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Mar 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2630
P. Schwarm FrankCorresponding author
Department of Neurosurgery, Justus-Liebig University Giessen, Giessen, Germany
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.
Sep 2024 DOI 10.14302/issn.2577-137X.ji-24-5207
Olutola AyodotunCorresponding author
COVID-19 vaccine hesitancy has emerged as a major challenge to global efforts to control the pandemic, particularly in Nigeria, where hesitancy to other effective vaccines such as polio and measles has been widely reported. Several individual, societal, and structural factors contribute to this behaviour and prevent the effectiveness of COVID-19 prevention efforts. Objectives This study sought to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria. Methods A population-based cross-sectional online survey was conducted among residents using a semi-structured questionnaire adapted from the WHO SAGE vaccine hesitancy scale and distributed via social media networks over 8-weeks. Results A total of 1,429 responses met the inclusion criteria and were analysed. Among the respondents, 60.7% were males, 47.5% were between the ages of 26 and 45, and 80.1% had postsecondary education. A total of 421 respondents (29.5%) were hesitant and unwilling to receive the vaccine. The reasons for hesitancy were concerns about side effects (37.1%), doubt about the existence of COVID-19 (11.0%), and the perception of time required to receive the vaccine (9.6%). Post-secondary education (AOR: 0.49, 0.36-0.66) and people of the Islamic faith (AOR: 0.68, 0.52-0.90) were found to be associated with lower levels of hesitancy. Conclusion The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment, lower income and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. In order to protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.
Aug 2024 DOI 10.14302/issn.2470-0436.jos-24-5162
Alves Ambrósio JoãoCorresponding author
Introduction Cystoid macular edema (CME) is a sight-threatening condition caused by fluid accumulation in the macula due to blood-retinal barrier disruption. Various factors, including drug reactions, can lead to retinal fluid leakage. Leflunomide, a disease-modifying anti-rheumatic drug, marked significant progress in managing rheumatoid arthritis. Although effective, Leflunomide has rarely been linked to CME. This report presents a unique case of Leflunomide-induced CME, adding to the limited literature on this subject. Methods We report the case of a 75-year-old female with rheumatoid arthritis treated with Leflunomide, presenting with bilateral CME and reduced visual acuity (VA). Comprehensive ophthalmic evaluations, including VA tests, fundus examination, and optical coherence tomography, were conducted. Results The patient presented with CME and decreased VA in both eyes for several months. She had undergone cataract surgery 20 years prior and was using topical nepafenac, dorzolamide, and dexamethasone. Initial VA was OD 20/50 and OS 20/40. VA improved with treatment, but CME recurred upon discontinuation. The patient had been on Leflunomide for one year. After consulting with the Rheumatology department and considering a previous case of bilateral Leflunomide-induced CME, the drug was discontinued. CME resolved without recurrence or the need for topical treatment. At her final visit, VA was OU 20/25. Conclusion This case highlights Leflunomide as a potential, though rare, cause of CME. It emphasizes considering systemic medications in CME diagnosis. Timely discontinuation of Leflunomide may resolve CME and prevent further visual impairment. Further studies are needed to understand this rare side effect comprehensively.
Feb 2024 DOI 10.14302/issn.2998-4211.jalr-23-4813
del Carmen Teruel Hernández EstherCorresponding author
This study systematically reviews the literature on non-pharmacological interventions for disrupted sleep-in people meeting established criteria for moderate-severe dementia, and to analyze the methodological quality of the included studies. The PubMed, PEDro, Cochrane, Virtual Health Library, APA PsycInfo databases were searched using a systematic literature review approach to identify various types of non-pharmacological treatments that improve disrupted sleep-in subjects with moderate-severe dementia. In accordance with the inclusion criteria, eight studies were systematically reviewed and analyzed according to the type of non-pharmacological treatment carried out. This systematic review showed that 50% of the studies used bright light therapy, 12.5% the use of manual therapy, and 37.5% sleep hygiene or walking or a combination of these interventions. Based on the results of the present study, although there is some evidence to support these strategies, it is not significantly supported and highlights variation in the way the interventions were delivered. Disrupted sleep is highly prevalent in people with dementia and have a negative impact on the quality of life of the sufferer and the caregiver. Non-pharmacological approaches to its treatment are increasingly popular as an alternative to drugs, whose efficacy and side effects have raised concerns among the population. Currently, there is a need to carry out more future research to establish its effectiveness and to be able to provide clear guidelines at the time of clinical practice.
Jan 2024 DOI 10.14302/issn.2328-0182.japst-23-4771
Tariku Belay YilkalCorresponding author
Background Immunoglobulins are bio-receptors found embedded in the cell membrane with a biological role that detects the harmful molecules of a test compound. These bio-receptors interface between a biological system and its external environment that transduce information to the effector via intermediate messengers in which its response efficiency usually exhausts at high doses of exposure to external stimuli. The purpose of this review article is, therefore, to elaborate on the computational method for systemic biology which was designed to convert qualitative pharmacological data into the quantitative one that might help to determine the toxicity of a test compound. Methods First, acute toxicity studies using different levels of doses prepared from each test compound have been conducted on Balb c mice. Then, blood specimens from the tail and facial veins of each sampled Balb c mouse were collected 3 days before dosing as a reference test and 4 hr after dosing for comparison. The changes in the efficiency of immunoglobulins immune response (ΔIg) after dosing were determined using quantitative immunoassay and the body’s response against the dose as the toxic reaction rate (r) and the toxic severity (s) were finally determined using computational methods as r=d/t-ΔIg mg/sec and (s=r/w×100) %/sec respectively, where (w) represents the body weight of a study animal, (t) represents the period of time at which undesirable bio-physiological responses manifested on treated study animals and (ΔIg) represents the changes in the concentration of immunoglobulins in blood serum after dosing. Results The results of different studies revealed that the dose has never limited the toxic property of a test compound but the length of time at which the undesirable side effect was manifested on study animals. The period of time at which adverse effects manifested on treated Balb c mice was inversely related to the amount of dose administered in the oral route. The higher the dose of the administered test compound, the shorter the period of time at which the undesirable side effect was manifested on treated Balb c mice. This means that the adverse effect of test compounds was not because of the dose but rather due to its toxic reaction rate which ultimately determined the toxic severity in the natural process of treated Balb c mice. Balb c mice treated with a dose whose toxic reaction rate was ≤ 0 survived from death whereas Balb c mice treated with a dose that had a toxic reaction rate of > 0 died at different lengths of time after dosing depending on the toxic severity of a test compound. It could be a scientific fact to declare that a test compound is safe when the toxic reaction rate (r) and toxic severity (s) of a dose is ≤ 0 and toxic when it is > 0 in the natural processes of a study animal.
