Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke

Evidence is scarce regarding the polypharmacy in patients with sarcopenia. The aim of this study was to investigate the effect of deprescribing for polypharmacy on the improvement of nutritional intake and sarcopenia in older patients with sarcopenia. A retrospective cohort study was conducted with hospitalized older patients with sarcopenia undergoing rehabilitation after stroke. Study outcomes included energy intake, protein intake, handgrip strength (HG) and skeletal muscle mass index (SMI) at hospital discharge. To consider the effects of deprescribing for polypharmacy, we used multivariate analyses to examine whether the change in the number of medications during hospitalization was associated with outcomes. Of 361 patients after enrollment, 91 (mean age 81.0 years, 48.4% male) presented with sarcopenia and polypharmacy and were eligible for analysis. The change in the number of medications was independently associated with energy intake (β = −0.237, p = 0.009) and protein intake (β = −0.242, p = 0.047) at discharge, and was not statistically significantly associated with HG (β = −0.018, p = 0.768) and SMI (β = 0.083, p = 0.265) at discharge, respectively. Deprescribing was associated with improved nutritional intake in older sarcopenic patients with polypharmacy undergoing stroke rehabilitation.     

Potential of various drugs to inhibit nucleoside uptake in rat syncytiotrophoblast cell line, TR-TBT 18d-1

The placenta requires nucleosides as nutrients for fetal growth, so it is important to examine potential interactions between placental transports of nucleosides and drugs to ensure the safety of pharmacotherapy during pregnancy. The purposes of this study are to clarify the uptake mechanisms of nucleosides from the maternal side of the syncytiotrophoblast and to investigate the inhibitory effect of various drugs on nucleoside uptake, using the rat syncytiotrophoblast cell line TR-TBT 18d-1, which shows syncytial-like morphology and functional expression of several transporters. Initial uptake of [(3)H]uridine or [(3)H]adenosine from the apical side of TR-TBT 18d-1 was markedly reduced by an excess of the respective unlabelled compound, and was slightly reduced by replacement of Na(+) with N-methyl-d-glucamine, indicating that both uptakes were Na(+)-independent. [(3)H]Uridine and [(3)H]adenosine uptakes in the absence of Na(+) were significantly and concentration-dependently inhibited by both 0.1 microM and 100 microM nitrobenzylthioinosine, suggesting the involvement of equilibrative nucleoside transporters (ENTs, SLC29). Kinetic analysis of adenosine uptake yielded a K(m) value of approximately 17 microM. These results are consistent with the reported uptake characteristics of uridine and adenosine by ENT1 and ENT2. The uptakes were significantly reduced by high concentrations of several nucleoside drugs, including cytarabine, vidarabine, zidovudine, mizoribine, caffeine and amitriptyline, but the effects were small within the therapeutic concentration ranges. In summary, our results suggest that ENTs are involved in apical uptake of uridine and adenosine in the syncytiotrophoblast. However, therapeutic concentrations of the drugs tested in this study might have little influence on maternal-to-fetal nucleoside transfer.     

Antenatal administration of granulocyte-macrophage colony-stimulating factor increases fetal lung maturation and endothelial nitric oxide synthase expression in the fetal rat lung

Objective

To study subsequent pregnancy outcome in women with severe, very early onset preeclampsia (onset before 24 weeks’ gestation) and to analyze cardiovascular risk profiles of these women and their partners.

Study design

Twenty women with preeclampsia with an onset before 24 weeks’ gestation, admitted between 1 January 1993 and 31 December 2002 at a tertiary university referral center, were enrolled in the study. Data on subsequent pregnancies were obtained from medical records. Their cardiovascular risk profiles and those of their partners (n = 15) were compared with those of 20 control women after uncomplicated pregnancies only, matched for age and parity, and those of their partners (n = 13). Body weight, height, waist and hip circumference, blood pressure and intima media thickness (IMT) of the common carotid artery were measured. Fasted blood samples were drawn for detection of metabolic cardiovascular risk factors.

