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1. Incidence and Causes of Iatrogenic Hypoglycemia in the Emergency Department

Author

Chittineni, Chaitanya, Driver, Brian E., Halverson, Matthew, Cole, Jon B., Prekker, Matthew E., Pandey, Vidhu, Lai, Tarissa, Harrington, Justin, Zhao, Sean, and Klein, Lauren R.

Subjects
Hypoglycemia, iatrogenic, insulin, general emergency medicine, metabolic disorders
Abstract

Introduction: Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes.Methods: We included adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009–2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis. The data analysis was descriptive.Results: We reviewed the charts of 591 patients meeting inclusion criteria. Of these 591 patients, 99 (17%; 95% confidence interval, 14-20%) were classified as iatrogenic. Of these 99 patients, 61 (61%) cases of hypoglycemia were caused by insulin administration and 38 (38%) were caused by unrecognized malnutrition. Of the 61 patients with iatrogenic hypoglycemia after ED insulin administration, 45 and 15 patients received insulin for hyperkalemia and uncomplicated hyperglycemia, respectively. One patient received insulin for diabetic ketoacidosis.Conclusion: In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.

Published
2019

21. Prescription channeling of COX-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs: a population-based case–control study

Author

Moride, Yola, Ducruet, Thierry, Boivin, Jean-François, Moore, Nicholas, Perreault, Sylvie, Zhao, Sean, and Université de Montréal. Faculté de pharmacie

Subjects
administrative health care databases, Adult, Male, pharmacoepidemiology, Adolescent, Databases, Factual, Formularies as Topic, Drug Prescriptions, COX-2 inhibitors, prescription channeling, Insurance Coverage, Sampling Studies, Lactones, Sex Factors, Risk Factors, Prevalence, Humans, Sulfones, Aged, Aged, 80 and over, nonsteroidal anti-inflammatory drugs, Sulfonamides, Cyclooxygenase 2 Inhibitors, Contraindications, Anti-Inflammatory Agents, Non-Steroidal, Age Factors, Quebec, Confounding Factors, Epidemiologic, Middle Aged, Insurance, Pharmaceutical Services, Drug Utilization, Logistic Models, Celecoxib, Case-Control Studies, Gastritis, Multivariate Analysis, Medicine, Pyrazoles, Female, Gastrointestinal Hemorrhage, Research Article, Specialization
Abstract

This pharmacoepidemiologic study was conducted to determine whether risk factors for upper gastrointestinal bleeding influenced the prescription of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) at the time when COX-2 inhibitors were first included in the formulary of reimbursed medications. A population-based case–control study was conducted in which the prevalence of risk factors and the medical histories of patients prescribed COX-2 inhibitors and traditional nonselective NSAIDs were compared. The study population consisted of a random sample of members of the Quebec drug plan (age 18 years or older) who received at least one dispensation of celecoxib (n = 42,422; cases), rofecoxib (n = 25,674; cases), or traditional nonselective NSAIDs (n = 12,418; controls) during the year 2000. All study data were obtained from the Quebec health care databases. Adjusting for income level, Chronic Disease Score, prior use of low-dose acetylsalicylic acid, acetaminophen, antidepressants, benzodiazepines, prescriber specialty, and time period, the following factors were significantly associated with the prescription of COX-2 inhibitors: age 75 years or older (odds ratio [OR] 4.22, 95% confidence interval [CI] 3.95–4.51), age 55–74 years (OR 3.23, 95% CI 3.06–3.40), female sex (OR 1.52, 95% CI 1.45–1.58), prior diagnosis of gastropathy (OR 1.21, 95% CI 1.08–1.36) and prior dispensation of gastroprotective agents (OR 1.57, 95% CI 1.47–1.67). Patients who received a traditional nonselective NSAID recently were more likely to switch to a coxib, especially first-time users (OR 2.17, 95% CI 1.93–2.43). Associations were significantly greater for celecoxib than rofecoxib for age, chronic NSAID use, and last NSAID use between 1 and 3 months before the index date. At the time of introduction of COX-2 inhibitors into the formulary, prescription channeling could confound risk comparisons across products., Affiliation: Faculté de pharmacie, Université de Montréal

Published
2005

23. Functional Status and Health-Related Quality of Life of Elderly Osteoarthritic Patients Treated With Celecoxib

Author

Lisse, Jeffrey, Espinosa, Luis, Zhao, Sean Z., Dedhiya, Seema D., and Osterhaus, Jane T.

