- Email: [email protected]
SPOUSE-RELATED DRUG SIDE-EFFECTS
468 J, Andrieu B, Hatin I, Savel J, Coulaud JP. Plasmodium falciparum: Interprétation du semi-microtest de chimiosensibilité in vitro par incorporation de 3-hypoxanthine. Path Biol 1984; 32: 463-66. Simon F, Le Bras J, Coulaud JP Efficacité in vivo et vitro de la méfloquine dans les cas de paludisme à Plasmodium falciparum importés en France en 1985 et 1986. Bull
1. Le Bras
2.
Soc Fr Parasitol 1986; 4: 177-81.
Supérieur d’Hygiene Publique de France, Section Prophylaxie des Maladies. Actualisation des recommendations en matière de prophylaxie du paludisme des voyageurs. Bull Epidemiol Hebdom 1987; no 24.
3. Conseil
SPOUSE-RELATED DRUG SIDE-EFFECTS
SIR,-For certain drug side-effects, the responsible drug is not easily found, even when the victim was the person who took the drug. Finding the culprit can be even harder when the victim did not take the drug.
Fig 1-Mefloquine IC,,, values (as mean and SD). Statistical
analysis: F"Z81 =
5 68
(p <<
0-001).
*No of isolates.
An attractive young woman doctor complained of excessive facial hair growth, with a distinctly male pattern. She was extensively tested for endocrine abnormalities. She was taking no drugs other than an oral contraceptive, and stopped even that, with little effect. She knew that her husband was using a testosterone cream for hypogonadism, but the pharmaceutical company had assured her that the hair growth could not be due to the cream. Everything else being negative, she asked her husband to stop using the cream, and the hair growth stopped worsening within days. After epilation, it did not relapse, as it had done before. A middle-aged man in perfect health and not taking any medication complained of unilateral breast enlargement. A clinical check-up was negative apart from gynaecomastia. Investigations were normal and the physician was completely baffled until he learned that the patient’s wife was using a cream containing oestrogen for menopausal symptoms. He asked the wife to use the cream in the morning rather than in the evening, and the husband’s breast enlargement rapidly subsided. Other instances of transdermal heterologous drug penetration are known, especially with nitroglycerin ointments. Physicians should be aware of this possiblity in the presence of unexplained findings in a
patient not taking any drugs.
Centre Régional de
N. MOORE G. PAUX C. NOBLET M. ANDREJAK
Pharmacovigilance
de
Rouen, 76233 Bois Guillaume, France
CARDIOPULMONARY RESUSCITATION: WHOSE
JOB? Fig 2-Mefloquine and chloroquine ICso values compared.
chloroquine IC50 values contrasted Mali (slope 8-89) and Senegal (3-36), where the mean chloroquine ICso was less than 30 nmol/l, with Benin (0 16), Cameroon (0-07), and Zaire (0-30), where the mean chloroquine ICso was greater than 200 nmol/1 (fig 2). All 50 patients treated with the standard mefloquine regimen were cured. Among the 6 patients infected in West Africa we did not note any modification in clinical response to mefloquine. Mefloquine IC,,) for 5 of these patients were less than 15 nmol/1, and =
in 1 from Guinea it
was
26
nmol/1; Oduola et al set the cut off for
mefloquine resistance at 26 nmol/1. The work of Oduola et al confirms our observations on the low in-vitro sensitivity to mefloquine of chloroquine-sensitive P falciparum strains in some West African countries, which behaves differently from strains from other countries.2 French health authorities recommend chloroquine as first-choice treatment for malaria patients coming from West African choroquine-sensitive areas.3 Rapid extension of chloroquine resistance in Africa has led to a more frequent use of mefloquine for prophylaxis and treatment in visitors to these countries. -In vivo and in vitro surveillance of mefloquine sensitivity is clearly needed for West Africa. National Centre for Malaria Chemoresistance; and INSERM Unit 13; Tropical Medicine Service, Hôpital Claude Bernard, 75944 Paris, France
F. SIMON J. LE BRAS C. GAUDEBOUT P. M. GIRARD
SIR,—That the performance of basic and advanced cardiopulmonary resuscitaton by medical staff was suspect was recognised in the United States 7 years ago.! In the UK, junior staff performance of basic cardiopulmonary resuscitation was not shown to be wanting until 4 years agoz although, presumably, this state of affairs was long-standing. The performance of UK junior staff in advanced techniques has not been published. Nurses’ poor performance of basic resuscitation was reported last year.3 Your Feb 6 editorial states the obvious-that nurses should be capable of defibrillation and that doctors should be capable of intubation. Unfortunately, they are not. The problem revolves around "training" of the medical staff, and both "training" and "extended role" for nurses. The two issues are distinct. Junior doctors, who make up most arrest teams, rotate from hospital to hospital and job to job, sometimes every two months. Once trained, they may take part in the arrest team only once every 3-5 days, perhaps with different colleagues every time. Not all cardiac arrest teams boast an anaesthetist, and intubation training is often picked up on the job or not at all. Junior doctors on the arrest team needing intubation training constitute a major challenge: up to 12 may require training in the operating-theatre, every 2-3 months and all in the same week. This is a formidable logistic problem-not only must these young doctors be available (ie, missing a round or a clinic) but also the list must be appropriate and their instruction must not interrupt the training of others (eg, anaesthetists). It can take up to 2 months for an anaesthetist to become competent enough to be able to intubate under adverse circumstances, such as those at a cardiac arrest. One quick list is insufficient to gain competence and confidence. Mannikins, good as they are, cannot induce the sheer terror of intubating a cyanosed patient whose mouth is full of
1. Le Bras
2.
