Successful management of severe bupropion toxicity with lipid emulsion therapy: a complex case report and literature review

This case report presents the management of a 53-year-old female with a complex psychiatric history who ingested multiple medications, resulting in severe cardiovascular compromise and subsequent respiratory failure. The patient’s ingestion included clonidine, fluoxetine, gabapentin, quetiapine and bupropion. Initial treatment involved supportive measures, including fluid resuscitation, bicarbonate infusion and correction of electrolyte imbalances. Despite these interventions, the patient remained haemodynamically unstable, requiring multiple vasopressors. Lipid emulsion therapy was initiated and led to a remarkable improvement in the patient’s cardiovascular status. However, she developed acute respiratory distress syndrome (ARDS) and required prolonged mechanical ventilation. Steroid therapy was initiated to manage the ARDS, and the patient was successfully extubated on day 6. The case highlights the potential effectiveness of lipid emulsion therapy in managing bupropion toxicity, but emphasises the need for further research to establish clear guidelines on dosing, timing and safety protocols. Adverse effects associated with lipid emulsion therapy must be carefully considered. Individualised decision-making and patient-centred care is crucial in optimising outcomes in cases of bupropion toxicity

Successful Management of Infertile Patient with Trans-Fundal Uterine Membrane

Background: This case report describes an infertile patient with a rare endometrial cavity pathology diagnosed on hysteroscopy. Case: The patient was a 39-year-old female with primary infertility of 9 years' duration. A diagnosis of a possible T-shaped uterus on a previous hysterosalpingogram was not confirmed on diagnostic hysteroscopy 5 years earlier at a different infertility center, where she had undergone a cycle of in-vitro fertilization with embryo transfer (IVF-ET) but was unable to conceive. At the time of diagnostic hysteroscopy at the current, unit the patient was found to have a T-shaped cavity and a trans-fundal uterine membrane obscuring an arcuate fundus. Hysteroscopic division of this thin membrane was performed successfully, followed by hysteroscopic division of the uterine septum and hysteroscopic metroplasty of her T-shaped uterus. Results: Subsequently, the patient conceived with IVF-ET but had an early miscarriage. A second IVF-ET cycle resulted in resulted in delivery of a healthy male infant at term. Conclusions: This report described a case of an infertile patient with a trans-fundal membrane in association with a uterine anomaly. The discovery of such a membrane and the uterine anomaly described above, and their hysteroscopic surgical correction, may have contributed to the successful reproductive outcome for this patient. (J GYNECOL SURG 29:88)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140092/1/gyn.2012.0028.pd

Increased expression of T-helper cell activation markers in peripheral blood of children with atopic asthma

Background: Activated T-helper (CD4) cells have been implicated to contribute to the pathogenesis of bronchial asthma. However, the profile of circulating CD4 subsets in relation to disease activity and asthma severity is unclear.Objective: To study the dynamic changes in peripheral blood CD4 cells expressing the activation markers naïve/memory (CD45RA/CD45RO) and interleukin–2 light chain receptor (CD25) in asthmatic children during and after resolution of acute asthma attacks and to determine whether the expression of these activation markers would be of value in monitoring asthma severity and the response to glucocorticoid inhalation.Methods: Peripheral blood samples were obtained from 20 asthmatic children aged between 0.5 and 9 years (mean±SD: 4.37±2.37 years) with acute asthma attacks, 10 children with lower respiratory tract infection and 20 healthy, age-matched subjects. CD4 cells expressing CD45RA, CD45RO, CD45RA+RO+ and CD25 were analyzed by dual flow cytometry and serum IgE was measured by ELISA. In asthmatic children, the measurements were repeated after the resolution of acute attacks.Results: During acute asthma attacks, the percentages of CD45RA, CD45RO, CD45RA+RO+ and CD25 were significantly increased as compared to the control group (p<0.05 for CD45RA and <0.0001 for the other 3 subsets). After resolution of asthma attacks, a significant reduction of all subsets was noticed and the percentages of CD45RA and CD45RO decreased to normal values while those of CD45RA+RO+ and CD25 remained significantly higher than the controls (p<0.05 for each marker). Unlike healthy children and patients with acute lower respiratory infections, asthmatic children showed increased CD45RO/CD45RA ratio (>1) and a significant increase of the percentage of CD45RA+RO+. During acute asthma attacks, patients with severe persistent asthma showed the highest percentages of all T- helper subsets when compared to those with moderate or mild persistent asthma. Positive correlations were found between serum IgE levels and both CD45RO and CD25 (r = 0.962, p<0.001 and 0.882, p<0.05 respectively) during acute asthma attacks and these correlations remained significant in remission (r = 0.632, p<0.05 and 0.589, p<0.05 respectively). Glucocorticoid inhalation therapy induced a significant reduction in the percentage of CD45RO, CD45RA+RO+ and CD25.Conclusion: Peripheral blood T-helper cell activation markers are reliable indicators for monitoring disease activity and severity of asthma. The reversed ratio of memory/ naïve T-helper cells together with the presence of a clone of cells co-expressing both naive and memory surface markers feature atopic asthma from acute lower respiratory infections. Glucocorticoid inhalation therapy induces a significant inhibition of peripheral blood T-helper cell activation markers.Key words: Children, atopic asthma, T-helper cell subsets, glucocorticoid inhalation, lower respiratory infections, CD45RO, CD45RA, CD25

