SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "WFRF:(Helldén Anders) "

Sökning: WFRF:(Helldén Anders)

  • Resultat 1-10 av 15
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Hellden, Anders, et al. (författare)
  • Renal function estimations and dose recommendations for dabigatran, gabapentin and valaciclovir : a data simulation study focused on the elderly
  • 2013
  • Ingår i: BMJ Open. - London, UK : BMJ. - 2044-6055. ; 3:4, s. e002686-
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The thrombin inhibitor dabigatran is mainly excreted by the kidneys. We investigated whether the recommended method for estimation of renal function used in the clinical trials, the Cockcroft-Gault (CG(old)) equation and the estimated glomerular filtration rate (eGFR) modification of diet in renal disease equation 4 (MDRD4), differ in elderly participants, resulting in erroneously higher dose recommendations of dabigatran, which might explain the serious, even fatal, bleeding reported. The renally excreted drugs gabapentin and valaciclovir were also included for comparison. Design A retrospective data simulation study. Participants Participants 65years and older included in six different studies. Main outcome measure Estimated renal function by CG based on uncompensated (old Jaffe' method) creatinine (CG(old)) or by MDRD4 based on standardised compensated P-creatinine traceable to isotope-dilution mass spectrometry, and the resulting doses. Results 790 participants (432 females), mean age (SD) 77.6 +/- 5.7years. Mean estimated creatinine clearance (eCrCl) by the CG(old) equation was 44.2 +/- 14.8ml/min, versus eGFR 59.6 +/- 20.7ml/min/1.73m(2) with MDRD4 (p<0.001), absolute median difference 13.5, 95% CI 12.9 to 14.2. MDRD4 gave a significantly higher mean dose (valaciclovir +21%, dabigatran +25% and gabapentin +37%) of all drugs (p<0.001). With MDRD4 58% of the women would be recommended a full dose of dabigatran compared with 18% if CG(old) is used. Conclusions MDRD4 would result in higher recommended doses of the three studied drugs to elderly participants compared with CG, particularly in women, and thus increased the risk of dose and concentration-dependent adverse reactions. It is important to know which method of estimation of renal function the Summary of Products Characteristics was based on, and use only that one when prescribing renally excreted drugs with narrow safety window. Doses based on recently developed methods for estimation of renal function may be associated with considerable risk of overtreatment in the elderly.
  •  
2.
  • Kågedal, Bertil, 1943-, et al. (författare)
  • Determination of glomerular filtration rate, a spin off aftercontrast-enhanced computed tomography among criticallyill patients − proof of concept
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background Recently, Gong et al. (Gong et al. 2022) showed, in nine heathy subjects, that plasma clearance of high doses of iohexol given as contrast enhanced computed tomography (CT) could be used for determination of glomerular filtration rate (GFR). We utilized high doses of iohexol from angiographic or other contrast enhanced CT given to critical ill patients for calculation of GFRiohexol and compared these data with standard low dose iohexol GFR determinations.Method Patients at intensive care units (ICUs) in Southeast Sweden intended for radiographic investigations that included injection of 45-120 ml of iohexol (Omnipaque) were included, and the concentration of iohexol in plasma was measured by HPLC. Iohexol clearance was calculated by the method of Bröchner-Mortensen. The following days was iohexol clearance determined using the standard low dose of 5 mL of iohexol. Sixteen patients admitted to ICUs were included in this pilot study.Results GFR after high dosing of iohexol at contrast enhanced CT could be measured for all sixteen critically ill patients. Patients with normal or increased renal function had neglectable iohexol concentrations the day following the CT scan. There was excellent correlation between GFR determination with high and standard low iohexol dosing among these 6 patients. Ten patients had decreased renal function and delayed elimination of iohexol, thus was not GFR measurement with low dose iohexol possible to analyse the day after CT scan with high dose iohexol.Conclusion This pilot study showed that GFR can be measured after high doses of iohexol at enhanced CT and compare well with the standard low dose of iohexol clearance determinations.
  •  
3.
