Capecitabine induced Steven–Johnson syndrome: A rare case report

2021 ◽  
pp. 107815522110279
Author(s):  
Kavya Karthikeyan ◽  
Sameera K V ◽  
Shintu Shaji ◽  
Swetha M Ann C ◽  
Madhu C S
Keyword(s):  
Adverse Effects ◽  
Health Care Providers ◽  
Clinical Status ◽  
Metastatic Carcinoma ◽  
Care Providers ◽  
Johnson Syndrome ◽  
Rare Case Report ◽  
Hand Foot Syndrome ◽  
Carcinoma Pancreas ◽  
Steven Johnson Syndrome

Introduction Steven–Johnson syndrome (SJS) is a serious mucocutaneous reaction, characterized by fever, influenza-like symptoms and followed by dermatological manifestations. Capecitabine is an oral fluoropyrimidine carbamate analogue of 5-Fluorouracil (5-FU). It is widely accepted for many malignancies because of its better safety profile and tolerability. Hand-foot syndrome is the common dermatological toxicity associated with Capecitabine and SJS is the rarest manifestation. Case presentation: We report a case of Capecitabine induced SJS in a 70 years old male patient with metastatic carcinoma pancreas. He was treated with intravenous Gemcitabine and Carboplatin initially and then switched to oral therapy with Capecitabine 1000 mg twice daily. After ten days of treatment with Capecitabine, he developed vomiting, mucositis, hyperpigmentation, itching and scrotal mucosal peeling. The clinical status of the patient was suggestive of SJS, which was confirmed by dermatologic consultation. According to Naranjo, WHO-UMC, and Hartwig’s scale, the reaction was found to be probable and severe. Pharmacological as well as supportive care measures were provided, but the condition progressively worsened, and the patient was deceased. Conclusion Capecitabine can cause severe hypersensitivity reactions which can be dangerous and life-threatening. Health care providers must be aware of all rare adverse effects, including SJS. Clinicians and clinical pharmacists should educate and counsel the patients regarding the likely adverse effects of their chemo drugs because the early identification of toxic symptoms is crucial to reduce further complications to the patient.

scholarly journals Drug induced Stevens Johnsons Syndrome : a case report

2018 ◽  
Vol 5 (1) ◽  
pp. 3465-3466
Author(s):  
Dr Gargi.H. Pathak ◽  
Dr Anuya Chauhan ◽  
Dr Dhriti Shukla
Keyword(s):  
Health Care Providers ◽  
Stevens Johnson Syndrome ◽  
Care Providers ◽  
Drug Induced ◽  
Antimicrobial Drugs ◽  
Topical Anesthetic ◽  
Anesthetic Agents ◽  
Johnson Syndrome ◽  
Chief Complaints ◽  
Steven Johnson Syndrome

Stevens Johnson syndrome is an acute self limited disease presenting with  severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets .The  majority of cases are drug induced affecting oral and perioral region. A 3 year old male child presented with chief complaints of fever, cough, cold , breathlessness and extensive rashes on the skin of face , oral mucosa, neck, abdomen, erythema of conjunctiva , ulceration of eyelid and oral cavity. The reaction was evoked after consumption of tab oxcarbamezapine   since 10  days . He was treated with corticosteroids   , antimicrobial drugs and oral topical anesthetic agents. Health care providers must be careful regarding the adverse effects of drugs especially the allergic manifestations like anaphylaxis and  Steven Johnson syndrome which are potentially fatal conditions. The most commonly and widely prescribed drug regimens should also be used judiciously and continuously monitored to prevent such a fatal adverse drug reaction.

Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units

2018 ◽  
Vol 36 (02) ◽  
pp. 141-147 ◽  
Author(s):  
Helen McCord ◽  
Elise Fieldhouse ◽  
Walid El-Naggar
Keyword(s):  
Intensive Care ◽  
Adverse Effects ◽  
Intensive Care Units ◽  
Health Care Providers ◽  
Neonatal Intensive Care ◽  
Chlorhexidine Gluconate ◽  
Neonatal Intensive Care Units ◽  
Care Providers ◽  
Level Ii ◽  
Canadian Provinces

Objective This article assesses the degree of variability in the current practice of skin antiseptics used in Canadian neonatal intensive care units (NICUs) and different experiences related to each antiseptic used. Methods An anonymous survey was distributed to a clinical representative of each of the 124 Canadian level II and level III NICUs. Results One hundred and two respondents (82.2%), representing all Canadian provinces, completed the survey. Chlorhexidine gluconate with/without alcohol was the antiseptic most used (96%) and the antiseptic with the highest reported adverse effects (68% reported skin burns/breakdown). Other antiseptics used include povidone-iodine (35%) and isopropyl alcohol (22%). Specific guidelines for antiseptic use were available in only 50% of the units with many NICUs lacking gestational and/or chronological age restrictions. Only 23% of responders believed that there was awareness among health care providers of the adverse effects of antiseptics used. Less than half (43%) were completely satisfied with the antiseptics used in their units. Conclusion Chlorhexidine gluconate is the most commonly used antiseptic in Canadian NICUs. The high number of associated adverse effects and the lack of guidelines regulating antiseptic use are of concern. Large clinical trials are urgently needed to guide practice and improve the safety of antiseptics.

Using On-scene EMS Responders’ Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers

2016 ◽  
Vol 31 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Greg Scott ◽  
Jeff Clawson ◽  
Mark C. Fivaz ◽  
Jennie McQueen ◽  
Marie I. Gardett ◽  
...  
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Vital Sign ◽  
Clinical Status ◽  
Vital Signs ◽  
Care Providers ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
Alpha Level ◽  
Nurse Triage

AbstractIntroductionUsing the Medical Priority Dispatch System (MPDS) – a systematic 911 triage process – to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.ObjectivesThe primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews’ patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN).MethodsIn this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a “hot” (lights-and-siren) transport.ResultsOut of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren.ConclusionWith the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls.ScottG, ClawsonJ, FivazMC, McQueenJ, GardettMI, SchultzB, YoungquistS, OlolaCHO. Using on-scene EMS responders’ assessment and electronic patient care records to evaluate the suitability of EMD-triaged, low-acuity calls for secondary nurse triage in 911 centers. Prehosp Disaster Med. 2016;31(1):46–57.

Why Do Patients Choose Chemotherapy Near the End of Life? A Review of the Perspective of Those Facing Death From Cancer

2006 ◽  
Vol 24 (21) ◽  
pp. 3490-3496 ◽  
Author(s):  
Robin Matsuyama ◽  
Sashidhar Reddy ◽  
Thomas J. Smith
Keyword(s):  
Health Care ◽  
Adverse Effects ◽  
End Of Life ◽  
Health Care Providers ◽  
Decision Aids ◽  
Good Choice ◽  
Care Providers ◽  
Number Of Patients ◽  
Small Benefit ◽  
Realistic Information

Purpose The number of patients receiving chemotherapy near the end of life is increasing, as are concerns about goals of treatment, toxicity, and costs. We sought to determine the available sources of knowledge, the choices, and concerns of actual patients, and how patients balanced competing issues. Methods We used a literature search from 1980 to present. Results Available patient sources provide little information about prognosis, choices, alternatives, consequences, or how to choose. Many patients would choose chemotherapy for a small benefit in health outcomes, and for a smaller benefit than perceived by their health care providers for their own treatment. Adverse effects are less a concern for patients than for their well health care providers. There are no decision aids to assist patients with metastatic disease in making their choices, such as there are for adjuvant breast therapy. Conclusion The perspective of the patient is different from that of a well person. Patients are willing to undergo treatments that have small benefits with major toxicity. Receiving realistic information about the different options of care and the likelihood of successful treatment or adverse effects is difficult. These factors may explain some of the increased use of chemotherapy near the end of life. Decision aids and honest, unbiased sources to inform patients of their prognosis, choices, consequences, typical outcomes, and ways to make decisions are needed. More prospective information about how patients make their choices, and what they would consider a good choice, would assist informed decision making.

scholarly journals Canadian Expert Panel Recommendations on the Management of CNS Symptoms Related to Efavirenz

