Primary adipsia and severe hypernatremia in a Pit Bull dog

ABSTRACT: Primary adipsia is a rare condition in which there is failure in the activation threshold of the hypothalamic osmoreceptors, leading to osmolality imbalance. Here, we reported the case of a Pit Bull dog with an altered level of consciousness (started after weaning) and adipsia. There was an increase in plasma osmolality (444 mOsm/kg), sodium (223.7 mg/dL), and chlorine (173 mg/dL) levels. Based on the suspicion of primary adipsia, water was administered via a nasogastric tube, with clinical improvement. The owner was instructed to supply water with food. Eight months after discharge, the dog returned with parvovirus and died. In the anatomopathological examination, no structural changes were observed in the central nervous system. To our knowledge, this is the first report of hypernatremia due to adipsia in a Pit Bull dog, showing that this is a differential diagnosis that should be considered in this breed.

Predictors of prolonged hospitalisation and mortality among children admitted with blackwater fever in eastern Uganda

Our study aimed at determining clinical factors associated with prolonged hospitalisation and death among children admitted with blackwater fever (BWF). We analysed 920 eligible records for the period January – December 2018 from Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. The median hospitalisation was 3 (IQR: 2–5 days) days. Prolonged hospitalisation was in 251/920 (27.3%). Clinical features independently associated with prolonged hospitalisation included abdominal tenderness, body pain and mild fever. 29/920 (3.2%) died, of these 20 (69.0%) within 48 h of admission. Features of severity associated with mortality were noisy or interrupted breathing, tachypnoea, chest pain, convulsions, delayed capillary refill time (≥3 s), severe pallor, high fever (>38.5°C), altered level of consciousness, prostration and acidotic breathing.

COMPARATIVE STUDY ON PREVALENCE AND ASSESSMENT OF ALTERED SENSORIUM AMONG SODIUM ABNORMALITY PATIENTS AT A TERTIARY CARE TEACHING HOSPITAL

Altered sensorium or altered level of consciousness is a common complaint among electrolyte abnormality patients and has several synonyms like altered behaviour, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behaviour, inattention, confusion, hallucination. The aim of the study was to evaluate the prevalence and to assess the level of consciousness dysnatremic patients at a tertiary care hospital. A prospective observational study, serum sodium level and other clinical profiles were recorded in a data collection form. GCS was used to analyses the level of consciousness among the enrolled patients. SPSS 22.0 statistical software was used for data analysis. During the study period, a total of 482 patients were enrolled in the study. Based on the serum sodium, they were categorized into Hyponatraemic (410) and Hyponatraemic (72) patients. Our study found a greater number of patients in the age group above 60 years and found that sodium imbalance increases generally in males with increasing age. Our study found that altered sensorium (60%) was predominant more in hyponatremia patients. Chi square test was performed to find statistically significant difference in level of consciousness between hypo and Hyponatraemic patients and was found to be significant p value (≤ 0.05). Abnormalities of plasma sodium are probably the most common electrolyte disorders and they are associated with serious morbidity including a poorer long-term neurologic outcome.

Common Comorbidities Among Stroke Patient and Their Outcome in a Tertiary Care Hospital, Bangladesh

Background: Stroke is worldwide second leading cause of death and the most common cause of disability. The aim of the study is to evaluate the common comorbidities and their impact on hospital outcome in patients after stroke Methods: This observational study was carried out amongst 228 of acute stroke patients after fulfills the inclusion and exclusion criteria and were admitted indifferent medicine unit of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from May 2020 to April 2021. All cases were confirmed by CT scan or MRI of brain. Stroke were categorizes as Ischemic stroke, Intra-cerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH). HTN, DM, IHD were considered as common comorbidities. Prognostic factors were included stage II or III hypertension, altered level of consciousness, previous stroke and large size of stroke. Results: In this study, male affected more than female (68.42% vs 31.58% and ratio 2.1:1). Age >60 years were more affected (68.86%). Most affected patients were Ischemic stroke (61.40%), then ICH (34.21%) and then SAH (3.07%). Common comorbidities were HTN and DM (48.68% and 34.64% respectively). Most of expired patients had comorbidities (80.64%). Worst prognostic factors were altered level of consciousness, stage II or III hypertension and large size of stroke (27.19%, 25.0% and 19.29% respectively). Among hospital outcome most of patients improved and discharged eventfully (41.22%), Deteriorate (17.98%), remain static and discharged (14.03%) and death 13.59%. Conclusion: The most of patients had been suffered from ischemic stroke which were more common in male. The commonest risk factor of stroke was hypertension followed by diabetes mellitus and ischemic heart disease. Our pooled result showed that majority of the patients were improved and discharged and around one sixth of stroke patients have died during hospitalization. The control of comorbid conditions will be much help for prevention of occurrence of stroke and will reduces the disability from stroke events. Bangladesh J Medicine July 2022; 33(1) : 8-11

Predicting mortality and readmission based on chief complaint in emergency department patients: a cohort study

