Management of Acute Kidney Injury in Patient with Dengue and COVID-19 Illness Simultaneously

Dengue is a viral illness spreads through the bite of Aedes aegypti mosquito leading to a serious health hazard. Dengue induced acute kidney injury is a fatal consequence and there are very few studies reported. Hence early identification of high risk groups is crucial for prevention, to restrict progression and effective treatment of acute kidney injury and to minimise associated morbidity and mortality. The coronavirus disease outbreak has widely spread into a pandemic all over the world. COVID-19 cases have presented with wide spectrum of severity ranging from a mild presentation to severe cases affecting the lungs(ARDS) mainly and rapidly affecting various body organs leading to multiorgan failure. Among these renal involvement is common, the severity of which ranges from mild loss of protein in urine to progressive acute kidney injury requiring renal replacement therapy.

Proteotoxicity: A Fatal Consequence of Environmental Pollutants-Induced Impairments in Protein Clearance Machinery

A tightly regulated protein quality control (PQC) system maintains a healthy balance between correctly folded and misfolded protein species. This PQC system work with the help of a complex network comprised of molecular chaperones and proteostasis. Any intruder, especially environmental pollutants, disrupt the PQC network and lead to PQCs disruption, thus generating damaged and infectious protein. These misfolded/unfolded proteins are linked to several diseases such as Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, and cataracts. Numerous studies on proteins misfolding and disruption of PQCs by environmental pollutants highlight the necessity of detailed knowledge. This review represents the PQCs network and environmental pollutants’ impact on the PQC network, especially through the protein clearance system.

Outpatient management of pulmonary emboli: when to ambulate

Pulmonary embolism is a potentially fatal consequence of venous thromboembolism and constitutes a significant proportion of the acute medical take. Standard management has previously required admission of all patients presenting with acute pulmonary embolism for initiation of anticoagulation and initial investigations. However, clinical trial data have demonstrated the feasibility and safety of managing a subset of patients with low-risk pulmonary embolism in the outpatient setting and this has since been reflected in national guidelines. This article provides a practical overview for general physicians with regards to identifying patients with low-risk pulmonary embolism, and when and how to manage these patients on an outpatient basis.

Four types of scrapie in goats differentiated from each other and bovine spongiform encephalopathy by biochemical methods

Scrapie in goats has been known since 1942, the archetype of prion diseases in which only prion protein (PrP) in misfolded state (PrPSc) acts as infectious agent with fatal consequence. Emergence of bovine spongiform encephalopathy (BSE) with its zoonotic behaviour and detection in goats enhanced fears that its source was located in small ruminants. However, in goats knowledge on prion strain typing is limited. A European-wide study is presented concerning the biochemical phenotypes of the protease resistant fraction of PrPSc (PrPres) in over thirty brain isolates from transmissible spongiform encephalopathy (TSE) affected goats collected in seven countries. Three different scrapie forms were found: classical scrapie (CS), Nor98/atypical scrapie and one case of CH1641 scrapie. In addition, CS was found in two variants—CS-1 and CS-2 (mainly Italy)—which differed in proteolytic resistance of the PrPresN-terminus. Suitable PrPres markers for discriminating CH1641 from BSE (C-type) appeared to be glycoprofile pattern, presence of two triplets instead of one, and structural (in)stability of its core amino acid region. None of the samples exhibited BSE like features. BSE and these four scrapie types, of which CS-2 is new, can be recognized in goats with combinations of a set of nine biochemical parameters.

Critical Illness Associated Fatal Hypoglycemia in a Nondiabetic Male

We present here the case of a 55-year-old male who presented to the emergency department with severe abdominal pain and respiratory distress secondary to mesenteric ischemia. His critical illness on preexisting chronic kidney disease, previously undiagnosed alcoholic cirrhosis, and congestive heart failure led to a rare yet fatal consequence of refractory hypoglycemia. Critical illness associated hypoglycemia generally occurs as a result of high metabolic consumption with relative insulin excess and insufficient nutritional intake that is seen frequently in critically ill patients. This, along with reduced hepatic and renal gluconeogenesis seen in preexisting liver and renal disease, can cumulate to life-threatening hypoglycemia and is seen as a poor prognostic factor in the ICU setting.

Acute adrenal failure: a potentially fatal consequence of an adulterated herbal remedy

Herbal remedies adulterated with glucocorticoids can cause Cushing’s syndrome. We report a severe presentation of a ‘herbal remedy’ adulterated with glucocorticoids; causing a potentially fatal adrenal crisis precipitated by acute illness. Investigations were consistent with adrenal suppression and confirmed, after tablet analysis, to be due to a ‘herbal remedy’ containing synthetic betamethasone/dexamethasone. This case highlights the need for clinical vigilance and patient education about the potential risks associated with the use of unlicensed treatments and the role of tablet analysis in routine biochemistry.

Delayed peracute capture myopathy in a Himalayan Ibex Capra sibirica (Mammalia: Cetartiodactyla: Bovidae)

The present study focused on the capture myopathy as a fatal consequence of capture and rescue operation in an endangered Himalayan Ibex kid. The Ibex died 48 hours after being captured without showing specific clinical signs. Post-mortem examination revealed renal cortical necrosis, degeneration of tubular cells and congestion as the main histopathological findings in kidneys. Myocardial lesions consisted of multifocal degenerative changes of myofibres, hyalinization and nuclear degeneration with pyknosis. Skeletal muscles that appeared grossly normal showed mild to moderate degeneration and fragmentation with intermittent loss of striation. The pathological findings were indicative of delayed peracute capture myopathy. This is believed to be the first report of capture myopathy in an endangered Himalayan ibex from India underlining the importance of understanding the causes of mortality in such endangered wild species as a prerequisite to successful conservation programme.

Análisis de la influencia de las acciones formativas en la prevención de riesgos laborales = Analysis of the influence of training actions in occupational risk prevention

ResumenEsta investigación analiza las etapas formativas en materia de prevención en las Pequeñas y Medianas Empresas (PYMES) del Sector Construcción en España, partiendo del indicador relativo a la elevada siniestralidad del Sector frente al resto de sectores productivos, para a través de los cuestionarios diseñados ex professo y las bases de datos de diversos organismos consultados, como los Servicios de Prevención Ajenos (SPAs) y la Fundación Laboral de la Construcción (FLC), observar la posible solución a esta casuística tan funesta. Se analizó la cualificación profesional de los docentes, las metodologías formativas empleadas y la formación e información que recibe el trabajador sobre su puesto de trabajo. Los resultados muestran el escaso nivel educativo y formativo de los trabajadores, y la baja especialización de los docentes que imparten la formación. Tanto el Sector como sus trabajadores demandan una necesaria profesionalización de los procesos que les permitan ser más competitivos.AbstractThis paper analyzes all the preventive-training stages in Small and Medium Enterprises (SMEs) that belong to the Spanish Construction Sector. One of the stages analyzed deals with the fatal consequence of incidence rate in Construction Sector compared to other productive sectors. To do that, a survey was made to evaluate the qualifications of the technicians in External Prevention Services (EPS) and in the Construction Labor Foundation (CLF), by looking at the possible solution to this problem. In order to execute the analysis, the qualifications of the trainers, the training methodologies used and the training and information received by the workers on their workplace were examined. The results show the deficient educational and training level of the workers, as well as the low specialization of the trainers who provide training actions. Both the Construction Sector and its workers demand a necessary professionalization of the processes to be more competitive and efficient