Sospecha fallida de síndrome neuroléptico maligno en una paciente con esquizofrenia / Failed suspicion of neuroleptic malignant syndrome in a patient with schizophrenia

Introducción: el estado mental alterado es un término general que se utiliza para describir varios trastornos del funcionamiento mental, que pueden variar desde una ligera confusión hasta el coma. En general no es un diagnóstico, por el contrario hace referencia a un grupo de síntomas neurológicos variables e inespecíficos que requieren una mayor determinación de las causas. Dentro de estas se deben considerar en el adulto mayor los efectos adversos e interacciones medicamentosas. Los pacientes con antecedente de esquizofrenia requieren tratamiento de por vida aunque los síntomas desaparezcan, por ello los medicamentos antipsicóticos deben tenerse en cuenta por sus potenciales efectos asociados. El síndrome neuroléptico maligno (SNM) es uno de estos efectos adversos con riesgo de mortalidad. Presentación del caso: se presenta el caso de una paciente de 78 años que ingresó al servicio de urgencias de un hospital de tercer nivel por alteración del estado de conciencia, con antecedentes de esquizofrenia y múltiples comorbilidades, que representan un reto en el abordaje inicial en el servicio de urgencias; los paraclínicos tomados mostraron elevación de la CPK

Introduction: Altered mental status (AMS) is a general term used to describe various disorders that affect mental function. AMS ranges from mild confusion to coma. Normally, it is not a diagnosis, instead it refers to a group of variable and nonspecific neurological symptoms which require further determination of the causes. Drugs adverse effects and interactions must be taken into account in the elderly. Schizophrenia patients require lifelong treatment even if their symptoms disappear, therefore antipsychotic drugs should be considered due to their potential side effects. Neuroleptic malignant syndrome (NMS) is one of these life-threatening adverse reactions. Case presentation: a case is presented in a 78-year-old female patient, with a history of schizophrenia and multiple comorbidities, admitted to a tertiary hospital emergency room for altered consciousness which posed a challenge for the emergency initial approach; laboratory workup revealed elevated CPK levels.

Urinary neutrophil gelatinase￣associated lipocalin and kidney injury molecule 1 measurements in children with urinary system diseases after contrast media administration and the evaluation of hydra￣tion therapy / 中国小儿急救医学

Objective To investigate the dynamic changes of neutrophil gelatinase-associated lipoca-lin(NGAL) and kidney injury molecule 1(KIM-1) in children after contrast media administration and evalu-ate the effect of hydration therapy. Methods A total of 58 patients with urinary system diseases who were admitted to Shengjing Hospital of China Medical University from March 2012 to March 2014 for intravenous pyelography(IVP) in pediatric department were enrolled. The 58 patients were randomly divided into hydra-tion group of 28 patients and non-hydration group of 30 patients. Contemporaneous 24 patients received respiratory system enhanced CT examination without urinary tract diseases and hydration were enrolled as control group. Urine NGAL and KIM-1 of the three groups at 0 h,24 h,48 h,72 h,96 h after using intravenous contrast media were detected by ELISA. Serum creatinine of the three groups at 0 h,48 h,96 h after using intravenous contrast media were detected. Results All of the 82 subjects in this study didn′t occur contrast- induced acute kidney injury. The urinary NGAL of non-hydrated group significantly increased at 24 h and 48 h after contrast media administration ( P < 0. 05 ) and the urinary NGAL of hydrated group significantly increased at 48 h and 72 h(P<0. 05). But the urinary NGAL at 24 h and 48 h of the hydration group were lower than these of the non-hydrated group,there were statistically significant differences(P<0. 05). At 24 h,48 h and 72 h after contrast media administration,the level of urine KIM-1 in the non-hydration group sig-nificantly increased(P<0. 05). Urine KIM-1 at 48 h and 72 h in the hydration group significantly increased (P<0. 05). But the urine KIM-1 at 24 h,48 h and 72 h of the hydration group were lower than these of the non-hydration group,the differences were statistically significant(P<0. 05). Comparison of urine NGAL and KIM-1 at different times before and after contrast media administration in children receiving enhanced CT examination who without urinary tract disease showed no statistically significant differences ( P >0. 05 ). Conclusion The urine NGAL and KIM-1 of children with urinary system diseases increase after contrast media administration and there is a trend of spontaneous recovery. Hydration intervention can alleviate the up-ward trend of urine NGAL and KIM-1. For children receiving enhanced CT examination but without urinary system diseases,the change of urine NGAL and KIM-1 are not significant.

