Severe Hyperbilirubinemia Associated With Thyrotoxicosis: Importance of Early Recognition

Thyroid storm (TS) is a rare and life-threatening condition due to a profound hypermetabolic state, leading to decompensation of homeostasis. It is commonly associated with a precipitating factor such as surgery, trauma, or infection. Occasionally, the clinical presentation may be non-specific, thus causing a potential delay in diagnosis. This could be problematic due to the condition’s high mortality rate, especially if not recognized early. Thyrotoxic jaundice presenting with a pattern of cholestatic hyperbilirubinemia (HBR) has been reported in the literature, although uncommon. We present the case of a 71-year-old woman with unexplained jaundice and direct HBR who was diagnosed with impending TS in the setting of toxic multinodular goiter (TMNG). This is a case of a 71-year-old woman with a remote history of hypothyroidism who presented with acute onset right upper quadrant abdominal pain, jaundice, a non-tender asymmetric nodular large goiter, and bilateral non-pitting leg edema. Ancillaries were significant for total and direct HBR of 4.3 and 3.5 mg/dL, respectively. An abdominal sonogram, abdomen CT and ERCP, all ruled out an obstructive biliary etiology. Unfortunately, the patient developed post-ERCP pancreatitis, with subsequent worsening of direct HBR. TSH was found to be suppressed, free T4 was significantly elevated at 4.3 ng/dL. A Burch-Wartofsky score of >40 was highly suggestive of TS. In addition, elevated thyroglobulin levels ruled out exogenous thyrotoxicosis, the absence of orbitopathy, pretibial myxedema, and negative TRAb pointed towards TMNG as the most likely etiology of hyperthyroidism. This diagnosis was confirmed through neck ultrasound, showing multiple nodules and the absence of high vascularity of the thyroid gland. The patient was managed in the ICU with beta-blockers, methimazole, potassium iodide solution, glucocorticoids, and bile acid sequestrants, leading to satisfactory and significant clinical improvement of thyrotoxicosis and bilirubin levels. Hepatic dysfunction has been described in patients with hyperthyroidism since the nineteenth century. Although the underlying mechanism remains unclear, it may be multifactorial. Different hypotheses have been proposed suggesting that the hypermetabolic state secondary to decompensated hyperthyroidism causes a supply-demand mismatch between hepatic oxygen consumption and hepatic blood flow, decreasing the oxygen tension in the centrilobular region resulting in cholestasis. Furthermore, hepatic hypermetabolism in response to excess thyroid hormone leads to the saturation of the bile flow rate. A possible direct toxic effect of T4 in the hepatocytes has been described although further research is needed. This case highlights the importance of considering decompensated hyperthyroidism as a differential diagnosis of cholestatic HBR.

Rhinofacial entomophthoromycosis: a case report

<p class="abstract">Rhinofacial entomophthoromycosis or conidiobolomycosis is a rare subcutaneous mycosis seen in immunocompetent people and shows significant male preponderance. It is caused by a saprophytic fungus ‘conidiobolus coronatus’ or rarely conidiobolus incogruus. The mode of transmission is probably inhalation of fungal spores, which implant in nasal mucosa and cause an orofacial granulomatosis. It is reported mainly in tropical and subtropical countries. The infection is frequently underreported since it requires high level of clinical suspicion. Histopathology and fungal culture are the diagnostic modalities. No single antifungal drug has been found to give consistent results against this infection. Here we present a case of rhinofacial entomophthoromycosis (conidiobolomycosis) in an adult male with a disfiguring lesion over the dorsum of nose. The patient was started on itraconazole initially. Following no response to the treatment, he was administered potassium iodide solution. The patient was observed to have symptomatic improvement, but was lost to follow up. </p><p class="abstract"> </p>

