July 08, 2011 . By Helen Albert . Contaminated cocaine use can cause painful, necrotic skin purpura . By Springer . MedWire News: Using cocaine contaminated with the animal de-worming drug levamisole can result in painful, necrotic purple skin lesions and low levels of white blood cells, report US researchers.
"We've seen a lot of cases in Rochester alone, so it is important to alert the gatekeepers of medicine, the primary care physicians who are in the trenches every day, of this diagnosis," said study author Mary Gail Mercurio from the University of Rochester in New York.
"This is one of those entities that with familiarity and recognition, can go a long way in helping physicians to quickly make a diagnosis and intervene without embarking on an elaborate workup where nothing will pan out," she said.
Co-author Noah Craft (University of California, Los Angeles) and colleagues describe a series of six patients with remarkably similar dermatological symptoms after cocaine use, treated in clinics in New York and California over the past few months.
Symptoms included net-like purple skin discoloration or purpura on the body, which included painful eruptions, skin necrosis, and scabbing, all occurring after cocaine use.
In addition, all the patients had positive perinuclear antineutrophil cytoplasmic antibody values, a common feature of many autoimmune conditions. Three also had a low white blood cell count (neutropenia), which can significantly increase infection risk.
The study authors believe that the cause of these symptoms is contamination of the cocaine with levamisole, rather than cocaine use per se, as the symptoms of purpura and neutropenia have been observed before in connection with levamisole-contaminated cocaine use.
Craft et al explain that levamisole-contaminated cocaine has been in use in the USA since 2003, and resulting toxic reactions have increased dramatically since 2008.
"When we first started seeing these patients they all had a similar clinical picture, but they were really an enigma because they weren't falling into any other pattern we'd seen before. When a colleague at the National Institutes of Health mentioned levamisole contamination, we did toxicity screens and lo-and-behold, all the patients came up positive for cocaine," said Mercurio.
She concluded: "We believe these cases of skin reactions and illnesses linked to contaminated cocaine are just the tip of the iceberg in a looming public health problem posed by levamisole."
The results of this study are published in the Journal of the American Academy of Dermatology.
My 68 yr old mother was an extremely healthy woman who was diagnosed with triple negative stage one breast cancer back in March. Her lumpectomy surgery in May was successful however given the rarity of her cancer, she elected for chemotherapy. Now, after one round of chemo treatment, she is fighting for her life. Seven days after receiving her first dose of chemo (a combo of cytoxan and taxotere), my mother was admitted to the ICU. She suffered from the standard side effects - tiredness, nausea, diarreha, etc. However, it turns out those signs were actually the result of a raging infection that was ravishing her body, leaving her white blood cell count at 0.4 and sending her into septic shock.
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An HIV-positive person who takes anti-retroviral drugs after diagnosis, rather than when their health declines, can cut the risk of spreading the virus to uninfected partners by 96%, according to a study.
The United States National Institutes of Health sampled 1,763 couples in which one partner was infected by HIV.
It was abandoned four years early as the trial was so successful.
The World Health Organization said it was a "crucial development".
The study began in 2005 at 13 sites across across Africa, Asia and the Americas.
HIV-positive patients were split into two groups. In one, individuals were immediately given a course of anti-retroviral drugs.
The other group only received the treatment when their white blood cell count fell.
Both were given counselling on safe sex practices, free condoms and treatment for sexually transmitted infections.
Among those immediately starting anti-retroviral therapy there was only one case of transmission between partners.
In the other group there were 27 HIV transmissions.
‘Renewed commitment’
"This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option," said Michel Sidibe, executive director of the Joint United Nations Programme on HIV/Aids (UNAIDS).
But he warned that it would cost more than ten billion dollars to provide drugs to the ten million people worldwide who are currently not receiving medication for HIV.
The World Health Organization says sexual transmission accounts for 80% of all new HIV infections. Its director general, Dr Margaret Chan, described the announcement as a "crucial development"
She added: "The findings from this study will further strengthen and support the new guidance that WHO is releasing in July to help people living with HIV protect their partners."
The value of anti-retrovirals, in preventing transmission, had been speculated for some time after observational studies, but researchers say this is the first time it has been proven in clinical trials.
Keith Alcorn, from the NAM, an HIV/AIDS charity, said: "This study resoundingly confirms what lots of smaller studies have been telling us for several years.
