Ben Taub General Hospital

Houston, TX, United States

Ben Taub General Hospital

Houston, TX, United States
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Greene S.,Ben Taub General Hospital | AufderHeide E.,Ben Taub General Hospital | French-Rosas L.,Ben Taub General Hospital
Psychiatric Clinics of North America | Year: 2017

Patients with psychiatric disorders are at risk for toxicologic emergencies. Psychotropic medications have numerous effects on the neurologic, cardiac, and other organ systems and interact with other medications, potentially leading to further side effects. It is important to become familiar with accepted psychiatric practice guidelines, common toxidromes, medical sequelae associated with prescribed medications, and the specific work-up and treatment of overdoses of frequently prescribed psychotropics. © 2017 Elsevier Inc.

Cheung L.K.,Texas Southern University | Agi R.,Ben Taub General Hospital | Hyman D.J.,Baylor College of Medicine
American Journal of the Medical Sciences | Year: 2012

Warfarin is widely used as an oral anticoagulant for the prevention and long-term treatment of venous thromboembolism and for the prevention of thromboembolic complications associated with atrial fibrillation, heart valve replacement and myocardial infarction. Warfarin exerts its anticoagulation effect by inhibiting the enzymes responsible for the cyclic interconversion of vitamin K in the liver. Vitamin K serves as a cofactor required for the carboxylation of the vitamin K-dependent coagulation proteins. By inhibiting the supply of vitamin K in the production of these proteins, warfarin indirectly slows their rate of synthesis. The authors describe a 46-year-old patient readily anticoagulated for a deep venous thrombosis who then required large doses of warfarin after initiation of total parenteral nutrition, which included lipid preparation that contained vitamin K, in addition to vitamin K required for the daily parenteral nutrition. The effect of total parenteral nutrition with vitamin K on anticoagulation is discussed. © 2012 Lippincott Williams & Wilkins.

Medford-Davis L.,Ben Taub General Hospital | Decamp M.,Northwestern University | Recht A.,Beth Israel Deaconess Medical Center | Flickinger J.,Pittsburgh Cancer Institute | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

We review the evidence for optimal surgical management and adjuvant therapy for patients with stages I and II non-small cell lung cancer (NSCLC) along with factors associated with increased risks of recurrence. Based on the current evidence, we recommend optimal use of mediastinal lymph node dissection, adjuvant chemotherapy, and post-operative radiation therapy, and make suggestions for areas to explore in future prospective randomized clinical trials. © 2012 Elsevier Inc. All rights reserved.

Mary Healy C.,Baylor College of Medicine | Mary Healy C.,Ben Taub General Hospital | Mary Healy C.,Texas Childrens Hospital | Rench M.A.,Baylor College of Medicine | And 3 more authors.
Pediatric Infectious Disease Journal | Year: 2015

Background: Tetanus, diphtheria and acellular pertussis immunization of infant contacts (cocooning) is recommended by the Centers for Disease Control and Prevention to prevent infant pertussis. We determined whether implementing a cocooning program at Ben Taub General Hospital, Houston, reduced severe pertussis in young infants. Methods: Infants ≤6 months of age, diagnosed with pertussis (determined by International Classification of Diseases, Ninth Revision codes and microbiology records) at 4 hospitals, and born at times when only postpartum women (January 2008 through May 2009) and all infant contacts (June 2009 through August 2011) were offered tetanus, diphtheria and acellular pertussis vaccine at Ben Taub General Hospital were compared with infants born preintervention (May 2004 through December 2007). Results: One hundred ninety-six (49%) infants with pertussis were born preintervention, 140 (35%) during maternal postpartum (PP) and 64 (16%) during cocooning (C) periods. Infants were similar in age at diagnosis (81.2 vs. 71.3 [PP] vs. 72.5 [C] days; P 0.07), sex (male 59% vs. 51% [PP] vs. 48% [C]; P 0.17), hospitalization (68% vs. 71% [PP] vs. 78% [C]; P 0.27) and outcome (2 deaths in the PP period; P 0.15), but more were admitted to intensive care units during cocooning (24% vs. 35% [PP] vs. 68% [C]; P < 0.001). Similar proportions of infants were born at Ben Taub General Hospital throughout the study (8% vs. 9% [PP] vs. 5% [C]; P 0.53). Conclusions: Postpartum immunization and cocooning did not reduce pertussis illness in infants ≤6 months of age. Efforts should be directed toward increasing tetanus, diphtheria and acellular pertussis immunization during pregnancy, combined with cocooning, to reduce life-threatening young infant pertussis. Copyright © 2014 by Lippincott Williams & Wilkins.

