Pregabalin drug interaction studies: lack of effect on the pharmacokinetics of carbamazepine, phenytoin, lamotrigine, and valproate in patients with partial epilepsy.

PURPOSE: Pregabalin (PGB) is an alpha2-delta ligand with demonstrated efficacy in epilepsy, neuropathic pain, and anxiety disorders. PGB is highly efficacious as adjunctive therapy in patients with refractory partial seizures. METHODS: Given its efficacy as adjunctive therapy, the potential for interaction of PGB with other antiepileptic drugs (AEDs) was assessed in patients with partial epilepsy in open-label, multiple-dose studies. Patients received PGB, 600 mg/day (200 mg q8h) for 7 days, in combination with their individualized maintenance monotherapy with valproate (VPA), phenytoin (PHT), lamotrigine (LTG), or carbamazepine (CBZ). RESULTS: Trough steady-state concentrations of CBZ (and its epoxide metabolite), PHT, LTG, and VPA were unaffected by concomitant PGB administration. Likewise, PGB steady-state pharmacokinetic parameter values were similar among patients receiving CBZ, PHT, LTG, or VPA and, in general, were similar to those observed historically in healthy subjects receiving PGB alone. The PGB-AED combinations were generally well tolerated. PGB may be added to VPA, LTG, PHT, or CBZ therapy without concern for pharmacokinetic drug-drug interactions.

Atorvastatin does not alter the anticoagulant activity of warfarin.

Twelve patients chronically maintained on warfarin were administered 80 mg atorvastatin for 2 weeks. Mean prothrombin times decreased slightly, but only for the first few days of the two-week treatment period. Thus atorvastatin had no consistent effect on the anticoagulant activity of warfarin and adjustment in warfarin dosing should not be necessary.

Child abuse: a time for new awareness.

There were 7602 cases of confirmed child abuse and neglect in Oklahoma in 1989. Twenty-five children died from abuse during the fiscal year. Physician training in diagnosis and management of child abuse must be expanded. Physicians are required by state statute to report all cases of suspected abuse to the Department of Human Services. Sexual abuse of children appears to be increasing. A coordinated multidisciplinary effort which involves physicians can help manage this threat to childrens' health.

Streptobacillus moniliformis isolated from blood in four cases of Haverhill fever.

During February, 1983, an outbreak of an unusual febrile illness occurred in over 130 children attending a boarding school in Chelmsford, Essex. The clinical features included fever, an erythematous rash that was most prominent on the hands and feet, arthralgia, and the subsequent development of a sore throat. The nature and distribution of the rash varied considerably between patients and at different stages of illness. At first a viral aetiology was regarded as most likely. When Streptobacillus moniliformis was later isolated from the blood of 4 of the patients with moderately severe illnesses it became apparent that an outbreak of Haverhill fever had occurred at this school. The most probable source of the outbreak was raw milk, since all 4 patients had consumed raw milk at the school shortly before the onset of symptoms and there was no evidence of person-to-person spread of infection.

Campylobacter enteritis associated with consumption of unpasteurised milk.

In October and November 1978 two outbreaks of enteritis occurred in the north of England. Symptoms lasted two to over eight days but in no case necessitated admission to hospital. Faecal specimens from most of the patients were found to contain thermophilic Campylobacter sp. Inquiry disclosed that all patients had consumed unpasteurised milk from local farms. Examination of rectal swabs from the cattle concerned and milk socks yielded strains of Campylobacter sp indistinguishable from those isolated from the patients. It was therefore concluded that, since campylobacters are not known to be excreted in milk, faecal contamination of the milk had probably occurred and had led to these outbreaks. Evidence suggests that thermophilic Campylobacter sp is an occasional contaminant of milk. So long as unpasteurised milk continues to be distributed further outbreaks will probably occur.

Processing urinary endoscopes in a low-temperature steam and formaldehyde autoclave.

Methods of disinfection and sterilisation of urinary endoscopes are considered. A small mobile low-temperature steam and formaldehyde autoclave (Miniclave 80) is evaluated and shown to be satisfactory for this purpose as judged by a variety of relevant microbiological test pieces.

A survey of treatment modalities used by mental health clinicians and activity therapists.

An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. The final sample consisted of 68 respondents: 34 clinicians, 17 activity therapists, and 17 art therapists. The three respondent groups agreed on the same optimum treatment modality for five patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modalities for those patients.

A disposable bedpan system using an improved disposal unit and self-supporting bedpans.

A system using totally disposable self-supporting bedpans requiring no carrier was examined in use in two hospitals. The bedpans and their contents were disposed of by destruction and flushing to waste carried out in a modified Haigh Sluicemaster disposal unit. This incorporates a positively closing and locking lid with refinements to avoid the lid slamming and has effective safety devices. The new bedpans and the improved disposal units reduce the risk of transfer and dispersal of pathogenic organisms to an acceptable level in ward and sluice room.