May 2023 DOI 10.14302/issn.2642-9241.jrd-23-4566
Krishna C VeligandlaCorresponding author
Safe and effective antitussive therapy remains a significant area of unmet need for cough management. Antitussive drugs are commonly used cough suppressants and include centrally acting (opioids and non-opioids) cough suppressants and peripherally acting antitussives. Authors searched PubMed, Google Scholar and additional studies from reference lists via cross-referencing to identify studies assessing levodropropizine for the treatment of cough. Of the 748 studies identified, 13 were included. Recent clinical evidence, guideline recommendations and findings from this review suggest that levodropropizine is a peripheral antitussive which reduces cough intensity, frequency, and nocturnal awakenings in children and adults and provides better efficacy outcomes with a more favourable risk/benefit ratio compared to centrally acting antitussive agents which pose greater safety concerns and present an unacceptable risk–benefit profile. This review is aimed at Indian primary care physicians for making effective cough management decisions where the clinical evidence needs to be translated to clinical practice. Key Messages The usage of currently available centrally acting antitussive agent is greatly limited by their central depressing action and frequent side effect. The findings of this review indicate that levodropropizine is an effective antitussive agent and well tolerated in the management of cough in patients of all ages.
Mar 2023 DOI 10.14302/issn.2690-4837.ijip-22-4342
Massood Nabavi SeyedCorresponding author
Introduction Vaccination against SARS CoV-2 started on March 2020 in Iran and people with multiple sclerosis (pwMS) have a priority to be vaccinated in line of other high-risk population. Up to now, BBIBP-CorV (Sinopharm) is the main vaccine which have been used in Iranian population, and in high risk population such as pwMS. Method In this survey, the safety and possible side effects of this vaccine after the first or/and second doses in 520 pwMS have been assessed from July to August 2021. MS Patients who have received one or two doses of Sinopharm vaccine were evaluated. Results Around 44% of pwMS who received Sinopharm reported few minor side effects, whereas its side effect have been reported in 60% of patients who received the second dose. All side effects have begun within the first 24 hours and subsided between 48-96 hours afterward. No serious side effects or mortality have been reported. There was no correlation between the side effects and age, the disability status, and the type of first or second line DMDs (disease modifying drugs). Only some side effects were significantly higher in the progressive form of the disease. Conclusion MS patients can receive Sinopharm vaccine safely and the minor side effects should not scare them.
Mar 2023 DOI 10.14302/issn.2474-7785.jarh-22-4381
Tariku Belay YilkalCorresponding author
Background Ageing is a life process in which progressive molecular, cellular, physiological and anatomical changes manifesting in humans and animals including other organisms lead to the decline of biological functions. Immunoglobulins (Igs) are glycoprotein molecules produced by white blood cells mainly B lymphocytes following signal transduction as a result of their interaction with pathogenic microbes or poisonous substances introduced into the body systems. They elicit responses against the side effects of pathogens and poisons in which their response efficiency usually declines as we are ageing. Objective Thus, the similarities between Igs’ immune response against the different amounts of xenobiotics and the biological changes associated with ageing have been systematically assessed using the reports of different study results on humans and animals. Methods First, a literature search was carried out in google, PubMed and google scholar using planned search terms related to the title of this study. Review and original articles were retrieved, downloaded and saved on a computer. And then the effects of different factors i.e. xenobiotics, age, sex and lifestyle-based practices on the levels of serum Igs (IgG, IgA and IgM) in animals and humans have been studied using a systematic review of different literature sources. Finally, the relationship between the findings of various studies has been assessed and judgment on the possible cause of ageing has been made. Results The findings of different research have demonstrated that the signaling efficiency of immunoglobulin M (IgM) has been limited by the amount of test compounds administered to study Balb c mice in the oral route. The response efficiency of IgM immune response against the lower doses of test compounds were high compared to the higher doses of test compounds which was low. The results of different other studies also demonstrated that the decline of serum IgM levels was associated with ageing. The relationship between alcohol consumption and the concentration of serum Igs was also described in the report of different studies. These studies have shown that there was lower level of IgG in the blood serum of alcohol consumers compared to non-consumers. The study has also demonstrated a lower level of serum IgM with higher alcohol consumption and higher serum concentration with moderate beer consumption. Conclusion The trajectory of Igs’ immune response against different amounts of xenobiotics was highly associated with the trajectory of biological changes during ageing. These research findings might be the possible evidence to conclude that ageing is caused by the foodstuffs and non-foodstuffs we usually consume, the lifestyles we usually experience and the way of life we usually live in the environment which gradually defiling the natural processes of the body.
