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Iatrogenic withdrawal

Alina Gavrila, Per-Olof Hasselgren, Allison Glasgow, Ashley N Doyle, Alice Lee, Peter Fox, Gautam Shiva, James V Hennessey, Gerald M Kolodny, Aaron M Cypess
BACKGROUND: In addition to its role in adaptive thermogenesis, brown adipose tissue (BAT) may protect from weight gain, insulin resistance/diabetes and metabolic syndrome. Prior studies have shown contradictory results regarding the influence of thyroid hormone (TH) levels on BAT volume and activity. The aim of this pilot study was to gain further insight regarding the effect of TH treatment on BAT function in adult humans by evaluating the BAT mass and activity prospectively in six patients, first in the hypothyroid and then in the thyrotoxic phase...
October 17, 2016: Thyroid: Official Journal of the American Thyroid Association
John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
Giovanni A Fava, Fiammetta Cosci, Emanuela Offidani, Jenny Guidi
In 1968, DiMascio and Shader provided a conceptual framework for behavioral toxicity of psychotropic drugs (ie, the pharmacological actions of a drug that, within the dose range in which it has been found to possess clinical utility, may produce alterations in mood, perceptual, cognitive, and psychomotor functions that limit the capacity of the individual or constitute a hazard to one's well-being). A drug effect such as sedation or motor stimulation may be considered adverse for one patient and yet therapeutic and desired for another patient; within the same patient, it may be of value at one stage of one's illness and adverse at a later stage...
September 14, 2016: Journal of Clinical Psychopharmacology
Nienke J Vet, Niina Kleiber, Erwin Ista, Matthijs de Hoog, Saskia N de Wildt
This article discusses the rationale of sedation in respiratory failure, sedation goals, how to assess the need for sedation as well as effectiveness of interventions in critically ill children, with validated observational sedation scales. The drugs and non-pharmacological approaches used for optimal sedation in ventilated children are reviewed, and specifically the rationale for drug selection, including short- and long-term efficacy and safety aspects of the selected drugs. The specific pharmacokinetic and pharmacodynamic aspects of sedative drugs in the critically ill child and consequences for dosing are presented...
2016: Frontiers in Pediatrics
Kaitlin M Best, David Wypij, Lisa A Asaro, Martha A Q Curley
OBJECTIVE: To generate a multidimensional predictive model of risk factors for iatrogenic withdrawal syndrome in critically ill children. DESIGN: Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. SETTING: PICU. PATIENTS: Children who received greater than or equal to 5 days of sedation during mechanical ventilation for acute respiratory failure...
August 4, 2016: Critical Care Medicine
L Vannucci, G Parenti, G Simontacchi, G Rastrelli, C Giuliani, A Ognibene, A Peri
PURPOSE: The aim of the present study was to evaluate the role of hypothyroidism as a cause of hyponatremia in a clinical model of iatrogenic acute hypothyroidism due to thyroid hormone withdrawal prior to ablative radioactive iodine (RAI) therapy after total thyroidectomy. METHODS: The study group consisted of 101 differentiated thyroid cancer (DTC) patients (77 women and 24 men). Plasma concentration of thyroid-stimulating hormone ([TSH]) and sodium ([Na(+)]) was evaluated before total thyroidectomy (pre[TSH] and pre[Na(+)]) and on the day of RAI therapy (post[TSH] and post[Na(+)])...
August 9, 2016: Journal of Endocrinological Investigation
Gina Riggi, Antonia Zapantis, Simon Leung
Prolonged use of sedative medications continues to be a concern for critical care practitioners, with potential adverse effects including tolerance and withdrawal. The amount of sedatives required in critically ill patients can be lessened and tolerance delayed with the use of pain and/or sedation scales to reach the desired effect. The current recommendation for prolonged sedation is to wean patients from the medications over several days to reduce the risk of drug withdrawal. It is important to identify patients at risk for iatrogenic withdrawal and create a treatment strategy...
June 2016: Critical Care Nursing Clinics of North America
Julia Harris, Anne-Sylvie Ramelet, Monique van Dijk, Pavla Pokorna, Joke Wielenga, Lyvonne Tume, Dick Tibboel, Erwin Ista
BACKGROUND: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient...
June 2016: Intensive Care Medicine
Birsen Sahıp, Mehmet Celık, Semra Ayturk, Ahmet Kucukarda, Onur Mert, Nejla Dıncer, Sıbel Guldıken, Armagan Tugrul
Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis...
January 2016: Indian Journal of Dermatology
Paulo Sérgio Lucas da Silva, Maria Eunice Reis, Thais Suelotto Machado Fonseca, Marcelo Cunio Machado Fonseca
BACKGROUND AND AIMS: Although iatrogenic withdrawal syndrome (IWS) has been recognized in patients exposed to opioids and benzodiazepines, very few studies have used a validated tool for diagnosis and assessment of IWS in critically ill children. We sought to determine IWS rate, risk factors, and outcomes of IWS patients. METHODS: Prospective observational study conducted in a pediatric intensive care unit. A total of 137 patients (31 with IWS and 106 with no IWS) received a continuous infusion of fentanyl and midazolam for 3 or more days...
March 2016: Journal of Addiction Medicine
Megan M Butler, Rachel M Ancona, Gillian A Beauchamp, Cyrus K Yamin, Erin L Winstanley, Kimberly W Hart, Andrew H Ruffner, Shawn W Ryan, Richard J Ryan, Christopher J Lindsell, Michael S Lyons
STUDY OBJECTIVE: Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses, as is typical of the emergency department (ED) setting. We preliminarily explore the possibility that initial exposure to opioids by EDs could be related to subsequent opioid misuse. METHODS: This cross-sectional study surveyed a convenience sample of patients reporting heroin or nonmedical opioid use at an urban, academic ED...