賢明な決定に関与する眼窩前頭皮質活動の同定と操作

富山大学・富生命博甲第152号・Mostafa Mohamed Reda Mohamed Fayed・2023/03/23・★論文非公開★富山大

LES PUBLICITES DE SENSIBILISATION ET LEUR IMPACT SUR LA PERCEPTION DES CITOYENS MAROCAINS A L’EGARD DE LA COVID-19

Le coronavirus ou la Covid-19 pourrait être évité car il s’agit d’une maladie transmutable et affecte les personnes de différentes manières. Il est un phénomène social qui touche la santé des citoyens et qui a mis fin à la vie de plusieurs personnes ces deux années. Le marketing social est une approche pour changer les comportements d’une audience et cherche à contribuer à la résolution des problèmes de société. Les publicités persuasives diffusées s’attachent à convaincre les citoyens marocains pour changer leurs comportements à travers des messages préventifs et par l’utilisation des différents moyens de communication sociale. Mon article vise à déterminer l’impact des publicités de sensibilisation sur la perception des citoyens marocains à l’égard du Coronavirus. Dans ce contexte, nous allons réaliser une étude quantitative pour détecter leur impact sur la perception des citoyens, afin d’apporter des pistes d’amélioration pour améliorer les publicités de sensibilisations au Maroc. Coronavirus or Covid-19 could be prevented as it is a communicable disease that can affect people in different ways. It is a social phenomenon that impacts citizens’ health, but at the same time it has ended the lives of numerous people in the last two years. Social marketing is an approach to changing an audience’s behavior that seeks to contribute to solving societal problems. The broadcast persuasive advertisements strive to convince Moroccan citizens to change their behavior through preventive messages and the use of different means of social communication. My article aims to determine the impact of awareness advertisements on the perception of Moroccan citizens towards the Coronavirus. In this context, we will carry out a quantitative study to detect their impact on the perception of citizens, in order to provide measures for improvement to upgrade awareness-raising advertisements in Morocco.

Diabetes Mellitus Prevalence and Burden among Community Acquired Pneumonia Patients

This work aimed at measuring the prevalence of Diabetes Mellitus among community acquired pneumonia (CAP) patients and declaring its effect on CAP patient's outcome. Both community acquired pneumonia and diabetes mellitus are common in Egypt, and patients with associated CAP and DM need special care and supervision. This   prospective study was carried out on 108 CAP patients admitted to Abassia Chest Hospital during the period from January 2016 to December 2016. Clinical and radiological diagnosis of pneumonia and DM diagnosis were performed. DM recorded a prevalence of 39.8% among community acquired pneumonia patients. Disturbed level of consciousness is more frequent among diabetic patients than non diabetics. Diabetic patients recorded higher rate of hospital admission, longer duration of hospital stay, higher rate of ICU admission and more sever pneumonia than among non diabetic patients. CURB-65 score showed significant positive correlation with HbA1c of the patients. Associated community-acquired pneumonia and diabetes mellitus is frequent in our locality and labor a double burden on the affected patients leading to poorer prognosis, higher rate of hospitalization with longer duration of hospital stay and ICU admission. So CAP patients with DM need intimate care

Effect of different parameters controlling the flexural behavior of RC beams strengthened with NSM using nonlinear finite element analysis

Near surface mounted technique become the most attractive technique for strengthening RC structures. Several researches had been conducted to study experimentally the flexural behavior of RC members strengthened with NSM technique unlike the numerical researches. In this paper a numerical investigation utilizes the non-linear finite element (FE) modeling using ANSYS was performed. The developed FE model considers the behavior of the epoxy-concrete interface using a particular continuum damage approach, called cohesive zone model (CZM) which is capable of predicting the failure mode of the strengthened beams. The modified model study the effect of different parameters such as NSM bar number, NSM bar length, end inclination angle and end inclination leg length on the flexural behavior of strengthened beams. The results showed that, The developed FE model able to predict the expected modes of failure in NSM technique, the NSM bar length was effective till 0.5 of beam span, beams strengthened with end inclined angle 45º NSM bar gives the highest improvement in load carrying capacity, this improvement was very close in case of using end inclined angle of 60º and 90º

