scholarly journals Differential Diagnosis of HyperCKemia

2018 ◽  
Vol 02 (01) ◽  
pp. E72-E83 ◽  
Author(s):  
Rudolf Kley ◽  
Tobias Schmidt-Wilcke ◽  
Matthias Vorgerd
Keyword(s):  
Differential Diagnosis ◽  
Incidental Finding ◽  
Elevated Serum ◽  
Asymptomatic Patients ◽  
Upper Limits ◽  
Electrophysiological Studies ◽  
Threatening Condition ◽  
Life Threatening ◽  
Muscle Disorder ◽  
The Individual

AbstractElevated serum creatine kinase (CK) activity is usually an indicator of muscle damage. HyperCKemia is often an incidental finding and should be controlled after refraining from physical activity for some days, especially in asymptomatic patients. Furthermore, data from recent studies indicate that the upper limits of normal (ULN) need to be revised upward. This review includes an algorithm for the differential diagnosis of CK elevation in patients without muscular symptoms. In the field of neurology, in particular myopathies and neuropathies with affection of the lower motor neuron can cause symptomatic hyperCKemia, with CK values >1000 U/l (16,7 µkat/l) being indicative of a primary muscle disorder. Diseases with very high CK values include subtypes of muscular dystrophies, idiopathic inflammatory myopathies and metabolic myopathies. However, a normal or only slightly elevated CK value does not exclude the presence of a myopathy. The individual diagnostic procedure (e. g., muscle imaging, special laboratory studies, muscle biopsy and genetic testing) depends on the clinical phenotype and the results of electrophysiological studies. HyperCKemia can also be an adverse effect of several drugs including statins. In asymptomatic patients, statin-associated CK elevations <5 times the ULN can be tolerated. In patients with higher CK values and/or muscle symptoms, LDL-cholesterol lowering therapy should be changed. Rhabdomyolysis is a potentially life-threatening condition and is accompanied by highly elevated CK values. Acute phase treatment includes preserving renal function and restoring metabolic derangements.

"To evaluate efficacy of Gruta in Grabhashaymukhgata Vrana with special reference to Cervical Erosion."

2020 ◽  
Vol 8 (06) ◽  
Author(s):  
Pravin Ashok Mali
Keyword(s):  
Vaginal Discharge ◽  
Benign Lesion ◽  
Modern Science ◽  
Routine Activity ◽  
Major Life ◽  
Causative Factors ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual ◽  
Gynaecological Disease

Cervical erosion is one of the causative factors for vaginal discharge. Cervical erosion, a benign lesion is sometimes much troublesome due to its chronic nature and recurrence. Cauterization and cryosurgery are most common treatment for cervical erosion in modern science. Certain diseases may not be life threatening but may be troublesome and irritating to the individual in her routine activity. When neglected may lead to serious complications or turn into major life threatening condition. Cervical erosion is one among them, increasingly prevalent nowadays, demanding great concern over it. Cervical erosion is a common gynaecological disease and seen in about 80-85% of women. As per Ayurveda classics Garbhashaya grivamukhagatavrana can be correlated with cervical erosion. Various research has been done in ayurveda on its treatment. One such compound Ghrut can be used incorporation with other treatment. This article is to enlighten on the same.

scholarly journals Severe hypertriglycerdemia in pregnancy

2021 ◽  
Vol 4 (1) ◽  
pp. 019-019
Author(s):  
Muralidhara Krithika ◽  
Dhareshwar Shashank
Keyword(s):  
Low Density Lipoprotein ◽  
Elevated Serum ◽  
Density Lipoprotein ◽  
Good Health ◽  
Glycerol Phosphate ◽  
Serum Triglycerides ◽  
Serum Lipase ◽  
Threatening Condition ◽  
Life Threatening ◽  
Membrane Plasma Separation

