scholarly journals Chlorambucil-Induced Acute Interstitial Pneumonitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Hammad Shafqat ◽  
Adam J. Olszewski
Keyword(s):  
Systematic Review ◽  
Interstitial Pneumonitis ◽  
Pulmonary Toxicity ◽  
Alkylating Agent ◽  
Randomized Trials ◽  
Case Reports ◽  
Lymphocytic Leukemia ◽  
Mechanism Of Injury ◽  
Review Of Literature ◽  
Drug Induced

Chlorambucil is an alkylating agent commonly used in treatment of chronic lymphocytic leukemia (CLL). We report a case of interstitial pneumonitis developing in an 83-year-old man 1.5 months after completing a six-month course of chlorambucil for CLL. The interstitial pneumonitis responded to therapy with prednisone. We performed a systematic review of literature and identified 13 other case reports of chlorambucil-induced pulmonary toxicity, particularly interstitial pneumonitis. No unifying risk factor could be discerned and the mechanism of injury remains unknown. In contrast, major randomized trials of chlorambucil therapy in CLL have not reported interstitial pneumonitis as an adverse effect, which may be due to the rarity of the phenomenon or due to underreporting of events occurring after completion of treatment. Clinicians should consider drug-induced interstitial pneumonitis in the differential diagnosis of a suggestive syndrome developing even after discontinuation of chlorambucil.

scholarly journals Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

2021 ◽  
pp. 1-4
Author(s):  
Simone Vidale
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Features ◽  
Case Reports ◽  
Clinical Severity ◽  
Large Artery ◽  
Causal Association ◽  
Review Of Literature ◽  
Increased Risk ◽  
Long Time

<b><i>Background and Purpose:</i></b> Coronavirus disease 2019 (CO­VID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with CO­VID-19 infection. <b><i>Method:</i></b> A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. <b><i>Results:</i></b> Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55–75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (<i>p</i><sub>trend</sub>: 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (<i>p</i><sub>trend</sub>: 0.03). <b><i>Conclusions:</i></b> Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

scholarly journals The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Claudia Cristina Biguetti ◽  
Joel Ferreira Santiago Junior ◽  
Matthew William Fiedler ◽  
Mauro Toledo Marrelli ◽  
Marco Brotto
Keyword(s):  
Systematic Review ◽  
Quantitative Analysis ◽  
Qualitative Analysis ◽  
Observational Studies ◽  
Skeletal Muscles ◽  
Case Reports ◽  
Meta Analysis ◽  
Toxic Effects ◽  
Drug Induced ◽  
Qualitative And Quantitative

AbstractThe aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

scholarly journals FCR achieves long-term durable remissions in patients with IGHV-mutated CLL

Blood ◽  
2017 ◽  
Vol 130 (21) ◽  
pp. 2278-2282 ◽  
Author(s):  
Chatree Chai-Adisaksopha ◽  
Jennifer R. Brown
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Chronic Lymphocytic Leukemia ◽  
Complete Remission ◽  
Randomized Trials ◽  
Progression Free Survival ◽  
Lymphocytic Leukemia ◽  
Inclusion Criteria ◽  
Free Survival

Abstract In chronic lymphocytic leukemia (CLL) patients with mutated IGHV, 3 recent studies have demonstrated prolonged progression-free survival (PFS) after treatment with fludarabine-cyclophosphamide-rituximab (FCR) chemoimmunotherapy. We performed a systematic review to assess the benefit of FCR for patients with CLL and identified 5 randomized trials that met our inclusion criteria. FCR improved complete remission, PFS and overall survival vs the comparator; median PFS was not reached in the subgroup of CLL patients with mutated IGHV.

scholarly journals VIEKIRA PAK associated drug-induced interstitial lung disease: Case series with systematic review of literature

2019 ◽  
Vol 25 (2) ◽  
pp. 218-222 ◽  
Author(s):  
Yu Jun Wong ◽  
Si Yuan Chew ◽  
John Chen Hsiang ◽  
Prem Harichander Thurairajah ◽  
Rahul Kumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Case Series ◽  
Review Of Literature ◽  
Drug Induced ◽  
Disease Case

scholarly journals Eruptive Seborrheic Keratoses Are Associated With a Co-Occurring Malignancy in the Majority of Reported Cases: A Systematic Review

2021 ◽  
pp. 120347542110351
Author(s):  
Sara Mirali ◽  
Asfandyar Mufti ◽  
Rafael Paolo Lansang ◽  
Muskaan Sachdeva ◽  
Jensen Yeung
Keyword(s):  
Systematic Review ◽  
Medical Condition ◽  
Case Reports ◽  
Healthcare Providers ◽  
Case Series ◽  
Latency Period ◽  
Skin Condition ◽  
Case Control Studies ◽  
Drug Induced ◽  
Seborrheic Keratoses

