Psoriasiform drug eruption associated with metformin hydrochloride: a case report

An 18 year-old-woman presented with a 1-week history of a psoriasiform eruption on her limbs and trunk that began 1 week after starting metformin hydrochloride. She had taken no other medications. She had no personal or family history of psoriasis. The lesions disappeared within 5 weeks after discontinuation of the drug. In the 4 months following the cessation of metformin hydrochloride, no relapse was observed, but rechallenge with oral metformin again produced the eruption. Metformin hydrochloride should be added to the list of drugs that can cause a psoriasiform eruption.     

Current and future microbicide approaches aimed at preventing HIV infection in women

Women from developing countries, in which the prevalence of HIV infection is very high, are at risk of becoming infected without having the possibility of personally controlling this risk. Therefore, there is an urgent need to develop anti-HIV vaginal microbicide strategies. This review considers the modes of entry of HIV through the mucosa of the female genital tract, the different classes of vaginal microbicide compounds, the mode of delivery of these drugs, the aims and methods of in vitro and animal experiments at the preclinical stage, the results of the Phase III trials conducted in different countries, including the ongoing assays, and the future orientations for the next 5 years with a discussion relative to antiviral resistance, combination strategies and development of new-generation compounds.     

Therapeutic apheresis for severe hypertriglyceridemia in pregnancy

Introduction

During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain <300 mg/dl. In women with genetic forms of hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy.

Materials and methods

We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used.

Result and conclusion

When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.     

Long-term health implications for children conceived by IVF/ICSI

Radical trachelectomy is an operation developed as an alternative to radical hysterectomy for patients with small-volume, early stage cervical cancer, who wish to retain their fertility. The body of the uterus is left in place, so that future pregnancies can occur. Patients who have undergone radical trachelectomy may face problems conceiving naturally and may request assisted conception. This article explains the operation and the difficulties that those working in reproductive medicine may face.     

Turkish dermatologists' approach for chronic spontaneous urticaria: A questionnaire based study

Background/Objectives

Chronic spontaneous urticaria (CSU) is a common skin disorder which represents a challenge both for the patients and physicians. Guidelines and treatment algorithms have been created to help physicians to ease management. Our aim was to determine Turkish dermatologists' approach to CSU with regard to treatment, search for causative factors and use of instruments to assess the quality of life and severity of the disease.

Hair tourniquet syndrome of toes and fingers in infants

ObjectiveHair tourniquet syndrome is an uncommon condition characterized by strangulation appendages by a hair or thread. The aim of this study was to evaluate the results of hair removal and antibiotic therapy in our patients with hair tourniquet syndrome.MethodsBetween January 2012 and August 2018, 16 patients (8 boys, 8 girls; mean age: 118.5 [range: 20 to 380] days) were treated surgically for hair tourniquet syndrome. All patients were treated surgically under local or general anesthesia in the pediatric emergency department or in the operating theater using magnifying loupes. The age, gender, affected fingers or toes and the affected sides of the patients and the duration of symptoms until presentation were recorded.ResultsA total of 24 toes and fingers were treated for hair tourniquet syndrome. The right side was affected in 12 patients, the left side was affected in three, and both sides in one. The second toe was affected in three patients, the third toe in eleven, the fourth in six, and the fifth in two patients. Both the thumb and the second finger were affected in one patient. The average duration of the symptoms (excessive crying, swelling, redness) was 1.5 (range: 1 to 2) days. All patients healed without any complications.ConclusionHair tourniquet syndrome should be kept in mind as an etiology in infants with toe and finger strangulation. These patients should be examined undressed. Immediate removal of hair is an effective treatment method to save appendage.Level of evidenceLevel IV, Therapeutic Study     