Jun 2022 DOI 10.14302/issn.2328-0182.japst-22-4193
Tariku Belay YilkalCorresponding author
School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
The strategy for safe drug discovery and development has limited clinical success as compared to wasted time and resources annually. This is due to the fact that the results of multiphase preclinical trials are less likely to make an accurate early prediction on the safety of test compounds to progress into the clinic as a valuable therapeutic agent. A lot of time and resources has been wasted in the multistage processes of drug discovery and development that does not work at the end of the procedure every year. During pre-marketing stage, for instance, the number of unsuccessful clinical trials are greater than the successful one because of safety issues. A toxicity study at different stages of preclinical and clinical trials is a routine procedure to investigate the undesirable side effects of test compounds being manifested on the natural processes of living things. It deals with the effect and mechanism of toxicity of test compounds that triggers different biological responses on different organ systems. The biological responses that would be manifested as a result of interaction between the receptors and active molecules of a test compound could be desirable pharmacological effect or undesirable side effect or both responses are manifested simultaneously depending on the selectivity or specificity of the molecule of a test compound for its receptor subtype which makes safe drug discovery and development very challenging. The response efficiency of the body (the net outcome of the body’s biological reaction against the side effect) would determine the potency of a test compound to manifest undesirable pharmacologic effect. In other words, the amount of a drug required to cause a biological harm or injury depends on the magnitude of the body’s biological reaction in which the immune response plays a great pharmacological role by neutralizing and harmonizing xenobiotics with the biological molecules. The dose of a test compound at 100 mg/kg body weight, for instance, could be lethal to some of the study animals while it is still non-lethal to some other study animals depending on the response efficiency of the body. The immune system is well connected to each and every biological systems of the body which allows it to detect undesirable side effects being manifested through immunoglobulins signalling and activation mechanisms. This complex communication network helps to localize the diverse side effects of a test compound being manifested on different organ systems into the immune system which makes a toxicity study relatively simple to monitor. The cellular immune system becomes active following the molecule-receptor interaction and start producing antibodies which is also known as immunoglobulins to protect bodily harm and destruction. Under normal biological circumstances, the amount of immunoglobulins produced by the cellular immune system following exposure to a test compound is proportional to the number of harmful molecules interacted with its receptor subtype. Thus, with the reference to the changes in the immune response against the administered dose, it would be able to deal with the diverse undesirable side effects of a test compound being manifested on treated study animals using computational systemic biology.
Mar 2022 DOI 10.14302/issn.2692-1537.ijcv-22-4117
Wu JianqingCorresponding author
Healthier World (Independent researcher for cause), P. O. Box 689, Beltsville, MD 20704. USA
Several mRNA vaccines are used on the population in the U.S. I started predicting the dangers of mRNA vaccines before March 2021 and update my findings periodically. My prior model study enabled me to identify many flaws in clinical trials, side-effect evaluation methods and mechanism studies, and I also considered consistent failure in predicting drug side effects in the past and systematic failure of FDA in keeping out dangerous drugs from market. I found that the risks of vaccination cannot be determined by experiments alone and must be determined by using a combination of methods. By studying mRNA expression dynamics and kinetics, I predict that vaccination with mRNA vaccines may increase cancer risks, multiple organ failure risks, earlier death risks, genome alteration speeds by one or more mechanisms, alter the normal selection process for viral evolution resulting in more virulent viruses, and aggravate chronic diseases or cause healed diseases to relapse. Two root problems are practical inability to control expression sites and severe adverse reactions from repeated vaccination. Based on mRNA bio-distribution, the mRNA mainly strikes the liver and other vital organs, and poses grave dangers to persons whose vascular functional reserves are relatively small, or whose vascular systems are temporarily burdened by other causes such as viral infections or life activities. If an mRNA vaccine is administered on a pregnant woman by second or booster shots, spike protein synthesis in fetus brain disrupts the highly regulated protein synthesis processes, resulting in potential brain damages. In less than a year, most of my early predicted damages are being materialized or are on the track to hit the population. In this update, I present a benefits-and-risks map to show how the number of deaths caused by mRNA vaccines is grossly underestimated and why claimed benefits like 95% effectiveness rate and 90% death rate reduction are meaningless and misleading.
Feb 2022 DOI 10.14302/issn.2692-1537.ijcv-21-4053
Wu JianqingCorresponding author
Healthier World (Independent researcher for cause), P. O. Box 689, Beltsville, MD 20704. USA
Drug industry, controlling medical publishers and large media promote flawed medicine for their revenues by systematically laundering medical knowledge in decades. They maintain and promote flawed research models and suppress disruptive discoveries, thereby precluding reform of medicine. In this study, I will deeply explore how the wrong life model, population-based research model, misused clinical trials, flawed statistical models, the symptom based research methods, binary disease classification, failure to address the massive vital organ capacities, failure to correct biases caused by expected delay in realizing side effects, and failure to address the interference effects of non-controllable factors affect the conclusions of “effectiveness and safety” for mRNA vaccines. I will directly analyze three studies that have been relied upon by FDA in approving mNRA use authorizations: one BNT162b2 effectiveness study published in NEJM, one booster shot study published in NEJM and a Seven Integrated Health Care Organizations study published by CDC. I will expose fatal flaws in the frequency risk concept, effectiveness rate, and hazard reduction ratios, and show why 3% death rate, 95% effectiveness rate and 90% mortality reduction are all meaningless and misleading, and should never have been used as treatment guidance. I will also examine common biases that can be easily practiced by sponsors’ researchers to alter conclusions in favor of approval. By relying on laundered medical “knowledge”, FDA has consistently failed to predict latent drug side effects for any drugs and vaccines in its history. FDA approved disastrous DES in 1941, Swine Flu vaccine in 1976, and mRNA vaccines in 2020. The vaccines are used to deliver short-term benefits on a small percent of persons at the costs of damaging health, causing deaths that could be avoided, and shortening lifespans for all people in the population. I thus urge FDA to reevaluate all mRNA vaccines and revoke their use authorizations.
Jan 2022 DOI 10.14302/issn.2379-7835.ijn-21-4059
Ford KristynCorresponding author
Bachelor of Nutrition and Dietetics, Accredited Practising Dietitian (APD), Department of Nutrition and Dietetics, The Royal Children’s Hospital, Melbourne Australia, Address: 50 Flemington Road, Parkville VIC 3052
Aim There is limited published data describing the characteristics of the paediatric population prescribed semi elemental formulas. This retrospective observational audit aimed to describe the characteristics of the paediatric patients who have been prescribed a hydrolysed whey protein, medium chain triglycerides (MCT) based formula, Peptamen Junior® and the nutritional outcomes. Methods A retrospective observation audit was completed on a cohort of patients that was prescribed a semi elemental formula between 2016 and 2019 from a single tertiary paediatric medical centre. Data variables were collated such as patient characteristics, indications and modalities of administration, duration and tolerance to the formula. Results Data was collated on 375 patients with a median age of 6.2 years. The main underlying medical conditions were haematological/oncology (67%), gastrointestinal disorders (10.7%) and neurological conditions (9.4%). The most common indications for use were chemotherapy related side effects (36.2%), post bone marrow transplant (25.8%) and gastrointestinal symptoms (17.9%). The formula was rarely used as a sole source of nutrition, with 88% patients requiring accompanying forms of nutrition support. The majority of orders prescribed were of standard concentration (80.8%) and tolerance was recorded in 82.8% of patients. Conclusion The semi elemental formula Peptamen Junior® appears to be well tolerated in paediatric patients with a variety of medical conditions that have complex pathologies and may have wider scope of use in a more diverse group of medical conditions than currently indicated.
