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Zitoun N, Campbell MK, Matsui D, Garcia-Bournissen F. Prospective evaluation of pregnancy outcomes after gestational exposure to prazosin. Br J Clin Pharmacol 2023; 89:3324-3329. [PMID: 37323115 DOI: 10.1111/bcp.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Prazosin is an antihypertensive medication which can be used to help with post-traumatic stress disorder (PTSD) symptoms. Little data is currently available on its safety in pregnancy. The aim of this study was to assess the fetal and pregnancy safety associated with prazosin exposures in early pregnancy. METHODS Subjects were 11 patients who took prazosin during pregnancy and were counselled at the FRAME clinic in London Health Sciences Centre (Ontario, Canada) between 1 January 2000 and 31 December 2021. Data on their other exposures and pregnancy outcomes were collected from medical records and through telephone questionnaires. RESULTS It was found that 6/11 (54.5%) subjects did not report any adverse outcomes and experienced uneventful pregnancies. There were two miscarriages. Birthweights were within the normal range for the remaining nine pregnancies. Adverse events reported were consistent with background population expectation, including: one postpartum haemorrhage, one case of preeclampsia, one preterm birth, two NICU admissions, and two caesarean sections. CONCLUSIONS For these 11 subjects, pregnancy outcomes after exposure to prazosin were consistent with typical outcomes from unexposed pregnancies. More data are needed to conclude that prazosin is safe for use in pregnant subjects. However, the lack of adverse effects above baseline is reassuring to future patients who may be unintentionally exposed to prazosin while pregnant. Therefore, this study contributes valuable data towards monitoring safety of prazosin in pregnancy.
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Affiliation(s)
- Natalie Zitoun
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - M Karen Campbell
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Obstetrics & Gynecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Doreen Matsui
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Facundo Garcia-Bournissen
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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2
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Barootes HC, Peebles ER, Matsui D, Rieder M, Abuzgaia A, Mohammed JA. Severe Generalized Bullous Fixed Drug Eruption Treated with Cyclosporine: A Case Report and Literature Review. Case Rep Dermatol 2021; 13:154-163. [PMID: 33790760 PMCID: PMC7989674 DOI: 10.1159/000513469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023] Open
Abstract
Generalized bullous fixed drug eruptions (GBFDEs) are rare in the paediatric population. We present the case of a 7-year-old girl with GBFDE believed to be secondary to oral ibuprofen, who experienced rapid resolution of lesions and cessation of blistering with a 3-week course of oral cyclosporine. To the best of our knowledge, this is the first report of a paediatric case of GBFDE treated with cyclosporine. In our report, we review published cases of GBFDE in children, and all adult cases managed with cyclosporine.
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Affiliation(s)
- Hailey C Barootes
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Erin R Peebles
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Doreen Matsui
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael Rieder
- Department of Paediatrics, Division of Paediatric Clinical Pharmacology, Children's Hospital, London Health Sciences Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Awatif Abuzgaia
- Department of Paediatrics, Division of Paediatric Clinical Pharmacology, Children's Hospital, London Health Sciences Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Javed A Mohammed
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
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3
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Azzola A, Eastabrook G, Matsui D, Berberich A, Tirona RG, Gray D, Gallego P, Van Uum S. Adrenal Cushing Syndrome Diagnosed During Pregnancy: Successful Medical Management With Metyrapone. J Endocr Soc 2020; 5:bvaa167. [PMID: 33305159 PMCID: PMC7712789 DOI: 10.1210/jendso/bvaa167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Adrenal Cushing syndrome during pregnancy is rare, and there is limited information on the effect and safety of metyrapone treatment both for mother and fetus. We present a 24-year-old woman diagnosed with adrenal Cushing syndrome at the end of the second trimester. We elected treatment with metyrapone titrated to 250 mg 3 times daily, resulting in good clinical response and maternal serum and saliva cortisol levels in the upper half of the normal pregnancy range. A healthy male infant was born at 35 weeks’ gestation, with no clinical signs of adrenal insufficiency, this despite a low cortisol of 5 nmol/L on the first day of life. We measured metyrapone in maternal and umbilical cord blood samples, demonstrating fetal venous metyrapone levels similar to maternal venous concentration, and a fetal arterial cord concentration at about 60% of the fetal venous cord concentration. This case demonstrates that salivary cortisol levels may be used to monitor the effect of metyrapone on adrenal Cushing syndrome during pregnancy. We show, for the first time in humans, that metyrapone does cross the placenta and may suppress fetal cortisol production without necessarily causing clinical signs of adrenal insufficiency.
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Affiliation(s)
- Alescia Azzola
- Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Genevieve Eastabrook
- Obstetrics and Gynaecology, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Doreen Matsui
- Paediatrics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Amanda Berberich
- Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Rommel G Tirona
- Physiology and Pharmacology, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Daryl Gray
- Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Patricia Gallego
- Paediatrics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Stan Van Uum
- Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada
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4
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Vasanthamohan L, Choo S, Marshall T, Symons YT, Matsui D, Eastabrook G, Solh Z. Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review. Transfusion 2020; 60:2448-2455. [PMID: 32851670 DOI: 10.1111/trf.16003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with hematologic complications including delayed hemolytic transfusion reactions (DHTRs) and pregnancy-related morbidity and mortality. Hyperhemolysis syndrome (HS) is the most severe form of DHTR in patients with SCD, in which both transfused and native red blood cells are destroyed. Further transfusions are avoided after a history of HS. Immunosuppressive agents can be used as prophylaxis against life-threatening hemolysis when transfusion is necessary. There is a paucity of evidence for the use of HS prophylaxis before transfusions, the continuation of hydroxyurea (HU) in lieu of chronic transfusion, and the use of erythropoiesis-stimulating agents (ESA) in pregnant SCD patients. CASE REPORT We present a case of a pregnant patient with SCD and a previous history of HS. HS prophylaxis was given before transfusion with corticosteroids, intravenous immunoglobulin, and rituximab. In addition, HU was continued during pregnancy to control SCD, along with the use of concomitant ESA to maintain adequate hemoglobin levels and avoid transfusion. We describe a multidisciplinary approach to pregnancy and delivery management including tailored anesthetic and obstetric planning. CONCLUSION This is the first published case of HS prophylaxis in a pregnant SCD patient, with good maternal and fetal outcomes after transfusion. HU and ESAs were able to control SCD and mitigate anemia in lieu of prophylactic transfusions during pregnancy. Further prospective studies are necessary to elucidate the ideal management of pregnant SCD patients with a history of HS or other contraindications to chronic transfusion.
