The Experts below are selected from a list of 174 Experts worldwide ranked by ideXlab platform
Martin Chalumeau - One of the best experts on this subject based on the ideXlab platform.
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Respiratory Paradoxical Adverse Drug Reactions Associated with Acetylcysteine and Carbocysteine Systemic Use in Paediatric Patients: A National Survey
2013Co-Authors: Pauline Mallet, Nadjette Mourdi, Jean-christophe Dubus, Françoise Bavoux, Marie-josèphe Jean-pastor, Martin ChalumeauAbstract:Objective: To report pediatric cases of paradoxical respiratory adverse drug reactions (ADRs) after exposure to oral mucolytic drugs (carbocysteine, acetylcysteine) that led to the withdrawal of licenses for these drugs for infants in France and then Italy. Design: The study followed the recommendations of the European guidelines of pharmacovigilance for medicines used in the paediatric population. Setting: Cases voluntarily reported by physicians from 1989 to 2008 were identified in the national French pharmacovigilance public database and in drug company databases. Patients: The definition of paradoxical respiratory ADRs was based on the literature. Exposure to mucolytic drugs was arbitrarily defined as having received mucolytic drugs for at least 2 days (.200 mg) and at least until the day before the first signs of the suspected ADR. Results: The non-exclusive paradoxical respiratory ADRs reported in 59 paediatric patients (median age 5 months, range 3 weeks to 34 months, 98 % younger than 2 years old) were increased Bronchorrhea or mucus vomiting (n = 27), worsening of respiratory distress during respiratory tract infection (n = 35), dyspnoea (n = 18), cough aggravation or prolongation (n = 11), and bronchospasm (n = 1). Fifty-one (86%) children required hospitalization or extended hospitalization because of the ADR
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acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho pulmonary disease
Cochrane Database of Systematic Reviews, 2013Co-Authors: Martin Chalumeau, Yvonne DuijvestijnAbstract:Background Acetylcysteine and carbocysteine are the most commonly prescribed mucolytic drugs in Brazil and many European and African countries. To our knowledge, no systematic review has been published on their efficacy and safety for acute upper and lower respiratory tract infections (RTIs) in children without chronic broncho-pulmonary disease. Objectives The objective was to assess the efficacy and safety and to establish a benefit-risk ratio of acetylcysteine and carbocysteine as symptomatic treatments for acute upper and lower RTIs in paediatric patients without chronic broncho-pulmonary disease. Search methods We searched CENTRAL (2013, Issue 2), MEDLINE (1966 to February week 3, 2013), EMBASE (1980 to March 2013), Micromedex (2010), Pascal (1987 to 2004) and Science Citation Index (1974 to March 2013). Selection criteria To study efficacy, we used randomised controlled trials (RCTs) comparing the use of acetylcysteine or carbocysteine versus placebo, either alone or as an add-on therapy. To study safety, we used trials comparing acetylcysteine or carbocysteine versus active treatment or no treatment and case reports. Data collection and analysis In this review update two review authors (YD, MC), with help from a colleague, extracted data and assessed trial quality. We performed a subgroup analysis of children younger than two years of age. Main results We included six trials involving 497 participants to study efficacy. They showed some benefit (e.g. reduction of cough at day seven) from mucolytic agents, although differences were of little clinical relevance. No conclusion was drawn about the subgroup of infants younger than two years because data were unavailable. Thirty-four studies, including the previous six trials involving 2064 children, were eligible to study safety. Overall safety was good but very few data were available to evaluate safety in infants younger than two years. However, 59 cases of paradoxically increased bronchorrhoea observed in infants were reported to the French pharmacovigilance system. Authors' conclusions The results have to be interpreted with caution because they are based on a limited number of participants included in studies whose methodological quality is questionable. Acetylcysteine and carbocysteine seem to have a limited efficacy and appear to be safe in children older than two years. These results should take into consideration the fact that acetylcysteine and carbocysteine are prescribed for self limiting diseases (for example, acute cough, bronchitis). Given strong concerns about safety, these drugs should only be used for acute upper and lower RTIs in the context of a RCT with regards to children younger than two years.
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Respiratory paradoxical adverse drug reactions associated with acetylcysteine and carbocysteine systemic use in paediatric patients: a national survey.
