Subject(s)
Digestive System/parasitology , Entamoeba histolytica/pathogenicity , Liver Abscess, Amebic/diagnosis , Animals , Antiprotozoal Agents/therapeutic use , Humans , Liver Abscess, Amebic/drug therapy , Male , Metronidazole/therapeutic use , Middle Aged , Paromomycin/therapeutic use , Tomography, X-Ray Computed , TravelABSTRACT
In England there were 7,290 cases of tuberculosis (TB) reported in 2013. The area with the highest incidence of the disease in England is London, with hotspots in other urban areas. TB affecting the head and neck is rare. We present three such cases of TB presenting as pre-auricular swelling. Two of the patients were initially misdiagnosed as having dental infection, demonstrating the importance of taking a good history and considering the differential diagnosis of TB when appropriate. TB remains a potentially fatal disease that should be considered in patients presenting with facial swelling where common causes have been excluded.
Subject(s)
Edema/etiology , Face , Tuberculosis/diagnosis , Abscess/diagnosis , Abscess/etiology , Diagnosis, Differential , Diagnostic Errors , Edema/diagnosis , Female , Humans , Male , Middle Aged , Mouth Diseases/diagnosis , Mouth Diseases/etiology , Tuberculosis/complications , Young AdultABSTRACT
INTRODUCTION: We report a case of a female neonate who developed respiratory depression following the unintentional administration of methylergonovine. The respiratory depression appeared to improve after the administration of bag mask ventilation, stimulation, and naloxone; and the baby was able to be managed without endotracheal intubation and prolonged positive-pressure ventilation. CASE: A full-term female neonate was delivered vaginally without issue. Approximately 10 min after delivery, the infant was inadvertently administered 0.1 mg of methylergonovine intramuscularly instead of vitamin K. Thirty minutes later the child developed cyanotic extremities and respiratory depression with an oxygen saturation of 75%. Naloxone, 0.4 mg IM, was recommended to mitigate respiratory depression. Within 5 min the patient's respirations improved to 40 breaths per minute, cyanosis improved, and she began resisting ventilations and crying loudly. The child continued to improve and was back to baseline that evening. DISCUSSION: Methylergonovine toxicity in neonates has been commonly associated with respiratory depression necessitating ventilatory support. In consideration of chemical structural similarity between methylergonovine and morphine, as well as signs/symptoms consistent with opioid-induced respiratory depression, naloxone was suggested. CONCLUSION: It appears that naloxone may reverse methylergonovine toxicity in neonates. The identification of a safe and potentially useful antidote to mitigate respiratory depression, potentially avoiding the need for intubation and more invasive interventions in this patient population is important.
Subject(s)
Medication Errors/adverse effects , Methylergonovine/poisoning , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Oxytocics/poisoning , Respiratory Insufficiency/chemically induced , Respiratory Insufficiency/drug therapy , Combined Modality Therapy , Cyanosis/etiology , Female , Humans , Infant, Newborn , Injections, Intramuscular , Methylergonovine/administration & dosage , Methylergonovine/antagonists & inhibitors , Naloxone/administration & dosage , Narcotic Antagonists/administration & dosage , Oxytocics/administration & dosage , Oxytocics/antagonists & inhibitors , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Treatment OutcomeABSTRACT
There has been a marked expansion in the discovery of new antifungal peptides. This paper describes a novel dodecapeptide, H-Arg-Trp-Trp-Arg-D-Trp-D-Phe-Ile-D-Phe-His-Trp-Arg-Trp-NH(2), derived from a previously described nonapeptide and synthesized by the combinatorial approach. Further, interaction of this peptide with antifungals such as amphotericin B, flucytosine and fluconazole was studied by checkerboard analysis and time-kill assay to obtain the dynamic picture with respect to time. The best synergistic activity was observed with a combination of peptide and fluconazole, followed by peptide and flucytosine.
