Cardiac Arrest as the First Presentation of Gitelman Syndrome

Gitelman syndrome is a salt-wasting tubulopathy characterized by profound hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Cardiac arrest is a relatively rare manifestation of Gitelman syndrome. Here we present a case of Gitelman syndrome in a patient with recurrent cardiac arrest. A 43-year-old female was admitted for out-of-hospital cardiac arrest secondary to ventricular fibrillation. Initial workup revealed severe hypokalemia, hypomagnesemia, metabolic alkalosis, and prolonged QTc. The workup revealed a picture of salt-wasting tubulopathy with hypokalemia, hypomagnesemia, and hypocalciuria. Potassium was repleted aggressively, and the patient received potassium-sparing agents resulting in the stabilization of potassium levels. Before discharge, an implantable cardioverter defibrillator (ICD) was placed for secondary prevention of cardiac arrest. The patient remained symptom-free, and electrolytes remained stable. This case highlights the diagnostic challenges of Gitelman syndrome and the importance of accurate diagnosis in improving patient outcomes

Algal community membership of estuarine mudflats from the Savannah River, United States

Algae represent a large and diverse group of photosynthetic organisms inhabiting all aquatic habitats. Although the traditional assessment of algal diversity relies mainly on microscopy-based morphological identification, certain limitations exist. In this study, we present a combined molecular and morphological assessment of algal diversity in mudflats from the Savannah River Estuary, Georgia. High diversity of diatoms was documented, and less than 20% of the algal community was physiologically active at the time of collection. From the total genomic DNA extracted from the field samples and lab isolates, 18S rDNA sequences were PCR amplified, cloned, sequenced, identified, and then compared to the taxa identified via microscopy. Only a few of the DNA sequences matched documented taxa, and the abundance of particular algal species was limited to morphological analysis. Surprisingly, upon examination of the remaining lysis buffer from the mechanical lysis step of algal cells, diatom species were left intact even in the presence of a detergent indicating that the diatom species resistant to lysis could be easily underrepresented. Generation of additional algal sequences data, tied to accurate taxonomic identification, is essential to current environmental sequencing projects and potentially would allow faster acquisition of algal community structure within these unique environments

A Case of Right Ventricular Failure Secondary to Acute Chest Syndrome Managed With Early Red Cell Exchange Transfusion

Patients with sickle cell disease are at risk of vaso-occlusive crises including acute chest syndrome (ACS) and pulmonary hypertension. ACS is a life-threatening complication of sickle cell disease and is associated with increased morbidity and mortality. It is known that pulmonary pressures increase during episodes of acute chest syndrome and may lead to acute right ventricular failure leading to increased morbidity and mortality. Given the paucity of randomized controlled trials, the management of ACS and pulmonary hypertension in the setting of a sickle cell crisis largely relies on expert opinion. We present a case of acute chest syndrome complicated by acute right ventricular failure that was managed with prompt red cell exchange transfusion with favorable clinical outcomes