Intoxication by Hand-Sanitizers and other Toxic Alcohols in a Low-Resource Setting: Two Case Reports

Toxic alcohol poisoning can be lethal if not identified early and treated appropriately. Toxic alcohol assays are often unavailable in low-resource setting, so clinicians have to infer a diagnosis based on suspicion, repeated evaluation and biochemical course. We report a case of toxic alcohol poisoning concealed by auto-intoxication with in-hospital hand sanitizer. The eventual appearance of a concurrent high anion gap prompted dialysis. In another case, a comatose patient presented with a high osmolal gap and a high anion gap. Incorrect a priori opinions caused us to defer dialysis and the patient died shortly afterwards. Clinicians should be aware that toxic alcohol poisoning can produce a confusing diagnostic picture with an insidious course, and that doctor delay can prove fatal.

Postpartum Thyroiditis: A Case Report

ABSTRACT: Background: Postpartum thyroiditis (PPT) is a thyroid dysfunctionn syndrome which is temporary or permanent that occurs 1 year after giving birth or abortion. The occurrence of postpartum thyroiditis is 5 – 10% of postpartum women in the world. It is caused by an inflammation of the thyroid gland which leads to a destruction of the thyroid follicle and proteolysis of thyroglobulin. Case presentation: A woman, 31 years old, was admitted to the hospital complaining an enlargement on her neck. The patient said her the enlargement keeps getting larger and she also complained a feeling of something stuck in the throat. The patient also complained a hoarse voice. The patient has just given birth of her second child 5 months ago. From a hematologic examination, radiologic, and blood culture, the patient was diagnosed with Postpartum Thyroiditis. The patient was given Euthyrox therapy and will undergo repeated evaluation after 1 months of the therapy. Conclusion: We reported a case of Postpartum Thyroiditis that was treated comprehensively, and showed a good prognosis.

Identification of Perspective Oat Cultivars with a Minimum Content of Gluten Homologous Peptides

There is still an ambiguous opinion on oat regarding its safety for people with celiac disease (CD). Some studies have confirmed different content of oat immunoreactive epitopes in different cultivars while others explain the differences in consequence of cross-contamination with gluten-rich species or as ELISA cross-reactivity of oat homological epitopes with antibodies against wheat gliadin. Our study was based on a two-year mapping of oat immunoreactive epitopes in a set of 132 oat cultivars using the G12-based ELISA kit. Although repeated evaluation confirmed high interannual variability (RSD ≥ 30%) in approximately 2/3 of the cultivars, the permitted gluten content (20 mg kg-1) has not been exceeded except for contaminated cultivar Sirene. The polymorphism of purified avenins determined by SDS-PAGE revealed the occurrence of 2 bands around 30 kDa in oat cultivars with relatively high gluten content (12-16 mg kg-1) except for the cultivar Leo while this pattern occurred only in 50% oat cultivars with low gluten content. Quantification of gluten epitopes on purified avenin unit further revealed the three materials (Mojacar, Maris Oberon, SG-K 16370) with the lowest gluten content and presence of one band at 30 kDa. The band pattern at 30 kDa thus represents a promising breeding marker.

The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment

Background Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC). Methods Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS. Conclusions The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures. Trial registration ClinicalTrials.gov ID: NCT04139239; Registered 24 October 2019 - Retrospectively registered.

The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated Coma-Recovery Scale-Revised assessment

Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC).Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed.Results: In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS. Conclusions: The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures. Keywords: Coma-Recovery Scale-Revised, Disorders of consciousness, Unresponsive wakefulness syndrome, Minimally conscious state, MisdiagnosisTrial registration: ClinicalTrials.gov ID: NCT04139239; Registered 24 October 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04139239

The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated Coma-Recovery Scale-Revised assessment

Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC). Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results: In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS. Conclusions: The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.

