It is challenging to balance the fetal risks associated with the use of antiepileptic drugs (AEDs) against maternal and fetal risks of seizure worsening, and therefore it is very important to define ...and distinguish the possible risks entailed by different AEDs. This paper aims to undertake a comprehensive review regarding the possible risks of four classical (phenytoin, carbamazepine, phenobarbital, and valproate) and two newer (lamotrigine and levetiracetam) AEDs during pregnancy. The review focuses on major and organ-specific malformations, dose-dependent risks, mono vs polytherapy, and clinical pharmacokinetics. A discussion regarding the safety of AED use during breastfeeding is also provided.
Paroxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression and anxiety disorders. In some epidemiological studies, slightly increased risks of major ...malformations and cardiac malformations have been reported following paroxetine exposure in the first trimester of pregnancy. However, such findings have been inconsistent. There is only one report of any overdose of an SSRI during pregnancy, and that involved escitalopram. The aim of this case report was to describe the impact of a paroxetine overdose in the first trimester of pregnancy on the health of the foetus. A 21-year-old mother of one child who was pregnant with a second child was prescribed 20 mg/day paroxetine hydrochloride for the treatment of anxiety/depression. The patient ingested 15 or 16 20-mg tablets of paroxetine hydrochloride (300–320 mg) during the 5th week of pregnancy as a suicide attempt. Within 15 min of ingestion, she was admitted to hospital and treated for intoxication. No evidence of maternal SSRI intoxication was observed after treatment. The patient consulted our teratology information service for further risk assessment regarding possible major congenital malformations following the paroxetine overdose. We were unable to find previous reports of paroxetine overdose during pregnancy in the literature. The timely administration of the overdose treatment and the lack of maternal intoxication symptoms were considered positive for the foetal well-being, and the patient was referred for perinatology and psychiatry follow-ups. A healthy, 3 500-g male infant was born at 38 weeks’ gestation, and his development at the age of 2 years was normal. This is the first reported case of paroxetine overdose during pregnancy. Comprehensive studies are needed to evaluate pregnancy outcomes after SSRI overdose.Key PointsThere are no reported data on paroxetine overdose during pregnancy.The aim of this case report was to describe the impact of a maternal paroxetine overdose in the first trimester of pregnancy on the health of the foetus. No evidence of maternal SSRI intoxication was observed.No congenital malformations or developmental disorders were observed in the child at 2 years of age.Comprehensive studies are needed to evaluate pregnancy outcomes following SSRI overdose.
Amaç: Kırılganlık son yıllarda gittikçe önem kazanan bir durumdur. Çalışmamızda 65 yaş üzeri kişilerde kırılganlık ile ilaç kullanımı ve polifarmasi arasındaki ilişkinin incelenmesi amaçlanmıştır.
...Yöntemler: Çalışmaya aile hekimliği polikliniklerine başvuran 65 yaş üstü kişiler dahil edildi. Çalışmamızda Tilburg kırılganlık ölçeği, kalk ve yürü testi ve yürüme hızı testi kullanıldı. Çok değişkenli doğrusal ve lojistik regresyon modeli uygulandı.
Bulgular: Beş ve üzerinde ilaç kullananlar (polifarmasi), katılımcıların %49,1’ini oluşturmaktaydı. Polifarmasi olanların %55,6’sı (n=74) kırılgandı. İlaç kullanımı olanlarda ve polifarmasi saptananlarda kronik hastalık sayısı, Tilburg kırılganlık ölçeği toplam skoru, kalk ve yürü testi skoru istatiksel anlamlı olarak daha yüksek; yürüme hızı testi skoru istatiksel anlamlı olarak daha düşük bulundu. Cinsiyet (β=-0,560, %95 Cl=-0,943;-0,177) ve kronik hastalık sayısının (β=1,496, %95 Cl=1,376; 1,616) toplam ilaç sayısı üzerine etkili olduğu saptandı. Polifarmasi üzerine yapılan lojistik regresyon analizi sonuçlarına göre; kadın cinsiyetin (aOR=3,4, %95 Cl=1,412-8,639), bekar/dul olmanın (aOR=2,8, %95 Cl=1,133-7,201), kronik hastalık sayısının (aOR=6,8, %95 Cl=4,218-11,075) polifarmasi riskini artırdığı tespit edildi.
Sonuç: Çalışmamızda polifarmasi tespit edilen yaşlılarda, kırılganlık skoru ve yürüme hızlarında belirgin olarak kötüleşme tespit edilmiştir. Altmış beş yaş üstü kişilerde ilaç kullanımı daha dikkatli bir şekilde sorgulanmalı, polifarmasi olan bireylerin kırılganlığa yatkın olabileceği unutulmamalıdır.
