Role of tumor necrosis factor inhibitor in granulomatous interstitial nephritis secondary to Crohn’s disease

A 17-year-old male with attention deficit hyperactivity disorder was admitted to the hospital with generalized weakness. Vital signs and physical examination were normal. Laboratory data were notable for a creatinine of 4.5 mg/dL (baseline 0.6 mg/dL), estimated glomerular filtration rate of 18 ml/min/1.73 m² and hemoglobin 10 g/dL. Urinalysis revealed only 30 mg/dL protein. Serology for autoimmune workup was negative. Renal ultrasound was normal. Kidney biopsy showed noncaseating granulomas and acute on chronic tubulointerstitial nephritis (TIN) with lymphocytes, macrophages, plasma cells and no eosinophils. Acid fast bacilli and Grocott’s methenamine silver stains were negative. Granulomatous interstitial nephritis (GIN) was diagnosed. Prednisone at 60 mg/day was started and tapered. He was then noted to have diarrhea. Colonoscopy showed active enteritis with granulomatous inflammation consistent with Crohn’s disease (CD). Azathioprine was started but due to worsening renal function and diarrhea, it was discontinued. He did not tolerate continued higher doses of prednisone because of mood swings and cushingoid features. Infliximab was initiated with improvement in renal function. There was rapid worsening of renal function when infliximab therapy was interrupted but improved when both prednisone and inflixamb were reinitiated.     

Chronic meningitis in systemic lupus erythematosus: An unusual etiology

Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus (SLE). Apart from immunological causes and drugs, the aseptic meningitis group can include some unidentified viral infections that cannot be detected by routine microbiological testing. It is imperative to do complete cerebrospinal fluid (CSF) workup before implicating the symptoms to disease activity or drugs, as untreated infections cause significant mortality in SLE. We present a case of young female with SLE who presented with chronic meningitis of an uncommon etiology.     

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

Background:

Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.

Materials and Methods:

We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.

Results:

There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.

Conclusion:

The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.     

Diarrhoea-related hospitalizations in children before and after implementation of monovalent rotavirus vaccination in Mexico

Objective

To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico.

Methods

Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea – per 10 000 hospitalizations for any cause – were calculated. Administrative data were used to estimate vaccine coverage.

Findings

In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine – among children younger than 5 years – had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea – per 10 000 admissions – fell from 1001, 834 and 1033 in the “prevaccine” period of 2003–2006, to 597, 497 and 705 in the “postvaccine” period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38–43), 41% (95% CI: 38–43) and 32% (95% CI: 29–34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16 500 hospitalizations for childhood diarrhoea in each year of the postvaccine period.

Conclusion

Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico.     

Interaction between rosuvastatin and rocuronium in rat sciatic-gastrocnemius nerve-muscle preparation

Purpose

Long-term use of rosuvastatin may be associated with myotoxicity. Statins are one of the groups commonly found to be associated with neuromuscular weakness. The present study was designed to investigate the interaction between rosuvastatin and rocuronium in vivo by using a sciatic-gastrocnemius nerve-muscle preparation of rat.

Methods

In our study groups, animals received rosuvastatin 2 mg/kg for 14 and 28 days. Train of four (TOF) stimulation was applied to the sciatic nerve, and gastrocnemius muscle contractions were recorded in Wistar albino rats. Intravenous infusion of rocuronium was given until the twitch responses were abolished. We ultimately compared the effective dose required for a desired effect in 95% of the population (ED₉₅), duration 25 %, deep block, recovery index, and time for returning of TOF ratio to 0.9 between the active control and study groups.

Results

Chronic administration of rosuvastatin at a dose of 2 mg/kg for 28 days significantly reduced the ED₉₅ of rocuronium as compared to the active control group. Deep block and duration 25 % were increased by 3.5 and 2.5 times, respectively, compared to the active control group. The spontaneous recovery of neuromuscular block was delayed, as evidenced by the prolonged recovery index and increase in time required for a return of the TOF ratio to 0.9.

Conclusion

The neuromuscular blocking potency of rocuronium is increased and recovery is delayed in rats that pre-treated with rosuvastatin.