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Affiliation(s)
- Lakshman Vasanthamohan
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
| | - Sheryl Choo
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Tonisha Marshall
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | | | - Doreen Matsui
- Department of Pediatrics, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Ziad Solh
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada.,Department of Pathology & Laboratory Medicine, Division of Transfusion Medicine, Western University, London, Ontario, Canada
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Abdulsatar F, Matsui D, Miller M, Taheri S. Teething necklaces and bracelets pose significant danger to infants and toddlers. Paediatr Child Health 2019; 24:132-133. [PMID: 30996608 DOI: 10.1093/pch/pxy155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/11/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Farah Abdulsatar
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Doreen Matsui
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
| | - Michael Miller
- Children's Health Research Institute, London, Ontario, Canada
| | - Sepideh Taheri
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
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6
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Shimanoe C, Hachiya T, Hara M, Nishida Y, Tanaka K, Sutoh Y, Shimizu A, Hishida A, Kawai S, Okada R, Tamura T, Matsuo K, Ito H, Ozaki E, Matsui D, Ibusuki R, Shimoshikiryo I, Takashima N, Kadota A, Arisawa K, Uemura H, Suzuki S, Watanabe M, Kuriki K, Endoh K, Mikami H, Nakamura Y, Momozawa Y, Kubo M, Nakatochi M, Naito M, Wakai K. A genome-wide association study of coping behaviors suggests FBXO45
is associated with emotional expression. Genes, Brain and Behavior 2018; 18:e12481. [DOI: 10.1111/gbb.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- C. Shimanoe
- Department of Preventive Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - T. Hachiya
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization; Disaster Reconstruction Center, Iwate Medical University; Iwate Japan
| | - M. Hara
- Department of Preventive Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - Y. Nishida
- Department of Preventive Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - K. Tanaka
- Department of Preventive Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - Y. Sutoh
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization; Disaster Reconstruction Center, Iwate Medical University; Iwate Japan
| | - A. Shimizu
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization; Disaster Reconstruction Center, Iwate Medical University; Iwate Japan
| | - A. Hishida
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - S. Kawai
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - R. Okada
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - T. Tamura
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - K. Matsuo
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
| | - H. Ito
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
| | - E. Ozaki
- Department of Epidemiology for Community Health and Medicine; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - D. Matsui
- Department of Epidemiology for Community Health and Medicine; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - R. Ibusuki
- Department of International Island and Community Medicine; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - I. Shimoshikiryo
- Department of International Island and Community Medicine; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - N. Takashima
- Department of Public Health; Shiga University of Medical Science; Otsu Japan
| | - A. Kadota
- Department of Public Health; Shiga University of Medical Science; Otsu Japan
- Center for Epidemiologic Research in Asia; Shiga University of Medical Science; Otsu Japan
| | - K. Arisawa
- Department of Preventive Medicine; Institute of Biomedical Sciences, Tokushima University Graduate School; Tokushima Japan
| | - H. Uemura
- Department of Preventive Medicine; Institute of Biomedical Sciences, Tokushima University Graduate School; Tokushima Japan
| | - S. Suzuki
- Department of Public Health; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - M. Watanabe
- Department of Public Health; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - K. Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences; University of Shizuoka; Shizuoka Japan
| | - K. Endoh
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences; University of Shizuoka; Shizuoka Japan
| | - H. Mikami
- Division of Cancer Prevention and Epidemiology; Chiba Cancer Center; Chiba Japan
| | - Y. Nakamura
- Division of Cancer Prevention and Epidemiology; Chiba Cancer Center; Chiba Japan
| | - Y. Momozawa
- Laboratory for Genotyping Development; RIKEN Center for Integrative Medical Sciences; Yokohama Japan
| | - M. Kubo
- RIKEN Center for Integrative Medical Sciences; Yokohama Japan
| | - M. Nakatochi
- Statistical Analysis Section; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; Nagoya Japan
| | - M. Naito
- Department of Maxillofacial Functional Development; Graduate School of Biomedical and Health Sciences, Hiroshima University; Hiroshima Japan
| | - K. Wakai
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
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7
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Cukiernik VA, Lim R, Warren D, Seabrook JA, Matsui D, Rieder MJ. Naproxen versus Acetaminophen for Therapy of Soft Tissue Injuries to the Ankle in Children. Ann Pharmacother 2016; 41:1368-74. [PMID: 17636113 DOI: 10.1345/aph.1h596] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Musculoskeletal (MSK) ankle injuries cause significant morbidity in ambulatory pediatric populations. No optimal pharmacotherapy is available. Objective: To conduct a randomized, double-blind trial to compare 2 drug therapies for soft tissue injury of the ankle. Methods: Patients (N = 77, aged 8–14 y, 61% male) with ankle injuries presenting to a regional pediatric emergency department were assigned to receive either acetaminophen (15 mg/kg 4 times a day) or naproxen (5 mg/kg 4 times a day) in a double-blind fashion on a routine basis for a 5 day period. On days 0 and 7, patients rated their degree of disability and pain on weight bearing using a 10 cm visual analog scale developed for this study. In addition, they were examined by a physician who rated pain, tenderness on palpation, and swelling using a 4 point scale. There were 3 follow-up telephone calls on days 3, 14, and 21. Adherence was evaluated by self-report and pill count. Results: Both the acetaminophen and naproxen groups had significant improvement in degree of disability and pain from day 0 to day 7. There was no statistically significant difference in outcome between the 2 groups by patient self-evaluation or physician assessment. There also was no significant difference in adverse event rates between the 2 groups, and the majority of patients in both groups felt that the medication was helpful. Conclusions: No significant difference in efficacy of pain control or improvement of disability between the naproxen and acetaminophen groups suggests no preferential advantage for naproxen over acetaminophen for MSK injuries when given on a regular basis, with concurrent supportive treatment. Possible differential benefit from intermittent therapy needs to be evaluated among children with ankle injury.
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Affiliation(s)
- Victoria A Cukiernik
- Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, Canada
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8
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Chitayat D, Matsui D, Amitai Y, Kennedy D, Vohra S, Rieder M, Koren G. Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. J Clin Pharmacol 2016; 56:170-5. [PMID: 26272218 PMCID: PMC4738404 DOI: 10.1002/jcph.616] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
Abstract
During the last decade critical new information has been published pertaining to folic acid supplementation in the prevention of neural tube defects (NTDs) and other folic acid-sensitive congenital malformations. These new data have important implications for women, their families, and health care professionals. We performed a review looking for the optimal dosage of folic acid that should be given to women of reproductive age who are planning or not avoiding conception to propose updated guidelines and thus help health care providers and patients. In addition to fortification of dietary staples with folic acid, women of reproductive age should supplement before conception with 0.4-1.0 mg of folic acid daily as part of their multivitamins. In the United States all enriched rice is also fortified with folic acid at 0.7 mg per pound of raw rice. However, this is not the case in many countries, and it has been estimated that only 1% of industrially milled rice is fortified with folic acid. In countries where rice is the main staple (eg, China), this does not allow effective folate fortification. Whereas the incidence of NTDs is around 1/1000 in the United States, it is 3- to 5-fold higher in Northern China and 3-fold higher in India. A recent population-based US study estimated that the reduction in NTD rates by folic acid is more modest than previously predicted. The potential of NTD prevention by folic acid is underutilized due to low adherence with folic acid supplementation, and calls for revising the policy of supplementation have been raised. We identified groups of women of reproductive age who may benefit from higher daily doses of folic acid, and this should be considered in current practice. These include women who have had previous pregnancies with NTDs, those who did not plan their pregnancy and hence did not supplement, and women with low intake or impaired adherence to daily folic acid supplementation. In addition, women with known genetic variations in the folate metabolic cycle, those exposed to medications with antifolate effects, smokers, diabetics, and the obese may benefit from higher doses of folic acid daily during the first trimester.
