Dose adjustment in patients with liver cirrhosis: impact on adverse drug reactions and hospitalizations.

AIM AND BACKGROUND: To assess drug-related problems in patients with liver cirrhosis by investigating the prevalence of inadequately dosed drugs and their association with adverse drug reactions (ADRs) and hospitalizations. METHODS: This was a cross-sectional retrospective study assessing the dose adequacy of drug treatment of 400 cirrhotic patients at hospital admission based on the authors' own previous studies and standard literature. The prevalence of total and preventable ADRs and of hospitalizations due to preventable ADRs was determined. RESULTS: Of all 1653 drugs prescribed (median 4 per patient), 336 (20 %) drugs were inadequately dosed in 184 patients. Overall, 210 ADRs (78 % preventable) occurred in 120 patients. Sixty-nine ADRs (33 % of all ADRs) were associated with inadequate drug dosing in 46 patients, of which 68 % were preventable. Nonsteroidal anti-inflammatory drugs and psycholeptics in particular frequently caused preventable ADRs associated with inadequate drug dosing. Inadequate drug dosing was more frequently associated with ADRs than adequate drug dosing, and patients receiving inadequately dosed drugs were more frequently admitted to the hospital due to ADRs. Hospitalization of patients receiving inadequately dosed drugs that caused preventable ADRs resulted in 94 additional hospital days. CONCLUSION: In this retrospective study, inadequate drug dosing was associated with an increased frequency of ADRs, hospital admissions and hospital days in cirrhotic patients. We therefore conclude that the careful dosing of critical drugs is important in patients with liver cirrhosis.

Potential drug-drug interactions and adverse drug reactions in patients with liver cirrhosis.

BACKGROUND AND AIMS: Patients with liver cirrhosis may be at risk for potential drug-drug interactions (pDDIs) and/or adverse drug reactions (ADRs) due to the severity of their disease and comorbidities associated with polypharmacy. METHODS: We performed a cross-sectional retrospective study including 400 cirrhotic patients and assessed diagnoses, medication patterns, pDDIs, and ADRs at hospital admission. RESULTS: The median (range) age of the patients was 60 (21-88) years; 68.5% were male. They had a total of 2,415 diagnoses, resulting in 6 (1-10) diagnoses per patient. Frequent were diagnoses of the digestive system (28.4%), circulatory system (14.2%), blood and blood-forming organs (8.7%), and psychiatric disorders (7.5%); 60.7% of the diagnoses were not liver-associated. The median number of drugs per patient was 5 (0-18), whereof 3 (0-16) were predominantly hepatically eliminated. Drugs were primarily indicated for gastrointestinal, cardiovascular, or nervous system disorders, reflecting the prevalent diagnoses. In 112 (28%) patients, 200 ADRs were detected, mainly associated with spironolactone, torasemide, furosemide, and ibuprofen. In 86 (21.5%) patients, 132 pDDIs were detected. Seven of these pDDIs were the direct cause of 15 ADRs, whereof 3 resulted in hospital admission. Patients with ADRs were older, had more comorbidities, were treated with more drugs, and had a worse renal function and more pDDIs than patients without ADRs. CONCLUSIONS: Pharmacotherapy is complex in cirrhotic patients. Hepatologists should know the principles of dose adjustment in cirrhosis and renal failure, but also the most important pDDIs of the drugs used to treat liver disease and comorbidities in this population.

Intraindividual comparison of surgical trauma after bimanual microincision and conventional small-incision coaxial phacoemulsification.

PURPOSE: To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed. RESULTS: There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08) CONCLUSIONS: Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.

Seven years of HAART impact on ophthalmic management of HIV-infected patients.

PURPOSE: The widespread use of highly active antiretroviral therapy (HAART) has changed the clinical picture of HIV-associated eye disease. We evaluated the incidence of ocular manifestations of HIV infection since the introduction of HAART. METHODS: Between January 1996 and December 2002, we examined 539 HIV-infected patients in our hospital. Follow-up of the patients was performed in case of ophthalmologic symptoms, regardless of current immunologic status, or for screening. RESULTS: A total of 217 patients (40.3%) had HIV-associated eye disease. Of these patients, 42.0% had no eye symptoms. Fifty-eight (10.8%) of the 539 patients had cytomegalovirus (CMV) retinitis, most of whom had CMV retinitis before receiving HAART. Four patients developed immune-recovery uveitis. A total of 145 patients (26.9%) had HIV-related microangiopathy and 96 (17.8%) had dry-eye syndrome. CONCLUSION: The introduction of HAART had a major impact on the medical history of patients with HIV-related eye disease with improved survival time and decreased morbidity.

