Out with the old, in with the new? Case reports of the clinical features and acute management of two novel designer drugs

Methoxydine (4-MeO-PCP) and Methoxetamine (3-MeO-2-Oxo-PCE) are both commercially produced designer drugs with structural and biochemical similarities to phencyclidine (PCP). Although phencyclidine toxicity is well documented, its recreational use in present times is rare. With the advent of new designer drugs being available widely through internet sites, Acute Physicians should be aware of the clinical features and management of these potential toxins. We present a case of methoxydine ingestion (which to our knowledge has not been previously documented in any medical journals) and a case of methoxetamine ingestion, and discuss their history, contrasting clinical features and acute management.

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Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

Cerebrovascular Diseases ◽

10.1159/000514267 ◽

2021 ◽

pp. 1-4

Author(s):

Simone Vidale

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Clinical Features ◽

Case Reports ◽

Clinical Severity ◽

Large Artery ◽

Causal Association ◽

Review Of Literature ◽

Increased Risk ◽

Long Time

Background and Purpose: Coronavirus disease 2019 (COVID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with COVID-19 infection. Method: A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. Results: Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55–75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (ptrend: 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (ptrend: 0.03). Conclusions: Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

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Non Odontogenic Soft Tissue Cysts of the Oral Cavity

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-66-218 ◽

1980 ◽

Vol 66 (3) ◽

pp. 218-222

Author(s):

T. J. C. Hall

Keyword(s):

Soft Tissue ◽

Oral Cavity ◽

Clinical Features ◽

Case Reports ◽

Tissue Cyst

AbstractThe aetiology and clinical features of five types of non odontogenic soft tissue cyst of the oral cavity are described and case reports presented.

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Clinical Features of Coexisting Anti-NMDAR and MOG Antibody-Associated Encephalitis: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.711376 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiayue Ding ◽

Xiangyu Li ◽

Zhiyan Tian

Keyword(s):

Optic Neuritis ◽

Clinical Features ◽

Antibody Titer ◽

Fixed Effects ◽

Clinical Symptoms ◽

Case Reports ◽

Involuntary Movement ◽

Meta Analysis ◽

Abnormal Behavior ◽

Fixed Effects Model

Coexisting anti-NMDAR and MOG antibody (anti-NMDAR-IgG+/MOG-IgG+)-associated encephalitis have garnered great attention. This study aimed to perform a secondary analysis to determine the clinical features of this disease. We searched several databases for related publications published prior to April 2021. A pooled analysis was conducted with the fixed-effects model using the Mante-Haenszel method (I2 ≤ 50%), or the random-effects model computed by the DerSimonian–Laird method (I2 > 50%). Stata software (version 15.0 SE) was used for the analyses. Nine observational studies and 16 case reports (58 cases with anti-NMDAR-IgG+/MOG-IgG+, 21.0 [8.5, 29.0] years, male 58.6%) were included. The incidences (95%CI) of anti-NMDAR-IgG+/MOG-IgG+ in the patients with serum MOG-IgG+ and CSF anti-NMDAR-IgG+ were 0.09 (0.02–0.19) and 0.07 (0.01–0.19), respectively. The median [IQR] of CSF anti-NMDAR antibody titer was 32 [10, 100], and the serum anti-MOG antibody titer was 100 [32, 320]. The prominent clinical symptoms were encephalitic manifestations, including seizures (56.9%) and abnormal behavior (51.7%), rather than demyelinating manifestations, such as speech disorder (34.5%) and optic neuritis (27.6%). Relapse occurred in 63.4% of anti-NMDAR-IgG+/MOG-IgG+ patients, in whom 50.0% of cases relapsed with encephalitic manifestations, and 53.8% relapsed with demyelinating manifestations. The common MRI changes were in the cortex or subcortex (70.7%) and brainstem (31.0%). 31.3% of patients presented with unilateral cerebral cortical encephalitis with epilepsy and 12.5% displayed bilateral frontal cerebral cortex encephalitis. Anti-NMDAR-IgG+/MOG-IgG+ patients showed more frequent mental behavior (OR, 95%CI, 68.38, 1.36–3,434.37), involuntary movement (57.86, 2.53–1,325.11), sleep disorders (195.00, 7.07–5,380.15), and leptomeninge lesions (7.32, 1.81–29.58), and less frequent optic neuritis (0.27, 0.09–0.83) compared to anti-NMDAR-IgG−/MOG-IgG+ patients and presented more common relapse (5.63, 1.75–18.09), preceding infection (2.69, 1.03–7.02), subcortical lesions (116.60, 4.89–2,782.09), basal ganglia lesions (68.14, 2.99–1,554.27), brainstem lesions (24.09, 1.01–574.81), and spinal cord lesions (24.09, 1.01–574.81) compared to anti-NMDAR-IgG+/MOG-IgG−. In conclusion, anti-NMDAR-IgG+/MOG-IgG+ was rarely observed, but the incidence rate of relapse was very high. The overall symptoms seemed to be similar to those of NMDAR encephalitis.

