N-Acetylcysteine Overdose: A Case Report

Background: N-Acetylcysteine (NAC) is a cost-effective antioxidant and very useful treatment for several diseases. Methods: Here we report a rare case of iatrogenic NAC overdose following the mistake in calculation of the loading dose. Results: The patient was 14 years old girl referred to a local hospital due to history of intentional ingesting about 7grams acetaminophen. The physician prescribed her 6 grams NAC as a loading dose but 42grams NAC were infused by mistake. After infusion, the patient showed signs of anaphylactic shock and then transferred to Imam Reza toxicology-unite with weakness, lethargy, extreme fatigue, nausea, and dizziness. NAC overdosing, in a short period of time, led to coagulopathy, reduced platelet count, acute renal failure and metabolic acidosis. After 24 h, the patient died. The Medical forensic examination showed minor lung hemorrhage and presence of little amount of Aluminum phosphide in tissues they did not find no vital organ hemorrhage. It is unclear related to NAC overdose, phosphine intoxication or synergic effects. Conclusion: Massive transfusion of NAC was associated with impairment of coagulation factors, intracranial hypertension, renal failure and metabolic acidosis. Thus, NAC administration should be with caution. The medical history of patients committed suicide are not always accurate and complete evaluation are recommended.

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Natural Oestrogen in the Female Climacteric - Influence on Blood Coagulation and Fibrinolysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648686 ◽

1978 ◽

Vol 40 (02) ◽

pp. 532-541 ◽

Cited By ~ 2

Author(s):

Anders Lagrelius ◽

Nils-Olov Lunell ◽

Margareta Blombäck

Keyword(s):

Blood Coagulation ◽

Antithrombin Iii ◽

Coagulation Factors ◽

Control Group ◽

Blood Coagulation Factors ◽

Excessive Bleeding ◽

Oestrone Sulphate ◽

Menopausal Women ◽

History Of ◽

Coagulation And Fibrinolysis

SummaryThe aim of the present study was to investigate the effect on blood coagulation and fibrinolysis of a natural oestrogen preparation, piperazine oestrone sulphate, prospectively in menopausal women. Scopolamine was given to the control group.The women were investigated before and during treatment with regard to factors VIII, VII, X, V, fibrinopeptide A, antithrombin III, plasminogen, rapid antiplasmin and α1-antitrypsin. There was no significant change towards hypercoagulability or decreased fibrinolysis in any group. In the oestrogen group, however, a tendency towards an increased level of plasminogen and a decreased level of antiplasmin was demonstrated. In the scopolamine group there was an unexpected fall in factors X and V and also in plasminogen and α1,-antitrypsin. A low level of some blood coagulation factors in some of the women before treatment is somewhat astonishing; none of them had any history of excessive bleeding.

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Stepping up detection, response, preparedness and readiness measures for “COVID-19”- A Pandemic

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3442 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1042-1047

Author(s):

Khushbu Balsara ◽

Deepankar Shukla

Keyword(s):

Health Care ◽

Health Care Workers ◽

Clinical History ◽

Frontline Workers ◽

Diagnostic Assays ◽

Care Workers ◽

Short Period ◽

History Of ◽

Detection Response ◽

Care Worker

In a very short period of time, “COVID-19” has seized the consciousness globally by making remarkable changes in our day to day living and has superintended as a public health emergency globally. It has high radar of transmission, affecting an individual at work to frontline workers. The measures and planning for a response plays a key role from drawing up an emergency committee and this follows an equation which broadly deals with epidemiological to clinical history of the patient, management steps from isolation, screening, diagnostic assays for identification and treatment. The application of an organized plan with secure structure aids in better performance, increases efficacy of management and saves time. Also saves time for a health care worker to g through routine levels of channels of administration if already a familiar way of operation is known for such situations. Thus, planning and developing a ‘blueprint of approach’ towards management of patient while facing such situation is a must. This review provides an insight to the measures for detection, response and preparedness of the hospital and health care workers should largely be inclusive of; also highlights the measures to be taken at every step after coming in contact with a positive case of “COVID-19”.