Study of a component of the urea-formaldehyde resin, is insoluble in water

Разработана методика химического анализа компонента карбамидоформальдегидной смолы (КФС), нерастворимого в воде. Синтезировали смолу при мольном соотношении исходных компонентов карбамид : формальдегид = 1 : 2, температуре 90 °С, начальной рН = 7,0…8,0, рН на кислой стадии 4,0…4,3. Для выделения водонерастворимого компонента КФС смешивали с большим количеством воды. Осадок промывали водой и растворяли в растворе йодида калия концентрацией 40%. В полученном растворе проводили окисление гидроксиметильных групп и свободного формальдегида йодом в щелочной среде. Избыток йода оттитровывали раствором тиосульфата натрия. В результате реакции образовывался белый хлопьевидный осадок, который отфильтровывали и подвергали анализу. В образце проводили определение общего содержания формальдегида и карбамида. Для этого анализируемый состав помещали в круглодонную колбу, снабженную прямым холодильником и капельной воронкой. В капельную воронку вливали отмеренное количество 45%-й фосфорной кислоты и по каплям добавляли ее в колбу. Колбу нагревали на металлической плитке, собирали выделяющийся формальдегид и сопутствующую воду в мерную колбу. После окончания процесса проводили определение выделившегося формальдегида. Определение карбамида осуществляли, используя уреазно-гипохлоритный метод, при котором уреаза гидролизует оставшийся карбамид до аммиака и двуокиси углерода. Далее весь образовавшийся аммиак определяли по его цветной реакции с гипохлоритом натрия и пересчитывали на карбамид. Разделив полученные массы карбамида и формальдегида на их молекулярные массы получили мольное соотношение карбамид : формальдегид в нерастворимом осадке, равное 1 : 1,5. Наименьшей молекулой, отвечающей этому условию, является олигомер, в котором четыре молекулы карбамида соединены тремя метиленэфирными связями, т. е. содержат шесть молекул формальдегида. Однако олигомеры с небольшой молекулярной массой хорошо растворимы в воде. К водонерастворимым относятся олигомеры с большой массой, значительно превышающей средний уровень. Расчёты показали, что среднее число звеньев из карбамида и метиленэфирной связи в олигомерах КФС составляет 10, а максимальное может доходить до 122. Исследование процесса отверждения компонента КФС, нерастворимого в воде, методом дифференциального термического анализа показало, что оно так же, как и КФС, проходит в три стадии. Однако температуры эндотермических пиков отличаются. Так, пик второй стадии отверждения КФС отмечен на уровне 241,0 °С, а для олигомера, нерастворимого в воде, он соответствует 244,2 °С. Ещё большие различия в температурах пиков третьей стадии отверждения: для КФС он 274,4 °С, для олигомера, нерастворимого в воде, 288,2 °С. Очевидно, что олигомер, нерастворимый в воде, значительно замедляет процесс отверждения КФС. A method of chemical analysis of a component of urea-formaldehyde resin (UFR) which is insoluble in water has been developed. The resin was synthesized at the molar ratio of the starting components urea : formaldehyde = 1 : 2, temperature 90 °С, initial pH = 7,0...8,0 pH in acidic stage 4,0...4,3. For isolation of the water-insoluble component, UFR was mixed with a large amount of water. The precipitate was washed with water and dissolved in a 40% potassium iodide solution. In the resulting solution, hydroxymethyl groups and free formaldehyde were oxidized with iodine in an alkaline medium. Excess of iodine was titrated with a solution of sodium thiosulfate. As a result of the reaction, a white flake-like precipitate was formed, which was filtered out and analyzed. The total content of formaldehyde and urea was determined in the sample. To do this, the analyzed composition was placed in a round-bottomed flask equipped with a direct condenser and a dropping funnel. A measured amount of 45% phosphoric acid was poured into the dropping funnel and added drop by drop to the flask. The flask was heated on a metal tile, and the released formaldehyde and accompanying water were collected in a measuring flask. After the end of the process, the released formaldehyde was determined. Urea was determined using the urease- hypochlorite method, in which urease hydrolyzes the remaining urea to ammonia and carbon dioxide. Then all the formed ammonia was determined by its color reaction with sodium hypochlorite and converted to urea. Separating the obtained masses of urea and formaldehyde by their molecular masses, we obtained a molar ratio of urea : formaldehyde in an insoluble precipitate equal to 1: 1.5. The smallest molecule that meets this condition is an oligomer in which four carbamide molecules are connected with three methylenester bonds, i.e. they contain six formaldehyde molecules. However, oligomers with a small molecular weight were highly soluble in water. Water-insoluble oligomers are those with a large mass that is significantly higher than the average level. Calculations showed that the average number of urea and methylene-ether links in UFR oligomers was 10, while the maximum number can reach 122. The study of the curing process of the UFR component, insoluble in water, by differential thermal analysis showed that it, like UFR, took place in three stages. However, the temperatures of endothermic peaks differed. Thus, the peak of the second stage of UFR curing was found at the level of 241.0 °C, and for an oligomer that was insoluble in water, it corresponded to 244.2 °C. There were even greater differences in the peak temperatures of the third stage of curing: 274.4 °C for UFR an,288.2 °C for the water-insoluble oligomer. It has been obvious that the water-insoluble oligomer significantly has slowed down the UFR curing process.

