Promethazine and Treatment Refractory Agitation in Clonidine Toxicity

Background:Delirium is an acute and transient turmoil disorder in consciousness which is often caused by drugs.One of the adverse effects of clonidine is agitation. Clonidine is an agonist of α2-receptor which functionally overlaps with μ-receptor of opioids. Promethazine is H1-receptor antagonist and has antipsychotic properties. The necessary dose for initial control of agitation is 25-50 milligrams. Case Presentation: A 27 year old man has been sent to emergency department following consumption of clonazepam 1 milligram, clonidine 0.1 milligram and alprazolam 0.5 milligram. Upon arrival at the toxicity emergency of the hospital, the patient's pulse rate suddenly dropped to 20 per min along with widening of QRS and increase of QTc as well as severe agitation. At the end of the second day due to continuous bradycardia pace maker was devised. The patient showed hallucination. In the third day, the patient's delirium increased. Due to no control of agitation by benzodiazepine, haloperidol, Promethazine 25 milligram was injected then slept after 5 minute. Conclusion:In such patient with above restrictions, prescription of promethazine not only maintained blood pressure and caused no disorder in electrocardiogram, but also it immediately and certainly controlled patient's agitation

Cause of murder or normal variation, which one is true?

Background: Parietal hole is formed as a result of defect or delay in the ossifying one third of the posterior parietal in the fifth month of fetal in genetic transfer of mutated gene dominant autosomal genetic. Artery, vein, meningia or brain cortex is exited through it, as for as the equal with its size. Parietal foramen is located in syndromic frame. Case Presentation: The case is Iranian 34 years old woman, that was found in dead state in the motel. The positive findings in examination: - Abrasion in skin of left upper posterior area of parietal. - Scars of cosmetic surgery and numerous tattoos. - Purple bruises in the arms. The positive findings in necropsy: - A hematoma under the right and posterior site of parietal skin in 2˟ 2 cm, under parietal skin abrasion. - A hole that it was in the posterior of right parietal bone,1 mm in diameter ,near the sagittal suture .It was extended to the inner surface of skull. -Very mild desquamation in dura mater with very mild bleeding about 2 cc above arachnoid (under dural desquamation).- A hematoma with 1˟1 cm , between the cervical muscles - A 3˟3 cm hematoma under the skin of upper and anterior of chest wall.The serologic, Toxicologic and pathologic sample were negative.Conclusion: As for as wearing in the left posterior parietal and hematoma under the skin in this area and finding a holes in mentioned area, at first, it seemed that the lesion is created by a sharp object, hard edges or shot. But in closer examinations there was no rupture on scalp and edge of the hole was perfectly sharp and smooth. Hence in order to prevent confusion in similar cases, the physician is familiar with these variations.ith these variations

The relative frequency, clinical and laboratory findings of adult glomerulonephritidies in Tehran

Background: Renal diseases information is population-based and has great geographic variability. Due to the lack of national renal data registry system, there is no information on the prevalence rate, and clinical and laboratory features of various glomerulonephritidies (GNs) in Iran. Methods: In a retrospective cross sectional study, we analyzed 462 adult renal biopsies in Hashemi Nejad hospital, Tehran, Iran. We determined the prevalence rate and the frequency of different clinical and laboratory findings in patients with different GNs. We also compared our results with the reports from other countries. Results: There were 267(57.8) males and 195(42.2) females. The mean age (± SD) was 33.6 ± 15.7 (range, 13-75) years old. After exclusion of 55 biopsies with pathologies other than GNs and in the remaining 407 biopsies, membranous glomerulopathy (MGN) was the most common GN (23.6), followed by IgAN (13.5), membranoproliferative GN (11.5), systemic lupus nephritis (10.6), focal segmental glomerulosclerosis (10.3), and minimal change disease (9.8). These 6 GNs comprised the majority (79.4) of all GNs. Conclusion: MGN is the most common form of GN, followed by IgAN, MPGN, SLE-GN, FSGS and MCD in adult patients in our study. The multi-center studies with a larger sample size are needed for more comprehensive data in Iranian population

