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1.
Am J Emerg Med ; 78: 242.e5-242.e6, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37973470

RESUMO

Here we present the case of a patient who purchased a Hawthorne root (Crataegus mexicana) product, Raiz de Tejocote, for weight loss purposes. She presented with diffuse myalgias, dizziness and a heart rate of 52 beats per minute. At triage and at initial evaluation, the patient denied taking any medications, but on iterative questioning concerning over-the-counter, over-the-internet and herbal medications, she reported taking Hawthorne root tablets in the three days prior to the emergency department (ED) visit for the purpose of weight loss. The product was purchashed through the internet. Her plasma digoxin concentration was 0.4 ng/ml the patient's constellation of symptoms, as well as the detectable plasma digoxin concentration, were consistent with hawthorne root toxicity. Hawthorne root has intrinsic cardiac glycoside activity. In addition, Hawthorne root may cause a range of toxicity. Mild symptoms can include flu-like syndrome with significant myalgias. However, in the more severe exposures the cardiac glycoside effects can result in bradycardia and hemodynamic instability. Symptoms resolved with ED observation. The heart rate normalized. This case reinforces the importance of asking a patient about all medications, including over-the-counter, over-the-internet and herbal medications.


Assuntos
Glicosídeos Cardíacos , Crataegus , Humanos , Feminino , Digoxina , Bradicardia , Redução de Peso
2.
Int J Pharm ; : 123192, 2023 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-37402441

RESUMO

Understanding the particulate content of formulated drug products is essential for ensuring patient safety. In particular, it is critical to assess the presence of aggregated proteins or extraneous particles (e.g. fibres) that pose potential dangers. Additionally, it is useful to be able to distinguish non-proteinaceous particles, such as silicone oil droplets that commonly occur in formulations stored in pre-filled syringes. Standard particle counting methods (e.g. light obscuration) provide only total numbers of particles of a given size, but provide no mechanism for particle classification. Significant recent work has focused on the use of flow imaging microscopy to enable simultaneous classification and counting of particles using machine learning (ML) models including convolutional neural networks (CNN). In this paper we expand upon this theme by exploring techniques for achieving high prediction accuracy when the size of the labeled dataset used for model training is limited. We demonstrate that maximum performance can be achieved by combining multiple techniques such as data augmentation, transfer learning, and novel (to this field) models combining imaging and tabular data.

3.
Am J Emerg Med ; 60: 225.e5-225.e6, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35821084

RESUMO

Here we present the case of a 4-year-old child who presented to the emergency department (ED) with bloody diarrhea. The causative agent was confirmed to be Citrullus colocynthis (bitter apple), which had been given to the patient by his grandmother for constipation. Hemorrhagic colitis can be induced by Citrullus colocynthis. Treatment is essentially support. Hypoglycemia and transaminitis have been associated with Citrullus colocynthis ingestion. The case highlights that pediatric patients can be inadvertently exposed to herbal medications that can cause harm. It also highlights that certain herbal medications with toxic potential, such as Citrullus, can be seen in emergency departments that are geographically quite distant from the most common origins of the plant. To our knowledge, this is the first American pediatric case report of bitter apple induced hemorrhagic colitis.


Assuntos
Citrullus colocynthis , Colite , Criança , Pré-Escolar , Colite/tratamento farmacológico , Ingestão de Alimentos , Humanos , Extratos Vegetais/uso terapêutico
4.
Clin Toxicol (Phila) ; 60(5): 623-627, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34812101

RESUMO

CONTEXT: Bupropion is a frequently used medication. Excessive doses may cause altered mental status, seizures, and dysrhythmias. There is a need for accurate estimate of seizure risk with therapeutic errors and determination if minor symptoms are harbingers of more severe effects. METHODS: A retrospective review of adult, acute, unintentional therapeutic error, single substance bupropion ingestions with known outcome reported to four poison centers from January 1, 2004 to December 31, 2016. Data included age, gender, single error dose, total bupropion dose over 18 h, prior history of seizure, management site, observation time, occurrence of an out-of-hospital adverse event, "jittery"/anxious/agitated, tachycardia/palpitations, seizures, and dysrhythmias. We recorded the total bupropion dose over 18 h if known; otherwise, we used the single error dose. We compared means for parametric data. We used Fisher's exact test and Mann-Whitney for nonparametric data. RESULTS: We identified 754 potential cases, of which 637 met inclusion criteria after case review. Median age was 42 years, and 76.1% were female. Cases were predominantly managed at home (56.2%). Outcomes were no effect (50.1%), minor (45.5%) and moderate (4.4%). The reported dose with no effect/minor outcome was 694 (±297) mg, and for moderate outcome was 1250 (±815) mg (p < 0.0001). Seizures occurred in four patients with median onset time of 7 h [range 2-21.5 h]. The median reported dose in patients who seized was 900 mg [range 600-3000 mg]. Of patients who developed a seizure and/or an out-of-hospital adverse event, 83% were "jittery"/anxious/agitated whereas "jittery"/anxious/agitated was present in 27% of cases that did not (p = 0.008). Tachycardia/palpitations was reported in 12% of cases; more serious dysrhythmias were not reported. CONCLUSIONS: Outcomes from single unintentional ingestions of bupropion in adults are overall mild and appear to be dose related. Home management may be an option with doses up to 900 mg in an appropriate patient population.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Venenos , Adulto , Bupropiona/toxicidade , Feminino , Humanos , Centros de Controle de Intoxicações , Estudos Retrospectivos , Convulsões/induzido quimicamente , Convulsões/epidemiologia , Taquicardia/induzido quimicamente , Estados Unidos/epidemiologia
9.
Am J Emerg Med ; 29(5): 541-4, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20825829

