Clinical uses of antibiotics: problems and tactics

Questionnaires were sent to directors of the 118 oral and maxillofacial surgery training programs in the United States and its territories to survey current trends and recent experience with maxillo-mandibular fixation (MMF). Eighty-eight percent of the respondents indicated that it was customary to keep wire cutters at the bedsides of hospitalized patients who were in MMF, and 49% discharged patients in MMF with wire cutters. The respondents were aware of 17 inpatients and 5 outpatients in their programs who had required emergency release from MMF during the previous 5 years. Emergent MMF release is a rare event. The availability of wire cutters at the hospital bed or issuance of wire cutters to outpatients in MMF should be based on a case-by-case consideration of the procedure performed, postoperative bleeding, vomiting potential, edema, airway integrity, patient dexterity, and patient compliance.     

Modern principles for studying the organotropic side effects caused by antibiotics

For prophylaxis of the organotropic side reactions in antibiotic therapy it is important to determine correlation between the drug blood level and the effect level. The study of this correlation under experimental conditions provides determination of the maximum permissible concentration of the antibiotic in the blood. When the antibiotic side effects are diagnosed in clinics it is advisable to determine as exact as possible the peculiar properties of the drug pharmacokinetics in the respective patients.     

Rediscovering thalidomide: a review of its mechanism of action, side effects, and potential uses

Thalidomide, a hypnosedative drug introduced in the 1950s, has been used in a variety of dermatologic conditions during the past few decades. Although originally withdrawn from the world market on discovery of its teratogenic effect, it has since been selectively reintroduced for use in various disorders thought to have an autoimmune or inflammatory basis. A review of the literature focused on clinical uses of thalidomide in the treatment of dermatologic diseases was performed. Diseases for which thalidomide has been found effective include erythema nodosum leprosum, prurigo nodularis, actinic prurigo, discoid lupus erythematosus, aphthous stomatitis, Beh?et's syndrome, and graft-versus-host disease. Side effects such as teratogenicity and peripheral neuropathy remain its limiting factor. Thalidomide is a useful addition to the therapeutic armamentarium for treatment-resistant dermatoses as long as proper vigilance for adverse effects is maintained.     

Distinctive therapeutic uses of metaphor.

Illustrates 4 functionally distinct kinds of therapeutic metaphors from the literature: making a point vividly with a comparison; accommodating disparate interests in a single designation having multiple meanings; changing perspective on a topic with terminology borrowed from another domain; and bringing to light something new by combining topics. Distinguishing metaphorical communications according to these uses brings order to this rich area and can help to guide future inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between early side effects and therapeutic effects of clomipramine therapy in obsessive-compulsive disorder

Recognizing that the scientific method is as critical to cancer control as it is to basic laboratory research, the National Cancer Institute (NCI) established a well-defined, systematic strategy for attaining its cancer control goals and objectives. This strategy, operationalized in the early 1980s as a five-phase process, emphasized cancer control as a research science rather than a demonstration science. The five phases of NCI's cancer control research strategy progress from hypothesis development, to methods development, to controlled intervention trials, to defined population studies, and finally to demonstration and implementation programs. This research base provides the foundation for nationwide prevention and health services programs. The application of this five-phase approach to NCI's efforts to reduce morbidity and mortality attributable to tobacco use is described, and some of the challenges that faced the Institute in this process are identified. These experiences provide an important framework for other disciplines faced with the challenge of translating science into practice.     

