Association of Celiac Disease with Aplastic Anemia

The authors report a case of 13-y-old boy who presented with pain in bilateral knee and ankle joints accompanied by petechiae all over the body and hematochezia. On investigation, he had pancytopenia, which on subsequent evaluation revealed aplastic anemia. On investigation for short stature, he was diagnosed as a case of celiac disease. He was started on gluten free diet and the counts improved over 8?mo. Association between aplastic anemia and celiac disease has rarely been reported. To the best of authors' knowledge only 8 adult cases of celiac disease associated with aplastic anemia have been published. This is the first report to suggest an association in children and response to a gluten free diet.     

In Vitro and In Vivo Characterization of CB-183,315, a Novel Lipopeptide Antibiotic for Treatment of Clostridium difficile

CB-183,315 is a novel lipopeptide antibiotic structurally related to daptomycin currently in phase 3 clinical development for Clostridium difficile-associated diarrhea (CDAD). We report here the in vitro mechanism of action, spontaneous resistance incidence, resistance by serial passage, time-kill kinetics, postantibiotic effect, and efficacy of CB-183,315 in a hamster model of lethal infection. In vitro data showed that CB-183,315 dissipated the membrane potential of Staphylococcus aureus without inducing changes in membrane permeability to small molecules. The rate of spontaneous resistance to CB-183,315 at 8× the MIC was below the limit of detection in C. difficile. Under selective pressure by serial passage with CB-183,315 against C. difficile, the susceptibility of the bacteria changed no more than 2-fold during 15 days of serial passages. At 16× the MIC, CB-183,315 produced a ≥3-log reduction of C. difficile in the time-kill assay. The postantibiotic effect of CB-183,315 at 8× the MIC was 0.9 h. At 80× the MIC the postantibiotic effect was more than 6 h. In the hamster model of CDAD, CB-183,315 and vancomycin both demonstrated potent efficacy in resolving initial disease onset, even at very low doses. After the conclusion of dosing, CB-183,315 and vancomycin showed a similar dose- and time-dependent pattern with respect to rates of CDAD recurrence.     

Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.     

Non-invasive assessment of exhaled biomarkers in lung transplantation

Biomarkers in exhaled breath condensate (EBC) and fractional exhaled nitric oxide (FeNO) have been widely evaluated in respiratory research as non-invasive methods of sampling the lungs. These methods are particularly attractive in lung transplantation (LTx) as they are simple, repeatable and sensitive. Chronic rejection, manifest by progressive airflow limitation and bronchiolitis obliterans syndrome (BOS), is currently the major limiting factor to long-term survival in LTx. Early detection of BOS and initiation of appropriate treatment could significantly improve survival. Exhaled breath biomarkers could allow early diagnosis of factors associated with chronic rejection. FeNO is elevated in LTx patients with infections and chronic rejection prior to clinical presentation, and several EBC biomarkers and volatile organic compound patterns also show promise in these areas. This review summarizes information on exhaled breath biomarkers in LTx and discusses their potential role in the management of LTx patients.     

Pituitary apoplexy after leuprolide

Clinically unsuspected pituitary adenomas are common among adults on autopsy and MRI survey. Acute pituitary hemorrhage is far more rare. We report a case of a 61-year-old male patient with locally advanced prostate cancer who presented with an acute picture of pituitary apoplexy after his first dose of leuprolide. He developed headache and neck pain within a few hours of treatment followed by nausea, vomiting, ptosis and diplopia. Pituitary apoplexy is a potentially life threatening medical emergency. Although the pathophysiology is poorly defined, various conditions and treatments have been reported to trigger apoplexy. Apoplexy has been reported in response to pituitary stimulation by GnRH or GnRH-agonists. Initial stimulatory effects of gonadotropin releasing hormone (GnRH) analogue may induce apoplexy in patients with asymptomatic gonadotroph adenomas.