Jan 2021 DOI 10.14302/issn.2692-1537.ijcv-20-3685
Elkhenany HodaCorresponding author
Department of Surgery, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt.
The current uncontrollable outbreak of novel coronavirus (COVID-19) has unleashed severe global consequences in all aspects of life and society, bringing the whole world to a complete halt and has modeled significant threats to the global economy. The COVID-19 infection manifests with flu-like symptoms such as cough, cold, and fever resulting in acute respiratory distress syndrome (ARDS), lung dysfunction, and other systemic complications in critical patients are creating panic across the globe. However, the licensed vaccine has started to show up; some resulted in side effects that would limit its possibility in some circumstances as allergic personnel, for example. Moreover, the production and approval of new drugs is a very complicated process and takes a long time. On the other hand, stem cells have gone the extra mile and intensively investigated at preclinical and clinical studies in various degenerative diseases, including infectious ones. Stem cells are proposed as a broad-spectrum therapeutic agent, which may suppress the exaggerated immune response and promote endogenous repair by enhancing COVID-19 infected lung microenvironment. Also, stem cells have different application manners, either direct transplantation, exosome transplantation, or drug delivery of specific cytokines or nanoparticles with antiviral property by engineering stem cells. This review discusses and summarizes the possible emerging role of cell-based therapy, especially stem cell therapy, as an alternative promising therapeutic option for the treatment and control of novel COVID-19 and its potential role in tissue rejuvenation after COVID-19 infection.
Dec 2020 DOI 10.14302/issn.2473-1005.jdoi-20-3659
C SzuhanekCorresponding author
Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy ‘Victor Babes’, Timisoara, Romania
Open bite malocclusion, due to it’s multifactorial etiology, has always been considered a difficult problem to treat. Often associated with transverse maxillary deficiency, this is a real challenge in the field of orthodontics. The traditional approach, for this type of anomaly, in adult patients, is orthognathic surgery and RME (rapid maxillary expansion). There are several approaches to the treatment of adult patients using digital technology. Mini-implant supported palatal expander limits the side effects of the conventional RME and is less invasive compared to orthognathic surgery. Precise and predictable mini-implant insertion, using a customized surgical guide, provides a safe therapeutic approach. This case report combines Cone-beam computed tomography (CBCT), laser scan superimposition, computer-aided design (CAD) and 3D printing in order to design and print a customized surgical guide for orthodontic mini-implant insertion. A CBCT scan was performed to determine the optimal site for mini-implants’ placement. Using the 3Shape Trios Intraoral Scanner the maxilla and the mandible were laser-scanned. Blue Sky Plan 4 software was used to design the surgical guide, and RayWare software was used for printing it. 4 mini-implants were inserted using a safe and predictable technique. The 3D technology represents the future of orthodontics, reducing the risks, chair-side time while providing the best treatment plan for the patient.
Nov 2020 DOI 10.14302/issn.2766-8630.jrnm-20-3594
Sakyanun PitchayaCorresponding author
Department of Radiation Oncology, Phramongkutklao Hospital, Bangkok, Thailand 10400
Purpose The purpose of this study was to assess the efficacy (overall survival, local control, progression free survival (PFS) and toxicities between two dimension (2D) and three dimension (3D) CT guided brachytherapy without using interstitial needles in cervical cancer patients. Material and Methods A retrospective case-control study was performed in Figo stage IB-IVA cervical cancer patients treated between March 1990 and August 2018. Concurrent chemoradiation using external beam radiotherapy followed by brachytherapy (BT) was the treatment method used in all patients. Clinical endpoints were overall survival, local control, progression free survival, acute toxicities and late toxicities. Results A 102 cervical cancer patients were included,52 patients have been treated with 2D and 50 patients with 3D using CT scan brachytherapy without interstitial needles. Baseline characteristics were similar between both groups. External beam was used in all patients during concurrent chemoradiation period before brachytherapy. All patients completed the treatment. Similar 3-year overall survival and local control was reported between 2D and 3D techniques. Overall 3-year survival rate was 95.7% in 2D and 91.8% in 3D brachytherapy (P value = 0.188). Local control at the 3 year follow up was 88.6% in 2D and 93.3% in 3D (P value = 0.571). Progression free survival was better in 2D rather than 3D (86.13% in 2D vs 27.4% in 3D, p value = 0.006). No grade 3 or 4 toxicity in 3D technique was observed whereas there are 1.9% of grade 3 acute GI toxicity and grade 3 late GI and GU toxicities in 2D technique (7.7% and 5.8 %). The 3D brachytherapy significantly reduced acute grade 2-3 GI side effect and grade 2-3 late GU side effect (acute GI 25% in 2D vs 4% in 3D, late GU (56% in 2D vs 16% in 3D). Conclusion Using CT guided 3D brachytherapy in treatment of cervical cancer showed similar outcomes in survival and local control but reduced toxicity compared to the 2D technique. Disease progression including metastasis was found better in the 2D brachytherapy technique. CT guided brachytherapy helped reduce dose to organs at risk and long term follow up for survival outcome and toxicities was needed.
