A practical case: features of the autoimmune insulin syndrome diagnosis

Autoimmune Insulin syndrome (AIS), also named Hirata disease, is a rare condition characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). AIS is a form of immune-mediated hypoglycemia, which develops when a triggering factor (medication or a viral infection) acts on an underlying predisposing genetic background. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglucemia. The article presents a case of Hirata disease diagnosing of a patient of the therapy department of the Multidisciplinary Medical Center of the Bank of Russia.Purpose: Determining of the features of the diagnosis of Autoimmune Insulin syndrome (Hirata disease)Materials and methods: the article presents a clinical case of the diagnosis of Autoimmune insulin syndrome (Hirata disease), focuses on the diagnostic significance of laboratory tests. The article is intended for general practitioners, endocrinologists, gastroenterologists.

Displacement Characterization and Spatial-Temporal Evolution of the 2020 Aniangzhai Landslide in Danba County Using Time-Series InSAR and Multi-Temporal Optical Dataset

On 17 June 2020, a large ancient landslide over the Aniangzhai (ANZ) slope, Danba County, Sichuan Province, China, was reactivated by a series of multiple phenomena, including debris flow triggered by heavy rainfall and flooding. In this study, Synthetic Aperture Radar (SAR) images acquired by the Sentinel-1A/B satellite and optical images captured by the PlanetScope satellites were jointly used to analyze and explore the deformation characteristics and the Spatial-Temporal evolution of the ANZ landslide before and after the multi-hazard chain. Several areas of pre-failure movements were found from the multi-temporal optical images analysis before the reactivation of the ANZ landslide. The large post-failure surface deformation over the ANZ slope was also retrieved by the optical pixel offset tracking (POT) technique. A major northwest movement with the maximum horizontal deformation of up to 14.4 m was found. A time-series InSAR technique was applied to analyze the descending and ascending Sentinel-1A/B datasets spanning from March 2018 to July 2020, showing that the maximum magnitudes of the Line of Sight (LoS) displacement velocities were −70 mm/year and 45 mm/year, respectively. The Spatial-Temporal evolution over the ANZ landslide was analyzed based on the time-series results. No obvious change in acceleration (precursory deformation) was detected before the multi-hazard chain, while clear accelerated deformation can be observed over the slope after the event. This suggested that heavy rainfall was the most significant triggering factor for the generation and reactivation of the ANZ landslide. Other preparatory factors, including the deformation behavior, the undercutting and erosion of the river and the outburst flood, the local terrain conditions, and earthquakes, might also have played an important role in the generation and reactivation of the landslide.

Neuroinflammation in Epilepsy—Diagnostics and Therapeutic Perspectives

Epilepsy is a neurological disease that affects approximately 1% of the world’s population. Epilepsy is characterized by the occurrence of repeated epileptic seizures due to abnormal neuronal activity. Although this disorder is currently incurable, it can be controlled for years with the appropriate therapy and patient adherence. Inflammation is an organism’s natural response to a pathological stimulus, aimed at eliminating the triggering factor. Multiple studies point out a significant correlation between an increased level of inflammatory mediators and the frequency of epileptic seizures. Increased levels of IL-1β, IL-2, IL-4, IL-6, IFN-γ, and TNF-α were found in the serum of patients with epilepsy. Additionally, pro-inflammatory cytokines were found to be upregulated during epileptic activity in rodents: CCL2 and CCR2 receptor expression was shown to be upregulated during inflammation induced by lipopolysaccharide administration, and CXCR5 was found to be primarily upregulated in brain cells. Early detection of the described factors may serve as a biomarker for epilepsy but also hold potential in developing novel immunomodulating therapies. Thus, a better understanding of the immune system’s involvement is necessary for the development of new therapeutic perspectives in epilepsy.

Neurotoxic complications of chemotherapy in children: posterior reversible encephalopathy syndrome

Introduction. The syndrome of posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological condition caused by vasogenic brain edema due to elevated blood pressure. The development of this syndrome is associated with the toxic effect of drugs in the treatment of oncological diseases. In most cases, timely diagnosis and therapy of PRES determine the complete reversibility of symptoms. However, a poor prognosis is possible with the development of severe disabling consequences or death. In practice, there are difficulties in the diagnosis of PRES due to the lack of specificity of clinical manifestations and awareness of many doctors about the existence of this syndrome.The aim of the study was to present the clinical-radiological aspect of the syndrome of posterior reversible encephalopathy in children with oncological diseases.Materials and methods. The analysis of 8 medical histories of children with oncological pathology complicated by the syndrome of posterior reversible encephalopathy was carried out.Results. The study group was dominated by patients with hemato-oncological diseases. The development of PRES occurred during chemotherapy and in most cases was not associated with arterial hypertension. The clinical picture was dominated by such symptoms as impairment of consciousness, seizures and movement disorders in the form of paresis. When carrying out magnetic resonance imaging (MRI), the lesion of the white matter of the brain was determined, mainly in the projection of the parieto-occipital regions. During treatment, all patients showed reversibility of neurological symptoms with leveling of radiological signs.Discussion. When analyzing the clinical and radiological characteristics of PRES in children, a comparison of the data with clinical observations presented in the literature was noted. The role of chemotherapy as a triggering factor in the development of posterior reversible encephalopathy syndrome has been determined.Conclusion. The necessity of including the syndrome of posterior reversible encephalopathy in the list of differential diagnoses in patients receiving chemotherapy is shown.

