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Pulcini CD, Lentz S, Saladino RA, Bounds R, Herrington R, Michaels MG, Maurer SH. Emergency management of fever and neutropenia in children with cancer: A review. Am J Emerg Med 2021; 50:693-698. [PMID: 34879488 DOI: 10.1016/j.ajem.2021.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/28/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Care of pediatric cancer patients is increasingly being provided by physicians in community settings, including general emergency departments. Guidelines based on current evidence have standardized the care of children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) presenting with fever and neutropenia (FN). OBJECTIVE This narrative review evaluates the management of pediatric patients with cancer and neutropenic fever and provides comparison with the care of the adult with neutropenic fever in the emergency department. DISCUSSION When children with cancer and FN first present for care, stratification of risk is based on a thorough history and physical examination, baseline laboratory and radiologic studies and the clinical condition of the patient, much like that for the adult patient. Prompt evaluation and initiation of intravenous broad-spectrum antibiotics after cultures are drawn but before other studies are resulted is critically important and may represent a practice difference for some emergency physicians when compared with standardized adult care. Unlike adults, all high-risk and most low-risk children with FN undergoing chemotherapy require admission for parenteral antibiotics and monitoring. Oral antibiotic therapy with close, structured outpatient monitoring may be considered only for certain low-risk patients at pediatric centers equipped to pursue this treatment strategy. CONCLUSIONS Although there are many similarities between the emergency approach to FN in children and adults with cancer, there are differences that every emergency physician should know. This review provides strategies to optimize the care of FN in children with cancer in all emergency practice settings.
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Affiliation(s)
- Christian D Pulcini
- Division of Emergency Medicine, Department of Surgery and Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Skyler Lentz
- Division of Emergency Medicine and Critical Care, Department of Surgery and Medicine, University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Richard A Saladino
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Richard Bounds
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Ramsey Herrington
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Marian G Michaels
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Scott H Maurer
- Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
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Grunvald W, Herrington R, King R, Lamberson M, Mackey S, Maruti S, Rawson R, Wolfson D. COVID-19: A new barrier to treatment for opioid use disorder in the emergency department. J Am Coll Emerg Physicians Open 2021; 2:e12403. [PMID: 33748808 PMCID: PMC7967916 DOI: 10.1002/emp2.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/31/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Start Treatment and Recover (STAR) is an emergency department (ED) program that expands access to medication for opioid use disorder by identifying patients with opioid use disorder and offering ED-initiated buprenorphine/naloxone and rapid access to outpatient treatment. We sought to determine the impacts of the coronavirus disease 2019 pandemic on STAR and the patients with opioid use disorder it serves. METHODS We conducted a retrospective review of records comparing 2 periods: pre-pandemic (February 1, 2019-February 29, 2020) and pandemic (March 1, 2020-May 31, 2020). Variables evaluated included the number of STAR enrollments, ED census, percentage of census screening positive for opioid use disorder, number and percentage of ED overdose visits, and overdose fatalities by month. All analyses were conducted using 2-sample t tests to calculate the mean and 95% confidence intervals (CIs). RESULTS Comparing the pre-pandemic to the pandemic period, the mean monthly ED visits decreased from 5126.9 to 3306.7 (difference = -1820.3; 95% CI, -3406.3 to -234.2), STAR mean monthly enrollments decreased from 9.7 to 1.3 (difference = -8.4; 95% CI, -12.8 to -4.0), and statewide monthly opioid-related fatalities increased from 9.4 to 15.3 (difference = 5.9; 95% CI, 0.8 to 11.1). However, the percentage of individuals who presented to the ED with opioid use disorder or overdose remained unchanged. CONCLUSION Although overall ED visits declined during the pandemic period, the percentage of patients presenting with opioid use disorder or overdose remained constant, yet there was a dramatic decline in enrollment in ED-initiated medication for opioid use disorder and an increase in statewide monthly opioid-related fatalities. Strategies to maintain medication for opioid use disorder treatment options must be implemented for this vulnerable population during the ongoing pandemic.