Sep 2020 DOI 10.14302/issn.2328-0182.japst-20-3526
Bekele AnbessaCorresponding author
Pharmacy School, Health Institute, Jimma University, Ethiopia
Background Self-medication (SM) can be defined as the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. A number of individuals in developing countries do not attend physicians for their illnesses; instead they commonly use self-medication. Self-medication could be using drugs existing in home like over the counter (OCT) drugs, traditional medicine, prescription only drug. Self-medication is not always bad, hence for the over the counter drugs it is beneficial. Inappropriate storage and use of medicines at home could have a direct influence on public health, the environment and the health-care services and it increases the risk of self-medication. Objective To assess the practice of self-medication and drug storage among South Sudanese community in Addis Ababa. Materials and Methods A cross sectional study design was conducted in Addis Ababa city from April 22 to April 26/2019. Data was collected by semi structure-questionnaire consisting questions on general demographic, socio-economic as well as on perceived illness/ symptoms in the past four weeks and actions taken for it. The data collected was screened before it is analyzed. Data analysis was done by using calculator. Results From the total 297 respondents 286 (96.2%) had reported self-medication in the last one month before the study period. The most common types of ailments for which the respondents reported to have practiced self-medication were cough, cold and sore throat 90(30.3%), followed by headache 66(22.2%), diarrhea 52(17.5%) ,abdominal pain 47(15.8%), fever 21(7.07%) and vomiting 10(3.3%). The reasons given for self-medication were; the illness was minor 226(76%) and previous experiences with similar ailments 31 (10.4%) were found to be the two major reasons given by the respondents for self-medication in this study. The majority of the respondents 242(81.4%) who practiced self-medication obtained information on self-medication from friends and 29(9.7%) obtained information from family members. The most frequently used group of drugs used for self-medication were analgesics/antipyretics 177(59.5%) and antimicrobial which account 75(25.2%) each followed by antihelmenthics 24(8.08%).The main source of drugs for SM was in pharmacy 220(74.07%) followed by leftover drugs 41(13.8%) while drug retail outlet, and neighbors and relatives were the suppliers to 12.13% respondents each. Conclusion and Recommendation A significant number of respondents (96.2%) use S/M from those perceived illness. Majority of the self-medicated individuals used due to minor illness. The most common category of drugs used was analgesics/antipyretics and antimicrobials. And the reason reported for using S/M was minor illness and previous experience with the illness. Most of respondents obtained drugs easily from pharmacy. So, pharmacies are the major sources of drugs used for S/M. The increased of drugs storage to treat similar illness/symptom and drugs left over from previous use contribute to the increase in the S/M practice. Common drugs store reported by respondents who store modern drugs were analgesic/antipyretic. Most of the respondents stored the drug in locked cabinets. A lot is need to be done in educating the public including the health care providers on the type of illnesses that can be self-diagnosed and self-treated, the type of drugs to be used for S/M, and the proper use of drugs. During dispensing of drugs emphasis should be given to all drug consumers and dispenser because of resistance and side effects of drug is the main challenging problem even in the world. Food, Medicines and Healthcare Administration and Control Authority (FMHACA) needs to effectively implement laws on drug handling and dispensing so as to take necessary measures on illegal providers of drugs.
Oct 2019 DOI 10.14302/issn.2641-7669.ject-19-3040
Kader Mohiuddin AbdulCorresponding author
Secretary & Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka 1215
Many lay people along with some so called “key opinion leaders” have a common slogan “There's no answer for cancer”. Again, mistake delays proper treatment and make situation worse, more often. Compliance is crucial to obtain optimal health outcomes, such as cure or improvement in QoL. Patients may delay treatment or fail to seek care because of high out-of- pocket expenditures. Despite phenomenal development, conventional therapy falls short in cancer management. There are two major hurdles in anticancer drug development: dose-limiting toxic side effects that reduce either drug effectiveness or the QoL of patients and complicated drug development processes that are costly and time consuming. Cancer patients are increasingly seeking out alternative medicine and might be reluctant to disclose its use to their oncology treatment physicians. But there is limited available information on patterns of utilization and efficacy of alternative medicine for patients with cancer. As adjuvant therapy, many traditional medicines shown efficacy against brain, head and neck, skin, breast, liver, pancreas, kidney, bladder, prostate, colon and blood cancers. The literature reviews non-pharmacological interventions used against cancer, published trials, systematic reviews and meta-analyses.
Feb 2019 DOI 10.14302/issn.2377-2549.jndc-18-2569
Tabassum Khan NidaCorresponding author
Department of Biotechnology, Faculty of Life Sciences and Informatics, Balochistan University of Information, Technology Engineering and Management Sciences, (BUITEMS), Quetta, Pakistan
Anthraquinones is a potent aromatic compound that besides being used commercially it offers numerous therapeutic benefits such as inhibits cancer growth by inducing apoptosis, relive constipation, ease bowl movement etc. Anthraquinones are found naturally in some plants such as senna, buckthorn, yellow dock etc while it can also be produced using chemical routes such as anthracene oxidation, naphthalene oxidation, condensation of 1, 4-naphthoquinone with butadiene etc. However its intake should strictly be regulated since it may cause some serious side effects.
Feb 2019 DOI 10.14302/issn.2578-8590.ipj-19-2623
Hinzpeter JaimeCorresponding author
Department of Orthopaedic Surgery, Clinical Hospital, University of Chile, Santos Dumontt # 999, Independencia, Zip Code: 8380456, Santiago, Chile.
Neosaxitoxin (NeoSTX) is a specific high-affinity inhibitor of voltage-dependent sodium channels, which has shown excellent results as a local anesthetic in various pathologies and post-operative protocols, since it effect is long-lasting and have virtually no side effects.The aim of this study was to analyze the effect of NeoSTX as an epidural anesthetic in female cats, undergoing ovariohysterectomy, compared to Lidocaine in a randomized and double-blind study. Two groups of 11 female cats were randomly in the NeoSTX group and the lidocaine group. They were administered, respectively, a single dose of NeoSTX (0.5 μg / kg) or lidocaine (4 mg / kg, 2%) by epidural via. Using the UNESP-Botucatu pain assessment scale, which considers multiple behavioral and physiological factors, the epidural anesthetic effect of NeoSTX and lidocaine was evaluated, up to 240 min after the ovariohysterectomy procedure. NeoSTX no altered the peripheral blood pressure during the cut of uterine cervix, and generated lower values on the pain scale as compared to the lidocaine treatment. None of the cats anesthetized with NeoSTX required an extra dose of pain-relieving drugs (2 mg / kg of tramadol) during the first 150 min after surgery, whereas nine cats from the lidocaine group did need an extra dose of analgesic. NeoSTX is a powerful pain blocker, with a long-lasting anesthetic effect when administered by an epidural procedure. Therefore, NeoSTX emerges as a promising alternative to conventional anesthetics for the treatment of postoperative pain.
