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Health Hazard Evaluation Report 1983-0019-1562
r ILi:. llUr I Health Hazard . Evaluation HETA 83-019-1562 I BERLEX LABS. Report WAYNE., NEW JERSEY . "'-':'. ·· J· PREFACE .......~ The Hazard Evaluation~ ·- ~nd .. "rechni cal Assistance Branch of NIOSH conducts field i nyesti gations of possible hea.lth hazards i n the workplace. These investigations ~are conducted ~under the authority of Section 20(a)(6) of the Occupational Safety and.,Heal'ttr Act of 1970 , 29 u ~ s.c. 66~(a)(6) which authorizes t he Secretary of Health·and Human Services, following a written request from any employer of~ au~horized representative of employees, to determine whether any substance normally found in the place of employ~nt has potentiall~ toxic· .effects in such concentrations as used or fotmd. The Hazard Evaluations and Technical Assistance Branch also provides, upon request, medical, nursing, and industrial hygiene technical and consultative assistance (TA) to Federal, state, and local agencies; labor; industry and other groups or individuals to control occupational health hazards and to prevent related trauma and disease. Mention of company nair.es or products does not constitute e ndorsement by the National Institute for Occupational Safety and Health. HETA 83-019-1562 Investigators: SEPTEMBER, 1985 REVISED Raja Igliewicz, RN, MS BERLEX LABS. Michael Schmidt, MD WAYNE, NEW JERSEY Peter Gann, MD 1. SUMMARY In October, 1982, the National Institute for Occupational Safety and Health (NIOSH) received a request to evaluate workers involved in the production of a drug, quinidine gluconate at Berlex Laborateries, Wayne, N.J. These workers had developed work-related skin rashes and respiratory symptoms. Staff from the Occupational Health Program of the New Jersey State Department of Health performed the investigation under a cooperative agreement with NlOSH. -
Food Allergy • Higher Prevalence in Children: Many Food Allergic Children Develop Immune Tolerance Background Ctd
Overview of Food-Related Adverse Reactions ALLSA 2017 Dr Claudia Gray Dr Claudia Gray • MBChB, FRCPCH (London), MSc (Surrey), Dip Allergy (Southampton), DipPaedNutrition(UK), PhD (UCT) • Paediatrician and Allergologist, UCT Lung Institute • Red Cross Children’s Hospital Allergy and Asthma Department • [email protected] Background 1. Food allergies are common: • Infants: 6-10%; children 2-8%, adults 1-2% true food allergy • Higher prevalence in children: many food allergic children develop immune tolerance Background ctd 2. Food allergies are increasing: • Peanut allergy in UK doubled in 1-2 decades: 1.8%. ? Stabilising in some regions Background 3. Spectrum changing: • Multiple food allergies increasing • “Rare” food allergies are increasing e.g. Eosinophilic oesophagitis; FPIES Allergenic Foods • Prevalence of food allergies influenced by geography and diet; egg and milk allergy universally common • Relatively small number of food types cause the majority of reactions: Allergenic Foods Young Children Adults • Cow’s milk • Fin-fish • Hen’s Egg • Shellfish • Wheat • Treenut • Soya • Peanut • Peanut • Fruit and vegetables • Treenut • Sesame • Kiwi • (* persistence likely) Allergenic Foods • A single food allergen can induce a range of allergic reactions e.g. wheat Classification of Adverse reactions to Food Classification of adverse reactions to food Adverse Reaction to food May occur in all Occurs only in some individuals if they eat susceptible sufficient quantity individuals Pharma- Micro- Toxic Food Food (e.g. cological biological scromboid) e.g. e.g food aversion hypersensitivity tyramine poisoning Classification of adverse reactions to food Food Hypersensitivity Non-allergic food Food Allergy hypersensitivity Mixed IgE- Unknown Metabolic IgE- and non Non IgE- e.g. -
Pulmonary Cancer And/Or GPA? Diagnostic Implications of Pulmonary Nodules
