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Concept: Adverse effect


BACKGROUND: Pre-eclampsia/eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate is the drug of choice for prevention of seizures as part of comprehensive management of the disease. Despite the compelling evidence for the effectiveness of magnesium sulfate, concern has been expressed about its safety and potential for toxicity, particularly among providers in low- and middle-income countries. The purpose of this review was to determine whether the literature published in these global settings supports the concerns about the safety of use of magnesium sulfate. METHODS: An integrative review of the literature was conducted to document the known incidences of severe adverse reactions to magnesium sulphate, and specific outcomes of interest related to its use. All types of prospective clinical studies were included if magnesium sulfate was used to manage pre-eclampsia or eclampsia, the study was conducted in a low- or middle-income country, and the study included the recording of the incidence of any adverse side effect resulting from magnesium sulfate use. RESULTS: A total of 24 studies that compared a magnesium sulfate regimen against other drug regimens and examined side effects among 34 subject groups were included. The overall rate of absent patellar reflex among all 9556 aggregated women was 1.6%, with a range of 0-57%. The overall rate of respiratory depression in 25 subject groups in which this outcome was reported was 1.3%, with a range of 0–8.2%. Delay in repeat administration of magnesium sulfate occurred in 3.6% of cases, with a range of 0-65%. Calcium gluconate was administered at an overall rate of less than 0.2%. There was only one maternal death that was attributed by the study authors to the use of magnesium sulfate among the 9556 women in the 24 studies. CONCLUSION: Concerns about safety and toxicity from the use of magnesium sulfate should be mitigated by findings from this integrative review, which indicates a low incidence of the most severe side effects, documented in studies that used a wide variety of standard and modified drug regimens. Adverse effects of concern to providers occur infrequently, and when they occurred, a delay of repeat administration was generally sufficient to mitigate the effect. Early screening and diagnosis of the disease, appropriate treatment with proven drugs, and reasonable vigilance for women under treatment should be adopted as global policy and practice.

Concepts: Pharmacology, Effectiveness, Magnesium sulfate, Sulfur, Morphine, Adverse effect, Salt, Iatrogenesis


Concern exists regarding the potential for chiropractic treatment to cause adverse effects in individuals with scoliosis. The aim of this paper is to present the self-reported responses of 189 scoliosis patients over 3198 unique visits, collected over one calendar year from nine chiropractic clinics, regarding how they felt and the side effects they experienced immediately after chiropractic treatment.

Concepts: Philosophy of science, Alternative medicine, Adverse effect


In vitro-based search for promising anti-cancer drug combinations may provide important leads to improved cancer therapies. Currently there are no integrated computational-experimental methods specifically designed to search for combinations, maximizing a predefined therapeutic index (TI) defined in terms of appropriate model systems. Here, such a pipeline is presented allowing the search for optimal combinations among an arbitrary number of drugs while also taking experimental variability into account. The TI optimized is the cytotoxicity difference (in vitro) between a target model and an adverse side effect model. Focusing on colorectal carcinoma (CRC), the pipeline provided several combinations that are effective in six different CRC models with limited cytotoxicity in normal cell models. Herein we describe the identification of the combination (Trichostatin A, Afungin, 17-AAG) and present results from subsequent characterisations, including efficacy in primary cultures of tumour cells from CRC patients. We hypothesize that its effect derives from potentiation of the proteotoxic action of 17-AAG by Trichostatin A and Afungin. The discovered drug combinations against CRC are significant findings themselves and also indicate that the proposed strategy has great potential for suggesting drug combination treatments suitable for other cancer types as well as for other complex diseases.

Concepts: Therapeutic effect, Pharmacology, Cancer, Oncology, Effectiveness, Chemotherapy, Model, Adverse effect


GM crops are the most studied crops in history. Approximately 5% of the safety studies on them show adverse effects that are a cause for concern, and tend to be featured in media reports. Although these reports are based on just a handful of GM events, they are used to cast doubt on all GM crops. Furthermore, they tend to come from just a few laboratories and are published in less important journals. Importantly, a close examination of these reports invariably shows methodological flaws that invalidate any conclusions of adverse effects. Twenty years after commercial cultivation of GM crops began, a bona fide report of an adverse health effect due to a commercialized modification in a crop has yet to be reported. This article is protected by copyright. All rights reserved.

Concepts: Scientific method, Agriculture, Epistemology, Report, Alternative medicine, Adverse effect, All rights reserved, Copyright


Abstract Background The oral tetracyclines, especially minocycline hydrochloride, are often used as an effective treatment for perioral dermatitis, however they are sometimes difficult to use because of the side effects, especially in children. Objective The effectiveness of β-lactam antibiotics was evaluated in three cases of perioral dermatitis. Methods Three Japanese patients with perioral dermatitis were treated with cefcapene pivoxil hydrochloride hydrate per os 100 to 300 mg per day. They were one girl (age 10) and two adult women (age 32, 37). One of the adult patients had a past history of Meniere’s disease and the other had had a side effect, vertigo, from minocycline hydrochloride treatment. The presence of fusobacteria before and after the treatment was examined using the tape-stripping toluidine blue method. Results These patients showed the improvement in 1 to 2 weeks and were much improved or cured after 2 to 5 weeks. No side effects were found during the treatment. Fusobacteria were positive before treatment but became negative after the treatment in all of them. Conclusion β-lactam antibiotics might be a useful treatment for perioral dermatitis, especially in cases who cannot take tetracyclines.

