scholarly journals Recurring Anaphylaxis: A New Line of Questioning for your HPI

2020 ◽  
Vol 3 (1) ◽  
pp. 18-21
Author(s):  
Wahid Lana ◽  
◽  
Aziz Sameh ◽  
Abraham Christina ◽  
◽  
...  
Keyword(s):  
Allergic Reaction ◽  
Unknown Etiology ◽  
Shortness Of Breath ◽  
Tick Bites ◽  
Ige Antibody ◽  
Delayed Onset ◽  
The Past ◽  
Delayed Anaphylaxis ◽  
Life Threatening ◽  
Mammalian Meat

Anaphylaxis is a serious life-threatening allergic reaction that typically has an immediate onset. It can present as flushing, angioedema, shortness of breath, rash and result in death if not treated immediately. In the past ten years, an emerging cause of delayed anaphylaxis has been identified. An IgE antibody to a mammalian oligosaccharide epitope (alpha-gal, or galactose-alpha-1,3-galactose) has been linked to both immediate and delayed onset anaphylaxis. The immediate form is associated with the first exposure to cetuximab; whereas the delayed onset occurs after ingestion of mammalian meat such as beef and pork. The presentation can develop 2-6 hours after ingestion. This IgE antibody to alpha-gal is strongly suggested that Lone Star tick bites have been the culprit. It is imperative when caring for an anaphylaxis patient of unknown etiology, to consider a line of questioning to not only include recent tick bites, but also last 2-3 meals ingested to identify if mammalian meat may have been the trigger.

scholarly journals Alpha-gal Allergy in a 6-Year-Old Male: A Case Report

2019 ◽  
Vol 57 (219) ◽  
Author(s):  
Masanosuke Kinoshita ◽  
Samuel Newton
Keyword(s):  
Immunoglobulin E ◽  
Past History ◽  
Meat Products ◽  
Amblyomma Americanum ◽  
Tick Bites ◽  
Delay In Diagnosis ◽  
Delayed Onset ◽  
History Of ◽  
Mammalian Meat ◽  
Pork Consumption

Alpha-gal allergy is a reaction where the immunoglobulin E antibody elicits a response to galactosealpha-1,3-galactose (alpha-gal) which is a mammalian oligosaccharide epitope found in nonprimate mammalian. After being exposed to a tick bite, particularly the Lone Star tick (Amblyomma americanum), an individual has been known to develop an alpha-gal allergy. Our patient presented with symptoms of delayed-onset allergy 3-8 hours after consuming mammalian meat products including beef and pork. These symptoms can include, but not limited to, the following: urticaria, angioedema, anaphylaxis, nausea, diarrhea, indigestion. Since symptoms do not present immediately, a delay in diagnosis can occur. Our patient highlights one of the few reported childhood cases with an alpha-gal allergy. We recommend a careful history, in particular, asking if the patient has a past history of tick bites and the appearance of allergy symptoms following beef or pork consumption.

scholarly journals Allergy to Mammalian Meat Linked to Alpha-Gal Syndrome Potentially After Tick Bite in the Amazon: A Case Series

2021 ◽  
Author(s):  
Loïc Epelboin ◽  
Florent Roche ◽  
Maryvonne Dueymes ◽  
Geneviève Guillot ◽  
Olivier Duron ◽  
...  
Keyword(s):  
United States ◽  
Latin America ◽  
Food Allergy ◽  
French Guiana ◽  
Case Series ◽  
The United States ◽  
Tick Bites ◽  
The Past ◽  
New Type ◽  
Mammalian Meat

