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Metronidazole-induced hepatitis in a teenager with xeroderma pigmentosum and trichothiodystrophy overlap
A teenage girl had the rare combined phenotype of xeroderma pigmentosum and trichothiodystrophy, resulting from mutations in the XPD (ERCC2) gene involved in nucleotide excision repair (NER). After treatment with antibiotics, including metronidazole for recurrent infections, she showed signs of acute and severe hepatotoxicity, which gradually resolved after withdrawal of the treatment. Cultured skin fibroblasts from the patient revealed cellular sensitivity to killing by metronidazole compared with cells from a range of other donors. This reveals that the metronidazole sensitivity was an intrinsic property of her cells. It is well recognized that patients with Cockayne syndrome, another NER disorder, are at high risk of metronidazole-induced hepatotoxicity, but this had not been reported in individuals with other NER disorders. We would urge extreme caution in the use of metronidazole in the management of individuals with the xeroderma pigmentosum and trichothiodystrophy overlap or trichothiodystrophy phenotypes.</p
Model bias of sea surface temperature (a) and chlorophyll (b) for the period 10<sup>th</sup> June 2011 to 10<sup>th</sup> October 2011.
<p>Model bias of sea surface temperature (a) and chlorophyll (b) for the period 10<sup>th</sup> June 2011 to 10<sup>th</sup> October 2011.</p
Study region with nested grids configuration of the atmospheric model (ATM) and ocean model (OCEAN-0 and target domain OCEAN-1).
<p>Study region with nested grids configuration of the atmospheric model (ATM) and ocean model (OCEAN-0 and target domain OCEAN-1).</p
Observed and modeled surface currents at three locations along the latitude 42°N at the longitudes 9°W (a and b), 9.75°W (c and d) and 10.5°W (e and f).
<p>These locations are shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0037343#pone-0037343-g002" target="_blank">Figure 2</a> as triangles.</p
Observed and modeled (in black) sea surface temperature (a, c and e) and chlorophyll (b, d and f) at latitude 42°N and longitudes 9°W, 9.75°W and 10.5°W (locations indicated as triangles in Figure 2.
<p>The satellite observations are distributed by OSISAF and by IFREMER. Note the different vertical scales for chlorophyll. Each data points is the average of the data inside a circle of radius 7 km. Error bars are the corresponding standard deviations.</p
Sea surface temperature from model (upper panel) and from satellite observations provided by OSISAF (lower panel, processed by Meteo-France/CMS-Lannion in the framework of the OSISAF project).
<p>Snapshots between 13<sup>th</sup> and 26<sup>th</sup> July 2011 are depicted, illustrating one episode of upwelling intensification and coastal bloom (next Figure).</p
Same as previous figure but showing the chlorophyll coastal bloom.
<p>Chlorophyll observations are provided by IFREMER and obtained from OC5 optimised interpolation of MODIS, SeaWiFS and MERIS observations.</p