Fatal neutropenic enterocolitis associated with docetaxel use: A review of cases reported to the United States Food and Drug Administration Adverse Event Reporting System.

Docetaxel is a microtubule inhibitor indicated for the treatment of multiple cancers as a single agent or in combination with other antineoplastics. The U.S. Food and Drug Administration (FDA) conducted a postmarketing review of fatal neutropenic enterocolitis cases reported with docetaxel using the FDA Adverse Event Reporting System (FAERS) and literature to determine whether the drug was a potential cause. We searched FAERS and the literature for reports of fatal neutropenic enterocolitis with docetaxel-based treatment reported between 14 May 1996 and 13 March 2017. We characterized the clinical course and severity of neutropenic enterocolitis and utilized the World Health Organization-Uppsala Monitoring Centre rubric to assess drug causality. We identified 41 fatal cases of neutropenic enterocolitis with docetaxel from FAERS and the literature. The median time to onset of neutropenic enterocolitis from last docetaxel dose was seven days (range 2-13 days), and median time to death was nine days (range 3-23 days). The cause of death in 83% (34/41) of patients was neutropenic enterocolitis. We determined the drug-event association as probable in seven cases. Neutropenic enterocolitis with docetaxel monotherapy occurred in six cases; however, in 85% (35/41) of cases, neutropenic enterocolitis occurred when docetaxel was used in combination with other cytotoxic chemotherapy. In some cases, neutropenic enterocolitis occurred despite use of granulocyte colony-stimulating factors. Neutropenic enterocolitis is a severe and potentially fatal complication of docetaxel-based treatment, especially when combined with other antineoplastic treatments known to cause neutropenia. Practitioners should be aware of this safety risk to promptly recognize and manage patients.

Wound healing complications with lenvatinib identified in a pharmacovigilance database.

The U.S. Food and Drug Administration (FDA) has approved several vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors, including lenvatinib, for thyroid and renal malignancies. Inhibition of the VEGFR signaling pathway impairs angiogenesis and can disrupt wound healing. The objective of this work was to evaluate wound healing complications as a potential safety risk for patients treated with lenvatinib. We searched the FDA Adverse Event Reporting System (FAERS) database for postmarketing reports of wound healing complications with lenvatinib between 13 February 2015 (FDA approval date) and 15 February 2017. The search identified nine FAERS cases of lenvatinib-associated wound healing complications that were not previously reported in the medical literature. Seven cases involved postoperative wound healing complications, such as impaired healing or wound dehiscence. In our case series, the reported time to identification of delayed wound healing from tissue injury or surgery varied over a wide range (4-58 days). The time of initial lenvatinib exposure relative to the tissue injury was also highly varied in our series, which may have influenced the development and detection of impaired healing. FAERS case-level evidence suggests that lenvatinib may have contributed to wound healing complications based on temporality and biologic plausibility. Healthcare professionals should be aware of this safety risk to facilitate prompt recognition and risk mitigation.

Caracterización proteómica de vesículas de membrana externa extraídas de Shigella sonnei / Proteomic characterisation of outer membrane vesicle extracted from Shigella sonnei

Las vacunas compuestas por vesículas de membrana externa (VMEs) previenen de manera exitosa la enfermedad meningocócica del serogrupo B. Esta plataforma tecnológica de obtención puede ser aplicada para otros patógenos bacterianos Gram negativos. Una vacuna de VMEs desarrollada contra Shigella sonnei fue obtenida a través de una extracción de componentes celulares y su caracterización por electroforesis en geles de poliacrilamida unidimensional (1D). Se estudiaron las mejores condiciones de solubilización de las muestras, separación electroforética e identificación a través de espectrometría de masas acoplada a cromatografía de alta presión después del corte de las bandas y su tratamiento enzimático con tripsina. En esta etapa se identificaron un total de 57 proteínas en 23 bandas (2,5 proteínas por banda escindida), 47 de las proteínas no repetidas. Las proteínas inmunogénicas presentes en VMEs de S. sonnei fueron cuantificadas en cuanto a masa molecular por 1D-Western blotting en membranas de nitrocelulosa con anticuerpos obtenidos a partir de ratones inmunizados con las VMEs. Como que las bandas electroforéticas 1D contenían más de una proteína, se estudiaron las mejores condiciones de separación por el método de electroforesis bidimensional (2D) para el establecimiento del mapa proteico; tal que el incremento del tamaño de las tiras, el tiempo de focalización y la aplicación catódica garantizaron la mayor resolución(AU)

Outer membrane vesicles (OMVs) vaccines successfully prevent Group B meningococcal disease. This platform technology may be applied against other Gram negative bacterial pathogens. An OMV vaccine against Shigella sonnei was prepared by detergent extraction of cells and characterised by one-dimensional polyacrylamide gel electrophoresis (1D). The protein components were quantified by staining and scanning and the composition of bands were defined by coupled high-performance low chromatography/electrospray ionization tandem mass spectrometry after band excision and in-gel trypsin digestion. 57 proteins contained in 23 bands (2.5 proteins/split band) were detected, 47 of them were not repeated. The S. sonnei OMVs immunogenic proteins were identified by 1D-immunoblotting, after transfer of proteins to a nitrocellulose membrane and treatment with antibodies generated by immunisation of mice with the OMVs. The bands detected by 1D had more than a single proteins, that is why we studied the best conditions for molecular separation by two-dimension electrophoresis (2D) for establishing the protein map; such that the increase of strips size, time of isoelectric focusing (IEF) and cup-cathodic loading guaranteed the highest resolution(AU)

Prognostic importance of presenting symptoms in patients undergoing exercise testing for evaluation of known or suspected coronary disease.

PURPOSE: Chest symptoms, along with standard cardiovascular risk factors, are commonly factored into pretest risk stratification of patients who are referred for stress testing. We sought to determine the independent prognostic value of chest symptoms. METHODS: We studied the outcomes of 10,870 patients referred for symptom-limited exercise testing who had no history of myocardial revascularization, heart failure, or arrhythmias. Chest symptoms were prospectively characterized according to prespecified definitions. Propensity analysis was used to account for differences in baseline and exercise characteristics. RESULTS: Typical angina was present in 635 patients (6%), atypical angina in 3408 (33%), nonanginal chest pain in 1805 (17%), and dyspnea in 841 (8%). The remaining 4181 patients (38%) were asymptomatic. During a mean follow-up of 4.3 years, there were 381 deaths. After propensity matching patients who had typical angina with asymptomatic patients, symptoms were not predictive of mortality (adjusted hazard ratio [HR] = 0.8; 95% confidence interval [CI]: 0.6 to 1.3; P = 0.4). Among patients who had chest pain, typical angina was associated with a highly significant risk of mortality as compared with nonanginal chest pain (HR = 2.7; 95% CI: 1.4 to 5.1; P = 0.002), but not compared with atypical angina (HR = 1.3; 95% CI: 0.9 to 2.1; P = 0.21). CONCLUSION: After accounting for baseline and exercise characteristics, the presence of symptoms was not independently associated with increased mortality among patients undergoing testing for known or suspected coronary disease. Among patients who actually had chest pain, typical angina carried a higher mortality risk.