scholarly journals Amiodarone Induced Thyrotoxicosis in the Setting of End Stage Cardiomyopathy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A919-A920
Author(s):  
Karolina Anderson ◽  
Howard B A Baum
Keyword(s):  
Medical Management ◽  
Systolic Heart Failure ◽  
The United States ◽  
Medical Intervention ◽  
Cardiac Resynchronization ◽  
Type I ◽  
Amiodarone Therapy ◽  
Type Ii ◽  
Class Iii ◽  
20Mg Daily

Abstract Amiodarone is a class III antiarrhythmic agent which has effects of myocardial depolarization and repolarization. Due to its many side effects including thyroid dysfunction, its use is limited to life-threatening arrhythmias. The thyrotoxicosis can be from the iodine content of amiodarone or its direct toxicity on the thyroid gland. Because of the long half-life, causing amiodarone to have effects for months, medical management can be challenging, and thyroidectomy may be indicated. This is a 76-year-old man with a history of systolic heart failure with reduced ejection fraction (15%), on milrinone after cardiac resynchronization therapy, and recurrent ventricular tachycardia on amiodarone. He was admitted after his ICD device fired. During initial admission, his TSH was <0.015mcunit/mL and FT4 was 2.34ng/dL. Due to concern for amiodarone induced thyrotoxicosis (AIT), he was started on methimazole, prednisone, and cholestyramine. FT4 decreased from 2.34ng/dL to 2.23ng/dL and he discharged on methimazole 30mg daily and prednisone 20mg daily with plans to taper. He was seen outpatient with continued improvement in his FT4 to 2.09ng/dL. He was then seen again and found to have a rising FT4 to 2.22ng/dL and his regimen of prednisone was reinitiated at 10mg daily and methimazole increased to 40mg daily. Despite the medication changes, he continued to have an elevation in his FT4 up to 3.00ng/dL at which point he returned to the hospital for further evaluation and was given methimazole 60mg TID, prednisone 20mg daily, and restarted cholestyramine. With his significant cardiovascular risk, aggressive medical management was attempted prior to surgical evaluation. After his thyroid function failed to respond to medical intervention, multidisciplinary discussion was had with patient, family, and physician teams regarding surgical intervention versus continued long-term monitoring. Family elected to pursue surgery. Thyroidectomy was performed by an experienced endocrine surgeon successfully and his FT4 and T3 decreased appropriately requiring him to be initiated on levothyroxine supplementation. AIT can be separated into Type I, in which there is an increase in synthesis of T4 and T3 with amiodarone providing increasing substrate, and Type II in which there is destructive thyroiditis, releasing excess T4 and T3. In the United States, approximately 5% of individuals who are on amiodarone therapy develop hyperthyroidism, majority being Type II. If possible, amiodarone should be discontinued in Type I AIT, but there is no clear evidence for discontinuation in Type II. Medical management includes thionamides for Type I AIT and glucocorticoids for Type II AIT. Patients who are refractory to drug therapy should be treated with thyroidectomy. The advantages of a surgical procedure with careful cardiovascular monitoring overall outweigh the morbidity and mortality of uncontrolled thyrotoxicosis.

scholarly journals Comparative Genetic Analysis of Magnaporthe oryzae Isolates Causing Gray Leaf Spot of Perennial Ryegrass Turf in the United States and Japan

Plant Disease ◽  
2007 ◽  
Vol 91 (5) ◽  
pp. 517-524 ◽  
Author(s):  
Y. Tosa ◽  
W. Uddin ◽  
G. Viji ◽  
S. Kang ◽  
S. Mayama
Keyword(s):  
United States ◽  
Perennial Ryegrass ◽  
Magnaporthe Oryzae ◽  
Leaf Spot ◽  
Genetic Relationships ◽  
The United States ◽  
Gray Leaf Spot ◽  
Genetic Lineage ◽  
Type I ◽  
Type Ii

