Pancreatitis aguda en la unidad de cuidados intensivos secundaria a tratamiento con tigeciclina / Acute pancreatitis in ICU secondary to treatment with tigecycline

La tigeciclina es un antibiótico de amplio espectro estructuralmente similar a la minociclina y que comparte algunos de los efectos adversos de las tetraciclinas. Presentamos el caso de una mujer de 68 años que se trató con tigeciclina por una sepsis de origen desconocido y desarrolló al 5° día de tratamiento un cuadro sugerente de pancreatitis aguda con dolor abdominal junto con elevación de enzimas pancreáticas. Tras descartar diferentes etiologías y basándonos en la escala de Naranjo para la probabilidad de reacciones adversas a fármacos, la tigeciclina fue la causa probable de la pancreatitis aguda, complicación de la cual ha habido 5 comunicaciones en la base de datos del sistema español de farmacovigilancia desde 2009. Se recomienda una vigilancia estrecha de signos y síntomas abdominales durante el uso de tigeciclina, ya que los efectos adversos en el aparato digestivo son los más prevalentes con este fármaco (AU)

Tigecycline is a broad spectrum antimicrobial agent, structurally similar to minocycline and that shares some tetracycline-related side effects. A case report is presented on a 68-year-old female who received tigecycline for a sepsis of unknown origin and who, in the following 5 days, developed abdominal pain and elevated pancreatic enzymes, which suggested acute pancreatitis. After ruling out other origins, and according to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of the acute pancreatitis, a complication that has been reported 5 times in the database of the Spanish pharmacosurveillance system since 2009. Close monitoring of abdominal signs and symptoms is recommended during treatment with tigecycline, since adverse effects affecting the digestive system are the most prevalent ones when using this drug (AU)

Acute pancreatitis in ICU secondary to treatment with tigecycline. / Pancreatitis aguda en la unidad de cuidados intensivos secundaria a tratamiento con tigeciclina.

Tigecycline is a broad spectrum antimicrobial agent, structurally similar to minocycline and that shares some tetracycline-related side effects. A case report is presented on a 68-year-old female who received tigecycline for a sepsis of unknown origin and who, in the following 5days, developed abdominal pain and elevated pancreatic enzymes, which suggested acute pancreatitis. After ruling out other origins, and according to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of the acute pancreatitis, a complication that has been reported 5 times in the database of the Spanish pharmacosurveillance system since 2009. Close monitoring of abdominal signs and symptoms is recommended during treatment with tigecycline, since adverse effects affecting the digestive system are the most prevalent ones when using this drug.

Sodium fluorescein influence on the hemorheological profile of non-insulin dependent diabetes mellitus patients.

Sodium fluorescein angiography is a widely used technology in ophthalmology, which allows us to visualise the chorioretinal microcirculation. Previous reports showed a prolongation of the retinal circulation time along with erythrocyte hyperaggregation and a decrease of erythrocyte acetylcholinesterase activity and a possible interference with the erythrocyte's membrane fluidity. The aim of the present work is to investigate the influence of sodium fluorescein on the hemorheological profile of a group of 23 non-insulin dependent diabetes mellitus (NIDDM) patients undergoing routine retinal angiography. Thirty minutes after the endovenous administration of the fluorescein there was: (I) an increase of whole blood viscosity (p = 0.015), erythrocyte elongation index (EEI, p < 0.05), whole blood pH (p < 0.001), methemoglobin (p < 0.001) and carboxyhemoglobin (p < 0.001) concentrations; (II) no variation of plasma osmolality and erythrocyte aggregation index (EAI); (III) a decrease of the erythrocyte acetylcholinesterase activity, p < 001; (IV) no variation in membrane lipid fluidity, although 1,6-diphenyl-1,3,5-hexatriene (DPH) correlated directly with the EEI, while 1,4-trimethyl-phenyl-1,3,5-hexatriene (TMA-DPH) and EAI correlated inversely, suggesting that the decreasing EEI (lower erythrocyte deformablity) might be associated with an increased rigidity of the external polar region and fluidification of the hydrophobic region of the erythrocyte membrane, with an increasing EAI. In conclusion, the endovenous administration of sodium fluorescein in NIDDM patients during the retinal angiography procedure interferes with the erythrocyte membrane and possibly with the microcirculatory blood flow.

