Multiple myeloma presenting as acute tubulointerstitial nephritis and normal serum protein electrophoresis

Multiple myeloma is uncommon in individuals younger than 40 years. Renal involvement is common in this disease, but acute tubulointerstitial nephritis is very rare. In 20% of patients, only the light chain is produced and serum protein electrophoresis is normal; however, in urine protein electrophoresis of these patients, the M spike is present. We reported a case of multiple myeloma in a 39-year-old man with acute tubulointerstitial nephritis. Serum protein electrophoresis was normal and there was no bone lytic lesion. Remission of multiple myeloma was achieved after treatment with thalidomide and dexamethasone; however, kidney failure was not improved and the patient was maintained on hemodialysis.     

Procalcitonin biomarker kinetics fails to predict treatment response in perioperative abdominal infection with septic shock

Introduction

Procalcitonin (PCT) biomarker is suggested to tailor antibiotic therapy in the medical intensive care unit (ICU) but studies in perioperative medicine are scarce. The aim of this study was to determine whether PCT reported thresholds are associated with the initial treatment response in perioperative septic shock secondary to intra-abdominal infection.

Methods

This single ICU, observational study included patients with perioperative septic shocks secondary to intra-abdominal infection. Demographics, PCT at days 0, 1, 3, 5, treatment response and outcome were collected. Treatment failure included death related to the initial infection, second source control treatment or a new onset intra-abdominal infection. The primary endpoint was to assess whether PCT thresholds (0.5 ng/ml or a drop from the peak of at least 80%) predict the initial treatment response.

Results

We included 101 consecutive cases. Initial treatment failed in 36 patients with a subsequent mortality of 75%. Upon admission, PCT was doubled when treatment ultimately failed (21.7 ng/ml ± 38.7 vs. 41.7 ng/ml ± 75.7; P = 0.04). Although 95% of the patients in whom PCT dropped down below 0.5 ng/ml responded to treatment, 50% of the patients in whom PCT remained above 0.5 ng/ml also responded successfully to treatment. Moreover, despite a PCT drop of at least 80%, 40% of patients had treatment failure.

Conclusions

In perioperative intra-abdominal infections with shock, PCT decrease to 0.5 ng/ml lacked sensitivity to predict treatment response and its decrease of at least 80% from its peak failed to accurately predict treatment response. Studies in perioperative severe infections are needed before using PCT to tailor antibiotic use in this population.     

A 2-year study of neonatal mortality in a large Malaysian hospital

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.     

Temephos (Abate®) metabolism and toxicity in rats

In order to clarifyin vivo relationships between the mammalian metabolism and toxicity of temephos, an organophosphate insecticide, activities of acetylcholinesterase and hepatic mixed function oxidases (MFO) were evaluated in adult female Sprague-Dawley rats after acute and subchronic temephos exposures. After acute and the last subchronic exposure, animals were exsanguinated at 2, 4, 6, 8, 12, 24, 36 and 48 hr. Plasma was collected for temephos extraction and subsequent analysis by high performance liquid chromatography. Red blood cell acetylcholinesterase (RBC AChE) activity was assayed radiometrically immediately after blood collection. Hexobarbital sleeping times after temephos treatments were measured four hr after the acute (1 day) and last subchronic (5 days) exposures to assess MFO activity. After acute and subchronic exposures, temephos elimination was monoexponential with half-lives of 7 and 24 hr, respectively. After acute temephos exposure, RBC AChE was inhibited by 67% at 4 hr and 47% after 48 hr. After subchronic temephos exposures, RBC AChE inhibition was 100% throughout the 48-hr period with presence of cholinergic signs. Plasma temephos concentrations were inversely correlated with RBC AChE inhibition (r=–0.92). Duration of hexobarbital sleeping times increased significantly after acute and subchronic treatments with high temephos doses. Plasma temephos concentrations were directly correlated with hexobarbital sleeping times (r=0.87). The results indicate that temephos effects on MFO were similar to many other organophosphates. Increased plasma elimination half-lives indicated MFO saturation and partition of temephos into peripheral tissues at high doses. RBC AChE inhibition was consistent with other organophosphates that are metabolized to active metabolites. MFO saturation resulted in optimum metabolite production and maximum RBC AChE inhibition after subchronic exposures.     

