Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via trans...Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompt-ing increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.展开更多
BACKGROUND Sodium glucose cotransporter 2(SGLT2)inhibitors use has been associated with toe amputations and non-healing ulcers and gangrene mostly of lower extremities.There are no case reports about association of Em...BACKGROUND Sodium glucose cotransporter 2(SGLT2)inhibitors use has been associated with toe amputations and non-healing ulcers and gangrene mostly of lower extremities.There are no case reports about association of Empagliflozin with finger ulcers or gangrene.This is the first case report of Empagliflozin(Jardiance)an SGLT2 inhibitor causing gangrene of fingers and second case in literature about any SGLT2 inhibitor causing gangrene of upper extremity.CASE SUMMARY A 76-year-old man with type 2 diabetes mellitus sustained minimal trauma to both middle fingers,which started healing.He was started on empagliflozin a week later for management of type 2 diabetes mellitus and started developing gangrene to both middle finger tips along with neuropathic pain which worsened over the course of next four months.Investigations were negative for vascular insufficiency,infection and vasculitis and imaging of hand was normal.Discontinuation of empagliflozin slowed progression of gangrene and caused symptomatic improvement with reduction in neuropathic pain.CONCLUSION This case report suggests possible association of empagliflozin and finger gangrene and recommends that more research and awareness among clinicians is needed in this area.展开更多
Chronic hepatitis C virus(HCV) infection is associated with multifarious extra-hepatic manifestations;the most described and discussed being mixed cryoglob-ulinemia which is strongly related to B-cell lympho-prolifera...Chronic hepatitis C virus(HCV) infection is associated with multifarious extra-hepatic manifestations;the most described and discussed being mixed cryoglob-ulinemia which is strongly related to B-cell lympho-proliferative disorders(LPDs).We present a case of chronic HCV infection and mixed cryoglobulinemia,with minimal liver involvement.The case is a 53-year-old patient who was diagnosed as having bone marrow hypoplasia at the age of three.She received several blood transfusions to normalize her haemoglobin.At the age of 31,she was diagnosed with rheumatoid ar-thritis on account of her diffuse joint pain and inflam-mation,elevated rheumatoid factor(RF) and Raynaud's phenomenon.Twenty years later,monoclonal gam-mopathy of IgG Lambda(one year later,changed to IgM Kappa) was detected during a routine examina-tion.A bone marrow biopsy showed hypoplasia,Kappa positive B-lymphocytes and low-grade malignant lym-phoma cells.PCR of the bone marrow aspirate was not contributory.No treatment was initiated owing to herpoor bone marrow function and she is under regular follow-up.展开更多
文摘Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompt-ing increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.
文摘BACKGROUND Sodium glucose cotransporter 2(SGLT2)inhibitors use has been associated with toe amputations and non-healing ulcers and gangrene mostly of lower extremities.There are no case reports about association of Empagliflozin with finger ulcers or gangrene.This is the first case report of Empagliflozin(Jardiance)an SGLT2 inhibitor causing gangrene of fingers and second case in literature about any SGLT2 inhibitor causing gangrene of upper extremity.CASE SUMMARY A 76-year-old man with type 2 diabetes mellitus sustained minimal trauma to both middle fingers,which started healing.He was started on empagliflozin a week later for management of type 2 diabetes mellitus and started developing gangrene to both middle finger tips along with neuropathic pain which worsened over the course of next four months.Investigations were negative for vascular insufficiency,infection and vasculitis and imaging of hand was normal.Discontinuation of empagliflozin slowed progression of gangrene and caused symptomatic improvement with reduction in neuropathic pain.CONCLUSION This case report suggests possible association of empagliflozin and finger gangrene and recommends that more research and awareness among clinicians is needed in this area.
文摘Chronic hepatitis C virus(HCV) infection is associated with multifarious extra-hepatic manifestations;the most described and discussed being mixed cryoglob-ulinemia which is strongly related to B-cell lympho-proliferative disorders(LPDs).We present a case of chronic HCV infection and mixed cryoglobulinemia,with minimal liver involvement.The case is a 53-year-old patient who was diagnosed as having bone marrow hypoplasia at the age of three.She received several blood transfusions to normalize her haemoglobin.At the age of 31,she was diagnosed with rheumatoid ar-thritis on account of her diffuse joint pain and inflam-mation,elevated rheumatoid factor(RF) and Raynaud's phenomenon.Twenty years later,monoclonal gam-mopathy of IgG Lambda(one year later,changed to IgM Kappa) was detected during a routine examina-tion.A bone marrow biopsy showed hypoplasia,Kappa positive B-lymphocytes and low-grade malignant lym-phoma cells.PCR of the bone marrow aspirate was not contributory.No treatment was initiated owing to herpoor bone marrow function and she is under regular follow-up.