Gray leaf spot caused by Magnaporthe oryzae is a serious disease of perennial ryegrass (Lolium perenne) turf in golf course fairways in the United States and Japan. Genetic relationships among M. oryzae isolates from perennial ryegrass (prg) isolates within and between the two countries were examined using the repetitive DNA elements MGR586, Pot2, and MAGGY as DNA fingerprinting probes. In all, 82 isolates of M. oryzae, including 57 prg isolates from the United States collected from 1995 to 2001, 1 annual ryegrass (Lolium multiflorum) isolate from the United States collected in 1972, and 24 prg isolates from Japan collected from 1996 to 1999 were analyzed in this study. Hybridization with the MGR586 probe resulted in approximately 30 DNA fragments in 75 isolates (designated major MGR586 group) and less than 15 fragments in the remaining 7 isolates (designated minor MGR586 group). Both groups were represented among the 24 isolates from Japan. All isolates from the United States, with the exception of one isolate from Maryland, belonged to the major MGR586 group. Some isolates from Japan exhibited MGR586 fingerprints that were identical to several isolates collected in Pennsylvania. Similarly, fingerprinting analysis with the Pot2 probe also indicated the presence of two distinct groups: isolates in the major MGR586 group showed fingerprinting profiles comprising 20 to 25 bands, whereas the isolates in the minor MGR586 group had less than 10 fragments. When MAGGY was used as a probe, two distinct fingerprint types, one exhibiting more than 30 hybridizing bands (type I) and the other with only 2 to 4 bands (type II), were identified. Although isolates of both types were present in the major MGR586 group, only the type II isolates were identified in the minor MGR586 group. The parsimony tree obtained from combined MGR586 and Pot2 data showed that 71 of the 82 isolates belonged to a single lineage, 5 isolates formed four different lineages, and the remaining 6 (from Japan) formed a separate lineage. This study indicates that the predominant groups of M. oryzae associated with the recent outbreaks of gray leaf spot in Japan and the United States belong to the same genetic lineage.

Metabolic Syndrome in Patients with Bipolar Disorders (BD): Findings from the BIMET study

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. González-Pinto ◽  
E. Vieta ◽  
J.M. Montes ◽  
J. Rejas-Gutiérrez ◽  
F. Mesa
Keyword(s):  
Metabolic Syndrome ◽  
Ldl Cholesterol ◽  
Bipolar Disorders ◽  
Blood Levels ◽  
Type I ◽  
Type Ii ◽  
Class Iii ◽  
Obesity Class ◽  
Routine Medical Practice ◽  
Dsm Iv

Purpose:To evaluate the 12-months prospective evolution of metabolic and cardiovascular risk factors in patients with types I or II Bipolar Disorder (BD) in Spain.Methods:The BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled patients with type I or II BD according to DSM-IV TR criteria. Fasting blood levels of glucose, total, HDL, LDL cholesterol and triglycerides as well as weight, height, waist circumference and blood pressure were recorded. The National Cholesterol Educational Program (NCEP)-ATP III definition was applied to consider presence of metabolic syndrome (MS).Results:A total of 524 patients were enrolled; 73% type I and 27% type II. 61.9% women, mean age 46.3 years. 28.4% of subjects work regularly. Smokers were 42.2%, 15.1% had a substance abuse history, 34.2% were obese according with WHO criteria (obesity class I; 23.2%, class II; 7.5%, and class III; 3.5%) and overweight was found in 37.4% of sample. Prevalence of diabetes was 7.3%, hypertension was present in 24.7%, 18.5% had cholesterol ≥240 mg/dL and 36.2% had triglycerides ≥150 mg/dL. Overall prevalence of MS was 27.0% (95% CI: 22.7%-31.3%), with 27.3% (22.2%-32.3%) in type I BD and 27.1% (19.0%-36.6%) in type II (p=0.973).Conclusions:The prevalence of metabolic syndrome in type I / II BD patients was considerably higher than in the general population. As an excess of mortality due to metabolic and cardiovascular reasons pointed out in these patients, it is recommended a close clinical monitoring of such parameters in the routine medical practice.

