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Cureus Aug 2020Leukostasis is a medical emergency caused by compromise of tissue perfusion secondary to hyperleukocytosis in acute myeloid leukemia (AML). Typically it affects lungs...
Leukostasis is a medical emergency caused by compromise of tissue perfusion secondary to hyperleukocytosis in acute myeloid leukemia (AML). Typically it affects lungs and brain, with cardiac involvement being exceedingly rare. We present a case of AML presenting as acute coronary syndrome secondary to leukostasis-induced myocardial ischemia. A 43-year-old morbidly obese gentleman presented with typical anginal chest pain. On examination, he was diaphoretic and in acute distress secondary to pain. EKG revealed ST elevation in lead I and aVL and PR depressions in precordial leads. Troponin peaked at 5.55 ng/mL. Echocardiogram showed normal left ventricle function with no wall motion abnormality. Blood work was notable for white blood cell (WBC) count of 185,200 cells/μL with 81% blasts. Coronary angiogram revealed no obstruction. Emergent leukapheresis and hydroxyurea were initiated. WBC count decreased to 48,200 cells/ μL and angina resolved after leukapheresis. With diagnosis of AML, he received 7+3 induction chemotherapy with cytarabine and idarubicin, followed by re-induction and consolidation chemotherapy. He subsequently underwent allogenic bone marrow transplantation and achieved complete remission. Hyperleukocytosis in AML can cause leukostasis, characterized by evidence of tissue ischemia. Coronary vasculature accounts for 6% of cases with leukostasis. This can manifest as myocardial infarction. Emergent and timely initiation of leukapheresis can potentially lead to a complete resolution of microvascular occlusion.
PubMed: 32775121
DOI: 10.7759/cureus.9551 -
Case Reports in Medicine 2015A 27-year-old Caucasian female with a history of depression was admitted to our local hospital with vague events that occurred a day before. This included an episode of...
A 27-year-old Caucasian female with a history of depression was admitted to our local hospital with vague events that occurred a day before. This included an episode of dysarthria, and unsteadiness, followed by feeling generally unwell. Two weeks prior to presentation she was commenced on phenelzine. During clinical assessment she suddenly deteriorated with a dramatic fall in her conscious level. Moreover, she became hyperthermic, tachycardic, and diaphoretic, and developed increased tone in all muscles and ocular clonus. Rectal diazepam was administered but failed to control the symptoms. Consequently, she was transferred to the intensive care unit for intubation and muscle relaxants were commenced. She responded well and recovered next day without complications. Her symptoms and signs were consistent with the serotonin syndrome with phenelzine being the likely cause. To the best of our knowledge, this is the first reported case to associate the condition with phenelzine alone at therapeutic dose.
PubMed: 25861278
DOI: 10.1155/2015/931963 -
Natural Product Research Jul 2022is a medicinal plant commonly known as little ironweed is used in various traditional systems of medicines. In , it is known as and is used as remedy for many...
is a medicinal plant commonly known as little ironweed is used in various traditional systems of medicines. In , it is known as and is used as remedy for many ailments. It has been reported to possess numerous biological properties including diaphoretic, anthelmintic, diuretic, lithontriptic, anti-inflammatory and anticancer activities. Metabolite profiling of aqueous extract of (CCE) and its herbal formulation KGS tablet has been carried out by liquid chromatography tandem mass spectroscopic analysis. ESI-MS/MS based characterisation led to the identification of several bioactive phytochemicals belonging to various classes of metabolites like phenolic acids, phenolic glycosides, flavonoids and anthocyanin. Most of the identified compounds are known for their various biological properties, such as antioxidant, anti-inflammatory and anticancer activities.
Topics: Anti-Inflammatory Agents; Asteraceae; Chromatography, High Pressure Liquid; Flavonoids; Phenols; Phytochemicals; Plant Extracts; Tandem Mass Spectrometry
PubMed: 33430627
DOI: 10.1080/14786419.2020.1869972 -
Heart (British Cardiac Society) Apr 2017A 50-year-old hypertensive smoker presented with a typical angina of 2 days duration. An urgent ECG revealed extensive anterior wall myocardial infarction. In view of...
