Role of Hydroxocobalamin in Acute Cyanide Poisoning

2008 ◽  
Vol 42 (5) ◽  
pp. 661-669 ◽  
Author(s):  
Greene Shepherd ◽  
Larissa I Velez
Keyword(s):  
Safety Profile ◽  
Data Extraction ◽  
Preclinical Study ◽  
Current Data ◽  
Human Studies ◽  
Smoke Inhalation ◽  
Cyanide Poisoning ◽  
Mesh Terms ◽  
Study Selection ◽  
Cyanide Antidote

Objective: To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy. Data Sources: Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000. Systematic searches were conducted through January 2008. References from identified articles were reviewed for additional pertinent human studies. Study Selection and Data Extraction: The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. Four new studies were identified by the search and 3 studies were identified from the references. Data Synthesis: Studies of antidote efficacy in humans are ethically and logistically difficult. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking. Conclusions: Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Hydroxocobalamin offers an improved safety profile lor children and pregnant women. Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxocobalamin to all victims of smoke inhalation.

Role of Topical Oxymetazoline for Management of Erythematotelangiectatic Rosacea

2017 ◽  
Vol 52 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Rebecca M. Hoover ◽  
John Erramouspe
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Drug Approval ◽  
Current Data ◽  
Patient Response ◽  
Study Selection ◽  
Cochrane Database ◽  
Drug Approval Process ◽  
Individual Patient Response

Objective: To review and summarize topical oxymetazoline’s pharmacology, pharmacokinetics, efficacy, safety, cost, and place in therapy for persistent redness associated with erythematotelangiectatic rosacea. Data Sources: Literature searches of MEDLINE (1975 to September 2017), International Pharmaceutical Abstracts (1975 to September 2017), and Cochrane Database (publications through September 2017) using the terms rosacea, persistent redness, α -agonist, and oxymetazoline. Study Selection and Data Extraction: Results were limited to studies of human subjects, English-language publications, and topical use of oxymetazoline. Relevant materials from government sources, industry, and reviews were also included. Data Synthesis: Data support the efficacy of oxymetazoline for persistent facial redness. Little study beyond clinical trials cited in the drug approval process has been conducted. Current data suggest that oxymetazoline is similar in safety and efficacy to brimonidine. Head-to-head comparisons of topical α-agonists for erythema caused by rosacea are needed. Conclusion: The topical α-agonist, oxymetazoline, is safe and effective for reducing persistent facial redness associated with erythematotelangiectatic subtype of rosacea. Health care practitioners selecting among treatments should consider not only the subtype of rosacea but also individual patient response, preference, and cost.

Toxic inhalational injury

2020 ◽  
Vol 13 (3) ◽  
pp. e232875 ◽  
Author(s):  
Victoria Davies ◽  
Jake Turner ◽  
Michael Greenway
Keyword(s):  
Blood Gas Analysis ◽  
Cardiovascular Effects ◽  
Gas Analysis ◽  
Smoke Inhalation ◽  
Cyanide Poisoning ◽  
First Line ◽  
Early Administration ◽  
Cyanide Antidote ◽  
Inhalational Injury ◽  
Haemoglobin Testing

A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.

Use of Fish Oil to Prevent Coronary Angioplasty Restenosis

1992 ◽  
Vol 26 (12) ◽  
pp. 1541-1545 ◽  
Author(s):  
Vincent F. Mauro ◽  
Lawrence A. Frazee
Keyword(s):  
Eicosapentaenoic Acid ◽  
Fish Oil ◽  
English Language ◽  
Data Extraction ◽  
Current Data ◽  
Study Selection ◽  
Number Of Patients ◽  
Bibliographic Search ◽  
Definition Of ◽  
Key Terms

