Persistent hiccup in a continuous ambulatory peritoneal dialysis patient following ingestion of star fruit

AbstractAnimal studies have suggested that ingestion of star fruit, which belongs to the Oxalidaceae family, may cause neurotoxicity. Outbreaks of intractable hiccups have been reported following ingestion of star fruit in patients on regular hemodialysis. Other complaints have included insomnia, agitation and mental confusion. We report a patient on continuous ambulatory peritoneal dialysis (CAPD) who presented with acute confusion and persistent hiccup following ingestion of star fruit. Symptoms resolved spontaneously. Other reported cases and management strategies are discussed

A Scleroderma Patient with Sudden Loss of Vision in Both Eyes

Abstract: Scleroderma is a multi-systemic disease. Patients with evidence of major internal organ involvement have increased risks of significant morbidity and mortality. Sudden bilateral painless loss of vision is an uncommon presentation of systemic sclerosis. We reported a case of autoimmune retinopathy in the form of Purtscher's like retinopathy in a scleroderma patient with major internal organ involvement. Keywords: Autoimmune retinopathy, Purtscher's retinopathy, Scleroderma Case History A 49-year-old housewife, with history of treated cutaneous tuberculosis, left hemi-thyroidectomy for thyroid colloid nodules and uterine fibroid, presented to us in June 2007 with symmetrical polyarthralgia, Raynaud's phenomenon, progressive skin thickening over her hands, forearms, legs, trunk, neck and face for six months. She also reported generalized fatigue, shortness of breath on exertion, and occasional acid regurgitation. She did not experience any malar rash, photosensitivity, alopecia, recurrent oral ulcers, sicca symptoms or proximal muscle weakness. Her elder sister has a history of Rheumatoid Arthritis and is on treatment. Physical examination revealed tightening of skin over her hands, forearms, trunk, legs, neck, and face. Raynaud's phenomenon was noted over her fingers with skin cracking of the fingertips. However, no digital gangrene or nail fold infarcts were detected. Prominent synovitis was detected over the small joints of her hands. Fine crepitations were heard over her lung bases. Laboratory investigations revealed a positive anti-nuclear antibody (ANA) at 1:320. Rheumatoid Factor (RF) was negative. Anti-double strended deoxyribonucleic acid (anti-dsDNA) antibody was not elevated. Anti-extractable nuclear antigen (anti-ENA) antibody was negative. Complements C3 and C4 levels were normal. Erythrocyte sedimentation rate (ESR) was elevated at 94 mm/hr. C-reactive protein (CRP) was normal. Lupus anticoagulant was negative. Anti-cardiolipin immunoglobulin G was negative. Baseline Chest X-Ray was unremarkable. X-Ray of her hands and wrists did not demonstrate any bony erosion. Barium swallow showed mild dilatation at mid-esophagus while the mucosal pattern remained unremarkable. Full lung function test revealed a severe diffusion defect as evidenced by a depressed carbon dioxide diffusion capacity (DLCO) as 44% predicted value, and a restrictive total lung volume at 75% predicted. High Resolution Computed Tomography (HRCT) of thorax revealed subpleural linear to reticular shadows compatible with pulmonary fibrosis in the right middle lobe, right lower lobe and left lower lobe. There were no ground glass opacities. Electrocardiography (ECG) and echocardiogram did not show any evidence of pulmonary hypertension. A diagnosis of scleroderma with interstitial lung disease was made. She was given oral diltiazem for relief of Raynaud's phenomenon and oral colchicine for sclerodactyly. Low dose prednisolone 5 mg once daily and cyclosporine A wer

Prevention of recurrent central venous stenosis using endovascular irradiation following stent placement in hemodialysis patients