Decompression Sickness Damaging the Spinal Cord in a Scuba Diver: Case Report

1987 ◽  
Vol 3 (2) ◽  
pp. 41-45
Author(s):  
B.G. Mathew
Keyword(s):  
Spinal Cord ◽  
Decompression Sickness ◽  
The United States ◽  
Neurological Involvement ◽  
Detailed Knowledge ◽  
Type I ◽  
Type Ii ◽  
Pulmonary Barotrauma ◽  
Emergency Personnel ◽  
Diving Accidents

Scuba diving has become a popular sport resulting in an increased incidence of diving accidents. A survey done by the United States Navy from 1955 to 1960 revealed that decompression sickness (D.C.S.) is the most common serious complication experienced by scuba divers and the third most likely cause of death. The major cause is drowning and the second is arterial gas embolism from pulmonary barotrauma.D.C.S. has been classified into two groups. Type I includes the less severe forms with bubbles in the skin (“itches”), joints and other tissues. Type II includes the serious conditions with neurological involvement “staggers.” A detailed knowledge of D.C.S., commonly known as “the bends,” is essential to both divers and emergency personnel in order to minimize the morbidity and mortality associated with this condition.A case of Type II bends with spinal cord damage is presented and the condition discussed.

Genotyping Dickeya dianthicola causing potato blackleg and soft rot outbreak associated with inoculum geography in the United States

Plant Disease ◽  
2020 ◽  
Author(s):  
Tongling Ge ◽  
He Jiang ◽  
Steven B Johnson ◽  
Robert Larkin ◽  
Amy O Charkowski ◽  
...  
Keyword(s):  
United States ◽  
Bacterial Pathogen ◽  
Soft Rot ◽  
The United States ◽  
Lower Percentage ◽  
Economic Losses ◽  
Type I ◽  
Type Ii ◽  
Northeastern United States ◽  
Type Iii

An outbreak of blackleg and soft rot of potato, caused primarily by the bacterial pathogen Dickeya dianthicola, has resulted in significant economic losses in the Northeastern United States since 2015. The spread of this seedborne disease is highly associated with seed distribution, therefore the pathogen likely spread with seed tubers. To describe the blackleg epidemic and track inoculum origins, a total of 1183 potato samples were collected from 11 states associated with blackleg outbreak from 2015 to 2019. Of these samples, 39.8% tested positive for D. dianthicola. Seventeen isolates of Dickeya dianthicola were recovered from these samples and the genetic diversity of these isolates was examined. Fingerprinting with BOX-PCR and phylogenetic analysis based on sequences of the 16S rRNA and gapA genes indicated that D. dianthicola isolates were divided into three genotypes, denoted Type I, II, and III. Ninety five percent of samples from Maine were Type I. Type II was found in Maine only in 2015 and 2018. Type II was present throughout the five years in some states at a lower percentage than Type I. Type III was found in Pennsylvania, New Jersey and Massachusetts, but not in Maine. Therefore, Type I appears to be associated with Maine, but Type II appeared to be endemic to the Northeastern United States. The Type II and rarer Type III strain were closer to the D. dianthicola type strain isolated from the United Kingdom. This work provides evidence that the outbreak of blackleg of potato in the Northeastern United States was caused by multiple strains of D. dianthicola. The geographic origins of these strains remain unknown.

scholarly journals Evidence-based analysis of odontoid fracture management

2000 ◽  
Vol 8 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Terrence D. Julien ◽  
Bruce Frankel ◽  
Vincent C. Traynelis ◽  
Timothy C. Ryken
Keyword(s):  
Selection Criteria ◽  
Odontoid Fracture ◽  
Evidence Based ◽  
Type I ◽  
Type Ii ◽  
Fracture Type ◽  
Class Iii ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Fracture Management

