ABSTRACT
Currently, pharmaceutical preparations are serious contributors to liver disease, with hepatotoxicity ranking as the most frequent cause for acute liver failure and post-marketing regulatory decisions. The diagnostic approach of drug-induced liver injury (DILI) is still rudimentary and inaccurate because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug's hepatotoxic potential, the exclusion of alternative causes of liver damage, and the ability to detect the presence of subtle data that favour a toxic aetiology. Clinical and laboratory data may also be assessed with algorithms or clinical scales, which may add consistency to the clinical judgment by translating the suspicion into a quantitative score. The CIOMS/RUCAM instrument is considered at present the best method for assessing causality in DILI, although it could be improved through the use of large database of bona fide DILI cases for validation criteria.
Subject(s)
Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/epidemiology , Drug-Related Side Effects and Adverse Reactions , Algorithms , Causality , Chemical and Drug Induced Liver Injury/etiology , Humans , Prognosis , Risk FactorsABSTRACT
We present the case of a 63-year-old woman who had undergone 7 months of treatment with Nimesulide (100 mg/b.i.d.) for symptomatic osteoarthritis. The patient was admitted to our unit with a clinical picture of progressive jaundice over 3 weeks. Clinical and analytical studies revealed acute liver failure, this being confirmed by liver biopsy, which showed submassive necrosis. Serological tests for different viral agents causing hepatitis were all negative. In addition, she presented a picture of severe haemolytic anaemia resistant to several treatments and needed multiple transfusions. Twenty-three days after admission, the patient presented hepatic encephalopathy and received an orthotopic liver transplant on day 25. The evolution after transplantation was good and the patient continues in good health with no evidence of haemolysis almost 2 years later. Liver toxicity due to Nimesulide is well known, but to our knowledge the occurrence of haemolytic anaemia has not been related to this drug previously. For these reasons, Nimesulide has been restricted or removed from the market in several countries in recent months.
Subject(s)
Anemia, Hemolytic/chemically induced , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Liver Failure, Acute/chemically induced , Liver Failure, Acute/surgery , Sulfonamides/adverse effects , Anemia, Hemolytic/complications , Female , Humans , Liver Failure, Acute/complications , Liver Transplantation , Middle Aged , Treatment OutcomeABSTRACT
The technique of Brillouin light scattering is used to observe strong excitation of magnons in antiferromagnetically coupled trilayers of Fe/Cr/Fe at room temperature. The magnons are driven out of equilibrium by a microwave current applied in the trilayer through point contacts. The magnitude of the scattering intensity is investigated as a function of the magnon wave number and applied magnetic field. Confirming recent theoretical predictions, the observations provide strong evidence of electronic spin injection in the rf driving field.
