-
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 -
Immunopharmacology and Immunotoxicology Apr 2019Leaf extracts of plants of the genus have traditionally been used as diuretic, anti-rheumatic and diaphoretic preparations. One of the main active ingredients of bark...
Modulating effect of a new ester, 28--phosphatidylbetulin (DAPB), obtained from hen egg yolk lecithin and betulin on lymphocyte subsets and humoral immune response in mice.
Leaf extracts of plants of the genus have traditionally been used as diuretic, anti-rheumatic and diaphoretic preparations. One of the main active ingredients of bark is betulin, lupane-type triterpene alcohol, with multiple biological activities. The aim of this study was to investigate and immunomodulatory effects of a newly synthesized ester of betulin: 28--phosphatidylbetulin [28--(1,2-diacyl--glycero-3-phospho)-betulin, DAPB] in comparison with betulin in mice. Cytotoxic activity of DAPB or betulin was tested against non-cancer (D10.G4.1 and J774E.1) and cancer (GL-1; CL-1 and Jurkat) cell lines. The part assessed total lymphocyte count, weight ratio and subsets of lymphocytes in the lymphatic organs, and humoral immune response to sheep erythrocytes (SRBC). assay showed that DAPB, contrary to betulin, had no antiproliferative activity. Exposure to four doses of DAPB increased the absolute count of immature CD4CD8 thymic cells as well as the percentage and absolute count of mature CD4 and CD8 thymocytes. DAPB enhanced the percentage or absolute count of CD3 cells in spleen and lymph nodes with corresponding decrease in the percentage and/or absolute count of CD19 cells. Both DAPB and betulin enhanced the percentage and absolute count of CD8 lymphocytes in lymph nodes. In SRBC-immunized mice, betulin contrary to DAPB enhanced the number of splenocytes producing anti-SRBC antibodies (PFC). Both DAPB and betulin increased the level of total (IgM + IgG) and IgG titers. Despite the lack of cytotoxic activity, DAPB shows valuable immunomodulatory properties.
Topics: Animals; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Egg Yolk; Female; Humans; Immunity, Cellular; Immunity, Humoral; Jurkat Cells; Lecithins; Male; Mice, Inbred BALB C; Neoplasms; Sheep; Triterpenes
PubMed: 31056969
DOI: 10.1080/08923973.2019.1578972 -
Heart Asia 2019A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and...
UNLABELLED
A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.
QUESTION
?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.
PubMed: 31031835
DOI: 10.1136/heartasia-2018-011156 -
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 -
BMJ Case Reports Mar 2019A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral...
A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.
Topics: 3,4-Methylenedioxyamphetamine; Adult; Aftercare; Anti-Arrhythmia Agents; Antithyroid Agents; Carbimazole; Delirium; Diagnosis, Differential; Humans; Intensive Care Units; Male; Propranolol; Serotonin Syndrome; Substance-Related Disorders; Thyrotoxicosis; Thyrotropin; Treatment Outcome; Tremor
PubMed: 30850570
DOI: 10.1136/bcr-2018-228404 -
Planta Medica May 2019has been traditionally used as a medicinal plant owing to its anti-inflammatory, anthelmintic, tonic, antihyperglycemic, and diaphoretic properties. We hypothesized...
