The Relationship between Statin Intake and Risk of Pancreatic Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Pancreatic neoplasm is one of the types of cancer with a high incidence and case-fatality rate.

OBJECTIVES

This study was designed to investigate the relationship between statin intake and the risk of pancreatic cancer with a systematic review and meta-analysis approach.

METHODS

This study was a systematic review and meta-analysis of studies published before 2023 in Cochrane Library, Web of Science (WOS), PubMed, Google Scholar, ScienceDirect, Scopus, and Embase databases. The statistical analyses were conducted using Stata software, version 15. The significance level for this study was set at 0.05.

RESULTS

This meta-analysis included 32 studies and a total of 5,849,814 participants. The risk ratio (RR) of pancreatic cancer in comparison to the non-statin receiving group in statin users in total was equal to 0.75 (95% CI: 0.66-0.86, p-value <0.001), in the cohort studies was obtained to be 0.70 (0.53-0.93), in the randomized clinical trials (RCTs) had a ratio of 0.99 (0.53-1.86), while studies conducted in American countries had a ratio of 0.69 (0.51-0.93), studies in Asian countries had a ratio of 0.73 (0.56-0.97), and studies in European countries had a ratio of 0.88 (0.76-1.02). Furthermore, the study did not detect any signs of publication bias.

CONCLUSION

The study findings suggest a potential connection between using statins and a lower risk of pancreatic cancer. However, it is important to note that controlled clinical trials did not find a statistically significant association between taking statins and the development of pancreatic cancer. Therefore, it is advisable to exercise caution when interpreting the results of this study.

Anti-seizure Effects and Mechanisms of Berberine: A Systematic Review

BACKGROUND

Epilepsy is one of the most common in all age groups and disabling neurologic disorders around the world.

OBJECTIVES

This systematic review was to explore whether berberine (BBR) has any anti-seizure or anti-epileptic effects and also reviewed this possible mechanism.

METHODS

The EMBASE, Scopus, Cochrane Library, PubMed, and Web of Science databases were searched before Sep 2023. All types of studies that investigated the effects of BBR on epilepsy or chemical-induced seizures were eligible for inclusion. Two authors independently evaluated and reviewed titles/abstracts to identify publications for potential eligibility, and a third team member resolved discrepancies. Data were extracted in an Excel form, and the outcomes were discussed.

RESULTS

BBR showed its neuroprotective properties by reducing oxidative stress, neuroinflammation, and anti-apoptosis effects. It also increases brain-derived neurotrophic factor (BDNF) release and reduces transforming growth factor-beta (TGF-β1) and hypoxia-inducible factor 1α (HIF-1α). BBR by increasing scavenging reactive oxygen species (ROS), nuclear factor erythroid 2-related factor 2 (Nrf2), endogenous antioxidant enzymes, heme oxygenase-1 (HO-1), and inhibition of lipid peroxidation insert its antioxidant activity. Moreover, BBR showed antiinflammatory activity by reducing Interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α) levels and through inhibiting cyclooxygenase-2 (COX-2), and including nuclear factor κB (NF-κB). In addition, it modulated c-fos expression and neuronal excitability in the brain.

CONCLUSION

BBR indicated promising anti-seizure effects with remarkable antioxidant, antiinflammatory, anti-apoptotic, and neuroprotective activity. Future studies should be based on well-designed clinical trial studies that are integrated with new methods related to increasing bioavailability.

Mesoporous organosilicas with highly-content tyrosine framework as extractive phases for non-steroidal anti-inflammatory drugs in aquatic media

BACKGROUND

Attentions regarding ordered mesoporous silica materials (OMSs), with large specific surface areas and narrow pore size distribution, which are prepared via self-assembly techniques, have been raised in sorption, separation, and sample preparation. However, in order to extend and improve their applications, a functionalization step is required. Organic units can be anchored on the inner or outer surface as well as in the silica wall framework by co-condensation-, grafting-, and periodic mesoporous organosilica (PMO) preparation approaches. Apparently, by synthesizing PMO with extensive and flexible organic bridging groups within the mesoporous wall, an efficient extractive phase can be achieved.