OBJECTIVE: To review the literature investigating the use of fish oil in preventing restenosis postangioplasty (RPA). DATA SOURCES: An Index Medicus and bibliographic search of the English-language literature pertaining to the use of fish oil in preventing RPA. The key terms used were fish oil, angioplasty, and eicosapentaenoic acid. STUDY SELECTION AND DATA EXTRACTION: The results of all trials, including abstracts, that were obtained are reviewed and critiqued. DATA SYNTHESIS: Restenosis of a coronary vessel at the site of angioplasty occurs 30–40 percent of the time. Because fish oil has been theorized to prevent atherosclerosis and because atherosclerotic-like processes are theorized to be involved in RPA restenosis, fish oil has been studied to determine whether it can prevent RPA. Results of such trials have been mixed. Some have observed a reduction in the number of patients with angiographic or clinical evidence of restenosis. Two trials have failed to observe such an effect. Reasons for the differences are unknown. Possible explanations include differences in study design, endpoint parameters, definition of restenosis, and dosing methods of the fish oil. Bleeding was not of significant concern in any of the trials, even when fish oil was combined with antiplatelet therapy. CONCLUSIONS: Fish oil may be considered for use in patients to prevent RPA. It probably should be continued for only six months following the procedure. Current data suggest that at least 3 g/d of eicosapentaenoic acid and 1 g/d of docosahexaenoic acid should be used. If possible, therapy should be started as soon as it is known that angioplasty will be performed or at least as soon as possible following the procedure. Many patients may not be able to tolerate fish oil because of its gastrointestinal effects.

Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae

2018 ◽  
Vol 53 (1) ◽  
pp. 70-81 ◽  
Author(s):  
Ola Mashni ◽  
Lama Nazer ◽  
Jennifer Le
Keyword(s):  
Klebsiella Pneumoniae ◽  
Clinical Studies ◽  
Case Reports ◽  
Therapeutic Option ◽  
Data Extraction ◽  
Gastrointestinal Symptoms ◽  
Current Data ◽  
Study Selection

Objective: To review the clinical data on the effectiveness and safety of double carbapenem therapy (DCT) in patients infected with carbapenemase-producing Klebsiella pneumoniae (CP-Kp). Data Sources: A literature search was performed utilizing PubMed and EMBASE (from 1966 to May 2018); bibliographies of the retrieved articles were also searched. Study Selection and Data Extraction: Articles were included if they evaluated patients with infections caused by CP-Kp and were treated with DCT. Meeting abstracts, editorials, and animal and in vitro studies were excluded. Data Synthesis: The search strategy revealed 8 case reports and 6 clinical studies (total of 171 patients) that evaluated the administration of ertapenem followed by prolonged infusions of meropenem or doripenem. Most patients were critically ill and commonly had infections in the blood, lungs, and urine. Clinical and microbiological success were reported in 70% of the patients and mortality in 24%. Adverse events, which included mostly seizures, sodium disorders, and gastrointestinal symptoms, were reported in 16 patients; none required interruption of treatment. Relevance to Patient Care and Clinical Practice: This review evaluated the clinical experience of DCT in the treatment of CP-Kp infections, based on case reports and clinical studies, for the potential role of DCT as a therapeutic option. Conclusion: Despite the limited studies, current data suggest that DCT may be an effective and safe strategy to treat CP-Kp. However, large randomized controlled trials are necessary to clearly define the role of DCT.

Oral Superabsorbent Hydrogel (Plenity) for Weight Management

2020 ◽  
pp. 106002802098304
Author(s):  
Alexa Pass ◽  
Damian Bialonczyk ◽  
Elaine Chiquette ◽  
Jennifer D. Goldman
Keyword(s):  
Weight Management ◽  
Safety Profile ◽  
Data Extraction ◽  
Safety Data ◽  
Clinical Trial Data ◽  
Superabsorbent Hydrogel ◽  
Study Selection ◽  
Significant Difference ◽  
Favorable Safety ◽  
Comorbidity Status

Objective To describe the mechanism, clinical trial data, adverse effects, and potential role in therapy of an oral superabsorbent hydrogel (OSH) for weight management. Data Sources A literature search was completed using MEDLINE and Google Scholar using the following search terms: oral superabsorbent hydrogel, Plenity, and Gelesis100 (September 1999 to July 2020). Abstracts and posters were identified from relevant scientific congress archives and published supplements. Study Selection and Data Extraction All available studies were considered. Only human studies were used for drug interaction, efficacy, and safety data. Data Synthesis OSH is a first-in-class, nonsystemic agent for weight management. It is indicated for use in patients with a body mass index (BMI) of 25 to 40 kg/m2 regardless of comorbidity status. OSH functions primarily through space occupancy in the stomach and small intestine. Studies have demonstrated that OSH has modest weight loss efficacy and a favorable safety profile, with no significant difference in overall adverse events compared with placebo. Relevance to Patient Care and Clinical Practice OSH is one of the only prescription antiobesity therapeutics (AOTs) that can be utilized in overweight patients with BMI equal to 25 to 30 kg/m2, regardless of comorbidity status. Given its nonsystemic mechanism of action and safety profile, OSH may help shift the focus of weight management toward patients with a lower BMI. Conclusions OSH offers a nonsystemic approach to weight management for patients who are diagnosed with overweight or obesity. As an alternative option to current pharmacological AOTs, OSH may address an existing clinical gap in weight management.

