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PubMed2002

Contraindications in noninvasive laser therapy: truth and fiction.

OBJECTIVE: Noninvasive laser therapy is a treatment method employed in many disciplines. This review article points out instances when it appears to be effective to administer such therapy. MATERIALS AND METHODS: Noninvasive laser therapy has a number of suitable applications that cause minimal damage to the patient. Many patients are not sent to institutions equipped with relevant instruments, since physicians are burdened by a number of contraindications, many of which are incorrect. The purpose of this article was to divide these contraindications into the following three groups: correct indications, indications doubtful under certain conditions, and incorrect indications. DISCUSSION: We consider the following contraindications as correct: history of a histologically demonstrated malignant carcinoma; irradiation of the neck region in hyperthyreosis; epilepsy; exposure of the retina; and exposure of the abdomen during pregnancy. The contraindications that are doubtful under certain conditions are as follows: fever and infectious diseases; certain blood diseases; heavy blood losses; neuropathies; and irradiation in the region of gonads. The other contraindications reported in the literature are considered to be incorrect.

Contraindications↗
PubMed2006

Over-the-counter access, changing WHO guidelines, and contraindicated oral contraceptive use in Mexico.

This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical eligibility guidelines, the prevalence of contraindications is low and that no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies. In 2000, however, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for oral contraceptive use. Applying the new guidelines, the authors found that 10 percent of pill users younger than 35 and 33 percent aged 35 and older have health conditions that are either relative or absolute (Category 3 or 4) contraindications. The relevance of these findings to the larger debate concerning screening and over-the-counter access to oral contraceptives is discussed.

Adult↗
PubMedDate not supplied

[An analysis of the medical contraindications for poliomyelitis vaccination in a district of the city of Bucharest].

The authors report on the results of the analysis of frequency, motives and possible consequences associated to the medical contraindication of inoculations with TPDV (thermal polio-destroyed virus) during the antipoliomyelitis vaccination in the spring of 1989 in District 3 of Bucharest. The failure share in the first antipoliomylitis vaccination was of 2.2% in the 2,500 children selected: 46 (83.6%) were CIM in one of the inoculations and 9 (16.4%) in both inoculations with TPDV of the vaccination. Infectious acute affections were the most numerous motives (89.1-57.1%) of the medical contraindications of inoculation with TPDV; in 59.6-31.2% of these causes the hospitalization of the cases was necessary. The false contraindications were at the basis of 10.9-42.9% of the medical decisions that contraindicated inoculation with TPDV. Of the children with contraindications at inoculation with TPDV, 41.8% met the risk criteria after the first stage and 12.7% after the second stage of the vaccination.

Child, Preschool↗
PubMed1997

Contemporary clinical practice of shock wave lithotripsy: a reevaluation of contraindications.

PURPOSE: The current clinical practice of shock wave lithotripsy is reviewed, specifically regarding patients in whom the presence of presumed absolute or relative contraindications may preclude treatment. MATERIALS AND METHODS: Peer reviewed basic scientific and clinical studies on shock wave lithotripsy in patients with urinary stones and concomitant conditions that might contraindicate treatment reported between 1982 and 1996 were critically reviewed. RESULTS: The exclusion of patients with conditions previously believed to contraindicate shock wave lithotripsy has almost always been empiric rather than based on experimental or clinical studies showing adverse effects in those settings. The contemporary literature suggests that shock wave lithotripsy in patients with proximate calcified aneurysms, implanted cardiac pacemakers and defibrillators, and bleeding diatheses can be accomplished safely and effectively with careful treatment and monitoring before, during and after shock wave lithotripsy. Likewise, patients with morbid obesity, children, and those with mid and distal ureteral calculi can also be treated successfully, even with first generation lithotriptors, with minor modifications that allow for appropriate positioning of the patient and stone. CONCLUSIONS: The designation of most conditions as absolute or relative contraindications to shock wave lithotripsy has been empiric. A review of experimental and clinical studies pertinent to these issues clearly shows that most concomitant conditions previously precluding shock wave treatment can be circumvented to allow safe and effective use of this minimally invasive technology. Currently, pregnancy is the only condition that should remain an absolute contraindication to this treatment.

Aneurysm↗
PubMed1998

Object-oriented modeling and terminologies for drug contraindications.

