A fatal case of severe serotonin syndrome accompanied by moclobemide and paroxetine overdose

Aim: To present a fatal case of serotonin syndrome accompanied by moclobemide and paroxetine overdose. Case presentation: A 34-year-old married woman was presented following intentional ingestion of 3.5 g moclobemide and 2.6 g paroxetine. She was drowsy, agitated, and having rigor. In 1 h she developed myoclonus and diffuse muscle rigidity prominent in lower extremities. All laboratory tests were unremarkable except hyperglycemia (160 mg/dl), sinus tachycardia (103/min), and metabolic acidosis (7.051 pH, 52 mmHg pO2, 74.7 mmHg pCO2, 15% HCO3, 77% SaO2). Despite oxygen supplementation, her respiratory acidosis got worse and the SaO2 concentration decreased to 72%. Endotracheal intubation and paralysis were decided to control muscle hyperactivity followed by hyperthermia (max. 42.3°C) unresponsive to benzodiazepine. Even aggressive supportive treatment (mechanical ventilation, buffer replacement, cyproheptadine, and dantrolene) were applied, the patient could not recover and suffered cardiopulmonary arrest 20 h after presentation. Conclusion: Physicians working in the emergency departments and intensive care units, managing patients presenting with acute ingestion of selective serotonin reuptake inhibitors combined with monoamine oxidase inhibitors, should be aware of recognizing and treating serotonin stndrome. This is because many of these patients may require intensive care monitoring as well as tracheal intubation and ventilatory support

The effect of different solvents on the performance of zeolite-filled composite pervaporation membranes

The aim of this research is to study effect of different solvents on the membrane morphology and on the performance of zeolite-filled composite pervaporation membranes. PAN (polyacrylonitrile) was used as a base polymer and zeolite 13x (32 wt.%) was used as the filler. The solvents considered were DMF (dimethyl formamide), DMSO (dimethyl sulfoxide), DMAc (dimethyl acedamide) and THF (tetrahydrofuran). The cross-sectional morphology of manufactured membranes shows three layers: a zeolite-free polymer layer, a zeolite-filled polymer layer and a skin layer. However, at the same casting content (5.4% PAN, 2.6% zeolite 13x, 92 wt.% solvent) the ratio of the thickness of these layers to total membrane thickness varies with the solvent used. The most homogeneous zeolite distribution in the polymer network is obtained with solvent DMSO

ACUTE ISCHEMIC STROKE IN PATIENTS WITH CANCER: RISK FACTORS, CLINICAL AND IMAGING OUTCOMES

WOS: 000403079700010Introduction: Cancer patients have higher risk of stroke compared with the normal population. The relationship between this increased risk and traditional vascular risk factors is not known exactly. The aims of this study were to investigate ischemic strokes, who had a history of cancer or diagnosed cancer during etiologic scanning, in terms of the cancer type, likely causes of stroke and demographic data. Materials and methods: In this retrospective study, the stroke patients with known cancer or diagnosed with cancer during follow-up were selected by screening the data of 1002 acute ischemic stroke patients who were followed-up in the hospital between 2012 and 2015 and demographic, clinical and imaging findings were recorded. Temporal association between cancer type, presence of metastasis, treatment administered, response to therapy, cancer and stroke, possible stroke etiology and stroke risk factors of the patients were investigated. Results: An association was determined between acute ischemic stroke and cancer in 58 (5.8%) of our patients. Sixty-nine percent of our patients were males and the mean age was 66.5-year. Cancers most commonly found were lung (20.7%), colorectal (15.5%) and prostate cancer (13.8%). The most frequently found risk factors for ischemic stroke were hypertension and diabetes mellitus. Twelve point one percent of the patients did not have any traditional risk factors for ischemic stroke. Eight point six percent of the patients had ischemic stroke as a presenting symptom of cancer. Sixty-eight point nine percent of the patients had supratentorial infarcts and 10.3% of them infratentorial infarcts. Supratentorial infarcts were most commonly located in the middle cerebral region, and infratentorial infarcts were located in the brainstem. Conclusion: Cancer patients with ischemic stroke showed different risk factors, stroke etiology and infarct localizations. Therefore, cancers need to be particularly studied in patients who do not have traditional risk factors for ischemic stroke

Significance of multiple acute ischemic lesions on initial diffusion-weighted imaging in stroke patients and relation of toast classification

Background: It is important to know whether or not the stroke risk factors and etiologies of patients with multiple acute infarcts are different to those of patients with a single acute infarct. Aim: The frequency of multiple acute infarct was investigated in ischemic stroke patients and a comparison was made of the characteristics of stroke patients with and without multiple acute infarct. Patients and Methods: We reviewed the clinical records of 988 ischemic stroke patients who were admitted within 1 week of the onset of stroke and diffusion-weighted imaging (DWI) was performed on first presentation. The clinical characteristics, laboratory, and imaging results were noted from the patient records. According to the DWI findings, the patients were separated into three groups as those with a single acute infarct in a single vascular territory (SI group), those with multiple acute infarcts in a single vascular territory (SMI group) and those with multiple acute infarcts in multiple vascular (MMI group) territories. The frequency of multiple acute infarcts was investigated, and a comparison was made of the characteristics of stroke patients with and without multiple acute infarcts. Results: The SMI group included 119 (12%) patients and the MMI group 126 (12.8%). The most common mechanisms of multiple acute infarcts are large artery atherosclerosis and cardiac origin emboli. Moreover, the risk factors most determined were hypertension, diabetes mellitus, and hyperlipidemia in the MMI group. Conclusion: No difference was determined between the groups in respect of stroke etiology and risk factors

Pulmonary Balloon Valvuloplasty In A Pregnant Woman With Severe Pulmonary Stenosis

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardio-graphy performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.WoSScopu