The nature and time course of temporal lobe abnormalities in
psychotic illness remain notorious. Confounds include disease chronicity,
demographic data, and handedness etc . Temporal lobe epilepsy is
associated with a substantial risk of psychosis but there are only
restricted studies investigating the underlying changes and causes.
momentous grey and white matter deficits occur in temporal lobe epilepsy
with psychosis....
The nature and time course of temporal lobe abnormalities in
psychotic illness remain notorious. Confounds include disease chronicity,
demographic data, and handedness etc . Temporal lobe epilepsy is
associated with a substantial risk of psychosis but there are only
restricted studies investigating the underlying changes and causes.
momentous grey and white matter deficits occur in temporal lobe epilepsy
with psychosis. Some of these deficits overlap with those found in
schizophrenia.I read the case report of Professor Amin Gadit with great
interest, As I can see in this case report which it shows clear and
valuable information .The findings of this report taken in conjunction
with the findings of previous studies that Epilepsy is one of the main
causes of functional disability, and it is usually associated to
psychiatric comorbidity, such as psychosis of epilepsy . the epileptic
psychosis management requires more careful pharmacological treatment,
considering the propensity of the antipsychotics to provoke seizures and
the risk of pharmacokinetic interaction with antiepileptic drugs also
threshold possible interactions. Electroconvulsive therapy (ECT) is a
useful yet controversial mode of treatment. Despite being in use for over
70 years, its mechanism of action is still not clearly understood. Also
various speculations on mode of actions of ECT have been anticipated over
the years. These have included looking at psychological, neuro
physiological, neuro chemical, neuro endocrine, and neuro peptides
mechanisms. Although ECT well established as safe and effective, some
basic questions about ECT remain unrequited.One study showed that ECT had
a significantly greater antidepressant/antipsychotics effect compared to
medication therapy. receptors were considered potential targets for
therapeutic efficacy of (ECT), but pre- clinical studies showed that
electroconvulsive shock up-regulates 5-HT2 receptors in contrast to
antidepressant medications, which down-regulate brain 5-HT2 receptors. I
personally believe that further studies and case reports are needed, to
look at longer-term effects of either ECT or role of
medications on organic psychosis and to better understand why quick
response changes occur. The role of ECT in schizophrenia and other non
affective (atypical) psychotic disorders remains controversial, but some
agreement exists about its usefulness in certain psychotic presentations.
This case example underscore the role of ECT in atypical psychotic
presentations, particularly when the symptoms resemble those found in
Temporal lobe epilepsy associated with psychosis .
References
Abrams R, Taylor MA, Volavka J. ECT- induced EEG asymmetry and therapeutic
response in melancholia: relation to treatment electrode placement. Am J
Psy-chiatry, 1987; 144: 327-329.
Abrams R, Taylor MA. Diencephalic stimulation and the effects of ECT
in endogenous depression. Br J Psy- chiatry. 1976; 129: 482-5.
UK ECT Review Group. Efficacy and safety of electroconvulsive therapy
in depressive disorders: a systematic review and meta- analysis. Lancet
2003; 361: 799-808.
The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations:
A Case Review John H. Montgomery et al 2007.
Yatham LN, Liddle PF, Lam RW, Zis AP, Stoessl AJ, Sossi V, et al.
Effect of electroconvulsive therapy on brain 5-HT2 receptors in major
depression.Br J Psychiatry 2010 196: 474-479.
We read with interest the article by Braithwaite et al. This article
has helped us in diagnosis and management of a patient here in Mumbai,
India.Dengue Eye Disease has become more common and has been investigated
extensively with many diagnostic modalities (1 to 33) and has been
suspected to have 10 percent prevalence in some outbreaks of dengue .
Dengue could present to an eye surgeon first as subconjunctival
haemorrh...
We read with interest the article by Braithwaite et al. This article
has helped us in diagnosis and management of a patient here in Mumbai,
India.Dengue Eye Disease has become more common and has been investigated
extensively with many diagnostic modalities (1 to 33) and has been
suspected to have 10 percent prevalence in some outbreaks of dengue .
