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Frontiers in Endocrinology 2023Ectopic adrenocorticotropic hormone syndrome (EAS) is a condition of hypercortisolism caused by non-pituitary tumors that secrete adrenocorticotropic hormone (ACTH). A...
Ectopic adrenocorticotropic hormone syndrome (EAS) is a condition of hypercortisolism caused by non-pituitary tumors that secrete adrenocorticotropic hormone (ACTH). A rare occurrence of this syndrome is due to an ACTH-producing neuroendocrine tumor that originates from the gallbladder. One patient with severe hypokalemia and alkalosis was admitted to our hospital. Clinical presentations and radiographic findings confirmed the diagnosis of an aggressive ACTH-producing gallbladder malignancy with multiple liver metastases. The diagnosis was verified by pathological and immunohistochemical measurements from a biopsy of the hepatic metastasis. A literature review identified only four similar cases had been reported. Despite being rare and having a poor prognosis, hormone-producing neuroendocrine tumors that derive from the gallbladder should be considered in the differential diagnosis of ectopic ACTH syndrome.
PubMed: 37772081
DOI: 10.3389/fendo.2023.1224381 -
Oxford Medical Case Reports Sep 2023Licorice can cause pseudoaldosteronism and QT prolongation as its side effect. Trigeminal nerve stimulation, including surgical intervention involving the face, can...
Licorice can cause pseudoaldosteronism and QT prolongation as its side effect. Trigeminal nerve stimulation, including surgical intervention involving the face, can cause transient bradycardia, known as the trigeminocardiac reflex. Although rare, a combination of these two etiologies can cause ventricular tachycardia. A 50-year-old female patient with a history of hypertension and intake of an herbal drug containing licorice underwent impacted wisdom tooth extraction under general anesthesia. Immediately after placing a month-long prop for visualization in the oral cavity, sinus bradycardia occurred, followed by ventricular tachycardia and torsade de pointes. Mouth prop was removed and cardiopulmonary resuscitation was initiated, and the arrhythmia was resolved. Hypokalemia, metabolic alkalosis and normal aldosterone levels were observed. An inverted T wave and a prominent U-wave were observed on the electrocardiogram. Potassium excretion in urine was normal, although hypokalemia was present. The patient was treated with potassium correction.
PubMed: 37771690
DOI: 10.1093/omcr/omad098 -
Radiology Case Reports Dec 2023We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main...
We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main pulmonary artery pulmonary embolism. Unilateral MPC is rare and is mostly seen in the context of ipsilateral pulmonary embolism. The proposed mechanism is the promotion of calcium salts precipitation by focal alkalosis resulting from reduced blood flow to the lung affected by the pulmonary arterial obstruction.
PubMed: 37766834
DOI: 10.1016/j.radcr.2023.08.102 -
Viruses Sep 2023High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to...
High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0-12.0) days vs. 7.00 (2.0-12.0) days; = 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.
Topics: Humans; Cannula; Respiration, Artificial; Prospective Studies; Respiratory Insufficiency; Noninvasive Ventilation; COVID-19; Respiratory Distress Syndrome
PubMed: 37766286
DOI: 10.3390/v15091879 -
Medicina (Kaunas, Lithuania) Sep 2023: Bartter syndrome (BS) is a rare group of autosomal-recessive disorders that usually presents with hypokalemic metabolic alkalosis, occasionally with hyponatremia and... (Review)
Review
: Bartter syndrome (BS) is a rare group of autosomal-recessive disorders that usually presents with hypokalemic metabolic alkalosis, occasionally with hyponatremia and hypochloremia. The clinical presentation of BS is heterogeneous, with a wide variety of genetic variants. The aim of this systematic review was to examine the available literature and provide an overview of the case reports and case series on BS. : Case reports/series published from April 2012 to April 2022 were searched through Pubmed, JSTOR, Cochrane, ScienceDirect, and DOAJ. Subsequently, the information was extracted in order to characterize the clinical presentation, laboratory results, treatment options, and follow-up of the patients with BS. : Overall, 118 patients, 48 case reports, and 9 case series ( = 70) were identified. Out of these, the majority of patients were male ( = 68). A total of 21 patients were born from consanguineous marriages. Most cases were reported from Asia (73.72%) and Europe (15.25%). In total, 100 BS patients displayed the genetic variants, with most of these being reported as Type III ( = 59), followed by Type II ( = 19), Type I ( = 14), Type IV ( = 7), and only 1 as Type V. The most common symptoms included polyuria, polydipsia, vomiting, and dehydration. Some of the commonly used treatments were indomethacin, potassium chloride supplements, and spironolactone. The length of the follow-up time varied from 1 month to 14 years. : Our systematic review was able to summarize the clinical characteristics, presentation, and treatment plans of BS patients. The findings from this review can be effectively applied in the diagnosis and patient management of individuals with BS, rendering it a valuable resource for nephrologists in their routine clinical practice.