Dec 2018 DOI 10.14302/issn.2379-7835.ijn-18-2491
Iacobelli StefanoCorresponding author
Janus Pharma S.r.l., Via Giacomo Peroni 386, 00131 Roma, Italy.
Objective: To evaluate the efficacy and safety of a novel tomato-based food supplement on the lower urinary tract symptoms (LUTS) of patients with benign prostatic hyperplasia (BPH). Methods: Twenty patients with BPH were enrolled in this observational study. They were assigned to consume daily a sachet of Lycoprozen® (5 grams) dissolved in water for two months. Results: All patients successfully completed the Lycoprozen scheduled regimen and the IPSS (International Prostatic Symptom Score) questionnaire before and after treatment. No side effects due to treatment were noticed. In this preliminary study, we have found that Lycoprozen® significantly reduced the LUTS severity (paired t-test, two-tailed p value < 0.0001). The IPSS mean values before and after the treatment were 16.95+6.0 SD (range 31-6) and 12.2+4.9 SD (range 20-2), respectively. Conclusions: Based on these data, Lycoprozen® may represent a suitable alternative option for the treatment of symptomatic BPH patients which worth of further testing in a phase 2 prospective randomized double blind placebo controlled study. The treatment was without side effects and acceptance among patients was high.
Aug 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2258
Meyer Peter-WolfgangCorresponding author
Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
We present a case of a 77-year-old male patient who was treated in our outpatient clinic for memory disorders because of episodic confusion and retrograde amnesia. The patient reported having symptoms repeatedly following intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents (Ranibizumab and Bevacizumab) as a treatment for wet macular degeneration. EEG showed a localized deceleration that intensified under prolonged voluntary hyperventilation. Symptoms resolved after the intraocular Anti-Vascular Endothelial Growth Factor treatment was stopped and anticonvulsive treatment with lamotrigine was begun. This case is important in that it describes a potential association between intraocular treatments with Anti-Vascular Endothelial Growth Factor Agents and seizures. Symptoms occurred in temporal correlation with intraocular treatment. Clinicians should be aware of this potential side effect on intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents in patients with high risk for seizures.
Mar 2018 DOI 10.14302/issn.2574-4518.jsdr-17-1785
W Chang-LitCorresponding author
Mount Sinai Beth Israel
Sleep is vital for the maintenance of physical health and mental wellbeing. Sleep also plays a cardinal role in the process of healing. It is estimated that 50 to 70 million Americans suffer chronically from sleep disturbances and insufficiency, which not only hinders daily functioning but also adversely affects health, quality of life and longevity.1 Deficient sleep is associated with an increased risk of developing chronic diseases such as hypertension, diabetes, obesity, heart disease, stroke, depression, frequent mental distress, as well as increased mortality, and reduced quality of life and productivity.1,2Aging, medical conditions, pain, and mental illness further aggravate sleep disturbances such as insomnia, sleep fragmentation and daytime sleepiness.3, 4, 5, 6, 7, 8 The a common treatment for sleep disturbances and insomnia is pharmacological therapy. Benzodiazepines may have negative long-term side effects including residual daytime sedation and tolerance development. Withdrawal difficulties may increase dependency. In the older patient there are safety issues related to daytime sedation including increase risk of falls. With the importance of sleep in hospital recovery and the side effects of sleep medication becoming more widely recognized, there has been an impetus to s use nonpharmacological alternatives , such as music.. This pilot study builds on the potential impact of music’s effectivity by introducing music therapy as a safe, cost effective and culturally sensitive intervention.
Mar 2018
Rizzello LorisCorresponding author
Department of Chemistry, University College London (UCL), 20 Gordon Street, WC1H 0AJ - London (UK)
The crusade against cancer has a new army: immunotherapy. The rational design is very simple, but brilliant at the same time. Extract the patients T-cells, reprogram them in vitro for the expression of highly specific receptors against cancer, perfuse them back to the patient. As a result, T-cells are now instructed to selectively kill circulating tumor cells, while avoiding potential side effects. This ‘Fairy Tale’ however does not lack of drawbacks and limitations. First, malignant progression can be accompanied by profound immune suppression, which counteracts the immune system-mediated tumor elimination. Second, the immune cells modification does not match high standards in terms of safety for humans. Here, nanotech can fill these gaps, and help immunotherapy to be safer and more effective.
Feb 2018 DOI 10.14302/issn.2640-690X.jfm-17-1900
Ali M. Elzohry AlaaCorresponding author
Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University.
Background PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast. Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite important disease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead to increased patient’s satisfaction and decrease fear of cancer breast. Objective Discuss different methods for management of PMPS with less side effects, adequate analgesia, improvement of quality of life, and better patient satisfaction in the future. Methods Treatment approaches include both pharmacological interventions and non-pharmacological strategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment. Conclusion Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanyl intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.
Nov 2017 DOI 10.14302/issn.2372-6601.jhor-17-1761
Lee Mortensen GitteCorresponding author
AnthroConsult, Fynsgade 24, 8000 Aarhus C, Denmark
With the introduction of tyrosine kinase inhibitors (TKI), patients with chronic myeloid leukemia (CML) have obtained survival rates close to normal. It may appear paradoxical, then, that medication adherence is suboptimal in some health care settings. As the first of its kind, this study aimed to explore drivers and barriers to TKI treatment adherence in Danish CML patients. A literature study informed the design of qualitative interviews with 20 patients, individually and in focus groups, focusing on their disease perceptions of CML, their health-related quality of life (QoL) and medication adherence. The study showed that many participants had previously switched treatment due to lacking efficacy or intolerance but most felt their current disease burden was tolerable. Anxiety might, however, resurface if treatment stopped working or with the occurrence of infections or side effects, creating a state of ‘fragile peace’. To these patients, their role functioning – as professionals, spouses, parents and grandparents – was crucial to uphold a positive self-image and meaningful life. Whether treatment enabled or hindered this was thus decisive to their QoL and medication adherence. Our participants expressed high adherence rates with only one having intentionally non-adhered due to side effects and poor QoL. Most participants felt well-informed about CML and treatment and privileged to receive specialised personal care from the public health care system acting to motivate their medication adherence. As a novel finding, this study indicates that the prospect of treatment-free remission may positively affect ‘adherence’ suggest this should be explored in future studies.
