SUMMARY: We report the first hepatic adverse effect of tosufloxacin tosylate in a muscle invasive bladder cancer patient with normal liver functions and with scheduling to undergo a surgical operation for a neobladder. Tosufloxacin tosylate 150 mg was administered to a 57-year-old man who maintained transurethral resection of bladder tumor (TUR-BT) postoperative multiple medications. His labs presented significant increases in alanine amino transferase (ALT) and aspartate amino transferase (AST) levels with 2-week compliance of 150 mg tablet three times a day. After discontinuing tosufloxacin tosylate, the levels slowly decreased and completely returned to normal ranges without any intervention in a few weeks. The Naranjo Causality Algorithm indicates a probable relationship between increased ALT and tosufloxacin. The patient was to have the second surgical operation as scheduled after getting normal range of ATL level. Therefore, tosufloxacin should be avoided in patients at risk for having liver dysfunctions or diseases if the patients have a schedule for any operation. BACKGROUND: Tosufloxacin tosylate has been shown to have favorable benefits as an antibiotic. Tosufloxacin tosylate may be considered to have the adverse effects such as nauseas, vomiting, diarrhea, abdominal pain, stomatitis, tendonitis, tendon rupture, headache, dizziness, drowsiness, insomnia, weakness, agitation including hemolysis in the event of glucose-6-phosphate dehydrogenase deficiency as other fluoroquinolones. More severe adverse reactions of tosufloxacin tosylate over the above common adverse effects of fluoroquinolones were thrombocytopenia and nephritis. It also is not well known that tosufloxacin can cause hepatic problem. Here the study reports the first hepatic reaction from tosufloxacin and might arouse heath care providers' attention to appropriate drug choice for patients.
Abdominal Pain ; Alanine ; Appointments and Schedules ; Aspartic Acid ; Compliance ; Diarrhea ; Dihydroergotamine ; Dizziness ; Fluoroquinolones ; Glucosephosphate Dehydrogenase Deficiency ; Headache ; Hemolysis ; Humans ; Liver Diseases ; Liver* ; Middle Aged ; Nausea ; Nephritis ; Reference Values ; Rupture ; Sleep Initiation and Maintenance Disorders ; Sleep Stages ; Stomatitis ; Tendinopathy ; Tendons ; Thrombocytopenia ; Transferases ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vomiting

An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.

An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.

SUMMARY: A 21-year-old healthy Korean man worked on a building construction site every day for almost 2 months and exercised every day for 1 or 2 hours after working hard. He felt dizziness, nausea, and experienced vomiting and body aches immediately after exercise and immediately took cold medicines including acetaminophen, cimetidine, bepotastine, and Codenal? complex for the common cold symptoms for 2 days because he was scheduled to participate in navy training at that time. He complained of severe trapezius pain and aches in his left calf 3 days after joining the Navy training. Testing revealed creatine phosphokinase (CPK) 6260 U/L, myogloblin 176 mcg/L in the urine, liver enzymes increased, and oliguria, suggesting rhabdomyolysis. He recovered with intravenous fluids without any complications.
Acetaminophen ; Cimetidine ; Common Cold ; Creatine Kinase ; Dizziness ; Humans ; Liver ; Nausea ; Oliguria ; Rhabdomyolysis* ; Superficial Back Muscles ; Vomiting ; Young Adult

OBJECTIVES: Manganese chloride (MnCl2) is one of heavy metals for causing neurogenerative dysfunction like Manganism. The purpose of this study was to determine the acute toxicity of MnCl2 using different times and various concentrations including whether manganese toxicity may involve in two intrinsic pathways, endoplasmic reticulum (ER) stress and mitochondria dysfunction and lead to neuronal apoptosis mediated by organelle disorders in neuroblastoma cell line SK-N-MC. METHODS: In the acute toxicity test, five concentrations (200, 400, 600, 800, 1,000 uM) of MnCl2 with 3, 6, 12, 24, 48 hours exposure were selected to analyze cell viability. In addition, to better understand their toxicity, acute toxicity was examined with 1,000 uM MnCl2 for 24 hours exposure via reactive oxygen species (ROS), mitochondria membrane potential, western blotting and mitochondrial complex activities. RESULTS: Our results showed that both increments of dose and time prompt the increments in the number of dead cells. Cells treated by 1,000 microM MnCl2 activated 265% (+/-8.1) caspase-3 compared to control cell. MnCl2 induced intracellular ROS produced 168% (+/-2.3%) compared to that of the control cells and MnCl2 induced neurotoxicity significantly dissipated 48.9% of mitochondria membrane potential compared to the control cells. CONCLUSIONS: This study indicated that MnCl2 induced apoptosis via ER stress and mitochondria dysfunction. In addition, MnCl2 affected only complex I except complex II, III or IV activities.
Apoptosis ; Blotting, Western ; Caspase 3 ; Cell Line ; Cell Survival ; Chlorides ; Endoplasmic Reticulum ; Endoplasmic Reticulum Stress ; Manganese ; Manganese Compounds ; Membrane Potentials ; Metals, Heavy ; Mitochondria ; Neuroblastoma ; Neurons ; Organelles ; Reactive Oxygen Species ; Toxicity Tests, Acute

