Thyroid Emergencies part 1: Thyroid Storm

2004 ◽  
Vol 3 (3) ◽  
pp. 93-93
Author(s):  
Ben C Turner ◽  
Keyword(s):  
High Mortality ◽  
Successful Outcome ◽  
Thyroid Storm ◽  
High Dose ◽  
Aggressive Treatment ◽  
High Dependency

Thyroid storm is associated with multisystem decompensation and high mortality if untreated. Early clinical recognition and aggressive treatment in a high dependency setting are crucial to a successful outcome. A combination of high-dose antithyroid medication, β-blockade, iodine, steroids and careful haemodynamic management are the essential therapeutic elements, with the potential for a prompt recovery. The pathophysiology, causes and treatment of thyroid storm are reviewed.

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals High-dose diquat poisoning: a case report

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110261
Author(s):  
Yanxia Huang ◽  
Renjing Zhang ◽  
Mei Meng ◽  
Dechang Chen ◽  
Yunxin Deng
Keyword(s):  
Renal Failure ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Organ ◽  
High Dose ◽  
Severe Respiratory Failure ◽  
Aggressive Treatment ◽  
Lung Lesions ◽  
Pulmonary Lesions ◽  
New Treatment

Diquat is a widely used herbicide that is substituted for paraquat. With paraquat off the market, cases of diquat poisoning have been gradually increasing. The kidney is the most frequently impaired organ in diquat poisoning. Few cases of multiple organ failure caused by diquat have been reported. We herein describe a 30-year-old man who orally ingested about 160 mL of enriched diquat. Despite aggressive treatment, the patient’s condition progressed to multiple organ failure and death. The pulmonary lesions in this patient were different from those previously reported. This patient did not die of renal failure but of severe respiratory failure. He exhibited three different stages of pulmonary disease. The lung lesions in this case were unique. We hope that doctors will pay more attention to the lung lesions in patients with diquat poisoning in future and find new treatment methods to save the lives of such patients.

Anorexia Nervosa

1982 ◽  
Vol 4 (4) ◽  
pp. 123-129
Author(s):  
Hans Steiner
Keyword(s):  
Differential Diagnosis ◽  
Anorexia Nervosa ◽  
High Mortality ◽  
Early Identification ◽  
Aggressive Treatment ◽  
Adolescent Women ◽  
Benign Disorder ◽  
Long Run ◽  
Medical Symptoms

Anorexia nervosa is a complex, chronic, remittent disorder of mostly adolescent women. It presents with multiple psychiatric and medical symptoms which are difficult to diagnose and treat, especially in the long run. Its differential diagnosis is complex and treatment requires dedicated effort and several specialists working cooperatively. Its etiology is still unclear, although there are several promising leads. Treatment is largely empirical and nonspecific at this point. Early identification and aggressive treatment are the only hope for preventing chronicity. Its relatively high mortality attests to the fact that it is not a benign disorder.

scholarly journals Estimating intervention dose of the multilevel multisite children’s healthy living program intervention

2019 ◽  
Vol 10 (4) ◽  
pp. 989-997
Author(s):  
Jean Butel ◽  
Kathryn L Braun ◽  
Claudio R Nigg ◽  
Rachael Leon Guerrero ◽  
Travis Fleming ◽  
...  
Keyword(s):  
Civic Engagement ◽  
Collective Efficacy ◽  
Screen Time ◽  
Common Good ◽  
Low Dose ◽  
Building Blocks ◽  
Successful Outcome ◽  
High Dose ◽  
Time Interval ◽  
Healthy Living

Abstract Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children’s Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL—reduction in children’s recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block—social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman’s rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention’s CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.

scholarly journals A Rare Case of Recurrent Klebsiella pneumoniae Liver Abscess

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Magdelene Amoateng ◽  
Pius Osei-Bagyina ◽  
Reba Varughese ◽  
Achsah Mathew ◽  
Ishan Malhotra
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
High Mortality ◽  
Rare Case ◽  
Pyogenic Liver Abscess ◽  
Important Risk Factor ◽  
Aggressive Treatment