Background Eruptive seborrheic keratoses (ESK) is a benign skin condition that has been associated with malignant and nonmalignant diseases. We conducted a systematic review of reported cases of ESK to identify and summarize associated comorbidities. Methods MEDLINE and Embase were searched from database inception (1946) to July 31, 2020 for original articles describing ESK with or without a co-occurring condition. Subject demographics, as well as details of ESK and associated diagnoses were extracted from 76 articles (70 case reports, 3 case series, 3 case control studies) representing 92 patients. Results In total, 76.1% ( n = 70/92) of patients with ESK had a co-occurring malignancy, 4.3% ( n = 4/92) presented with a nonmalignant condition, 9.8% ( n = 9/92) experienced ESK as an adverse drug reaction, and 9.8% ( n = 9/92) did not report any underlying medical condition. ESK preceded a cancer diagnosis in 76.1% ( n = 70/92) of patients with a mean latency period of 4.0 months (range: 0.25-9 months). The most common malignancies associated with ESK were cutaneous T-cell lymphoma ( n = 10/70, 14.3%) and gastrointestinal adenocarcinoma ( n = 9/70, 12.9%). ESK preceded nonmalignant conditions or no disease in 14.1% ( n = 13/92) of patients with a mean latency period of 3.1 months (range: 0.75-6 months). Drug-induced ESK occurred in 9.8% ( n = 9/92) of patients with a mean latency period of 7.1 weeks after changing medication. Conclusion Although the role of ESK as a paraneoplastic cutaneous marker is debated, healthcare providers should consider screening for underlying malignancy in patients presenting with ESK. Larger studies are needed to confirm its role as a marker for disease.

scholarly journals Bortezomib-Induced Pulmonary Toxicity: A Case Report and Review of Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Prakash Kharel ◽  
Deekchha Uprety ◽  
Abhinav B. Chandra ◽  
Yirui Hu ◽  
Anuradha Avinash Belur ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Lung Injury ◽  
Current Literature ◽  
Proteasome Inhibitor ◽  
Pulmonary Toxicity ◽  
Case Reports ◽  
Review Of Literature ◽  
Multiple Case ◽  
Review Current

Bortezomib, a proteasome inhibitor, is an established therapy against multiple myeloma. Bortezomib-induced lung injury, although not appreciated during the introductory time of the medication, has now been highlighted in multiple case reports. The objective of this study is to report a case of bortezomib-induced lung injury, review current literature, and perform exploratory analysis.

Drug-Induced Takotsubo Cardiomyopathy

2017 ◽  
Vol 22 (6) ◽  
pp. 552-563 ◽  
Author(s):  
Kazuhiko Kido ◽  
Maya Guglin
Keyword(s):  
Systematic Review ◽  
Takotsubo Cardiomyopathy ◽  
Case Reports ◽  
Database Search ◽  
Alternative Therapies ◽  
Drug Induced ◽  
Pubmed Database ◽  
Plausible Hypothesis ◽  
Direct Administration ◽  
Somatic Stress

Background: The most plausible hypothesis for takotsubo cardiomyopathy (TCM) is a catecholamine surge. Direct administration of catecholamines or medications causing catecholamine surge is frequently used in clinical practice. Methods: A Medline/PubMed database search was conducted for case reports or series of drug-induced TCM. All reported cases of drug-induced TCM were systemically identified and analyzed. Results: We identified 157 cases of drug-induced TCM. Fifty-seven (36.3%) cases were related to the administration of exogenous catecholamines. In 50 (31.9%) other cases, there was potential adrenergic effect. This included drugs with adrenergic vasoconstriction properties (3.2%), hyperadrenergic state due to alcohol or opioid withdrawal (7.7%), inhibitors of catecholamine reuptake (14.7%), anaphylactic reaction that is accompanied by catecholamine release (3.2%), and psychological or somatic stress coinciding with the administration of a drug that was thought to be the culprit (3.2%). Overall, 68.2% of these drug-induced TCM cases were catecholamine related. In 14 (8.9%) cases, the likely etiology of cardiomyopathy was chemotherapy-induced coronary vasospasm. Conclusion: Our systematic review showed that over two-thirds of drug-induced TCM cases were due to direct or indirect catecholamine stimulation. The lowest effective dose and shortest duration of catecholamines should be utilized, and alternative therapies should be considered if feasible.

scholarly journals A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E85-E102
Author(s):  
James Colson
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Quality Assessment ◽  
Observational Studies ◽  
Randomized Trials ◽  
Case Reports ◽  
The United States ◽  
Opioid Therapy ◽  
Strong Recommendation ◽  
Level Ii

Background: The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. Methods: The comprehensive literature search was conducted for the period 1996 through June 2010. Databases for the search included PubMed, EMBASE, Cochrane Reviews, and clinicaltrails.gov, along with reviews and cross references. Methodologic quality assessment of the observational studies managing chronic cancer pain with opioids was conducted utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. Analysis of evidence included 5 levels of evidence developed by the United States Preventive Services Task Force (USPSTF) ranging from Level I to III with 3 subcategories in Level II. Grading recommendations were based on Guyatt et al’s recommendations with 6 levels: 3 in the strong category and 3 in the weak category. Results: This evaluation is of 18 manuscripts considered for inclusion; 7 manuscripts met the inclusion criteria based on AHRQ quality assessment. Level of evidence for opioid therapy in cancer pain was Level II-3, and recommendations were 1C/strong recommendation based on observational studies, which could change based on future evidence. Conclusion: This systematic review of observational studies indicates Level II3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence. Key words: Chronic pain, cancer pain, non-cancer pain, randomized trials, observational studies, case reports, opioids, effectiveness

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