Erin C. Callen

Publication Metrics and Record of Pharmacy Practice Chairs

Background: Scholarship is an essential component of academic pharmacy. Department chairs are considered role models and mentors to junior faculty, but their publication record has not been documented. Objective: To quantify publication patterns of pharmacy practice chairs in general and, specifically, at health sciences center (HSC)-based versus non–HSC-based and public versus private colleges of pharmacy. Methods: Pharmacy practice chairs were identified using the 2006–2007 roster of faculty from the American Association of Colleges of Pharmacy. Of the 89 colleges of pharmacy in the roster, 11 listed no pharmacy practice chair and 5 listed more than one. Data were collected on the remaining 73 schools by searching each chairs name on PubMed and Web of Science (WoS). Data on total publications, publications per year, total citations, citations per article, h-index, and m quotient were collected. Results: A total of 2394 papers published by 73 pharmacy practice chairs were found in a search of PubMed. The mean number of total publications per chair was 33 (95% CI 21 to 44). The mean number of publications per year was 1.4 using PubMed and 1.6 using WoS. Mean h-index was 8.0 (95% CI 6.3 to 9.6). Mean number of total citations was 410 (95% CI 252 to 568). Thirty-three percent (n = 24) had less than 10 lifetime publications and 18% had more than 50 lifetime publications, HSC-based chairs averaged 51.3 papers while non–HSC-based chairs averaged 19.1 (p < 0.01). Similar data were found for total citations (HSC = 673 vs non-HSC = 216; p < 0.001). Public school chairs had an average of 41.5 articles cited on PubMed, versus 15 for private school chairs (p<0.01). Public school chairs had an average h-index of 9.7 versus 4.4 for private school chairs (p < 0.001), and an average of 9.2 citations per article compared with 5.2 for private school chairs (p < 0.001). Conclusions: These data provide a normative pattern of publication metrics and record for pharmacy practice chairs and demonstrate marked variability in scholarly productivity.

Myxedema Coma Associated with Combination Aripiprazole and Sertraline Therapy

Objective: To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy. Case Summary: A 41-year-old male presented to the emergency department with confusion, right-sided numbness and tingling, slurred speech, dizziness, and facial edema. His blood pressure was 160/113 mm Hg, with a pulse of 56 beats/min and temperature of 35.4 °C, Initial abnormal laboratory values included creatine kinase (CK) 439 U/L; serum creatinine 1.6 mg/dL; aspartate aminotransferase 85 U/L; and alanine aminotransferase 35 U/L. Repeat cardiac markers revealed an elevated CK level of 3573 U/L with a CK-MB of 24 ng/mL. Thyroid function tests showed thyroid-stimulating hormone 126.4 μIU/mL and free thyroxine 0.29 ng/dL. Home medications of unknown duration were sertraline 200 mg and aripiprazole 20 mg daily. He was admitted to the intensive care unit and initially treated with intravenous levothyroxine and dexamethasone. By hospital day 4, the patient was clinically stable and discharged to home. Discussion: Myxedema coma, the most significant form of hypothyroidism (HT), is a rare but potentially fatal condition. The known precipitating causes of MC were ruled out in this patient, which left his home medications as the likely cause. Cases of HT caused by certain atypical antipsychotics and antidepressants are found in the literature, but none was reported with aripiprazole therapy. There are also no reported cases of sertraline or aripiprazole inducing MC. Use of the Naranjo probability scale indicates that the combination of aripiprazole and sertraline was a probable inducer of MC in this patient. Conclusions: Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole.

Mycobacterium fortuitum Infections Associated with Laparoscopic Gastric Banding

Mycobacterium fortuitum, a rapidly growing atypical mycobacteria, is commonly found in soil and water. This organism is most often known to cause skin, bone, and soft tissue infections associated with local trauma, surgical procedures, and in patients with immunodeficiency. Nosocomial infections associated with a variety of contaminated devices and equipment have also been widely documented. This report presents the first cases of M. fortuitum infection following laparoscopic gastric banding procedures. Both patients had complicated clinical courses necessitating removal of their banding devices and long-term antibiotic therapy.

Possible Oseltamivir-Induced Angioedema in a Patient with Chronic Renal Failure:

Objective To report a case of angioedema possibly associated with oseltamivir administration in a patient with chronic renal failure. Case Summary A 46-year-old female with an extensive allergy history and multiple co-morbidities, including chronic renal failure, was diagnosed with H1N1 influenza and given prescriptions for oseltamivir and methylprednisolone at an outside emergency department. She was sent home and took the first dose of both medications. The following day, the patient developed tongue swelling and left-sided edema. She discontinued methylprednisolone but continued oseltamivir. Her symptoms continued to worsen with the development of hivelike lesions and significant shortness of breath leading to hospitalization. Upon admission, oseltamivir was discontinued and the patient was started on dialysis. The patients symptoms gradually improved, and she was discharged on hospital day 8. Discussion Oseltamivir was thought to be the causative agent due to the abrupt onset and resolution of symptoms associated with the administration and discontinuation of the medication. Application of the Naranjo probability scale found that oseltamivir was a possible cause of the patients angioedema. Conclusion Health care providers should be aware of the rare but potentially life-threatening angioedema that may be associated with oseltamivir use.

Aseptic meningitis associated with chronic sulindac use for osteoarthritis: a case report

We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.