Heart failure from thyrotoxicosis due to Graves' disease.

A 30-year-old female patient with a past medical history of pernicious anaemia presented with pleuritic chest pain, palpitations, fatigue, coryzal symptoms and a high temperature. She was hypoxic and tachycardic and was extensively investigated as well as aggressively treated. A type 1 'gut feeling' assessment by the admitting medical registrar made the diagnosis possible as thyroid function tests were grossly deranged and pointed to Graves' disease causing heart failure, complicated by pneumonia. The patient was discharged on carbimazole, antibiotics and beta blockers. Due to a resultant thrombocytopaenia, she has now been swapped onto propylthiouracil and is under active follow up.

Efficacy of Minocycline in Naturally Occurring Nonacute Ehrlichia canis Infection in Dogs.

BACKGROUND: Minocycline has been used in the treatment of Ehrlichia canis infection in dogs as an alternative to doxycycline, the recommended treatment. However, efficacy of this alternative therapy is unknown. OBJECTIVE: To assess the efficacy of minocycline in the treatment of natural occurring E. canis infection in dogs. ANIMALS: Ten privately owned dogs of mixed breed positive for E. canis by blood PCR. METHODS: Prospective, randomized clinical study. Dogs positive for E. canis by PCR were housed in a kennel environment and randomly allocated to receive doxycycline 10 mg/kg bodyweight PO once daily ("gold standard" control group) or minocycline (extralabel) 10 mg/kg bodyweight PO twice daily (treatment test group) for 28 days. Blood, analyzed by PCR to determine the presence or absence of E. canisDNA, was collected weekly during treatment starting on the first day of treatment and including through day 35, 7 days after the last treatment. RESULTS: In both groups, one dog tested negative after 7 days of treatment. For the doxycycline group, the latest time to a negative PCR test was after 3 weeks of treatment. For the minocycline group, the latest time was on day 28 of treatment. All dogs tested negative 7 days after the end of treatment. CONCLUSION AND CLINICAL IMPORTANCE: Minocycline can be an effective alternative to doxycycline for clearing E. canis from the blood in nonacute infections.

Factors affecting outcomes on the TEN (SPL) test in adults with hearing loss.

BACKGROUND: Recent work using the Threshold Equalizing Noise (TEN) test as a gold standard suggests that the presence of cochlear dead regions in persons with moderate-to-severe hearing loss may be quite common. In addition, previous data suggest that certain characteristics of hearing loss, such as severe-profound high-frequency hearing loss or steeply sloping configurations may be more commonly associated with positive TEN findings. These findings, however, are based largely on studies including a relatively small number of participants and/or participants that were included based on specific audiometric criteria (e.g., the presence of severe high-frequency hearing loss). Likewise, results from many of these studies are limited to the frequency regions of 500-4000 Hz. There has been less work that has systematically evaluated the relationship between audiometric characteristics and TEN test findings, particularly in the frequency regions above 4000 Hz, on a large number of individuals with a wide range of hearing losses and hearing loss configurations. PURPOSE: The purpose of this study was to further examine the effects of audiometric characteristics such as degree and slope of hearing loss on the rate of positive, negative, and inconclusive findings on the TEN test over a wide frequency range (250-8000 Hz). Given that the functional impact of positive findings (i.e., findings suggestive of a dead region) may vary with the extent of potential damage, we were also interested in determining the relative occurrence of "patchy" versus contiguous positive findings on the TEN. RESEARCH DESIGN: Fifty-nine adults (117 ears) with a wide range of SNHL participated. To examine results over a wide frequency range (250-8000 Hz), the TEN (SPL), rather than the TEN (HL), was utilized. Thresholds, in both ears, were measured in quiet and in the TEN (SPL). Results were categorized as positive (suggestive of a dead region), negative (not suggestive of a dead region), or inconclusive. RESULTS: Consistent with past research, positive TEN (SPL) results were more common when hearing losses exceeded 60 dB HL; however, there was not a systematic increase in positive results with increases in threshold. In contrast to previous work, however, positive test results among individuals with milder hearing losses (< 60 dB HL) were not uncommon, suggesting a potential for false positive results. In regard to audiometric slope, also consistent with past research, slope of hearing loss was an inadequate predictor of TEN (SPL) results. Negative results (not suggestive of a dead region) were less common in participants with steeply sloping losses while positive test findings were unaffected by hearing loss slope. Although a large proportion of participants had positive results on the TEN (SPL), for most participants, these positive findings occurred in isolated (i.e., one or two frequencies) rather than in contiguous frequency regions. CONCLUSIONS: The relatively large number of inconclusive results and the potential for false positive results makes interpreting the functional impact of TEN (SPL) results difficult, particularly when positive results are in the high (> 4000 Hz) frequencies. In addition, although a large proportion (84%) of study participants had positive findings on the TEN (SPL), the functional impact of these findings is not clear as, in the majority of cases, positive findings occurred at only one or two test frequencies.

Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes.

OBJECTIVE: To investigate the relationship between perception of comfort and electrolyte concentration and applied voltage during transcranial direct current stimulation (tDCS). METHODS: NaCl solutions (15, 140 and 220 mM NaCl) or deionised water were used as electrolytes to dampen tDCS sponge electrodes. Subjects (14, 7 M, 20-60 years of age) rated comfort on an 11-point scale during 2 min of tDCS (1 mA). RESULTS: Overall participants rated tDCS as comfortable. Perception of comfort was negatively correlated with NaCl concentration (Spearman's rho=-0.88; p<0.05), and a logarithmic relationship was found between applied voltage and ionic strength of electrolytes (Pearson's r=-0.635; p<0.01). There was no relationship between applied voltage and perception of comfort. CONCLUSIONS: The application of NaCl solutions between 15 and 140 mM to sponge electrodes is more likely to be perceived as comfortable during tDCS. SIGNIFICANCE: The reporting of solution concentration and ratings of perception would be useful adjuncts to tDCS studies.

Can I talk to a nurse?

Nurses need education to go from bedside to "phoneside" nursing at the growing number of call centers. The authors tell how to build technical and procedural skills, a preparative knowledge base, and nurses' confidence.

Myeloproliferative disorder with unusual marrow chromosome constitution.

This report describes a patient referred at 14 years in 1971, after one year's surveillance by the family physician, for a persistently elevated erythrocyte sedimentation rate, leukopenia, and relative lymphocytosis. Despite the documented myeloproliferative syndrome of seven years, significant physiologic impairment precluding strenuous ranching and rodeo work appeared only in the last six to nine months. Throughout the clinical course characterized by pancytopenia, refractory and somewhat megaloblastic anemia partially responsive to oxymetholone, and subacute myeloblastic leukemia, he showed a persistent double trisomy--48, XY, +8, +21 in bone marrow. This report reiterates the value of chromosome analysis in the study of hematologic disorders and, in addition, emphasizes the need to individualize each patient's prognosis.