North American Journal of Medical Sciences最新文献

Context: Scours, or calf diarrhea, is an infectious gastrointestinal disease commonly found in the calves of dairy farms. It primarily presents with diarrhea that can be life threatening to the animal and is also contagious and threatening to the other livestock. Cryptosporidium is one of the major causes of scours and can be transmitted to humans via fecal-oral route, resulting in diarrheal illnesses. Cryptosporidiosis infection usually occurs as a waterborne outbreak with the potential to affect many people at once.

Case report: We report a case of a 24-year-old female farmer who presented to the emergency department with diarrhea after taking care of ill cattle with similar symptoms. Fecal cultures were positive for Cryptosporidium parvum. Given the patient was immunocompetent, no further treatment was warranted.

Conclusion: Confirmed cases should be reported, however, treatment is only recommended in children and immunocompromised adults. Clinicians should educate patients on the importance of proper hygiene and handling techniques in order to decrease transmission and recurrence of the protozoan infection.

Background: Obesity among children and adolescents in the United States has tripled since 1980, and has become a major public health concern.

Aims: The purpose of this study was to evaluate the potential relationship between exposure to organic mercury from Thimerosal-containing hepatitis B vaccines and the children's subsequent risk of an obesity diagnosis.

Materials and methods: A hypothesis-testing, case-control study was undertaken to evaluate exposure to organic mercury from Thimerosal-containing hepatitis B vaccines, which were administered at specific intervals in the first 6 months of life, among cases diagnosed with childhood obesity and controls by examining automated medical records for children born from 1991 to 2000 who were continuously enrolled in the Vaccine Safety Datalink database.

Results: This study found highly significant associations as follows. Cases diagnosed with obesity were significantly (P < 0.00001) more likely to have received greater exposure to organic mercury from Thimerosal-containing hepatitis B vaccines administered within the first month of life (odds ratio (OR) =1.511), first 2 months of life (OR = 1.486), and first 6 months of life (OR = 3.795) than the controls. Similar outcomes were observed when the overall data were separated by gender. In a dose-response manner, cases diagnosed with obesity were significantly more likely than controls to have received greater exposure to organic mercury from Thimerosal-containing hepatitis B vaccines, which were administered within the first 6 months of life (OR = 1.0375 per μg of mercury, P < 0.00001).

Conclusions: In a dose-response manner, the present study associates an increased organic mercury exposure from Thimerosal-containing hepatitis B vaccines with an increased risk of obesity diagnosis, and suggests that Thimerosal is an obesogen. The results are biologically plausible and future studies are needed to examine this phenomenon.

Context: Novel psychoactive substances, including synthetic cannabinoids, are becoming increasingly popular, with more patients being seen in the emergency room following acute ingestion. These substances have been associated with a wide range of adverse effects. However, identification of complications, clinical toxicity, and management remain challenging.

Case report: We present the case of a young African-American male who developed severe agitation and bizarre behavior following acute K2 ingestion. Laboratory studies revealed markedly elevated serum creatine phosphokinase (CPK) with normal renal function. The patient was managed with aggressive intravenous (IV) fluid hydration and treatment of underlying psychiatric illness.

Conclusion: We recommend the routine evaluation of renal function and CPK levels with early initiation of IV hydration among patients who present to the emergency department following acute ingestion of synthetic cannabinoids to identify potential complications early as well as institute early supportive therapy.

Postpartum depression is the most prevalent emotional problem during a women's lifespan. Untreated postpartum depression may lead to several consequences such as child, infant, fetal, and maternal effects. The main purpose of this article is to briefly describe different theoretical perspectives of postpartum depression. A literature search was conducted in Psych Info, PubMed, and Science Direct between 1950 and 2015. Additional articles and book chapters were referenced from these sources. Different theories were suggested for developing postpartum depression. Three theories, namely, biological, psychosocial, and evolutionary were discussed. One theory or combinations of psychosocial, biological, and evolutionary theories were considered for postpartum depression. The most important factor that makes clinicians' choice of intervention is their theoretical perspectives. Healthcare providers and physicians should help women to make informed choices regarding their treatment based on related theories.

Background: Statins modify inflammatory cell signaling during the immune response to infection. This has been considered as a pleotropic effect. Effects of statins in inflammatory conditions such as bacteremia have been found to be controversial.

Aims: We examined the effect of statins on the mortality of bacteremia patients.

Materials and methods: Major databases were searched for the pertinent clinical trials.

Results: Six cohort studies comprising 7553 patients were included. Hospital mortality was lower (15.36% vs 22.28%) in patients on statin.

Conclusions: There may be a potential role of statins in similar inflammatory and infective conditions.

Context: Diagnosis of congenital Bochdalek's hernia (BH) in adulthood is extremely rare and requires a fastidious surgical repair, the failure of which might result in a recurrence with severe complications. We report a rare case of a giant, right BH that recurred after surgical repair and was complicated with complete bowel obstruction.

Case report: A 51-year-old Saudi male, with past surgical history of laparotomy that failed to repair BH, presented to the emergency room with severe abdominal pain, vomiting, and hypovolemic shock. Computerized tomography (CT) showed an unusual picture of closed-loop bowel obstruction above and below the diaphragm. We carried out laparotomy and thoracotomy that achieved lysis of adhesions, reduction of bowel, and repair of diaphragmatic defect.

Conclusion: Acute presentation of complicated BH poses a formidable challenge because of its rarity and complexity. The preferred approach for elective repair of adult BH is debatable, where surgeons-guided by hernia type and biased by their experience-recommend either laparotomy or thoracotomy. Nevertheless, a complicated, giant, recurrent BH typically requires both laparotomy and thoracotomy.