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Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia

Annals of Pharmacotherapy ◽

10.1177/10600280211070102 ◽

2022 ◽

pp. 106002802110701

Author(s):

Francisco Ibarra ◽

Kaitlyn Loi ◽

Ann W. Vu

Keyword(s):

Medical History ◽

Insulin Infusion ◽

Case Reports ◽

Retrospective Chart Review ◽

Acute Management ◽

Past Medical History ◽

Safety And Efficacy ◽

Intravenous Insulin ◽

Number Of Patients ◽

History Of

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.

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Methylenedioxymethamphetamine (MDMA): a.k.a. Ecstasy

Our Love Affair with Drugs ◽

10.1093/oso/9780190051464.003.0012 ◽

2020 ◽

Author(s):

Jerrold Winter

Keyword(s):

Therapeutic Potential ◽

Illegal Drug ◽

The Other ◽

Designer Drugs ◽

Pharmacological Effects ◽

Other Hand ◽

Gamma Hydroxybutyrate ◽

Amphetamine Derivatives ◽

Recreational Use ◽

Vanderbilt University

As these words are written, the chemical we will call MDMA is a Schedule I drug. This means that MDMA (a) has no currently accepted medical use, (b) no currently accepted safety even under medical supervision, and (c) has a high potential for abuse. On the other hand, there are those who see great therapeutic potential in MDMA, and the Food and Drug Administration (FDA) has designated MDMA- assisted psychotherapy as a breakthrough therapy. We can foresee the day when it will be available by prescription. There is no doubt as to the chemical identity of MDMA, and much is known of its pharmacological effects in humans and in animals. The recreational drug commonly known as Ecstasy is more complicated. As is true for any illegal drug used by millions of people, demand for the drug has been met by persons not noted for their high ethical or manufacturing standards. Simply stated, short of chemical analysis, one can never be sure what street-bought Ecstasy is. For example, investigators at Vanderbilt University determined the contents of 1,214 tablets sold as Ecstasy. Only 39% contained only MDMA, while fully 46% were “substances other than MDMA.” Mixtures of MDMA and other drugs comprised the remaining 15%. On the other hand, sometimes in some places over the past several decades, nearly pure MDMA has been available on the illicit market. Nonetheless, a buyer of Ecstasy may ingest, rather than MDMA, drugs such as ketamine, gamma-hydroxybutyrate (GHB), cathinone, ephedrine, caffeine, or any one of the so-called designer drugs, many of which are amphetamine derivatives. A consequence of this pharmacological chaos is that many of the hazards associated with the use of Ecstasy have been uncritically attributed to MDMA. This fact has been a boon for those who would continue the Schedule I status of MDMA and a bane for those who would explore its therapeutic potential. However, in contrast with recreational use where purity of the drug is uncertain, MDMA in clinical trials is FDA approved and of known composition.

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Clinical Features and Outcome of SARS-CoV-2 Infection in Neonates: A Systematic Review

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa059 ◽

2020 ◽

Cited By ~ 2

Author(s):

Shashi Kant Dhir ◽

Jogender Kumar ◽

Jitendra Meena ◽

Praveen Kumar

Keyword(s):

Caesarean Section ◽

Clinical Features ◽

Search Strategy ◽

Web Of Science ◽

Case Reports ◽

Mode Of Delivery ◽

Case Series ◽

Congenital Infection ◽

Modes Of Transmission ◽

Mesh Terms

Abstract Objective The objective of this study is to systematically synthesize the currently available literature on various modes of transmission (congenital, intrapartum, and postpartum), clinical features and outcomes of SARS-CoV-2 infection in neonates. Methods We conducted a comprehensive literature search using PubMed, EMBASE, and Web of Science until 9 June 2020. A combination of keywords and MeSH terms, such as COVID-19, coronavirus, SARS-CoV-2, 2019-nCoV, severe acute respiratory syndrome coronavirus 2, neonates, newborn, infant, pregnancy, obstetrics, vertical transmission, maternal–foetal transmission and intrauterine transmission, were used in the search strategy. We included studies reporting neonatal outcomes of SARS-CoV-2 proven pregnancies or neonatal cases diagnosed with SARS-CoV-2 infection. Results Eighty-six publications (45 case series and 41 case reports) were included in this review. Forty-five case series reported 1992 pregnant women, of which 1125 (56.5%) gave birth to 1141 neonates. A total of 281 (25%) neonates were preterm, and caesarean section (66%) was the preferred mode of delivery. Forty-one case reports describe 43 mother-baby dyads of which 16 were preterm, 9 were low birth weight and 27 were born by caesarean section. Overall, 58 neonates were reported with SARS-CoV-2 infection (4 had a congenital infection), of which 29 (50%) were symptomatic (23 required ICU) with respiratory symptoms being the predominant manifestation (70%). No mortality was reported in SARS-CoV-2-positive neonates. Conclusion The limited low-quality evidence suggests that the risk of SARS-CoV-2 infections in neonates is extremely low. Unlike children, most COVID-positive neonates were symptomatic and required intensive care. Postpartum acquisition was the commonest mode of infection in neonates, although a few cases of congenital infection have also been reported.