Chung C.,Lyndon B Johnson General Hospital | Reilly S.,Ben Taub General Hospital
American Journal of Health-System Pharmacy | Year: 2015

Purpose. The pharmacology, pharmacokinetics, clinical efficacy, safety, administration, cost, and place in therapy of trametinib for the treatment of metastatic melanoma are reviewed. Summary. Approximately 40-60% of malignant melanomas have gene mutations at codon 600 of the BRAF gene that result in the activation of the mitogen-activated protein kinase (MAPK) pathway. Trametinib is the first-in-class mitogen-activated, extracellular signal-regulated kinase (MEK) inhibitor that targets a kinase in the MAPK pathway that plays a key role in oncogenic cell proliferation, survival, invasion, tumor angiogenesis, and escape from apoptosis. It is approved by the Food and Drug Administration for use in patients whose tumors express the BRAF V600E or V600K gene mutations. Moreover, trametinib is also indicated for use in combination with dabrafenib (a BRAF inhibitor). Trametinib is not indicated in patients who have received prior BRAF-inhibitor therapy due to poor response and possible cross- resistance. The most common adverse effects associated with the use of trametinib for both monotherapy and combination therapy are rash, diarrhea, peripheral edema, fatigue, and dermatitis. The recommended dosage of trametinib monotherapy is 2 mg orally once daily until disease progression or unacceptable toxicity occurs. With a daily dose of 2 mg, an estimated 30-day course of treatment would cost approximately $9135. Conclusion. Trametinib, a novel MEK inhibitor, provides an alternative therapy for patients with BRAF V600 E/K metastatic melanoma as a single agent or in combination therapy for patients not previously treated with a BRAF inhibitor. More studies are needed to determine the safe and effective combination or sequencing of trametinib with other therapies. Copyright © 2015, American Society of Health-System Pharmacists, Inc. All rights reserved.

Oelze L.L.,Baylor College of Medicine | Oelze L.L.,Ben Taub General Hospital | Pillow M.T.,Baylor College of Medicine
Journal of Emergency Medicine | Year: 2013

Background: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction most frequently associated with antiepileptics. Clinical manifestations include rash, fever, and visceral organ involvement, most commonly hepatitis. The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure. Objectives: We report one case of phenytoin-induced DRESS syndrome in a patient who presented to the Emergency Department (ED). Our objectives for this case report include: 1) to learn the importance of DRESS syndrome; 2) to recognize the signs and symptoms of DRESS syndrome; 3) to know what diagnostic studies are indicated; and 4) to learn the appropriate treatment. Case Report: We report one case of phenytoin-induced DRESS syndrome in a 34-year-old man, previously on phenytoin for seizure prophylaxis, who presented to the ED with 5 days of worsening symptoms including generalized rash, fever, tongue swelling, and dysphagia. Laboratory results revealed an eosinophilia and elevated liver enzymes. With initiation of steroids, the transaminitis improved despite increasing eosinophilia and development of an atypical lymphocytosis. Fever and angioedema resolved with improvement of the rash, and the patient was discharged on hospital day 3. Conclusion: Given the significant mortality related to DRESS syndrome, ED staff should have a low threshold for suspecting the condition in patients who present with unusual complaints and skin findings after starting any antiepileptic drug. Early diagnosis and prompt treatment with corticosteroids is imperative. Copyright © 2013 Elsevier Inc.

