The relationship between bone marrow characteristics and the clinical prognosis of antithyroid drug-induced agranulocytosis.

This study is aimed to explore the relationship between bone marrow characteristics and clinical prognosis of antithyroid drug (ATD) induced agranulocytosis. A retrospective study was conducted in the first affiliated hospital of the University of South China. A total of 33 hospitalized patients diagnosed with ATD-induced agranulocytosis were analyzed. The bone marrow characteristics were classified into two types. Type I was characterized by reduction or absence of granulocytic precursors and type II was recognized as hypercellular bone marrow with dysmaturity of granulocytic cells. Bone marrow of 20 cases (61%) were characterized with type I whereas 13 cases (39%) with type II. The median duration of neutrophil recovery and high-grade fever were 4.7 ± 1.0 days and 3.6 ± 2.5 days respectively for type II, compared to 8.0 ± 2.8 days and 8.6 ± 3.1 days for type I (p < 0.01 in both compared groups). However, there was no significant difference between the two types in terms of age, median duration of drug administration before the diagnosis of agranulocytosis, the amount of neutrophil count on admission and the total administration dose of granulocyte-colony stimulating factor (G-CSF) before bone marrow examination. Two cases of type I died of complications from infection. This study showed that the bone marrow characteristics of ATD-induced agranulocytosis could be classifed into two types. Also, the clinical prognosis was closely related to the bone marrow features. Type I is the dominant type which is usually associated with worse clinical prognosis compared to type II.

The Spectrum of Tigecycline-Induced Pancreatitis in Clinical Characteristics, Diagnosis, and Management.

Introduction: Tigecycline-induced acute pancreatitis (AP) has been frequently increasingly reported in solid organ transplant patients. This review aimed to summarize the characteristics, possible mechanisms, and management of tigecycline-induced AP. Methods: Case reports of tigecycline-induced AP published in Chinese or English were collected until February 2023 for retrospective analysis. Results: Thirty-four patients from 29 articles were included. Fifteen patients (46.9%) had solid organ transplantation, and 4 patients (12.5%) had malignant tumors. Twenty-five patients (89.3%) received a recommended maintenance dose of tigecycline (50 mg q12 h). The median age was 50 years (range 9-87). Compared to the nontransplant patients, the median age of the transplant patients was significantly younger, 44 years (range 12.5-61) versus 57.5 years (range 9-87) (P=0.03). The median time of symptom onset was 7 days (range 2-29), and 91.2% (31/34) were less than 14 days. Typical initial symptoms included abdominal pain (90.6%), nausea (46.9%), vomiting (43.8%), and abdominal distention (21.9%). Most cases were accompanied by elevated levels of pancreatic enzymes. The main radiological features included edematous infiltrate and acute pancreatitis on computed tomography (CT) scan and abdominal ultrasound. Except for one patient who continued tigecycline treatment, all patients discontinued treatment and received symptomatic support such as fasting, acid suppression, and enzyme suppression. The median time to recover pancreatic enzymes to the normal range was 5 days (range 1-43), and the median time to relieve symptoms was 4 days (range 1-12). Four patients died, of whom two died of severe pancreatitis complications and two of cardiogenic shock and septicemia. Conclusion: Tigecycline-induced AP was a rare and serious complication that occurred mainly within two weeks of the medication. This serious side effect should be kept in mind while treating severe infections especially in transplant recipients.

[Effects of different feeding patterns on body weight of perinatal women in rural area].

OBJECTIVE: To study the relations between different feeding patterns and the body weight retention of the perinatal women living in rural areas of China. METHODS: A cluster sampling method was used to investigate 409 women, who are currently living in rural areas of Tianjin, at pregnant and perinatal status. While, their body weights and heights before pregnancy, antepartum and postpartum were measured, respectively. Body weight retention was the difference of the measured data after postpartum minus pre-pregnant weight. Variance analysis was used for statistic comparison. RESULTS: The rate of exclusive breastfeeding was 70.9% (290/409) within four months. The net body weight retention of women (5.8 kg) using the exclusive breastfeeding was lower than that of the women (7.0 kg) using artificial feeding within 4 - 6 months, but there was no significantly statistic difference (F = 1.45, P = 0.236). However, there was the opposite result within 7 - 9 months, the data showed that the body weight retention in the women using the exclusive breastfeeding was 4.9 kg, which was significantly higher than that the women (2.9 kg) with artificial feeding (F = 3.17, P = 0.043). The food consumption of the women (901 g) using exclusive breastfeeding was the highest, followed by those (877 g) using mixed feeding and the women (750 g) using artificial feeding. CONCLUSION: The body weight retention after postpartum should be related to infant feeding patterns. After postpartum, the weight loss of women using the exclusive breastfeeding is relatively low. While, for the women using the exclusive breastfeeding, the net weight retention during pregnancy and after postpartum were lower than those with artificial feeding. Therefore, it is necessary to enhance health education and guidance on promoting exclusive breast-feeding as well as increasing awareness on pre-pregnant health.

Sudden onset agranulocytosis and hepatotoxicity after taking methimazole.

Agranulocytosis is a rare adverse effect of methimazole. The usual duration of treatment prior to the onset of agranulocytosis is approximately 1 to 4 months, and can be as long as 1 year. Agranulocytosis together with hepatotoxicity is an extremely rare idiosyncratic side effect of methimazole treatment. We present an unprecedented case of a Grave's disease patient who showed a strong reaction to methimazole with obvious agranulocytosis and hepatotoxicity which developed only six days after administration. This case, along with a literature review, is offered with the aim to increase the awareness of physicians of sudden onset agranulocytosis and hepatotoxicity from methimazole.