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Affiliation(s)
- David Chitayat
- The Prenatal Diagnosis and Medical Genetics ProgramDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, University of TorontoTorontoOntarioCanada
- Division of Clinical and Metabolic GeneticsThe Hospital for Sick Children, University of TorontoTorontoOntarioCanada
| | - Doreen Matsui
- Department of PediatricsWestern UniversityOntarioCanada
| | | | | | - Sunita Vohra
- Department of PaediatricsUniversity of AlbertaEdmontonCanada
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9
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Poonai N, Li J, Langford C, Lepore N, Taddio A, Gerges S, Stitt L, Teefy J, Manji K, Castelo M, Rieder M, Qui T, Matsui D, Ali S. Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial. Pediatrics 2015; 136:e879-86. [PMID: 26416942 DOI: 10.1542/peds.2015-1852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether lidocaine is superior to nonanesthetic lubricant (NAL) for relieving pain in children undergoing urethral catheterization (UC). METHODS Children 0 to 24 months requiring UC were randomized to NAL or topical and intraurethral 2% lidocaine gel. Primary outcome was facial grimacing in the pre to during drug administration and catheterization phases. Secondary outcome was caregiver satisfaction by using a Visual Analog Scale. RESULTS There were 133 participants (n = 68 lidocaine, n = 65 NAL). There were no significant differences in mean (SD) scores during UC between lidocaine and NAL (86.4% [121.5%] vs 85.2% [126.6%]), respectively (Δ [confidence interval (CI)] = -1.2 [-21.0 to 49.0], P = .4). There was a significantly greater difference in mean (SD) scores during instillation of lidocaine versus NAL (61.8% [105.6%] vs 3.2% [84.9%]), respectively (Δ [CI] -58.6 [-95.0 to -32.0], P < .001). There were no significant differences in mean (SD) parental satisfaction scores between lidocaine and NAL (4.8 [3.2] vs 5.9 [2.9]), respectively (CI-0.1 to 2.2; P = .06). In the subgroup analysis, age, gender, and positive urine culture did not significantly influence between-group differences in facial grimacing. CONCLUSIONS Compared with NAL, topical and intraurethral lidocaine is not associated with significant pain reduction during UC, but significantly greater pain during instillation. Therefore, clinicians may consider using noninvasive pain-reducing strategies for young children who require UC.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Children's Health Research Institute, and
| | - Jennifer Li
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cindy Langford
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Natasha Lepore
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Gerges
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Larry Stitt
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - John Teefy
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karim Manji
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matt Castelo
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Rieder
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Tingting Qui
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Doreen Matsui
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; and Women and Children's Health Research Institute, Edmonton, Alberta, Canada
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10
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Kuriyama N, Watanabe I, Miyatani F, Matsui D, Ozaki E, Nomura R, Nakano K, Watanabe Y. The Correlation between Microbleeds and Cnm-positive Streptococcus Mutans: A Pilot Survey Study Based on Magnetic Resonance Imaging. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Kakei Y, Akashi M, Shigeta T, Takahashi Y, Matsui D, Sakakibara A, Hasegawa T, Minamikawa T, Hashikawa K, Komori T. Venous thromboembolism after oral oncologic surgery with simultaneous reconstruction. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Miyatani F, Kuriyama N, Watanabe I, Nomura R, Nakano K, Matsui D, Ozaki E, Koyama T, Nishigaki M, Yamamoto T, Mizuno T, Tamura A, Akazawa K, Takada A, Takeda K, Yamada K, Nakagawa M, Ihara M, Kanamura N, Friedland RP, Watanabe Y. Relationship between Cnm-positive Streptococcus mutans and cerebral microbleeds in humans. Oral Dis 2015. [PMID: 26205098 DOI: 10.1111/odi.12360] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cerebral hemorrhage has been shown to occur in animals experimentally infected with Streptococcus mutans carrying the collagen-binding Cnm gene. However, the relationship between cerebral microbleeds and oral hygiene, with a focus on Cnm gene-positive S. mutans infection, remains unclear. MATERIAL AND METHODS One hundred and thirty-nine subjects participated. The presence or absence of Cnm-positive S. mutans and its collagen-binding activity were investigated using saliva samples, and relationship with cerebral microbleeds detected on MRI investigated, including clinical information and oral parameters. RESULTS Fifty-one subjects were identified as Cnm-positive S. mutans carriers (36.7%), with cerebral microbleeds being detected in 43 (30.9%). A significantly larger number of subjects carried Cnm-positive S. mutans in the cerebral microbleeds (+) group. S. mutans with Cnm collagen-binding ability was detected in 39 (28.1%) of all subjects, and the adjusted odds ratio for cerebral microbleeds in the Cnm-positive group was 14.4. Regarding the presence of cerebral microbleeds, no significant differences were noted in the number of remaining teeth, dental caries, or in classic arteriosclerosis risk factors. CONCLUSIONS The occurrence of cerebral microbleeds was higher in subjects carrying Cnm-positive S. mutans, indicating that the presence of Cnm-positive S. mutans increases cerebral microbleeds, and is an independent risk for the development of cerebrovascular disorders.
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Affiliation(s)
- F Miyatani
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Kuriyama
- Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - I Watanabe
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - R Nomura
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - K Nakano
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - D Matsui
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - E Ozaki
- Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Koyama
- Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - M Nishigaki
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Yamamoto
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - A Tamura
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Akazawa
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - A Takada
- Kyoto Industrial Health Association, Kyoto, Japan
| | - K Takeda
- Kyoto Industrial Health Association, Kyoto, Japan
| | - K Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - M Nakagawa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - M Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - N Kanamura
- Departments of Dental Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - R P Friedland
- Department of Neurology, University of Louisville, KY, USA
| | - Y Watanabe
- Department of Epidemiology for Community health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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13
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Abstract
Clinical research in the pediatric emergency department (ED) has been rapidly growing in the past decade, and has resulted in some of the most important milestone studies in the pediatric medical literature. However, it presents a unique ethical goal and requires that additional challenges, such as the acute medical condition, fear and anxiety, unfamiliar physician(s), fatigue, and lack of time be addressed in addition to the standard ethical requirements. These may impair several fundamental elements of research, including the patient enrollment process, informed consent/assent, randomization, and others. Every possible attempt must be made to reduce or minimize the risks to which the children are exposed, and one must be cognizant of the special needs of children and their families in the ED. Nevertheless, we are also obliged to find ethical ways to include them in appropriate research endeavors that aim to improve treatments for conditions unique to the ED. This paper explores and overviews the most recent literature in order to characterize the nature of ethical challenges complicating clinical research in pediatric emergency medicine, and then suggests some ethically sound solutions such as deferred/waived consent, designated research staff, and alternative study designs. Finally, a few examples of prospective, blinded randomized trials involving drugs in pediatric emergency medicine are provided, with special emphasis on how the investigators are overcoming the obvious ethical challenges.