Immunomodulating effects of antibiotics: literature review

Antibiotics can interact directly with the immune system. This is a review of the immunomodulating effects of antibiotics. The Medline database on CD-ROM was searched for the years 1987 to 1994 using the following search string: "thesaurus explode antibiotics/all AND (thesaurus explode immune-system/drug effects OR thesaurus immune-tolerance/drug effects)." Aspects of the immune system studied were aspects of phagocyte functions: phagocytosis and killing, and chemotaxis and aspects of lymphocyte functions: lymphocyte proliferation, cytokine production, antibody production, delayed hypersensitivity and natural killer-cell activity. In order to quantify and to compare immunomodulatory properties of antibiotics we calculated an "immune index," defined as: number of positive statements--number of negative statements/total number of statements. Concerning phagocytosis, positive effects were observed for cefodizime, imipenem, cefoxitin, amphotericin B and clindamycin and negative effects for erythromycin, roxithromycin, cefotaxime, tetracycline, ampicillin and gentamicin. Clindamycin, cefoxition and imipenem induce enhancement of chemotaxis, whereas cefotazime, rifampicin and teicoplanin decrease chemotaxis. Regarding lymphocyte proliferation, cefodizime has the strongest stimulating effect, whereas tetracycline has the strongest negative effect. Except for erythromycin and amphotericin B the number of statements reported is too small to be conclusive for the interpretation of effects on cytokine production. Erythromycin and amphotericin B appear to stimulate cytokine production. As to antibody production, cefodizime has the strongest positive effect, whereas josamycin, rifampicin and tetracycline have marked negative effects. For delayed hypersensitivity and the natural killer-cell activity the number of statements is too small for any single antibiotic to be conclusive. There are three markedly immuno-enhancing antibiotics (imipenem, cefodizime and clindamycin) and eight markedly immuno-depressing antibiotics (erythromycin, roxithromycin, cefotaxime, tetracycline, rifampicin, gentamicin, teicoplanin and ampicillin).     

Toxicity and side effects of antibiotics in radiation sickness and during the use of aminothiol group radioprotective agents

It was shown in experiments on mice, rats and rabbits that resistance of animals in the state of acute radiation sickness to severe intoxication by aminoglycoside antibiotics, such as streptomycin, dihydrostreptomycin and monomycin did not significantly change. The exception was kanamycin the toxicity of which during the period of the acute state of radiation sickness increased by 30 per cent. The use of cystamine and merkamine before irradiation or their administration to non-irradiated animals resulted in lowering of the antibiotic tolerance by 1.5--2 times. The above aftereffects of the radioprotectors was observed within 3--12 days after their use and was most pronounced for the combination of cystamine and streptomycin. The acute toxicity of tetracyclines did not significantly differ at various stages of radiation disease and at the background of cystamine use. No significant cumulation of the toxicity of aminoglycoside antibiotics and tetracyclines or signs of adaptation in the healthy and irradiated animals was observed on prolong treatment with therapeutic doses. Cystamine had no effect on the tolerance of the antibiotics on their prolonged use.     

Further observations on carbamazepine plasma levels in epileptic patients. Relationships with therapeutic and side effects

Plasma levels of carbamazepine, phenytoin and phenobarbital were monitored weekly over a period of 9 weeks in 20 epileptic patients unresponsive to treatment. No attempts were made to modify phenytoin and/or phenobarbital plasma levels; emphasis was on achieving carbamazepine plasma levels of 4 to 10 mug per milliliter. A remarkable drop in seizure frequency was attained within 2 to 3 weeks of monitoring, with carbamazepine plasma and concentrations within the desired range. Children disposed of the drug faster than adults. No effects of phenytoin and phenobarbital on carbamazepine plasma levels could be observed, while phenobarbital on carbamazepine plasma levels fluctuated remarkably without any relationship to carbamazepine levels. Transient leukopenia was present in most of the patients, while a significant reversible drop in red blood cells was observed in eight patients. The data reported confirm that with a careful monitoring of drug plasma levels, carbamazepine may exert a definite passive effect on seizure frequency in epileptic patients poorly responsive to therapy.     

Oral antihistamines reduce the side effects from rapid vancomycin infusion

Recombinant human mu-calpain whose active site Cys-115 was substituted with Ser was expressed in insect cells using baculovirus system. The mutant mu-calpain, purified using an affinity-column of calpastatin oligopeptides, had no proteolytic activities of autolysis and caseinolysis. The large subunit of the mutant mu-calpain was processed from the 80 kDa form to the 76 kDa form by the wild type calpain, supporting the intermolecular cleavage mechanism of procalpain during activation. Fluorescence polarization analysis revealed that the mutant mu-calpain retained high affinity toward fluorescein-labeled calpastatin domain 1. Fragmentation of the full-length calpastatin by the wild type calpain was enhanced by pre-incubating the inhibitor with the mutant calpain. The recombinant mutant calpain was suggested to retain the integrity of the high ordered structure of the wild type calpain.     

