Pregabalin- and azithromycin-induced rhabdomyolysis with purpura: An unrecognized interaction: A case report

AbstractIntroductionRhabdomyolysis associated with the use of pregabalin or azithromycin has been demonstrated to be a rare but potentially life-threatening adverse event. Here, we report an extremely rare case of rhabdomyolysis with purpura in a patient who had used pregabalin and azithromycin.Presentation of caseWe present the case of a 75-year-old woman with a history of fibromyalgia who was admitted with mild limb weakness and lower abdominal purpura. She was prescribed pregabalin (75mg, twice daily) for almost 3 months to treat chronic back pain. Her medical history revealed that 3days before admission, she began experiencing acute bronchitis and was treated with a single dose of azithromycin (500mg). She had developed rapid onset severe myalgia, mild whole body edema, muscle weakness leading to gait instability, abdominal purpura and tender purpura on the lower extremities. Laboratory values included a white blood cell count of 25,400/mL and a creatinine phosphokinase (CPK) concentration of 1250 IU/L. Based on these findings and the patient’s clinical history, a diagnosis of pregabalin- and azithromycin-induced rhabdomyolysis was made.DiscussionThe long-term use of pregabalin and the initiation azithromycin therapy followed by a rapid onset of rhabdomyolysis is indicative of a drug interaction between pregabalin and azithromycin.ConclusionWe report an extremely rare case of rhabdomyolysis with purpura caused by a drug interaction between pregabalin and azithromycin. However, the mechanisms of the interactions between azithromycin on the pregabalin are still unknown

Interfacial fracture strength property of micro-scale SiN/Cu components

AbstractThe strength against fracture nucleation from an interface free-edge of silicon-nitride (SiN)/copper (Cu) micro-components is evaluated. A special technique that combines a nano-indenter specimen holder and an environmental transmission electron microscope (E-TEM) is employed. The critical load at the onset of fracture nucleation from a wedge-shaped free-edge (opening angle: 90°) is measured both in a vacuum and in a hydrogen (H2) environment, and the critical stress distribution is evaluated by the finite element method (FEM). It is found that the fracture nucleation is dominated by the near-edge elastic singular stress field that extends about a few tens of nanometers from the edge. The fracture nucleation strength expressed in terms of the stress intensity factor (K) is found to be eminently reduced in a H2 environment

Microstructure and conductivity of blacklight‐sintered TiO₂, YSZ, and Li₀.₃₃La₀.₅₇TiO₃

Rapid densification of ceramics has been realized and its merits were demonstrated through multiple approaches out of which UHS and flash sintering attract recent attention. So far, however, scalability remains difficult. A rise in throughput and scalability is enabled by the introduction of blacklight sintering powered by novel light source technology. Intense illumination with photon energy above the bandgap (blacklight) allows high absorption efficiency and, hence, very rapid, contactless heating for all ceramics. While heating the ceramic directly with light without any furnace promises scalability, it simultaneously offers highly accurate process control. For the technology transfer to industry, attainable material quality needs to be assured. Here, we demonstrate the excellent microstructure quality of blacklight‐sintered ceramics observed with ultrahigh voltage electron microscopy revealing an option to tune nanoporosity. Moreover, we confirm that electronic, electron, oxygen, and lithium‐ion conductivities are equal to conventionally sintered ceramics. This gives the prospect of transmitting the merits of rapid densification to the scale of industrial kilns

In-Situ TEM Study of a Nanoporous Ni–Co Catalyst Used for the Dry Reforming of Methane

We performed in-situ transmission electron microscopy (TEM) on a dealloyed nanoporous NiCo catalyst used for the dry reforming of methane (DRM) to investigate the origin of the catalytic activity and structural durability. The in-situ observations and local chemical analysis indicated that the DRM induced chemical demixing of Ni and Co accompanied by grain refinement, implying possible “synergic effects” in a general bimetallic NiCo catalyst when used for the DRM

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC

Purpose: Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. Materials and Methods: In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. Results: In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. Conclusions: LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement

Microstructure and conductivity of blacklight-sinteredTiO2, YSZ, and Li0.33La0.57TiO3

Rapid densification of ceramics has been realized and its merits were demonstrated through multiple approaches out of which UHS and flash sintering attract recent attention. So far, however, scalability remains difficult. A rise in throughput and scalability is enabled by the introduction of blacklight sintering powered by novel light source technology. Intense illumination with photon energy above the bandgap (blacklight) allows high absorption efficiency and, hence, very rapid, contactless heating for all ceramics. While heating the ceramic directly with light without any furnace promises scalability, it simultaneously offers highly accurate process control. For the technology transfer to industry, attainable material quality needs to be assured. Here, we demonstrate the excellent microstructure quality of blacklight-sintered ceramics observed with ultrahigh voltage electron microscopy revealing an option to tune nanoporosity. Moreover, we confirm that electronic, electron, oxygen, and lithium-ion conductivities are equal to conventionally sintered ceramics. This gives the prospect of transmitting the merits of rapid densification to the scale of industrial kilns

Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure

Introduction: Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. Presentation of case: We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. Discussion: The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. Conclusion: We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF