Populations at Risk for Penicillin-Induced Seizures

1992 ◽  
Vol 26 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Robert W. Barrons ◽  
Kim M. Murray ◽  
Robert M. Richey
Keyword(s):  
At Risk ◽  
The Elderly ◽  
Pharmacokinetic Parameters ◽  
High Dose ◽  
Gamma Aminobutyric Acid ◽  
Beta Lactam ◽  
Populations At Risk ◽  
History Of ◽  
Discontinue Therapy ◽  
At Risk Populations

OBJECTIVE: This article reviews principles associated with penicillin's epileptogenic activity in an effort to alert clinicians of patients at high risk for penicillin-induced seizures. The case presentation exemplifies the most prevalent factor predisposing patients to penicillin-induced seizures—renal impairment. DATA SOURCES: References are identified from pertinent articles and books. DATA SYNTHESIS: The epileptogenic properties of penicillin are explained on the basis of the beta-lactam ring's binding to gamma aminobutyric acid receptors. Several patient populations are at risk for potentially fatal neurotoxic symptoms. Most of these patients demonstrate impaired renal function, either as the primary condition or secondary to an infectious process. The other at-risk populations include infants and the elderly, patients with meningitis, patients undergoing intraventricular antibiotic therapy, and patients with a history of seizures. Treatment remains controversial; however, benzodiazepines theoretically produce a favorable response. CONCLUSIONS: Pharmacokinetic parameters explain patient populations most at risk; a guideline equation has been recommended to allow clinicians to make appropriate dose adjustments based on creatinine clearance. Physicians and pharmacists must recognize the populations most at risk for high-dose, penicillin-induced neurotoxicities; monitor these patients at least during the first 72 hours, and reduce or discontinue therapy when appropriate.

scholarly journals Respiratory Syncytial Virus Vaccines

1998 ◽  
Vol 11 (3) ◽  
pp. 430-439 ◽  
Author(s):  
Robert A. Dudas ◽  
Ruth A. Karron
Keyword(s):  
Respiratory Syncytial Virus ◽  
The Elderly ◽  
Temperature Sensitive ◽  
Young Infants ◽  
Populations At Risk ◽  
History Of Disease ◽  
History Of ◽  
Respiratory Tract Illness ◽  
Syncytial Virus ◽  
Vector Delivery

SUMMARY Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract illness (LRI) in infants and children worldwide and causes significant LRI in the elderly and in immunocompromised patients. The goal of RSV vaccination is to prevent serious RSV-associated LRI. There are several obstacles to the development of successful RSV vaccines, including the need to immunize very young infants, who may respond inadequately to vaccination; the existence of two antigenically distinct RSV groups, A and B; and the history of disease enhancement following administration of a formalin-inactivated vaccine. It is likely that more than one type of vaccine will be needed to prevent RSV LRI in the various populations at risk. Although vector delivery systems, synthetic peptide, and immune-stimulating complex vaccines have been evaluated in animal models, only the purified F protein (PFP) subunit vaccines and live attenuated vaccines have been evaluated in recent clinical trials. PFP-2 appears to be a promising vaccine for the elderly and for RSV-seropositive children with underlying pulmonary disease, whereas live cold-passaged (cp), temperature-sensitive (ts) RSV vaccines (denoted cpts vaccines) would most probably be useful in young infants. The availability of cDNA technology should allow further refinement of existing live attenuated cpts candidate vaccines to produce engineered vaccines that are satisfactorily attenuated, immunogenic, and phenotypically stable.

scholarly journals Aspirin misuse: a case report

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
David Goldrich ◽  
Anita Sreedhar ◽  
Rehan Aziz ◽  
Kenneth R. Kaufman ◽  
Anthony Tobia ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Case Report ◽  
Signs And Symptoms ◽  
Over The Counter ◽  
Medication Misuse ◽  
Counter Medication ◽  
History Of ◽  
Salicylate Intoxication ◽  
At Risk Populations

Aspirin-use disorder is an underreported condition. Identification of the signs and symptoms of aspirin misuse are important in light of prevalent non-prescribed medicine/over-the-counter medication (NPM/OTC) misuse. We discuss here the case of a patient with a history of chronic aspirin misuse who presented to the emergency department with salicylate intoxication and described elation secondary to deliberate aspirin consumption. This case highlights the importance of screening for NPM/OTC medication misuse in at-risk populations.

