The Thionamide Paradox: Thyrotoxicosis With Neutropenia as Initial Presentation of Grave’s Disease

Hyperthyroidism typically presents with symptoms such as tremors, palpitations, weight loss, heat intolerance and anxiety. Although rare, anemia, leukopenia or thrombocytopenia may develop as an unusual manifestation of thyrotoxicosis. Hematologic derangements have been reported as a side effect of antithyroid drugs (ATD) as well, and while ATD associated agranulocytosis is uncommon, it is a life-threatening condition. A 49-year-old Hispanic female with history of iron deficiency anemia came to the emergency department (ED) with a chief complaint of palpitations. Also reported fatigue, myalgias, headache and anxiety of 1 week duration. Upon​ arrival to the ED she was tachycardic, appeared anxious and diaphoretic. Physical examination revealed a very discrete, non-tender goiter. Bloodwork showed hemoglobin 9.1 g/dL (12.0-16.0), WBC 2.30 c/µ​L (4.8-10.8),​ ANC 1.04 c/µ​L​ (1.80-7.20), ALC 0.88 c/µ​L​ (1.20-4.0), PLT 209 c/µ​L​ (150-450). TFTs were pertinent for TSH 0.007 UIU/mL (0.35-3.74), free T4 5.11 ng/dL (0.76-1.46) and total T3 555 ng/dL (60-181). She received initial treatment with hydrocortisone 300 mg and PTU 300 mg. She was admitted and started on propranolol 40 mg TID and prednisone 20 mg daily, but further doses of ATD were initially held due to concerns for her marked leukopenia. She subsequently became acutely psychotic with psychomotor agitation, visual and auditory hallucinations. CT of the brain revealed no acute abnormalities. She was started on olanzapine 2.5 mg daily for hyperthyroidism induced psychosis, along with methimazole 20 mg daily, KI (Lugol solution) 0.35 mL BID and cholestyramine 4g BID. Further workup of leukopenia showed no dysplastic​ cells on​ peripheral smear, normal vitamin B12 and folate levels, and negative HIV. She displayed marked improvement, denied ongoing hallucinations after 72 hours of initiating ATD, and WBC subsequently normalized. Thyroid workup was diagnostic for GD with positive TRAB and TSI. She was discharged in stable condition on methimazole 40 mg daily. Agranulocytosis is a rare side effect of ATD (prevalence ~0.5%) and average time of onset is usually within 2-3 months after starting therapy. Although the majority of cases of hematologic alterations in GD are seen as a complication of ATD, our patient presented with the peculiarity that leukopenia (with both neutropenia and lymphopenia) was associated to untreated hyperthyroidism. This case illustrates the fact that in patients presenting with hyperthyroidism and leukopenia, treatment with ATD has proven to result in achievement of euthyroid state along with a sustained improvement in blood cell levels. Despite its rarity, agranulocytosis has become essentially ingrained to ATD amongst medical professionals. Clinicians should be aware that neutropenia is an uncommon feature of uncontrolled hyperthyroidism and feel confident with initiating ATD in this setting.

Lugol Increases Lipolysis through Upregulation of PPAR-Gamma and Downregulation of C/EBP-Alpha in Mature 3T3-L1 Adipocytes

Overweight and obesity are defined as excessive and abnormal fat accumulation that is harmful to health. This study analyzes the effect of different concentrations of the lugol solution (molecular iodine dissolved in potassium iodide) on lipolysis in cultured 3T3-L1-differentiated adipocytes. The mature adipocytes were treated with doses from 1 to 100 µm of lugol for 0.5, 6, and 24 h. The results showed that mature adipocytes exposed to lugol decrease their viability and increase caspase-3 activity with a lethal dose (LD50) of 473 µm. In mature adipocytes, lugol decreased the total intracellular lipid content, being significant at doses of 10 and 100 µm after 6 and 24 h of treatment (P<0.01), and the accumulation of intracellular triglycerides decreased after 24 h of exposure to lugol (P<0.05). Lugol treatment significantly increases the release of glycerol to the culture medium (P<0.05). The levels of adipocyte-specific transcription factors C/EBP-α were downregulated and PPAR-γ upregulated after 30 min with lugol. These results indicate a lipolytic effect of lugol dependent on PPAR-γ and C/EBP-α expression in mature 3T3-L1 adipocytes.

