VV-ECMO as bridge and safety net for successful therapeutic polypragmasy in a case of influenza-triggered near-fatal asthma.

Key Clinical Message: In near-fatal asthma, the combination of ECMO therapy and isoflurane application via an intensive care ventilator with an anesthetic conservation device represents a therapeutic combination in seemingly hopeless clinical situations. Abstract: We report a case of an adult patient with near-fatal asthma, who was implanted venovenous extracorporeal membrane oxygenation in an extern hospital before transfer to our tertiary center. After 13 days and various therapeutic approaches, including inhaled isoflurane therapy via an anesthetic-conserving device, the patient was decannulated and extubated 3 days later.

Cytochrome P450-mediated inhibition of venlafaxine metabolism by trimipramine.

OBJECTIVE: The aim of this study was to ensure patients' safety and to enhance treatment efficacy, knowledge about pharmacokinetic interactions even in complex clinical situations of polypharmacy is invaluable. This study is to uncover the potential of pharmacokinetic interactions between venlafaxine and trimipramine in a naturalistic sample. METHODS: Out of a therapeutic drug monitoring database with plasma concentrations of venlafaxine (VEN) and O-desmethylvenlafaxine (ODV), we considered two groups of patients receiving venlafaxine without known cytochrome P450 confounding medications, taking solely venlafaxine: V0 (n = 905), and a group of patients co-medicated with trimipramine, VTRIM (n = 33). For VEN, ODV and active moiety (sum of VEN + ODV) plasma concentrations and dose-adjusted concentrations as well as ODV/VEN ratios were compared between groups using the Mann-Whitney U test with a significance level of 0.05. RESULTS: Patients co-medicated with trimipramine had higher plasma concentrations of VEN (183.0 vs. 72.0, +154%, P = 0.002) and AM (324.0 vs. 267.5, +21%, P = 0.005) and higher dose adjusted plasma concentrations than patients in the control group (P = 0.001 and P = 0.003). No differences were found for ODV and C/D ODV (P < 0.05 for both comparisons). The metabolite to parent ratio, ODV/VEN, was significantly lower in the VTRIM group (1.15 vs. 2.37, P = 0.012). CONCLUSION: Findings suggest inhibitory effects of trimipramine on venlafaxine pharmacokinetics most likely via an inhibition of CYP 2D6 or by saturated enzyme capacity. The lack of in vitro data hampers the understanding of the exact mechanisms. Clinicians should be aware of drug-drug interactions when combining these agents. Therapeutic drug monitoring helps to ensure treatment efficacy and patients' safety.

Subclinical hyperthyroid patients' knowledge about radioiodine therapy--the key role of medical information.

OBJECTIVES: Many patients with a chronic disease are dissatisfied with the information they are given. A brief questionnaire completed by patients would assist health professionals to identify areas of information needed to be provided, tailored to the patient's mental condition. AIM: The aim of our study was to assess how often thyroid patients report being adequately informed about iodine treatment in connection with their real need thereof, emotional state and acceptance of the disease. METHODS: One hundred outpatients who had presented subclinical hyperthyroidism "[19 men (19%), 81 women (81%); mean (SD±) age 53±14,range 18-77 yr ] treated with radioiodine (RAI) responded to an Experimental Questionnaire, 54 of them answered to AIS, HADS-M and Beck Inventory measuring their acceptance of the illness and depressive symptoms, 37 of them answered the Patient Request Form (PRF). RESULTS: The obtained results indicated that about 50% of patients treated with 131I therapy did not receive suitable information about their treatment. Neither written information prepared by the specialist, nor verbal information given by physicians were adequate for specific problems of study group. The examined patients presented with a comparable intensity of three distinct types of requests: for explanation and reassurance, for emotional support, and for investigation and treatment. The acceptance of their disease was mediocre for most of the study group. CONCLUSION: We conclude that the reported lack of satisfaction with medical information in study group was associated with depressive symptoms influencing cognitive efficiency, patients' great need of emotional and cognitive support, influencing the acceptance of their disease, and social prejudice to radioiodine (as a method of treatment), worrying them additionally. All thyroid patients even these with subclinical symptoms of hyperthyroidism should be treated with specific attention by physicians, especially during information process.