scholarly journals Adverse effects of alternative therapy (minocycline, ofloxacin, and clofazimine) in multibacillary leprosy patients in a recognized health care unit in Manaus, Amazonas, Brazil

2013 ◽  
Vol 88 (2) ◽  
pp. 205-210 ◽  
Author(s):  
Marina Valente Maia ◽  
Maria da Graça Souza Cunha ◽  
Carolina Souza Cunha
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Skin Pigmentation ◽  
Alternative Therapy ◽  
Health Care Unit ◽  
Leprosy Patients ◽  
Treatment Abandonment ◽  
Multibacillary Leprosy ◽  
Monthly Dose

BACKGROUND: After the introduction of the multidrug therapy, there was a decline in the coefficients of prevalence and detection of new cases of leprosy. However, the records of drug resistance and relapses are threatening factors in leprosy control. Hence, new alternative schemes and monitoring of adverse effects to avoid treatment abandonment are important considerations. OBJECTIVE: Describe the side effects of a multidrug regimen containing minocycline, ofloxacin, and clofazimine in multibacillary leprosy patients. METHODS: We conducted a prospective, descriptive, and observational study with multibacillary patients, including cases of intolerance to standard MDT and relapses. The study was carried out at Fundação Alfredo da Matta (Alfredo da Matta Foundation), in Manaus, Amazonas, from April 2010 to January 2012. The patients received alternative therapy, which consisted of daily self-administered doses of 100mg of minocycline, 400 mg of ofloxacin, and 50mg of clofazimine and a supervised monthly dose of 300mg of clofazimine for six months, followed by eighteen months of daily doses of ofloxacin 400mg, clofazimine 50mg, and a supervised monthly dose of clofazimine 300mg. Results: Twenty-one cases were included. Mild and transitory side effects occurred in 33.3% of patients. Of the total episodes, 45.9% were attributed to ofloxacin and they included abdominal pain, nausea, vomiting, headache, and insomnia; 21.6% were due to clofazimine, with 100% of patients presenting skin pigmentation. The mean time for the development of adverse effects after beginning the therapy was 15.2 days. CONCLUSION: All patients tolerated the drugs well, and compliance was satisfactory, with no serious events. Unlike other standard MDT studies had shown, no treatment was stopped due to side effects. Nevertheless, patient follow-up and studies with bigger samples are necessary to guarantee the efficacy and safety of the alternative regimen as a second-line scheme in multi-drug therapy.

Recommendations for Monitoring Lithium Therapy

1983 ◽  
Vol 17 (5) ◽  
pp. 346-350 ◽  
Author(s):  
Ronald B. Salem
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Serum Levels ◽  
Normal Serum ◽  
Lithium Therapy ◽  
Organ Systems

The literature concerning side effects of normal serum levels of lithium on various organ systems is reviewed. Suggestions for monitoring and managing these adverse effects are discussed. A table is presented that provides recommendations for evaluation prior to initiation and during follow-up of therapy.

scholarly journals Powerful Bactericidal Activity of Moxifloxacin in Human Leprosy

2008 ◽  
Vol 52 (9) ◽  
pp. 3113-3117 ◽  
Author(s):  
Fe Eleanor F. Pardillo ◽  
Jasmin Burgos ◽  
Tranquilino T. Fajardo ◽  
Eduardo Dela Cruz ◽  
Rodolfo M. Abalos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Bactericidal Activity ◽  
Mycobacterium Leprae ◽  
Skin Lesions ◽  
Definite Improvement ◽  
Highly Effective ◽  
Leprosy Patients ◽  
Multibacillary Leprosy

ABSTRACT In a clinical trial of moxifloxacin in eight multibacillary leprosy patients, moxifloxacin proved highly effective. In all trial patients, a single 400-mg dose of moxifloxacin resulted in significant killing (P ≤ 0.006) of Mycobacterium leprae, ranging from 82% to 99%, with a mean of 91%. In all instances, no viable bacilli were detected with an additional 3 weeks of daily therapy, this observed rapid bactericidal activity being matched previously only by rifampin. On moxifloxacin therapy, skin lesions cleared exceedingly rapidly with definite improvement observed consistently after eight doses and progressive resolution continuing for the 56 days of the trial. Side effects, toxicities, and laboratory abnormalities were mild, not requiring discontinuation of therapy.

scholarly journals Ocular Adverse Effects of Antidepressants – Need for an Ophthalmic Screening and Follow up Protocol

2019 ◽  
pp. 1-6
Author(s):  
Varsha Narayanan
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Visual Disturbance ◽  
Significant Rise ◽  
Angle Closure ◽  
Ocular Side ◽  
Screening Protocol

Depression is emerging to be one of the commonest mental health disorders worldwide affecting a wide age group. The prescription of antidepressants has risen considerably in last decade with a preference for using newer antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs). There have been many published reports of Ocular side effects with Antidepressants related to Dry eye, Visual disturbance, Angle closure glaucoma and Retinal effects. There has also been a significant rise in antidepressant usage by the elderly, which is a population at risk for ocular adverse effects. Therefore, it is pertinent to understand the antidepressants from the perspective of their mechanisms of action and all possible Ocular adverse effects, and develop an Ophthalmic screening protocol and follow up for patients being put on Antidepressants. Patients should also be counselled for reporting alert signs of ocular side effects immediately. These steps may help to avert and decrease visual complications with Antidepressants.

Delayed Onset Adverse Effects Associated with Rituximab Treatment in Patients with Non-Hodgkin's Lymphoma – A Single Center Experience

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4888-4888
Author(s):  
Evelyne Shabad ◽  
Eitan Mangoubi ◽  
Olga Valkovsky ◽  
Salim Habib Alla ◽  
Miriam Quitt
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
B Cell ◽  
Medical Center ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Late Side Effects ◽  
Late Side ◽  
Lymphoma Type

Abstract Abstract 4888 Introduction. Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has now become a cornerstone in the treatment of many CD20 positive B cell lymphomas. RTX induces a rapid depletion of normal CD20 expressing B-cells in the peripheral blood, and their level remains low for 2–6 months before returning to pretreatment levels, generally within 12 months. Some patients develop late side effects such as neutropenia and hypogammaglobulinemia regardless of the level of B cells; these patients are more vulnerable to life-threatening infections. In addition, treatment with RTX is a risk factor for HBV and HCV reactivation in occult and chronic carriers. Aims. The goal of the study was to identify the clinical and laboratory indices that serve as predictors of risk for developing late side effects in patients with non- Hodgkin's lymphoma (NHL) treated with RTX in a single medical center. Statistical correlation between these variables and occurrence of infectious complications secondary to late hematologic adverse effects such as neutropenia and hypogammaglobulinemia was performed. Clinical outcome of patients with infectious complications was evaluated. Methods. We conducted a retrospective study of 120 patients who were diagnosed with B cell NHL and were followed in the Institute of Hematology of Carmel Medical Center in Haifa between 2000–2008. Each patient received RTX as a monotherapy or in combination with chemotherapy. All the patients in the study were RTX naive. The study was approved by the local Helsinki committee. For the purpose of the study, the follow-up period was defined from the time of termination until a period of 24 months from the last therapeutic dose of RTX. Late side effects were defined as side effects that appeared 6 months after the last therapeutic dose of RTX or continued beyond the 6 month period. For each variable we evaluated retrospectively the proportion of patients who developed late side effects. In an attempt to characterize the risk factors such as age, sex, status of lymphoma, type of chemotherapy, number of treatments and the interval between the treatments, comparison was made between the patients who developed side effects and those who did not. Results. Twenty two of the 120 surveyed patients (18.3%) developed infections. Hematologic side effects observed were anemia (28.3%), thrombocytopenia (7.5%) and neutropenia (3.28%). We found that age ≥70 years and recurrence of the disease were significant risk factors for developing side effects. Laboratory indexes that were found to be significant predicting factors for the risk of infection were: PMN<2.0×109/mm3, LDH≥480u/l, SGOT≥44u/l. An active disease and grade 3–4 neutropenia were both variables that contributed to the risk of infection. There was no correlation between gender of patients, the histological type and stage of lymphoma, type of chemotherapy, or number of therapeutic courses with RTX and increased risk of infection. We did not find any association between hypogammaglobulinemia and the risk of infection. Regarding viral infections, only 2 HCV carriers were detected in the study; none of them had reactivation during the follow up. Reactivation of HBV occurred in 1 of the 6 occult carriers (16.7%). Conclusions. In recent years RTX has become an essential component in the therapy of B cell NHL. Late side effects of this drug are now beginning to emerge and require new risk assessment for safety. Twenty two patients (18.33%) in our study developed infectious complications. This rate is lower than the one reported in the literature (30%). In contrast, mortality following infection was 7% as compared to 2% reported in the literature. These data can be explained by the fact that our study examined hospitalized patients who had more severe infections. Our study supports the previous observation that hypogammaglobulinemia does not present a risk factor for infection. In contrary to the reports in literature, we found no correlation between the number of therapeutic courses with RTX and the risk of infection. In conclusion, we suggest that RTX should be used with caution in patients over age 70 and in patients with recurrent disease. In order to confirm our findings, further assessment of late adverse effects on the larger population of patients treated with rituximab is warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