Dent disease: A window into calcium and phosphate transport

This review examines calcium and phosphate transport in the kidney through the lens of the rare X-linked genetic disorder Dent disease. Dent disease type 1 (DD1) is caused by mutations in the CLCN5 gene encoding ClC-5, a Cl- /H+ antiporter localized to early endosomes of the proximal tubule (PT). Phenotypic features commonly include low molecular weight proteinuria (LMWP), hypercalciuria, focal global sclerosis and chronic kidney disease; calcium nephrolithiasis, nephrocalcinosis and hypophosphatemic rickets are less commonly observed. Although it is not surprising that abnormal endosomal function and recycling in the PT could result in LMWP, it is less clear how ClC-5 dysfunction disturbs calcium and phosphate metabolism. It is known that the majority of calcium and phosphate transport occurs in PT cells, and PT endocytosis is essential for calcium and phosphorus reabsorption in this nephron segment. Evidence from ClC-5 KO models suggests that ClC-5 mediates parathormone endocytosis from tubular fluid. In addition, ClC-5 dysfunction alters expression of the sodium/proton exchanger NHE3 on the PT apical surface thus altering transcellular sodium movement and hence paracellular calcium reabsorption. A potential role for NHE3 dysfunction in the DD1 phenotype has never been investigated, either in DD models or in patients with DD1, even though patients with DD1 exhibit renal sodium and potassium wasting, especially when exposed to even a low dose of thiazide diuretic. Thus, insights from the rare disease DD1 may inform possible underlying mechanisms for the phenotype of hypercalciuria and idiopathic calcium stones

An on-line repository for embedded software

Abstract The use of off-the-shelf components (COTS) can significantly reduce the time and cost of developing largescale software systems. However, there are some difficult problems with the component-based approach. First, the developers have to be able to effectively retrieve components. This requires the developers to have an extensive knowledge of available components and how to retrieve them. After identifying the components, the developers also face a steep learning curve to master the use of these components. We are developing an On-line Repository for Embedded Software (ORES) to facilitate component management and retrieval. In this paper, we address the issues of designing software repository systems to assist users in obtaining appropriate components and learning to understand and use the components efficiently. We use an ontology to construct an abstract view of the organization of the components in ORES. The ontology structure facilitates repository browsing and effective sea rch. We also develop a set of tools to assist with component comprehension, including a tutorial manager and a component explorer

Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial

To test an intervention to increase adherence to diagnostic follow-up tests among Asian American women. Korean American women who were referred for a diagnostic follow-up test (mainly diagnostic mammograms) and who had missed their follow-up appointment were eligible to participate in the study. Women from two clinics (n = 176) were randomly allocated to a usual care control arm or a peer navigator intervention arm. A 20-min telephone survey was administered to women in both study arms six months after they were identified to assess demographic and socio-economic characteristics and the primary outcome, self-reported completion of the recommended follow-up exam. Among women who completed the survey at six-month follow-up, self-reported completion of follow-up procedures was 97% in the intervention arm and 67% in the control arm (p < 0.001). Based on an intent-to-treat analysis of all women who were randomized and an assumption of no completion of follow-up exam for women with missing outcome data, self-reported completion of follow-up was 61% in the intervention arm and 46% in the usual care control arm (p < 0.069). Our results suggest that a peer navigator intervention to assist Korean American women to obtain follow-up diagnostic tests after an abnormal breast cancer screening test is efficacious

Noscapine suppresses angiotensin converting enzyme inhibitors-induced cough

Background: Dry cough is a common side-effect of the angiotensin converting enzyme inhibitors (ACEI) and is a major limiting factor of their use. It has been suggested that ACEI cause this side-effect by potentiation of the bradykinin effect. Previous work in our laboratory has shown that noscapine, an antitussive drug, inhibits the effect of bradykinin. Methods: To investigate the effect of noscapine on ACEI-induced cough, 611 hypertensive patients who were being treated with ACEI were evaluated for the incidence of persistent dry cough. Results: A cough had developed in 65 (10.6) patients, two (3.1) of whom also had severe respiratory distress that required hospitalisation and immediate discontinuation of the ACEI. Forty-two (64.6) patients had developed a mild cough and 21 (32.3) patients had developed a moderate to severe cough. The patients with moderate to severe cough received 15 mg of noscapine, orally three times daily, while they continued ACEI. Noscapine effectively resolved the cough in 19 (90) patients within 4-9 days of starting treatment. Conclusion: Noscapine, possibly by inhibition of bradykinin synthesis, eliminates ACEI-induced cough in the majority of patients and allows them to continue with ACEI therapy. © 2005 Asian Pacific Society of Nephrology

