Acute Isoniazid Neurotoxicity in an Urban Hospital

In the May issue of Pediatrics, Dr Shah and collaborators pointed out an increased incidence of isoniazid (INH) neurotoxicity.1 At the Children's University Hospital in Tuzla, Bosnia, and Herzegovina, four patients (age range, 6 to 9 years) were admitted for INH neurotoxicity in a 15-month period.2 None of them had liver dysfunction or metabolic disturbance, such as acidosis or hyperglycemia. All intoxications were accidental. Patients responded well to high doses of intravenous pyridoxine, including two with seizures and coma that had been unresponsive to treatment with phenobarbital and diazepam, respectively, before admission.

Download Full-text

Effective Treatment of Neurological Symptoms with Normal Doses of Botulinum Neurotoxin in Wilson’s Disease: Six Cases and Literature Review

Toxins ◽

10.3390/toxins13040241 ◽

2021 ◽

Vol 13 (4) ◽

pp. 241

Author(s):

Harald Hefter ◽

Sara Samadzadeh

Keyword(s):

Botulinum Neurotoxin ◽

Wilson’S Disease ◽

Animal Experiments ◽

Symptomatic Treatment ◽

Wilson's Disease ◽

University Hospital ◽

Laboratory Findings ◽

Dose Information ◽

High Doses ◽

The University

Background: Recent cell-based and animal experiments have demonstrated an effective reduction in botulinum neurotoxin A (BoNT/A) by copper. Aim: We aimed to analyze whether the successful symptomatic BoNT/A treatment of patients with Wilson’s disease (WD) corresponds with unusually high doses per session. Methods: Among the 156 WD patients regularly seen at the outpatient department of the university hospital in Düsseldorf (Germany), only 6 patients had been treated with BoNT/A during the past 5 years. The laboratory findings, indications for BoNT treatment, preparations, and doses per session were extracted retrospectively from the charts. These parameters were compared with those of 13 other patients described in the literature. Results: BoNT/A injection therapy is a rare (<4%) symptomatic treatment in WD, only necessary in exceptional cases, and is often applied only transiently. In those cases for which dose information was available, the dose per session and indication appear to be within usual limits. Conclusion: Despite the evidence that copper can interfere with the botulinum toxin in preclinical models, patients with WD do not require higher doses of the toxin than other patients with dystonia.

Download Full-text

Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

Annals of Intensive Care ◽

10.1186/s13613-021-00835-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kevin Roedl ◽

Dominik Jarczak ◽

Andreas Drolz ◽

Dominic Wichmann ◽

Olaf Boenisch ◽

...

Keyword(s):

Critically Ill ◽

Liver Dysfunction ◽

Critically Ill Patients ◽

Severity Of Illness ◽

University Hospital ◽

Severe Liver ◽

Saps Ii ◽

Severe Liver Dysfunction ◽

Global Threat ◽

The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

Download Full-text

Severity of traumatic events in patients with eating disorders. A case-control study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.332 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S165-S166

Author(s):

A.M. Pignatelli ◽

C. Loriedo ◽

M. Biondi ◽

P. Girardi ◽

J. Vanderlinden ◽

...

Keyword(s):

Eating Disorders ◽

Childhood Abuse ◽

Emotional Abuse ◽

Traumatic Events ◽

University Hospital ◽

Traumatic Experiences ◽

Emotional Neglect ◽

Psychiatric Outpatient Clinic ◽

Competing Interest ◽

Age Range

IntroductionA high proportion of individuals with eating disorders (EDs) report childhood abuse and neglect. The prevalence of traumatic events in ED patients has been extensively investigated; less is known about their self-perceived–and reported–severity. Objectives/Aims: We aimed to assess in ED patients vs. healthy controls the severity, i.e., duration, perpetrator, and subjective impact, of sexual, physical, and emotional traumas suffered from 0 to 18 years, paying particular attention to emotional neglect.MethodsFifty-seven consecutive DSM-V ED patients (91.2% females; age range: 18–42 years) were recruited at the Psychiatric Outpatient Clinic of our University Hospital. Ninety controls (78.9% females; age range: 20–39 years) were also recruited. Among ED patients, 43.9% had restrictive anorexia nervosa (AN), 29.8% binge/purging AN, 26.3% bulimia nervosa. Individuals completed the Eating Disorder Inventory-2 (EDI-2) and the Traumatic Experiences Checklist (TEC).ResultsThe severity of all traumatic events, according to the TEC total score, was significantly higher in ED patients than controls (P < 0.001). Moreover, ED patients showed significantly higher scores with regard to emotional neglect (P < 0.001) and emotional abuse (P < 0.001). The same can be said for physical traumas (P < 0.01) and physical abuse (P < 0.01), although with a lower significance, and for sexual abuse (P < 0.05), with an even lower significance. No difference in the severity of sexual harassment was found.ConclusionsAll types of traumas, especially neglect, can occur in ED patients and controls, however they are reported as more severe by ED patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Journal of Anesthesia ◽

10.1007/s00540-021-02960-6 ◽

2021 ◽

Author(s):

Azzeddine Kermad ◽

Jacques Speltz ◽

Guy Danziger ◽

Thilo Mertke ◽

Robert Bals ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Retrospective Study ◽

Linear Regression ◽

Chart Review ◽

Distress Syndrome ◽

Minute Ventilation ◽

Retrospective Chart Review ◽

University Hospital ◽

High Doses ◽

End Tidal

Abstract Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.