Soc Fr Parasitol 1986; 4: 177-81.
Supérieur d’Hygiene Publique de France, Section Prophylaxie des Maladies. Actualisation des recommendations en matière de prophylaxie du paludisme des voyageurs. Bull Epidemiol Hebdom 1987; no 24.
3. Conseil
SPOUSE-RELATED DRUG SIDE-EFFECTS
SIR,-For certain drug side-effects, the responsible drug is not easily found, even when the victim was the person who took the drug. Finding the culprit can be even harder when the victim did not take the drug.
Fig 1-Mefloquine IC,,, values (as mean and SD). Statistical
analysis: F"Z81 =
5 68
(p <<
0-001).
*No of isolates.
An attractive young woman doctor complained of excessive facial hair growth, with a distinctly male pattern. She was extensively tested for endocrine abnormalities. She was taking no drugs other than an oral contraceptive, and stopped even that, with little effect. She knew that her husband was using a testosterone cream for hypogonadism, but the pharmaceutical company had assured her that the hair growth could not be due to the cream. Everything else being negative, she asked her husband to stop using the cream, and the hair growth stopped worsening within days. After epilation, it did not relapse, as it had done before. A middle-aged man in perfect health and not taking any medication complained of unilateral breast enlargement. A clinical check-up was negative apart from gynaecomastia. Investigations were normal and the physician was completely baffled until he learned that the patient’s wife was using a cream containing oestrogen for menopausal symptoms. He asked the wife to use the cream in the morning rather than in the evening, and the husband’s breast enlargement rapidly subsided. Other instances of transdermal heterologous drug penetration are known, especially with nitroglycerin ointments. Physicians should be aware of this possiblity in the presence of unexplained findings in a
patient not taking any drugs.
Centre Régional de
N. MOORE G. PAUX C. NOBLET M. ANDREJAK
Pharmacovigilance
de
Rouen, 76233 Bois Guillaume, France
CARDIOPULMONARY RESUSCITATION: WHOSE
JOB? Fig 2-Mefloquine and chloroquine ICso values compared.
chloroquine IC50 values contrasted Mali (slope 8-89) and Senegal (3-36), where the mean chloroquine ICso was less than 30 nmol/l, with Benin (0 16), Cameroon (0-07), and Zaire (0-30), where the mean chloroquine ICso was greater than 200 nmol/1 (fig 2). All 50 patients treated with the standard mefloquine regimen were cured. Among the 6 patients infected in West Africa we did not note any modification in clinical response to mefloquine. Mefloquine IC,,) for 5 of these patients were less than 15 nmol/1, and =
in 1 from Guinea it
was
26
nmol/1; Oduola et al set the cut off for
mefloquine resistance at 26 nmol/1. The work of Oduola et al confirms our observations on the low in-vitro sensitivity to mefloquine of chloroquine-sensitive P falciparum strains in some West African countries, which behaves differently from strains from other countries.2 French health authorities recommend chloroquine as first-choice treatment for malaria patients coming from West African choroquine-sensitive areas.3 Rapid extension of chloroquine resistance in Africa has led to a more frequent use of mefloquine for prophylaxis and treatment in visitors to these countries. -In vivo and in vitro surveillance of mefloquine sensitivity is clearly needed for West Africa. National Centre for Malaria Chemoresistance; and INSERM Unit 13; Tropical Medicine Service, Hôpital Claude Bernard, 75944 Paris, France
F. SIMON J. LE BRAS C. GAUDEBOUT P. M. GIRARD
SIR,—That the performance of basic and advanced cardiopulmonary resuscitaton by medical staff was suspect was recognised in the United States 7 years ago.! In the UK, junior staff performance of basic cardiopulmonary resuscitation was not shown to be wanting until 4 years agoz although, presumably, this state of affairs was long-standing. The performance of UK junior staff in advanced techniques has not been published. Nurses’ poor performance of basic resuscitation was reported last year.3 Your Feb 6 editorial states the obvious-that nurses should be capable of defibrillation and that doctors should be capable of intubation. Unfortunately, they are not. The problem revolves around "training" of the medical staff, and both "training" and "extended role" for nurses. The two issues are distinct. Junior doctors, who make up most arrest teams, rotate from hospital to hospital and job to job, sometimes every two months. Once trained, they may take part in the arrest team only once every 3-5 days, perhaps with different colleagues every time. Not all cardiac arrest teams boast an anaesthetist, and intubation training is often picked up on the job or not at all. Junior doctors on the arrest team needing intubation training constitute a major challenge: up to 12 may require training in the operating-theatre, every 2-3 months and all in the same week. This is a formidable logistic problem-not only must these young doctors be available (ie, missing a round or a clinic) but also the list must be appropriate and their instruction must not interrupt the training of others (eg, anaesthetists). It can take up to 2 months for an anaesthetist to become competent enough to be able to intubate under adverse circumstances, such as those at a cardiac arrest. One quick list is insufficient to gain competence and confidence. Mannikins, good as they are, cannot induce the sheer terror of intubating a cyanosed patient whose mouth is full of