Cardiac Arrest With Pulmonary Edema in a Non-Parturient After Ergonovine Administration Recovered With Extracorporeal Membrane Oxygenation -a Case Report-.

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation -A case report-.

Filed under: Drug and Alcohol Rehabilitation

Korean J Anesthesiol. 2012 Dec; 63(6): 559-62
Lee HS, Min JY, Lee Y

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.
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Clinical testing for neutralizing antibodies to interferon-? in multiple sclerosis.

Filed under: Drug and Alcohol Rehabilitation

Ther Adv Neurol Disord. 2013 Jan; 6(1): 3-17
Creeke PI, Farrell RA

Biopharmaceuticals are drugs which are based on naturally occurring proteins (antibodies, receptors, cytokines, enzymes, toxins), nucleic acids (DNA, RNA) or attenuated microorganisms. Immunogenicity of these agents has been commonly described and refers to a specific antidrug antibody response. Such immunogenicity represents a major factor impairing the efficacy of biopharmaceuticals due to biopharmaceutical neutralization. Indeed, clinical experience has shown that induction of antidrug antibodies is associated with a loss of response to biopharmaceuticals and also with hypersensitivity reactions. The first disease-specific agent licensed to treat multiple sclerosis (MS) was interferon-? (IFN?). In its various preparations, it remains the most commonly used first-line agent. The occurrence of antidrug antibodies has been extensively researched in MS, particularly in relation to IFN?. However, much controversy remains regarding the significance of these antibodies and incorporation of testing into clinical practice. Between 2% and 45% of people treated with IFN? will develop neutralizing antibodies, and this is dependent on the specific drug and dosing regimen. The aim of this review is to discuss the use of IFN? in MS, the biological and clinical relevance of anti-IFN? antibodies (binding and neutralizing antibodies), the incorporation of testing in clinical practice and ongoing research in the field.
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Use of Potentially Harmful Medications and Health-Related Quality of Life among People with Dementia Living in Residential Aged Care Facilities.

Filed under: Drug and Alcohol Rehabilitation

Dement Geriatr Cogn Dis Extra. 2012 Jan; 2(1): 361-71
Bosboom PR, Alfonso H, Almeida OP, Beer C

Use of potentially harmful medications (PHMs) is common in people with dementia living in Residential Aged Care Facilities (RACFs) and increases the risk of adverse health outcomes. Debate persists as to how PHM use and its association with quality of life should be measured. We designed this study to determine the association of exposure to PHM, operationalized by three different measures, with self-reported Health-Related Quality of Life among people with dementia residing in RACFs.Cross-sectional study of 351 people aged >65 years diagnosed with dementia residing in RACFs and with MMSE ?24. The primary outcome measure was the self-rated Quality of Life – Alzheimer’s disease questionnaire (QoL-AD). We collected data on patients’ medications, age, gender, MMSE total score, Neuropsychiatric Inventory total score, and comorbidities. Using regression analyses, we calculated crude and adjusted mean differences between groups exposed and not exposed to PHM according to potentially inappropriate medications (PIMs; identified by Modified Beers criteria), Drug Burden Index (DBI) >0 and polypharmacy (i.e. ?5 medications).Of 226 participants able to rate their QoL-AD, 56.41% were exposed to at least one PIM, 82.05% to medication contributing to DBI >0, and 91.74% to polypharmacy. Exposure to PIMs was not associated with self-reported QoL-AD ratings, while exposure to DBI >0 and polypharmacy were (also after adjustment); exposure to DBI >0 tripled the odds of lower QoL-AD ratings.Exposure to PHM, as identified by DBI >0 and by polypharmacy (i.e. ?5 medications), but not by PIMs (Modified Beers criteria), is inversely associated with self-reported health-related quality of life for people with dementia living in RACFs.
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