“CLINICAL STUDY OF SCORPION STING ENVENAMATION - CLINICAL PROFILE, COMPLICATIONS, TREATMENT AND EFFECT OF EARLY TREATMENT WITH PRAZOCIN IN PREVENTING THE COMPLICATIONS”

BACKGROUND:The incidence and severity of scorpion sting are higher in the deferent parts of world , South India is not an exception. AIM :To study the clinical manifestations , complications and preventing the complications with early use of Prazosin in scorpion sting. RESULTS :Age of the study subjects were ranging from 21 -45 years, among them 70% were male and 30% were female. All the study subjects witness pain at the site of sting, other symptoms were paraesthesia (93%), profuse sweating all over the body (78%),cold extremities (76%), swelling at the sie of the sting (65%), nausea and vomiting (48%). CONCLUSIONS : Severity of the clinical features are mild as prazosin included in management of scorpion bite , no case fatility reported in the study. Prazosin is the effective pharmacological and physiological antidote to venom.

A case report of Morvan syndrome

ABSTRACT Authors describe the case of a 22-year-old Caucasian male who presented acutely with psychomotor agitation, insomnia and muscle twitching with painful cramps. Autonomic symptoms were as well present, with profuse sweating, blood pressure fluctuations and tachycardia. He presented a miliary rash in his left forearm as well as in the neck. Electromyography documented myokymic movements bilaterally at both gastrocnemii and pretibial muscles. Brain imaging had no abnormalities, and anti-LGI1 and anti-CASPR2 resulted positive; this data together with electrophysiological findings suggested a Morvan syndrome. High-dose steroid therapy and plasma exchange improved substantially the clinical picture of the patient.

Giant Adrenal Pheochromocytoma Presenting With Stroke

Background: Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla or from paravertebral ganglia of the sympathetic chain(1). The tumours commonly produce one or more catecholamines: epinephrine, norepinephrine, and dopamine leading to a classic triad of presentation with pounding headache, profuse sweating, and palpitations occurs in spells; However, one in 10 patients may be completely asymptomatic and the diagnosis of PPGL is frequently missed(2). Care Report: A 29 years old African female presented with one-month history of throbbing headache, palpitations, profuse sweating, and unintentional weight loss. Her previous medical history and family history was unremarkable. She was found to have accelerated hypertension and a small lacunar infarct and some suspected subarachnoid hemorrhage on MRI head but was clinically silent. Investigation for secondary causes of hypertension revealed high metanephrine in urine and her imaging showed giant adrenal mass suggestive of pheochromocytoma. CT Abdomen of large left adrenal necrotic solid mass lesion with heterogenous enhancement of its solid components measuring 6.5 x 6.1 x 7 cm in maximum AP, TR and CC dimensions respectively. She was scheduled for open resection and left adrenalectomy after approximatly10 day and was treated with high-sodium diet, alpha blockers, and beta blockers perioperatively. Histopathology examination revealed Pheochromocytoma measuring 8 x 7 x 5 cm with diffuse growth >10% of tumor volume with central necrosis; PASS =4, which has malignant potential. She recovered well post operatively and required no further antihypertensive therapy or hormonal replacement, follow up hormonal profile and imaging with Iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were negative for remnants or metastasis, further evaluation with gallium DOTATATE PET CT and molecular genetic testing was considered, but it was not available. Conclusion: Pheochromocytoma is a rare cause of secondary hypertension with a variable clinical presentation. Episodes of tumoral catecholamine release, are thought to be responsible for the high prevalence of cardiovascular emergencies, such as myocardial infarction, heart failure, and stroke as a complication of hypertensive crisis. Timely diagnosis and treatment are crucial to prevent life-threatening complications.

The English Sweating Sickness of 1485-1551 and the Ecclesiastical Response

During the 15th and 16th centuries, five epidemics of a disease characterized by high fever and profuse sweating ravaged England. The disease became known as English sweating sickness because it started in England, though it also struck Ireland and mainland Europe. The infectious disease was reportedly marked with pulmonary components, and the mortality rate was estimated to be between 30% and 50%. The evidence of the “sweating sickness” story is medically fascinating and historically noteworthy as to its sudden appearance in 1485 and major disappearance in 1551. This was a period when the Church of England broke away from the Roman Catholic Church; and the then Prince of Wales, Arthur Tudor, died possibly of sweating sickness. The Church played a vital role during those periods: responses were made in the form of treatment (in Germany), ecclesiastical prayers, tailored worship, and devotions during those trying times, and the preservation of fragile records relating to the epidemics.

The practical significance of septic patients found in sweat of pyogenic cocci

As you know, Brunner and Eissberg stated the presence of staphylococci in the blood and sweat of pyemic patients. In three respective cases, the author, on the one hand, confirmed their observations, and on the other, tried to use this fact for therapeutic purposes, proceeding from the idea that artificially induced profuse sweating, perhaps, will facilitate the elimination of microorganisms from the blood and their toxins.

POSTOPERATIVE BLEEDING AFTER LAPAROSCOPIC GASTRIC-SLEEVE: WHAT OPTIONS DO WE HAVE?

Laparoscopic sleeve gastrectomy is a relatively simple procedure, but the complications can quickly become life-threating. The aim of this study was to investigate based on our experience when is best to follow a conservative protocol in postoperative bleeding after sleeve gastrectomy. The study is retrospective, we identified a number of 150 cases of sleeve gastrectomy, of which 18 has postoperative bleeding. A conservative approach with close observation (ultrasound, CT, Hb levels) was practiced in 10 cases and no surgical intervention was required. The recommendations are as follows: The first and obvious recommendation is to stop anticoagulants. The perigastric drainage should drain, if Hb levels go down an nothing is coming through the drain consider other sources of bleed or try to reopen the blocked drain. A blood cloth developed around the bleeder may maintain the active bleed due to local fibrinolysis, in these cases, one should take into consideration guided drainage (ultrasound/CT) and monitor Hb levels afterward. The presence of a small perigastric collection without clinical manifestation should be left as such. Take into consideration reintervention if: signs of hypovolemia are present (tachycardia, hypotension, profuse sweating), Hb below 7g/dL. The patient's clinical state should always play an important role in decision making.

A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre

Tricholoma equestre (hereinafter – T. equestre) is a common edible fungus that is considered to be toxic under certain conditions. Here, we report four cases of acute poisoning caused by T. equestre, including one lethal outcome in Lithuania between 2004 and 2013. In the severe case, fatigue, nausea without vomiting and muscle pain, profuse sweating without fever, and respiratory insufficiency occurred. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Although clinical findings and laboratory tests support evidence of rhabdomyolysis, no renal insufficiency was observed. Significance of T. equestre in cardiac changes is feasible but remains unclear.