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1.  Neonatal Herpes Simplex Fulminant Hepatitis Successfully Treated with Acyclovir 
Disseminated neonatal herpes simplex virus (HSV) infection is characterized by progressive multiple organ failure and high mortality rates up to 85% for untreated neonates. It can result from infection with either HSV-1 or HSV-2. We report the first known case of disseminated neonatal herpes associated with fulminant liver failure caused by HSV-2 who survived without liver transplant.
doi:10.4103/2249-4847.96761
PMCID: PMC3743148  PMID: 24027697
Disseminated herpes simplex; liver failure; neonate
2.  Recombinant-activated factor VII in patients with uncontrolled bleeding: A retrospective observational analysis 
Background:
Factor VIIa (recombinant) has an off-label use to control life-threatening bleeding that is refractory to other measures and was shown to decrease transfusion requirements.
Objective:
The primary objective of this study was to assess the safety and effectiveness of factor VIIa (recombinant) on blood transfusion requirements and coagulation parameters when used in patients whose bleeding was uncorrected by other means. The pharmacoeconomic impact for any discrepancy from our protocol was evaluated. Secondary outcomes included 4-hour and 28-day mortality, as well as safety of this agent in terms of thromboembolic complications.
Materials and Methods:
We retrospectively evaluated patients who received recombinant-activated factor VII (rFVIIa) for uncontrolled bleeding from June 2008 to April 2011. The medical records of 33 patients were evaluated. Coagulation parameters and blood products were determined 24 hours before and 24 hours after administration of rFVIIa, and the results compared. Patients were also screened for any thromboembolic complications.
Results:
Administration of rFVIIa reduced blood transfusion requirements and improved coagulation parameters significantly (P<0.05). No thromboembolic complications were reported. Most of the dosing was consistent with those recommended in our institutional protocol, with discrepancies resulting in an average cost of $56 058. Moreover, pH was reported in only 67% of patients. All patients treated with rFVIIa survived up to 4 hours after receiving this agent, while the 28-day mortality was 24% (8/33).
Conclusion:
The use of rFVIIa appears to be safe and effective in promoting hemostasis, as evident from reducing transfusion requirements and improving the coagulation variables.
doi:10.4103/0973-6247.95044
PMCID: PMC3353622  PMID: 22623836
Coagulopathy; hemorrhage; recombinant-activated factor VIIa; trauma; uncontrolled bleeding
3.  Therapeutic drug monitoring of vancomycin in an obese patient with renal insufficiency 
We report the pharmacokinetics of vancomycin in an obese patient with renal insufficiency using pharmacokinetic equations, and comparing them with actual levels. A 47-year-old man with morbid obesity had a complicated hospital course with acute renal failure. Due to sputum growth of coagulase-negative Staphylococcus aureus, vancomycin 1500 mg intravenously twice daily was given empirically. Peak and trough plasma concentrations were drawn at steady state. Based on levels, true pharmacokinetic parameters for the patient were calculated using equations. This revealed that calculating individual pharmacokinetic parameters using equations may be a valid tool for dosing vancomycin in obese patients with renal insufficiency.
doi:10.4103/0970-9185.86601
PMCID: PMC3214562  PMID: 22096290
Obese; renal insufficiency; vancomycin therapeutic drug monitoring

Results 1-3 (3)