Idiopathic Membranous Glomerulonephritis Leading to Secondary Polycythemia: A Rare Association.

Primary polycythemia is caused due to mutations in erythropoietin (EPO) receptor or Janus Kinase 2 (JAK2). Secondary polycythemia is seldom associated with renal diseases, such as adult polycystic kidney disease, kidney tumors (like renal cell carcinoma and reninoma), renal artery stenosis, and kidney transplant due to increased EPO production. Polycythemia associated with nephrotic syndrome (NS) is very rare. Here, we report a case with membranous nephropathy, the patient had polycythemia at presentation. Nephrotic range proteinuria causes nephrosarca leading to renal hypoxia which causes increased EPO and IL-8 production, this is proposed to cause secondary polycythemia in NS. The reduction of polycythemia following remission in proteinuria further suggests the correlation. The exact mechanism remains to be found out.

Comparison of laundry detergent and antiformin solution methods to retrieve clean bones from embalmed cadavers / Comparación de los métodos de solución de antiformina y detergente de lavandería para recuperar huesos limpios de cadáveres embalsamados

SUMMARY: Traditional methods of bone retrieval from embalmed cadaver are not able to meet the demand of medical colleges as they are time consuming & tedious, thus there is need of evaluating an alternative approach that includes use of laundry detergent. The purpose of the study was to compare & establish the most effective method between laundry detergent and 10 % antiformin solution methods to procure clean bones. Thirty-two bones of the right side that were included in the inclusion criteria obtained from the four embalmed cadaver were cleaned by laundry detergent and of the left side by 10 % antiformin solution methods. Retrieved clean bones were evaluated for their cleanness using the scale from 0 to 5. The mean cleanness scores of the bones cleaned by laundry detergent method were not significantly different at 95 % confidence interval than the mean cleanness scores of the bones cleaned by 10 % antiformin solution method. The study found that though there is no significant difference in the mean cleanness score of the bones cleaned by two employed methods nevertheless, bones were found to be cleaner by using 10 % antiformin solution method and bones obtained by using laundry detergent method had smooth surface as well as more suitable for flat bones.

Los métodos tradicionales de recuperación de huesos de cadáveres embalsamados no pueden satisfacer la demanda de las facultades de medicina, ya que consumen mucho tiempo y son tediosos de realizar, por tanto es necesario evaluar un enfoque alternativo que incluya el uso de detergente de lavandería. El propósito del estudio fue comparar y establecer el método más eficaz entre el detergente para la ropa y los métodos de solución de antiformina al 10 % para obtener huesos limpios. Fueron utilizados 32 huesos del lado derecho que se incluyeron en los criterios de inclusión obtenidos de los cuatro cadáveres embalsamados. Los huesos se trataron con detergente de lavandería y los del lado izquierdo con métodos de solución de antiformina al 10 %. Los huesos tratados se evaluaron respecto a su limpieza utilizando una escala de 0 a 5. Las puntuaciones media de limpieza de los huesos tratados con el método de detergente no fueron significativamente diferentes en un intervalo de confianza del 95 % de las puntuaciones medias obtenidas respecto a la limpieza de los huesos tratados con antiformina al 10 %. El estudio determinó que, aunque no hay hubo diferencia significativa en la puntuación media de la limpieza de los huesos tratados por los dos métodos, se observó que utilizando el método de solución de antiformina al 10 %, la limpieza de los huesos era mejor, sin embargo, los huesos planos presentaban una superficie más lisa cuando se usó el método de detergente de lavandería.

Thrombotic Thrombocytopenic Purpura: A Tale of Two Cases.

Microangiopathic hemolytic anaemia, thrombocytopenia, renal failure, neurologic abnormalities, and fever form the pentad of thrombotic thrombocytopenic purpura (TTP). Early diagnosis is crucial because TTP responds well to plasmapheresis therapy but is associated with substantial mortality if left untreated. A substantial percentage of patients with TTP used to die from systemic microvascular thrombosis in the brain and the heart. However, since plasma exchange therapy became a mainstay in the treatment of TTP, mortality has reduced considerably. Diagnosing TTP can be difficult due to the vast range of symptoms and the absence of clearly defined diagnostic criteria. Hemolytic uremic syndrome and disseminated intravascular coagulation are a close differential of TTP. Here we report two patients with TTP who achieved remission when treated with steroids, plasmapheresis and were free of disease relapse till about two months during follow-up in the outpatient department.

Spectrum of toxicity due to pheniramine overuse in a COVID-19 patient. How much do we know?

Pheniramine maleate is an easily accessible, potent antihistaminic compound used for the treatment of various allergic conditions. It acts on histamine one (H1) receptors on the central nervous system (CNS) and the peripheral tissues. It is a safe drug in therapeutic doses. However, overdoses as in suicidal cases, can result in serious, life-threatening drug-toxicity. These include atropine-like antimuscarinic effects like dryness of mucosal membranes, blurring of vision, hallucinations, CNS excitation such as irritability, insomnia, and seizures. Rhabdomyolysis can also occur as a result of its direct toxic effect on muscles, resulting in myoglobinuria, renal failure and electrolyte imbalance. Cardiotoxicity though rare, is also reported. We report a case of pheniramine maleate induced ventricular tachycardia, myoglobinuria with acute kidney injury (AKI) in a 20-year-old man who had consumed 50 tablets. He was incidentally also found to have SARS-CoV2 infection. However, timely intervention and aggressive supportive therapy helped in the recovery of the patient.

