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Laeknabladid Jun 2023A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal...
A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.
Topics: Male; Humans; Middle Aged; Aneurysm, False; Retroperitoneal Space; Hemorrhage; Hematoma; Adrenal Glands
PubMed: 37233620
DOI: 10.17992/lbl.2023.05.744 -
BMJ Case Reports Mar 2019A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral...
A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.
Topics: 3,4-Methylenedioxyamphetamine; Adult; Aftercare; Anti-Arrhythmia Agents; Antithyroid Agents; Carbimazole; Delirium; Diagnosis, Differential; Humans; Intensive Care Units; Male; Propranolol; Serotonin Syndrome; Substance-Related Disorders; Thyrotoxicosis; Thyrotropin; Treatment Outcome; Tremor
PubMed: 30850570
DOI: 10.1136/bcr-2018-228404 -
European Journal of Case Reports in... 2022The abuse of inhalants has become a public health concern in the USA over the past decade. Compressed air duster cans currently available in the USA contain highly toxic...
UNLABELLED
The abuse of inhalants has become a public health concern in the USA over the past decade. Compressed air duster cans currently available in the USA contain highly toxic substances including different hydrofluorocarbons (including tetrafluoroethane and difluoroethane) which exert a psychoactive effect on the central nervous system. Several cases of inhalant-induced lethal arrhythmia such as ventricular fibrillation evolving to torsade de pointes and leading to cardiac arrest, have been reported in the literature. Furthermore, multiorgan failure including liver and kidney injury has been described after inhalant abuse. We report the case of a 33-year-old man found diaphoretic and with a near syncopal episode after inhalation of several cans of Surf Onn electronic duster gas cleaner, who subsequently developed acute cardiac, liver and kidney injury.
LEARNING POINTS
Although the pathophysiological mechanisms have not been fully elucidated, the hydrofluorocarbons in air duster cans may exert a psychoactive effect through GABA receptor stimulation and NMDA receptor inhibition.Clinicians should maintain a low threshold of suspicion for patients presenting with multiorgan failure, predominantly cardiac arrhythmias after inhalant overdose.Prompt recognition and early intervention are imperative for preventing fatal outcomes such as cardiac arrest secondary to life-threatening cardiac arrhythmias.
PubMed: 36299844
DOI: 10.12890/2022_003556 -
European Journal of Case Reports in... 2024Epipericardial fat necrosis (EFN) is a rare and self-limiting cause of acute chest pain. We describe a case of EFN in a patient with a recent coronavirus disease...
BACKGROUND
Epipericardial fat necrosis (EFN) is a rare and self-limiting cause of acute chest pain. We describe a case of EFN in a patient with a recent coronavirus disease (COVID-19).
CASE PRESENTATION
A 55-year-old male presented with a sudden onset of left-sided pleuritic chest pain for the past two days. The patient was diaphoretic, tachypneic, and tachycardic. Acute coronary syndrome was ruled out. A computed tomography (CT) pulmonary angiogram revealed an ovoid encapsulated fatty mass surrounded by dense appearing tissue. Patient symptoms improved remarkably with a short course of non-steroidal anti-inflammatory drugs (NSAIDs).
DISCUSSION
EFN typically presents with a sudden onset of excruciating chest pain. Misdiagnosis, under-diagnosis, and mismanagement are unavoidable. EFN is incidentally diagnosed on CT scan. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects visceral adipose tissue and appears to increase the risk of EFN by promoting inflammatory cytokine production and death of adipocytes.
CONCLUSION
EFN is a rare cause of acute chest pain. SARS-CoV-2 is likely to induce EFN. This rare clinical entity should be considered in the differential of acute chest pain especially in patients with active or recent COVID-19.
LEARNING POINTS
Epipericardial fat necrosis (EFN) is a rare cause of acute pleuritic chest pain that is often misdiagnosed and mismanaged.SARS-CoV-2 can possibly increase the risk of EFN and this entity should be considered in the differential of chest pain, especially in patients with active or recent coronavirus disease (COVID-19).Clinician awareness of EFN and its potential association with COVID-19, can reduce unnecessary testing and emotional distress.
PubMed: 38455703
DOI: 10.12890/2024_004346 -
Cureus Oct 2023Camphor is a highly toxic ingredient that can be found in commonly used rubs and preparations such as Tiger balm and Vicks. There is a wide range of symptoms resulting...