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Affiliation(s)
- Gal Neuman
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G1X8, Canada,
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14
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Bock D, Roach-Fox E, Seabrook J, Matsui D, Rieder M. Physician Prescribing Habits of Sleep-Promoting Medications for Children and Adolescents in Southwestern Ontario, Canada. Chest 2014. [DOI: 10.1378/chest.1994656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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Thomson B, Joseph G, Clark WF, Hladunewich M, Patel A, Blake P, Eastabrook G, Matsui D, Sharma A, House A. Maternal, pregnancy and fetal outcomes in de novo anti-glomerular basement membrane antibody disease in pregnancy: a systematic review. Clin Kidney J 2014; 7:450-6. [PMID: 25878776 PMCID: PMC4379344 DOI: 10.1093/ckj/sfu086] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background Outside of pregnancy, anti-glomerular basement membrane (GBM) antibody disease is associated with significant morbidity and mortality. However, there is limited knowledge regarding de novo anti-GBM disease in pregnancy. Methods A systematic review was performed to identify maternal, pregnancy and fetal outcomes in de novo anti-GBM disease in pregnancy. Studies were selected from PubMed, EMBASE, Cochrane Library databases and conference proceedings, without language restriction. Results Data from eight patients were derived from seven case reports and one unpublished case. Most (6/8) patients presented after the first trimester. During pregnancy, acute kidney injury (5/8), anemia (5/8), hematuria (8/8) and proteinuria (8/8) were common. When hemodialysis was required antepartum (5/8), renal function recovery to independence of renal replacement was unlikely (2/5). While pulmonary involvement was common (5/8), no permanent damage was reported (0/8). The majority of cases ended in live births (6/8) although prematurity (6/6), intrauterine growth restriction (2/6), small for gestational age (4/6) and complications of prematurity (1/6) were common. When anti-GBM levels were tested in the living newborn, they were detectable (2/5), but no newborn renal or lung disease was reported (0/6). Complications in pregnancy included gestational diabetes (3/8), hyperemesis gravidarum (2/8) and preeclampsia (2/8). Conclusions Live births can be achieved in de novo anti-GBM disease in pregnancy, but are commonly associated with adverse maternal, pregnancy and fetal outcomes. Only with awareness of common presentations, and management strategies can outcomes be optimized.
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Affiliation(s)
- Benjamin Thomson
- Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada
| | - Geena Joseph
- Division of Nephrology, Department of Medicine , McMaster University , Hamilton, ON , Canada
| | - William F Clark
- Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada ; Kidney Clinical Research Unit , Schulich School of Medicine and Dentistry, Western University , London, ON , Canada
| | - Michelle Hladunewich
- Division of Nephrology, Department of Medicine , University of Toronto , Toronto, ON , Canada
| | - Amit Patel
- Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada
| | - Peter Blake
- Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynaecoology , London Health Sciences Centre and Western University , London, ON , Canada
| | - Doreen Matsui
- Department of Paediatrics , Western University , London, ON , Canada
| | - Ajay Sharma
- Department of Paediatrics , Western University , London, ON , Canada
| | - Andrew House
- Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada
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16
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Fujii H, Goel A, Bernard N, Pistelli A, Yates LM, Stephens S, Han JY, Matsui D, Etwell F, Einarson TR, Koren G, Einarson A. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology 2013; 80:1565-70. [PMID: 23553472 DOI: 10.1212/wnl.0b013e31828f18c1] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Our objectives were to 1) determine whether first-trimester use of gabapentin is associated with an increased risk for major malformations; 2) examine rates of spontaneous abortions, therapeutic abortions, stillbirths, mean birth weight and gestational age at delivery; and 3) examine rates of poor neonatal adaptation syndrome following late pregnancy exposure. METHODS The study design was prospective. Women were included who initially contacted the services between 5 and 8 weeks with a comparison group of women exposed to nonteratogens, collected in a similar manner. RESULTS We have data on 223 pregnancy outcomes exposed to gabapentin and 223 unexposed pregnancies. The rates of major malformations were similar in both groups (p = 0.845). There was a higher rate of preterm births (p = 0.019) and low birth weight <2,500 g (p = 0.033) in the gabapentin group. Among infants who were exposed to gabapentin up until delivery, 23 of 61 (38%) were admitted to either the neonatal intensive care unit or special care nursery for observation and/or treatment, vs 6 of 201 (2.9%) live births in the comparison group (p < 0.001). There were 2 cases of possible poor neonatal adaptation syndrome in neonates exposed to gabapentin close to delivery, compared with none in the comparison group, although it must be noted that these infants were concomitantly exposed to other psychotropic drugs. Among the women who took gabapentin, the major indications were pain (n = 90; 43%) and epilepsy (n = 71; 34%); the remainder were for other indications, mostly psychiatric. CONCLUSION Our results suggest that although this sample size is not large enough to make any definitive conclusions, and there was no comparator group treated with other antiepileptic drugs, gabapentin use in pregnancy does not appear to increase the risk for major malformations. This finding and the increased risk for low birth weight and preterm birth require further investigation.
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Affiliation(s)
- Hisaki Fujii
- Motherisk Program, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Canada
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18
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Abstract
Translational research is expanding and has become a focus of National Research funding agencies, touted as the primary avenue to improve health care practice. The use of human tissues for research on disease etiology is a pillar of translational research, particularly with innovations in research technologies to investigate the building blocks of disease. In pediatrics, translational research using human tissues has been hindered by the many practical and ethical considerations associated with tissue procurement from children and also by a limited population base for study, by the increasing complexities in conducting clinical research, and by a lack of dedicated child-health research funding. Given these obstacles, pediatric translational research can be enhanced by developing strategic and efficient biobanks that will provide scientists with quality tissue specimens to render accurate and reproducible research results. Indeed, tissue sampling and biobanking within pediatric academic settings has potential to impact child health by promoting bidirectional interaction between clinicians and scientists, helping to maximize research productivity, and providing a competitive edge for attracting and maintaining high-quality personnel. The authors of this review outline key issues and practical solutions to optimize pediatric tissue sampling and biobanking for translational research, activities that will ultimately reduce the burden of childhood disease.
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19
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Cormier A, Rieder MJ, Matsui D. What is the risk of using a cephalosporin in a patient with a penicillin allergy? Paediatr Child Health 2011; 12:387-8. [PMID: 19030395 DOI: 10.1093/pch/12.5.387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2007] [Indexed: 11/12/2022] Open
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20
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Kuriyama N, Ozaki E, Yoshikawa A, Shigeta M, Matsui D, Watanabe I, Inoue K, Watanabe Y. SP1-21 Correlation of mild bone fragility and related indicators of biological markers or ultrasonic bone densitometry in a normal Japanese population. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976m.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Shigeta M, Ozaki E, Kuriyama N, Matsui D, Watanabe I, Inoue K, Nakazawa A, Ozasa K, Watanabe Y. P2-276 Influence of smoking and smoking cessation on pulmonary function in Japanese healthy people. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976k.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Warkentin J, Chan M, Igric A, Seabrook JA, Matsui D, Lim R, Joubert G. A needs assessment for obesity-related anticipatory guidance in the paediatric emergency department. Paediatr Child Health 2011; 13:769-71. [PMID: 19436537 DOI: 10.1093/pch/13.9.769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2008] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of Canadian childhood obesity has been increasing, resulting in a call for improved prevention efforts and anticipatory guidance. OBJECTIVE To evaluate interest in obesity-related anticipatory guidance in a paediatric emergency department. METHODS Between September 2005 and September 2006, parents or patients older than 14 years of age were approached at the emergency department of the Children's Hospital (London, Ontario) to complete a survey. The survey compiled demographic data and asked questions regarding self-perceived weight status, use of dieting and/or exercise for weight loss, desire for nutrition and/or exercise information, and interest in receiving anticipatory guidance related to obesity. RESULTS Two hundred people completed the survey; the vast majority (92%) of respondents were parents. The mean (+/- SD) age of the children was 12.6+/-3.9 years. Forty-one per cent of the respondents indicated an interest in further information on obesity (95% CI 34% to 48%). Fifty-two per cent of respondents considered themselves overweight or obese (95% CI 45% to 59%), and 52% reported someone in their family who was dieting, exercising or both to lose weight. Parents who stated that their children considered themselves to be overweight or obese were significantly less interested in anticipatory guidance than parents who did not believe that their children considered themselves to be overweight or obese (67% versus 90%, respectively; P=0.009). DISCUSSION Many patients in the paediatric emergency department desire information on nutrition and exercise. Further research into risk-stratified targeting of patients and parents are needed to help identify good candidates for anticipatory guidance.