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Acute Management of Intracranial Hemorrhage in Patients Receiving Thrombolytic Therapy: Case Reports

Neurosurgery ◽

10.1227/00006123-199005000-00022 ◽

1990 ◽

Vol 26 (5) ◽

pp. 867-869 ◽

Cited By ~ 15

Author(s):

Scott M. Eleff ◽

Cecil Borel ◽

William R. Bell ◽

Donlin M. Long

Keyword(s):

Early Diagnosis ◽

Thrombolytic Therapy ◽

Intracranial Hemorrhage ◽

Antithrombotic Therapy ◽

Perioperative Management ◽

Case Reports ◽

Acute Management ◽

Anticoagulant Treatment ◽

Life Threatening ◽

Uncommon Complication

Abstract Intracranial hemorrhage is an uncommon complication of antithrombotic therapy. We present two patients who suffered life-threatening intracranial bleeding as a complication of thrombolytic/anticoagulant treatment. Early diagnosis and treatment appear to be crucial factors for survival. We suggest an approach to perioperative management for intracranial hemorrhage resulting from antithrombotic therapy.

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Effects of tofacitinib on the clinical features of periodontitis in patients with rheumatoid arthritis: two case reports

BMC Rheumatology ◽

10.1186/s41927-019-0062-y ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 2

Author(s):

Tetsuo Kobayashi ◽

Satoshi Ito ◽

Akira Murasawa ◽

Hajime Ishikawa ◽

Hiromasa Yoshie

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Features ◽

Case Reports

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Clinical Characteristics of 76 Patients with IgG4-Related Hypophysitis: A Systematic Literature Review

International Journal of Endocrinology ◽

10.1155/2019/5382640 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Yujuan Li ◽

Hua Gao ◽

Zhen Li ◽

Xinxin Zhang ◽

Yizhi Ding ◽

...

Keyword(s):

Clinical Features ◽

Case Reports ◽

Disease Onset ◽

Elevated Serum ◽

Median Number ◽

Normal Serum ◽

Hormone Deficiency ◽

Serum Igg4 Level ◽

Serum Igg4 ◽

Igg4 Level

Background. IgG4-related hypophysitis (IgG4-RH) is a rare disease, and its prevalence remains unclear. In recent years, an increasing number of cases have been reported because of the increasing recognition of this disease. We aimed to summarize case reports of IgG4-RH and outline the clinical features and outcomes. Methods. We performed PubMed search of articles using the search terms “hypophysitis [AND] IgG4.” Consequently, only 54 English articles (76 cases) met Leporati’s diagnostic criteria. Results. Of the 76 cases, the ratio of men to women was 1.5 : 1, and the age at diagnosis was 54.1 ± 17.8 years. The median IgG4 concentration was 405.0 mg/dl. Anterior hypopituitarism, isolated central diabetes insipidus, and panhypopituitarism were observed in 14 (18.4%), 12 (15.8%), and 44 (57.9%) cases, respectively. The sequence of anterior hormone deficiency was as follows: gonadotropin (68.4%), ACTH (63.2%), TSH (59.2%), GH (48.7%), and prolactin (42.1%). The median number of involved organs was 1.5, and the lung (18.4%), retroperitoneum (17.1%), kidney (15.8%), submandibular glands (14.5%), and pancreas (13.2%) were the common involved organs. Elevated IgG4 concentration and normal IgG4 level were in 42 (76.4%) and 13 (23.6%) cases, respectively. Patients with elevated serum IgG4 concentration were older (60.9 ± 14.3 vs 45.6 ± 17.4, p=0.001) and male-prone (78.6% vs 40.4%, p=0.003) and had a susceptibility of multiple organ involvement (78.6% vs 35.0%, p=0.001) compared to those with normal serum IgG4 levels. Males were older at disease onset (61.5 ± 12.6 vs 42.9 ± 18.8, p<0.001) and had a higher IgG4 concentration (425.0 vs 152.5, p=0.029) and a greater number of involved organs (2.0 vs 0.0, p=0.001), while isolated hypophysitis was more prominent in female (63.3% vs 26.1%, p=0.001). Conclusion. In this review, we found that there were different characteristics between different genders. Patients with elevated serum IgG4 level in terms of some clinical features were also different from those with normal serum IgG4 level. However, the data in this review were limited by bias and confounding. Further clinical studies with larger sample sizes are warranted.

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