Evaluation of the Antihyperglycaemic Activities, Safety and Phytochemical Profile of Celtis zenkeri Engl
Published on: 14th July, 2023
Objective: The study evaluated the hyperglycaemia-lowering effects, safety, and phytochemical profile of Celtis zenkeri leaf extract in order to justify its antidiabetic folkloric usage. Methods: Modified OECD test guidelines were used to assess its acute and sub-acute toxicity while its effect on blood parameters such as blood glucose, and haematological and biochemical levels were evaluated using appropriate assays. Both in vitro and in vivo antihyperglycaemic assays were used for the antidiabetic studies while histology of the pancreas, liver, and kidney of the rats was examined after treatment with the extract at 250, 500, and 1000 mg/kg for 21 days. GC-MS analysis was used to determine the chemical constituents of the extract. Results: The results obtained showed that the leaf extract of C. zenkeri was not toxic in rats at 5000 mg/kg. It elicited a significant decrease in the blood glucose levels of the animals but did not affect the haematological and biochemical components of normal rats. It significantly inhibited α-amylase and α-glucosidase actions and gave comparable activity to glibenclamide (5 mg/kg) at all time points at 200 and 400 mg/kg. The extract comparably reduced blood glucose levels with glibenclamide at 100 and 200 mg/kg on days 10 and 14 in drug-induced diabetic rats and maintained the histoarchitecture of the liver, kidney, and pancreas at 250 and 500 mg/kg.Conclusion: The study justified the ethnomedicinal use of C. zenkeri in diabetes management.
Challenges and Concerns of Parents with Children with Down Syndrome
Published on: 18th July, 2023
Down syndrome is a common chromosomal abnormality that affects individuals in their physical, cognitive, and social development. The diagnosis of this syndrome in a newborn can be challenging for parents as it may disrupt family dynamics. In this study, we describe the different aspects of the impact of Down syndrome on parents, including psychological, social, and familial impacts. 55 cases participated in this survey; the average age of parents was 34 years old, and mothers represented 96% of the participants. 70% of cases were from urban areas. The average time between diagnosis and parental evaluation was 32.7 months. In 57% of families, the diagnosis of Down syndrome was established only after the third month of pregnancy, and only 5% obtained it during the prenatal period. Depression was reported in 32% of mothers at the time of diagnosis, while one mother exhibited persistent denial of her child’s disability. 30% of families indicated that their child with Down syndrome was the source of tension within the couple and that learning difficulties were the main factor of tension, while 1% eventually divorced. 5% of parents regretted having a child with Down syndrome. All mothers expressed concerns about their child’s future and are in favor of the establishment of a national screening program for trisomy 21 and dedicated learning centers to ensure social and professional integration.
Review of the Efficiency of Ten Different Commercial Kits for Extracting DNA from Soil Mixed Biological Samples
Published on: 19th July, 2023
Soil-mixed bodily fluids are the most common kind of evidence at outdoor crime scenes. This biological evidence contains DNA, which is a key component of forensic science’s ability to prove an accused person’s guilt because it connects the victim and suspect to the crime scene and aids in identifying the offender and victim. The yield of DNA is significantly influenced by factors including temperature, humidity, storage environment, time since deposition, etc. DNA degradation is caused by a variety of microbes, bacteria, humic acid, and other substances present in soil. Nowadays for DNA extraction, a variety of commercial DNA extraction kits was used now. This paper’s objective is to compare the efficiency of ten different commercial kits used to extract mixed DNA samples. It has been observed that samples stored at a low temperature (-20 °C) are the best for soil blood mixture samples. Compared to samples paired with other types of soil (silt, clay, and marshland), sand soil had the largest production of DNA using the QIAmp investigator kit (Qiagen). Blood Miniprep kit extractions were mostly inhibited, the control that amplified confirms that this kit was the worst in terms of DNA extraction potency. The samples with fewer dirt particles had a much greater yield of DNA.
