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As the number of elderly people increases, Alzheimer's disease (AD) and hypertension have become more common. This is an important case report that shows severe hyponatremia induced by a combination of angiotensin II receptor blocker (ARB) and thiazide, causing the deterioration of cognitive functions in an elderly patient. In rapidly aging societies around the world, more attention should be paid to hyponatremia under combination therapy of ARB plus thiazide to assist elderly patients. This article is protected by copyright. All rights reserved.

Following the treatment of the first Gaucher disease patient with enzyme replacement therapy (ERT), it was clear that ERT had the potential to be transformative with dramatic improvements in systemic manifestations of the disease within 2 years. Following over 20 years existence of the International Collaborative Gaucher Group Gaucher Registry and evidence from ∼6000 patients, the long-term effects of therapy have been documented. It has been shown that ERT can result in improvements in all clinical and laboratory parameters of nonneuronopathic disease. However, different aspects of the disease, such as hematologic parameters, organ volumes and bone disease do not necessarily respond to therapy at the same rate or to the same extent, and this has had major implications for disease monitoring and for the establishment of therapeutic goals for ERT. Response may be affected by factors such as the timing of therapy initiation, the presence of irreversible complications such as osteonecrosis, and by enzyme dose. It is also apparent that ERT has no impact on neurological aspects of disease and highlights the need for additional or alternative treatment strategies able to meet the needs of patients with neuronopathic disease.

NMR metabolite fingerprints of fractions from an extract of the bryozoan Amathia tortuosa allowed identification of three known (1–3) and evidence of a new tribrominated metabolite. The new compound, kororamide B (4), was purified through NMR-guided isolation and the structure assigned by mass and detailed NMR analysis. The absolute configuration of the new compound was established by comparison of the experimental and calculated electronic circular dichroism spectra. The compounds displayed effects on early endosomes when profiled on human olfactory neurosphere-derived cells (hONS) derived from a Parkinson's disease patient using a multidimensional phenotypic assay.

Polypharmacy has not been defined for Crohn's disease.To determine the prevalence of polypharmacy, factors associated with polypharmacy, and consequences of polypharmacy in a Crohn's disease population.A review of 291 Crohn's disease patients was performed. Polypharmacy was defined as either minor (two to four medications) or major (or = 5 medications). Clinical status was evaluated with the Harvey-Bradshaw index of disease activity (HBI) and the short inflammatory bowel disease questionnaire (SIBDQ).Major polypharmacy was identified in 50% of patients. Crohn's disease patients on less than two medications at the intake visit had an HBI of 3.6 compared with 5.4 and 6.0 in the minor and major polypharmacy groups (P0.05). Similarly, patients on less than two medications had an SIBDQ of 60.3 compared with 55.7 and 53.4 in the minor and major polypharmacy groups (P = 0.11). Predictors of polypharmacy included age40 years (OR 1.9), duration of disease10 years (OR 2.0), and female sex (OR 2.5).Polypharmacy is common in Crohn's disease and correlates with increased disease activity and decreased quality of life. Increasing age, increasing duration of disease, and female sex are associated with major polypharmacy. These findings emphasize the need for improved treatment algorithms to optimize Crohn's disease patient management.

Human leukocyte antigen (HLA)-DQA1*0510 has been identified in a Spanish patient diagnosed with celiac disease. DQA1*0510 differs from DQA1*0505/09 by a point mutation at exon 2 producing an amino acid replacement at codon 77 (I>V).