scholarly journals Rapid Glomerulotubular Nephritis as an Initial Presentation of a Lethal Diquat Ingestion

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Daniel Guck ◽  
Reynaldo Hernandez ◽  
Steven Moore ◽  
Andry Van de Louw ◽  
Philippe Haouzi
Keyword(s):  
Early Recognition ◽  
Severe Depression ◽  
Acute Glomerulonephritis ◽  
Tubular Dysfunction ◽  
System Failure ◽  
Atypical Symptoms ◽  
Intentional Ingestion ◽  
Similar Chemical ◽  
Toxic Ingestion ◽  
Refractory Hypoxemia

Introduction. Diquat is an herbicide that can lead to rapid multiorgan system failure upon toxic ingestion. Although Diquat shares a similar chemical structure with paraquat, diquat is still readily available to the general population, and in contrast to paraquat, it is not regulated. We present a case of an intentional diquat poisoning which emphasizes the necessity of the early recognition due to atypical symptoms within the first 24 hours and certainly enhanced regulatory restrictions on this very toxic compound. Case. A 60-year-old male with a history of severe depression presented to the emergency department after intentional ingestion of a commercial herbicide containing diquat dibromide 2.30%. The earliest manifestations of this acute diquat intoxication comprised a glomerulonephritis and proximal tubular dysfunction. Progressive multiorgan system failure then developed with a significant delay (24–38 hours) including acute renal, liver failure, and then respiratory failure with refractory hypoxemia. Despite maximal supportive care, the end organ failure was lethal. Discussion. Diquat intoxication should be suspected in patient presenting an acute glomerulonephritis with coma. Diquat should undergo the same regulatory restrictions as paraquat-containing compounds.

Lower extremity artery disease

ESC CardioMed ◽  
2018 ◽  
pp. 2720-2733
Author(s):  
Marianne Brodmann
Keyword(s):  
Early Recognition ◽  
Ankle Brachial Index ◽  
Clinical Signs ◽  
Treatment Decision ◽  
Tissue Loss ◽  
Limb Ischaemia ◽  
First Line ◽  
Atypical Symptoms ◽  
Asymptomatic Patients ◽  
Artery Disease

Most patients with LEAD are asymptomatic. Walking capacity must be assessed to detect clinically masked LEAD. The clinical signs vary broadly. Atypical symptoms are frequent. Even asymptomatic patients with LEAD are at high risk of CV events and must benefit from most CV preventive strategies, especially strict control of risk factors. Antithrombotic therapies are indicated in patients with symptomatic LEAD. There is no proven benefit for their use in asymptomatic patients. Ankle-brachial index is indicated as first-line test for screening and diagnosis of LEAD. DUS is the first imaging method. Data from anatomical imaging tests should always be analysed in conjunction with symptoms and haemodynamic tests prior to treatment decision. In patients with intermittent claudication, CV prevention and exercise training are the cornerstones of management. If daily life activity is severely compromised, first-line revascularization can be proposed, along with exercise therapy. Chronic limb-threatening ischaemia specifies clinical patterns with a vulnerable limb viability related to several factors. The risk is stratified according to the severity of ischaemia, wounds, and infection. Early recognition of tissue loss and/or infection and referral to the vascular specialist is mandatory for limb salvage by a multidisciplinary approach. Revascularization is indicated whenever feasible. Acute limb ischaemia with neurological deficit mandates urgent revascularization.

scholarly journals COVID-19: A Geriatric Emergency

Geriatrics ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 24 ◽  
Author(s):  
Virginia Boccardi ◽  
Carmelinda Ruggiero ◽  
Patrizia Mecocci
Keyword(s):  
Intensive Care ◽  
Early Diagnosis ◽  
Older Patients ◽  
Early Recognition ◽  
Health Conditions ◽  
Italian Population ◽  
Management Skills ◽  
Atypical Symptoms ◽  
Clinical Complexity ◽  
Compensatory Effort