2015 ◽  
Vol 60 (3) ◽  
pp. 1854-1858 ◽  
Author(s):  
Ibai Los-Arcos ◽  
Carles Pigrau ◽  
Dolors Rodríguez-Pardo ◽  
Nuria Fernández-Hidalgo ◽  
Antonia Andreu ◽  
...  
Keyword(s):  
Side Effects ◽  
Oral Therapy ◽  
Alternative Therapy ◽  
Multidrug Resistant ◽  
Chronic Bacterial Prostatitis ◽  
Content Type ◽  
Bacterial Prostatitis ◽  
Patient Side

This is a retrospective study of 15 difficult-to-treat (i.e., exhibiting previous failure, patient side effects, or resistance to ciprofloxacin and co-trimoxazole) chronic bacterial prostatitis infections (5 patients with multidrug-resistantEnterobacteriaceae[MDRE]) receiving fosfomycin-tromethamine at a dose of 3 g per 48 to 72 h for 6 weeks. After a median follow-up of 20 months, 7 patients (47%) had a clinical response, and 8 patients (53%) had persistent microbiological eradication; 4/5 patients with MDRE isolates achieved eradication. There were no side effects. Fosfomycin-tromethamine is a possible alternative therapy for chronic bacterial prostatitis.

Fifteen-minute consultation: A clinical approach to the management of the child with hypertonia

2020 ◽  
Vol 105 (5) ◽  
pp. 276-281
Author(s):  
Daniel E Lumsden ◽  
Jill Cadwgan
Keyword(s):  
Side Effects ◽  
Young People ◽  
Adverse Effects ◽  
Clinical Approach ◽  
High Tone ◽  
Children And Young People ◽  
Functional Problems

Elevated tone (hypertonia) is a common problem seen in the paediatric clinic. For most children and young people, hypertonia is just one aspect of a broader disorder of movement and posture. This paper describes a clinical approach to the management of hypertonia in children, considering the contribution of high tone to the functional problems experienced by the child, the potential adverse effects of reducing tone, side effects of the intervention and the importance of setting objectives/goals for intervention which can be measured at follow-up. We describe this as the ‘MOTOR’ approach and provide some examples of how it can be used in practice.

scholarly journals A Retrospective Study: Epidemiology, Onset, and Duration of Erythema Nodosum Leprosum in Surabaya, Indonesia

2021 ◽  
Vol 33 (1) ◽  
pp. 8
Author(s):  
Cindy Fransisca ◽  
Iskandar Zulkarnain ◽  
Evy Ervianti ◽  
Damayanti Damayanti ◽  
Maylita Sari ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Retrospective Study ◽  
Erythema Nodosum ◽  
First Year ◽  
Erythema Nodosum Leprosum ◽  
Regular Control ◽  
Leprosy Patients ◽  
Multibacillary Leprosy

Background: Erythema nodosum leprosum (ENL) has a chronic and recurrent nature which could reduce patient’s quality of life in addition to the onset of ENL that occurs before, during, or after multidrug treatment, further emphasizing the importance of regular control and education.Purpose:This study aimed to evaluate the epidemiology, onset, duration, and recurrence of ENL. Methods:Data from medical records were obtained for a 3-year retrospective study of multibacillary leprosy patients at the Leprosy Division of the Dermatology and Venereology Outpatient Department, Dr. Soetomo General Hospital Surabaya, with a minimum of 2–5 years follow-up period.Result:The prevalence of  ENL continued to increase almost every year especially in 2017 (32% in 2015; 32% in 2016; and 36% in 2017). ENL most often occurs during the first year of multi-drug therapy (MDT) administration followed by after the release from treatment (RFT) with the latest onset occurring 4 years after RFT. The majority of patients experienced chronic and recurrent reactions with the longest reactions lasting up to 4.5 years (55 months). Conclusion:Knowledge about the onset, duration, and recurrences of ENL are essential, and strict supervision for routine control shall be encouraged to increase the patients’ compliance so as to increase their quality of life.

scholarly journals Comparison of Two Provocative Tests for Calcitonin in Medullary Thyroid Carcinoma: Omeprazole vs Pentagastrin

