Fatal Rhabdomyolysis in a Patient with Liver Cirrhosis after Switching from Simvastatin to Fluvastatin

HMG-CoA reductase inhibitors (statins) are widely used to treat hypercholesterolemia. Among the adverse effects associated with these drugs are statin-associated myopathies, ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis. Fluvastatin-induced fatal rhabdomyolysis has not been previously reported. We describe here a patient with liver cirrhosis who experienced fluvastatin-induced fatal rhabdomyolysis. This patient had been treated with simvastatin (20 mg/day) for coronary artery disease and was switched to fluvastatin (20 mg/day) 10 days before admission. He was also taking aspirin, betaxolol, candesartan, lactulose, and entecavir. Rhabdomyolysis was complicated and continued to progress. He was treated with massive hydration, urine alkalization, intravenous furosemide, and continuous renal replacement therapy for acute renal failure, but eventually died due to rhabdomyolysis complicated by hepatic failure. In conclusion, fluvastatin should be used with caution in patients with liver cirrhosis, especially with other medications metabolized with CYP2C9

A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 ≤ 250), bilateral lung infiltration, and old age (≥ 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of ≥ 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of ≥ 13. As a prediction rule, the presence of ≥ 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009

Nutritional Adequacy and Latent Tuberculosis Infection in End-Stage Renal Disease Patients

Background: Latent tuberculosis infection (LTBI) is prevalent in end-stage renal disease (ESRD) patients. The risk of tuberculosis activation is also high. The appropriate LTBI screening and treatment is required in this population. Meanwhile, whether hemodialysis adequacy is associated with LTBI in the ESRD population is unclear. In this study, we aimed to investigate the association between hemodialysis adequacy and LTBI in ESRD patients. Methods: In the present cross-sectional study, we reviewed all outpatient-based ESRD patients in our artificial kidney room. Interferon gamma release assay (IGRA) was used for the diagnosis of LTBI. Clinical variables including nutritional adequacy (i.e., normalized protein catabolic rate, nPCR) and dialysis adequacy (i.e., Kt/V) were compared between IGRA-positive and IGRA-negative patients. Results: A total of 90 patients were enrolled, of which 20 (22.2%) had positive IGRA results using the QuantiFERON-TB method. Old fibrotic changes and nPCR (g/kg/day) were significantly different between IGRA-positive and IGRA-negative patients (both p &lt; 0.005), while serum albumin and Kt/V were comparable (p = 0.429 and p = 0.590, respectively). Normalized PCR remained to be significant in a multivariate logistic regression analysis (adjusted hazard ratio, 0.911 (0.861&ndash;0.963); p = 0.001). The cutoff nPCR value less than 0.87 g/kg/day had an adjusted hazard ratio of 7.74 (1.77&ndash;33.74) for predicting LTBI. Patients with nPCR value less than 0.87 g/kg/day were older and had lower serum hemoglobin, albumin, calcium concentration, and Kt/V levels than those with nPCR value greater than 0.87 g/kg/day. Conclusions: Nutritional adequacy, especially when assessing nPCR value, was associated with LTBI, while dialysis adequacy was not associated with LTBI

Distribution, density, and habitat use of the Korean water deer (Hydropotes inermis argyropus) in Korea

