Open Access Case Study

Susceptibility to a Dexamethasone Intraocular Implant with and Without Concomitant Oral Steroid Intake: A Case Report

Paolo Mora, Stefania Gonzales, Stella Ghirardini, Giovan Battista Scazzi

International Journal of Medical and Pharmaceutical Case Reports, Page 76-80
DOI: 10.9734/IJMPCR/2015/14202

Introduction: This case report addresses the possible and controversial influence of a concomitant oral steroid intake on the efficacy of a dexamethasone intravitreal implant (Ozurdex) in treating macular edema (ME), mostly when related to inflammatory ocular diseases.
Case Presentation: A 34-year-old Caucasian male with Behçet's disease (BD) presented with central retinal vein occlusion (CRVO), first in one eye and then in the other. The eye affected first showed a favorable course. The eye next affected, instead, developed chronic ME poorly responsive to systemic and local treatments. In this eye, two Ozurdex implants were finally performed with a 6-month interval. During the uneventful follow up to the first injection, an episode of central serous chorioretinopathy occurred in the fellow non-implanted eye. This caused the end of the long-lasting oral steroidal regimen, due to the well known negative effect of steroids on central serous chorioretinopathy. The interruption was then maintained during the whole follow up to the second injection. After both treatments, a complete resolution of ME quickly occurred, followed by a partial rebound at the end of the implant's activity (6-month).
Conclusion: In this peculiar case with an internal control, macular reaction to Ozurdex was similar in effectiveness and duration with or without concomitant oral steroid intake.

Open Access Case Study

Torsades De Pointes Induced by Methadone and Clonazepam Use

Anthony G. Ashkar, Tamara Goldberg, Ilir Maraj, Alina Masters, Samy I. McFarlane

International Journal of Medical and Pharmaceutical Case Reports, Page 81-85
DOI: 10.9734/IJMPCR/2015/13517

Background: While recent data showed that illicit drug use rates at six months of treatment with either methadone or buprenorphine were comparable among patients [1] and that slow-release oral morphine was not inferior to methadone as detoxification treatment [2], methadone continues to be commonly prescribed in drug addiction centers [3]. The compound was developed in Germany in 1937, by scientists who sought to solve Germany's longstanding opioid shortage and derive a synthetic opium from readily available precursors [4]. According to the most recent CDC statistics, between the period of 1999 to 2006, the number of deaths from opioid pain relievers more than tripled in the U.S., from 4,000 to 13,800. Of these, deaths from methadone overdose increased from 790 to 5,420 individuals. Methadone was involved in approximately one in three opioid-related overdose deaths [5]. This medication has been implicated in prolongation of the QT interval which may predispose to Torsades de Pointes, a fatal cardiac arrhythmia. The mechanism of QT prolongation by methadone, is thought to be the result of inhibition of the hERG K+ channel [6]. Additionally, methadone blocks Na+ channels, and this blockade compensates for hERG K+ inhibition by methadone resulting in diminished risk of Torsades by this agent. Benzodiazepines have been shown to reverse the methadone induced Na+ channel blockade, thus resulting in action potential prolongation by intensifying methadone-induced hERG K+ channel inhibition and potentiating methadone’s ability to induce Torsades De Pointes [7]. In addition, evidence exists that QT prolongation was greater among patients on methadone who also had a positive urine test for benzodiazepines [8,9].

Open Access Case Study

Vitamin D Status among Egyptian Mothers and Their Neonates: An Exploratory Study

Manal A. Mohsen, Mai M. Youssef, Maha M. El-Shamy, Mona Anwar, Nagwa A. Kantoush, Ebtissam M. Salah, Samar M. E. Salem, Hala S. Megahed

International Journal of Medical and Pharmaceutical Case Reports, Page 86-94
DOI: 10.9734/IJMPCR/2015/12291

