Prolonged cholestasis after raloxifene and fenofibrate interaction： A case report

Assigning causality in drug-induced liver injury is challenging particularly when more than one drug could be responsible. We report a woman on long-term therapy with raloxifen who developed acute cholestasis shortly after starting fenofibrate. The picture evolved into chronic cholestasis. We hypothesized that an interaction at the metabolic level could have triggered the presentation of hepatotoxicity after a very short time of exposure to fenofibrate in this patient. The findings of an overexpression of vascular endothelial growth factor in the liver biopsy suggest that angiogenesis might play a role in the persistance of toxic cholestasis.     

Development of working memory maintenance

The neural circuitry supporting mature visual spatial working memory (VSWM) has been well delineated in nonhuman primates and in human adults. However, we still have limited understanding about developmental change through adolescence in this network. We present results from a fast event-related functional MRI (fMRI) study aimed at characterizing developmental changes in brain mechanisms supporting VSWM across different delay periods. Forty-three healthy subjects (17 adults, 18-30 yr; 13 adolescents, 13-17 yr; 13 children, 8-12 yr) were scanned as they performed an oculomotor delayed response (ODR) task with short (2.5 s) and long (10 s) delay period trials. Results showed that all age groups recruited a common network of regions to support both delay trials, including frontal, parietal, and temporal regions, indicative of a core circuitry needed to perform the task. Several age-related differences were found in the recruitment of regions, supporting short delay trials, including fronto-caudal areas, which could contribute to known differences in initial memory-guided saccade precision. To support extended delay trials, adults primarily recruited additional posterior parietal cortex (PPC), whereas children and adolescents recruited a considerably more extensive distributed circuitry. Our findings indicate that brain processes supporting basic aspects of working memory across cortex are established by childhood. We also find evidence for continued immaturities in systems supporting working memory precision, reflected by differences in the circuitry recruited by children and by continued refinement of fronto-insular-temporal regions recruited by adolescents. Taken together, these results suggest distinct developmental changes in the circuitry supporting visual spatial working memory.     

Prevalencia de infecciones de piel y tejidos blandos producidas por Staphylococcus aureus resistente a Meticilina Comunitario en Madrid

Introduction

Since it was first described in the 1990s, Methicillin-Resistant Staphylococcus aureus infection among people with no contact with a hospital setting or with no traditional risk factors, has spread worldwide and is now an important epidemiological and public health problem.

Methods

The present prospective and observational study was carried out from April to November 2010. All adult patients with community-acquired suppurative skin and soft tissue infection (SSTI) attending the Emergency Department were enrolled. Clinical, microbiological and epidemiological features of the infection were assessed.

Results

A total of 59 samples were collected from 59 patients and CA-MRSA was isolated in 13 of them. Prevalence of CA-MRSA in patients with suppurative SSTI seen in the emergency department was 22.03%, and was 33.3% in patients with staphylococcal infection. Is worth noting the greater presence of necrosis detected in CA-MRSA lesions. Only 3 patients required hospital admission. Eleven of the 13 strains were Panton-Valentine leucocidin producers, and 5 were resistant to non-betalactam antibiotics. CA MRSA infection is still more frequent in the immigrant population.

Conclusion

Data on CA-MRSA prevalence in Spain are sparse. This study aims to emphasise the current importance of this emergent pathogen in our area. About one third of suppurative staphylococcal SSTI presenting in our emergency department are caused by this agent, confirming a rapid spread in our country. Some clinical features, such as the high presence of necrosis, are closely related to CA-MRSA.     

Bronquiolitis folicular asociada a inmunodeficiencia común variable

Common variable immunodeficiency is one of the most frequent immunity alterations. The most common clinical presentation occurs with recurrent respiratory infections, from pneumonia to otitis, and may be associated with other diseases such as bronchiectasis or interstitial lung diseases. We report the case of a 28-year-old patient with frequent respiratory infections and nodular pulmonary infiltrates, who was diagnosed with common variable immunodeficiency and follicular bronchiolitis. In some cases, follicular bronchiolitis is associated with immunodeficiencies and should be included in a differential diagnosis with lymphoid nodular hyperplasia, lymphocytic interstitial pneumonia and low-grade BALT lymphoma.     