Oct 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1750
Niknam ZahraCorresponding author
PhD candidate of Exercise Physiology, University of Tabriz
Background The prevalence of obesity and type 2 diabetes is escalating at an alarming rate in many developed as well as developing countries. Irisin is a novel muscle and adipose drived chemokine that is, proteolytically processed from the product of the FNDC5 (fibronectin type ш domain containing 5) gene. The purpose of this study is to examine the effect of three kind of training on irisin in sedentary obese women. METHODSː33 obese women (medium age: 37.99 ± 3.7 year, height: 1.55 ± 0.03 meter, BMI: 34.6 ± 5.07 kg/m2) participated in the study, on three groups, including endurance, resistance and concurrent. Results After 8 weeks exercise we did not find significant differences in fasting glucose, insulin, HOMA-IR and irisin between the groups (P>0.05), but glucose and insulin in resistance groups and irisin in all groups had significant changes (P<0.05). Conclusions In summery in this study in contrast to hypothesis there were no difference between groups of training. It can be hypothesise that the increase of irisin in obese people is one of the preventing ways against of obesity's side effects. Exercise could improve the signaling pathways and consume the fat accumulations, therefore at the end of exercise duration, irisin decreased.
Sep 2017 DOI 10.14302/issn.2471-2175.jdrt-17-1774
Aksoy BernaCorresponding author
Assistant Professor, Bahcesehir University, Faculty of Medicine, Department of Dermatology, Istanbul.
Topical corticosteroids are main therapeutic agents for the treatment of a wide variety of dermatological disorders. Three cases of chronic cutaneous ulceration affecting the skin of the breasts that were caused presumably by previous and continued use of potent topical corticosteroids for the treatment of psoriasis and/or intertrigo lesions were reported here. These three cases were presented to emphasize the potential serious local side effects of topical steroids even progressing to ulceration in breast' skin. These cases highlight the importance of appropriate use of topical corticosteroids, necessity of a strict follow up for adverse effects and the need of warning every patient about possible side effects of topical corticosteroids
Sep 2017 DOI 10.14302/issn.2471-2140.jaa-17-1728
Md. Badrul IslamCorresponding author
The use of herbal medicine is becoming popular day by day due to toxicity and side effects of allopathic medicines. Considering the medicinal importance of the plant Murraya koenigii Linn (Curry leaf), the antioxidant activity (AC), total phenolic content (TPC), total flavonoid content (TFC), of different fractions of methanolic extract (DIA-ion resin adsorbed fraction, chloroform, Ethyl acetate and petroleum ether) of M. koenigii were investigated. Among the fractions, DIA-ion resin-adsorbed fraction showed the highest total antioxidant activity with absorbance 2.320±06 and petroleum ether fraction showed the lowest total antioxidant activity with absorbance 1.944 at 100 mg/ml concentration. The TPC were found range between 13.285 to 17.52 mg GAE/g while the highest amount of TFC recorded among the extracts was 16.65 mg CatE/g. DPPH free radical scavenging activity of different extracts of leaves was also measured where DIA-ion resin-adsorbed fraction had the highest free radical scavenging activity with IC50 value 15.53 µg/ml. In the present study phenolic compound were found to be the predominant components in the leaves of M. koenigii indicating that they are potent antioxidant.
Jul 2017 DOI 10.14302/issn.3070-5835.jcpn-17-1562
V. Seeman MaryCorresponding author
Professor Emerita, Department of Psychiatry, University of Toronto, 260 Heath Street W. Toronto, Ontario, Canada M5P 3L6.
Second-generation antipsychotics have relatively recently become available in long-acting intramuscular formulations (LAIs) and have been receiving a substantial amount of pharmaceutical industry promotion on the grounds that they improve treatment adherence in patients with psychotic illness. LAIs do have some drawbacks, however, which is the topic area covered by this review. A Global Scholar search of the nursing and medical literature reveals several factors that can negatively impinge on the clinical efficacy of LAIs: 1. The extent of training of injection personnel 2. The quality of surveillance of patient symptoms and side effects 3. The skilled use of the full range of injection techniques 4. The extent of drug accumulation over time 5. The potential loss of drug dose flexibility 6. The impact of exercise and temperature on drug distribution 7. The burden of the medication routine and the social burdens of LAIs 8. The safety of LAIs during pregnancy 9. The perceived coerciveness of LAIs 10. Issues of overdose and polypharmacy 11. Issues of cost 12. The important issue of responsibility for self-management of illness. Although the evidence is clinical and anecdotal, LAIs appear to work well for many patients, but their drawbacks are not negligible. Clinicians need to weigh individual risks and benefits when making treatment decisions.
Nov 2016 DOI 10.14302/issn.2474-9273.jbtm-16-1273
O. Jack-Ide IzibelokoCorresponding author
Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Niger Delta University.
Background: Many people with mental illness rely on family and friends for support and to help them in their activities of daily living. At all points in the care of ill relatives, caregivers need information to deal with the patient’s care and treatment demands. Methods: This was a descriptive study carried out in a Public owned mental health out-patient clinic. The study consisted of fifty participants, who voluntarily completed a questionnaire regarding their knowledge about their ill relatives’ mental illness and treatment. Results: Majority (62%) were female, and (28%) were parents (66%) has primary level education, (76%) had no knowledge about illness of relatives, (84%) did not know the diagnosis (76%) had poor knowledge of medication, and (84%) could not recognize the side effects of medication. Conclusion: The need for information and education of family caregivers about ill relatives’ mental illness, and the important role of medication regimen in the control of symptoms of the disorders. Education on medication and other treatment strategies should be tailored towards each family caregiver’s understanding and level of education.
Nov 2016
Robst JohnCorresponding author
Department of Mental Health Law & Policy Florida Mental Health Institute, University of South Florida 13301 Bruce B Downs Blvd Tampa
The purpose of this paper is to review the literature linking schizophrenia with chronic inflammation and gluten sensitivity. In addition, the paper discusses the need for dietary interventions that may improve multiple health outcomes for patients. Individuals with schizophrenia are at much greater risk for the development of additional autoimmune disorders. Second generation anti-psychotic medications are the most effective treatment for schizophrenia, but there are numerous potential side effects to the medications. More specifically, individuals with schizophrenia who are treated with SGAs are at increased risk for obesity, diabetes, as well as elevated lipids and blood pressure. An effective evidence-based dietary intervention has the potential to improve numerous outcomes for individuals with schizophrenia.
