Heterocyclic Compounds Commons^™

Ketorolac Use Following Operative Clavicle Fracture Fixation Is Not Associated With Increased Nonunion Or Surgical Complications: A Propensity-Matched Analysis, Tuckerman Jones, Tej Joshi, Akhil Katakam, Daniella Ogilvie, Sefy Paulose, Balazs Galdi

Wills Eye Hospital Papers

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

METHODS: This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and …

Brivaracetam For Spinal Cord Injury-Related Neuropathic Pain: Results Of A Pilot Double-Blinded, Randomized, Placebo-Controlled Clinical Trial, Leslie R. Morse, Ricardo A. Battaglino, Nguyen Nguyen, Brian Devries, Abigail Welch, Ana Lucia Battaglino, Clas Linnman, Michael Stillman, Robert Wudlick, Joda Glossner, Grant Anderton, Richard Goldstein, Scott P. Falci

Department of Medicine Faculty Papers

OBJECTIVE: Assess feasibility, safety, and tolerability of 3 months of oral brivaracetam for severe (9-10/10) spinal cord injury-related neuropathic pain.

METHODS: We conducted a multisite pilot study where adults were randomized to 3 months of brivaracetam (100 mg BID) or placebo. Pain was assessed via the Brief Pain Inventory, the International Spinal Cord Injury Pain Basic Dataset (version 2.0), and a daily pain diary.

RESULTS: We enrolled 24 participants across 2 sites and 14 participants were included in the final analysis (n = 8 placebo, n = 6 brivaracetam). The drug was tolerated with expected, nonserious side effects (nausea if …

Hydralazine-Induced Vasculitis Resulting In Large Pleural Effusion And Progressive Renal Dysfunction, Michael A. Acevedo, Hammad Choudhry

Rowan-Virtua Research Day

Hydralazine is a vasodilator commonly used to treat high blood pressure. Even with the safety profile of Hydralazine, it is necessary to know that it may lead to Hydralazine-Induced Vasculitis. Here, we discuss how this rare side effect can present in an 80-year-old female with a past medical history of hypertension who presented to the emergency department with complaints of progressive shortness of breath on exertion and while lying supine. Further evaluation revealed a large right-sided pleural effusion with consolidation at the right lower lobe. The patient’s dyspnea worsened, and the surgical team placed a chest tube. The patient also …

Identifying Early Presentation Of Serotonin Syndrome In A 20-Year-Old Male Prescribed Clomipramine And Quetiapine: A Case Report, Veronica Alday, Justin Scarano, Jonathan Yuh, Christie Richardson

Rowan-Virtua Research Day

Serotonin syndrome, a potentially life-threatening condition, can be challenging to diagnose due to its diverse etiology and varied symptomatology. Despite its severity, serotonin syndrome may present from mild to fatal, with symptoms such as autonomic instability, altered mental status, and neuromuscular excitation (e.g. muscle rigidity, hyperreflexia). Here, we present a 20-year-old male with an extensive psychiatric history who was prescribed clomipramine and developed serotonin syndrome. Few cases of serotonin syndrome have been reported to date, exacerbating the difficulty in recognizing and quickly treating such cases. Cases of serotonin syndrome should continue to be reported, in order to familiarize clinicians with …

Case Report: Lamotrigine-Induced Rash In An Adult Patient, Dhruvin Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Lamotrigine (Lamictal®) is a commonly prescribed anticonvulsant and mood-stabilizing medication. One of the rare but serious adverse effects of lamotrigine is the development of a drug-induced rash, which can be potentially life-threatening. This case report highlights the occurrence of a drug-induced rash in a 33-year-old female patient who was prescribed lamotrigine for the management of bipolar disorder. The patient presented with a characteristic rash, and following timely intervention, the rash resolved without complications. This case emphasizes the importance of monitoring for early signs of rash in patients receiving lamotrigine and outlines management strategies.