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Affiliation(s)
- Warren Grunvald
- University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Ramsey Herrington
- Division of Emergency Medicine, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Roz King
- Division of Emergency Medicine, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Miles Lamberson
- Division of Emergency Medicine, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Scott Mackey
- Division of Psychiatry, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Sanchit Maruti
- Division of Psychiatry, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Richard Rawson
- Division of Psychiatry, University of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Daniel Wolfson
- Division of Emergency Medicine, University of Vermont Larner College of MedicineBurlingtonVermontUSA
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Samuels-Kalow ME, Boggs KM, Cash RE, Herrington R, Mick NW, Rutman MS, Venkatesh AK, Zabbo CP, Sullivan AF, Hasegawa K, Zachrison KS, Camargo CA. Screening for Health-Related Social Needs of Emergency Department Patients. Ann Emerg Med 2020; 77:62-68. [PMID: 33160720 DOI: 10.1016/j.annemergmed.2020.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associated with screening, and understand how screening patterns for health-related social needs differ from those for violence, substance use, and mental health needs. METHODS We analyzed data from the 2018 National Emergency Department Inventory-New England survey, which was administered to all 194 New England EDs during 2019. We used descriptive statistics to compare ED characteristics by screening practices, and multivariable logistic regression models to identify factors associated with screening. RESULTS Among the 166 (86%) responding EDs, 64 (39%) reported screening for at least one health-related social need, 160 (96%) for violence (including intimate partner violence or other violent exposures), 148 (89%) for substance use disorder, and 159 (96%) for mental health needs. EDs reported a wide range of social work resources to address identified needs, with 155 (93%) reporting any social worker availability and 41 (27%) reporting continuous availability. CONCLUSION New England EDs are screening for health-related social needs at a markedly lower rate than for violence, substance use, and mental health needs. EDs have relatively limited resources available to address health-related social needs. We encourage research on the development of scalable solutions for identifying and addressing health-related social needs in the ED.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ramsey Herrington
- Division of Emergency Medicine, University of Vermont, Burlington, VT
| | - Nathan W Mick
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Maia S Rutman
- Departments of Pediatrics and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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4
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Teferi MM, Boggs KM, Espinola JA, Herrington R, Mick NW, Rutman MS, Venkatesh AK, Zabbo CP, Hasegawa K, Samuels-Kalow ME, Weiner SG, Camargo CA. Change in opioid policies in New England emergency departments, 2014 vs 2018. Drug Alcohol Depend 2020; 213:108105. [PMID: 32615413 DOI: 10.1016/j.drugalcdep.2020.108105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The U.S. opioid epidemic persists, yet it is unclear if opioid-related emergency department (ED) policies have changed. We investigated: 1) the prevalence of opioid use disorder (OUD) prevention and treatment policies in New England EDs in 2018, and 2) how these policies have changed since 2014. METHODS Using the National Emergency Department Inventory-USA, we identified and surveyed all New England EDs in 2015 and 2019 about opioid-related policies in 2014 and 2018, respectively. The surveys assessed OUD prevention policies (to use a screening tool, access the Prescription Drug Monitoring Program [PDMP], notify primary care providers, prescribe/dispense naloxone) and treatment policies (to refer to recovery resources, prescribe/dispense buprenorphine). RESULTS Of 194 EDs open in 2018, 167 (86 %) completed the survey. Of 193 EDs open in 2018 and 2014, 147 (76 %) completed both surveys. In 2018, the most commonly-reported policy was accessing the PDMP (96 %); the least commonly-reported policy was prescribing/dispensing buprenorphine to at risk patients (37 %). EDs varied in prescribing/dispensing naloxone: 35 % of EDs offered naloxone to ≥80 % of patients at risk of opioid overdose versus 33 % of EDs to <10 % of patients at risk. Most EDs (74 %) reported prescribing/dispensing buprenorphine to <10 % of patients with OUD. Comparing 2018 to 2014, the greatest difference in policy use was in prescribing/dispensing naloxone (+55 %, p < 0.001). CONCLUSION Implementation of opioid-related ED policies increased between 2014 and 2018. Continued effort is needed to understand the extent to which policy implementation translates to clinical care, and to best translate evidence-based policies into clinical practice.
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Affiliation(s)
- Maranatha M Teferi
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
| | - Ramsey Herrington
- Division of Emergency Medicine, University of Vermont, 111 Colchester Ave., Burlington, VT 05401, United States.
| | - Nathan W Mick
- Department of Emergency Medicine, Maine Medical Center, 22 Bramhall St., Portland, ME 04102, United States.
| | - Maia S Rutman
- Departments of Pediatrics and Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, United States.
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, United States.
| | - Christopher P Zabbo
- Department of Emergency Medicine, Kent Hospital, 455 Toll Gate Rd., Warwick, RI 02886, United States.
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 920, Boston, MA 02114, United States.