Klebsiella pneumoniae liver abscess (KPLA) is an emerging syndrome with the initial cases described in Taiwan in the 1980s. There is high mortality with this condition, and immediate aggressive treatment is necessary. Diabetes mellitus (D.M.) is the single most important risk factor for developing KPLA. Here, we describe a rare case of recurrent cryptogenic Klebsiella pneumoniae pyogenic liver abscess (KPLA) in a young man with poorly controlled type 1 D.M.

scholarly journals Use of Partially Mismatched Related Donors Extends Access to Allogeneic Marrow Transplant

Blood ◽  
1997 ◽  
Vol 89 (10) ◽  
pp. 3864-3872 ◽  
Author(s):  
P. Jean Henslee-Downey ◽  
Sunil H. Abhyankar ◽  
Rudolph S. Parrish ◽  
Asim R. Pati ◽  
Kamar T. Godder ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Disease Status ◽  
Marrow Transplant ◽  
Successful Outcome ◽  
High Dose ◽  
Allogeneic Bone ◽  
Significant Difference

Most patients requiring allogeneic bone marrow transplant (allo-BMT) do not have an HLA-matched sibling donor. A phenotypically matched unrelated donor graft has been made available for approximately 50% of Caucasians and less than 10% of ethnic and racial minorities in need. However, almost all patients have a readily available partially mismatched related donor (PMRD). We summarize our experience with 72 patients who ranged from 1 to 50 years of age (median, 16 years) and who were recipients of a PMRD allo-BMT from haploidentical family members following conditioning therapy using total body irradiation (TBI) and multiagent, high-dose chemotherapy. T-cell depletion and post-BMT immunosuppression were combined for graft-versus-host disease (GVHD) prophylaxis. The probability of engraftment was 0.88 at 32 days. Six of 10 patients who failed to engraft achieved engraftment after secondary transplant. Grade II to IV acute GVHD was seen in 9 of 58 (16%) evaluable patients; extensive chronic GVHD was seen in 4 of 48 (8%) evaluable patients. There was a statistically significant difference in 2-year survival probability between low-risk and high-risk patients (0.55 v 0.27, P = .048). Prognostic factors that affected outcomes in multivariate analysis were (1) a lower TBI dose and 3-antigen rejection mismatch decreased stable engraftment (P = .005 and P = .002, respectively); (2) a higher T-cell dose increased acute GVHD (P = .058); (3) a higher TBI dose increased chronic GVHD (P = .016); and (4) a high-risk disease category increased treatment failure from relapse or death (P = .037). A PMRD transplant can be performed with acceptable rates of graft failure and GVHD. Using sequential immunomodulation, the disease status at the time of transplant is the only prognostic factor significantly associated with long-term successful outcome after PMRD allo-BMT. When allogeneic rather than autologous BMT is indicated, progression in disease status before transplant can be avoided using a PMRD with equal inclusion of all ethnic or racial groups.

scholarly journals Drug-induced resistance evolution necessitates less aggressive treatment

2021 ◽  
Vol 17 (9) ◽  
pp. e1009418
Author(s):  
Teemu Kuosmanen ◽  
Johannes Cairns ◽  
Robert Noble ◽  
Niko Beerenwinkel ◽  
Tommi Mononen ◽  
...  
Keyword(s):  
Clinical Investigation ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Target Population ◽  
Drug Dosage ◽  
Analytical Relationship ◽  
High Dose ◽  
Aggressive Treatment ◽  
Drug Induced ◽  
Resistance Evolution

Increasing body of experimental evidence suggests that anticancer and antimicrobial therapies may themselves promote the acquisition of drug resistance by increasing mutability. The successful control of evolving populations requires that such biological costs of control are identified, quantified and included to the evolutionarily informed treatment protocol. Here we identify, characterise and exploit a trade-off between decreasing the target population size and generating a surplus of treatment-induced rescue mutations. We show that the probability of cure is maximized at an intermediate dosage, below the drug concentration yielding maximal population decay, suggesting that treatment outcomes may in some cases be substantially improved by less aggressive treatment strategies. We also provide a general analytical relationship that implicitly links growth rate, pharmacodynamics and dose-dependent mutation rate to an optimal control law. Our results highlight the important, but often neglected, role of fundamental eco-evolutionary costs of control. These costs can often lead to situations, where decreasing the cumulative drug dosage may be preferable even when the objective of the treatment is elimination, and not containment. Taken together, our results thus add to the ongoing criticism of the standard practice of administering aggressive, high-dose therapies and motivate further experimental and clinical investigation of the mutagenicity and other hidden collateral costs of therapies.