  • Fransson, Marcus, et al. (författare)
  • Case Report : Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
  • 2021
  • Ingår i: Frontiers in Pharmacology. - : Frontiers Media SA. - 1663-9812. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodontitis, endophthalmitis, and multiple brain abscesses caused by Streptococcus intermedius. Initial treatment with meropenem and vancomycin was unsuccessful due to subtherapeutic concentrations, despite recommended dosages. Adequate concentrations could be reached only after increasing the dose of meropenem to 16 g/day and vancomycin to 1.5 g x 4. The patient exhibited high creatinine clearance consistent with augmented renal clearance, although iohexol and cystatin C clearances were normal. Plasma free vancomycin clearance followed that of creatinine. A one-day dose of trimethoprim-sulfamethoxazole led to an increase in serum creatinine and a decrease in both creatinine and urea clearances. These results indicate that increased tubular secretion of the drugs was the cause of suboptimal antibiotic treatment. The patient eventually recovered, but his left eye needed enucleation. Our case illustrates that augmented renal clearance can jeopardize the treatment of serious bacterial infections and that high doses of antibiotics are needed to achieve therapeutic concentrations in such cases. The mechanisms for regulation of kidney tubular transporters of creatinine, urea, vancomycin, and meropenem in critically ill patients are discussed.
  •  
4.
  •  
5.
  • Helldén, Anders (författare)
  • Aciclovir-induced neuropsychiatric symptoms : a clinical pharmacology study
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aciclovir (ACV) and its prodrug valacyclovir (VACV) are used to treat infections caused by herpes simplex virus (HSV) and varicella zoster virus (VZV), and as prophylaxis against cytomegalovirus (CMV) infections in immunocompromised patients. Treatment with ACV has decreased the mortality in herpes simplex encephalitis (HSE) from about 70 % to less than 30 %, and has also reduced the morbidity. ACV is excreted mainly by the kidneys, while a minor proportion is metabolized to 9-carboxymethoxymethylguanine (CMMG) and 8-hydroxy-ACV. It has been found that CMMG concentrations increase if renal function is decreasing. ACV is considered to have low toxicity and benign side effects. However, increasing serum creatinine and acute renal failure have been reported, and in rare cases aciclovir-induced neuropsychiatric symptoms (AINS) have developed. The mechanism behind AINS is unknown. The aim of this thesis was to investigate if there is a correlation between increased serum and cerebrospinal fluid (CSF) concentrations of CMMG, and the development of AINS. In paper I we studied the ACV and CMMG serum concentrations in 44 asymptomatic patients and 49 patients with AINS. The CMMG concentration was significantly higher in AINS patients than in the asymptomatic group (p<0.001). A ROC analysis showed that a cut-off value of 11 μmol/L had the highest sensitivity and specificity to predict AINS compared to other predictors, such as ACV exposure, ACV concentrations and renal function tests. The hypothesis that CMMG is directly involved in AINS implies that it is present in the CNS. In paper II we did find measurable concentrations of CMMG in CSF, but only in subjects with AINS. Asymptomatic control subjects had CSF CMMG levels below the limit of detection. Paper III is a description of two cases developing Cotard s syndrome- a delusion of being dead- as a result of ACV treatment. Both patients had high serum concentrations of ACV and CMMG. In paper IV the signs and symptoms pattern of AINS were analyzed in a larger group of patients. We retrieved data from published case reports, ADR cases reported to the Swedish Medical Products Agency and from our own Therapeutic Drug Monitoring database, in all 275 cases. We also compared AINS with signs and symptoms from herpes encephalitis (HSE). The study confirmed that altered level of consciousness, confusion, and hallucinations were the most frequent clinical characteristics of AINS, while HSE patients presented with high fever, altered level of consciousness, focal neurological signs, and headache. Paper V is a single-dose, open-label pharmacokinetic crossover study with one intravenous part and one oral part. We found that CMMG levels in hemodialysis patients were more than 10 times higher than in healthy volunteers. Subjects with normal and moderately impaired renal function had CMMG levels close to, or below, measurable concentrations. The results of this thesis support the hypothesis that CMMG is a useful predictor of AINS and that it may be mechanistically involved. Symptoms of AINS cannot always be reliably discriminated from symptoms of HSE, and vice versa. Determination of serum and CSF CMMG concentrations may be a useful tool to diagnose AINS and when distinguishing between AINS and HSE. Dose regimens aimed to minimize CMMG exposure can be developed based on the PK results.
