Drug use in patients with short bowel syndrome and intestinal failure.

INTRODUCTION: In patients with short bowel syndrome (SBS), severe malabsorption may cause a need for parenteral support and, by definition, these patients suffer from SBS intestinal failure. Absorption of oral medications is likely diminished in patients with SBS intestinal failure and higher than normal doses may be required to achieve sufficient pharmacologic effect. We investigated the prescription patterns and oral dosages in a well-defined population of patients with non-malignant SBS intestinal failure. METHODS: This was a cross-sectional analysis based on a cohort of adult patients with SBS intestinal failure treated with home parenteral support and registered in 2016 at the Department of Gastroenterology at the Copenhagen University Hospital - Rigshospitalet. The patients' clinical data and prescription patterns were extracted from electronic medical and medications records. RESULTS: The patients in our cohort (n = 74) were primarily females (58%), the median age was 63 years (interquartile range (IQR): 52-72 years) and the median BMI was 22 kg/m2 (IQR: 19-26 kg/m2). Each patient was treated with a median of eight drugs (range: 1-20). Most (75%) of the medications were administered orally. Only codeine, levothyroxine and loperamide were prescribed in higher dosages than recommended in their product labelling. All medication-treated patients were prescribed between one and four different analgesics. CONCLUSION: In our single-centre cohort of patients with SBS intestinal failure, orally administered medications were generally prescribed in recommended dosages. FUNDING: none Trial registration. Approved by the Danish Data Protection Agency (BFH-2016-058, I-Suite no.: 04906) and the Danish Patient Safety Authority (3-3013-1884/1/).

[Respiratory dyskinesia].

In this review, we discuss respiratory dyskinesia, which is a rare adverse reaction to antipsychotic medications. The condition may mimic psychogenic hyperventilation syndrome or other respiratory or cardiac disorder. Respiratory dyskinesia is mostly seen in patients with tardive dyskinesia but may precede manifestations of tardive dyskinesia. If a patient receiving antipsychotic medication presents with symptoms of tachypnoea or acute respiratory distress, the possibility of respiratory dyskinesia should be considered, since it is a potentially reversible condition.

[Metoclopramide-induced respiratory dyskinesia].

This case report describes a patient, who presented with extrapyramidal side effects to the treatment with metoclopramide, which is used as an antiemetic, for gastroparesis and reflux. However, beyond its desired effect, serious neurological adverse reactions can be seen, which is why the European Medicines Agency and the Danish Medicines Agency have changed the recommendations for its use. If the extrapyramidal side effects include the respiratory muscles, the patient's ability to breathe can be affected. If a patient receiving metoclopramide or anti-psychotic drugs shows signs of tachypnoea or acute respiratory distress, the possibility of respiratory dyskinesia should always be considered.

Diagnostic accuracy and radiation dose of CT coronary angiography in atrial fibrillation: systematic review and meta-analysis.

PURPOSE: To determine by means of a systematic review and meta-analysis the diagnostic accuracy, associated radiation dose, and technical challenges of computed tomographic (CT) coronary angiography in patients with atrial fibrillation. MATERIALS AND METHODS: A systematic literature search was performed to compare CT angiography with conventional coronary angiography in patients with atrial fibrillation and to compare CT angiography in patients with atrial fibrillation with that in patients with sinus rhythm. The search yielded seven eligible studies (247 patients) in which CT angiography was compared with conventional coronary angiography. Six additional studies were found for the assessment of CT angiography in patients with atrial fibrillation (n = 158) and those with sinus rhythm (n = 416). Extracted data were analyzed for diagnostic accuracy parameters. Mean effective radiation doses in patients with atrial fibrillation were compared with those in patients with sinus rhythm by using the weighted mean difference method. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of the selected studies. RESULTS: At per-patient analysis of the diagnostic accuracy of CT angiography versus conventional coronary angiography, the sensitivity, specificity, positive predictive value, and negative predictive value were 94% (95% confidence interval [CI]: 85%, 98%), 91% (95% CI: 85%, 94%), 79% (95% CI: 66%, 85%), and 97.5% (95% CI: 94%, 99%), respectively. Comparison of patients with atrial fibrillation and those with sinus rhythm showed no difference in heart rate (P = .16) or number of nondiagnostic segments (P = .10). Patients with atrial fibrillation were older than those with sinus rhythm (mean age ± standard deviation, 68 years ± 10 vs 61 years ± 12, respectively; P = .001). The effective radiation dose was significantly higher in patients with atrial fibrillation than in those with sinus rhythm, with a mean difference of 4.03 mSv (95% CI: 0.97, 7.1; P = .01). CONCLUSION: CT angiography has high diagnostic accuracy in patients with atrial fibrillation but is associated with significantly higher effective radiation dose than that in patients with sinus rhythm. The older age of patients with atrial fibrillation, however, may make the risk of developing cancer less of a concern.