Shaul Dollberg MD and Francis B. Mimouni MD
Background and Objective: Very low birthweight infants (<1,500 g birthweight) often develop significant anemia that requires multiple blood transfusions, which carry a significant risk. Erythropoietin therapy is known to reduce the need for blood transfusions in preterm VLBW(1) infants. Analysis of cost had been reported in prospective studies with conflicting results. No studies comparing the cost-effectiveness of EPO(2) have been reported during routine use in preterm VLBW infants.
Methods: We compared the cost of treating anemia of prematurity in two consecutive 12-month periods: before and after the introduction of EPO therapy in our unit. The cost of blood bank charges as well as disposable items and the cost of EPO were compared.
Results: A significantly smaller number of infants required blood transfusions in the EPO group (2 of 25 vs. 9/21 before EPO was introduced). The cost of therapy for anemia of prematurity was significantly smaller in the EPO group (128±168 US$ per infant vs. 151±189 US$ per infant before the introduction of EPO).
Conclusion: We conclude that EPO is an efficient and cost-effective alternative to blood transfusions in VLBW infants.
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(1) VLBW = very low birthweight
(2) EPO = erythropoietin
Peretz Weiss MD, Meir Mouallem MD, Rafael Bruck MD, David Hassin MD, Amir Tanay MD, Chaim M. Brickman MD, Zvi Farfel MD and Simon Bar-Meir MD
Background: Nimesulide is a relatively new non-steroidal anti-inflammatory drug that is gaining popularity in many countries because it is a selective cyclooxygenase 2 inhibitor. Occasionally, treatment is associated with mild elevation of liver enzymes, which return to normal upon discontinuation of the drug. Several cases of nimesulide-induced symptomatic hepatitis were also recently reported, but these patients all recovered.
Objectives: To report the characteristics of liver injury induced by nimesulide.
Patients and Methods: We report retrospectively six patients, five of them females with a median age of 59 years, whose aminotransferase levels rose after they took nimesulide for joint pains. In all patients nimesulide was discontinued, laboratory tests for viral and autoimmune causes of hepatitis were performed, and sufficient follow-up was available.
Results: One patient remained asymptomatic. Four patients presented with symptoms, including fatigue, nausea and vomiting, which had developed several weeks after they began taking nimesulide (median 10 weeks, range 2–13). Hepatocellular injury was observed with median peak serum alanine aminotransferase 15 times the upper limit of normal (range 4–35), reversing to normal 2–4 months after discontinuation of the drug. The remaining patient eveloped symptoms, but continued taking the drug for another 2 weeks. She subsequently developed acute hepatic failure with encephalopathy and hepatorenal syndrome and died 6 weeks after hospitalization. In none of the cases did serological tests for hepatitis A, B and C, Epstein-Barr virus and cytomegalovirus, as well as autoimmune hepatitis reveal findings.
Conclusions: Nimesulide may cause liver damage. The clinical presentation may vary from abnormal liver enzyme levels with no symptoms, to fatal hepatic failure. Therefore, monitoring liver enzymes after initiating therapy with nimesulide seems prudent.
Shmuel Kivity MD, Amir Onn MD, Yoel Greif MD, Elizabeth Fireman PhD, Shmuel Pomeranz MD and Marcel Topilsky MD
Background: Nedocromil sodium confers both acute and chronic protective effects in patients with bronchial asthma, the interactions of which are unknown.
Objective: To examine to what extent and for how long nedocromil sodium prevents exercise-induced asthma when given immediately before exertion compared to chronic administration.
Patients and Methods: Eighteen asthmatic patients were given 4 mg NS at 30 min or 3.5 hours before exertion. We compared the resultant effect with that of the same protocol measured after 2 and 4 weeks of continuous treatment with the drug.
Results: Nedocromil sodium decreased exercise-induced asthma similarly at both points when given acutely. Chronic treatment of up to 4 weeks did not improve this protective effect at either interval following the inhalation.
Conclusion: Nedocromil sodium most likely reaches its maximal effect on exercise-induced asthma upon the first administration, although treatment for longer than 4 weeks might be required to prove a chronic effect of the drug.
Arnon D. Cohen, MD, Eli Reichental, MD and Sima Halevy, MD
Background: Cutaneous drug reactions are attributed usually to one culprit drug, however, some CDRs1 may be associated with drug interactions.
Objectives: To present a case series of foyr patients with phenytion-induced severe CDRs, including toxic epidermal necrolysis (2 patients), exanthematous eruption (1 patient) and hypersensitivity syndrome (1 patient). In all patients the reactions appeared following the combined intake of phenytion, corticosteroids and H2 blockers.
Conclusions: Our case series may imply the role of drug interactions between phenytion, corticosteroids and H2 blockers in the induction of severe CDRs.
Ariel Roguin MD and Rafael Beyar MD DSc
Jacob George, MD, Dror Harats, MD and Yehuda Shoenfeld, MD
Arie Augarten MD, Stephen Buskin MBBCH, Dorit Lewin DVM, Ora Havatinsky MD and Joseph Laufer MD
Samuel Ariad, MD, Judith Sandbank MD and Liliana Lupu MD
Sharon Shklarsky MD. Dan Miron and Yoseph Horowitz MD
Igor Sukhotnik MD, Bassem Kawar MD, Dan Miron MD, Dani Yardeni MD and Leonardo Siplovich MD
Edward Rosenblatt MD, Jamal Zidan MD, Ofer Ben-Izhak MD and Abraham kuten MD