456: SEVERE ADRENAL CRISIS WITH WIDE SPECTRUM OF LIFE-THREATENING COMPLICATIONS IN A PEDIATRIC PATIENT

AbstractAcute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

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Polymeric Nanocarriers: A Transformation in Doxorubicin Therapies

Materials ◽

10.3390/ma14092135 ◽

2021 ◽

Vol 14 (9) ◽

pp. 2135

Author(s):

Kamila Butowska ◽

Anna Woziwodzka ◽

Agnieszka Borowik ◽

Jacek Piosik

Keyword(s):

Drug Delivery ◽

Wide Spectrum ◽

Stimuli Responsive ◽

First Line ◽

Medical Expenses ◽

Polymeric Nanocarriers ◽

Essential Properties ◽

Life Threatening ◽

History Of ◽

Cancerous Cells

Doxorubicin, a member of the anthracycline family, is a common anticancer agent often used as a first line treatment for the wide spectrum of cancers. Doxorubicin-based chemotherapy, although effective, is associated with serious side effects, such as irreversible cardiotoxicity or nephrotoxicity. Those often life-threatening adverse risks, responsible for the elongation of the patients’ recuperation period and increasing medical expenses, have prompted the need for creating novel and safer drug delivery systems. Among many proposed concepts, polymeric nanocarriers are shown to be a promising approach, allowing for controlled and selective drug delivery, simultaneously enhancing its activity towards cancerous cells and reducing toxic effects on healthy tissues. This article is a chronological examination of the history of the work progress on polymeric nanostructures, designed as efficient doxorubicin nanocarriers, with the emphasis on the main achievements of 2010–2020. Numerous publications have been reviewed to provide an essential summation of the nanopolymer types and their essential properties, mechanisms towards efficient drug delivery, as well as active targeting stimuli-responsive strategies that are currently utilized in the doxorubicin transportation field.

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Myopericarditis Associated with COVID-19 in a Pediatric Patient with Kidney Failure Receiving Hemodialysis

Pathogens ◽

10.3390/pathogens10040486 ◽

2021 ◽

Vol 10 (4) ◽

pp. 486

Author(s):

Marcela Daniela Ionescu ◽

Mihaela Balgradean ◽

Catalin Gabriel Cirstoveanu ◽

Ioana Balgradean ◽

Loredana Ionela Popa ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Replacement Therapy ◽

Female Patient ◽

Pediatric Patient ◽

Kidney Failure ◽

Cardiac Tissue ◽

Pulmonary Involvement ◽

Rt Pcr ◽

Acute Pericarditis ◽

Life Threatening

The outbreak of COVID-19 can be associated with cardiac and pulmonary involvement and is emerging as one of the most significant and life-threatening complications in patients with kidney failure receiving hemodialysis. Here, we report a critically ill case of a 13-year-old female patient with acute pericarditis and bilateral pleurisy, screened positive for SARS-CoV-2 RT-PCR, presented with high fever, frequent dry cough, and dyspnea with tachypnea. COVID-19-induced myopericarditis has been noted to be a complication in patients with concomitant kidney failure with replacement therapy (KFRT). This article brings information in the light of our case experience, suggesting that the direct effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiac tissue was a significant contributor to myopericarditis in our patient. Further studies in this direction are required, as such associations have thus far been reported.

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Chronic granulomatous ‘Aspergillus lung mass’

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1371 ◽

2020 ◽

Vol 90 (3) ◽

Author(s):

Kavitha Venkatnarayan ◽

Uma Devaraj ◽

Uma Maheswari Krishnaswamy ◽

Priya Ramachandran ◽

Sreekar Balasundaram ◽

...

Keyword(s):

Immune Response ◽

Lung Disease ◽

Respiratory Symptoms ◽

Clinical Presentation ◽

Wide Spectrum ◽

Lung Mass ◽

Pulmonary Aspergillosis ◽

Histological Picture ◽

Life Threatening ◽

Disseminated Disease

The diverse clinicopathological spectrum of pulmonary aspergillosis is a consequence of varying levels of invasiveness of this ubiquitous fungus, which largely depends on the host immune response and pre-existing lung disease. The clinical presentation of pulmonary aspergillosis spans a wide spectrum from hypersensitivity to life threatening angio-invasive and disseminated disease. We report the case of a young immunocompetent male with no underlying lung disease, who presented with an incidentally detected ‘infective mass’ lesion in the lung associated with minimal respiratory symptoms. The diagnostic challenges posed by the unusual clinical, radiological and histological picture as well as the therapeutic dilemmas faced are discussed in this report.