August 2016: Annals of Emergency Medicine
I M Skipskiy, N W Efimov, A S Remizov, B I Miroshnikov
We report a case of iatrogenic lesion of the lungs in a 61 year old patient following simultaneous subtotal resection and plastic surgery of esophagus using a gastric stem with the removed cardial portion along with subtotal mediastinal lympho-dissection for the treatment of 2 x 1 cm T2NoMO tumour in the middle third of esophagus. The patient's medical history contained no evidence of previous pulmonary pathology, preoperative chest X-ray study revealed neither focal nor infiltrative changes in the lungs. On day 5 after extensive surgical intervention with the use of a parenteral beta-lactam antibiotic, the patient developed acute respiratory distress the symptoms of which increased wavelike during the next 4...
2015: Klinicheskaia Meditsina
Kaitlin M Best, Lisa A Asaro, Linda S Franck, David Wypij, Martha A Q Curley
OBJECTIVE: To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness. DESIGN: A descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management. SETTING: Twenty-two PICUs across the United States. PATIENTS: The sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure...
January 2016: Pediatric Critical Care Medicine
Robert J Smith, Markus D Boos, Jon M Burnham, Eileen M McKay, Jason Kim, Melinda Jen
Blastomyces dermatitidis is a dimorphic fungus endemic to much of North America, particularly the soils of the midwestern and southeastern United States. Human infection typically occurs through inhalation of airborne conidia, which can be followed occasionally by dissemination to the skin, bone, genitourinary system, and central nervous system. A hallmark of the pathogen is that it can cause disease in both immunocompetent and immunosuppressed populations. Blastomycosis is rare in pediatric patients, with cutaneous manifestations occurring even less frequently...
November 2015: Pediatrics
Gregor E Berger, André Della Casa, Dagmar Pauli
Adolescence is associated with a dramatic surge in suicide rate. While worldwide age-adjusted suicides rate per 100’000 in under 14-year olds are relatively low around 0.6, a dramatic increase to 7.4 can be observed in 15 – 19 year olds with suicide being one of the three leading causes of mortality in most countries in this age group. From 2000 to 2013 the Swiss annual average of completed suicides in 15 – 19 year olds was 33.1 (minimum 24; maximum 47). This corresponds to an average age-specific death rate of 7...
October 2015: Therapeutische Umschau. Revue Thérapeutique
Tamorah Lewis, Betty Luan Erfe, Tarrah Ezell, Estelle Gauda
OBJECTIVE: Neonatal intensive care unit (ICU) care involves use of opiates to treat postoperative, ventilated, or chronically ill infants. Opiates provide necessary analgesia and sedation, but the morbidities include prolonged neonatal abstinence syndrome (NAS) and extended length of stay for dose tapering. Our objective was to quantify trends in opiate exposure in a tertiary care NICU. The authors hypothesize that medical opiate exposure and resultant ICU-acquired NAS would increase over time...
July 2015: Journal of Opioid Management
Anubhav Singhal, Sudeep Kumar, Aditya Kapoor
It is important to obtain a good withdrawal pressure tracing while performing cardiac catheterization in cases with right ventricular outflow tract (RVOT) obstruction to document the site and severity of obstruction. However efforts to manipulate the catheter in the RVOT (either to obtain the gradients or to position the catheter for an outflow angiogram) can sometimes precipitate severe dynamic RVOT obstruction with complete cessation of forward flow leading to life threatening hypotension. The following hemodynamic traces highlight this rare phenomenon which needs to be borne in mind at all times while performing cardiac catheterization in such patients...
July 2015: Indian Heart Journal
Abdullah Alobaid, Emina Torlakovic, Paul Kongkham
BACKGROUND: Immunosuppression and immunomodulatory therapy-induced lymphoproliferative disorders (ILPD) represent a heterogeneous group of lymphoid cell disorders that occur secondary to iatrogenic immune dysfunction, best described in the post-transplant setting. CASE DESCRIPTION: We describe a case of a primary central nervous system ILPD in a patient with ulcerative colitis treated chronically with the immunomodulatory agents infliximab and azathioprine. This 52-year-old woman presented with a 1-month history of left-side weakness and paresthesias...
December 2015: World Neurosurgery
Joanne Neale, John Strang
AIM: To analyse drug users' views and experiences of naloxone during emergency resuscitation after illicit opiate overdose to identify (i) any evidence of harm caused by excessive naloxone dosing ('over-antagonism'); and (ii) implications for the medical administration of naloxone within contemporary emergency settings. DESIGN: Re-analysis of a large qualitative data set comprising 70 face-to-face interviews conducted within a few hours of heroin/opioid overdose occurring, observations from hospital settings and a further 130 interviews with illicit opiate users...
October 2015: Addiction
Gabriela Casabona
BACKGROUND: Filler injection for cosmetic treatment of the aging face may be complicated by visual impairment, skin necrosis, or anaphylaxis because of accidental intravascular injection. Blood aspiration test (withdrawal of blood by the syringe plunger before injection) may decrease the risk of intravascular injection. OBJECTIVE: To evaluate the reliability of the aspiration test. METHODS AND MATERIALS: A red ink solution was withdrawn from a cup using a syringe containing 0...
July 2015: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
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