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Cureus May 2023Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of...
Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of pneumopericardium due to gastro-pericardial fistula secondary to gastric cancer presented with an inferior ST-elevation myocardial infarction (STEMI)-like picture. Our case is a 57-year-old male with a past medical history of metastatic gastric cancer status post chemotherapy and radiotherapy who presented to the emergency with acute onset severe burning chest pain with radiation to his back. He was diaphoretic, saturating 96% on room air, and hypotensive with a blood pressure of 80/50 mmHg, and his EKG showed sinus rhythm with a heart rate of 60 BPM and ST elevation in inferior leads meeting STEMI criteria. The patient was transferred for an emergency coronary angiogram with possible percutaneous intervention. Surprisingly, no significant lesions in his epicardial vessels would corroborate his clinical presentation and EKG changes. The decision was to obtain CT angiography to exclude aortic dissection and pulmonary embolism. His CT chest revealed a large pneumopericardium with a gastric-pericardial fistula. A nasogastric tube was placed with suctioning of gastric contents. Given his tamponade physiology, it was decided to do emergent pericardiocentesis draining only 20 cc of gastric contents and a significant amount of air. After the procedure, the patient was transferred to the ICU with stable hemodynamics. The case was discussed with surgery, but given his inoperable cancer, a palliative team was involved. Acknowledging his very poor prognosis, the patient requested discharge to home with home hospice. As reported in the literature, pneumopericardium is rare, and gastro-pericardial fistula associated with gastric cancer is even rarer. Clinical presentation is variable and can be confusing. Providers should be aware of how a patient with gastric cancer can be complicated with pneumopericardium, and they should have a lower threshold of suspicion in patients having risk factors. CT scan is the most sensitive tool for diagnosis.
PubMed: 37378126
DOI: 10.7759/cureus.39358 -
Frontiers in Plant Science 2022() Jepson is a medicinal plant that is frequently used by the Chumash Indians in southern California as a diaphoretic, calmative, diuretic, or antimicrobial agent....
() Jepson is a medicinal plant that is frequently used by the Chumash Indians in southern California as a diaphoretic, calmative, diuretic, or antimicrobial agent. Abietane-type diterpenoids (ATDs) and phenolic acids (PAs) are the main bioactive ingredients in . However, few studies have looked into the biosynthesis of ATDs and PAs in . In this study, using metabolic profiling focused on the ATDs and PAs in the roots and leaves of , we found a distinctive metabolic feature with all-around accumulation of ATDs, but absence of salvianolic acid B. To identify the candidate genes involved in these biosynthesis pathways, full-length transcriptome was performed by PacBio single-molecule real-time (SMRT) sequencing. A total of 50 and 40 unigenes were predicted to be involved in ATDs and PAs biosynthesis, respectively. Further transcriptional profile using Illumina HiSeq sequencing showed that the transcriptional variations of these pathways were consistent with the accumulation patterns of corresponding metabolites. A plant kingdom-wide phylogenetic analysis of cytochromes (CYPs) identified two CYP76AK and two CYP76AH subfamily genes that might contribute for the specific ATDs biosynthesis in . We also noticed that the clade VII laccase gene family was significantly expanded in compared with that of , indicating their involvements in the formation of salvianolic acid B. In conclusion, our results will enable the further understanding of ATDs and PAs biosynthesis in and genus.
PubMed: 35755672
DOI: 10.3389/fpls.2022.919025 -
Journal of Ethnopharmacology Apr 2015Mahuang decoction, Ephedra combined with Cassia twig, Bitter apricot kernel and Prepared licorice, has been widely used as a multi-herb prescription in traditional...
Effects of herbal drugs in Mahuang decoction and their main components on intestinal transport characteristics of Ephedra alkaloids evaluated by a Caco-2 cell monolayer model.
ETHNOPHARMACOLOGICAL RELEVANCE
Mahuang decoction, Ephedra combined with Cassia twig, Bitter apricot kernel and Prepared licorice, has been widely used as a multi-herb prescription in traditional Chinese medicine (TCM). Many modern pharmacological studies have shown that the compatibility application of these four herbs has promising therapeutic effects on respiratory infection, acute glomerulonephritis and chronic renal failure. However, the underlying principles for governing the formulation of Mahuang decoction remain unknown. In this study, we used a Caco-2 cell monolayer model to explicate the possible compatibility mechanism of Mahuang decoction from the perspective of intestinal absorption.
MATERIAL AND METHODS
Firstly, the apical-to-basolateral and basolarteral-to-apical transport of the main characteristic active alkaloids in Ephedra, l-ephedrine (LEP), d-pseudoephedrine (DPEP) and l-methylephedrine (LMEP), as a single compound, was investigated. Secondly, the influence of main components in Cassia twig, Bitter apricot kernel and Prepared licorice on the transport of LEP, DPEP and LMEP was investigated. Finally, the bidirectional transport of these three alkaloids in single Ephedra extract, in Mahuang decoction and in drug pair extracts, such as Ephedra-Cassia twig, Ephedra-Bitter apricot kernel, Ephedra-Prepared licorice, was assessed.
