MO323MEDICATION INDUCED RELAPSE OF FGSG

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Evamaria Anvari ◽  
Julie Barnes
Keyword(s):  
Competitive Inhibition ◽  
High Dose ◽  
P Glycoprotein ◽  
First Case ◽  
Mild Improvement ◽  
Grand Mal ◽  
History Of ◽  
Cyp Metabolism ◽  
To Come ◽  
Rat Study

Abstract Background and Aims 31-year-old female with past medical history of Multiple Sclerosis diagnosed with Minimal Change Disease (MCD) in 2011. At diagnosis she had proteinuria that exceeded 7 g per day. She was treated with steroids and went into complete remission. In 2017 presented again with nephrotic syndrome and on repeat biopsy she was diagnosed with Focal Segmental Glomerulosclerosis (FSGS). She was restarted on steroids and had some improvement but despite 20 weeks of high dose steroids did not achieve remission. After every attempt of tapering, she would relapse. Method Other treatments tried without success were tacrolimus, cyclophosphamide and rituximab. Mild improvement with tacrolimus but stopped after a grand mal seizure. The lowest achievable steroid dose was 20mg daily. She was started on combination therapy tacrolimus and mycophenolate mofetil and was able to come off steroids and went into remission. Results After a few months of remission, she began to relapse. It was noted after extensive investigation that she had been placed on cabergolin for hyperprolactinemia by her endocrinologist at the time she began to relapse. Cabergolin was stopped and she went into remission again. We present the first case of FSGS relapse due to cabergolin. Conclusion Cabergoline is metabolized by hydrolysis and has limited cytochrome P450 (CYP) metabolism. Despite limited CYP metabolism, cabergoline does have an interaction with clarithromycin, a known inhibitor of CYP and p-glycoprotein. One rat study suggest that mycophenolate is a substrate for p-glycoprotein, so it is possible that there is some competitive inhibition. This would explain why the patient relapsed while on cabergoline and in remission after stopping it.

scholarly journals Tocilizumab for massive refractory pleural effusion in an adolescent with systemic lupus erythematosus

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Arianna De Matteis ◽  
Emanuela Sacco ◽  
Camilla Celani ◽  
Andrea Uva ◽  
Virginia Messia ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Common Symptom ◽  
Systemic Lupus ◽  
Malar Rash ◽  
Case Presentation ◽  
Double Stranded Dna ◽  
First Case ◽  
History Of

Abstract Background Pleural effusion in systemic lupus erythematous (SLE) is a common symptom, and recent studies demonstrated that IL-6 has a pivotal role in its pathogenesis. Case presentation We report a case of a 15 years old Caucasian boy with a history of persistent pleural effusion without lung involvement or fever. Microbiological and neoplastic aetiologies were previously excluded. Based on the presence of pleuritis, malar rash, reduction of C3 and C4 levels and positivity of antinuclear antibody (ANA) and anti-double stranded DNA (dsDNA), the diagnosis of juvenile SLE (JSLE) was performed. Treatment with high dose of intravenous glucocorticoids and mycophenolate mofetil was started with partial improvement of pleural effusion. Based on this and on adults SLE cases with serositis previously reported, therapy with intravenous tocilizumab (800 mg every two weeks) was started with prompt recovery of pleural effusion. Conclusion To the best of our knowledge, this is the first case of JSLE pleuritis successfully treated with tocilizumab.

P-glycoprotein expression in malignant lymphoma and reversal of clinical drug resistance with chemotherapy plus high-dose verapamil.

1991 ◽  
Vol 9 (1) ◽  
pp. 17-24 ◽  
Author(s):  
T P Miller ◽  
T M Grogan ◽  
W S Dalton ◽  
C M Spier ◽  
R J Scheper ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Continuous Infusion ◽  
Efflux Pump ◽  
Competitive Inhibition ◽  
Transmembrane Protein ◽  
Immunohistochemical Method ◽  
High Dose ◽  
Drug Resistant ◽  
P Glycoprotein ◽  
Clinical Drug

