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Cureus Nov 2019Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout is an idiopathic articular disease that predominantly affects elderly patients. It is...
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout is an idiopathic articular disease that predominantly affects elderly patients. It is caused by a systemic deposition of calcium pyrophosphate (CPP) crystals in the articular and hyaline joint cartilage. The majority of cases present as chronic arthritis, but a subset of CPPD can present as rapid onset of sharp pain and joint swelling, posing a diagnostic challenge. We present a case of a 64-year-old man with a history of hypertension, urologic cancer, and gout presenting to the emergency department (ED) with a sudden-onset, severe stabbing right shoulder pain radiating to the neck and upper back. On ED arrival, he was mildly hypotensive, afebrile, diaphoretic, and uncomfortable, causing concern for aortic dissection. His exam was significant for limited shoulder range of motion; his sensation, strength, and distal pulses were intact and equal in bilateral upper extremities. His plain films showed multilevel cervical degenerative disc disease and facet arthrosis and right glenohumeral osteoarthritis without fracture or malalignment. A computed tomography (CT) angiogram was negative for vascular anomalies. Throughout his ED stay, his pain was refractory to medication, and he developed a new fever, prompting a targeted shoulder ultrasound; this revealed large glenohumeral effusion, and synovial analysis revealed CPP crystals without organism growth. This case illustrates an unusual acute CPPD attack that mimicked an aortic dissection. Emergency physicians should recognize both common and uncommon presentations for chronic disease processes in maintaining a broad differential diagnosis and delivering quick, targeted treatment.
PubMed: 31890437
DOI: 10.7759/cureus.6239 -
Biomedicine & Pharmacotherapy =... Jan 2020Cynaroside (CYN) is the predominant derivative of luteolin in aerial parts of Bidens tripartita which has been used in folk medicine as a diaphoretic, diuretic,...
OBJECTIVES
Cynaroside (CYN) is the predominant derivative of luteolin in aerial parts of Bidens tripartita which has been used in folk medicine as a diaphoretic, diuretic, antiseptic and anti-inflammatory agent. In our study, alginate (ALG), which is an anionic polymer with bioadhesive properties, was used as a CYN carrier, and multiple hydrogel formulations were created. Additionally, the present study evaluated the in vivo anti-inflammatory and anti-allergic activities of all preparations.
METHODS
Novel gel formulations as topical carriers for CYN obtained from B. tripartita were developed and characterized. The bioadhesive properties of the designed preparations were also evaluated in an ex vivo model using the skin of hairless mice. In vitro CYN release from all formulations was examined and analysed by HPLC. Histopathological evaluation of mouse skin sections stained with H&E after carrageenan and oxazolone administration was also carried out. In addition, the influence of CYN on cell proliferation was examined by the PCNA staining method.
RESULTS
The results showed that 10 % CYN inhibited the release of anti-inflammatory mediators, and both tested concentrations, which included 5 % and 10 % (2 mg and 20 mg CYN per site, respectively), reduced oxazolone-induced ear swelling. Histopathological examination of the samples revealed a marked reduction in paw skin and ear tissue inflammation and in inflammatory infiltrates. The influence of CYN on cell proliferation was examined by the PCNA staining method, and the staining and distribution of PCNA-immunoreactive (PCNA-IR) cells were observed. After the application of the 5 % and 10 % hydrogels, the investigated samples showed decreased nuclear immunoreactivity to PCNA, which was similar to that of the control. Moreover, after application of the placebo formulation, fewer PCNA-IR cells were also observed.
CONCLUSION
The obtained data suggest that the topical application of CYN significantly reduces the number of T cells, mast cells and histiocytes in mouse skin with inflammation or atopic dermatitis.
Topics: Animals; Anti-Allergic Agents; Anti-Inflammatory Agents; Disease Models, Animal; Drug Compounding; Drug Liberation; Edema; Glucosides; Hydrogels; Luteolin; Male; Mice, Inbred C57BL; Oxazolone; Proliferating Cell Nuclear Antigen
PubMed: 31810125
DOI: 10.1016/j.biopha.2019.109681 -
Clinical Toxicology (Philadelphia, Pa.) Apr 2020Amygdalin, marketed misleadingly as supplement "Vitamin B17," is a cyanogenic glycoside. When swallowed, it is hydrolyzed into cyanide in the small intestine, which...
