1.
Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.
Chen, TK, Groncy, PK, Javahery, R, Chai, RY, Nagpala, P, Finkelman, M, Petraitiene, R, Walsh, TJ
Medical mycology. 2017;(1):109-117
Abstract
Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.
2.
Serum clozapine levels: a review of their clinical utility.
Greenwood-Smith, C, Lubman, DI, Castle, DJ
Journal of psychopharmacology (Oxford, England). 2003;(2):234-8
Abstract
Therapeutic drug monitoring (TDM) is frequently utilized in the treatment of psychiatric conditions, but its clinical application concerning the use of clozapine is unclear. We present three case reports of patients taking clozapine, review the relevant literature, and propose guidelines to aid the clinical use of TDM of clozapine. Due to its complex metabolism, there are significant inter- and intra-individual variations in clozapine serum levels, for a given dose. However, the range of serum levels that corresponds with toxicity remains unclear. Although central nervous system side-effects may correlate with serum level, many adverse effects of clozapine appear to be unrelated, including haematological and cardiac events. There are numerous clinically significant interactions between clozapine and other substances, including prescribed medications, nicotine and caffeine. TDM of clozapine may be of clinical value in certain situations, such as poor clinical response; signs of toxicity; onset of seizures; changes in concurrent medication, caffeine or nicotine; liver disease; and suspected non-compliance. The current literature does not support the routine testing of serum clozapine levels in everyday clinical practice.
3.
Individualizing insulin management. Three practical cases, rules for regimen adjustment.
Stoller, WA
Postgraduate medicine. 2002;(5):51-4, 59-60, 63-6
Abstract
Many patients with diabetes become frustrated by the tedium of inflexible insulin instructions and unpalatable dietary restrictions. They lose confidence when their blood glucose levels fluctuate widely, and they may begin to think of themselves as "bad diabetics." Therefore, choosing the appropriate insulin and injection regimen for each patient is essential. Coordinated efforts by a concerned team of diabetes educators, dietitians, and physicians enhance the effectiveness of treatment. Patients should be taught how to count carbohydrates, select foods with a low glycemic index, and adjust their insulin regimen by using sliding scales based on the 1500 or 1800 rule. Regular exercise and solid emotional support from family and friends also are helpful. By teaching patients the rules for insulin management, physicians can empower them to be much more actively involved in their own care and to lead healthier lives.