RESUMO
We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine. Two years later, clozapine was re-trialled due the refractory nature of her psychiatric symptoms. She subsequently developed renal failure and AIN was confirmed by renal biopsy. Renal function improved after cessation of clozapine; however, she never fully regained normal renal function.
Assuntos
Clozapina , Nefrite Intersticial , Transtornos Psicóticos , Clozapina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/induzido quimicamente , Nefrite Intersticial/patologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológicoRESUMO
Relapse is still a common problem after bone marrow transplant (BMT) and teh value of adding etoposide to standard conditioning agents is being tested. The aim of the study was to assess the extramedullary toxicity which resulted from adding etoposide to busulphan 16 mg/kg and cyclophoshamide 120 mg/kg (BuCY2). Eighty four patients received etoposide 40 mg/kg in addition to BuCY2 as conditioning for autologous and allogeneic BMT for leukemia and lymphoma. The Bearman system of grading extramedullary toxicity was used along with a system of grading skin toxicity that we devised. There were seven acute toxic deaths (8%) and in total 15 patients experienced life-threatening or fatal toxicity. The major finding was a striking increase in pulmonary toxicity with six deaths (five alveolar hemorrhage and one pulmonary embolus). Five of seven of the patients with severe pulmonary toxicity had been given irradiation to the lung fields (P < 0.001). Thirty nine per cent of patients had veno-occlusive disease of the liver but the case fatality rate was low (1 of 33). Dermatologic toxicity was experienced by 82% of patients and was symptomatically troublesome but rapidly reversible. The addition of etoposide to BuCY2 increases non-hematological toxicity. This regimen is associated with severe pulmonary toxicity in patients with a history of prior chest irradiation. A high incidence of skin toxicity was seen; a system for describing this toxicity is proposed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Transplante de Medula Óssea , Leucemia/terapia , Linfoma/terapia , Adolescente , Adulto , Biópsia , Bussulfano/efeitos adversos , Terapia Combinada , Ciclofosfamida/efeitos adversos , Etoposídeo/efeitos adversos , Feminino , Doença Enxerto-Hospedeiro/etiologia , Humanos , Leucemia/mortalidade , Pulmão/efeitos dos fármacos , Linfoma/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Pele/efeitos dos fármacos , Pele/patologia , Pele/efeitos da radiação , Taxa de Sobrevida , Transplante Autólogo , Transplante HomólogoRESUMO
Mutation of human immunodeficiency virus (HIV) to drug resistance is an obstacle to HIV containment, and may account for the transitory nature of the improvement in CD4 cell counts of patients receiving azidothymidine (AZT). The emergence of AZT-resistant (AZTR) virus might be suppressed if a second therapeutic could be added; however, such a regimen would have to confer not only additional control over HIV replication but also no additional toxicity, especially to bone marrow progenitor cells. In the present study, HIV was isolated from patients receiving AZT alone and was studied for sensitivity to the mismatched double-stranded RNA, poly(I):poly(C12U) (ampligen). In addition, the combination of poly(I):poly(C12U) plus AZT was studied in vitro for toxicity to bone marrow CFU-GM and in patients receiving combined therapy for bone marrow toxicity. HIV isolated from patients receiving AZT alone showed higher resistance to AZT than wildtype virus, but remained sensitive to poly(I):poly(C12U). Poly(I):poly(C12U) and AZT were synergistic in inhibiting all isolates of HIV tested, regardless of their AZTR phenotype. Furthermore, the combination of poly(I):poly(C12U) and AZT showed no toxicity in vitro to bone marrow CFU-GM compared to AZT alone. In 11 HIV infected individuals receiving the combinational regimen, bone marrow function gradually improved. These results indicate that poly(I):poly(C12U) was active against AZTR HIV, synergistic with AZT and did not convey added toxicity.
Assuntos
Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/efeitos dos fármacos , Células-Tronco Hematopoéticas/efeitos dos fármacos , Poli I-C/uso terapêutico , Poli U/uso terapêutico , RNA de Cadeia Dupla , Zidovudina/uso terapêutico , Antivirais/efeitos adversos , Ensaio de Unidades Formadoras de Colônias , Resistência a Medicamentos , Sinergismo Farmacológico , Quimioterapia Combinada , Humanos , Poli I-C/efeitos adversos , Poli U/efeitos adversos , Zidovudina/efeitos adversosRESUMO
Over the last 10 years, low-pathogenicity avian influenza (LPAI) viruses have been isolated from the live-bird markets (LBMs) of the Northeast. Despite educational efforts, surveillance, and increased state regulatory efforts, the number of positive markets has persisted and increased. In an effort to address the continued levels of LPAI in the retail LBM and address the question of persistence and circulation of the virus within the LBM system itself, these markets were closed for a continuous 3-day period. This effort was a cooperative effort between the State Departments of Agriculture and coordinated by the U.S. Department of Agriculture and led to the first successful system-wide closure of the retail LBMs in the Northeast.