RESULTS

We employed tyrosine amino acid to synthesize a PMO-based extractive phase. The FT-IR, 1H NMR, HR-ESI-MS, Low angle-XRD, TEM, FESEM, BET, and EDX-MAP analyses confirmed the successful synthesis of PMO within the salt-assisted templating method. A comprehensive study on sorption behavior of PMO was performed and its efficiency was evaluated against the grafting and co-condensation methods. Then, it was implemented to the pipette tip-micro solid phase extraction (PT-μ-SPE) of widely used non-steroidal anti-inflammatory drugs (NSAIDs) in water/wastewaters. Limits of detection and quantification were obtained in the range of 0.1-1.5 and 0.3-5 μg L-1, respectively. The calibration plots are linear in the 1-1000, 3-1000, 10-750, and 3-750 μg L-1, respectively. The intra-and inter-day precision at 50 and 200 μg L-1 levels are 2.9-7.1 % and 3.5-8%, while recoveries are between 84 and 111 %.

SIGNIFICANCE

High-capacity tyrosine functionalized PMO with 2D hexagonal symmetry silica mesoporous structures found to be highly efficient extractive media. Despite the bulkiness and flexibility of the bridging group within the mesoporous wall, the synthesis condition was optimized in order to load more organic content in the PMO structure. The PMO performance was superior over organically modified ordered mesoporous silica materials prepared by the grafting and co-condensation methods.

Breathing in the future: prenatal exposure to air pollution and infants' health outcomes in the USA

OBJECTIVES

This study aimed to investigate the impact of air pollution on birth outcomes in the USA over several decades.

STUDY DESIGN

Approximately 70 million birth records were assessed for the years 1980-2020. This study focussed on seven measures of birth outcomes, including birth weight, low birth weight, very low birth weight, full-term birth weight, foetal growth, gestational age and very premature birth.

METHODS

An instrumental variable identification strategy was used that exploited within county-month and within month-year of birth variations in exposure to precipitation-induced changes in air pollution.

RESULTS

Air pollution was found to have negative and large effects on a wide range of birth outcomes. The study findings suggest that a one-standard-deviation increase in ozone was associated with a 6.4% and 12.8% increase (from the mean) in the proportion of low birth weight and very preterm birth infants, respectively. Further analyses suggest that these effects were heterogeneous across trimesters of pregnancy and reveal larger impacts during the second and third trimesters.

CONCLUSIONS

The results suggest that the ordinary least square estimates of previous studies considerably underestimate the true effects of pollution on birth outcomes. Policies that aim to improve the health capital of future generations should allocate more resources and initiatives to improving environmental air quality.

Cardiovascular risk profile of patients with peripheral arterial occlusive disease during nilotinib therapy

BACKGROUND

Over the past few years, data have suggested that severe peripheral arterial occlusive disease (PAOD) is associated with nilotinib exposure. However, the characteristics of this adverse drug reaction are poorly described since its frequency is low. As far as we know, no study using a spontaneous adverse drug reactions reporting system was performed to describe the characteristics of cases of PAOD related to nilotinib.

OBJECTIVE

We performed a study to describe the cardiovascular risk profile of cases of PAOD in patients treated with nilotinib spontaneously reported to the French Pharmacovigilance Database (FPVD).

PATIENTS/METHODS

We selected all cases of "vascular disorders," as the System Organ Class in MedDRA®, in which nilotinib was "suspected" and recorded in the French Pharmacovigilance Database between 2007 and 21 October 2014. We then identified cases of PAOD with a Low Level Term and through a detailed summary of the clinical description.