The older Italian population is posing a challenge in the number of deaths for coronavirus disease 2019 (COVID-19). According to previous data from China, pre-existing health conditions dramatically increase the risk of dying from COVID-19. The presence of multiple diseases in older patients may be considered as a mark of frailty, which increases the person’s vulnerability to stress and impairs the multisystemic compensatory effort to restore homeostasis. The clinical complexity associated with the management of frailty may increase the risk of complications during infection as well as the lack of the early recognition of atypical symptoms. There is an urgent need to share expertise and clinical management skills with geriatricians as well as the need for early diagnosis to start treatment at the earliest convenience in the community, with the aim to avoid the collapse of intensive care units.

scholarly journals Symptom presentation of acute myocardial infarction – can we correctly identify patients with atypical symptoms of myocardial infarctions over the phone?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Moeller ◽  
E.H.A Mills ◽  
F Gnesin ◽  
N Zylyftari ◽  
F Folke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Early Recognition ◽  
High Risk Patient ◽  
Funding Source ◽  
Symptom Presentation ◽  
Atypical Symptoms ◽  
Risk Of Death ◽  
Emergency Ambulance

Abstract Introduction Acute myocardial infarction (AMI) can manifest itself with a variety of symptoms which can hinder early recognition of the disease, particularly when diagnosis is performed over the phone. It is currently unknown to what extent AMI patients are correctly recognized and quickly referred to treatment when calling for help at the emergency medical services (EMS) and out-of-hours service (OOHS). Therefore, we investigated how the symptom presentation of AMI patients affected their chances of being recognized. Purpose This study aimed to describe the symptoms reported by AMI patients when calling the EMS and OOHS and investigate to what extent these patients were correctly recognized and lastly, how the symptom presentation affected the survival. Methods All calls to the EMS and OOHS in the Capital Region of Denmark from 1st January 2014 to 31st December 2017 are included in this study resulting in 4,905,318 calls made by 1,313,980 people. A total of 5,526 people were identified with either a hospital admission with an AMI or an AMI as cause of death maximum 72 hours after a call to the EMS or OOHS. The main symptoms were registered by the EMS and OOHS personnel and we grouped the symptoms into symptom categories. Finally, a patient was defined as recognized if an emergency ambulance were dispatched. The unrecognized patients were separated into one group which were not referred to any treatment and another group that received none-urgent treatment. Results 72% of all AMI patients reported chest pain as their main symptom followed by breathing problems (7%) and unknown problems (5%). A total of 76% of all AMI patients were correctly recognized and received an emergency ambulance. The proportion of recognized AMIs was 88% at the EMS, but only 55% at the OOHS. The symptom presentation was highly associated with the help provided to the patient and less than 14% of patients reporting musculoskeletal pain, infection/fever or pain in stomach/back/intestine received an emergency ambulance. In comparison, 87% of patients with chest pain and 96% of unconscious patients received an emergency ambulance (Figure 1). Results from a multiple logistic regression showed that chest pain patients had the lowest risk of death at 30-days follow-up compared to all other symptom presentation. Conclusion 24% of AMI patients were not correctly recognized with an acute life-threatening disease when calling for help. Patients presenting without chest pain and unconsciousness had a much lower chance of being recognized. Similarly, patients calling the OOHS were less likely to be recognized compared to patients calling the EMS. Symptom presentations without chest pain had a dramatically increased 30-day mortality indicating that AMI patients with atypical symptoms truly are a high-risk patient group. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Danish Heart Association

scholarly journals The clinical profile of dengue infection cases presenting in a tertiary care institute: an observational study

2018 ◽  
Vol 5 (6) ◽  
pp. 2294
Author(s):  
Kiran Shrivastava ◽  
Sakshi Ojha ◽  
Jayashree Nadkarni
Keyword(s):  
Observational Study ◽  
Early Recognition ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Central India ◽  
Febrile Illness ◽  
Viral Disease ◽  
Clinical Profile ◽  
Tertiary Referral Centre ◽  
Atypical Symptoms