Topics: Humans; Male; Female; Bartter Syndrome; Potassium; Hyponatremia; Spironolactone; Europe
PubMed: 37763757
DOI: 10.3390/medicina59091638 -
Cureus Aug 2023Here, we report on a case of a 24-year-old female who is previously medically healthy. She was admitted with a case of gastroenteritis. During her hospitalization, we...
Here, we report on a case of a 24-year-old female who is previously medically healthy. She was admitted with a case of gastroenteritis. During her hospitalization, we noticed that the patient's wrists and metacarpophalangeal (MCP) joints were flexed, with her bilateral proximal (PIP) and distal (DIP) interphalangeal joints extended. Furthermore, she exhibited positive Chvostek and Trousseau signs. Her clinical features were consistent with acute tetany; however, she was demonstrating normal levels of calcium. Other laboratory results were positive for severe metabolic alkalosis and hypophosphatemia. Her signs and symptoms resolved completely after one dose of intravenous calcium gluconate. This case is notable because tetany alongside normocalcemia is a rare condition. Therefore, the immediate management of such cases is crucial.
PubMed: 37719534
DOI: 10.7759/cureus.43521 -
SAGE Open Medicine 2023Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy sufficiently enough to produce weight loss greater than 5%, dehydration, ketosis,...
OBJECTIVES
Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy sufficiently enough to produce weight loss greater than 5%, dehydration, ketosis, alkalosis, and hypokalemia. Several studies have investigated risk factors for hyperemesis gravidarum in Ethiopia, but the studies have reported conflicting results attributed to study design, lack of proper sample size, and the selection of variables. This study aimed to assess the determinants of hyperemesis gravidarum among pregnant women in public hospitals of Guji, West Guji, and Borana zones, Southern Ethiopia, 2022.
METHODS
An institutional-based case-control study design was conducted from April 15 to June 15, 2022 with a ratio of 1:2 (103 cases and 206 controls). Cases were all pregnant women admitted with a diagnosis of hyperemesis gravidarum by a clinician while controls were pregnant women who were visiting antenatal care services at the same time. Cases were selected consecutively until the required sample size is attained, while controls were selected by a simple random sampling technique. Data were collected using structured questionnaires with face-to-face interviews. The collected data were cleaned, coded, and entered into EpiData version 3.1, and then exported to SPSS version 25 for analysis. Frequency distribution for categorical variables, median, and interquartile range for continuous variables was computed. Backward stepwise logistic regression analyses were done. A significant association was declared with a 95% confidence interval at a value less than 0.05.
RESULTS
Those mothers who had antenatal follow-up (adjusted odds ratio = 0.082, 95% confidence interval: 0.037-0.180), pregnancy with multiple gestations (adjusted odds ratio = 3.557, 95% confidence interval: 1.387-9.126), previous history of hyperemesis gravidarum (adjusted odds ratio = 6.66, 95% confidence interval: 2.57-17.26), family history of hyperemesis gravidarum (adjusted odds ratio = 2.067, 95% confidence interval: 1.067-4.015), and those women had exercised before pregnancy (adjusted odds ratio = 0.352, 95% confidence interval: 0.194-0.639) were determinants of hyperemesis gravidarum.
CONCLUSION
Antenatal follow-up, number of the fetus, previous and family history of hyperemesis gravidarum, and exercise before pregnancy were significantly associated with outcome. Lifestyle modification, early treatment, and early ultrasound scans for pregnant women are crucial to reducing the burden of hyperemesis gravidarum.
PubMed: 37701795
DOI: 10.1177/20503121231196713 -
Cureus Aug 2023Hyperaldosteronism is a common cause of secondary hypertension. It has been classically associated with the clinical triad of hypertension, unexplained hypokalemia, and...
