Spectrum of digoxin-induced ocular toxicity: a case report and literature review.

BACKGROUND: Digoxin intoxication results in predominantly digestive, cardiac and neurological symptoms. This case is outstanding in that the intoxication occurred in a nonagenarian and induced severe, extensively documented visual symptoms as well as dysphagia and proprioceptive illusions. Moreover, it went undiagnosed for a whole month despite close medical follow-up, illustrating the difficulty in recognizing drug-induced effects in a polymorbid patient. CASE PRESENTATION: Digoxin 0.25 mg qd for atrial fibrillation was prescribed to a 91-year-old woman with an estimated creatinine clearance of 18 ml/min. Over the following 2-3 weeks she developed nausea, vomiting and dysphagia, snowy and blurry vision, photopsia, dyschromatopsia, aggravated pre-existing formed visual hallucinations and proprioceptive illusions. She saw her family doctor twice and visited the eye clinic once until, 1 month after starting digoxin, she was admitted to the emergency room. Intoxication was confirmed by a serum digoxin level of 5.7 ng/ml (reference range 0.8-2 ng/ml). After stopping digoxin, general symptoms resolved in a few days, but visual complaints persisted. Examination by the ophthalmologist revealed decreased visual acuity in both eyes, 4/10 in the right eye (OD) and 5/10 in the left eye (OS), decreased color vision as demonstrated by a score of 1/13 in both eyes (OU) on Ishihara pseudoisochromatic plates, OS cataract, and dry age-related macular degeneration (ARMD). Computerized static perimetry showed non-specific diffuse alterations suggestive of either bilateral retinopathy or optic neuropathy. Full-field electroretinography (ERG) disclosed moderate diffuse rod and cone dysfunction and multifocal ERG revealed central loss of function OU. Visual symptoms progressively improved over the next 2 months, but multifocal ERG did not. The patient was finally discharged home after a 5 week hospital stay. CONCLUSION: This case is a reminder of a complication of digoxin treatment to be considered by any treating physician. If digoxin is prescribed in a vulnerable patient, close monitoring is mandatory. In general, when facing a new health problem in a polymorbid patient, it is crucial to elicit a complete history, with all recent drug changes and detailed complaints, and to include a drug adverse reaction in the differential diagnosis.

Has the airway microbiome been overlooked in respiratory disease?

The respiratory disease field is changing because of recent advances in our understanding of the airway microbiome. Central to this is dysbiosis, an imbalance of microbial communities that can lead to and flag inflammation in the airways. The increasing momentum of research in this area holds promise for novel treatment strategies.

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome septième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome dix-septième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Liberal alcohol legislation: does it amplify the effects among Swiss men of person-related risk factors on heavy alcohol use?

AIM: To estimate the statistical interactions between alcohol policy strength and the person-related risk factors of sensation-seeking, antisocial personality disorder and attention-deficit/hyperactivity disorder related to heavy alcohol use. DESIGN: Cross-sectional survey. SETTING: Young Swiss men living within 21 jurisdictions across Switzerland. PARTICIPANTS: A total of 5701 Swiss men (mean age 20 years) participating in the Cohort Study on Substance Use Risk Factors (C-SURF). MEASUREMENTS: Outcome measures were alcohol use disorder (AUD) as defined in the DSM-5 and risky single-occasion drinking (RSOD). Independent variables were sensation-seeking, antisocial personality disorder (ASPD), attention-deficit/hyperactivity disorder (ADHD) and an index of alcohol policy strength. FINDINGS: Alcohol policy strength was protective against RSOD [odds ratio (OR) = 0.91 (0.84-0.99)], while sensation-seeking and ASPD were risk factors for both RSOD [OR = 1.90 (1.77-2.04); OR = 1.69 (1.44-1.97)] and AUD [OR = 1.58 (1.47-1.71); OR = 2.69 (2.30-3.14)] and ADHD was a risk factor for AUD [OR = 1.08 (1.06-1.10)]. Significant interactions between alcohol policy strength and sensation-seeking were identified for RSOD [OR = 1.06 (1.01-1.12)] and AUD [OR = 1.06 (1.01-1.12)], as well as between alcohol policy strength and ASPD for both RSOD [OR = 1.17 (1.03-1.31)] and AUD [OR = 1.15 (1.02-1.29)]. These interactions indicated that the protective effects of alcohol policy strength on RSOD and AUD were lost in men with high levels of sensation-seeking or an ASPD. No interactions were detected between alcohol policy strength and ADHD. CONCLUSION: Stronger alcohol legislation protects against heavy alcohol use in young Swiss men, but this protective effect is lost in individuals with high levels of sensation-seeking or having an antisocial personality disorder.

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome dix-huitième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome quatorzième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome quatrième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome quinzième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome onzième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome premier / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome huitième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome douzième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome neuvième / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188

Bibliotheque françoise ou Histoire de la litterature françoise : dans laquelle on montre l'utilité que l'on peut retirer des livres publiés en françois depuis l'origine de l'imprimerie.... Tome second / par M. l'abbé Goujet,..

Collection : Archives de la linguistique française ; 188