We report a rare case with gabapentin overdose that caused severe rhabdomyolysis and acute tubular necrosis which required renal replacement therapy. A better awareness of its adverse effect and a close follow‐up of laboratory tests are recommended. Prescribers should also be aware of high‐risk population and monitor for signs of abuse.
To investigate the role of vaginocervical smears in alleged victims of rape, we reviewed the findings in 4,220 consecutive rape victims between the years 1982 and 1989. These rape victims showed a slight increase in cellular abnormalities (1.18% vs. .93%) when compared to a group of 17,187 routine smears from an indigent population in 1989. While the differences in the spectrum of cellular abnormalities were not statistically significant, the increase in abnormal smears is remarkable because of the younger age distribution and lower risk factors for cervical cancer in this group of rape victims (41% of the victims were never seen at our institution before their evaluation for alleged rape and were most probably of higher socioeconomic status and at lower risk for cervical cancer than the indigent population served at our hospital). This finding may reflect the low incidence of vaginocervical cytology screening among the general population of which rape victims are a random sample. Fifty-seven percent of the rape victims with cellular abnormalities who were also regular patients at our hospital returned for follow-up by appropriate repeat smears or biopsies. This was lower than the 95% general follow-up rate of vaginocervical smear abnormalities among the rest of the population screened at our hospital. We detected spermatozoa in 56% of the smears from victims who were examined within three days of the alleged sexual assault. Cytology adds to the criminal investigation of rape cases as we detected spermatozoa in four of 16 semen-negative cases from a random sample of 53 cases evaluated by the state crime lab.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially fatal severe adverse reaction to medications. Numerous drugs have been implicated, with carbamazepine and allopurinol being the most common. Tenofovir-induced DRESS is extremely rare. We report a case of a 65-year-old male patient with a diffuse exfoliative maculopapular rash across his entire body of five weeks of duration. The patient also had icteric sclera, abnormal liver enzymes and Raynaud’s of the tongue, nose and the left fifth finger. After discontinuation of tenofovir, the case resolved over a span of ten days. A high index of suspicion is crucial along with the prompt withdrawal of the offending medication for a good outcome.
Background: Smoldering multiple myeloma (SMM) was stratified into risk classes based on several models including Mayo clinic and Spanish myeloma working group models. After the revision of diagnostic criteria for multiple myeloma (MM) in 2014, the ultra-high risk SMM patients (>80% clonal plasma cells at two years) were re-classified as active MM patients. Thus, predictors of progression in patients currently diagnosed as SMM are unknown and reassessment of existing models is required. We aim to identify the risk factors associated with progression in SMM patients classified according to updated guidelines. Methods We performed a literature search following PRISMA guidelines and used following bibliographic databases: MEDLINE (Ovid and PubMed), EMBASE, The Cochrane Library and Cochrane Central Register of Controlled Trials (CENTRAL), as well as annual meetings abstracts from inception till 1st,August 2019. We used MeSH and Emtree terms as well as performed open search for "smoldering multiple myeloma", "smoldering myeloma", and "asymptomatic multiple myeloma". Two independent reviewers screened the literature. We used snowballing technique to screen abstracts and reference within articles to include titles. Cochrane collaboration tool was used to asses risk of bias among included studies Results Our search retrieved 419 titles. After going through the titles and abstracts 38 articles were selected for full text review. Final review led to inclusion of 11 articles. Levels of serum M proteins, percentage of bone marrow plasma cells (BMPCs), serum free light chain ratio (FLCr) and PET/CT scan findings of whole body were most consistently and reliably indicated the progression of SMM to MM (Table 1). New studies are suggesting that B-cell maturation levels (BCMA), evolving M-proteins (eMP) and evolving hemoglobin levels (eHb) are also an accurate measure of SMM progression and should be incorporated in the risk stratification models. A study by Gonsalves WI et al. also suggested that levels of circulating clonal plasma cells with a cutoff of 150 was an important prognostic marker in their study. Immunoparesis status and role of Bence Jones proteins in reliably predicting the progression of SMM was debatable because they were significant in univariate analysis but were not significant in multivariate analysis (Table 1). Conclusion Serum M protein levels (2 g/dL), percentage of BMPCs (20%), serum FLCr (20) and PET/CT scan were reliable in predicting the prognosis of smoldering MM. New techniques like B-cell maturation levels(74.4 ng/mL), evolving M-proteins and evolving hemoglobin levels can play a significant role in proposing future risk predictive models of SMM. Role of immunoparesis and Bence Jones proteins is debatable. Table 1 Disclosures Anwer: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; In-Cyte: Speakers Bureau.
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