Bilateral angle-closure glaucoma induced by trimetoprim and sulfamethoxazole combination: case report

Sulfamethoxazole-trimethoprim (cotrimoxazole) is an antibiotic combination widely used for infections treatment and prophylaxis. These and others sulfonamides have been implicated in a rare syndrome of choroidal effusion with transient myopia and angle-closure glaucoma. Previous cases reported in literature evolved to complete resolution after drug withdrawal. In contrast, we describe a rare case in which a patient developed the syndrome while taking cotrimoxazole, but did not recover visual acuity. A 49-year-old man started Pneumocystis carini prophylaxis with cotrimoxazole; four days later, the patient presented severe ocular pain, hyperemia and chemosis. Intraocular pressure reached more than 50 mmHg in both eyes a 360 degrees choroidal effusion occurred. Medication was removed soon after the diagnosis was suspected and intraocular pressure decreased in four days. Even so total cataract and phthisis bulbi occurred in both eyes two months later. This would be the first case in the literature in which the outcome was unfavorable despite early diagnosis and withdrawal of the drug.     

Prevalence of morphometric vertebral fractures in old men and the agreement between different methods in the city of Recife,Brazil

Osteoporosis is relatively common in men and has a great impact on quality of life. Despite the importance of the subject, there are few studies regarding the prevalence of morphometric vertebral fractures in men and the associated risk factors. To determine the prevalence of morphometric vertebral fractures in elderly men by three different methods and the agreement between them, 234 asymptomatic men aged >60 years (mean age 69.4 ± 6.5 years) were evaluated using lateral thoracolumbar radiograph that were analyzed by two experienced radiologists according to semiquantitative (SQ) Genant and algorithm-based qualitative (ABQ) Jiang methods. A third senior radiologist adjudicated Genant’s method. The highest prevalence of fractures in ABQ Jiang and SQ Genant methods were 37.6 and 36.8 %, respectively (both examiner 2). The lowest prevalence rates were 26.5 % in ABQ Jiang method and 5.6 % in SQ Genant (both examiner 1). The prevalence found by the Genant adjudicated was 31.6 %. The agreement between the examiners were 69.2 % in ABQ Jiang method (κ 0.30; 95 % CI 0.17–0.43) and 65.5 % in SQ Genant (κ 0.09; 95 % CI 0.01–0.17). We evaluated skin phototype, waist circumference, hypertension, body mass index (BMI), history of fracture, calcium intake, serum 25 OHD and sun index. After multivariate regression analysis, we found that lower BMI (prevalence ratio = 1.41; p = 0.024; 95 % CI 1.05–2.03) and sun index (prevalence ratio = 1.45; p = 0.049; 95 % CI 1.01–1.95) were independently associated with morphometric vertebral fractures.     

Synthesis of 3H, 13C,2H3,15N and 14C‐labelled SCH 466036, a histamine 3 receptor antagonist

The synthesis of [³H]SCH 466036, [Me‐³H₃]SCH 466036, [¹³C,²H₃,¹⁵N]SCH 466036 and [¹⁴C]SCH 466036 is described. [³H]SCH 466036 was prepared in two steps via Raney Ni‐catalysed exchange with tritiated water. [Me‐³H₃]SCH 466036 was prepared in a single step from [³H]methyl iodide in 45% yield. [¹³C,²H₃,¹⁵N]SCH 466036 was prepared in two steps from [¹⁵N]hydroxylamine and [¹³C,²H₃]methyl iodide with an overall yield of 16%. [¹⁴C]SCH 466036 was prepared in seven steps from [¹⁴C]potassium cyanide in an overall yield of 13%.