Eculizumab for Gemcitabine-Induced Hemolytic Uremic Syndrome: A Novel Therapy for an Emerging Condition

Introduction Atypical hemolytic uremic syndrome (aHUS), a thrombotic microangiopathy (TMA), is a disease characterized by hemolytic anemia, thrombocytopenia, and renal impairment. Gemcitabine, a commonly used chemotherapy, is emerging as a cause of aHUS. Although rare, the morbidity and mortality can be significant. Few studies have explored the use of eculizumab, an anti-C5 monoclonal antibody as a potential therapy for gemcitabine-induced aHUS. Case Presentation A 45 year old Caucasian male with metastatic urothelial carcinoma was started on weekly gemcitabine (1000 mg/m2 per dose) to treat recurrent disease. During his seventh cycle, he was hospitalized for hypertension, acute kidney injury, and anemia. Laboratory data at that time revealed a hemoglobin of 6.2 g/dL (reference range 14.0-17.0 g/dL) and a platelet count of 70 x 109/L (reference range 140-400x 109/L). Hemolysis was suggested by an elevated lactate dehydrogenase (LDH) of 420 IU/L (reference range 125-240 IU/L), undetectable haptoglobin, and the presence of schistocytes on the peripheral smear (see Figure 1). Creatinine was elevated to 2.8 mg/dL (reference range 0.7-1.4 mg/dL) and an ADAMTS-13 (A disintegrin and metalloproteinase with a thromboSpondin type 1 motif, member 13) returned as normal. The patient was diagnosed with gemcitabineinduced aHUS. Gemcitabine was discontinued, and the patient was started on steroids. Two weeks later, he presented with generalized tonic-clonic seizures, uncontrolled hypertension, and worsening renal failure. His labs on admission showed continued hemolysis and thrombocytopenia. In light of the patient’s poor response to steroids, the decision was made to start eculizumab

Oral premedication with pregabalin and clonidine for hemodynamic stability during laryngoscopy: A comparative study

Background: Airway instrumentation of direct laryngoscopy and tracheal intubation are noxious stimuli that should be attenuated by appropriate premedication, smooth induction, and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with pregabalin or clonidine for attenuation of hemodynamic pressure response of airway instrumentation. The objective was to find out the efficacy of pregabalin and clonidine as an oral premedication and to observe hemodynamic stability during laryngoscopy.Methods: A total of 100 healthy patients aged 30-70 years with American Society of Anesthesiology Physical Status I and II of both gender, who met the inclusion criteria of general anesthesia, were randomly received pregabalin (150 mg) Group I or clonidine (100 µg) Group II, 60-70 mins before surgery as an oral premedication. Both groups were compared to pre-operative sedation, anxiety, heart rate (HR), and mean arterial pressure (MAP) at baseline, after premedication, induction, laryngoscopy, and extubation. Intraoperative analgesic drug requirement and any post-operative complication were recorded.Results: Incidence of hypotension and bradycardia were observed in 4% case in the clonidine group. Pre-operative sedation level was higher in the pregabalin group as compared to clonidine group. p>0.05 which shows there is no difference in both the drugs in terms of control of HR and MAP perioperatively. Both drugs are equally good to maintain hemodynamic stability during laryngoscopy. None of the patients has suffered from any post-operative side effects.Conclusion: Hemodynamic pressure response of airway instrumentation was attenuated with pregabalin and clonidine oral premedication without prolongation of recovery time and side effects

A Correlative Blood Assay to Monitor Patients at Risk for Chemotherapy-Induced Peripheral Neuropathy

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling side effect of platinum-based chemotherapies like cis-, oxali- and carboplatin. While not all patients experience this effect, those that do are at risk for lifelong neuropathy. Platinum-based therapies cause bursts of reactive oxygen species (ROS), which can trigger structural changes in peripheral nerves including neuronopathy, axonopathy and/or myelinopathy. Glutathione, an antioxidant, plays an important role in redox homeostasis. The recycling of glutathione can be determined by the ChemoTox assay and the aim of this study was to examine its ability to predict CIPN. Methods: Blood drawn from consented and chemotherapy naïve patients (N= 59) were tested for glutathione recycling capacity and normalized to total red cell numbers. At each session patients reported outcomes, including neuropathy, using the Rotterdam Symptom Check List. Patient’s glutathione recycling capacities were correlated to self-reported neuropathy. Results: 42 patients experienced neuropathy and 21 reported neuropathy at ≥2 (Rotterdam 0-3) for an extended period of time during their treatment. This preliminary study showed an inverse correlation between ChemoTox and CIPN; in combining this data with a clinical vignette, the test proved efficacious in at risk patients. Conclusions: This assay might be a tool for physicians to identify patient’s relative risk over the course of treatment to avoid permanent neuropathy