Gaceta Médica de México. 2016;152 Contents available at PubMed www.anmm.org.mx PERMANYER Gac Med Mex. 2016;152:468-74 www.permanyer.com GACETA MÉDICA DE MÉXICO ORIGINAL ARTICLE Pulmonary pseucotumor in granulomatosis with polyangiitis (GPA). Pulmonary cancer and/or GPA? Diagnostic implications of pulmonary nodules Gabriel Horta-Baas1*, Esteban Meza-Zempoaltecatl2, Mario Pérez-Cristóbal2 and Barile-Fabris Leonor Adriana2 1Rheumatology Department, Hospital General Regional 220, IMSS, Toluca; 2Rheumatology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico Abstract Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic necrotizing vasculitis, which affects small and medium sized blood vessels and is often associated with cytoplasmic anti-neutrophil cytoplasmic antibodies (ANCA). Inflammatory pseudotumor is a rare condition characterized by the appearance of a mass lesion that mimics a malignant tumor both clinically and on imaging studies, but that is thought to have an inflammatory/reactive pathogenesis. We report a patient with a GPA which was originally diagnosed as malignancy. (Gac Med Mex. 2016;152:468-74) Corresponding author: Gabriel Horta-Baas, [email protected] KEY WORDS: Granulomatosis with polyangiitis. Pseudotumor. Malignancy. Introduction Presentation of the case According to the 2012 revised Chapel Hill classifica- This is the case of a 39-year old male who was tion, granulomatosis with polyangiitis (GPA), previously admitted in the hospital presenting with asthenia, gen- known as Wegener’s granulomatosis (WG), is an auto- eral malaise, intermittent fever (3 to 4 times a month), immune systemic disease of unknown etiology, charac- diaphoresis with no time of day predominance and loss terized by necrotizing granulomatous inflammation of the of 10-kg weight in 6 months. -
Print Your Symptom Diary
MEDICATION GUIDE FETZIMA® (fet-ZEE-muh) (levomilnacipran) extended-release capsules, for oral use What is the most important information I should know about FETZIMA? FETZIMA may cause serious side effects, including: • Increased risk of suicidal thoughts or actions in some children, adolescents, and young adults. FETZIMA and other antidepressant medicines may increase suicidal thoughts or actions in some children and young adults, especially within the first few months of treatment or when the dose is changed. FETZIMA is not for use in children. o Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression, bipolar illness (also called manic-depressive illness) or have a history of suicidal thoughts or actions. How can I watch for and try to prevent suicidal thoughts and actions? o Pay close attention to any changes, especially sudden changes in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions. This is very important when an antidepressant medicine is started or when the dose is changed. o Call your healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings. o Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms. Call your healthcare provider or -
© 2019 First Aid for the USMLE Step 1 732 INDEX INDEX
Index A Abnormal uterine bleeding (AUB), heart failure, 306 Achondroplasia, 454 A-a gradient 618, 619 hypertension, 312 chromosome disorder, 64 in elderly, 654 adenomyosis, 634 naming convention for, 253 endochondral ossification in, 450 with hypoxemia, 654, 655 anemia with, 410 preload/afterload effects, 282 inheritance, 60 restrictive lung disease, 661 Asherman syndrome, 634 teratogenicity, 600 AChR (acetylcholine receptor), 229 Abacavir, 201, 203 leiomyoma (fibroid), 634 Acetaldehyde, 72 Acid-base physiology, 580 Abciximab, 122 polyps (endometrial), 634 Acetaldehyde dehydrogenase, 70, 72 Acidemia, 580 Glycoprotein IIb/IIIa inhibitors, thecoma, 632 Acetaminophen, 474 diuretic effect on, 595 429 ABO blood classification, 397 vs. aspirin for pediatric patients, 474 Acid-fast oocysts, 177 thrombogenesis and, 403 newborn hemolysis, 397 free radical injury and, 210 Acid-fast organisms, 125, 140, 155 Abdominal aorta, 357 Abruptio placentae, 626 hepatic necrosis from, 249 Acidic amino acids, 81 atherosclerosis in, 300, 687 cocaine use, 600 N-acetylcysteine for overdose, 671 Acid maltase, 86 bifurcation of, 649 preeclampsia, 629 for osteoarthritis, 458 Acidosis, 578, 580 Abdominal aortic aneurysm, 300 Abscess, 470 toxicity effects, 474 contractility in, 282 Abdominal colic acute inflammation and, 215 toxicity treatment for, 247 hyperkalemia with, 578 lead poisoning, 411 lung, 670 Acetazolamide, 252, 539, 594 Acid phosphatase in neutrophils, 398 Abdominal pain Absence seizures idiopathic intracranial Acid reflux bacterial peritonitis, 384 characteristics -
Pharmacology/Therapeutics Ii Block 1 Handouts – 2015-16
PHARMACOLOGY/THERAPEUTICS II BLOCK 1 HANDOUTS – 2015‐16 55. H2 Blockers, PPls – Moorman 56. Palliation of Contipation & Nausea/Vomiting – Kristopaitis 57. On‐Line Only – Principles of Clinical Toxicology – Kennedy 58. Anti‐Parasitic Agents – Johnson Histamine Antagonists and PPIs January 6, 2016 Debra Hoppensteadt Moorman, Ph.D. Histamine Antagonists and PPIs Debra Hoppensteadt Moorman, Ph.D. Office # 64625 Email: [email protected] KEY CONCEPTS AND LEARNING OBJECTIVES . 1 To understand the clinical uses of H2 receptor antagonists. 2 To describe the drug interactions associated with the use of H2 receptor antagonists. 3 To understand the mechanism of action of PPIs 4 To describe the adverse effects and drugs interactions with PPIs 5 To understand when the histamine antagonists and the PPIs are to be used for treatment 6 To describe the drugs used to treat H. pylori infection Drug List: See Summary Table. Histamine Antagonists and PPIs January 6, 2016 Debra Hoppensteadt Moorman, Ph.D. Histamine Antagonists and PPIs I. H2 Receptor Antagonists These drugs reduce gastric acid secretion, and are used to treat peptic ulcer disease and gastric acid hypersecretion. These are remarkably safe drugs, and are now available over the counter. The H2 antagonists are available OTC: 1. Cimetidine (Tagamet®) 2. Famotidine (Pepcid®) 3. Nizatidine (Axid®) 4. Ranitidine (Zantac®) All of these have different structures and, therefore, different side-effects. The H2 antagonists are rapidly and well absorbed after oral administration (bioavailability 50-90%). Peak plasma concentrations are reached in 1-3 hours, and the drugs have a t1/2 of 1-3 hours. H2 antagonists also inhibit stimulated (due to feeding, gastrin, hypoglycemia, vagal) acid secretion and are useful in controlling nocturnal acidity – useful when added to proton pump therapy to control “nocturnal acid breakthrough”. -
Rhinotillexomania in a Cystic Fibrosis Patient Resulting in Septal Perforation Mark Gelpi1*, Emily N Ahadizadeh1,2, Brian D’Anzaa1 and Kenneth Rodriguez1
ISSN: 2572-4193 Gelpi et al. J Otolaryngol Rhinol 2018, 4:036 DOI: 10.23937/2572-4193.1510036 Volume 4 | Issue 1 Journal of Open Access Otolaryngology and Rhinology CASE REPORT Rhinotillexomania in a Cystic Fibrosis Patient Resulting in Septal Perforation Mark Gelpi1*, Emily N Ahadizadeh1,2, Brian D’Anzaa1 and Kenneth Rodriguez1 1 Check for University Hospitals Cleveland Medical Center, USA updates 2Case Western Reserve University School of Medicine, USA *Corresponding author: Mark Gelpi, MD, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA, Tel: (216)-844-8433, Fax: (216)-201-4479, E-mail: [email protected] paranasal sinuses [1,4]. Nasal symptoms in CF patients Abstract occur early, manifesting between 5-14 years of age, and Cystic fibrosis (CF) is a multisystem disease that can have represent a life-long problem in this population [5]. Pa- significant sinonasal manifestations. Viscous secretions are one of several factors in CF that result in chronic sinona- tients with CF can develop thick nasal secretions con- sal pathology, such as sinusitis, polyposis, congestion, and tributing to chronic rhinosinusitis (CRS), nasal conges- obstructive crusting. Persistent discomfort and nasal man- tion, nasal polyposis, headaches, and hyposmia [6-8]. ifestations of this disease significantly affect quality of life. Sinonasal symptoms of CF are managed medically with Digital manipulation and removal of crusting by the patient in an attempt to alleviate the discomfort can have unfore- topical agents and antibiotics, however surgery can be seen damaging consequences. We present one such case warranted due to the chronic and refractory nature of and investigate other cases of septal damage secondary to the symptoms, with 20-25% of CF patients undergoing digital trauma, as well as discuss the importance of sinona- sinus surgery in their lifetime [8]. -
Levomilnacipran (Fetzima®) Indication
