Severe hyperkalaemia due to a potential drug–drug interaction between eplerenone and antiretrovirals in a HIV-positive patient after a myocardial infarction

We present a case of a 48-year-old white HIV-1 positive man who presented an acute myocardial infarction. The patient was on ART for the last ten years with emtricitabine/tenofovir and ritonavir-boosted fosamprenavir. Eplerenone 25 mg/day was also initiated due to a left ventricular dysfunction. A week after discharge a routine laboratory examination revealed severe hyperkalaemia. Due to suspicion of a potential drug–drug interaction, both eplerenone and ARVs were interrupted. Despite daily treatment for hyperkalaemia, serum potassium levels normalized after two weeks. Eplerenone is metabolized by the hepatic P450 cytochrome isoenzyme CYP3A4; therefore, concomitant administration with CYP3A4 inhibitors, like ritonavir, may increase plasma levels of eplerenone and, therefore, the risk of side effects, mainly hyperkalaemia. Based on this case, it is important to alert the medical community of this possible life-threatening drug-drug interaction between eplerenone and ritonavir-boosted protease inhibitor.

Application of assessment of deviations of hematological indices as a sign of destabilization of homeostasis in greenhouse workers

Introduction. Sustainable socio-economic development of any country depends on the state of its labor resources, the quality of which is determined by the number and level of health of the working-age population. The current stage of development of society is characterized by the need to increase the efficiency of agriculture. An important role in the implementation of this task belongs to greenhouses. Purpose. To investigate the hematological indices in greenhouse workers and determine their significance as early signs of the destabilization of homeostasis and the development of occupational diseases. Material and methods. In the present work, laboratory studies were conducted on greenhouse workers. Results. A routine laboratory examination workers in the greenhouse economy to show abnormalities in the blood system. The average hemoglobin level in the main group was 106.00 ± 9.04 g / l. White blood changes in the form of neutrophilic leukocytosis were detected in 8.82 ± 3.46%, lymphocytosis in 39.71 ± 5.98%, eosinophilia in 14.71 ± 4.33% of all examined individuals of the main group. Discussion. Significant changes were revealed depending on the duration of exposure to adverse factors and manifested by the formation of an anemic syndrome, lymphocytosis, increased allergization, severe thrombocytopenia. Conclusion. The results obtained can serve as one of the criteria for the early diagnosis of chronic intoxication.

Detection of Metalo-Beta-Lactamase Gene in Carbapenem Resistant Pseudomonas Aeruginosa Isolated From Lahore, Pakistan

Pseudomonas aeruginosa is a widespread organism, caused severe nosocomial infection in human andassociated with multiple drug resistance (MDR) Objective: The present study was carried out to observecurrent antimicrobial resistant pattern of Pseudomonas aeruginosa in Lahore and to detect the Metallobeta-lactamase (MBL) gene in carbapenem resistant Pseudomonas aeruginosa Methods: By screening360 samples total 123 Pseudomonas aeruginosa was identified by standard microbiology techniques suchas microscopy and biochemical testing. The isolated Pseudomonas aeruginosa was evaluated for drugresistance by disc diffusion method and polymerase chain reaction (PCR) was used to identify thecarbapenem resistance causing gene (bla-VIM and bla-IMP) Results: Following antibiotic resistantpattern was observed, Gentamycin (59.00%), Ceftazidime (58.7%), Ceftriaxone (58.00%), Cefotazime(57.0%) and Ciprofloxacin (55.00%). Resistance rates to carbapenem group of antibiotics is Doripenem(30.5%) Meropenem (31.0%) and Imipenem (28.0%). Out of 123 samples of Pseudomonas aeruginosa, 28isolates were found resistant to carbapenem group of antibiotic which was supposed to be highlysensitive for this bacterium. Molecular based identification of resistance genes showed that bla-IMP genewas present in 32.1% (09) and bla-VIM was found positive in 17.8% (04) samples. Metallo-beta-lactamasesproducing genes (bla-VIM and bla-IMP), among carbapenem resistant Pseudomonas aeruginosa weredetected in 28.1% of samples. If other carbapenem resistant gene were also included this number mightbe higher Conclusions: PCR based test should be included in routine laboratory examination for quickdetection of the resistance causing genes.