P-glycoprotein is a transmembrane protein thought to function as an efflux pump to detoxify cells. It is associated with multidrug resistance in laboratory systems and has recently been found in human tumors associated with in vitro and clinical drug resistance. We used an immunohistochemical method employing two monoclonal antibodies, JSB-1 and C-219, to detect expression of P-glycoprotein in lymphoma patients. One of 42 newly diagnosed and untreated lymphoma patients (2%) and seven of 11 previously treated and drug-resistant patients (64%) had detectable levels of P-glycoprotein (P less than .001). Based on prior reports suggesting that verapamil sensitizes drug-resistant cancer cells to chemotherapy by competitive inhibition of the P-glycoprotein, we tested the efficacy of verapamil as a chemosensitizer in 18 patients with drug-refractory disease. All patients had previously failed or relapsed within 3 months of a doxorubicin-vincristine-containing drug regimen. Patients received day-1 cyclophosphamide, and 4-day continuous infusion doxorubicin and vincristine and oral dexamethasone (CVAD). CVAD was combined with 5-day continuous infusion verapamil given at maximally tolerated dose. Overall, 13 of 18 patients (72%) responded to treatment including five complete remissions (CRs; 28%). The median duration of response was 200 days and median survival was 242 days. The dose-limiting toxicity of the verapamil infusion was temporary cardiac dysfunction including hypotension, congestive heart failure, and cardiac arrhythmia. We conclude that the P-glycoprotein is uncommonly expressed in untreated lymphomas and frequently expressed in clinically drug-resistant disease, and that chemotherapy using CVAD plus maximally tolerated doses of verapamil results in a high response rate in patients carefully selected for clinical drug resistance.

scholarly journals Enterococcus gallinarum meningitis in an immunocompetent host: a case report

2010 ◽  
Vol 52 (2) ◽  
pp. 111-112 ◽  
Author(s):  
Vicente Sperb Antonello ◽  
Francis de Moura Zenkner ◽  
Josiane França ◽  
Breno Riegel Santos
Keyword(s):  
Case Report ◽  
Gastrointestinal Tract ◽  
Rare Case ◽  
Human Infection ◽  
High Dose ◽  
Immunocompetent Host ◽  
First Case ◽  
History Of ◽  
Enterococcus Gallinarum ◽  
Gentamicin Therapy

We describe a rare case of a 53-year-old man with a long history of alcohol abuse, with Enterococcus gallinarum meningitis, an organism that rarely causes human infection and is primarily found in the gastrointestinal tract of poultry. The patient improved with high-dose ampicillin and gentamicin therapy. To our knowledge, this is the first Brazilian reported case of E. gallinarum meningitis and probably the first case described in an immunocompetent host.

An unusual case of ‘laughing gas’ addiction in Singapore

2017 ◽  
Vol 41 (S1) ◽  
pp. s878-s878
Author(s):  
A. Selvaraj ◽  
K.E. Wong
Keyword(s):  
Nitrous Oxide ◽  
Young Male ◽  
Western Country ◽  
High Dose ◽  
Laughing Gas ◽  
First Case ◽  
The Press ◽  
History Of ◽  
Competing Interest ◽  
Gas Inhalation

ObjectiveRecreational use of nitrous oxide (N20) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent.MethodsA 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far.ResultsThe patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N20 use.ConclusionThis case is unique for 2 reasons:– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Electron-diffraction studies in synthetic polymer materials

1983 ◽  
Vol 41 ◽  
pp. 362-365
Author(s):  
D.T. Grubb
Keyword(s):  
Electron Diffraction ◽  
Synthetic Polymer ◽  
Polymer Materials ◽  
Crystallographic Structure ◽  
High Dose ◽  
Electron Dose ◽  
Dose Rates ◽  
First Case ◽  
Diffraction Patterns ◽  
The Many

Diffraction studies in polymeric and other beam sensitive materials may bring to mind the many experiments where diffracted intensity has been used as a measure of the electron dose required to destroy fine structure in the TEM. But this paper is concerned with a range of cases where the diffraction pattern itself contains the important information.In the first case, electron diffraction from paraffins, degraded polyethylene and polyethylene single crystals, all the samples are highly ordered, and their crystallographic structure is well known. The diffraction patterns fade on irradiation and may also change considerably in a-spacing, increasing the unit cell volume on irradiation. The effect is large and continuous far C94H190 paraffin and for PE, while for shorter chains to C 28H58 the change is less, levelling off at high dose, Fig.l. It is also found that the change in a-spacing increases at higher dose rates and at higher irradiation temperatures.