RESULTS

We identified 25 cases of POAD. Most of the patients were older than 60 years (84 %) or had another cardiovascular risk factor such as hypercholesterolemia, arterial hypertension, overweight/obesity, smoking, or diabetes mellitus (72 %). Females (13 cases) and males (12 cases) were equally represented, but the presence of cardiovascular risk factors was more frequent in females than in males. The mean time from initiation of nilotinib to PAOD onset was 24 months and was significantly longer in patients aged less than 60 years compared with those aged over 60 years (33.8 ± 24.6 months vs. 22.6 ± 17.5 months, p = 0.002). Pre-existing cardiovascular risk factors, especially diabetes mellitus, also seem to accelerate its occurrence.

CONCLUSIONS

The FPVD is a useful tool in describing the cardiovascular risk profile of patients with PAOD during nilotinib exposure. Physicians have to be particularly vigilant in patients older than 60 years of age; in patients younger than 60 years of age, long-term surveillance has to be maintained.

Sensitive electrochemical determination of rifampicin using gold nanoparticles/poly-melamine nanocomposite

Green and facile method for fabrication of a conductive polymer–Au nanocomposite platform as a novel electrochemical sensing layer for rifampicin.

Fabrication of a novel electrochemical sensing platform based on a core–shell nano-structured/molecularly imprinted polymer for sensitive and selective determination of ephedrine

A simple methodology was used to develop a novel sensor based on a core–shell/molecularly imprinted polymer (MIP) for the determination of ephedrine.

Ischaemic stroke after exposure to aflibercept: interaction with vitamin K antagonist and/or direct pharmacodynamic effect?

WHAT IS KNOWN AND OBJECTIVE

Vascular endothelial growth factor (VEGF) proteins are involved in the regulation of vascular endothelium, and their inhibition led to the development of a number of drugs used for malignancies or exudative neo-vascular age-related macular degeneration (AMD).

CASE SUMMARY

We report a case of ischemic stroke in an 87-year-old woman having received intravitreal aflibercept, a new anti-VEGF for AMD. She had been treated with ranibizumab since 2007. In 2013, ranibizumab was replaced with aflibercept, followed by a decrease in the International Normalized Ratio, complicated by a stroke a few days later. The rechallenge was positive.

WHAT IS NEW AND CONCLUSION

A potential time-dependent interaction between aflibercept and VKA antagonist and/or a direct effect of aflibercept may have contributed to the occurrence of the ischaemic stroke. Currently available data suggest some pharmacokinetic and pharmacodynamic effects of aflibercept by explaining its pro-thrombotic profile.

Simultaneous and sensitive determination of melatonin and dopamine with Fe3O4 nanoparticle-decorated reduced graphene oxide modified electrode

An electrochemical sensor based on a new nanocomposite of graphene/Fe₃O₄ has been fabricated for simultaneous determination of melatonin and dopamine.

Gold nanoparticles deposited on fluorine-doped tin oxide surface as an effective platform for fabricating a highly sensitive and specific digoxin aptasensor

Fabrication steps of digoxin aptasensor. The DPVs are for accumulated MB at FTO/GNPs/Ap, before (a) and after (b) incubation with digoxin.

The structure of clinical consultation: a case of non-native speakers of English as participants

BACKGROUND

In many parts of the world, patients may find it difficult to visit doctors who share the same language and culture due to the intermingling of people and international recruitment of doctors among many other reasons. In these multilingual multicultural settings (MMSs), doctor-patient interactions face new communication challenges. This study aims to identify the structure of clinical consultation and its phases in an MMS where both doctors and patients are non-native speakers (NNSs) of English.

METHOD

This study takes on a discourse analytic approach to examine the structure of clinical consultation as an activity type. 25 clinical consultation sessions between non-native speakers of English in a public healthcare centre in Malaysia were audio-recorded.

FINDINGS & DISCUSSION

The results show that there are some deviations from the mainstream structure of clinical consultations although, in general, the pattern is compatible with previous studies. Deviations are particularly marked in the opening and closing phases of consultation.

