Adverse effects of synthetic cannabinoids

Baum RA, et al. Suspected synthetic cannabinomimetic intoxication. J Pharm Pract. 2017 Jan 1:897190017699761.

Recent legislation has failed to curb the public health concerns emanating from SC misuse. Education about the risks of SC use along with additional regulation may be required to remove the false sense of safety that some individuals, especially adolescents and young adults, may associate with these compounds, which are often misconstrued as “herbal marijuana.” Clinicians need to be prepared to identify and treat symptoms of SC intoxication as incidents of toxicity continue to rise.

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Castellanos D, Gralnik LM. Synthetic cannabinoids 2015: An update for pediatricians in clinical practice. World J Clin Pediatr. 2016 Feb 8;5(1):16-24.

Synthetic cannabinoids are a group of substances that are typically much more potent than natural cannabis. These substances have been increasingly abused by youth over the past few years. A number of published reports have emerged documenting the serious health consequences associated with use of these products. Seizures, myocardial infarction and renal damage are some of the significant physical consequences associated with their use. With current limitations of toxicological analyses pediatricians are urged to familiarize themselves with these drugs and the typical presentations of patients who use them.

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Spasmus nutans

Delorme C, Gras D, Roze E. Spasmus nutans: more than meets the eye. Pediatr
Neurol. 2015 Oct;53(4):367-8.

“Spasmus nutans is a rare transient movement disorder of early childhood, defined by the clinical triad (1) nystagmus, (2) head nodding, and (3) torticollis, in the absence of any associated ophthalmological or neurological condition. [1] This condition might be difficult to recognize and is rarely reported in the literature.”

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Practice Based Learning: Management of agitation in Autism Spectrum Disorder

 

 

 

Presented by Mohammed Shahnawaz MD (PGY1)

Objectives:

  • Elucidate Autism Spectrum Disorder (ASD) characteristics and prevalence of aggression
  • Discuss options for relieving agitation and aggression
  • Inform ourselves about pharmaceutical options to reduce aggressive behavior
  • Explore future study opportunities

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Antibiotic treatment for Shigella infections

Klontz KC, Singh N. Treatment of drug-resistant Shigella infections. Expert Rev Anti Infect Ther. 2015 Jan;13(1):69-80.

Since the introduction of sulfonamides in the late 1930s, selective pressure and the widespread dissemination of mobile genetic elements conferring antimicrobial resistance have forced clinicians to seek successive agents for the treatment of multidrug-resistant shigellosis. Over the decades, the principal antibiotics used to treat Shigella infections have included tetracycline, chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid. Presently, ciprofloxacin, azithromycin, and ceftriaxone serve as the mainstays of treatment, although growing evidence has documented decreased susceptibility or full resistance to these agents in some regions. With diminishing pharmaceutical options available, there is an enhanced need for preventive measures in the form of improved sanitation and hygiene standards, strict use of currently effective agents, and a safe and effective licensed vaccine.

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Holmes LC. Shigella. Pediatr Rev. 2014 Jun;35(6):261-2.

“The choice of which antibiotic to administer is another treatment question. A 2010 Cochrane review of 16 randomized controlled trials evaluating antibiotics for shigella dysentery found all classes of antibiotics had similar efficacy, and the authors were not able to identify a superior class of antibiotics. In the United States, the 2010 National Antimicrobial Resistance Monitoring System found 41% of Shigella species resistant to ampicillin, 48% resistant to trimethoprim-sulfamethoxazole, 2% resistant to ciprofloxacin, and less than 1% resistant to ceftriaxone. Antibiotic resistance in outbreaks has been reported to be much higher. Arvelo et al found 90% of the Shigella strains involved in a large daycare center–associated outbreak resistant to both ampicillin and trimethoprim-sulfamethoxazole. Knowing regional resistance patterns and the susceptibility pattern of the pathogen once available is essential to guide therapy.”

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Christopher PR, et al. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD006784.

Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

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Antibiotic prophylaxis of pertussis

Altunaiji S, et al. Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004404. (Edited (no change to conclusions), comment added to review in Issue 3, 2013.)

