Acetazolamide intoxication in an elderly patient with diabetes and chronic renal failure after cataract surgery

Carbonic anhydrase inhibitors, such as acetazolamide, are widely used in the treatment of open-angle glaucoma. Severe metabolic acidosis is a rare complication of acetazolamide use, and life-threatening acidosis occurs most commonly in elderly patients, in patients with advanced renal failure, and in patients with diabetes. We describe an unusual case of an elderly patient with diabetic nephropathy and chronic renal failure who presented to the emergency department with severe metabolic acidosis and coma after exposure to high doses of acetazolamide in the postoperative period of ophthalmic surgery. As symptoms of acetazolamide intoxication and uremia are similar, high suspicion is required to detect excessive plasma drug concentrations and intoxication in patients presenting with concomitant uremia. Clinical symptoms are potentially reversible with prompt diagnosis and treatment, including supportive treatment, bicarbonate therapy, and renal replacement therapy. Hemodialysis is particularly helpful in the management of acetazolamide overdose as the medication is dialyzable

A presença de Microlobius foetidus causa alteraçõess na defesa antioxidante de Urochloa decumbens?

Urochloa decumbens (Stapf) R. D. Webster (Poaceae) is an exotic species with has spread rapidly through the Cerrado area of Pantanal, Mato Grosso do Sul, Brazil. It has covered the soil aggressively turning it into cultivated pastures. Thus, it has become a challenge to protect native areas due its capacity of exclusion of native species. It has been observed that Microlobius foetidus (Jacq.) M.Sousa & G.Andrade species (Fabaceae) shows a dominant pattern over the development of U. decumbens. This work shows that M. foetidus interfere on the natural growth of U. decumbens within 10 m ratio. Between 15 and 20 m, it was observed an increase of Importance Value index (IVI) and Relative cover (RC) values. It was also observed a variation on the antioxidant defense system of U. decumbens within 10m ratio from M. foetidus. The enzymes superoxide dismutase, catalase and peroxidase present higher levels of activity then those found for glutathione reductase. This data indicates that M. foetidus may have an effect on U. decumbens, increase the activity of antioxidant enzymes. This effect probably happens as means to neutralize the toxic effects of the oxygen generated due to the presence of allelochemicals, which increases oxidative stress. © 2015, Instituto Internacional de Ecologia. All Rights Reserved

Acetazolamide Intoxication in an Elderly Patient with Diabetes and Chronic Renal Failure after Cataract Surgery

Carbonic anhydrase inhibitors, such as acetazolamide, are widely used in the treatment of open-angle glaucoma. Severe metabolic acidosis is a rare complication of acetazolamide use, and life-threatening acidosis occurs most commonly in elderly patients, in patients with advanced renal failure, and in patients with diabetes. We describe an unusual case of an elderly patient with diabetic nephropathy and chronic renal failure who presented to the emergency department with severe metabolic acidosis and coma after exposure to high doses of acetazolamide in the postoperative period of ophthalmic surgery. As symptoms of acetazolamide intoxication and uremia are similar, high suspicion is required to detect excessive plasma drug concentrations and intoxication in patients presenting with concomitant uremia. Clinical symptoms are potentially reversible with prompt diagnosis and treatment, including supportive treatment, bicarbonate therapy, and renal replacement therapy. Hemodialysis is particularly helpful in the management of acetazolamide overdose as the medication is dialyzable

The impact of maternal syphilis and associated factors on HIV vertical transmission

Maternal syphilis may increase HIV vertical transmission or it may be a marker of other risk factors. In a Brazilian historical series, HIV vertical transmission risk was higher in newborns exposed to maternal syphilis-HIV co-infection than in newborns exposed to maternal HIV infection alone. Maternal syphilis was a risk factor for HIV vertical transmission independent of education and prenatal visits but not independent of maternal elevated HIV viral loads or inadequate maternal antiretroviral treatment