Hypoprothrombinemia Associated with Cefmetazole

1997 ◽  
Vol 31 (2) ◽  
pp. 180-184 ◽  
Author(s):  
Gail A Breen ◽  
Wendy L St Peter
Keyword(s):  
At Risk ◽  
Vitamin K ◽  
Clinical Symptoms ◽  
The Elderly ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Endstage Renal Disease ◽  
Populations At Risk ◽  
Increased Risk ◽  
Patients At Risk

Objective To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem. Case Summary A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (FT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization. Discussion The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk. Conclusions Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.

scholarly journals Ticks infesting humans and associated pathogens: a cross-sectional study in a 3-year period (2017–2019) in northwest Italy

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Tania Audino ◽  
Alessandra Pautasso ◽  
Veronica Bellavia ◽  
Valerio Carta ◽  
Alessio Ferrari ◽  
...  
Keyword(s):  
At Risk ◽  
Age Groups ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Infectious Agents ◽  
Pcr Assay ◽  
Cross Sectional ◽  
At Risk Populations ◽  
Tick Borne Disease ◽  
Biomolecular Analysis

Abstract Background Tick-borne diseases are common throughout Europe. Ticks transmit pathogens to the host while feeding and together with mosquitoes, they are major vectors of infectious agents worldwide. In recent years, there has been a marked increase in the incidence of tick-bite events and tick-borne disease in northwest Italy, but information on the prevalence of tick-borne pathogens in ticks removed from humans remains scarce. To fill this gap, we report here the prevalence of tick bites and tick-borne pathogens documented for humans in Piedmont, northwest Italy, in the 3-year period 2017–2019. Methods Ticks attached to humans during 2017–2019 were collected from residents of urban and rural area by physicians and veterinarians working with local veterinary agencies. All ticks (n = 1290) were morphologically identified to the species level. A subset of ticks removed from children (age 0–18 years) and the elderly (> 70 years), both age groups considered to be at-risk populations, was screened by biomolecular analysis to detect pathogens (e.g. Rickettsia spp., Borrelia spp., Anaplasma spp.). Pathogen identity was confirmed by Sanger sequencing. Results Ticks were taxonomically assigned to ten species of six genera (Amblyomma, Dermacentor, Haemaphysalis, Hyalomma, Ixodes and Rhipicephalus). Most belonged to the genus Ixodes: 1009 ticks (78.22%) were classified as Ixodes ricinus. A subset of 500 ticks collected from the two at-risk populations were subjected to PCR assay to determine the presence of Rickettsia spp., Borrelia spp., and Anaplasma spp. The overall prevalence of infection was 22.8% (n = 114; 95% confidence interval [CI]: 19.19–26.73%), meaning that at least one pathogen was detected: Rickettsia spp. (prevalence 15%, n = 76; 95% CI 12.17–18.65%); Borrelia spp. (prevalence 6.4%, n = 32; 95% CI 4.42–8.92%); and Anaplasma spp. (prevalence 1.2%, n = 6; 95% CI 0.44–2.6%). Conclusions Our data underline the importance of surveillance in the epidemiology of tick-borne diseases and the implementation of strategies to control tick infestation and associated pathogens.

scholarly journals Additive effect of dabigatran and high-dose aspirin in the development of haemorrhagic pleural effusion in a patient with tuberculous pleuritis

2020 ◽  
Vol 32 (3) ◽  
pp. 176-179
Author(s):  
Duygu Karagül
Keyword(s):  
Pleural Effusion ◽  
Dabigatran Etexilate ◽  
Chronic Atrial Fibrillation ◽  
The Elderly ◽  
Additive Effect ◽  
High Dose ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
High Doses

Tuberculous pleuritis can rarely cause haemorrhagic pleural effusion. Dabigatran etexilate can have an additive effect on increasing the risk of haemorrhage. Aspirin cannot cause major haemorrhage, but in the elderly it can cause gastrointestinal bleeding via ulceration of the gastrointestinal mucosa. We report here the case of a 77-year-old male who presented to the hospital with a 2-month history of progressive dyspnoea. He had been taking dabigatran etexilate (220 mg) and high-dose acetylsalicylic acid (aspirin; 300 mg) daily for chronic atrial fibrillation. A chest X-ray revealed a moderately sized right pleural effusion confirmed by a computed tomography scan, which also showed bronchiectasis of both lungs. Dabigatran was discontinued and aspirin was decreased to the minimal therapeutic dose of 100 mg before thoracentesis was performed. Lymphocyte-predominant (50%) haemorrhagic fluid of 500 ml was drained, positive for acid-fast bacilli smear and polymerase chain reaction of Mycobacterium tuberculosis. A chest tube was placed and an additional 1250 ml of haemorrhagic exudate drained out. We treated the patient with a routine regimen of antituberculous medication and the infection resolved without complications other than the bronchiectasis present before treatment. We think that the combination of dabigatran etexilate and high doses of aspirin increased the risk of pleural haemorrhage in this patient with tuberculous pleuritis

scholarly journals Public Health Aspects in the Prevention and Control of Vitamin Deficiencies

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Ian Darnton-Hill
Keyword(s):  
Public Health ◽  
At Risk ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
The Elderly ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Vitamin Deficiencies ◽  
Populations At Risk ◽  
And Control

ABSTRACT Vitamin deficiencies remain major etiological factors in the global burden of disease, especially in low- and middle-income countries. The purpose of this state-of-the-art review was to update current information on deficiencies of vitamins and public health approaches to addressing them. Some stages of life present a higher risk of deficiency than others: risks are higher in pregnant women, children (from conception to young childhood), adolescents, the elderly, and all of the over 800 million people globally who are undernourished. At risk are approximately 125 million preschool children with vitamin A deficiency, as well as sub-populations at risk of deficiencies of folate, thiamin, vitamin B12, niacin, riboflavin, other B vitamins. and vitamin D. Addressing micronutrient deficiencies requires identifying those at risk and then working to prevent and manage that risk. Public health approaches include improved, diversified diets; supplementation; fortification and biofortification; and other supportive public health measures. Historically, as with pellagra and beriberi and, in the last 3 decades, with vitamin A and folic acid, there has been encouraging progress, but much remains to be done.

scholarly journals Pharmacokinetics of high-dose intravenous ciprofloxacin in young and elderly and in male and female subjects.

1995 ◽  
Vol 39 (4) ◽  
pp. 1003-1006 ◽  
Author(s):  
A Shah ◽  
J Lettieri ◽  
D Nix ◽  
J Wilton ◽  
A H Heller
Keyword(s):  
Healthy Volunteer ◽  
The Elderly ◽  
Pharmacokinetic Parameters ◽  
High Dose ◽  
Age And Gender ◽  
Male And Female ◽  
Volunteer Study ◽  
Healthy Volunteer Study ◽  
Local Reactions ◽  
And Gender

The effects of age and gender on the pharmacokinetics of high-dose intravenous ciprofloxacin in a healthy volunteer study were investigated. Plasma ciprofloxacin concentrations were higher in the elderly than in the young, and the pharmacokinetic parameters were not significantly different between the genders. Ciprofloxacin was well tolerated, with the majority of adverse events related to local reactions at the IV site.

scholarly journals Pharmacokinetics and safety of multiple-dose valaciclovir in geriatric volunteers with and without concomitant diuretic therapy.

1996 ◽  
Vol 40 (1) ◽  
pp. 80-85 ◽  
Author(s):  
L H Wang ◽  
M Schultz ◽  
S Weller ◽  
M L Smiley ◽  
M R Blum
Keyword(s):  
Steady State ◽  
Multiple Dose ◽  
The Elderly ◽  
Elderly Subjects ◽  
Pharmacokinetic Parameters ◽  
High Dose ◽  
Double Blind Study ◽  
Concentration Time ◽  
Dose Oral ◽  
Normotensive Subjects

