Dangerous interaction of bitter melon (Momordica charantia) with pazopanib: A case of acute pancreatitis

Introduction Acute pancreatitis associated with Pazopanib has been reported in the literature. Bitter Melon (Momordica Charantia) is traditionally used as a folk medicine in many regions. In this report, we describe a 65-year-old patient with a diagnosis of renal cell carcinoma, admitted to the hospital with symptoms of acute pancreatitis at the 8th year of pazopanib treatment. Case Report The patient diagnosed with renal cell carcinoma was admitted to the hospital with the complaint of abdominal pain, nausea, and vomiting in the 8th year of Pazopanib treatment. It was noticed from the patient's history that he had received Bitter Melon extract for 4 days prior to the beginning of his complaints (100–150 ml/day). Levels of serum amylase and lipase were measured as 9163 U/L and 14,206 U/L, respectively. Management & Outcome Pazopanib drug was held. The patient was treated for acute pancreatitis. Pazopanib treatment was started again after the clinical condition of the patient had improved and levels of serum amylase and lipase had returned to normal levels. Levels of serum amylase and lipase did not increase again after re-administration of pazopanib treatment. Discussion It is thought that Bitter Melon extract and pazopanib interaction might have led to acute pancreatitis. To the best of our knowledge, this case is the first to highlight the interaction of Bitter Melon extract with pazopanib. The Drug Interaction Probability Scale indicates that there is a probable association between bitter melon and acute pancreatitis.

Possible inhibitory effects of terbinafine on aripiprazole metabolism: Two case reports

Aripiprazole, an atypical antipsychotic, is a metabolic substrate for cytochrome P450 (CYP)3A4 and 2D6. Terbinafine, an antifungal agent used for onychomycosis, is a CYP2D6 inhibitor and could theoretically reduce the metabolism of aripiprazole. However, there are no published reports describing this interaction. We present 2 female patients hospitalized in a psychiatric unit who were both taking aripiprazole 15 mg daily and terbinafine 250 mg daily prior to admission. The first patient was a 58-year-old female who was prescribed aripiprazole and terbinafine concomitantly for approximately 5 months prior to admission. A commercial pharmacogenetic testing platform classified this patient as a normal metabolizer for CYP3A4 and 2D6. The first patient's serum trough aripiprazole concentration at steady-state concentration (Css) was 207.5 ng/mL. The second patient was a 43-year-old female who was taking aripiprazole and terbinafine concomitantly for approximately 2 weeks prior to admission who had a Css aripiprazole concentration of 278.9 ng/mL. Aripiprazole has a wide therapeutic range (100 to 350 ng/mL) and a reference dose-related drug concentration of 11.7 (mean) ± 5.6 (SD) ng/mL/mg/d. Our patients had Css aripiprazole concentrations 18% and 59% higher than guideline-supported dose-related drug concentrations. Through the use of therapeutic drug monitoring, pharmacogenetic data, electronic pharmaceutical claims data, and the Drug Interaction Probability Scale, we suggest terbinafine possibly increases aripiprazole concentrations 18% to 59%. Further reports are needed to confirm these findings prior to using this information in clinical practice.

Computational evaluation of a novel beta radiation probe design using integrated circuits

Researchers at Texas A&M University (TAMU) have designed the radiation integrated circuit (RIC) for deployment as a new radiation detection system. Most integrated circuits are susceptible to radiation-induced failures, and decades of research have gone into solving this problem. Research at TAMU has led to a novel integrated circuit design that utilizes both radiation-hardened areas (RHAs) and radiation-sensitive areas (RSAs) to take advantage of these failures. The RSAs are susceptible to charged particle interactions, allowing the RIC to detect alpha and beta particles. However, beta particles are more penetrating compared to alpha particles, resulting in a lower interaction probability for beta particles incident on a bare RIC. In any material, the higher the beta energy, the deeper the beta particle can penetrate; therefore, the use of a wedge-shaped attenuator for beta particle detection not only increases interaction probability, but also provides the capability to perform maximum beta energy discrimination in the field. The objective of this research was to optimize the design of the RIC. Monte Carlo N-particle radiation transport code (MCNP) simulations assessed the beta particle detection and maximum energy discrimination performance of plate glass, borosilicate (Pyrex®) glass, acrylic (Lucite®), and natural rubber attenuators. In this proof-of-concept analysis, natural rubber was observed to be the optimal attenuating material for the beta probe with respect to maximum energy discrimination capability and weight, but all materials considered proved to be good candidates. The results of this study are promising and indicate the potential to achieve maximum beta particle energy discrimination of 50 keV using a wedged, natural rubber attenuator on the RIC.