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“The last chord of the Silver Age”: science and culture in Crimea in 1920

OOO Zhurnal Voprosy Istorii ◽

10.31166/voprosyistorii202010statyi74 ◽

2020 ◽

Vol 2020 (10-4) ◽

pp. 4-14

Author(s):

Vladimir Kalinovsky ◽

Alexander Puchenkov

Keyword(s):

Civil War ◽

The South ◽

Silver Age ◽

Russian Culture ◽

Short Period ◽

The Crimea ◽

Science And Culture ◽

History Of ◽

Russian Intelligentsia

This article is devoted to the development of science and culture in the short period of the Wrangel Crimea - 1920. At this time, the brightest figures of Russian culture of that time worked on the territory of the small Peninsula: O. E. Mandelstam, M. A. Voloshin, B.D. Grekov, G.V. Vernadsky, V.I. Vernadsky and others. The article provides an overview of the life and activities of the Russian intelligentsia in 1920 in the Crimea, based on materials of periodicals as the most important source for studying the history of the Civil war in the South of Russia whose value is to be fully evaluated.

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Genetic Analysis of a Cohort of 275 Patients with Hyper-IgE Syndromes and/or Chronic Mucocutaneous Candidiasis

Journal of Clinical Immunology ◽

10.1007/s10875-021-01086-4 ◽

2021 ◽

Author(s):

Natalie Frede ◽

Jessica Rojas-Restrepo ◽

Andrés Caballero Garcia de Oteyza ◽

Mary Buchta ◽

Katrin Hübscher ◽

...

Keyword(s):

Screening Method ◽

Cost Effective ◽

Illumina Miseq ◽

Clinical Findings ◽

Genetic Defects ◽

Chronic Mucocutaneous Candidiasis ◽

Mucocutaneous Candidiasis ◽

Serious Infections ◽

History Of ◽

Panel Sequencing

AbstractHyper-IgE syndromes and chronic mucocutaneous candidiasis constitute rare primary immunodeficiency syndromes with an overlapping clinical phenotype. In recent years, a growing number of underlying genetic defects have been identified. To characterize the underlying genetic defects in a large international cohort of 275 patients, of whom 211 had been clinically diagnosed with hyper-IgE syndrome and 64 with chronic mucocutaneous candidiasis, targeted panel sequencing was performed, relying on Agilent HaloPlex and Illumina MiSeq technologies. The targeted panel sequencing approach allowed us to identify 87 (32 novel and 55 previously described) mutations in 78 patients, which generated a diagnostic success rate of 28.4%. Specifically, mutations in DOCK8 (26 patients), STAT3 (21), STAT1 (15), CARD9 (6), AIRE (3), IL17RA (2), SPINK5 (3), ZNF341 (2), CARMIL2/RLTPR (1), IL12RB1 (1), and WAS (1) have been detected. The most common clinical findings in this cohort were elevated IgE (81.5%), eczema (71.7%), and eosinophilia (62.9%). Regarding infections, 54.7% of patients had a history of radiologically proven pneumonia, and 28.3% have had other serious infections. History of fungal infection was noted in 53% of cases and skin abscesses in 52.9%. Skeletal or dental abnormalities were observed in 46.2% of patients with a characteristic face being the most commonly reported feature (23.1%), followed by retained primary teeth in 18.9% of patients. Targeted panel sequencing provides a cost-effective first-line genetic screening method which allows for the identification of mutations also in patients with atypical clinical presentations and should be routinely implemented in referral centers.

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Electrochemical Biosensors for Cytokine Profiling: Recent Advancements and Possibilities in the Near Future

Biosensors ◽

10.3390/bios11030094 ◽

2021 ◽

Vol 11 (3) ◽

pp. 94

Author(s):

Nirmita Dutta ◽

Peter B. Lillehoj ◽

Pedro Estrela ◽

Gorachand Dutta

Keyword(s):

