Paraneoplastic cerebellar degeneration as a presenting manifestation of non-Hodgkin’s lymphoma

Background

Paraneoplastic Cerebellar degeneration (PCD) is one of the classical paraneoplastic syndromes (PNS) which is characterised by subacute onset, progressive cerebellar ataxia and is usually associated with small cell lung carcinoma, adeno carcinoma of breast and ovary followed by Hodgkin’s lymphoma.

Objective

We herein report a case of subacute onset, progressive cerebellar ataxia in a 37-year-old female, who on evaluation was found to have non-Hodgkin’s lymphoma and experienced good clinical response to treatment.

Discussion

As compared to solid tumours, chances of association of PNS with Lymphomas is quite low and there are only few case reports in the literature showing association of PCD with non-Hodgkin’s lymphoma. As PCD is one of the classical PNS, it is very important to identify subtle cerebellar manifestations in an otherwise apparently normal individual, as early diagnosis and aggressive treatment can immensely improve the mortality and morbidity associated with this syndrome.

Conclusion

This case signifies the importance of suspecting PNS as an important differential diagnosis in a young patient presenting with subacute onset progressive cerebellar ataxia and evaluating her extensively for malignancy in spite of no paraneoplastic antibody been detected as early diagnosis and treatment can lead to gratifying response. We do agree that 2 weeks follow up is a short time interval to determine whether the response was sustained or not, for which a long term follow up is required.

     

Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis

Journal of Robotic Surgery - To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length...     

Multidrug-Resistant Mycobacterium tuberculosis of the Latin American Mediterranean Lineage,Wrongly Identified as Mycobacterium pinnipedii (Spoligotype International Type 863 [SIT863]), Causing Active Tuberculosis in South Brazil

We recently detected the spoligotype patterns of strains of Mycobacterium pinnipedii, a species of the Mycobacterium tuberculosis complex, in sputum samples from nine cases with pulmonary tuberculosis residing in Porto Alegre, South Brazil. Because this species is rarely encountered in humans, we further characterized these nine isolates by additional genotyping techniques, including 24-locus mycobacterial interspersed repetitive-unit–variable-number tandem-repeat (MIRU-VNTR) typing, verification of the loci TbD1, RD9, pks15/1, RD^Rio, and fbpC, the insertion of IS6110 at a site specific to the M. tuberculosis Latin American Mediterranean (LAM) lineage, and whole-genome sequencing. The combined analysis of these markers revealed that the isolates are in fact M. tuberculosis and more specifically belong to the LAM genotype. Most of these isolates (n = 8) were shown to be multidrug resistant (MDR), which prompted us to perform partial sequencing of the rpoA, rpoB, rpoC, katG, and inhA genes. Seven isolates (77.8%) carried the S315T mutation in katG, and one of these (11%) also presented the C(−17)T single-nucleotide polymorphism (SNP) in inhA. Interestingly, six of the MDR isolates also presented an undescribed insertion of 12 nucleotides (CCA GAA CAA CCC) in codon 516 of rpoB. No putative compensatory mutation was found in either rpoA or rpoC. This is the first report of an M. tuberculosis LAM family strain with a convergent M. pinnipedii spoligotype. These spoligotypes are observed in genotype databases at a modest frequency, highlighting that care must be taken when identifying isolates in the M. tuberculosis complex on the basis of single genetic markers.     

Analysis of Research and Scholarship Criteria Within Promotion and Tenure Documents of US Pharmacy Schools

Objective. To describe criteria for evaluating faculty scholarship within the promotion and tenure guidance documents of US schools and colleges of pharmacy.Methods. Promotion and tenure documents were obtained from the websites of US pharmacy schools or requested via electronic mail, and institutional characteristics were collected from publicly available online data. A qualitative content analysis was conducted to systematically catalogue document characteristics and criteria for promotion and tenure.Results. Promotion and tenure guidance documents from 121 (85%) of 142 pharmacy schools were analyzed. Institutions were 55% public and equally distributed across Carnegie institutional classifications as well as geographic and extramural funding stratifications. Publications (94%) and grants and contracts (87%) were the most frequently included criteria for faculty advancement. More than 50% of schools recognized the criteria within promotion and tenure guidance documents but did not explicitly require faculty to achieve them before receiving promotion and/or tenure. For institutions that required publications for advancement, the most frequently required criterion was publication in peer-reviewed journals (47%). Few schools (22%) documented a specific number of required publications.Conclusion. This analysis provides a comprehensive review of scholarship criteria in academic pharmacy promotion and tenure guidance documents. There was wide variability among scholarship criteria, and documents often lacked specific language defining scholarship requirements. As a result, faculty may find the documents less helpful for self-assessment and preparation toward promotion and/or tenure. These benchmark data can assist pharmacy faculty and administrators in developing and revising promotion and tenure guidance documents to include clear criteria and better align with peer institutions.     

Enhancement of phenytoin elimination by multiple-dose activated charcoal

The effect of multiple-dose activated charcoal on the elimination of intravenously administered phenytoin was studied. Seven normal volunteers received phenytoin sodium 15 mg/kg IV with and without activated charcoal. During the charcoal phase, a total dose of 300 g was administered in repeated doses over 48 hours with sufficient sorbitol to produce one to two bowel movements per day. Serum phenytoin concentrations were determined from one to 72 hours after the infusions and were fitted to a one-compartment linear elimination model. The administration of multiple-dose activated charcoal reduced the phenytoin half-life from 44.5 to 22.3 hours. In addition, phenytoin area under the curve was decreased and the elimination rate was increased. Multiple-dose activated charcoal is effective in enhancing the elimination of phenytoin in normal volunteers. Although future studies are needed to determine its role in treating patients with phenytoin toxicity, multiple-dose activated charcoal may provide a readily available, inexpensive therapeutic intervention.