Acute kidney injury associated with metamizole sodium ingestion

Metamizole sodium, a nonsteroidal anti-inflammatory drug, has been widely used in the last 100 years. Its efficacy as an analgesic and antipyretic is unquestionable. Only few cases of acute kidney injury (AKI) induced by metamizole sodium were reported in the medical literature. We report 11 adult patients with AKI that resulted from metamizole sodium ingestion. The data suggest a good prognosis in these cases of AKI. Renal biopsies, corticosteroids treatment, or renal replacement therapy seem to be not necessary. Hydration was sufficient to ensure spontaneous recovery.     

Bilateral hip reconstruction in severe whole-body cerebral palsy: ten-year follow-up results

The results of a functional, clinical and radiological study of 30 children (60 hips) with whole-body cerebral palsy were reviewed at a mean follow-up of 10.2 years (9.5 to 11). Correction of windsweep deformity of the hips was performed by bilateral simultaneous combined soft-tissue and bony surgery at a mean age of 7.7 years (3.1 to 12.2). We were able to recall 22 patients; five had died of unrelated causes and three were lost to follow-up. Evaluation involved interviews with patients/carers and clinical and radiological examination. The gross motor functional classification system was used to assess overall motor function and showed improvement in seven patients. Of the 12 patients thought to have pain pre-operatively, only one had pain post-operatively. Improved handling was reported in 18 of 22 patients (82%). Those with handling problems were attributed by the carers to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, and the mean windsweep index improved from 50 pre-operatively to 36 at follow-up. The migration percentage and centre-edge angle were assessed on plain radiographs. Radiological containment improved, the mean migration percentage improved from 50 pre-operatively to 20 at follow-up and the mean centre-edge angle improved from -5 degrees to 29 degrees . No statistical difference was noted between the three-year and ten-year follow-up results, indicating that the improvements in clinical and radiological outcome had been maintained.     

Evaluation of apoptosis regulatory markers in androgenetic alopecia

Background Androgenetic alopecia (AGA) is a common androgen‐induced progressive disorder; the pathways of which are regulated by local genetic codes and hormonal control. Meanwhile, it is unclear whether an altered proliferation or increased apoptosis could contribute to its pathogenesis. Aims To evaluate the role of some apoptosis regulatory markers and follicular proliferation in the pathogenesis of AGA. Patients/Methods Thirty biopsies were taken from the frontal (bald) area and occipital (hair‐bearing) area of 15 male patients with AGA, as well as five specimens from the frontal area of five age‐matched controls. The biopsies were stained with apoptosis regulatory markers (Bcl‐2, p53, Bax & Fas) and PCNA (proliferating cell nuclear antigen), as well as TUNEL (terminal deoxynucleotidyl transferase‐mediated deoxyuridine triphosphate nick end‐labeling) staining for the detection of DNA fragmentation in apoptotic cells. Results Bcl‐2 expression was localized to epidermal basal layer and follicular dermal papilla with highly significant correlation with PCNA expression (P < 0.001). Perifollicular lymphocytic infiltrate of the bald area showed significant expression of Bcl‐2. However, pro‐apoptotic Bax and Fas were expressed in the epidermis and not in the hair follicles which does not show any apoptotic keratinocytes by TUNEL staining. Conclusion The low proliferation rate in the bald area of patients, together with persistent perifollicular inflammatory infiltrate as evidenced by the anti‐apoptotic Bcl‐2 expression in dermal lymphocytes, would result in follicular miniaturization and fibrosis.     

Acute cytomegalovirus infection associated with the onset of inflammatory bowel disease

A 29-year-old man was admitted with high-grade fever, crampy abdominal pain, and watery diarrhea that had persisted for 2 weeks before his admission. Symptomatic treatment (acetaminophen only) was of no benefit. On physical examination, there was diffuse abdominal tenderness. Laboratory tests showed a leukomoid reaction with atypical lymphocytosis, and serology tests revealed acute cytomegalovirus infection. Abdominal computed tomography and colonoscopy revealed an inflammatory process involving the large intestine. On histologic examinations of intestinal biopsy samples, there was an active inflammation with no inclusion bodies.The patient was treated with ganciclovir with only mild improvement. Adding 5-aminosalicylic acid caused little further improvement. Repeated colonoscopy performed 2 months later showed severe chronic ulcerative colitis. Only the addition of systemic steroids caused complete resolution of the symptoms.On review of the literature (Medline search for cytomegalovirus colitis in immunocompetent patients), 18 cases were found. On follow-up, 10 of these patients were found to have inflammatory bowel disease.     