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Affiliation(s)
- Joel Warkentin
- Department of Paediatrics, University of Western Ontario, Children's Hospital, London Health Sciences Centre, London, Ontario
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23
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Oki K, Washio K, Matsui D, Hirata Y, Morikawa M. The role of urease activity on biofilm and urolith formation by Staphylococcus sp. T-02 that was isolated from a toilet bowl. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Bentur Y, Matsui D, Koren G. Safety of 14C-UBT for diagnosis of Helicobacter pylori infection in pregnancy. Can Fam Physician 2009; 55:479-480. [PMID: 19439698 PMCID: PMC2682300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
QUESTION A 29-year-old woman had a carbon 14 urea breath test for diagnosis of Helicobacter pylori infection. At time of consultation, it had been 6 weeks since her last menstrual period. Four weeks after her last menstrual period, the results of a urine pregnancy test were negative. On that day, she received an ionizing radiation dose of 74 KBq (2 microCi) carbon 14 urea, followed by the breath test 30 minutes thereafter. Four days later, when the urine pregnancy test results turned positive, she was concerned about the possible effect of her exposure to ionizing radiation on the developing fetus. ANSWER The amount of radiation used in these tests is extremely low-much lower than the amount a pregnant woman is absorbing through natural sources.
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Affiliation(s)
- Yedidia Bentur
- Israel Poison Information Center at the Rambam Health Care Campus, Haifa, Israel
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25
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Koren G, Finkelstein Y, Matsui D, Berkovich M. Diagnosis and Management of Poor Neonatal Adaptation Syndrome in Newborns Exposed In Utero to Selective Seretonin/Norepinephrine Reuptake Inhibitors. Journal of Obstetrics and Gynaecology Canada 2009; 31:348-350. [DOI: 10.1016/s1701-2163(16)34157-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Levy S, Fayez I, Taguchi N, Han JY, Aiello J, Matsui D, Moretti M, Koren G, Ito S. Pregnancy outcome following in utero exposure to bisphosphonates. Bone 2009; 44:428-30. [PMID: 19059370 DOI: 10.1016/j.bone.2008.11.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 10/01/2008] [Accepted: 11/06/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM The safety of bisphosphonates in human pregnancy has not been well established. To characterize pregnancy outcome in women receiving bisphosphonates, we conducted a multi-centre, prospective cohort study with a comparison group. METHODS Patients were recruited through 3 teratogen information centres in Canada and South Korea. We followed 21 women exposed to bisphosphonates during or <3 months before pregnancy, and 21 matched-comparison group women without exposure to known teratogens. Pregnancy/neonatal outcome data were collected by interview. The primary endpoint was neonatal outcome including major birth defects. The secondary endpoints included other pregnancy outcomes such as spontaneous abortions. RESULTS Indication of the therapy was osteoporosis in all patients. There was no difference in the maternal demographics between the 2 groups. In the bisphosphonate group, there were 18 live births, 2 spontaneous abortions and 1 therapeutic abortion, which were not significantly different from the comparison group. The mean gestational age (mean+/-SD) of the bisphosphonate group was 38.7+/-1.9 weeks (comparison group: 39.3+/-1.9 weeks; P=0.42), and the mean birth weight was 3.1+/-0.3 kg (comparison group: 3.3+/-0.5 kg; P=0.11). In the bisphosphonate group, there was a child diagnosed with Apert syndrome, an autosomal dominant acrocephalosyndactyly, with a fibroblast growth factor 2 mutation. CONCLUSION Coupled with existing data in the literature, our findings suggest that preconceptional and first-trimester use of bisphosphonates may not pose substantial fetal risks.
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Affiliation(s)
- Shirley Levy
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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27
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Koren G, Dugoua JJ, Magee L, Vohra S, Matsui D, Bérard A, Johnson B, Moretti M, Einarson A. MotherNature: Establishing a Canadian Research Network for Natural Health Products (NHPs) During Pregnancy and Lactation. J Altern Complement Med 2008; 14:369-72. [DOI: 10.1089/acm.2007.0696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gideon Koren
- Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Jean-Jacques Dugoua
- Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | - Laura Magee
- Obstetric Medicine, BC Women's Hospital, Vancouver, British Columbia, Canada
| | | | - Doreen Matsui
- Department of Pediatrics, University of Western Ontario
| | - Anick Bérard
- Department of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | | | - Myla Moretti
- Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrienne Einarson
- Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada
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28
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Hames H, Seabrook JA, Matsui D, Rieder MJ, Joubert GI. A palatability study of a flavored dexamethasone preparation versus prednisolone liquid in children. Can J Clin Pharmacol 2008; 15:e95-e98. [PMID: 18245869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Palatability is an important factor in medication compliance for children where the acceptability of a liquid medication and its ease of administration will be greatly affected by its taste. OBJECTIVES The objective of this study was to determine which, if any of two steroid preparations, oral dexamethasone or oral prednisolone, was more palatable to children requiring steroid treatment for asthma. METHODS A single-blind taste test of 2 different steroid suspensions, liquid prednisolone (1mg/ml) versus liquid dexamethasone (1mg/ml), was conducted in children aged 5-12 years, presenting to the pediatric emergency department with an exacerbation of asthma requiring steroid treatment. Children received 2.5mls of either prednisolone or dexamethasone and were asked to score their impression of taste on a 10 cm visual analog scale. After cleansing of the palate they were given the other steroid and scored its taste. RESULTS Thirty-nine children (54% male) were enrolled in the study. The mean age was 7.1 years (SD=2.0). The median visual analog scale measurement for dexamethasone was 8.2 cm (IQR= 5.2) whilst the median measurement for prednisolone was 5.0 cm (IQR= 7.3), p=0.03. Male children were more likely to prefer dexamethasone than females with a median score of 9.9 cm (IQR=3.8) for males vs. 5.9 cm (IQR=9.3) for females, p=0.005. There was no gender preference for prednisolone. CONCLUSIONS There was a statistically significant difference between the taste of dexamethasone and prednisolone, with dexamethasone being the preferred steroid among pediatric patients with asthma. Males were much more likely to prefer dexamethasone than females.
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Affiliation(s)
- Heather Hames
- Department of Medicine, University of Western Ontario, London, Canada.
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29
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Abstract
With the recent emphasis on investigating the efficacy of medication in children, it is also important to assess what determines whether pediatric patients do or do not take their medication. In general, children are no better at adhering to drug therapy than older individuals. Dealing with medication nonadherence is essential given its association with a failure to achieve the desired treatment goal. In addition to the many factors that influence adherence in adults, there are some unique challenges faced in the pediatric age group including the role of family (and its dysfunction), the changes of adolescence, and the lack of appropriate drug formulations. Intervention strategies to improve adherence include behavioral and educational strategies. Although there is no consensus as to what is the best approach to promote adherence with therapy, attention should be given to determining what barriers exist and trying to overcome them by involving children and their parents in the treatment planning process. If possible, the medication regimen, taking into account the frequency and timing of administration, should be tailored to the child and family's lifestyle and daily routine. Consideration should be given to the palatability and formulations of medications prescribed for young children. The use of simplified regimens of better tasting medications and age-appropriate delivery mechanisms may enhance the ability of pediatric patients to adhere to their drug therapy.