Background/Objective: The potential impact of vitamin D deficiency during pregnancy has attracted much interest in recent years. This study was an exploratory one aimed to assess vitamin D status among a small random sample of Egyptian pregnant women and their newborns, and to evaluate its effect on pregnancy outcome.
Materials and Methods: A cross-sectional study was conducted on 45 mothers and their newborns. Venous blood obtained from the mothers and from the cord blood to assess serum 25-hydroxyvitamin D (25(OH) D), human Parathormone (hPTH) and serum calcium and phosphorus.
Results: The prevalence of vitamin D deficiency among the examined pregnant mothers was 37.78%. Based on umbilical cord 25(OH)D concentration 31.11% of newborns were categorized as having deficient vitamin D status. The maternal serum 25(OH) D was significantly positive correlated with the cord blood 25(OH)D (r=0.719, P=0.019). Newborns 25(OH) D was lower compared to their mothers but this difference was insignificant, the parathormone cord blood level was significantly lower compared to the maternal serum parathormone level (P<0.05). Maternal serum calcium and phosphorus showed no significant difference compared to cord blood levels. There was no significant effect of maternal vitamin D on the newborn's birth weight or length. The newborns head circumference was significantly negative correlated with the maternal serum 25(OH) D (r=-0.587, P=0.035).
Conclusion: In this preliminary study a high prevalence of vitamin D deficiency among studied mothers and their newborns was recorded; the magnitude of which warrants the need for large multiple studies in different Egyptian districts. In this study, neonatal 25(OH) D concentrations were strongly positively correlated to maternal 25(OH) D levels with neonatal head circumference was the most affected anthropometric parameter.

Open Access Case Study

Severe and Prolonged Myelosuppression during Concomitant Temozolomide and Radiotherapy Treatment in a Patient with Glioblastoma Multiforme

Claudia Scaringi, Vitaliana De Sanctis, Giuseppe Minniti, Raffaele Porrini, Alessia Carnevale, Maurizio Valeriani, Maria Christina Cox, Maria Antonietta Aloe Spiriti, Giovanna Gentile, Maurizio Simmaco, Luigi Ruco, Agostino Tafuri, Riccardo Maurizi Enrici

International Journal of Medical and Pharmaceutical Case Reports, Page 95-100
DOI: 10.9734/IJMPCR/2015/13957

Aims: We describe the case of a patient with glioblastoma (GBM) who developed severe and prolonged myelosuppression during concomitant daily temozolomide (TMZ) and radiotherapy (RT) treatment. Analysis of polymorphisms in genes correlated with TMZ-induced myelotoxicity was also performed.
Presentation of the Case: A 67–year-old man with diagnosis of GBM undergoing concomitant RT-TMZ treatment developed severe and prolonged pancytopenia that led to discontinuation of TMZ and required frequent platelet and red cells transfusions. Analysis of single nucleotide polymorphisms (SNPs) in the genes NAD(P)H dehydrogenase, quinone 1 (NQO1) and glutathione S-transferase pi 1 (GSTP1) was carried out. Both SNPs were found to be wild-type.
Discussion: TMZ is an oral alkylating agent used for the treatment of glioblastoma. TMZ is usually considered well tolerated and safe, with nausea and mild myelosuppression being the most common side effects. However, severe haematologic adverse events have been also reported. Recently, there has been growing interest in gene polymorphisms that might be associated with an increased risk of hematologic toxicity.
Conclusion: Myelosuppression is a side effect that can occur relatively early during concomitant TMZ treatment and can negatively impact on patient’s quality of life. Further studies are warranted to find out a correlation between genetic factors and the occurrence of severe hematologic toxicity.

Open Access Case Study

Abdominal Pregnancy a Report of Two Cases

Martin Cuellar Torriente, Wilhelm Johannes Steinberg

International Journal of Medical and Pharmaceutical Case Reports, Page 101-105
DOI: 10.9734/IJMPCR/2015/13995

Background: Abdominal pregnancy is a rare condition and potentially life-threatening if not diagnosed early and treated adequately. It has a high maternal and foetal mortality.
Two cases of abdominal pregnancy are discussed. Both occurred in mothers aged 35 yrs and were managed as part of the author’s routine work during 2011. In both cases the mother booked for antenatal care, had an ultrasound performed that missed the condition initially. The diagnosis of an abdominal pregnancy was only made in advanced pregnancy. Both were treated with definitive surgery and recovered post operatively.
Conclusion: In both cases there was a failure in the diagnosis of an abdominal pregnancy during the initial ultrasound. In both cases the placenta was attached to the outside of the fallopian tube. The latter may be the reason for the initial sonar to appear intrauterine. Surgical removal of an advanced abdominal pregnancy with foetal demise is advocated.