RESULTS
The investigated LEP, DPEP and LMEP could transport through the Caco-2 cell monolayer at a high level, with the efflux ratio (ER) of 1.41, 1.33 and 1.30, respectively, when the cells were treated with each single compound solution. In the presence of verapamil, the permeability from apical side to basolateral side (PAB) of the three alkaloids increased significantly (P<0.05), and their ERs decreased. The treatment of cells with Mahuang decoction and the drug pair extracts from Ephedra-Cassia twig, Ephedra-Bitter apricot kernel and Ephedra-Prepared licorice appreciably decreased PAB of LEP, DPEP and LMEP with increased ERs, compared to the treatment with single Ephedra extract. When concomitant administration with herbal drugs and their main ingredients (including cinnamaldehyde-cinnamyl alcohol-cinnamic acid group, volatile oil from Cassia twig, liquiritin-glycyrrhizic acid group from Prepared licorice, Cassia twig extract, Bitter apricot kernel extract and Prepared licorice extract), was adopted, PAB of LEP, DPEP and LMEP were reduced significantly and the ERs of the corresponding compounds were promoted appreciably. Only amygdalin (from Bitter apricot kernel) had little influence on the transport of Ephedra alkaloids.
CONCLUSION
The findings indicate that LEP, DPEP and LMEP in Ephedra extract have similar absorption as in the pure solution of each compound. The intestinal absorption of LEP, DPEP and LMEP is through passive diffusion and these compounds may be P-gp substrates. The compatibility application of Cassia twig, Bitter apricot kernel and Prepared licorice, and their main components except amygdalin can suppress the absorption of the three main Ephedra alkaloids across the Caco-2 cell monolayer. On the basis of our results, Cassia twig, Bitter apricot kernel and Prepared licorice in Mahuang decoction decrease the absorption of Ephedra alkaloids, which may alleviate the drastic diaphoretic function and toxicity of Ephedra.
Topics: Alkaloids; Caco-2 Cells; Drug Interactions; Drugs, Chinese Herbal; Ephedra sinica; Humans; Intestinal Absorption
PubMed: 25660335
DOI: 10.1016/j.jep.2015.01.043 -
Chemistry & Biodiversity Dec 2014Elderberries are used in the preparation of pie, jelly, punch, wine, or liqueur, as well as in many herbal remedies and food supplements. Elderberry products may provide...
Elderberries are used in the preparation of pie, jelly, punch, wine, or liqueur, as well as in many herbal remedies and food supplements. Elderberry products may provide diaphoretic, diuretic, antioxidant, and immunostimulant activities that offer protection against cold and flu. Herein, we report for the first time the qualitative and quantitative evaluation of two isomeric triterpenoids isolated from Sambuci fructus. The analysis revealed that ursolic acid and oleanolic acid are present in Sambuci fructus. The average concentration of ursolic acid was ca. three times higher than the concentration of oleanolic acid. The triterpenoids were detected and quantified using chromatographic methods such as TLC and HPLC. Spectroscopic techniques, including HR-MS and 2D-NMR, allowed unequivocal structure determination.
Topics: Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Mass Spectrometry; Oleanolic Acid; Proton Magnetic Resonance Spectroscopy; Sambucus; Triterpenes; Ursolic Acid
PubMed: 25491337
DOI: 10.1002/cbdv.201400118 -
Prehospital and Disaster Medicine Feb 2017Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a...
Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified. This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions. Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%). Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may decrease PPR, TTHR, and overall mortality. Friedman MS , Plocki A , Likourezos A , Pushkar I , Bazos AN , Fromm C , Friedman BW . A prospective analysis of patients presenting for medical attention at a large electronic dance music festival. Prehosp Disaster Med. 2017; 32(1):78-82.
Topics: Adolescent; Adult; Crowding; Dancing; Emergency Medical Services; Female; Humans; Male; Middle Aged; Music; New York City; Patient Acceptance of Health Care; Prospective Studies; Transportation of Patients; Wounds and Injuries; Young Adult
PubMed: 27978861
DOI: 10.1017/S1049023X16001187 -
Clinical Practice and Cases in... Feb 2020A 39-year-old female presents to the emergency department with chest pain and shortness of breath. Her electrocardiogram suggests ST-elevation myocardial infarction, but...
A 39-year-old female presents to the emergency department with chest pain and shortness of breath. Her electrocardiogram suggests ST-elevation myocardial infarction, but she has no atherosclerotic risk factors. She is gravida 4, para 4, and four weeks postpartum from uncomplicated vaginal delivery. She is diaphoretic and anxious, but otherwise her exam is unremarkable. Cardiac enzymes are markedly elevated and point-of-care echocardiogram shows inferolateral hypokinesis and ejection fraction of 50%. In this clinicopathological case, we explore a classically underappreciated cause of acute coronary syndrome in healthy young women.
