Influenza remains a major cause of morbidity and mortality worldwide, particularly among elderly patients with comorbidities. Oseltamivir (Tamiflu), a neuraminidase inhibitor, is the most widely prescribed antiviral therapy for influenza A and B. Although oseltamivir is associated with increased nausea and vomiting, it is generally well tolerated. On rare occasions, oseltamivir has been associated with rare hypersensitivity reactions, including angioedema. Angiotensin-converting enzyme (ACE) inhibitors are also well known to cause angioedema, sometimes years after therapy initiation. We present the case of a 73-year-old man with influenza A who developed acute lip swelling after starting oseltamivir while on long-term lisinopril therapy. Oseltamivir was discontinued, and the swelling subsided. This raised important diagnostic and therapeutic considerations in differentiating viral illness, drug reaction, and medication-induced angioedema.

Renal arteriovenous malformations (AVMs) are uncommon vascular abnormalities that may present a diagnostic challenge, particularly in young patients undergoing evaluation for persistent hypertension. We present the case of a 20-year-old woman with hypertension that remained elevated despite treatment with lisinopril and extended-release nifedipine. During outpatient cardiology follow-up, her blood pressure was 163/91 mmHg, prompting further evaluation for a secondary cause. Renal ultrasonography demonstrated asymmetric kidney size, with the left kidney smaller than the right. Subsequent computed tomography angiography of the chest, abdomen, and pelvis demonstrated a normal aorta without evidence of coarctation and no significant stenosis of the main renal arteries. Despite unrevealing noninvasive vascular imaging, persistent clinical suspicion for an underlying renal vascular abnormality prompted selective renal angiography. Angiography revealed a hypervascular nidus in the lower pole of the left kidney supplied by a tortuous branch of the left main renal artery, consistent with a slow-flow renal AVM. Superselective embolization of the feeding vessel was performed through right distal radial access using a detachable microcoil. Final angiography demonstrated successful occlusion of the targeted AVM while preserving perfusion to the surrounding renal parenchyma. The procedure was completed without immediate complications. At four-month follow-up, hypertension persisted and required intensification of antihypertensive therapy, suggesting that the AVM could not be established as the sole cause of the patient's hypertension. This case highlights the importance of considering uncommon renal vascular abnormalities in young patients with severe hypertension and renal asymmetry when the initial evaluation is inconclusive. Selective renal angiography can provide detailed anatomic characterization while simultaneously offering an opportunity for targeted endovascular therapy.

Pairwise drug-drug interaction databases flag co-prescribed pairs, but they under-weight multi-drug combinations that drive adverse drug events in older adults. We studied that gap in Virginia All-Payer Claims Database records (2016-2019) for adults aged 65-114 years with non-opioid emergency department visits (n = 1182 cases; 16,105 matched controls across three geriatric age bands). Features came from pharmacy and medical claims in a short pre-index window optimized for acute ADE timing (21-30 days by age band; 21 days for ages 65-84). We trained gradient-boosting models separately among patients with similar pre-index healthcare contact volume (2016-2018 training; 2019 holdout), then used Formal Feature Attribution to score drug pairs and triplets and Intervention Rate ranks to order deprescribing review. On the 2019 holdout, geriatric AUPRC was 0.101-0.335 (PR lift 1.6×-4.2×). FFA flagged 115 synergistic pairs and 312 high-confidence triplets (e.g., furosemide + hydrochlorothiazide + lisinopril; digoxin + furosemide + amiodarone, IE = 8.7). Top Intervention Rate drugs included simvastatin, furosemide, and alprazolam. Moderate preventive Z-code monitoring (Q2) was protective (OR = 0.25; 95% CI 0.18-0.34) versus no monitoring, while fragmented high-intensity monitoring (Q4) was not. The framework prioritizes medication combinations for pharmacist review in claims data; it does not replace pharmacokinetic confirmation or prove that changing a drug caused fewer ED visits.

Pharyngolaryngeal dysfunction associated with myopathy is not well characterized. We present a case of toxic or inflammatory myopathy causing severe vocal fold hypomobility and dysphagia, with complete recovery. A 47-year-old female with tuberous sclerosis, lymphangioleiomyomatosis, and a recent upper respiratory infection, taking atorvastatin and, until recently, everolimus, presented with several weeks of myalgias and 10 days of dyspnea. Examination demonstrated full extremity strength and inspiratory stridor. Flexible laryngoscopy revealed severely hypomobile bilateral vocal folds with pooled pharyngeal secretions. Creatine phosphokinase (CK) was >40,000 U/L at presentation. Rheumatology workup was negative. Magnetic resonance imaging of the brain demonstrated enhancement of facial and cervical musculature. Computed tomography of the neck showed new laryngeal muscle heterogeneity. Neither identified vagal or laryngeal nerve pathology. Treatment included high-dose dexamethasone, racemic epinephrine, albuterol, intravenous fluids, a temporary feeding tube, and discontinuation of atorvastatin and lisinopril. By hospital day 14, CK decreased to 1,420 U/L, and vocal fold motion had significantly improved. At one-month follow-up, vocal fold mobility normalized, symptoms resolved, and CK was 320 U/L. Extended myositis antibody panel at four-month follow-up was negative. Recovery was sustained at seven months. This case suggests pharyngolaryngeal musculature can be preferentially affected in acute myopathy.