2002 ◽  
Vol 48 (9) ◽  
pp. 1505-1510 ◽  
Author(s):  
Giovanni Vitale ◽  
Antonio Ciccarelli ◽  
Michele Caraglia ◽  
Maurizio Galderisi ◽  
Riccardo Rossi ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Serum Concentrations ◽  
Cell Disease ◽  
Provocative Test ◽  
Medullary Thyroid ◽  
Hereditary Medullary Thyroid Carcinoma

Abstract Background: Provocative tests for calcitonin (CT) are fundamental in the diagnosis and follow-up of C-cell disease and in the detection of hereditary medullary thyroid carcinoma (MTC) carriers with unknown RET mutations. A recent report has proposed omeprazole, which can increase endogenous gastrin (GT), as a new provocative test for MTC. Methods: We compared the omeprazole test (20 mg twice a day for 4 days) to the pentagastrin test (0.5 μg/kg of body weight) for the diagnosis and management of MTC. Twenty healthy individuals and 20 MTC patients with mildly or moderately increased basal CT serum concentrations underwent the pentagastrin and omeprazole tests. Results: In MTC patients, the pentagastrin test produced a significantly higher increase in serum CT than did omeprazole. After the pentagastrin injection, several patients reported unpleasant side effects, including substantial tightness in 38 of 40 participants. No adverse effects were observed during the omeprazole test. A significant direct correlation was recorded between CT% (ratio of CT peak to basal value × 100) and GT% (ratio of GT peak to basal value × 100) during the omeprazole test in MTC patients (r = 0.73; P &lt;0.001). Conclusions: In spite of several adverse effects, pentagastrin remains the best provocative test for the diagnosis of MTC. Omeprazole may be useful when pentagastrin is contraindicated or refused because of the unpleasant side effects, but further validation is needed.

scholarly journals Variations in the Clinical Management of Multibacillary Leprosy Patients in Selected Hospitals in Metro Manila

2018 ◽  
Vol 52 (3) ◽  
Author(s):  
Veincent Christian F. Pepito ◽  
Arianna Maever L. Amit ◽  
Rae Erica D. Samontina ◽  
Sarah Jane A. Abdon ◽  
David Norman L. Fuentes ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Treatment Compliance ◽  
Treatment Completion ◽  
World Health ◽  
Diagnosis And Management ◽  
Who Standards ◽  
Leprosy Patients ◽  
Metro Manila ◽  
Multibacillary Leprosy

Introduction. This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country’s leprosy control and elimination program. Methods. Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed. Results. There were variations in the hospitals’ procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals. Conclusion. Given the variations in patient management, we recommended that effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.

scholarly journals An audit assessing the monitoring of SSRIS after initiation in children and adolescents

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S41-S41
Author(s):  
Ella McGowan
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Alternative Plan ◽  
Medication Dose ◽  
The Common ◽  
The One ◽  
Accurate Record

AimsTo identify children and adolescents started on SSRIs to see if they are being followed up in accordance to NICE and Maudsley guidelinesObjectivesHas the patient been followed up after a week to check for adverse effects or improvement in their mental state?Has the patient been re-evaluated every 4-6 weeks, if not is there an alternative plan?If there is no improvement has the dose been increased?If there is an adverse effect has the dose been lowered or the medication stopped?MethodPaper case notes including clinic letters and handwritten notes were reviewed on the 19/10/2020. The following data were collected anonymously.AgeGenderDate seen / Date medication startedName of medicationDate medication startedDate of Follow-upMonitoring of improvementMonitoring of adverse effectsOutcome of monitoringResultA total of 18 sets of cases were identified.Follow-up occurred in 17 of the 18 cases.The one case that had not been followed up had started the medication 8 weeks before the audit. The median follow-up time was 42 days (6 weeks). No cases were followed up within a week.Monitoring of improvement was recorded in 88% of case notes reviewed.Monitoring for adverse effects occurred in 36% of case notes and none of these patients had reported any side effects. 53% of cases did not have monitoring of adverse effects documented. There were two patients (11%) who did not take the medication as prescribed. One out of choice and one their parent had not collected it.The medication dose was increased in 22% of patients without clear documentation of monitoring for adverse effects.ConclusionAfter discussion with the clinical lead it was decided it is impractical to follow up patients a week after starting medication. However, patients and their carers should be informed of the side effects and advised to contact CAMHS if adverse effects occur.The area of practice that can be improved is the documentation of adverse effects at follow-up.Recommendations:All patients to be informed of the common side effects of the medication before it is initiated and advised to contact the CAMHS team if they have concernsAll CAMHS patients started on SSRIs should be followed up within 4-6 weeksAt follow-up any adverse events and clinical response should be discussedAn accurate record of the exchanges of the above information should be documented in the notesRe-audit

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