Immune System ◽

Cost Effective ◽

Anomalous Behavior ◽

Quantitative Detection ◽

Electrochemical Biosensors ◽

Aberrant Expression ◽

Detection Techniques ◽

Short Period ◽

User Friendly ◽

Cytokine Profiling

Cytokines are soluble proteins secreted by immune cells that act as molecular messengers relaying instructions and mediating various functions performed by the cellular counterparts of the immune system, by means of a synchronized cascade of signaling pathways. Aberrant expression of cytokines can be indicative of anomalous behavior of the immunoregulatory system, as seen in various illnesses and conditions, such as cancer, autoimmunity, neurodegeneration and other physiological disorders. Cancer and autoimmune diseases are particularly adept at developing mechanisms to escape and modulate the immune system checkpoints, reflected by an altered cytokine profile. Cytokine profiling can provide valuable information for diagnosing such diseases and monitoring their progression, as well as assessing the efficacy of immunotherapeutic regiments. Toward this goal, there has been immense interest in the development of ultrasensitive quantitative detection techniques for cytokines, which involves technologies from various scientific disciplines, such as immunology, electrochemistry, photometry, nanotechnology and electronics. This review focusses on one aspect of this collective effort: electrochemical biosensors. Among the various types of biosensors available, electrochemical biosensors are one of the most reliable, user-friendly, easy to manufacture, cost-effective and versatile technologies that can yield results within a short period of time, making it extremely promising for routine clinical testing.

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Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02842-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

T. M. Skipina ◽

S. Macbeth ◽

E. L. Cummer ◽

O. L. Wells ◽

S. Kalathoor

Keyword(s):

Emergency Department ◽

Metabolic Acidosis ◽

Mental Status ◽

Rare Case ◽

Liver Function Tests ◽

Altered Mental Status ◽

Potassium Citrate ◽

Metabolic Encephalopathy ◽

History Of ◽

Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

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Case report: Manual therapies promote resolution of persistent post-concussion symptoms in a 24-year-old athlete

SAGE Open Medical Case Reports ◽

10.1177/2050313x20952224 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2095222

Author(s):

Susan Vaughan Kratz

Keyword(s):

Case Report ◽

Symptom Severity ◽

Impact Test ◽

Manual Therapies ◽

Symptom Checklist ◽

Post Concussion Syndrome ◽

Persistent Symptoms ◽

Short Period ◽

History Of ◽

Headache Impact

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.

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Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

Applied Sciences ◽

10.3390/app11083365 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3365

Author(s):

Benjie Law ◽

Hui Yuh Soh ◽

Syed Nabil ◽

Rama Krsna Rajandram ◽

Abd Jabar Nazimi ◽

...

Keyword(s):

Case Series ◽

Cost Effective ◽

Control Group ◽

Platelet Rich Fibrin ◽

Tissue Healing ◽

Number Of Patients ◽

Short Period ◽

Oral And Maxillofacial Region ◽

Surgical Adjunct ◽

Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

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Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽

10.1136/openhrt-2020-001380 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001380

Author(s):

Rasmus Bo Hasselbalch ◽

Mia Marie Pries-Heje ◽

Sarah Louise Kjølhede Holle ◽

Thomas Engstrøm ◽

Merete Heitmann ◽

...

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

Primary Outcome ◽

Multislice Ct ◽

Cost Effective ◽

University Hospital ◽

Before And After ◽

History Of ◽

Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

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Resonant trans-Neptunian objects as a source of Jupiter-family comets

Proceedings of the International Astronomical Union ◽

10.1017/s1743921307003031 ◽

2006 ◽

Vol 2 (S236) ◽

pp. 31-34

Author(s):

E. L. Kiseleva ◽

V. V. Emel'yanenko

Keyword(s):

Solar System ◽

Dynamical Evolution ◽

Early History ◽

Substantial Contribution ◽

Outer Solar System ◽

Symplectic Integrator ◽

Relative Fraction ◽

Outward Transport ◽

Short Period ◽

History Of

AbstractThe dynamical interrelation between resonant trans-Neptunian objects and short-period comets is studied. Initial orbits of resonant objects are based on computations in the model of the outward transport of objects during Neptune's migration in the early history of the outer Solar system. The dynamical evolution of this population is investigated for 4.5 Gyr, using a symplectic integrator. Our calculations show that resonant trans-Neptunian objects give a substantial contribution to the planetary region. We have estimated that the relative fraction of objects captured per year from the 2/3 resonance to Jupiter-family orbits with perihelion distances q<2.5 AU is 0.4×10−10 near the present epoch.

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