Palovarotene In Fibrodysplasia Ossificans Progressiva: Review And Perspective, Vincent Verheij, Robert Diecidue, Esmée Botman, Joseph Harrington, Nobuhiko Haga, Alberto Hidalgo-Bravo, Patricia Delai, Vrisha Madhuri, Mona Al Mukaddam, Keqin Zhang, Tae-Joon Cho, Rolf Morhart, Richard Keen, Carmen De Cunto, Clive Friedman, Zvi Grunwald, Michael Zasloff, J. Coen Netelenbos, Edward Hsiao, Frederick Kaplan, Robert Pignolo, Christiaan Scott, Elisabeth Marelise Eekhoff

Department of Oral and Maxillofacial Surgery Faculty Papers

INTRODUCTION: Palovarotene is a retinoic acid receptor gamma agonist that was studied in phase-2 and phase-3 clinical trials for the inhibition of new heterotopic ossification (HO) in fibrodysplasia ossificans progressiva (FOP). Despite numerous setbacks and regulatory delays, palovarotene is now the first approved FOP treatment in the U.S.A., Canada and Australia but remains unapproved in Europe where concerns surrounding the drug and its path to regional market authorization persist.

AREAS COVERED: The developmental history of palovarotene and an overview of the clinical trials and the regulatory approval journey are discussed by global FOP experts.

EXPERT OPINION: While post hoc analyses …

Odevixibat: A Novel Bile Salt Inhibitor Treatment For Pruritus In Progressive Familial Intrahepatic Cholestasis, Farrah E. Flattmann, Farhan S. Mohiuddin, Anjuni Singh, Anamika Tandon, Stewart J. Lockett, Jon D. Hirsch, Chizoba N. Mosieri, Adam M. Kaye, Giustino Varrassi, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye

School of Medicine Faculty Publications

Chronic pruritus is defined as an itch lasting greater than six weeks. It can manifest from a wide variety of etiologies, as many different substances can act as pruritogens, such as steroids, histamine, progesterone, endogenous opioids, and serotonin. In the setting of cholestatic liver disease, increased bile acids play a major role in chronic pruritus. The itching in cholestatic liver disease is worsened in intensity at night and localized frequently to the palms, soles, knees, and other pressure sites. It can be hard to manage, affecting the quality of sleep and causing irritability, poor attention, and, in some cases, depression. …

Etiology Of Drug-Induced Edema: A Review Of Dihydropyridine, Thiazolidinedione, And Other Medications Causing Edema, Evan S. Sinnathamby, Bretton T. Urban, Robert A. Clark, Logan T. Roberts, Audrey J. De Witt, Danielle M. Wenger, Aya Mouhaffel, Olga Willett, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye, Giustino Varrassi

School of Medicine Faculty Publications

Edema is an accumulation of fluid in the body's tissues that affects millions of Americans yearly. It can affect multiple body parts, for example, the brain or eyes, but often occurs in the periphery, including the feet and legs. Medications, such as dihydropyridine and thiazolidinediones (TZDs), can be the etiology of edema. Edema can develop in association with problems in the vasculature or lymphatic flow. In recent years, a better understanding of these drug-induced mechanisms has been appreciated. Specifically, dihydropyridines can increase hydrostatic pressure and cause selective pre-capillary vessel vasodilation. TZDs can cause edema through increased vascular permeability and increased …

Doxazosin Immediate Release As A Novel Treatment For Nightmares In Posttraumatic Stress Disorder., Danyaal Khan, Christie Richardson, Martin Forsberg

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Nightmares and flashbacks are common debilitating symptoms of posttraumatic stress disorder (PTSD) that can disrupt daily functioning. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of these intrusion symptoms, although its short half-life makes it so that often multiple doses are needed. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its lesser side effect profile and longer half-life. In our case series, we present three cases of patients with PTSD-related nightmares who were successfully treated with doxazosin following a relapse of symptoms after discontinuation of prazosin …