This study was done to evaluate the outcome after brachytherapy (BT) given to prevent restenosis after stent insertion for central venous stenosis in patients with ipsilateral hemodialysis arteriovenous fistulas (AVF). Angioplasty and stenting were performed on 9 primary central venous stenoses in 8 patients with AVF followed by BT, delivering Iridium-192 radiation using an afterloading technique. BT was also administered to three patients with five recurrent stenoses at the stent margins. There was no residual stenosis after angioplasty and stenting. Venographic follow-up (77-644 days, mean 272 days) showed no restenosis in seven primary stenoses. New strictures (45%-100%) developed at the stent margin in six veins (five patients). Angioplasty or stenting was performed for five margin stenoses in three patients, followed by a second BT. Residual stenosis before BT was 0-30%. In our venographic follow-up (140-329 days, mean 215 days), three restenoses occurred (35%-100%). All progressed to complete occlusion on later venographic follow-up irrespective of whether BT was given to the stent margin or not. The mean primary and assisted primary patency of the central veins were 359 days and 639 days, respectively. Endovascular irradiation with a noncentering source does not prolong the patency after angioplasty and stenting of central venous stenosis in hemodialysis patients.Link_to_subscribed_fulltex

Treatment of Severe Tumoral Calcinosis with Teriparatide in a Dialysis Patient after Total Parathyroidectomy

Tumoral calcinosis is a rare but debilitating condition that can affect dialysis patients. Optimal management is largely unknown. We report the clinical course, treatment, and outcome of a peritoneal dialysis (PD) patient who developed tumoral calcinosis refractory to conventional treatment but improved with teriparatide therapy. A 26-year-old lady on PD for 2 years presented to us with tumoral calcinosis involving bilateral hands. Response to surgical excision, parathyroidectomy, and conversion to hemodialysis failed to result in sustained remission, and tumoral calcinosis progressed. After total parathyroidectomy, the patient had transient but partial remission in which her calcinosis deposits remained but were asymptomatic without pain or clinical signs of inflammation. However, she later experienced a relapse with involvement of the left elbow, right shoulder, right hip, and right thigh. Tumoral calcinosis remained uncontrolled resulting in debilitation, likely attributable to poor calcium and phosphate control because of adynamic bone disease after parathyroidectomy despite treatment of superimposed tuberculosis and therapy with sodium thiosulphate and pamidronic acid. Clinical improvement was however evident after the use of teriparatide. Asymptomatic hypocalcemia occurred after teriparatide therapy but resolved after 2 months. In conclusion, teriparatide appears to be useful for treating tumoral calcinosis in the presence of adynamic bone disease. Hypocalcemia can occur in the initial months of therapy

One stop shop: backbones trees for important phytopathogenic genera: I (2014)

Many fungi are pathogenic on plants and cause significant damage in agriculture and forestry. They are also part of the natural ecosystem and may play a role in regulating plant numbers/density. Morphological identification and analysis of plant pathogenic fungi, while important, is often hampered by the scarcity of discriminatory taxonomic characters and the endophytic or inconspicuous nature of these fungi. Molecular (DNA sequence) data for plant pathogenic fungi have emerged as key information for diagnostic and classification studies, although hampered in part by non-standard laboratory practices and analytical methods. To facilitate current and future research, this study provides phylogenetic synopses for 25 groups of plant pathogenic fungi in the Ascomycota, Basidiomycota, Mucormycotina (Fungi), and Oomycota, using recent molecular data, up-to-date names, and the latest taxonomic insights. Lineage-specific laboratory protocols together with advice on their application, as well as general observations, are also provided. We hope to maintain updated backbone trees of these fungal lineages over time and to publish them jointly as new data emerge. Researchers of plant pathogenic fungi not covered by the present study are invited to join this future effort. Bipolaris, Botryosphaeriaceae, Botryosphaeria, Botrytis, Choanephora, Colletotrichum, Curvularia, Diaporthe, Diplodia, Dothiorella, Fusarium, Gilbertella, Lasiodiplodia, Mucor, Neofusicoccum, Pestalotiopsis, Phyllosticta, Phytophthora, Puccinia, Pyrenophora, Pythium, Rhizopus, Stagonosporopsis, Ustilago and Verticillium are dealt with in this paper

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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