Leech induced pyoderma gangrenosum in an ulcerative colitis patient: a case report

Pyoderma gangrenosum [PG] is a painful skin lesion that results from excessive inflammatory response to a host of traumatic, inflammatory, or neoplastic processes in susceptible individuals. A clear pathogenetic mechanism as well as an exhaustive list of potential triggers for PG is yet to be fully characterized. This case documents the occurrence of pyoderma gangrenosum following leech-therapy in a patient who is a known case of ulcerative colitis and it deserves attention because leeches have been part of medical armamentarium since ancient times and have re-emerged in the last century relying on their ancient charm and modern research revealing potential benefits of several bioactive substances in their saliva

[ international randomized placebo-controlled trial of a four-component combination pill [[polypill]] in people with raised cardiovascular risk]

There is widespread interest in the potential for combination cardiovascular medications consisting of aspirin and other agents to lower blood pressure and cholesterol [polypills] to reduce cardiovascular diseases [CVDs]. However, no reliable placebo-controlled data are available on both efficacy and tolerability. We conducted a randomized, double-blind placebo-controlled trial of a polypill [aspirin 75 mg, lisinopril 10 mg, hydrochloro-thiazide 12.5 mg and simvastatin 20 mg] in 378 individuals with no indications for any component of the polypill, whose estimated five-year CVD risks were over 7.5%. The primary outcomes were systolic blood pressure [SBP], LDL-cholesterol and tolerability [proportion discontinued randomized therapy] at 12 weeks follow-up. At baseline, mean blood pressure was 134/81 mmHg and mean LDL-cholesterol was 3.7mmol/L. Over 12 weeks, polypill treatment reduced SBP by 9.9 [95% CI: 7.7 to 12.1] mmHg and LDL-cholesterol by 0.8 [95% CI: 0.6 to 0.9] mmol/L. The discontinuation rates in the polypill group compared to placebo were 23% vs. 18% [RR 1.33, 95% CI: 0.89 to 2.00, P=0.2].There was an excess of side effects known to the component medicines [58% vs. 42%, P=0.001], which was mostly apparent within a few weeks and usually did not warrant cessation of trial treatment. This polypill achieved sizeable reductions in SBP and LDL-cholesterol but caused side effects in about 1 in 6 people. The halving in predicted cardiovascular risk is moderately lower than previous estimates, with a moderately higher rate of side effects. Nonetheless, substantial net benefits would be expected among patients at high risk for CVDs

Hepatitis B virus infection during pregnancy: transmission and prevention

Hepatitis B virus [HBV] infection is a global public health problem. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother to child transmission [MTCT] accounting for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an essential step in reducing the global burden of chronic HBV. Natal transmission accounts for most of MTCT, and providing immunoprophylaxis to newborns is an excellent way to block natal transmission. Prenatal transmissions is responsible for the minority of MTCT not preventable by immunoprophylaxis. Because of the correlation between prenatal transmission is responsible for the minority viremia, some authors find it sound to offer lamivudine in women who have a high viral load [more than 8 to 9 log 10 copies/ mL]. In addition to considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing therapy. Management of chronic HBV infection in pregnancy is mostly supportive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease