Immunosuppression in liver transplantation: renoprotective regimens

Both acute and chronic renal insufficiency are highly prevalent in liver transplant recipients. The etiology is multifactorial, with administration of nephrotoxic drugs playing a major role. Calcineurin inhibitors (CNI) (cyclosporin and tacrolimus) are the mainstay of immunosuppressive therapy in liver transplantation and produce acute and chronic nephrotoxicity. There are three main strategies to prevent renal injury: a) reduction of CNI to minimal levels accompanied by the use of an adjuvant drug such as azathioprine, mycophenolate mofetil or mammalian target of rapamycin (mTOR) inhibitors; b) complete withdrawal of CNI, using non-nephrotoxic drugs in their place; and c) use of protocols without CNI from the outset. The present article reviews these three strategies as well as their influence on renal function and on the results of liver transplantation.     

Changes in phenolic antioxidants during chuño production (traditional Andean freeze and sun-dried potato)

Total antioxidant capacity (TAC), total phenolic compounds (TPH), total flavonoids (TF) and the amounts of individual phenolic compounds were assessed in Bolivian potato cultivars (various Solanum species) before, during and after the traditional freezing and sun-drying of potatoes known as chuños. The TAC of chuños ranged from 0.4 to 2.7 μmol Trolox equivalents/g dry matter using 2,2′-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid) (ABTS) and from 0.7 to 3.0 according to the ferric reduction antioxidant power (FRAP). The values of TAC obtained using FRAP were about 70% lower after freeze-drying while they remained essentially constant when measured using ABTS. High-performance liquid chromatography showed the presence of epicatechin, chlorogenic acid, gallic acid, syringaldehyde and protocatechuic acid in both potato and chuño samples although the values were lower in the chuño samples. The results suggest that the antioxidant capacity and the content of individual phenolics are somewhat decreased but far from eliminated during the process. Chuño can therefore still be considered an important source of antioxidants in the diet.     

Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report

Context: Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury. The aim of this case report was to study the immediate, short-term effects of dry needling treatment (10 weeks) on spasticity, dynamic stability, walking velocity, self-independence, and pain in a single patient with an incomplete spinal cord injury.

Findings: The dry needling treatment resulted in immediate, short-time effects on basal spasticity in the upper (reduction from 2 to 0 point median) and lower (reduction from 2 to 0 point median) limbs, as measured by the modified Ashworth Scale. Dynamic-stability, assessed by trunk accelerometry, improved more than 50% (Root Mean Squared of acceleration, Root Mean Squared of Jerk and step variability), and gait speed improved by 24.7?s (i.e. time to walk 20?m). Self-independence and pain were respectively scored by the Spinal Cord Independence Measure (21 points improvement) and visual analog scale (4 points improvement).

Conclusions: This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury.     

Pemphigus-like eruption as a complication of molluscum contagiosum treatment with imiquimod in a 5-year-old girl

Pemphigus and pemphigus-like reactions can be triggered by a variety of medications including topical therapies, such as imiquimod. While the association between imiquimod and pemphigus-like reactions has been reported in adults, this is the first report of a generalized reaction beyond the site of imiquimod application in a child. The mechanism by which this occurs may be through a unique pathway, separate from the classic antibody-mediated pathway. Our patient had a full recovery without recurrence after cessation of the inciting drug.