Dengue could present to an eye surgeon first as subconjunctival
haemorrhage and ecchymosis (17) , or some patients may be suffering from
dengue eye disease without symptoms .A subtle foveolitis may be missed
without OCT.Dengue may also cause symptomatic retinochoroiditis,
vasculitis, choroidal neovascularisation (19) secondary to immune damage ,
central retinal artery occlusion (14) , AION, frosted branch angitis (11)
and even panophthalmitis (23) , bilateral vitreous haemorrhage (31) ,
bilateral stellar neuroretinitis , bilateral choroidal effusion (33) and
may be suspected as an etiology even for bilateral acute angle closure
glaucoma (28) and also oculomotor paralysis (26) . We used iPad softwares
to examine severely ill dengue patients at bedside. We used it to identify
optic neuropathy and foveolitis in one patient and confirmed it on the
basis of this present article. A 32 year old female patient was admitted
with dengue and a routine examination was sought for eye check up at
bedside because of the patient complaining of "funny vision " . The
patient was tested with iPad based softwares encompassing everything from
visual acuity, contranst sensitivity , colour sensitivity, Amslers, Stero
vision , bedside iPad based visual field testing in order to give patients
a state of the art management (4) The diagnosis of optic neuropathy was
confirmed on OCT following dengue related micropsia which was diagnosed
and monitored with Amslers test. The patient was observed to see if
spontaneous resolution takes place as reported in some cases (2) . OCT
was repeated when the Amsler was reported to be worse and the macular
thickness was documented to be increased and so the patient was given
steroids following which the micropsia resolved and the macular thickness
reduced .Recently we have seen quite a few cases of Dengue with visual
involvement including a patient who lost both eyes to dengue
panophthalmitis like that reported earlier (23) and we would suggest that
not asking for an eye check if a patient reports distortion or "funny
vision" or reports the " Seet Quek Lim triad" of flashes of light,floaters
and blurring of vision(29) , may now be construed as being negligence if
patient loses vision eventually because dengue vision loss can be
irreversible and may be seen in upto 10 percent of cases and severe cases
may include cerebral venous thrombosis (13) which may be picked up by
papillodema which can be diagnosed by a fundoscopy and very severe cases
may proceed to even proptosis and globe rupture secondary to Dengue as
seen by Nagaraj et al (18)
References:-
1) Juanarita, Jaafar et al. "Dengue Related Maculopathy and Foveolitis."
Asian Pacific Journal of Tropical Biomedicine 2.9 (2012): 755-756.
2) Luk F, O, Chan C, K, Lai T, Y, A Case of Dengue Maculopathy with
Spontaneous Recovery. Case Rep Ophthalmol 2013;4:28-33
3) Chan, David P.L. et al. "Ophthalmic Complications of Dengue." Emerging
Infectious Diseases 12.2 (2006): 285-289.
4) Gan VC. Dengue: Moving from Current Standard of Care to State-of-the-
Art Treatment. Current Treatment Options in Infectious Diseases.
2014;6(3):208-226. doi:10.1007/s40506-014-0025-1.
5)Ng AW, Teoh SC. Dengue eye disease. Surv Ophthalmol. 2015
Mar-Apr;60(2):106-14. doi: 10.1016/j.survophthal.2014.07.003. Epub 2014
Aug 12.
6) Teoh SC, Chee CK, Laude A, Goh KY, Barkham T, Ang BS; Eye Institute
Dengue-related Ophthalmic Complications Workgroup. Optical coherence
tomographypatterns as predictors of visual outcome in dengue-related
maculopathy. Retina. 2010 Mar;30(3):390-8. doi:
10.1097/IAE.0b013e3181bd2fc6.
7) Su DH, Bacsal K, Chee SP, Flores JV, Lim WK, Cheng BC, Jap AH; Dengue
Maculopathy Study Group. Prevalence of dengue maculopathy in patients
hospitalized for dengue fever. Ophthalmology. 2007 Sep;114(9):1743-7.
8) Chee E, Sims JL, Jap A, Tan BH, Oh H, Chee SP. Comparison of prevalence
of dengue maculopathy during two epidemics with differing predominant
serotypes. Am J Ophthalmol. 2009 Dec;148(6):910-3. doi:
10.1016/j.ajo.2009.06.030.