Apr 2016 DOI 10.14302/issn.2474-3585.jpmc-15-704
Rott DavidCorresponding author
Cardiac Rehabilitation Institute, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer Israel
Objective: Statins are highly effective medications for reducing low-density lipoprotein cholesterol concentrations and cardiovascular events. Their most common side effects are a variety of myopathic complaints, possibly due to reduced circulating Coenzyme Q10 (CoQ10) levels. We sought to determine whether CoQ10 supplementation decreases the rate of myalgia in patients with statin-related myalgia. Methods: Patients treated with a statin for clinical indications who reported statin induced myalgia were eligible. Patients were randomized to treatment with CoQ10 120 mg/day (17 patients) or placebo (20 patients) in a double-blind manner. Treatment was continued for 12 weeks. All patients were instructed to continue taking their prescribed statin as usual. Myalgia score was assessed before intervention and then weekly, for 12 weeks of therapy, using a visual analogue scale (VAS). Results: Over 12 weeks of treatment, myalgia score gradually decreased in both the treatment group and placebo group to the same extent (from 6.2 to 3.3 in the treatment group and from 5.9 to 3.1 in the placebo group), without significant differences between the groups. No significant change was noted between the two groups in the number of patients tolerated statin therapy. Conclusions: CoQ10 does not appear to decrease the rate of myalgia when compared to placebo in patients with statin-related myalgia.
Feb 2016 DOI 10.14302/issn.2574-4488.jna-15-712
Bernieh BassamCorresponding author
Nephrology, Department of Internal Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
Background Dapagliflozin; the new oral hypoglycemic agent; is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that acts by inhibiting glucose reabsorption in the proximal tubule of the nephron. Main reported side effects are osmotic diuresis, dehydration, urinary tract and genital infections. Here, we report a case of acute bilateral hydronephrosis after the introduction of dapagliflozin. Case Presentation A 52 year old nurse lady, with 15 year history of type2 diabetes mellitus (T2 DM) complicated by type4-renal tubular acidosis, hypertension, proteinuria, and hyperlipidemia. Patient had two episodes of UTI’s in 2011 required full urologic work up, were successfully treated with simple courses of oral antibiotics. CT pyelography done in 2011 was normal. Dapagliflozin was added to her therapeutic regimen in March 2015. Results Within 48 hours after starting dapagliflozin, she reported increased urine output. Ten days later; she developed severe bilateral loin and lower back pain, followed by suprapubic pain, dysuria and fever. Urine analysis and cultures confirmed E. coli urosepsis. Renal US revealed echogenic kidneys with 12 mm bilateral hydronephrosis, normal ureters and urinary bladder. Discontinuation of dapagliflozin in April 2015 resulted in resolution of symptoms. Repeat CT of the abdomen in July 2015 revealed no hydro nephrosis. Conclusions This is the first case report of reversible bilateral hydronephrosis after the use of dapagliflozin. The cause of hydronephrosis, could be explained by over-diuresis and/or by the unmasking of underlying subclinical obstruction in both uretero-pelvic junctions (UPJ).
Jul 2015 DOI 10.14302/issn.2372-6601.jhor-15-657
Aguayo AlvaroCorresponding author
Division of Medicine, Medical Oncology Department, The American British Cowdray Medical Center, Mexico City
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a known side effect of several oncology drugs, but it is rarely seen secondary to vinblastine with only a few cases reported worldwide. Herein we present a patient with nodular lymphocyte-predominant Hodgkin disease that developed a severe acute hyponatremia seven days after her first cycle of chemotherapy with R-ABVD. After fluid restriction, symptoms and concentration of blood sodium were restored. After a comprehensive review of the literature vinblastine was thought to be the cause and avoided in the second infusion of chemotherapy without recurrence of the SIADH.
May 2015 DOI 10.14302/issn.2471-2175.jdrt-14-515
Abbas OssamaCorresponding author
Dermatology Department, American University of Beirut Medical Center, Lebanon
Isotretinoin is notorious for having a myriad of mucocutaneous side effects including cheilitis, xerodermia, facial erythema, pruritis, hair thinning, and brittle nails, among others. Although photosensitivity is considered to be one of the side effects of oral isotretinoin therapy, cutaneous hyperpigmentation has not, to the best of our knowledge, yet been reported as a side effect. This report presents a case of striking facial hyperpigmentation in a patient on oral isotretinoin.
May 2015 DOI 10.14302/issn.2574-4488.jna-14-601
Andreucci MicheleCorresponding author
Nephrology Unit, Department of “Health Sciences”, Campus “Salvatore Venuta”, “Magna Graecia” University, Viale Europa, loc. Germaneto, I-88100 Catanzaro, Italy ([email protected])
Iodinated radiographic contrast agents (IRCA) are pharmaceutical agents used to improve the visibility of internal organs and structures in X-ray based imaging techniques. However, IRCA may have adverse unwanted effects, ranging from a mild inconvenience, such as itching, to a life-threatening emergency. The adverse effects of IRCA include delayed allergic reactions, anaphylactic reactions, and/or cutaneous reactions. But exposure to IRCA may be associated also with the development of either hyperthyroidism or hypothyroidism, presumably due to the effect of free, biologically active elemental iodine ions present in these agents. Among the side effects associated with the use of intravascular injection of IRCA, Contrast-induced nephropathy (CIN) is undoubtedly their most important and frequent well known adverse reaction. The pathogenesis of CIN is discussed in detail including the factors that increase the incidence of CIN, the main ones being pre-existing renal impairment, particularly when associated with diabetes mellitus. Finally, the measures to reduce the nephrotoxicity of IRCA are suggested beginning with monitoring renal function, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible. The main procedure for prevention of CIN is an adequate hydration of the patient with either isotonic sodium chloride or sodium bicarbonate solutions. A long list of references is provided that will enable readers a deep appreciation of the topic.