Background: Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. It is an acute febrile illness, caused by infection with any of 4 related positive-sense, single-stranded RNA viruses of the genus Flavivirus, dengue viruses 1, 2, 3, or 4. Objective of study was to study the clinical profile of dengue viral infection in the paediatric age group.Methods: This observational study was conducted in a tertiary referral centre in Central India. Cases were classified based on the WHO 2009 Dengue guidelines for diagnosis, treatment, prevention and control and the clinical and laboratory parameters were analyzed for demographic and other correlates.Results: 75 patients met all the inclusion criteria and were analyzed. Most children were in age group 6-10 years. Fever, bleeding, rash, abdominal pain and vomiting were the common symptoms. We noted some atypical symptoms also.Conclusions: When infected, early recognition and prompt supportive treatment in dengue infection can substantially lower the risk of medical complications and death.

scholarly journals Autoimmune Ataxia During Maintenance Therapy for Acute Lymphoblastic Leukemia

2018 ◽  
Vol 5 ◽  
pp. 2329048X1881923 ◽  
Author(s):  
Julie Voeller ◽  
Chrysanthy Ikonomidou ◽  
Justin Brucker ◽  
Carol Diamond ◽  
Sharon Frierdich ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Acute Lymphoblastic Leukemia ◽  
Early Recognition ◽  
Lymphoblastic Leukemia ◽  
Autoimmune Encephalitis ◽  
Oligoclonal Bands ◽  
Autoimmune Process ◽  
Atypical Symptoms ◽  
Progressive Ataxia ◽  
Leukemia Treatment

Neurologic dysfunction during acute lymphoblastic leukemia treatment is commonly associated with chemotherapy. Nonchemotherapy contributions should be considered for persistent atypical symptoms. We describe a boy with acute lymphoblastic leukemia who developed recurrent fevers, diarrhea, progressive ataxia, and neuropsychiatric impairment during maintenance chemotherapy. He was found to have cytomegalovirus in his serum and colon, but not in his cerebrospinal fluid. Instead, his cerebrospinal fluid revealed oligoclonal bands not present in the serum, suggesting an autoimmune process. Prompt treatment with ganciclovir and immunotherapy resulted in marked clinical improvement. Early recognition and treatment of an autoimmune encephalitis is paramount for optimal clinical outcome.

scholarly journals Gasping on Oxygen: A Case Report on Toxic Methemoglobinemia

2021 ◽  
Vol 6 (2) ◽  
pp. 112-115
Author(s):  
Mahavishnu Sahadevan ◽  
Menaka Mahendran ◽  
Subasini Govindan ◽  
Thilagavathi Thanusia Viswanathan
Keyword(s):  
Methylene Blue ◽  
Case Report ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Male Patient ◽  
Early Recognition ◽  
Unknown Substance ◽  
Refractory Hypoxemia

Abstract We report the case of a 27-year-old male patient who presented with refractory hypoxemia following the alleged inhalation of an unknown substance. The patient appeared to show worsening cyanosis despite increment of supplemental oxygenation. A drawn sample of the patient’s blood appeared chocolate brown in color, and disparity was noted between the patient’s oxygen saturation (SaO2) in his blood against the pulse oximetry (SpO2) reading. A diagnosis of toxic methemoglobinemia was established following elevated levels of methemoglobin discovered in his blood. The patient was started on methylene blue and instantaneously recovered without any complications. Methemoglobinemia should be suspected in any patient with refractory cyanosis, and early recognition of this condition could be potentially lifesaving.

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

2011 ◽  
Vol 21 (3) ◽  
pp. 89-99
Author(s):  
Michael F. Vaezi
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Best Practice ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Tools ◽  
Swallowing Function ◽  
Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

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