Ciprofloxacin induced acquired long QT syndrome in a patient under class III antiarrhythmic therapy

We report one case of cardiac arrest related to ciprofloxacin administration. One female patient (aged 70 years old) developed a marked QTc prolongation (QTc = 0.62 s) within 24 hours of ciprofloxacin administration, with documented torsades de pointes and recurrent syncope that required defibrillation. The patient was under amiodarone and sotalol therapy for atrial fibrillation, with no obvious QT prolongation prior to ciprofloxacin therapy. QT prolongation and subsequent torsades de pointes appeared only after initiation of ciprofloxacin and normalized after drug discontinuation. Even though ciprofloxacin is thought to be safer than other agents in its class, it may cause QT prolongation and torsades de pointes, particularly in high risk patients with predisposing factors. Prolongation of the QT interval related to the effect of fluoroquinolones on rapid potassium channels (IKr) may result on potentially serious proarrhythmic effect, leading to torsades de pointes

Simultaneous occurrence of cerebellar medulloblastoma and pituitary adenoma: A case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

An experimental investigation of the action of leptin on this hypophysiotropic - hypothalamic axis: a stereotaxic study on rats

The aim of this study is to evaluate the leptin action in vivo, on the tonical secretion of the gonanotropins. Adult female Wistar rats were divided in five groups. Group A rats (n=4) were normal intact rats (control). In Group B (n=4), the rats were stereotaxically administrated with recombinant rat leptin in the third cerebral ventricle (specific control). In Groups C (n=4), D (n=4) and E (n=4), the rats were subjected to electrolytic lesion of the Arcuate nucleus (Arc), of the Ventromedial nucleus (VMN) and of both of these hypothalamic nuclei respectively. Then they were injected with leptin as the control subjects and blood sampling was performed after 6hr and 24hr for serum LH and FSH levels estimation. The results show that LH serum level increased dramatically (340%) in group B, 6 hours after leptin administration. However, the levels reverted on the initial basic level after 24 hours after leptin administration. The LH level in Groups C, D and E showed the same pattern with a lower peak (148%, 157% and 123%). The FSH level duplicated in all groups without any difference. The results indicate that leptin affects the gonanotropin secretion, when administrated ventricularly and acts on both the hypothalamus and the pituitary gland. Nuclei lesions have an impact on the LH, but not on the FSH secretion. The different responses observed on the LH and FSH secretion showed that this could be due to: a) different localization of Ob-Rs, b) different Ob-R isoforms, c) different mechanism of leptin hormonal action and d) existence of specific releasing factors for the FSH.Η εργασία εστίασε στην επίδραση της λεπτίνης στην τονική έκκριση των γοναδοτροπινών. Οι θήλεις επίμυες της φυλής Wistar, που χρησιμοποιήθηκαν διαιρέθηκαν στις ακόλουθες ομάδες: Την ομάδα Α που περιλάμβανε άθικτα ζώα (γενικοί μάρτυρες), την ομάδα Β στα ζώα της οποίας χορηγήθηκε μόνο λεπτίνη (ειδικοί μάρτυρες) και σε τρεις ομάδες (Γ, Δ, και Ε) πειραματοζώων στα οποία, αφού καταστράφηκαν με επίδραση ηλεκτρικού ρεύματος είτε ο τοξοειδής (ομάδα Γ), είτε ο κοιλιακός-έσω πυρήνας (ομάδα Δ) του υποθαλάμου, είτε και οι δύο μαζί (ομάδα Ε), στη συνέχεια χορηγήθηκε λεπτίνη στερεοταξικά στην τρίτη κοιλία. Ακολούθησαν δύο αιμοληψίες μετά από 6 και 24 ώρες, οπότε μετρήθηκαν η LH και η FSH στον ορό του αίματος. Η επιλογή καταστροφής του τοξοειδή και του κοιλιακού-έσω πυρήνα έγινε επειδή αυτοί ελέγχουν την τονική έκκριση των LH και FSH και επειδή αποτελούν θέση του εγκεφάλου στην οποία εκφράζονται με αφθονία και ποικιλία οι υποδοχείς της λεπτίνης (Οb-R). Διαπιστώθηκε σημαντική αύξηση της LH (340%) στις 6 ώρες, μετά την χορήγηση στα λεπτίνης ζώα της ομάδας Β, η οποία αποσβέσθηκε στις 24 ώρες. Η ιδία απάντηση, αλλά ασθενέστερη, παρατηρήθηκε στα ζώα των ομάδων Γ και Δ (148% και 157% αντίστοιχα). Η αύξηση ήταν ακόμη μικρότερη, χωρίς βέβαια να εξαλείφεται πλήρως, όταν καταστράφησαν και οι δύο πυρήνες (123%). Συμπεραίνεται επομένως, ότι η λεπτίνη εμφανίζεται ότι δρα τόσο στους πυρήνες του υποθαλάμου όσο και απευθείας στην υπόφυση. Η FSH διπλασιάσθηκε στο πρώτο εξάωρο μετά τη χορήγηση λεπτίνης στα ζώα της ομάδας Β και σε 24 ώρες επανέκαμψε στα προηγούμενα επίπεδα. Η καταστροφή των πυρήνων (τοξοειδούς ή/και κοιλιακού) δεν είχε συνέπειες στην αύξηση της έκκρισης της FSH. Η διαφορετική επίδραση της λεπτίνης στην έκκριση των γοναδοτροπινών θα μπορούσε να αποδοθεί στα ακόλουθα: α) διαφορετική εντόπιση των Οb-R υποδοχέων β) διαφορετική ισομορφή Ob-R, γ) διαφορετικό μηχανισμό ορμονικής δράσης ή τέλος δ) στην ύπαρξη διαφορετικού εκλυτικού παράγοντα για LH και FSH

