'Enemy within': an interesting cause for anemia during warfarin therapy for atrial fibrillation.

The oral anticoagulant warfarin is a vitamin K antagonist and is considered the first line anticoagulant in valvular atrial fibrillation. However prothrombin time should be closely monitored, drug interactions checked and compliance regarding diet ensured when the patient is on warfarin therapy. Anaemia should be looked for, evaluated for the cause and corrected since it is an independent predictor of bleeding and thrombotic episodes during warfarin therapy for atrial fibrillation We present an interesting case of anaemia which developed during warfarin therapy for atrial fibrillation. The patient was on amiodarone and was consuming leafy vegetables resulting in frequent raise in prothrombin time during which time she developed bleeding into the right femoral pseudoaneurysm which had developed following catheterisation for thrombectomy. Surgical correction of pseudoaneurysm was done, comedication was changed and diet compliance ensured which resulted in the subsequent maintenance of prothrombin time in the therapeutic range and steady haemoglobin levels.

Goitrogenic/antithyroidal potential of moringa leaves (Moringa oleifera) and spinach (Spinacia oleracea) of Indian origin on thyroid status in male albino rats

Moringa leaves and spinach used as vegetables containing cyanogens and polyphenols having suspected antithyroidal activity; however, detailed studies in this aspect found unavailable. Goitrogenic/antithyroid potentiality of those plant foods of Indian origin was evaluated. To explore the goitrogenic/antithyroid effect of those plant foods cyanogenic glucosides, glucosinolates, thiocyanate and polyphenol content were measured. These plant foods were fed with diet regularly to adult male albino rats for 30 and 60 days respectively, followed by evaluation of morphological and functional status of thyroid,as thyroid gland weight, the activity status of thyroid hormone synthesizing enzymes viz. TPO, Na+-K+-ATPase, deiodinase I, thyroid hormone profiles, thyroid histoarchitecture as well as urinary iodine and thiocyanate. In moringa leaves and spinach fed diet, there was a significant increase in urinary excretion of thiocyanate and iodine, enlargement of thyroid gland along with hypertrophy of thyroid follicles and altered in the activities of thyroid hormone synthesizing enzymes with concomitant changes of thyroid hormone profiles. Effects were more severe in moringa leaves treated group than that of spinach. Biochemical analysis moringa leaves and spinach reveal that those are rich sources of goitrogens and their prolonged consumption gradually developed a relative state of biochemical and morphological hypothyroidism.

Oral administration of oxalate-enriched spinach extract as an improved methodology for the induction of dietary hyperoxaluric nephrocalcinosis in experimental rats.

Experimental induction of hyperoxaluria by ethylene glycol (EG) administration is disapproved as it causes metabolic acidosis while the oral administration of chemically synthesized potassium oxalate (KOx) diet does not mimic our natural system. Since existing models comprise limitations, this study is aimed to develop an improved model for the induction of dietary hyperoxaluria, and nephrocalcinosis in experimental rats by administration of naturally available oxalate rich diet. Male albino Wistar rats were divided into five groups. Group I, control; group II rats received 0.75% EG, group III rats fed with 5% KOx diet and group IV and V rats were administered with spinach extract of 250 and 500 mg soluble oxalate/day respectively, for 28 d. Urine and serum biochemistry were analyzed. After the experimental period, rats were sacrificed, liver and kidney tissue homogenates were used for antioxidant and lipid peroxidation assay. Relative change in expression of kidney injury molecule-1 (KIM-1) and crystal modulators genes in kidney tissues were evaluated. Tissue damage was assessed by histology studies of liver and kidney. Experimental group rats developed hyperoxaluria and crystalluria. Urine parameters, serum biochemistry, antioxidant profile, lipid peroxidation levels and gene expression analysis of experimental group II and III rats reflected acute kidney damage compared to group V rats. Histopathology results showed moderate hyperplasia in liver and severe interstitial inflammation in kidneys of group II and III than group V rats. Ingestion of naturally available oxalate enriched spinach extract successfully induced dietary hyperoxaluria and nephrocalcinosis in rats with minimal kidney damage.