Feto-maternal outcome of pregnancy with thrombocytopenia

Background: Thrombocytopenia is the second most haematological abnormality in pregnancy where the platelets count below 1,50,000/µl. Gestational thrombocytopenia is most common cause of thrombocytopenia, accounts for 70% of thrombocytopenia in pregnancy. Methods: It is retrospective study with 30 antenatal women at any gestational age having thrombocytopenia, platelet count less than 1,50,000/µl at SVP Hospital, Ahmedabad during duration of May 2023-November 2023.  All the pregnant women who attend OPD and admitted in SVP Hospital, Ahmedabad were included in the study. Results: The present study found that gestational thrombocytopenia (53.34%) accounted for most common cause of thrombocytopenia, followed by hypertensive disorders (10.0%), HELLP syndrome (6.67%), dengue and malaria (6.67%), DIC (6.67%) and ITP (3.34%) in which 53.34%  women has mild,  36.67%  has moderate and 10% has severe thrombocytopenia. In this study vaginal delivery accounts for 33.34% and caesarean delivery accounts for 66.67%. In present study 50.0% patient of gestational thrombocytopenia didn’t required any treatment.  About 6.67% patients required transfusion of PRC and 33.34% of neonates needed NICU admission. Neonatal mortality due to complications like prematurity, septicemia was seen in 10.0% of the cases. Conclusions: Outcome of pregnancy with moderate to severe thrombocytopenia depends mainly on the etiology of thrombocytopenia. Early interdisciplinary evaluation of thrombocytopenia during pregnancy can help in optimizing care as fetal outcomes and management depend on the etiology

Easy Identification of Missed DVT Prophylaxis-A Chance for Intervention

Goal: To minimize the number of missed or refused medications for inpatients so that adverse patient events such as PE or DVT are prevented SMART AIM: Within 3 months of initiating an EMR based electronic identification system for refused and missed medications, we will decrease the rate at which DVT prophylaxis was ordered however not eventually administered by 50%.https://jdc.jefferson.edu/patientsafetyposters/1014/thumbnail.jp

Cross-Sectional Study on Exam Anxiety among Medical Students of a Tertiary Care Teaching Hospital of Western India

"Background: Students with test anxiety feel tense, fearful and worried in evaluative situations. This study was carried out with the objective to find out the levels of exam anxiety and factors contributing to it. Methodology: It was a cross-sectional study conducted among 150 randomly selected medical students with the help of a tool used for measuring exam anxiety, Test Anxiety Inventory (TAI). Results: The mean score of TAI-worry was 16.95 (+ 3.39), TAI-emotionality was 17.04 (+ 2.901) and that of TAI-total was 41.99 (+5.336). The TAI-emotionality subscale and TAI-total scores was higher in female medical students. Those students who were living in hostel had higher mean TAI-emotionality scores. No significant difference between TAI-worry, TAI-emotionality and TAI-total with respect to regular/repeater batch, parental pressure, extent of course of study and duration of exams. No association was found TAI-total with year of study in MBBS and medium of study in higher secondary education. Conclusion: The total anxiety scores were significantly higher among female medical students. The emotional effect of exam anxiety was significantly higher among the female medical students than the males and among the students living at hostel than those living with their families. [Natl J Community Med 2016; 7(5.000): 449-454

Maintenance Therapy Containing Metformin and/or Zyflamend for Advanced Prostate Cancer: A Case Series

Metformin is derived from galegine, a natural ingredient, and recent studies have suggested that metformin could enhance the antitumor effects of hormone ablative therapy or chemotherapy and reduce prostate cancer-specific mortality. Zyflamend is a combination of herbal extracts that reduces inflammation and comprises turmeric, holy basil, green tea, oregano, ginger, rosemary, Chinese goldthread, hu zhang, barberry, and basil skullcap. We propose a maintenance regimen with metformin and/or Zyflamend that targets cancer stem cells and the tumor microenvironment to keep the cancer dormant and prevent it from activation from dormancy. Herein, we report the clinical course of four patients who experienced a clinical response after treatment with metformin and/or Zyflamend

The quest for reliable prediction of chemotherapy-induced delayed nausea among breast cancer patients

Aim: Though female sex is considered a risk factor when predicting chemotherapy-induced nausea, not all women will experience nausea. Therefore, the aim of this pilot study was to evaluate the accuracy, and usefulness, of a blood-based assay for predicting chemotherapy-induced delayed nausea among breast cancer patients.Methods: Whole blood from consented breast cancer patients, determined to benefit from chemotherapy, were used to test each individual for their intrinsic glutathione recycling capacity. Both highly-emetogenic and moderately-emetogenic chemotherapies were included in the study. Test results obtained from chemotherapy naïve patients were used to predict delayed nausea. Predicted outcomes were later compared to reported outcomes documented in medical records. Statistical analyses were used to test the accuracy and efficacy of our blood-based test.Results: Even with current and effective anti-emetics, we report that ~31% of breast cancer patients reported delayed nausea. Using the SAS/STAT classification and regression tree method we were able to show that this assay can be used as a predictive tool with an AUC of 0.71-0.74 depending on treatment regimen.Conclusion: The new predictive assay provides an added value in identifying individual breast cancer patients at high risk of developing moderate or severe delayed nausea after treatment with taxane- based therapies such as docetaxel/cyclophosphamide and docetaxel/carboplatin/trastuzumab/pertuzumab. We believe that this assay could help guide the use of anti-emetics for improved patient-oriented care