Sudden onset of melanuria in a patient with metastatic melanoma and toxic epidermal necrolysis

A 46‐year‐old man presented to our institution with blisters and eruption on the body and oral mucosa. He had a history of metastatic melanoma to the brain and had undergone radiation therapy to the head and chemotherapy with temozolomide. He was then started on dexamethasone and phenytoin. One month later, he developed a fever of 39.5 °C and an eruption in the axilla and groin. He was admitted to another hospital with a presumptive diagnosis of disseminated herpes zoster and was started on acyclovir, vancomycin, methylprednisolone, and fluconazole. The phenytoin was discontinued. Three days after admission, the eruption progressed and the patient developed respiratory distress. Biopsies from several lesions showed focal necrosis of keratinocytes with minimal superficial perivascular inflammation, consistent with toxic epidermal necrolysis. He was intubated and transferred to our medical center. On physical examination, the patient had exfoliation of over 70% of his body surface area ( Fig. 1 ), and scattered blisters were observed on the hands, chest, abdomen, and back. He also had crusted hemorrhagic plaques on the lips and conjunctiva. The patient was admitted with a diagnosis of toxic epidermal necrolysis, secondary to phenytoin.

Figure Figure 1  Open in figure viewer PowerPoint Extensive desquamation over the patient’s flank and thigh     

Insulin-like growth factor binding protein-3 in preterm infants with retinopathy of prematurity

Background:

Retinopathy of prematurity (ROP) is the main cause of visual impairment in preterm newborn infants.

Objective:

This study was conducted to determine whether insulin-like growth factor binding protein -3 (IGFBP-3) is associated with proliferative ROP and has a role in pathogenesis of the disease in premature infants.

Materials and Methods:

A total of 71 preterm infants born at or before 32 weeks of gestation participated in this study. Studied patients consisted of 41 neonates without vaso-proliferative findings of ROP as the control group and 30 preterm infants with evidence of severe ROP in follow up eye examination as the case group. Blood samples obtained from these infants 6-8 weeks after birth and blood levels of IGFBP-3 were measured using enzyme-linked immunosorbent assay (ELISA).

Results:

The mean gestation age and birth weight of the studied patients were 28.2±1.6 weeks and 1120.7±197 gram in the case group and 28.4±1.6 weeks and 1189.4±454 gram in the control group (P=0.25 and P=0.44 respectively). The infants in the case group had significantly lower Apgar score at first and 5 min after birth. Insulin-like growth factor binding protein -3 (IGFBP-3) was significantly lower in the patients with proliferative ROP than the patients without ROP [592.5±472.9 vs. 995.5±422.2 ng/ml (P=0.009)]. Using a cut-off point 770.45 ng/ml for the plasma IGFBP-3, we obtained a sensitivity of 65.9% and a specificity of 66.7% in the preterm infants with vasoproliferative ROP.

Conclusion:

Our data demonstrated that the blood levels IGFBP-3 was significantly lower in the patients with ROP and it is suspected that IGFBP-3 deficiency in the premature infants may have a pathogenetic role in proliferative ROP.     

Gatifloxacin produces both hypoglycemia and hyperglycemia: a retrospective study

BACKGROUND: Gatifloxacin, until recently one of the most commonly prescribed antibiotics, has been shown to produce hypoglycemia. METHODS: To further examine the effects of Gatifloxicin (G) on blood glucose (BS), we conducted a retrospective chart review on 264 inpatients, examining for both hypoglycemia and hyperglycemia, comparing G with another quinolone, Ciproflaxin (C), and nonquinolone, Ceftriaxone (R). RESULTS: We found that of 292 patient encounters, 28 hypoglycemia and 48 hyperglycemic events occurred. Patients given G were 5 times as likely to become hypoglycemic as C (P < 0.01) and 9 times as likely as those given R (P < 0.02). Patients given G were 5.6 times more likely to develop hypoglycemia (P < 0.001) than the combined group, R+C. Conversely, patients treated with G were 3.8 times as likely to become hyperglycemic as those give C (P < 0.01) and 9.8 times as those given R (P < 0.01). With C and R combined, those given G were 5.2 times as likely to develop hyperglycemia (P < 0.01). Looking at patient encounters where G was given, we found that having preexisting diabetes mellitus (DM) was positively associated with hypoglycemia (21/144, P < 0.001). Steroid use (P < 0.05) and being in the ICU (P < 0.01) were also positively associated with hyperglycemia (38/144, P < 0.01). CONCLUSIONS: In summary, G was clearly associated with both hypoglycemia and hyperglycemia compared with C and R. The risk of hyperglycemia increased in the presence of DM, steroid use, and "sick enough" to be in the intensive care unit.     

Perceptions toward HIV, HIV screening, and the use of antiretroviral medications: a survey of maternity-based health care providers in Zambia

Mother-to-child transmission of HIV (MTCT) is a major contributor to Zambia's HIV burden. Based on our experience in Zambia, we felt that provider perceptions, knowledge base, and practice patterns toward HIV-positive mothers may pose as significant obstacles to preventing MTCT. Two hundred and twenty-five health care providers throughout Zambia were surveyed in 2002. Providers reported widespread stigma associated with HIV. Physicians (OR = 1.9), providers with research affiliations (OR = 2.3), and those located in Lusaka (OR = 9.0) were more likely to offer HIV testing. Only 30% routinely prescribed antiretroviral treatment (ART) to reduce MTCT. Practitioners from district facilities, those from Lusaka, and those employed at research facilities were more likely to prescribe ART routinely (OR = 2.8, 10.1 and 3.4 respectively). Among those never prescribing ART, most cited a lack of availability (83%). Our results highlight the need for further provider education, critical appraisal of the current system for HIV testing, and widespread distribution of ART.