Pre-radiotherapy plasma carotenoids and markers of oxidative stress are associated with survival in head and neck squamous cell carcinoma patients: a prospective study

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare plasma levels of antioxidants and oxidative stress biomarkers in head and neck squamous cell carcinoma (HNSCC) patients with healthy controls. Furthermore, the effect of radiotherapy on these biomarkers and their association with survival in HNSCC patients were investigated.</p> <p>Methods</p> <p>Seventy-eight HNSCC patients and 100 healthy controls were included in this study. Follow-up samples at the end of radiotherapy were obtained in 60 patients. Fifteen antioxidant biomarkers (6 carotenoids, 4 tocopherols, ascorbic acid, total antioxidant capacity, glutathione redox potential, total glutathione and total cysteine) and four oxidative stress biomarkers (total hydroperoxides, γ-glutamyl transpeptidase, 8-isoprostagladin F_2αand ratio of oxidized/total ascorbic acid) were measured in plasma samples. Analysis of Covariance was used to compare biomarkers between patients and healthy controls. Kaplan-Meier plots and Cox' proportional hazards models were used to study survival among patients.</p> <p>Results</p> <p>Dietary antioxidants (carotenoids, tocopherols and ascorbic acid), ferric reducing antioxidant power (FRAP) and modified FRAP were lower in HNSCC patients compared to controls and dietary antioxidants decreased during radiotherapy. Total hydroperoxides (d-ROMs), a marker for oxidative stress, were higher in HNSCC patients compared to controls and increased during radiotherapy. Among the biomarkers analyzed, high levels of plasma carotenoids before radiotherapy are associated with a prolonged progression-free survival (hazard rate ratio: 0.42, 95% CI: 0.20-0.91, p = 0.03). Additionally, high relative increase in plasma levels of d-ROMs (hazard rate ratio: 0.31, 95% CI: 0.13-0.76, p = 0.01) and high relative decrease in FRAP (hazard rate ratio: 0.42, 95% CI: 0.17-0.998, p = 0.05) during radiotherapy are also positively associated with survival.</p> <p>Conclusions</p> <p>Biomarkers of antioxidants and oxidative stress are unfavourable in HNSCC patients compared to healthy controls, and radiotherapy affects many of these biomarkers. Increasing levels of antioxidant biomarkers before radiotherapy and increasing oxidative stress during radiotherapy may improve survival indicating that different factors/mechanisms may be important for survival before and during radiotherapy in HNSCC patients. Thus, the therapeutic potential of optimizing antioxidant status and oxidative stress should be explored further in these patients.</p

Umbilical hernia rupture with evisceration of omentum from massive ascites: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence of hernias is increased in patients with alcoholic liver disease with ascites. To the best of our knowledge, this is the first report of an acute rise in intra-abdominal pressure from straining for stool as the cause of a ruptured umbilical hernia.</p> <p>Case presentation</p> <p>An 81-year-old Caucasian man with a history of alcoholic liver disease presented to our emergency department with an erythematous umbilical hernia and clear, yellow discharge from the umbilicus. On straining for stool, after initial clinical assessment, our patient noted a gush of fluid and evisceration of omentum from the umbilical hernia. An urgent laparotomy was performed with excision of the umbilicus and devitalized omentum.</p> <p>Conclusion</p> <p>We report the case of a patient with a history of alcoholic liver disease with ascites. Ascites causes a chronic increase in intra-abdominal pressure. A sudden increase in intra-abdominal pressure, such as coughing, vomiting, gastroscopy or, as in this case, straining for stool can cause rupture of an umbilical hernia. The presence of discoloration, ulceration or a rapid increase in size of the umbilical hernia signals impending rupture and should prompt the physician to reduce the intra-abdominal pressure.</p