9) Mendes TS, Sobrinho EF, Rosa AA, dos Anjos LM, da Costa GM, Souza Gda
S, Gomes BD, Saito CA, da Silva Filho M, Silveira LC. Dengue maculopathy:
visual electrophysiology and optical coherence tomography. Doc Ophthalmol.
2009 Oct;119(2):145-55. doi: 10.1007/s10633-009-9178-5.
10) Tan MH, Tan PE, Wong EN, Chen FK. Structure and function correlation
in a patient with dengue-associated maculopathy. Clin Experiment
Ophthalmol. 2014Jul;42(5):504-7. doi: 10.1111/ceo.12269.
11) Rani PK, Chhablani J, Bhargava A. Frosted Branch Angiitis in a Patient
Co Infected With Dengue Hemorrhagic Fever and Malaria. JAMA Ophthalmol.
2015 Jun;133(6):e1568. doi: 10.1001/jamaophthalmol.2015.68.
12) Lim WK, Mathur R, Koh A, Yeoh R, Chee SP. Ocular manifestations of
dengue fever. Ophthalmology. 2004 Nov;111(11):2057-64. PubMed PMID:
15522372.
13) Vasanthi N, Vairamon PM, Gowtham T, Das AK. Unusual Presentation of
Dengue Fever-Cerebral Venous Thrombosis. J Clin Diagn Res. 2015
Jun;9(6):OD09-10. doi: 10.7860/JCDR/2015/13132.6068.
14) Sadiq N, Naqaish T, Arif A, Mohammad K, Jalis M. Central retinal
artery occlusion secondary to dengue fever. J Ayub Med Coll Abbottabad.
2014 Jan-Mar;26(1):98-9.
15) Kanungo S, Shukla D, Kim R. Branch retinal artery occlusion secondary
to dengue fever. Indian J Ophthalmol. 2008 Jan-Feb;56(1):73-4.
16)Gupta S, Das D. Subhyaloid haemorrhage in dengue fever. J Indian Med
Assoc. 2013 Sep;111(9):623-4.
17) Jain S, Goswami A, Singh N, Kaur S. Bilateral eyelid ecchymosis and
sub conjunctival haemorrhage manifesting as presenting feature in a case
of dengue haemorrhagic fever. Trop Doct. 2014 Dec 24. pii:
0049475514565429.
18) Nagaraj KB, Jayadev C, Yajmaan S, Prakash S. An unusual ocular
emergency in severe dengue. Middle East Afr J Ophthalmol. 2014 Oct-
Dec;21(4):347-9. doi:10.4103/0974-9233.142276.
19) Veloso CE, Schmidt-Erfurth U, Nehemy MB. Choroidal neovascularization
induced by immunogenic alteration of the retinal pigment epithelium in
dengue Fever. Case Rep Ophthalmol. 2015 Jan 17;6(1):18-23. doi:
10.1159/000371791.
20) Rhee TK, Han JI. Use of optical coherence tomography to evaluate
visual acuity and visual field changes in dengue fever. Korean J
Ophthalmol. 2014
Feb;28(1):96-9. doi: 10.3341/kjo.2014.28.1.96.
21) Yamamoto K, Takahashi H, Kanno M, Noda Y, Fujino Y. Changes in
parafoveal retinal thickness and subfoveal choroidal thickness in a
patient with dengue fever-associated maculopathy. J Ophthalmic Inflamm
Infect. 2013 Oct 31;3(1):63.doi: 10.1186/1869-5760-3-63.
22) Koh YT, Sanjay S. Characteristics and Ophthalmic Manifestations of the
Classic Dengue Fever Epidemic in Singapore (2005-2006). Asia Pac J
Ophthalmol (Phila).2013 Mar-Apr;2(2):99-103. doi:
10.1097/APO.0b013e31828a1917.
23) Saranappa S B S, Sowbhagya HN. Panophthalmitis in dengue fever. Indian
Pediatr. 2012 Sep;49(9):760.
24) Chhavvi N, Venkatesh C, Soundararajan P, Gunasekaran D. Unusual ocular
manifestations of dengue fever in a young girl. Indian J Pediatr. 2013
Jun;80(6):522-3. doi: 10.1007/s12098-012-0871-0.
25) Tabbara K. Dengue retinochoroiditis. Ann Saudi Med. 2012 Sep-
Oct;32(5):530-3. doi: 10.5144/0256-4947.2012.30.4.1105.
