A questionable diagnosis in a woman with drowsiness

A 60-year-old caucasian woman was admitted to our Division of Internal Medicine for a 10-day history of drowsiness, irritability, dysphasia, weakness and difficulties in the maintenance of an upright position with numerous falls, with a traumatic lumbar spine injury and on the left shoulder. Then, while general clinical conditions were getting worse with drowsiness and hyposthenia of the right side of the body, after neurological evaluation, she was recovered in hospital. Pathological history includes a 20-year epilepsy and depression with emotional lability, behavior’s disorders and attempted suicide. For such reason, she was followed in a mental health institute, treated with phenobarbita…

Protocol of BRONJ prevention: successful use of antiseptics during oral surgical procedures

Aim: The overall prevention and treatment of Bisphosphonates related osteonecrosis of the jaws (BRONJ) have been the goals of our project structured (labelled PROMaB) within the hospital AOUP “P. Giaccone” (Italy) in order to make better quality life of patients in therapy with amminobisphosphonates (NBP). Material and Methods: Among all procedures, in case of preprogrammed oral surgical procedure, oral antimicrobial rinses (i.e. chlorexidine 0,2% mouthwash and 0,5% gel, three times/day) plus oral systemic antibiotic therapy –e.g. amoxicilin/clavulanate- have been used to reduce the risk of BRONJ in secondary prevention (1 day before and 6 days after). Three hundred and twenty-one patients …

Fluoroquinolone-induced liver injury: three new cases and a review of the literature.

PURPOSE: Fluoroquinolones are popular and widely used in primary care and hospital settings. Premarketing studies showed a favourable side-effect profile. However, significant morbidity and the need for liver transplantation for acute liver failure have been reported. We reviewed the available data on liver damage linked to fluoroquinolones. METHODS: A systematic search of case reports on the MEDLINE database encompassing the years 2000-2011 was carried out. Additional references were found by a manual search of the retrieved paper. We also describe three new cases of hepatotoxicity attributable to fluoroquinolones seen at our Unit. RESULTS: Thirty-five cases were retrieved from MEDLINE (51…

Findings of osteonecrosis of the jaw under combined bisphosphonate and antiangiogenic therapies: an emergent problem?

Isolated Nodal TBC Reactivation in a Patient with Post-Thrombocythemia Myelofibrosis Treated with Ruxolitinib: Case Report and Review of the Literature

Ruxolitinib side effects include the most frequent hematological toxicity along with a more recently evidenced immunosuppressive activity, interfering both with the innate and adaptive immunity, and several cases of reactivation of latent infections by opportunistic agents in patients in treatment with ruxolitinib have been published in the last years. Several pathophysiological mechanisms may explain an association between ruxolitinib and opportunistic infections. From what we know, the only case of an isolated lymph node TBC reactivation in a ruxolitinib-treated myelofibrosis (MF) patient was reported by Patil et al. in 2016 [Int J Med Sci Public Health. 2017;6(3):1]. Other 10 cases descr…

Could the Combined Administration of Bone Antiresorptive Drug, Taxanes, and Corticosteroids Worsen Medication Related Osteonecrosis of the Jaws in Cancer Patients?

The study presents a report of 58 metastatic cancer patients who developed osteonecrosis of the jaws after being treated with zoledronic acid and taxanes, plus corticosteroids. A retrospective analysis of data registered in the archives of two Italian osteonecrosis of the jaws treatment centers, who are based at the University of Messina and at the University of Palermo, was performed in order to study, in these patients, demographic data and characteristics such as frequency of cancer location, lines of therapy, frequency of cancer drugs, presence/absence of oral trigger, number, location, and stage of jaw osteonecrosis. It was found that the majority of patients developed advanced stages …

Farmacovigilanza in oncologia: la nostra esperienza nel "Centro di consulenza ed informazione sugli effetti tossici da farmaci antitumorali e sulle ADR in pazienti neoplastici" della Regione Sicilia

La segnalazione delle reazioni avverse da farmaci (ADR) in ambito post-marketing è fondamentale per la tempestiva identificazione di nuove, in particolare gravi, tossicità, che, non emergono facilmente nei trial pre-registrativi.per vari limiti. La farmacovigilanza (FV) è necessaria per una identificazione più completa della sicurezza e dell’impatto sulla qualità di vita di un nuovo medicamento nella pratica clinica reale, dove i pazienti, per differenti ragioni (patologie multiple, corredo genetico, usi off-label, etc.) sono a maggior rischio di ADR e di interazioni tra farmaci. In passato i farmaci antineoplastici non sono stati oggetto di attenzione prioritaria nei programmi nazionali o …

The use of proton pump inhibitors in an Italian hospital: focus on oncologic and critical non-ICU patients

Background Proton pump inhibitors (PPIs) are among the most misused drugs both at the community and hospital level. Recently, possible risks have been underscored, suggesting the importance of limiting PPI use to proven indications. Objective To survey the appropriateness of PPI use in a University hospital in Italy. Setting Azienda Ospedaliera Universitaria Policlinico ‘P. Giaccone’, in Palermo, Italy. Method A one day-observational study, reviewing patients’ medical records to identify treatments with PPIs and the indications for their use. After discharge, a subgroup of the cohort was followed up to assess the continuation of therapy at home. Appropriateness was evaluated according to th…

Use of herbal products among cancer and transplanted patients in the town of Palermo,Sicily.

Medication-related osteonecrosis of the jaw in a cancer patient receiving lenvatinib.

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction that affects the mandible and maxilla of patients exposed to bone-targeting agents such as anti-resorptive and anti-angiogenic agents. Several MRONJ cases have been reported after dental extractions in patients under treatment with anti-angiogenic agents, including receptor activator of nuclear factor κB ligand (RANKL) inhibitor, anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody, mammalian target of rapamycin (mTOR) inhibitors, and tyrosine kinase inhibitors (TKIs). The aim of this article was to describe an original case of lenvatinib-related osteonecrosis of the jaw in a patient affected …

La segnalazione delle reazioni avverse da farmaci in oncologia: considerazioni di base e analisi dell'esperienza organizzativa e scientifica nella Regione Sicilia.

Rivaroxaban-induced hepatotoxicity

Aim/Objective/Background Direct-acting oral anticoagulant drugs are marketed worldwide for the primary and secondary prevention and treatment of thromboembolic disorders. Rivaroxaban, an oral, direct factor Xa inhibitor, is one of the most used. Rivaroxaban-induced hepatotoxicity is unusual, although a number of adverse reports have recently been reported. Here, we report two new cases of rivaroxaban-induced hepatitis. Methods A systematic search of case reports on the MEDLINE database encompassing the years 2008–2016 was carried out.Additional references were obtained following a manual search of the retrieved papers. We report two new cases of adverse events occurred in patients treated w…