There is no available standardized representation of contraindications that can be used in drug knowledge bases. In this paper, an object-oriented representation of contraindications is proposed that would allow computerized checking of drug prescription safety. It distinguishes four types of contraindications: pathological state, physiological state, findings of investigation procedures, and diagnostic or therapeutic procedures. The vocabulary usable for expressing the contraindications appropriate for automated prescription checking was also investigated. ICD10 (International Classification of Diseases, tenth revision), SNOMED III (Systematized Nomenclature of Medicine), ICPC (International Classification of Primary Care), and ATC (Anatomic Therapeutic and Chemical Classification) were studied as potential sources of standardized vocabulary. A system to support entering data on contraindications into a drug knowledge base, compatible with the proposed structure and using the identified vocabulary sources, is also presented.

Artificial Intelligence↗
PubMed2001

[Asthma and scuba diving Absolute contraindication? in all asthma patients?].

Physical and psychological fitness are required for scuba diving, leading to medical contraindications in certain subjects. Asthma, a condition exhibiting increasing prevalence in the general population is currently considered an absolute contraindication for scuba diving by the French Federation for Submarine Sports and Education (FFESSM). There is however no documented evidence demonstrating a higher risk in asthmatic divers. Our English-speaking colleagues have suggested that certain asthmatic subjects could participate in scuba diving sports under certain conditions without any higher risk compared with non-asthmatic divers. We recall here the impact of diving on respiratory function and potential consequences in asthmatic subjects, proposing that the formal contraindication against scuba diving should be maintained for asthmatic patients who experience frequent symptoms (step 2 or more of the International Consensus Report on Diagnosis and Treatment of Asthma) and/or have a baseline obstructive syndrome. It would appear reasonable to discuss the contraindication concerning patients with rare acute episodes and who have a perfectly normal respiratory function. The question of bronchodilator inhalation prior to diving may be a question to debate. However, such a proposal cannot be considered to be valid unless well-conducted studies of the clinical manifestations are available (frequency and severity of the acute episodes, triggering factors) for the diver candidate. Because of the highly restrictive nature of the contraindication notification and the absence of arguments backing up the decision, the question should be put to competent authorities (sports federations, learned societies) in order to ascertain the pathophysiological mechanisms involved and collect reliable epidemiological data before proposing a consensus discussion. This process may lead to the delivery of scuba diving authorizations for selected asthmatic subjects without a higher risk than non-asthmatic subjects.

Acute Disease↗
PubMed2003

Mortality benefit of immediate revascularization of acute ST-segment elevation myocardial infarction in patients with contraindications to thrombolytic therapy: a propensity analysis.

CONTEXT: There are no definitive recommendations for the management of acute myocardial infarction (AMI) in patients with ST-segment elevation who have contraindications to thrombolytic therapy. It is not clear whether, and the extent to which, immediate mechanical reperfusion (IMR) reduces in-hospital mortality in this population. OBJECTIVE: To determine whether IMR (defined as percutaneous coronary intervention or coronary artery bypass graft surgery) is associated with a mortality benefit in patients with acute ST-segment elevation AMI who are eligible for IMR but have contraindications to thrombolytic therapy. DESIGN, SETTING, AND PATIENTS: From June 1994 to January 2003, the National Registry of Myocardial Infarction 2, 3, and 4 enrolled 1 799 704 patients with AMI. A total of 19 917 patients with acute ST-segment elevation were eligible for IMR but had thrombolytic contraindications after excluding patients who were transferred in from or out to other facilities, patients who received intracoronary thrombolytics, and those who received no medications within 24 hours of arrival. MAIN OUTCOME MEASURE: In-hospital mortality. RESULTS: Of the 19 917 patients, 4705 patients (23.6%) received IMR and 5173 patients (25.9%) died. In-hospital mortality rates in the IMR and non-IMR treated groups in the unadjusted analysis were 11.1%, representing 521 of 4705 patients, and 30.6%, representing 4652 of 15 212 patients, respectively, for a risk reduction of 63.7% (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.26-0.31). In a further analysis using a propensity matching score to reduce the effects of bias, 3905 patients who received IMR remained at lower risk for in-hospital mortality than 3905 matched patients (10.9% vs 20.1%, respectively, for a risk reduction of 45.8%; OR, 0.48; 95% CI, 0.43-0.55). Following a second logistic model applied to the matched groups to adjust for residual differences, a significant treatment effect persisted (OR, 0.64; 95% CI, 0.56-0.75). CONCLUSIONS: In this population, IMR was associated with a reduced risk of in-hospital mortality after appropriate adjustments. Of those we studied who were eligible for IMR, 15 212 patients (76.4%) did not receive it. These results suggest that using IMR in patients with acute ST-segment elevation AMI and contraindications to thrombolytics should be strongly considered.

Aged↗
PubMed2003

Vaginal hysterectomy in generally considered contraindications to vaginal surgery.

OBJECTIVE: The objective was to evaluate the feasibility and complication rate of vaginal hysterectomy with or without adnexectomy in women with enlarged uteri and/or other considered contraindications to the vaginal route. STUDY DESIGN: Over a period of 2 years, a total of 204 women underwent vaginal hysterectomy for benign pathology. Normally considered contraindications to the vaginal route were: moderate to excessive uterine enlargement, nulliparity or no prior vaginal delivery, previous cesarean or pelvic surgeries and adnexal pathologies. Laparoscopy was used only if it became necessary. Patients with uterine prolapse were excluded. The clinical outcomes and complication rate were analyzed even with regards to the type of contraindication. RESULTS: The mean age of the patients was 46.96+/-4.8 years (range: 38-68). The mean uterine weight was 427.74+/-254.75 g (range: 150-2,000). The operative time ranged from 30 to 140 min (mean: 61.59+/-21.80 SD) for vaginal hysterectomy alone, increasing up to 170 min (mean: 83.6+/-38.28 SD) in case of adnexectomy or laparoscopic assistance. The patient characteristics, the uterine weight and the postoperative results and clinical outcome did not differ among the groups of contraindications. Overall, the complication rate was 9.8%. No patient required a transfusion for surgical blood loss, a return to the operating room or readmission to the hospital. During vaginal hysterectomy, adnexectomy was possible in 90.6% of the cases in which it was indicated (unilateral in 21.8% because of adnexal pathology) and was technically impossible in 9.3%. In 4 cases (1.9%) it was not possible to complete vaginal hysterectomy owing to the presence of thick adhesions obliterating the cul-de-sac, of severe endometriosis or other unforeseen circumstances. In these few cases with a difficult access to the ovaries (2.9% of all VH) or with difficulties in mobilizing the uterus, we resorted to laparoscopy. The pneumoperitoneum was achieved by means of an insufflation tube inserted via the vagina into the abdominal cavity and packing the vagina. Thus, the risks associated to the insertion of the Veress needle were avoided. In all but two cases in which conversion to laparotomy was necessary, laparoscopy was successfully completed. CONCLUSIONS: Vaginal hysterectomy appears to be feasible in about 97% of cases in which this approach would have been judged unsuitable. This figure decreases to 94.2% when oophorectomy is indicated.

Adnexa Uteri↗
PubMed1996

Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public providers in Los Angeles.

BACKGROUND: Missed opportunities to vaccinate occur commonly and contribute to the underimmunization of young children. They are related to provider knowledge of the immunization schedule and contraindications to vaccination. METHODS: We surveyed private physicians (n = 50) and public health department physicians and nurses (n = 47). The questionnaire presented two sets of clinical scenarios in which they had to assess what immunizations were due and assess whether there were any contraindications to vaccination. RESULTS: The mean percent correct responses on the immunization schedule questions was 64% (sd = 3.6%) for the private physicians, 71% (SD = 4.7%) for the public physicians and 78% (SD = 2.8%) for the public nurses (P = 0.04). The mean percent correct responses on the contraindications to vaccinate questions was 73% (SD = 5.4%) for public physicians, 58% (SD = 3.3%) for private physicians, and 55% (SD = 4.7%) for public health nurses (P = 0.02). CONCLUSIONS: Our survey shows that providers in the public and private sectors have important deficits in their knowledge of the immunization schedule and the appropriate contraindications to vaccinate which might lead to missed opportunities to vaccinate and low immunization coverage.

Child↗
PubMed2000

Inferior vena cava filters for HIV infected patients with pulmonary embolism and contraindications to anticoagulation.

OBJECTIVES: To describe the mode of presentation, interventions, and outcome of HIV infected patients with pulmonary embolism and a contraindication to anticoagulation, who were treated with a bird's nest filter. METHODS: Retrospective review of case records and imaging department database at UCL Hospitals, London, UK. RESULTS: Three patients had pulmonary embolism and contraindications to anticoagulation. Contraindications were concomitant intracerebral pathology in two patients (one also had bleeding from gastric Kaposi's sarcoma and the other was cognitively impaired with HIV associated dementia complex) and alcohol induced liver disease/binge drinking in the third patient. Anticoagulation was avoided by introducing a bird's nest filter into the inferior vena cava via the common femoral vein. During follow up (7, 8, and 21 months) no complications or recurrent pulmonary emboli occurred. CONCLUSION: The bird's nest inferior vena cava filter has a role in preventing further pulmonary emboli in HIV infected patients with contraindications to anticoagulation.

