Electromyographic and laboratory findings in acute Solanum torvum poisoning

CONTEXT

Solanum torvum berries, known as susumber or turkey berries, are prepared as part of traditional Jamaican dishes usually served with cod and rice. Poisoning is rare. Although toxic compounds have never been definitively isolated, previous reports suggest toxicity results from inhibition of acetylcholinesterases. We present a case of susumber berry poisoning with detailed electromyographic studies and laboratory analysis.

CASE DETAILS

A 54-year-old woman presented to the Emergency Department (ED) complaining of vision, speech, and gait changes; emesis; and diffuse myalgias following consumption of susumber berries. The physical examination demonstrated an intact, lucid mental status, miosis, opsoclonus, severe dysarthria, dysmetria, mild extremity tenderness and weakness, and inability to ambulate. Her symptom constellation was interpreted as a stroke.

DISCUSSION

Electromyography demonstrated a pattern of early full recruitment as well as myotonia during the period of acute toxicity. Additionally, solanaceous compounds, in particular solasonine and solanidine, were identified in leftover berries and the patient's serum. Store-bought commercial berries and subsequent serum samples were free of such toxic compounds. EMG studies, together with a laboratory analysis of berries or serum can assist in the differential diagnosis of stroke, and provide both a prognostic screening and confirmation of suspected glycoside toxicity.

Nicotine metabolite ratio (3-hydroxycotinine/cotinine) in plasma and urine by different analytical methods and laboratories: implications for clinical implementation

BACKGROUND

The highly genetically variable enzyme CYP2A6 metabolizes nicotine to cotinine (COT) and COT to trans-3'-hydroxycotinine (3HC). The nicotine metabolite ratio (NMR, 3HC/COT) is commonly used as a biomarker of CYP2A6 enzymatic activity, rate of nicotine metabolism, and total nicotine clearance; NMR is associated with numerous smoking phenotypes, including smoking cessation. Our objective was to investigate the impact of different measurement methods, at different sites, on plasma and urinary NMR measures from ad libitum smokers.

METHODS

Plasma (n = 35) and urine (n = 35) samples were sent to eight different laboratories, which used similar and different methods of COT and 3HC measurements to derive the NMR. We used Bland-Altman analysis to assess agreement, and Pearson correlations to evaluate associations, between NMR measured by different methods.

RESULTS

Measures of plasma NMR were in strong agreement between methods according to Bland-Altman analysis (ratios, 0.82-1.16) and were highly correlated (all Pearson r > 0.96, P < 0.0001). Measures of urinary NMR were in relatively weaker agreement (ratios 0.62-1.71) and less strongly correlated (Pearson r values of 0.66-0.98, P < 0.0001) between different methods. Plasma and urinary COT and 3HC concentrations, while weaker than NMR, also showed good agreement in plasma, which was better than that in urine, as was observed for NMR.

CONCLUSIONS

Plasma is a very reliable biologic source for the determination of NMR, robust to differences in these analytical protocols or assessment site.

IMPACT

Together this indicates a reduced need for differential interpretation of plasma NMR results based on the approach used, allowing for direct comparison of different studies.

[Changes in corneal thickness in glaucoma]

It is a clinical, observational, retrospective, randomised study, performed on 46 eyes. We have evaluated the effects of some of the drugs used to treat glaucoma (prostaglandine analogues, beta blockers, carbonic anhydrase inhibitors) on the central corneal thickness.

[Corneal endothelium in glaucoma]

It is a clinical, observational, retrospective, randomised study, performed on 34 eyes with hipertensive primary open angle glaucoma (POAG) drug equilibrated and 18 eyes with normotensive POAG. We have evaluated the endothelial cells number variation in the hypertensive POAG and normotensive POAG.

