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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 -
Cureus Dec 2020Life-threatening cardiovascular complications can occur as a result of Guillain-Barré Syndrome (GBS) induced autonomic dysfunction necessitating the need for early...
Life-threatening cardiovascular complications can occur as a result of Guillain-Barré Syndrome (GBS) induced autonomic dysfunction necessitating the need for early recognition and potential cardiac pacing. We present the case of a 69-year-old female who was admitted to the hospital for worsening fatigue, bilateral lower extremity weakness and inability to ambulate for two days. Five days later, she experienced large fluctuations in blood pressure, appeared diaphoretic, and had spells of bradycardia. This was soon followed by an episode of unresponsive and cardiac arrest with rhythm strip consistent with asystole. Cardiopulmonary resuscitation (CPR) was initiated with a return of spontaneous circulation (ROSC) after 6 minutes. The patient was intubated and transferred to the intensive care unit (ICU). Reassessment of the patient revealed a new bilateral symmetric upper extremity weakness. Respiratory failure with ascending symmetric paralysis warranted a lumbar puncture which revealed albuminocytologic dissociation-ultimately leading to the diagnosis of GBS.
PubMed: 33489561
DOI: 10.7759/cureus.12149 -
Molecules (Basel, Switzerland) Nov 2020is a well-known species for flavoring many food products and for formulation of perfume and medicated balm. It is also used to treat indigestion, stomach ulcers, liver...
is a well-known species for flavoring many food products and for formulation of perfume and medicated balm. It is also used to treat indigestion, stomach ulcers, liver disorders, and, as emmenagogue, diaphoretic, diuretic, nervine, and aphrodisiac. We examined antioxidant properties and bioactive compounds in various solvent extracts from the seeds of . Methanol, ethanol, and acetone extracts exhibited relatively strong antioxidant activities by 2,2-diphenyl-1-(2,4,6-trinitrophenyl)hydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), superoxide radical, and hydroxyl radical scavenging tests. Furthermore, methanol extracts also displayed significant anti-α-glucosidase activity. Examined and compared to the various solvent extracts for their chemical compositions using HPLC analysis, we isolated the ten higher content compounds and analyzed antioxidant and anti-α-glucosidase activities. Among the isolates, dehydrodiisoeugenol, malabaricone B and malabaricone C were main antioxidant components in seeds of . Malabaricone C exhibited stronger antioxidant capacities than others based on lower half inhibitory concentration (IC) values in DPPH and ABTS radical scavenging assays, and it also showed significant inhibition of α-glucosidase. These results shown that methanol was found to be the most efficient solvent for extracting the active components from the seeds of , and this material is a potential good source of natural antioxidant and α-glucosidase inhibitor.
Topics: Acetone; Antioxidants; Ethanol; Eugenol; Glycoside Hydrolase Inhibitors; Methanol; Myristica; Plant Extracts; Resorcinols; Seeds; Solvents; alpha-Glucosidases
PubMed: 33171671
DOI: 10.3390/molecules25215198 -
The Journal of Pediatric Pharmacology... 2020Oseltamivir is a neuraminidase inhibitor that is labeled for prophylaxis and treatment of influenza. We describe a previously healthy 4-month-old infant who tested...
Oseltamivir is a neuraminidase inhibitor that is labeled for prophylaxis and treatment of influenza. We describe a previously healthy 4-month-old infant who tested positive for influenza A and was started on oseltamivir. One hour after receiving his first dose of oseltamivir, the infant had a diaphoretic episode and appeared grey and clammy. The infant was subsequently seen by the primary care physician and referred for admission to the hospital. Approximately 40 minutes after the second dose of oseltamivir in the hospital, the infant's heart rate rose to greater than 300 bpm. An electrocardiogram was suggestive of supraventricular tachycardia. At the time of the event, the infant received 2 doses of adenosine, and oseltamivir was discontinued prior to transfer to a tertiary facility for a higher level of care.
PubMed: 33041722
DOI: 10.5863/1551-6776-25.7.654 -
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 -
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 -
Cureus Nov 2019Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout is an idiopathic articular disease that predominantly affects elderly patients. It is...