RESUMO

OBJECTIVE: Emergency physicians routinely perform emergency department procedural sedation (EDPS), and its safety is well established. We are unaware of any published reports directly evaluating the safety of EDPS in older patients (≥65 years old). Many EDPS experts consider seniors to be at higher risk. The objective was to evaluate the complication rate of EDPS in elderly adults. METHODS: This was a prospective, observational study of EDPS patients at least 65 years old, as compared with patients aged 18 to 49 and 50 to 64 years. Physicians were blind to the objectives of this research. The study protocol required an ED nurse trained in data collection to be present to record vital signs and assess for any prospectively defined complications. We used American Society of Anesthesiologists (ASA) physical status classification for systemic disease to evaluate and account for the comorbidities of patients. We used the Fisher exact test for the difference in proportions across age groups and analysis of variance for the differences in dosing across age and ASA categories. RESULTS: During the 4-year study, we enrolled 50 patients at least 65 years old, 149 patients aged 50 to 64 years, and 665 patients aged 18 to 49 years. Adverse event rates were 8%, 5.4%, and 5.2%, respectively (P = .563). The at least 65 years age group represented a greater percentage of those with higher ASA scores (P < .001). The average total sedative dose in the at least 65 years group was significantly lower than the comparisons (P < .001). CONCLUSIONS: This study demonstrated no statistically significant difference in complication rate for patients 65 years or older. There was a significant decrease in mean sedation dosing with increased age and ASA score.


Assuntos
Sedação Consciente/efeitos adversos , Serviço Hospitalar de Emergência , Adolescente , Adulto , Fatores Etários , Idoso , Análise de Variância , Distribuição de Qui-Quadrado , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Entorpecentes/administração & dosagem , Entorpecentes/efeitos adversos , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
11.
Reprod Biomed Online ; 11(5): 562-9, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16409704

RESUMO

Ovarian stimulation is an integral part of assisted reproduction treatments. Ovarian response to gonadotrophin treatment, besides other factors, determines the outcome of treatment, as the number and quality of oocytes retrieved are related to the chance of achieving a pregnancy. A number of factors have been identified that might predict ovarian response, such as age of the patient and antral follicle count. In addition, it has been shown that genetic factors such as the patient's FSH-receptor genotype also determine individual response to FSH treatment. Besides patient-related factors, the choice of drugs for ovarian stimulation plays a significant role. Until recently, biopotency of gonadotrophin preparations was tested by an in-vivo bioassay with an intrinsic variability up to 20%. Due to a superior manufacturing technique, follitropin alpha can now be filled by mass. This allows assessment of FSH with a precise SE-HPLC assay and variability of the FSH content between production lots has now been estimated at 1.6%. Results of recent studies indicate that treatment with follitropin alpha filled by mass results in consistent ovarian response, fewer treatment days and fewer cancelled cycles. This is an important step towards further minimizing drug-related variability of ovarian response to FSH treatment.


Assuntos
Fármacos para a Fertilidade Feminina/uso terapêutico , Hormônio Foliculoestimulante/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/métodos , Fatores Epidemiológicos , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Fármacos para a Fertilidade Feminina/normas , Fertilização in vitro , Hormônio Foliculoestimulante/administração & dosagem , Hormônio Foliculoestimulante/normas , Subunidade alfa de Hormônios Glicoproteicos/fisiologia , Humanos , Masculino , Folículo Ovariano/crescimento & desenvolvimento , Isoformas de Proteínas/fisiologia , Injeções de Esperma Intracitoplásmicas
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