Camphor is a highly toxic ingredient that can be found in commonly used rubs and preparations such as Tiger balm and Vicks. There is a wide range of symptoms resulting from camphor oil toxicity, manifesting in sweating and agitation and can progress to more serious symptoms of seizures, cardiac arrhythmias, and cardiopulmonary arrest. We present a 61-year-old male, who is a known case of major depressive disorder, was brought to the emergency department on 10/09/2022, two hours after ingesting approximately 500 mL of camphor oil in its liquid form. He developed two episodes of tonic-clonic seizures at home and then later had another episode in the emergency department. As he presented to the emergency room, he was confused, agitated, restless, and diaphoretic. The management in the Emergency Department started with assessing his airway and administration of intravenous (IV) benzodiazepines and IV fluids. The ECG revealed sinus rhythm with borderline QT and QRS. During his stay in the emergency room, his mental status worsened and he became more confused and restless, and he developed another tonic-conic seizure. Therefore, he was intubated. The patient was shifted and managed in the intensive care unit, and 48 hours later the patient was extubated. This case report illustrates the importance of addressing the potential risks of home remedies as they are increasingly being used by the population considering them as safe. Camphor, being the most cultivated essential oil, is a highly toxic compound that, even in very small concentrations, can be lethal to infants and children. It is a component of numerous over-the-counter remedies and has the potential for accidental consumption. Generalized tonic-clonic seizure being the most prominent manifestation which can occur as early as five minutes after exposure needs to be anticipated and treated accordingly. Treatment for symptomatic patients is primarily supportive with special attention paid to QRS complex widening in the ECG.
PubMed: 38022187
DOI: 10.7759/cureus.47412 -
BMJ Case Reports Apr 2021A 33-year-old man without significant medical history presented to the emergency department with a 6-month history of fatigue and 30 pounds of unintentional weight loss,...
A 33-year-old man without significant medical history presented to the emergency department with a 6-month history of fatigue and 30 pounds of unintentional weight loss, with a recent cough and fever over the past week. He recalled two similar illnesses during college that did not require medical care. He denied tobacco use but reported inhaling marijuana 1-2 times daily over the past year with a vaping device. Physical exam was notable for a temperature of 100.0°F and an elevated blood pressure at 161/77 mm Hg. He was diaphoretic with clear breath sounds bilaterally. Chest imaging revealed diffuse ground glass opacities with subpleural sparing and mildly enlarged hilar lymph nodes. Bronchoscopy with transbronchial lung biopsies and needle aspirate of lymph nodes revealed organising pneumonia, and subsequent cultures grew He was treated with amoxicillin and corticosteroids with subsequent resolution on repeat chest imaging.
Topics: Actinomycosis; Adult; Cannabis; Cough; Humans; Lung Diseases; Male; Vaping
PubMed: 33795280
DOI: 10.1136/bcr-2020-240973 -
Journal of Ethnopharmacology Apr 2017Notopterygium incisum Ting ex H.T. Chang, known in Chinese as 'Qianghuo' is a traditional Chinese medicinal herb with the rhizome and roots associated with meridians of... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Notopterygium incisum Ting ex H.T. Chang, known in Chinese as 'Qianghuo' is a traditional Chinese medicinal herb with the rhizome and roots associated with meridians of the kidney and urinary bladder. It is pungent, bitter and warm in nature. It has been used over the years to disperse cold, prevent painful obstructions from wind, damp and warm pain. It has also been used with other herbs to treat wind-cold exterior syndrome and wind-cold-damp bi-syndromes and has been known to grow well in regions of high altitude such as Gansu, Tibet etc.
THE AIM OF THE REVIEW
This systematic review focuses on the ethnopharmacological uses of this herb, including recent advances on the phytochemical and pharmacological study of N. incisum. Recent analytical methods developed for the quantitative and qualitative determination of constituents in this herb have also been reviewed. Additionally, future trends and prospects in the study of this herb have been proposed.
MATERIALS AND METHOD
Various literature and electronic databases such as Pubmed, Science Direct, Springer, Wiley etc were searched and data obtained. Other online academic libraries such as Google Scholar and ethnopharmacological literature were searched systematically for more information on the herb.
RESULTS
This review focuses on the ethnopharmacological uses of N. incisum and also the various chemical constituents present in the herb and their various therapeutic effects such as analgesic, anti-inflammatory, anti-cancer and antioxidants effects. Analytical methods developed for the quantitative and qualitative determination of various compounds in this herb were further reviewed.
CONCLUSION
In this paper, we have reviewed various researches conducted on N. incisum especially in areas of its ethnopharmacological use, phytochemicals, pharmacology and developed analytical methods. This herb has been used over the years in treating headache, rheumatoid arthritis, cold, diaphoretic etc, prompting many types of research into identifying which compounds are responsible for these activities and their mechanism of action. More research is needed in the area of pharmacokinetics and toxicology to give further information on the clinical use and control the quality of the herb.
Topics: Animals; Apiaceae; China; Drugs, Chinese Herbal; Ethnopharmacology; Humans; Medicine, Chinese Traditional; Phytotherapy; Plant Extracts; Tibet
PubMed: 28336469
DOI: 10.1016/j.jep.2017.03.022 -
Frontiers in Pharmacology 2022Antipyretic (heat-clearing) and diaphoretic (exterior-releasing) drugs are two main groups of traditional Chinese medicines (TCMs) possessing anti-microbes and...