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5
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Farrugia A, Douglas S, James J, Whyte G, Herrington R. Use of Plasma with High Levels of lonised Calcium in the Production of Model Scale Goagulation Factor Concentrates. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe have attempted to exploit the Ca2+ -dependent stability of factor VIII in producing factor VIII concentrates of higher yield. Plasma levels of ionised calcium were increased in two ways: (a) whole blood collection into half-strength citrate CPD anticoagulant, leading to free Ca2+ levels of ca 120 µM and (b) apheresis collection of plasma which was then recalcified to free Ca2+ levels
of ca 300 µM under heparin cover. Coagulation factor concentrates were prepared using model versions of our industrial scale manufacturing methods. Factor VIII yield was increased through low citrate collection. This did not compromise factor IX yield or thrombogenic potential. Use of recalcified heparinised plasma did not lead to any improvement in factor VIII yield and resulted in a marked drop in factor IX recovery, possibly from interference by
heparin of factor IX binding in ion-exchange chromatography. The benefits accruable through the use of half-strength citrate CPD anticoagulant support the continued evaluation of this preservative in large scale blood collection and fractionation. The deleterious effects of heparin in charge-mediated plasma fractionations may pose serious difficulties in harvesting vitamin K dependent factors.
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Affiliation(s)
- A Farrugia
- The Red Cross Blood Bank, South Melbourne, Victoria, Australia and the Commenwealth Serum Laboratories, Parkville, Victoria, Australia
| | - S Douglas
- The Red Cross Blood Bank, South Melbourne, Victoria, Australia and the Commenwealth Serum Laboratories, Parkville, Victoria, Australia
| | - J James
- The Red Cross Blood Bank, South Melbourne, Victoria, Australia and the Commenwealth Serum Laboratories, Parkville, Victoria, Australia
| | - G Whyte
- The Red Cross Blood Bank, South Melbourne, Victoria, Australia and the Commenwealth Serum Laboratories, Parkville, Victoria, Australia
| | - R Herrington
- The Red Cross Blood Bank, South Melbourne, Victoria, Australia and the Commenwealth Serum Laboratories, Parkville, Victoria, Australia
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Herrington R, Bidad R, Blohm E. Serotonin syndrome after electroconvulsive therapy for refractory depression. Toxicology Communications 2018. [DOI: 10.1080/24734306.2018.1512697] [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: 10/28/2022] Open
Affiliation(s)
- Ramsey Herrington
- Department of Surgery, Division of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Roz Bidad
- Department of Surgery, Division of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Eike Blohm
- Department of Surgery, Division of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
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7
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Farrugia A, Spiers D, Young I, Oates A, Herrington R, Damianos F. Effects of Plasma Collection Systems and Processing Parameters
on the Quality of Factor IX Concentrate. Vox Sang 2017. [DOI: 10.1159/000460992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Herrington R, Lévesque M, Avoli M. Neurosteroids modulate epileptiform activity and associated high-frequency oscillations in the piriform cortex. Neuroscience 2013; 256:467-77. [PMID: 24157930 DOI: 10.1016/j.neuroscience.2013.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 07/22/2013] [Revised: 10/09/2013] [Accepted: 10/12/2013] [Indexed: 01/13/2023]
Abstract
Allotetrahydrodeoxycorticosterone (THDOC) belongs to a class of pregnane neurosteroidal compounds that enhance brain inhibition by interacting directly with GABAA signaling, mainly through an increase in tonic inhibitory current. Here, we addressed the role of THDOC in the modulation of interictal- and ictal-like activity and associated high-frequency oscillations (HFOs, 80-500 Hz; ripples: 80-200 Hz, fast ripples: 250-500 Hz) recorded in vitro in the rat piriform cortex, a highly excitable brain structure that is implicated in seizure generation and maintenance. We found that THDOC: (i) increased the duration of interictal discharges in the anterior piriform cortex while decreasing ictal discharge duration in both anterior and posterior piriform cortices; (ii) reduced the occurrence of HFOs associated to both interictal and ictal discharges; and (iii) prolonged the duration of 4-aminopyridine-induced, glutamatergic independent synchronous field potentials that are known to mainly result from the activation of GABAA receptors. Our results indicate that THDOC can modulate epileptiform synchronization in the piriform cortex presumably by potentiating GABAA receptor-mediated signaling. This evidence supports the view that neurosteroids regulate neuronal excitability and thus control the occurrence of seizures.
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Affiliation(s)
- R Herrington
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Qc, Canada
| | - M Lévesque
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Qc, Canada
| | - M Avoli
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Qc, Canada.