26) Donnio A, B?ral L, Olindo S, Cabie A, Merle H. [Dengue, a new etiology
in oculomotor paralysis]. Can J Ophthalmol. 2010 Apr;45(2):183-4. doi:
10.1139/i09-207.
27) Sanjay S, Wagle AM, Au Eong KG. Dengue optic neuropathy.
Ophthalmology. 2009Jan;116(1):170; author reply 170. doi:
10.1016/j.ophtha.2008.08.015.
28) Pierre Filho Pde T, Carvalho Filho JP, Pierre ET. Bilateral acute
angle closure glaucoma in a patient with dengue fever: case report. Arq
Bras Oftalmol. 2008 Mar-Apr;71(2):265-8.
29) Seet RC, Quek AM, Lim EC. Symptoms and risk factors of ocular
complications following dengue infection. J Clin Virol. 2007 Feb;38(2):101
-5.
30) Chia A, Luu CD, Mathur R, Cheng B, Chee SP. Electrophysiological
findings in patients with dengue-related maculopathy. Arch Ophthalmol.
2006 Oct;124(10):1421-6.
31) Sanjay S, Au Eong KG. Bilateral vitreous haemorrhage associated with
dengue fever. Eye (Lond). 2007 Jan;21(1):144-5.
32) de Amorim Garcia CA, Gomes AH, de Oliveira AG. Bilateral stellar
neuroretinitis in a patient with dengue fever. Eye (Lond). 2006
Dec;20(12):1382-3.
33) Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral choroidal effusions
associated with dengue fever. Retina. 2003 Aug;23(4):576-8.
I read with enjoyment your unusual case report of mucinous
adenocarcinoma arising from a villous adenoma in the terminal ileum and
invading the bladder.
This case represents the importance of team collaboration i.e.
urology and colorectal surgeons in complicated and rare cases.
It would be interesting to know what percentage of small bowel
tumours fistulae to the bladder? and how many similar case re...
I read with enjoyment your unusual case report of mucinous
adenocarcinoma arising from a villous adenoma in the terminal ileum and
invading the bladder.
This case represents the importance of team collaboration i.e.
urology and colorectal surgeons in complicated and rare cases.
It would be interesting to know what percentage of small bowel
tumours fistulae to the bladder? and how many similar case reports there
are in the literature.
The bilateral loss of vision in a case of dengue is very unfortunate
and the present case report (1) is very interesting because it has been
written quite well and helped in management of a case with bilateral
visual loss seen in Mumbai in a case referred to the author for opinion.
Dengue causes visual loss due to various reasons ranging from uveitis (2)
to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5...
The bilateral loss of vision in a case of dengue is very unfortunate
and the present case report (1) is very interesting because it has been
written quite well and helped in management of a case with bilateral
visual loss seen in Mumbai in a case referred to the author for opinion.
Dengue causes visual loss due to various reasons ranging from uveitis (2)
to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5) and
branch retinal artery occlusion (6)
Bilateral visual loss has been documented due to stellar
neuroretinitis (8),vitreous haemorrhage (9),vasculitis and macular oedema
(10) angle closure glaucoma (11),choroidal effusion (12), optic neuritis
(13) ,pituatory haemorrhage (14) and is also known to be recurrent in both
eyes (15)due to recurrent maculopathy
The patient in question in Mumbai had a bilateral uveitis which
caused bilateral visual loss following dengue.The review of literature
shows that bilateral visual loss is becoming pretty common over the last
10 years
This only proves that routine eye examination should be made
mandatory in cases presenting with diagnosis of dengue because they are
prone to bilateral visual loss due to various conditions
References
1) Braithwaite T, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-200542
2) Gupta A, Srinivasan R, Setia S, Soundravally R,
Pandian DG. Uveitis following dengue fever. Eye
(Lond). 2009;23:873-6.
3) Sanjay S, Wagle AM, Au Eong KG. Optic
neuropathy associated with dengue fever. Eye
(Lond). 2008;22:722-4.
4) Zohar Halbot Wilner et al. A returned traveller with Dengue fever
and visual impairment.IMAJ 2005;7:200-201
5)Loh BK, Bacsal K, Chee SP, Cheng BC, Wong D.