Antipyretic (heat-clearing) and diaphoretic (exterior-releasing) drugs are two main groups of traditional Chinese medicines (TCMs) possessing anti-microbes and anti-inflammation effects, with the former mainly through clearing pyrogens while the latter through promoting diaphoresis. Although anti-microorganism is a common action of these two kinds of TCMs, their difference in antimicrobial spectrums and their interactions when combinedly used remain unclear. Herein, we prepared aqueous extracts from (HL) and other antipyretic or diaphoretic TCMs, orally administrated them to C57BL/6 mice at a clinical dose for fourteen days, and analyzed their impaction on both gut bacteria and fungi using full-length 16 S rRNA gene sequencing and internal transcribed spacer 1/2 (ITS1/2) gene sequencing, respectively. Oral administration of HL significantly changed the structure of gut bacteria but showed little influence on gut fungi. Co-treatment with antipyretic or diaphoretic TCMs alleviated the impact of HL on gut bacteria to a similar degree. However, combined with either heat-clearing or exterior-releasing TCMs significantly strengthened the influence of HL on gut fungi, with the latter superior to the former. The antipyretic TCMs enriched spp. while diaphoretic TCMs promoted spp. Further analysis revealed that the diaphoretic TCMs-enriched fungi spp. were positively related to spp., a beneficial bacterium that interacts with Toll-like receptor 4 (TLR4) and regulates thermogenesis, thus providing a potential linkage with their pro-diaphoresis effect. Together, our results reveal that gut fungi differentially respond to the impact of heat-clearing and exterior-releasing TCMs on -conditioned gut microbiota, which provides insights into their functional characteristics.
PubMed: 36467054
DOI: 10.3389/fphar.2022.1032919 -
Critical Reviews in Food Science and... 2023Elderberry (.) has been used in traditional medicine and as a supplement in many beverages and meals. Elderberry is a good source of bioactive flavonoids like quercetin,... (Review)
Review
BACKGROUND
Elderberry (.) has been used in traditional medicine and as a supplement in many beverages and meals. Elderberry is a good source of bioactive flavonoids like quercetin, kaempferol, and rutin, as well as other phenolic compounds. Extraction techniques significantly influence the efficiency of extraction of bioactive compounds. Green chemistry elements such as safety, environmental friendliness, run-down or at least minimal contaminants, efficiency, and economic criteria should all be addressed by an effective bioactive extraction process. Furthermore, micro/nanoencapsulation technologies are particularly effective for increasing bioavailability and bioactive component stability.
SCOPE AND APPROACH
This review article comprehensively describes new developments in elderberry extraction and encapsulation. Elderberry is largely employed in the food and pharmaceutical industries due to its health-promoting and sensory characteristics. Elderberry has traditionally been used as a diaphoretic, antipyretic, diuretic, antidepressant, and antitumor agent in folk medicine.
KEY FINDINGS AND CONCLUSIONS
Conventional extraction methods (e.g. maceration and Soxhelt extraction) as well as advanced green techniques (e.g. supercritical fluids, pulsed electric field, emulsion liquid extraction, microwave, and ultrasonic extraction) have been used to extract bioactives from elderberry. Over the other protective measures, encapsulation techniques are particularly recommended to protect the bioactive components found in elderberry. Microencapsulation (spray drying, freeze drying, extrusion, emulsion systems) and nanoencapsulation (nanoemulsions, solid lipid nanoparticles and nanodispersions, nanohydrogels, electrospinning, nano spray drying) approaches for elderberry bioactives have been examined in this regard.
Topics: Sambucus; Emulsions; Fruit; Flavonoids; Phenols; Plant Extracts
PubMed: 35021911
DOI: 10.1080/10408398.2022.2026290 -
HCA Healthcare Journal of Medicine 2023Metformin is considered a first-line therapy for patients with diabetes secondary to its cost efficiency, minimal side effects, and marked improvement in one's...
INTRODUCTION
Metformin is considered a first-line therapy for patients with diabetes secondary to its cost efficiency, minimal side effects, and marked improvement in one's hemoglobin A1c; however, metformin is avoided in patients with renal insufficiency out of concern for drug accumulation and lactic acidosis. In fact, there is a black box warning for metformin, identifying lactic acidosis as the inciting trigger for fatal arrhythmias and death.
CASE PRESENTATION
A 62-year-old male presented with multiple episodes of nausea, vomiting, abdominal pain, and decreased urine output for 3 days after working on a roof, all day in the summer heat. He did not drink more than a bottle of water throughout that day and noted that afterward, he seemed to have little to no urine output. At presentation, he was in moderate distress due to abdominal pain and was diaphoretic, tachypneic, and hypertensive. The patient was given dextrose and started on a sodium bicarbonate drip. He was also given calcium gluconate. His mentation and respiratory status continued to decline throughout that day, and he required intubation and mechanical ventilation. The patient ultimately recovered quite rapidly upon receiving hemodialysis.
CONCLUSION
This case report shows the critical nature of identifying and quickly treating metformin toxicity.
PubMed: 37424987
DOI: 10.36518/2689-0216.1508