Adult↗
PubMed1994

Safety of esmolol in patients with acute myocardial infarction treated with thrombolytic therapy who had relative contraindications to beta-blocker therapy.

OBJECTIVE: This study was conducted to evaluate the safety of esmolol in 114 patients treated with thrombolytic therapy for acute myocardial infarction who also had relative contraindications to beta-blockade, and the predictive value of patient tolerance to esmolol and subsequent patient tolerance of oral beta-blocker therapy. PATIENTS: One hundred and fourteen patients with myocardial infarction documented by enzyme concentrations and electrocardiographic changes who also had relative contraindications to beta-blockade. METHODS: Esmolol was initiated during acute myocardial infarction for myocardial ischemia (n = 88), hypertension (n = 13), or supraventricular tachycardia (n = 13). Relative contraindications to beta-blocker therapy included either active signs/symptoms of left ventricular dysfunction or a history of congestive heart failure (n = 40), a history of chronic obstructive pulmonary disease or asthma (n = 31), bradycardia (HR < 60 beats/min; n = 18), peripheral vascular disease (n = 15), or hypotension (systolic BP < 100 mm Hg; n = 14). RESULTS: During initial esmolol dose titration, 69 patients tolerated 300 micrograms/kg/min, 12 patients tolerated 200 micrograms/kg/min, 17 patients tolerated 100 micrograms/kg/min, and 16 patients tolerated 50 micrograms/kg/min. Twenty-eight patients (25 percent) developed dose-limiting adverse effects during esmolol maintenance infusions. Sixteen patients required esmolol dose reduction and 12 required esmolol discontinuation. Adverse effects reversed within 30-45 minutes following dose reduction or discontinuation. The 86 patients who tolerated esmolol infusions without dose reduction or drug discontinuation were subsequently treated with oral beta-blockers. Eleven of these patients (13 percent) developed adverse effects requiring oral beta-blocker discontinuation. Nine of these patients had tolerated only 50 micrograms/kg/min of esmolol, and the other 2 patients had tolerated only 100 micrograms/kg/min. CONCLUSIONS: Esmolol can be used safely in most patients treated with thrombolytic therapy for acute myocardial infarction who have relative contraindications to beta-blockers. Tolerance to higher maintenance doses of esmolol is a good predictor of subsequent outcome with oral beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed2003

Physician knowledge of catch-up regimens and contraindications for childhood immunizations.

OBJECTIVES: To determine physician success at designing catch-up regimens for children delayed in immunizations and physician knowledge regarding contraindications to immunization. METHODS: A self-administered survey was completed by pediatricians, general practitioners, and family practitioners in Cook County, Illinois. Surveys included 6 open-ended vignettes describing hypothetical children delayed in immunization for whom participants were asked to design catch-up regimens. Bivariate and multivariate logistic regression were used to determine predictors of correct response. The surveys also inquired about management of scenarios that might be perceived as contraindications to immunize with the Haemophilus influenzae type b or measles-mumps-rubella vaccines. RESULTS: The mean score of correct responses was 1.83 of a possible 6.0. Almost one third of respondents answered all 6 vignettes incorrectly. The proportion of incorrect responses was high for all 6 vignettes (39%-86%), but higher for questions that addressed the immunization of children older than 12 months. Errors in vaccine administration were most commonly attributed to omitted vaccines, with varicella-zoster vaccine and pneumococcal conjugate vaccine omitted most frequently. Pediatricians were >4 times more likely to answer correctly than were family practitioners. Participants in the Vaccines for Children (VFC) program were more than twice as likely to answer correctly than were non-VFC providers. Knowledge of contraindications was inconsistent, particularly for measles-mumps-rubella vaccine. CONCLUSIONS: Childhood vaccine providers have substantial knowledge deficits of recommended immunization schedules and vaccine contraindications that may contribute to missed opportunities to immunize. Pediatricians and participants in the VFC program were more successful at designing catch-up regimens for children with immunization delay.

Age Factors↗
PubMed1993

Diagnosis of renal cell carcinoma: value of fine-needle aspiration cytology in patients with metastases or contraindications to nephrectomy.

