Clinical pharmacology consultations: consultation requests may be misleading -- an organized approach to drug-induced hepatitis.

The present case report describes a consultation with the Clinical Pharmacology Consultation Service at the Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, for drug-induced hepatitis in a patient with multiple drug exposures. The original question to be addressed was whether dalteparin was responsible for an acute rise in liver transaminases. The approach involved establishing a best possible diagnosis of the adverse event, obtaining a comprehensive history of drug exposure and evaluating the possible contributory role of alternate etiologies supported by a literature search. On balance, based on temporal relationships and previous case reports, ranitidine was considered to be the most likely causal agent. The initial consultation request was to investigate the likelihood that daltaperin caused hepatitis; however, a systematic and comprehensive approach led to the conclusion that it was more likely to be ranitidine-induced hepatitis.

Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis of pregnancy outcome after metformin use for polycystic ovary syndrome (PCOS), because the efficacy of metformin has been demonstrated in the treatment of infertility caused by PCOS, whereas the fetal safety of metformin has received very little attention, and the few studies addressing this issue are limited by small sample sizes. DESIGN: Meta-analytic review. SETTING: All pertinent studies in MEDLINE and EMBASE from 1966 to September 2004. PATIENT(S): Women with PCOS or diabetes. INTERVENTION(S): Exposure to metformin in the first trimester of pregnancy. MAIN OUTCOME MEASURE(S): Major malformations. RESULT(S): Eight studies were included in the meta-analysis, with an odds ratio of 0.50 (95% confidence interval, 0.15, 1.60). After adjustment for publication bias, metformin treatment in the first trimester was associated with a statistically significant 57% protective effect. After pooling the studies, the malformation rate in the disease-matched control group was approximately 7.2%, statistically significantly higher than the rate found in the metformin group (1.7%). CONCLUSION(S): On the basis of the limited data available today, there is no evidence of an increased risk for major malformations when metformin is taken during the first trimester of pregnancy. Large studies are needed to corroborate these preliminary results.

Metformin use during the first trimester of pregnancy. Is it safe?

QUESTION: A pregnant patient with polycystic ovary syndrome asked me whether continuing metformin, which she was taking to treat infertility before her pregnancy, is safe for her fetus. She has heard that metformin is a "drug for diabetes." How safe is it to take metformin during the first trimester of pregnancy and beyond? ANSWER: Despite the traditional response that all oral hypoglycemic agents are absolutely contraindicated during pregnancy, evidence that metformin is probably safe during the first trimester of pregnancy and beyond is accumulating. Results of a recent meta-analysis by the Motherisk Program showed no increase in incidence of major malformations and a potential protective effect in this patient population.

Tratamento de candidiase bucal na Unidade de Saude Ipiranga / Oral candidiases treatment at the Ipiranga Health Unit

A Unidade de Saude Ipiranga motivou-se a melhorar a qualidade de vida dos usuarios acomentidos por candidiase, priorizando inicialmente pacientes do grupo de hipertensos. Para tanto, foi realizado um treinamento especifico de toda a equipe com um profissional, cirurgiao-dentista com grande experiencia em diagnostico bucal. A candidiase e causada por fungos e aparece em qualquer regiao do tegumento cutaneo ou das superficies mucosas dermatologicas e estomatologicas, mais frequentemente em pacientes nos extremos da idade. Primeiramente foram atendidos 20 pacientes hipertensos, dos quais 18 apresentaram uma doenca e eram portadores de protese totais superiores. Todos os hipertensos receberam orientacao quanto a doenca, sua prevencao, enfatizando a higienizacao bucal e a das proteses, bem como o tratamento especifico para a patologia. Como conclusao deste trabalho foi observado que 90 (por cento) dos pacientes atendidos apresentavam a doenca em razao das precarias condicoes das protoses, significando que estas se encontravam em pessimo estado: antigas, fraturadas, deficitarias e com algum grau de porosidade, alem da presenca de higienizacao deficiente