Aim:Frailty has become an important health issue in recent years. The aim of this study was to investigate the relationship between frailty and medicine use and polypharmacy in people over 65 years ...of age.Methods:Patients aged 65 years and over, who were admitted to family medicine outpatient clinics, were included in the study. The Tilburg frailty indicator, timed up and go test and gait speed test were used. Multivariate linear and logistic regression model were conducted.Results:Individuals, who used five or more medicines (polypharmacy) daily, constituted 49.1% of all participants. 55.6% of patients on polypharmacy were frail. Gender (β=-0.560, 95% Cl=-0.943-0.177) and the number of chronic diseases (β=1.496, 95% Cl=1.376-1.616) were found to have an effect on the total number of medicines. According to the results of logistic regression analysis on polypharmacy; female gender (aOR=3.4, 95% Cl=1.412-8.639), living alone (single/divorced/widowed) (aOR=2.8, 95% Cl=1.133-7.201) and number of chronic diseases (aOR=6.8, 95% Cl=4.218-11.075) were significantly associated with increased risk of polypharmacy.Conclusion:A significant increase in frailty score and reduction in walking speeds were detected in patients aged 65 years and over on polypharmacy. It should be kept in mind that polypharmacy is significantly related with frailty in elderly patients.
Aims
The objective of this meta‐analysis was to determine whether gestational use of hydroxychloroquine (HCQ) for autoimmune disorders leads to an increase in the risk for adverse pregnancy outcomes.
...Methods
MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched from inception to November 21 2014. Studies which reported the outcomes of pregnant women after exposure to HCQ during pregnancy and including a control (unexposed) group were included. Two independent reviewers carried out the review and the quality assessment using the Methodological Index for Non‐Randomized Studies (MINORS). A random effects method was used to calculate the odds ratios (OR) for the outcomes.
Results
The meta‐analysis reported no significant increases in rates of major congenital (OR 1.13, 95% confidence interval (CI) 0.59, 2.17), craniofacial (OR 0.62, 95% CI 0.13, 3.03), cardiovascular (OR 1.06, 95% CI 0.29, 3.86), genitourinary (OR 1.38, 95% CI 0.42, 4.53), nervous system malformations (OR 1.81, 95% CI 0.31, 10.52), stillbirth (OR 0.69, 95% CI 0.35, 1.34), low birth weight (OR 0.69, 95% CI 0.21, 2.27) or prematurity (OR 1.75, 95% CI 0.95, 3.24). The rate of spontaneous abortions, however, was found to be significantly increased in HCQ exposed pregnancies (OR 1.85, 95% CI 1.10, 3.13). No significant heterogeneity was detected among the studies for the evaluated outcomes except prematurity.
Conclusions
Prenatal exposure to HCQ for autoimmune diseases does not appear to increase the risk of adverse pregnancy outcomes except spontaneous abortion rate, which may be associated with the underlying disease activity (bias by indication) and needs further investigation.
The objective of this study was to determine whether smoking was associated with the cumulative radiographic spinal damage and radiographic progression in patients with ankylosing spondylitis (AS). ...Thus, we conducted a systematic review and meta-analysis of the available studies to date.
An electronic search was conducted from inception to June 21, 2016, in EMBASE, the MEDLINE/PubMed Cochrane Central Register of Controlled Trials databases. Cross-sectional and longitudinal cohort studies investigating the association between smoking and cumulative spinal structural damage or radiographic progression were included. The outcome of interest was the presence of syndesmophytes in cross-sectional studies and radiographic progression in longitudinal studies. The quality assessment was done using the Agency for Healthcare Research and Quality checklist. The authors of potentially relevant studies were contacted regarding the unpublished data. Data from eligible cross-sectional studies were extracted and arranged in a 2x2 table. The odds ratios (ORs) and 95% confidence intervals (CIs) for the dichotomous outcome of interest were computed.
The combined data of eight eligible cross-sectional studies for the assessment of association between smoking and cumulative spinal structural damage suggested a significant association (OR, 2.02; 95% CI, 1.51-2.70). No significant heterogeneity was detected between studies (I
=23.0%, p=0.25). The heterogeneity of the longitudinal study data did not permit us to undertake a meta-analysis. Hence, a qualitative review was performed.
The results of our meta-analysis show that smoking is associated with increased cumulative spinal structural damage in patients with AS. Therefore, rheumatologists should encourage patients with AS to quit smoking.
Anti-consumption attitudes affect public health when they expand from the domain of private goods to that of social goods and services, including health services.6 Anti-consumption refers to 'a ...resistance to, distaste for, or even resentment of consumption'.7 This attitude assumes forms ranging from active behaviors - boycotting or choosing to voluntarily simplify one's life - to more passive ones - avoiding a particular brand, product, or category of products.8 Avoidance may emanate from product-related dissatisfaction, unwillingness to identify with groups of users, or be a manifestation of moral and ideological values.9 Studies now suggest that moral and ideological values contribute to vaccine avoidance.
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