Peacock W.F.,Ben Taub General Hospital | Disomma S.,University of Rome La Sapienza
Critical Pathways in Cardiology | Year: 2014

Emergency medicine represents a unique practice environment where diagnostic accuracy, treatment, and critical disposition decisions must occur in a time-sensitive environment intolerant of both errors and inefficiency. These pressures can make an accurate heart failure diagnosis challenging, as it must be predominately based on clinical findings. Although accuracy is improved by natriuretic peptide testing, at some point in the clinical course a disposition is required regardless of diagnostic certainty. Disposition options range widely from expensive and highly specialized intensive care unit admissions to low-tech/low-cost observation management or even discharge directly to home. In this vein, success is predicated on matching patient needs to available resources while minimizing the untimely discharge that results in a return visit to the emergency room. Thus, the role of the emergency physician is to predict the future based on limited objective data. Biomarkers may aid in this task, and the newly available galectin-3 assay may be of particular utility. Elevated galectin-3, reflective of myocardial fibrosis and inflammation, is associated with increased risk of short-term death and the necessity for 30-day rehospitalization. The availability of accurate risk stratification tools for predicting the probability of rehospitalization or death could guide in the matching of resource-intensive heart failure disease management efforts to the higher risk cohort, while simultaneously identifying lower risk candidates for successful observation unit or outpatient management. This article reviews the potential utility of galectin-3 measurement for use in emergency department decision making. Copyright © 2014 by Lippincott Williams & Wilkins.

Medford-Davis L.,Baylor College of Medicine | Medford-Davis L.,Ben Taub General Hospital | Rafique Z.,Baylor College of Medicine | Rafique Z.,Ben Taub General Hospital
Emergency Medicine Clinics of North America | Year: 2014

Changes in potassium elimination, primarily due to the renal and GI systems, and shifting potassium between the intracellular and extracellular spaces cause potassium derangement. Symptoms are vague, but can be cardiac, musculoskeletal, or gastrointestinal. There are no absolute guidelines for when to treat, but it is generally recommended when the patient is symptomatic or has ECG changes. Treatment of hyperkalemia includes cardiac membrane stabilization with IV calcium, insulin and beta-antagonists to push potassium intracellularly, and dialysis. Neither sodium bicarbonate nor kayexelate are recommended. Treatment of symptomatic hypokalemia consists of PO or IV repletion with potassium chloride and magnesium sulfate. © 2014 Elsevier Inc.

Gutierrez A.D.,Baylor College of Medicine | Balasubramanyam A.,Baylor College of Medicine | Balasubramanyam A.,Ben Taub General Hospital
Endocrine | Year: 2012

HIV-infected patients on highly active antiretroviral therapy (HAART) have increased prevalence of a number of chronic metabolic disorders of multifactorial but unclear etiology. These include disorders of lipid metabolism with or without lipodystrophy, insulin resistance, and an increased prevalence of impaired glucose tolerance, diabetes mellitus, and cardiometabolic syndrome. While much attention has been focused on the lipid and cardiovascular disorders, few investigations have attempted to characterize the prevalence, incidence, etiology, mechanisms, and management of glycemic disorders in HIV patients. In this review, we have focused specifically on a comprehensive assessment of dysglycemia in the context of HIV infection and HAART. © Springer Science+Business Media, LLC 2011.

Patel P.S.,Baylor College of Medicine | Buras E.D.,Baylor College of Medicine | Balasubramanyam A.,Baylor College of Medicine | Balasubramanyam A.,Ben Taub General Hospital
Journal of Obesity | Year: 2013

The innate immune system provides organisms with rapid and well-coordinated protection from foreign pathogens. However, under certain conditions of metabolic dysfunction, components of the innate immune system may be activated in the absence of external pathogens, leading to pathologic consequences. Indeed, there appears to be an intimate relationship between metabolic diseases and immune dysfunction; for example, macrophages are prime players in the initiation of a chronic inflammatory state in obesity which leads to insulin resistance. In response to increases in free fatty acid release from obese adipose depots, M1-polarized macrophages infiltrate adipose tissues. These M1 macrophages trigger inflammatory signaling and stress responses within cells that signal through JNK or IKKβ pathways, leading to insulin resistance. If overnutrition persists, mechanisms that counteract inflammation (such as M2 macrophages and PPAR signaling) are suppressed, and the inflammation becomes chronic. Although macrophages are a principal constituent of obese adipose tissue inflammation, other components of the immune system such as lymphocytes and mast cells also contribute to the inflammatory cascade. Thus it is not merely an increased mass of adipose tissue that directly leads to attenuation of insulin action, but rather adipose tissue inflammation activated by the immune system in obese individuals that leads to insulin resistance. © 2013 Payal S. Patel et al.

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