Progression of KRAS mutant pancreatic adenocarcinoma during vemurafenib treatment in a patient with metastatic melanoma

Vemurafenib is a tyrosine kinase inhibitor of BRAF that prolongs survival in patients with BRAF V600‐mutant metastatic melanoma. Secondary cutaneous malignancies are a well‐documented toxicity of vemurafenib, thought to be mediated by enhanced ERK signalling in BRAF wild‐type, RAS‐mutant cells. Vemurafenib could also promote growth of non‐cutaneous secondary malignancies by a similar mechanism. We present a case of an individual who received vemurafenib for metastatic melanoma and experienced rapid growth of a pre‐existing KRAS‐mutant pancreatic adenocarcinoma.     

The association between polypharmacy and late life deficits in cognitive,physical and emotional capability: a cohort study

International Journal of Clinical Pharmacy - Background Polypharmacy is a growing health concern for older adults and is associated with poorer clinical outcome. Objective This study aim is to...     

Leishmania infantum DNA detection in Phlebotomus tobbi in a new northern focus of visceral leishmaniasis in Iran

Objective

To identify the vector(s), the parasite and the species composition of sand flies in the district during May-October 2012.

Methods

For reaching our objectives we used polymerase chain reaction of kDNA, ITS1-rDNA, followed by restriction fragment length polymorphism.

Results

Two species of Phlebotomus sergenti and Phlebotomus tobbi were the most prevalent among 8 species identified comprising 51.1% and 32.9% respectively. Among the 160 specimens of female sand flies tested by polymerase chain reaction of kDNA, ITS1-rDNA, followed by restriction fragment length polymorphisms, only 1 out of 80 Phlebotomus tobbi (1.25%) were positive to Leishmania infantum parasites.

Conclusions

Our finding showed that Phlebotomus tobbi may play as a vector to circulate the parasite of Leishmania infantum among reservoir(s) and human.     

Neuropsychological Characteristics of the Dementia Syndrome of Depression: Onset,Resolution, and Three-Year Follow-Up

In this prospective double-blind study 13 hospitalized older adults with dementia syndrome of depression (DSD) were compared to 14 with Alzheimer's dementia with a concurrent major depression on a battery of neuropsychological tests. On admission to hospital (onset), patients with DSD differed from those with Alzheimer's dementia and depression only in that the former had stronger short-term verbal memory. Resolution of depression in patients with DSD resulted in a return to normal levels in most measures of verbal functioning, but nonverbal abilities remained impaired. Three years later those with DSD continued to cognitively outperform those with Alzheimer's dementia, indicating that treating depression in DSD appears to “buy back” up to 3 years of above-baseline cognitive functioning.     

A safety analysis of oral prednisone as a pretreatment for rituximab in rheumatoid arthritis

The administration of 100?mg of methylprednisolone intravenously (IV) 1/2?h prior to rituximab decreases the incidence of acute infusion reactions (AIRs). However, this pretreatment adds considerable time and conveys potential risk. We performed an open-label prospective assessment of oral prednisone as a pretreatment to rituximab. This was a 26-week open-label trial of 40?mg of oral prednisone given 1/2?h prior to rituximab as a prophylaxis against AIRs in patients with rheumatoid arthritis (RA). The primary endpoint was AIRs in the first 24?h after their initial infusion. Secondary endpoints include AIRs during the 24?h following their second infusion and any adverse events experienced during the 26-week study; efficacy measures were also followed as secondary endpoints. Sixty-four subjects were screened, and 50 subjects qualified. Fourteen out of the 50 (28?%) subjects had AIRs within 24?h of their first infusion. There were four AIRs (8.3?%) within 24?h of their second infusion. One of day?0 AIRs required drug discontinuation (wheezing/bronchospasm). Forty out of 50 (80?%) subjects experienced an adverse event during the 26?weeks. There were three SAEs deemed not to be study-drug related. The DAS28 and HAQ-DI all improved significantly at weeks?8, 16, and 26 compared to baseline. Historical controls demonstrate that 27?% of RA subjects experience AIRs with their first rituximab infusion. Our data suggest a smaller dose of oral prednisone is an effective alternative to IV methylprednisolone as a pretreatment for rituximab in patients with RA.     

The role of atypical pathogens in community-acquired pneumonia

The term atypical pneumonia was first used in 1938, and by the 1970s it was widely used to refer to pneumonia due to Mycoplasma pneumoniae, Legionella pneumophila (or other Legionella species), and Chlamydophila pneumoniae. However, in the purest sense all pneumonias other than the classic bacterial pneumonias are atypical. Currently many favor abolition of the term atypical pneumonia.This review categorizes atypical pneumonia pathogens as conventional ones; viral agents and emerging atypical pneumonia pathogens. We emphasize viral pneumonia because with the increasing availability of multiplex polymerase chain reaction we can identify the agent(s) responsible for viral pneumonia. By using a sensitive assay for procalcitonin one can distinguish between viral and bacterial pneumonia. This allows pneumonia to be categorized as bacterial or viral at the time of admission to hospital or at discharge from the emergency department and soon thereafter further classified as to the etiology, which should be stated as definite or probable.