An improved method of dyeing of bakery yeast according to Gram

Knowledge and practical skills of working with microorganisms are required for mastering the modern level of development of veterinary and biological sciences. Microorganisms are the main objects of biotechnology, molecular biology and genetics, and they constantly accompany human and animals in the environment and cohabit inside the body. Direct acquaintance with them and the development of the principles of microbiological research will not only improve their professional level, but also to acquire knowledge and skills are not superfl uous in everyday life. The microscopic method involves the study of living or killed representatives of the microbial (bacteria, bacilli, clostridiums and plectridia) and yeast (bakery, fruit and vegetable, berry and grape yeast) world in a colored or unpainted state using a binocular light microscope. An improved technique of the famous Danish microbiologist G. K. Gram for coloring bakery’s yeast has been presented in the article. On the basis of laboratory researches it has been shown that the diff erentiated coloring according to Gram can be changed on color scale, depending on dyes. Classically according to Gram used: gentian violet, Lugol solution, fuchsin Pfeiff er (based on carbolic fuchsin), but in our technique instead of gentian violet methylene blue has been used, Lugol solution, instead of fuchsin Pfeiff er took red safranin and additionally in the manufacture of the third drug – diamond green dye. It has been shown that the coloring of microbial or yeast cultures has being achieved through the latter dye. So, for example with methylene blue, microbes or yeast are colored blue, with safranin in red and with diamond green in green.

ANALYSIS OF NITRATE, PHOSPHATE AND CONCENTRATION ABILITY OF DIATOM (Bacillariophyta) PLANKTONIK IN THE SUMATERA PROVINCE OF WEST NIRWANA BEACH

This research was conducted in August 2018 with the aim to determine the concentration of nitrate and phosphate in the waters of Nirwana Beach, find out the type and abundance of diatoms found in the waters of Nirwana Beach, and determine the relationship of nitrate and phosphate concentrations to diatoms in Nirwana Beach waters. Determination of sampling location using purposive sampling, namely by taking into account the conditions and conditions of the research area. Sampling of nitrate and phosphate using a sample bottle measuring 100 ml then given preservatives and diatom samples using a bucket and filtered with plankton net no.25 and preserved with 4% lugol solution as much as 3-4 drops and analysis was carried out at the Marine Chemistry and Marine Biology Laboratory , Faculty of Fisheries and Marine Affairs, University of Riau. The results showed nitrate concentration in Nirwana Beach waters ranging from 0.5 mg / l - 0.3 mg / l. And phosphate concentration in the waters of Nirwana Beach ranges from 0.19 mg / l - 0.08 mg / l. In the coastal waters of Nirvana there are 16 species of diatoms found. The highest abundance of diatom species from all species found was Cosconidiscus sp with an average of 4263 ind / l per station. While the lowest abundance of species is Melosira sp, Thalassionema sp, Neodelphinies sp, Rhizossolenia sp and Cocconeis sp with an average of 73.5 ind / l. Diatom diversity index (H ') in Nirwana Beach waters is classified as moderate and community stability is categorized as moderate, there is no type that dominates the uniformity index (E) Nirwana Beach waters are still balanced and there is no competition for food or places. and phosphate with an abundance of diatoms which in this case means that the higher the concentration of nitrate and phosphate, the more abundance of diatoms.

DIAGNOSIS OF GIARDIOSIS IN CHILDREN: RESULTS OF A RETROSPECTIVE COHORT STUDY

Giardiasis in children remains an urgent problem, the importance of which is determined by the endemicity for many countries and regions, polymorphism of the clinic, which causes difficulties in clinical diagnosis of this pathology. The report presents the results of the diagnostic significance of methods of laboratory diagnostics giardiase: microscopy of native and stained with Lugol solution preparation fecal enzyme-linked immunoassay (ELISA) for the presence of antibodies of class IgM and IgG antibodies to the antigens of Giardia in the serum and antigen of G. Lamblia in feces, polymerase chain reaction (PCR) - detection of Giardia DNA in feces obtained during the examination of 160 patients with giardiasis children aged 3 to 14 years. The results of our study suggest that the most informative methods of diagnosis of giardiasis in children is coproscopy (specificity - 96.2%, sensitivity - 98.1%), PCR coprofiltrate. (specificity - 85%, sensitivity 82.5%), determination of antigen in feces by ELISA (specificity - 87,5%, sensitivity - 60%). With high specificity of the blood ELISA method (90%), the sensitivity of the method is only 27.5%. It should be recognized that the «gold standard» diagnosis of giardiasis remains microscopy of native and stained with a solution of Lugol preparation of feces with a three - time study at intervals of 2-3 days.

Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

SUMMARY INTRODUCTION: Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management. CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression. DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications. CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.