Clinical incidents case example

For less well defined incidents however, these detection systems may be inadequate. Portable chemical detectors may not be able to be deployed to the site, not detect the agen, or give inconclusive results. Clinical findings may be non-specific, present in an atypical manner, or for example in the case of sulphur mustard, have a latency period that delays firm pattern recognition. Due to the physico-chemical properties of the agent or the time between release and collection, environmental samples may have low agent levels or sufficiently high contaminants to prevent adequate results. 

The interpretation of these sporadic cases is controversial, although some have argued that the reported cardiovascular adverse effects occur more often with sildenafil than with other pharmacological treatments of erectile dysfunction. It is at present unclear whether there is an increased risk with sildenafil. For example, in placebo-controlled trials there have been no differences in the incidences of myocardial infarction, angina, or coronary artery disorders between sildenafil and placebo (9). Exclusion criteria in clinical trials may have prevented the inclusion of patients who are at increased risk of adverse events. On the other hand, sexual activity itself increases cardiac workload and the risk of myocardial infarction. Patients with cardiovascular disease should be cautious in their use of sildenafil. 

Fibrillin is encoded by a gene located in the long arm of chromosome 15. Mutations in the fibrillin gene lead to an autosomal dominant trait known as Marfan s syndrome. The incidence of this disorder is 1 10,000, and 15-30% of cases are caused by new mutations in the fibrillin gene. Consistent with the function of fibrillin in the elastic connective tissues, the clinical manifestations present as disorders of cardiovascular, musculoskeletal, and opthalmic systems. For example, dissecting aneurysm of... 

The following section describes (1) examples for the incidence of anti-protein drug antibodies, (2) the potential impact of such antibodies, and (3) two cases of clinical consequences. 

The reduction in oropharyngeal deposition by using a spacer with an MDI is especially important in the case of inhaled steroids because it also reduces the incidence of candidiasis. Thus, using a spacer with an inhaled steroid is a good example of how the therapeutic index of this class of drug can be enhanced. Nevertheless, there is little evidence to suggest that spacers improve the clinical outcome of inhaled medications. For more details about spacers, we refer the reader to Chap. 12. 

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