2001 ◽  
Vol 12 (suppl c) ◽  
pp. 20C-30C ◽  
Author(s):  
M John Gill ◽  
Anita Rachlis ◽  
Sharon Walmsley ◽  
Mark Halman ◽  
The Efavirenz Consensus Working Group
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Health Care Providers ◽  
Highly Active Antiretroviral Therapy ◽  
Primary Care Physicians ◽  
Sleep Disturbances ◽  
Present Report ◽  
Management Strategies ◽  
Routine Practice ◽  
Care Providers

Efavirenz is a potent antiretroviral agent used in combination with other antiretroviral agents as part of highly active antiretroviral therapy. Efavirenz is generally well tolerated because the majority of its adverse effects are self-limiting, with central nervous symptoms and rash being the most frequent. In routine practice, the discontinuation rate of efavirenz due to adverse effects appears higher than that described in clinical trials. To minimize early treatment interruption and maximize the benefit of long term viral suppression that can be achieved with efavirenz therapy, health care providers and patients have identified that there is a need for information, education about and practical tools for the management of efavirenz-related side effects. To this end, a panel of experts in the care of HIV patients consisting of primary care physicians, infectious disease specialists, psychiatrists and pharmacists was convened. Through the evaluation of current literature and discussion among the group, the panel arrived at consensus recommendations. The present report outlines general management recommendations that apply to adverse effects related to efavirenz initiation, as well as specific management strategies for central nervous system symptoms such as agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. It is hoped that these practical recommendations will aid clinicians in minimizing and improving patient tolerance of side effects, thereby achieving improved adherence and patient outcomes.

scholarly journals Motivators and Barriers to Prenatal Supplement Use Among Women in Northern Ghana

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 220-220
Author(s):  
Clement Kubreziga Kubuga ◽  
Jeremiah Asangalisa ◽  
Caroline Boahen ◽  
Sawudatu Mohammed ◽  
Eugenia Akoto-Mensah ◽  
...  
Keyword(s):  
Health Care ◽  
Social Network ◽  
Adverse Effects ◽  
Focus Groups ◽  
Family Support ◽  
Health Care Providers ◽  
Northern Region ◽  
Care Providers ◽  
Network Support ◽  
Social Network Support

Abstract Objectives In developing countries, the benefits of using prenatal supplements on birth outcomes have been well established. The rate of prenatal supplement (iron-folic acid) use compliance is low (52.8%) in northern region of Ghana even though the supplements are provided free to all pregnant women by the government. Little is known about the reasons for the non-compliance. We aimed to investigate through focus groups the barriers and motivators for taking the supplement among subjects who attend health facilities located in northern region of Ghana. Methods We conducted six focus groups with lactating women with toddlers (0–23 months) as they were expected to reflect a complete experience of pregnancy cycle. Results We identified five common themes: a) knowledge on supplement benefits, b) family support, c) social network support, d) reinforcement by health care providers, and e) different views on benefits of prenatal supplements. Key motivators were knowledge on supplement benefits, family support, social network support, and reinforcement by health care providers. Common barriers were adverse effects, inadequate knowledge on supplements, and disrespectful communication from health care providers. Conclusions Motivators/barriers for prenatal supplements usage/non-usage is a complex web. Adherence may be enhanced by reducing barriers related to communication of health care providers and adverse effects, improving social network support, improving family support, and improving health care provider interactions. Funding Sources None.

scholarly journals Safety and Efficacy of Armodafinil in the Treatment of Excessive Sleepiness

2011 ◽  
Vol 3 ◽  
pp. CMT.S5124
Author(s):  
Jamie N. Brown ◽  
Dustin T. Wilson
Keyword(s):  
Adverse Effects ◽  
Health Care Providers ◽  
English Language ◽  
Rating Scales ◽  
Data Extraction ◽  
Current Evidence ◽  
Care Providers ◽  
Sleep Study ◽  
Excessive Sleepiness ◽  
Obstructive Sleep

