Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

Abstract: Because the majority of colubrid species are considered harmless to human beings, colubrid snakebites are rarely reported. However, the venom of Rhabdophis, which is part of the Colubridae family, is procoagulant and leads to severe coagulopathy. Here, we present a case of disseminated intravascular coagulation with enhanced fibrinolysis following a Rhabdophis bite. Although coagulopathy can be treated effectively with the specific Rhabdophis antivenom, this antivenom is not widely available in Indonesia. We also found transient hypertension secondary to the colubrid venom, an unusual finding.

Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength in Indonesian elderly women living in three nursing homes.

AIM: to investigate the correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength. METHODS: this was a cross-sectional correlative study, conducted at three nursing homes in Jakarta and one nursing home in Bekasi in January 2005. The subjects were women aged 60 years or above. Those selected study subjects underwent quadriceps femoris muscle strength examination with Cybex dynamometer with 150 degrees/second speed, twice (three repetitions with 30 second rest time). The 25 (OH)D concentration was measured by ELISA. RESULTS: out of 67 subjects who met the required criteria for this study, five subjects withdrew from the study during muscle strength examination. The mean age was 71.1 (SD 7.2) years old while the mean serum vitamin D concentration was 68.2 (SD 21.6) nmol/l. Vitamin D deficiency (<or= 50 nmol/l) was found in 22.6% of subjects. It was also found that the median (minimum-maximum) quadriceps femoris muscle strength was 40.00 (11-116) N.m. Approximately 82.3% of the subjects were of generalized muscle weakness. Correlation was found between serum 25 (OH)D concentration and quadriceps femoris muscle strength (r = 0.327; P = 0.009). CONCLUSION: this study reveals that serum 25 (OH) D concentrations in Indonesian elderly women is correlated with quadriceps femoris muscle strength. The proportion of elderly women with muscle weakness is higher than the normal ones. The group with older age shows higher proportion of muscle weakness. Most subjects have normal serum vitamin D concentration.

Coagulopathy in dengue infection and the role of interleukin-6.

Interleukin-6 (IL-6) is a multifunctional cytokine that plays a central role in host defense due to its wide range of immune and hematopoietic activities and also its potential ability to induce the acute phase response. The high concentration of IL-6 has implication in the pathology of some diseases especially in DHF/DSS patients. This cytokine play a crucial role in the enhanced production of anti-platelet or anti-endothelial cell auto antibodies local or systemic, elevated levels of tPA, as well as a deficiency in coagulation, leading to plasma leakage and bleeding. We describe the pathogenic, characteristic and mechanism of IL-6 during DV infection.