Severe cutaneous adverse reactions due to inappropriate medication use

Summary

Backgroud

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Objectives

To estimate the proportion of SCARs related to inappropriate medication use.

Methods

Retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected to induce SCARs (i.e., not just the drug regarded as "the most probable") were considered regarding three causes of preventability: (1) prescription for an inappropriate indication, (2) unintentional rechallenge despite a previous allergy to the drug, or (3) self-medication with prescription medicines.

Results

602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered appropriately used for 417 of the 602 individuals included in the study population (69.3%, 95% CI [65.6-73.0]),and inappropriately used. for 144 individuals (23.9% [20.5-27.3]).. These inappropriate uses were mainly due to prescriptions for inappropriate indication (65.8% [58.4-73.2]) or unintentional rechallenge (20.9% [14.6-27.2]). Allopurinol and cotrimoxazole were the drugs most frequently involved in inappropriate indications (accounting for 51.9% [42.3-61.5] and 13.5% [6.9-20.1] of cases, respectively). Antibiotics were the largest group involved in unintentional rechallenge. Non-steroidal anti-inflammatory drugs available on prescription were most involved in inappropriate self-medication.

Conclusions

Our results underline the need for respecting the appropriate indication of drugs to reduce the incidence of SCARs. All efforts to reduce unintentional rechallenge also seem to be necessary preventive measures.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EZMViW

A multi-centre, open, investigator initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0.015% on the face and scalp, and 0.05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT)

Abstract

Background

Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations.

Objectives

To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population.

Methods

In this multi-centre, open-label, interventional, parallel group, prospective phase 4 study (PERFECT, NCT02716714), the eligible subjects were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the subjects were followed-up for 6 months. The primary efficacy endpoint was complete clearance (CC) rate of AK lesions in the selected treatment area on Day 57. The quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain, and adverse events.

Results

In total, 78.1% (95% CI: 66.86–86.92%) of subjects had CC on day 57, with 76.6% (95% CI: 64.31–86.25%) in face/scalp group and 88.9% (95% CI: 51.75–99.72%) in trunk/extremities group. Among them, the CC rate was sustained in 88.9% (48/54 subjects, 95% CI: 77.37–95.81%) on Month 6. The local skin responses significantly increased 1 day after the treatment compared to baseline, and decreased afterwards. Among the total subjects, 7.8% (6/77 subjects) had hyperpigmentation on the application area. Scars were not reported.

Conclusions

Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

This article is protected by copyright. All rights reserved.

http://ift.tt/2DxXZXA

Severe cutaneous adverse reactions due to inappropriate medication use

Summary

Backgroud

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Objectives

To estimate the proportion of SCARs related to inappropriate medication use.

Methods

Retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected to induce SCARs (i.e., not just the drug regarded as "the most probable") were considered regarding three causes of preventability: (1) prescription for an inappropriate indication, (2) unintentional rechallenge despite a previous allergy to the drug, or (3) self-medication with prescription medicines.

Results

602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered appropriately used for 417 of the 602 individuals included in the study population (69.3%, 95% CI [65.6-73.0]),and inappropriately used. for 144 individuals (23.9% [20.5-27.3]).. These inappropriate uses were mainly due to prescriptions for inappropriate indication (65.8% [58.4-73.2]) or unintentional rechallenge (20.9% [14.6-27.2]). Allopurinol and cotrimoxazole were the drugs most frequently involved in inappropriate indications (accounting for 51.9% [42.3-61.5] and 13.5% [6.9-20.1] of cases, respectively). Antibiotics were the largest group involved in unintentional rechallenge. Non-steroidal anti-inflammatory drugs available on prescription were most involved in inappropriate self-medication.

