Phentermine induced acute interstitial nephritis

Acute interstitial nephritis (AIN) has a number of medication-related aetiologies. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are common causes; however, any medication has the potential to cause drug-induced AIN. We report the first case of phentermine-induced AIN. A Caucasian woman aged 43 years presented with a 5-week history of lethargy, left-sided lower abdominal pain, nausea and vomiting. She had been taking phentermine for weight loss for 9 months and had recently ceased the medication. The patient underwent a renal biopsy that showed a predominantly lymphohistiocytic interstitial infiltrate with a moderate number of eosinophils consistent with AIN. Phentermine is increasingly used for weight loss in obese patients. This is the first case implicating phentermine as the causative agent for drug-induced AIN. While rare, phentermine-induced AIN is a possible adverse reaction of phentermine. Physicians and patients need to be aware of this risk

Surgical outcomes in a retrospective cohort of adult patients with severe obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) surgery may improve quality of life, apnea-hypopnea index (AHI) scores and cardiovascular risk parameters. We determined the effect of multilevel upper airway surgery on very severe OSA in continuous positive airway pressure (CPAP) non-adherent patients. Methods: A retrospective cohort of thirty-nine very severe OSA patients [defined by AHI ≥50 or 3% overnight desaturation index (ODI) ≥40] who were non-adherent to CPAP, with surgically-modifiable anatomical traits, were included. Patients were recruited consecutively. All patients underwent multilevel airway reconstructive surgery by a sleep-otolaryngologist Wollongong Hospital and Wollongong Private Hospital in New South Wales, Australia, between January 2009 and December 2018. This included various combinations of lingual and palatine tonsillectomy, Australian modified uvulopalatopharyngoplasty (modified UPPP), radiofrequency-in-saline tongue channelling, trans-palatal advancement pharyngoplasty and midline glossectomy. The primary outcome was changed in AHI. Secondary outcomes included achievement of surgical success (defined as a postoperative AHI \u3c20 and a 50% AHI reduction), changed in 3% ODI, lowest measured oxygen saturations, snoring severity scale, and Epworth sleepiness scale. Statistical analysis was done through SPSS statistics version 21. Results: Of 39 total participants, 31 (79%) were male, with a mean age of 41 years. After surgery, significant improvements were seen in mean AHI [69 to 14, reduction of 55; 95% confidence interval (CI): 48–62, P\u3c0.01]. Twenty-nine (74%) achieved surgical success. There were also improvements in mean 3% ODI [54 to 12, reduction of 41 (95% CI: 32–50)], lowest measured oxygen saturations [73% to 81%, improvement of -9% (95% CI: -17% to -1%, P=0.02)], snoring severity scale (8 to 0.5, P\u3c0.01), and median Epworth sleepiness scale (12 to 4, P\u3c0.01). Conclusions: Non-adherent CPAP patients with very severe OSA may benefit significantly from upper-airway surgery. Patients with severe OSA should be referred to an experienced otolaryngologist for consideration of this surgery, although further prospective studies are needed

Bladder malignancy as a cause of spontaneous bladder rupture: A systematic review

Abstract Objectives To characterise cases of spontaneous rupture of the urinary bladder in the context of bladder cancer. Methods A systematic review was performed to characterise cases of spontaneous bladder rupture in patients with bladder cancer. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) system was utilised, with databases being searched for relevant cases. Patient characteristics were extracted, including age, sex, presenting signs and symptoms, management modalities, tumour histology and mortality. Results Thirty cases were included. Seventeen (57%) were male, and the median age of presentation was 59. Abdominal pain and peritonism were the most common presenting symptoms, in 80% and 60% of patients, respectively. Most patients (n = 16, 53%) had urothelial cell carcinoma. Nine patients (30%) died during their initial hospitalisation. Conclusion Spontaneous bladder perforation in the context of bladder cancer is a rare cause of acute abdomen. The diagnosis is associated with high mortality, highlighting the aggressive nature of the malignancies that cause spontaneous bladder rupture. This raises important questions about the role of emergency cystectomy, the timing of systemic therapy and the appropriate involvement of palliative care