Red blood cell membrane integrity in primary open angle glaucoma: ex vivo and in vitro studies.

PURPOSE: There is increasing evidence that abnormal perfusion of the optic nerve head is an important factor involved in the pathophysiology of glaucoma. Transport and distribution of oxygen to the tissues takes place through the erythrocyte membrane. Red blood cell (RBC) acetylcholinesterase (AChE) is a marker of RBC membrane integrity. The aim of this study was to find out whether RBC membrane integrity is preserved in primary open angle glaucoma (POAG), and whether it is modified by the use of topical timolol maleate and pilocarpine. METHOD: RBC AChE activity was determined ex vivo by Kaplan's spectrophotometric method in 19 POAG patients undergoing topical treatment for glaucoma with timolol, pilocarpine or a combination of the two drugs, and compared with that in 20 controls. To assess the effect of antiglaucomatous therapy in our findings, we carried out an in vitro study in 26 non-glaucomatous patients in which we measured RBC AChE activity after incubation of blood with either timolol maleate, pilocarpine or a combination of the two drugs, using the same spectrophotometric method. RESULTS: There was a significant increase in RBC AChE enzyme activity in POAG patients compared with the control group (p < 0.002). However, timolol and pilocarpine, individually or in combination, have the opposite effect, significantly decreasing RBC AChE activity (p < 0.05). CONCLUSION: This change in RBC AChE enzyme activity could suggest alterations in RBC membrane integrity in primary open angle glaucoma. Whether or not this finding has implications regarding the microcirculation at the optic nerve head needs to be investigated further.

The effect of sodium fluorescein angiography on erythrocyte properties.

Sodium fluorescein angiography is a widely used routine ophthalmological diagnostic procedure which enables the study of chorioretinal microcirculation and consists of the injection of sodium fluorescein into the systemic bloodstream. The aim of the present study was to evaluate whether or not fluorescein interferes with erythrocyte properties during the angiographic procedure. In a group of 37 patients, 26 with non-insulin-dependent diabetes mellitus (DM) with and without retinopathy, and 11 without diabetes mellitus (non-DM) although affected by other ophthalmological diseases, all undergoing routine angiography, blood samples were drawn before (T0) and 30 min (T30) after fluorescein injection. The erythrocyte aggregation index (EAI), membrane lipid fluidity and erythrocyte acetylcholinesterase activity were determined in both groups. After fluorescein injection there was no statistical change in EAI and erythrocyte membrane fluidity in either group. Erythrocyte acetylcholinesterase activity, a marker of membrane protein integrity, decreased significantly (p < 0.01) in the DM group. Membrane lipid fluidity did not change with fluorescein injection, however (i) in the DM group erythrocyte membranes became more rigid than in the non-DM (DPH: p < 0.01); (ii) EAI and membrane lipid fluidity became significantly correlated (r = 0.6263, p < 0.05) in non-DM patients at T30. In conclusion, fluorescein administration for angiographic procedures seems to interact with erythrocyte membrane, namely, in diabetic patients, which may interfere with the blood flow in the microcirculation.

[The effect of angiography with disodium fluorescein on the hemorheologic parameters of diabetics]. / Estudo da influência da angiografia com fluoresceína bissódica nos parâmetros hemorreológicos de doentes com diabetes mellitus.