Blood pH and urinary uric acid-creatinine ratio in newborns with asphyxia

Background Asphyxia is one of the leading causes of death inthe world. Prematurity (28%), sepsis (26%), and asphyxia (23%)are the most common causes of death in newborns. In Indonesia,the newborn mortality incidence is 82 per 1,000 live births. BloodpH is a routine laboratory examination to diagnose newbornasphyxia, but it is preferrable to avoid such invasive procedures innewborns. An examination of urinary uric acid-creatinine (UA/Cr) ratio may be useful as an alternative method for diagnosisof asphyxia. Hypoxia causes anaerobic metabolism which willincrease the blood acidity, while creatinine will decline as a resultof incomplete renal function in newborns.Objective To assess for a possible correlation between blood pHand urinary UA/Cr ratio in newborn asphyxia.MethodsWe conducted an observational, cross-sectional study inProf. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, fromNovember 2013 to April 2014. Subjects were full term newbornswith asphyxia. Blood pH and urinary UA/Cr ratio were comparedwith Pearson’s correlation test. Data was analyzed with SPSSversion 22 software and P values <0.05 were considered to bestatistically significant.Results Forty subjects met the inclusion criteria. Theirpredominant risk factor for asphyxia was fetal distress. Subjects’mean blood pH was 7.1 (SD 0.1) and mean urinary UA/Cr ratio was3.7 (SD 1.9). There was a moderate negative correlation betweenblood pH and urinary UA/Cr ratio (r= -0.55; P<0.001).Conclusion In newborns with asphyxia, lower blood pH iscorrelated with higher urinary UA/Cr ratio.

An unusual case of mesalazine intoxication: Oral and rectal overloading of the rectal suppository form

Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel diseases for more than half a century, but no case about overdose of suppository form of mesalazine which was taken both orally and rectally has been reported in the related literature up to now. In the present case, a 20-year-old male patient who took 14.5 g of mesalazine rectally and orally for suicide purpose is discussed. He was an ulcerative colitis patient and depressed about his illness and routine life traffic. Although it was hard for him to take the suppository form orally because of its bad taste and structure, he took it with the help of water. In the patient’s colonoscopy, diffuse hyperemia and edema extending from the anal channel to the proximal rectal mucosa and a 1.5 cm diameter ulcer expanding from anal channel through the rectum were identified. No pathology was found in the upper gastrointestinal endoscopy. Routine laboratory examination was performed and no abnormality was identified in the patient’s total blood account, biochemical parameters and full-urine examination. In the control rectoscopy applied to the patient 15 days later, recovery of the ulcer was observed and he was discharged to be followed in the psychiatry clinic.

Antimicrobial Susceptibility Testing ofBilophila wadsworthia Isolates Submitted for Routine Laboratory Examination

MICs of antibiotics against Bilophila wadsworthiaisolates were measured by agar and broth microdilution with pyruvic acid and by Etest. The inoculum size influenced greatly agar dilution. Despite discrepancies in MICs depending on the measurement method used, clindamycin consistently showed potent activity. Broth microdilution and Etest appear to be candidates for laboratory susceptibility testing.

A NEW ASYMPTOMATIC TYPE III VARIANT OF ANTITHROMBIN III WITH DECREASE HEPARIN COFACTOR ACTIVITY : AT III AMIENS

A qualitative abnormality of AT III suggested by the discrepancy between a normal level of AT III antigen (0,33 g/1) and a decreased heparin cofactor activity (60 % of normal) was discovered in a 37 years old woman during a routine laboratory examination for oral contraceptive. The propositus was asymptomatic as she did not developpe any thrombo-embolic disease during three previous pregnancies. There was no familial history of thrombo-embolism. The AT III level measured by radial immuno-diffusion was within the normal range. The progressive anti factor lia and anti factor Xa activities (chromogenic substrates CBS 3 447 and CBS 3 139) were normal (92 % and 100 %). Plasma and serum crossed immunoelectrophoresis (CIE) showed a normal pattern. In the presence of heparin, anti factor Xa and anti factor Xa activities were decreased (60 % and 45 %); Plasma and serum crossed immunoelectrophoresis showed an abnormal slow moving peak exhibiting the inhability of the molecule to bind completely to heparin. CIE with various other glycosaminoglycans are on experiments.Familial study revealed that the daughter of the propositus was carrying the same molecular abnormality.We conclude that AT III Amiens is an hereditary type III variant.