  •  
6.
  • Helldén, Anders, et al. (författare)
  • Adverse drug reactions and impaired renal function in elderly patients admitted to the emergency department : a retrospective study
  • 2009
  • Ingår i: Drugs & Aging. - : Wolters Kluwer. - 1170-229X .- 1179-1969. ; 26:7, s. 595-606
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Adverse drug reactions (ADRs) are common in elderly patients. There are various reasons for this, including age- and disease-related alterations in pharmacokinetics and pharmacodynamics as well as the common practice of polypharmacy. The decline in renal function in elderly patients may also predispose them to pharmacological ADRs (type A, augmented). Patients receiving home healthcare may be at even higher risk.OBJECTIVES: To study ADRs as a cause of acute hospital admissions in a defined cohort of elderly patients (aged >or=65 years) registered to receive home healthcare services, with special reference to impaired renal function as a possible risk factor.METHODS: This was a retrospective study of 154 elderly patients aged >or=65 years admitted to the emergency department of a university hospital in Stockholm, Sweden, in October-November 2002. Estimated creatinine clearance (eCL(CR)) was calculated from the Cockcroft-Gault formula, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD) equation. ADRs were defined according to WHO criteria. All medications administered to patients at admission and at discharge were collated. These and other data were collected from computerized hospital records.RESULTS: ADRs were judged to contribute to or be the primary cause of hospitalization in 22 patients, i.e. 14% of 154 patients registered to receive home healthcare. Eleven of the 22 patients were women. All but one ADR were type A. Excessive doses or drugs unsuitable in renal insufficiency were present in seven patients in the ADR group compared with only four patients in the group without ADRs (p = 0.0001). Patients with ADRs did not differ significantly from those without ADRs in relation to age, plasma creatinine, eCL(CR), weight or number of drugs prescribed at admission. However, women with ADRs were significantly older than women without ADRs (mean +/- SD age 88.8 +/- 5.7 years vs 82.5 +/- 8.0 years, respectively; p = 0.014) and had significantly lower mean +/- SD eCL(CR) values (25.5 +/- 10.8 and 37.1 +/- 17.1 mL/min, respectively; p = 0.035). Median MDRD eGFR was significantly higher than median eCL(CR) (59 [range 6-172] mL/min/1.73 m2 vs 38 [range 5-117] mL/min, respectively; p = 0.0001).CONCLUSIONS: In elderly patients registered to receive home healthcare, 14% of hospital admissions were primarily caused by ADRs. One-third of these ADRs were related to impaired renal function, generally in very old women. These ADRs may be avoided by close monitoring of renal function and adjustments to pharmacotherapy (drug selection and dose), particularly in very elderly women.
  •  
7.
  • Helldén, Anders, et al. (författare)
  • Death delusion. : Cotard's syndrome as an adverse drug reaction to (val-)aciclovir
  • 2007
  • Ingår i: BMJ (Clinical research ed.). - 1468-5833. ; 335:7633
  • Tidskriftsartikel (refereegranskat)abstract
    • We report two cases of Cotard’s syndrome that occurred as an adverse drug reaction to aciclovir and its prodrug valaciclovir. In the 1880s Jules Cotard first described his eponymous syndrome, a rare psychiatric condition with strong delusions of being dead. Aciclovir or valaciclovir may cause neuropsychiatric side effects such as confusion, somnolence, and hallucinations, mainly in patients with impaired renal function. To our knowledge, Cotard’s syndrome has never been reported as a suspected adverse drug reaction but associated with severe somatic stress as well as general and localised cerebral pathologies. Our findings add adverse response to an antiviral drug as another cause and provide clues to the syndrome’s possible neuropsychiatric origin. Clinicians should be aware of the association between body scheme disturbances and (val)aciclovir. Affected patients with Cotard’s syndrome and renal failure should preferably be sent to the dialysis unit, not to the department of psychiatry.