Hyperaldosteronism is a common cause of secondary hypertension. It has been classically associated with the clinical triad of hypertension, unexplained hypokalemia, and metabolic alkalosis. We present a case of a 66-year-old man who experienced blindness, hypokalemia, and hypertension that was resistant to anti-hypertension medications. He was found to have a retinal detachment and central retinal vein occlusion (CRVO). Laboratory evaluation revealed a marked elevation of plasma aldosterone activity and suppressed renin. A computerized tomography (CT) abdomen was subsequently ordered, which revealed bilateral adrenal nodules. Adrenal vein sampling was performed, which confirmed bilateral hyperfunctioning adrenal nodules. He was successfully treated with spironolactone. CRVO in the setting of hyperaldosteronism is an uncommon presentation.
PubMed: 37692695
DOI: 10.7759/cureus.43195 -
International Journal of Molecular... Aug 2023The Cl-transporting proteins CFTR, SLC26A9, and anoctamin (ANO1; ANO6) appear to have more in common than initially suspected, as they all participate in the pathogenic... (Review)
Review
The Cl-transporting proteins CFTR, SLC26A9, and anoctamin (ANO1; ANO6) appear to have more in common than initially suspected, as they all participate in the pathogenic process and clinical outcomes of airway and renal diseases. In the present review, we will therefore concentrate on recent findings concerning electrolyte transport in the airways and kidneys, and the role of CFTR, SLC26A9, and the anoctamins ANO1 and ANO6. Special emphasis will be placed on cystic fibrosis and asthma, as well as renal alkalosis and polycystic kidney disease. In essence, we will summarize recent evidence indicating that CFTR is the only relevant secretory Cl channel in airways under basal (nonstimulated) conditions and after stimulation by secretagogues. Information is provided on the expressions of ANO1 and ANO6, which are important for the correct expression and function of CFTR. In addition, there is evidence that the Cl transporter SLC26A9 expressed in the airways may have a reabsorptive rather than a Cl-secretory function. In the renal collecting ducts, bicarbonate secretion occurs through a synergistic action of CFTR and the Cl/HCO transporter SLC26A4 (pendrin), which is probably supported by ANO1. Finally, in autosomal dominant polycystic kidney disease (ADPKD), the secretory function of CFTR in renal cyst formation may have been overestimated, whereas ANO1 and ANO6 have now been shown to be crucial in ADPKD and therefore represent new pharmacological targets for the treatment of polycystic kidney disease.
Topics: Humans; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Polycystic Kidney, Autosomal Dominant; Polycystic Kidney Diseases; Anoctamins; Membrane Transport Proteins; Sulfate Transporters; Antiporters
PubMed: 37686084
DOI: 10.3390/ijms241713278 -
PloS One 2023Little is known about the long-distance telecoupling effects of urban food demands on land use changes (LUCs) in remote oases of the Southern Sahara. Using the example...
Little is known about the long-distance telecoupling effects of urban food demands on land use changes (LUCs) in remote oases of the Southern Sahara. Using the example of two typical oasis settlements on Mont Bagzam in the southern Aϊr Mountains of Niger which are linked to regional and global markets by an unpaved road since 2015, this study aimed at analyzing time trajectories of LUCs and related changing agricultural production patterns. LUCs were quantified for 1955 to 2022 using GIS-based mapping of agriculture and natural vegetation based on historical aerial photographs, CORONA and multi-spectral satellite images, and high resolution drone-based surveys. The results show a major increment in actively used agricultural land in the 850 ha watershed of the two oases from 11 ha in 1955 to 13 ha in 2003 and 68 ha in 2022 as well as the addition of 92 irrigation wells to 16 existing ones between 2003 and 2022. LUCs and evapotranspiration calculated from climatic data of a local weather station allowed to estimate changes of irrigation water needs in the selected watershed. While annual precipitation averages only 214 mm, local reference evapotranspiration may reach 1,476 mm year-1. Therefore, the additional annual irrigation water needs for the newly established fields between 2003 and 2022 cultivated to cash crops rose by 696 million l. To detect LUC effects on soil quality, soil samples of onion and garlic fields of different ages were collected employing a false-time-series approach. Results reveal increasing soil pH and salt concentrations and falling ground water tables, which reflects a negative water balance and ground water extraction above recharge levels. Our study provides evidence that the newly established telecoupled production systems on Mont Bagzam threaten the sustainability of existing local agricultural production and related livelihoods of agro-pastoralists.
Topics: Cities; Causality; Africa, Northern; Alkalosis; Crops, Agricultural; Garlic
PubMed: 37682955
DOI: 10.1371/journal.pone.0289694