OBJECTIVE: A retrospective study of imaging-directed percutaneous fine-needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspiration biopsy in establishing the diagnosis of renal cell carcinoma and avoiding nephrectomy in patients with a renal mass and disseminated metastases or with a renal mass and relative contraindications to nephrectomy. MATERIALS AND METHODS: Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biopsies at our institution. We examined the medical records, pathology reports, imaging studies, and follow-up information of the 23 patients who had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminary diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients). RESULTS: Cytopathologic findings were true-positive in 12 patients, true-negative in eight, false-negative in three, and false-positive in none. The sensitivity was 80%, the specificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, and all died within 1 year. Of the 13 patients with relative contraindications to surgery, seven were treated without surgery. The cytologic diagnosis was renal cell carcinoma in two of the seven, and these two patients have since died. Cytopathology was negative for renal cell carcinoma in five of the seven, and subsequent imaging studies in these patients have shown no renal mass enlargement or metastases 2-3 years after biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining six patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications. CONCLUSION: Percutaneous renal aspiration biopsy cytology is accurate, safe, and useful in establishing the diagnosis of renal cell carcinoma in patients with disseminated metastases or relative contraindications to surgery.

Aged↗
PubMed1997

Contraindications to metformin therapy in patients with NIDDM.

OBJECTIVE: Treatment with metformin is occasionally associated with the development of severe lactic acidosis. However, this is usually observed in patients with major contraindications to the drug. In this study, we aimed to determine the prevalence of conditions currently regarded as either contraindications or cautions to the use of metformin in patients with NIDDM. RESEARCH DESIGN AND METHODS: The case notes of metformin-treated NIDDM patients (mean age 62 years) attending a United Kingdom university hospital diabetes clinic over a 3-month period were reviewed according to criteria reflecting a pragmatic view of current prescribing recommendations. RESULTS: Of 89 consecutive patients whose notes could be evaluated in detail, only 41 (46%) had no contraindications or cautions to metformin whatsoever. Concomitant chronic disorders associated with a potentially increased risk of hyperlactatemia were renal impairment (n = 2; plasma creatinine concentrations 1.7 and 2.3 mg/dl, respectively), cardiac failure (n = 2), and chronic liver disease (n = 2). Other potentially relevant disorders included ischemic heart disease (n = 20), clinical proteinuria (n = 14), peripheral vascular disease (n = 22), and pulmonary disease (n = 7). Multiple conditions (i.e., two, three, or four) were present in eight, five, and one patient(s), respectively. CONCLUSIONS: More than half the patients in our series had concomitant conditions or complications conventionally regarded as cautions or contraindications to metformin; approximately 10% had a multiplicity of such conditions. Regular surveillance is necessary to detect the development of complications such as renal impairment. Vigilance is also required in view of the increased risk of major intercurrent illnesses, which may independently disturb lactate metabolism in patients with NIDDM. Metformin should be withdrawn promptly under such circumstances.

Acidosis, Lactic↗
PubMed2000

[True and presumed contraindications of beta blockers. Peripheral vascular disease, diabetes mellitus, chronic bronchopneumopathy].