Object The management of odontoid fractures remains controversial. Evidence-based methodology was used to review the published data on odontoid fracture management to determine the state of the current practices reported in the literature. Methods The Medline literature (1966–1999) was searched using the keywords “odontoid,” “odontoid fracture,” and “cervical fracture” and graded using a four-tiered system. Those articles meeting selection criteria were divided in an attempt to formulate practice guidelines and standards or options for each fracture type. Evidentiary tables were constructed by treatment type. Ninety-five articles were reviewed. Five articles for Type I, 16 for Type II, and 14 for Type III odontoid fractures met selection criteria. All studies reviewed contained Class III data (American Medical Association data classification). Conclusions There is insufficient evidence to establish a standard or guideline for odontoid fracture management. Given the extent of Class III evidence and outcomes reported on Type I and Type III fractures, a well-designed case-controlled study would appear to provide sufficient evidence to establish a practice guideline, suggesting that cervical immobilization for 6 to 8 weeks is appropriate management. In cases of Type II fracture, analysis of the Class III evidence suggests that both operative and nonoperative management remain treatment options. A randomized trial or serial case-controlled studies will be required to establish either a guideline or treatment standard for this fracture type.

scholarly journals Crystal structure of the ferredoxin reductase component of carbazole 1,9a-dioxygenase from Janthinobacterium sp. J3

2021 ◽  
Vol 77 (7) ◽  
Author(s):  
Yuji Ashikawa ◽  
Zui Fujimoto ◽  
Kengo Inoue ◽  
Hisakazu Yamane ◽  
Hideaki Nojiri
Keyword(s):  
Crystal Structure ◽  
Electron Transfer ◽  
Conformational Changes ◽  
Docking Simulation ◽  
Type I ◽  
Type Ii ◽  
Class Iii ◽  
Docking Simulations ◽  
Ferredoxin Reductase ◽  
C Terminus

Carbazole 1,9a-dioxygenase (CARDO), which consists of an oxygenase component and the electron-transport components ferredoxin (CARDO-F) and ferredoxin reductase (CARDO-R), is a Rieske nonheme iron oxygenase (RO). ROs are classified into five subclasses (IA, IB, IIA, IIB and III) based on their number of constituents and the nature of their redox centres. In this study, two types of crystal structure (type I and type II) were resolved of the class III CARDO-R from Janthinobacterium sp. J3 (CARDO-RJ3). Superimposition of the type I and type II structures revealed the absence of flavin adenine dinucleotide (FAD) in the type II structure along with significant conformational changes to the FAD-binding domain and the C-terminus, including movements to fill the space in which FAD had been located. Docking simulation of NADH into the FAD-bound form of CARDO-RJ3 suggested that shifts of the residues at the C-terminus caused the nicotinamide moiety to approach the N5 atom of FAD, which might facilitate electron transfer between the redox centres. Differences in domain arrangement were found compared with RO reductases from the ferredoxin–NADP reductase family, suggesting that these differences correspond to differences in the structures of their redox partners ferredoxin and terminal oxygenase. The results of docking simulations with the redox partner class III CARDO-F from Pseudomonas resinovorans CA10 suggested that complex formation suitable for efficient electron transfer is stabilized by electrostatic attraction and complementary shapes of the interacting regions.

scholarly journals Amiodarone Induced Thyrotoxicosis: A Case of Refractory Disease Treated With Thyroidectomy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A920-A920
Author(s):  
Malek Mushref ◽  
Kathrin Sandra Tofil ◽  
Kathie Lynn Hermayer
Keyword(s):  
Heart Failure ◽  
Mixed Type ◽  
Calcium Supplementation ◽  
The United States ◽  
High Dose ◽  
Thyroid Autoantibodies ◽  
Type I ◽  
Thyroid Function Tests ◽  
Type Ii ◽  
Thyroid Ultrasound

