Renal angiomyolipoma; polycystic kidney, and renal cell carcinoma in patient with tuberous sclerosis.

A patient with tuberous sclerosis presented with renal failure secondary to bilateral angiomyolipoma. The angiomyolipoma was associated with polycystic disease and a foci of renal cell carcinoma. This unusual combination has not been reported previously, although each entity has been described separately in tuberous sclerosis.     

Coccidioidomycosis and renal transplantation.

Two cases of coccidioidomycosis detected in a group of more than 750 renal transplants are presented. The first patient died from unsuspected disseminated coccidioidomycosis 4 1/2 years after primary transplantation and 6 days after retransplantation. In the second patient pulmonary coccidioidomycosis was recognized and treated by lobectomy and amphotericin B before transplantation; subsequent transplantation has provided good renal function without recurrence of infection for 5 years. Experience with six other reported cases of coccidioidomycosis illustrates the high risk of exacerbation and dissemination of preexisting coccidioidal infection in immuno-suppressed transplanted recipients. Nevertheless, this risk can be made acceptable if active coccidioidomycosis is treated vigorously before immunosuppression is started and if the possibility of exacerbation of infection after transplantation is carefully monitored.     

Clinical echinococcosis.

In 221 patients (0.48% of hospital admissions) with hydatid disease (122 female and 99 males), 81% had single and 19% multiple organs involved. Lungs, liver and spleen as single sites of echinococcosis together represented 83.24% of cases and the liver alone represented 95.24% of instances with multiple organ involvement. One hundred seventy-nine single and 74 multiple cysts (ratio of 2.42/1) represented a total of 363 cysts (1.64 cysts/patient). The incidence of intact cysts was 51.52% and 48.48% had ruptured. Ruptures numbered highest in the lungs (73.44%) and greater in multiple (79.66%) than in single cysts (68.12%). In the liver, 27.14% of single and 54.55% of multiple cysts (40.44% of all liver cysts) had ruptured. Cysts varied in size from 0.8 to 35 cm diameter. Single cysts averaged significantly higher (14.16 cm) and multiple ones lower (5.71 cm) as did intact (6.75 cm) versus reptured cysts (4.33 cm). Except for 10 silent and 15 symptomatic cysts treated medically, all the rest were treated surgically by removal of the endocyst or resection of both endo and exocysts including 205 first, 31 second and 5 third procedures (1.75% of all major operations). Complications occurred in 28.57%. Surgical mortality (3.57%) was markedly lower than with conservative treatment (60%) and significantly less than that of the whole group (14.48%).     

Drugs, Parkinson's disease and parkinsonian syndroms: recent advances in pharmacovigilance

This paper reviews recent data on the pharmacovigilance of antiparkinsonian drugs and drugs inducing parkinsonian syndroms. Sudden sleep attacks were first described in 1999 with dopamine agonists. In fact, they can be induced by all the dopaminergic antiparkinsonian drugs. Favorising factors are duration of the disease, dose of dopaminergic drugs, daytime somnolence or dysautonomia. This adverse drug reaction can be serious leading, for example, to road accidents. Cardiac valvulopathies were more recently (end of 2002) described with pergolide. Thus, this dopamine agonist should now be prescribed as a last choice among dopamine agonists. Dopamine drugs (levodopa as well as dopamine agonists) can induce hypersexual behaviours or pathological gambling. Among the long list of drugs inducing parkinsonian syndroms, recent data suggest the involvement of serotoninergic antidepressants, valproic acid and trimetazidine. Finally, these data on pharmacovigilance allow to precise the physiological role of dopamine: beside its motor and psychic effects, dopamine is also involved in the sleep-arousal control. It is also an important mediator for pleasure, hedonic regulations and sexual behaviour. This review also underlines the major role of spontaneous reports to the pharmacovigilance systems to identify new adverse drug reactions.     

Increased furin activity enhances the malignant phenotype of human head and neck cancer cells

Many proteins are synthesized as inactive proforms requiring a proteolytic processing to render them active. A variety of proteases catalyze these cleavage reactions. Proprotein convertases are a family of serine proteases capable of activating substrates that will subsequently intervene in extracellular matrix (ECM) degradation, cell growth, differentiation and viral pathogenesis. Furin, the prototype of this family, has been implicated in many physiological and pathological processes. Some of its substrates such as TGF-beta, MT-MMP's, and IGFR-1 have been identified. Overexpression of furin has been observed in several human tumors. In this report we demonstrate that overexpression of furin causes a significant increase in the invasive potential of human tumor cells of low and moderate aggressive potential in vitro and in vivo. SCC12 and SCC15 were transfected with furin cDNA, resulting in efficient processing of furin substrates. An in vivo invasion assay showed enhancement of invasive ability. Inhibition of furin activity with the synthetic inhibitor decanoyl-Arg-Val-Lys-Arg-chloromethyl-ketone, CMK, showed a significant decrease in both processing and in vitro invasiveness. A moderate enhancement in proliferation rate was observed when cells were transfected with furin. CMK treatment resulted in a marked reduction of this effect. Tumors obtained after subcutaneous (s.c.) inoculation of furin-overexpressing cells were larger and developed earlier than the controls. Furin overexpression caused an imbalance in the activation of invasion and proliferation-related substrates leading to the acquisition of an advanced malignant phenotype. In addition, inhibition of furin activity decreases substrate activation, proliferation rate, and invasive potential of cancer cells, suggesting that furin is a potentially useful target for therapeutics.     

