Machine Learning in High-Alert Medication Treatment: A Study on the Cardiovascular Drug

The safety of high-alert medication treatment is still a challenge all over the world. Approximately one-half of adverse drug events (ADEs) are related to high-alert medications, which motivates us to improve the predicament faced in clinical practice. The purpose of this study is to use machine-learning techniques to predict the risk of high-alert medication treatment. Taking the cardiovascular drug digoxin as an example, we collected the records of 513 patients who received the pertinent therapy during hospitalization at a tertiary medical center in Taiwan. Considering serum digoxin concentration (SDC) is the primary indicator for assessing the risk of digoxin therapy, patients with SDC being controlled at the recommended range before their discharge were defined as a low-risk population; otherwise, patients were defined as the high-risk population. Weka 3.9.4—an open source machine learning software—was adopted to develop binary classification models to predict the risk of digoxin therapy by a number of machine-learning techniques, including k-nearest neighbors (kNN), decision tree (C4.5), support vector machine (SVM), random forest (RF), artificial neural network (ANN) and logistic regression (LGR). The results showed that the performance of RF was the best, followed by C4.5 and ANN; the remaining classifiers performed poorly. This study confirmed that machine-learning techniques can yield favorable prediction effectiveness for high-alert medication treatment, thereby decreasing the risk of ADEs and improving medication safety.

Resolution of Fetal Hydrops Dependent on Sustained Fetal Supraventricular Tachycardia after Digoxin Therapy

We present a special case of fetal supraventricular tachycardia detected at 34 weeks gestation. Fetal hydrops was noted on ultrasound upon admission. Normal fetal heart rate was maintained for three weeks by maternal administration of digoxin. A live infant was delivered via caesarian section at 37 weeks gestation. This clinical case demonstrated that pharmacological treatment can be effective and helps to prolong pregnancy safely.

The Dark Purple Side of Ceftriaxone: A Case Report on Leucocytoclastic Vasculitis

We present a case of an 85-year-old woman diagnosed with uncomplicated pyelonephritis, who was treated with intravenous ceftriaxone. Her chronic medications were phenprocoumon, diltiazem and bisoprolol. During the infectious phase, the patient presented tachycardia – despite high-dose beta-blocker treatment – and developed left acute heart failure, with acute renal failure (pre-renal origin). After introduction of furosemide diuretic therapy, clinical conditions improved and better control of the volemic status and heart rate was achieved. Several days after ceftriaxone and digoxin therapy initiation, worsening multiple non-blanching palpable purpuric lesions with bullae and papules, limited to the lower extremities, were noted. Skin biopsy was performed and a diagnosis of leucocytoclastic vasculitis, with associated panniculitis, was made. Ceftriaxone was discontinued and systemic corticosteroids were introduced, with a clear improvement in the cutaneous condition.

Fetal supraventricular tachycardia at 12 weeks of gestation: diagnosis and follow up. A case report

This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.