Pazopanib and Statin-Induced Rhabdomyolysis

Background: The VEGF inhibitor pazopanib is a widely used first-line therapy for the treatment of advanced renal cell carcinoma. Potential drug-drug interactions and toxicities may be underrecognized. Case Presentation: A 73-year-old woman with metastatic renal cell carcinoma on treatment with pazopanib presented with progressive inability to ambulate. The initial concern was for metastasis to the spine. However, MRI of the spine revealed diffuse muscle edema with no metastatic deposits or lytic lesions. Upon further evaluation, creatine kinase was significantly elevated and the diagnosis of rhabdomyolysis was made. With aggressive hydration and discontinuation of both pazopanib and rosuvastatin, the patient made a full recovery. Conclusion: This case of drug-induced rhabdomyolysis demonstrates an unexpected toxicity resulting from concomitant pazopanib and rosuvastatin therapy. This combination is predicted to be safe due to different, nonoverlapping effects on the cytochrome p450 enzymes. Discontinuation of statin therapy in patients with metastatic cancer should be considered when the risk of cancer-related death exceeds the risk of cardiovascular-related death

Hypotensive effect of Cichorium intybus extract in rats

Introduction: Oxidative stress is involved in many diseases, including hypertension, kidney failure, and heart disease. This study aimed to evaluate the effect of hydroalcoholic Cichorium intybus extract on blood pressure in rats. Antioxidant activity, phenolic and flavonoid contents of the plant extract were also evaluated. Methods: In this study, 32 male Wistar rats weighing 250-300 g were divided into four groups of eight each. Animals in the control group were administered with normal saline and in the C. intybus groups with extract at 25, 50, and 100 mg/kg for two weeks. Then, the homodynamic parameters were examined by the Power lab. The phenolic and flavonoid contents were also evaluated by a spectrophotometer and the rate of free radical scavenging activity was measured by the diphenyl-1-picyryl-hydrazyl (DPPH) free radical method. Results: The free radical scavenging activity of C. intybus extract was obtained 47.85 of DPPH, and flavonoid and phenolic contents were 8.21 and 27.19 mg/g of dry extract, respectively. Meanwhile, median (MAP), systolic (SAP) and diastolic arterial pressure (DAP) significantly decreased in the 50 mg/kg extract-treated group compared to the control and 200 mg/kg extract-treated groups. Conclusion: Ethanol extract of C. intybus plays a protective role against hypertension, which, in part, might be due to antioxidant compounds of the plant against free radicals

Effects of muscle quantity and bone mineral density on injury and outcomes in older adult motor vehicle crash occupants

Objectives: Quantify the independent and combined effects of abdominal muscle quantity and lumbar bone mineral density (BMD) on injury risk and in-hospital outcomes in severely injured motor vehicle crash (MVC) occupants ages 50 and older. Methods: Skeletal muscle area measurements of MVC occupants were obtained through semi-automated segmentation of an axial computed tomography (CT) slice at the L3 vertebra. An occupant height-normalized Skeletal Muscle Index (SMI) was calculated - a defining metric of sarcopenia and low muscle mass (sarcopenia thresholds: 2/m2 females; 2/m2 males). Lumbar BMD was obtained using a validated, phantomless CT calibration method (osteopenia threshold: 3). SMI and BMD values were used to categorize occupants, and logistic regression was used to associate sarcopenia, osteopenia, and osteosarcopenia predictors to injury outcomes (e.g., Injury Severity Score (ISS), maximum Abbreviated Injury Scale (MAIS) score, fractures) and hospital outcomes (e.g., length of stay, ICU days). Results: Of the 336 occupants, 210 (63%) were female (mean ± SD: age 66.3 ± 10.6). SMI was 41.7 ± 8.0 cm2/m2 in females and 51.2 ± 10.8 cm2/m2 in males. Based on SMI, 40% of females and 55% of males were classified as sarcopenic. BMD was 163.2 ± 38.3 mg/cm3 in females and 164.1 ± 35.4 mg/cm3 in males, with 41% of females and 33% of males classified as osteopenic. Prevalence of both conditions (osteosarcopenia) was similar between females (21%) and males (22%). Incidence of low SMI and BMD increased with age. Sarcopenic individuals were less likely to sustain a MAIS 2+ thorax injury and had longer ICU stays. Osteopenic individuals were more likely to sustain upper extremity injuries and fractures, and were less likely to be discharged to a rehabilitation facility. Osteosarcopenic individuals were less likely to be ventilated or admitted to the ICU but tended to spend more time on the ventilator if placed on one. Conclusions: Osteosarcopenia was not associated with any injury outcomes, but sarcopenia was associated with thoracic injury and osteopenia was associated with upper extremity injury incidence. Sarcopenia was only associated with ICU length of stay, while osteopenia was only associated with discharge destination. Osteosarcopenia was associated with likelihood of being ventilated, being admitted to the ICU, and with increased length of ventilation.</p