Long-term results of implantation of phakic posterior chamber intraocular lenses.

PURPOSE: To study the incidence and progression of lens opacification after implantation of phakic posterior chamber intraocular lenses for myopia and its correlation with vaulting and endothelial cell density (ECD). SETTING: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHODS: An implantable contact lens (ICL V4, Staar Surgical Inc.) was inserted in 76 myopic eyes. Patients were prospectively followed preoperatively and at 1, 3, 6, 12, 24, and 36 months. The uncorrected visual acuity and best corrected visual acuity (BCVA) were determined. Vaulting was measured optically with a Jaeger II pachymeter, and the crystalline lens was examined at the slitlamp for the presence and characteristics of opacification. Endothelial cell morphometry was performed by specular microscopy, and the ECD was calculated. Eyes in which lens opacification developed were followed for at least 12 months to determine the degree and course of visual impairment. RESULTS: Lens opacification occurred in 11 eyes (14.5%). Opacification was correlated with intraoperative trauma to the crystalline lens, age older than 50 years, and decreased ECD values throughout the observation period. Vaulting of the ICL did not correlate with the risk for lens opacification. After onset of lens opacification, 6 eyes (55%) had a stable BCVA within +/-0.5 lines and 5 eyes had progressive opacification, losing between 3.5 lines and 0.5 lines (mean 1.8 lines +/- 1.1 [SD]). Three eyes (3.9%) in the progressive group had a 1- to 2-line loss of BCVA over preoperative values and subsequently had cataract surgery. CONCLUSIONS: Risk factors for lens opacification after implantation of the model V4 ICL included intraoperative trauma to the crystalline lens and older age. Decreased ECD in eyes with opacification suggests ongoing inflammation as a cause. Patients younger than 45 years may have a significantly lower incidence of opacification.

Influence of spectacle-related changes in retinal image size on contrast sensitivity function after laser in situ keratomileusis.

PURPOSE: To evaluate changes in contrast sensitivity after laser in situ keratomileusis (LASIK) for the correction of myopia using a monitor-based method and considering the preoperative minification effect of high-diopter spectacles. SETTING: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHODS: Fifteen eyes of 11 patients had LASIK to correct myopia. The best corrected visual acuity (BCVA) and contrast sensitivity function (CSF) were measured preoperatively and 1, 3, and 6 months postoperatively using the AcuityMax (Science 2020) computer program. The error in contrast sensitivity measurement due to different angular sizes of the test figures deriving from the spectacle refractions before and after LASIK were considered. RESULTS: Preoperatively, and at 1, 3, and 6 months, the mean Snellen BCVA was 0.93 +/- 0.19 (SD), 0.80 +/- 0.26, 0.85 +/- 0.21, and 0.84 +/- 0.27, respectively. The best mean CS (measured at 1.1 logMAR) was 1.17 +/- 0.05, 1.12 +/- 0.07, 1.13 +/- 0.08, and 1.18 +/- 0.04, respectively. The strongest CS changes were observed at 0.7 logMAR (6 cycles per degree), where CS was 1.10 +/- 0.07 preoperatively and 1.06 +/- 0.09, 1.07 +/- 0.12, and 1.14 +/- 0.07, at 1 month, 3 months, and 6 months, respectively. With correction for the spectacle effect, the preoperative CS was approximately 3% higher and CS at 3 months for intermediate optotype sizes was significantly inferior to preoperatively. CONCLUSIONS: With correction of different retinal image sizes before and after LASIK (due to different spectacle refraction), the CS was significantly below the preoperative values at 1 and 3 months and approached the preoperative values at 6 months. The proposed method is potentially capable of quality monitoring and method comparisons after photorefractive surgery.

Psychosomatic aspects of chronic pain: a new way of description based on MMPI item analysis.

Certain psychic structures which are represented in special configurations of MMPI scale values--the 'neurotic triad' and the 'conversion V'--are said to be typical of chronic pain patients. But considering the problems of reliability and validity of MMPI scales and new theoretical reflections regarding psychosomatic disorders, the diagnostic information given by these scale-based descriptions seems to be low. The present study examines the MMPI patterns of patients suffering from chronic headaches (N = 45) and chronic low back pain (N = 45) in comparison with a control group (N = 33) to obtain more relevant diagnostic information. Both pain groups claim to have strange bodily sensations accompanied by anxiety. Headache patients as well as low back pain patients tend to deny feelings of anger and aggressiveness. In comparison with the control group all pain patients adapt themselves to their immediate social environment to a much higher degree.