Subjects
Quality of life -- Health aspects, Aged -- Health aspects, Osteoarthritis -- Research, Celecoxib -- Research, Health, Seniors
Abstract

Background. This study evaluates the impact of celecoxib on functional status, health-related quality of life (HRQOL), and safety of elderly patients ([is greater than or equal to] 70 years) with osteoarthritis (OA) of the knee and/or hip. Methods. Data were pooled from three prospective, randomized, multicenter, double-blind, parallel group trials, each having a 12-week treatment period. Multicenter studies were conducted in the United States and Canada. Data for patients diagnosed with active OA of the knee and/or hip in a flare state who were 70 years of age and older were included in the comparison of therapeutic doses of celecoxib or naproxen versus placebo (N = 768). Elderly patients from each of the three trials who were randomly assigned to groups treated with a placebo, 200 mg/day of celecoxib, 400 mg/ day of celecoxib, or 1000 mg/day of naproxen were included in this analysis. The Western Ontario and McMaster Universities Osteoarthritis Index was used to measure functional status. The Short Form-36 was used as a general measure of HRQOL. Safety was assessed according to the incidence and type of adverse reactions as reported by the patients and the rate of withdrawal due to adverse events. Results. At the end of the treatment period, patients in the celecoxib groups had significant improvement in both functional status and HRQOL in comparison with the placebo group. The effects of total daily doses of 200 mg of celecoxib, 400 mg of celecoxib, and 1000 mg of naproxen on functioning and HRQOL were not found to be significantly different from each other. The incidence of serious adverse events and withdrawal from the studies due to adverse events were similar in the celecoxib groups as they were in the placebo group. Overall, the naproxen group reported a significantly higher incidence of gastrointestinal adverse events than did the placebo and the 200-mg-daily celecoxib groups. Conclusions. This study showed that celecoxib and naproxen significantly improved functional status and HRQOL in elderly patients compared with those treated with a placebo. Celecoxib-treated patients were also found to experience safety and tolerability similar to that of the placebo-treated patients.

Published
2001

34. The authors reply

Author

Arellano, Felix M., primary, Zhao, Sean Z., additional, Reynolds, Matthew W., additional, Lefkowith, James, additional, and Whelton, Andrew, additional

Published
2002
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44. Letters.

Author

Dudley, Nigel, Bonney, G L W, Field, Tim, Becker, Kristin, Mackenzie, Graeme M, Crossan, Liz, MacHale, Siobhan, Tuddenham, L M, Jones, Chris, Clark, Andrew, Ravnskov, Uffe, Anton, Christopher, Arellano, Felix M, Zhao, Sean Z, Reynolds, Matthew W, Johnson, A G, Majeed, A W, McLean, Fiona, and Kotzin, Sheldon

Subjects
MEDICINE, BULLYING, VIOLENCE in the workplace
Abstract

Presents letters to the editor on topics in medicine as of March 30, 2002. Leadership conference of the National Health Service of Great Britain; Bullying in medicine; Violence in the workplace; Use of statins in place of aspirin.

Published
2002

45. Blood Pressure Destabilization and Edema Among 8538 Users of Celecoxib, Rofecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs (NSAID) and Nonusers of NSAID Receiving Ordinary Clinical Care