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.

Pendidikan Kesehatan pada Ibu Hamil tentang Anemia menggunakan Media Video di Kota Palangka Raya

In developing countries with high levels of morbidity in pregnant women, anemia is a significant health problem and is one of the risk factors for postpartum bleeding. One area with low Fe intake data in Palangka Raya City is Puskemas Jekan Raya. In pregnant women, the intake of Fe is low and thus should be suspected as an indication of the anemia triggering factor during pregnancy. Efforts to increase pregnant women's knowledge of anemia can be made through improving healthcare employees with information or health education; particularly video media consist of a combination of images and sounds. Three methods have been applied in the Community Service Activity Method, including the preparation, implementation of activities, and evaluation. The activity was carried out at the Puskemas Pembantu Bumi Palangka, Jekan Raya District, Palangka Raya City, using a class meeting of pregnant women. Media or aids used in performing these activities, such as paperwork, laptops, projectors, and videos on anemia prevention in pregnant women. This activity increases pregnant women's knowledge by 80%. In addition, pregnant women's classroom activities are also very beneficial because they improve interaction and share information.

A COMPREHENSIVE REVIEW OF KARNA ROGA NIDANA AND THEIR IMPACT ON PATHOGENESIS OF EAR DISORDERS

Ear disorders have a wide range of sharing in a load of global illnesses, and their incidences with a continuous hike and difficulty can be contributed to the obscure understanding of the causative agents, including their action mechanisms in the generation of ear pathology. Karna roga has been well theorized in all the authoritative textbooks. Nidana is the first component of ‘Trisutra’ and is not only the triggering factor but also the initial diagnostic tool, which help learn the course of disease progression. Relevant content of the selected topic was obtained from classics, journals and online search portals for a judicious review. The Acharya in Shalakya has provided an ample account of Karna roga nidana, including their count, causative factors and pathogenesis, which can be compared with their recent counterparts and interpreted in modern ways for a clearer perspective of ear disorders.

A life-threatening reverse Takotsubo syndrome in a young breastfeeding woman: a case report

Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder. Case Summary A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission she was lethargic, hypotensive and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock was made. The patient was transferred to the Intensive Care Unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In three days, the patient was weaned from hemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS. DISCUSSION We present a case of a young woman, eight months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary edema and cardiogenic shock.

Una aproximación al estudio del suicidio en Venezuela

Esta investigación ahonda en el conocimiento de los suicidios en Venezuela, país que vive una profunda crisis humanitaria, agravada desde el año 2014. Se plantean dos enfoques: uno cuantitativo y otro cualitativo. Mediante el primero, se estiman indicadores numéricos para analizar la ocurrencia y la frecuencia de suicidios en el país. Por medio del segundo, se llevan a cabo entrevistas a familiares de víctimas de hechos suicidas y a profesionales vinculados con el tema. Los resultados indican que la tasa de suicidios en Venezuela se incrementó entre 2015 y 2018, muy probablemente como consecuencia de la crisis que atraviesa la nación. Esto se refuerza con los hallazgos derivados de las entrevistas, de donde se extrae que el contexto nacional está presente como factor de riesgo interviniente y componente clave explicativo del probable aumento de los suicidios. La principal conclusión es que la crisis podría haber actuado como detonante de un cúmulo de sentimientos y pensamientos negativos, y de trastornos de depresión y ansiedad, los cuales, a su vez, podrían haber impulsado a venezolanos de distintas edades hacia actos suicidas. Abstract This research tries to deepen the knowledge of suicides in Venezuela, a country that experiences a deep humanitarian crisis, which has become worse since 2014. For this purpose, two approaches are proposed: a quantitative approach and a qualitative one. In the first one, numerical indicators are estimated in order to know, analyze and understand the incidence of the occurrence and frequency of suicides in the country. Through the second approach, interviews to relatives of victims of suicide and with professionals related to the topic are carried out. The results indicate that the suicide rate in Venezuela increased between 2015 and 2018, most probably as a consequence of the crisis the nation is going through. This conclusion is reinforced with the findings derived from the interviews from which it is deduced that the national context was present as an intervening risk factor and as a key explanatory component of the probable increase in suicide figures. The main conclusion is that the crisis could have acted as a triggering factor for an accumulation of negative feelings and thoughts, and for disorders of depression and anxiety, which, in turn, could have driven Venezuelans of different ages towards suicidal acts.