Calciphylaxis in Hemodialysis
Published on: 20th July, 2023
Calciphylaxis (CP) or uremic calcific arterial disease (CUA) is a rare, potentially fatal calcific vasculopathy characterized by calcific and thrombotic occlusion of the vessels of the subcutaneous and dermis leading to extremely painful necrotic lesions. It mainly affects patients with end-stage kidney disease (ESKD) and under long time dialysis. The only therapeutic option is represented by intravenous sodium thiosulfate. Currently, clear guidelines are lacking. We have had a good therapeutic response with doses of sodium thiosulfate in association with multidisciplinary management of the patient (vulnologist, dermatologist, nephrologist, dietitian, and cardiologist). There is limited literature on the use of DOAC therapy as a successful alternative to warfarin in patients on dialysis with calciphylaxis. The left atrial appendage closure could represent an important alternative to dicumarolics in patients with atrial fibrillation with calciphylaxis. A new perspective for the treatment of this disease is SNF472 a selective inhibitor of vascular calcification.
A Perspective on Conservation Technologies for Endangered Marine Birds
Published on: 26th July, 2023
Seabirds are species in a collection of avian orders that live on and feed in saltwater and include penguins; albatrosses and petrels; gannets and cormorants; and gulls, terns, and auks. They are at risk from human activities with habitat loss, fisheries bycatch, food shortages, introduced predators and pollution impact. These effects are all exacerbated by human-induced climate change. Many researchers, non-governmental organizations, communities, and governments are working to conserve endangered seabird species by developing and implementing technologies and conservation management systems to assist seabird conservation. More recently moves are afoot to ensure organizations share data and outcomes.
Sea Level Rise Impacts in Coastal Areas and Possible Mitigation Engineering Approaches
Published on: 21st July, 2023
Coastal areas are subjected to both natural and man-made actions, leading to a deterioration of coastal structures. Climate change has had a heavy impact on these areas in recent years. An important consequence of these actions is sea level rise. This phenomenon is the most important cause of coastal erosion, a serious problem with ecological, economic, and human health consequences. The countermeasures to contrast this phenomenon and the degradation of the entire coastal system, are represented by engineering interventions. These basically consist of approaches for adaptation to sea level rise, namely protection, retreat, and accommodation. Variations and site adaptation of these actions can involve procedures of no intervention; advancement; protection; retreat; accommodation; and ecosystem-based adaptation. While these procedures have provided coastal benefits and protection, in the long run, they may cause further coastal disruption and further aggravate the situation. Such interventions, therefore, require an accurate assessment of the advantages and disadvantages. However, it is certainly necessary to proceed with actions aimed at mitigating climate change, respecting the rules in a sustainable way.
Sudden Cardiac Death in a Neonate Due to Bilateral Absence of Coronary Artery Ostium
Published on: 24th July, 2023
Introduction: Congenital heart disease is a leading cause of neonatal mortality linked to birth defects. Despite the widespread availability of prenatal screenings, detection rates remain low. Accurate early detection of these lesions is pivotal to reducing neonatal morbidity and mortality.Methods: In this case, we present a neonate who experienced sudden cardiac death due to a rare, undiagnosed congenital cardiac anomaly - the bilateral absence of coronary artery ostium. Discussion: This case highlights the importance of prenatal detection of congenital cardiac anomalies. While fetal echocardiography is frequently utilized, it only identifies CHD in 36-50% of cases. This is attributed to inadequate imaging procedures, varied operator skills, and regional discrepancies. Early detection of severe CHD is essential for specialized treatment, thereby mitigating neonatal health risks and improving survival rates.Conclusion: Prenatal detection of CHD, especially coronary anomalies, continues to pose significant challenges. There is a pressing need to establish and enforce standardized protocols for fetal echocardiography aimed at these anomalies. To enhance care and improve outcomes, a joint effort between academic institutions and community centers is encouraged.Learning Objectives: • Congenital coronary artery anomalies are a significant cause of sudden cardiac death in children.• The absence of a coronary artery ostium is known to be associated with other congenital heart diseases, particularly pulmonary atresia with an intact ventricular septum. However, isolated coronary disease has also been reported in this case.• Prenatal echocardiography is a valuable tool for diagnosing congenital heart disease. However, certain limitations may be encountered when diagnosing coronary artery anomalies.