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Affiliation(s)
- Doreen Matsui
- Department of Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada
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30
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Leipert BD, Matsui D, Wagner J, Rieder MJ. Rural women and pharmacologic therapy: needs and issues in rural Canada. Can J Rural Med 2008; 13:171-179. [PMID: 18845069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The needs and issues of rural women regarding pharmacologic information and therapy are rarely explored. We sought to explore the needs and issues of rural women in Canada regarding drug-related information and prescription and nonprescription pharmaceuticals. METHODS We used the qualitative methodology of interpretive description. In-depth semistructured face-to-face interviews were conducted with 20 women aged 17-88 years who lived in rural southwestern Ontario. RESULTS Although rural women accessed prescription medications, complementary and alternative medicine (CAM) was highly favoured, and alcohol and illicit drugs such as marijuana, crystal meth and cocaine were prevalent in rural communities. Factors that affected rural women's decisions about which medications to use included access to health care practitioners, costs of medications, experiences of family members and friends with prescribed and alternative medications, attitudes and approaches of health care providers and health store employees, and the women's own expectations and desires. Factors that affected the use of illicit drugs included availability, boredom, peer pressure and cultural norms. Rural factors that influenced access to drug information and use included presence or lack of confidential care, distance to resources, and presence, accessibility and acceptability of rural resources. CONCLUSION Rural women use a variety of drug therapies and sources of information, and experience unique socioeconomic and environmental issues that affect access to appropriate drug-related information and therapies. Further research is needed to clarify and articulate pharmacologic needs, issues and solutions for women in diverse rural settings.
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Affiliation(s)
- Beverly D Leipert
- Rural Women's Health Research, Faculty of Health Sciences and Faculty of Medicine and Dentistry, University of Western Ontario, London, Ont.
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31
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32
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Berard R, Matsui D, Lynch T. Screening for iron deficiency anemia in at risk children in the pediatric emergency department: a survey of Canadian pediatric emergency department physicians. Pediatr Emerg Care 2007; 23:281-4. [PMID: 17505267 DOI: 10.1097/01.pec.0000270169.08734.be] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the attitudes and reported practices of physicians regarding screening for iron deficiency anemia in at-risk children in pediatric emergency departments (PEDs) across Canada. METHODS A standardized survey was mailed to 183 PED physicians at 10 tertiary care PED across Canada. The practices and attitudes regarding screening for iron deficiency anemia were collected via a questionnaire consisting of single select closed-ended items and items which required ranking in order of importance. RESULTS Sixty-one percent (111/183) of physicians responded to the survey. Ninety-six percent of respondents do not routinely screen for iron deficiency anemia. One third of respondents believed that screening for iron deficiency anemia in the PED is possible. The remaining stated lack of time, difficulty with follow-up, it not being an emergent issue and cost as prohibitive factors. One third of participants stated that 21% to 40% of the pediatric patients seen in their PED did not have a primary care physician. The main considerations in deciding on whom to perform venipuncture were based on dietary history and physical examination with a history of consumption of milk greater than 24 ounces per day (94%) and conjunctival or skin pallor (97%, 94%, respectively) selected as the most important items. CONCLUSION The results of this study indicate that Canadian PED physicians are not routinely screening for iron deficiency anemia, although they demonstrate knowledge of the risk factors for iron deficiency anemia and recognize the importance of diagnosis and treatment to prevent long-term morbidity.
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MESH Headings
- Anemia, Iron-Deficiency/diagnosis
- Anemia, Iron-Deficiency/epidemiology
- Anemia, Iron-Deficiency/ethnology
- Animals
- Attitude of Health Personnel
- Breast Feeding/statistics & numerical data
- Canada
- Cattle
- Child, Preschool
- Cross-Sectional Studies
- Data Collection
- Educational Status
- Emergency Service, Hospital/organization & administration
- Emergency Service, Hospital/statistics & numerical data
- Health Services Accessibility/statistics & numerical data
- Humans
- Indians, North American/statistics & numerical data
- Infant
- Infant Food/adverse effects
- Infant, Newborn
- Infections
- Inuit/statistics & numerical data
- Iron, Dietary
- Mass Screening/economics
- Mass Screening/organization & administration
- Mass Screening/psychology
- Milk/adverse effects
- Milk, Human
- Parents/psychology
- Pediatrics/organization & administration
- Pediatrics/statistics & numerical data
- Physicians/psychology
- Practice Patterns, Physicians'/statistics & numerical data
- Primary Health Care/statistics & numerical data
- Referral and Consultation/statistics & numerical data
- Risk
- Risk Factors
- Socioeconomic Factors
- Surveys and Questionnaires
- Unnecessary Procedures
- White People/statistics & numerical data
- Workforce
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Affiliation(s)
- Roberta Berard
- Department of Pediatrics, University of Western Ontario, Children's Hospital of Western Ontario, London, Ontario, Canada.
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Sammons HM, Malhotra J, Choonara I, Sitar DS, Matsui D, Rieder MJ. British and Canadian views on the ethics of paediatric clinical trials. Eur J Clin Pharmacol 2007; 63:431-6. [PMID: 17364191 DOI: 10.1007/s00228-007-0281-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ethical problems are quoted as a reason not to perform clinical trials in children. Little is known about the views of researchers regarding ethics. OBJECTIVES A pilot study was conducted to assess the applicability of a questionnaire design containing trial scenarios to examine views regarding the use of children in drug trials and to elicit possible international differences. SETTING Paediatricians and researchers in the United Kingdom and Canada. METHODS Responders were presented with a questionnaire containing direct questions and six trial scenarios, each containing an ethical dilemma. Responders were asked regarding their own approval and their perceived opinion of whether an ethical review board (ERB) would approve. RESULTS One hundred questionnaires (50 each country) were received. Few responders had research ethics training (14% United Kingdom and 8% Canada). Most (80 and 88%) felt children could be harmed by participation in trials and half (47 and 59%) felt children should only participate if they receive direct benefit. Many (58 and 61%) disagreed with payments beyond travel expenses. In the trial scenarios, 34% of responders were willing to enter healthy children in a pharmacokinetics study of an antibiotic for cystic fibrosis and 22% considered their ERBs would approve. Only a third (33%) would enter children in an analgesia trial that was placebo-controlled. CONCLUSION Using healthy children and placebos in trials caused concern. Similar views were found between the two countries. The majority had no training in research ethics. The study highlights the usefulness of a questionnaire with clinical trial scenarios to try to elicit views on the ethics of conducting research in children.
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Affiliation(s)
- H M Sammons
- Academic Division of Child Health, University of Nottingham, Medical School, Derbyshire Children's Hospital, Uttoxeter Road, Derby, DE22 3DT, UK.