Background: Hypertensive individuals are known to exhibit greater increases in blood pressure during an isometric handgrip exercise (IHE) than their normotensive counterparts.

Aim: This study tests the hypothesis that, compared to normotensive individuals, prehypertensive individuals exhibit an exaggerated response to IHE.

Materials and methods: In this study, the effects of IHE were compared in matched prehypertensive vs. normotensive healthy African-American females. Six healthy young adult African-American female university students were screened in a physician's office for blood pressure in the range of prehypertension, systolic blood pressure (SBP) 120-139 mmHg and diastolic blood pressure (DBP) 80-89 mmHg. Six young adult African-American women were also recruited to serve as a healthy normotensive control group with SBP ≤119 mmHg and DBP ≤79 mmHg. Cardiovascular fitness was determined by peak oxygen uptake (VO2 peak) measured during a progressive exercise test.

Results: During the handgrip exercise, the prehypertensive group exhibited greater increases in SBP (from 139 ± 6 to 205 ± 11 mmHg, +48%) than the controls (from 132 ± 3 to 145 ± 3 mmHg, +10%); intergroup difference P < 0.001. The prehypertensive group also exhibited greater increases in DBP (from 77 ± 2 to 112 ± 5 mmHg, +46%) compared to the controls (from 72 ± 3 to 78 ± 4 mmHg, +8%); intergroup difference P < 0.001. The increase in systemic vascular resistance was also greater in the prehypertensive group (from 1713 ± 91 to 2807 ± 370 dyne.s.cm(-5), +64%) than in the controls (from 1668 ± 80 to 1812 ± 169 dyne.s.cm(-5), +9%); intergroup difference P < 0.05.

Conclusion: These results suggest that blood pressure measurements performed during IHE may be a useful screening tool in evaluating prehypertensive individuals for antihypertensive treatments.

Background: Topical squaric acid dibutylester and diphenylcyclopropenone are still the most effective therapy for alopecia areata among widely available treatment options. Hence, it is important to know which one is more effective and safer between the two.

Aims: The aim of this study was to compare topical squaric acid dibutylester and diphenylcyclopropenone for the treatment of alopecia areata in terms of their efficacy and side effects.

Subjects and methods: In the time period of January-March 2015, a total of 40 patients were selected for this study from the outpatient department of Rajendra Institute of Medical Sciences, Ranchi. After dropout of 16 patients, the remaining 24 patients were randomly divided into two groups; that is, group A for squaric acid dibutylester and group B for diphenylcyclopropenone. Each group received treatment for 6 months between March-November 2015. Their efficacy and side effects were compared.

Statistical test: Unpaired student t-test was performed. P < 0.05 was considered to be significant and 95% confidence interval was also used to evaluate the efficacy.

Results: The mean values of percentage change in baseline severity of alopecia tool score for squaric acid dibutylester and diphenylcyclopropenone were 52.25 and 34.45, respectively. At 6 months, 95% confidence interval was 43.5-61% for group A and 25-44% for group B. In 58.33% of group A patients, A3 (50-74%) grade of improvement was observed, whereas in group B patients, it was 33.33%. A4 grade of improvement (75-99%) was also seen in 1 patient of group A. Minor side effects were seen in 2 patients of group A and 10 patients of group B. None of the group A patients showed major side effects, however, 2 patients suffered major side effects in group B.

Conclusions: Between squaric acid dibutylester and diphenylcyclopropenone, squaric acid dibutylester is more efficacious. Further, frequencies of major and minor side effects are also lower than diphenylcyclopropenone.

Context: Coronary embolization is potentially a fatal sequela of endocarditis. Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is imperative to consider septic embolism as an etiological factor.

Case report: Herein, we report a case of ventricular fibrillation and ST-segment depression myocardial infarction occurring in a patient who initially presented with fever and increased urinary frequency. Coronary angiography revealed new 99% occlusion of the left main coronary artery (LMCA). Transesophageal echocardiography showed bioprosthetic aortic valve with an abscess and vegetation. Histologic examination of the embolectomy specimen confirmed the presence of thrombus and Enterococcus faecalis bacteria. Subsequently, the patient was discharged to the skilled nursing facility in a stable condition where he completed 6 weeks of intravenous ampicillin.

Conclusion: We present a rare case of LMCA embolism due to prosthetic valve endocarditis. The present report also highlights the diagnostic and therapeutic challenges associated with such patients.

Context: According to the recent World Health Organization reports, lung cancer has become the most common type of malignancy and the leading cause of death from cancer. Lung cancer frequently metastasizes to hilar lymphnodes, brain, adrenal glands, bone, but rarely to skin.

Case report: We report a case of a 72-year-old male with a past medical history of pulmonary fibrosis and no prior history of smoking who presented to the emergency room for progressive dyspnea over three weeks. The patient reported having a rapidly growing scalp lesion as well. A computed tomography (CT) scan of the chest showed diffuse fibrotic changes and multiple densities of different diameters; a CT guided biopsy of lung revealed a poorly differentiated adenocarcinoma. Excision of right scalp lesion was performed, and pathology revealed poorly differentiated malignant neoplasm favoring adenocarcinoma.

Conclusion: We are presenting a rare case of lung adenocarcinoma presenting with skin metastasis, which was simultaneously diagnosed during the same hospitalization. Although cutaneous metastasis from the lung is rare, it must be ruled out in patients with suspicious skin lesions, smoking history, or lung cancer.