Conclusions

Our results underline the need for respecting the appropriate indication of drugs to reduce the incidence of SCARs. All efforts to reduce unintentional rechallenge also seem to be necessary preventive measures.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EZMViW

Heath risk among pesticide sellers in Bamenda (Cameroon) and peripheral areas

Abstract

In Bamenda and peripheral zones, studies have been focused on the effects of pesticides on farmers (pesticide users) while nothing has been done to assess the exposure of sellers to pesticides. This study aimed at evaluating the exposure of pesticide sellers in the same area. Thirty-two questionnaires were administered to 32 pesticide sellers systematically selected, and chi-square was used for statistical analysis. From each shop, a respondent was chosen among the workers according to its daily time spent in the workplace. The results showed that there is similarity between sellers in Bamenda and peripheral area; one active ingredient (metalaxyl) and one formulation (beauchamp) sold are not registered; throat irritation, headaches, fatigue, skin irritation, eye irritation, and difficulty in breathing with more cases of nose irritation were symptoms observed; pesticides are stored either in the shops or in warehouses; safety measures generally applied are sitting outside the shop, taking medicated charcoal and the use of protective clothing; 56% have less than 5 years experience. Permanent pesticide sellers are then exposed to chronic intoxication in Bamenda and neighboring zones. Employers should make use of protective clothing in their shops when manipulating pesticides in the application of safety measures.

http://ift.tt/2DRDfb7

Modeling the impact of transport energy consumption on CO 2 emission in Pakistan: Evidence from ARDL approach

Abstract

The objective of this research is to examine the relationship between transport energy consumption, economic growth, and carbon dioxide emission (CO₂) from transport sector incorporating foreign direct investment and urbanization. This study is carried out in Pakistan by applying autoregressive distributive lag (ARDL) and vector error correction model (VECM) over 1990–2015. The empirical results indicate a strong significant impact of transport energy consumption on CO₂ emissions from the transportation sector. Furthermore, foreign direct investment also contributes to CO₂ emission. Interestingly, the impact of economic growth and urbanization on transport CO₂ emission is statistically insignificant. Overall, transport energy consumption and foreign direct investment are not environmentally friendly. The new empirical evidence from this study provides a complete picture of the determinants of emissions from the transport sector and these novel findings not only help to advance the existing literature but also can be of special interest to the country's policymakers. So, we urge that government needs to focus on promoting the energy efficient means of transportation to improve environmental quality with less adverse influence on economic growth.

http://ift.tt/2DoN4fH

Cortical visual prostheses: from microstimulation to functional percept.

Cortical visual prostheses: from microstimulation to functional percept.

J Neural Eng. 2018 Jan 19;:

Authors: Najarpour Foroushani A, Pack C, Sawan M

Abstract
Cortical visual prostheses are intended to restore vision by targeted electrical stimulation of the visual cortex. The perception of spots of light, called phosphenes, resulting from microstimulation of the visual pathway, suggests the possibility of creating meaningful percept made of phosphenes. However, to date electrical stimulation of V1 has still not resulted in perception of phosphenated images that goes beyond punctate spots of light. In this review, we summarize the clinical and experimental progress that has been made in generating phosphenes and modulating their associated perceptual characteristics in human and macaque primary visual cortex (V1). We focus specifically on the effects of different microstimulation parameters on perception and we analyse key challenges facing the generation of meaningful artificial percepts. Finally, we propose solutions to these challenges based on the application of supervised learning of population codes for spatial stimulation of visual cortex.

PMID: 29350199 [PubMed - as supplied by publisher]

http://ift.tt/2DtxPW9

Integrated biocircuits: engineering functional multicellular circuits and devices.

Integrated biocircuits: engineering functional multicellular circuits and devices.

J Neural Eng. 2018 Jan 19;:

Authors: Prox J, Smith T, Holl C, Chehade N, Guo L

Abstract
Novel in vitro platforms are currently revolutionizing the study and reconstruction of cellular circuitry to bypass the pertaining obstacles of data retrieval in vivo. While earlier approaches have provided great insights into culturing circuits in planar dissociated cell culture systems, the lack of full control over network activity and formation limits our understanding of their functionality. Thus, integrating various controllable parameters are required in creating a suitable microenvironment including cell patterning, highly-specified electrical and chemical stimuli, and rational circuit formation via logic functions. Recent advancements in organoid and 3D culture systems account for another major microenvironment factor of cytoarchitecture to construct multicellular circuits as they are normally formed in the brain and other neural structures and compare them to disease models to identify the underlying principles of pathology. This perspective focuses on exploring the current state of the art of living multicellular device technologies to provide knowledge of the advancements of the fabrication processes and identify the current biological principles that are applied in designing these devices. It then provides perspectives and proposes new insights into the future of these devices within the scope of living cellular devices that can be applied in designing more reliable and biocompatible stimulation-based neuroprosthetics.

PMID: 29350183 [PubMed - as supplied by publisher]

http://ift.tt/2EYPguG