Albert Einstein College of Medicine, Yeshiva University: Open Journal Systems
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Preemptive Use of Eculizumab for Living-Donor Kidney Transplantation in a Child with Atypical Hemolytic Uremic Syndrome
Get PDFEculizumab is an anti-complement C5 monoclonal antibody that has recently been reported as an effective therapy for atypical hemolytic uremic syndrome. However, few data are available on the preemptive use of this medication in pediatric kidney transplantation. This report describes a successful preemptive use of eculizumab in combination with living unrelated kidney transplanta- tion in a 10-year-old child with end-stage renal disease secondary to atypical hemolytic uremic syndrome who has a complement factor H mutation that has not been previously reported. Further observations and clinical trials are required to address the challenges and areas of uncertainty related to preemptive eculizumab therapy for kidney transplantation in children and adults with atypical hemolytic uremic syndrome.
Alteration in the Collagen Content of the Human Uterus During Pregnancy and Post Partum Involution
Get PDFThe physiological resorption of collagen during recoveryfrom experimental cirrhosis was demonstrated in1947 (1). Factors which influence the deposition anddisappearance of collagen in experimental cirrhosis,as well as the phenomenon of the regression of scartissue, were examined subsequently (2, 3). A strikingresorption of collagen from the rat uterus followingparturition was described by Harkness and Harknessin 1954 (4). Later these authors (5), and Harkness andMoralee (6), suggested that the post partum uterus isespecially suitable for investigation of the physiologicaldissolution and catabolism of endogenous collagen. Thepresent study was undertaken to determine the alterationsin the nature and content of collagen occurring inthe myometrium of the human uterus during pregnancyand the post partum involutionary period
Global Antiretroviral Therapy: The Hope Within Pandora’s Box?
Get PDFThe vast numbers of individuals now infected with the HIV-1 virus and its spread to all corners of the globe have been well chronicled. It is difficult to convey, however, the desperation and hopelessness of the majority of those HIV-1-infected individuals that live in regions where resources are sparse. Pursuit of the unique and complex medical and societal issues relating to the HIV pandemic is globally creating a discrete area within the field of infectious disease. The consequences of the severe immunologic compromise resulting from HIV-1 infection vary from those seen in the West, both in terms of entities and their frequency. While a number of antiretroviral distribution programs are in place, the development of guidelines that simplify antiretroviral regimens, enrollment in treatment programs, and monitoring remain difficult. Furthermore, the epidemiology, response to antiretroviral therapy, and resistance patterns of non-B sybtypes await further elucidation. The goals that have been set may be compromised by concomitant endemic diseases (such as tuberculosis and malaria), unpreventable mother-to-child transmission, malnutrition, poor sanitation, inadequate public health systems, and, especially, the lack of an adequate healthcare workforce. However, awareness of these impediments is growing. The understanding of the complex and diverse economic, political and cultural forces entwined with and driving the epidemic is evolving. Finally, the need for a long-term, multifaceted response to the broad crisis in underdeveloped nations where AIDS is but one of a number of critical elements is becoming appreciated.
Yellow Fever and the Emotional Consequences of Untreatable Epidemic Disease
Get PDFYellow fever terrorized communities in tropical and urban settings during its height in the nineteenth-century American south. Carried by Aedes aegypti mosquitoes, which breed in stagnant water, the virus infects humans fervently and is most known for its symptoms of jaundice and vomito negro, a dark vomit of coagulated blood. During the near-annual outbreaks of yellow fever, caregivers struggled to cope with the emotional consequences of failing medicine, sometimes leaving behind clues to their confusion in treating the disease and offering salient reflections on their inadequacies. The disease ravaged the Gulf region for decades. Records of the health workers’ feelings of futility reflect their questions of what to do for others and what to do for themselves, offering a new perspective on yellow-fever scholarship and insight into contemporary clinical practice and research.
Retrotranslocation: Endoplasmic Reticulum’s Junk Disposal Mechanism
Get PDFThe primary structure of polypeptides is converted to their final tertiary and quaternary structure by sequential maturation steps, and the endoplasmic reticulum (ER) provides the environment for the polypeptides to attain their proper 3-dimensional architecture. Proteins that misfold or fail to oligomerize with their partners (Chen et al., 1998; Wileman et al., 1990) are quickly degraded, as unfolded or unassembled proteins could interfere with normal cellular function. Retrotranslocation is the process by which terminally misfolded or unassembled ER proteins are translocated back into the cytosol for degradation mediated by the proteasomal machinery. Increasing amounts of evidence now support the fact that the same translocon pore that is involved in the translocation of polypeptides into the ER is also used for the retrotranslocation process. But questions, like how the misfolded proteins are recognized and targeted to the translocon pore, whether the process requires energy, and what pulls the polypeptides as they emerge out of the pore into the cytoplasm, remain to be elucidated. This review addresses our current knowledge about the retrotranslocation process.
What Is the Evidence that Riboflavin Can Be Used for Migraine Prophylaxis?
Get PDFIndividuals with migraine often have recurrent, painful symptoms, and symptomatic treatments have detrimentalside effects and do not prevent further attacks. Studies indicate that riboflavin can be used to decrease headachefrequency and lessen the need for symptomatic treatment. Mitochondrial dysfunction may play a role in migrainepathogenesis by interfering with oxygen metabolism. Daily doses of riboflavin, vitamin B2, may improve mitochondrialfunction by increasing the reserve of brain mitochondrial energy, and there are minimal side effects with dailytreatment. However, there is a need for further randomized, double-blind controlled studies to determine the effectivedose. Although riboflavin may not fully eliminate migraine nor take effect for several months, riboflavin is apromising prophylactic agent with minimal adverse effects that may significantly reduce the frequency of migraine
The Price of Professional Integrity—Ethics of the Physician-Patient Relationship
Get PDFHistorically, the science of medicine has met a great deal of social rejection, if not outright hostility. Through the years physicians have had to maintain a delicate balance between the norms and values established by societies and the dictates of their own conscience of what constitutes the best interest of their patients. Confronted by the dilemma of facing social ostracism or defying their duties as stated in the Hippocratic oath to be “bound by a stipulation and oath according to the law of medicine, but to none others (Information for Research on Euthanasia, 2003)”, physicians have often faced difficult ethic quandaries. It is a hotly debated issue whether the duty of physicians is to assess every individual case and act solely according to their own best judgment or act in line with the rigid norms and social structures imposed by the community. Issues such as euthanasia, abortion and organ transplantation present the very essence of this controversial bioethical debate.