Delayed Lithium Reintoxication in a Case of Severe Multidrug Intoxication: A Case Study.

ABSTRACT: The authors present a case of severe multidrug intoxication following massive ingestion of lithium, nortriptyline, aripiprazole, lorazepam, and temazepam. After initial treatment, serum lithium levels decreased significantly. However, 28 hours post ingestion, recurrent elevated lithium levels were observed, and serum lithium level increased 0.71 mmol/L in 12 hours. The intensivist consulted a hospital pharmacist about this. After administering clearance-inducing therapy using continuous venovenous hemodialysis, the lithium level was reduced to a long-lasting nontoxic level. The occurrence of secondary elevation in lithium levels exceeding the toxic limit in cases of massive ingestion of lithium tablets, whether in combination with anticholinergic drugs, should be anticipated. Close monitoring and prompt initiation of clearance-inducing therapy can improve clinical outcomes.

High-flow Nasal Cannula therapy: A feasible treatment for vulnerable elderly COVID-19 patients in the wards.

BACKGROUND: Invasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation. OBJECTIVES: To investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients. METHODS: This retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge. RESULTS: Thirty-two patients with a median age of 79.0 years (74.5-83.0) and a Clinical Frailty Score of 4 out of 9 (3-6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge. CONCLUSIONS: This study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients.

Prothrombotic and Proinflammatory Activities of the ß-Hemolytic Group B Streptococcal Pigment.

A prominent feature of severe streptococcal infections is the profound inflammatory response that contributes to systemic toxicity. In sepsis the dysregulated host response involves both immunological and nonimmunological pathways. Here, we report a fatal case of an immunocompetent healthy female presenting with toxic shock and purpura fulminans caused by group B streptococcus (GBS; serotype III, CC19). The strain (LUMC16) was pigmented and hyperhemolytic. Stimulation of human primary cells with hyperhemolytic LUMC16 and STSS/NF-HH strains and pigment toxin resulted in a release of proinflammatory mediators, including tumor necrosis factor, interleukin (IL)-1ß, and IL-6. In addition, LUMC16 induced blood clotting and showed factor XII activity on its surface, which was linked to the presence of the pigment. The expression of pigment was not linked to a mutation within the CovR/S region. In conclusion, our study shows that the hemolytic lipid toxin contributes to the ability of GBS to cause systemic hyperinflammation and interferes with the coagulation system.

The mouse enhancer element D6 directs Cre recombinase activity in the neocortex and the hippocampus.

We have created a transgenic mouse line that expresses Cre recombinase under the control of the novel mouse promoter/enhancer D6. We describe the expression pattern of D6-Cre in a Gtrosa26 reporter background as assayed by LacZ activity. The enhancer activity starts at 10.5 days post-coitum in the telencephalon and is at the later embryonic stages highly restricted to the hippocampus and the neocortex. In adult mice D6-derived cells are found in cortical layers II-VI, in the granular cells of the dentate gyrus and in hippocampal fields CA1-CA3. D6-Cre activity is also detected in the ependymal and subependymal zone of the lateral ventricles which is known to harbor neural stem cells.

Targeted disruption of mouse Dach1 results in postnatal lethality.

Mouse Dach1 is a nuclear factor that is expressed during development in restricted areas of the central nervous system, neural crest, and limb buds. Its Drosophila homologue dachshund plays a role in differentiation of the eye imaginal disc, in leg morphogenesis, and in controlling neural differentiation in the mushroom bodies of the insect brain. Mouse Dach1 null homozygous survive pregnancy but become cyanotic after birth and subsequently die within 24 hr. In this report, the brain of Dach1 mutants was analyzed. Examination of mRNA expression of the central neuropeptides oxytocin, vasopressin, thyrotropin-releasing hormone, growth hormone releasing hormone, and somatostatin revealed no difference between wild-type and mutant newborn brains. Furthermore, no significant difference in cell proliferation as well as in the distribution of neurons, glia, radial glia, and neuronal progenitors was detected in the developing forebrain. Dach1-positive cells, which were visualized with Enhanced Green Fluorescent Protein (EGFP), show similar distribution and axonal projections in the cortex and hippocampus in mutants and wild-type controls. Neural stem cells derived from mutant and wild-type newborn brains display similar growth kinetics when cultivated in vitro.