A Case Report of Sudden Sensorineural Hearing Loss (SSNHL) After Administration of the COVID-19 Vaccine.

Since the issuance of the emergency use authorization (EUA) of 3 coronavirus disease 2019 (COVID-19) vaccines, there have been over 180 million individuals fully vaccinated in the United States (US). With the increasing administration of COVID-19 vaccinations, there have been over 550,000 adverse events reported in the Vaccine Adverse Event Reporting System (VAERS) with approximately 230,000 experienced after receipt of the Pfizer-BioNTech COVID-19 Vaccine as of September 23rd 2021. Audio-vestibular symptoms (including Sudden Sensorineural Hearing Loss (SSNHL)) secondary to immunizations has previously been evaluated. However, this report describes the first case of bilateral sudden sensorineural hearing loss potentially due to the Pfizer-BioNTech COVID-19 vaccine. We further review the available literature regarding the treatment of Sudden Sensorineural Hearing Loss, and the association of SSNHL with previous immunizations and COVID-19 infection. Lastly, we hypothesize the underlying potential mechanisms between SSNHL and the Pfizer-BioNTech COVID-19 vaccine.

Stability of Insulin Detemir Injection in Different Primary Packaging Systems at Room Temperature.

PURPOSE: To assess the stability of insulin detemir at controlled room temperature (RT) at 25°C in different packaging systems over 7 days. METHODS: The degradation characteristics of insulin detemir were determined based on the assay results in different packaging systems (pinhole glass vial, closed glass vial, glass syringe, and plastic syringe) at RT using a reverse-phase high-performance liquid chromatography (HPLC) assay method for insulin injection. Each packaging system was compared to insulin detemir stored in the original packaged closed glass vial at 2°C to 8°C. RESULTS: Insulin detemir stored in a closed glass vial and a glass syringe showed minor degradation at the end of day 7 (98.96% ± 1.49% and 99.78% ± 0.10%, respectively). Insulin detemir stored in plastic syringe decreased to 94.90% ± 2.50% by day 3 and to 93.52% ± 0.29% by day 7. Storage in pin-hole glass vial showed an increase in the assay (152.13% ± 0.12%) by day 7. CONCLUSION: Stability studies in different packaging systems demonstrated that insulin detemir remained stable for at least 7 days in a closed glass vial or glass syringe, but for only 3 days in a plastic syringe at RT. This study will allow pharmacists in the hospital setting to deliver patient-specific insulin doses into an insulin syringe with confidence in the stability.

Implementation of an Advanced Pharmacy Practice Model in the Emergency Department.

STUDY OBJECTIVE: The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). METHODS: Data from January 2015 to August 2017 extracted from the department of pharmacy's electronic documentation system and the hospital's electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution's administration as an acceptable reflection of the impact for activity. RESULTS: The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. CONCLUSION: We created and implemented an advanced practice model tailored to our institution's needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.

Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): A double-blind randomized controlled trial.

BACKGROUND: The aim of this randomized controlled trial was to assess the effectiveness of transversus abdominis plane (TAP) block in post-operative pain management in patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: Ninety consecutive patients undergoing LSG were randomly assigned to three groups: placebo, TAP block with 0.25% bupivacaine (40mL total), and TAP block with 0.25% bupivacaine + 1/100,000 epinephrine (40mL total). Pain and nausea/vomiting scores were evaluated at varying times until discharge. Other parameters included, additional analgesia required, time to ambulation, length of stay and time required for return to work after discharge. RESULTS: There was decrease in post-operative pain 3 hours after surgery between the placebo group and the bupivacaine group and between the placebo group and the bupivacaine with epinephrine group, however, no difference in 1, 6, 12 and every 6 hours after. There was no significant difference in post-operative analgesia requirements, nausea/vomiting scores, time to ambulation, hospital length of stay, or time to return to work after discharge. CONCLUSION: The efficacy of TAP block is not apparent likely due to the ERAS protocol set in place for bariatric surgery, which already targets early postoperative pain control and mobility.

The Feasibility and Impact of Prospective Medication Review in the Emergency Department.

OBJECTIVE: We evaluated the feasibility and impact of prospective medication review (PMR) in the emergency department (ED). METHODS: This was a retrospective cohort study of all nonadmitted ED patients who were prescribed medication orders by ED clinicians from September 2014 to September 2015 to determine the time intervals utilized during each step of the medication use process and quantify the number of interventions conducted by the pharmacist and cost avoidance accrued from the interventions. RESULTS: A total of 834 medication orders were included for evaluation. The median time for order verification, order verification to dispense, and dispense to administration were 3 minutes (interquartile range [IQR] = 1-7 minutes), 20 minutes (IQR = 7-45 minutes), and 10 minutes (IQR = 6-16 minutes). The median time interval for order verification was longer during the overnight pharmacy shift (median = 5 minutes, IQR = 2-9 minutes) compared to the day and evening shifts (median = 3 minutes, IQR = 1-6 minutes). A total of 563 interventions were recommended by the pharmacists and accepted by ED clinicians. These interventions equated to US$47 585 worth of cost avoidance. CONCLUSION: The PMR is a feasible process that resulted in safe and effective use of medications without causing delays to patient care.

Elevated International Normalized Ratio in a Patient Taking Warfarin and Mauby: A Case Report.