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Goodwin J, Rieder S, Rieder MJ, Matsui D. Counseling regarding pregnancy--related drug exposures by family physicians in Ontario. Can J Clin Pharmacol 2007; 14:e58-69. [PMID: 17314415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Family physicians may play a significant role in providing information to their patients on the effects of medication exposure during pregnancy. Women must receive accurate information, as unrealistic perception of teratogenic risk may lead to inadequate treatment of maternal disease or termination of otherwise wanted pregnancies. OBJECTIVES To collect data on the current practices of family physicians in providing information regarding pregnancy-related drug exposures, in particular, their confidence in providing counseling and their sources of information. METHODS A mailed survey was sent to a random sample of family physicians in Ontario. Outcome measures included the proportion of family physicians that feel confident in providing counseling regarding drugs in pregnancy, most common resources, barriers to counseling and preferences for future educational programs. RESULTS Of the 756 surveys, 400 (53%) were returned, 265 (66%) by practicing physicians caring for women of childbearing age. Most (80.3%) felt confident in providing counseling, though a majority (56%) stated that available sources of information are not adequate. The most commonly consulted source was the Motherisk Program (62%). Lack of evidence-based information was cited as the major barrier. CONCLUSIONS Although family physicians were confident in providing counseling to pregnant patients with regards to drug use, more than one-half thought that the available sources of information are not adequate. The dissemination of more evidence-based information in this field is needed.
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Affiliation(s)
- Jodi Goodwin
- Department of Paediatrics, Children's Hospital of Western Ontario, Children's Health Research Institute, University of Western Ontario, London, Canada
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Abstract
OBJECTIVE The aim of the study was to determine if young children have a preference regarding whether physicians wear standard precautions attire. METHODS One hundred ninety-seven children, aged 4 to 8 years, and their parents were recruited from the pediatric emergency department of a tertiary care center. Two sets of 4 photographs-the same man in formal attire, a white coat, greens, and severe acute respiratory syndrome (SARS) standard precautions attire, and the same woman in formal attire, a white coat, greens, and SARS standard precautions attire-were shown to the children and their caregiver. Both were asked which physician's attire he or she liked the most and which he or she liked the least. Parents filled out a questionnaire regarding their experiences in the pediatric emergency department during the SARS epidemic. RESULTS The children selected the physician in SARS standard precautions attire as most liked 17.5% of the time and least liked 53.3% of the time. The parents selected the physician in SARS standard precautions attire as most liked 0% of the time and least liked 94.8% of the time. CONCLUSIONS Physicians wearing standard precautions attire while working in the pediatric emergency department need to be aware that this attire may negatively impact their relationship with pediatric patients 4 to 8 years of age.
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Affiliation(s)
- Jennifer Truong
- Child Health Research Institute, Department of Paediatrics, University of Western Ontario, Children's Hospital of Western Ontario, London, Ontario, Canada.
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Leipert BD, Matsui D, Rieder MJ. Women and pharmacologic therapy in rural and remote Canada. Can J Rural Med 2006; 11:296-300. [PMID: 17054831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Koren G, Oren D, Rouleau M, Carmeli D, Matsui D. Comparison of verbal claims for natural health products made by health food stores staff versus pharmacists in Ontario, Canada. Can J Clin Pharmacol 2006; 13:e251-6. [PMID: 17038760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND This study tested the hypothesis that while there are no written medical claims existing for many NHP, such claims are made verbally, giving a false impression that these are proven medical products. OBJECTIVE To compare the number and type of verbal claims for NHP made by pharmacists to those made by health food stores personnel. METHODS Randomly selected Canadian pharmacies selling NHP and health food stores were visited and the staff was asked to recommend natural health products for the treatment of hypertension. RESULTS All health food stores (n=20) but only 4 out of 38 pharmacies (p< 0.001) recommended NHP for the treatment of hypertension. A majority of health food store staff (70%) stated that NHP are superior or equal to medicinal drugs in treating hypertension based on efficacy. CONCLUSION Unlike pharmacy practice, verbal claims are common practice in health food stores, despite the lack of either written claims and/or proof of efficacy for most of them. These may be a very effective approach given that 30-40% of North American adults are functionally illiterate. These verbal claims are often inappropriate and not evidence-based.
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Affiliation(s)
- Gideon Koren
- Schulich School of Medicine and Dentistry, University of Western Ontario, Canada.
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Seabrook JA, Cukiernik V, Matsui D, Speechley KN, Rieder MJ. Paediatrician human resource planning in Canada: A 10-year follow-up. Paediatr Child Health 2005; 10:595-6. [DOI: 10.1093/pch/10.10.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koren G, Matsui D, Einarson A, Knoppert D, Steiner M. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005; 172:1457-9. [PMID: 15911861 PMCID: PMC557982 DOI: 10.1503/cmaj.1041100] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gideon Koren
- Motherisk Program, The Hospital for Sick Children and University of Toronto, Toronto, Ont.
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Matsui D, Kwan C, Steer E, Rieder MJ. The trials and tribulations of doing drug research in children. CMAJ 2003; 169:1033-4. [PMID: 14609972 PMCID: PMC236228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Doreen Matsui
- Children's Hospital of Western Ontario, Child Health Research Institute and University of Western Ontario, Department of Paediatrics, London.
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Koren G, Matsui D, Bailey B. DEET-based insect repellents: safety implications for children and pregnant and lactating women. CMAJ 2003; 169:209-12. [PMID: 12900480 PMCID: PMC167123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Reducing the risk of mosquito bites is currently the only way to reduce the risk of West Nile virus infection. Methods for avoiding mosquito bites include limiting the time spent outdoors at dawn and dusk, wearing protective clothing and using an insect repellent. Repellents containing DEET (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methylbenzamide) are the most effective and most widely used. However, concerns have been raised over the risk of adverse toxic effects, especially in young children and pregnant and lactating women. In this article, we review the available evidence on the effectiveness and safety of DEET-based products. The evidence does not support increased risk in young children.
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Affiliation(s)
- Gideon Koren
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children and University of Toronto, Toronto, Ont.
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Abstract
The use of complementary and alternative medicine (CAM) in Canada is increasing. This may be due to a variety of factors, including limitations of current therapy and patient perceptions of safety. The increasing use of CAM is exposing large numbers of patients to various forms of CAM Commentary - patients who might be very different from the populations who have traditionally used the type of CAM in question, including children and pregnant women. It is critically important that therapies involving CAM be evaluated for safety, efficacy and cost-effectiveness in order to determine where they might fit in the healthcare system. One potential approach is the creation of a Canadian Institute of Therapeutics, with a broad mandate to evaluate conventional, complementary, alternative and novel therapies. Such an Institute, in partnership with investigators and conventional and CAM practitioners, might provide a focus and impetus for studies to define where CAM and other therapies are best configured in the Canadian healthcare system.
