An in vivo intestinal perfusion model was used to investigate how experimental hyperglycemia affects intestinal elimination and biliary excretion in the rat. Experimental diabetes was induced by administration of streptozotocin (65 mg/kg, i.v.). The intestinal perfusion medium contained 250 μM (±)-ibuprofen. An isocratic high-performance liquid chromatography method with UV–visible detection was developed to quantitate ibuprofen in the intestinal perfusate, while a gradient method was applied to quantitate ibuprofen and ibuprofen-β-d-glucuronide in the bile. The limit of quantitation of ibuprofen was found to be 0.51 μM in the perfusate of the small intestine. In the bile, the limit of quantitation of ibuprofen and ibuprofen-β-d-glucuronide was 4.42 and 10.3 μM, respectively. Unconjugated ibuprofen and ibuprofen-β-d-glucuronide were detected in the bile; however, no β-d-glucuronide of ibuprofen could be detected in the intestinal perfusate. The results indicate that experimental diabetes can cause a decrease in the disappearance of ibuprofen from the small intestine. Excretion of both ibuprofen and ibuprofen-β-d-glucuronide decreased to the bile in experimental diabetes. The results can be explained by the results of molecular biological studies indicating streptozotocin-initiated alterations in the intestinal and hepatic transport processes.
Reported here is a rare case of atypical pneumonia due to a non- pneumophila Legionella sp. that occurred in a young patient with systemic lupus erythematosus. In spite of aggressive treatment, the patient died 24 h following admission to the intensive care unit. Legionella longbeachae was cultured from respiratory tract specimens and identified to the genus level by PCR and to the species level by an immunofluorescence test. Since most current laboratory tests for Legionella spp., including urinary antigen and serology, cannot detect infections caused by non- pneumophila Legionella spp., culture on legionella-selective media should be strongly considered when diagnosing immunosuppressed patients with pneumonia.
Background Patients with inflammatory bowel disease (IBD) have a high risk for infection. Pneumonia related to influenza and pneumococcal infection is one of the most common infection-related complication in IBD. Our aim was to evaluate the immunogenicity of pneumococcal and influenza vaccination in patients with IBD receiving different treatment. Methods We searched four databases for studies evaluating seroprotection and seroconversion rates after influenza or pneumococcal vaccination in IBD. In meta-analysis, odds ratios (OR) were calculated with 95% confidence intervals (CI). Results Twelve studies (1429 patients) were included in this meta-analysis. The seroconversion rate after pneumococcal vaccination was significantly lower in the immunosuppressed group and in the subgroup of patients with anti-TNF mono- or combination therapy compared to the non-immunosuppressed patients (OR = 0.38, 95% CI: 0.23–0.62, OR = 0.28, 95% CI: 0.15–0.53, and OR = 0.27, 95% CI: 0.15–0.49, p < 0.001, respectively). Following influenza vaccination there was no significant difference in the seroprotection rate between immunosuppressed and non-immunosuppressed patients (OR = 0.59, 95% CI: 0.34–1.03, p = 0.065). Seroprotection rate was not significantly reduced in patients with immunomodulator compared to anti-TNF monotherapy or combination therapy (OR = 1.45, 95% CI: 0.62–3.38, p = 0.84 and OR = 0.91 95% CI: 0.37–2.22, p = 0.391, respectively). Following both vaccinations, the seroresponse was not significantly reduced in patients treated with immunomodulator monotherapy compared to non-immunosuppressed patients. Conclusion Our results suggest that response rate is reduced in patients treated with anti-TNF therapy but not in patients treated with immunomodulator monotherapy. Patients treated with immunosuppressive treatment should be vaccinated against pneumococcus and influenza despite immunosuppressive therapy.
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