"International donors cannot ignore the evidence any longer: HIV treatment is a very powerful form of HIV prevention, and could have a major effect on the HIV epidemic in the worst-affected countries.
"What we need now is a renewed commitment to HIV treatment, and studies to show how to get the maximum benefit out of this breakthrough at country level."
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My afternoon (4 pm) serum cortisol was 21.4 ug/dl (the normal range was 3.1-16.7). Apparently, serum cortisol from one time point is not the best test for Cushing's, but is this high enough that I likely have Cushing's? Some background: I am a 29 year-old woman and have had most of the symptoms of Cushing's for years, including fatigue, weight gain (much of it abdominal), round face, big buffalo hump, easy bruising, irregular periods, many infections, poor wound healing, irritability, anxiety, muscle weakness, severe joint pain, poor memory/concentration, headaches, edema, abdominal pain, facial hair, dizziness, and many more. I also have a lot of white shiny stretch marks (some about 1 cm wide), but they are not purple (sometimes they're pink).
When my PCP called about my test results she said that everything was normal, and then I looked at the results online. Not only was the cortisol high, but my white blood cell count was high (I probably have another sinus infection),my Vitamin D was low, my TSH has increased (from 2.6 last summer to 3.3 now), and my alkaline phosphatase is high. She probably thought I had PCOS, but my free testosterone was near the low end of the range. I think I'm going to have to either beg or argue with my PCP to get a referral to an endocrinologist. I'm afraid that she is going to say that serum cortisol 30% above the top of the normal range is nothing, and that I am just depressed. Unfortunately, I've had this experience before when doctors just blew off my severe abdominal pain for 3 years, and were still insisting I was just depressed after my gallbladder had collapsed and I could barely walk. If they did that with something obvious, then what chance do I stand with getting a Cushing's diagnosis? feedproxy.google.com
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A number of factors decide the course of treatment for lung cancer. Oncologists have to first determine the histopathology type of the lung cancer and the stage of progression of the disease. Apart from that, the health of the patient, his other medical conditions and the prognosis of the disease are all quite important for the development of the treatment plan.
The options for treatment include surgical resection, radiation and chemotherapy, individually or in combination, depending on the factors mentioned above.
If the tumor is contained in the lung and is operable, surgical resection is indicated. There are many standard techniques for lung cancer surgery that are invasive like thoracotomy and median sternotomy. There are alternative methods too, of which anterior limited thoracotomy is less invasive. The patient loses less blood overall and has less pain and postoperative drainage.
The latest surgical procedures like video assisted thoracoscopy require much smaller incisions as they involve the use of video cameras. Yet some doctors feel that VAT is appropriate only for the initial stages of lung cancer because the lung examination with the cameras is not perfect. VAT technology has therefore been improved with Computed tomography scans for more effective lung cancer surgery.
However, surgical procedures are known to result in lymphocytopenia, in other words, deficiency of lymphocytes in the blood which shortens the survival period of the patients who are in an advanced stage of lung cancer. To take care of the decrease in the white blood cell count caused by surgical procedures, the patient is treated preoperatively with interleukin-2.
Not every lung cancer is operable. In non-small cell lung carcinoma, surgery is, in most cases, a good option in stages I and II. When the progression of the disease in stage IIIA is very limited, surgery may be recommended, but certainly not in stage IIIB. But in small cell lung carcinoma, surgery is not possible except in rare cases when the disease is at a very early stage of growth. The treatment option here is a combination of radiotherapy and chemotherapy.
Radiotherapy for each patient is planned on the basis of the progression of his disease and the state of his health. Mostly it is given in combination with chemotherapy and where surgery is possible, with surgery too. Advanced imaging techniques like CT and PET scans help radiologists in targeting the tumor precisely from several angles with limited damage to healthy tissue. Stereotactic body radiotherapy works with great precision on small tumors and research is on to see this as an alternative to surgical intervention.
Chemotherapy is a kind of drug treatment that kills cancer cells. It can be taken orally or intravenously. Together with radiation therapy, it deals effectively with cancer. At the extensive stage of the disease, it is the principal treatment option. When the tested drugs fail to contain the disease, experimental drugs under clinical trial are also administered. These drugs may not cure lung cancer but may improve the quality of the patient’s life and may, actually, extend it too. lungcancertreatment.blognub.com
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