Indoxacarb poisoning presenting as methemoglobinemia: A case report.

A 34-year-old Sri Lankan man presented with multiple episodes of vomiting following accidental ingestion of 100 ml of indoxacarb (Avaunt). He had a significant saturation gap (discrepancy between oxygen saturation [98%] in blood gas analysis and saturation on pulse oximetry [70%] in finger pulse oximetry), the color of the blood was muddy brown, and the methemoglobin level (60%) was high in the blood gas analysis. A diagnosis of methemoglobinemia secondary to indoxacarb poisoning was made, and he was treated with methylene blue with a favorable outcome. Methemoglobinemia secondary to indoxacarb poisoning is extremely rare, and clinicians should be aware of this important complication. Methemoglobinemia secondary to indoxacarb poisoning has a favorable outcome if recognized and treated promptly.

May-Thurner Syndrome, an Often Overlooked Cause of Deep Vein Thrombosis: A Case Report.

Deep vein thrombosis (DVT) is a common medical condition, but the predisposing anatomical factors, which may be amenable to definitive treatment, are usually overlooked. Therefore, a high index of clinical suspicion is the key to early diagnosis. We report here one such case of May-Thurner syndrome (MTS) to raise awareness. MTS (also known as iliac vein compression syndrome) should be suspected in cases of extensive DVT of the leg, particularly involving the iliac vein on the left side. The prognosis is improved with thrombolysis followed by angioplasty and stent to address the venous stenosis.

Hats Off to HIT: A Case Report.

Thrombocytopenia is a well- recognized complication of heparin therapy. The diagnosis is mostly clinical and the main value of laboratory testing is in excluding the diagnosis. We describe here a patient with stroke who had aspiration pneumonia leading to sepsis. She developed atrial fibrillation and received heparin which had to be stopped prematurely due to melena. Within 5 days of heparin, she had thrombocytopenia which was heparin-induced thrombocytopenia (HIT), but the diagnosis was missed initially as heparin was no longer on the drug chart.

Clinical Presentation and Outcome in Hospitalized Patients of 2009 Pandemic Influenza A (H1N1) viral infection in Oman.

OBJECTIVES: In 2009, cases of human infection with a novel influenza A (H1N1) virus were detected and soon reached a pandemic level. Presenting clinical features of this disease in Oman were observed and an attempt was made to identify features predicting the high risk of mortality. METHODS: The clinical and laboratory features at the time of presentation in adult patients admitted with flu-like illness or pneumonia were studied who were later diagnosed as H1N1 infection by PCR of nasopharyngeal and/or throat swabs. RESULTS: H1N1 infection mostly affected younger individuals who presented with fever and cough. One-third of the patients had rhinorrhea and a few had vomiting and diarrhea. Chest crepitations were common. Most of the patients had normal or low cell counts. The chest X-ray was normal in 23 (41.8%) cases, while in other cases pneumonia was detected characteristically starting from base and extending up. Almost half of the patients were either in frank or impending respiratory failure. Nine (16.4%) patients died. CONCLUSION: It is difficult to identify H1N1 influenza cases from other patients with a flu-like illness, but it can be strongly suspected when a patient presents with basal pneumonia, particularly if bilateral, with lymphocytopenia, and is hypoxemic, in the presence of other H1N1 infected cases in the community. These features are also indicative of severe illness with high mortality risk.