CLINICAL INTRODUCTION
A 50-year-old hypertensive smoker presented with a typical angina of 2 days duration. An urgent ECG revealed extensive anterior wall myocardial infarction. In view of the delayed presentation, the patient was conservatively managed with heparin. In-hospital echocardiogram showed akinesia of entire left anterior descending artery (LAD) territory with severe left ventricular (LV) dysfunction. He was discharged with a plan for early coronary intervention. However, he presented a fortnight later with acute pulmonary oedema. General appraisal revealed a restless individual who was dyspnoeic and diaphoretic at rest. On clinical examination, the patient was in hypotension with features of biventricular failure. A 12-lead ECG showed QS pattern with persistent ST segment elevation in precordial leads. The chest radiograph demonstrated features of pulmonary oedema, cardiomegaly and bilateral pleural effusion. Creatine Phosphokinase-MB (CPK-MB) was negative. A preliminary transthoracic echocardiography was done (figure 1 and see online supplementary video 1).
QUESTION
What is the most likely diagnosis based on the echocardiogram? LV pseudo-aneurysm with contained ruptureDissecting intramural haematoma of LV apexVentricular apical aneurysm with thrombusLV non-compaction with prominent ventricular trabaculations.
Topics: Anterior Wall Myocardial Infarction; Echocardiography, Doppler, Color; Heart Aneurysm; Heart Failure; Humans; Male; Middle Aged; Pulmonary Edema; Thrombosis; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 27686517
DOI: 10.1136/heartjnl-2016-309715 -
Cureus Jul 2021Metformin rarely, if ever, causes hypoglycemia when it is used as labeled. A 55-year-old woman presented to the medicine ward with an altered level of consciousness. She...
Metformin rarely, if ever, causes hypoglycemia when it is used as labeled. A 55-year-old woman presented to the medicine ward with an altered level of consciousness. She had been reviewed in an outpatient department three days earlier and prescribed 500 mg two times per day of metformin immediate-release (Met IR) for newly diagnosed type 2 diabetes mellitus (T2DM), to which she had been adherent; however, she had been experiencing intermittent episodes of hypoglycemia after taking the medication prescribed to treat her T2DM. On physical examination, she was diaphoretic and disoriented but responsive to sensory stimuli. In the ward, she received 25 ml of intravenous dextrose as the initial blood glucose reading was low at 54 mg/dl, and 4 ounces of apple juice additionally two hours later as her blood glucose level fell below 70 mg/dl again. She was no longer hypoglycemic a few hours later, and there was a significant neurological improvement. The remainder of the laboratory results, including serum renal and liver function tests, were normal. Met IR was discontinued, and metformin extended-release (Met XR) 500 mg/day was initiated at discharge. The patient's hypoglycemic episodes resolved within days after the initiation of Met XR. Hypoglycemia is rarely associated with accidental or suicidal overdose of metformin, metabolic dysfunction (e.g., renal insufficiency), exercise, missed meal, acute illness, or the initiation of additional antidiabetic medication. Albeit even uncommon, metformin-associated hypoglycemia may occur with no obvious trigger. In this context, we determine to what extent Met IR may contribute to the development of hypoglycemia in an individual case, but also that the risk could be mitigated by a switch to Met XR. In a preferred embodiment, the Met XR dosage form can be administered once a day, ideally with or after a meal, preferably with or after the evening meal, and it provides therapeutic levels of the drug throughout the day with peak plasma levels being obtained between four to eight hours after the administration (T).
PubMed: 34350076
DOI: 10.7759/cureus.16112 -
Relaxant Effects of Piperine and Piperlongumine from Piper longum Fruits on Porcine Coronary Artery.Biological & Pharmaceutical Bulletin Jan 2024Since ancient times, Piper longum Linn. fruits have been recognized for exhibiting various effects, including the diaphoretic effects linked to enhanced blood flow....