Download Full-text

Risk Factors for Post-Thrombotic Syndrome in Patients With a First Proximal Deep Venous Thrombosis Treated With Direct Oral Anticoagulants

Angiology ◽

10.1177/00033197211070889 ◽

2022 ◽

pp. 000331972110708

Author(s):

Luca Spiezia ◽

Elena Campello ◽

Chiara Simion ◽

Anna Poretto ◽

Fabio Dalla Valle ◽

...

Keyword(s):

Risk Factors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

University Hospital ◽

First Episode ◽

Minimum Period ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Age Range ◽

Deep Vein

The incidence of post-thrombotic syndrome (PTS) in patients with deep vein thrombosis (DVT) treated with direct oral anticoagulants (DOACs) remains a matter of debate. Hence, our endeavor to investigate a large cohort of patients with a first episode of proximal DVT treated with DOACs to ascertain the incidence and predisposing risk factors for PTS. All consecutive patients referred to the Thrombotic and Haemorrhagic Diseases Unit of Padova University Hospital (Italy) between January 2014 and January 2018 for a first episode of proximal DVT were considered for enrollment. Participants received DOACs for a minimum period of 3 months. PTS was assessed using the Villalta score up to 36 months after DVT diagnosis. Among 769 enrolled patients (M/F 353/416, age range 26–87 years), 152 (19.8%) developed PTS and 30 (3.9%) developed severe PTS. The adjusted hazard ratio was significant for obesity (1.64, 95% CI 1.28–2.39) and DVT site (femoral and/or iliac veins vs popliteal vein) (1.23, 95% CI 1.15–3.00). The incidence of PTS is not negligible in patients with proximal DVT despite the use of DOACs. We identified obesity and iliofemoral DVT as possible risk factors for PTS. Larger prospective studies are needed to confirm our findings and optimize therapeutic strategies.

Download Full-text

Acute Isoniazid Neurotoxicity in an Urban Hospital

PEDIATRICS ◽

10.1542/peds.95.5.700 ◽

1995 ◽

Vol 95 (5) ◽

pp. 700-704

Author(s):

Binita R. Shah ◽

Karen Santucci ◽

Richard Sinert ◽

Phillip Steiner

Keyword(s):

New York ◽

Case Series ◽

Pediatric Emergency ◽

Tuberculous Infection ◽

Urban Hospital ◽

Average Delay ◽

Number Of Children ◽

Refractory Seizures ◽

Age Range ◽

Increasing Trends

Objectives. To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital. Design. Case series. Participants. Seven patients (eight patient visits) with an age range of 5 days to 14.9 years. Results. At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made. Intervention. Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine. Conclusions. We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.

Download Full-text

Impact of epileptic patient's knowledge level on their quality of life

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n2p31 ◽

2018 ◽

Vol 9 (2) ◽

pp. 31

Author(s):

Sahar A. Abd-El Mohsen ◽

Nagwa M. Ahmed

Keyword(s):

Quality Of Life ◽

Management Program ◽

University Hospital ◽

Patient Interview ◽

Knowledge Questionnaire ◽

Hospital Patients ◽

Patients With Epilepsy ◽

Age Range ◽

The Impact

Background and objective: Inadequate epileptic patient’s knowledge regarding their disorder may affect the quality of their life. The aim of the study was to determine the impact of epileptic patient’s knowledge on the quality of their life.Methods: Research design: a descriptive study was conducted in the period from February to April 2017 to determine the impact of epileptic patient's knowledge on the quality of their life. Setting; this study was carried out in the neurology department and neurology outpatient clinic of Assiut Neurology University Hospital. Patients; a sample of sixty epileptic male and female patients, with an age range between 18 to 65 years was included. Two tools were used: Tool I: Structured patient interview questionnaire sheet and it included two parts: Part one: Sociodemographic data about of the studied patients, Part two: knowledge assessment regarding their disorder using Epilepsy Patient Knowledge Questionnaire (EPKQ). Tool II: Quality of Life in Epilepsy (QOLIE 31).Results: The highest percentage of the studied sample was male, married, their mean age was 38.97 ± 11.21, and their duration of epilepsy was 16.82 ± 9.7. 58.3% were having satisfactory level of knowledge regarding their condition.Conclusions and recommendation: The present study concluded that: epileptic patients are lacking knowledge regarding their condition (58.3% vs. 41.7%). There was No significant correlation between total QOL and score of knowledge. Recommendation: A self-management program is needed for patients with epilepsy in order to improve their knowledge regarding their disease.