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

We Have Tasted the Powers of the Age to Come: Thinking the Force of the Event—from Dynamis to Puissance

2018 ◽  
Vol 40 (1) ◽  
pp. 76-94 ◽  
Author(s):  
Thomas Clément Mercier
Keyword(s):  
History Of ◽  
To Come ◽  
Interpretative Model

Responding to the provocative phrase ‘The Age of Grammatology’, I propose to question the notion of ‘age’, and to interrogate the powers or forces, the dynameis or dynasties attached to the interpretative model of historical periodisation. How may we think the undeniable actuality of the event beyond the sempiternal history of ages, and beyond the traditional, onto-teleological chain of power, possibility, force or dynamis that undergirds such history?

Conclusion

2018 ◽  
Author(s):  
Stefan Winter
Keyword(s):  
Middle Eastern ◽  
Rich Diversity ◽  
The Social ◽  
Local Contexts ◽  
History Of ◽  
Religious Oppression ◽  
The Rich ◽  
To Come

This concluding chapter summarizes key themes and presents some final thoughts. The book has shown that the multiplicity of lived ʻAlawi experiences cannot be reduced to the sole question of religion or framed within a monolithic narrative of persecution; that the very attempt to outline a single coherent history of “the ʻAlawis” may indeed be misguided. The sources on which this study has drawn are considerably more accessible, and the social and administrative realities they reflect consistently more mundane and disjointed, than the discourse of the ʻAlawis' supposed exceptionalism would lead one to believe. Therefore, the challenge for historians of ʻAlawi society in Syria and elsewhere is not to use the specific events and structures these sources detail to merely add to the already existing metanarratives of religious oppression, Ottoman misrule, and national resistance but rather to come to a newer and more intricate understanding of that community, and its place in wider Middle Eastern society, by investigating the lives of individual ʻAlawi (and other) actors within the rich diversity of local contexts these sources reveal.

Case Report: Management of a Patient with mTBI and Vestibular Hypofunction with the Binasal Occlusion Technique

2018 ◽  
pp. 87-90
Keyword(s):  
Case Report ◽  
Visual Motion ◽  
Hand Movement ◽  
Motion Sensitivity ◽  
Vestibular Hypofunction ◽  
First Case ◽  
Neurological Exam ◽  
History Of ◽  
Occlusion Technique ◽  
Visual Vertigo

Background: Binasal Occlusion (BNO) is a clinical technique used by many neurorehabilitative optometrists in patients with mild traumatic brain injury (mTBI) and increased visual motion sensitivity (VMS) or visual vertigo. BNO is a technique in which partial occluders are added to the spectacle lenses to suppress the abnormal peripheral visual motion information. This technique helps in reducing VMS symptoms (i.e., nausea, dizziness, balance difficulty, visual confusion). Case Report: A 44-year-old AA female presented for a routine eye exam with a history of mTBI approximately 33 years ago. She was suffering from severe dizziness for the last two years that was adversely impacting her ADLs. The dizziness occurred in all body positions and all environments throughout the day. She was diagnosed with vestibular hypofunction and had undergone vestibular therapy but reported little improvement. Neurological exam revealed dizziness with both OKN drum and hand movement, especially in the left visual field. BNO technique resulted in immediate relief of her dizziness symptoms. Conclusion: To our knowledge, this is the first case that illustrates how the BNO technique in isolation can be beneficial for patients with mTBI and vestibular hypofunction. It demonstrates the success that BNO has in filtering abnormal peripheral visual motion in these patients.

Scales and Units

2018 ◽  
Author(s):  
Kathryn M. de Luna
Keyword(s):  
Language Change ◽  
Historical Linguistics ◽  
Bantu Languages ◽  
The North ◽  
First Case ◽  
Linguistic Evidence ◽  
River Region ◽  
History Of ◽  
Alternative Approaches

This chapter uses two case studies to explore how historians study language movement and change through comparative historical linguistics. The first case study stands as a short chapter in the larger history of the expansion of Bantu languages across eastern, central, and southern Africa. It focuses on the expansion of proto-Kafue, ca. 950–1250, from a linguistic homeland in the middle Kafue River region to lands beyond the Lukanga swamps to the north and the Zambezi River to the south. This expansion was made possible by a dramatic reconfiguration of ties of kinship. The second case study explores linguistic evidence for ridicule along the Lozi-Botatwe frontier in the mid- to late 19th century. Significantly, the units and scales of language movement and change in precolonial periods rendered visible through comparative historical linguistics bring to our attention alternative approaches to language change and movement in contemporary Africa.

Sign in / Sign up

Export Citation Format

Share Document