These data demonstrate that IL-17 activates RhoA/Rho-kinase leading to endothelial dysfunction and hypertension. Inhibitors of IL-17 or Rho-kinase may prove useful as anti-hypertensive drugs in IL-17-associated autoimmune diseases.

Metformin (MTF) is one of the most common oral agents used to treat diabetes mellitus. Intoxication is associated with lactic acidosis and has significant clinical consequences. We report 12 cases requiring dialytic intervention. Twelve patients were analyzed from 2005 to 2010; 10 of these patients were treated with dialysis. Conventional hemodialysis (HD) and continuous veno-venous hemodialysis treatments with bicarbonate dialysis were used, and the results were presented as mean and standard deviation. The results are as follows: 33% of the patients were male, hospital stay was 9.3 (± 12) days, average MTF dose 1.7 g/day, mortality was 25%. Baseline glomerular filtration rate for these patients was 51.5 mL/min, with an average age of 64 (± 11) years. On presentation, all had acute kidney injury with blood urea nitrogen/creatinine 75 (± 30)/8.1 (± 3.7) mg/dL, lactic acid 12.4 (± 8.1) mmol/L, pH 7.04 (± 0.19), bicarbonate 7.2 (± 4.5) mmol/L. Metformin level was 25 (± 17) µg/mL; anion gap was 28 (± 9), and serum potassium was 5.4 (± 1.3) mEq/L. Seventy percent of patients were treated with conventional HD. Patients required 4 (± 5) dialysis treatments at blood flow QB 330 (± 53), dialysis flow QD 571 (± 111) for 305 (± 122) minutes. Postdialysis, the acidosis parameters improved: bicarbonate 19.2 (± 4.1) mmol/L, lactic acid 6 (± 4) mmol/L and MTF levels decreased 8.9 (± 5.7) µg/mL. Metformin percentage removal was calculated to be 60% (± 24). No difference was found between HD and continous veno-venous hemodialysis. The only difference between survivors was the age 53 (± 7) vs. 78 (± 10) (P < 0.05). Metformin toxicity is a serious clinical condition and causes severe lactic acidosis and significant mortality. Hemodialysis is an efficient method to treat MTF intoxication and correct the metabolic abnormalities.

Severe cholestasis with anabolic androgenic steroids is well-known to cause acute liver injury. Treatment is usually supportive after withdrawal of the offending agent. Acute kidney injury (AKI) frequently occurs in acute liver injury and may complicate management and prognosis. We highlight the use of plasmapheresis resulting in rapid improvement in cholestatic jaundice with resolution of AKI. Plasmapheresis should be considered in special cases in which there is progressive clinical decline despite supportive care.

Statistical data show that heterosexual transmission of AIDS among teenagers is a significant problem. The purpose of this study was to assess and compare the level of knowledge concerning HIV/AIDS among high school freshmen- and senior-level students and to determine the association between certain demographic variables and the students' knowledge level. A convenience sample of 169 freshmen and 274 senior high school students were surveyed at a local area high school (N = 443). A 49-item knowledge questionnaire, used by the high school district HIV/Abstinence program, and a demographic questionnaire developed by the investigators were used to collect the data. The findings revealed that both the freshmen and senior students had several misconceptions about HIV/AIDS, including the modes of transmission, the sure way of preventing the sexual transmission, donating blood, and the usual causes of death for people with AIDS. A comparison of the mean knowledge scores among freshmen and senior students indicated there was no significant difference among the two groups. The mean knowledge score of the seniors was significantly affected by whether they had received HIV/AIDS education. However, this was not the case for the freshmen. African American students, especially the female students, had significantly lower knowledge scores than other ethnic groups.

We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (1:1024) and positive immunoglobulin M titer (1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.KEYWORDS Bartonella henselae; culture-negative endocarditis; glomerulonephritis; prosthetic valve B artonella species are rare causes of infective endocarditis (IE).1,2 Patients with Bartonella endocarditis usually present with signs and symptoms of IE, but blood cultures are usually negative.2 Bartonella henselae usually affects patients with previous valvular disease, prosthetic or bioprosthetic valves, or congenital heart defects. 3,4 In rare instances, patients with Bartonella endocarditis may develop glomerulonephritis. 5,6 CASE DESCRIPTIONA 29-year-old man had complete transposition of the great arteries and ventricular septal defect, for which he received Rastelli repair at age 4 and right ventricle-to-pulmonary artery conduit replacement with a porcine valve at age 18 for conduit stenosis. He initially presented with fatigue, prolonged fever, and leg edema. His temperature was 101 F. A 5/6 harsh systolic murmur was heard over the left sternal border, his jugular veins were distended, his liver was enlarged, and his ankles were edematous. His erythrocyte sedimentation rate was 58 (normal range 0-15 mm/hr), C-reactive protein was 5.1 (normal range 0.0-0.3 mg/dL), creatinine was 3.3 mg/dL, red blood cells were 2.83 M/mL, white blood cells were 3.2 K/mL, and platelets were 105 K/mL. Echocardiogram showed a left ventricular ejection fraction of 35% to 40%. The pulmonic valve had thickened cusps and a prolapsing mass. He was treated with vancomycin, doxycycline, and piperacillin/tazobactam.The blood cultures, drawn at the time of presentation, showed no growth. The urine protein-creatinine ratio was 4.4 and his 24-hour urine protein was 6.4 g. C3 was 61.4 mg/dL (normal range 90-180 mg/dL), complement C4 was 9.4 mg/dL (normal range 10-40 mg/dL), and serum albumin was 2.3 g/ dL. Antineutrophil cytoplasmic antibody in the serum was positive. A kidney biopsy revealed focal segmental proliferative glomerulonephritis with incomplete crescent formation. Electron microscopy showed small mesangial electron-dense deposits and widespread foot process effacement. The mesangial regions were positive for the following immunofluorescence markers: immunoglobulin G (IgG), immunoglobulin M (IgM), C3, C1q, and kappa and lambda light chains. Though not specific, IgM immunofluorescence demonstrated the brightest signal, suggestive of a recent or ongoing infection (Figure 1).Brucella antibody, Coxiella burnetii IgG and IgM, and Ehrlichia IgG were negat...

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