Delayed Death Due to Methanol Poisoning: An Autopsy Case Report

Methanol is a non-drinking type of alcohol used for industrial and automotive purposes. Methanol itself is not dangerous, but its harmful metabolites may cause the accumulation of acid in the blood, leading to metabolic acidosis, permanent blindness, and death. In this case report study, the case was a 28-year-old Nepalese man who was admitted in a semi-unconscious state to the emergency department. A working diagnosis of methanol poisoning was made. After more than two weeks, he succumbed to death due to a worsening cerebral infarction. At autopsy, extensive hemorrhagic infarction was observed, involving bilateral cerebral hemispheres. Well-defined subcortical hemorrhages leading to laminar necrosis were seen at the frontoparietal lobes. Cystic or lacunar necrosis was present at the basal ganglia. The brainstem showed the presence of duret hemorrhage. The man died approximately three weeks after the methanol ingestion. This case highlights the important pathological changes and accumulating effects of methanol in the brain

Familial Hypercholesterolaemia: An Updated Overall Management

Familial hypercholesterolaemia (FH), the commonest and serious but potentially treatable form of inherited dyslipidaemias, is characterised by severely elevated plasma low-density lipoprotein-cholesterol (LDL-C) level, which subsequently leads to premature coronary artery disease (pCAD). Effectiveness of FH early detection and treatment is supported by the outcome of several international cohort studies. Optimal FH management relies on prescription of statins either alone or together with other lipid-lowering therapies (LLT). Intensive lifestyle intervention is required in parallel with LLT, which should be commenced at diagnosis in adults and childhood. Treatment with high intensity statin should be started as soon as possible. Combination with ezetimibe and/or bile acid sequestrants is indicated if target LDL-C is not achieved. For FH patients in the very-high risk category, if their LDL-C targets are not achieved, despite being on maximally tolerated statin dose and ezetimibe, proprotein convertase subtilisin/kexin type1 inhibitor (PCSK9i) is recommended. In statin intolerance, ezetimibe alone, or in combination with PCSK9i may be considered. Clinical evaluation of response to treatment and safety are recommended to be done about 4-6 weeks following initiation of treatment. Homozygous FH (HoFH) patients should be treated with maximally tolerated intensive LLT and, when available, with lipoprotein apheresis. This review highlights the overall management, and optimal treatment combinations in FH in adults and children, newer LLT including PCSK9i, microsomal transfer protein inhibitor, allele-specific oligonucleotide to ApoB100 and PCSK9 mRNA. Family cascade screening and/or screening of high-risk individuals, is the most cost-effective way of identifying FH cases and initiating early and adequate LLT

Saff-Chol Juice: Your Healthy Drink

Atherosclerosis has been established to be an indolent inflammatory disease of the arteries which can gives rise to coronary artery disease (CAD), one of the most prevalent causes of death in developed and developing countries. Saffron, one of the world’s most expensive spices, is collected from dried stigmas of Crocus sativus L. Saffron exhibits favourable effects in the prevention or treatment of a variety of diseases including dyslipidemia, hypertension and diabetes mellitus. Our previous in-vitro work showed that Saffron downregulates gene and protein expressions of inflammation, endothelial activation and upregulate the gene of oxidative stress and inhibit monocyte- endothelial interactions which are the key events in pathogenesis of atherosclerosis. Thus, we have translated our research finding into saffron formulated drink; Saff-Chol Juice. It can be used as daily healthy drink to combat many atherosclerosis complications such as heart attack, stroke and renal failure. It is safe and easy to consume. This product may benefit patients with heart problem, hypertension and renal failure. It is also useful for smokers who is at risk to develop atherosclerosis

Ficus deltoidea var. kunstleri extract administration in Hypercholesterolaemic, atherosclerotic rabbits: effects on organ function, morphology, and atherosclerosis development

Ficus deltoidea (FD) is used in traditional Malay medicine to treat various ailments and has been shown to be safe in toxicity studies. However, the information on the safety and efficacy of FD in the atherosclerosis-induced animal model is limited. This study aims to investigate the safety of FD var. kunstleri (FDK) extract on high cholesterol diet (HCD)-induced atherosclerotic rabbits and its efficacy in treating atherosclerosis. New Zealand White rabbits were randomly divided into two groups: G1 (1% HCD for 4 weeks) and G2 (1% HCD for 8 weeks). Each group was randomised into FDK700 (700 mg FDK/kg/day for G1 and G2), FDK800 (800 mg FDK/kg/day for G2), simvastatin (5 mg/kg/day) and placebo. The body weight, blood pressure, serum biochemistry and histopathological examination were obtained to assess any toxicity signs. Fasting lipid profile, soluble c-reactive protein (sCRP) level and atherosclerotic plaque formation were compared between treated and placebo groups to evaluate treatment efficacy. Results: No significant differences were observed in all safety parameters between the treated and placebo groups (p<0.05). FDK treatment did not show significant differences in all parameters evaluated in both treatment arms. In conclusion, FDK extract up to 800 mg/kg is safe for use in atherosclerotic rabbits. It has neutral effects on lipid profile, inflammation and atherosclerosis formation

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Glucose, Liver and Renal Function Test Data

The effects of high cholesterol diet and saffron ethanolic extracts on the glucose, liver function test, and renal function test of the early and established atherosclerotic New Zealand white rabbits.</p

S1 Bodyweight Data.xlsx

The effects of high cholesterol diet and saffron ethanolic extracts on the body weight of the early and established atherosclerotic New Zealand white rabbits.</p

S5 Histopathological Figures of Tissues

The effects of high cholesterol diet and saffron ethanolic extracts on the tissues of the early and established atherosclerotic New Zealand white rabbits.</p

S2 Lipid Profile Data.xlsx

The effects of high cholesterol diet and saffron ethanolic extracts on the lipid profile of the early and established atherosclerotic New Zealand white rabbits.</p

Hematological Analysis Data

The effects of high cholesterol diet and saffron ethanolic extracts on the hematological analysis of the early and established atherosclerotic New Zealand white rabbits.</p