Download Full-text

PS01.171: DOUBLE-PEDICLED FREE JEJUNAL TRANSFER FOR RECONSTRUCTION OF PHARYNGOLARYNGOESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.171 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 97-99

Author(s):

Hiromi Mukaide ◽

Taku Michiura ◽

Kentaro Inoue ◽

Hirokazu Miki ◽

Keigo Yamamichi ◽

...

Keyword(s):

Anastomotic Leakage ◽

Conflicts Of Interest ◽

University Hospital ◽

Perioperative Outcomes ◽

Arteriovenous Anastomoses ◽

Vascular Thrombosis ◽

Transfer Group ◽

Free Jejunal Transfer ◽

Medical University ◽

Age Range

Abstract Background We recently selected double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy to reduce the vascular thrombosis-induced necrosis in free jejunal transfer. We herein report our experience with this procedure. Methods Single-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy was performed from January 2006 to November 2013, and double-pedicled free jejunal transfer (i.e. two pairs of jejunal arteriovenous anastomoses) was performed from December 2013 to December 2016 in Kansai Medical University Hospital. We compared the perioperative outcomes and complications between these two procedures. Results Sixty-two patients (58 men, 4 women; median age, 66 years; age range, 51–83 years) underwent single-pedicled free jejunal transfer. Twenty-eight patients (25 men, 3 women; median age, 70 years; age range, 47–84 years) underwent double-pedicled free jejunal transfer. Twenty-eight patients received preoperative treatments. Table 1 shows the perioperative outcomes and complications. Conclusion No thrombus of the free jejunum occurred, no anastomotic leakage occurred, and all flaps survived in the double-pedicled free jejunal transfer group. We believe that double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy is a reliable and useful procedure. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Surgical outcome of multiple intracranial aneurysms

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1092 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Mubashir Ahmed ◽

Anjum Habib Vohra

Keyword(s):

Surgical Outcome ◽

Glasgow Outcome Scale ◽

Intracranial Aneurysms ◽

Clinical Presentation ◽

Metabolic Disturbance ◽

Ruptured Aneurysm ◽

Multiple Intracranial Aneurysms ◽

Good Outcome ◽

Ct Brain ◽

Age Range

Multiple intracranial aneurysms are relatively uncommon among patients of intracranial aneurysms. The aim of management has traditionally been the same i.e. clipping of all the aneurysms to eliminate the risk of rebleed. This study was conducted to determine the outcome of patients of multiple intracranial aneurysms at Mayo Hospital Lahore, Pakistan. The study period was from September 1999 to January 2002. Four patients were diagnosed having multiple intracranial aneurysms. Age range was 40 to 65 years and 2 (50%) patients were female. Patients were assessed according to Hunt & Hess grade. Clinical presentation was favoring the site of ruptured aneurysm in one patient and CT brain was suggestive of site in two patients. All patients had 2 aneurysms. In three (75%) cases, aneurysm were unilateral and in one (25%) case, bilateral. Half (50%) patients had clipping of aneurysms through single craniotomy and half (50%) had bilateral craniotomies. Outcome was graded according to Glasgow Outcome Scale. Three (7 5%) patients had good outcome and one (25%) patient died after clipping of aneurysms due to vasospasm, infarction and metabolic disturbance.

Download Full-text

Follow Up of COVID-19 Features in Recovered Adults without Comorbidities– Persistent Symptoms and Lab-Abnormalities

10.21203/rs.3.rs-116030/v1 ◽

2020 ◽

Author(s):

Julian Varghese ◽

Sarah Sandmann ◽

Richard Vollenberg ◽

Kevin Ochs ◽

Inga Schrempf ◽

...

Keyword(s):

University Hospital ◽

Persistent Symptoms ◽

Plasma Donation ◽

Serum Iga ◽

Significant Difference ◽

Follow Up Care ◽

Follow Up Studies ◽

Age Range ◽

Positive Effect

Abstract Background: With increasing numbers of patients recovering from COVID-19, there is increasing evidence for persisting symptoms and the need for follow-up studies. Methods: This retrospective study included patients without comorbidities, who recovered from COVID-19 and attended an outpatient clinic at a university hospital for follow-up care and potential convalescent plasma donation. Network analysis was applied to visualize symptom combinations and persistent symptoms. Comprehensive lab-testing was ascertained at each follow-up to analyze differences regarding patients with vs without persistent symptoms. Results: 116 patients were included, age range was 18-69 years (median: 41) with follow-ups ranging from 22 to 102 days. The three most frequent persisting symptoms were Fatigue (54%), Dyspnea (29%) and Anosmia (25%). Lymphopenia was present in 13 of 112 (12%) cases. Five of 35 cases (14%) had Lymphopenia in the later follow-up range of 80-102 days. Serum IgA concentration was the only lab parameter with significant difference between patients with vs without persistent symptoms with reduced serum IgA concentrations in the patient cohort of persisting symptoms (p=0.0219). Conclusion: Lymphopenia persisted in a noticeable percentage of recovered patients. Moreover, higher serum IgA concentration is associated with a positive effect regarding symptom persistence.

Download Full-text