Traditional contraindications to beta-blockers are peripheral vascular diseases, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma. Recent data seem to show that rigorous application of these rules are not completely justified and indicate that many patients would be inappropriately excluded from the beneficial effects of this therapy. Appraisal of clear guidelines for a safe use of beta-blockers is thus mandatory for the clinician. A brief review of the effects of beta-adrenergic receptor blockade is offered. The therapy is aimed at blocking beta 1-receptors. On the other hand, the block of beta 2-receptors causes the well known side effects, i.e. vasoconstriction, delayed response to hypoglycemia in diabetic patients, bronchoconstriction. From the first compound, propranolol, with uniform action on beta 1 and beta 2-receptors, further generation of beta-blockers were subsequently developed: beta 1-selective, with intrinsic sympathomimetic activity, and with associated vasodilating "ancillary" property. Some favorable reduction in collateral effects has thus been obtained with new compounds, without reaching complete safety. Examination of exclusion criteria applied in clinical trials offers no useful indications because of their imprecise definition. Examination of the literature and a more accurate understanding of the diseases, traditionally considered contraindications, may help setting up a uniform and clear path: peripheral vascular disease: beta-blockers should be avoided only in those patients with vasospastic disorders, rest pain with severe peripheral vascular disease or nonhealing lesions. In patients with mild to moderate disease, beta-blockers can be prescribed, but careful surveillance for any changes in symptoms related to intermittent claudicatio should be achieved; diabetes mellitus: previous apprehension for the lessening reaction to hypoglycemia in patients treated with insulin has been retracted. Beta-blockers are not contraindicated in these patients. Some caution should be addressed when signs of autonomic disease are present or in patients with difficult glycemic control. Patients on oral long-acting antidiabetic drugs should not be neglected. The risk of prolonged and paucisymptomatic hypoglycemia while taking beta-blocker agents is somewhat more relevant than in patients treated regularly with insulin; COPD and asthma: confusion may arise if rigorous definition of these diseases and their severity is not applied following the guidelines of the American Thoracic Society. Because bronchial hyperreactivity seems the crucial factor in determining collateral effects to beta-blocker agents, agreement can be reached on the following statements. Beta-blockers are contraindicated a) when history of asthma is present, b) when COPD is moderate to severe, i.e. with FEV1 reduction < 50% of the predicted value, c) in patients on chronic bronchodilator treatment, d) in chronic airflow limitation with evidence of > or = 20% reversibility in airway obstruction in response to inhaled salbutamol. When FEV1 is > 50% of the predicted value, beta-blockers can be given, providing adequate control of stability of ventilatory conditions.

Adrenergic beta-Antagonists↗
PubMed2003

Contraindications to vaccination in children. Mainly immunosuppression and a history of severe reactions.

(1) A history of severe anaphylactic reaction to a vaccine or one of its components is an absolute contraindication to the use of the same vaccine. (2) Live vaccines (viral or bacterial) are contraindicated in children with impaired immune response; this includes children receiving high-dose steroids. (3) BCG vaccination is contraindicated in HIV-seropositive children regardless of immune status. (4) Vaccination need not be postponed in children with common illnesses such as rhinopharyngitis; in children with a history of asthma or eczema; in children taking antibiotics; or in babies who are breast fed. (5) The contraindications of pertussis vaccination are now well defined (mainly neurological diseases). (6) Very few studies have assessed the adverse effects of vaccination on the outcome of pregnancy or on the unborn child. In practice, vaccination of pregnant women can usually wait until after delivery.

Anaphylaxis↗
PubMed2005

Prescribing of contraindicated protease inhibitor and statin combinations among HIV-infected persons.

HIV-1 protease inhibitors (PIs) contribute to hyperlipidemia in persons treated for HIV infection. There are potential drug-drug interactions between PIs and some statins, which are drugs frequently used to treat hyperlipidemia. We performed a retrospective cohort study using the TennCare program to determine prescribing rates of contraindicated combinations of PIs and statins in HIV-infected persons in Tennessee and to assess changes in prescribing after publication of treatment guidelines. Computerized files identified adult patients with antiretroviral prescriptions and overlapping prescriptions for PIs and statins from January 1, 1996 through June 30, 2002. A subset of these combinations was defined as contraindicated based on published guidelines. Changes in patterns of prescribing after publication of preliminary treatment guidelines were examined using a mixed-effects logistic regression model. There were 3448 persons who received PIs during the study period. The proportion of PI users receiving statins increased from 3.5% during January 1996 through December 2000 to 7.9% during January 2001 through June 2002 (P < 0.001). Contraindicated PI-statin use decreased from 42.0% of combinations to 20.8% during the same periods (P < 0.001). Use of PIs and statins has increased in the adult TennCare population. Contraindicated combinations have decreased but remain unacceptably high.

Adolescent↗
PubMed1994

The Australian College of Paediatrics Policy Statement. Contraindications to immunization against pertussis.

Absolute contraindications to pertussis immunization should be limited to anaphylaxis or unexplained encephalopathy following a previous dose. Other contraindications including marked febrile reactions (> 40.5 degrees C), hypotonic-hyporesponsive episodes, prolonged screaming (> 3 h) and severe local reactions (more than half the limb involved) are relative, as no long-term adverse consequences have been noted, and must be weighed up in the context of the risk of pertussis to the individual child. Each of these contraindications will affect less than 1% of children. Paediatricians should strongly discourage the inappropriate deferral of pertussis immunization due to mild illness and the omission of pertussis vaccine because of inappropriate contraindications, such as many of those mentioned in the product information. This is especially important in children who have underlying conditions which may place them at greater risk of acquisition of and complications from natural pertussis infection.

Australia↗