Pharmacological Side Effects Research Articles

Psychological and pharmacological interventions for depression in patients with coronary artery disease.

Psychological and pharmacological interventions for depression in patients with coronary artery disease.

Design, Development and Evaluation of Matrix Tablet

Recently, sustained release formulations have become a very helpful tool in medical practice, providing patients with a variety of benefits. Sustained release is also a potential method for reducing pharmacological side effects by preventing fluctuations in the concentration of the drug in the plasma. Nowadays, relatively few pharmaceuticals are emerging from research and development, and current drugs are suffering from resistance as a result of their inappropriate usage. Thus, altering the operation is an appropriate and optimum method of increasing the effectiveness of a medicine by a little variation in the drug distribution. The release of the medication through such a system is regulated by both dissolution and diffusion processes. Most medications, if not correctly designed, may quickly release the drug at a higher pace, resulting in hazardous concentrations of the drug upon oral administration. This review discusses the fundamentals of sustained release formulations and the many varieties available.
 Key words: Matrix tablets, Sustained release, Sustain release polymers, Patient convenience and compliance.

Issue Highlights

BioFactorsVolume 47, Issue 6 p. 884-884 ISSUE HIGHLIGHTSFree Access Issue Highlights First published: 11 December 2021 https://doi.org/10.1002/biof.1657AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Targeting tumor microenvironment by curcumin Xiao Fu, Yingni He, Mu Li, Zezhi Huang and Masoud Najafi To achieve the appropriate therapeutic response, we must kill cancer cells and suppress the release of immunosuppressive molecules. The balance between anti-tumor immunity and immunosuppressive cells, such as regulatory T cells, cancer-associated fibroblasts, tumor-associated macrophages, and myeloid-derived suppressor cells, plays a key role in the suppression or promotion of cancer cells. Curcumin is a plant-derived agent that has shown interesting properties for cancer therapy. It has shown that not only directly inhibit the growth of cancer cells but can also modulate the growth and activity of immunosuppressant and tumor-promoting cells. In this review, we explain how curcumin modulates interactions within TME in favor of tumor treatment. 914 Biological effects of ginger and its bioactive components in cardiovascular disease Nazanin Momeni Roudsari, Naser-Aldin Lashgari, Saeideh Momtaz, Basil Roufogalis, Amir Hossein Abdolghaffari and Amirhossein Sahebkar Inflammation and oxidative stress play critical roles in progression of cardiovascular disease. The anti-inflammatory and antioxidant properties of ginger (the rhizome of Zingiber officinale) and its bioactive components have been confirmed in many studies. Ginger blocks pro-inflammatory cytokines and the activation of the immune system and suppresses the activity of oxidative molecules. Ginger has been shown to have potent inhibitory effects against NF-κB; signal transducer and activator of transcription; NOD-, LRR-, and pyrin domain-containing proteins; toll-like receptors; MAPK; and mTOR signaling pathways. We summarize the biochemical pathologies underpinning a variety of cardiovascular diseases and the effects of ginger and its bioactive components, including 6-shogaol, 6-gingerol, and 10-dehydrogingerdione. 933 Therapeutic studies and biological properties of Teucrium polium Golgi stress response Fatma Rahmouni, Mongi Saoudi and Tarek Rebai Teucrium polium has been used in traditional medicine as antifungal, antipyretic, antispasmodic, and antibacterial. The effects of this plant have been investigated in kidney, liver, and brain. Its antidiabetic, antimicrobial, antioxidant, and anticancer effects have been introduced. Polyphenolic compounds, flavonoids, monoterpenes, alkanoides, and essential oils were identified. Several studies revealed that this plant has a hypoglycemic effect and can help to control blood sugar. In addition, T. polium has secondary effects on different organs, namely liver, kidney and at high doses this plant becomes toxic. In conclusion, this review investigates many pharmacological properties and side effects of T. polium. 952 Biological and pharmacological activities of noscapine Fahimeh Nourbakhsh and Vahid Reza Askari With few side effects and amazing capabilities, noscapine can be considered different from other opioids-like structure compounds. Since 1930, extensive studies have been conducted in the field of pharmacological treatments for malaria to control cough and cancer treatment. Furthermore, recent studies have shown that noscapine and some analogues, like 9-bromonoscapine, amino noscapine, and 9-nitronoscapine, can be used to treat polycystic ovaries syndrome, stroke, and other diseases. Given the numerous results presented in this field and the role of different receptors in the therapeutic effects of noscapine, we review the properties, therapeutic effects, and the role of receptors in the treatment of noscapine. 975 REFERENCES 1Xiao Fu, Yingni He, Mu Li, Zezhi Huang and Masoud Najafi. Targeting tumor microenvironment by curcumin. BioFactors. 2021; 47: 914– 932. Wiley Online LibraryGoogle Scholar 2Nazanin Momeni Roudsari, Naser-Aldin Lashgari, Saeideh Momtaz, Basil Roufogalis, Amir Hossein Abdolghaffari and Amirhossein Sahebkar. BioFactors. 2021; 47: 933– 951. Google Scholar 3Fatma Rahmouni, Mongi Saoudi and Tarek Rebai. Therapeutic studies and biological properties of Teucrium polium Golgi stress response. BioFactors. 2021; 47: 952– 963. Wiley Online LibraryGoogle Scholar 4Fahimeh Nourbakhsh and Vahid Reza Askari. Biological and pharmacological activities of noscapine. BioFactors. 2021; 47: 975– 991. Wiley Online LibraryGoogle Scholar Volume47, Issue6November/December 2021Pages 884-884 ReferencesRelatedInformation