Abstract Amiodarone induced thyrotoxicosis (AIT) is a challenging diagnosis that affects 3-5% of patients taking amiodarone in the United States. Type I AIT is seen in patients with preexisting thyroid disease and is generally treated with thionamides while type II AIT represents a destructive thyroiditis that responds to glucocorticoids. A mixed type exists and is associated with higher mortality, especially in older adults with cardiovascular disease. Thyroidectomy is considered a last resort option for patients intolerant or refractory to medical treatment. A 70 year-old male with a history of coronary artery disease, ventricular tachycardia (VT), and heart failure was referred to the endocrine clinic for abnormal thyroid function tests that showed TSH <0.0023 uIU/mL (0.4-4.7), Free T4 2.51 ng/dL (0.7-1.48) and Free T3 5.37 pg/mL (1.71-3.71). He endorsed palpitations, excessive sweating, tremors, and reported taking amiodarone for 3 years prior to presentation. Vitals showed normal pulse and blood pressure. Thyroid autoantibodies including TSI and TBII were within normal limits. Thyroid ultrasound showed mild thyromegaly with normal vascularity and no nodules. AIT was suspected and he was started on methimazole 20 mg daily, prednisone 30 mg daily and continued on his home metoprolol 100 mg daily. Methimazole and prednisone were both up titrated in a week because his labs did not improve. One month later, he presented to the hospital with acute exacerbation of heart failure. His TFTs showed (TSH <0.0021 uIU/mL, FT4 >5.0 ng/dL, FT3 4.61 pg/mL). Thyroid RAIU showed severely decreased uptake secondary to the high iodine content of amiodarone. He remained thyrotoxic despite using higher doses of prednisone (60 mg daily) and methimazole (90 mg daily). He was changed to PTU (900 mg daily) and started on cholestyramine, with no improvement in overall status. Several weeks after admission, a total thyroidectomy was performed. His postoperative course was unremarkable except for hypoparathyroidism. He was clinically and biochemically euthyroid one week after his procedure. At 6 months follow up, he remained stable on levothyroxine 100 mcg/day but continued to require calcitriol and calcium supplementation. We present an interesting case of mixed type AIT refractory to medical therapy associated with cardiovascular compromise. This case highlights the challenges in the diagnosis and management of such patients. Thyroid autoantibodies, thyroid ultrasound and RAIU were more indicative of Type II AIT, however, lack of response to high dose steroids was inconsistent with the diagnosis. While receiving the treatment for both Type I and II AIT, our patient had persistent clinical and biochemical thyrotoxicosis and required thyroidectomy. Although most AIT patients are treated medically, thyroidectomy is reserved for those most severe and refractory cases and is considered a viable option in such patients.

scholarly journals Predictability and KSR's Fundamental Change to Nonobviousness in Patent Law

2017 ◽  
Author(s):  
Christopher A Cotropia
Keyword(s):  
Hindsight Bias ◽  
The United States ◽  
Patent Law ◽  
Type I ◽  
Type Ii ◽  
Flexible Approach ◽  
Prior Art ◽  
Lower Courts ◽  
Basic Patent ◽  
Predictability Analysis

In KSR International Co. v. Teleflex, Inc., the Supreme Court addressed the doctrine of nonobviousness, the ultimate question of patentability, for the first time in thirty years. In mandating a flexible approach to deciding nonobviousness, the KSR opinion introduced two predictability standards for determining nonobviousness. The Court described predictability of use (hereinafter termed "Type I predictability" )-whether the inventor used the prior art in a predictable manner to create the invention-and predictability of the result (hereinafter termed "Type II predictability")-whether the invention produced a predictable result-both as a means for proving obviousness. Although Type I predictability is easily explained as part of the flexible approach endorsed by KSR, Type II predictability represents a potentially radical shift in the nonobviousness doctrine. Instead of focusing on whether reasons already existed to create the invention, like Type I predictability does, a Type II predictability analysis takes the invention's creation as a given and examines instead the invention's operation. Type II predictability moves the analysis away from the gap between the prior art and the invention to the invention only. The United States Patent and Trademark Office ("USPTO"), the Federal Circuit, and lower courts are using Type II predictability fairly extensively after KSR. The problem with this usage is that Type II predictability runs counter to statutory language, introduces hindsight bias, discriminates against certain technologies, and conflicts with basic patent theory. Accordingly, the USPTO and courts need to reconsider the use of Type II predictability and their interpretation of KSR.