Avaliação dos fatores etários sobre a função renal de ovelhas Santa Inês / Evaluation of the renal function in aging Santa Ines ewes

Este estudo avaliou a função renal de fêmeas ovinas hígidas da raça Santa Inês, criadas no Estado de São Paulo, com o objetivo de estabelecer valores de referência, além de determinar possíveis variações dos valores de seus parâmetros causados por fatores etários. Foram determinados os valores de ureia, creatinina, sódio e potássio séricos e urinários, e os valores de GGT urinário de 128 animais, divididos em 4 grupos de acordo com a idade. Foi realizada, também a urinálise das 128 amostras de urina. Não foi observada diferença significativa dos valores de densidade entre todos os grupos. Entretanto, constatou-se aumento de valores de ureia, creatinina, sódio e diminuição de proteínas e GGT urinários nos grupos 2, 3 e 4 que eram mais velhos do que o grupo 1. Em relação aos parâmetros séricos, observou-se diferença significativa dos valores de ureia e creatinina entre os grupos, pois uréia e creatinina aumentaram e potássio diminuiu nos animais do grupo 2, 3 e 4 que eram mais velhos. Avaliando-se os resultados obtidos para os exames da função renal, verificou-se que os valores médios na urina da densidade foi de 1,03±0,01; pH 7,71±1,35; ureia em mg/dL foi 1342±1085; de creatinina 42,39±23,36; de proteínas totais em g/dL foi de 5,61±2,88; GGT em U/L foi de 1,44±1,31; sódio e potássio em mmol/L foi de 15,93±20,13 e 240±117 respectivamente. No soro verificou-se que os valores médios foram: de ureia em mg/dL 32,33±19,81; de creatinina 1,22±0,20; de sódio e potássio em mmol/L foram de 145,7±8,8 e 5,5±1,30 respectivamente.(AU)

This study evaluated kidney function of healthy Santa Inês ewes, bred in São Paulo State. The aim of this paper was to establish standard reference values and stipulate value variation caused by age group factor. We determined seric and urinary levels of urea, creatinine, sodium and potassium, and urinary GGT from 128 ewes, divided into 4 groups according to age. Also urinalysis was made in 128 urine samples. No significant statistical difference was found regarding density values between all groups, although there was an increase in urea values, creatinine and sodium, and an decrease in urinary proteins and GGT in group 2, 3 and 4 older than group1. In relation to the seric parameters, there was significative statistical difference in urea and creatinine values between the groups, as an increase in urea and creatinine. Potassium decreased in the older groups 2, 3 and 4. Evaluating the results obtained for renal function, we found that the mean values of density were 1.03±0.01, pH 7.1±1.35, urea (mg/dL) 1342±1085, creatinin 42.39±23,36, total protein (g/dL) 5.61±2.88, GGT (U/L) 1.44±1.31, sodium and potassium (mmol/L) were 15.93±20.13 and 240±117 respectively. In the serum medium values were: urea (mg/dL) 32.33±19.81, creatinine 1.22±0.20, sodium and potassium (mmol/L) 145.7±8.8 and 5.5±1.30 respectively.(AU)

Miositis en pacientes pediátricos con inmunoglobulina M antidengue positiva / Myositis in pediatric patients with positive anti-dengue M immunoglobulin