INVESTIGATION OF CHANGING PHYTIC ACID IN LEGUMINOUS SEEDS DEPENDING ON SOAKING AND SPROUTING CONDITIONS

The results of studying changes of phytic acid in seeds of soya of “Diamond” variety and ones of chick-pea of “Krasnokutsky – 195” depending on seed soaking and sprouting conditions are presented. The content of phytic acid and changes of phytic globoloids in native soya and chick-pea seeds, sprouted in water, sprouted in the solution of mineral salts, preliminarily washed by the solution of lemon acid (C6Н8О7) were studied. The research topicality is conditioned by the necessity to develop food technologies using vegetable protein, which agent is soya and chick-pea, and to develop technological methods, favoring phytic acid inactivation. As a result of the study, it has been established, that a decrease of the phytic acid content in soya and chick-pea seeds is influenced by the sprouting process, and seeds washing by C6Н8О7 solution (pH – 3.5) is a catalyst of these processes. Soya seeds, sprouted in the potassium iodide solution (PI), and chick-pea seeds, sprouted in the sodium hydroselenite (NaHSeO3), preliminarily washed by C6Н8О7 solution (pH – 3.5), have less content of phytic acid, comparing with other samples. The phytic acid content decrease has been proved by a phytic globoloid decrease. It has been established, that the least diameter of a phytic globoloid is inherent to samples of soya, sprouted in PI solution and washed by C6Н8О7 solution (pH – 3.5), – 3.2 mcm, and a sample of chick-pea seeds, sprouted in NaHSeO3 solution, washed by C6Н8О7 solution (pH – 3.5) – 3.0 mcm. An undesirable “pea” smell also disappears. The established regularities are important for scientists because they allow to widen the assortment of products with vegetable protein, safe for the human organism

DEVELOPMENT OF THE TECHNOLOGY OF SOYA FLOUR ENRICHED WITH IODINE

A research on developing a technology of iodine-enriched soya flour has been conducted. The technology developed will allow the body to receive organic forms of this micronutrient, the deficiency in which causes thyroid disorders in 40% of Ukrainians and 35% of people throughout Europe. The research has shown that promising soya bean varieties to be enriched with iodine are the early-ripening varieties Almaz, Anzhelika, Kyivska 98, Faeton, Medeya, PSV 808, Podyaka, Khortytsya, Yug 30, Rusa. They are the highest in protein (42.75% on average), the maximum content of which is necessary for iodine accumulation. Besides, their cropping period is short (up to 95–105 days), which is cost-effective for a manufacturing enterprise, because there is no overlapping with the winter crops sowing time and thus, there are no periods when cultivation areas remain idle. The following parameters of steeping soya beans have been found rational: the iodine concentration in the solution 98-100 μg/g, the duration of steeping 48 hours. The mass fraction of iodine in the steeped soya beans is 126 μg/g. Longer steeping leads to microbiological spoilage of sprouted soya beans. It has been determined how iodine is distributed in cotyledons, sprouts, seed coats, and whole sprouted soya beans. This has allowed establishing that in a whole sprouted soya bean of the early-ripening soya variety Almaz, the iodine content is 126 μg/g, of which 123 μg/g is accumulated in the cotyledons of a seed, and 3 μg/g in the sprouts and the seed coats. This indicates a high level of iodine conversion into the organic form when soya seeds are steeped in potassium iodide solution. A technology of manufacturing iodine-enriched flour from sprouted soya beans has been developed. It differs from the control one in that soya seeds, washed and disinfected, are soaked in potassium iodide solution (with the iodine concentration 98–100 μg/g and the hydromodulus 1:2) for 48 hours at the solution temperature 14-16°С. Flour from sprouted soya beans contains 126 μg/g of iodine. The technology suggested can be used at hotel and catering enterprises, in sanatoria and health centres, to treat iodine-deficiency disorders, and to make food for people who need special dietetic nutrition.