CONCLUSION

In almost all interactions, there is a straightforward manner of beginning medical consultations. The absence of greetings may have naturally reduced the length of talk. Hence, by directly entering medical talks, the doctors voice their concern on the curing aspects of the consultation rather than its caring facets. The preference of curing priority to caring is more goal-oriented and in alignment with the consultation as an activity type.

From antiretroviral originator to generic drugs: bioequivalence and pharmacovigilance

Antiretroviral drugs have been available in generic form in developing countries, which has expanded access to treatment; they have also become available in developed countries more recently.

OBJECTIVES

The validation of generic drugs (GD) compared to originator drugs (OD) is mandatory to ensure that using generics will lead to a decreased cost of treatment.

RESULTS

The results were obtained by analyzing published data as well as European Medicines Agency recommendations.

METHOD

The GD should have the same qualitative and quantitative active principle formula, the same pharmaceutical forms, and the same criteria in terms of quality, effectiveness, and safety. This equivalence is based on bioequivalence rules: comparison of the concentration/time curves (AUC); Cmax and Tmax (90%), for which the confidence intervals in the range of 80-125% should be included. Naturally, that does not mean that the concentrations can vary from 80 to 125%: this would indicate unacceptable deviations. Conforming to these criteria allows substituting an OD by a GD. Adverse effects should not be different from those observed for the OD. Adverse effects observed when the GD is used must be notified, as is the case for the OD. Accountability is established according to 4 essential pieces of information: a prescriber, a patient, a drug, and an adverse effect. It is sometimes difficult to identify the provider of the GD that has been delivered.

CONCLUSION

The level of safety concerning effectiveness and tolerance required is identical for OD and GD, in Europe. Analyzing confirmed adverse effects and therapeutic failures is the only way to identify differences that could question a GD's effectiveness.

Effects of cyclic static stretch on fatigue recovery of triceps surae in female basketball players

Static stretch is a safe and feasible method which usually is used before exercise to avoid muscle injury and to improve muscle performance. The purpose of this study was to determine the effects of cyclic static stretch (CSS) on fatigue recovery of triceps surae (TS) in female basketball players. Nine athlete volunteers between 20 and 30 years participated in this study containing two sessions. After warm-up a pressure cuff was fastened above the knee joint and its pressure was increased to 140 mmHg. The subjects were asked to perform one maximum voluntary contraction (MVC) followed by a fatigue test including maximum isometric fatiguing contraction of TS. These steps were similar in both sessions. Then, a two-minute rest was included in the first session while 4 static stretches were performed to TS in the second session. After interventions, one MVC was done and the pressure cuff was released. During these steps, peak torque (PT) and electromyography (EMG) were recorded. The amount of lower leg pain was determined by the visual analogue scale (VAS). The value of PT increased significantly after CSS but its increase was not significant after rest. It seems that the effects of rest and CSS on the EMG parameters, PT and pain are similar.

Modulation of the ipsilateral and contralateral H reflexes following ipsilateral mechanical pressure of the foot in normal subjects

OBJECTIVE

Mechanoreceptors from the foot sole likely contribute in the reflex regulations. Therefore, it was hypothesized that repetitive low threshold afferents stimulation would have an inhibitory effect on the soleus H-reflexes.

METHODS

Sixteen normal subjects voluntarily, participated in the study and were randomly allocated. Subjects were remained in prone position. The Cutaneous Mechanical Pressure (CMP equal to 50% of leg and foot weight) was applied to the ipsilateral lateral and Medial plantar surface by a designed instrument through a square plate (30 x 30 mm). H reflex as an indicator for excitability of motoneurones was bilaterally elicited before and after the application of the CMP. The H-reflex parameters were estimated.

RESULTS

Mechanical pressure significantly depressed soleus H-reflex excitability in ipsilateral and contralateral feet in all subjects.

CONCLUSION

The demonstration of a decrease in H-reflex excitability as a result of applied pressure to the foot sole suggests that the change in reflex excitability is the result of a common spinal mechanism. The results highlight the modulatory effects that natural stimulation of afferents can have on reflex excitability.