Impact of COVID-19 on Laboratory Health Staff in an Indian Tertiary Care Hospital
Published on: 24th July, 2023
Background: The COVID-19 pandemic has resulted in significant burdens globally. Healthcare workers (HCWs), at the heart of the unparalleled crisis of COVID-19, face challenges treating patients and doing testing for COVID-19: reducing the spread of infection; developing suitable short-term strategies; and formulating long-term plans. We aimed to assess the psychological impact of COVID-19 on Laboratory health staff. Material and methods: Between February - March 2021, 72 laboratory staff workers of a tertiary care teaching hospital were invited to fill out a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with a coping scoring system and General health questionnaire level (GHQ-12) survey. Results: Out of 72 laboratory health staff who completed the survey questionnaire, 10 were faculty members, 17 were residents (including senior residents, junior residents, and demonstrators), 39 were lab technicians, followed by 4 were attendants and 2 were data operators. Laboratory staff workers with an age group range from 30 years - 60 years had a higher level of depression symptoms than respondents with 20 years - 29 years of age. Similarly, the symptoms of anxiety were noted to be significantly higher among female respondents and respondents with age >30yrs. The most frequent concern was transmitting the infection to family than to themselves only. A considerable number of laboratory staff workers utilized online psychological resources to deal with their psychological distress.Conclusion: The findings of this survey recognize the various problems faced by laboratory health workers during the period of COVID-19 which affect their working ability. Therefore, in the future, we have to implement such strategies that enhance the performance of laboratory workers, boost their energy level, and encourage them to take care of themselves, in times of such crisis.
Magnets, Gradients, and RF Coils of MR Scanners
Published on: 25th July, 2023
The topic of this paper is the parts of modern MR devices, which contain magnet coils. MR scanner magnets are made of four types of electromagnetic coils: 1) Main magnet, made of superconducting material. The main magnet of an MR (Magnetic Resonance Imaging) scanner creates a strong and uniform magnetic field around the patient being scanned. This magnetic field is typically in the range of 0.5 to 3 Tesla and is used to align the magnetic moments of the hydrogen atoms in the patient's body. The superconductors, which create the main magnetic field, should be cooled with liquid helium and liquid nitrogen. The main magnets made of superconductors should use a cryostat, with cooling vessels with liquid helium and liquid nitrogen, thermal insulation, and other protective elements of the magnet system. 2) The gradient magnetic field is made of three types of coils: x-coils, y-coils, and z-coils. The X coil, made of resistive material, creates a variable magnetic field, horizontally, from left to right, across the scanning tube; 3) The Y coil creates a variable magnetic field, vertically, from bottom to top; 4) The Z coil creates a variable magnetic field, longitudinally, from head to toe, inside the scanning tube. RF coils are used to generate RF pulses to excite the hydrogen protons (spins) in the patient's body and detect the signals emitted by the protons when they return to their equilibrium state after the RF excitation is turned off. The resulting interaction between the magnetic field and the aligned hydrogen atoms produces a signal that is used to generate the images seen in an MRI scan. The main magnetic field is what allows MR imaging to produce detailed anatomical and functional information non-invasively. The structure of the MR scanner magnet is complex. The resonant frequency changes at each point of the field in a controlled manner. Inside the copper core are embedded the windings of the main magnet made of superconducting material in the form of microfibers. A non-linear gradient field is created by coils of conductive material. It adds to the main magnetic field. Thus the resulting magnetic field is obtained. The types of magnets that exist in the basic configurations of MR scanners are analyzed. Scanners in the form of a closed cylindrical cavity generate their magnetic fields by passing current through a solenoid, which is maintained at the temperature of a superconductor. Exclusively used superconductors are niobium-titanium (NbTi), niobium-tin (Nb3Sn), vanadium-gallium (V3Ga), and magnesium-diboride (MgB2). Only magnesium diboride is a high-temperature superconductor, with a critical temperature Tc = 390K. The three remaining superconductors are low temperatures. New high-temperature superconductors have been discovered, as well as superconductors at room temperature. Newly discovered superconducting materials are not used in MR scanners.