The impact of generic form of Clopidogrel on cardiovascular events in patients with coronary artery stent: results of the OPCES study

Background: To compare the early and late cardiovascular events as well as side effects of Osvix, a generic form of Clopidogrel versus Plavix regimens in patients with chronic stable angina, undergoing bare metal stent (BMS) or drug eluting stent (DES) placement, this study was carried out. Methods: A total of 442 patients with chronic stable angina who were scheduled for elective percutaneous coronary intervention (PCI) were included in a randomized, double blind, multi-centric clinical trial being performed in 6 distinct university hospitals in 5 cities of Iran from March 2007 to November 2009. Baseline, demographic and history of risk factors were recorded using the patients′ medical charts. Stenting procedure was performed via transfemoral approach using low osmolar contrast agents. Patients underwent BMS or DES placements based on the physician selection and were randomly assigned to Osvix or Plavix groups. Patients were followed by telephone in 0 and 6 months intervals regarding the major adverse cardiovascular events (MACE) including death, myocardial infarction, in-stent thrombosis, stroke, target lesion revascularization, and target vascular revascularization. Angina episodes, bleeding, liver enzymes, neutrophils and platelets count were also assessed in these intervals. Results: There was not any significant difference between these two groups regarding the baseline characteristics. In the DES group, the 6-month mortality rate and the incidence of MACE in Osvix and Plavix groups were 0.9% and 1.9% (p = 0.61) and 1.8% and 4.9% (p = 0.26), respectively. During the follow up period after DES or BMS placement, there wasn′t any significant difference regarding neutrophil and platelet counts or liver enzymes between study groups. Conclusions: Using Osvix and Plavix are followed by similar major cardiovascular events and side-effect profile in patients undergoing PCI

The Epidemiology of Aggression and Associated Factors among Iranian Adult Population: A National survey

Background: This survey was conducted to determine the level of aggression among the Iranian adult population and underlying predisposing factors. Study design: A cross-sectional study. Methods: This cross-sectional study included 10,957 participants, involving 23 out of the 31 provinces of Iran in 2019. The outcome of interest was aggression, evaluated by the Buss & Perry aggression questionnaire. The association between aggression and 34 demographic, behavioral, social, and cultural characteristics was assessed using simple and multiple linear regression. Results: The overall mean (SD) score of aggression was 77.10 (22.53). Based on the severity of aggression, the participants were categorized into four groups as follows: 2,464 (23.1%) nonaggressive, 4,692 (43.9%) mild, 3,071 (28.8%) moderate, and 454 (4.2%) severe aggressive. Aggression was more likely to occur in people with the following characteristics: younger ages, having several siblings, lower ranks of birth, having an intimate friend of the opposite sex, having an aggressive father/mother, history of parental divorce, interest in watching action/porn movies, listening to music, history of escape from home/school, using neuropsychiatric drugs, using illicit drugs, history of suicidal thoughts/attempt, and family conflict and hostility. Aggression was less likely to occur with the following characteristics: reading, regular physical exercise, the ability to control anger, regular prayer, adherence to avoid lying, respect to other people's rights, sexual satisfaction, and attachment to parents. Conclusions: A majority of the population has some degree of aggression. Aggression is a multifactorial behavior corresponding with several demographical, social, cultural, and religious factors, some of which back to early childhood events