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Cureus Nov 2021Methamphetamine is the second most commonly abused drug worldwide. It is a sympathomimetic agent that works by inhibiting the reuptake of monoamine neurotransmitters,...
Methamphetamine is the second most commonly abused drug worldwide. It is a sympathomimetic agent that works by inhibiting the reuptake of monoamine neurotransmitters, including dopamine, norepinephrine, and serotonin. Methamphetamine use is associated with early mortality, and cardiovascular complications are the leading cause of increased mortality. We discuss the case of a 41-year-old man who presented to the emergency department with a sudden abdominal pain of eight hours' duration. The pain was located in the epigastric area with radiation to the back. Upon examination, the patient appeared agitated and diaphoretic. His pupils were dilated bilaterally. His vital signs included tachycardia (120 bpm), tachypnea (24 bpm), hypertension (150/90 mmHg), and normal temperature (36.9 ℃). Abdominal examination revealed a soft and lax abdomen with no tenderness. His bowel sounds were normal. Given the physical signs, a toxicology screen was conducted and was positive for methamphetamine use. The patient reported that he used recreational drugs occasionally and admitted that the abdominal pain developed a few hours following methamphetamine use. The patient was treated with fluid resuscitation, analgesic, antihypertension medications, and anticoagulant therapy. The patient had significant improvement in his condition within 48 hours with complete resolution of the abdominal pain. Isolated superior mesenteric artery dissection is a very rare clinical condition. This case report highlights the importance of recognizing the cardiovascular adverse effects that may develop after methamphetamine use.
PubMed: 34917433
DOI: 10.7759/cureus.19551 -
Saudi Journal of Biological Sciences Oct 2013Ziziyphus nummularia (family: Rhamnaceae) is a thorny small bush, grows in abundance in the grazing lands of the arid areas of Rajasthan, India. It is an important...
Ziziyphus nummularia (family: Rhamnaceae) is a thorny small bush, grows in abundance in the grazing lands of the arid areas of Rajasthan, India. It is an important ethnomedicinal plant of the Thar Desert; local inhabitants use every part of the plant as medicine. Kernels are prescribed in pregnancy as soporific, antiemetic and for relieving abdominal pain. The insect gall is powered and given orally with water to cure bone fracture. Crushed root is applied on the paining shoulder of the bullock. The decoction of leaves is used for the treatment of cough and cold; leaves are also regarded as diaphoretic and prescribed in typhoid. Paste of leaves is used for healing of cuts, boils and cutaneous disease. It is widely used in pain and inflammatory conditions. Z. nummularia contains a unique group of alkaloids known as cyclopeptide alkaloids, in continuation of our work carried out on the leaves of Z. nummularia , present study was initiated to explore antiinflammatory and analgesic potential of cyclopeptide alkaloids isolated from the leaves of Z. nummularia (IFZN). Anti-inflammatory activity was tested against rat paw oedema, mouse peritonitis and cotton pellet granuloma. For screening of analgesic activity, acetic acid induced writhing, tail flick and hot plate test were performed. IFZN 30 mg/kg shows the anti-oedematogenic effect against paw oedema induced by carrageenan, dextran, serotonin and histamine; IFZN 20 and 30 mg/kg were found to have highly significant anti-nociceptive effects. Result of pharmacological studies indicated that IFZN is a potent and efficacious analgesic agent. The analgesic activity of IFZN is mediated by the peripheral as well as central pathways.
PubMed: 24235873
DOI: 10.1016/j.sjbs.2013.04.003 -
Psychiatry Research Case Reports Jun 2023Cytotoxic lesions of the corpus callosum syndrome (CLOCC) is an inflammatory disorder caused by various etiologies such as medications, malignancies, seizure, metabolic...
BACKGROUND
Cytotoxic lesions of the corpus callosum syndrome (CLOCC) is an inflammatory disorder caused by various etiologies such as medications, malignancies, seizure, metabolic abnormalities, and infections, especially COVID-19. It presents on MRI as an area of restricted diffusion in the corpus callosum. We present a case of psychosis and CLOCC in a patient with mild active COVID-19 infection.