Results

Of the 20 case women 17 women had 24 subsequent pregnancies, of which 12 (50%) were complicated by preeclampsia. Severe preeclampsia developed in five (21%) pregnancies. No perinatal deaths occurred. Case women had significantly more often chronic hypertension as compared to controls (55% vs. 10%, P = 0.002). IMT of the common carotid artery was increased in a subset of case women using antihypertensive medication (P = 0.03). Case women showed increased microalbuminuria (P < 0.05). No differences were found in cardiovascular risk profiles between partners of cases and controls.

Conclusions

Women with severe, very early onset preeclampsia have an increased risk of preeclampsia in future pregnancies, yet neonatal outcome is, in general, favourable. Regarding cardiovascular health, women after severe, very early onset preeclampsia exhibit more risk factors compared to controls whereas men who fathered these pregnancies do not.     

An immunohistochemical profile of giant cell carcinoma of the larynx

OBJECTIVE: This report describes a case of a 62-year-old male with giant cell carcinoma of the larynx that presented as a neck mass and hoarseness. METHODS: Case report, review of the world literature, and an immunohistochemical examination. RESULTS: Extended total laryngectomy and bilateral functional neck dissection were performed. Microscopical examination showed that the tumor was composed of solid masses of anaplastic small cells with hyperchromatic nuclei. There were multinucleated giant cells with huge nuclei, prominent nucleoli, and clear or eosinophylic cytoplasm. The diagnosis of giant cell carcinoma of the larynx was made. An immunohistochemical staining was applied to the case and tumor showed immunoreactivity with cytokeratin 8/18, cytokeratin 18, cytokeratin 19, vimentin, epithelial membrane antigen, S-100, cytokeratin 7 and did not show immunoreactivity with cytokeratin 10, cytokeratin 20, and carcinoembryogenic antigen. CONCLUSION: Giant cell carcinoma of the larynx is an extremely rare tumor the origin of which is not clearly understood. It is believed to be the counterpart of giant cell carcinoma of the lung in larynx. It is the sixth case reported in English literature and also the first case that is examined immunohistochemically. In conclusion, giant cell carcinoma of the larynx is confirmed to be a specific entity of simple epithelial origin and it is the counterpart of giant cell carcinoma of the lung.     

A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey

We aimed to assess the incidence, neurologic and neurodevelopmentaloutcome of breastfeeding-associated hypernatremic dehydrationamong hospitalized neonates in rural area of central Turkey.A retrospective study was conducted at Gevher Nesibe Hospitalover a 6-year period, to identify otherwise healthy term andnear-term ( 35 weeks of gestation) breastfed neonates (<29days of age) who were admitted with serum sodium concentrationsof >150 mEq/l and no explanation for hypernatremia otherthan inadequate milk intake. The incidence of breastfeeding-associatedhypernatremic dehydration among hospitalized term and near-termneonates (n = 5592) was 2.1%, occurring for 116 breastfed infants.More than one half of the infants admitted with breastfeeding-associatedhypernatremia exhibited abnormal development at 12 or more monthsof age. Increased efforts are required to establish successfulbreastfeeding.     

Cutaneous anthrax involving the genital area

A 5-year-old girl was admitted with a lesion of the labia majora which was found to be owing to anthrax. She had been licked on the hand by a sick cow (which subsequently died) 5 days prior to admission to a health clinic and 8 days before admission to hospital.     

Serum leptin levels in patients with childhood immune thrombocytopenic purpura

Acute immune thrombocytopenic purpura (ITP) induces thrombocytopenia by means of an autoimmune mechanism. Recent studies suggested that T helper immune response is responsible for the pathogenesis of chronic ITP. Despite several studies that were carried out, we do not have a clue as to what triggers the autoimmunity. Leptin is a 16-kd protein secreted from the adipose tissue. Leptin is structurally similar to interleukin (IL)-2, IL-6, and IL-15. The structural similarities between leptin receptor and hematopoietic cytokine receptors suggested that leptin could play a role in hematopoiesis and immune function. Recent studies suggested that leptin could play an important role in autoimmunity. We made a prospective analysis of a series of 39 newly diagnosed acute childhood ITP in a year period. Serum leptin levels were obtained after diagnosis and before treatment and all patients were followed up at least 6 months to designate acute or chronic event. We conclude that in childhood acute ITP, leptin did not play a role in the pathophysiology of the disease. Further investigations are needed to examine what triggers T cells and how the autoimmune disease became.