Description of a novel panallergen of cross-reactivity between moulds and foods.

The present investigation is undertaken to demonstrate a novel cross-reactivity between aeroallergens (moulds fungi imperfecti) and allergens from foods (spinach and mushroom Agaricus bisporus). We have performed a dual study in vivo and in vitro, in a population of atopic patients. Data from in vivo tests performed with spinach and mushroom have been statistically analysed. To the in vitro assays, mushroom and spinach extracts have been obtained, and sera from moulds allergic patients analysed by means of IgE-immunoblott assays. Inhibition experiments have been also performed to study a possible relation between proteins. Statistical analysis of data showed a relation between allergenicity to moulds (Alternaria alternata, Cladosporium herbarum and/or Aspergillus fumigatus), and positive skin prick tests with mushroom and/or spinach. The immunoblotts performed showed that seven moulds allergic patients had a strong recognition of a protein with a molecular weight of about 30 kD present both in spinach and mushroom extracts, and by means of inhibition assays we could determine that these two proteins were related. This study demonstrates the existence of a new allergen responsible for cross reactivity between moulds and two frequently consumed foods, mushroom and spinach. We conclude that a novel cross-reactive allergen between aeroallergens and foods has been identified.

[Contact dermatitis caused by spinach, hedge mustard and chives]. / Kontaktdermatitis auf Spinat, Rauke und Schnittlauch.

A 54-year-old female working as a vegetable farmer presented with painful pruritic skin lesions on both hands. Physical examination showed a hyperkeratotic fissured eczema. RAST, prick- and patch testing revealed type I and IV hypersensitivity to spinach, ruccola, and chives, so that a protein contact dermatitis was diagnosed.

Asma ocupacional por polvo de espinaca / Asthma occupational to Spinach powder

Antecedentes y objetivos: Los alimentos pueden ser causa de enfermedades respiratorias como antígenos inhalados. Se presenta un caso de un varón de 45 años, panadero, sin antecedentes de atopia, que presenta síntomas de rinoconjuntivitis y asma bronquial en relación con la manipulación de polvo de espinaca deshidratada, que utiliza para el enriquecimiento de harinas integrales en la fabricación del pan integral. El paciente tolera la ingesta de espinaca, pan y bollería. Material y métodos: Se realizó prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) y prueba de provocación nasal con extracto de espinaca deshidratada, así como determinación de IgE específica mediante el método HY-TEC-EIA e SDSPAGE-immunoblotting. Resultados: El prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) fue positivo. La prueba de provocación nasal con el extracto de espinaca deshidratada fue positiva a una dilución 1/1000 desencadenándose de forma inmediata síntomas clínicos de rinitis; se pudo observar aumento de las resistencias y disminución en el flujo total mayor del 50 por ciento. La IgE específica fue de 1,64 kU/L y mediante la técnica SDS-PAGE immunoblotting se determinó una banda proteica fijadora de IgE de 29,6 KDa. Conclusiones: Se describe la hipersensibilidad mediada por IgE frente a polvo de espinaca en un paciente panadero que presentaba síntomas de rinitis y asma con su manipulación. El paciente se encuentra asintomático al evitar su contacto. La sensibilización a otros vegetales utilizados en la masa del pan puede ser la causa de asma ocupacional por antígenos ocultos y poco frecuentes (AU)

[Crossed spinach-latex allergy revealed by exercise-induced anaphylaxis]. / Allergie croisée épinard-latex révélée par une anaphylaxie induite par l'exercice.

Diagnosis of exercise-induced anaphylaxis is based on conjunction between a specific factor: a specific or nonspecific food allergy and exercise. The authors report observation of a patient who presented with exercise-induced anaphylaxis associated with food allergy to spinach, but also with a cross reaction with latex.

Torsade de pointes due to consumption of Sauropus androgynus as a weight-reducing vegetable.

Sauropus Androgynus, known as cekur manis or sweet shoot, is a popular vegetable in Southeast Asia and is used as a weight-reducing vegetable in Taiwan. Three women who developed torsade de pointes after consuming large amounts of sauropus androgynus are described in this report.