BACKGROUND: Piperacillin/tazobactam (TZP) is an antibiotic against a broad spectrum of gram-positive, gram-negative, and aerobic and anaerobic strains of bacteria. Due to changes in its pharmacokinetic and pharmacodynamic parameters by TZP-treated patients' renal functions and obesity, it is important to administrate and monitor TZP based on their renal functions and Body Mass Index (BMI) levels. The purpose of this study was to determine the appropriateness of administration doses of TZP based on renal functions of obese cancer patients in a tertiary hospital. METHODS: This study was retrospectively conducted with obese cancer patients with BMI ≥ 30 kg/m₂ in a tertiary hospital, Korea from September 2004 to August 2014. Data were collected through Electronic Medical Record (EMR) which contained laboratory data and TZP dosing of each patient. RESULTS: Among 7,058 patients during the study period, 102 prescriptions were selected based on inclusion and exclusion criteria and classified by their renal functions. Although TZP should be used based on patients' renal functions to adjust its dose, its initial dose and dosing interval were consistently used without considering patients' renal functions on a regular basis. Especially, in the comparison with FDA dosing standard of TZP, approximately twice patients with 20 mL/min ≤ CrCl ≤ 40 mL/min received domestically 4.5 g instead of 2.25 g as the TZP starting dose. CONCLUSION: The appropriate doses of TZP were administered to almost all of obese cancer patients; however, the recommended TZP dose was different between Korea and other countries by twice the amount. Further related studies are necessary to clearly determine the results, to optimize TZP treatment for obese patients with cancer in clinical practice, and to design and develop new TZP formulations for them in pharmaceutical industry.
Bacteria ; Body Mass Index ; Body Size* ; Drug Industry ; Electronic Health Records ; Humans ; Korea ; Obesity ; Prescriptions ; Retrospective Studies ; Subject Headings* ; Tertiary Care Centers ; Tertiary Healthcare*

Background: Direct-acting antivirals are recommended for the treatment of chronic hepatitis C virus in Korea. However, evaluation of direct-acting antiviral regimens in a real-world setting is limited. The aims of this study were to investigate the effectiveness and safety of direct-acting antiviral treatment in Korean patients infected with chronic hepatitis C virus genotype 1b or 2 at a tertiary care hospital. Methods: This was a retrospective study conducted with patient data obtained between August 2015 and August 2019 at Jeonbuk National University Hospital. The primary effectiveness endpoint was sustained virological response 12 weeks posttreatment (SVR12) via intention-to-treat (ITT) and modified intention-to-treat (mITT) analyses. Results: Of the 270 patients, 47.0% were infected with genotype 1b and 53.0% with genotype 2. ITT analysis revealed that SVR12 was achieved in 78.9% of all patients, 77.2% in genotype 1b patients, and 80.4% in genotype 2 patients. Of the 21.1% of all patients who did not achieve SVR12, the majority of treatment failures were non-virologic failures (19.7%). mITT analysis revealed that SVR12 was achieved in 98.2% of all patients, 98.0% in genotype 1b patients, and 98.3% in genotype 2 patients. Almost half of all patients experienced one or more adverse events (43.3%), leading to 2.6% discontinuing scheduled treatment. The most common adverse event was anemia. Conclusions Direct-acting antiviral-based treatment regimens showed high effectiveness and safety. Non-virological factors, such as premature treatment discontinuation due to adverse events or loss of follow-up, were the major disruptors in achieving SVR12.