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout is an idiopathic articular disease that predominantly affects elderly patients. It is caused by a systemic deposition of calcium pyrophosphate (CPP) crystals in the articular and hyaline joint cartilage. The majority of cases present as chronic arthritis, but a subset of CPPD can present as rapid onset of sharp pain and joint swelling, posing a diagnostic challenge. We present a case of a 64-year-old man with a history of hypertension, urologic cancer, and gout presenting to the emergency department (ED) with a sudden-onset, severe stabbing right shoulder pain radiating to the neck and upper back. On ED arrival, he was mildly hypotensive, afebrile, diaphoretic, and uncomfortable, causing concern for aortic dissection. His exam was significant for limited shoulder range of motion; his sensation, strength, and distal pulses were intact and equal in bilateral upper extremities. His plain films showed multilevel cervical degenerative disc disease and facet arthrosis and right glenohumeral osteoarthritis without fracture or malalignment. A computed tomography (CT) angiogram was negative for vascular anomalies. Throughout his ED stay, his pain was refractory to medication, and he developed a new fever, prompting a targeted shoulder ultrasound; this revealed large glenohumeral effusion, and synovial analysis revealed CPP crystals without organism growth. This case illustrates an unusual acute CPPD attack that mimicked an aortic dissection. Emergency physicians should recognize both common and uncommon presentations for chronic disease processes in maintaining a broad differential diagnosis and delivering quick, targeted treatment.
PubMed: 31890437
DOI: 10.7759/cureus.6239 -
Biomedicine & Pharmacotherapy =... Jan 2020Cynaroside (CYN) is the predominant derivative of luteolin in aerial parts of Bidens tripartita which has been used in folk medicine as a diaphoretic, diuretic,...
OBJECTIVES
Cynaroside (CYN) is the predominant derivative of luteolin in aerial parts of Bidens tripartita which has been used in folk medicine as a diaphoretic, diuretic, antiseptic and anti-inflammatory agent. In our study, alginate (ALG), which is an anionic polymer with bioadhesive properties, was used as a CYN carrier, and multiple hydrogel formulations were created. Additionally, the present study evaluated the in vivo anti-inflammatory and anti-allergic activities of all preparations.
METHODS
Novel gel formulations as topical carriers for CYN obtained from B. tripartita were developed and characterized. The bioadhesive properties of the designed preparations were also evaluated in an ex vivo model using the skin of hairless mice. In vitro CYN release from all formulations was examined and analysed by HPLC. Histopathological evaluation of mouse skin sections stained with H&E after carrageenan and oxazolone administration was also carried out. In addition, the influence of CYN on cell proliferation was examined by the PCNA staining method.
RESULTS
The results showed that 10 % CYN inhibited the release of anti-inflammatory mediators, and both tested concentrations, which included 5 % and 10 % (2 mg and 20 mg CYN per site, respectively), reduced oxazolone-induced ear swelling. Histopathological examination of the samples revealed a marked reduction in paw skin and ear tissue inflammation and in inflammatory infiltrates. The influence of CYN on cell proliferation was examined by the PCNA staining method, and the staining and distribution of PCNA-immunoreactive (PCNA-IR) cells were observed. After the application of the 5 % and 10 % hydrogels, the investigated samples showed decreased nuclear immunoreactivity to PCNA, which was similar to that of the control. Moreover, after application of the placebo formulation, fewer PCNA-IR cells were also observed.
CONCLUSION
The obtained data suggest that the topical application of CYN significantly reduces the number of T cells, mast cells and histiocytes in mouse skin with inflammation or atopic dermatitis.
Topics: Animals; Anti-Allergic Agents; Anti-Inflammatory Agents; Disease Models, Animal; Drug Compounding; Drug Liberation; Edema; Glucosides; Hydrogels; Luteolin; Male; Mice, Inbred C57BL; Oxazolone; Proliferating Cell Nuclear Antigen
PubMed: 31810125
DOI: 10.1016/j.biopha.2019.109681 -
Heart Asia 2019A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and...
UNLABELLED
A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.
QUESTION
?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.
PubMed: 31031835
DOI: 10.1136/heartasia-2018-011156 -
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