Case Report of Gardner-Diamond Syndrome
Published on: 25th July, 2023
Gardner-Diamond syndrome or psychogenic purpura is a rare vasculopathy disorder characterized by spontaneous painful purpuric rash without a history of trauma or antiplatelet or anticoagulant therapy. It occurs in women with mental health disorders. Gardner and Diamond in 1955 described a syndrome of auto erythrocyte sensitization which presented in abnormal crops of painful inflammatory ecchymosis in 4 patients at the site of trauma followed by progressive erythema and edema.
We present a 52-year-old age woman who was admitted to the internal medicine department and referred for dermatological consultation for recurrent spontaneous purpuric eruptions. The patient was under treatment for depression for many months. Her investigations and coagulation profile were nearly within normal.
Psychosis in Parkinson’s Disease and Current Management Trends- an Updated Review of Literature
Published on: 26th July, 2023
As a neurodegenerative disorder, Parkinson’s disease (PD) is characterized by a combination of premotor, motor, and nonmotor symptoms. PD is commonly accompanied by psychosis, which is one of the commonest symptoms in the long run. As a result of Parkinson’s disease psychosis (PDP), symptoms can range from minor consequences of the disease (illusions, passage hallucinations, and presence hallucinations), to visual and nonvisual hallucinations and delusions. PDP is associated with a reduction in function and a reduction in quality of life as well. It is commonly believed that PDP is related to economic burden, and it has a significant impact on the utilization of long-term care services. The main focus should be on diagnosing, classifying, and managing PDP in an appropriate manner. As a first step in the management of PDP patients, the emphasis should be on identifying and treating any contributing medical factors, reducing or discontinuing medications that could cause or worsen psychosis, as well as nonpharmacological strategies and considering acetylcholinesterase inhibitors for treatment when dementia is present. A number of medications are being considered for use in PDP, including pimavanserin, quetiapine, and clozapine. The purpose of the current review is to provide a comprehensive understanding of the disorder in the general population with PD, including epidemiology, psychotic symptoms, risk factors, triggers, neuro-signaling pathways, diagnosis, and treatment of PDP.
Myxedema Coma and Acute Respiratory Failure in a Young Child: A Case Report
Published on: 26th July, 2023
Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.
latrogenic Pneumothorax Caused by Thoracic Puncture Secondary to Anti-aging Medicine
Published on: 27th July, 2023
Introduction: Pneumothorax is defined as air in the pleural cavity, the iatrogenic cause happens after invasive procedures as thoracic needle aspiration, central line placement, pacemaker placement, etc. Nevertheless, it is possible to be found in non-medical procedures, such as alternative medicine, more specifically acupuncture. There are medications used against aging that FDA has warned to be used only in its first objective, an example is procaine hydrochloride.Case: A 63 y/o female, Mexico City resident, with anxiety, came to a follow-up appointment for an aging cohort, where CT, PFT, and laboratories are made for pulmonary healthy subjects to investigate normal lung aging and how other environmental factors can affect the lungs; at physical examination, we did not find any pleuropulmonary syndrome, but in the CT a left Iatrogenic pneumothorax was found; we re-asked for antecedents and she described that 15 days before the date she had 2 punctures in the middle clavicular line to apply procaine hydrochloride as an anti-aging treatment.Discussion: There is diverse evidence of adverse effects associated with acupuncture, and even if pneumothorax has a small percentage of incidence, in some cases it can be severe and can even cause fatalities.Conclusion: The pneumothorax in this case was iatrogenic due to the thoracic puncture for an anti-aging treatment, with a total resolution with conservative treatment, however we as health professionals have the responsibility to inform our patients that initiatives of administration ways can cause important complications.
