Zinc as an antiperoxidative agent following iodine-131 induced changes on the antioxidant system and on the morphology of red blood cells in rats

Iodine-131 ((131)I) irradiation is the first line treatment for Graves' disease and thyroid carcinoma. In such cases, (131)I gets accumulated in the thyroid, and is released in the form of radioiodinated triiodothyronine (T3) and tetraiodothronine (T4). Various reports describe changes in the blood picture after radioiodine treatment. Zinc, on the other hand, has been reported to maintain the integrity of red blood cells (RBC) under certain toxic conditions. The present study was conducted to evaluate the adverse effects of (131)I on the antioxidant defense system and morphology of RBC and also to assess the possible protection by zinc under irradiation by (131)I. Thirty two female Wistar rats were equally segregated into four main groups. Animals with Group I served as normal controls; Group II animals were administered a dose of 3.7 MBq of (131)I (carrier free) intraperitoneally, Group III rats were supplemented with zinc (227 mg/L drinking water) and Group IV rats were given a combined treatment of (131)I and zinc, in a similar way as in Group II and IV rats. After seven days of (131)I treatment, RBC lysate was prepared and its antioxidant status assessed. The activity of superoxide dismutase (SOD), reduced glutathione (GSH) and malondialdehyde (MDA) in the lysate of RBC was increased. On the contrary, the activity of catalase was found to be significantly decreased. The activity of glutathione reductase (GR) remained unchanged. Marked changes in the shape of RBC from normal discocytes to echinocytes, spherocytes, stomatocytes and acanthocytes were also observed in the blood of the rats treated with (131)I. Zinc supplementation to (131)I treated rats, significantly attenuated the adverse effects caused by (131)I on the levels of MDA, GSH, SOD and catalase. In conclusion, the study revealed significant oxidant/antioxidant changes in RBC following (131)I administration in rats, while zinc was shown to act as a radioprotector agent.     

Juvenile idiopathic arthritis in the new world of biologics

Juvenile idiopathic arthritis results in significant pain and disability in both children and adults. Advances in treatment resulting in improved long‐term outcomes have occurred; however, an emphasis on early and aggressive diagnosis and management hopes to improve outcomes further. Juvenile idiopathic arthritis remains a clinical diagnosis of exclusion, but further research may delineate biological markers associated with the disease and its subtypes. Therapy for patients includes intra‐articular steroid injections, disease modifying agents such as methotrexate and biological agents. Biological agents have provided exciting new therapeutic options in the last decade; however, long‐term side effects of modulating the immune system are not yet fully understood. Systemic steroids may also be required but their long‐term use is avoided. Uveitis needs to be screened for in all of those with the diagnosis. Multidisciplinary team care is required in managing these young people.     

Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: a retrospective study

Background The incidence and management of trastuzumab-mediated cardiotoxicity outside of clinical trials has not been well described. Objective and methods The aim of the study was to retrospectively evaluate the incidence of cardiac dysfunction, characterize its natural history, and identify the degree of reversibility using cardiac MRI, in a population of HER-2 positive breast cancer patients receiving trastuzumab in the adjuvant setting. Results Out of 152 patients (mean age 52 ± 10 years), 36 (24%) developed trastuzumab mediated cardiomyopathy, the majority asymptomatic. Factors that predicted the development of trastuzumab mediated cardiac dysfunction were a pre-existing history of hypertension, smoking history, and a family history of coronary artery disease. Within 3 months of treatment with trastuzumab, there was a difference in LVEF between the normal cohort and those patients who developed LV systolic dysfunction (61 ± 5% vs. 51 ± 8%, P < 0.01). During the 6-month-followup, 34/36 patients demonstrated subepicardial linear delayed enhancement of the lateral wall of the left ventricle on cardiac MRI, suggesting trastuzumab induced myocarditis. Conclusion Approximately 1 in 4 women may develop LV systolic dysfunction after treatment with adjuvant trastuzumab, necessitating careful patient selection and close serial monitoring using noninvasive cardiac imaging.     

Femoral artery access site closure with perclose suture mediated device in coronary interventions

ObjectiveTo compare the outcome of suture mediated vascular closure device Perclose Proglide (PP) with manual compression (MC) following transfemoral access for coronary interventions (CI).MethodsIt is a retrospective, observational, single centre study from January 2018 to September 2019. Consecutive patients undergoing interventions through transfemoral access were divided into PP and MC groups. Those with less than 3 months follow up were excluded. Two groups were compared for baseline characteristics and various complications at 24 h and at 30 days.ResultsOut of 1743 patients studied, PP group included 1343 and MC group, 400 patients. Both groups were comparable in baseline characteristics, sheath size and use of antiplatelets and anticoagulation. PP group had significantly less minor bleeding (P = .01, CI 0.34–4.03) and hematoma (P = .0007, CI 0.95–5.10) at 24 h. At 30 days, minor bleeding (P < .0001, CI 0.97–4.25), hematoma (P = .0002, CI 1.05–4.93) and pseudo-aneurysm (P = .0095, CI 0.03–1.18) were also significantly less in PP group. Obesity (OR 3.5, CI 1.29–9.49) and hypertension (OR 2.41, CI 1.12–5.19) were associated with increased minor bleeding at 24 h. Device failure rate was 2.38%.ConclusionsPP device is safe, effective and is associated with fewer complications than MC in CI. Device failure rate is low. Obesity and hypertension are associated with increased minor bleeding in both groups.