has been traditionally used as a medicinal plant owing to its anti-inflammatory, anthelmintic, tonic, antihyperglycemic, and diaphoretic properties. We hypothesized that might have therapeutic potential in alleviating allergy and atopic dermatitis. Thus, we investigated the inhibitory effects of extract against allergic responses and 2,4-dinitrochlorobenzene-induced atopic dermatitis-like dorsal skin lesions using immunoglobulin E-sensitized rat basophilic leukemia-2H3 mast cells and NC/Nga mice. Degranulation and enzyme-linked immunosorbent assays were conducted to measure degranulation, proinflammatory cytokine levels, and prostaglandin E concentrations in immunoglobulin E/antigen-sensitized RBL-2H3 mast cells. The therapeutic efficacy of extract in 2,4-dinitrochlorobenzene-induced atopic dermatitis was evaluated through morphological, physiological, and immunological analysis. extract inhibited -hexosaminidase and histamine release and reduced tumor necrosis factor-, interleukin-4, and prostaglandin E secretion. Furthermore, extract suppressed atopic dermatitis-like skin lesions by regulating the serum levels of immunoglobulin E and immunoglobulin G2a, and messenger ribonucleic acid expression of T helper cell 1- and T helper cell 2-related mediators in the skin lesions. Histopathological analyses showed a decrease in epidermal thickness and intradermal inflammatory cell infiltration. These results suggested that extract might have beneficial effects in treating allergic and atopic dermatitis-like skin disorders.
Topics: Animals; Cell Line; Dermatitis, Atopic; Dermatologic Agents; Dinitrofluorobenzene; Female; Immunoglobulin E; Immunoglobulin G; Mast Cells; Mice; Plant Extracts; Pterocarpus; Rats
PubMed: 30609435
DOI: 10.1055/a-0824-1282 -
Journal of the Advanced Practitioner in... Mar 2018RS, a 36-year-old female, presented to the emergency department (ED) of a large academic medical center upon the advice of her primary care provider because of 3 weeks... (Review)
Review
RS, a 36-year-old female, presented to the emergency department (ED) of a large academic medical center upon the advice of her primary care provider because of 3 weeks of progressive mental status changes, weakness, and decreased oral intake. According to her husband, RS was diagnosed with stage IIIA large cell lung cancer 8 months earlier and was treated with concurrent chemotherapy (carboplatin, pemetrexed, and bevacizumab) and radiation therapy that was completed 4 months prior to admission. No other specific information about her treatment or outside health records was available. According to her husband, RS had been in her usual state of health until approximately 3 weeks prior, when she began having significant mental status changes. She first exhibited some difficulty finding words and later was noted to be putting food in a coffee maker. This spontaneously resolved after approximately 1 week; however, she rapidly developed slurred speech and began to make nonsensical statements. These manifestations also slowly improved but were followed by worsening speech deficit, difficulty walking, and impaired balance. During one of these episodes, she had an occurrence of incontinence. Her husband also noted an incident where her "eyes were beating back and forth and the left side of her face was twitching." RS also had periods (according to her husband) where she "did not seem to be interacting with her environment." These progressively worsened during the last week, and she completely stopped walking and talking 2 days prior to coming to the ED. According to her husband, RS had rheumatoid arthritis and no surgical history. Her family history was unknown except that RS's mother had "seizures." RS had reportedly not used tobacco, alcohol, or drugs, and she was sexually active with her husband. Home medications included transdermal fentanyl 12 μg/hr patch changed every 72 hours; oxycodone-acetaminophen tablets 5-325 mg, two every 4 hours as needed for pain; prednisone 10 mg, one tablet daily; and megestrol 40 mg/mL suspension, 20 mL once daily for appetite stimulation. RS was admitted to an inpatient medical oncology service and evaluated by the oncology advanced practitioner (AP) on her second inpatient day. Upon exam, RS was nonverbal except for moaning in response to painful stimuli and to her sister's voice. Her vital signs were normal. She appeared ill but well-nourished, and she was mildly diaphoretic. Neurologic examination revealed that her pupils were slightly sluggish but equal, round, and reactive to light. Extraocular muscle movements were intact, but she did not move her eyes in response to commands. She tracked the AP and family members around the room