PubMed: 32064413
DOI: 10.5811/cpcem.2019.10.44141 -
Case Reports in Emergency Medicine 2018Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndrome with a spectrum of disease that can include unstable angina, acute...
INTRODUCTION
Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndrome with a spectrum of disease that can include unstable angina, acute myocardial infarction, or sudden cardiac death. It has also been found in case reports to be caused by shear stress from physical exertion. We present a rare cycling induced SCAD that occurred in our institution in an otherwise healthy male with no cardiac risk factors.
CASE PRESENTATION
A 36-year-old male presented to the emergency department with complaints of lightheadedness and diaphoresis after a bicycle fall. In the emergency department, he complained of feeling lightheaded and diaphoretic and having mid back pain. Patient had an ECG performed which showed lateral ST segment elevation and troponin I that was positive. A coronary angiography was subsequently performed demonstrating a spontaneous coronary artery dissection of left anterior descending coronary artery.
CONCLUSION
SCAD is a rare cause of myocardial infarction, occurring in healthy individuals, which is rarely reported in the literature. Nearly 70% are diagnosed in postmortem studies after sudden cardiac death. Only 12 cases have been reported from activities involving physical exertion and no studies to our knowledge demonstrate this.
PubMed: 29984009
DOI: 10.1155/2018/2740513 -
Pakistan Journal of Pharmaceutical... Sep 2018Macrotyloma uniflorum (Lam.) Verdc. (Papilionaceae) is commonly known as Horse gram and Kulthi. The seeds are reported as anthelmintic, diaphoretic, diuretic and...
Macrotyloma uniflorum (Lam.) Verdc. (Papilionaceae) is commonly known as Horse gram and Kulthi. The seeds are reported as anthelmintic, diaphoretic, diuretic and emmenagogue. It is also useful in asthma, bronchitis and urolithiasis. In the present study, analgesic, anti-inflammatory and diuretic effects of the methanol extract of Macrotyloma uniflorum seeds were evaluated in doses of 200 and 400mg/kg. Significant results were obtained in all activities.
Topics: Analgesics; Animals; Anti-Inflammatory Agents; Diuretics; Dose-Response Relationship, Drug; Edema; Fabaceae; Mice; Pain Measurement; Plant Extracts; Rats; Rats, Wistar; Seeds
PubMed: 30150181
DOI: No ID Found -
Cureus Dec 2022The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of...
The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of shock. It was designed to be performed in under two minutes with evaluation of the pump (heart), tank (inferior vena cava, thoracic and abdominal compartments) and the pipes (large arteries and veins). However, its application or one similar should extend beyond the ED and into the hospital floor. Here we present an 80-year-old gentleman with a history of atrial fibrillation (A-Fib) on anticoagulation who arrived at the ED due to an episode of pre-syncope just prior to arrival. Initial EKG is concerning for A-Fib with rapid ventricular response (RVR) with a rate in the 130s. After fluid resuscitation patient improved and he was admitted to the telemetry floor for further cardiac workup and cardiology consultation. While waiting for a room in the ED, patient became hypotensive, diaphoretic and pale. After complaining of lower abdominal pain, the ED physician performed a RUSH which showed an abdominal aorta of 8 cm concerning for dissection. Diagnosis was confirmed with CT angiography of the abdomen and he was taken to the OR with successful repair of the abdominal aortic aneurysm (AAA). Patient made meaningful recovery and was discharged to in-patient rehab. The patient described in this vignette was delayed in the ED due to lack of beds on the floor. This allowed for quick ultrasound work-up by the ED physician which led to immediate recognition of the AAA and immediate response by the vascular surgery team. Should this patient have been on the hospital floor, it is unclear if such prompt steps would have occurred prior to patient's further hemodynamic demise.
PubMed: 36540318
DOI: 10.7759/cureus.32565 -
BMJ Case Reports Aug 2022A woman in her 30s presented to the emergency department with acute onset, progressively worsening left-sided abdominal pain after exercise. She was found to be...
A woman in her 30s presented to the emergency department with acute onset, progressively worsening left-sided abdominal pain after exercise. She was found to be hypotensive and diaphoretic, with free intraperitoneal fluid detected on bedside point-of-care ultrasound. Resuscitation was initiated, a presumptive diagnosis of ruptured ectopic pregnancy was made, and obstetrics and gynaecology were consulted. Point-of-care urine pregnancy testing, however, was negative, and subsequent CT angiography of the patient's abdomen revealed an angiomyolipoma (AML) with active haemorrhage. Ultimately, embolisation was performed in the interventional radiology suite, with improvement of patient haemodynamics. Ruptured AML is a rare, life-threatening condition that needs to be included in the differential diagnosis of haemorrhagic shock in female patients of reproductive age presenting to the emergency department.
Topics: Angiomyolipoma; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Leukemia, Myeloid, Acute; Physicians; Pregnancy; Shock, Hemorrhagic
PubMed: 35944938
DOI: 10.1136/bcr-2021-248626