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9
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Lôo H, Saiz-Ruiz J, Costa E Silva JA, Ansseau M, Herrington R, Vaz-Serra A, Dilling H, De Risio S. Efficacy and safety of tianeptine in the treatment of depressive disorders in comparison with fluoxetine*. Hum Psychopharmacol 2001; 16:S31-S38. [PMID: 12404533 DOI: 10.1002/hup.268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/31/2022]
Abstract
Depression is treated by a great variety of antidepressant treatments. SSRIs (such as fluoxetine) are well known: it is, however, sure that further progress is needed and the search for antidepressants with other mechanisms of action (such as tianeptine) or different efficacy is still of interest. A multinational study compared tianeptine with fluoxetine in 387 patients with Depressive Episode, or Recurrent Depressive Disorder, or Bipolar Affective Disorder (ICD-10), in a double-blind parallel group design. They were treated for six weeks. At inclusion, no significant difference between groups was shown. Final MADRS scores were 15.7 and 15.8 with tianeptine and fluoxetine, respectively (ITT population) (p = 0.944). MADRS responders were 58% and 56% with tianeptine and fluoxetine, respectively (p = 0.710). No statistical difference was observed for the other efficacy parameters. Thirty-six withdrawals occurred in each group, without any difference for the reasons of discontinuation. There was no major difference between groups for the other safety parameters. In this study, both tianeptine and fluoxetine exhibited a good efficacy and safety. Copyright 1999 Elsevier Science B. V. All rights reserved.
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Affiliation(s)
- H. Lôo
- Service Hospitalo-universitaire de Santé Mentale et de Thérapeutique. Sainte-Anne Hospital, Paris Cedex 14, France
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10
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Lôo H, Saiz-Ruiz J, Ansseau M, Herrington R, Vaz-Serra A, Dilling H, de Risio S. Efficacy and safety of tianeptine in the treatment of depressive disorders in comparison with fluoxetine. J Affect Disord 1999; 56:109-18. [PMID: 10701468 DOI: 10.1016/s0165-0327(99)00009-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
BACKGROUND Depression is treated by a great variety of antidepressant treatments. SSRIs (such as fluoxetine) are well known: it is, however, sure that further progress is needed and the search for antidepressants with other mechanisms of action (such as tianeptine) or different efficacy is still of interest. METHODS A multinational study compared tianeptine with fluoxetine in 387 patients with Depressive Episode, or Recurrent Depressive Disorder, or Bipolar Affective Disorder (ICD-10), in a double-blind parallel group design. They were treated for six weeks. RESULTS At inclusion, no significant difference between groups was shown. Final MADRS scores were 15.7 and 15.8 with tianeptine and fluoxetine, respectively (ITT population) (p = 0.944). MADRS responders were 58% and 56% with tianeptine and fluoxetine, respectively (p = 0.710). No statistical difference was observed for the other efficacy parameters. Thirty-six withdrawals occurred in each group, without any difference for the reasons of discontinuation. There was no major difference between groups for the other safety parameters. CONCLUSIONS In this study, both tianeptine and fluoxetine exhibited a good efficacy and safety.
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Affiliation(s)
- H Lôo
- Service Hospitalo Universitaire de Santé Mentale et de Therapeutique, Sainte-Anne Hospital, Paris, France
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11
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Garner MM, Herrington R, Howerth EW, Homer BL, Nettles VF, Isaza R, Shotts EB, Jacobson ER. Shell disease in river cooters (Pseudemys concinna) and yellow-bellied turtles (Trachemys scripta) in a Georgia (USA) lake. J Wildl Dis 1997; 33:78-86. [PMID: 9027694 DOI: 10.7589/0090-3558-33.1.78] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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: 02/03/2023]
Abstract
A disfiguring shell disease was detected in river cooters (Pseudemys concinna) and yellow-bellied turtles (Trachemys scripta) from Lake Blackshear, Georgia (USA). The turtles used were part of a mark-recapture study conducted from September 1991 to June 1993. Histologic changes on four turtles included acute segmental necrosis of the epidermis, followed by ulceration, necrosis of the underlying dermis and dermal bone, and exaggerated remodeling of bone. Additional findings included visceral inflammatory lesions and bacterial infection, sepsis and marked trematode ova granulomatosis. The cause of the shell lesions was not determined.
