acute mixed liver injury associated with tolterodine therapy. CASE SUMMARY: An 81-year-old white woman with urge incontinence experienced malaise, fever, and gastrointestinal disturbances 18 days after starting tolterodine 2 mg twice daily. The patient's concurrent medications included flunitrazepam, diclofenac, and dorzolamide/timolol eye drops. Laboratory examination was consistent with the presentation of an acute mixed liver injury with increased transaminase enzymes, alkaline phosphatase, gamma-glutamyltransferase, and bilirubin. Additionally, she had mild leukocytosis with eosinophilia. After tolterodine was discontinued, the abnormal liver and hematologic parameters returned to normal within 4 weeks. DISCUSSION: Tolterodine, a muscarinic receptor antagonist, has predominantly anticholinergic effects. To our knowledge, this is the first case published describing tolterodine-associated acute mixed liver injury. However, some of the patient's additional symptoms can also be considered part of a drug-induced hypersensitivity syndrome. This is usually defined by the triad of fever, cutaneous reaction, and involvement of internal organs, mainly affecting the liver. The close temporal relationship between the start of tolterodine therapy and the first symptoms and the reversibility after dechallenge led us to conclude that the adverse reaction was possibly related to tolterodine exposure. CONCLUSIONS: Our case illustrates that tolterodine may rarely be associated with liver injury. This may have been an organ manifestation of tolterodine-induced hypersensitivity syndrome.

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PubMedDate not supplied

Discontinuation of nonsteroidal anti-inflammatory drug therapy and risk of acute myocardial infarction.

BACKGROUND: Systemic inflammation has been shown to be associated with an increased risk of acute myocardial infarction (AMI). However, the effect of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) on the risk of AMI has not yet been well defined. We therefore studied the risk of AMI during NSAID exposure and after the cessation of NSAID therapy. METHODS: We conducted a large case-control analysis on the British General Practice Research Database. The study included 8688 cases with a first-time AMI between 1995 and 2001 and 33 923 controls, matched to cases on age, sex, calendar time, and general practice attended. RESULTS: After adjusting for hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, rheumatoid arthritis, systemic lupus erythematosus, acute chest infection, body mass index, smoking, and aspirin use, the risk of AMI was 1.52 (95% confidence interval [CI], 1.33-1.74) for subjects who stopped taking NSAIDs 1 to 29 days prior to the index date, compared with nonusers. The risk was highest in subjects with rheumatoid arthritis or systemic lupus erythematosus (adjusted OR, 3.68 [95% CI, 2.36-5.74]) and for subjects who discontinued therapy with NSAIDs after previous long-term use (adjusted OR, 2.60 [95% CI, 1.84-3.68]). Current and past NSAID use (discontinued therapy >/=60 days prior to the index date) were not associated with an increased risk of AMI (adjusted OR, 1.07 [95% CI, 0.96-1.19] and 1.05 [95% CI, 0.99-1.12], respectively). CONCLUSION: Our findings suggest that the risk of AMI is increased during several weeks after the cessation of NSAID therapy.

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