Is there any potential link among caspase-8, p-p38 MAPK and bcl-2 in clear cell renal cell carcinomas? A comparative immunohistochemical analysis with clinical connotations

10.1186/1746-1596-4-7Diagnostic Pathology41

Is there any potential link among caspase-8, p-p38 MAPK and bcl-2 in clear cell renal cell carcinomas? A comparative immunohistochemical analysis with clinical connotations

Abstract Background Clear cell renal cell carcinomas (ccRCCs) constitute the most common renal carcinomas, characterized by a relatively aggressive clinical course. Thus, scientific research is targeting towards the identification of immunohistochemical and molecular markers that could be useful regarding diagnosis, appropriate therapy and prediction of prognosis. In the present study we assessed and correlated the expression of caspase-8, phosphorylated p38 mitogen-activated protein kinase (p-p38) and bcl-2 protein with histopathological features and clinical outcome of 27 patients with ccRCCs. Method Immunohistochemistry in formalin-fixed and paraffin-embedded tissue sections was performed. The associations among various features were assessed utilizing statistical analysis. Results We found that increased expression of cytoplasmic caspase-8 and bcl-2 protein was strongly associated with low Fuhrman's grade of carcinomas (p = 0.019 and p = 0.041, respectively). On the other hand, increased p-p38 expression was significantly related to high Fuhrman's grade (p = 0.006). Moreover, high bcl-2 expression was correlated with low pathological stage of ccRCCs (p = 0.026). Increased expression of cytoplasmic caspase-8 as well as low-grade tumors (grade 1 and 2) implied a greater probability of patients' survival, in univariate statistical analysis (p = 0.037 and p = 0.019, respectively). Neither p-p38 nor bcl-2 expression was significantly linked to patients' survival. There were not emerged statistically significant associations among caspase-8, p-p38 kinase and bcl-2 protein. Conclusion For the first time the prognostic impact of caspase-8 and p-p38 was studied in a series of ccRCCs, using immunohistochemistry in formalin-fixed and paraffin-embedded tissue sections. The suggestive relationship of caspase-8 with patients' clinical outcome, as well as the role of p-p38 within different grade categories, mandates further studies in larger cohorts of RCCs.</p

Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients’ everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS

Factors Affecting the Nuclei in Newborn and Children

It is known that children are more sensitive to the effects of medical treatments and environment than adults. Today there is limited information regarding the differences in genotoxic effects in children. The micronucleus assay is a method that is used to monitor genotoxicity, and it was validated several years before. Today there is international interest for exfoliated buccal cells. Most of the micronuclei studies in children have been performed with the analyses of lymphocytes. However, there is vast interest in using exfoliated cells from the oral cavity. The reason is that other type of cells are acquired non-invasively, this is an important issue in paediatric cohorts. Unfortunately a limitation of measuring micronuclei frequency is that it has been observed to be low in newborns and on the other hand there are a large number of patients and cell sample counts. It has been observed that radiation exposure and environmental pollutants increase the micronuclei frequency in newborn and children. Regarding the medical treatments, there is little data and several studies are needed to optimise the doses. There is the need to observe if there is a relationship between micronuclei in lymphocytes and exfoliated cells and to identify the baseline of the micronuclei levels. Moreover, we evaluate the changes in response to the toxic agents. Prospective cohorts studies will clarify the predictive value of micronuclei for cancer and chronic diseases for both children and adults. Novel molecular technologies will assist in the elucidation of different biological pathways and molecular mechanisms connected with the micronulcei levels in newborn and children

Radial-EBUS: CryoBiopsy Versus Conventional Biopsy: Time-Sample and C-Arm

Introduction: Diagnosis of lung nodules is still under investigation. We use computed tomography scans and positron emission tomography in order to identify their origin. Patients and Methods: In our retrospective study, we included 248 patients with a single lung nodule or multiple lung nodules of size &ge;1 cm. We used a radial-endobronchial ultrasound and a C-Arm. We used a 1.1 mm cryoprobe versus a 22G needle vs. forceps/brush. We compared the sample size of each biopsy method with the number of cell-block slices. Results: Central lesions indifferent to the method provided the same mean number of cell-block slices (0.04933&ndash;0.02410). Cryobiopsies provide less sample size for peripheral lesions due to the higher incidence of pneumothorax (0.04700&ndash;0.02296). Conclusion: The larger the lesion &ge;2 cm, and central, more cell-blocks are produced indifferent to the biopsy method (0.13386&ndash;0.02939). The time of the procedure was observed to be less when the C-Arm was used as an additional navigation tool (0.14854&ndash;0.00089)