SIGNIFICANCE

The placement of a small flat plate, in order to apply pressure to the plantar eminence, may be useful for modulation of muscle tone. In addition, these findings might be useful for reducing spasticity; because spasticity is at least partially caused by hyperexcitability of the motorneuron pool.

The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction

BACKGROUND

Lateral scapular slide test (LSST) quantitatively measures the distance between thoracic spine (T7) and inferior angle of scapula.

OBJECTIVE

In this study, the intra-rater reliability, inter-rater reliability and diagnostic accuracy of LSST were measured using a caliper.

METHODS

Three measurements of each test position were obtained bilaterally. Intraclass correlation coefficient (ICC) (2.1), 95% CI and 2 SEMs were calculated for intra-rater and inter-rater reliability of the absolute scapular distance. Sensitivity, specificity, positive and negative likelihood ratios were determined.

RESULTS

27 people with and 30 people without shoulder pain participated. The mean age (SD) for the participant was 47.7 (11.6) years and 33.5 (11.7) years, respectively. The ICCs for intra-rater reliability were high. A range of poor to good ICCs was found for inter-rater reliability. The 2 SEMs ranged from 4.6 to 7.9 mm for intra-rater reliability and from 6.8 to 13.4 mm for inter-rater reliability for people with shoulder pain. Positive and negative likelihood ratios from 0.94 to 1.22 and from 0.21 to 2.5, respectively, were demonstrated.

CONCLUSION

SST did not show a consistent high reliability. The diagnostic accuracy of the LSST was low, which questions the clinical importance of the tests outcomes.

Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry

OBJECTIVE

To describe cases of lymphoma associated with anti-TNF therapy, identify risk factors, estimate the incidence and compare the risks for different anti-TNF agents.

METHODS

A national prospective registry was designed (Research Axed on Tolerance of bIOtherapies; RATIO) to collect all cases of lymphoma in French patients receiving anti-TNF therapy from 2004 to 2006, whatever the indication. A case-control analysis was conducted including two controls treated with anti-TNF per case and an incidence study of lymphoma with the French population was used as the reference.

RESULTS

38 cases of lymphoma, 31 non-Hodgkin's lymphoma (NHL) (26 B cell and five T cell), five Hodgkin's lymphoma (HL) and two Hodgkin's-like lymphoma were collected. Epstein-Barr virus was detected in both of two Hodgkin's-like lymphoma, three of five HL and one NHL. Patients receiving adalimumab or infliximab had a higher risk than those treated with etanercept: standardised incidence ratio (SIR) 4.1 (2.3-7.1) and 3.6 (2.3-5.6) versus 0.9 (0.4-1.8). The exposure to adalimumab or infliximab versus etanercept was an independent risk factor for lymphoma in the case-control study: odds ratio 4.7 (1.3-17.7) and 4.1 (1.4-12.5), respectively. The sex and age-adjusted incidence rate of lymphoma was 42.1 per 100 000 patient-years. The SIR was 2.4 (95% CI 1.7 to 3.2).

CONCLUSION

The two to threefold increased risk of lymphoma in patients receiving anti-TNF therapy is similar to that expected for such patients with severe inflammatory diseases. Some lymphomas associated with immunosuppression may occur, and the risk of lymphoma is higher with monoclonal-antibody therapy than with soluble-receptor therapy.

Overview of adverse reactions to nefopam: an analysis of the French Pharmacovigilance database