Severe mitral regurgitation and heart failure due to caseous calcification of the mitral annulus

Caseous calcification is a rare form of mitral annular calcification. Echocardiography reveals an echodense mass in the inferior mitral annulus with smooth borders and an echolucent inner core. We present a case where caseous calcification of the mitral annulus caused severe mitral regurgitation, atrial fibrillation and heart failure. Transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance and computed tomography were performed and ensured the diagnosis. The mass was surgically removed and a prosthetic valve was implanted. We conclude that caseous calcification of the mitral annulus should be considered not only in the differential diagnosis of cardiac masses but also in the background of mitral regurgitation, atrial fibrillation and heart failure. This case also represents the usefulness of multimodal imaging in identifying cardiac masses.     

Mobile phone radiation interferes laboratory immunoenzymometric assays: Example chorionic gonadotropin assays

The radiofrequency radiation is of concern in hospital laboratories as the microwaves have many health effects even on immune functions. The aim of this study was, however, to evaluate the effects of cell phone radiation on chorionic gonadotropin immunoassays of human serum. Two cell phones with 0.69 and 1.09W/kg (head SAR) emitting 900MHz radiation were used. Sixty wells with five human serum concentrations (0, 10, 100, 250, 500mIU/mL) were used in three batches. The well heads in each batch were exposed to 900MHz emitted from these phones, and the 0.69, 1.09W/kg exposed batches were compared with the unexposed controls. Radiation exposure from mobile phones altered the measured serum levels especially in the wells with 100, 250, 500mIU/mL hormone concentrations. Exposure at 1.09W/kg SAR caused a significant loss compared to 0.69W/kg SAR exposure. In conclusion, the microwave exposures may require attention in laboratories using immunoassays.     

Passive opium smoking does not have beneficial effect on plasma lipids and cardiovascular indices in hypercholesterolemic rabbits with ischemic and non-ischemic hearts

Background

To scientifically test a traditionally belief of some Asian countries residents that opium may prevent or have ameliorating effects on cardiovascular diseases (CVD) we investigated the effect of passive opium smoking (POS) on plasma lipids and some cardiovascular parameters in hypercholesterolemic rabbits with ischemic and non-ischemic hearts.

Methods

40 rabbits were fed for 2 weeks with cholesterol-enriched diet and divided to control (CTL), short-term opium (SO) and long-term opium (LO) groups. SO and LO groups were exposed to POS for 3 days and 4 weeks respectively. ECG, blood pressure (BP) and left ventricular pressure recorded and serum lipid and cardiac troponin I levels were measured. Isoproterenol (ISO) injected for induction of cardiac ischemia and after 4 h the above variables were measured along with cardiac histopathology assessment.

Results

HDL cholesterol decreased significantly in LO compared to CTL group (35 ± 5 vs 53 ± 5 mg/dl). Groups treated with ISO showed significantly higher increments in troponin I level (P < 0.05) except for LO group and reduction of BP was higher in ISO and SO + ISO groups compared to CTL and SO groups respectively (−38 ± 6 vs −23 ± 4 and −37 ± 11 vs −11 ± 3 percent respectively, P < 0.05). Reduction in BP was significantly lower in LO + ISO compared to ISO group. Opium exposure caused a trend of increase in blood pressure, LDL cholesterol and ECG disturbances, attenuated ISO induced myonecrosis but augmented tissue congestion and hemorrhage.

Conclusion

POS can be considered as a CVD risk factor. Opium does not reduce BP or cholesterol level, as is anticipated by its users.