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Affiliation(s)
- Michael J Rieder
- Department of Pediatrics Pharmacology/Toxicology, University of Western Ontario and Children's Hospital of Western Ontario, London, Ontario, Canada
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Einarson A, Bonari L, Voyer-Lavigne S, Addis A, Matsui D, Johnson Y, Koren G. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry 2003; 48:106-10. [PMID: 12655908 DOI: 10.1177/070674370304800207] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Trazodone and nefazodone are phenylpiperazine antidepressants. Currently, there are no adequate, well-controlled studies on the fetal safety of these drugs. Our primary objective was to determine whether the use of trazodone or nefazodone during pregnancy is associated with an increased risk for major malformations. Secondary outcomes of interest included rates of spontaneous and therapeutic abortions, rates of premature labour, and birth weight. METHODS Pregnant women from 5 centres who had been exposed to these drugs (n = 147) were enrolled in the study during their first trimester. We compared the women with 2 groups of women who took either other antidepressant drugs (n = 147) or nonteratogenic drugs (n = 147). All the women were followed up after delivery to ascertain pregnancy outcome and the health of the baby. RESULTS We have completed 147 follow-ups. There were 121 (82.4%) live births, 20 (13.6%) spontaneous abortions, and 6 (4%) therapeutic abortions. Of the live births, there were 2 (1.6%) major malformations. In all cases, drug exposure occurred during the first trimester, with 52 (35%) of the women using these drugs throughout pregnancy. The mean gestational age at birth was 38 weeks (SD 4.2), and the mean birth weight was 3306.34 g (SD 655). We found no statistically significant differences among the 3 groups in any of the endpoints of interest that we examined. Of the sample, 58 women were exposed to trazodone, and 89 were exposed to nefazodone. CONCLUSION Our results suggest that these drugs do not increase the rates of major malformations above the baseline rate of 1% to 3%.
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Affiliation(s)
- Adrienne Einarson
- Motherisk Program, Division of Clinical Pharmacology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8.
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Kwan C, Steers E, Rieder M, Matsui D. Perspective of canadian pediatricians on barriers to drug investigation in children in Canada. Clin Pharmacol Ther 2003. [DOI: 10.1016/s0009-9236(03)90393-6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C. Kwan
- University of Western Ontario London Canada
| | - E. Steers
- University of Western Ontario London Canada
| | | | - D. Matsui
- University of Western Ontario London Canada
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Bellaire JD, Rieder MJ, Matsui D. The 12-Year Experience of a Paediatric Adverse Drug Reaction Clinic. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.55a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kwan C, Steers E, Rieder MJ, Matsui D. Barriers to Drug Investigation in Children in Canada: Perspectives from Academic and Community Practice. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.45ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To evaluate the palatability of 4 common flavoring vehicles (water, chocolate milk [CM], orange juice [OJ], and cola) combined with activated charcoal (AC) in pediatric volunteers. DESIGN A single-blind taste test of 4 different vehicles (water, OJ, a cola drink, and CM) was conducted in healthy volunteer children. Each child tasted 1.25 mL of Charcodote (0.2g/mL) mixed with 1.25 mL of each vehicle. SETTING Palatability testing was conducted at the office of 1 of the authors. PARTICIPANTS Thirty children (16 male, 14 female), aged 6.5 +/- 1.4 years (range 5-9 years). OUTCOME MEASURES After each test dose, each child rated its taste on a modified 10 cm visual analog scale incorporating a facial-hedonic scale. Each child was also asked for his/her overall preference. RESULTS Taste scores (cm) were as follows: water 5.6 +/- 1.8, OJ 5.4 +/- 1.0, cola 7.6 +/- 0.7, and CM 5.6 +/- 0.8. There was a significant difference in the taste scores between the cola drink (P = 0.01) and the other 3 vehicles. The cola drink was also selected as the most preferred vehicle by 50% of the children as compared with 19.2% for CM and 15.4% for OJ. In contrast, water was selected as the least preferred vehicle by 36.4% of children versus 31.8% for CM and 27.3% for OJ. Only 4 children (15.4%) stated that water was their preferred vehicle, and only 1 child (4.5%) stated that cola drink was the least preferred drink. CONCLUSIONS Children rate the palatability higher and prefer charcoal given with a cola drink rather than with water. OJ and CM do not seem to improve the acceptability of charcoal.
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Affiliation(s)
- Damon Dagnone
- University of Western Ontario, London, Ontario, Canada.
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Einarson A, Fatoye B, Sarkar M, Lavigne SV, Brochu J, Chambers C, Mastroiacovo P, Addis A, Matsui D, Schuler L, Einarson TR, Koren G. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry 2001; 158:1728-30. [PMID: 11579012 DOI: 10.1176/appi.ajp.158.10.1728] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Because there are no studies available on the safety of venlafaxine during pregnancy, the authors' goal in this study was to determine whether venlafaxine increases the risk for major malformations. METHOD Data on 150 women exposed to venlafaxine during pregnancy in seven pregnancy counseling centers were compared with data from studies of pregnant women who 1) received selective serotonin reuptake inhibitor antidepressants (SSRIs) (N=150) and 2) who received nonteratogenic drugs (N=150). RESULTS Among the 150 women who were exposed to venlafaxine during pregnancy, 125 had live births, 18 had spontaneous abortions, and seven had therapeutic abortions; two of the babies had major malformations. There were no significant differences between these women and the two comparison groups on any of the measures analyzed. CONCLUSIONS These results suggest that the use of venlafaxine during pregnancy does not increase the rates of major malformations above the baseline rate of 1%-3%.
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Affiliation(s)
- A Einarson
- The Motherisk Program, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
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Matsui D, Rieder MJ. Canadian directions for enhancing drug discovery and investigation in children: A brighter future. Paediatr Child Health 2001; 6:123-4. [DOI: 10.1093/pch/6.3.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Park J, Matsui D, Rieder MJ. Multiple antibiotic sensitivity syndrome in children. Can J Clin Pharmacol 2000; 7:38-41. [PMID: 10822212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Multiple antibiotic sensitivity syndrome with adverse drug reactions to multiple classes of antibiotics has been described in adults but is not well characterized in children. PATIENTS AND METHODS Charts of children referred to the adverse drug reaction clinic at the Children's Hospital of Western Ontario, London, Ontario, with adverse drug reactions to multiple antibiotics were reviewed to determine the number of patients with adverse drug reactions to multiple classes of antibiotics and the clinical characteristics of the adverse events. RESULTS The records of 97 children who were selected as possible candidates for multiple antibiotic sensitivity were studied. These records constituted 11% of referrals to a highly specialized adverse drug reaction clinic, suggesting that in usual clinical practice, this entity, if it does indeed constitute a distinct clinical entity, is quite uncommon. Age at time of the first adverse drug reaction was 26.1+/-26.3 (mean +/- SD) months. Among the 97 children, adverse reactions to five classes of antibiotic were noted in 3.1%, to four in 10.3%, to three in 47. 4% and to two in 39.2%. Most children (85.6%) experienced an adverse reaction to a penicillin, while 71.1% reacted to a cephalosporin, 80. 4% to a sulphonamide and 35.1% to a macrolide. Clinical presentations of the adverse reactions included urticaria or pruritus, other rash, serum sickness-like reaction, angioedema or anaphylaxis, erythema multiforme or Stevens-Johnson syndrome. CONCLUSIONS There are children who have what appears to be immunologically mediated adverse drug reactions to antibiotics of multiple classes. These reactions, which most commonly manifest as urticaria or other rashes, follow drug use patterns. It remains to be defined whether this is a distinct clinical syndrome or a manifestation of a more fundamental problem in dealing with xenobiotics in the setting of infection. Further work on the immunological and/or biochemical determinants of the multiple antibiotic sensitivity syndrome (MASS) is needed to understand the pathophysiology and determinants of MASS and whether MASS constitutes a distinct clinical entity.
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Affiliation(s)
- J Park
- Children's Hospital of Western Ontario, London, Canada
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