Levomilnacipran (Fetzima®) Indication: Indicated for the treatment of major depressive disorder (MDD), FDA approved July 2013. Mechanism of action Levomilnacipran, the more active enantiomer of racemic milnacipran, is a selective SNRI with greater potency for inhibition of norepinephrine relative to serotonin reuptake Compared with duloxetine or venlafaxine, levomilnacipran has over 10-fold higher selectivity for norepinephrine relative to serotonin reuptake inhibition The exact mechanism of the antidepressant action of levomilnacipran is unknown Dosage and administration Initial: 20 mg once daily for 2 days and then increased to 40 mg once daily. The dosage can be increased by increments of 40 mg at intervals of two or more days Maintenance: 40-120 mg once daily with or without food. Fetzima should be swallowed whole (capsule should not be opened or crushed) Levomilnacipran and its metabolites are eliminated primarily by renal excretion o Renal impairment Dosing: Clcr 30-59 mL/minute: 80 mg once daily Clcr 15-29 mL/minute: 40 mg once daily End-stage renal disease (ESRD): Not recommended Discontinuing treatment: Gradually taper dose, if intolerable withdrawal symptoms occur, consider resuming the previous dose and/or decrease dose at a more gradual rate How supplied: Capsule ER 24 Hour Fetzima Titration: 20 & 40 mg (28 ea) Fetzima: 20 mg, 40 mg, 80 mg, 120 mg Warnings and Precautions Elevated Blood Pressure and Heart Rate: measure heart rate and blood pressure prior to initiating treatment and periodically throughout treatment Narrow-angle glaucoma: may cause mydriasis. Use caution in patients with controlled narrow- angle glaucoma Urinary hesitancy or retention: advise patient to report symptoms of urinary difficulty Discontinuation Syndrome Seizure disorders: Use caution with a previous seizure disorder (not systematically evaluated) Risk of Serotonin syndrome when taken alone or co-administered with other serotonergic agents (including triptans, tricyclics, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. -
Mantke, Peitz, Surgical Ultrasound -- Index
419 Index A esophageal 218 Anorchidism 376 gallbladder 165 Aorta 364–366 A-mode imaging 97 gastric 220 abdominal aneurysm (AAA) AAA (abdominal aortic aneurysm) metastasis 142 20–21, 364, 366 20–21, 364, 366 pancreatic 149, 225 dissection 364, 366 Abdominal wall Adenofibroma, breast 263 perforation 366 abscess 300–301 Adenoma pseudoaneurysm 364 diagnostic evaluation 297 adrenal 214 Aortic rupture 20 hematoma 73, 300, 305 colorectal 231, 232 Aplasia, muscular 272 rectus sheath 297–300 duodenal papilla 229, 231 Appendicitis 1–4 hernia 300, 302–304 gallbladder 165 consequences for surgical indications for sonography 297 hepatic 54, 58, 141 treatment 2 seroma 298, 300, 305 multiple 141 sonographic criteria 1 trauma 297–300 parathyroid 213 Archiving 418 Abortion, tubal 30 renal 241 Arteriosclerosis 346, 348 Abscess thyroid 202–203 carotid artery 335, 337, 338 abdominal wall 300–301 Adenomyomatosis 8, 164, 165 plaque 337, 338, 345, 367, 370 causes 301 Adrenal glands 214–216 Arteriovenous (AV) malformation amebic 138 adenoma 214 139, 293, 326–329 breast 264 carcinoma 214 Artery chest wall 173, 178 cyst 214 carotid 334–339 diverticular 120, 123 hematoma 214 aneurysm 338 drainage 85–88, 93 hemorrhage 214 arteriosclerosis 335 hepatic 6, 138, 398 hyperplasia 214 plaque characteristics inflammatory bowel disease limpoma/myelipoma 214 337, 338, 345 116, 119 metastases 214 bifurcation 334, 337 intramural 5 sonographic criteria 214 bulb 339 lung 183, 186, 190 tuberculosis 214 dissection 338, 339, 346 pancreatic 11 Advanced dynamic flow (ADF) sonographic -
Levomilnacipran for the Treatment of Major Depressive Disorder
Out of the Pipeline Levomilnacipran for the treatment of major depressive disorder Matthew Macaluso, DO, Hala Kazanchi, MD, and Vikram Malhotra, MD An SNRI with n July 2013, the FDA approved levomil- Table 1 once-daily dosing, nacipran for the treatment of major de- Levomilnacipran: Fast facts levomilnacipran pressive disorder (MDD) in adults.1 It is I Brand name: Fetzima decreased core available in a once-daily, extended-release formulation (Table 1).1 The drug is the fifth Class: Serotonin-norepinephrine reuptake symptoms of inhibitor serotonin-norepinephrine reuptake inhibi- MDD and was well Indication: Treatment of major depressive tor (SNRI) to be sold in the United States disorder in adults tolerated in clinical and the fourth to receive FDA approval for FDA approval date: July 26, 2013 trials treating MDD. Availability date: Fourth quarter of 2013 Levomilnacipran is believed to be the Manufacturer: Forest Pharmaceuticals more active enantiomer of milnacipran, Dosage forms: Extended–release capsules in which has been available in Europe for 20 mg, 40 mg, 80 mg, and 120 mg strengths years and was approved by the FDA in Recommended dosage: 40 mg to 120 mg 2009 for treating fibromyalgia. Efficacy of capsule once daily with or without food levomilnacipran for treating patients with Source: Reference 1 MDD was established in three 8-week ran- domized controlled trials (RCTs).1 cial and occupational functioning in addi- Clinical implications tion to improvement in the core symptoms Levomilnacipran is indicated for treating of depression.5 -
Cytology of Myeloma Cells
J Clin Pathol: first published as 10.1136/jcp.29.10.916 on 1 October 1976. Downloaded from J. clin. Path., 1976, 29, 916-922 Cytology of myeloma cells F. G. J. HAYHOE AND ZOFIA NEUMAN1 From the Department of Haematological Medicine, Cambridge University SYNOPSIS A cytological, cytochemical, and cytometric study of plasma cells from 195 cases of multiple myeloma showed that, contrary to earlier reports, flaming cells, thesaurocytes, and intra- nuclear inclusions are not confined to IgA-secreting cases but are common also in IgG and Bence Jones varieties of myeloma. IgA-secreting cells are not larger, nor do they have a lower nuclear- cytoplasmic ratio than other myeloma cells. On average, for a given mass of tumour, Bence-Jones, IgG, and IgA varieties of myeloma produce amounts of paraprotein in the ratio 1 to 1 6 to 2-7. In 1961 Paraskevas et al reported a correlation the results of a larger scale survey carried out some between the morphological features of plasma cells years ago but previously unpublished. in myeloma and the type of immunoglobulin secreted. The cases studied included 12 with y1A Material and methods (f2A, IgA) myeloma, 30 with y (IgG) myeloma, and six myelomas without M protein (probably Bence The study was performed on bone marrow smearscopyright. Jones myelomas). Flaming cells, thesaurocytes, and from 200 consecutive patients newly entered into a intranuclear, PAS-positive inclusion bodies were comparative trial of treatments in myeloma, under found only in cases of IgA myeloma, and flaming the auspices of the Medical Research Council. Five cells especially were present in most cases and in patients were subsequently excluded as not confirmed high percentage in several. -
Rectal Indomethacin Or I.V. Gabexate Mesylate As Prophylaxis for AP ERCP
European Review for Medical and Pharmacological Sciences 2017; 21: 5268-5274 Rectal indomethacin or intravenous gabexate mesylate as prophylaxis for acute pancreatitis post-endoscopic retrograde cholangiopancreatography V. GUGLIELMI, M. TUTINO, V. GUERRA, P. GIORGIO National Institute of Gastroenterology, “S. de Bellis” Research Hospital Castellana Grotte, Bari, Italy Abstract. – OBJECTIVE: We aimed to evaluate mechanisms of AP are obstruction of the com- the results in our case series of AP ERCP over mon bile duct by stones, and alcohol abuse. En- the last three years. The prophylaxis for acute doscopic retrograde cholangiopancreatography pancreatitis (AP) post-endoscopic retrograde (ERCP) is the most frequent iatrogenic cause. cholangiopancreatography (ERCP) consists of rectal indomethacin, but some studies are not Post-ERCP AP is the most common and fear concordant. some adverse event for this procedure. In the PATIENTS AND METHODS: We compared 241 United States this complication costs $150 mil- ERCP performed from January 2014 to February lion annually for American Healthcare2,3 and it 2015 with intravenous gabexate mesylate (Group is a common cause of endoscopy-related lawsu- A), with the 387 ERCP performed from March its against gastroenterologists in the world. It 2015 to December 2016 with rectal indometha- has a significant morbidity and rare mortality cin (Group B) as prophylaxis for AP post-ERCP. RESULTS: There were 8 (3.31%) AP post-ERCP rate. About 10% of post-ERCP AP is moderate in Group A vs. 4 (1.03%) in Group B. or severe. Post-ERCP severe AP is associated CONCLUSIONS: Rectal indomethacin shows a with a higher mortality than non-ERCP-indu- better statistically significant performance than ced pancreatitis, but without statistical eviden- intravenous gabexate mesylate in the prophylax- ce4.