The Response of Osmotic Demyelination Syndrome to Plasmapheresis in a Patient Presenting with Catatonia after Correction of Hyponatraemia in Hyperemesis Gravidarum.

Osmotic demyelination syndrome (ODS) is a disorder characterised by the widespread development of demyelination in both pontine and extrapontine regions. It has been recognised as a complication arising from the rapid correction of hyponatraemia. This study presents the case of a 20-year-old Thai female patient at 10 weeks gestation, exhibiting an initial presentation of catatonia - an uncommon manifestation of ODS. The patient developed symptoms following the rapid correction of hyponatraemia in the context of hyperemesis gravidarum. Magnetic resonance imaging (MRI) of the brain revealed a trident or bat-wing-shaped pattern in T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences at the central pons. The patient underwent five cycles of plasmapheresis and received rehabilitation, leading to clinical improvement. LEARNING POINTS: Osmotic demyelination syndrome (ODS) is a rare but potentially devastating neurological complication, such as catatonia, resulting from the correction of hyponatraemia.Pregnancies complicated by hyperemesis gravidarum tend to exhibit hyponatraemia and hypokalaemia, which serve as contributing risk factors for ODS.Plasmapheresis is considered as an option in the treatment of ODS for the removal of inflammatory substances.

A Rare Case of Immunoglobulin G4-Related Disease Presenting With Coronary Artery Pseudotumor And Aneurysm.

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease characterized by elevated serum IgG4 levels. It has the potential to affect multiple organs. Despite the diverse manifestations of IgG4-RD, the association with coronary artery disease (CAD) remains poorly understood due to limited evidence. We report the case of a 52-year-old male patient who exhibited typical angina upon exertion, accompanied by elevated serum IgG4 levels. Coronary computed tomographic angiography (CCTA) revealed the presence of pseudotumor formations surrounding and aneurysm changes affecting all coronary arteries, consistent with IgG4-RD. The patient was treated with prednisolone and azathioprine, with the possibility of additional rituximab therapy if symptomatology failed to improve. This case sheds light on the rare occurrence of IgG4-RD with coronary artery involvement and underscores the importance of recognizing this unique clinical entity for appropriate management and further research. LEARNING POINTS: Immunoglobulin G4-related disease (IgG4-RD) is a chronic systemic disease characterized by inflammatory fibrosis and high serum IgG4 levels.IgG4-RD can involve the coronary artery, presenting as a coronary aneurysm, and may mimic coronary artery disease.Treatment of IgG4-RD with coronary artery involvement includes corticosteroid therapy, with or without other immunosuppressant, as well as surgical intervention.

Effects of Riceberry Rice Bran Oil Supplementation on Oxidative Stress and Cardiovascular Risk Biomarkers in Older Adults with Prehypertension.

We investigated the changes in the oxidative stress and cardiovascular disease risk biomarkers, including the activity of the cardiac autonomic nervous system, in older adults with prehypertension following Riceberry rice bran oil supplementation. A total of 35 women aged 60 to 76 years with prehypertension were randomly allocated to two groups, one of which was supplemented with rice bran oil (n=18) and the other with Riceberry rice bran oil (n=17) at 1,000 mg daily for 8 weeks. Prior to and after the supplementation, oxidative stress and cardiovascular risk biomarkers (primary outcomes), heart rate variability, and blood pressure (secondary outcomes) were investigated. Results showed that plasma malondialdehyde, blood glutathione disulfide, and tumor necrosis factor-alpha levels were significantly decreased, and the ratio of reduced glutathione to glutathione disulfide significantly increased in both groups after supplementation (all P<0.05). No significant differences were observed between groups. Heart rate variability and blood pressure did not statistically significantly change subsequent to supplementation in either group and did not differ between groups. In conclusion, Riceberry rice bran oil supplementation for 8 weeks alleviates oxidative stress and inflammation in older adults with prehypertension to a similar extent as rice bran oil supplementation.

Practical Risk Stratification Score for Prediction of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Contrast-induced nephropathy (CIN) is a common complication of percutaneous coronary intervention (PCI). This study aimed to develop a new risk stratification score that is simpler and more practical than the standard Mehran risk score (MRS) in prediction of CIN after primary PCI in ST-segment elevation myocardial infarction (STEMI) patients. METHODS: A prognostic prediction research with clinical risk score development was conducted. All STEMI patients who underwent primary PCI at the Central Chest Institute from June 1, 2017 to June 30, 2018 were included. Multivariable logistic regression analysis was used to identify independent predictors of CIN with a significant P value < 0.05. Logistic coefficients of each predictor were used for score weighting and transformation. Predictive performance was validated and compared between newly-derived risk score and the MRS by non-parametric receiver operating characteristic (ROC) regression. RESULTS: A total of 217 patients, 43 (19.8%) with CIN and 174 (80.2%) without CIN, were included for score derivation. A total of 13 potential predictors were explored under multivariable logistic regression model and were subsequently eliminated. The new risk score was based on three final predictors which were ejection fraction of less than 40%, triple-vessel disease as findings from angiogram, and the use of intra-aortic balloon pump (IABP). With only three predictor variables, the score predicted the risk of CIN with good discriminative ability (area under the receiver operating characteristic curve (AuROC): 0.83, 95% confidence interval (CI): 0.76 - 0.90) which was higher than that of the MRS (AuROC: 0.78, 95% CI: 0.69 - 0.87). The score was categorized into low-risk (positive predictive value (PPV): 9.9, 95% CI: 5.4 - 14.4) and high-risk (PPV: 56.5, 95% CI: 42.4 - 70.8) groups at the cut-off point of 2. CONCLUSIONS: The newly developed score was proved to have good predictive performance with fewer numbers of predictors and could be practically applied for risk stratification of CIN in STEMI patients who required emergent primary PCI.