scholarly journals Defining the role of asymptomatic and pre-symptomatic SARS-CoV-2 transmission – a living systematic review

2020 ◽  
Author(s):  
Xueting Qiu ◽  
Ali Ihsan Nergiz ◽  
Alberto Enrico Maraolo ◽  
Isaac I. Bogoch ◽  
Nicola Low ◽  
...  
Keyword(s):  
Systematic Review ◽  
Index Case ◽  
Data Extraction ◽  
Contact Tracing ◽  
Summary Estimate ◽  
Mesh Terms ◽  
Asymptomatic Patients ◽  
Study Selection ◽  
Asymptomatic Individuals ◽  
Index Cases

AbstractBackgroundReports suggest that asymptomatic individuals (those with no symptoms at all throughout the infection) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are infectious, but the extent of asymptomatic transmission requires further understanding.PurposeThis living review aims to critically appraise available data about secondary attack rates from people with asymptomatic and pre-symptomatic SARS-CoV-2 infection.Data sourcesMedline, EMBASE, China Academic Journals full-text database (CNKI), and pre-print servers were searched from 30 December 2019 to 3 July 2020 using relevant MESH terms.Study selectionStudies that report on contact tracing of index cases with asymptomatic or pre-symptomatic SARS-CoV-2 infection, in either English or Chinese were included.Data extractionTwo authors independently extracted data and assessed study quality and risk of bias. We calculated the secondary attack rate as the number of contacts with SARS-CoV-2, divided by the number of contacts tested.Data synthesisOf 928 studies identified, 19 were included. Secondary attack rates from asymptomatic index cases ranged from 0% to 2.8% (9 studies). Pre-symptomatic secondary attack rates ranged from 0.7% to 31.8% (10 studies). The highest secondary attack rates were found in contacts who lived in the same household as the index case. Other activities associated with transmission were group activities such as sharing meals or playing board games with the index case.LimitationsWe excluded some studies because the index case or number of contacts were unclear. Owing to the anticipated heterogeneity, we did not produce a summary estimate of the included studies.ConclusionAsymptomatic patients can transmit SARS-CoV-2 to others, but our findings indicate that such individuals are responsible for fewer secondary infections than people with symptoms in the same studies.Systematic review registrationPROSPERO CRD42020188168

Focus on Smoke Inhalation—The Most Common Cause of Acute Cyanide Poisoning

2006 ◽  
Vol 21 (S2) ◽  
pp. s49-s55 ◽  
Author(s):  
Marc Eckstein ◽  
Paul M. Maniscalco
Keyword(s):  
Treatment Options ◽  
Signs And Symptoms ◽  
The United States ◽  
Morbidity And Mortality ◽  
Smoke Inhalation ◽  
Closed Space ◽  
Cyanide Poisoning ◽  
Cyanide Antidote ◽  
Prehospital Management ◽  
Fire Smoke

AbstractThe contribution of smoke inhalation to cyanide-attributed morbidity and mortality arguably surpasses all other sources of acute cyanide poisoning. Research establishes that cyanide exposure is: (1) to be expected in those exposed to smoke in closed-space fires; (2) cyanide poisoning is an important cause of incapacitation and death in smoke-inhalation victims; and (3) that cyanide can act independently of, and perhaps synergistically with, carbon monoxide to cause morbidity and mortality. Effective prehospital management of smoke inhalation-associated cyanide poisoning is inhibited by: (1) a lack of awareness of fire smoke as an important cause of cyanide toxicity; (2) the absence of a rapidly returnable diagnostic test to facilitate its recognition; and (3) in the United States, the current unavailability of a cyanide antidote that can be used empirically with confidence outside of hospitals. Addressing the challenges of the prehospital management of smoke inhalation-associated cyanide poisoning entails: (1) enhancing the awareness of the problem among prehospital responders; (2) improving the ability to recognize cyanide poisoning on the basis of signs and symptoms; and (3) expanding the treatment options that are useful in the prehospital setting.