The past decade has seen the emergence of a new type of food allergy occurring after ingestion of mammalian meat. This allergy is related to immunoglobulin (Ig)E specific for galactose-alpha-1,3 galactose (α-Gal). Originally described in the United States in 2009, other cases have subsequently been described in Australia and in Europe, but still very few in Latin America. The purpose of this study was to show the existence of this pathology in French Guiana and to describe the historical, clinical, and biological characteristics of these patients. Patients reporting an allergy to mammalian meat were included between September 2017 and August 2019. Eleven patients were included, nine of whom exhibited digestive symptoms; four, urticaria reactions; three, respiratory reactions; and angioedema. The time between ingestion of red meat and reaction varied between 1.5 and 6 hours. The implicated meats were most often beef and pork. All patients had been regularly exposed to tick bites before the appearance of symptoms. All the samples (n = 7) were positive for anti-α-Gal anti-mammalian meats IgE. All the patients were Caucasian French expatriates. This study confirms the presence of this new entity in French Guiana and is the largest reported in Latin America. Our results do not clearly allow us to state that tick bites are the cause of this allergy, but all patients reported being exposed regularly to these arthropods.

Isolation of Asbestos from Lung Tissue and Sputum

1982 ◽  
Vol 40 ◽  
pp. 330-331
Author(s):  
M. G. Williams ◽  
C. Corn ◽  
R. F. Dodson ◽  
G. A. Hurst
Keyword(s):  
Sodium Hypochlorite ◽  
Lung Tissue ◽  
Body Fluids ◽  
Unknown Etiology ◽  
The Past

During this century, interest in the particulate content of the organs and body fluids of those individuals affected by pneumoconiosis, cancer, or other diseases of unknown etiology developed and concern was further prompted with the increasing realization that various foreign particles were associated with or caused disease. Concurrently particularly in the past two decades, a number of methods were devised for isolating particulates from tissue. These methods were recently reviewed by Vallyathan et al. who concluded sodium hypochlorite digestion was both simple and superior to other digestion procedures.

The Evolution of Lead Extraction

2009 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Melanie Maytin ◽  
Laurence M Epstein ◽  
◽  
Keyword(s):  
Natural Selection ◽  
Lead Extraction ◽  
Significant Morbidity ◽  
Extraction Techniques ◽  
Extraction Technology ◽  
Device Management ◽  
Future Developments ◽  
The Past ◽  
New Methods ◽  
Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy

2019 ◽  
Vol 19 (12) ◽  
pp. 980-987 ◽  
Author(s):  
Mohammad Ridwane Mungroo ◽  
Ayaz Anwar ◽  
Naveed Ahmed Khan ◽  
Ruqaiyyah Siddiqui
Keyword(s):  
Mortality Rate ◽  
Free Living ◽  
Outdoor Activities ◽  
The Past ◽  
Free Living Amoeba ◽  
Challenges And Opportunities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Living Nature ◽  
Treatment And Diagnosis

Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as “brain-eating amoebae”. The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.

scholarly journals Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 16
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Luca Caneva ◽  
Sebastiano Gerosa ◽  
Giovanni Ricevuti
Keyword(s):  
Major Trauma ◽  
Management Strategies ◽  
Medical Problem ◽  
Current Evidence ◽  
Potential Drug ◽  
The Past ◽  
Trauma Induced Coagulopathy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

scholarly journals 20th century cooling of the deep ocean contributed to delayed acceleration of Earth’s energy imbalance

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
A. Bagnell ◽  
T. DeVries
Keyword(s):  
20Th Century ◽  
Heat Content ◽  
Deep Ocean ◽  
Ocean Warming ◽  
Ocean Heat Content ◽  
Global Ocean ◽  
Energy Imbalance ◽  
Delayed Onset ◽  
The Past ◽  
Historical Reconstructions

AbstractThe historical evolution of Earth’s energy imbalance can be quantified by changes in the global ocean heat content. However, historical reconstructions of ocean heat content often neglect a large volume of the deep ocean, due to sparse observations of ocean temperatures below 2000 m. Here, we provide a global reconstruction of historical changes in full-depth ocean heat content based on interpolated subsurface temperature data using an autoregressive artificial neural network, providing estimates of total ocean warming for the period 1946-2019. We find that cooling of the deep ocean and a small heat gain in the upper ocean led to no robust trend in global ocean heat content from 1960-1990, implying a roughly balanced Earth energy budget within −0.16 to 0.06 W m−2 over most of the latter half of the 20th century. However, the past three decades have seen a rapid acceleration in ocean warming, with the entire ocean warming from top to bottom at a rate of 0.63 ± 0.13 W m−2. These results suggest a delayed onset of a positive Earth energy imbalance relative to previous estimates, although large uncertainties remain.

