scholarly journals Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients

2018 ◽  
Vol 9 (7) ◽  
pp. 199-208 ◽  
Author(s):  
Mabrouk Bahloul ◽  
Olfa Turki ◽  
Anis Chaari ◽  
Mounir Bouaziz
Keyword(s):  
Emergency Department ◽  
Pulmonary Oedema ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Haemodynamic Instability ◽  
Scorpion Envenomation ◽  
Icu Length Of Stay ◽  
Life Threatening ◽  
Initiation Of Therapy ◽  
Scorpion Stings

Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpion-envenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department. The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion’s species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).

Determinants of pyelonephritis onset in patients with obstructive urolithiasis

2021 ◽  
pp. 039156032110352
Author(s):  
Georges Abi Tayeh ◽  
Ali Safa ◽  
Julien Sarkis ◽  
Marwan Alkassis ◽  
Nour Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Demographic Data ◽  
Vital Signs ◽  
Kidney Injury ◽  
Stone Size ◽  
Positive Urine ◽  
Life Threatening ◽  
Fat Stranding ◽  
Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

scholarly journals Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

2002 ◽  
Vol 30 (6) ◽  
pp. 804-806 ◽  
Author(s):  
H. Butterell ◽  
R. H. Riley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Airway Obstruction ◽  
Pulmonary Oedema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Tracheal Compression ◽  
Negative Pressure Pulmonary Oedema ◽  
Life Threatening ◽  
Thyroid Goitre

We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.

Nocardia spp.: A Rare Cause of Pneumonia Globally

2020 ◽  
Vol 41 (04) ◽  
pp. 538-554
Author(s):  
Joseph P. Lynch ◽  
Gail Reid ◽  
Nina M. Clark
Keyword(s):  
Susceptibility Testing ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
Community Acquired Pneumonia ◽  
Solid Organ ◽  
In Vitro Susceptibility ◽  
Timely Initiation ◽  
Life Threatening ◽  
Initiation Of Therapy

AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

Prazosin treatment in the management of scorpion envenomation

2010 ◽  
Vol 29 (3) ◽  
pp. 231-233 ◽  
Author(s):  
Erdal Peker ◽  
Suleyman Oktar ◽  
Murat Dogan ◽  
Ergun Kaya ◽  
Mehmet Duru
Keyword(s):  
Public Health ◽  
Body Surface ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Neurological Complications ◽  
Receptor Stimulation ◽  
Scorpion Envenomation ◽  
High Incidence ◽  
Scorpion Stings ◽  
Fast Acting

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications due to lesser body surface area. Alpha receptor stimulation plays important role in the pathogenesis of pulmonary edema. Prazosin, a post synaptic alpha blocker, can be recommended as an effective drug in the treatment of serious scorpion envenomations with significant sympathetic symptoms. Oral prazosin is fast acting, easily available, relatively cheap, free from any anaphylaxis and highly effective.

scholarly journals A case of vocal cord dysfunction with Takotsubo cardiomyopathy: is there a link?

2011 ◽  
Vol 1 (1) ◽  
pp. 8
Author(s):  
Xuan Ye ◽  
Sultana Aziza ◽  
Sean Gomes ◽  
William Lancashire ◽  
Paul S. Thomas
Keyword(s):  
Pulmonary Oedema ◽  
Vocal Cord ◽  
Takotsubo Cardiomyopathy ◽  
Vocal Cord Dysfunction ◽  
Haemodynamic Instability ◽  
Acute Pulmonary Oedema ◽  
Pathophysiological Mechanism ◽  
Pleural Effusions ◽  
Life Threatening ◽  
Closed Airway

Vocal cord dysfunction (VCD) is an underrecognised cause of dyspnoea as it is seldom life threatening, and also difficult to diagnose. However, there have been rare accounts of VCD, as in the present case, which have led to haemodynamic instability. This patient with VCD episodically developed acute pulmonary oedema, bilateral pleural effusions and Takotsubo cardiomyopathy, treated effectively with tracheostomy. This presentation hints at the possible existence of a common pathophysiological mechanism, namely, forced inspiration against a closed airway or sympathetic overstimulation.

scholarly journals Asymmetric pulmonary edema after scorpion sting: a case report

2008 ◽  
Vol 50 (6) ◽  
pp. 347-350 ◽  
Author(s):  
Ebrahim Razi ◽  
Elaheh Malekanrad
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Pulmonary Edema ◽  
Good Condition ◽  
Clinical Manifestations ◽  
Scorpion Sting ◽  
Scorpion Envenomation ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

A 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.

scholarly journals Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients.