The heat shock protein 90 inhibitor IPI-504 induces KIT degradation, tumor shrinkage, and cell proliferation arrest in xenograft models of gastrointestinal stromal tumors

The activity of the receptor tyrosine kinase KIT is crucial for gastrointestinal stromal tumor (GIST) growth and survival. Imatinib and sunitinib are very effective in advanced GIST, but have no curative potential. The observation that heat shock protein 90 (HSP90) inhibition results in KIT degradation prompted us to assess the efficacy of the HSP90 inhibitor retaspimycin hydrochloride (IPI-504) alone or in combination with imatinib or sunitinib in two GIST xenografts with distinctive KIT mutations. Nude mice were grafted with human GIST carrying KIT exon 13 (GIST-882; n = 59) or exon 11 (GIST-PSW; n = 44) mutations and dosed with imatinib (50 mg/kg twice daily), sunitinib (40 mg/kg once daily), IPI-504 (100 mg/kg 3 times per week), IPI-504 + imatinib, or IPI-504 + sunitinib. We evaluated tumor volume, proliferation and apoptosis, KIT expression and activation, as well as adverse events during treatment. Treatment with IPI-504 alone resulted in tumor regression, proliferation arrest, and induction of tumor necrosis. We documented downregulation of KIT and its signaling cascade in IPI-504-treated animals. Treatment effects were enhanced by combining IPI-504 with imatinib or sunitinib. On histologic examination, liver damage was frequently observed in animals exposed to combination treatments. In conclusion, IPI-504 shows consistent antitumor activity and induces KIT downregulation in GIST, as a single agent, and is more potent in combination with imatinib or sunitinib. The sequence of drug administration in the combination arms warrants further studies.

Impact of the HIV epidemic and Anti-Retroviral Treatment policy on lymphoma incidence and subtypes seen in the Western Cape of South Africa, 2002-2009: preliminary findings of the Tygerberg Lymphoma Study Group

The Tygerberg Lymphoma Study Group was constituted in 2007 to quantify the impact of HIV on the pattern and burden of lymphoma cases in the Western Cape of South Africa which currently has an HIV prevalence of 15%. South Africa has had an Anti-Retroviral Treatment (ART) policy and a roll-out plan since 2004 attaining 31% effective coverage in 2009. This study is designed to qualify and establish the impact of HIV epidemic and the ARV roll-out treatment program on the incidence of HIV Related Lymphoma (HRL). Early data document that despite the ART roll out, cases of HRL are increasing in this geographical location, now accounting for 37% of all lymphomas seen in 2009 which is an increase from 5% in 2002. This is in contrast to trends seen in developed environments following the introduction of ART. Also noted are the emergence of subtypes not previously seen in this location such as Burkitt and plasmablastic lymphomas. Burkitt lymphoma is now the commonest HRL seen in this population followed by diffuse large B-cell lymphoma subtypes. The reasons for this observed increase in HRL are not ascribable to improved diagnostic capacity as the tertiary institute in which these diagnoses are made has had significant expertise in this regard for over a decade. We ascribe this paradoxical finding to an ART treatment environment that is ineffective for a diversity of reasons, paramount of which are poor coverage, late commencement of ART and incomplete viral suppression.

[Advances in preservative-free glaucoma drops]

Ophthalmic solutions are the main therapeutic methods used in the treatment of ocular diseases, including glaucoma. Preservatives are added in multidose solutions to reduce the risk of microbial contamination. Repeated use of topical medication, especially in patients treated for glaucoma, has many adverse effects especially on the ocular surface. This paper provides an overview of the role of preservatives in antiglaucoma preparations, and their impact on the ocular surface.

[Fixed combination of topical prostaglandin analogue in glaucoma treatment]

The purpose of glaucoma treatment is to prevent progressive loss of optic nerve fibers and thereby to preserve the visual field. Because increased IOP is a primary risk factor in developing glaucoma, descrease its value below which may affect the optic is the antiglaucoma treatment target. This paper provides an overview of glaucoma treatment and the use of fixed combinations of topical prostaglandin analogues (PGA).

[Glaucoma and ocular surface]

Topical eye-drops remain the cornerstone of treatment for ocular diseases, including glaucoma. Preservatives are added to multi-dose medication bottles to reduce the risk of microbial contamination, to extend the validity of the product and to allow an easily use of the bottles. However the repetitious use of ophthalmic medications containing preservatives, particularly when treating chronic diseases, has been linked to adverse effects and ocular surface disease (OSD). Therefore, this presentation provides an overview of glaucoma and OSD, the role of preservatives in ophthalmic preparations, and the impact of preservatives on the ocular surface.