Foveolitis associated with dengue fever: a case
series. Ophthalmologica. 2008;222:317-20
6)Kanungo S, Shukla D, Kim R. Branch retinal artery
occlusion secondary to dengue fever. Indian J
Ophthalmol. 2008;56:73-4.
7)Chlebicki MP, Ang B, Barkham T, Laude A. Retinal
hemorrhages in 4 patients with dengue fever.
Emerg Infect Dis. 2005;11:770-2.
8) de Amorim Garcia CA, Gomes AH, de Oliveira AG.
Bilateral stellar neuroretinitis in a patient with
dengue fever. Eye (Lond). 2006;20:1382-3
9)Nainiwal S, Garg SP, Prakash G, Nainiwal N.
Bilateral vitreous haemorrhage associated with
dengue fever. Eye. 2005;19:1012-3
10)Tan CS, Teoh SC, Chan DP, Wong IB, Lim TH.
Dengue retinopathy manifesting with bilateral
vasculitis and macular oedema. Eye (Lond).
2007;21:875-7.
11)Pierre Filho Pde T, Carvalho Filho JP, Pierre ET.
Bilateral acute angle closure glaucoma in a patient
with dengue fever: case report. Arq Bras Oftalmol.
2008;71:265-8
12)Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral
choroidal effusions associated with dengue fever.
Retina. 2003;23:576-8.
13)Preechawat P, Poonyathalang A. Bilateral optic
neuritis after dengue viral infection.
J Neuroophthalmol. 2005;25:51-2.
14)Vimal Kumar et al. Dengue hemorrhagic fever: A rare cause of
pituitary tumor hemorrhage and reversible vision loss.Indian J Ophthalmol.
2011 Jul-Aug; 59(4): 311-312
15)Quek DT, Barkham T, Teoh SC. Recurrent bilateral
dengue maculopathy following sequential
infections with two serotypes of dengue virus. Eye
(Lond). 2009;23:1471-2.
Ketoacidosis is a direct result of exteremly low cellular magnesium
levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6-
Pase is very magnesium dependent so if magnesium levels are severely
reduced blood glucose levels plummet starving neurons of energy. The
neurons in the hypothalamus signal the gut get more in 'the hunger pangs
in Obesity'.
Pyruvate carboxylase is also very magnesium dependent and if...
Ketoacidosis is a direct result of exteremly low cellular magnesium
levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6-
Pase is very magnesium dependent so if magnesium levels are severely
reduced blood glucose levels plummet starving neurons of energy. The
neurons in the hypothalamus signal the gut get more in 'the hunger pangs
in Obesity'.
Pyruvate carboxylase is also very magnesium dependent and if impaired by
low magnesium levels and will also shutdown gluconeogenesis. Ketoacidosis
is a direct result of beta oxidation of fat converting to AcetylCoA and
Ketones. This continuous manufacture of ketones results in acid blood.
Kidney failure in severe obesity and Diabetes-2 are other complications
caused by a failure of gluconeogenesis.
A magnesium sulphate injection would rectify the condition in amatter of
minutes. If you require a comprehensive article please email. Arthur
Henderson
What if the patient gave in his history that he went to Nigeria?
Would it be mandatory to do all the tests for infectious diseases in
Nigeria?. His travel history would give no indication for any further
investigation unless we find something relevant clinically. What is always
important is to have full history always regardless whether he is
undergoing elective surgery or not, he is traveling or not.
What if the patient gave in his history that he went to Nigeria?
Would it be mandatory to do all the tests for infectious diseases in
Nigeria?. His travel history would give no indication for any further
investigation unless we find something relevant clinically. What is always
important is to have full history always regardless whether he is
undergoing elective surgery or not, he is traveling or not.
What I want to emphasize is that full history is always important and
don't try to link travel history to elective surgery only, you are giving
wrong message to junior doctors.
I have read with interest the paper by Jenkins et al on discharging a patient to home with a Thopaz drain thus avoiding a surgical procedure. I agree with the author on the benefits of digital thoracic drainage devices. The author does reference previous work by Cerfolio RJ and Brunelli A, in our experience (Mier JM, Molins L, Fibla JJ Cir Esp. 2010(6):385-9) in a prospective and comparative study we demonstrate the benefi...