scholarly journals Recurrent Thyroid Storm Caused by a Complete Hydatidiform Mole in a Perimenopausal Woman

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Anuradha Jayasuriya ◽  
Dimuthu Muthukuda ◽  
Preethi Dissanayake ◽  
Shyama Subasinghe
Keyword(s):  
Molecular Mimicry ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
High Dose ◽  
Complete Hydatidiform Mole ◽  
Free Triiodothyronine ◽  
Rare Presentation ◽  
Perimenopausal Woman ◽  
Trophoblastic Disease

Background. Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma is a rare cause of hyperthyroidism due to excess production of placental human chorionic gonadotrophin hormone (hCG) by tumor cells. Molecular mimicry between hCG and thyroid stimulating hormone (TSH) leads to continuous stimulation of TSH receptor by extremely high levels of hCG seen in these tumors. Consequently, biochemical and clinical hyperthyroidism ensues and it is potentially complicated by thyrotoxic crisis which is fatal unless urgent therapeutic steps are undertaken. Case Description. We present a 49-year-old perimenopausal woman who presented with recurrent thyroid storm and high output cardiac failure. The initial workup revealed suppressed TSH, high-free thyroxine (FT4), and free triiodothyronine (FT3) levels with increased vascularity of the normal-sized thyroid on ultrasonography. She was managed with parenteral beta blockers, steroids, and high-dose carbimazole. Her lower abdominal tenderness led to further investigations which revealed tremendously elevated beta-hCG and a snow storm appearance on transabdominal ultrasound suggestive of GTD. She underwent curative surgery and was diagnosed with complete hydatidiform mole postoperatively by histology. Conclusion. Recurrent thyroid crisis in gestational trophoblastic disease is an exceedingly rare presentation and that is highly fatal. This case highlights the importance of early detection and treatment of the etiology of thyrotoxicosis to eliminate mortality.

Concomitant Usage of Rasburicase and Allopurinol May Augment Toxic Epidermal Necrolysis Syndrome TEN

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4949-4949
Author(s):  
Ahmad Jajeh
Keyword(s):  
Uric Acid ◽  
Toxic Epidermal Necrolysis ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Burkitt’S Lymphoma ◽  
Burkitt's Lymphoma ◽  
Urate Oxidase ◽  
Successful Outcome ◽  
High Dose ◽  
Type Iv

Abstract Abstract 4949 Rasburicase is used succesfully in conjunction with Allopurinol in the tratment and prevention of tumor lysis syndrrome. Rasburicase is a recombinant form of urate oxidase, which is an enzyme present in primates but not humans and convert uric acid to allantoin, which is five to ten time soluble than uric acid. This abstract represent our experience in four males patients, mean age is thirty five years, two with Acute Lymphoblastic Leukemia ALL and two patients with Burkitt's Lymphoma. Three patients has successful outcome in the treatment with Rasburicase followed by allopurinol. Only one patient with Burkitt's Lymphoma arising from congenital combined immunodeficiency syndrome who developed fatal Toxic Epidermal Necrolysis syndrome TEN. TEN is a relatively rare incidence and can be deadly. The mechanism of action is different for both drugs. In this patient Rasburicase was used initially with excellent reduction of uric acid levels, then patient was put latter on allopurinol. The TEN syndrome appeared after three days of initiating the drug and progressed rapidly. High dose Methotrexate and sever neutropenia may contributed to the fast progression and not respoding to steriods after allopurinol was stopped. Since this patient has combined humoral and cellular immunodeficiency with no recent administartion of immunoglobulins therapy, it is difficult to explain the allopurinol reaction based on any type of immune response, particulary type IV hypersensitivity reaction. In conclusion: This particular case may draw the light on Rasburicase possible role in contribution or augumentation of TEN syndrome induced by allopurinol. Disclosures: No relevant conflicts of interest to declare.

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