Use Of Intravenous Route Research Articles

P-30 ROLE OF PLASMAPHERESIS IN TREATING A RARE CASE OF EXOGENOUS INSULIN ANTIBODY SYNDROME (EIAS) IN A YOUNG PATIENT WITH TYPE 1 DIABETES MELLITUS IN BABYLON GOVERNORATE: A CASE REPORT

Abstract Clinical Case A 17-year old female patient who was diagnosed with type 1 diabetes mellitus (DM) seven years ago, and she had continuously very high blood glucose readings with recurrent admissions to the emergency unit due to attacks of DKA. In addition to a planned diet, she was on more than 250 units of insulin per day (while her weight was 75 kilograms). She was initially on human insulin in the form of twice NPH insulin injections, and pre-meal regular insulin injections, in addition to repeated regular insulin correction doses without any reduction of her blood glucose. Then she was shifted to insulin analogues (to eliminate the possibility of insulin immunogenicity which have been encountered with the use of human insulin), in form of basal insulin Glargine OD, plus pre-meal rapid acting insulin Glulisine without any noticeable response. Continuous switching of her injection sites, with an in-hospital observed insulin injections (to avoid noncompliance), even the use of intravenous route did not help to achieve a glycemic control. Later on, metformin 1000 mg XR BID was added to her daily treatment without any benefit. A screen of anti-insulin antibodies was done and found to be elevated (which should be negative after all these years after her initial diabetes diagnosis). A presumptive diagnosis of EIAS (Exogenous Insulin Antibody Syndrome) was put. A small dose of steroids was administered with close observation (to avoid exacerbation ketosis) without any improvement. Then Cellcept (Mycophenolate mofetil), an immune modulator was added at a dose of 500 mg BID and increased 48 hrs. later to 1000 mg BID and resulted in a minimal reduction of her blood glucose levels. Finally the decision of plasmapheresis was made and an informed consent was obtained from the family after explaining the condition. A good response was recorded after the 1st session, with a minimal decrease of her total daily insulin doses. Later on, an additional excellent response was received during the next 2 sessions with a rapid decline of her glucose readings and her total daily insulin doses. She had recurrent attacks of hypoglycemia during her third and last plasmapheresis session. Her total daily dose of insulin was successfully reduced by more than 50%, and her general condition was improved noticeably without any recorded adverse reactions, as shown in the blood glucose logbook photos attached below.Figure 1:Glucose logbook after the 3rd and last session of Plasmapheresis Table 1:Response parameters to three sessions plasampheresis therapy

Antidepressants abuse in subjects with opioid use disorders: A 10-year study in the French OPPIDUM program.

Accumulating evidence shows that some antidepressants are abused for their psychostimulant effects, but the extent of antidepressants abuse is unknown in subjects with opioid use disorders (OUD). The objective of this work is to assess the prevalence of antidepressant abuse and its correlates in subjects with OUD. Subjects ≥18 year-old in an opiate maintenance treatment (OMT) program who reported using an antidepressant were selected from the OPPIDUM program from 2011 to 2020. The outcome was antidepressant abuse. Antidepressant abusers were identified as subjects reporting at least one of the following behaviors: "drug abuse," "concomitant use of alcohol," "illegal obtaining," and "dose higher than recommended in the Summary of Product Characteristics." Among the 83 040 observations of subjects ≥18 year-old in an OMT program included in the OPPIDUM program from 2011 to 2020, 2708 (3.3%) subjects reported using an antidepressant in monotherapy. Among them, there were 385 (14.2%) abusers. The proportion of abusers was the highest for amitriptyline (n= 31, 25.0%). In multivariate analysis, antidepressant abuse was positively associated with amitriptyline (OR 2.07, 95% CI [1.16, 3.73]; p=0.015), unemployment (OR 1.52, 95% CI [1.16, 2.01]; p=0.003), the use of intravenous route of administration (OR 1.77, 95% CI [1.12, 2.80]; p=0.014), and the use of benzodiazepines (OR 1.53, 95% CI [1.21, 1.94]; p<0.001). Clinicians should be aware of the risk of antidepressant abuse when prescribing in subjects with OUD, accounting for their heterogeneous pharmacological properties that may account for their abuse potential.

Antibiotic use during end of life in patients with advanced malignancy: A retrospective analysis.

e24002 Background: Patients with advanced malignancy have complex symptoms towards end of life. Some of these symptoms include febrile illness and infections. Benefits of treating infection and fever with antibiotics should be weighed out with goals of care for these patients. This study aims to understand the frequency of use of antibiotics and its association with symptom control in the last two weeks of life in advanced cancer patients on best supportive care. Methods: This is an observational retrospective analysis of medical records maintained for advanced cancer patients who have been enrolled in home-based palliative care services. 8 months data was analyzed. Sociodemographic variables, cancer diagnoses, symptoms, use and type of antibiotics prescribed were noted. Relevant statistical analysis was done using IBM SPSS v 25. Results: Of 256 patients included in the analysis, 133 (52%) were male. 57 (22.3% ) patients had gastrointestinal (GI) cancer and 45 ( 17.6%) had lung cancer. 175 (68.4)% died at home and 50 (19.5%) in hospital. 9 (3.1 %) patients had fever. 10 (3.9%) patient had respiratory, and 18 (7%) had gastrointestinal symptoms, respectively. Other symptoms noted were wound infection (10,3.9%), skin and soft tissue (5,2%). Other symptoms noted were wound infection (10,3.9%), skin and soft tissue (5,2%). Only 2 patients had urinary tract symptom. 49 (19.1%) patients had received antibiotics in their last two weeks of life. Intravenous (IV) route of administration was slightly higher than oral (28 vs 21 patients).More than half the patients received 2 antibiotics. Amoxicillin/clavulanate was the most common oral antibiotic and Cefoperazone/ sulbactam was the most common IV antibiotic. Symptom relief was noted in 9 patients (18.4%) however it was statistically significant (p&lt;0.001). Conclusions: Of 256 patients included in the study, 19% had received antibiotics in last two week of their life. Use of intravenous route for antibiotic administration was more than oral route. Gastrointestinal and respiratory symptoms were common cause for antibiotic prescription. Symptomatic benefit was noted with antibiotics use in these patients. Judicious use of antibiotics during end of life care should be considered.

Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals

The use of antimicrobial prophylaxis for surgical procedures is one of the measures employed to prevent the development of surgical site infections (SSI). The appropriate choice of antimicrobial agents, dosage regimen, timing, duration and use of intravenous route must be evidence based. This study aimed to assess the practice of surgical antibiotic prophylaxis and adherence of practitioners to the American Society of Health-System Pharmacists (ASHP) guidelines for antimicrobial prophylaxis in surgery and to explore reasons for non-compliance. A cross-sectional study was conducted in 20 Jordanian hospitals from October 2006 to June 2007. A questionnaire was designed to collect information from physicians regarding the practice of surgical antibiotic prophylaxis (SAP), references used for guiding SAP practice, prevalence of surgical site infection (SSI), and causative microorganisms. SAP was employed in almost all surgical departments of hospitals. The improper timing of antimicrobial administration for SAP was attributed to lack of knowledge of the guidelines (46.1%), while the improper antimicrobial choice was ascribed to drug unavailability (61.8%). This study shows that physicians are aware of the importance of antimicrobial prophylaxis before surgical procedures. However, further efforts are needed to ensure the implementation of the standard SAP guidelines in Jordanian hospitals.