with her eyes. Cranial nerve examination was intact with the exception of cranial nerves IX, X, and XI, which were difficult to examine given her inability to cooperate and open her mouth. Motor examination revealed increased tone throughout and intermittent, inconsistent resistance to passive movement. She was seen to move all four extremities spontaneously although not in response to commands. Deep tendon reflexes were intact and equal in all extremities. Examination of other body systems was as follows: there was dry, peeling skin on her lips, but her mucous membranes were moist and free of erythema or lesions. Her lungs were clear to auscultation bilaterally. Her heart rate and rhythm were regular, there were no murmurs, rubs, or gallops, and distal pulses were intact. Her abdomen was nondistended with normally active bowel sounds in all four quadrants. Her abdomen was soft, nontender to palpation, and without palpable masses. There was no peripheral discoloration, temperature changes, or edema, and examination of her skin was benign. On admission to the emergency department, serum laboratory studies were unrevealing for any potential causes of encephalopathy. Kidney and liver function were normal, making diagnoses of uremic and hepatic encephalopathies less likely. Cultures of the urine and blood were negative. Samples of cerebrospinal fluid (CSF) were obtained via lumbar puncture and were unrevealing for any abnormalities. Computed tomography (CT) of the head without contrast was negative for any acute intracranial process. Ultrasound of the right upper quadrant revealed a single, nonspecific, hypoechoic hepatic lesion. Computed tomography scans of the chest, abdomen, and pelvis demonstrated the primary malignancy in the upper lobe of the left lung, as well as possible metastatic disease within the left lung, right lung, and liver, and widespread osseous metastatic disease. Magnetic resonance imaging (MRI) of the brain performed 1 day after admission demonstrated numerous scattered punctate foci of enhancement throughout the supratentorial and infratentorial brain parenchyma, measuring at most 3 to 4 millimeters in diameter. There was no significant mass effect or midline shift. A paraneoplastic panel was sent to an outside laboratory and returned positive for antivoltage-gated potassium channel (VGKC) autoantibodies. Clinically, RS was exhibiting signs of encephalopathy, a broad term that indicates general brain dysfunction, the hallmark of which is altered mental status. Diagnosing encephalopathy is challenging, as many differential diagnoses must be considered. The clinician must consider metabolic derangements, toxic and infectious etiologies, psychiatric disorders, and less commonly, prion disorders and progressive dementia. Cultures of RS's blood and urine as well as other specialized endocrine tests were negative, decreasing the likelihood of a metabolic or infectious cause for her presentation. The abnormalities on her brain MRI were reviewed by a neuro-oncology team, who felt that the faint, nondescript nature of the visualized lesions was not suspicious for metastatic disease. Sequelae of seizures was also considered by neuro-oncology but dismissed given a grossly normal prolonged electroencephalogram. Some encephalopathies are caused by autoimmune or inflammatory mechanisms, which are confirmed by the presence of autoantibody markers and/or clear response to immunomodulatory treatment (Vernino, Geschwind, & Boeve, 2007). These types of encephalopathies have been seen in patients with cancer and have thus been termed paraneoplastic. The presence of anti-VGKC antibodies on RS's paraneoplastic panel directed the inpatient medical oncology team toward a paraneoplastic neurologic disorder (PND) as the most likely diagnosis.
PubMed: 30588355
DOI: No ID Found -
Pakistan Journal of Pharmaceutical... Sep 2018Macrotyloma uniflorum (Lam.) Verdc. (Papilionaceae) is commonly known as Horse gram and Kulthi. The seeds are reported as anthelmintic, diaphoretic, diuretic and...
Macrotyloma uniflorum (Lam.) Verdc. (Papilionaceae) is commonly known as Horse gram and Kulthi. The seeds are reported as anthelmintic, diaphoretic, diuretic and emmenagogue. It is also useful in asthma, bronchitis and urolithiasis. In the present study, analgesic, anti-inflammatory and diuretic effects of the methanol extract of Macrotyloma uniflorum seeds were evaluated in doses of 200 and 400mg/kg. Significant results were obtained in all activities.
Topics: Analgesics; Animals; Anti-Inflammatory Agents; Diuretics; Dose-Response Relationship, Drug; Edema; Fabaceae; Mice; Pain Measurement; Plant Extracts; Rats; Rats, Wistar; Seeds
PubMed: 30150181
DOI: No ID Found