Toll-like receptor family (TLRs), pattern recognition receptors, is expressed not only on immune cells but also on non-immune cells, including cardiomyocytes, fibroblasts, and vascular endothelial cells. One main function of TLRs in the non-immune system is to regulate apoptosis. TLRs are the central mediators in hepatic, pulmonary, brain, and renal ischemic/reperfusion (I/R) injury. Up-regulation of TLRs and their ligation by either exogenous or endogenous danger signals plays critical roles in ischemia/reperfusion–induced tissue damage. Conventional TLR-NF-κB pathways are markedly activated in failing and ischemic myocardium. Recent studies have identified a cross talk between TLR activation and the PI3K/Akt pathway. The activation of TLRs is proposed to be the most potent preconditioning method after ischemia, to improve the cell survival via the mechanism involved the PI3K/Akt signaling pathway and to attenuate the subsequent TLR-NF-κB pathway stimulation. Thus, TLRs could be a great target in the new treatment approaches for myocardial I/R injury.
The side effects of heparin include hemorrhage, osteoporosis, telogen effluvium, hypoaldosteronism, hypersensitivity reactions (urticaria and anaphylactic shock), hypereosinophilia, vasospastic reactions (pain, cyanosis and severe itching or burning plantar sensations), erythematous infiltrated plaques, skin necrosis and thrombocytopenia [1].Stevens-Johnson Syndrome (SJS) is a life threatening cutaneous adverse drug reaction. The incidence of SJS is evaluated from one to two cases per million person-years [2]. We hereby report SJS as a rare complication of heparin.A 61-year-old married woman, from central Iran was hospitalized due to acute pancreatitis and pancreatic abscess. Heparin prophylaxis was initiated, subsequent to which mucocutaneous lesions appeared [Table/ Fig-1]. Dermatology consultation was done and the required treatment was started.The patient had a history of diabetes mellitus, hypothyroidism and hypertension. She received tablet prednisolone 50 mg 1/2 bid, tablet metoprolol 50 mg bid, tablet lorazepam 2 mg 1/2 qhs, tablet alprazolam 0.5 mg daily.For the present condition, fluconazole and pantoprazole were prescribed. She was irritable, had insomnia, persecutory and visual hallucinations because of severe lip and oral mucosa burning. Psychiatric consultation was requested for delirium. The patient had a history of insomnia without mood or psychotic disorder. The psychiatrist prescribed tablet doxepin 25 mg/every night, tablet chlorodiazopoxide 10 mg/12 hourly, and tablet halopridol 0.5 mg/8 hourly. The patient responded favourably to drugs. Naranjo score was 9 in our case. Irritability decreased significantly and the patient was able to get adequate sleep. She was discharged after 48 hours with a good general condition. The skin. Eur J Intern Med. 2016;28:17-24.
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Cutaneous actinomycosis of finger is very unusual, chronic granulomatous disease caused by a group of anaerobic or microaerophilic Gram-positive filamentous bacteria that normally colonize the mouth, colon and urogenital tract. Actinomycosis of finger is rare but clinically important condition that requires suitable evaluation for guiding appropriate therapy. We hereby report a case of cutaneous actinomycosis of the right finger- a rare site, in a 34-year-old female patient which underwent usual treatment of surgical excision. This patient complained of existence of a mass and tenderness in the pulp of right index finger. The X-ray of hand revealed no significant abnormality. The patient was treated successfully with surgical excision. Surgery detected five small nodules measuring 0.5 to 1 cm in size. Histopathologic examination of the biopsy from the lesions confirmed diagnosis of cutaneous actinomycosis. Here, we report a cutaneous actinomycosis in a 34-year-old female located in the index finger.
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