A patient receiving daptomycin developed asymptomatic transaminitis and hyperbilirubinemia without concurrent multiorgan dysfunction or elevation of his creatinine kinase level. After ruling out other etiologies, the liver injury was attributed to daptomycin and was subsequently resolved. A single-center retrospective cohort analysis of baseline and follow-up liver function panels (n ؍ 614) from all admissions from 2008 to 2013 during which daptomycin was administered did not reveal any other cases of probable or definite drug-induced liver injury associated with daptomycin. Drug-induced liver injury (DILI) has been ascribed to Ͼ1,000 medications (1). While various scales have been developed to establish causality (e.g., the Naranjo probability scale, the Roussel Uclaf causality assessment method [RUCAM], the Maria and Victorino [M&V] scale, and the Council for International Organizations of Medical Sciences [CIOMS] scale), none has been adopted as a gold standard (2-5). The U.S. National Library of Medicine suggests that expert opinion is also suitable for attributing causality (see http://livertox.nih.gov/).Daptomycin has been associated with transaminase elevations in 3% of subjects (6) but not with other findings indicating a hepatic origin (e.g., gamma-glutamyl transferase [GGT]) (Cubist Pharmaceuticals Medical Affairs, written communication). Therefore, the elevations likely reflect myocyte injury, a known effect that necessitates creatinine kinase (CK) monitoring. One previous case of daptomycin-associated DILI mirrored this pattern, while another report described a patient with multiorgan failure (7,8). The case discussed below is unique because the patient developed isolated asymptomatic liver injury.Case report. A 31-year-old man with a history of psychiatric disorders, degenerative disc disease with chronic back pain, and intravenous drug abuse presented with suicidal ideation. He also reported a productive cough, left-sided inspiratory chest pain, abdominal pain, and back pain. He denied using ethanol or drugs except previously prescribed oxycodone (30 mg every 4 h as needed) and alprazolam (2 mg daily). The physical exam revealed an abscess involving the left antecubital fossa, into which the patient eventually admitted to injecting crushed morphine tablets. No jaundice or hepatosplenomegaly was identified. He was febrile to 39.3°C. His urine drug screen was positive for opiates and benzodiazepines. His liver function test (LFT) values were elevated, including a total bilirubin level of 2.1 mg/dl, an aspartate aminotransferase (AST) level of 95 IU/liter, an alanine aminotransferase (ALT) level of 95 IU/liter, and an alkaline phosphatase (ALP) level of 150 IU/liter (Fig. 1). After ruling out vertebral osteomyelitis with a gallium-67-tagged white cell scan, the abdominal pain was attributed to opioid withdrawal, and the patient was treated with dicyclomine and an opioid taper.On hospital day 3, the blood cultures started at admission grew Gram-positive cocci, and vancomycin was initiated. Treatment ...
Introducción: La prevalencia de obesidad pregestacional es un problema de salud. Objetivo: determinar mediante variables antropométricas y analíticas, el riesgo cardio metabólico en mujeres que inician el embarazo con sobrepeso y obesidad Método: estudio analítico transversal en el Hospital Mariana Grajales de Santa Clara, del 2019 al 2021, en 404 gestantes que iniciaron su gestación con sobrepeso y obesidad. Resultados: Predominó la obesidad en las mujeres con edad fértil (78.2%) y en las de edad avanzada (82%). La circunferencia abdominal mayor de 80 cms, el índice cintura cadera mayor de 85 y el producto de acumulación de lípidos LAP mayor de 34.2 resultaron las tres variables antropométricas que se asociaron significativamente a la edad, presentando valores significativamente mayores en las gestantes de edad avanzada. La circunferencia abdominal mayor de 80, el índice cintura cadera mayor de 85, la glicemia en la captación mayor de 4,4 mmol/L, los niveles de triglicéridos mayor de 1,7 mmol/L y el LAP mayor de 34.2 fueron las cinco variables antropométricas que se asociaron significativamente a la obesidad. Del total de 404 gestantes con sobrepeso y obesidad el 59.4% tiene un fenotipo cintura hipertrigliceridemica y dentro de la clasificación de la obesidad en las obesas clase III el 90.9% así como en el subtotal de obesidad el 63.6%. Predominó la salud metabólica en el 94.8%. Conclusiones: Se encontró asociación de variables antropométricas y analíticas predictoras de riesgo cardio metabólico en mujeres con obesidad pregestacional.
Introducción: La hemorragia obstétrica constituye una emergencia obstétrica que requiere una reanimación urgente y ordenada, inclusive antes de establecer su causa. Objetivo: caracterizar el manejo de la morbilidad materna extremadamente grave por hemorragia obstétrica. Método: Estudio de desarrollo, observacional y de corte transversal y retrospectivo de las pacientes con morbilidad materna extremadamente grave por hemorragia obstétrica en el Hospital Gineco-Obstétrico Docente Universitario “Mariana Grajales” de Villa Clara, durante el período de enero 2016 a diciembre del 2018. Resultados: La gran mayoría de las pacientes, requirió para la resolución de la morbilidad materna grave, algún tipo de tratamiento quirúrgico, a pesar de que se emplearan en estos casos los tratamientos farmacológicos o avanzados. El 56,1% no presentaron signos clínicos de shock, a pesar de lo cual, un 34,8%% de estos requirió un manejo avanzado en el tratamiento y hasta un 43,5% de manejo quirúrgico se realizaron 15 histerectomías obstétricas 36,6% Conclusiones: predominó el manejo quirúrgico para la resolución de la morbilidad materna extremadamente grave por hemorragia obstétrica, y se caracterizó por un modesto empleo de las técnicas quirúrgicas conservadoras. La histerectomía obstétrica fue la técnica más utilizada, la que no estuvo condicionada por la causa de la hemorragia, sino más bien por el estado de afectación materno.
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