scholarly journals Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 103 ◽  
Author(s):  
Saira B. Chaudhry ◽  
Michael P. Veve ◽  
Jamie L. Wagner
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Antimicrobial Stewardship ◽  
Clinical Utility ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Side Chain ◽  
Safety And Efficacy ◽  
History Of

Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.

Proactive management of penicillin and other antibiotic allergies

2020 ◽  
Vol 41 (2) ◽  
pp. 82-89 ◽  
Author(s):  
David A. Khan
Keyword(s):  
Cross Reactivity ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Proactive Management ◽  
Patient Morbidity ◽  
Life Saving ◽  
Inpatient Settings ◽  
History Of ◽  
Drug Challenge

Background: Antibiotic allergies, especially penicillin, are the most frequent drug allergy listed in the medical record. Proactive evaluations of antibiotic allergies, particularly penicillin allergies, have been recommended by various specialty societies. Objective: To review the history of the discovery of penicillin, implications of the penicillin allergy label, various delabeling strategies as well as a brief overview of the approach to cephalosporin, fluoroquinolone, and macrolide allergy. Methods: Recent studies on penicillin allergy delabeling and on cephalosporin and fluoroquinolone allergies were reviewed. Results: Although Alexander Fleming is often solely credited with the discovery of penicillin, other scientists were critical to the development of penicillin as a life-saving antibiotic. The vast majority of patients with a penicillin allergy label are not allergic; however, this label results in increased morbidities and mortality. A variety of penicillin delabeling strategies can be used in both the outpatient and the inpatient settings. The role of direct penicillin challenge in patients at low risk is emerging and is the method of choice for children. Patients with an unconfirmed penicillin allergy have a low risk of reacting to cephalosporins. The R1 side chain largely dictates cephalosporin allergy and cross-reactivity. Drug challenge is the preferred method for evaluation of both fluoroquinolone and macrolide allergy. Conclusion: Multiple effective methods are available to delabel patients of common antibiotic allergies. Delabeling patients in a proactive manner can reduce patient morbidity.

Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 80-86 ◽  
Author(s):  
Sami Hamdan ◽  
Nadine Melhem ◽  
Israel Orbach ◽  
Ilana Farbstein ◽  
Mohammad El-Haib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Suicidal Behavior ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Suicidal Risk ◽  
Arab Population ◽  
Psychiatric Interview ◽  
History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

Stress, Cortisol and Suicide Risk

2019 ◽  
Author(s):  
Daryl Brian O'Connor
Keyword(s):  
Risk Factors ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Stressful Events ◽  
Additional Risk ◽  
Global Health Issue ◽  
History Of ◽  
Hpa Axis Activity ◽  
The Impact

Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.

scholarly journals Is there a link between glucose levels and heart failure? An update

2010 ◽  
Vol 54 (5) ◽  
pp. 488-497 ◽  
Author(s):  
Arnaldo Schainberg ◽  
Antônio Ribeiro-Oliveira Jr. ◽  
José Marcio Ribeiro
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Epidemiological Studies ◽  
Left Ventricular ◽  
Glucose Levels ◽  
Factors Analysis ◽  
History Of ◽  
Cv Disease ◽  
The Relationship

It has been well documented that there is an increased prevalence of standard cardiovascular (CV) risk factors in association with diabetes and with diabetes-related abnormalities. Hyperglycemia, in particular, also plays an important role. Heart failure (HF) has become a frequent manifestation of cardiovascular disease (CVD) among individuals with diabetes mellitus. Epidemiological studies suggest that the effect of hyperglycemia on HF risk is independent of other known risk factors. Analysis of datasets from populations including individuals with dysglycemia suggests the pathogenic role of hyperglycemia on left ventricular function and on the natural history of HF. Despite substantial epidemiological evidence of the relationship between diabetes and HF, data from available interventional trials assessing the effect of a glucose-lowering strategy on CV outcomes are limited. To provide some insight into these issues, we describe in this review the recent important data to understand the natural course of CV disease in diabetic individuals and the role of hyperglycemia at different times in the progression of HF.

Diagnostic Studies for Thrombophilia in Women on Hormonal Therapy and During Pregnancy, and in Children

2002 ◽  
Vol 126 (11) ◽  
pp. 1296-1303
Author(s):  
Benjamin R. Brenner ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
Marilyn Manco-Johnson ◽  
Michael Laposata
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Oral Contraceptive ◽  
Medical Literature ◽  
Data Extraction ◽  
Data Sources ◽  
Current Clinical Practice ◽  
Extensive Review ◽  
Prothrombotic Risk Factors

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

Evaluation of Hypercholesterolemia in Childhood

1996 ◽  
Vol 17 (3) ◽  
pp. 94-97
Author(s):  
Thomas J. Starc ◽  
Richard J. Deckelbaum
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Heart Disease ◽  
Family History ◽  
Direct Proof ◽  
Children At Risk ◽  
History Of

For many adults, the risk of atherosclerosis can be reduced by intervention and treatment of known risk factors. Direct proof that similar intervention will be effective in children is not available. However, evidence suggests that prevention beginning in childhood will lead to a decrease in incidence of heart disease later in life. The majority of families are eager to take steps to prevent heart disease in their children, especially if there is a family history of early heart disease. It is the role of the pediatrician to identify those children at risk for early heart disease and to initiate advice on reducing risk factors.

Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids

2019 ◽  
Vol 50 (11) ◽  
pp. 1862-1871 ◽  
Author(s):  
E. Appiah-Kusi ◽  
R. Wilson ◽  
M. Colizzi ◽  
E. Foglia ◽  
E. Klamerus ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Childhood Trauma ◽  
Childhood Maltreatment ◽  
Peripheral Blood ◽  
Endocannabinoid System ◽  
History Of Childhood ◽  
Increased Risk ◽  
History Of

AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.

scholarly journals Unorthodox Parenteral β-Lactam and β-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care

2020 ◽  
Vol 64 (5) ◽  
Author(s):  
Snehal Palwe ◽  
Balaji Veeraraghavan ◽  
Hariharan Periasamy ◽  
Kshama Khobragade ◽  
Arun S. Kharat
Keyword(s):  
Clinical Practice ◽  
Drug Development ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Fixed Dose ◽  
Resistance Development ◽  
Safety And Efficacy ◽  
India And China ◽  
Lactamase Inhibitor

ABSTRACT In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.

ID: 12: THE ROLE OF ALCOHOL ABUSE AND TOBACCO USE IN THE INCIDENCE OF EARLY ACUTE CORONAY SYNDROME

2016 ◽  
Vol 64 (4) ◽  
pp. 922.2-923
Author(s):  
H Alkhawam ◽  
M Mariya Fabisevich ◽  
R Sogomonian ◽  
JJ Lieber ◽  
R Madanieh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Alcohol Abuse ◽  
Synergistic Effect ◽  
Tobacco Use ◽  
P Value ◽  
Healthcare Intervention ◽  
Tobacco Abuse ◽  
History Of

BackgroundTobacco abuse and alcohol dependence have been established as risk factors for atherosclerotic heart disease (ASHD). Their potential synergistic effect, however, have not been previously evaluated.Abstract ID: 12 Table 1Alcohol abuse/ DependenceAlcoholic abuse (n=172)Alcoholic- Smoker (n=51)Alcoholic Non-Smoker (n=121)Mean age (years)55.151.156.195% CI(52–58)(48–54.2)(54.6–57.6)Non-Alcohol abuse/DependenceNon-Alcoholic (n=7904)Non-Alcoholic Smoker (n=909)Non-alcoholic Non-smoker (n=6995)Mean age (years)63.856.371.395% CI(63.6–63.9)(55–57.7)(71–71.6)p Value<0.0010.02<0.001Objective/PurposeTo investigate the synergistic role of alcohol abuse/dependence and tobacco use in the early incidence of ACS.MethodsA retrospective chart analyses of 8076 patients diagnosed with ACS between 2000 to 2014, defined by ICD-9 codes for acute MI, alcohol abuse/dependence and tobacco use. Average age of ACS was calculated for the general population. Patients were then divided into 4 subgroups based on alcohol abuse/dependence and tobacco use status as follows: non-alcoholic non-smokers, non-alcoholic smokers, alcoholic non-smokers and alcoholic smokers.ResultsThe mean age of our 8076 ACS patients population was ∼59.5 (95% CI 59.2–59.8). Patients with history of alcohol abuse/dependence appeared to develop ACS ∼8.7 years younger than their non-alcoholic counterparts. When tobacco use is incorporated as a risk factor, those with both alcohol abuse/dependence and tobacco use seemed to develop ACS ∼5 years earlier than those with history of either alone, and ∼20 years earlier when compared to those with neither alcohol abuse/dependence nor tobacco use.(table 1 summarizes mean age of ACS incidence in our study subgroups).ConclusionsAlcohol abuse/dependence appears to be a risk factor for earlier ACS. In our population, the average age of ACS incidence in alcoholic patients was significantly earlier than non-alcoholic patients. Furthermore, alcoholic patients who also used tobacco developed ACS at an even younger age when compared to those who had history of either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect of these two risk factors in developing early ACS. Healthcare intervention in this population through screening, counseling and education regarding alcohol abuse/dependence and smoking cession is warranted to reduce early ACS.

scholarly journals Prevalence and Risk Factors of Asthma in Children Aged 13-14 Years

2017 ◽  
Vol 38 (11-12) ◽  
pp. 265
Author(s):  
Ina Rosalina ◽  
Cissy B Kartasasmita ◽  
Myrna Soepriadi
Keyword(s):  
Risk Factors ◽  
International Study ◽  
Junior High Schools ◽  
Asthma Prevalence ◽  
The Family ◽  
History Of ◽  
Asthma In Children ◽  
Paternal Smoking ◽  
Cumulative Prevalence

To determine the asthma prevalence and the role of some risk factors of asthma in children aged 13-14 years in Bandung, a study was conducted from April to May 1996 using using the International Study of Asthma and Allergies in childhood (ISAAC) written questionnaire. The study was conducted in 12 Junior high schools (SMP), selected by multistage population random sampling from 6 district in municipality of Bandung. A total of 3118 questionnaires were collected. The cumulative prevalence of asthma was 6.4% and the 12 month prevalence was 2.6%. The prevalence was higher in male, with a ratio of male : female of 1.48:1. The prevalence of asthma increased significantly in children with history of atopy in the family (OR 6.1; p<0.01); however no significant differences was found between children with one or both parents having history of atopy. The prevalence of asthma in smoking children, maternal and room mates had also increased significantly (OR = 2.1; 2.3; 2.6 and p=<0.05;<0.01;<0.01 respectively). However there was no significant effect of paternal smoking (p=0.074). The use of mosquito spray in the bedroom and having pets showed no effect on the prevalence of asthma (p=0.86 and 0.56 respectively).

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