31 year old female presented with abdominal pain and respiratory distress in the third trimester of her second pregnancy. Her blood workup revealed a lipemic sample (Figure 1) due to markedly elevated serum triglycerides of 8178 mg/dl (Glycerol Phosphate Oxidase method). Total cholesterol and Low Density Lipoprotein were elevated at 1701 mg/dl and 788 mg/dl respectively. There was no family history of lipid disorders. Diagnosis was consistent with gestational hypertriglyceridemia with acute pancreatitis (Serum Amylase-50 U/L, Serum Lipase- 96 U/L), though genetic tests to rule out pre-existing primary hypertriglyceridemia was not feasible. In view of the life threatening condition, she was initiated on Insulin-Dextrose infusion and offered one session of Plasma Exchange. Figures 2,3 depict membrane plasma separation with the obtained effluent as lipemic plasma. Her serum triglycerides showed a declining trend and was discharged in good health (serum triglycerides at discharge-651 mg/dl).

scholarly journals Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

2021 ◽  
Author(s):  
Surat Tongyoo ◽  
Suneerat Kongsayreepong
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ecmo Support ◽  
Janus Kinase ◽  
Systemic Steroid ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Rescue Treatment ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

scholarly journals T-wave inversion in the precordial leads: сardiac and non-cardiac causes

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 136-145
Author(s):  
I. R. Tsoy ◽  
I. P. Kolos
Keyword(s):  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardiac Memory ◽  
T Wave ◽  
Wave Inversion ◽  
Threatening Condition ◽  
Life Threatening

The T-wave inversion (TWI) is a common electrocardiographic finding. Causes for TWI are numerous and sometimes TWI may appear in life-threatening conditions. The aim of this review was to provide an up-to-date analysis of TWI, including i) definition and prevalence; ii) causes, and iii) differential diagnosis in benign TWI, reversible myocardial ischemia of the left ventricular anterior wall; takotsubo cardiomyopathy; subarachnoid hemorrhage; pulmonary embolism; right ventricular arrhythmogenic cardiomyopathy; and “cardiac memory”. The review presents practical electrophysiological criteria, which allow suspecting in time a life-threatening condition to choose an up-to-date treatment.

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e239697
Author(s):  
Sarah Cheyney ◽  
Zachary Field ◽  
Jacqueline Kropf ◽  
Steve Carlan
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Topical Anaesthetic ◽  
Over The Counter ◽  
Perimenopausal Woman ◽  
Threatening Condition ◽  
Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

Thoracic Spine Pain

2018 ◽  
Author(s):  
Mark R. Jones ◽  
Matthew Novitch ◽  
Graham R. Hadley ◽  
Alan D. Kaye ◽  
Sudhir A. Diwan
Keyword(s):  
Genetic Research ◽  
Spinal Pain ◽  
Thoracic Pain ◽  
Spine Pain ◽  
Thoracic Spinal ◽  
Threatening Condition ◽  
Disc Herniations ◽  
Life Threatening ◽  
The Individual ◽  
Thoracic Disc

Thoracic spinal pain (TSP) tends to receive less attention from clinical, epidemiologic, and genetic research communities owing to a reduced incidence in comparison to pain arising from cervical and lumbar derangement. Nevertheless, TSP can be similarly disabling to other forms of spinal pain, imposing significant burdens on the individual and society. Thoracic pain may arise from a multitude of underlying pathologies, including angina pectoris, herpes zoster infection, thoracic disc herniations, pulmonary or pleural tumors, and aneurysms. This chapter focuses on TSP of musculoskeletal origin; however, a thorough history and physical are imperative to avoid overlooking a potentially life-threatening condition.

Nutcracker syndrome and phenomenon

2015 ◽  
Author(s):  
John Neary ◽  
Neil Turner
Keyword(s):  
Renal Vein ◽  
Incidental Finding ◽  
Left Renal Vein ◽  
Stent Migration ◽  
Nutcracker Syndrome ◽  
Pain Syndromes ◽  
Asymptomatic Patients ◽  
Weak Evidence ◽  
Life Threatening ◽  
Postural Proteinuria

Nutcracker syndrome describes symptomatology associated with obstruction to the left renal vein caused by pressure from the overlying superior mesenteric artery. Modern imaging methods show that some degree of left renal vein obstruction may be a common incidental finding in asymptomatic patients so it is better described as ‘nutcracker phenomenon’, NCP. The association of NCP with symptoms and signs is often speculative. NCP may be seen at any age but most patients with symptoms attributed to it are teenagers or young adults. The strongest evidence is for association with episodic macroscopic haematuria. There is weak evidence that it may in some circumstances account for orthostatic (postural) proteinuria, microscopic haematuria, or pain syndromes. Apart from rare examples of extreme haemorrhage the syndrome has not been associated with life-threatening features other than through complications of treatment. Various interventions have been employed, recently most commonly endovascular or extravascular approaches to stenting the vein, but serious adverse consequences from stent migration and thrombosis have been described.