Chorioretinal angiography with fluorescein is an auxiliary method widely used in Ophthalmology which enables us to study the blood/humour and blood/retina/choroid interface. The presence of a strange compound in circulation may interfere with blood flow homeostasis. With the aim of studying fluorescein influence in blood rheology, blood samples were drawn before, immediately after and 30 minutes after fluorescein bolus injection; from 10 patients with diabetes mellitus, with or without retinopathy, blood fluidity (hematocrit, erythrocyte aggregation and whole blood viscosity) and erythrocyte membrane functional properties were determined. After fluorescein injection there was erythrocyte hyperaggregation (37.7%, p = 0.004), was detected, hemoglobin concentration (p = 0.039) and hematocrit (p = 0.013) decrease, and a double time increase of methemoglobin concentration (p < 0.001) the erythrocyte membrane hydrophobic region became more rigid (p = 0.016). All these abnormalities normalized after 30 minutes. In conclusion, fluorescein angiography interferes acutely with the hemorheological parameters of patients with diabetes mellitus, with erythrocyte hyperaggregation which could interfere with the microcirculation of these patients.

Carcinoma pulmonar de pequeñas células, síndrome nefrótica e insuficiencia renal rápidamente evolutiva / Small cell pulmonar carcinoma, nephrotic syndrome and kidney failure of rapid evolution

La asociación de síndrome nefrótico con neoplasias es un hecho relativamente frecuente. Por el contrario, la insuficiencia renal rápidamente evolutiva con glomerulonefritis con semilunas extensas como consecuencia de una neoplasia es infrecuente. Presentamos el caso de un hombre de 55 años, previamente sano, que sufrió un síndrome nefrótico y una insuficiencia renal de rápida evolución en quien se detectó un cáncer pulmonar de pequeñas células. En la autopsia, se observaron proliferación mesangial y engrosamiento de las membranas basales con semilunas en el 90 por ciento de los glomérulos. La microscopia electrónica también demonstró engrosamiento de la membrana basal. No se evidenciaron estructuras compatibles con depósitos de inmunocomplejos. Realizamos una revisión de los casos comunicados de asociación de lesiones glomerulares y neoplasias y detallamos los 20 casos publicados con este tipo particular de lesión glomerular. Ninguno pertenece a esta variedad de cáncer de pulmón; los únicos tres casos de carcinoma pulmonar de pequeñas células con síndrome nefrótico referidos en la literatura se asociaron a glomerulonefritis membranosa

Carcinoma pulmonar de pequeñas células, síndrome nefrótica e insuficiencia renal rápidamente evolutiva / Small cell pulmonar carcinoma, nephrotic syndrome and kidney failure of rapid evolution

La asociación de síndrome nefrótico con neoplasias es un hecho relativamente frecuente. Por el contrario, la insuficiencia renal rápidamente evolutiva con glomerulonefritis con semilunas extensas como consecuencia de una neoplasia es infrecuente. Presentamos el caso de un hombre de 55 años, previamente sano, que sufrió un síndrome nefrótico y una insuficiencia renal de rápida evolución en quien se detectó un cáncer pulmonar de pequeñas células. En la autopsia, se observaron proliferación mesangial y engrosamiento de las membranas basales con semilunas en el 90 por ciento de los glomérulos. La microscopia electrónica también demonstró engrosamiento de la membrana basal. No se evidenciaron estructuras compatibles con depósitos de inmunocomplejos. Realizamos una revisión de los casos comunicados de asociación de lesiones glomerulares y neoplasias y detallamos los 20 casos publicados con este tipo particular de lesión glomerular. Ninguno pertenece a esta variedad de cáncer de pulmón; los únicos tres casos de carcinoma pulmonar de pequeñas células con síndrome nefrótico referidos en la literatura se asociaron a glomerulonefritis membranosa (AU)

Pharmacologic properties of Moringa oleifera. 2: Screening for antispasmodic, antiinflammatory and diuretic activity.

Hot water infusions of flowers, leaves, roots, seeds and stalks or bark of Moringa oleifera were screened to detect three pharmacologic activities in experimental models in rats. The antispasmodic activity was demonstrated using isolated duodenum, oral anti-inflammatory activity by carrageenan-induced hindpaw edema and oral diuretic activity by urine output in metabolic cages. The seed infusion showed a significant inhibition of acetylcholine-induced contraction with an ED50 of 65.6 mg/ml bath concentration, inhibition of carrageenan-induced edema at 1000 mg/kg and diuretic activity at 1000 mg/kg. Some activity was also demonstrated in the roots. All doses expressed here are as equivalents of dried starting plant material.