2020 ◽  
Author(s):  
Andrea Hankins ◽  
Heejung Bang ◽  
Paul Walsh
Keyword(s):  
Emergency Department ◽  
Null Hypothesis ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Vital Signs ◽  
P Value ◽  
Inclusion Criteria ◽  
Upper Respiratory Infection ◽  
Life Threatening ◽  
Emergency Department Patients

Background CoVid-19 can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) screening in symptomatic patients with normal vital signs is frequently limited to oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for CoVid-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with CoVid-19 less than 2% of the time. Methods Subjects Subjects were identified from ED ultrasound logs. Inclusion criteria Age 14 years or older with symptoms prompting ED screening for CoVid-19. Exclusion criteria Known congestive heart failure or other chronic lung condition likely to cause excessive B lines on LUS. Intervention Structured blinded ultrasound review and chart review Analysis We used an exact hypothesis tests for binomial random variables. We also measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 62 met inclusion criteria. Vital signs were normal in 31 patients; 10 (32%) of these patients had LUS consistent with CoVid-19. We rejected the null hypothesis (p-value for bitest <0.001). The treating physicians' interpretation of their own point of care lung ultrasounds had a sensitivity of 100% (95% CI 75%, 100%) and specificity of 80% (95% CI 68%, 89%). Conclusion LUS has a meaningful detection rate for CoVid-19 in symptomatic emergency department patients with normal vital signs. We recommend at least LUS be used in addition to PCR testing when screening symptomatic ED patients for CoVid-19.

Value of troponin levels in the diagnosis of cardiac dysfunction in moderate scorpion envenomation

2017 ◽  
Vol 37 (6) ◽  
pp. 580-586 ◽  
Author(s):  
O Chakroun-Walha ◽  
R Karray ◽  
M Jerbi ◽  
A Ben Rebeh ◽  
C Jammeli ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Clinical Manifestations ◽  
Mean Value ◽  
Left Ventricular ◽  
Early Management ◽  
Scorpion Envenomation ◽  
T Wave ◽  
Life Threatening ◽  
Chest X Ray ◽  
Systemic Manifestations

Context: Cardiac dysfunction is one of the most serious consequences of scorpion envenomation. The best tool to evaluate cardiac function is echocardiography, but it is not available at all emergency departments. Many studies aimed to describe biological predictive factors of cardiac dysfunction in scorpion envenomation. Troponin is one of these biomarkers but its correlation with myocarditis is not well established. The aim of this study was to evaluate correlation between troponin levels and cardiac dysfunction in moderate scorpion envenomation. Methods: A retrospective monocentric study including patients admitted in the emergency department for moderate scorpion envenomation with troponin measurement during their early management. On arrival, an electrocardiogram and a chest X-ray were realized for all patients. Results: We enrolled 132 patients with a mean age at 31.3 ± 24.4 years and a 1.35 sex-ratio. All patients had moderate systemic manifestations. There were 28 patients with clinical manifestations of cardiac dysfunction without life-threatening troubles (21.2%). Troponin was undetectable in 69 patients (56%). The mean value of troponin level (pg/ml) was higher in patients with clinical manifestations of left ventricular dysfunction (1.80 ± 3.8 vs. 0.11 ± 0.5; p = 0.02). Troponin levels were significantly higher in patients with positive T wave on electrocardiogram. Conclusion: In patients with moderate scorpion envenomation with positive T wave, high values of troponin suggest the presence of cardiac dysfunction.

scholarly journals Familial homozygous hypercholesterolemia in children: early diagnosis and treatment

2021 ◽  
Vol 66 (4) ◽  
pp. 118-128
Author(s):  
I. V. Leontyeva
Keyword(s):  
Low Density Lipoprotein ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Density Lipoprotein ◽  
Vascular Lesions ◽  
Late Initiation ◽  
Life Threatening ◽  
Initiation Of Therapy ◽  
High Level ◽  
Familial Homozygous Hypercholesterolemia

Familial homozygous hypercholesterolemia is a rare life-threatening disease, the prevalence is 1: 160,000-1: 320,000. The main manifestation of the disease is an extremely high level of low-density lipoprotein cholesterol (more than 13 mmol / l), which causes early atherosclerotic vascular lesions, including coronary arteries, starting from the first decade of life, and can lead to myocardial infarction in childhood. Familial homozygous hypercholesterolemia remains a little-known disease in the clinical practice of the pediatrician; it leads to delayed diagnosis and late initiation of therapy. The most common cause of the disease is mutations in the LDLR (90%) gene, less often in the APOB (5–10%), PCSK9 (1%), LDLRAP1 (1%) genes. The article presents the criteria for the diagnosis of familial homozygous hypercholesterolemia in children. The authors discuss clinical manifestations on the skin and at the level of the cardiovascular system, eyes. They present the strategy of management and the possibilities of treating patients. The paper presents the indications for the appointment and the effectiveness of statins, ezetrol, monoclonal antibodies to PCSK9, apheresis for the treatment of the disease. It discusses prospects for further therapy.

Acute atraumatic peri-arrest tension gastrothorax presenting to the emergency department

2021 ◽  
Vol 14 (4) ◽  
pp. e240478
Author(s):  
James Phelan ◽  
Rengarajan Subramanian ◽  
Adeep Krishnan Kutty Menon
Keyword(s):  
Emergency Department ◽  
Sudden Onset ◽  
Haemodynamic Instability ◽  
Management Options ◽  
Rare Presentation ◽  
Shopping Centre ◽  
Mediastinal Shift ◽  
Portable Chest ◽  
Life Threatening ◽  
Tension Gastrothorax

A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Successful needle decompression followed by tube thoracostomy improved patient condition with no further complications. Surgical repair was performed but was delayed by COVID-19. This case provides a rare presentation of an acute life-threatening tension gastrothorax with difficult management considerations. A review of the management options is undertaken.

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