Trimethoprim-sulfamethoxazole-related hallucinations

Although adverse drug reactions are a well-recognized cause of mental status changes in the elderly, antimicrobials are not often implicated. Trimethoprim-sulfamethoxazole-induced hallucinations in immune-competent patient with switching to nitrofurantoin and risperidone, without associated polypharmacy, have not been reported in the literature. In this case report, we present an 86-year-old Caucasian immune-competent female with major depressive disorder and insomnia who developed hallucinations when treated with two trimethoprim-sulfamethoxazole tablets (80 mg/400 mg) in every 12 hours (4 tablets daily) because of lower urinary infection. After trimethoprim-sulfamethoxazole discontinuation and switching to nitrofurantoin and risperidone, symptoms significantly improved.     

Prediction of maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation by non-deterministic modelling.

AIMS: Atrial fibrillation (AF) is the most common rhythm disorder. Because of the high recurrence rate of AF after cardioversion and because of potential side effects of electrical cardioversion, it is clinically important to predict persistence of sinus rhythm after electrical cardioversion before it is attempted. The aim of our study was the development of a mathematical model by "genetic" programming (GP), a non-deterministic modelling technique, which would predict maintenance of sinus rhythm after electrical cardioversion of persistent AF. PATIENTS AND METHODS: Ninety-seven patients with persistent AF lasting more than 48h, undergoing the first attempt at transthoracic cardioversion were included in this prospective study. Persistence of AF before the cardioversion attempt, amiodarone treatment, left atrial dimension, mean, standard deviation and approximate entropy of ECG R-R intervals were collected. The data of 53 patients were randomly selected from the database and used for GP modelling; the other 44 data sets were used for model testing. RESULTS: In 23 patients sinus rhythm persisted at 3 months. In the other 21 patients sinus rhythm was not achieved or its duration was less than 3 months. The model developed by GP failed to predict maintenance of sinus rhythm at 3 months in one patient and in six patients falsely predicted maintenance of sinus rhythm. Positive and negative likelihood ratios of the model for testing data were 4.32 and 0.05, respectively. Using this model 15 of 21 (71.4%) cardioversions not resulting in sinus rhythm at 3 months would have been avoided, whereas 22 of 23 (95.6%) cardioversions resulting in sinus rhythm at 3 months would have been administered. CONCLUSION: This model developed by GP, including clinical data, ECG data from the time-domain and nonlinear dynamics can predict maintenance of sinus rhythm. Further research is needed to explore its utility in the present or an expanded form.     

Sex difference in the effect of ACE-DD genotype on the risk of premature myocardial infarction

In this association study the authors compared the insertion/deletion (I/D) angiotensin-I converting enzyme (ACE) gene polymorphism in females and males with premature myocardial infarction (MI). I/D ACE gene polymorphism was tested in 738 subjects: 302 patients with MI (151 men and 151 women) and 436 healthy subjects (207 men and 229 women). In women the ACE-DD genotype was not associated with MI (OR 1.1, 95% CI 0.6-2.1, p=0.6), whereas the ACE-DD genotype conferred a 2-fold independent risk for MI in men (95% CI=1.2-3.4; p=0.013) after adjustment for cardiovascular risk factors. The authors found evidence for the sex difference in the effect of the ACE-DD genotype on MI risk. The ACE-DD genotype conferred a 2-fold independent risk for premature MI in males.     

IL-4 polymorphisms,HRCT score and lung tissue markers in idiopathic pulmonary fibrosis

Aims

We studied the influence of IL-4 gene polymorphisms on the IPF phenotype, i.e., extent of radiological changes (HRCT interstitial (IS) and alveolar (AS) score) and histopathological markers from lung biopsies.

Patients and methods

46 IPF patients underwent genotyping, 43 of them had HRCT and 14 patients had a surgical lung biopsy. The HRCT scans were evaluated for AS and IS. The histopathological evaluation comprised myofibroblast foci (MF), intensity of inflammation and fibrosis (Ashcroft score) and numbers of eosinophils and granulomas. For immunohistochemical evaluation primary antibodies against PAR-2, CD124, TGF beta, YY-1 and TSLP were used. The IL-4 and IL-4 R alpha gene polymorphisms were characterized.

Results

We found a correlation between eosinophils in lung biopsies and AS. The Ashcroft score was higher in IL-4 HA 2 GCC and MF were more frequent in IL-4 HA 2 TCC carriers. A relationship was found between IL-4 (−1098) A2 T and PAR-2 expression and IL-4 (−590) A1 T, IL-4 HA1TTT and CD124 expression. AS was lower in IL-4 (−590) A1 C, in IL-4 HA1 TCC and in IL-4RA (+1902) A1 A carriers.

Conclusions

We suggest that the polymorphisms of IL-4 genes might influence the phenotype of IPF reflected by histopathological changes in lung biopsies and HRCT score.     

Compound 21 Induces Vasorelaxation via an Endothelium- and Angiotensin II Type 2 Receptor-Independent Mechanism

Angiotensin II type 2 (AT(2)) receptor stimulation has been linked to vasodilation. Yet, AT(2) receptor-independent hypertension and hypotension (or no effect on blood pressure) have been observed in vivo after application of the AT(2) receptor agonist compound 21 (C21). We, therefore, studied its effects in vitro, using preparations known to display AT(2) receptor-mediated responses. Hearts of Wistar rats, spontaneously hypertensive rats (SHRs), C57Bl/6 mice, and AT(2) receptor knockout mice were perfused according to Langendorff. Mesenteric and iliac arteries of these animals, as well as coronary microarteries from human donor hearts, were mounted in Mulvany myographs. In the coronary vascular bed of Wistar rats, C57Bl/6 mice, and AT(2) receptor knockout mice, C21 induced constriction followed by dilation. SHR hearts displayed enhanced constriction and no dilation. Irbesartan (angiotensin II type 1 receptor blocker) abolished the constriction and enhanced or (in SHRs) reintroduced dilation, and PD123319 (AT(2) receptor blocker) did not block the latter. C21 relaxed preconstricted vessels of all species, and this did not depend on angiotensin II receptors, the endothelium, or the NO-guanylyl cyclase-cGMP pathway. C21 constricted SHR iliac arteries but none of the other vessels, and irbesartan prevented this. C21 shifted the concentration-response curves to U46619 (thromboxane A(2) analog) and phenylephrine (α-adrenoceptor agonist) but not ionomycine (calcium ionophore) to the right. In conclusion, C21 did not cause AT(2) receptor-mediated vasodilation. Yet, it did induce vasodilation by blocking calcium transport into the cell and constriction via angiotensin II type 1 receptor stimulation. The latter effect is enhanced in SHRs. These data may explain the varying effects of C21 on blood pressure in vivo.     

Potential drug interactions with antibacterials in long-term care facilities analyzed by two interaction checkers

International Journal of Clinical Pharmacy - Background Residents in long-term care facilities take many medications concomitantly, including antibacterials, which increases the risk of...