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Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data

Journal of the Endocrine Society ◽

10.1210/jendso/bvab184 ◽

2021 ◽

Author(s):

Sarpreet S Sekhon ◽

Katelynn Crick ◽

Tyler W Myroniuk ◽

Kevin S C Hamming ◽

Mahua Ghosh ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Healthcare Utilization ◽

Population Based ◽

Adrenal Crisis ◽

Published Data ◽

Clinical Settings ◽

Healthcare Burden ◽

Data Limitations ◽

Life Threatening ◽

Outpatient Settings

Abstract Introduction Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients. Objective We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada. Methods This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records and visit reasons. Results The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3-4 times as frequent as the average Albertan and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medications only. Conclusion The prevalence of AI in Alberta is higher than published data in other locations. The frequency of visits suggests a significant healthcare burden and emphasizes the need for a strong understanding of this condition across all clinical settings. Our most concerning finding is that 94.3% of visits were not labelled with AI, even though many of the top presenting complaints were consistent with adrenal crisis. Several data limitations were discovered that suggest improvements in the standardization of data submission and coding can expand the yield of future studies using this method.

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Parvovirus Infection in a Child Presenting with Erythema Multiforme and Vasculitis after a Yellow Jacket Bee Sting

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa043 ◽

2020 ◽

Author(s):

Ceren Can ◽

Mehtap Yazicioglu ◽

Selman Gokalp ◽

Nese Ozkayin

Keyword(s):

Erythema Multiforme ◽

Wide Spectrum ◽

Parvovirus B19 ◽

Clinical Manifestations ◽

Yellow Jacket ◽

Systemic Reactions ◽

Bee Sting ◽

Life Threatening ◽

Insect Stings ◽

Parvovirus B 19

Abstract Parvovirus B19 has a wide spectrum of clinical manifestations. Erythema multiforme and vasculitis are rarely reported with parvovirus B19 infections. Reactions to insect stings can range from local swelling to life-threatening systemic reactions. There have been rare reports of unusual reactions, such as vasculitis, occurring in a temporal relationship with insect stings. We report an 8-year-old patient having Parvovirus B-19-related erythema multiforme and vasculitis after a yellow jacket bee sting.

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Nivolumab-Induced Pericardial Tamponade: A Case Report and Discussion

Cardiology ◽

10.1159/000447053 ◽

2016 ◽

Vol 136 (1) ◽

pp. 49-51 ◽

Cited By ~ 40

Author(s):

Igal Kushnir ◽

Ido Wolf

Keyword(s):

Pericardial Effusion ◽

Cell Carcinoma ◽

Checkpoint Inhibitors ◽

Wide Spectrum ◽

Corticosteroid Treatment ◽

Pericardial Tamponade ◽

Programmed Death ◽

Proven Efficacy ◽

Life Threatening ◽

Programmed Death 1

Nivolumab, a programmed death 1 (PD1) inhibitor, belongs to a family of drugs known as immune checkpoint inhibitors that share a similar toxicity profile, which includes rash, pruritus, colitis, hepatitis, pneumonitis and thyroid dysfunction. Nivolumab has a proven efficacy in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. We present the case of a 67-year-old male patient with metastatic squamous cell carcinoma of the lung who suffered from a massive pericardial effusion secondary to treatment with nivolumab, which he began in June 2015. After five cycles the patient was hospitalized due to acute respiratory failure requiring mechanical ventilation. An echocardiogram revealed a massive pericardial effusion with tamponade. After pericardiocentesis and corticosteroid treatment, the patient's condition improved rapidly. A CT scan revealed a response of the tumor. Although anti-PD1 treatment is usually regarded as less toxic than chemotherapy, a wide spectrum of life-threatening immune-related side effects may still occur and clinical vigilance is required.

