A rare and unusual cause of Vibrio cholerae non-O1, non-O139 causing spontaneous peritonitis in a patient with cirrhosis

@#Spontaneous bacterial peritonitis caused by Vibrio cholerae non-O1/ non-O139 is a rare phenomenon. V. cholerae is known as a common aetiology of epidemic diarrheal disease and rarely causes extra-gastrointestinal infections. In this report, a 52-year-old man presented to our hospital with a clinical scenario for chronic liver cirrhosis with low grade fever and loose stools. V. cholerae was isolated from peritoneal fluid culture, which was further confirmed as non-O1/ non-O139 strain by multiplex polymerase chain reaction. The patient was successfully treated with antimicrobial therapy and peritoneal drainage. This case represents the first isolation of V. cholerae non-O1/ non-O139 strain from peritoneal fluid.

Phytochemical screening, cytotoxic and antimicrobial activities of Limonium socotranum and Peperomia blanda extracts

@#Limonium socotranum and Peperomia blanda are used in ethnomedicine to treat several diseases, such as infection, cancer, and inflammation. P. blanda (family: Piperaceae) is from the genus Peperomia, and mostly found in Madagascar, Yemen, USA to South America, while L. socotranum (family: Plumbaginaceae) from the genus Limonium and this species is found only on Socotra Island, Yemen. These plants have attracted great interest in recent years because of their phytochemical contents. Consequently, the current study is aimed to investigate the phytochemical constituents, the cytotoxic and antimicrobial activities of L. socotranum (leaves and stem) and P. blanda extracts. Successive extraction had been performed which resulted in nine crude extracts. Phytochemical screening of the extracts was then conducted using qualitative chemical analysis. The antimicrobial activity of the plant extracts was determined using the well diffusion method against eleven selected pathogenic microbes and the minimum inhibitory concentrations (MIC) were measured. The cytotoxic activities of the plant extracts against MCF-7 and HepG2 cell lines were investigated using sulforhodamine B assay. It was noted that methanol leaves extract from L. socotranum exhibited higher antibacterial activity against Micrococcus luteus (MIC 15.6 μg/mL), Staphylococcus aureus (MIC 125 μg/mL) and Pseudomonas aeruginosa (MIC 125 μg/mL), than stem parts, while petroleum ether extract displayed stronger antifungal activity, with MIC of 125 μg/mL. On the other hand, petroleum ether extract of P. blanda was effective against Gram-positive bacteria and exhibited moderate antifungal activity. Petroleum ether extract of P. blanda displayed cytotoxic activity against MCF-7 cells, with an IC50 of 4.60 ± 0.02 μg/mL, while the methanol extracts showed higher activity against the HepG2 cell line, with an IC50 of 13.90 ± 0.14 μg/mL. Phytochemical findings confirmed the presence of flavonoids, alkaloids and terpenoids. The promising obtained results suggest the potential use of these plants in cancer and antimicrobial therapies.

Severe Hypokalaemia as a Cause of Reversible Diabetes Mellitus.

Aims: To discuss the likelihood of severe hypokalaemia as a cause of reversible diabetes. Presentation of the Case: A 46 year old patient presented to the Accident and Emergency unit (A&E) with a history of polyuria and polydipsia of recent onset. He was severely hyperglycaemic (glucose = 40 mmol/L, HbA1c = 11%), hypokalaemic (serum potassium < 2.0 mmol/L) and hypertensive [Blood Pressure (BP) = 180/115]. Conn's syndrome was confirmed by finding a raised serum aldosterone (1650 pmol/L; normal value < 440 pmol/L), suppressed renin (< 0.2 ng/ml/h; normal range: 0.2-2.5 ng/ml/h) and a left sided adrenal tumour (2.0 x 2.0 cm) on CT scanning. He was managed initially with IV potassium and insulin (initially 100 units daily) together with oral potassium, spironolactone 100 mg daily, lisinopril 20 mg daily and amlodipine 10 mg daily. After six days his potassium was 3.4 mmol/L and the IV potassium infusion was stopped. Twelve days later his fasting blood glucose, serum potassium and BP's were normal and the insulin and antihypertensive medications, apart from spironolactone, were stopped. He was discharged on spironolactone alone for four months during which time his blood glucose, blood pressure, and serum potassium levels remained normal and his HbA1c had fallen from 11.0 to 5.2%. He then underwent successful laparoscopic adrenalectomy and his serum aldosterone came down to 127pmol/L (within normal range). Histology confirmed the diagnosis of a Conn’s tumour. Conclusion: Although hyperaldosteronism per se predisposes to diabetes we suspect that this patient’s rapidly reversible hyperglycaemia resulted primarily due to a failure of insulin secretion as a result of his severe potassium depletion.