We describe a 70-year-old Haitian man who had been taking warfarin for 5 years for atrial fibrillation and pulmonary hypertension. This patient had his international normalized ratio (INR) checked in the pharmacist-run anticoagulation clinic and was followed monthly. Prior to the interaction, his INR was therapeutic for 5 months while taking warfarin 10.5 mg/d. The patient presented with an INR > 8.0. Patient held 4 days of warfarin and restarted on warfarin 8.5 mg/d. Two weeks later, his INR was 2.5. After continuing dose, patient presented 2 weeks later and INR was 4.8. Upon further questioning, the patient stated he recently began ingesting mauby. Mauby is a bitter dark liquid extracted from the bark of the mauby tree that is commonly used in the Caribbean population as a folk remedy with many health benefits. This case report illustrates that mauby may have a probable drug-herb interaction (Naranjo Algorithm Score of 6) when given with warfarin. There is a lack of published literature and unclear information on the Internet describing the interaction of mauby and warfarin. Health professionals should be cautious regarding interactions between warfarin and mauby until the interaction is fully elucidated.

Readministration of drotrecogin alfa (activated) in an adult with severe sepsis.

PURPOSE: The case of a patient with severe, multidrug-resistant, postoperative sepsis who was successfully treated with drotrecogin alfa (activated) on two occasions is reported. SUMMARY: After a thigh debridement procedure, a 55-year-old African-American woman developed systemic inflammatory response syndrome (SIRS) secondary to necrotizing fasciitis. Despite empiric treatment including piperacillin-tazobactam and vancomycin, the patient remained severely hemodynamically unstable, exhibiting signs of multiorgan failure and requiring mechanical ventilation and the placement of a tracheostomy tube. After the administration of i.v. drotrecogin alfa (activated) 160 mg (24 µg/kg/hr) over 96 hours in combination with standard i.v. antimicrobials and vasopressin, the patient's hemodynamic status improved considerably. About three weeks later, the patient again developed SIRS that was refractory to standard therapies. After the results of laboratory cultures indicated ventilator-associated pneumonia due to multidrug-resistant Klebsiella pneumoniae, the woman received a second course of drotrecogin alfa and other therapies. Her condition improved and she was extubated and eventually transferred to a medical-surgical unit for continued care. While drotrecogin alfa, a recombinant form of human activated protein C (APC), has been shown to reduce mortality in adults with severe sepsis and acute organ dysfunction, previous reports indicated an increased risk of thrombotic events with the use of the drug, and there is speculation that the development of anti-APC antibodies might result in a diminished therapeutic response. In the case described here, there were no thrombotic events during or after either drotrecogin alfa infusion and no clinical evidence of antibody formation. CONCLUSION: A patient received two complete courses of drotrecogin alfa (activated) without any treatment-related complications.

Rhabdomyolysis caused by a potential sitagliptin-lovastatin interaction.

A 75-year-old woman with diabetes mellitus, hypertension, and hyperlipidemia came to the emergency department with generalized and upper-extremity weakness; she had experienced a fall 2 months earlier. On admission, her drug therapy included lovastatin 40 mg/day, controlled-release diltiazem 240 mg/day, and glimepiride 1 mg/day. Nineteen days earlier, sitagliptin 100 mg/day had been started; it was discontinued 2 weeks later, and glimepiride was begun. A cardiology consultation performed on the day of admission determined that a markedly elevated creatine kinase-myocardial band isoenzyme level and borderline-high troponin I level were diagnostic of rhabdomyolysis secondary to statin use. Because the patient had been taking lovastatin for the past 12 years, the possibility that the rhabdomyolysis may have been caused by a drug interaction between lovastatin and a concomitant drug was evaluated. As it had been 10 months since her last dosage adjustment of diltiazem, it was unlikely that the statin-induced rhabdomyolysis was precipitated by diltiazem. Use of the Drug Interaction Probability Scale to determine the strength of a lovastatin-sitagliptin interaction indicated a possible association (score of 4). Multiple drug interactions have been reported with lovastatin. To our knowledge, however, this is the first case report of a possible sitagliptin-lovastatin interaction that may have caused rhabdomyolysis. Studies must be performed to further evaluate the in vivo effect of sitagliptin on the cytochrome P450 3A4 enzyme system and to elucidate other mechanisms that may potentiate such a drug-drug interaction. In the meantime, however, clinicians should be aware of this possible drug interaction.

A comparison of allogeneic and autogenous iliac monocortical grafts to augment the deficient alveolar ridge in a canine model. I. Clinical study.

A canine model was used to compare autogenous alveolar ridge augmentation bone grafting with allogeneic grafts. Defects were created by premolar extractions and measured by radiopaque markers. These markers were used for subsequent measurements made before and after grafting, and after animal sacrifice to evaluate the status of the grafted sites. The results were unexpected and disappointing.

A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults.

STUDY OBJECTIVE: We sought to compare the efficacy and safety of nebulized magnesium sulfate (MgSO(4)) plus albuterol with that of albuterol alone in adult patients with mild-to-moderate acute asthma exacerbations. METHODS: Patients were randomized to receive nebulized MgSO(4) (384 mg in 6 mL of sterile water) or an equal volume of placebo (normal saline solution) in a double-blind fashion after each dose of nebulized albuterol administered (2.5 mg/3 mL) every 20 minutes for the first hour of the study. Spirometry was performed at baseline and every 20 minutes for 2 hours. Monitoring for safety included vital signs, pulse oximetry, and serum magnesium levels. Improvement in percent predicted forced expiratory volume in 1 second was chosen as a primary efficacy end point. RESULTS: Among 74 patients enrolled, 37 were randomized to each of 2 study groups. There were no statistically or clinically significant differences between the 2 study groups in percent predicted forced expiratory volume in 1 second at any point during the trial or overall. There were no significant differences in vital signs, pulse oximetry, or serum magnesium levels at any point during the study. CONCLUSION: The combination of nebulized MgSO(4) and albuterol provides no benefit in addition to that provided by therapy with albuterol in adult patients with mild-to-moderate asthma exacerbations. The efficacy of nebulized MgSO(4) in patients with severe asthma exacerbations remains unknown.