Mood influences on helping: Direct effects or side effects?

A review of the literature concerning the promotive influence of experimentally generated happiness and sadness on helping suggests that (a) increased helping among saddened Ss is an instrumental response designed to dispel the helper's negative mood state, and (b) increased helping among elated Ss is not an instrumental response to (maintain) the heightened effect but is a concomitant of elevated mood. A derivation from this hypothesis—that enhanced helping is a direct effect of induced sadness but a side effect of induced happiness—was tested in an experiment that placed 86 undergraduates in a happy, neutral, or sad mood. Through a placebo drug manipulation, half of the Ss in each group were led to believe that their induced moods were temporarily fixed, that is, temporarily resistant to change from normal events. The other Ss believed that their moods were labile and, therefore, manageable. As expected, saddened Ss showed enhanced helping only when they believed their moods to be changeable, whereas elated Ss showed comparable increases in helping whether they believed their moods to be labile or fixed. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo-controlled evaluation of Ritalin side effects

OBJECTIVE: To address the frequency of side effects of Ritalin therapy in children with attention deficit hyperactivity disorder (ADHD) using the Barkeley Side Effects Questionnaire (BSEQ) in a clinical setting. DESIGN: Randomized double-blind placebo-controlled cross-over trial. SETTING: A large rural tertiary care clinic. PATIENTS: 234 consecutive children aged 5 through 15 years who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for ADHD were enrolled. Of these children, 206 had sufficient side effects data for analysis. INTERVENTIONS: 0.3 mg/kg per dose and 0.5 mg/kg per dose Ritalin compared to placebo in separate 2-week trials. Each treatment was given three times a day for 7 consecutive days. MEASUREMENTS AND MAIN RESULTS: Parents, blinded to the treatment assignment, assessed side effects via the BSEQ at baseline and at the end of each of the 4 treatment weeks. Univariate odds ratios (OR) were used to describe the magnitude of differences in observed side effects between Ritalin and placebo weeks of the trial for each of the items on the BSEQ. The frequency of the following side effects significantly increased with Ritalin therapy: insomnia (OR = 3.13, 95% confidence interval [CI] = (1.80,5.42)), appetite disturbance (OR = 19.00, 95% CI = (9.18,39.31)), stomachache (OR = 7.00, 95% CI = (3.29, 14.89)), headache (OR = 5.29, 95% CI = (2.51,11.15)), and dizziness (OR = 7.50, 95% CI = (1.93,29.13)). The frequency of the following side effects significantly decreased with Ritalin therapy: staring and daydreaming (OR = 0.47, 95% CI = (0.27,0.84)), irritability (OR = 0.33, 95% CI = (0.18,0.61)), anxiety (OR = 0.42, 95% CI = (0.23,0.76)), and nailbiting (OR = 0.19, 95% CI = (0.07, 0.53)). The incidence rates of the remaining BSEQ items did not differ significantly between the Ritalin and placebo weeks of the trial. CONCLUSION: The BSEQ proved to be clinically effective in tracking Ritalin side effects and should be incorporated into the routine evaluation and monitoring of ADHD patients for whom stimulants are prescribed.     

Fringe benefits, side effects, and indifference: A reply to Feltz.

In a previous paper, I suggested that if an agent is a morally praiseworthy person and one of the consequences of the action she knowingly brings about is morally positive, then this consequence isn't really a side effect for the agent. Adam Feltz (see record 2008-01492-011) has recently developed a case that purportedly puts pressure on my account of side effects. In the present paper, I am going to argue that Feltz's purported counter-example fails to undermine my view even if it happens to shed new light on the difference between negative side effects and positive fringe benefits. After responding to Feltz's criticisms, I will conclude by presenting the results of a pilot study that provide prima facie support for my view. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burns in a suicide attempt related to psychiatric side effects of interferon

Tardive dystonia is one of the most serious adverse events of typical neuroleptic treatments. They differ from tardive dyskinesia by their clinical and evolutive features. The occurrence of tardive dystonia due to new antipsychotics remained unknown. For the first time in the literature, we report a case of typical tardive dystonia occurring in a young male schizophrenic patient treated for 8 months with risperidone. No remission was observed despite several therapeutics including botulinic toxin.