[About ocular surface damage]

Tear film maintain ocular surface health and functional through nutritional support, anti-bacterial properties, viscoelastic protection, smooth optical surface and increase of lubrication. The ocular surface may be affected after surgery (cataract, glaucoma, refractive surgery) or chronic glaucoma treatment.

[Progresses in antiinflamatory treatment in cataract surgery]

Anti-inflamatory medication is commonly used to reduce inflammation, edema and symptoms associated with allergies, trauma and infections diseases. Topical nonsteroidial anti-inflammatory (NSAIDs) and topical corticosteroids are overview of the role of topical NSAIDs and the progress of their use in eye surgery

[Increased ocular perfusion--visual field preservation]

Adjustment of the ocular flow has clear implications in glaucomatous pathology. It cannot be drawn a clear barrier between causality and effect of ocular vascular factor in glaucoma but altered hemodynamics leads clearly to node loss. Unstable ocular perfusion creates a low blood flow to the optic nerve directly involved in glaucomatous optic neuropathy , ocular perfusion pressure (PPO) being a risk factor predictor of progression associated with impairment of visual function in glaucoma.

[Alternative treatments in glaucoma, independent from ocular pressure]

Glaucoma is a medical condition that affects the optic nerve of the eye and can lead to a permanent loss of vision if left untreated. It is now clear that IOP (intraocular pression) lowering treatment may significantly delay or prevent glaucoma development and progression. Although current ocular hypotensive therapy is generally considered safe, alternative treatments may also be considered to slow the progression and prevent the development of complications of the disease.

[Extract of Ginkgo biloba in glaucoma]

Protective and curative effects of the ginkgo biloba extract are known for a long time and confirmed the practical reality. Its main benefit is due to its antioxidant properties, manifested by activation of free radicals by flavonoids contained in gingko by binding free radicals.

[Refractive stability of artificial crystallins--acrysof TORIC]

PURPOSE

To evaluate the results of AcrySof Toric intraocular lens (Alcon) implantation to correct pre-existing astigmatism and rotational stability in patients having cataract surgery or not.

METHODS

Retrospective study three surgical teams, between February 2009-August 2010, included 37 eyes with more than 1 diopter (D) of preexisting corneal astigmatism having or not cataract surgery.

RESULTS

Rotation at 6 M post-op: 32 patients (87%)--> rotation between aprox. 0-5 degrees, 4 patients (11%)--> rotation between A 5-10 degrees, 1 patient (2%) rotation of A 20 degrees. The mean refractive cylinder decreased significantly after surgery: 34 (91.90%) of cases between 0.25-0.75 D--2 (5.40%) of cases 1.5 D--1 (2.70%) of cases > 1.5 D.

CONCLUSIONS

In conclusion the results indicate that TheAcrySof Toric IOL is a viable option of preoperative corneal astigmatism in carefully selected cases. The Toric IOL showed good rotational stability The most frequent cause of turnover is the: viscoelastic left in the capsular bag (early rotation); fibrosis of the bag (late rotation).

[Neuroprotection in glaucoma]

The present paper is a revue of the basic terms related to the neuroprotection, an up-to-date on the pathophysiology of glaucoma. There are emphasized some of the main directions of evolution in the antiglaucomatous and neuroprotective treatment.

[Cornea in glaucoma]

The authors present a clinical, observational, retrospective, randomized study, performed between 06.01-01.05.2010, on 84 eyes. We have followed the changes of corneal endothelial cell density in patients with primary hypertensional open angle glaucoma, treated using the same therapeutic method, with compensated, undercompensated and decompensated IOP.

High efficacy of panobinostat towards human gastrointestinal stromal tumors in a xenograft mouse model

PURPOSE

Histone deacetylase inhibitors have emerged as potent anticancer compounds. Using a nude-mouse xenograft model, for the first time we evaluated the response of human gastrointestinal stromal tumors (GIST) carrying different oncogenic KIT mutations to panobinostat (LBH589), administered single or in combination with imatinib.