Author

Wolfe, Frederick, Zhao, Sean, and Pettitt, Dan

Abstract

OBJECTIVE: To investigate the relationship between nonselective nonsteroidal antiinflammatory drugs (NS NSAID), rofecoxib, celecoxib, and risk of edema and blood pressure destabilization in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) receiving ordinary clinic care. METHODS: Patients participating in a longterm outcome study reported drug use, as well as the presence of edema and blood pressure increases occurring during the previous 6 months. To measure pure drug effect, analyses were restricted to 8538 patients who exclusively used a NS NSAID, rofecoxib, or celecoxib, and compared to nonusers of NS NSAID, rofecoxib, or celecoxib. We evaluated blood pressure destabilization using patient-reported increases in blood pressure and/or difficulty in controlling blood pressure. RESULTS: Compared with nonusers, after adjusting for age, sex, presence of RA, and history of heart disease and hypertension, patients using rofecoxib, but not celecoxib or NS NSAID, had an increased rate of edema (23.3% vs 18.0%), while the rates for celecoxib and NS NSAID were 17.5% and 18.2%, respectively. The adjusted risk of edema was significantly increased for rofecoxib compared to celecoxib (OR 1.33, 95% CI 1.08–1.64). For blood pressure increases, among patients who did not report having hypertension, no significant increase was noted for NS NSAID and celecoxib compared with nonusers. However a significant increased risk of blood pressure increase was seen for rofecoxib (OR 2.08, 95% CI 1.41–3.06). Among patients who reported having hypertension, patients taking rofecoxib had a significant increased risk of blood pressure increase compared to nonusers (OR 1.55, 95% CI 1.23–1.96), while the risks of blood pressure increase for users of celecoxib and NS NSAID were not significantly different than among nonusers. After controlling for age, sex, RA, and new starts on NSAID, the risk of blood pressure increase was significantly higher for users of rofecoxib than celecoxib (OR 1.21, 95% CI 1.03–1.61) among patients with hypertension, and numerically higher for nonhypertensives (OR 1.42, 95% CI 0.96–2.22). The increased risk for hypertension and edema of rofecoxib compared to celecoxib users was further confirmed by analysis of specific reported side effects during 2 separate 6-month periods (July 1 to December 31, 1999, and January 1 to June 30, 2000). During these 2 periods, rofecoxib-treated patients were 2.16 to 3.82 times more likely to report edema or blood pressure increase side effects compared to celecoxib-treated patients. CONCLUSION: Rofecoxib, but not celecoxib and NS NSAID, is associated with an increased risk of edema and blood pressure increase compared to nonusers of NSAID.

Published
2004

47. Evaluation of health-related quality of life of rheumatoid arthritis patients treated with celecoxib

Author

Zhao, Sean Z., Fiechtner, Justus I., Tindall, Elizabeth A., Dedhiya, Seema D., Zhao, William W., Osterhaus, Jane T., and Yu, Shawn S.

Abstract

To study the functional status and health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) after treatment with celecoxib, compared with placebo and naproxen. This was a prospective, randomized, double-blind, parallel group trial conducted at 79 sites in the United States and Canada over a 12-week treatment period. Patients were randomly assigned to 5 groups: placebo, 100 mg twice a day of celecoxib, 200 mg twice a day of celecoxib, 400 mg twice a day of celecoxib, and 500 mg twice a day of naproxen. The Health Assessment Questionnaire (HAQ) disability index was used to measure functional status. The Medical Outcomes Study Short Form 36 (SF-36) was used to measure general HRQOL. Enrollees were 1,149 patients with diagnosed and active RA. At the end of the treatment period, patients in the 4 active treatment groups had significant improvement in both functional status and overall HRQOL in comparison with the placebo group. Patients in the twice-daily 100 mg celecoxib group significantly differed from placebo at weeks 2 and 6 on HAQ scores and at week 12 on 5 domains and both summary scores of the SF-36. Patients treated with twice-daily 200 mg celecoxib had significantly better functional status than placebo at all times of testing with the HAQ, and also had significantly better function than those treated with naproxen after 2 and 12 weeks of treatment. Patients in the twice-daily 200 mg and 400 mg celecoxib groups showed similar improvement in HRQOL as determined by the 8 domain scores and 2 summary scores of the SF-36. Celecoxib was better than placebo and comparable with naproxen in improving functional status and overall HRQOL among RA patients.

Published
2000
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50. Postural Orthostatic Tachycardia Syndrome

Author

Zhao S and Tran VH

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a common form of autonomic dysregulation characterized as an excessive tachycardia upon standing in the presence of orthostatic intolerance.[1][2][3] Current adult diagnostic criterion requires a heart rate increase of greater than or equal to 30 bpm within the initial 10 minutes of standing or head-up tilt (HUT) in the absence of orthostatic hypotension.[4][5] POTS predominantly affects premenopausal females (5 to 1) between 15 and 50 years of age, manifesting with symptoms of fatigue, headache, palpitations, sleep disturbance, nausea, bloating, among others.[2][6][3] A multitude of pathophysiologic mechanisms including but not limited to disproportionate sympathoexcitation, volume depletion, autoimmune dysfunction, cardiac and physical deconditioning point to a heterogeneously complex etiology.[3][5][7] Most significantly, the debilitating nature of POTS predisposes patients to a high degree of functional impairment and decreased quality of life,[8] emphasizing the need for further investigation into the understanding and management of this increasingly prevalent clinical syndrome., (Copyright © 2021, StatPearls Publishing LLC.)

Published
2021

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