The global burden of hypertension and its severe form, resistant hypertension, affecting up to 20% of 1.4 billion adults worldwide, drives mass consumption of multiple drugs. Consequently, antihypertensive agents from different classes enter aquatic environments, yet simultaneous extraction of such chemically diverse drugs remains challenging. This work developed a green analytical method for the simultaneous determination of three model antihypertensive agents from distinct classes, namely, furosemide, atenolol, and lisinopril, in water samples. The method employed dispersive liquid-liquid microextraction using a thymol-based natural deep eutectic solvent selected for its superior hydrophobicity and tunability across varying analyte polarities and acid-base characteristics. Extraction was optimized via Box-Behnken design, followed by HPLC-UV analysis on a phenyl column with gradient elution (detection at 220 nm). The validated method showed good linearity (furosemide: 2-100 µg L[-1], lisinopril: 5-100 µg L[-1], and atenolol: 0.1-50 µg L[-1]) with LODs of 0.18, 0.66, and 0.031 µg L[-1], respectively. The practical applicability of the developed method was evaluated by analyzing real water samples collected from multiple sites across Egypt. The results revealed detectable concentrations of the target pharmaceuticals in several samples, confirming the presence of these contaminants in Egyptian water systems. Specifically, furosemide was detected at 4.72 µg L[-1], atenolol at 0.43 µg L[-1], and lisinopril at 7.21 µg L[-1] in samples collected from Giza. A comprehensive greenness assessment using the GAPI, AGREE, BAGI, and EVG tools confirmed strong alignment with sustainable chemistry principles. By enabling multi-class extraction of antihypertensive drugs with a low-ecological-footprint NADES-based protocol, this method addresses a critical gap as no prior NADES-based method exists for these three therapeutic classes together, supporting environmental monitoring and clean water objectives.

Doxorubicin-induced cardiotoxicity classically manifests as dose-dependent left ventricular systolic dysfunction. Herein, we describe an unusual case of acute mitral papillary muscle rupture following cumulative anthracycline therapy, presenting despite a preserved ejection fraction.

Because no information is available on the use of lisinopril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Psoriasis is a chronic, immune-mediated skin disorder characterized by excessive inflammation and the overexpression of pro-inflammatory cytokines, including IL-6, IL-1β, IL-17 A, and IFN-γ. Despite the availability of targeted therapies, current treatments often entail high costs, limited accessibility, and adverse side effects. Drug repurposing-utilizing approved medications for novel indications-offers a cost-effective strategy to accelerate the development of alternative therapies with established safety profiles. Twelve FDA-approved antihypertensive drugs-including ACE inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers-were computationally evaluated for anti-inflammatory potential in psoriasis. Target cytokines were identified using network analysis via STRING and Cytoscape. Molecular docking was performed against IL-6, IL-1β, IL-17 A, and IFN-γ. The top-performing ligands underwent further analysis using ADMET prediction, BOILED-Egg visualization, Density Functional Theory (DFT) calculations, and molecular dynamics (MD) simulations to assess pharmacokinetics, electronic properties, and protein-ligand complex stability. Apremilast, a clinically approved anti-psoriatic agent, served as the reference drug. Lisinopril, Ramipril, Amlodipine, and Atenolol emerged as top candidates based on docking scores and pharmacokinetic profiles. Among them, Lisinopril exhibited the strongest binding affinity across all four cytokines, comparable to or exceeding that of Apremilast. Amlodipine demonstrated the highest electronic reactivity, and all selected drugs showed favorable ADMET properties. MD simulations over 200 ns confirmed the dynamic stability of the Lisinopril-IL-6 complex. Lisinopril has shown potential as a molecular candidate through detailed computational analysis of cytokine interactions. However, these results are purely predictions and should be viewed with caution, especially considering reports of potential ACE inhibitor-related psoriasis worsening. Further thorough laboratory, animal, and clinical studies are necessary to assess its practical application and safety in treating psoriasis.