Our results concluded that the liposome encapsulated ATRA has an enhanced anti-metastasis potency than the free ATRA during B16F10 metastatic cell line implantation.
Febrile infection-related epilepsy syndrome is characterized by super refractory status epilepticus that is resistant to conventional antiepileptic drugs. This case report critically analyses the treatment options adopted in a hospital to manage this syndrome. Despite the aggressive efforts that were taken, the patient succumbed to the complications of the illness and side effects of the treatment strategies adopted. This shows that the treatment options currently available are in adequate, so an intensive research in the area of pathogenesis of status epilepticus is required to frame treatment strategies that can bring out better outcomes.
Wilson's disease (WD) is an inherited autosomal genetic abnormality which results in impairment in cellular copper transport. Overtime, this may lead to liver cirrhosis. The main focus of this case is to shows the importance of taking a medical history. Here, we discuss a case of a 35-year-old male diagnosed with WD-induced liver cirrhosis and portal hypertension. He was physically very weak. Since the same genetic abnormality was the reason for the death of his sibling which was not considered while taking the medical history of this patient, this led to a late diagnosis of 4 years while the patient's condition became worst. Herein, we report a case that provides an insight to medical professionals about taking proper medical history of patients
Background:Mycophenolate mofetil (MMF) is an effective treatment option for systemic sclerosis (SSC). However, many patients require co administration of proton pump inhibitors (PPI) or H2 receptor blockers (HRB) because of significant gastrointestinal manifestations in SSC. Co-treatment with PPI or HRB have shown to be associated with reduced drug exposure in post-transplant patients.1, 2 There is scarcity of data among patients with SSC. We evaluated the drug concentration of MMF over 12 hours of exposure and assessed the impact of ranitidine and PPI in twenty patients with SSC.Objectives:To assess the effect of esomeprazole or ranitidine on the bioavailability of MMF in SSC patients who are on a stable dose of MMF.Methods:Twenty SSC patients, who were on a stable dose of MMF (1.5-3 g) for the past 3 months were selected for the study after obtaining informed written consent. All patients were given either MMF (without PPI or HRB), MMF + esomeprazole, MMF + ranitidine for one month each. At the end of each month, EDTA plasma samples were collected at various time points including 0, 1/2, 1, 1½, 2, 2½, 3, 4, 5, 6, 8 and 12 hours following drug administration to determine the 12-hour area under curve (AUC) of mycophenolic acid (MPA) levels. Estimation of MPA levels was carried out using reverse phase high performance liquid chromatography (HPLC). Total gastrointestinal score was calculated at the end of each month using UCLA Scleroderma Clinical Trial Consortium GIT 2.0 scoring. To compare the mean AUC, linear mixed effect model was fit by considering treatment as the fixed effect and subject as the random effect. MMF was set as the reference treatment for the other three treatments and these were analysed together using Linear mixed effect model.Results:All patients were females with mean age of 45 years. Addition of either ranitidine or esomeprazole significantly reduced the mean AUC and C max of the MMF over 12-hour time period. On the other hand, PPI or HRB helped in reduction of the total GI score at the end of 1 month. Details of pharmacokinetics are depicted in the table 1.Table 1.Pharmacokinetics and GI score with MMF in combination with PPI / HRBMMFMMF+ RMMF + EpAUCmean (95% CI)67.97 (62.73, 73.20)53.04 (44.80, 61.27)45.69 (41.10, 50.28)<0.001*T- MAXmean (95% CI)42.00 (33.60, 50.40)46.50 (32.48, 60.52)79.50 (58.99, 100.01)<0.001*C-MAXmean (95% CI)29.61(26.74, 32.48)15.14 (11.32, 18.97)12.62 (10.58, 14.66)<0.001*Mean GI scoremean (95% CI)0.28 (0.15,0.40)0.19 (0.09, 0.30)0.14 (0.06,0.23)0.009AUC, area under curve Mycophenolic acid; C-MAX, maximum concentration of MPA in 12 hours following MMF; CI confidence interval;Mean GI score, UCLA Scleroderma Clinical Trial Consortium GIT 2.0 scoring; MMF, mycophenolate mofetil; MMF+E, mycophenolate mofetil + esomeprazole; MMF+R, mycophenolate mofetil+ ranitidine;*p value < 0.05 considered as significantConclusion:As co administration of PPI or HRB can significantly reduce the bioavailability of MMF in patients with systemic sclerosis. To avoid therapeutic failure of MMF drug level monitoring is essential when these agents re prescribed with MMF.References:[1]Schaier M, Scholl C, Scharpf D, Hug F, Bönisch-Schmidt S, Dikow R, et al. Proton pump inhibitors interfere with the immunosuppressive potency of mycophenolate mofetil. Rheumatology (Oxford, England). 2010;49:2061–7.[2]Rissling O, Glander P, Hambach P, Mai M, Brakemeier S, Klonower D, et al. No relevant pharmacokinetic interaction between pantoprazole and mycophenolate in renal transplant patients: a randomized crossover study. British Journal of Clinical Pharmacology. 2015;80:1086–96.Disclosure of Interests:None declared
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