Amygdalin, marketed misleadingly as supplement "Vitamin B17," is a cyanogenic glycoside. When swallowed, it is hydrolyzed into cyanide in the small intestine, which causes histotoxic hypoxia via inhibition of cytochrome c oxidase. It remains available for purchase online despite a ban from the US Food and Drug Administration. We report a case of massive intentional amygdalin overdose resulting in recurrent cyanide toxicity after initial successful antidotal therapy. A 33-year-old woman intentionally ingested 20 g of "apricot POWER B17 Amygdalin" supplements. She presented five hours post-ingestion with vital signs: P 127 bpm, BP 112/65 mmHg, RR 25/min, temperature 98.1 °F, and SpO2 98% RA. She was in agitated delirium, diaphoretic, and mydriatic. Her VBG was notable for a pH of 7.27 (rr 7.32-7.42) and lactate 14.1 mmol/L (rr 0.5-2.2), with ECG demonstrating QTc 538 ms (normal <440 ms). She was empirically treated with hydroxocobalamin and supportive care, but worsened clinically, requiring intubation and additional hydroxocobalamin and sodium thiosulfate, which resolved her toxicity. Twelve hours later, she developed recurrent hypotension, acidemia, and QTc prolongation that resolved with repeat hydroxocobalamin and sodium thiosulfate dosing. Our case demonstrates rebound metabolic acidosis after massive amygdalin overdose. Toxicity was associated with prolonged QTc, which warrants further investigation into clinical significance. Redosing of combination antidotal therapy suggested efficacy without adverse effects.
Topics: Acidosis; Adult; Amygdalin; Antidotes; Dietary Supplements; Drug Overdose; Female; Humans; Long QT Syndrome; Suicide, Attempted
PubMed: 31322009
DOI: 10.1080/15563650.2019.1640369 -
Journal of Ethnopharmacology Jul 2019The genus Carlina (Asteraceae) comprises approx. 30 plant species growing in Europe and Asia. Carlina acaulis L. was widely used as medicine, especially in Germany and... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
The genus Carlina (Asteraceae) comprises approx. 30 plant species growing in Europe and Asia. Carlina acaulis L. was widely used as medicine, especially in Germany and Poland. The plant root was applied e.g. to treat various skin diseases and as a diaphoretic, diuretic, and anthelmintic agent. At the end of the 19th century, the medicinal use of the plant ceased though C. acaulis roots are still used in folk medicine, especially in rural areas of the Balkans where the plant grows in the wild.
AIM OF THE REVIEW
The aim of this review is to compile historical and current ethnomedical uses of C. acaulis and compare these applications with the results of modern chemical and pharmacological research of this plant. This analysis may give a lead for further research on this old, almost forgotten medicinal plant.
METHODOLOGY
Historical data on the medicinal application of C. acaulis over many centuries were collected. The historical uses were compared with the contemporary indications. The present day knowledge on the chemistry and biological activity of C. acaulis is also reviewed. This information is compared with the ethnopharmacological information.
RESULTS
Plants from the genus Carlina were already described by Theophrastus of Eresus, Dioscorides, Pliny the Elder, and Galen of Pergamum. Carlinae radix was still featured in Renaissance botanical books and in official pharmacopoeias, but disappeared from the scene in the 19th century. The present day information on the phytochemistry and pharmacological activity of these plants is limited. There are some data on the occurrence of common plant ingredients such as essential oil, flavonoids, phenolic acids, triterpenes, inulin, and fatty acids. However, most concern the green parts of the plant. Its medicinal use remains poorly understood, as there are only very limited results of in-vitro studies on the roots.
CONCLUSIONS
The historical uses of the plant can still be found in rural areas. Yet, detailed phytochemical and pharmacological research is needed to evaluate the effectiveness and safety of the medical use of Carlina acaulis.
Topics: Animals; Asteraceae; Ethnobotany; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Medicine, Traditional; Plants, Medicinal
PubMed: 30948315
DOI: 10.1016/j.jep.2019.111842