INTRODUCCIÓN: la miositis aguda benigna infantil es un proceso poco frecuente, transitorio y autolimitado, que afecta predominantemente a la edad escolar tras una infección viral. OBJETIVO: divulgar esta forma de presentación de una virosis y contribuir a su diagnóstico. MÉTODOS: se estudiaron 13 pacientes, ingresados en el Hospital Pediátrico Docente del Cerro, por síndrome febril durante el año 2013 con inmunoglobulina M positiva antidengue, que presentaron impotencia funcional y concentraciones de creatininfosfokinasa superiores a 190 µl. Se evaluaron elementos demográficos, clínicos y niveles enzimáticos, y se aplicó el estadígrafo promedio. RESULTADOS: los signos y síntomas más comunes en todos los pacientes resultaron ser la fuerza muscular disminuida, el dolor intenso a la presión de los músculos gastrocnemios y la flexión dorsal de ambos pies. El dolor retro-ocular y el rash se presentaron indistintamente en ambos sexos. El promedio de edad fue de 11 años. Las cifras de la frecuencia cardiaca, respiratoria y tensión arterial fueron normales. La duración de los síntomas clínicos tuvo una media aritmética de 4 días. El conteo de leucocitos alcanzó promedio de 6 000 x 109/L, plaquetas 170 000 x 109/L, el hematocrito 37 vol/% y creatininfosfokinasa 217 µl. CONCLUSIONES: se concluye que el dolor muscular intenso con impotencia funcional en la extremidades inferiores, acompañado de cifras de cratinfosfokinasa elevadas en pacientes con inmunoglobulina M positiva antidengue, confirma el diagnóstico de miositis viral en el curso de esta arbovirosis. Se comenta que en Cuba no se ha efectuado algún reporte sobre esa entidad, por lo cual es oportuno realizar la presente comunicación que contribuya a su divulgación.

INTRODUCTION: benign acute childhood myositis is a infrequent, transient and self-limited process that mainly affects children at school age after viral infections. OBJECTIVE: to disseminate information on this form of presentation of a type of virosis and to contribute to its correct diagnosis. METHODS: thirteen patients admitted to the teaching pediatric hospital of Cerro with febrile syndrome during 2013 were studied. They showed positive anti-dengue M immunoglobuline, functional impotence and creatinin-phosphokinase over 190 µl. Several demographic and clinical elements as well as enzyme levels were assessed and the average statistic was applied. RESULTS: most frequent signs and symptoms in all the patients were reduced muscle strength, intense pain to gastrocnemy muscle pressure and dorsal flexion of both feet. The retroocular pain and rash occurred regardless of sex. The average age was 11 years. The heart and respiratory rate and blood pressure figures were all normal. The duration of clinical systems had an arithmetic mean of 4 days. Leukocyte count reached averages of 6 000 x 109/l; platelets showed 170 000 x 109/L; hematocrit reached 37 vol/% and creatinine-phosphokinase was 217 µl. CONCLUSIONS: intense muscular pain with functional impotence at the lower limbs accompanied by high creatinin-phosphokinase figures in patients with positive antidengue M immunoglobulin confirms the diagnosis of viral myositis in the course of this arbovirosis. It is commented that there has been no report on this disease in Cuba so far, so it is timely to provide the present communication in order to contribute to dissemination of information about this entity.

Creatinina sérica elevada en el paciente hipotiroideo: miopatía o verdadera nefropatía?: propuesta de clasificación / Elevated serum creatinine in hypothyroidism: myopathy or real nephropathy?: classification proposal

En el paciente hipotiroideo la creatinina sérica puede aumentar no solo por fallo renal, sino también por miopatía en presencia de función renal normal. Se reportan 2 pacientes representativos de sendos tipos de la clasificación aquí propuesta sobre la asociación disfunción tiroidea / creatinina sérica. El primer enfermo presenta aumento de la creatinina sérica secundario a miopatía hipotiroidea con función renal normal, tipo I, esta se puede complicar con rabdomiolisis y causar insuficiencia renal aguda en hipotiroideos no diagnosticada. El otro paciente con creatina sérica alta mejoró su función renal al tratarse su hipotiroidismo, tipo 2. Ocasionalmente, este ha permanecido oculto y al ser diagnosticado y tratado, se mejora la función renal. El hipotiroidismo cursa con hipercolesterolemia y si no se valora la función tiroidea y se administran estatinas, se empeora el daño muscular del paciente. Lo mismo ha sucedido con el uso de gemfibrozil en condiciones similares. El tercer tipo de daño renal relacionado con hipotiroidismo es la proteinuria en rango de síndrome nefrótico, vinculada con suspensión de la levotiroxina. Las biopsias muestran lesiones histológicas de diversas glomerulopatías, que mejoran con la administración de levotiroxina. En pacientes con tiroiditis de Hashimoto aparecen otras glomerulopatías que responden a los glucocorticoides...