Memantine for the Prevention of Primary Headache Disorders

2014 ◽  
Vol 48 (11) ◽  
pp. 1507-1511 ◽  
Author(s):  
Linda Huang ◽  
Michael Bocek ◽  
Joseph K. Jordan ◽  
Amy Heck Sheehan
Keyword(s):  
Chronic Migraine ◽  
English Language ◽  
Data Extraction ◽  
Primary Headache ◽  
Current Data ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Migraine Headaches ◽  
Study Selection ◽  
Refractory Chronic Migraine

Objective: To describe the current data evaluating the efficacy and safety of memantine for the prevention of primary headache disorders. Data Sources: A literature search using MEDLINE (1966-July 2014) and EMBASE (1973-July 2014) was conducted using the search terms memantine, headache, migraine, glutamate, and NMDA. References of identified articles were reviewed for additional, relevant citations. Study Selection and Data Extraction: All English-language articles dealing with the use of memantine for prevention of primary headache disorders were included. Data Synthesis: Data from several retrospective reports and 2 prospective clinical trials suggest that memantine may be a useful treatment option for the prevention of primary headache disorders. The majority of available literature focuses specifically on chronic migraine prevention in refractory patients who had failed multiple previous prophylactic therapies. In these patients, 10 to 20 mg of memantine daily reduced the frequency and intensity of migraine headaches and was generally well tolerated, with few adverse events. Data regarding the efficacy of memantine for other primary headache disorders such as chronic tension type and cluster headaches are limited. Conclusion: Although further studies evaluating the efficacy of memantine for prevention of primary headache disorders are warranted, memantine may be a reasonable option, used either as monotherapy or adjunctive therapy, in the refractory chronic migraine prophylaxis setting.

Prophylaxis of HIV Infection following Occupational Exposure

1993 ◽  
Vol 27 (10) ◽  
pp. 1243-1256 ◽  
Author(s):  
Douglas N. Fish
Keyword(s):  
Occupational Exposure ◽  
Hiv Infection ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Inoculum Size ◽  
Current Data ◽  
Human Studies ◽  
Retroviral Infection

OBJECTIVE: To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis. DATA SOURCES: English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis. STUDY SELECTION: Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included. DATA EXTRACTION: In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed. DATA SYNTHESIS: Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain. CONCLUSIONS: Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.

Formulary Considerations for Insulins Approved Through the 505(b)(2) “Follow-on” Pathway

2018 ◽  
Vol 53 (2) ◽  
pp. 204-210 ◽  
Author(s):  
Jack T. Rasmussen ◽  
Heather J. Ipema
Keyword(s):  
Insulin Glargine ◽  
Insulin Lispro ◽  
Lower Cost ◽  
Data Extraction ◽  
Safety Data ◽  
Current Data ◽  
Regulatory Change ◽  
Efficacy And Safety ◽  
Data Synthesis ◽  
Study Selection

Objective: To summarize formulary-relevant issues for follow-on insulins approved through the Food and Drug Administration (FDA) 505(b)(2) approval pathway (Basaglar and Admelog). Data Sources: A search of the MEDLINE database was performed for articles pertaining to clinical and formulary considerations for follow-on insulin products through July 2018. Study Selection and Data Extraction: All clinical trials used in the 505(b)(2) approval process for follow-on insulin glargine and insulin lispro products were included and summarized. Data Synthesis: Follow-on insulin glargine and insulin lispro products have been recently approved as the first lower-cost alternatives to innovator insulin products. The follow-on insulins were approved via the 505(b)(2) pathway, making them neither generics nor biosimilars. Current data do not suggest any clinically relevant differences between the follow-on insulins and their respective innovator products. Clinicians should be aware that follow-on insulins will be reclassified as biologic products in the year 2020. Relevance to Patient Care and Clinical Practice: This article provides information about currently available follow-on insulin products that were approved through the 505(b)(2) pathway, including product characteristics and efficacy and safety data. These products will likely be considered for both clinical use and formulary placement because of their potentially lower cost compared with innovator products. Conclusions: Follow-on insulin products approved through the 505(b)(2) pathway are supported by robust efficacy and safety data. As new follow-on insulins are approved and the regulatory change that will occur with these products in 2020 approaches, formulary decisions and clinical policies (eg, substitution) will continue to be revisited.

Sign in / Sign up

Export Citation Format

Share Document