A randomized, double-blind study was conducted to evaluate the safety and pharmacokinetics of acyclovir following multiple-dose oral administration of valaciclovir (three times a day for 8 days) in geriatric volunteers (65 to 83 years of age). Pharmacokinetic evaluation was performed for three groups: normotensive subjects given 500-mg doses of valaciclovir (n = 11), normotensive subjects given, 1,000-mg doses of valaciclovir (n = 9), and thiazide diuretic-treated hypertensive subjects given 500-mg doses of valaciclovir (n = 9). Valaciclovir, the l-valyl ester of acylclovir, was rapidly absorbed and converted to acyclovir, with plasma valaciclovir concentrations generally undetectable or < or = 0.4 microgram/ml. The peak concentration of drug in plasma (Cmax) for acyclovir occurred at 1 to 2 h, and the half-life of acyclovir was 3 to 4 h in all three elderly groups. The Cmax and area under the concentration-time curve from 0 h to infinity (AUC0-infinity) values of acyclovir obtained on days 1 and 8 indicated no unexpected accumulation at steady state. The steady-state acyclovir Cmax (4.30 and 5.98 micrograms/ml) and daily AUC0-infinity (44 and 74 h.micrograms/ml) following dosing of valaciclovir (500 and 1,000 mg) three times a day were two to three times greater than those expected after high-dose oral acyclovir treatment (800 mg, five times daily). There were no valaciclovir-related changes or abnormalities in safety parameters and no reports of serious adverse experiences in these elderly volunteers. The plasma acyclovir concentration-time curves for the hypertensive and normotensive (500-mg valaciclovir treatment) elderly groups were almost superimposable, and acyclovir pharmacokinetic parameters for the two groups were not significantly different, indicating that concomitant thiazide diuretics do not alter acyclovir pharmacokinetics following valaciclovir dosing in the elderly. Compared with historical data for younger volunteers (creatinine clearance [CLCR] > 75 ml/min/1.73 m2), the elderly subjects (CLCR = 40 to 65 ml/min/1.73 m2) showed higher (approximately 15 to 20%) mean Cmaxs and higher (approximately 30 to 50%) mean AUC(0-infinity)s of acyclovir (P < 0.01), which were consistent with age-related decreases in CLCR. The increased acyclovir exposure from valaciclovir dosing will permit reduced dosing frequency and may result in improved efficacy in the management of herpesvirus diseases.

Follow-up and chain of care in the prevention of suicide recurrence

2016 ◽  
Vol 33 (S1) ◽  
pp. S49-S50
Author(s):  
P.A. Sáiz Martinez
Keyword(s):  
At Risk ◽  
Suicide Attempts ◽  
Specific Treatment ◽  
Clinical Settings ◽  
Global Public Health ◽  
History Of ◽  
At Risk Populations ◽  
Competing Interest ◽  
Specific Disorders

Suicide constitutes one of the most important problems in global public health. However, assessment as well as corresponding verification of suicide risk, either in case histories or clinical reports, is handled poorly in several clinical settings. Aspects as important as the existence of a personal history of suicidal tendencies are frequently omitted, despite this being one of the risk factors that most clearly predict the possibility of a complete suicide in the future. During this presentation, I would like to refer specific interventions in at-risk populations, with special emphasis on individuals who have made previous suicide attempts. Suicidal behaviour is a very complex phenomenon, making a specific treatment for it difficult to produce. Consequently, when the most appropriate therapeutic approach for an at-risk population is raised, the following fact is mentioned: in approximately 90% of suicide cases, there is an underlying psychiatric disorder. This makes psychopharmacological treatment of the base pathology the most adequate. Still totally in agreement with that affirmation, we want to point out that we often forget there is proven evidence of the preventative utility of non-pharmacological interventions designed to increase clinical follow-up and adherence to post-attempt outpatient treatment. It is important to indicate that these interventions are not aimed at specific disorders or population groups, but rather they are of a more universal character and are thus more easily generalised. During this presentation, some of these approaches will be addressed and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals COVID-19 versus the 1918 influenza pandemic: different virus, different age mortality patterns

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
G Dennis Shanks
Keyword(s):  
At Risk ◽  
Young Adults ◽  
Influenza Pandemic ◽  
The Elderly ◽  
Host Pathogen Interactions ◽  
Host Pathogen ◽  
History Of ◽  
1918 Influenza

The influenza pandemic of 1918-19 and the SARS-CoV 2 pandemic of 2020 had markedly different age mortality patterns. Influenza in 1918 particularly killed young adults whereas the elderly are most at risk from COVID-19. Mortality depends on complex host-pathogen interactions specific to the viral and human population’s history of infection.

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