Pediatric Sporotrichosis in Jilin Province of China (2010–2016): a Retrospective Study of 704 Cases

Background Pediatric patients make a substantial contribution to the epidemiologic profile of sporotrichosis in Jilin Province, a region of China in which the disease is strongly endemic. However, the exact epidemiologic and clinical manifestations of childhood sporotrichosis in China are unclear. Methods The medical records of 704 pediatric patients aged &lt;15 years with sporotrichosis diagnosed by fungus culture at the Department of Dermatology at the First Hospital of Jilin University in a 7-year period (January 2010 to December 2016) were reviewed retrospectively. The patients were from rural areas of Jilin Province, located in northeast China. Results Among the 704 pediatric patients, the male/female ratio was 1.41:1, and the highest incidence of sporotrichosis (63%) occurred in those aged 0 to 6 years; 561 patients (80%) contracted sporotrichosis in a colder month. Overall, 655 (93%) patients had lesions in the facial region, whereas 602 (86%) patients had fixed cutaneous sporotrichosis. The incidence of the fixed cutaneous form in the 0- to 6-year age group was significantly higher than that in the 7- to 14-year age group (P = .009). Patients were treated with 10% potassium iodide solution, itraconazole, or terbinafine. Conclusions The characteristics of pediatric sporotrichosis in Jilin Provence include the following: (1) a more frequent occurrence in the colder months; (2) the facial region is affected predominantly, in most cases manifesting in the fixed cutaneous form; and (3) significantly more cases occur in younger children than in older ones. Decaying cornstalks used as fire materials might be the source of infection in this population; however, additional research is needed to explore the exact mechanism of infection.

IMPACT INJURY DIAGNOSIS IN MANGO THROUGH STARCH DEGRADATION INDEX

ABSTRACT This study aimed to evaluate the use of starch degradation index (SDI) in the diagnosis of areas of impact injuries in 'Tommy Atkins' mango, in different maturation stages. The experiment layout was a fully randomized factorial design (5 x 2), represented by five maturation stages and two handlings, with and without impact, with four replicates. SDI was determined through a subjective scale of scores indicating mango pulp darkened areas by reaction with iodine-potassium iodide solution. Subsequently, these scores were correlated with physicochemical quality variables. The results showed no influence of impact on fruit quality, in any of the studied maturation stages. Moreover, soluble solid contents increased throughout maturation stages, regardless of whether the fruits suffered impact or not. As a result, SDI is unsuitable to indicate fruit impact injury. However, there is a good correlation between SDI and pulp color, vitamin C, pH, titratable acidity, soluble solids, SS/ TA ratio and non-reducing sugars.

Advantages and Limitations of Salmon-Gal/Tetrazolium Salt Histochemistry for the Detection of LacZ Reporter Gene Activity in Murine Epithelial Tissue

The Escherichia coli LacZ gene is a widely used reporter for gene regulation studies in transgenic mice. It encodes bacterial β-galactosidase (Bact β-Gal), which causes insoluble precipitates when exposed to chromogenic homologues of galactose. We and others have recently reported that Bact β-Gal detection with Salmon-Gal (S-Gal) in combination with nitro blue tetrazolium chloride (NBT) is very sensitive and not prone to interference by acidic endogenous β-galactosidases. Unfortunately, as we show here, the method appears to be inadequate for evaluation of Bact β-Gal expression in keratinized epithelial appendages but not in other keratinized epithelia. NBT in the reaction mixture, just as other tetrazolium salts, inevitably causes unwanted staining artifacts in lingual filiform papillae, penile spines, and hair fibers by interacting with keratin sulfhydryl-rich regions. The methodological limitation can be overcome in part by pretreating the tissues before the S-Gal/NBT staining with an iodine–potassium iodide solution. Alternatively, the use of iodonitrotetrazolium chloride instead of NBT in the S-Gal reaction mixture provides enough color resolution to distinguish the specific Bact β-Gal staining in orange from the artifact staining in dark red. In summary, we provide evidence that S-Gal/NBT histochemistry has limitations, when staining keratinized epithelial appendages.