ABSTRACT
Yellow oleander (Thevetia peruviana), known for its cardiac glycosides, can cause severe poisoning with varied clinical manifestations, primarily affecting the cardiovascular system. We present a unique case of a 57-year-old Saudi woman with a history of type 2 diabetes, dyslipidemia, and previous meningioma excision who ingested 3.4 grams of yellow oleander fruit, mistaking it for an edible fruit. Remarkably, she remained asymptomatic with no gastrointestinal, neurological, or cardiovascular symptoms. Examination and investigations, including electrocardiograms and laboratory tests, showed no abnormalities. Despite the known high toxicity of yellow oleander and its documented fatal cases, our patient's asymptomatic presentation is rare. This case highlights the importance of close monitoring and observation in yellow oleander ingestion cases, even in the absence of symptoms, due to variable absorption kinetics and potential delayed onset of toxicity. Our findings also underscore the need for public health awareness regarding the identification and dangers of toxic plants like yellow oleander, especially as they are commonly grown at home.
ABSTRACT
PURPOSE: Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns. PATIENTS AND METHODS: A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy. RESULTS: There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P <0.01 by chi-square overall comparison). CONCLUSION: Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.
ABSTRACT
Retained placenta is clinically diagnosed when the placenta has failed to deliver within 18 to 60 minutes after birth. The retained placenta is a risk factor for postpartum fever. In this paper, we report a patient with a delivery complicated by a retained placenta and postpartum fever. This patient, a 34-year-old pregnant female, was admitted at 32 weeks of gestation for a case of preterm labor with preterm premature rupture of membranes and bacterial vaginosis. A 2.5 kg infant was delivered by normal vaginal delivery, which was followed by active management of the third stage of labor. The retained placenta was removed manually under general anesthesia. Two days later, the patient developed a fever and elevated inflammatory markers. Ultrasound-guided evacuation and curettage were done, and two endometrial cavities were noted. Both cavities were evacuated of products of conception. Two days later, the patient started to have spikes of fever. Imaging revealed an intra-cavity soft tissue mass measuring 6.5 cm. Hysteroscopy with dilation and curettage was performed and showed fibrous bands covering a soft mass of products of conception, which was then evacuated.