In patients with hypothyroidism is possible to find an increased serum creatinine not only due to renalfailure but to myopathy in presence of normal renal function. Two patients, each representing 1 type of a proposed classification regarding thyroid dysfunction and abnormal creatinine are presented, in order to communicate thisrelationship, until now based on isolated reports. The first individual had an increased serum creatinine withnormal renal function due to hypothyroid myopathy (type 1). Rhabdomyolysis related to this myopathy is pointed as a cause of acute renal failure. The 2nd patient had an increased serum creatinine with abnormal kidney function (type 2),which improved when he became euthyroid after levothyroxine administration. The diagnosis of hypothyroidism is often missed in patients with altered renal function, if it becomes evident and is properly treated the renal function will improve. As isknown hypothyroidism causes hypercholesterolemia, if such patient unknowingly receives statins or gemfibrozil, severe rhabdomyolysis and renal falilure may occur, as reported inthe literature. The 3d category of the classification is the occurrence of nephrotic syndrome in hypothyroid patients who discontinue T4 treatment due to thyroid cancer for further studies or by patient non adherence, developingsignificant proteinuria few months later. Kidney biopsy lesions vary from membranous glomerulopathy tomembranoproliferative glomerulonephritis. These findingswill resolve with the administration of levothiroxine, without glucocorticoids. However patients with nephrotic syndrome related to Hashimoto thyroiditis will improve withglucocorticoids.

The measurements of some biochemical values of hypertensive adults in Xuan Canh Dong Anh Hanoi

Hypertension is increasing in the world including the Vietnam. Changes in concentrations of bood lipid, glucose are often correlated with hypertension. Changes in bood lipid concentration are major cause of cardiovascular disease. Finding and treatment of dyslipidemia in hypertensive patients will reduce cardiac complications. Objective: To detemnine serum total cholesterol, glucose, creatinine and urine protein, glucose in adults with hypertension and to find out the correlation between biochemical values and hypertension grades. Objects and method: 379 people with hypertension (grade 1: 221 people; grade 2: 134 people; grade 3: 24 people) and 86 people without hypertension served as control. This cross-sectional study was conducted from 12/2004-3/2005. Results: Biochemical values in people with hypertension were: total cholesterol: 4.75- 5.95 mmol/l; glucose: 4.83-5.11 mmol/l; creatinine: 69.22-89.02mmol/l. Urine protein test was positive in 6.3% of people with hypertesion. Values of total cholesterol, creatinine in people with grade-3 hypertension were significantly higher than these in normotensive people (p< 0.01). There were significantly regressed between diastolic blood pressure (DBP), systolic blood pressure (SBP) with creatinin (DBP: r=0.157 P< 0.01 ; Y=(0.101 X creatinin)+83.668 - SBP: r=0.113 P=0.02 Y= (0.127 X creatinin)+139.369.

Study the relationship between hair lead level length of service and renal creatinin and clearance in traffic polismen in Hai Phong (2001 – 2002)

Creatinin level in control group was 93.55 ± 10.96 micromol/l. This level in exposed group was 114.03 ± 9.72 micromol/l. Renal creatinin clearance control group was 81.0 ± 4.0 micromol/l and in exposed group was 70.71 ± 9.0 micromol/l. There was not a relationship between hair lead level and renal creatinin and renal clearance but the length of service clearly influenced creatinin level and renal clearance