The American journal of the medical sciences
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Acute hepatic porphyria (AHP) is a group of rare, metabolic diseases where patients can experience acute neurovisceral attacks, chronic symptoms, and long-term complications. Diagnostic biochemical testing is widely available and effective, but a substantial time from symptom onset to diagnosis often delays treatment and increases morbidity. A panel of laboratory scientists and clinical AHP specialists collaborated to produce recommendations on how to enhance biochemical diagnosis of AHP in the USA. ⋯ Substantial PBG elevation confirms an AHP diagnosis and allows for prompt treatment initiation. Additional testing can determine AHP subtype and identify at-risk family members. Increased awareness of AHP and correct diagnostic methods will reduce diagnostic delay and improve patient outcomes.
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Review Case Reports
When too many hits breaks the heart: A case of Radiation Induced Takotsubo Cardiomyopathy.
Takotsubo cardiomyopathy (TCM), or stress induced cardiomyopathy is being increasingly recognized as a cause of acute heart failure. Often seen in women and older individuals with acute stressors, it can cause significant hemodynamic compromise. ⋯ Left ventriculogram revealed apical ballooning, characteristic of TCM. Often linked to physical and emotional stressors, TCM has been found to be more prevalent in patients with malignancies.
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Review Case Reports
Alkalemia and Hepatic Encephalopathy in a Chronic Dialysis Patient.
Hepatic encephalopathy (HE) includes cognitive, psychiatric and neuromotor abnormalities observed from brain dysfunction secondary to liver disease and/or porto-systemic shunting. HE can have a wide range of clinical manifestations ranging from trivial lack of awareness, decreased attention span, personality changes to confusion, seizures, coma, and death. ⋯ Alkalemia facilitates the conversion of NH4+ to NH3, which is free to cross the blood-brain barrier exacerbating HE. Prompt recognition and correction of underlying risk factors is central to the management of HE.
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Abdominal obesity and brachial-ankle pulse wave velocity (baPWV) are indicators of atherosclerosis. But few studies have shown the relationship between baPWV combined with waist-hip ratio (WHR) and cardiac-cerebrovascular events (CCVEs). ⋯ BaPWV and WHR were important risk factors for CCVEs and had synergistic effects. When baPWV increased, WHR may contribute more to the risk of CCVEs in hypertensive patients.
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The incidence of drug related problems (DRPs) in intensive care units (ICU) is higher compared to any other wards in the hospital, requiring a structured pathway to ensure optimum detection of DRPs. The study aimed to evaluate the impact of implementing a pharmaceutical care pathway on the detection and management of DRPs in an ICU. ⋯ The implementation of a unified pharmaceutical care pathway improved the detection of DRPs in ICU patients.