Antinucleosome antibodies as early predictors of lupus nephritis

Background: The role of the nucleosome in the induction of antibody response in lupus mediated tissue damage especially glomerulonephritis, may provide a new insight in the early diagnosis and alternative therapeutic developments in systemic lupus erythematosus (SLE). Objectives: To evaluate the frequency and specificity of antinucleosome antibody expression in SLE patients in relation to disease activity. Also, to assess their predictive value in subclinical lupus nephritis. Methods: This study included 26 patients with SLE and 52 control subjects (26 were healthy and 26 had juvenile rheumatoid arthritis "JRA"). Among lupus patients, 15 had clinical evidence of renal involvement. After clinical evaluation to calculate the SLE disease activity index (SLEDAI), measurements of urinary microalbumin and serum antinucleosome antibodies (antinucleosome specific, antihistone and anti ds-DNA antibodies by ELISA) were performed. Patients without clinical evidence of renal involvement were followed up for one year and measurement of urinary microalbumin was repeated at the end of the study period. Those who later developed microalbuminurea were categorized as patients with subclinical lupus nephritis. Results: The expression of the 3 studied antinucleosome antibodies was significantly higher among lupus patients as compared to JRA patients and healthy controls. Seropositivity for one or more antinucleosome antibodies was elicited in 84.5% of lupus patients. Serum levels of the 3 antinucleosome antibodies were significantly higher among lupus patients with clinical nephritis than those without nephritis. ANSAb had higher sensitivity, specificity and positive and negative predictive values for subclinical lupus nephritis (100%) than antihistone and anti ds-DNA antibodies (43%, 100%, 100% and 50% respectively for either antibodies). All patients with lupus nephritis were seropositive for at least one of the antinucleosome antibodies, while those without clinical or subclinical nephritis were seronegative for the 3 antinucleosome antibodies. In 27.3% of patients with lupus nephritis, ANSAB was positive while both antihistone and ds-DNA antibodies were negative. Antinucleosome antibodies correlated positively with SLEDAI and cumulative steroid dose and negatively with corrected creatinine clearance. Conclusions: The observed sensitivity and specificity of antinucleosome specific antibodies as early indicators of subclinical lupus nephritis appear encouraging and deserve further analysis on a large scale in order to confirm their validity, especially in the anti ds-DNA seronegative lupus patients.Keywords: antinucleosome antibodies, antinucleosome specific antibodies, anti ds-DNA antibodies, antihistone antibodies, SLE, lupus nephritisEgypt J Pediatr Allergy Immunol 2005; 3(2):54-6

Efficacy and safety of the new generation Watchman FLX device compared to the Watchman 2.5: a systematic review and meta-analysis.

The first-generation Watchman 2.5 (W 2.5) presented several limitations, such as challenges in implantation within complex left atrial appendage (LAA) anatomies, higher incidence of peri-device leak, device recapture, and device-related thrombus (DRT). The newer generation Watchman FLX (W-FLX) was introduced with a modified design aiming to overcome these limitations. The purpose of this meta-analysis is to conduct a comparative assessment of the safety and efficacy of the W-FLX and 2.5 devices in clinical practice. The meta-analysis was conducted according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). Studies were located through a search strategy utilizing PubMed, Cochrane, Google scholar and MEDLINE from inception to March 2023, with a primary objective to compare the safety and efficacy of the W-FLX and W 2.5 devices. After applying the selection criteria, five studies were included in this analysis. The analysis included five studies comprising 54,727 patients. The W-FLX is associated with an increase in procedural success (OR 7.49 [95% CI 1.98-28.26, P = 0.02; = 0%]), and a significant reduction in mortality (OR 0.52 [95% CI 0.51-0.54, P<0.01; = 0%], major bleeding 0.57 [95% CI 0.51-0.64, P<0.01; = 0%]), device embolism (OR 0.35 [95% CI 0.18-0.70, P = 0.02; = 0%]), and pericardial effusion (OR 0.33 [95% CI 0.26-0.41, P<0.01; = 0%]). The rates of DRT and stroke were similar between the two groups. Compared to the W 2.5, the W-FLX was associated with a higher procedural success rate and significantly reduced adverse outcomes including mortality, major bleeding, device embolization, and pericardial effusion. [Abstract copyright: AJCD Copyright © 2023.