scholarly journals Potential Adverse Consequences of Combination Therapy with Gabapentin and Pregabalin

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Muhammad Nabeel Ghayur
Keyword(s):  
Adverse Effects ◽  
Diabetic Neuropathy ◽  
Gamma Aminobutyric Acid ◽  
Prescribing Practices ◽  
Pharmacy Staff ◽  
Inhibitory Neurotransmitter ◽  
Antiepileptic Medication ◽  
History Of ◽  
Impaired Awareness

Gabapentinoids comprise the medications gabapentin and pregabalin. These were designed to not only look chemically like the central inhibitory neurotransmitter gamma-aminobutyric acid (GABA) but also act like it. The prototype gabapentin was primarily introduced to be used as antiepileptic medication. Today, both chemicals are not only utilized as adjunct antiepileptics in focal (aware and impaired awareness) seizures but are also used in several neuropathic pain conditions and other clinical indications. Their use has skyrocketed in the past few years and this has brought forward more instances of adverse effects and errors in prescribing practices. We describe here a case of a female patient with a history of diabetes, diabetic neuropathy, and hypertension being prescribed both gabapentin and pregabalin concomitantly which led to adverse effects like drowsiness, dizziness, fatigue, and ataxia. Once the patient medication profile was revisited, the pharmacy staff was able to identify the therapeutic duplications (gabapentin and pregabalin). The physician was contacted and pregabalin was discontinued. This led to the disappearance of the adverse effects. The dose of the existing gabapentin was increased to control the symptoms of diabetic neuropathy. This report sheds light on the importance of responsible prescribing, efficient checking of medication profiles on the level of dispensing pharmacies, and timely follow-up to patients to keep the patients safe and their medical conditions under check.

scholarly journals Predictors of Diabetic Foot Reulceration beneath the Hallux

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
R. J. Molines-Barroso ◽  
J. L. Lázaro-Martínez ◽  
J. V. Beneit-Montesinos ◽  
F. J. Álvaro-Afonso ◽  
E. García-Morales ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
Cox Model ◽  
Sociodemographic Factors ◽  
Hallux Limitus ◽  
Therapeutic Footwear ◽  
Custom Made ◽  
History Of ◽  
A Prospective Study

Aims. To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. Methods. A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study. Results. Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p=0.005, 95% CI (2.097–73.128), HR 12.384) and increased body mass index (p=0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model. Conclusions. Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.

Reasons why patients with tuberculosis in South Korea stop anti-TB treatment: a cross-sectional study

2020 ◽  
Vol 24 (10) ◽  
pp. 1016-1023
Author(s):  
H. W. Kim ◽  
J. Min ◽  
A. Y. Shin ◽  
H-K. Koo ◽  
S. Y. Lim ◽  
...  
Keyword(s):  
Adverse Effects ◽  
South Korea ◽  
Previous History ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of ◽  
Specialist Nurses ◽  
Lost To Follow Up

BACKGROUND: As there had been no reduction in the TB burden in South Korea since 2000, a public-private mix (PPM) strategy was launched in 2011. The purpose of this study was to investigate the reasons for lost to follow-up (LTFU) among TB patients and their clinical characteristics.METHOD: A multicentre, cross-sectional study based on in-depth interviews with patients and their families by TB specialist nurses was conducted. Patients who were reported with a final outcome of LTFU in 2015–2017 at all PPM hospitals across the country were enrolled. Enrolled patients were classified into six subgroups by age and three major reasons for LTFU (adverse effects, refusal of treatment, marginalisation) and their clinical features were compared.RESULTS: Among 780 patients, those who were lost to follow-up due to adverse effects accounted for the largest proportion (n = 387). LTFU in those aged <65 years who refused treatment (n = 189) and those aged <65 years who were marginalised (n = 108) were related to having smear-positive TB and a previous history of unfavourable outcomes.CONCLUSION: To reduce LTFU in South Korea, comprehensive strategies, including management of adverse effects, systematic counselling and education, should be implemented.

scholarly journals Clobazam is a Better Option for Intermittent Prophylaxis of Febrile Convulsion

2014 ◽  
Vol 13 (3) ◽  
pp. 62-64
Author(s):  
Shahed Iqbal ◽  
Monir Ullah ◽  
Razia Sultana ◽  
Mahmood Ahmed Chowdhury
Keyword(s):  
Adverse Effects ◽  
Controlled Trial ◽  
Central Nervous System Infection ◽  
Febrile Convulsion ◽  
Similar Efficacy ◽  
Normal Children ◽  
Randomized Controlled ◽  
History Of ◽  
Neurologically Normal

Aims: To compare safety and efficacy of diazepam and clobazam. Objectives: This study was undertaken to compare the effectiveness of intermittent clobazam versus diazepam therapy in preventing the recurrence of febrile convulsion and assess adverse effects of each drug.Methods: This is a hospital based randomized controlled trial was performed on neurologically normal children with the history of simple febrile convulsion and normal electroencephalogram without any evidence of acute central nervous system infection, done in Chattagram Maa Shishu-O-General Hospital/CMSOGH between November’12 to April’13. A total of 37 patients were randomly prescribed with oral clobazam and diazepam was given in 35 patients when they developed a febrile disease. All the patients were monitored regarding developing seizure and adverse effects of the drugs. All patients were followed for 12 months.Results: It was observed that 243 attacks of fever occurred during the period, including 116 attacks in the clobazam group and 127 episodes in the diazepam group. Recurrence of convulsion occurred in 2 (1.7%) subjects in the clobazam group, and in 4(3.1%) cases in the diazepam group. Twenty cases (54%) in the diazepam group and 5 (14.2% ) cases in the clobazam group developed drowsiness and sedation during the follow-up period.Conclusion: Intermittent clobazam therapy has better advantage over diazepam with similar efficacy but significantly lower adverse effects such as drowsiness and sedation.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21027

scholarly journals Auras and the risk of seizures with impaired consciousness following epilepsy surgery: implications for driving

