Catheter-Related Sepsis by Candida pararugosa in an Adult Patient under Chemotherapy Regimen

Candida pararugosa is present in animals and humans in different organs and biological liquids, usually as a saprophyte. We report the case of a 61-year-old woman diagnosed with de novo stage IV metastatic lobular breast cancer, carrying a central venous catheter (port-a-cath) and bilateral stents for perirenal infiltration by malignancy. During chemotherapy regimen, a febrile episode occurred, along with a high level of serum glucan. The port-a-cath was removed after blood collection for culture, which gave isolation of Candida pararugosa strains. Given high glucan level and the patient’s frailty, empirical treatment with fluconazole was started with load-dose, 800 mg orally, at day 1 and, afterwards, with 400 mg daily for two weeks. The phenotype of susceptibility to antibiotics of the strain demonstrated lower minimal inhibitory concentration to fluconazole than that reported in the literature. The patient remained asymptomatic, and inflammation parameters showed normalization. Unfortunately, three weeks later, meningeal localization of cancer caused rapid deterioration and death.

Effect of CYP2C9 *11/*11 genotype on initial and long-term warfarin dose requirement and therapeutic response

The warfarin dose requirement and therapeutic response of a 42-year-old African–American male with genotype CYP2C9 *11/*11, VKORC1 -1639GG and CYP4F2 433Val/Val anticoagulated for ischemic stroke is described herein. Warfarin was dosed according to the institution’s personalized medicine program recommendations of a 10 mg mini-load dose, followed by dose decreases to 4–6 mg/day through discharge. Stable international normalized ratio was achieved after eight doses, with good overall long-term maintenance of therapeutic international normalized ratio over several years with warfarin doses of 3.1–4.3 mg/day. This case report sheds further light on the clinical impact of CYP2C9 *11/*11 on warfarin dose requirements, short- and long-term treatment response and practical considerations for warfarin management in suspected carriers of rare variant CYP2C9 alleles.

COMPARATIVE ANALYSIS OF THE CONCENTRATION OF INJECTED HORSERADISH PEROXIDASE IN CYTOPLASMIC GRANULES OF THE KIDNEY CORTEX, IN THE BLOOD, URINE, AND LIVER

The concentration of horseradish peroxidase in total particulate fractions from the kidney cortex did not change much during the first few hours after injection, as long as most of the injected protein was not yet cleared from the blood. It decreased at a rate of 6–8% per hr afterwards. The concentration of peroxidase in total particulate fractions increased in proportion to the load (dose) over a wide range, suggesting that a constant fraction of the protein was reabsorbed by micropinocytic vesicles into the tubule cells from the glomerular filtrate. The amount of peroxidase excreted in the urine also increased in proportion to the injected dose. The proportion of peroxidase taken up by the liver, however, decreased several times when the dose was increased. A marked decrease of protein uptake into the kidney cortex and an increase of urinary excretion were observed when rats received a second, equal dose of peroxidase 4 hr after the first injection, and the rate of clearance of peroxidase from the blood was decreased after the second injection. The liver, on the other hand, took up almost twice as much peroxidase after two injections as after one. The uptake of peroxidase by the kidney cortex increased with age. Cytochemical observations on the preferential absorption of peroxidase by certain cell types and segments of the renal tubules in relation to dose are reported.