Nefopam is widely used for the relief of moderate acute pain. Its safety profile remains to be specified. The objective of the study was to review adverse reactions to nefopam spontaneously reported to the French Pharmacovigilance system. All cases of adverse drug reactions (ADRs) associated with nefopam, registered in the French Pharmacovigilance database from January 1, 1995 to December 31, 2004, were reviewed. For each reported ADR, information about patient (age, gender, medical history), drug exposure (suspected and concomitantly used drugs), characteristics of ADRs (imputability score, time of onset, seriousness, outcome) were collected. A total of 114 ADRs with an imputability rated from 'plausible' (I2) to 'likely' (I3) and 'very likely' (I4) was analysed. The most frequent ADRs included 'expected' ADRs such as sweating, nausea, tachycardia, malaise or vomiting; 61 ADRs were 'unexpected. No overdose was reported; 26 ADRs (23%) were considered as 'serious'. Most of them were 'unexpected', including neuropsychiatric (hallucinations, convulsions) or cutaneous (pruritus, erythema, urticaria) ADRs. Six cases of anaphylactic ADRs (two angioedema and four anaphylactic shocks) were reported, all occurring shortly after use of nefopam during the post-operative period. Physicians should be aware of the possible occurrence of some serious ADRs when using nefopam such as convulsions and anaphylactic shocks, especially when the drug is used in special medical conditions, like post-operative periods.

Therapeutic ultrasound in the treatment of ankle plantarflexor spasticity in a unilateral stroke population: a randomized, single-blind, placebo-controlled trial

Spasticity is a common and disabling symptom associated with Upper Motor Neuron Syndrome. The current methods of treatment for muscle spasticity have been claimed as unsatisfactory. Therapeutic ultrasound (US) is a common therapeutic modality in physiotherapy used for treating a wide variety of disorders. The aim of present study was to quantify the effects of continuous US on ankle plantarflexor spasticity in a randomized, single-blind, placebo-controlled trial. Twelve stroke patients (6 women and 6 men) randomly allocated to ultrasound (n = 6) or placebo (n = 6) groups. The patients were treated with either US or sham US for three days per week, every other day for 15 treatment sessions. The primary efficacy measures were the H-reflex and the Ashworth Scale (AS). In experimental group there was a significant reduction in the Hmax/Mmax ratio (p = 0.03). The Hmax/Mmax ratio was increased in the placebo group patients (p > 0.05). The difference between two groups was statistically significant (p = 0. 02). In both groups there was a reduction in the posttreatment AS scores. The Ashworth scores demonstrated statistically significant changes in the US group (p = 0.04). There was no statistical difference, however, when these two groups were compared (p > 0.05). Results from the present study show that treatment with US can reduce HmaxlMmax ratio as a measure of alpha motoneuron excitability and spasticity measure of AS in stroke patients with ankle plantarflexor spasticity.

Evaluation of the effect of group counselling on post myocardial infarction patients: determined by an analysis of quality of life

AIM AND OBJECTIVE

The aim of this study was to investigate the effect of group counselling program on quality of life in survivors of myocardial infarction.

BACKGROUND

Myocardial infarction is one of the most dramatic illnesses that can afflict patients. Despite decreases in mortality from coronary heart disease in most developed countries, mortality is increasing in most eastern European countries and developing countries.

DESIGN

A randomized-controlled trial design.

METHODS

Sixty-two patients with myocardial infarction were chosen, case group, (31 patients), distributed in five subgroup (each subgroup conclude six or seven patients) and control group (31 patients). A group-counselling program was performed two days per week, each session last one hour. However, no counselling was performed for the control group. The quality of life score was estimated in both groups by the use of the MacNew Quality of Life after Myocardial Infarction questionnaire, before the group counselling program, and one month after the group counselling program, and the quality of life between both groups were compared. The data were analyzed using SPSS software.

RESULTS

Results indicated that there was no significant difference between the mean quality of life score of case and control groups before group counselling program. While there was a significant difference (P = 0.001) between the mean of quality of life score after the group counselling in both groups. The mean of quality of life score, before and after group counselling program indicated a significant difference (P < 0.001) in the case group, while there was no significant difference in the control group. The statistical comparison of the mean of quality of life score in general and in each dimensions before and after group counselling program indicated that there was a significant difference between before and after group counselling in the case group whereas in the control group it has slightly decreased. Pearson's correlation coefficient test (P = 0.002) showed a significant correlation between the duration of myocardial infraction and the quality of life score. The effectiveness of the planned counselling program on quality of life was estimated 24.08 by growth test.