2017 ◽  
Vol 89 (6) ◽  
pp. 599-602 ◽  
Author(s):  
Sam Fairclough ◽  
Aidan G O’Keeffe ◽  
Jane de Tisi ◽  
John S Duncan
Keyword(s):  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Prior History ◽  
Surgery Outcome ◽  
History Of ◽  
Impaired Awareness ◽  
The Uk ◽  
International League

ObjectiveTo calculate the chance of a seizure in the next year (COSY) for seizures with impaired awareness in those experiencing auras only, those with no seizures and those with continuing seizures. Epilepsy surgery is an effective treatment for refractory focal epilepsy. Driving is an important factor affecting quality of life. In the UK, driving is not permitted if focal seizures with no impairment of awareness (auras, simple partial seizures) continue, if there is a prior history of seizures with impaired awareness, as will invariably be the case in those having epilepsy surgery. Current UK driving regulations allow driving if COSY is less than 20%.MethodWe calculated COSY in 819 epilepsy surgery patients with up to 25 years follow-up. Each patient year was graded on the The International League against Epilepsy surgery outcome scale.ResultsPatients who were entirely seizure-free for 1, 2 and 3 years had COSY of 4.9%, 3.5% and 2.4% respectively. Patients with only auras within the last 1, 2 or 3 years had a COSY of 11.3%, 9.2% and 7.8% respectively.ConclusionsIndividuals with auras only after epilepsy surgery had a higher COSY than those who were seizure-free. If a COSY of below 20% is regarded as an acceptable risk, it may be suggested that those with auras only in a given year be allowed to drive. The relative risk of these patients causing accidents is lower than population groups such as those aged <25 or >75 years, who are permitted to drive.

Abstract 14604: Flecainide Induced Myalgias. A Rare but Important Adverse Reaction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dilpat Kumar ◽  
Rehman Muhammad Ebad ◽  
Prashant Patel ◽  
Tracey Mersfelder
Keyword(s):  
Adverse Effects ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Knee Joints ◽  
Extensor Muscles ◽  
Rare Side Effect ◽  
History Of ◽  
Dose Ranging

Introduction: Flecainide is an anti-arrhythmic used in patients with symptomatic arrhythmias without structural heart anomalies. It is known to cause several non-cardiac adverse reactions, most commonly headaches, dizziness, fatigue and nausea. We report a case of symmetric polymyalgia, a rare side effect of flecainide. Case Report: A 62 year-old woman with history of atrial fibrillation presented with chest heaviness and generalized myalgias. Just 5 days prior to her presentation, she underwent a cardiac ablation and was started on flecainide 150 mg twice daily. Her other home medications included furosemide, carvedilol, dabigatran, losartan and aspirin, all of which were unchanged. Vital signs were stable. Pertinent exam findings included tenderness to palpation over bilateral calf muscles, muscle strength testing with 3/5 in bilateral flexor and extensor muscles of hip and knee joints, and absent bilateral knee and ankle reflexes. EKG showed normal rate and rhythm. ESR and CRP were elevated with a normal ANA and creatinine kinase. The Naranjo score of 7 suggested a probable cause for flecainide-induced myalgias. Flecainide was discontinued leading to improvement in muscle weakness and reflexes at the time of discharge, and at follow-up visits, her symptoms completely resolved. Discussion: Antiarrhythmics are commonly used medications with cardiac and non-cardiac adverse effects. Flecainide-induced adverse effects are dose dependent. In dose ranging studies, increasing flecainide dosages caused significant myalgias, especially in patient taking 300 mg/day. In the appropriate clinical context, healthcare providers should be aware of this rare, reversible adverse effect, to prevent extensive inflammatory or neuromuscular disease workup. As our case illustrates, early discontinuation of flecainide can resolve myalgias and prevent long-term sequelae.

Natural history of helicobacter pylori infection from infancy to adulthood: A 21-year follow-up cohort study

2001 ◽  
Vol 120 (5) ◽  
pp. A128-A128 ◽  
Author(s):  
H MALATY ◽  
D GRAHAM ◽  
A ELKASABANY ◽  
S REDDY ◽  
S SRINIVASAN ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Cohort Study ◽  
Natural History ◽  
Helicobacter Pylori Infection ◽  
History Of

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Lingual Dystonia Treated with Botulinum Toxin - A Case Report

1970 ◽  
Vol 24 (2) ◽  
pp. 75-78
Author(s):  
MA Hayee ◽  
QD Mohammad ◽  
H Rahman ◽  
M Hakim ◽  
SM Kibria
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
X Ray ◽  
Medical College ◽  
Lingual Dystonia ◽  
History Of ◽  
Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

The natural history of pituitary apoplexy: long term follow-up study

2019 ◽  
Author(s):  
Ayesha Shaikh ◽  
Natasha Shrikrishnapalasuriyar ◽  
Giselle Sharaf ◽  
David Price ◽  
Maneesh Udiawar ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Apoplexy ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
History Of
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