Comparative Study of Various Nuclear Medicine Imaging Technique - A Review

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). The radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The most serious issue with their use is the potential for diagnostic mistakes due to changes in their biodistribution. The appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic domains, as well as the impact of new multimodality imaging techniques, are all having a significant impact on nuclear medicine (SPECT-CT, PET-CT, PET-MRI, etc.). It is crucial to understand the techniques limitations, radiopharmaceutical distribution and potential physiological changes, radiological contrast contraindications and bad responses, and the possibility of both interfering. The process of generating radiopharmaceuticals is introduced and relevant interactions of radiation with matter are discussed. Diagnostic nuclear medicine instrumentation is explained, and future trends in nuclear medicine imaging technology are forecasted.

Comparative Study of Various Nuclear Medicine Imaging Technique - A Review

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). The radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The most serious issue with their use is the potential for diagnostic mistakes due to changes in their biodistribution. The appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic domains, as well as the impact of new multimodality imaging techniques, are all having a significant impact on nuclear medicine (SPECT-CT, PET-CT, PET-MRI, etc.). It is crucial to understand the techniques limitations, radiopharmaceutical distribution and potential physiological changes, radiological contrast contraindications and bad responses, and the possibility of both interfering. The process of generating radiopharmaceuticals is introduced and relevant interactions of radiation with matter are discussed. Diagnostic nuclear medicine instrumentation is explained, and future trends in nuclear medicine imaging technology are forecasted.

Comparative Study of Ondansetron Versus Dexamethasone in the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia

Introduction: Postoperative nausea and vomiting (PONV) have been termed as the “big little problem” for anesthesiology during laparoscopic surgery. Pain and postoperative nausea and vomiting are the most common causes of morbidity after anesthesia and surgery. We aimed to evaluate the effects of Ondansetron and Dexamethasone in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy, as well as to note any pharmacological side effects that occurred after their usage. Methods: In this prospective, randomized, double blind controlled study, trial was done after approval from the IRB and trail registry, 60 female patients of American Society of Anesthesiologists physical status I and II, aged 18 to 65 years, weighing 50-60 kg, and standing 150 to 160 cm, were given institutional ethical committee clearance and written informed consent before undergoing laparoscopic cholecystectomy (duration 90 minutes) under general anesthesia. Patients arriving in the operating room were sorted into two groups of 30 patients each. All patients were monitored after surgery, documenting vital signs and any difficulties that arose. For the first 12 hours after surgery, all bouts of PONV (nausea, vomiting, and retching) were documented. Each patient's data was gathered and tallied. Results: The patients in the study group were similar in age, weight, height, ASA status, and operation duration (p 0.05), and there was no significant statistical difference between the data gathered throughout the study Conclusions: Ondansetron is just as effective as Dexamethasone at lowering nausea and vomiting after laparoscopic cholecystectomy, and it comes with less adverse effects.

