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At least 649 records · Page 36Linked to original sources
PubMed1991

Potential drug interactions in an ambulatory geriatric population.

Drug interactions are a common cause of iatrogenic disease in geriatric patients. Computer programs now exist which allow one to analyse groups of drugs for potential interactions. In an audit of charts of 100 geriatric patients seen in the Family Practice Center at Barberton Citizens Hospital, a computer printout was obtained, listing all patients aged 60 years and over who were seen at the Center during 1989. Names were selected randomly from this list by the head nurse and their charts were obtained for review, generating information on patient identification number, age, sex, diagnoses, medications, and allergies. The medications were analysed using the Hansten Drug Interaction Knowledge Base Program, which identified 27 patients as being on a combination of medications which had one or more potential drug interactions. A total of 37 potential drug interactions were identified in this group of 27 patients. Relative risk ratios were determined using the computer program, 'Epi Info,' for sex (female versus male), age (greater than or equal to 75 vs. 60-75 years), number of diagnoses greater than or equal to 3 vs. 0-2), and number of medications (greater than or equal to 4 vs. 0-3). The five medications, or groups of medications, which were most likely to be involved in potential drug interactions were digoxin, beta-blockers, oestrogen, oral hypoglycaemic agents, and diuretics.

Aged↗
PubMed1989

Munchausen syndrome by proxy.

Munchausen syndrome by proxy (MBP) is the deliberate induction or reporting of physical symptoms in a child. It is a form of child abuse that can result in death, iatrogenic disease, or the masking of a genuine illness. MBP is suggested by symptoms that do not follow the usual course of illness, particularly if the symptoms only occur in the presence of the same person. MBP may occur when caretakers (usually mothers) perceive that being the parent of a sick child will solve personal conflicts and be socially rewarded, or if life experiences have demonstrated that the price of love is physical illness. When MBP is suspected, the health care team needs to take aggressive action to confirm or disprove it and to protect the child. A social worker confronted with possible MBP must manage a difficult situation that often involves painful team issues as well as confusion over the nature of reality.

Child↗
PubMedDate not supplied

Cyclosporine A neurotoxicity among bone marrow transplant recipients.

Cyclosporine A (CsA) neurotoxicity is an iatrogenic disease with significant morbidity and occasional mortality. We retrospectively reviewed the cases of CsA neurotoxicity among bone marrow transplant recipients at our institution, and summarized the current literature on the subject. The neurologic presentation is varied and the neurologic manifestations are reversible, even after prolonged toxicity, in most instances. Serum CsA level is useful in evaluation, as the level is high in most instances. However, in a case of suspected neurotoxicity, withdrawal of the drug is the only way of determining presence or absence of such toxicity. The electrophysiologic studies, especially electroencephalogram (EEG), is very sensitive in identifying the problem, but lacks specificity. On the other hand, the neuroimaging studies are helpful in making a diagnosis if they show characteristic findings of hyperintense lesions affecting posterior cerebral regions on T2 weighted magnetic resonance images (MRI) or white matter hypodensities on computed tomographic (CT) scan. These lesions are probably due to breakdown of blood-brain barrier resulting in leakage of fluid in interstitial space. The breakdown could be serious enough to cause microhemorrhages that may coalesce to produce macrohemorrhages.

Adult↗
PubMed1999

Pathophysiology of radiocontrast nephropathy: a role for medullary hypoxia.