EXPERIMENTAL DESIGN

We grafted the human GIST882 cell line with KIT exon 13 mutation and two biopsies from patients radiologically progressing under imatinib showing KIT exon11 and KIT exon9 mutations, respectively. Our study included 4 groups: A (n = 9; control), B (n = 10; panobinostat 10 mg/kg daily, i.p.), C (n = 9; imatinib 150 mg/kg bidaily, p.o), and D (n = 8; combination panobinostat-imatinib, same dose/schedule as above). Treatment lasted 12 days. Tumor size was measured regularly using standard variables. Histopathological assessment was by H&E, and immunohistochemically with KIT, cleaved caspase-3, Ki-67, and histone acetylation staining.

RESULTS

Overall, GIST xenografts responded rapidly to panobinostat as indicated by tumor regression, necrosis, hemorrhages, fibrosis, and/or myxoid degeneration, remarkable apoptosis, and substantial decline of cell proliferation. H3 and H4 acetylation increased significantly from control level in all treated groups. The combination of panobinostat and imatinib further enhanced most of the assessed parameters.

CONCLUSIONS

We show for the first time potential therapeutic activity of panobinostat in human GISTs, in vivo. Our results warrant further exploration of histone deacetylase inhibitors for the treatment of advanced GISTs. Our study is also the first one on human GIST mouse xenografts established using patient biopsies.

Assessment of the heat shock protein 90 (HSP90) inhibitor IPI504 alone or in combination with the tyrosine kinase inhibitor (TKI) imatinib in mice carrying xenografts of human gastrointestinal stromal tumors (GIST)

10534

Background: Inhibition of HSP90 is a new strategy for treatment of GIST. IPI-504 is a potent i.v. HSP90 inhibitor. We assessed the activity of IPI-504 in imatinib-sensitive GIST xenografts, alone/combined with the TKI. Methods: Human GIST882 cells (KIT exon 13 mut.) were grafted in 43 nude mice, who were randomized to 4 groups: A (n=13; control); B (n=18; IPI-504 100 mg/kg 3x/wk p.o.); C (n=8; imatinib 50 mg/kg 2x/d p.o.); D (n=4; IPI-504+imatinib, dose/schedule as above) for 2 weeks. Histopathological assessment was done by H&E and KIT immunostaining, histological response (HR) was defined by magnitude of necrosis and myxoid degeneration [grade 1 (0–10%), 2 (>10% - ≤ 50%), 3 (> 50% - ≤90%), 4 (>90%)]. Expression/activation of KIT and its signaling (AKT, S6, MAPK) was assessed by Western blot. Results: IPI-504 alone significantly reduced tumor volume (41%) at day 14, further enhanced by adding imatinib (58%). Imatinib alone led to only a 5% reduction. IPI-504 induced grade 2 HR in 17/36 tumors, while the majority of tumors (13/15) treated with imatinib showed grade 1 HR. Grade 3/4 HRs were only seen with the combination. Mitosis decreased 3.3-fold, apoptosis increased 1.3-fold with IPI-504. Despite substantial reduction in mitotic activity in C and D (8.2- and 82-fold), apoptosis was virtually unaffected. In the IPI-504 arm, KIT levels were partially downregulated. Imatinib alone had no effect on KIT expression, while the combination produced a marked suppression of total KIT, accompanied by complete downregulation of the signaling. Loss of KIT in the combination arm was confirmed by immunostaining. Although KIT was not completely degraded with IPI-504, measurable effects on activation of AKT, S6 and MAPK were observed. Conclusions: IPI-504 has consistent antitumor effects in GIST xenografts, both histologically and on the molecular level. Combining IPI-504 with imatinib substantially enhances anti-tumor activity, providing a strong rationale for clinical trials of IPI-504 in GIST as single agent and in combination.

[Table: see text]

[Ocular hypertension--follow up or treatment?]

Ocular hypertension is an increase in the pressure in the eyes that is above the range considered normal with no detectable changes in vision or damage to the structure of your eyes. The term is used to distinguish people with elevated pressure from those with glaucoma, but not all people with ocular hypertension will develop this disease. However, there is an increased risk of glaucoma among those with ocular hypertension, so regular comprehensive eye examinations are essential to the overall eye health.