I have read with interest the paper by Jenkins et al on discharging a patient to home with a Thopaz drain thus avoiding a surgical procedure. I agree with the author on the benefits of digital thoracic drainage devices. The author does reference previous work by Cerfolio RJ and Brunelli A, in our experience (Mier JM, Molins L, Fibla JJ Cir Esp. 2010(6):385-9) in a prospective and comparative study we demonstrate the benefits of using a digital thoracic drainage device.
In our experience the outpatient management of patients with plolonged air leak after pulmonary resection, is possible, avoiding a second surgery. (Mier JM, Fibla JJ, Molins L. RevPortPneumol.2011.7(5):225-7).
On the idiopathic pulmonary fibrosis case described by the author, the patient decided to reject surgery, I absolutely agree with the author on proposing the use of the Thopaz Medela system as an option for conservatory management, but I would like to know if the medical team suggested other therapeutic treatment like talc pleurodesis. I believe that this option could have been a good alternative and probably allow for an early chest drain removal.
The second observation, in this case the CT scan shows very important fibrous disease, one of the most typical complications of this is secondary pneumothorax. When the patient presents 100% lung re-expansion, some studies suggest discontinuing suction through the chest drain, while others talk about the advantage of maintaining suction, in my opinion this is to be decided by the medical team in each case. But it is my opinion that one of the most important advantages of the the Thopaz Medela digital chest drain system is that we can have the evolution of the air leak presented as a graphic, showing us how and when the air leak is near 0 ml/min, so at a given time we can reduce or remove suction all together in order to avoid secondary barotrauma, since it has been reported that sometimes continued suction could be a cause for prolonged air leak like I reference in the paper ( Mier JM, EurJCardiothoracSurg 2011.39(3):432), I would like to know if in this particular case the suction was managed with a ¨step down¨ approach.
In conclusion, I am in complete agreement with the use of the Thopaz Medela Digital Chest Drain device for very selected non surgical cases, it is a great tool not only because of comfort issues but because it keeps a record that can be later referenced for further therapeutic decisions in ambulatory patients. I believe it can also be used as a research instrument since it allows us to evaluate directly when normal pulmonary, chest cavity dynamics and physiology have been achieved.
In the United Kingdom this is a medication used rarely within the
hospital environment, although it is gaining popularity in the pre-
hospital field. I would be intrigued to know the specialty of the
attending physician in this case, and his or her prior experience with
ketamine.
In addition, do the authors feel that ketamine is a superior first
choice analgesi...
In the United Kingdom this is a medication used rarely within the
hospital environment, although it is gaining popularity in the pre-
hospital field. I would be intrigued to know the specialty of the
attending physician in this case, and his or her prior experience with
ketamine.
In addition, do the authors feel that ketamine is a superior first
choice analgesic than opiates in the prehospital environment and that it
should be the first line treatment in cases such as this?
I read with interest this rare case report of ureteric obstruction
secondary to fungal mycella.
The authors concluded that antibiotics dramatically reduce the
commensal flora, compromising the physiological balance that prevents the
outgrowth of fungi and they recommended that probiotics should be
considered to prevent this complication, which can be severe and life
threatening in immunocompromised patients....
I read with interest this rare case report of ureteric obstruction
secondary to fungal mycella.
The authors concluded that antibiotics dramatically reduce the
commensal flora, compromising the physiological balance that prevents the
outgrowth of fungi and they recommended that probiotics should be
considered to prevent this complication, which can be severe and life
threatening in immunocompromised patients.
However, searching the available English literature on the use of
probiotics I feel that we cannot conclude with confidence that probiotics
should be used in such cases as the one described here.
There are several case reports of sepsis in the literature that were
attributed to the ingestion of certain probiotics I summarize these cases
here
Rautio et al [1] reported a Lactobacillus GG (LGG) liver abscess in a
74-year-old diabetic woman, four months after commencing dialy LGG.
Mackay et al [2] reported a Lactobacillus (L.) rhamnosus endocarditis in a
67-year-old man with mitral regurgitation after a simple dental
extraction.
However another case report showed that L. rhamnosus could be found in the
intestinal flora of healthy individuals and different strains than those
ingested could be the source of infection. Molecular typing might be
needed to prove the latter.