Water deer (Hydropotes inermis) belong to the genus Hydropotes, which is ecologically well adapted for environments ranging from desert to forest. Water deer tend to occupy the richest areas between forest and grasslands. There are two distinct subspecies in far East Asia: one in China (H. inermis inermis), and the other in Korea (H. inermis argyropus). Despite being listed as vulnerable on the International Union for Conservation of Nature (IUCN) Red List, little is known about the water deer. The species occurs in most areas of the Korean peninsula, except for Seoul and Jeju Island. Kyunggi Province near Seoul showed the lowest rate (56%) due to urbanization. There was a high difference in their presence between inland (81%) and coastal (60%) areas . In addition, large cities (67%) showed much lower rates than did rural areas (83%) where human population size is relatively low. Water deer are distributed differently based on habitat type, with differences in mean density observed among lowland (6.93 ind./km(2)), mountainous (1.91), and urban (1.27) areas. There was also a difference in mean density between low-elevation and high-elevation areas. Finally, whereas the deer preferred landscapes with 20A degrees-25A degrees of slope and broadleaf forest (P < 0.01), they did not avoid areas with other types of slopes and habitats.NEU CW, 1974, J WILDLIFE MANAGE, V38, P541HARRIS RB, 2008, IUCN 2010 IUCN RED L*MIN CONSTR TRANSP, 2007, 2007 ANN STAT REP MIZHANG ED, 2006, ACTA THERIOL SIN, V26, P49Borkowski J, 2004, FOREST ECOL MANAG, V201, P287, DOI 10.1016/j.foreco.2004.07.011LEE BK, 2003, THESIS CHUNGBUK NATLCOLLINS WB, 1981, J WILDLIFE MANAGE, V45, P969BYERS CR, 1984, J WILDLIFE MANAGE, V48, P1050WOO HC, 1990, ECOLOGICAL SURVEY MA, V4WHITE GC, 1990, ANAL WILDLIFE RADIO, P183BUTZLER W, 1990, GRZIMEKS ENCY MAMMAL, V5WELCH D, 1990, J ZOOL, V221, P453GUILLET C, 1995, GIBIER FAUNE SAUVAGE, V12, P253DOBIAS K, 1996, BEITRAGE JAGD WILDFO, V21, P57WANG S, 1998, CHINA RED DATA BOOKGEIST V, 1998, DEER WORLD THEIR EVOCOOKE A, 1998, CHINESE WATER DEERXU HF, 1999, ACTA THERIOLOGICA SI, V18, P161Won CM, 1999, MAMMAL REV, V29, P3, DOI 10.1046/j.1365-2907.1999.00034.x*MIN ENV KOR, 2000, 2000 2005 REP NAT ENMarques FFC, 2001, J APPL ECOL, V38, P349, DOI 10.1046/j.1365-2664.2001.00584.xYANG BG, 2002, THESIS CHUNGBUK NATLZhu HG, 2004, BIODIVERS CONSERV, V13, P1335, DOI 10.1023/B:BIOC.0000019401.52391.a9KIYOTA M, 2005, MAMMALIAN SCI, V45, P1Hu J, 2006, BIOCHEM GENET, V44, P161, DOI 10.1007/s10528-006-9020-7Hu J, 2007, SMALL RUMINANT RES, V67, P252, DOI 10.1016/j.smallrumres.2005.10.007WON PH, 1967, ILLUSTRATED ENCY FAU, V7

Change in alkaline phosphatase activity associated with intensive care unit and hospital length of stay in patients with septic acute kidney injury on continuous renal replacement therapy

Abstract Background Evidence suggests that alkaline phosphatase attenuates inflammatory response in sepsis by lipopolysaccharide detoxification and adenosine triphosphate dephosphorylation. We sought to determine changes in alkaline phosphatase (AP) activity during septic acute kidney injury (AKI) and clinical parameters associated with AP activity. Methods In this retrospective study, we investigated baseline (when initiating CRRT) and follow-up AP activity on day 3, and associated outcomes in patients who underwent continuous renal replacement therapy (CRRT) due to septic AKI. Results We analyzed the baseline AP activity of 155 patients and day 3 AP activity in 123 patients. Baseline AP activity was not associated with renal or inflammatory biomarkers, or outcomes. It did not significantly differ between the 75 survivors and 80 non-survivors (p = 0.155). AP activity was higher on day 3 than at baseline (105 U/L [interquartile range, 79–156] vs 90 U/L [interquartile range, 59–133]). In particular, liver and bone isoforms increased significantly (p < 0.05), but intestine isoforms did not reach statistical significance (p = 0.367). In addition, day 3 AP activity showed a weak correlation with length of ICU stay (r = 0.213, p = 0.018) and length of hospital stay (r = 0.216, p = 0.017), but not with survival (r = − 0.035, p = 0.698). Conclusion Endogenous AP activity significantly increased in patients with septic AKI. However, neither baseline nor follow-up AP activity was associated with survival

Potential antimicrobial effects of human lactoferrin against oral infection with Listeria monocytogenes in mice

Listeria monocytogenes is a food-borne pathogen that causes serious listeriosis in humans. Antimicrobial effects of human lactoferrin (hLF) against L. monocytogenes have been clearly demonstrated in in vitro studies. However, in vivo studies have not been reported yet. This study investigated whether the oral administration of hLF could inhibit oral infection of listeria in BALB/c mice. The MICs for several strains of L. monocytogenes were determined, and the most sensitive strain was used for the animal work. hLF was administered to BALB/c mice for 7 days, commencing 4 days before oral infection. The effect of hLF was determined by bacterial enumeration and histopathological analysis of the liver and spleen, which are well-known as the major targets of oral listeria infection in mice. In bacterial enumeration, hLF decreased the number of L. monocytogenes cells in the liver. Histopathologically, the size and frequency of necrotic foci in the liver samples decreased with hLF administration. However, these changes were not observed in the spleen samples. The mRNA levels of inflammatory cytokines, such as interleukin (IL)-1 beta, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma, decreased in the liver of mice receiving hLF. This study has shown that hLF decreases the hepatic colonization of L. monocytogenes, hepatic necrosis and expression of inflammatory cytokines. It revealed that perorally given hLF could mediate antimicrobial and anti-inflammatory activities remote from the gut (i.e. in the liver) of mice challenged with L. monocytogenes.Y