BackgroundEmergency department (ED) patients present with complaints and not diagnoses. Characterization and risk stratification based on chief complaint can therefore help clinicians improve ED workflow and clinical outcome. In this study we investigated the 30-day mortality and readmission among ED patients based on chief complaint.MethodsIn this cohort study we retrieved routinely collected data from electronic medical records and the Danish Civil Registration System of all ED contacts from July 1, 2016 through June 30, 2017. All patients triaged with one chief complaint using the Danish Emergency Process Triage system were included. Patients with minor injuries were excluded. The chief complaint assigned by the triaging nurse was used as exposure, and 30-day mortality and 30-day readmission were the primary outcomes. Logistic regression was used to determine crude and adjusted ORs with reference to the remaining study population.ResultsA total of 41 470 patients were eligible. After exclusion of minor injuries and patients not triaged, 19 325 patients were included. The 30-day mortality and 30-day readmission differed significantly among the chief complaints. The highest 30-day mortality was observed among patients presenting with altered level of conscousness (ALOC) (8.4%, OR=2.0, 95% CI 1.3 to 3.1) and dyspnea (8.0%, OR=2.1, 95% CI 1.6 to 2.6). 30-day readmission was highest among patients presenting with fever/infection (11.7%, OR=1.9, 95% CI 1.4 to 2.4) and dyspnea (11.2%, OR=1.7, 95% CI 1.4 to 2.0).DiscussionChief complaint is associated with 30-day mortality and readmission in a mixed ED population. ALOC and dyspnea had the highest mortality; fever/infection and dyspnea had the highest readmission rate. This knowledge may assist in improving and optimizing symptom-based initial diagnostic workup and treatment, and ultimately improve workflow and clinical outcome.Level of evidenceLevel III.

Artery of Percheron Occlusion: A Diagnostic Challenge

Artery of Percheron occlusion is a rare cause of ischaemic stroke characterized by bilateral thalamus infarction. Presentation is varied and non-specific, with the most frequent manifestations being altered level of consciousness, hypersomnolence or altered oculomotor movements. We describe the case of a 37-year-old man hospitalized for hypersomnia and hypomnesia with 3 days of evolution, who was diagnosed with a bilateral thalamus stroke due to artery of Percheron occlusion.

Delirium and Cognitive Impairment as Predisposing Factors of COVID-19 Infection in Neuropsychiatric Patients: A Narrative Review

SARS-CoV-2 neuroinvasive and neurotropic abilities may underlie delirium onset and neuropsychiatric outcomes. Only a limited number of studies have addressed the potential effect of SARS-CoV-2 infection on mental health so far. Most studies mainly reported the acute onset of mixed neuropsychiatric conditions in patients infected with SARS-CoV-2, characterized by agitated behavior, altered level of consciousness, and disorganized thinking, regardless of psychological or socioeconomic triggering factors. The present narrative review aims to analyze and discuss the mechanisms underlying the neuroinvasive/neurotropic properties of SARS-CoV-2 and the subsequent mental complications. Delirium appeared as a clinical manifestation of SARS-CoV-2 brain infection in some patients, without systemic or multiple organ failure symptoms. A small number of studies demonstrated that neuropsychiatric symptoms associated with COVID-19, initially presenting as a confused state, may subsequently evolve in a way that is consistent with the patients’ neuropsychiatric history. A literature analysis on this topic prevalently showed case reports and case series of patients presenting delirium or delirium-like symptoms as the main outburst of COVID-19, plus a cognitive impairment, from mild to severe, which pre-existed or was demonstrated during the acute phase or after infection. Dementia appeared as one of the most frequent predisposing factors to SARS-CoV-2 infection complicated with delirium. Instead, contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a neuropsychiatric history. Therefore, clinicians should contemplate the possibility that COVID-19 appears as delirium followed by a psychiatric exacerbation, even without other systemic symptoms. In addition, cognitive impairment might act as a predisposing factor for COVID-19 in patients with delirium.

Sgt1 Regulates α-Synuclein Subcellular Localization and Expression of Parkinson’s Disease Related Genes, PINK1 and PARK9

The SGT1 protein is highly expressed in the mammalian brain, particularly in neurons of the hippocampus and cortex, and in Purkinje cells of the cerebellum. There are literature data indicating that the protein may be involved in pathogenesis of neurodegenerative disorders such as Parkinson’s disease (PD). In the present work we have found that SGT1 protected cells from the toxicity of rotenone, an agent that evokes behavioral and histopathological symptoms of PD. To gain more insight into the possible mechanism underlying the protective action of SGT1 we looked at α-synuclein subcellular distribution in HEK293 cells with an altered SGT1 level. By immunofluorescent staining we have found that in HEK293 cells overexpressing SGT1 α-synuclein was mainly localized in the cytoplasm while in control cells it was present in the nucleus. Accordingly, when SGT1 expression was silenced, α-synuclein was predominantly present in the nucleus. These results were then confirmed by subcellular fractionation and Western blot analysis. Moreover, we have found that altered level of SGT1 in HEK293 cells influenced the expression of PD related genes, PINK1 and PARK9. Altogether, our results point to SGT1 as an important factor that might be involved in the pathogenesis of Parkinson’s disease (PD).

Evaluation of Seizures and Seizurelike Events

Correctly diagnosing seizures and seizurelike events is important for numerous reasons, including safety issues, social consequences, and therapy. Patients with transient neurologic events of unknown cause are commonly admitted to hospitals, and an estimated 10% of the people in the United States have a seizure in their lifetime. These facts highlight the importance of diagnostic accuracy. History taking is imperfect, but it is still a cornerstone in making the proper diagnosis of transient neurologic events. Focused, supporting diagnostic tests may add accuracy in arriving at the proper diagnosis, but even with a good history, diagnostic testing, and physical examination findings, the diagnosis may be inaccurate. Self-reports of seizure frequency are notoriously inaccurate and often miss more than 50% of focal-onset seizures, especially if the seizures begin in the dominant hemisphere (largely because the effects of the event cause an altered level of consciousness).