Concepts: Effect, Effectiveness, Ménière's disease, Adverse effect, Acne vulgaris, Rosacea, Tetracycline antibiotics, Minocycline


Background Talaromyces marneffei infection is a major cause of human immunodeficiency virus (HIV)-related death in South and Southeast Asia. Guidelines recommend initial treatment with amphotericin B deoxycholate, but this drug has substantial side effects, a high cost, and limited availability. Itraconazole is available in oral form, is associated with fewer unacceptable side effects than amphotericin, and is widely used in place of amphotericin; however, clinical trials comparing these two treatments are lacking. Methods In this open-label, noninferiority trial, we randomly assigned 440 HIV-infected adults who had talaromycosis, confirmed by either microscopy or culture, to receive either intravenous amphotericin B deoxycholate (amphotericin) (219 patients), at a dose of 0.7 to 1.0 mg per kilogram of body weight per day, or itraconazole capsules (221 patients), at a dose of 600 mg per day for 3 days, followed by 400 mg per day, for 11 days; thereafter, all the patients received maintenance therapy with itraconazole. The primary outcome was all-cause mortality at week 2. Secondary outcomes included all-cause mortality at week 24, the time to clinical resolution of talaromycosis, early fungicidal activity, relapse of talaromycosis, development of the immune reconstitution inflammatory syndrome (IRIS), and the side-effect profile. Results The risk of death at week 2 was 6.5% in the amphotericin group and 7.4% in the itraconazole group (absolute risk difference, 0.9 percentage points; 95% confidence interval [CI], -3.9 to 5.6; P<0.001 for noninferiority); however, the risk of death at week 24 was 11.3% in the amphotericin group and 21.0% in the itraconazole group (absolute risk difference, 9.7 percentage points; 95% CI, 2.8 to 16.6; P=0.006). Treatment with amphotericin was associated with significantly faster clinical resolution and fungal clearance and significantly lower rates of relapse and IRIS than itraconazole. The patients who received amphotericin had significantly higher rates of infusion-related reactions, renal failure, hypokalemia, hypomagnesemia, and anemia than patients in the itraconazole group. Conclusions Amphotericin was superior to itraconazole as initial treatment for talaromycosis with respect to 6-month mortality, clinical response, and fungicidal activity. (Funded by the Medical Research Council and others; IVAP Current Controlled Trials number, ISRCTN59144167 .).

Concepts: HIV, Immune system, Pharmacology, Epidemiology, Clinical trial, Medical statistics, Adverse effect, Hypokalemia


Cantharidin is a widely used treatment for molluscum contagiosum (MC) that is often favored because of its speed of application and lack of pain at the time of application. Previous studies have supported its safety and reported high parental and dermatologist satisfaction with its use. Nonetheless, a lack of safety data has contributed to ambiguous U.S. Food and Drug Administration status that has made it increasingly difficult to obtain. All children treated with cantharidin for MC at a tertiary care center between January 1, 2005, and December 31, 2011, who had at least one follow-up visit or telephone call were included in the current study. Information related to treatment with cantharidin and adverse effects was abstracted from medical records. Of 512 children identified, 405 had at least one follow-up visit or telephone call after treatment and were included in this study. Cantharidin was applied to 9,688 lesions over 1,056 visits. Fifty-seven percent of children experienced blistering, an expected effect of therapy. Eleven percent of patients experienced adverse events. The most common adverse events were pain (7%) and significant blistering (2.5%). Other side effects were rare (<1%) and included pruritus, possible mild infection, significant irritation, id reactions, and bleeding. Eighty-six percent of parents reported satisfaction with cantharidin or opted to use it again. Cantharidin is a safe treatment modality for MC and should be considered when symptomatic infection necessitates treatment. The cantharidin application protocol used in this study may serve as a model protocol with a known side-effect profile.

Concepts: Immune system, Medicine, Adverse effect, Tertiary referral hospital, Molluscum contagiosum, Iatrogenesis, Wart, Cantharidin


Cancer disease is one of the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and around 8 million cancer-related deaths yearly. Estimates expect to increase these figures over the next few years. Therefore, it is very important to develop more effective and targeted therapies. Polysaccharides are widely used for biomedical and pharmaceutical applications due to their interesting properties, and can be utilised in the production of nanovehicles for drug delivery, since they frequently extend the half-life and improve the stability of chemotherapeutic agents in bloodstream allowing them to reach the tumour tissue. Moreover, polysaccharide-based nanovehicles are generally expected to increase the therapeutic benefit by reducing the undesired side effects and promoting a more efficient cellular uptake. Here, we highlight the application of various polysaccharides as nanovehicles in cancer therapy, focusing mainly on in vivo applications and describing the main advantages of each designed system in a critical way. The use of different polysaccharides interacting with metal nanoparticles to develop new nanovehicles for cancer therapy will also be discussed.

Concepts: Pharmacology, Medicine, Cancer, Oncology, Cure, Chemotherapy, Adverse effect, Targeted therapy


Gastrointestinal (gi) symptoms are the most notable side effects of chemotherapeutic drugs; such symptoms are currently treated with drugs. In the present study, we investigated the effect of acupuncture on gi symptoms induced by chemotherapy in patients with advanced gastric cancer.

Concepts: Immune system, Cancer, Metastasis, Oncology, Chemotherapy, Lymphoma, Adverse effect


Not all women initiate clinically indicated breast cancer adjuvant treatment. It is important for clinicians to identify women at risk for noninitiation.

Concepts: Cancer, Breast cancer, Metastasis, Oncology, Chemotherapy, Chemotherapy regimens, Alternative medicine, Adverse effect