Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers

Recent studies have identified sprue-like illness associated with the use of the antihypertensive agent olmesartan medoxomil. However, whether this condition is specific to the use of olmesartan or is associated with the use of drugs belonging to the class of “sartans” remains to be clarified. A 45-year-old woman with chronic kidney disease along with hypothyroidism and hypertension presented with chronic diarrhea and significant weight loss. Endoscopy of the upper gastrointestinal tract showed scalloping and grooving of the duodenum, and histopathological examination showed subtotal villous atrophy. She was on telmisartan for hypertension, which was discontinued. Subsequently, diarrhea ameliorated dramatically, and she regained weight. To our knowledge, this is the first study to report telmisartan-associated sprue-like enteropathy. Further, we have reviewed the cases of patients with sprue-like enteropathy caused by valsartan, irbesartan, and eprosartan.

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

Over the last two decades coronary artery calcium (CAC) scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300) have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year), with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

Erratum: Correction of Figure. The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

We found an error in Fig. 5A in the review article.

Bone marrow negative visceral leishmaniasis in an adolescent male

Visceral Leishmaniasis or Kala Azar is endemic in certain regions of India. In endemic areas, the constellation of fever, progressive weight loss, weakness, pronounced splenomegaly, anemia, leukopenia, and hypergammaglobulinemia is highly suggestive of visceral leishmaniasis. Demonstration of the parasite in liver, splenic or bone marrow aspirates is confirmatory. We present a case in which Leishmania donovani [LD] bodies were demonstrated on splenic aspirate. We were unable to demonstrate LD bodies on bone marrow aspiration

Verification of dose calculation algorithms in a multi-layer heterogeneous phantom using films

The development of advanced radiation treatment techniques such as intensity modulated radiation therapy [IMRT] and volumetric intensity modulated arc therapy [VMAT] require more accurate dose calculation algorithms within the treatment planning systems [TPS] considering that the human body is composed of tissues of widely differing radiological properties and the characteristics of a therapeutic radiation treatment beam along a heterogeneous path will be different. The objective of this study was to evaluate the accuracy of 2D-isodose distributions predicted by pencil beam convolution algorithm [PBC] and anisotropic analytic algorithm [AAA] in a heterogeneous slab phantom composed of media equivalent to air, water and bone density. The measurements were done by using the films at multiple depths in the phantom for open field sizes 5 × 5 cm[2] and 10 × 10 cm[2]. The results from this study indicated that the AAA had better agreement with the measurement compared to PBC for both the test field sizes at all selected depths; however, the limitation of AAA in predicting doses within and beyond low-density medium was observed, especially for a smaller field size [up to 32.7% and 34.0% for AAA and PBC, respectively]. Furthermore, discrepancies up to -4.8% for AAA and -14.6% for PBC was seen in the high-density medium as well. Dose prediction errors by the AAA and PBC were more pronounced for a smaller test field size, especially in the low-density medium

Embryonic stem cells cultured in biodegradable scaffold repair infarcted myocardium in mice / 生理学报

Our previous findings demonstrated that directly injecting embryonic stem cells (ESCs) into ischemic region of the heart improved cardiac function in animals with experimental myocardial infarction (MI). Tissue engineering with stem cells may provide tissue creation and repair. This study was designed to investigate the effectiveness of grafting of ESC-seeded biodegradable patch on infarcted heart. MI in mice was induced by ligation of the left coronary artery. Mouse ESCs were seeded on polyglycolic-acid (PGA) material patches. Three days after culture, an ESC-seeded patch was transplanted on the surface of ischemic and peri-ischemic myocardium. Eight weeks after MI operation and patch transplantation, hemodynamics and cardiac function were evaluated in four (sham-operated, MI, MI + cell-free patch, and MI + ESC-patch) groups of mice. The blood pressure and left ventricular function were significantly reduced in the MI animals. Compared with MI alone and MI + cell-free patch groups, the animals received MI + ESC-seeded patches significantly improved blood pressure and ventricular function. The survival rate of the MI mice grafted with MI + ESC-seeded patches was markedly higher than that in MI alone or MI + cell-free patch animals. GFP-positive tissue was detected in infarcted area with grafting of ESC-seeded patch, which suggests the survivors of ESCs and possible myocardial regeneration. Our data demonstrate that grafting of ESC-seeded bioabsorbable patch can repair infarcted myocardium and improve cardiac function in MI mice. This novel approach of combining stem cells and biodegradable materials may provide a therapeutic modality for repairing injured heart.