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study

PurposeDiffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphomas. The incidence of DLBCL increases with age and has a fairly rapid fatal course without treatment. Patients often have difficulty tolerating standard chemotherapy regimens due to their comorbidities. Charlson Comorbidity Index (CCI), which is calculated by considering 19 different comorbidities, was developed in 1987 and is widely used for mortality prediction in cancer patients. Literature data on CCI and hematological malignancies are limited. Main aim in this study is to evaluate the effectiveness of CCI and compare to the International Prognostic Index (IPI) scoring system in the DLBCL patient group.MethodsA total of 170 patients diagnosed with DLBCL between 1.1.2002- 1.12.2020 were included in the study. Statistical analyzes were performed among patients whose IPI and CCI scores were recorded by considering baseline data.ResultsThe median age of patients was 58 (range: 17–84). Thirty-five (20.6%) patients had stage III and 76 (44.7%) had stage IV disease. When the CCI, IPI and ECOG scores were compared with the mortality status of the patients as a reference, AUCs were resulted as 0.628 (95% CI: 0.506–0.749), 0.563 (95% CI: 0.484–0.639) and 0.672 (95% CI: 0.596–0.743), respectively. There was no significant difference between the ROC curves of CCI, IPI and ECOG scores. Patients with a CCI score of ≥ 4 had shorter OS comperad to those with a score of < 4.ConclusionRather than claiming that CCI is superior to IPI, ECOG or another scoring system in a single-center patient population, it should be stated that CCI is also an effective scoring system in patients diagnosed with DLBCL.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12288-022-01567-5.     

Diagnostic significance of plasma osteopontin in hepatitis C virus-related hepatocellular carcinoma

Background and aim: Outcome of hepatocellular carcinoma (HCC) depends mainly on its early diagnosis. The performance of traditional biomarkers is not satisfactory. Osteopontin (OPN) is of potential importance. This study aim to assess the diagnostic value of plasma OPN compared with alpha-fetoprotein (AFP) for the diagnosis of HCV- related HCC.Methods: We recruited 113 HCC patients compared with 120 matched cirrhotic patients and 120 Controls. The plasma level of OPN and serum AFP for all participants were assessed.Results: The median plasma OPN level was significantly higher in the HCC group than in the cirrhotic patient group or in the normal control group (p-value < 0.001), while OPN levels were not differed significantly in correlation with the degree of liver function deterioration in terms of advanced Child-Pugh class (p-value < 0.9). The diagnostic efficacy of OPN were superior to AFP in terms of AUC, sensitivity, specificity, PPV and NPV either in diagnosis of early or late stages of HCC (0.88 vs. 0.56; P = 0.0001, 0.991 vs. 0.899; p = 0.01; respectively).Conclusion: Plasma OPN level is a potential diagnostic marker for HCC, especially among high-risk group of patients. These values extend beyond the traditional tumor biomarkers as AFP, as it possesses good prognostic value.     

In vitro activities of candidate microbicides against cell-associated HIV

Most research on HIV transmission and microbicides focuses on the inhibition of cell-free virus (CFV) present in genital secretions. However, an effective microbicide should also block the transmission of cell-associated virus (CAV) originating from seminal T cells and macrophages. Because inhibition of CAV remains controversial, especially for viral entry inhibitors, we developed a novel in vitro assay to evaluate the activities of different classes of candidate microbicides against cell-free HIV and HIV-infected leukocytes (i.e., resting peripheral blood mononuclear cells [PBMC], activated PBMC, and monocyte-derived macrophages). The assay is based on two CD4(+) CXCR4(+) T-cell lines (R5MaRBLE and X4MaRBLE) that both contain a firefly luciferase reporter gene but differ in the expression of the CCR5 coreceptor. Consequently, the quantification of the luciferase activities and the Gag p24 concentrations in cocultures of R5-tropic HIV-infected leukocytes with each cell line separately allowed us to discriminate between the infection of the cell lines (i.e., target cells), the ongoing infection in the HIV-infected leukocytes (i.e., effector cells), and the total infection of the coculture (i.e., effector plus target cells). All 14 antiretrovirals tested were able to block target cell infection by all three sources of CAV, although a small decrease in activity (2- to 18-fold) was observed for all entry inhibitors. On the other hand, the production of Gag p24 by the infected effector cells could be blocked only by protease inhibitors. Overall, these results show that entry and protease inhibitors are eligible drug classes for inclusion in future combination microbicides.