Diastolic versus systolic dysfunction in patients with chronic liver disease ­ a single center study in South-South, Nigeria

Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients. Keywords: Chronic liver disease, Diastolic dysfunction, Systolic dysfunction

Hepatitis E in Namibia: A Historical Review

Namibia has had three outbreaks of Hepatitis E Virus (HEV), in 1983, 1995 and 2017. HEV is particularly dangerous to pregnant women. The objective of this study was to present a thorough review of the history of HEV in Namibia; the genotypes which have appeared since 1983, and the possible reasons for the nationwide spread of HEV that has occurred since 2017. MATERIALS AND METHODS As this is a review article, no primary research data will be presented. However, an exhaustive literature study has been undertaken and there will be in-depth discussion of the findings of primary researchers in Namibia and elsewhere. RESULTS The first two episodes were confined to the Rundu area. The 1983 outbreak may have been genotype 1; that of 1995 contained genotypes 1 and 2. The genotype of 2017 episode has not been clearly established. Increased road traffic may have spread HEV during 2017-2020. Lack of clean water and washing facilities, and lack of awareness of what causes HEV, are the main factors in spreading it. CONCLUSIONS AND RECOMMENDATIONS There remain challenges to the containment of HEV. A recent government initiative to stop COVID-19 has helped slow its progress. Both infections are propagated by poor hygienic practice and lack of clean water.

Comparación de la conducta de enfermedad en pacientes colombianos con hemofilia A, en una muestra con dolor crónico y sin dolor crónico / Comparison of disease behavior in Colombian patients with hemophilia A, in a sample compared with chronic pain and without chronic pain

Objetivo. Identificar las variables de conducta de enfermedad en una muestra de pacientes colombianos con Hemofilia A y comparar los resultados de grupos (con dolor crónico y sin dolor crónico) para un análisis de relaciones entre variables. Método. El enfoque fue cuantitativo y su diseño transversal; la metodología empleada fue ex post facto de tipo retrospectiva. Para el análisis estadístico se hizo una comparación de grupos (sin dolor crónico y con dolor crónico). El factor de conducta de enfermedad se evaluó a través del Cuestionario de Conducta de Enfermedad de Ballester y Botella del año 1993. Los resultados obtenidos mediante la prueba T, la correlación de Spearman, la prueba U de Mann-Whitney y la Curva de ROC. Resultados. Se evaluaron veintisiete sujetos con diagnóstico de Hemofilia A con un rango de edad entre 19 y 55 años. Diecisiete sujetos conformaron el grupo con dolor crónico y diez sujetos el grupo sin dolor crónico. En conclusión se hallaron asociaciones significativas entre el dolor crónico y las variables relacionadas a inestabilidad emocional, así como correlaciones positivas con resultados de investigaciones previas sobre la caracterización de la población con hemofilia.

Objective. To Identify the variables of illness behavior in a sample of Colombian patients with hemophilia A and to compare the results of groups (with chronic pain and without chronic pain chronic) for an analysis of relationships between variables. Methods. The approach was quantitative and its cross-sectional design. The methodology used was ex post facto retrospective type. A comparison groups (without chronic pain and chronic pain) was done for the statistical analysis. The disease behavior factor was evaluated through the Ballester and Botella Disease Questionnaire Conduct of 1993. The results obtained by the T-test, the Spearman correlation, the Mann-Whitney U test and the ROC curve. Results. Twenty-seven subjects diagnosed with haemophilia A diagnosed with a age range between 19 and 55 years were evaluated. Seventeen subjects formed the group with chronic pain and ten subjects the group without chronic pain. In conclusion, we found significant associations between chronic pain and variables related to emotional instability, as well as positive correlations with results of previous research on the characterization of the population with hemophilia.

Utilidad de la escala pronóstica SWIFT en una Unidad de Cuidados Intensivos Polivalente / Utility of the SWIFT prognostic scale at a Polyvalent Intensive Care Unit

Introducción: el SWIFT es un índice creado para predecir eventos adversos reingresos y mortalidad oculta tras el alta de la Unidad de Cuidados Intensivos. Objetivo: evaluar la utilidad de la escala pronóstica SWIFT en la predicción de eventos adversos tras el alta de la unidad. Métodos: se realizó un estudio de cohorte en la Unidad de Cuidados Intensivos polivalente 8B del Hospital Clínico Quirúrgico Hermanos Ameijeiras, de provincia La Habana, en el periodo comprendido desde el 1ro de marzo de 2009 hasta el 28 de febrero de 2011. Los pacientes fueron divididos en dos grupos según el resultado de la escala: < 15 puntos y otro con ≥ 15, evaluándose la ocurrencia de mortalidad oculta y reingresos. Como variables principales se midieron: la mortalidad, los eventos adversos, la puntuación de la escala SAPS- 3 y la comparación de ésta con la escala SWIFT. Resultados: La escala SWIFT resultó ser útil en la predicción de eventos adversos tras el alta de UCI sin discriminar en el tiempo. La mayor puntuación de SAPS-3 al ingreso se correspondió con un mayor valor del Índice de SWIFT al egreso de la Unidad de Cuidados Intensivos.Conclusiones: los pacientes egresados de la Unidad de Cuidados Intensivos con una puntuación SWIFT ≥15 puntos presentaron una estadía discretamente superior aquellos con SWIFT‹15 puntos no teniendo relevancia estadística