Sigmoid volvulus in children

2021 ◽  
Vol 14 (5) ◽  
pp. e241869
Author(s):  
Merete Berthu Damkjaer ◽  
Waqas Farooqui ◽  
Inge Ifaoui ◽  
Luit Penninga
Keyword(s):  
Differential Diagnosis ◽  
Ct Scan ◽  
Sigmoid Volvulus ◽  
Abdominal Discomfort ◽  
Paediatric Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
Abdominal Distress ◽  
Emergency Resection

Sigmoid volvulus in paediatric patients is a rare but potentially life-threatening condition. Since 1940, only 100 cases have been reported. There are no consensual guidelines for juvenile sigmoid volvulus unlike in adults, where the condition and the treatment is well described. We report a case of a 12-year-old patient, who presented with uncharacteristic symptoms of mild abdominal discomfort and lack of passage of stool. A CT-scan showed a sigmoid volvulus and emergency resection was performed with placement of a colostomy. With this case, we want to emphasise juvenile sigmoid volvulus as a probable differential diagnosis when symptoms of abdominal distress and constipation occur.

scholarly journals Sudden cardiac death in excited delirium, and how to prevent it

2021 ◽  
Keyword(s):  
Medical Emergency Team ◽  
Panic Attacks ◽  
Medical Emergency ◽  
Physical Restraints ◽  
Police Intervention ◽  
Emergency Team ◽  
Excited Delirium ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual

The purpose of this study was to review data on restraint related deaths in persons in a state of excited delirium (ExDS) and to propose guidelines for treatment. We analysed three unexpected deaths in persons in a state of ExDS shortly after police restraint. Death which occurs during a police intervention, using physical restraints, may be related to placing the individual in a prone position, the use of neck holds, expert grips, and handcuffs or pepper spray. ExDS results in an altered mental state with agitation, aggression, paranoia, and panic attacks, and is a life-threatening condition. Therefore, before police intervention is initiated, a medical emergency team should be present. In patients with ExDS, physical restraints used by the police should be brief, effective, and include rapid tranquilization (sedation) using benzodiazepines, and antipsychotics.

scholarly journals Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asami Yoshinaka ◽  
Masayuki Akatsuka ◽  
Shuji Yamamoto ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Arrest ◽  
Differential Diagnosis ◽  
Physical Examination ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Clinical Findings ◽  
Neurological Dysfunction ◽  
Myxedema Coma ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background Myxedema coma, which occurs due to hypothyroidism, is a rare and life-threatening condition. Some patients have hemodynamic dysfunction, which consequently leads to cardiac arrest. The rarity of this condition makes it difficult to determine the cause of cardiac arrest. It is important to diagnose myxedema coma based on clinical findings, including physical examination and laboratory parameters. We present a case of undiagnosed and untreated hypothyroidism that initially caused myxedema coma and then led to cardiac arrest. Case presentation A 56-year-old woman who had no medical history was transferred to our hospital for the management of return of spontaneous circulation due to sudden cardiac arrest. Findings of laboratory tests revealed that she had hypothyroidism. On physical examination, she was found to have a puffy face, thin eyebrows, and severe systemic non-pitting edema. Therefore, the patient was clinically diagnosed with myxedema coma, which was the cause of cardiac arrest. She was treated with thyroid hormone and hydrocortisone, resulting in improvement in her general condition, except for the neurological dysfunction. Conclusions This case suggests that myxedema coma is caused by undiagnosed and untreated hypothyroidism, leading to sudden cardiac arrest. Our findings are useful in the differential diagnosis of hypothyroidism based on characteristic physical examination findings. Clinicians should be aware of the differential diagnosis of myxedema coma based on findings from physical examination and laboratory testing of thyroid function, and the treatment should be started immediately.

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