“This systematic review of RCTs examining the treatment of whooping cough has found that antibiotic treatment is effective in eliminating B. pertussis from the nasopharynx and thus rendering participants non-infectious, but does not alter the clinical course of the illness. Prophylaxis with antibiotic was significantly associated with side effects; it did not significantly improve clinical symptoms, prevent the development of culture-positive B. pertussis, nor paroxysmal cough for more than two weeks, in contacts older than six months of age.”

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Staphylococcal scalded skin syndrome

Mishra AK, et al. A Systemic Review on Staphylococcal Scalded Skin Syndrome (SSSS): A Rare and Critical Disease of Neonates. Open Microbiol J. 2016 Aug 31;10:150-9.

The symptoms of Staphylococcal scalded skin syndrome (SSSS) include blistering of skin on superficial layers due to the exfoliative toxins released from Staphylococcus aureus. After the acute exfoliation of skin surface, erythematous cellulitis occurs. The SSSS may be confined to few blisters localized to the infection site and spread to severe exfoliation affecting complete body. The specific antibodies to exotoxins and increased clearance of exotoxins decrease the frequency of SSSS in adults. Immediate medication with parenteral anti-staphylococcal antibiotics is mandatory. Mostly, SSSS are resistant to penicillin. Penicillinase resistant synthetic penicillins such as Nafcillin or Oxacillin are prescribed as emergency treatment medicine. If Methicillin-resistant Staphylococcus aureus (MRSA) is suspected), antibiotics with MRSA coverage (e.g., Vancomycin or Linezolid) are indicated. Clindamycin is considered as drug of choice to stop the production of exotoxin from bacteria ribosome. The use of Ringer solution to to balance the fluid loss, followed by maintenance therapy with an objective to maintain the fluid loss from exfoliation of skin, application of Cotrimoxazole on topical surface are greatly considered to treat the SSSS. The drugs that reduce renal function are avoided. Through this article, an attempt has been made to focus the source, etiology, mechanism, outbreaks, mechanism, clinical manifestation, treatment and other detail of SSSS.

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Braunstein I, et  al. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014 May-Jun;31(3):305-8.

Historical resistance patterns often guide empiric antibiotic choices in staphylococcal scalded skin syndrome (SSSS), but little is known about the difference in susceptibility between SSSS and other childhood staphylococcal infections. A retrospective chart review of culture-confirmed cases of SSSS seen in the inpatient dermatology consultation service at the Children’s Hospital of Philadelphia between 2005 and 2011 was performed. Most cases of SSSS at our institution are due to oxacillin-susceptible Staphylococcus aureus, and approximately half of the cases are due to clindamycin-resistant strains. Clindamycin and a penicillinase-resistant penicillin are suggested as empiric treatment for SSSS until culture susceptibility data are available to guide therapy.

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The utility of blood cultures in pyelonephritis

Kim Y, et al. Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis. Infect Chemother. 2017 Mar;49(1):22-30.

APN is diagnosed by clinical signs and symptoms of upper urinary tract infection, and isolation of the pathogen from urine [4]. In clinical practice, blood cultures and radiologic imaging studies such as CT are commonly used [5,6,13]. Although these tests have been performed on a substantial number of patients, there has been controversy as to their accuracy and usefulness. The purpose of this study was to evaluate the impact of blood cultures and radiologic tests on the management of CA-APN patients.

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Polymicrogyria

Shain C, et al. Polymicrogyria-associated epilepsy: a multicenter phenotypic study from the Epilepsy Phenome/Genome Project. Epilepsia. 2013 Aug;54(8):1368-75.

Polymicrogyria (PMG) is an epileptogenic malformation of cortical development. We describe the clinical epilepsy and imaging features of a large cohort with PMG-related epilepsy.

Participants with PMG had both focal and generalized onset of seizures. Our data confirm the involvement of known topographic patterns of PMG and suggest that more extensive distributions of PMG present with an earlier age of seizure onset and increased prevalence of developmental delay prior to seizure onset.

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Barkovich AJ. Current concepts of polymicrogyria. Neuroradiology. 2010 Jun;52(6):479-87.

Polymicrogyria is one of the most common malformations of cortical development. It has been known for many years and its clinical and MRI manifestations are well described. Recent advances in imaging, however, have revealed that polymicrogyria has many different appearances on MR imaging, suggesting that is may be a more heterogeneous malformation than previously suspected. The clinical and imaging heterogeneity of polymicrogyria is explored in this review.

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