  •  
8.
  • Helldén, Anders, et al. (författare)
  • Fluconazole-induced intoxication with phenytoin in a patient with ultra-high activity of CYP2C9
  • 2010
  • Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 66:8, s. 791-5
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The cytochrome P450 enzyme CYP2C9 metabolizes several important drugs, such as warfarin and oral antidiabetic drugs. The enzyme is polymorphic, and all known alleles, for example, CYP2C9*2 and*3, give decreased activity. Ultra-high activity of the enzyme has not yet been reported.METHODS: We present a patient with Behçet's disease who required treatment with high doses of phenytoin. When fluconazole, a potent inhibitor of CYP2C9, was added to the treatment regimen, the patient developed ataxia, tremor, fatigue, slurred speech and somnolence, indicating phenytoin intoxication. On suspicion of ultra-high activity of CYP2C9, a phenotyping test for CYP2C9 with losartan was performed.RESULTS: The patient was shown to have a higher activity of CYP2C9 than any of the 190 healthy Swedish Caucasians used as controls.CONCLUSIONS: Our finding of an ultrarapid metabolism of losartan and phenytoin may apply to other CYP2C9 substrates, where inhibition of CYP2C9 may cause severe adverse drug reactions.
  •  
9.
  •  
10.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-10 av 15
Typ av publikation
tidskriftsartikel (9)
konferensbidrag (3)
doktorsavhandling (2)
annan publikation (1)
Typ av innehåll
refereegranskat (12)
övrigt vetenskapligt/konstnärligt (3)
Författare/redaktör
Helldén, Anders (14)
Odar-Cederlöf, Ingeg ... (7)
Lindén, Thomas, 1962 (4)
Ståhle, Lars (4)
Bergman, Ulf (3)
von Euler, Mia, 1967 ... (3)
visa fler...
Lycke, Jan, 1956 (2)
Haglund, Mats (2)
Ohlén, Gunnar (2)
Studahl, Marie, 1957 (1)
Håkansson, Anders (1)
Hanberger, Håkan (1)
Bertilsson, Leif (1)
Svensson, Jan-Olof (1)
Carlsson, Björn, 195 ... (1)
Lindberg, Mats (1)
Nilsson, Göran (1)
Kågedal, Bertil (1)
Östholm Balkhed, Åse (1)
Tobieson, Lovisa (1)
Kågedal, Bertil, 194 ... (1)
Masquelier, Michèle (1)
Milos, Peter (1)
Fehrman-Ekholm, Inge ... (1)
Hanberger, Håkan, 19 ... (1)
Grahn, Anna, 1973 (1)
Ekman, Andreas (1)
Ärlemalm, Andreas (1)
Lindensjö, Bo (1)
Fransson, Marcus (1)
Dernroth, Dzeneta (1)
Ha, Maria (1)
Hentschke, Maria (1)
Larsson, Kajsa (1)
Engström Hellgren, K ... (1)
Nilsson Remahl, Inge ... (1)
Ramsjö, Margareta (1)
Odar-Cederlof, Ingeg ... (1)
Sjoviker, Susanne (1)
Söderström, Anders (1)
Vander, Tatiana (1)
Helldén, Daniel, 196 ... (1)
Östholm Balkhed, Åse ... (1)
Nezirevic Dernroth, ... (1)
Kataria, Bharti, 195 ... (1)
Andersen, Anders (1)
Oskarsson, Frida (1)
Lindström, Johan, 19 ... (1)
Axelsson, Gudmundur (1)
Karlsson, Louise, 19 ... (1)
visa färre...
Lärosäte
Karolinska Institutet (6)
Göteborgs universitet (5)
Linköpings universitet (4)
Örebro universitet (3)
Uppsala universitet (1)
Stockholms universitet (1)
visa fler...
Sophiahemmet Högskola (1)
visa färre...
Språk
Engelska (14)
Svenska (1)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (10)
Samhällsvetenskap (2)
Naturvetenskap (1)
Humaniora (1)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy