Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study.

BACKGROUND: Long QT syndrome (LQTS) is a heterogeneous syndrome that may be congenital or, more frequently, acquired. The real-world prevalence of acquired LQTS (aLQTS) in the emergency department (ED) remains to be determined. The aim of this study was to determine prevalence of aLQTS and its impact on symptoms on ED admissions. METHODS: Electrocardiograms (ECG) of 5,056 consecutively patients admitted in the ED of a tertiary hospital between January 28th and March 17th of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without corrected QT (QTc) interval greater than 500 ms (value that is considered severely increased). RESULTS: A total of 383 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.82%. Patients with aLQTS were more commonly men (53.3%) with an age of (73.49±14.79) years old and QTc interval of (505.3±32.4) ms. Only 20.4% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500 ms were more frequently female (59.5%; P<0.001) and were more frequently on QT prolonging drugs (77.3%; P=0.025). Main contributing factor was intake of antibiotics (odds ratio [OR] 4.680) followed by female gender (OR 2.473) and intake of antipsychotics (OR 1.925). CONCLUSION: aLQTS is particularly prevalent in the ED. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible.

Metal Fume Fever: An Underdiagnosis.

Metal fume fever (MFF) is an auto-limited acute febrile respiratory syndrome that may mimic an acute viral respiratory disease after exposure to the fumes of metal oxides. Due to the similar presentation of an influenza-like illness, it remains an underdiagnosed disease. It is typically a benign and self-limited entity that resolves over 12-48 hours following cessation of exposure, but symptoms may reoccur with repeated exposure. Supportive and symptomatic care is recommended.

Immunoglobulin a (IgA) Vasculitis in the Elderly.

IgA vasculitis is a small vessel vasculitis mediated by the deposition of IgA immune complexes. It mostly occurs in children and is rare in adults, with increased severity and mortality in the latter. Its aetiology remains largely unknown, and its prognosis depends primarily on the extent of renal involvement. We present the case of a 71-year-old woman with purpuric lesions in both lower and upper limbs associated with fever, abdominal pain, vomiting and blood in her stools for the past month. The patient was diagnosed with IgA vasculitis and the full systemic involvement (renal, dermatological, intestinal, and cerebral) of the disease was identified with excellent response to parenteral corticotherapy.

Caffeine Intoxication: Unregulated, Over-the-Counter Sale of Potentially Deadly Supplements.

Caffeine is an integral part of beverages, food, and medications. Severe intoxication of caffeine is rare, and reports are even scarcer. However, over-the-counter, unregulated sale of performance-enhancing compounds, such as caffeine, turns high-dose consumption into a real concern. Severe intoxication may be fatal, usually by malignant cardiac arrhythmia. We report a case of a 23-year-old university student who accidentally consumed about 100 times the amount present in an expresso of anhydrous caffeine.

Chlorpyrifos-Induced Delayed Neurotoxicity with A Rare Presentation of Flaccid Quadriplegia: A Diagnostic Challenge.

Chlorpyrifos is an organophosphate compound recognized as causing acute toxicity. However, organophosphate-induced delayed polyneuropathy (OPIDP), although rare, has also been described. We describe an unusual presentation of OPIDP with flaccid quadriplegia progressing to a locked-in-like syndrome, 30 days after a 60-year-old man voluntarily ingested chlorpyrifos. In the absence of specific treatment, the patient only recovered partial motor responses and the ability to communicate. The authors present this report in order to highlight a form of OPIDP which can hinder diagnosis due to its atypia and the delay in the onset of symptoms from initial contact with the toxicant. LEARNING POINTS: Organophosphate-induced delayed polyneuropathy (OPIDP) is a late presentation which is often overlooked despite causing significant morbidity.OPIDP can present in several forms, hindering the final diagnosis and consuming resources.

Mesenteric Panniculitis in Sjögren's Syndrome: A New Systemic Manifestation to Consider?

The association between mesenteric panniculitis and Sjögren's syndrome, although rare, is starting to be recognized. Usually, mesenteric panniculitis is symptomatic, presenting with either general or gastrointestinal symptoms. Sjögren's syndrome is an autoimmune disease that typically affects secretory glands, but may have serious systemic involvement. We report the case of a 77-year-old patient in whom accidental discovery of asymptomatic mesenteric panniculitis on computed tomography led to the diagnosis of Sjögren's syndrome with several systemic manifestations. LEARNING POINTS: Mesenteric panniculitis is a rare condition, sometimes associated with autoimmune diseases, which can make the differential diagnosis with more frequent systemic diseases difficult. There is no specific treatment for mesenteric panniculitis, but it is agreed that only symptomatic patients should be treated.Although Sjögren's syndrome typically presents with xerostomia and xerophthalmia (dry eyes and mouth syndrome, DEMS), it should always be kept in mind that systemic manifestations can occur, especially in more severe cases.