Since ancient times, Piper longum Linn. fruits have been recognized for exhibiting various effects, including the diaphoretic effects linked to enhanced blood flow. Piperine and piperlongumine coexist in Piper longum Linn. fruits, although the cardiovascular effects of both compounds remain elusive. We investigated their action of piperine and piperlongumine in porcine coronary arteries, comparing them to the Ca channel antagonist diltiazem. Piperlongumine, unlike piperine or diltiazem, concentration-dependently inhibited basal contractile tone in endothelium-denuded coronary arteries. All three compounds inhibit tonic contractions induced by high potassium chloride (KCl) concentrations. The order of relaxation potency indexed by the half-maximal effective concentration (EC) were as follows: diltiazem > piperlongumine > piperine. These effects were not different between endothelium-intact and -denuded preparations. In endothelial-denuded preparations, pretreatment with these compounds not only inhibited KCl-induced tonic contractions attenuated calcium chloride (CaCl)-induced ones in a Ca-free medium. Histamine-induced phasic contractions in a Ca-free medium containing intracellular Ca chelator was completely suppressed by selective inositol trisphosphate receptor antagonist and piperlongumine, whereas piperine or diltiazem do not have the same effect. These findings suggest that piperine and piperlongumine similar to diltiazem cause vasorelaxation by inhibiting both KCl- and CaCl-induced contractions in coronary arteries, possibly through the inhibition of voltage-dependent Ca channels. Piperlongumine inhibits histamine-induced contractions in a Ca-free medium, which is associated with the intracellular Ca signaling pathway, suggesting that the relaxant effect of piperlongumine differs from that of piperine.
Topics: Animals; Swine; Diltiazem; Coronary Vessels; Fruit; Calcium Chloride; Histamine; Piper; Calcium; Potassium Chloride; Muscle Contraction
PubMed: 37989300
DOI: 10.1248/bpb.b23-00694 -
Oncology Reports Jan 2017Arctigenin is a bioactive lignan isolated from the seeds of Arctium lappa L. which has been widely used as a diuretic and a diaphoretic in Traditional Chinese Medicine....
Arctigenin is a bioactive lignan isolated from the seeds of Arctium lappa L. which has been widely used as a diuretic and a diaphoretic in Traditional Chinese Medicine. In the present study, the authors investigated the effects of arctigenin on tumor migration and invasion in aggressive human breast cancer cells. The MTT assay results showed that arctigenin did not show a significant cytotoxic effect on the cell viability of MDA-MB-231 cells. However, wound healing migration and Boyden chamber invasion assays demonstrated that arctigenin significantly inhibited in vitro migration and invasion of the MDA-MB-231 cells. Furthermore, gelatin zymography results showed that arctigenin reduced the activity of MMP-2 and MMP-9. Western blot analysis results demonstrated that the expression of MMP-2, MMP-9 and heparanase proteins was significantly downregulated following the treatment of arctigenin. Finally, the antiangiogenic activity of arctigenin was also examined by the chick embryo chorioallantoic membrane (CAM) assay. Arctigenin treatment significantly inhibited angiogenesis in the CAM. In conclusion, the results revealed that arctigenin significantly inhibited the migration and invasion of MDA-MB-231 cells by downregulating MMP-2, MMP-9 and heparanase expression. However, further studies are still necessary to investigate the exact mechanisms involved and to explore signal transduction pathways to better understand the biological mechanisms.
Topics: Animals; Arctium; Breast Neoplasms; Cell Line, Tumor; Cell Movement; Chick Embryo; Down-Regulation; Female; Furans; Gene Expression Regulation, Enzymologic; Gene Expression Regulation, Neoplastic; Glucuronidase; Humans; Lignans; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Neoplasm Metastasis
PubMed: 27878294
DOI: 10.3892/or.2016.5269 -
Evidence-based Complementary and... 2017Ephedra have been used as a common traditional Chinese medicine for thousands of years. However, the perspiration effect of the unprocessed ephedra was too strong....
Comparative Pharmacokinetics and Bioavailability of Three Ephedrines in Rat after Oral Administration of Unprocessed and Honey-Fried Ephedra Extract by Response Surface Experimental Design.