scholarly journals Sequence Variation in the ftsZ Gene ofBartonella henselae Isolates and Clinical Samples

2000 ◽  
Vol 38 (2) ◽  
pp. 682-687 ◽  
Author(s):  
C. Ehrenborg ◽  
L. Wesslén ◽  
Å. Jakobson ◽  
G. Friman ◽  
M. Holmberg
Keyword(s):  
16S Rrna ◽  
Sequence Variation ◽  
Gene Sequence ◽  
Bartonella Henselae ◽  
The United States ◽  
Clinical Samples ◽  
Type I ◽  
Type Ii ◽  
Gene Variation ◽  
Nucleotide Sequence Variation

In a search for methods for subtyping of Bartonella henselae in clinical samples, we amplified and sequenced a 701-bp region in the 3′ end of the ftsZ gene in 15 B. henselae isolates derived from cats and humans in the United States and Europe. The ftsZ sequence variants that were discovered were designated variants Bh ftsZ 1, 2, and 3 and were compared with 16S rRNA genotypes I and II of the same isolates. There was no ftsZ gene variation in the strains of 16S rRNA type I, all of which were Bh ftsZ 1. The type II strains constituted two groups, with nucleotide sequence variation in theftsZ gene resulting in amino acid substitutions at three positions, one of which was shared by the two groups. One 16S rRNA type II isolate had an ftsZ gene sequence identical to those of the type I strains. Variants Bh ftsZ 1 and 2 were detected in tissue specimens from seven Swedish patients with diagnoses such as chronic multifocal osteomyelitis, cardiomyopathy, and lymphadenopathy. Patients with similar clinical entities displayed either BhftsZ variant. The etiological role of B. henselae in these patients was supported by positiveBartonella antibody titers and/or amplification and sequencing of a part of the B. henselae gltA gene. B. henselae ftsZ gene sequence variation may be useful in providing knowledge about the epidemiology of various B. henselaestrains in clinical samples, especially when isolation attempts have failed. This report also describes manifestations of atypicalBartonella infections in Sweden.

scholarly journals erbB2Overexpression in Uterine Serous Cancer: A Molecular Target for Trastuzumab Therapy

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Karim S. ElSahwi ◽  
Alessandro D. Santin
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Case Reports ◽  
Uterine Cancer ◽  
Female Genital Tract ◽  
The United States ◽  
Type I ◽  
Type Ii ◽  
Erbb2 Overexpression

Endometrial cancer is the most common female genital tract malignancy in the United States. Type I endometrial cancer is usually diagnosed at an early stage, and has a good prognosis. Type II is very aggressive, and is responsible for most uterine cancer relapses and deaths. Uterine serous adenocarcinomas (USC) constitute the majority of Type II variants. They have a higher propensity for lymph node and distant metastases. They are frequently aneuploid and associated with p53 mutations. erbB2 overexpression in USC has been described. The incidence, which is higher in African Americans, ranges from 18–80%. erbB2 overexpression was found to be associated with higher stage, chemoresistance, and worse survival. Trastuzumab a humanized mAb was approved by the FDA for treatment of breast cancers that overexpress erbB2 in combination with standard chemotherapy. Evidence of trastuzumab activity in USC has been reported in vitro, as well as in case reports of advanced and recurrent cases. Promising results were obtained in these heavily pretreated patients either with trastuzumab alone or in combination with chemotherapy. This supports the hypothesis that trastuzumab may very well be an attractive and viable treatment option for advanced stage USC tumors that overexpress the erbB2, and is worthy of further study.

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