Rhabdomyolysis: An evidence-based approach

2021 ◽  
pp. 175114372110507
Author(s):  
Sarah Burgess
Keyword(s):  
Fluid Overload ◽  
Kidney Injury ◽  
Community Acquired Pneumonia ◽  
Evidence Based ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Urine Dipstick ◽  
The Past ◽  
Acting Insulin ◽  
History Of

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

When things go wrong: Exploring possible mechanisms driving the progressive fibrosis phenotype in interstitial lung diseases

2021 ◽  
pp. 2004507
Author(s):  
Moisés Selman ◽  
Annie Pardo
Keyword(s):  
Pulmonary Fibrosis ◽  
Lung Diseases ◽  
Molecular Mechanisms ◽  
Lung Parenchyma ◽  
Interstitial Lung Diseases ◽  
Unknown Etiology ◽  
Clinical Behavior ◽  
The Past ◽  
Appropriate Treatment ◽  
Different Types

Interstitial lung diseases (ILD) comprise a large and heterogeneous group of disorders of known and unknown etiology characterised by diffuse damage of the lung parenchyma. In the past years, it has become evident that patients with different types of ILD are at risk of developing progressive pulmonary fibrosis known as pulmonary fibrosing ILD (PF-ILD). This is a phenotype behaving similar to idiopathic pulmonary fibrosis, the archetypical example of progressive fibrosis. PF-ILD is not a distinct clinical entity but describes a group of ILD with a similar clinical behavior. This phenotype may occur in diseases displaying distinct etiologies and different biopathology during their initiation and development. Importantly, these entities may have the potential for improvement or stabilisation prior to entering in the progressive fibrosing phase. The crucial questions are (1) why a subset of patients develops a progressive and irreversible fibrotic phenotype even with appropriate treatment, and (2) what the pathogenic mechanisms driving progression possibly are. We here provide a framework highlighting putative mechanisms underlying progression, including genetic susceptibility, aging, epigenetics, the structural fibrotic distortion, the aberrant composition and stiffness of the extracellular matrix, and the emergence of distinct profibrotic cell subsets. Understanding the cellular and molecular mechanisms behind PF-ILD will provide the basis for identifying risk factors and appropriate therapeutical strategies.

Reporting altered test results in hemolyzed samples: is the cure worse than the disease?

2017 ◽  
Vol 55 (8) ◽  
pp. 1112-1114 ◽  
Author(s):  
Giuseppe Lippi ◽  
Gianfranco Cervellin ◽  
Mario Plebani
Keyword(s):  
Laboratory Data ◽  
Turnaround Time ◽  
Reliable Data ◽  
Test Results ◽  
The Past ◽  
Laboratory Test Results ◽  
Performance Specifications ◽  
Life Threatening ◽  
The Many ◽  
Definition Of

AbstractThe management of laboratory data in unsuitable (hemolyzed) samples remains an almost unresolved dilemma. Whether or not laboratory test results obtained by measuring unsuitable specimens should be made available to the clinicians has been the matter of fierce debates over the past decades. Recently, an intriguing alternative to suppressing test results and recollecting the specimen has been put forward, entailing the definition and implementation of specific algorithms that would finally allow reporting a preanalytically altered laboratory value within a specific comment about its uncertainty of measurement. This approach carries some advantages, namely the timely communication of potentially life-threatening laboratory values, but also some drawbacks. These especially include the challenging definition of validated performance specifications for hemolyzed samples, the need to producing reliable data with the lowest possible uncertainty, the short turnaround time for repeating most laboratory tests, the risk that the comments may be overlooked in short-stay and frequently overcrowded units (e.g. the emergency department), as well as the many clinical advantages of a direct communication with the physician in charge of the patient. Despite the debate remains open, we continue supporting the suggestion that suppressing data in unsuitable (hemolyzed) samples and promptly notifying the clinicians about the need to recollect the samples remains the most (clinically and analytically) safe practice.

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