Kunz et al [3] reported Lactobacillus bacteremia in two premature infants
with short gut syndrome who were fed via gastrostomy or jejunostomy. One
of the two cases was taking LGG supplements
De Groote et al [4] reported a similar case
Two cases of probiotic sepsis were reported in children [5]; the first
case is that of four months old infant who developed LGG endocarditis
three weeks after consuming LGG.
The second case is that of a six year old girl with cerebral palasy who
developed LGG bacteremia after 44 days of consuming LGG through a
gastrojejunosotmy tube.
Other types of probiotic attributed sepsis were also prescribed including
cholangitis, bacteremia and fungemia.
All cases of probiotic bacteremia or fungemia have been described in
patients who have underlying immune deficiency.
Most fatal cases were attributed to the underlying disease rather than the
probiotic sepsis [6,7,8], however once exception is the case described by
Lestin et al. [9] of a 48 year olf diabetic woman with Clostridium
difficile diarrhoea who developed multiorgan failure and septic shock
secondary to probiotic fungemia which lead to her death. However molecular
methods were not used in this case to confirm the homology between the
probiotic and pathogenic fungi.
Boyle J.R. et al [10] proposed minor and major risk factors for probiotic
sepsis based on their studies of different case reports of probiotic
sepsis published in the literature.
I include the table they proposed for such classification
Proposed risk factors for probiotic sepsis
Major risk factors
1- Immune compromise, including a debilitated state or malignancy
Furthermore, impaired integrity of the gut, such as that caused by
mucosal ulcerations or mucositis which is observed in patients undertaking
chemotherapy may allow translocation of bacteria across the intestinal
barriers and may lead to bacteremia and invasive disease [11].
So in conclusion the patient described in this case report had one
major risk factor and at least one minor risk factor for probiotic sepsis
according to Boyle J.R. classification, she is immuno-compromised (she had
cancer, she had radio-chemotherapy), she had colitis, and was treated with
broad spectrum antibiotics, and introducing probiotics to such a patient
could prove to be risky as per the case reports of probiotic sepsis
previously published in the literature.
References:
[1] Rautio M, Jousimies-Somer H, Kauma H, et al. Liver abscess due to
a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus
strain GG. Clin Infect Dis 1999;28:1159-60. FREE Full Text
[2] Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM.
Lactobacillus endocarditis caused by a probiotic organism. Clin Microbiol
Infect 1999;5:290-2.
[3] Kunz AN, Noel JM, Fairchok MP. Two cases of Lactobacillus
bacteremia during probiotic treatment of short gut syndrome. J Pediatr
Gastroenterol Nutr 2004;38:457-8.
[4] De Groote MA, Frank DN, Dowell E, Glode MP, Pace NR.
Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a
child with short gut syndrome. Pediatr Infect Dis J 2005;24:278-80.
[6] Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C. Recurrent
septicemia in an immunocompromised patient due to probiotic strains of
Bacillus subtilis. J Clin Microbiol 1998;36:325-6.
[7] Lherm T, Monet C, Nougiere B, et al. Seven cases of fungemia with
Saccharomyces boulardii in critically ill patients. Intensive Care Med
2002;28:797-801.
[8] Rijnders BJ, Van Wijngaerden E, Verwaest C, Peetermans WE.
Saccharomyces fungemia complicating Saccharomyces boulardii treatment in a
non-immunocompromised host.
[9] Lestin F, Pertschy A, Rimek D. [Fungemia after oral treatment
with Saccharomyces boulardii in a patient with multiple comorbidities.]
Dtsch Med Wochenschr 2003;128:2531-3(in German).
[10] Robert J Boyle, Roy M Robins-Browne, and Mimi LK Tang, Probiotic
use in clinical practice: what are the risks?, Am J Clin Nutr June 2006,
Vol. 83 no. 6 1256-1264
[11] Ishibashi N, Shoji Y. Probiotics and safety. Am J Clin
Nutr.2001;73(suppl) :465S
It was a pleasure to see the article by Dr. Goldhammer and colleagues
published in a mainstream medical journal. As discussed elsewhere (1)
activated water can potentially provide tumor cells with sufficient
cellular energy via the alternative cellular energy (ACE) pathway to
either undergo apoptosis or complete the maturation process. Moreover, the
provision of cellular energy probably explains the effectiveness of
homeo...