Food omega-3 fatty acid intake of individuals (total, linolenic acid, long-chain) and their blood pressure: INTERMAP study

Findings from short-term randomized trials indicate that dietary supplements of omega-3 polyunsaturated fatty acids (PFA) lower blood pressure of hypertensive persons, but effect size in nonhypertensive individuals is small and nonsignificant. Data are lacking on food omega-3 PFA and blood pressure in general populations. The International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP) is an international cross-sectional epidemiologic study of 4680 men and women ages 40 to 59 from 17 population-based samples in China, Japan, United Kingdom, and United States. We report associations of food omega-3 PFA intake (total, linolenic acid, long-chain) of individuals with blood pressure. Systolic and diastolic blood pressure were measured 8 times at 4 visits. With several models to control for possible confounders (dietary, other), linear regression analyses showed inverse relationship of total omega-3 PFA from food (percent kilocalories, from four 24-hour dietary recalls) to systolic and diastolic blood pressures. With adjustment for 17 variables, estimated systolic blood pressure/diastolic blood pressure differences with 2 standard deviation higher (0.67% kcal) omega-3 PFA were -0.55/-0.57 mm Hg (Z-score -1.33, -2.00); for 2238 persons without medical or dietary intervention, -1.01/-0.98 mm Hg (Z -1.63, -2.25); for 2038 nonhypertensive persons from this sub-cohort, -0.91/-0.92 mm Hg (Z -1.80, -2.38). For linolenic acid (largely from vegetable foods), blood pressure differences were similar, eg, for the 2238 "nonintervened" individuals, -0.97/-0.87 mm Hg (Z -1.52, -1.95); blood pressure differences were -0.32/-0.45 mm Hg for long-chain omega-3 PFA (largely from fish). In summary, food omega-3 PFA intake related inversely to blood pressure, including in nonhypertensive persons, with small estimated effect size. Food omega-3 PFA may contribute to prevention and control of adverse blood pressure levels.     

Development and results of the Spanish registry of patients with alpha-1-antitrypsin deficiency

The Spanish registry of alpha-1 antitrypsin deficiency was founded in 1993 and became a member of the International Registry (AIR) in 1999. We describe the updating process following its incorporation into AIR and compare the data collected in the first period (1993–1999) and the second period (1999–2005), during which time patients were included exclusively by internet.The registry included 301 patients during period 1, 69% males and 46% had a history of smoking. Their mean age was 46 years (SD = 13) and 284 (94%) had the ZZ phenotype, 49% received augmentation therapy. During period 2, 161 new cases were included, 63% of whom were males with a mean age of 44 years (SD = 16). A total of 126 (78%) had the ZZ phenotype. Only 12% received augmentation therapy. A total of 462 different patients were included in both periods. Significant differences were observed in the number of cases with the SZ phenotype and the severity of FEV₁ impairment between the two periods.Implementation of an internet-based collection of data did not result in a lower rate of reporting to the registry. However, data from a significant number of patient included in period 1 could not be actualized in the new data base.     

No depletion of Wolbachia from Onchocerca volvulus after a short course of rifampin and/or azithromycin

Endosymbionic Wolbachia bacteria inside adult Onchocerca volvulus worms (causing river blindness) are necessary for female worm fertility. We evaluated whether rifampin and/or azithromycin used in a five-day course could kill Wolbachia. In an open-label trial in Guatemala, 73 patients with 134 palpable onchocercal nodules were randomized into four treatment groups: rifampin, azithromycin, a combination of the two drugs, and controls (multivitamins). After five days of antibiotic treatment, all participants received a single dose of ivermectin on day 6. Nine months after treatment, the nodules were removed and the worms were examined. Skin snips to determine microfilariae were obtained at baseline and nine months. There were no significant differences between any of the treatment groups in the condition of the worms in the nodules, the presence of Wolbachia surface protein, or the number of microfilariae in skin. Short courses with these antibiotics will not clear Wolbachia from O. volvulus.