Role of RBC Parameters to Differentiate between Iron Deficiency Anemia and Anemia of Chronic Diseases
Published on: 27th July, 2023
Introduction: In the present study we evaluated and compared RBC parameters, iron status, and ferritin for discriminating between patients with iron deficiency anemia and anemia of chronic disease. Anemia that accompanies infection, inflammation, and cancer, is commonly termed anemia of chronic disease (ACD). Methods: We compared the ability of serum ferritin concentration, using the microplate immunoenzymometric assay method with other, more traditional indicators of iron status like total iron binding capacity [TIBC], mean corpuscular volume [MCV], percent transferrin saturation [%TS], RBC distribution width [RDW], and serum iron concentration [SIC]. The ferritin concentration was determined in 80 serum samples selected from men and women above the age of 18 years. The patients were assigned to IDA and ACD groups based on serum ferritin concentration.Observation: By studying the ROC Curve for various red cell parameters for the diagnosis of IDA and ACD, we found that diagnostic accuracy of various indicators was as follows TIBC>TS%>MCV>MCH>SI>MCHC for anemia of chronic diseases, and TIBC>MCH>MCV>MCHC>TS%>SI for iron deficiency anemia. When both the value of AUCs (Area under Curve) of ROC were compared it is apparent that TIBC, TS%, MCV, and MCH are important discriminating factors between IDA and ACD. Conclusion: Conventional laboratory parameters play an important role in distinguishing overt causes of IDA and ACD. MCV, MCH, and TIBC were found to be (p -value < .05) significantly discriminated against IDA and ACD. Serum ferritin is an important diagnostic tool with reasonable accuracy for the detection and differentiation of iron deficiency anemia and anemia of chronic disease.
Extracorporeal Membrane Oxygenation in Acute Aluminum Phosphide (AlP) Poisoning
Published on: 28th July, 2023
Introduction: Aluminum Phosphide (AlP) poisoning is a life-threatening condition that commonly occurs in developing countries, often resulting in cardiac, respiratory, and metabolic complications, leading to multi-organ failure and mortality. Extracorporeal Membrane Oxygenation (ECMO) has been proposed as a potential therapy for severe AlP poisoning cases refractory to conventional management, though its use remains controversial. Methodology: for this literature review, we conducted a comprehensive analysis of existing literature concerning the utilization of ECMO in patients with severe AlP poisoning. We meticulously examined available publications to explore the relationship between ECMO initiation and patient outcomes. Discussion: The review reveals that early ECMO initiation within 6 hours of presentation is associated with better outcomes and higher survival rates in severe AlP poisoning cases. However, uncertainties persist regarding the optimal timing and duration of ECMO support, and potential complications, including bleeding, acute renal injury, and ventilator-associated pneumonia, need careful consideration. Conclusion: Despite promising results in certain cases, the risks and benefits of ECMO in AlP poisoning require meticulous evaluation. Ethical considerations, encompassing resource allocation and implications for other patients, necessitate appropriate patient selection criteria.
Evaluation of a Weight-Based Mycophenolate Mofetil Dosing Protocol for Kidney Transplant Maintenance Immunosuppression
Published on: 28th July, 2023
To evaluate the safety and efficacy of weight-based mycophenolate mofetil (MMF) dosing in adult kidney transplant recipients (KTR), this single-center retrospective study of adult KTR compared biopsy-proven acute rejection (BPAR), infections, hospitalizations, granulocyte colony-stimulating factor (G-CSF) use, and MMF dose changes within one year of transplant pre-and post-implementation of a weight-based MMF dosing protocol. Adult patients who received a kidney transplant at University Health Transplant Institute were reviewed for inclusion. Patients in the weight-based MMF group received 1000 mg twice daily by the first clinic visit if ≥ 80 kg, 750 mg twice daily if 50-79 kg, and 500 mg twice daily if < 50 kg. Patients in the fixed-dose MMF group received MMF 1000 mg twice daily. A total of 170 KTR (50.0% ≥ 80 kg, 44.1% 50-79 kg, 5.9% < 50 kg) were included. Baseline characteristics were similar between groups. The majority of patients were middle-aged Hispanic males and received lymphocyte-depleting induction therapy. Incidences of BPAR, infection, and hospitalization were similar between both groups at one-year post-transplant. Weight-based MMF dosing is safe and effective in adult KTR.
