A Case of an Increase in Prothrombin Time-International Normalized Ratio by Interaction Between Warfarin and Baloxavir Marboxil in a Patient on Implantable Ventricular Assist Device.

BACKGROUND: Baloxavir marboxil (BM) is a novel drug with a cap-dependent endonuclease inhibitory action for influenza A or B; it is highly safe and requires just a single oral dose. Patients with severe heart failure use implantable ventricular assist device (iVAD) until transplantation, but they have an increased risk of thrombosis development. Their warfarin is administered based on point-of-care testing (POCT) with a strict control of prothrombin time-international normalized ratio (PT-INR). CASE REPORT: Here, we report a case of a patient with iVAD whose PT-INR was significantly increased from the target range after BM administration. The patient was a 45-year-old man and transplanted with iVAD; warfarin treatment was started when his PT-INR target range was 3.0-3.5. At home, he frequently self-measured PT-INR by POCT and precisely controlled the warfarin dose. He had a fever, was diagnosed with influenza A and was administered BM 40 mg. Thereafter, his PT-INR continued to increase, reaching 4.8 on day 12 of BM administration, exceeding his target range; warfarin was skipped for 1 day. In this case, based on the history of BM administration and clinical course, the increase in PT-INR could be due to BM. Considering the interaction between warfarin and BM, we suspected a possibility of competition for protein-binding sites. Increased PT-INR in the patient was detected early by POCT and thus severe bleeding was avoided. CONCLUSION: Strict monitoring of PT-INR when using BM in patients taking warfarin is of clinical importance.

Pharmacokinetic analysis of transcellular transport of levofloxacin across LLC-PK1 and Caco-2 cell monolayers.

To characterize the membrane transport responsible for the renal excretion and intestinal absorption of levofloxacin, we performed pharmacokinetic analysis of transcellular transport across LLC-PK(1) and Caco-2 cell monolayers. Transcellular transport of levofloxacin in LLC-PK(1) cells was greater in the basolateral-to-apical direction than in the opposite direction. Pharmacokinetic analysis indicated that basolateral uptake was the direction-determining step for the transcellular transport of levofloxacin in LLC-PK(1) cells. The apical efflux clearance of levofloxacin in LLC-PK(1) cells was increased at the medium pH 6 as compared with at pH 8, suggesting that membrane transport characteristics of levofloxacin are apparently similar to those of a prototypical organic cation, tetraethylammonium. On the other hand, transcellular transport of levofloxacin in Caco-2 cells was only slightly greater in the basolateral-to-apical direction than in the opposite direction. The apical efflux clearance of levofloxacin in Caco-2 cells was greater than basolateral efflux clearance, and apical influx clearance was greater than any other membrane transport clearance. In addition, the apical uptake of levofloxacin as well as quinidine in Caco-2 cells was inhibited significantly by nicotine and imipramine. The findings indicated that some transporters are responsible not only for the efflux but also for the influx of levofloxacin at the apical membrane of Caco-2 cells.

Tratamento da úlcera corneana perfurada: revisäo da literatura / Treatment of perforated corneal ulcers: a review

Os autores enumeram os principais tratamentos das úlceras de córnea perfuradas, dividindo-os em dois grupos, o grupo dos tecidos biológicos utilizados para tamponar ou substituir a regiäo perfurada e o grupo dos adesivos, com destaque para o adesivo de fibrina, que é fisiológico por ser reabsorvido e substituido por cicatriz epitelizada quando aplicado na córnea perfurada, em contraste com o ciano-acrilato, näo reabsorvível e irritante

Desenvolvimento de equipamento de geraçäo e registro de pressäo intra-ocular suportada por perfuraçäo corneana colada com fibrina / Development of an equipment for generating and recordin intra-ocular pressure borne by fibrin-glued corneal perforations

Foi desenvolvido equipamento de geraçäo e registro de pressäo intraocular, com faixa de medida de 0 a 480mmHG, para medida da resistência à pressäo intraocular em ferimentos perfurantes corneanos colados com fibrina

Carcinoma metatástico de íris: descriçäo de 2 casos / Metastic carcinoma of the iris: 2 case reports

Descrevemos 2 casos de carcinoma metastático para o segmento anterior ocular. Apesar da raridade desta patologia é importante suspeitar de tal diagnóstico ao avaliar tumoraçöes em segmento anterior e proceder a investigaçäo clínica adequada. Nos 2 casos descritos, a hipótese diagnóstica de metástase foi feita pelo exame oftalmológico. Os pacientes näo apresentavam queixa sistêmica e näo tinham o diagnóstico do tumor primário. Em um dos casos, o diagnóstico foi confirmado pela biópsia aspirativa, sugerindo ser um instrumento valioso no diagnóstico desta patologia