Recent experimental data underlies the role of hypoxic tubular injury in the pathophysiology of radiocontrast nephropathy. Although systemic transient hypoxemia, increased blood viscosity, and a leftward shift of the oxygen-hemoglobin dissociation curve may all contribute to intrarenal hypoxia, imbalance between oxygen demand and supply plays a major role in radiocontrast-induced outer medullary hypoxic damage. Low oxygen tension normally exists in this renal region, reflecting the precarious regional oxygen supply and a high local metabolic rate and oxygen requirement, resulting from active salt reabsorption by medullary thick ascending limbs of Henle's loop. Radiologic contrast agents markedly aggravate outer medullary physiologic hypoxia. This results from enhanced metabolic activity and oxygen consumption (as a result of osmotic diuresis and increased salt delivery to the distal nephron) because the regional blood flow and the oxygen supply actually increase. The latter effect may result in part from the activation of various regulatory mediators of outer medullary blood flow to ensure maximal regional oxygen supply. Low-osmolar radiocontrast agents may be less nephrotoxic because of the smaller osmotic load and vasomotor alterations. Experimental radiocontrast-induced renal failure requires preconditioning of animals with various insults (for example, congestive heart failure, reduced renal mass, salt depletion, or inhibition of nitric oxide and prostaglandin synthesis). In all these perturbations, which resemble clinical conditions that predispose to contrast nephropathy, outer medullary hypoxic injury results from insufficiency or inactivation of mechanisms designed to preserve regional oxygen balance. This underlines the importance of identifying and ameliorating predisposing factors in the prevention of this iatrogenic disease.

Acute Kidney Injury↗
PubMed2002

Ex vivo bone morphogenetic protein-9 gene therapy using human mesenchymal stem cells induces spinal fusion in rodents.

OBJECTIVE: Ex vivo gene therapy with the use of human mesenchymal stem cells (hMSCs) and bone morphogenetic protein (BMP) genes provides a local supply of precursor cells and a supraphysiological dose of osteoinductive molecules that may promote bone formation in patients with inadequate hMSC populations because of age, osteoporosis, metastatic bone disease, iatrogenic depletion, or other metabolic derangements. This study was undertaken to evaluate the efficacy of ex vivo gene therapy with the use of hMSCs and the BMP-9 gene to promote spinal fusion in the rat. METHODS: Sixteen athymic nude rats were treated with hMSCs transduced with recombinant, replication-defective Type 5 adenovirus containing the cytomegalovirus promoter and either the BMP-9 (Ad-BMP-9) or the beta-galactosidase (Ad-beta-gal) gene. Ad-beta-gal served as the control. Each animal received a percutaneous, paraspinal injection of 10(6) hMSCs transduced with 50 plaque-forming units/cell adenovirus in the lumbar region, with Ad-BMP-9 on the left and Ad-beta-gal on the right. At 8 weeks postinjection, computed tomographic scans of the lumbosacral spine were obtained, and the lumbosacral spine specimens were examined histologically. RESULTS: Both computed tomographic studies and histological analysis clearly demonstrated large volumes of ectopic bone at the Ad-BMP-9-transduced hMSC injection sites, resulting in successful spinal fusion and no evidence of nerve root compression or local or systemic toxicity. The contralateral regions that were treated with Ad-beta-gal-transduced hMSCs showed no evidence of osteogenesis. CONCLUSION: The results of this study suggest that hMSC and BMP-9 ex vivo gene therapy may be useful in inducing spinal fusion as well as other related procedures and certainly warrants further clinical development.

Animals↗
PubMed1993

Optimal use of beta irradiation in the treatment of pterygia.

Beta irradiation with strontium 90 has been associated with significant iatrogenic disease, causing such complications as ptosis, symblepharon, iridic and scleral atrophy, cataracts, and endophthalmitis. We studied 171 eyes in 140 patients treated and followed up during a 17-year period from 1973 to 1990. We sought to show that a single small dose of radiation administered immediately after surgical excision not only prevents decrease recurrence, but also avoids significant complication. Pterygia recurred in 14 (8%) of the 171 eyes treated. Six of these recurrences were corneal and eight were conjunctival. Complications were seen in five (3%) of the 171 eyes treated. All were minor except for one case of scleral thinning in a diabetic patient. Optimal radiation dosage to avoid significant recurrence in this adult population is a single dose of 2,000 rads using a bare sclera technique that vaults the limbus.

Combined Modality Therapy↗
PubMed2005

Prevention of radiocontrast nephropathy.