The interaction of a β2 adrenoceptor agonist drug with biomimetic cell membrane models: The case of terbutaline sulphate

Terbutaline sulphate (TS) is a selective short-acting β2 adrenoceptor agonist used for asthma treatment. The pharmacological activity of TS depends on its binding to the transmembrane protein, β2 adrenoceptor. Thus, the interactions of this drug with biological membranes are expected, affecting its pharmacological activity. Using in vitro models to study the interaction of TS with biological membranes can provide important information about the activity of the drug. Here, liposomes with different lipid compositions were used as biomimetic models of cell membranes to evaluate the effect of composition, complexity, and physical state of membranes on TS-membrane interactions. For that, liposomes containing dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and liposomes containing DMPC and cholesterol (CHOL) were prepared. For the study of TS-membrane interactions, the TS lipophilicity was evaluated in terms of i) partition coefficient; ii) the preferential location of the drug within the membrane; iii) and the effect of TS on the membrane fluidity. The obtained data suggest that TS has an affinity for the lipid membrane, partitioning from the aqueous to the lipid phase. The affinity was dependent on the liposomes' compositions, showing a greater affinity for DMPC membranes than for DMPC:CHOL model. Dynamic light scattering (DLS) results revealed that this is due to the rigidizing effect caused by CHOL molecules. These findings provide valuable insights in the understanding of the complex interaction of TS with biomembrane models as well as the relevance of lipid compositions and membrane structure in such interactions, which may be related to its pharmacological activity and side effects.

Safety Pharmacological studies of Kalyanaka ghrita

Safety pharmacology is a study of unfavorable, pharmacodynamic effects of a drug on physiological functions with therapeutic range by using International Conference on Harmonization (ICH) S7A guidelines. The cardiovascular, central nervous, and respiratory systems are most affected by pharmacological side effects, resulting withdrawal of multiple medications from the market. Kalyanaka ghrita (KG) is an Ayurvedic formulation with ghee as a major basic component, though a promising candidate in treatment of AD, KG has not been documented for its safety profile, which prompted the study. In this study we evaluated safety pharmacology of KG oral (4, 2, 1g/kg), and nasal (100, 50, 25 µl/rat), in Wistar rats for 28 days subjected to CNS, CVS and the respiratory safety profile was evaluated on day 0, 14 and 28. At the end of the study the nasal turbinate was evaluated histopathologically. In the present study KG did not cause any significant change in CNS profile. However KG treatment had increased the grooming and rearing behaviors, which were not significant compared to vehicle control and did not cause change in CVS and respiratory profile upon treatment with KG for 28 days. The epithelium of nasal turbinate of animals was found intact after 28 days of nasal administration. After sustained dosing, the KG oral and intranasal treated groups showed no harmful events, which illustrates the CNS, CVS and respiratory safety profile of Kalyanaka ghrita.

Lack of consideration of sex and gender in COVID-19 clinical studies

Sex and gender differences impact the incidence of SARS-CoV-2 infection and COVID-19 mortality. Furthermore, sex differences influence the frequency and severity of pharmacological side effects. A large number of clinical trials to develop new therapeutic approaches and vaccines for COVID-19 are ongoing. We investigated the inclusion of sex and/or gender in COVID-19 studies on ClinicalTrials.gov, collecting data for the period January 1, 2020 to January 26, 2021. Here, we show that of the 4,420 registered SARS-CoV-2/COVID-19 studies, 935 (21.2%) address sex/gender solely in the context of recruitment, 237 (5.4%) plan sex-matched or representative samples or emphasized sex/gender reporting, and only 178 (4%) explicitly report a plan to include sex/gender as an analytical variable. Just eight (17.8%) of the 45 COVID-19 related clinical trials published in scientific journals until December 15, 2020 report sex-disaggregated results or subgroup analyses.

Dopamine docking studies of biologically active metabolites from Curcuma longa L.