Introduction: SWIFT is an index created to predict adverse events (readmissions and hidden mortality) after discharge from the ICU.Objective: to evaluate the usefulness of the SWIFT prognostic scale in predicting adverse events after unit discharge.Methods: It was conducted a cohort study in Unit 8B Polyvalent Intensive Care Unit of Hermanos Ameijeiras Clinical Surgical Hospital, of Havana province, in the period from March 1st, 2009 until February 28, 2011. The patients were divided into two groups according to the result of the scale: <15 points and another with ≥ 15, evaluating the occurrence of hidden mortality and readmissions. As main variables it was measured: mortality, adverse events, the SAPS- 3 scale score and its comparison with the SWIFT scale.Results: the SWIFT scale proved to be useful in predicting adverse events after discharge from the ICU without discriminating over time. The highest SAPS-3 score on admission corresponded to a higher value of the SWIFT Index at discharge from Intensive Care Unit.Conclusions: patients discharged from the ICU with a SWIFT score ≥ 15 points presented a slightly higher stay than those with SWIFT <15 points having no statistical significance.

Mercury Promotes Catecholamines Which Potentiate Mercurial Autoimmunity and Vasodilation: Implications for Inositol 1,4,5-Triphosphate 3-Kinase C Susceptibility in Kawasaki Syndrome

Previously, we reviewed biological evidence that mercury could induce autoimmunity and coronary arterial wall relaxation as observed in Kawasaki syndrome (KS) through its effects on calcium signaling, and that inositol 1,4,5-triphosphate 3-kinase C (ITPKC) susceptibility in KS would predispose patients to mercury by increasing Ca2+ release. Hg2+ sensitizes inositol 1,4,5-triphosphate (IP3) receptors at low doses, which release Ca2+ from intracellular stores in the sarcoplasmic reticulum, resulting in delayed, repetitive calcium influx. ITPKC prevents IP3 from triggering IP3 receptors to release calcium by converting IP3 to inositol 1,3,4,5-tetrakisphosphate. Defective IP3 phosphorylation resulting from reduced genetic expressions of ITPKC in KS would promote IP3, which increases Ca2+ release. Hg2+ increases catecholamine levels through the inhibition of S-adenosylmethionine and subsequently catechol-O-methyltransferase (COMT), while a single nucleotide polymorphism of the COMT gene (rs769224) was recently found to be significantly associated with the development of coronary artery lesions in KS. Accumulation of norepinephrine or epinephrine would potentiate Hg2+-induced calcium influx by increasing IP3 production and increasing the permeability of cardiac sarcolemma to Ca2+. Norepinephrine and epinephrine also promote the secretion of atrial natriuretic peptide, a potent vasodilator that suppresses the release of vasoconstrictors. Elevated catecholamine levels can induce hypertension and tachycardia, while increased arterial pressure and a rapid heart rate would promote arterial vasodilation and subsequent fatal thromboses, particularly in tandem. Genetic risk factors may explain why only a susceptible subset of children develops KS although mercury exposure from methylmercury in fish or thimerosal in pediatric vaccines is nearly ubiquitous. During the infantile acrodynia epidemic, only 1 in 500 children developed acrodynia whereas mercury exposure was very common due to the use of teething powders. This hypothesis mirrors the leading theory for KS in which a widespread infection only induces KS in susceptible children. Acrodynia can mimic the clinical picture of KS, leading to its inclusion in the differential diagnosis for KS. Catecholamine levels are often elevated in acrodynia and may also play a role in KS. We conclude that KS may be the acute febrile form of acrodynia.

