Drug allergies documented in electronic health records of a large healthcare system.

BACKGROUND: The prevalence of drug allergies documented in electronic health records (EHRs) of large patient populations is understudied. OBJECTIVE: We aimed to describe the prevalence of common drug allergies and patient characteristics documented in EHRs of a large healthcare network over the last two decades. METHODS: Drug allergy data were obtained from EHRs of patients who visited two large tertiary care hospitals in Boston from 1990 to 2013. The prevalence of each drug and drug class was calculated and compared by sex and race/ethnicity. The number of allergies per patient was calculated and the frequency of patients having 1, 2, 3…, or 10+ drug allergies was reported. We also conducted a trend analysis by comparing the proportion of each allergy to the total number of drug allergies over time. RESULTS: Among 1 766 328 patients, 35.5% of patients had at least one reported drug allergy with an average of 1.95 drug allergies per patient. The most commonly reported drug allergies in this population were to penicillins (12.8%), sulfonamide antibiotics (7.4%), opiates (6.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (3.5%). The relative proportion of allergies to angiotensin-converting enzyme (ACE) inhibitors and HMG CoA reductase inhibitors (statins) have more than doubled since early 2000s. Drug allergies were most prevalent among females and white patients except for NSAIDs, ACE inhibitors, and thiazide diuretics, which were more prevalent in black patients. CONCLUSION: Females and white patients may be more likely to experience a reaction from common medications. An increase in reported allergies to ACE inhibitors and statins is noteworthy.

Differential effects of prostaglandin E(2) and enamel matrix derivative on the proliferation of human gingival and dermal fibroblasts and gingival keratinocytes.

BACKGROUND AND OBJECTIVE: Elevated levels of prostaglandins contribute to periodontal destruction but can impair gingival healing by affecting local fibroblasts. Enamel matrix derivative (EMD) has beneficial effects on supporting and gingival tissues. We showed that prostaglandin E(2) (PGE(2) ) inhibits the proliferation of human gingival fibroblasts (hGFs) and that EMD stimulates it. Prostaglandins and EMD may also affect skin healing by targeting dermal fibroblasts (DFs). Thus, we compared the effects of these two agents on the proliferation of hGFs, human gingival keratinocytes (hGKs) and hDFs. MATERIAL AND METHODS: Cells from healthy human gingiva or skin were treated with PGE(2) and/or EMD, and proliferation was assessed by measuring cell number and DNA synthesis. RESULTS: In hGFs, PGE(2) (1 µm) inhibited proliferation while EMD stimulated it. When present together, EMD abolished the PGE(2) -induced inhibition. Serum increased (by a factor of 10) the amount of phosphorylated extracellular signal-regulated kinase (p-ERK), PGE(2) reduced it (by 70-80%) and EMD restored it when present with PGE(2). Prostaglandin E(2) stimulated cAMP production in hGFs while serum or EMD did not. Enamel matrix derivative stimulated hDF proliferation, but the inhibitory effect of PGE(2) was milder than with hGFs. When present together, EMD abolished the PGE(2) -induced inhibition. Enamel matrix derivative inhibited the proliferation of primary hGKs, but PGE(2) had no effect. Finally, we found that hDFs contained about five times less prostaglandin EP(2) receptor mRNA than hGFs, while hGKs contained none. CONCLUSION: Prostaglandin E(2) inhibits and EMD stimulates hGF proliferation via distinct pathways. The different sensitivities of hDFs and hGKs to PGE(2) can be explained by the levels of EP(2) expression.

Standard Information Models for Representing Adverse Sensitivity Information in Clinical Documents.

BACKGROUND: Adverse sensitivity (e.g., allergy and intolerance) information is a critical component of any electronic health record system. While several standards exist for structured entry of adverse sensitivity information, many clinicians record this data as free text. OBJECTIVES: This study aimed to 1) identify and compare the existing common adverse sensitivity information models, and 2) to evaluate the coverage of the adverse sensitivity information models for representing allergy information on a subset of inpatient and outpatient adverse sensitivity clinical notes. METHODS: We compared four common adverse sensitivity information models: Health Level 7 Allergy and Intolerance Domain Analysis Model, HL7-DAM; the Fast Healthcare Interoperability Resources, FHIR; the Consolidated Continuity of Care Document, C-CDA; and OpenEHR, and evaluated their coverage on a corpus of inpatient and outpatient notes (n = 120). RESULTS: We found that allergy specialists' notes had the highest frequency of adverse sensitivity attributes per note, whereas emergency department notes had the fewest attributes. Overall, the models had many similarities in the central attributes which covered between 75% and 95% of adverse sensitivity information contained within the notes. However, representations of some attributes (especially the value-sets) were not well aligned between the models, which is likely to present an obstacle for achieving data interoperability. Also, adverse sensitivity exceptions were not well represented among the information models. CONCLUSIONS: Although we found that common adverse sensitivity models cover a significant portion of relevant information in the clinical notes, our results highlight areas needed to be reconciled between the standards for data interoperability.

Decreased density of epidermal dendritic cells in melanocytic naevi: the possible role of in vivo sun exposure.

