Another D in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis.

Ketogenic diet or very-low-carbohydrate diet gained widespread popularity in the 1990s due to their favorable effects on weight loss and diabetes among others with good short-term safety data. People on ketogenic diets exist in a state of dietary ketosis in which the body production of ketone is equal to consumption and no harmful effects of ketonemia occur. However, in face of stress, the harmless dietary ketosis can lead to profound acid-base disturbances due to massive overproduction of ketone bodies that overwhelms the acid buffer system of the body. A handful of case reports have been published on this topic calling the safety of ketogenic diet into question. In this article, we chronicle a unique case of ketogenic (Atkins) diet-associated ketoacidosis, and we present a comprehensive literature review on the etiology of ketoacidosis

Complete Heart Block in Association With Dengue Hemorrhagic Fever

Dengue virus infection affects the heart structurally and functionally. Clinical manifestations of cardiac complications secondary to dengue virus infection vary from self-limiting arrhythmias to severe myocardial infarction, leading to hypotension, pulmonary edema, and cardiogenic shock. However, we report a case of dengue hemorrhagic fever (DHF) complicated by a complete heart block. A female with DHF due to dengue virus serotype 2, presented to the emergency department with fever, headache, rash, and fatigue followed by an episode of syncope. She was found to have a third-degree atrioventricular block, with pulseless polymorphic ventricular tachycardia. Patient was resuscitated and a temporary trans-venous pacemaker was placed. She reverted back to normal sinus rhythm after 4 days of syncope and was subsequently discharged from the hospital after complete resolution of symptoms, without the need for a permanent pacemaker. Physicians are warranted to have high index of suspicion for dengue virus infection as an etiology in patients with acute cardiovascular compromise, especially in tropical areas

Lafora Disease Masquerading as Hepatic Dysfunction

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson\u27s disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this rare disorder initially manifesting with abnormal liver enzymes. It underscores the importance of clinical suspicion of Lafora disease in cases with unexplained hepatic dysfunction. Prompt liver biopsy and genetic testing should be performed to antedate the onset of symptoms in these patients

Comparison of Caralluma tuberculata with Metformin for Anti-Diabetic Activity: An Animal Study

Background: Caralluma tuberculata, is a wild herb, which grows in the hills of Balochistan and has been known to have medicinal and nutritional properties since antiquity. This experimental research was designed to study the hypoglycemic properties of Caralluma tuberculata and to compare them with Metformin.Material and Methods: This was a laboratory-based animal experimental study. It was conducted in the Pharmacology laboratory of Khyber Medical University, Peshawar from February 2016 to August 2016. Two types of extracts of Caralluma tuberculata [crude extract and carbon tetrachloride (CCl4) extract] were prepared and administered to normal and alloxan treated diabetic rabbits. To study anti-diabetic activity, eighty-four rabbits were divided into two main groups. Group I (Normal/Non-Diabetic Rabbits; n= 21) and Group II (Diabetic/Alloxanized Rabbits; n=63). Each group was further divided into sub-groups (7 rabbits in each). Effect of Caralluma tuberculata, Metformin and 2% gum tragacanth on blood glucose levels were checked at 0, 2, 4, 6, 8, 12 and 24 hours of drug administration. The extracts were given in capsule form and in cooking oil. Data analysis was done using SPSS version 16. For calculation and comparison of the hypoglycemic effects at various doses and different time intervals, analysis of variance (ANOVA) and Tukey’s post hoc test were applied.Results: The crude extract, 200mg/kg body weight of Caralluma tuberculata showed significant decrease (p<0.001) in mean blood glucose levels from 2-hour till12 hours. Whereas, highly significant reduction of blood glucose was seen from 2 hours after treatment till 24 hours, when carbon tetrachloride (CCl4) fraction of Caralluma (100mg/kg body weight) in capsule form was administered. Metformin 500mg/kg body weight was given to compare its effects with plant crude extract and it was found that metformin appeared to be less effective in comparison with Caralluma tuberculata.Conclusion: Caralluma tuberculata lowered the blood glucose level and turned out to be more significant in developing hypoglycemia when taken with cooking oil. More work is essential to provide stronger evidence for the use of this natural agent in the management of Diabetes Mellites

Spontaneous Coronary Artery Dissection: A Case Series of 9 Patients With Literature Review.

Spontaneous coronary artery dissection is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. Reports regarding the prognosis and natural history of this disease are limited. In addition to the diagnostic difficulty, this condition poses a significant therapeutic challenge due to the lack of specific management guidelines. We present here a case series of 9 patients with spontaneous coronary artery dissection. Additionally, this article reviews the incidence, clinical characteristics, risk factors, diagnostic modalities, therapeutic approaches, and patterns of recurrence in patients with spontaneous coronary artery dissection

Takotsubo cardiomyopathy: a rare complication of acute viral gastroenteritis

Takotsubo Cardiomyopathy (TCM) is characterized by a transient but reversible ventricular dysfunction in post-menopausal females following, but not always, a recent emotional or physical stress. Typically, chest pain is reported as a presenting symptom in the majority of patients. The severe diarrheal illness secondary to acute viral gastroenteritis is not commonly reported as the stressor event prior to TCM. We report a unique case of a middle-aged male presented with syncope shortly after loose bowel movements. He was diagnosed with TCM and was successfully managed with supportive care. The purpose of this case is to make clinicians aware of this rare association

Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs

Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?

A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management