The dopaminergic system is involved in a wide range of neuropsychiatric and neurodegenerative disorders. The lack of receptor subtype specificity is related to several pharmacological side effects that are observed during therapy among parkinsonian and schizophrenic patients. It is of paramount importance to search for new compounds that act on dopamine receptors with therapeutic potential, higher clinical effectiveness, and fewer adverse effects. In the present study, we performed a molecular docking study of D2, D3, and D4 receptor interactions with 92 metabolites from Curcuma longa using an in silico approach. We sought to identify compounds for possible drug development. A virtual library of compounds was built using molecules that were identified in the phytochemical characterization of C. longa. Protocols that were validated by redocking were applied to a virtual scan of this library using the Autodock-v4.2.3, Autodock Vina, and Molegro-v6.0 Virtual Docker programs, with four repetitions each. The three-dimensional structures of D2, D3, and D4 receptors in complex with risperidone, eticlopride, and nemonapride were obtained from the Protein Data Bank. Four compounds—stigmasterol, β-sitosterol, cholest-5-en-3-one, and cholestan-3-ol,2-methylene-(3β, 5α)—were the most likely to bind D2, D3, and D4 dopamine receptors, suggesting their potential for possible drug development.

Abuse Potential of Synthetic Cannabinoids: AM-1248, CB-13, and PB-22.

Currently, the expanding recreational use of synthetic cannabinoids (SCBs) threatens public health. SCBs produce psychoactive effects similar to those of tetrahydrocannabinol, the main component of cannabis, and additionally induce unexpected pharmacological side effects. SCBs are falsely advertised as legal and safe, but in reality, SCB abuse has been reported to cause acute intoxication and addictive disorders. However, because of the lack of scientific evidence to elucidate their dangerous pharmacological effects, SCBs are weakly regulated and continue to circulate in illegal drug markets. In the present study, the intravenous self-administration (IVSA) paradigm was used to evaluate the abuse potential of three SCBs (AM-1248, CB-13, and PB-22) in rats. All three SCBs maintained IVSA with a large number of infusions and active lever presses, demonstrating their reinforcing effects. The increase of active lever presses was particularly significant during the early IVSA sessions, indicating the reinforcement-enhancing effects of the SCBs (AM-1248 and CB-13). The number of inactive lever presses was significantly higher in the SCB groups (AM-1248 and CB-13) than that in the vehicle group, indicating their impulsive effects. In summary, these results demonstrated that SCBs have distinct pharmacological properties and abuse potential.

Vagus nerve stimulation in chronic refractory epilepsy: chasing the cardiologist

Epilepsy the second most common chronic neurological disorder after stroke affect 0.5-2% population worldwide. Antiepileptic drugs though remain the corner stone in management of epilepsy in majority of patients but still 30% of patients continues to have seizure or experience unacceptable pharmacological side effect. Electrical stimulation of vagus nerve is an effective and promising neurophysiological treatment for patients with refractory epilepsy who are either unsuitable candidate of surgery or falls in category of surgically refractory epilepsy.

Narcolepsy Treatment: Voices of Adolescents

ABSTRACT Introduction Narcolepsy, characterized by excessive daytime sleepiness, is a debilitating lifelong sleep disorder for which there is no cure. Current pharmacological and nonpharmacological treatments directed toward symptom management may be suboptimal. This qualitative study explores the perspective of adolescents on therapeutic interventions for narcolepsy. Methods Semi-structured interviews with adolescents with narcolepsy were conducted from May to August 2019 at The Hospital for Sick Children in Toronto, Canada. Qualitative thematic analysis was utilized to generate themes emerging from the data. Results Eighteen adolescents with narcolepsy (age range = 10–17, mean age = 14.4 ± 2.0 years, 72% male) participated and 56% had cataplexy. Four prominent themes arose regarding therapeutic interventions for narcolepsy. Firstly, participants described that pharmacotherapy was moderately effective but did not fully relieve symptoms associated with narcolepsy. Secondly, while medications are the first line treatment for narcolepsy, many participants reported frustration regarding medication dependence and side effects. Thirdly, nonpharmacological strategies including scheduled sleep times and exercise were accepted and often employed. Lastly, adolescents desired more psychosocial support to address mental health sequelae of narcolepsy that were not fully managed by current treatment modalities. Conclusions Medications were perceived as moderately effective for managing narcolepsy but almost all participants expressed concerns with taking medications due to side effects. Adolescents valued the importance of more holistic care for their narcolepsy treatment such as psychosocial support and nonpharmacological modalities. Further anticipatory guidance regarding pharmacological side effect profiles and better integration with nonpharmacological modalities are needed to improve disease control in adolescent patients.

Flavonoids Alleviate Peripheral Neuropathy Induced by Anticancer Drugs.

