RESUMEN
Brugada syndrome is a rare genetic disorder of the cardiac sodium channels associated with an increased risk of sudden cardiac death. It is characterized by an electrocardiogram (EKG) showing a right bundle branch block with an elevation in the ST segment. This condition is associated with mutations in several pathologic genes including the most notable mutation in the SCN5A gene, which encodes for a voltage-gated cardiac sodium channel. The Brugada pattern on EKG can be spontaneous but can also be induced by a variety of etiologies including fever, electrolyte abnormalities, increased vagal tone and drugs such as sodium channel blockers, calcium channel blockers, tricyclic antidepressants and alcohol. One uncommon cause of Brugada syndrome is hyperglycemia. Of particular importance in diabetic patients, hyperglycemia can induce chronic cardiovascular complications as well as acute cardiac events via the induction of the Brugada pattern on EKG. We present a case of a 21-year-old non-insulin compliant diabetic man presenting to the Emergency Department with diabetic ketoacidosis (DKA) who exhibits the Brugada pattern EKG prior to developing ventricular tachycardia followed by cardiac arrest. The patient's condition was induced by prolonged hyperglycemia in the setting of DKA with relatively mild electrolyte and pH abnormalities. Herein, this case is presented to highlight the Brugada pattern leading to cardiac arrest as a potential consequence of hyperglycemia and inform physicians on its incidence.
RESUMEN
INTRODUCTION: Vision loss is an ophthalmologic emergency with broad differential requiring prompt medical attention. CASE REPORT: We describe a 55-year-old male presenting to the emergency department (ED) with unilateral, painless visual field deficit with ipsilateral conjunctivitis induced by a presumed foreign body. The patient described a foreign body sensation nine days prior to developing visual changes. In the ED, the patient was diagnosed with a retinal detachment using point-of-care ultrasonography, and emergent ophthalmologic consultation was obtained. CONCLUSION: Concurrent retinal detachment and conjunctivitis in a patient is extremely rare. Healthcare providers should be aware that foreign body-induced conjunctivitis could lead to retinal detachment.
RESUMEN
IMPORTANCE: Tonsil size assessment on physical examination is often used as a key component of clinical decision-making, specifically in estimating the success or failure of adenotonsillectomy surgery. The accuracy of this approach is not specifically known. OBJECTIVE: To systematically review the biomedical literature for data comparing subjective preoperative tonsil (and adenoid) size (0- to >4-point scale) with adenotonsillectomy outcomes using polysomnography and/or quality of life outcomes. EVIDENCE REVIEW: A PubMed and Embase search was conducted from June 1, 2018, through November 1, 2018, to identify articles comparing preoperative subjective tonsil and adenoid size with surgical outcomes. Key search terms included adenotonsillectomy, tonsil size, Brodsky scale, apnea-hypopnea index, OSA-18, polysomnography, and quality of life, with limits of 0 to 18 years of age. Inclusion criteria included articles on pediatric patients only, articles on patients who underwent tonsillectomy or adenotonsillectomy, and articles that included presurgical and postsurgical data. Exclusion criteria included patients who received surgery beyond adenotonsillectomy and studies that did not compare tonsil and adenoid size grades with surgical outcomes. FINDINGS: A total of 27 studies were included in the final data set. The mean sample size was 79.7 (range, 17-250), and the mean age was 6.3 years (range, 4.2-12.8 years). Case series was the predominant study design (20 studies). Fourteen studies specifically excluded obesity and craniofacial syndromes, whereas 2 studies addressed patients with trisomy 21 only, and 5 studies focused on patients with obesity. Outcome measures included polysomnography (19 studies), Obstructive Sleep Apnea 18 survey (4 studies), Obstructive Sleep Apnea 6 (1 study), oxygen desaturation index (1 study), and overnight pulse oximetry (1 study). Ten studies conducted postoperative evaluations within 90 days of the intervention, and 17 studies had greater than 90-day follow-up. A total of 22 of the 27 studies (81.5%) concluded that there was no association between tonsil and adenoid size and surgical outcome, whereas 5 studies (18.5%) concluded that there was an association. Studies that found no association had a higher mean quality score than those that found an association (15.6 vs 14.5; difference in means, 1.13; 95% CI, 0.07-2.19). CONCLUSIONS AND RELEVANCE: Most published clinical evidence suggests that subjective tonsil and adenoid size is not reliably associated with adenotonsillectomy success or failure because success rates are typically high regardless of tonsil size. Physicians should understand the potential limitations of using tonsil size alone as the key component of clinical decision-making for adenotonsillectomy.
RESUMEN
In many species, courtship displays are reliable signals of male quality, and current hypotheses suggest that these displays allow females to choose males with high cellular function. Environmental stressors generate excess reactive oxygen species (ROS) that impair cellular function, and thus antioxidant pathways that remove ROS are probably critical for preserving complex sexual behaviours. Here, we test the hypothesis that enhanced antioxidant activity in mitochondria preserves mating performance following oxidative stress. Using a transgenic approach, we directly manipulated mitochondrial antioxidant activity in the Caribbean fruit fly, Anastrepha suspensa, a lek-mating species with elaborate sexual displays and intense sexual selection that is also a model for sterile insect technique programmes. We generated seven transgenic lines that overexpress mitochondrial superoxide dismutase (MnSOD). Radiation is a severe oxidative stressor used to induce sterility for sterile insect programmes. After radiation treatment, two lines with intermediate MnSOD overexpression showed enhanced mating performance relative to wild-type males. These improvements in mating corresponded with reduced oxidative damage to lipids, demonstrating that MnSOD overexpression protects flies from oxidative stress at the cellular level. For lines with improved mating performance, overexpression also preserved locomotor activity, as indicated by a laboratory climbing assay. Our results show a clear link between oxidative stress, antioxidant capacity and male performance. Our work has implications for fundamentally understanding the role of antioxidants in sexual selection, and shows promise for using transgenic approaches to enhance the field performance of insects released for area-wide pest management strategies and improving performance of biological control agents in general.
