Life-Threatening Hypercalcemia due to Graves' Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

A 47-year-old woman presented with the complaints of nausea, vomiting, and weight loss. She had a history of bilateral surrenalectomy due to Cushing's syndrome. On examination she had tachycardia and orthostatic hypotension. Laboratory examinations revealed hypercalcemia and suppressed parathyroid hormone levels. She also had thyrotoxicosis due to Graves' disease. The investigations to rule out a malignancy were negative. With steroid, zoledronic acid, and antithyroid drug treatment her symptoms were resolved and calcium level was normalized. This case highlights the importance of recognizing thyrotoxicosis and concomitant adrenal failure as a possible cause of severe hypercalcemia

Polyamidoamine Dendron-Bearing Lipids as Drug-Delivery Excipients

An amine-terminated polyamidoamine (PAMAM) dendron and two long alkyl groups were designed as a novel drug carrier that possesses an interior for the encapsulation of drugs and a biocompatible surface. We synthesized three dendron-bearing lipids, DL-G1, DL-G2, and DL-G3, which included first, second, and third generation polyamidoamine dendrons, respectively. The synthesized dendrimer encapsulating anticancer drug, 5-fluorouracil (5-FU), was prepared by extraction with chloroform from mixtures of the dendrimers and varying amounts of the drug. In vitro cytotoxicity of PAMAM conjugated di-n-dodecylamine micelles (G1, G2, G3) were analyzed on human gastric adenocarcinoma cells (AGS) by water-soluble tetrazolium-1 (WST-1) cell proliferation assay. Upon exposure to 5-FU loaded micelles, the viability of the cells decreased gradually in all generations. Cytotoxicity increased with increasing generation and reached its highest rate of 69.8 ± 3.2% upon 15 µM 5FU-loaded 25 µM PAMAM DL-3 micelle treatment. These results demonstrate that 5FU-loaded PAMAM conjugated di-n-dodecylamine treatment inhibits the proliferation of AGS cells in a generation-dependent manner

Photocatalytic degradation of ciprofloxacin from water with waste polystyrene and TiO2 composites

Ciprofloxacin (CIP) is one of the widely used antibiotics with a broad antimicrobial spectrum in the fluoroquinolone type. Its concentration in water bodies has increased over the years due to its frequent use. Since ciprofloxacin in the aquatic ecosystem adversely affects human health as well as other organisms, it must be removed from wastewater.The aim of this study was to develop Polystyrene (PS) and Titanium dioxide (TiO2) composites that can be used as catalysts in CIP removal by photocatalytic process. Waste PS (obtained from disposable cutlery) was used in the synthesis of these composites. In this study, PS-TiO2 composites with different PS content (C20, C50, C80; the numbers in the names indicate the PS percentage in the composite by weight) were synthesized. This is important in terms of the use of one waste in the removal of another waste.This process was optimized using Box-Behnken design, one of the response surface method. Parameters such as the amount of polymer in the composite, pH and initial CIP concentration were studied and their effects on CIP removal were found. The validity and adequacy of the selected model were evaluated according to the relevant statistical data. These are R2 = 0.9751, adjusted R2 = 0.9565, the model's p-value <0.05 and the lack of fit-value 0.246. Optimum conditions for CIP removal were obtained when the C50 was used, with a pH value of 3 and an initial CIP concentration of 5 mg/L.In the process carried out under these conditions, the CIP removal was found to be 95.01 % at the end of 180 min. This value was predicted as 94.37 % in the model. According to these results, C50 composite synthesized with waste PS can be used effectively for CIP removal

Unintentional Monotherapy in Rheumatoid Arthritis Patients Receiving Tofacitinib and Drug Survival Rate of Tofacitinib

ObjectiveTo determine the rate of unintentional monotherapy (UM; switching to monotherapy from combination therapy of patients' own volition) in rheumatoid arthritis patients receiving tofacitinib and to evaluate tofacitinib survival rate.MethodsThis national, multicenter study included patients' data from the TURKBIO Registry. Demographics, clinical characteristics, disease duration and activity, comorbidities, and treatments were analyzed.ResultsData of 231 rheumatoid arthritis patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy on their own volition (UM); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The rate of comorbidities at the time of data retrieval was higher in the UM group than in the combination group (83.3% vs. 60.3%, p = 0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p = 0.039; odds ratio, 3.29; 95% confidence interval, 1.06-10.18). The combination and UM groups did not differ regarding remission rate assessed by Disease Activity Score 28-joint count C-reactive protein (60.5% and 70%, respectively; p = 0.328). Drug survival rates of the UM and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with 1- and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the UM group.ConclusionsAlthough 13.4% of the study population started monotherapy unintentionally, drug survival and remission rates of the UM and combination groups were not different. Comorbidity was a factor affecting transition from combination therapy to monotherapy