Minoxidil Weakens Newly Synthesized Collagen In Fibrotic Synoviocytes From Osteoarthritis Patients, Stefan Sarkovich, Peter P. Issa, Andrew Longanecker, Davis Martin, Kaitlyn Redondo, Patrick Mcternan, Jennifer Simkin, Luis Marrero

School of Medicine Faculty Publications

Purpose: Synovial fibrosis (SFb) formation and turnover attributable to knee osteoarthritis (KOA) can impart painful stiffness and persist following arthroplasty. To supplement joint conditioning aimed at maximizing peri-operative function, we evaluated the antifibrotic effect of Minoxidil (MXD) on formation of pyridinoline (Pyd) cross-links catalyzed by Plod2-encoded lysyl hydroxylase (LH)2b that strengthen newly synthesized type-I collagen (COL1) in fibroblastic synovial cells (FSCs) from KOA patients. MXD was predicted to decrease Pyd without significant alterations to Col1a1 transcription by FSCs stimulated with transforming growth factor (TGF)β1. Methods: Synovium from 10 KOA patients grouped by SFb severity was preserved for picrosirius and LH2b …

Growing Use Of Xylazine As An Adulterant In Opioids And Its Effects, Oluwapelumi Oluwo

Rowan-Virtua Research Day

Xylazine, according to the National Institutes of Health (NIH), is a non-opioid tranquilizer used in veterinary medicine. Although this drug has not been approved for human use, it can be linked to an increase in opioid overdose deaths due to its role as an adulterant in drugs like fentanyl.

Xylazine was detected in drugs involved in 41% of all opioid-involved unintentional deaths and in 44% of all unintentional overdose deaths with fentanyl involved in the year of 2021 in Philadelphia.

Case Series: Continued Remission Of Ptsd Symptoms After Discontinuation Of Prazosin, Christie Richardson, Jonathan Yuh, Jing Su, Martin Forsberg

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Post-traumatic stress disorder is a debilitating chronic illness that affects 6 out of 100 adults after a severe trauma. The alpha-adrenergic antagonist prazosin, which is prescribed off-label for flashbacks and nightmares due to trauma, is often continued indefinitely due to reports of symptoms returning upon discontinuation. There is no standard guidance for a trial of discontinuation of prazosin due to intolerance or side effects. In this case series, three patients are started on prazosin leading to remission of trauma-related symptoms, and symptoms continue to remit after treatment for an average of about 2 years followed by discontinuation of the medication. …

Prazosin Dosed 3 Times A Day To Treat Flashbacks Related To Ptsd: A Case Report, Christie Richardson, Alexander Swartz, Martin Forsberg

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Prazosin is an alpha-1 adrenergic receptor antagonist widely known by mental health providers for its off-label use for nightmares in patients with PTSD. Prazosin is lipophilic and crosses the blood-brain barrier to antagonize alpha-1 receptors in the central nervous system, potentially reducing autonomic arousal caused by PTSD. There have been numerous case reports describing the reduction of nightmares and daytime flashbacks due to PTSD with prazosin dosed at night and during the day, respectively. This case report illustrates the resolution of flashbacks related to chronic PTSD with prazosin dosed 3 times a day. As the half-life of prazosin is only …

Treating Trichotillomania With Olanzapine, Christopher Lee

Rowan-Virtua Research Day

Trichotillomania (TTM) is characterized by repetitive pulling of one’s hair leading to hair loss and problems in social, occupational, or other important areas of functioning. Often individuals with TTM try to decrease or stop hair pulling, however are often unsuccessful without treatment. Community prevalence studies suggest that TTM is a common disorder with point prevalence estimate of 0.5% to 2.0% and with significant psychological comorbidity. Of note, people with TTM are often embarrassed about their condition, so epidemiology data may be underestimated compared to the true prevalence of this condition. The female to male ratio for this condition is 4:1. …