PURPOSE OF REVIEW: The vast numbers of radiocontrast procedures performed yearly paired with the increasing prevalence of renal insufficiency in the aging population has focused recent attention on radiocontrast nephropathy. No effective treatment exists for this iatrogenic disease: therefore prevention remains the key strategy. Several clinical investigations have been published over the past 2 years that address potential prophylaxis against contrast nephropathy. RECENT FINDINGS: Iso-osmolar non-ionic contrast media appear to have the least nephrotoxicity. Pooled data of published randomized controlled trials of pre-procedural intravenous hydration plus N-acetylcysteine versus placebo demonstrate that acute renal failure from contrast nephropathy is rare when these therapies are given several hours in advance. Strategies that employ fenoldopam and theophylline, however, do not appear to be effective. Urine alkalinization with intravenous sodium bicarbonate may be useful, especially in high-risk patients, but further investigation is needed. SUMMARY: Available evidence indicates that several hours of intravenous pre-hydration is protective against contrast nephropathy and some studies suggest that oral N-acetylcysteine administration adds to this protection. Further research is needed, however, with agents that can be administered immediately prior to contrast administration. This is particularly important for diabetics with baseline kidney disease who require emergent contrast studies and are at high risk for acute renal failure.

Acetylcysteine↗
PubMed2004

After the euphoria: HIV medical technologies from the perspective of their prescribers.

This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral combination therapies and associated tests from the perspective of their prescribers. The prescribers were interviewed during the later part of 2002 at three London HIV clinics. Their comments, considered in light of other recent studies in the field, suggest that current therapies are part of a transitional phase in the epidemic which informs the identification and negotiation of known risks and uncertainty. An undetermined but extended life expectancy, afforded by anti-retroviral therapies, is understood against risk of iatrogenic diseases and/or viral drug resistance. The tension arising in this situation of unwanted and even uncertain phenomena poses ethical dilemmas and affects doctor/patient relations. Indeed, it also contributes to a reconfiguring of the lived experience of managing HIV. While the new technologies have offered considerable advances in the medical management of HIV, they are altering the nature of HIV medicine both materially and socially. The scenario is further complicated by the uneven allocation of resources and different patient health and disease states. The heterogeneity of resources, disease states and technological effects points to the need for ongoing and extended evaluation as the relationship between these and the everyday practice of medicine continues to change.

Antiretroviral Therapy, Highly Active↗
PubMed2004

Non-steroidal anti-inflammatory drugs: who should receive prophylaxis?

Non-steroidal anti-inflammatory drugs (NSAIDs) are the major recognized cause of iatrogenic disease, and may cause 100 000 deaths per annum through peptic ulcer complications. A number of risk factors can be identified that indicate patients at high risk. These patients can be managed by substitution of a COX-2 inhibitor or by prophylaxis with a proton pump inhibitor (PPI). Because risk factors that render patients at high risk of ulcer complications also act in the absence of NSAID use, PPI prophylaxis (or Helicobacter pylori eradication where H. pylori is the risk factor) have much to offer and controlled studies show that the incidence of recurrent peptic ulcer bleeding can be reduced substantially by PPI co-administration. Substitution of COX-2 inhibitors also has much to offer, arguably most in those without risk factors (although regulatory authorities do not accept this argument). Recent data show that PPI and COX-2 inhibitors can play complementary roles in the management of patients with moderate to severe dyspepsia and at high risk of ulcer complications.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Rhodococcus equi infection in non-HIV-infected patients. Two case reports and review.

OBJECTIVE: To review two recent cases in HIV-negative subjects in the light of literature reports (52 patients without HIV infection till 1994). METHODS: Epidemiology (animal contacts, risk factors, year, country), clinical presentation, diagnostic methods (X-ray, tomography, microbiological techniques), therapeutic approach (antibiotics, surgery) and outcome were evaluated on the basis of clinical literature reports. RESULTS: Tumors constituted an important predisposing factor and less frequently hepatobiliary pathology, rheumatologic diseases, iatrogenic causes, psychiatric pathology and trauma. Exposure to animals was reported by 55% of the patients. Pneumonia and pleurisy, without preferential localization, were detected in 50% of the patients. Etiologic diagnosis was usually obtained after an invasive collection. Combined medical therapy and surgery were required by 27.8% of the patients, and 16.7% of the patients died. CONCLUSIONS: In recent years the number of Rhodococcus equi cases has been rising also in HIV-negative patients. The infection is ubiquitous. Accurate diagnosis and the prompt selection of the most appropriate therapy depend on close cooperation between clinicians and microbiologists.