Long-term sonographic evaluation of the peritoneum in peritoneal dialysis patients: A retrospective cohort study

Background Long-term peritoneal dialysis (PD) causes morphological changes to the peritoneum. However, the sequential morphological changes of the peritoneum remain unclear due to the invasiveness and ethical dilemmas surrounding peritoneal biopsies. We aimed to evaluate these long-term morphological peritoneal changes using sonography, which was recently reported to be useful for morphological peritoneal evaluation. Methods We retrospectively identified 115 PD patients who underwent sonographic peritoneal membrane thickness (PMT) measurement. Univariate and multivariate linear regression analyses identified factors related to PMT at baseline (bPMT), at last measurement (lPMT), and the PMT change rate. Of the 115 patients, 42 patients had at least two PMT measurements, including a bPMT measurement. We evaluated the PMT change between bPMT and lPMT. We also evaluated the annual PMT change for 3 years before PD withdrawal in patients who discontinued PD due to peritoneal dysfunction. Clinical characteristics and parameters were analyzed according to PMT change rates (≤ 0 [n = 28] or > 0 [n = 20]). Results The mean age at PD introduction and mean PD duration were 63.7 ± 12.7 years and 40.5 ± 30.1 months, respectively. There was a significant positive correlation between the dialysate to plasma ratio of creatinine (D/P Cr) and lPMT (r = 0.386, p = 0.004), but not bPMT (r=-0.114, p = 0.326). In the multivariate analyses, D/P Cr remained an independent predictor of lPMT (r = 0.478, p = 0.001) after adjusting for age, sex, body mass index, PD duration, diabetes, and peritonitis rate. The mean bPMT and lPMT were 0.67 ± 0.15 mm and 0.69 ± 0.10 mm, respectively, without statistical difference (p = 0.49). Annual PMTs for 3 years before PD withdrawal were 0.67 ± 0.13 mm, 0.66 ± 0.11 mm, and 0.67 ± 0.08 mm, respectively, with no significant differences among measurements (p = 0.967). There were no differences in PD duration, the use of a dialysate containing over 2.5% glucose or icodextrin, and the peritonitis rate between groups divided by the PMT change rate. Conclusions PMT, measured by sonography, was positively correlated with peritoneal permeability. Repeated evaluation of the peritoneum by sonography will enable the recognition of transition in peritoneal function in real time and allow for more appropriate PD management. Furthermore, the peritoneum was not necessarily thickened regardless of PD duration or cause of withdrawal.

Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment

Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high misdiagnosis rate for a clinical consensus. The aim of this study was to investigate the misdiagnosis rate of clinical consensus compared to repeated behavior scale assessments in patients with prolonged disorders of consciousness (DOC). Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical consensus diagnosis. Trained professionals also used the CRS-R to evaluate the consciousness levels of the enrolled patients for repeated times (≥5 times) within a week. After the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Furthermore, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results: In this study, 137 patients with a clinical consensus of prolonged DOC were enrolled. After the single CRS-R behavior evaluation, it was found that the misdiagnosis rate of clinical MCS was 24.7%, while the repeated CRS-R evaluation results showed that the misdiagnosis rate of clinical MCS was 38.2%. A total of 16.7% of EMCS cases were misdiagnosed as MCS, and 1.1% of EMCS cases were misdiagnosed as UWS. Conclusions: The current clinical consensus of the misdiagnosis rate is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool to daily procedures.

Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment

Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high misdiagnosis rate for a clinical consensus. The aim of this study was to investigate the misdiagnosis rate of clinical consensus compared to repeated behavior scale assessments in patients with prolonged disorders of consciousness (DOC). Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical consensus diagnosis. Trained professionals also used the CRS-R to evaluate the consciousness levels of the enrolled patients for repeated times (≥5 times) within a week. After the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Furthermore, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results: In this study, 137 patients with a clinical consensus of prolonged DOC were enrolled. After the single CRS-R behavior evaluation, it was found that the misdiagnosis rate of clinical MCS was 24.7%, while the repeated CRS-R evaluation results showed that the misdiagnosis rate of clinical MCS was 38.2%. A total of 16.7% of EMCS cases were misdiagnosed as MCS, and 1.1% of EMCS cases were misdiagnosed as UWS. Conclusions: The current clinical consensus of the misdiagnosis rate is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool to daily procedures.