Hydralazine-Induced Isolated Lupus Nephritis.

Background: Hydralazine has been known to cause multiple side effects, both localized and systemic. The literature includes case reports of systemic vasculitis caused by hydralazine. Case Report: A 79-year-old male with stage 3 chronic kidney disease attributable to hypertension and type 2 diabetes was started on hydralazine to control his hypertension. Three weeks after starting hydralazine, the patient developed nephrotic syndrome and acute kidney injury with progressively worsening proteinuria. Pathologic evaluation of the kidney tissue revealed that the patient had lupus nephritis. Immunologic markers confirmed hydralazine-induced lupus nephritis with positive antihistone antibodies. No evidence of systemic vasculitis was found. The patient's hydralazine was stopped, and the patient was treated with immunosuppressive therapy. After 7 months of immunosuppressive therapy, the patient achieved complete remission of lupus nephritis. Conclusion: Isolated renal disease induced by hydralazine as part of drug-induced lupus is uncommon. Our patient developed isolated classic lupus nephritis after hydralazine therapy with no associated systemic vasculitis. Treatment required stopping the hydralazine and initiating systemic immunosuppressive therapy to achieve complete remission.

Thiamine Responsive Megaloblastic Anaemia, Diabetes Mellitus and Sensorineural Hearing Loss in a Child.

Thiamine-responsive megaloblastic anemia (TRMA) syndrome is an autosomal recessive inherited disorder characterised by a triad of megaloblastic anemia, diabetes mellitus, and sensorineural deafness. We report a case of 2-year-old girl whose anemia improved following administration of thiamine. She came with the history of persistent anaemia for the last one year. Anaemia was not responding to iron, vitamin B12, and folate replacement therapy. The bone marrow aspiration revealed hypercellular marrow with megaloblastic changes and more than 15% ring sideroblasts. The hearing assessment revealed sensorineural hearing loss. Blood sugar random and HBA1c was raised. Final diagnosis of TRMA was made. She was started on thiamine 100 mg OD, with normal routine balanced diet. She responded very well to thiamine. Her haemoglobin improved and blood sugar fasting came down in normal range. This case report sensitises the early diagnosis, and treatment with thiamine in children presenting with anemia, diabetes and deafness.

Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan.

OBJECTIVE: Review of obstetric cases admitted to the intensive care unit. DESIGN: Ten year retrospective review of individual patients' medical records. PARTICIPANTS: Records of obstetric patients admitted from 2005-2014. SETTING: Aga Khan University Hospital Karachi. MAIN OUTCOME MEASURES: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality. FINDINGS: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis. CONCLUSION: When the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women.

Expert testimony influences juror decisions in criminal trials involving recovered memories of childhood sexual abuse.

We examined the impact of expert witness orientation (researcher or clinical practitioner) and type of testimony (testimony for the prosecution, defense, both prosecution and defense, or no testimony) on mock jurors' decisions in a sexual abuse trial. Participants acted as mock jurors on a sexual abuse criminal trial based on recovered memory that included expert witness testimony. Results showed that expert witness testimony provided by a researcher did not impact mock jurors' guilt ratings any differently than the expert witness testimony provided by a clinical practitioner. However, type of testimony had a significant effect on jurors' guilt ratings such that jurors who read only defense or only prosecution testimony made decisions favoring the relevant side.

Semantic satiation effect in young and older adults.

Auditory and auditory+visual massed repetition served to examine semantic satiation in young and older adults and to understand the possible sources of this phenomenon. In Exp. 1, participants either heard or heard and saw prime words (ROYALTY) repeated 2, 15, or 30 times and made relatedness judgments on targets that were either semantically related (queen) or unrelated (box) to the repeated word. To distinguish satiation from general boredom, semantic satiation was operationally defined as a repetition-induced change in the difference between related and unrelated pairs (relatedness effect). Auditory massed repetition, either alone or in conjunction with prolonged visual exposure, produced semantic satiation effects in both young and older adults. In Exp. 2, participants heard the prime words of the earlier experiment, each repeated 30 times and reported perceptual changes (verbal transformations) during the repetition treatment. In this experiment, older adults were less susceptible to this type of habituation. The discussion focuses on the mechanisms that may be responsible for producing semantic satiation effects in young and older adults with different forms of massed repetition.

An immunogenetic and molecular basis for differences in outcomes of invasive group A streptococcal infections.

The role of host genetic factors in conferring predisposition or protection in infectious diseases has become evident. Infection with group A streptococci causes a wide spectrum of disease ranging from pharyngitis to streptococcal toxic shock syndrome. The release of inflammatory cytokines triggered by streptococcal superantigens has a pivotal role in invasive streptococcal disease. However, individuals infected with the same strain can develop very different manifestations. We report here that the immunogenetics of the host influence the outcome of invasive streptococcal infection, and demonstrate the underlying mechanism for these genetic associations. Specific human leukocyte antigen class II haplotypes conferred strong protection from severe systemic disease, whereas others increased the risk of severe disease. Patients with the DRB1*1501/DQB1*0602 haplotype mounted significantly reduced responses and were less likely to develop severe systemic disease (P < 0.0001). We propose that human leukocyte antigen class II allelic variation contributes to differences in severity of invasive streptococcal infections through their ability to regulate cytokine responses triggered by streptococcal superantigens.