Quality of Antenatal Care and its Determinants in the Urban-Rural Environment of Kamina, Democratic Republic of the Congo
Published on: 28th July, 2023
Introduction: Every woman should receive quality antenatal care during pregnancy wherever she lives. We carried out this research with the objective of evaluating the quality of antenatal consultations (ANC) in terms of periodicity, screening, and prophylaxis interventions during antenatal consultations in Kamina and to identify the determinants associated with inadequate ANC. Material and methods: This was a descriptive and analytical cross-sectional study carried out in 6 health facilities in Kamina over a period of 17 months with 476 women who had given birth having attended antenatal consultations at least once. A scoring grid of periodicity standards, screening, and prophylactic interventions with a score of 40 was used to qualify the ANC as adequate. Logistic regression was performed to identify the determinants of inadequate ANC. Results: 40.3% of mothers had reached at least 4 antenatal visits (3.4±1.36); 21.2% had started the ANC no later than 16 weeks for an average age of 22.8 weeks ± 6.19. Overall, 72.5% of pregnant women had benefited from ANC qualified as inadequate. After adjustment, the determinants of inadequate ANC were multigestity (aOR=1.86[1.08-3.19]), low level of education of the mother (aOR=3.93; 95% CI=[2, 08-7.42]), and attendance at a first-level health facility (aOR=3.22; 95% CI=[2.06-5.05]. Conclusion: In the majority of cases, the ANC received by pregnant women in Kamina is inadequate. The determinants thus identified should serve the actors to direct the means to improve the quality of antenatal care in Kamina.
Factors Associated with Elevated Transcranial Doppler Ultrasound Velocities in Children With Sickle Cell Anemia in Mwanza, Tanzania
Published on: 28th July, 2023
Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%.Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA).Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD (> 170 cm/s)was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA.Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.
Rare Presentation of Chromoblastomycosis Due to Multiple Simultaneous Inoculations: A Case Report
Published on: 7th August, 2023
Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface.The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.
Diagnostic Challenge of Gitelman Syndrome: A Rare but Significant Cause of Electrolyte Imbalance
Published on: 1st August, 2023
Objective: This case study presents a young female patient diagnosed with symptomatic electrolyte disturbances, later confirmed as Gitelman syndrome (GS). It highlights the underlying pathophysiology and emphasizes the importance of its proper management. Background: GS is a rare genetic disorder affecting kidney electrolyte reabsorption, leading to symptoms like weakness, muscle cramps, fatigue, nausea, and vomiting. Diagnosis involves lab tests and genetic confirmation, with treatment comprising electrolyte supplementation and medications. Ongoing management is vital to prevent complications. Case presentation: A 23-year-old Caucasian female presented to the ED with sudden weakness in all extremities, thirst, and lightheadedness. Lab results showed hyperglycemia 166 (70-100 mg/dL),severe hypokalemia 1.1 (3.6-5.1 mmol/L), mild hypercalcemia 11 (8.9-10.4 mg/dL), and severe hypophosphatemia 0.6 (2.3-7.0 mg/dL). Incidentally, she had prior hypokalemia history from a motor accident hospitalization and managed it with KCl for a year but stopped when symptoms improved. She was treated with electrolyte replacement and discharged with oral potassium. Five days later, she returned with severe hypokalemia 1.3, mild hypercalcemia 10.7, and severe hypophosphatemia 0.6. A 24-hour urinary test showed distal convoluted tubulopathy indicative of GS. She was treated with replacement therapy and spironolactone, with instructions for ongoing supplementation and follow-up with a nephrologist. Discussion: GS is mostly caused by mutations in the SLC12A3 gene, affecting the kidneys’ sodium chloride cotransporter function, as confirmed in our patient. Conclusion: While GS has no cure, appropriate treatment with medication and dietary adjustments can enhance patients’ quality of life by maintaining electrolyte balance. Healthcare providers’ awareness is crucial for effective care and complication prevention.
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