CASE
A 25-year-old male with a history of asthma and unclear past psychiatric history presented to the emergency room with shortness of breath, chest pain, and disorganized behavior. His-COVID-19 PCR was negative, and he was voluntarily admitted to psychiatry for management of unspecified psychosis. Overnight, he spiked a fever and was diaphoretic with headache and altered mental status. Repeat COVID-19 PCR at this time was positive and cycle threshold indicated infectivity. A brain MRI showed a new restricted diffusion within the midline of the splenium of the corpus callosum. Lumbar puncture was unremarkable. He continued to have flat affect and exhibit disorganized behavior with unspecified grandiosity, unclear auditory hallucinations, echopraxia, and poor attention and working memory. He was started on risperidone, with an MRI after 8 days showing complete resolution of the lesion in the corpus callosum and symptoms.
CONCLUSION
This case discusses diagnostic difficulties and treatment options for a patient presenting with psychotic symptoms and disorganized behavior in the context of active COVID-19 infection and CLOCC and highlights differences between delirium, COVID-19 psychosis and neuropsychiatric symptoms of CLOCC. Future research directions are also discussed.
PubMed: 37251527
DOI: 10.1016/j.psycr.2023.100133 -
International Journal of Molecular... May 2018Periostracum cicadae, the cast-off shell of the cicada Fabricius, is used in traditional Chinese medicine for its diaphoretic, anticonvulsive, sedative, antipyretic,...
Periostracum cicadae, the cast-off shell of the cicada Fabricius, is used in traditional Chinese medicine for its diaphoretic, anticonvulsive, sedative, antipyretic, and antiallergic effects. However, the exact pathogenesis of immunoglobulin A nephropathy (IgAN) remains unclear, thereby hindering investigations to identify novel therapeutic agents. A rat IgAN model was established by administration of bovine serum albumin, lipopolysaccharide, and carbon tetrachloride, which simultaneously established blood stasis and a heat syndrome model. The animals were sacrificed to detect changes in protein levels in urine and blood. Immunofluorescence was performed to assess IgA deposition in the glomeruli. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin 6 (IL-6) levels were measured in bronchoalveolar lavage fluid (BALF) by enzyme-linked immunosorbent assay. Hematology and eosin, periodic acid-Schiff, TUNEL (TdT-mediated dUTP Nick-End Labeling), and immunohistochemical staining were performed to evaluate histopathological changes in kidney tissues. Additionally, target-related proteins were measured by Western blotting. Periostracum cicadae resulted in a reduction in blood and urine protein levels. Serum TNF-α, IL-1β, and IL-6 levels significantly decreased in the periostracum cicadae-treated groups compared to the IgAN group. Furthermore, a reduction in MCP-1 (Monocyte Chemotactic Protein-1), TLR4 ((Toll-Like Receptor 4)), and IgA expression levels and a dose-dependent increase in caspase 3 expression were observed in response to periostracum cicadae treatment. TGF-β1(Transforming Growth Factor-β) levels decreased, whereas that of Fas increased in the kidney tissues of the periostracum cicadae-treated groups. The findings of the present study indicate that periostracum cicadae induces apoptosis and improves kidney inflammation and fibrosis in IgA nephropathy rat models.
Topics: Animals; Apoptosis; Apoptosis Regulatory Proteins; Complex Mixtures; Cytokines; Disease Models, Animal; Glomerulonephritis, IGA; Hemiptera; Male; Rats; Rats, Sprague-Dawley
PubMed: 29844269
DOI: 10.3390/ijms19061599 -
The Southern Medical Record Sep 1888
PubMed: 36023000
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 -
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 -
Respiratory Care Oct 2014Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma...
Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma patient who presented to our emergency department via emergency medical services. The patient was responsive, diaphoretic, and breathing at 35 breaths/min on 100% oxygen with bag-mask assistance, with S(pO2) 88%, heart rate 110-120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8 °C. NIV at 12/5 cm H2O and FIO2 0.40 was applied, and albuterol at 40 mg/h was initiated. Admission arterial blood gas revealed a pH of 6.95, P(aCO2) 126 mm Hg, and P(aO2) 316 mm Hg. After 90 min of therapy, P(aCO2) was 63 mm Hg. Improvement continued, and NIV was stopped 4 h following presentation. NIV tolerance was supported with low doses of lorazepam. The patient was transferred to the ICU, moved to general care the next morning, and discharged 3 days later. We attribute our success to close monitoring in a critical care setting and the titration of lorazepam.
Topics: Acute Disease; Adult; Anti-Anxiety Agents; Asthma; Blood Gas Analysis; Humans; Lorazepam; Male; Noninvasive Ventilation
PubMed: 24782556
DOI: 10.4187/respcare.02730 -
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