Predictions of Ultra-High Energy Cosmic Ray Propagation in the Context of Homogeneously Modified Special Relativity

Ultra high energy cosmic rays (UHECRs) may interact with photon backgrounds and thus the universe is opaque to their propagation. Many Lorentz Invariance Violation (LIV) theories predict a dilation of the expected horizon from which UHECRs can arrive to Earth, in some case even making the interaction probability negligible. In this work, we investigate this effect in the context of the LIV theory that goes by the name of Homogeneously Modified Special Relativity (HMSR). In this work, making use of a specifically modified version of the SimProp simulation program in order to account for the modifications introduced by the theory to the propagation of particles, the radius of the proton opacity horizon (GZK sphere), and the attenuation length for the photopion production process are simulated and the modifications of these quantities introduced by the theory are studied.

Modeling Evacuation of High-Rise Buildings Based on Intelligence Decision P System

High-rise buildings usually have more complex architectural structures and hold more people than single-storey buildings. Currently, crowd management under emergent conditions, especially rapid evacuations of high-rise buildings, is a worldwide problem. In this study, a bio-inspired simulation technology extracted from a cell migration process, namely Intelligent Decision System (IDPS), was used to model the dynamic evacuation of high-rise buildings and calculate the evacuation time for different scenarios. This work was motivated by the comparability between the pedestrian movement behavior and cell migration process. Specific structure information of high architecture was also described in IDPS. A case study was done about evacuation simulation of a 12-storey teaching building in China University of Geosciences in Beijing. The simulation results showed that evacuation time varied with different parameters, such as density threshold, interaction probability, walking speed, population distribution, and stair width. With the proper density threshold and good interaction probability, the load balance of staircases and exits can be improved. For staircases with high utilization ratios, it was recommended that the evacuation process can be accelerated by widening the staircases appropriately. Finally, the impact of initial number of evacuees at each floor level was also analyzed in view of safety management.

Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

Objective: To report a probable interaction between warfarin and edible cannabis that resulted in an elevated international normalized ratio (INR) without bleeding complications. Case Summary: A 35-year-old Middle Eastern male on warfarin long term with an INR goal of 2.5 (accepted range: 2.0-3.0). The patient has generally been stable on warfarin 10 mg daily from 2010 to 2018, until INR suddenly increased to 7.2 following 1 month of edible cannabis ingestion and cannabis smoking. Patient denied any signs and symptoms of bleeding. No other reasonable causes of the elevation in INR were apparent. The patient was advised to hold 2 doses of warfarin and discontinue cannabis use. The INR dropped below 4 upon discontinuation of cannabis with dose adjustments to warfarin. Discussion: The elevation in INR can be explained by the inhibition of CYP2C9 by cannabis use causing decreased metabolism of warfarin. The interaction between warfarin and cannabis was determined to be probable using the Horn Drug Interaction Probability Scale. Conclusions: There are no previous reports of interactions between edible cannabis and warfarin, with very few case reports describing the interaction with other forms of cannabis. Close monitoring of INR in patients with concomitant cannabis is recommended for proper warfarin management.

Modeling Corruption as a Contagious Disease

A system of ordinary differential equations (ODEs) was developed to model the interaction dynamics between public servants and the citizens they serve to provide insights to the evolution of corruption in the public service. Corruption is modeled as a contagious disease that can "infect" susceptible citizens when they interact with "infected" (i.e., corrupt) public servants through harassment bribery. In this model, the public servants and the citizens are compartmentalized into different classes. The public servants could be honest (SH), on a crossroad (SX), corrupt (SC), or dismissed (SD), while citizens could either be upright (CU), apathetic (CA), cooperators (CC), or whistleblowers (CW). SH do not ask for harassment bribery while SX have asked for harassment bribery but only choose which citizen to ask from. SC always ask for harassment bribery no matter what, while SD have been dismissed from public service (and prosecuted) as a result of complaints. CU and CA do not give bribery but the former always complain when public servants ask for them, while the later do not do anything. CC and CW give bribery but the former willingly give them, while the later grudgingly give them and then complain. The ODEs provide for intra- and inter-action dynamics between the public servants and citizens with probabilities of interactions among actors as parameters of the model. Various combinations of interaction probability values provide for scenarios when corruption in the form of harassment bribery will become contagious, epidemic, and self-correcting (i.e., self-healing).