Public Library of Science (PLoS), 2024Co-Authors: Pauline Mallet, Nadjette Mourdi, Jean-christophe Dubus, Françoise Bavoux, Marie-josèphe Jean-pastor, Marie-josé Boyer-gervoise, Martin ChalumeauAbstract:OBJECTIVE: To report pediatric cases of paradoxical respiratory adverse drug reactions (ADRs) after exposure to oral mucolytic drugs (carbocysteine, acetylcysteine) that led to the withdrawal of licenses for these drugs for infants in France and then Italy. DESIGN: The study followed the recommendations of the European guidelines of pharmacovigilance for medicines used in the paediatric population. SETTING: Cases voluntarily reported by physicians from 1989 to 2008 were identified in the national French pharmacovigilance public database and in drug company databases. PATIENTS: The definition of paradoxical respiratory ADRs was based on the literature. Exposure to mucolytic drugs was arbitrarily defined as having received mucolytic drugs for at least 2 days (>200 mg) and at least until the day before the first signs of the suspected ADR. RESULTS: The non-exclusive paradoxical respiratory ADRs reported in 59 paediatric patients (median age 5 months, range 3 weeks to 34 months, 98% younger than 2 years old) were increased Bronchorrhea or mucus vomiting (n = 27), worsening of respiratory distress during respiratory tract infection (n = 35), dyspnoea (n = 18), cough aggravation or prolongation (n = 11), and bronchospasm (n = 1). Fifty-one (86%) children required hospitalization or extended hospitalization because of the ADR; one patient died of pulmonary oedema after mucus vomiting. CONCLUSION: Parents, physicians, pharmacists, and drug regulatory agencies should know that the benefit risk ratio of mucolytic drugs is at least null and most probably negative in infants according to available evidence
Non Renseigné - One of the best experts on this subject based on the ideXlab platform.
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Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis.
European Respiratory Journal, 2009Co-Authors: G. Devouassoux, V. Cottin, H. Lioté, E. Marchand, I. Frachon, A. Schuller, F. Béjui-thivolet, J.-f. Cordier, Non RenseignéAbstract:The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) 140% predicted) was conducted. Patients (mean+/-SD age 64+/-11 yrs) included 17 never-smokers and eight ex-smokers (10.5+/-5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and Bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV(1) 41+/-12% pred, FEV(1)/FVC 49+/-14%, FVC 70+/-20% pred, RV 148+/-68% pred and RV/TLC 142+/-34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+/-49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.
G. Devouassoux - One of the best experts on this subject based on the ideXlab platform.
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Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis.
European Respiratory Journal, 2009Co-Authors: G. Devouassoux, V. Cottin, H. Lioté, E. Marchand, I. Frachon, A. Schuller, F. Béjui-thivolet, J.-f. Cordier, Non RenseignéAbstract:The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) 140% predicted) was conducted. Patients (mean+/-SD age 64+/-11 yrs) included 17 never-smokers and eight ex-smokers (10.5+/-5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and Bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV(1) 41+/-12% pred, FEV(1)/FVC 49+/-14%, FVC 70+/-20% pred, RV 148+/-68% pred and RV/TLC 142+/-34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+/-49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.
Jokanovic Milan - One of the best experts on this subject based on the ideXlab platform.
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acute organophosphate poisoning 17 years of experience of the national poison control center in serbia
Toxicology, 2018Co-Authors: Vucinic Slavica, Bokonjic Dubravko, Jokanovic MilanAbstract:Abstract Based on human toxicity studies, by appropriate regulatory decisions, the number of organophosphates (OP) on Serbian market has reduced significantly over the last two decades, followed by a gradual decrease in the number of poisonings by organophoshates, treated at the National Poison Control Centre (NPCC). Methodology The aim of this retrospective study is to present data regarding the clinical management of poisoning with OP pesticides at the NPCC, that we collected during the 17 years period (1998–2014). Results In the period 1998–2014, about 17.250 patients were hospitalized at the NPCC, there were around 14.000 patients treated for poisoning by various toxic agents, and among them 410 cases (3%) due to poisoning with OP pesticides. In this period, 92% of OPI poisonings treated in the NPCC were suicidal by intention, while only 8% were due to accidental ingestion or inhalation. The most common clinical signs of poisoning in patients exposed to anticholinesterase pesticides, observed at Clinic of Toxicology of the NPCC were miosis (63.4%), bronchorrhoea (51.9%), vomiting and diarrhea (44.8%), hypotension (19.5%). Acute respiratory insufficiency was registered in 81 (19.7%) and acute cardiocirculatory failure in 16 (3.9%) patients. There were about 25% of most severely poisoned patients. Besides general supportive measures (decontamination, respiratory support), specific pharmacological treatment (atropine, oxime, diazepam) was applied. The highest total administered dose of atropine at NPCC was 6400 mg. However, the most patients received total doses of atropine up to 500 mg (32%). Conclusion Acute poisoning with OP pesticides is not frequent in Serbia, however, it represents important clinical feature due to severity, possible complications and their impact on duration and costs of hospitalization. Initial treatment involves prevention of further absorption and provision of supportive care, followed by administration of specific antidotes. According to its role, the National Poison Control Centre in Belgrade, in addition to treatment of acute poisonings, continuously performs toxicovigilance, i.e. the identification, investigation and evaluation of various toxic risks in the community in order to undertake adequate and timely procedures. Permanent efforts are being made in order to reduce availability and to improve control measures for pesticides marketing.
Nicole Guiso - One of the best experts on this subject based on the ideXlab platform.
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RESEARCH Bordetella petrii Infection with Long-lasting Persistence in Human
2013Co-Authors: Alain Le Coustumier, Elisabeth Njamkepo, Vincent Cattoir, Sophie Guillot, Nicole GuisoAbstract:in the sputum of a 79-year-old female patient with diffuse bronchiectasis and persistence of the bacterium for>1 year. The patient was fi rst hospitalized due to dyspnea, which developed into severe cough with purulent sputum that yielded B. petrii on culture. After this fi rst episode, the patient was hospitalized an additional 4 times with Bronchorrhea symptoms. The isolates collected were analyzed by using biochemical, genotypic, and proteomic tools. Expression of specifi c proteins was analyzed by using serum samples from the patient. The B. petrii isolates were compared with other B. petrii isolates collected from humans or the environment and with isolates of B. pertussis, B. parapertussis, B. bronchiseptica, and B. holmesii, obtained from human respiratory tract infections. Our observations indicate that B. petrii can persist in persons with chronic pulmonary obstructive disease as has been previously demonstrated for B. bronchiseptica. The genus Bordetella comprises 9 species; all, except B. petrii, are obligatorily associated with host organisms (1). The first isolations of B. ansorpii were from a cyst (2) and from a blood sample (3), whereas B. trematum has been isolated from infected ears and from wounds in humans. The reservoir and the pathogenic role of these 2 species remain unknown (4). B. pertussis, a strictly human pathogen, and B. parapertussis, a pathogen in both humans and sheep, are agents of whooping cough (5). B. avium and B. hinzii caused respiratory infections in birds and poultry and have also been reported to cause infections in humans (6–9). The latter 4 Bordetella spp. are usually describe
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Bordetella petrii Infection with Long-lasting Persistence in Human
'Centers for Disease Control and Prevention (CDC)', 2011Co-Authors: Alain Le Coustumier, Elisabeth Njamkepo, Vincent Cattoir, Sophie Guillot, Nicole GuisoAbstract:We report the repeated isolation of Bordetella petrii in the sputum of a 79-year-old female patient with diffuse bronchiectasis and persistence of the bacterium for >1 year. The patient was first hospitalized due to dyspnea, which developed into severe cough with purulent sputum that yielded B. petrii on culture. After this first episode, the patient was hospitalized an additional 4 times with Bronchorrhea symptoms. The isolates collected were analyzed by using biochemical, genotypic, and proteomic tools. Expression of specific proteins was analyzed by using serum samples from the patient. The B. petrii isolates were compared with other B. petrii isolates collected from humans or the environment and with isolates of B. pertussis, B. parapertussis, B. bronchiseptica, and B. holmesii, obtained from human respiratory tract infections. Our observations indicate that B. petrii can persist in persons with chronic pulmonary obstructive disease as has been previously demonstrated for B. bronchiseptica