Hypertensive encephalopathy induced by mercury poisoning; A report of 3 cases [in one iranian family]

Mercury poisoning is one of the important recent causes of mortality and mortality in children worldwide, particularly in industrial environments; mercury is a poisonous metal, especially harmful to the nervous and immune systems and the kidneys and can even be fatal. Elemental mercury is present in thermometers, barometer batteries, sphygmomanometers and latex paints. Inorganic mercury salts are found in antiseptics, pesticides, pigments and explosives and are used as preservatives in medicine. Mercury was once used to stop fever, and this worked because the immune system was so weakened that it could no longer sustain the attack for which the fever was created. Some medical drugs still contain mercury chloride and mercurous chloride and certain forms of mercury are still used in some laxatives. Mercury toxicity of the nervous system causes anorexia, ataxia, lack of ability to coordinate voluntary muscle movements, dementia, depression, dizziness, emotional instability, erethism. [abnormal irritability in response to stimulation], incoordination, insomnia, irritability, loss of ability to speak, memory impairment, numbness, saresthesias [sensation of prickling, tingling or creeping on the skin], psychosis, tremors, drowsiness, fatigue and weakness. Other organ damages include kidney failure, headaches, hearing impairment, visual impairment, hypertension, dermatitis, digestive tract problems, colitis, diarrhea, stomatitis and excessive salivation, loss of teeth, metallic taste, chromosomal damage, birth defects and ensuing organ failure. Chronic mercury poisoning can cause Acrodynia [Pink disease]. Mercury poisoning is a rare cause of hypertension in children. Herein we report 3 cases, the first a child with hypertensive encephalopathy due to severe mercury poisoning and his two siblings with moderate symptoms

Talidomida: indicaçöes e legislaçäo vigente / Thalidomide: indications and actual legislation

A talidomida, droga que tem ampla aplicaçäo clínica e potentes efeitos antiinflamatórios, qualifica-se como primeira escolha para tratamento de várias doenças. Seu efeito teratogênico, entretanto, limita seu uso clínico. Baseando-se neses conhecimentos, após estudo detalhado de cada um de seus efeitos, e avaliando-se cuidadosamente o risco/benefício de seu emprego, pretende-se indicar a talidomida para algumas situaçöes clínicas já bem estabelecidas. Säo elas: eritema nodoso hansênico, lúpus eritematoso discóide, estomatite aftosa recorrente, doença enxerto-verus-hospedeiro em sua fase crônica, úlceras dolorosas de mucosas em pacientes com HIV/Aids, prurigo nodular, síndrome de Behçet e prurigo actínico. A essas somam-se outras, em que seu uso só deve se indicado se outras drogas resultarem ineficazes. Complementando a avaliaçäo, foram consideradas as situaçöes nas quais a talidomida poderia ser eficaz, necessitando de estudo prévio das características da doença e do paciente para que se efetive sua utilizaçäo. O uso da talidomida deve sempre obedecer às portarias do Ministério da Saúde que regulamentam sua fabricaçäo, indicaçöes e dispensäo. Os principais pontos dessa legislaçäo seräo destacados, em especial a proibiçäo para uso em mulheres em idade fértil.

Intoxicación por mercurio / Mercury poisoning

Se presenta el caso de un adolescente intoxicado por mercurio por intento autodestructivo. Se analizan las diversas formas de intoxicación por este metal así como su sintomatología, haciendo énfasis en la terapéutica utilizada y al mismo tiempo se mencionan las causas que pueden motivar esta autodestrucción.

Polineuropatia carencial associada à sindrome de Korsakoff / Deficiency polyneuropathy associated with Korsakoff's syndrome

Um caso raro de polineuropatia carencial concomitante com a Síndrome de Korsakoff é apresentado. Säo discutidos os aspectos clínicos, laboratoriais, além do sucesso terapêutico

Acrodinia / Acrodynia

Se presenta un paciente de 13 meses de edad, con un cuadro de intoxicación mercurial debido a la aplicación de una pomada con cloruro mercurioso (Calomel) para tratamiento de dermatitis del pañal. Se destaca lo raro de la observación de este cuadro en la actualidad, resaltando las lesiones cutáneo-mucosas, que en nuestro paciente consistieron en eritema descamativo palmoplantar y exantema morbiliforme diseminado máculopapuloso, cuyo estudio histopatológico reveló vasculitis linfocitaria, y una estomatitis ulcerosa con pérdida de piezas dentarias

A Case of Acrodynia / 대한피부과학회지

Acrodynia is caused by chronic mercury poisoning and/or mercury, hypersensitivity occuring in infants and children only. Ingestion or inhalation of mercury contained in some house paints, calomel ingestion, the use of mercury ointments and other mercurial preparations can be the causes of acrodynia. We herein report a 3-year-old boy with typical acrodynia after expoaure to house paints and lacquer for 2 months. His hands and feet were erythematous and edematous vesiculo-bullous lesion with acral dark bluish discoloration. Mercury levels of blood and urine were significantly incresed by 61. 2ug/dl and 264ug/L (normal; below 30ug/dl and 100ug/L).