Gemcitabine-induced pseudocellulitis: a case report and review of the literature.

Gemcitabine is a chemotherapeutic agent used in a wide variety of solid tumours. Known side effects include a dose-limiting myelosuppressive toxicity, mild rash, and radiation-dependent dermatitis. Rarely, localized inflammation in the form of pseudocellulitis has also been observed. We present the case of a 77-year-old woman with a history of a Whipple procedure for pancreatic adenocarcinoma who presented to the emergency department after the start of gemcitabine therapy with increased erythema, swelling, and tenderness in her lower legs. Relevant past medical history included peripheral vascular disease, dyslipidemia, and hypertension. A diagnosis of gemcitabine-induced pseudocellulitis aggravated by venous stasis was confirmed after an extensive workup. This case report and the literature review describe this rare reaction, highlighting the need for increased recognition to avoid unnecessary therapeutic intervention.

The effect of bariatric surgery on serum 25-OH vitamin D levels: a systematic review and meta-analysis.

BACKGROUND: Concerns have emerged about post-operative decreases in calcium and vitamin D following bariatric surgery. This review explores changes in metabolic bone health in persons with obesity undergoing gastric bypass surgery compared to non-surgical controls, providing an updated and comprehensive perspective on the literature. METHODS: An electronic search was conducted in MEDLINE, Pubmed, EMBASE and Cochrane databases to 8 November 2016. Eligible trials included randomized controlled trials or controlled observational studies of patients who have undergone laparoscopic gastric bypass surgery. Statistical analysis was carried out using the Cochrane Collaboration Review Manager (RevMan 5.0), and a random effects model was implemented. Outcomes were expressed as weighted mean difference (WMD). The primary outcome examined was change in 25-OH-D levels at 12 months post surgery, and secondary outcomes included change in bone mineral density (BMD) measurements at 12 months post surgery at the lumbar spine (LS) and total hip (TH). RESULTS: At 12 months, there was no significant difference in 25-OH vitamin D in the surgical group compared to controls (WMD = 6.79%; 95% CI: -9.01, 22.59; p = 0.40; I2 = 68%). There was no statistically significant difference between fracture risk in the surgical population compared to controls (RR = 1.24; 95% CI: 0.99, 1.56; p = 0.06; I2 = 0%). A significant BMD reduction was however shown at the TH (WMD, -7.33%, 95% CI = -8.70 to -5.97, p < .001, I2 = 0%), and a trend towards decline was observed at the LS (WMD, -1.73%, 95% CI = -3.56 to 0.11, p = 0.06, I2 = 0%). Changes at 24 months for applicable outcomes were similar to the results at 12 months. CONCLUSIONS: Bariatric surgery may compromise metabolic bone health, but the paucity of high-quality literature limits conclusions.

Stability of Cannabis sativa L. samples and their extracts, on prolonged storage in Delhi.

The percentage rate of change into cannabinoids (Cannabidiol [CBD], tetrahydrocannabinol [THC] and cannabinol [CBN]) was higher in cannabis samples than in the extracts. This is probalby due to the decomposition of acids into corresponding neutral cannabinoids under the conditions of storage. Previous claims that CBD content in plant material is relatively constant are not substantiated by our results. There was a 1.0-2.5-fold increase in CBD content in plant material compared with the extracts. However, the fact that there was no appreciable increase in CBD/CBN content in the stored extracts of the same samples supports the view that the step-wise extraction does not bring the acids into the final extract pure delta 9THC decomposed at a rate of 41 per cent per year under tropical storage conditions. The delta 9THC content decreased in the samples and equally in the extracts though 100 per cent conversion of THC to CBN does not take place. The higher CBN content found in extracts than that expected by the conversion THC to CBN is a result of metabolic conversion.