Melanocytic naevi are benign skin tumours that originate in the epidermis. The pathogenesis of naevi and cutaneous malignant melanoma has been linked to sun exposure. This study evaluates alterations in the density of immunologically active epidermal dendritic cells (EDCs) in naevi in response to sun exposure. Immunohistologically stained sections of 266 naevi from patients from Israel (n=135) and Germany (n=131) were evaluated. The proportion of naevi with decreased density of HLA-DR+ (dDR+) and CD1a+ (dCD1a+) EDCs was analysed according to country, last exposure to sunlight, anatomical location and histological subtype. The risk of dDR+ was found to be linked to residence in Israel compared with Germany (odds ratio [OR] = 4.2; 95% confidence interval [CI] = 2.0-8.9), suggesting a latitude-dependent effect. Naevi removed in summer had a higher risk of dCD1a+ (OR = 4.7; 95% CI = 2.3-9.8) compared with those removed in winter. The most conspicuous dDR+ among the German cases, and dCD1a+ among the Israelis, occurred in naevi located on commonly exposed skin. The similar densities of EDCs in the lesional and perilesional skin of the majority of the naevi indicates that the underlying naevus cells have no effect on EDC density. It is not unlikely that an altered immune response due to dDR+ and dCD1a+ in sun-exposed skin in the vicinity of naevi contributes to the subsequent melanoma risk in highly susceptible individuals.

EPR analysis of radicals generated in ultrasound-assisted lipoplasty simulated environment.

The generation of various radicals by application of continuous wave (CW) high-intensity ultrasound energy (HIUE) to an aqueous biologic medium containing spin traps, under conditions simulating ultrasound-assisted lipoplasty (UAL), was demonstrated by EPR spectroscopy. The addition of water- soluble antioxidants, ascorbic acid and glutathione to the wetting solution substantially reduces the levels of hydroxyl radicals in the sonicated medium. These findings provide direct evidence for the generation of cavitation in the simulated intercellular environment, corroborating previous data, and pointing out that generation of transient cavitation in clinical UAL and other therapeutic and surgical applications of ultrasound is possible. The findings indicate that the effect of transient cavitation in aqueous biologic media may be similar to the effects of ionizing radiation, and raise the question of the long-term biosafety of the use of CW HIUE in UAL. The introduction of biocompatible water-soluble antioxidants to the sonicated medium may be utilized to suppress accumulation of radicals and reduce their possible adverse effects.

Electrical impedance scanning for melanoma diagnosis: a validation study.

BACKGROUND: A multicenter study was conducted to test the ability of electrical impedance scanning to differentiate between benign and malignant skin lesions. The performance of a dual electrical impedance scanning/image analysis device was also assessed. METHODS: Electrical impedance scanning measurements of 449 preoperative lesions found on 382 patients and including 53 melanomas from the trunk and extremities were performed. Results were correlated with histopathologic findings. In addition, ABCD parameters for the lesions were automatically calculated by the system. RESULTS: Electrical impedance scanning detected melanomas of the trunk and extremities with 91 percent sensitivity and 64 percent specificity. Moreover, sensitivity of electrical impedance scanning was increased to 100 percent for in situ and thin melanomas of smaller size (n = 27). Visual examination identified as malignant only 67 percent of these early tumors (p = 0.002). Clinical examination detected 96 percent of the larger or thicker melanomas (n = 26), whereas electrical impedance scanning detected only 81 percent of them. Combined electrical impedance scanning and image analysis detected 100 percent of the melanomas, independent of their thickness, and with no significant decrease of specificity. Because of electrical differences between the head/neck and the rest of the body, the assessed electrical impedance scanning parameters were not adequate for the diagnosis of melanomas from the head and neck. CONCLUSIONS: A validation study proved the value of electrical impedance scanning as a noninvasive technique for detection of melanoma lesions of the trunk and extremities, specifically, of in situ and thin type. In addition, image analysis was shown to be a valuable, complementary procedure. New parameters should be designed to optimize the performance of electrical impedance scanning for melanomas of the head and neck.

Saksenaea vasiformis infection in a burn wound.

Saksenaea vasiformis was isolated, after 18 days, from a burn wound caused by a petrol bomb. The fungus was locally invasive and was treated successfully by excision and systemic administration of amphotericin B. Identification of the isolate was accomplished by inducing sporulation on 1% agar containing grass clippings and on hay infusion agar.

Verapamil and digoxin: interactions in the rat.

Verapamil and digoxin are often used in combination and clinical experience suggests that verapamil may increase digoxin toxicity. We have explored the effects of verapamil upon digoxin induced tachyarrhythmias and have undertaken a preliminary study of the influence of verapamil on digoxin pharmacokinetics in the rat. Anesthetized rats received 20 mg/kg of digoxin intraperitoneally followed by verapamil i.v., 0.3 mg/kg, in repeated doses either immediately after digoxin or only after the onset of digoxin induced arrhythmias. Digoxin alone produced prolonged paroxysmal atrial tachycardia in 88-100% of rats and verapamil converted 75% of rats to sinus rhythm and significantly reduced digoxin induced mortality. In a later study, rats were injected with 10 mg/kg verapamil i.p. twice a day for 7 days or only with saline. On the seventh day all the rats received 0.5 mg/kg of digoxin i.p. Eight hours later the animals were sacrificed and plasma, heart, brain, liver, kidney and muscle (diaphragm) digoxin concentration was measured by radioimmunoassay. Digoxin levels were twice as high in plasma, heart, liver and muscle of verapamil pretreated rats (p less than 0.01). Two types of verapamil - digoxin interactions are demonstrated in the above studies; one in which verapamil modifies digoxin induced arrhythmias and a second pharmacokinetic effect in which pretreatment with verapamil increases digoxin concentration in the plasma and in several tissues.