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The incidence of adrenal crisis in the postoperative period of HPA axis insufficiency after surgical treatment for Cushing’s syndrome

Acta Endocrinologica ◽

10.1530/eje-19-0202 ◽

2019 ◽

Vol 181 (2) ◽

pp. 201-210 ◽

Cited By ~ 1

Author(s):

Leonie H A Broersen ◽

Femke M van Haalen ◽

Tina Kienitz ◽

Olaf M Dekkers ◽

Christian J Strasburger ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Hpa Axis ◽

Cushing’S Syndrome ◽

Cushing's Syndrome ◽

Adrenal Crisis ◽

Pituitary Hormone ◽

Increased Risk ◽

Potential Risk Factors ◽

Life Threatening ◽

Glucocorticoid Deficiency

Background Adrenal crisis, the most feared complication of adrenal insufficiency, is a potentially life-threatening state of acute glucocorticoid deficiency. After successful surgery for Cushing’s syndrome, many patients develop (transient) adrenal insufficiency. The incidence of adrenal crisis in patients treated for hypercortisolism is unknown. Methods Cohort study included consecutive patients with Cushing’s syndrome with adrenal insufficiency after surgery from Leiden and Berlin from 2000 to 2015. We summarized the incidence of adrenal crisis, compared patients with and without adrenal crisis regarding potential risk factors for its occurrence and assessed the effect of better education in time on incidence of adrenal crisis. Results We included 106 patients, of whom 19 patients had a total of 41 adrenal crises. There were 9.0 crises per 100 patient-years at risk (95% confidence interval (CI): 6.7–12.0). All crises occurred while on hydrocortisone replacement. The risk ratio for a recurrent crisis was 2.3 (95% CI: 1.2–4.6). No clear change in incidence of adrenal crisis due to better education in time was observed. There was no difference in recurrence rate between patients with, and without any crisis, but patients with adrenal crisis had more often pituitary deficiencies. Conclusions The incidence of adrenal crises after treatment for Cushing’s syndrome is substantial, and patients who suffered from an adrenal crisis have higher risk for recurrent crisis. Adrenal crisis tends to present early after remission of Cushing’s syndrome, which is probably the period of severest HPA axis suppression, despite in general higher hydrocortisone replacement doses for withdrawal complaints in this period. Additional pituitary hormone deficiencies may be a risk marker for increased risk of adrenal crisis. However, further risk factor analysis is needed to identify risks for a first crisis. Effective education methods to prevent adrenal crises should be identified and implemented, including stress instructions by trained nursing staff before hospital discharge.

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454: DANTROLENE AS TREATMENT FOR HYPERPYREXIA AND RHABDOMYOLYSIS DUE TO LIFE-THREATENING ADRENAL CRISIS

Critical Care Medicine ◽

10.1097/01.ccm.0000808140.35677.58 ◽

2021 ◽

Vol 50 (1) ◽

pp. 217-217

Author(s):

Charlene Pringle ◽

Zasha Francheska Vazquez-Colon ◽

Lara Nicolas

Keyword(s):

Adrenal Crisis ◽

Life Threatening

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Ileal volvulus due to ascaris lumbricoides: a diagnosis revisited

International Surgery Journal ◽

10.18203/2349-2902.isj20190416 ◽

2019 ◽

Vol 6 (2) ◽

pp. 614

Author(s):

Ipseet Mishra ◽

Sudip Haldar ◽

Souvik Paul

Keyword(s):

Ascaris Lumbricoides ◽

Wide Spectrum ◽

Primary Anastomosis ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Small Bowel Volvulus ◽

Clinical Presentations ◽

Life Threatening ◽

High Index Of Suspicion ◽

Early Surgical Intervention

Ascariasis infestation is a common helminthic disease in developing countries with a wide spectrum of clinical presentations, one of which can be acute abdomen. Small bowel volvulus is a serious life-threatening emergency. The aetiology may be primary as is often seen in Africa and Asia, while in Western countries other predisposing conditions usually initiate the volvulus. Ascariasis is highly prevalent in India and so, a myriad of different presentations is quite obvious. Here the authors have reported a case of a 6year old boy presenting with features of acute intestinal obstruction-central abdominal pain, repeated vomiting and abdominal distension. After evaluation with abdominal radiography and ultrasonography, exploratory laparotomy was planned. A secondary ileal volvulus compact with worms of ascaris lumbricoides was found. Resection of non-viable ileum was done after evacuation of worms by enterotomy followed by primary anastomosis. Prompt clinical diagnosis, a high index of suspicion for complications and early surgical intervention are critical in minimizing morbidity in cases of Intestinal Ascariasis.

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