Ephedra have been used as a common traditional Chinese medicine for thousands of years. However, the perspiration effect of the unprocessed ephedra was too strong. Clinical trials have shown that processing methods play a critical role in moderating the perspiration property of ephedra according to the needs. A LC-MS/MS method was developed and validated to compare the pharmacokinetic properties of the three ephedrines after oral administration of unprocessed and honey-fried ephedra extract. The contents of honey, frying temperature, and frying time were set at 20%, 116°C, and 7 min by the Box-Behnken response surface method, respectively. In the pharmacokinetics study, the biosamples were pretreated and extracted by protein precipitation method with acetonitrile and separated on an Agilent TC-C column (250 mm × 4.6 mm, 5 m) using a mobile phase consisting of 0.1% formic acid methanol and 5 mM ammonium acetate aqueous solution (5 : 95, v/v). All calibration curves were linear ( > 0.9932) with lower limits of quantitation (LLOQs) < 12 ng/mL. The mean recoveries of the three analytes were higher than 75%. The pharmacokinetics study indicated that the reduced absorption of ephedrine hydrochloride (EH) and pseudoephedrine hydrochloride (PEH) in honey-fried ephedra group might be the main reason for the moderation of the diaphoretic property.
PubMed: 28706557
DOI: 10.1155/2017/2802193 -
The American Journal of Case Reports May 2017BACKGROUND Isolated ST elevation in lead aVR in combination with global ST depression with normalization after rehydration is a unique electrocardiographic pattern that...
BACKGROUND Isolated ST elevation in lead aVR in combination with global ST depression with normalization after rehydration is a unique electrocardiographic pattern that is associated with a broad range of diagnoses. Its association with left main coronary artery disease and other acute coronary syndromes suggest the need for early and aggressive cardiac evaluation. CASE REPORT A 53-year-old man presented with altered mental status and loss of consciousness. He was unresponsive, hypotensive, tachycardiac, and diaphoretic. An initial ECG showed diffuse ST depression with isolated ST elevation in lead aVR, and initial troponin levels were negative. After rehydration, a repeat ECG showed sinus rhythm without ischemic changes. An emergent echocardiogram showed severe aortic stenosis and global hypokinesis. Repeat troponin results were elevated. The patient had 2 subsequent cardiac arrests. Emergent cardiac catheterization showed an occluded right coronary artery with collaterals and complete occlusion of the LAD. Urgent intra-aortic balloon pump was placed, followed by coronary artery bypass graft, aortic valve replacement, and a placement of a left ventricular assist device. Despite maximal hemodynamic support, the patient died after cardiac arrest due to massive myocardial infarction. CONCLUSIONS Normalization of diffuse ST depression with isolated aVR ST elevation on electrocardiography with improvement in clinical and hemodynamic status through fluid resuscitation can mask a stuttering myocardial infarction given its association with left main coronary artery disease and partial right coronary artery occlusion.
Topics: Aortic Valve Stenosis; Coronary Occlusion; Electrocardiography; Fatal Outcome; Fluid Therapy; Heart Arrest; Humans; Male; Middle Aged; Myocardial Infarction
PubMed: 28529306
DOI: 10.12659/ajcr.902510 -
Autopsy & Case Reports 2016Gastric volvulus is a rare condition resulting from rotation of the stomach beyond 180 degrees. It is a difficult condition to diagnose, mostly because it is rarely...
Gastric volvulus is a rare condition resulting from rotation of the stomach beyond 180 degrees. It is a difficult condition to diagnose, mostly because it is rarely considered. Furthermore, the imaging findings are often subtle resulting in many cases being diagnosed at the time of surgery or, as in our case, at autopsy. We present the case of a 76-year-old man with an extensive medical history, including coronary artery disease with multiple bypass grafts, who became diaphoretic and nauseated while eating. His presumptive diagnosis at arrival to the hospital was an acute coronary event; however, his initial cardiac work-up was negative. A computed tomography scan revealed a type III hiatal hernia. The following day, after consistent complaints of nausea and episodes of nonbloody emesis, he suddenly became hypotensive, tachycardic and had an episode of coffee-ground emesis. Subsequently, the patient's condition suddenly deteriorated and resuscitation attempts were unsuccessful. The autopsy revealed a partially sliding hiatal hernia, which was consistent with the radiologic impression. Additionally, a gastric volvulus was present with extensive, focally transmural necrosis involving the body/fundus. Gastric volvulus is a rare entity with variable, nonspecific clinical presentations, which requires a high level of suspicion for radiologic diagnosis. Acute cases have a high mortality rate and require emergency surgery. This case highlights the value of autopsy in the diagnosis of unsuspected cases of gastric volvulus when death occurs prior to surgical intervention.
PubMed: 27284537
DOI: 10.4322/acr.2016.024