CONCLUSION

As indicated by the results of this study, group counselling program can promote patient's quality of life in all dimensions.

RELEVANCE TO CLINICAL PRACTICE

There is a need for nurses and physicians to apply group counselling program in a wide variety of settings ranging from community to intensive care, as a simple and safe intervention to promote patient's quality of life.

Detection and incidence of drug-induced agranulocytosis in hospital: a prospective analysis from laboratory signals

AIMS

Our objectives were to assess the detection and incidence of drug-induced agranulocytosis in two university hospitals using hematology laboratory data.

METHODS

A prospective study was undertaken at Toulouse University Hospital (France) and Navarra University Hospital (Spain) for 1 year (from 1 May 2004 to 30 April 2005). Using a computerized process and hematology laboratory data, all neutrophil counts with a value less than 500/mm(3) were registered, allowing identification of inpatients suffering from agranulocytosis during the period of the study. Medical records of all selected patients were then consulted. Cytostatic drugs were excluded from this study.

RESULTS

During the period of the study, 225,659 neutrophil counts were performed in both hospitals, of which 2,835 (1.26%) had a neutrophil count less than 500/mm(3), corresponding to 739 patients. Seventeen patients were excluded because of lack of data, and 20 cases of infants younger than 3 months were excluded. Among the remaining patients (n = 702), 23 cases of drug-induced agranulocytosis (excluding cytostatic drugs) were suspected. All cases were classified as "serious" since they led to death in 2 cases, hospitalization or prolongation of hospitalization in 19 cases and threatening of vital prognosis in 2 cases. Withdrawal of suspected drugs was done in all cases with regression of neutropenia in 21 cases. According to hospitalization data, the annual incidence of drug-induced agranulocytosis was 1.62 (1.0-2.6) per 10,000 inpatients in Toulouse University hospital (based on 534 cases) and 3.24 (0.9-8.3) per 10,000 inpatients in Navarra University Hospital (based on 168 cases). The involved drugs were mainly antibacterial (30.4%), immunosuppressive (17.4%), antithyroid (13.0%), antiplatelet (8.7%) and nonsteroidal anti-inflammatory (8.7%) ones. Only seven cases from Toulouse University Hospital were spontaneously reported by physicians during the same period. Thus, the underreporting coefficient (U) was 2.71 (63.2%) in France.

CONCLUSION

Our survey allowed us to identify the suspected drug-induced agranulocytosis through a prospective study in a large sample of inpatients using only laboratory data analysis. We also note an important underreporting rate of this serious adverse drug reaction (ADR) to the official French pharmacovigilance system. Laboratory data analysis could be used for identifying serious ADRs.

Valvular heart disease in a patient taking benfluorex

The authors describe a case of valvular heart disease in a 48-year-old woman receiving benfluorex (150 mg t.i.d. for 8 years) and leading to surgical mitral valve replacement. Examination showed severe dyspnea with severe mitral regurgitation associated with tricuspid regurgitation. No other common disease known to affect mitral valves nor intake of other drugs (ergot derivatives or appetite suppressant drugs) was found. The paper discusses the imputability of benfluorex, a drug used as an adjuvant in hypercholesterolemia, structurally related to amphetamines.

Is there any relationship between the Modified Ashworth Scale scores and alpha motoneuron excitability indicators?

The purpose of this study was to investigate the relationship between the modified Ashworth scale (MAS) scores and alpha motoneuron excitability indicators. Thirty-one post-stroke patients were assessed for this object. The main outcome measures were the MAS and electro physiologic assessments. The latter was performed using both conventional (Hmax/Mmax) and new (Hslope/Mslope) measures of spinal excitability. Data on thirty-one adult subjects with hemiplegia (twenty-five men and six women) were analysed. The soleus Hmax/Mmax ratio appeared to correlate directly with the MAS scores (r = 0.36; P < 0.05). Correlation between the MAS scores and either Hslope/Mslope ratio or H-reflex latency was not significant (P > 0.05). In seventeen patients whose H-reflex could be evoked bilaterally, spinal excitability indicators showed significant difference between the affected and non-affected sides (P < 0.05). Based on the results of this study, there is no relationship between the MAS scores and the preferred measure of alpha motoneuron excitability. This research suggests that the MAS could not distinguish between the reflexive and non-reflexive components of the hypertonicity in ankle plantar flexors.