Modelação hidráulica e de qualidade da água dos sistemas de drenagem em meios urbanos / Hydraulic and water quality modelling of urban drainage systems

RESUMO: As inundações urbanas estão se tornando cada vez mais frequentes, de tal forma que a União Europeia publicou a Diretiva 2007/60/CE no sentido de mitigar as consequências relacionadas com este fenômeno e de impor limites à concentração de poluentes nas águas pluviais. O objetivo deste artigo foi apresentar uma modelação dos sistemas de drenagem em situação de inundações, baseada no software da United States Environmental Protection Agency (EPA), Storm Water Management Model (SWMM), em que o estudo de caso é analisar um sistema de drenagem urbana unitário, inserido na Zona Central de Coimbra, em Portugal. Recorrendo à metodologia Automatic Overland Flow Delineation (AOFD) para a geração de uma rede de drenagem superficial e implementando-a no SWMM, obteve-se um modelo de drenagem dual, que permite a análise do escoamento em situação de inundações, incluindo o controle de escoamento entre a superfície e a rede de coletores e a modelação da qualidade da água à superfície. Este modelo permite quantificar a carga poluente à superfície, relativamente ao parâmetro de sólidos suspensos totais, para um evento de precipitação extrema.

ABSTRACT: Urban floods are becoming more frequent. Thus, the European Union published the Directive 2007/60/CE to mitigate costs related with this phenomenon and to impose limits on the concentration of pollutants in pluvial water. The purpose of this study was to present the modelling of drainage systems in flood situations, based on the software of the United States Environmental Protection Agency (EPA), the Storm Water Management Model (SWMM), in which the study case is to analyze a unitary urban drainage system of Zona Central catchment in Coimbra, Portugal. By using the Automatic Overland Flow Delineation (AOFD) methodology for the generation of a superficial drainage network and implementing it in the SWMM, it was obtained a dual drainage model that allows the flow analysis in flood conditions, including flow control between the surface and collectors network and also modeling of water quality at the surface. This model allows quantifying the pollution load at the surface, relatively to the parameter of total suspended solids, for any extreme rainfall event.

Rapidly Progressive Encephalopathy: Initial Diagnosis of Creutzfeldt Jakob Disease in an Intensive Care Unit.

Creutzfeldt-Jakob disease (CJD) is a rare, incurable and fatal condition that can only be confirmed through neuropathological investigation, such as brain biopsy or post-mortem study. However, a probable diagnosis can be made using clinical criteria. CJD manifests as rapidly progressive dementia with myoclonus and to a lesser extent visual impairment and cerebellar and pyramidal/extrapyramidal signs. We report the case of a previously independent adult male that met all the clinical criteria. Taken together, the investigation results suggested probable CJD. LEARNING POINTS: Creutzfeldt-Jakob disease (CJD) is a rare cause of dementia.The rapidly progressive neurological signs and symptoms suggest the diagnosis.Mortality rates are very high even with surgical treatment in these complex patients.

A Celiac Crisis in an Adult: Raising Awareness of a Life-threatening Condition.

OBJECTIVES: The Authors report the case of a 56-year-old man with celiac disease, who after ingesting a food containing gluten and experiencing a flu-like syndrome, developed severe diarrhea, vomiting, weight loss (15 kg), hypotension, renal dysfunction, hypokalemia and metabolic acidosis. MATERIALS AND METHODS: Admission to the Intensive Care Unit and exclusion of an infectious cause was determined. RESULTS: After receiving noradrenaline, methylprednisolone and correction of ionic disturbances, the patient recovered rapidly and had no further complication. CONCLUSION: The authors intend to increase awareness of celiac crisis, because despite being extremely rare in adults, it is potentially fatal and an quick diagnosis and treatment are crucial. LEARNING POINTS: Celiac crisis is an acute, life-threatening presentation of celiac disease.Its clinical presentation consists of severe diarrhea, metabolic disturbances (namely hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia and metabolic acidosis), hypoproteinemia and dehydration.Hospitalization and correction of metabolic imbalance with intravenous fluids are required, with corticotherapy being necessary in some cases.