RESUMEN
BACKGROUND: Venlafaxine is a potent neuronal serotonin and noradrenaline re-uptake inhibitor, and to a lesser extent an inhibitor of dopamine reuptake. Paroxetine is a potent selective inhibitor of serotonin reuptake. CASE REPORT: A 27-year-old man ingested 1987.5 mg of venlafaxine and 360 mg of paroxetine. He subsequently developed systolic and diastolic hypertension, transient electrocardiographic abnormalities, and an area of persistent myocardial damage. He recovered from his overdose with his blood pressure and electrocardiogram returning to normal. The area of myocardial damage was documented on echocardiogram as an area of marked hypokinesia at the basal anterior septum. Despite the absence of confirming blood levels or the absolute exclusion of cocaine, this case indicates that venlafaxine and paroxetine have the potential for serious cardiotoxicity when taken in overdose.
Asunto(s)
Cardiomiopatías/inducido químicamente , Cardiomiopatías/diagnóstico , Ciclohexanoles/envenenamiento , Corazón/efectos de los fármacos , Paroxetina/envenenamiento , Inhibidores Selectivos de la Recaptación de Serotonina/envenenamiento , Adulto , Antiarrítmicos , Dolor en el Pecho/inducido químicamente , Electrocardiografía , Humanos , Hipertensión/inducido químicamente , Hipertrofia Ventricular Izquierda/inducido químicamente , Masculino , Taquicardia Sinusal/inducido químicamente , Clorhidrato de Venlafaxina , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
The serum from an 85-year-old man with a clinical diagnosis of post-transfusion purpura (PTP) was investigated for the presence of platelet-specific antibodies. Clinically, the case was typical of PTP but, unusually, the serum was found to contain multiple platelet-specific alloantibodies. Anti-HPA-1a, anti-HPA-2b and anti-HPA-3a antibodies were detected together with multispecific anti-HLA (class I) antibodies. Additional (but weaker) antibody reactivity was also observed with platelet glycoproteins (Gp) IIb/IIIa, GpIb and GpIa/IIa which lacked the antigens recognized by the alloantibodies, suggesting the presence of auto- or cross-reacting antibodies. The patient's genotype was HPA-1b/1b, HPA-2a/2a, HPA-3b/3b, HPA-5a/5b and was consistent with the platelet alloantibodies detected. The patient made a complete recovery following treatment with intravenous gamma-globulin.
Asunto(s)
Antígenos de Plaqueta Humana/inmunología , Isoanticuerpos/inmunología , Púrpura Trombocitopénica/etiología , Púrpura Trombocitopénica/inmunología , Reacción a la Transfusión , Anciano , Anciano de 80 o más Años , Antígenos de Plaqueta Humana/sangre , Antígenos de Plaqueta Humana/genética , Genotipo , Humanos , Isoanticuerpos/sangre , MasculinoRESUMEN
Many studies have shown the indigenous elderly population and Asian immigrants to be groups at particular risk of vitamin D deficiency and osteomalacia, but there are no data on the risks in elderly Asians. In this community-based study a group of elderly Asians was compared with control groups of elderly and young whites and young Asians. Levels of 25-hydroxyvitamin D3 (25-OHD3) were significantly lower (p < 0.0001) in elderly Asians (21/37) and young Asians (7/17) compared with white controls. The difference in parathyroid hormone (PTH) between Asians and whites was also significant (p < 0.0007) as was that between young and old (p < 0.0002). Abnormal PTH and 25-OHD3 (high PTH and low 25-OHD3), indicative of a high risk of osteomalacia, occurred in 22% of elderly Asians compared with 6% of elderly whites. The calcium, phosphate and alkaline phosphatase were normal in all individuals. Among the Asians, vegetarianism was not related to lower 25-OHD3 levels. Symptoms suggestive of osteomalacia were more common (p < 0.05) in elderly Asians than in their white counterparts. This first study of 25-OHD3 levels in community-resident elderly Asians suggests that more than half were low, placing them at a significantly higher risk of osteomalacia.
Asunto(s)
Comparación Transcultural , Emigración e Inmigración , Etnicidad , Evaluación Geriátrica , Osteomalacia/etnología , Deficiencia de Vitamina D/etnología , Adulto , Anciano , Anciano de 80 o más Años , Asia/etnología , Calcifediol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomalacia/sangre , Osteomalacia/prevención & control , Hormona Paratiroidea/sangre , Factores de Riesgo , Reino Unido , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/prevención & controlRESUMEN
Rheumatoid arthritis is associated with a number of pleuropulmonary disorders. A retrospective study of the frequency of rheumatoid disease in patients with bronchiectasis and pulmonary fibrosis was performed. The results suggest that the frequency of bronchiectasis and rheumatoid disease is similar to that of the well established, but rare, association between pulmonary fibrosis and rheumatoid arthritis. We therefore suggest that bronchiectasis should be remembered as a pulmonary association of rheumatoid disease which occurs as commonly as pulmonary fibrosis.