Acamprosate (Aotal): could adverse effects upset the treatment of alcohol dependence?

Acamprosate, a stimulant of central inhibitory GABA neurotransmision and an antagonist of excitatory amino acids, is used in alcohol withdrawal and for the maintenance of abstinence. After identification of several cases of treatment discontinuation during alcohol abstinence because of acamprosate-induced adverse drug reactions (ADRs), a retrospective study was conducted in order to investigate and quantify acamprosate-induced ADRs. Up to July 2002, 472 patients were included for treatment of alcohol withdrawal: of these, 68% (n = 322) received acamprosate. At least one ADR occurred in 98 patients (30%). The mean age of the patients was 41.5 +/- 8.8 years (range: 24-65) and 70% were male. All ADRs were classified as 'non serious'. However, ADRs required a dose decrease in 61 cases or acamprosate discontinuation in 76 cases (62.2% and 77.5%, respectively, of patients with an ADR). We identified mainly gastrointestinal ADRs in 67 patients (mean delay before occurrence: 7.6 days), i.e. 20.8% of patients treated with acamprosate (corresponding to 68.3% of ADRs), with a positive rechallenge in five cases. Moreover, cutaneous ADRs (pruritus) occurred in 29 patients (mean delay before occurrence: 9.0 days), and required acamprosate withdrawal in 22 patients (75.9%) with a prior dose decrease in 18 of these patients (62.1%). Our results show that a dose decrease or withdrawal of acamprosate was necessary in 18.9% and 23.6%, respectively, of patients because of the occurrence of ADRs. The present study shows the important role of acamprosate-induced ADRs among the various causes for failure of alcohol abstinence.     

Two SARS-CoV-2 IgG immunoassays comparison and time-course profile of antibodies response

Introduction: The persistence of circulating antibodies to SARS-CoV-2 infection is not yet well known. We compare the results of 2 automated systems for the determination of IgG against SARS CoV-2 and assess the time-course of the IgG response. Methods: IgG were measured in 103 specimens of 55 patients with COVID-19 (time from the symptoms’ onset: 3–187 days) using the automated tests "Abbott SARS-COV-2 IgG" and "MAGLUMI 2019-nCoV IgG". Results: The 2 methods had a concordance of 90.3%, but the quantitative correlation, although significant, showed dispersed results. All the specimens resulted positive after 17 days. However, the median concentrations of IgG rapidly increased up to 20 days and decreased for Maglumi IgG while Abbott IgG showed a constant trend up to 85 days, and then slowly declined. Conclusions: The titer of IgG against SARS-CoV-2 may significantly and rapidly decrease, but with a very different time-course depending on the method used for the determination.     

Diagnosing Postpartum Hemorrhage: A New Way to Assess Blood Loss in a Low-Resource Setting

Introduction Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The largest barriers to treating PPH are symptom recognition and timely diagnosis. The SAPHE (Signaling a Postpartum Hemorrhage Emergency) Mat was constructed so that each square on the Mat absorbs up to 50 mL of blood. The objective of this study was to evaluate the correlation of visually estimated blood loss (EBL) using the SAPHE Mat with actual blood loss. Methods Thirty-six patients gave birth via vaginal delivery using the SAPHE Mat. Visual estimation of blood loss using the SAPHE Mat was calculated by multiplying the number of blood- saturated squares or partial squares by 50 mL. The visual EBL was compared with the actual blood loss calculated based on Mat weight before and after use (volume blood loss). Results Visual blood loss estimations were within 100 mL of the volume blood loss 69 % of the time and within 200 mL 97 % of the time. The mean difference between the visual EBL and volume blood loss (Mat weight change) was 80.91 mL. The Pearson correlation coefficient for visual EBL and volume blood loss was positive at 0.96 (p < 0.001). Discussion The SAPHE Mat is able to provide a visual estimate of blood loss that is highly correlated with the actual blood loss on the mat. Future studies will assess the ability to deploy the SAPHE Mat in low-resource settings as a potential guide for estimating blood loss to assist in improved management of PPH.