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Affiliation(s)
- M M Garner
- College of Veterinary Medicine, University of Florida, Gainesville 32610, USA
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12
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Oates A, Polmear E, Herrington R, Farrugia A, Sykes S, Raines G, Aumann H, Street A. von Willebrand factor characterization of a severe dry-heat treated factor VIII concentrate, AHF (high purity). Thromb Res 1992; 65:389-99. [PMID: 1631803 DOI: 10.1016/0049-3848(92)90169-b] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eight batches of a severe dry-heat treated (80 degrees C for 72 hours) Factor VIII concentrate manufactured by the Commonwealth Serum Laboratories (CSL Ltd.) were analysed for the following von Willebrand factor-related (vWf) activities: ristocetin cofactor activity (vWf:RCof), collagen binding activity (CBA), vWf antigen levels (vWf:Ag), vWf multimeric analysis and 2-stage FVIII clotting activity (VIII:C). The average potency per vial of vWf:Ag was 440 +/- 80 units, vWf:RCof 500 +/- 60 units, CBA 350 +/- 50 units and VIII:C 242 +/- 36 International Units. Multimeric analysis indicated the presence of high molecular weight multimers and a triplet structure slightly different to normal plasma. Viral inactivation studies using a marker virus, Sindbis, demonstrated that the terminal severe dry- heating step reduced the viral load in the product by greater than 6 log10TCID50/ml. This CSL Ltd. FVIII concentrate may thus provide a safer, purer and more convenient source of vWf than cryoprecipitate. Clinical studies to establish product efficacy in patients with von Willebrand's disease are underway.
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Affiliation(s)
- A Oates
- Blood Products Division, Commonwealth Serum Laboratories Limited, Parkville, Victoria, Australia
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13
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Farrugia A, Douglas S, James J, Whyte G, Herrington R. Use of plasma with high levels of ionised calcium in the production of model scale coagulation factor concentrates. Thromb Haemost 1990; 64:374-8. [PMID: 2128967] [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: 12/30/2022]
Abstract
We have attempted to exploit the Ca2(+)-dependent stability of factor VIII in producing factor VIII concentrates of higher yield. Plasma levels of ionised calcium were increased in two ways: (a) whole blood collection into half-strength citrate CPD anticoagulant, leading to free Ca2+ levels of ca 120 microM and (b) apheresis collection of plasma which was then recalcified to free Ca2+ levels of ca 300 microM under heparin cover. Coagulation factor concentrates were prepared using model versions of our industrial scale manufacturing methods. Factor VIII yield was increased through low citrate collection. This did not compromise factor IX yield or thrombogenic potential. Use of recalcified heparinised plasma did not lead to any improvement in factor VIII yield and resulted in a marked drop in factor IX recovery, possibly from interference by heparin of factor IX binding in ion-exchange chromatography. The benefits accruable through the use of half-strength citrate CPD anticoagulant support the continued evaluation of this preservative in large scale blood collection and fractionation. The deleterious effects of heparin in charge-mediated plasma fractionations may pose serious difficulties in harvesting vitamin K dependent factors.
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Affiliation(s)
- A Farrugia
- Red Cross Blood Bank, South Melbourne, Victoria, Australia
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14
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Farrugia A, Spiers D, Young I, Oates A, Herrington R, Damianos F. Effects of plasma collection systems and processing parameters on the quality of factor IX concentrate. Vox Sang 1989; 57:4-9. [PMID: 2800464 DOI: 10.1111/j.1423-0410.1989.tb04975.x] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Using pilot-scale production of our present factor IX (II and X) concentrate, we have studied the effects of starting plasma source and processing parameter on two in-vitro indicators of product quality - yield and thrombogenic potential. Plasma source did not affect factor IX yield but had a marked effect on thrombogenic potential. Factor IX concentrates produced from plasma derived through centrifugation-based technology showed significantly higher thrombogenic potential than products derived from plasma derived through a filtration-based system. Removal of Cohn fraction I prior to ion-exchange chromatography resulted in a drop in factor IX yield and thrombogenic potential, as did heat treatment to 80 degrees C for 72 h. We conclude that a membrane-filtration-based plasmapheresis system may be the preferred method of plasma procurement for factor IX concentrate production.
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Affiliation(s)
- A Farrugia
- Blood Products Division, Commonwealth Serum Laboratories, Parkville, Victoria, Australia
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Farrugia A, Oates A, Spiers D, Young I, Herrington R. A microtitre plate test for assessment of in-vitro thrombogenicity in factor IX concentrates using a chromogenic substrate. Thromb Res 1989; 53:191-6. [PMID: 2922707 DOI: 10.1016/0049-3848(89)90379-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A Farrugia
- Blood Products Development Department, Commonwealth Serum Laboratories, Parkville, Victoria, Australia
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Ashcroft GW, Beaumont G, Bonn J, Brandon S, Briggs A, Clark D, Davison K, Gelder MG, Goldberg D, Herrington R. Consensus statement: panic disorder. Br J Psychiatry 1987; 150:557-8. [PMID: 3664142 DOI: 10.1192/bjp.150.4.557] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Herrington R. Handbook of Affective Disorders. Journal of Neurology, Neurosurgery & Psychiatry 1982. [DOI: 10.1136/jnnp.45.11.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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