Journal Article↗
PubMed1976

Acquired thrombophilia: a hitherto unrecognized procoagulant-antithrombin imbalance.

Inherited, acquired and iatrogenic 'diseases of low antithrombin activity' share a common denominator: each is associated with an increased tendency toward, or incidence of, thrombosis. This suggested the possibility that these diseases constituted a distinct pathogenetic entity. Molecular models and clinical studies suggested 3 interrelated phenomena: increased serum procoagulants; decreased antithrombin; a tendency to thrombosis. The term 'Acquired Thrombophilia' is proposed to designate pre-thrombotic and thrombotic individuals presenting this non-inherited combination of laboratory and clinical findings. The antithrombin clotting time is shown to be inversely related to the level of circulating serine procoagulants, directly related to the level of antithrombin, and results from a procoagulant-antithrombin inter-molecular reaction. Patients with Acquired Thrombophilia have 'turned-on' or excessive procoagulants resulting in 'turned-off' or tightly bound antithrombin molecules.

Adult↗
PubMed1993

Xerostomia: the missing diagnosis?

Xerostomia is a distressing condition which may be associated with a number of specific diseases, iatrogenically induced following the administration of drugs or radiotherapy, or the result of inflammatory processes affecting salivary gland tissue. In this article epidemiological background is briefly reviewed and aetiological conditions associated with xerostomic states are summarized. The oral sequelae of xerostomia are discussed and approaches to diagnosis demonstrated. Treatment of xerostomia is basically supportive and the main elements are presented.

Humans↗
PubMed1981

Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis.

The human demyelinative disorder central pontine myelinolysis may be an iatrogenic disease caused by a rapid rise in serum sodium, usually when hyponatremia is corrected. Rats treated with hypertonic saline after 3 days of vasopressin-induced hyponatremia had demyelinative lesions in the corpus striatum, lateral hemispheric white matter, cerebral cortex, hippocampal fimbria, anterior commissure, thalamus, brainstem tegmentum, and cerebellum. Thus, rapid correction of hyponatremia can lead to demyelinative lesions and may be the cause of central pontine myelinolysis in man.

Animals↗
PubMed2000

Medication errors in a paediatric teaching hospital in the UK: five years operational experience.

BACKGROUND: In the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients. AIMS: To determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence. METHODS: Retrospective review of medication errors documented in standard reporting forms completed prospectively from April 1994 to August 1999. Main outcome measure was incidence of error reporting, including pre- and post-interventions. RESULTS: Medication errors occurred in 0.15% of admissions (195 errors; one per 662 admissions). While the highest rate occurred in neonatal intensive care (0.98%), most errors occurred in medical wards. Nurses were responsible for most reported errors (59%). Errors involving the intravenous route were commonest (56%), with antibiotics being the most frequent drug involved (44%). Fifteen (8%) involved a tenfold medication error. Although 18 (9.2%) required active patient intervention, 96% of errors were classified as minor at the time of reporting. Forty eight per cent of parents were not told an error had occurred. The introduction of a policy of double checking all drugs dispensed by pharmacy staff led to a reduction in errors from 9.8 to 6 per year. Changing the error reporting form to make it less punitive increased the error reporting rate from 32.7 to 38 per year. CONCLUSION: The overall medication error rate was low. Despite this there are clear opportunities to make system changes to reduce error rates further.

Adolescent↗
PubMed1974

Awareness and experience of general practitioners of selected drug interactions.

The awareness of general practitioners of selected adverse drug interactions has been assessed. The drugs studied included adrenergic neurone blockers, warfarin, antidiabetic agents, and monoamine oxidase inhibitors. The findings must be interpreted with caution but they suggest that there is a clear need to improve the effectiveness of communication of information about adverse drug interactions if unnecessary iatrogenic disease is to be avoided.

Amitriptyline↗