Simple SummaryChemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition that severely reduces the quality of life of a considerable proportion of cancer patients. There is no cure for CIPN to date. Here, we explore the potential of flavonoids as pharmacological agents in combating CIPN. Flavonoids alleviate CIPN by reducing oxidative stress, inflammation, and neuronal damage, among other mechanisms. Future research should evaluate the efficacy and side effects of flavonoids in human models of CIPN.Purpose: This study aimed to assess the potential of flavonoids in combating CIPN. Methods: PubMed and Google Scholar were used, and studies that investigated flavonoids in models of CIPN and models of neuropathic pain similar to CIPN were included. Only studies investigating peripheral mechanisms of CIPN were used. Results: Flavonoids inhibit several essential mechanisms of CIPN, such as proinflammatory cytokine release, astrocyte and microglial activation, oxidative stress, neuronal damage and apoptosis, mitochondrial damage, ectopic discharge, and ion channel activation. They decreased the severity of certain CIPN symptoms, such as thermal hyperalgesia and mechanical, tactile, and cold allodynia. Conclusions: Flavonoids hold immense promise in treating CIPN; thus, future research should investigate their effects in humans. Specifically, precise pharmacological mechanisms and side effects need to be elucidated in human models before clinical benefits can be achieved.

A case of juvenile CLN1– challenge in diagnosis and epilepsy treatment

ABSTRACT Introduction Classic onset of CLN1 disease is within the first year of life with developmental arrest, epilepsy and rapid progression. In an atypical variant of CLN1 disease onset is later in the juvenile epoch. Although epilepsy in the juvenile form of CLN1 often is less severe than in typical CLN1, treatment of seizures and status epilepticus may be challenging. Case presentation The clinical course, misdiagnosis and epilepsy phenotype are presented in a girl with juvenile CLN1. Cognitive and neurologic regression started at age 5.5 years. Epilepsy was a major clinical issue as the patient suffered from focal seizures, recurrent status epilepticus and epilepsia partialis continua. In one episode of refractory status epilepticus, the patient had significant bradycardia associated with the intravenous infusion of levetiracetam. Diagnosis was made at the age of 12 years, based on palmitoyl protein-thioesterase (PPT) enzyme deficiency and genetic testing that documented a homozygous exon missense mutation in the CLN1 gene (PPT1, c.541G>A, p.Val181Met). Discussion Epilepsy in all NCL patients is a major clinical issue and presumed related to neuronal excitation and epileptogenesis. The treatment of status epilepticus, in juvenile CLN1 patients, presents a particular challenge and requires monitoring of potential serious pharmacologic side effects of therapy.

Amantadine withdrawal syndrome masquerading as COVID-19 encephalopathy: a case report and review of the literature

ABSTRACTAmantadine withdrawal syndrome (AWS) is a rare but recognized cause of severe and persistent altered mental status sometimes with co-occurring extrapyramidal symptoms. First described in a case series from 1987, its clinical manifestations have been characterized along a spectrum ranging from profound hypoactive delirium to hyperactive delirium with hallucinations. Risk factors for withdrawal include abrupt medication discontinuation, prolonged use, older age and underlying dementia.Herein we describe a case of a 52-year-old woman who presented with confusion, hallucinations, and coronavirus disease-2019 infection. She subsequently developed a prolonged hypoactive delirium after her amantadine was tapered and held. Her hypoactive delirium entirely resolved with resumption of amantadine confirming the diagnosis of AWS. This case illustrates the importance of slowly tapering dopaminergic medications and being aware of rare pharmacologic side effects.

Epigenetic Reader BRD4 (Bromodomain-Containing Protein 4) Governs Nucleus-Encoded Mitochondrial Transcriptome to Regulate Cardiac Function.