Web-based chatbot for Frequently Asked Queries (FAQ) in Hospitals.

OBJECTIVES: Local hospitals are operated by the resigned association of patients as passive communication channels. The online hospital data related to the users' queries are not transparent and reliable. Therefore, it is crucial to have an intelligent web chatbot that manages user requests and provides quick access to local hospital information. In this paper, we present a framework and functionality of a chatbot developed using web technologies. METHODS: The bot engine was integrated by several machine learning approaches like gradient descent (GD) and natural language processing (NLP) algorithms. The trained data entered into the bot were split into mini-word batches, and the GD algorithm was applied sequentially on each mini-batch. The NLP methods involved in converting a word to its stem with a text result less readable by humans. RESULTS: The employed ML algorithms were successfully incorporated to manage the alternative synchronisation of text and voice messages. CONCLUSIONS: The proposed bot can be a better solution for data extraction from local hospital which functioning as a good communication channel for both users and hospital staff and helpful in reducing the crowd.

Effect of local bee honey on dihydrofolate reductase enzyme inhibitor-induced mucositis: A histological study on albino wistar rats.

INTRODUCTION: Mucositis is a common complication in around 40% of patients receiving chemotherapy which profoundly impact the quality of life. Despite the availability of many therapeutic agents that claim to prevent or reduce the severity of oral mucositis, no intervention that is completely successful at preventing oral mucositis exists. The present study aimed to demonstrate the effect of local honey on methotrexate-induced mucositis of the tongue. MATERIALS AND METHODS: The study was done in albino rats (n = 24), divided into four groups: honey-normal saline group (H/NS), distilled water-NS group (DW/NS), DW-methotrexate group (DW/MTX), and H/MTX group. Local honey was given (2.5 g/kg) twice a daily for 8 days. NS or methotrexate (60 mg/kg) interrupted the experiment procedure on day 4. At day 8, rats were sacrificed and middle third of tongue was removed for preparation of histological slides. Slides were examined for inflammatory cell infiltration (ICI), cell vacuolization (CV), congested blood vessels (CBV), thickness of epithelium (both dorsal and ventral mucosa), and thickness keratin. RESULTS: Statistically significant association was found between the groups for ICI and CV, χ2 (3) = 11.97, P= 0.003 for ICI, and χ2 (3) = 8.307, P= 0.023 for CV. Mean number of CBV per microscopic filed was 0.445, 0.389, 1.28, and 0.5 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of dorsal epithelial thickness (µm) was 96.78 ± 13.59, 100.50 ± 9.75, 75.53 ± 9.24, and 98.75 ± 10.92 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of ventral epithelial thickness (µm) was 70.45 ± 13.60, 58.38 ± 14.26, 37.04 ± 5.37, and 52.80 ± 7.97 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. The thickness of epithelium of DW/MTX group was significantly different from other groups (P < 0.05). CONCLUSION: The present study demonstrated the palliative effect of local honey over the mucositis induced by the chemotherapeutic drug (methotrexate).

Warfarin: A double-edged sword.

Warfarin is the commonest anticoagulant used in today's practice; it has a very narrow therapeutics window. Under and overdosing results in various life-threatening complications. Warfarin-related nephropathy (WRN) is a rare cause of acute kidney injury (AKI) in patients on long-term anticoagulation, as a result of supratherapeutic anticoagulation. Warfarin causes AKI by inducing glomerular hemorrhage with subsequent tubular obstruction by red blood cell (RBC) casts. WRN has been associated with irreversible kidney injury and increased risk of mortality. Despite a better understanding of pathophysiology and histopathology of WRN, its preventive measures and clinical outcome are not well known. We report here the case of a 62-year-old male, who was on a long-term warfarin therapy due to chronic atrial fibrillation with a history of old ischemic stroke and dilated cardiomyopathy. He was presented with AKI and his renal biopsy was suggestive of WRN. He was managed by withholding warfarin for a few days until the therapeutic range of international normalized ratio was achieved and steroids and N-acetylcysteine (NAC) recovered. WRN is a diagnosis of exclusion; other causes of AKI must be ruled out. Renal biopsy is the gold standard for diagnosis. Patients on chronic anticoagulant therapy should be monitored periodically for the therapeutic range of anticoagulants, deterioration of renal function, and hematuria.

Rhabdomyolysis - Exercise induced nightmare.

The term rhabdomyolysis refers to the disintegration of striated muscle which results in the release of muscular cell constituents into the extracellular fluid and circulation. Exertional rhabdomyolysis is occasionally seen after strenuous exercise. The progression to compartmental syndrome or renal failure is a rare complication that requires prompt recognition and treatment to prevent morbidity. We present the case of a 35-year-old male who came to our emergency department after a strenuous workout followed by fasting for a day. He presented with generalized weakness, decreased urine output, and one episode of dark-colored urine. He was found to have rhabdomyolysis with acute kidney injury (AKI). His condition progressed to frank renal shutdown requiring several sittings of dialysis and a very stormy course in hospital lasting about a month.