Adverse drug reactions in patients older than 70 years during the heat wave occurred in France in summer 2003: a study from the French PharmacoVigilance Database

OBJECTIVE

To evaluate adverse drug reactions (ADRs) in patients older than 70 years reported during the 2003 summer heat wave in France to the French Network of Pharmacovigilance Centres and to discuss the interest of such a pharmacovigilance database in the surveillance of such sanitary alerts.

METHODS

All 'serious' ADRs occurred in patients older than 70 years between 1st July and 31st August 2003, reported to the French network of Pharmacovigilance Centres and recorded in the French PharmacoVigilance Database, were analysed with respect to age, gender, type of ADR, drug(s) involved as well as imputability of heat wave.

RESULTS

The total number of 'serious' ADRs registered in the French PharmacoVigilance Database in patients older than 70 years was similar in 2003 (a year with heat wave) and in 2002 (a year without heat wave). Sixty-eight ADRs [27 'possible' (I1), 27 'plausible' (I2) and 14 'likely' (I3)] related to heat occurred in 2003, with a maximal peak between the 28th July and the 17th August. The most frequently ADRs were metabolic (dehydratation, hydroelectrolytic disturbances) and neuropsychiatric (confusion, falls, coma). Drugs more frequently involved were diuretics, angiotensin converting enzyme inhibitors, antidepressants (mainly serotonin reuptake inhibitors), proton pump inhibitors, digoxin, benzodiazepines, oral hypoglycemics and sartans.

CONCLUSION

This study underlines the role of heat wave in the occurrence of 'serious' ADRs in elderly. However, the French PharmacoVigilance Database was not enough sensitive to be used as an efficient surveillance system during such an acute episode, like a heat wave (at least while underreporting remains so important).

Detection and incidence of muscular adverse drug reactions: a prospective analysis from laboratory signals

AIMS

The awareness of muscular adverse drug reactions (ADRs) increased since the withdrawal of cerivastatin, a HMG-CoA reductase inhibitor, from the market in August 2001. Our objectives were to assess the detection and incidence of muscular ADRs in a University Hospital using biochemical laboratory data and to evaluate the underreporting rate of drug-induced muscular disorders.

METHODS

A prospective study was undertaken at Toulouse University Hospital, France, for 1 week per month from November 2001 to October 2002. Patients were selected by means of a computerized process using biochemical laboratory data based on serum creatine phosphokinase (CPK) values (over twofold normal). Medical records of all selected patients were then consulted.

RESULTS

During the period of the study, 2017 CPK tests were performed, among which 171 values were over twofold normal corresponding to 129 patients. Because of lack of data, 26 patients were excluded. Among these patients ( n=103), 28 cases of muscular ADRs were suspected, 22 of which were detected in outpatient departments. Four patients were totally asymptomatic and five had an increase of CPK over fivefold normal. Nine cases were classified as "serious". Withdrawal of suspected drugs were done in 16 cases with regression of ADRs in 13 cases. According to hospitalization data, the incidence of muscular ADRs was estimated as 7.2 (2.6-15.7) per 10,000 inpatients and 9.3 (5.8-14.1) per 10,000 outpatients over 12 weeks. The involved drugs were mainly: statins (46.4%), fibrates (14.3%), antiretrovirals (14.3%), angiotensin-II receptor antagonists (10.7%), immunosuppressants (7.1%) or hydroxychloroquine (7.1). Only two cases, judged as "serious", were spontaneously reported by physicians during the same period.

CONCLUSION

The results of this survey underline the importance to take into account drug hypothesis in muscular injuries diagnosis.