BET (bromodomain and extraterminal) epigenetic reader proteins, in particular BRD4 (bromodomain-containing protein 4), have emerged as potential therapeutic targets in a number of pathological conditions, including cancer and cardiovascular disease. Small-molecule BET protein inhibitors such as JQ1 have demonstrated efficacy in reversing cardiac hypertrophy and heart failure in preclinical models. Yet, genetic studies elucidating the biology of BET proteins in the heart have not been conducted to validate pharmacological findings and to unveil potential pharmacological side effects. By engineering a cardiomyocyte-specific BRD4 knockout mouse, we investigated the role of BRD4 in cardiac pathophysiology. We performed functional, transcriptomic, and mitochondrial analyses to evaluate BRD4 function in developing and mature hearts. Unlike pharmacological inhibition, loss of BRD4 protein triggered progressive declines in myocardial function, culminating in dilated cardiomyopathy. Transcriptome analysis of BRD4 knockout mouse heart tissue identified early and specific disruption of genes essential to mitochondrial energy production and homeostasis. Functional analysis of isolated mitochondria from these hearts confirmed that BRD4 ablation triggered significant changes in mitochondrial electron transport chain protein expression and activity. Computational analysis identified candidate transcription factors participating in the BRD4-regulated transcriptome. In particular, estrogen-related receptor α, a key nuclear receptor in metabolic gene regulation, was enriched in promoters of BRD4-regulated mitochondrial genes. In aggregate, we describe a previously unrecognized role for BRD4 in regulating cardiomyocyte mitochondrial homeostasis, observing that its function is indispensable to the maintenance of normal cardiac function.

Impact of exergames on psychiatric symptoms in older adults with serious mental illness

Objectives Older adults with serious mental illness (SMI) are more likely to have high body mass index (BMI) and chronic conditions such as cardiovascular disease and diabetes. A sedentary lifestyle, which may be attributed to pharmacologic side effects and the symptoms of mental illness, has been difficult to treat. Patients experiencing negative symptoms (e.g. apathy, anhedonia) may be more likely to exercise in a group setting with activities that are designed to stimulate the mind and encourage engagement. “Exergames,” or exercise-based videogames, are an interactive and stimulating method to provide aerobic activities. Exercise has also been shown to reduce the symptoms of depression. The purpose of this study is to evaluate the impact of a 10-week exergame program on depressive and negative symptoms in older adults with SMI. Materials and Methods A single-group pretest posttest study was conducted with 52 older adults diagnosed with SMI. Participants engaged in group exergame activities for 50-minute sessions three times a week for 10 weeks. The Patient Reported Outcome Measurement Information System (PROMIS) and the Scale for the Assessment of Negative Symptoms (SANS) were conducted at enrollment, 5 weeks, and 10 weeks. Results Participants achieved statistically significant reductions in self-reported depressive symptoms (-0.83, LL −1.46, UL −0.12) and observed negative symptoms (-5.29, LL −7.67, UL −3.14) over a 10-week period. Conclusions Our results suggest utilization of exergames as an adjunct treatment can be an effective, engaging, and cost-efficient method to reducing depressive and negative symptoms in older adults with SMI.

Behavioral alterations associated with levetiracetam in pediatric epilepsy

Levetiracetam (LEV) has an improved pharmacological profile and is one of the most commonly used antiepileptic drugs (AEDs). However, associations between this pharmacological profile and behavioral side effects have been extensively reported in pediatric populations. We assessed behavioral changes after initiation of LEV, prescribed by the treating neurologist, in Chilean patients with epilepsy aged 4–15 years. A behavioral questionnaire was applied at baseline and at two, four, and twelve weeks of treatment. Thirty patients were enrolled: 16 males, 14 females, average age 8 years (range: 4–14). By week four, 23.3% of patients showed significant behavioral alterations that persisted throughout the observation period. No significant alterations emerged after four weeks in the remaining patients. Family history of psychiatric disease and prior behavioral difficulties were predisposing factors for adverse behavioral effects.Although previous studies associated adverse behavioral effects with LEV in pediatric patients with epilepsy, we believe that this is the first study to use a prospective methodology and standardized tools to quantify the symptomatology. Adverse behavioral effects may significantly affect quality of life for patients and families, diminishing the tolerability of treatment. To ensure successful therapy and improve medical decision-making, it is essential to consider predisposing factors for drug-related adverse effects and to regularly assess for behavioral alterations during treatment.

Anesthesia for Patients with Juvenile Idiopathic Arthritis Current Practice: A Review

Juvenile Idiopathic Arthritis is one of the most common chronic diseases in children. The disease affects one or multiple joints. Additionally, systemic involvement can be present either due to the condition itself or due to pharmacologic side effects resulting from treatment. This article reviews different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis. It outlines the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.