Triclabendazole and its two main metabolites lack activity against Schistosoma mansoni in the mouse model

Some have claimed that triclabendazole, a safe and efficacious drug for the treatment of fascioliasis, also exhibits antischistosomal properties, but results are conflicting. We assessed the effect of triclabendazole and its two main metabolites against two different strains of Schistosoma mansoni harbored in mice. Low worm burden reductions (18.6-35.9%) were observed in mice infected with an Egyptian strain of S. mansoni and treated with a single dose of 120 mg/kg 3 days before infection or single/double doses of 120-200 mg/kg 7 weeks after infection. Triclabendazole failed to significantly reduce hepatic and intestinal tissue egg loads, and eggs of all developmental stages were observed. Administration of 400 mg/kg of either triclabendazole, triclabendazole sulphone, or triclabendazole sulfphoxide to mice infected with a Liberian strain of S. mansoni resulted in worm burden reductions < 10%. In comparison, high worm burden reductions (82-100%) were observed in S. mansoni-infected mice treated with single oral doses of 400, 500, or 500 mg/kg twice a day praziquantel, regardless of the S. mansoni strain. We conclude that triclabendazole and its main metabolites display weak and inconsistent schistosomicidal activities.     

Cellular repair strategies for spinal cord injury

The implantation of exogenous cells or tissues has been a popular and successful strategy to overcome physical discontinuity and support axon growth in experimental models of spinal cord injury (SCI). Cellular therapies exhibit a multifarious potential for SCI restoration, providing not only a supportive substrate upon which axons can traverse the injury site, but also reducing progressive tissue damage and scarring, facilitating remyelination repair, and acting as a source for replacing and re-establishing lost neural tissue and its circuitry. The past two decades of research into cell therapies for SCI repair have seen the progressive evolution from whole tissue strategies, such as peripheral nerve grafts, to the use of specific, purified cell types from a diverse range of sources and, recently, to the employment of stem or neural precursor cell populations that have the potential to form a full complement of neural cell types. Although the progression of cell therapies from laboratory to clinical implementation has been slow, human SCI safety and efficacy trials involving several cell types within the US appear to be close at hand.     

Visceral leishmaniasis complicated by fungal pulmonary valve endocarditis

We present a rare neglected case of fungal pulmonary valve endocarditis which presented with typical extra cardiac manifestations after repeated injections for treatment of visceral leishmaniasis. Surgical intervention to replace the pulmonary valve was the only option to manage the patient in spite of extensive medical treatment.     

Diclofenac sodium loaded-cellulose acetate butyrate: Effect of processing variables on microparticles properties,drug release kinetics and ulcerogenic activity

The aim of this study was to develop and characterize diclofenac sodium loaded-cellulose acetate butyrate microparticles in order to obtain a controlled-release system. The influence of the type of polymer, the volume and composition of the internal phase, drug loading, surfactant concentration and additive added on microparticles characteristics (particle size, encapsulation efficiency, surface morphology and in vitro release profiles) was studied to optimize the microparticles system. The resultant microparticles were evaluated for the recovery, average particle size, drug loading and incorporation efficiency. The microparticles exhibited good flowing nature and compressibility index when compared to pure drug. Dissolution rate of diclofenac sodium in phosphate buffer (pH 6.8) increased with increases in initial drug loading, surfactant concentration and addition of alcohol as co-solvent but decreased with increases in the concentration of additives such as Gantrez® AN or Eudragit S100 in the internal phase. The dissolution data showed a Higuchi diffusion pattern for most of the formulations. About 56–81% reduction in ulcerogenic activity was observed with microparticles containing Eudragit S100 17–25%, based on total polymer concentration, when compared with pure diclofenac sodium.