Objective To review the efficacy and safety of armodafinil for the treatment in patients with excessive sleepiness. Data sources Literature was accessed via MEDLINE (1966–February 2011) and EMBASE (1980–February 2011) using the medical subject heading terms armodafinil and sleep. Study selection and data extraction All English-language, peer-reviewed publications were analyzed for relevance. Studies appropriate to the objective were evaluated if they prospectively assessed the effectiveness of armodafinil in patients with excessive sleepiness in a multiple-dose, comparator trial. The literature search identified published reports of 7 randomized, placebo-controlled studies. Data synthesis Armodafinil is a wakefulness-promoting agent used in the treatment of patients with excessive sleepiness and is the R-enantiomer of modafinil. Studies have demonstrated that armodafinil may be effective and safe when used in patients with obstructive sleep apnea, circadian rhythm disorders, and narcolepsy. Although the studies identified had limited sample sizes, they consistently demonstrated improvement on various efficacy rating scales for sleep. Study durations ranged from 3 days to 12 weeks, with doses ranging from 50 mg to 250 mg daily. The most common adverse effects associated with armodafinil therapy were headache, nausea, diarrhea, dizziness, and anxiety, although increases in systolic blood pressure and pulse rate were also reported. Conclusion Current evidence suggests that armodafinil significantly improves wakefulness in patients with excessive sleepiness in studies up to 12 weeks. Long-term effectiveness and safety cannot be adequately determined at this time. Although armodafinil should be considered safe for use, health-care providers should monitor for adverse effects, particularly cardiovascular complications.

Causes and Associated factors of Operation Cancellation at Cardiothoracic Ain-Shams University Hospital

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shaymaa M El Bokl ◽  
Aisha M Aboul-Fotouh ◽  
Ehab S Habil ◽  
Ahmed A Saleh ◽  
Azza M Hassan
Keyword(s):  
Operating Room ◽  
Health Care Providers ◽  
Clinical Status ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Care Providers ◽  
Cross Sectional ◽  
Pareto Chart ◽  
Cancellation Rate

Abstract Background Cancellation of elective operations is a sensitive indicator of operating room management. It results in loss of time, resources and affects quality of care. Operating room cancellation of elective operations is defined as cases that appeared in the definitive operative room list that ultimately were not performed on that day. Objectives To measure cancellation rate at Cardiothoracic Ain-Shams University hospital, Egypt and to identify causes and factors associated to cancellations. Methods Cross-sectional study that included 254 operations in all operating rooms of Cardiothoracic Ain Shams university hospital which provides specialized tertiary level of care. Results The overall cancellation rate is 21.7%, The most frequent cause of cancellation is standby operations accounting for 29.4%. Pareto chart shows that vital few causes are “patient prepared as stand by”, “previous long operation”, “change in Patient’s clinical status”, “equipment failure” and “ICU bed unavailable”. These causes are responsible for 80% of cancellations. Conclusion and Recommendation The avoidable causes of the problem should be addressed. Policy changes are recommended as well as continuous documentation and analysis of cancellation and its causes. Periodic awareness lectures for health care providers are suggested.

scholarly journals The Adverse Effect Reporting for the Most Commonly Used Antibiotics

2020 ◽  
pp. 22-28
Author(s):  
Nehad J. Ahmed ◽  
Mohammed I. Fouda ◽  
Dina I. Fouda ◽  
Ahmed I. Foudah
Keyword(s):  
Saudi Arabia ◽  
Side Effects ◽  
Adverse Effects ◽  
Health Care Providers ◽  
Allergic Reactions ◽  
Care Providers ◽  
Drug Reactions ◽  
Antibiotic Drugs ◽  
Pharmacovigilance Center ◽  
Gastrointestinal Side Effects

Aim: Antibiotics save lives, but the excess use of antibiotics leads to more side effects. Patients benefit from medications but also complain about their adverse effects. This study aims to explore the reports of the adverse effects for the most commonly used antibiotics in Saudi Arabia. Methodology: The Data regarding the adverse events reports were collected from The National Pharmacovigilance Center in Saudi Arabia. The data include the major allergic reactions and gastrointestinal side effects for the most commonly used antibiotic classes. Results: The total number of allergic and gastrointestinal adverse effects in 2017 and 2018 for the included antibiotic drugs is 583 reports. The majority of the reports were for penicillin antibiotics (39.96) particularly Amoxicillin/Clavunate. Conclusion: The most common adverse effects of antibiotics are allergic and gastrointestinal effects. It is important to report any adverse drug reactions either by health care providers or patients to the Saudi Pharmacovigilance Center.

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