It was a pleasure to see the article by Dr. Goldhammer and colleagues
published in a mainstream medical journal. As discussed elsewhere (1)
activated water can potentially provide tumor cells with sufficient
cellular energy via the alternative cellular energy (ACE) pathway to
either undergo apoptosis or complete the maturation process. Moreover, the
provision of cellular energy probably explains the effectiveness of
homeopathy. Ketones may similarly be able to enhance the ACE pathway.
1. Martin WJ, Laurent D (2015) Homeopathy as a misnomer for
activation of the alternative cellular energy pathway: Evidence for the
therapeutic benefits of Enercel in a diverse range of clinical illnesses.
International J Complementary & Alternative Medicine 2(1): 00045.
http://medcraveonline.com/IJCAM/IJCAM-02-00045.pdf
The nature and time course of temporal lobe abnormalities in psychotic illness remain notorious. Confounds include disease chronicity, demographic data, and handedness etc . Temporal lobe epilepsy is associated with a substantial risk of psychosis but there are only restricted studies investigating the underlying changes and causes. momentous grey and white matter deficits occur in temporal lobe epilepsy with psychosis....
We read with interest the article by Braithwaite et al. This article has helped us in diagnosis and management of a patient here in Mumbai, India.Dengue Eye Disease has become more common and has been investigated extensively with many diagnostic modalities (1 to 33) and has been suspected to have 10 percent prevalence in some outbreaks of dengue . Dengue could present to an eye surgeon first as subconjunctival haemorrh...
I read with enjoyment your unusual case report of mucinous adenocarcinoma arising from a villous adenoma in the terminal ileum and invading the bladder.
This case represents the importance of team collaboration i.e. urology and colorectal surgeons in complicated and rare cases.
It would be interesting to know what percentage of small bowel tumours fistulae to the bladder? and how many similar case re...
The bilateral loss of vision in a case of dengue is very unfortunate and the present case report (1) is very interesting because it has been written quite well and helped in management of a case with bilateral visual loss seen in Mumbai in a case referred to the author for opinion. Dengue causes visual loss due to various reasons ranging from uveitis (2) to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5...
Ketoacidosis is a direct result of exteremly low cellular magnesium levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6- Pase is very magnesium dependent so if magnesium levels are severely reduced blood glucose levels plummet starving neurons of energy. The neurons in the hypothalamus signal the gut get more in 'the hunger pangs in Obesity'. Pyruvate carboxylase is also very magnesium dependent and if...
What if the patient gave in his history that he went to Nigeria? Would it be mandatory to do all the tests for infectious diseases in Nigeria?. His travel history would give no indication for any further investigation unless we find something relevant clinically. What is always important is to have full history always regardless whether he is undergoing elective surgery or not, he is traveling or not.
What I wan...
I have read with interest the paper by Jenkins et al on discharging a patient to home with a Thopaz drain thus avoiding a surgical procedure. I agree with the author on the benefits of digital thoracic drainage devices. The author does reference previous work by Cerfolio RJ and Brunelli A, in our experience (Mier JM, Molins L, Fibla JJ Cir Esp. 2010(6):385-9) in a prospective and comparative study we demonstrate the benefi...
Thank for your this interesting case.
In the United Kingdom this is a medication used rarely within the hospital environment, although it is gaining popularity in the pre- hospital field. I would be intrigued to know the specialty of the attending physician in this case, and his or her prior experience with ketamine.
In addition, do the authors feel that ketamine is a superior first choice analgesi...
I read with interest this rare case report of ureteric obstruction secondary to fungal mycella.
The authors concluded that antibiotics dramatically reduce the commensal flora, compromising the physiological balance that prevents the outgrowth of fungi and they recommended that probiotics should be considered to prevent this complication, which can be severe and life threatening in immunocompromised patients....
It was a pleasure to see the article by Dr. Goldhammer and colleagues published in a mainstream medical journal. As discussed elsewhere (1) activated water can potentially provide tumor cells with sufficient cellular energy via the alternative cellular energy (ACE) pathway to either undergo apoptosis or complete the maturation process. Moreover, the provision of cellular energy probably explains the effectiveness of homeo...
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