Lethal coagulopathy resulting from the consumption of contaminated synthetic cannabinoids: the story of a public health crisis.

In March 2018, Illinois saw the outbreak of an unprecedented public health crisis, which manifested as the development of a potentially lethal coagulopathy associated with the consumption of synthetic cannabinoids. This outbreak impacted a reported 174 patients, and was responsible for the deaths of five patients. While events unfolded, it was uncovered that the coagulopathy was not caused directly by the consumption of synthetic cannabinoids, but by the contamination of these products with Brodifacuom, bromadiol and difenacoum, potent Vitamin K antagonists that are the active ingredient in most rodenticides. This article chronicles the first reported instance of clinically significant Long Acting Anticoagulant Rodenticide poisoning on such a widespread and uniform scale, and examines the challenges posed to the providers and Public Health authorities tasked with the management of this outbreak. Crisis preparedness determines mitigation, response and recovery during trying times. It is prudent that healthcare agencies engage in collective measures to establish preparedness plans and build up their capacity to respond to health-related crises such as the one faced by Illinois in early 2018. By examining the solutions developed to tackle each unique challenge, the objective of this article is to lay a framework for action and response to similar public health crises.

Pseudohypoparathyroidism and Cardiomyopathy: A Case Report with a New Perspective on the Cardiovascular-Endocrine Axis with Respect to Calcium Homeostasis.

Pseudohypoparathyroidism encompasses a group of heterogeneous disorders defined by targeted organ unresponsiveness to parathyroid hormone (PTH). With an estimated prevalence of approximately 0.79 per 100,000, this is an extremely rare group of genetic disorders. The documented phenotypic manifestations and complications of this condition include skeletal abnormalities, thyroid-stimulating hormone (TSH) resistance, growth hormone deficiencies and abnormalities in gonadotropic hormones. However, the cardiovascular effects of this condition have never been studied. To the knowledge of the writer, this is the first report of pseudohypoparathyroidism resulting in profound hypocalcaemia leading to heart failure in a previously healthy 22-year-old man with no known cardiac history. Following treatment with calcium replacement therapy, the patient's cardiac function improved dramatically, demonstrating the seminal role played by serum calcium in myocardial contractility and its influence on cardiac function. LEARNING POINTS: In patients with heart failure, serum calcium must be measured, especially if the underlying aetiology of heart failure is unclear.In patients with heart failure, correction of calcium levels is an important aspect of management.Patients with pseudohypoparathyroidism should undergo cardiac evaluation, especially in the presence of symptoms such as peripheral oedema and dyspnoea on exertion.

Enduring Oaths.

In this image, 3 figures-Hippocrates, a plague doctor, and a modern physician-represent continuity of ethical standards in ancient, medieval, and contemporary medical communities.

The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics.

OBJECTIVE: The primary objective of this study was to determine the correlation between procalcitonin values and illness severity by evaluating the degree of end organ dysfunction using the Sequential Organ Failure Assessment score, length of stay and the severity of sepsis (sepsis alone vs. septic shock), The hypothesis that procalcitonin values would be higher in sicker patients was formulated before data collection began. Secondary outcomes studied in relation to procalcitonin levels included infection characteristics such as the site of infection, microbial agent and dialysis dependent CKD. DESIGN: Unblinded retrospective cohort study. September 2014-December 2016. SETTING: 364 patients with a diagnosis of sepsis or severe sepsis who were admitted to the general medical ward and ICU at Methodist Medical Center and Proctor Hospital in Peoria, Illinois, USA. RESULTS: This study demonstrates the following: Weak positive correlation between procalcitonin and SOFA score. Negligible correlation with length of stay. Higher values in patients who died than in patients who survived to discharge (p = 0.058). Sensitivity and specificity of procalcitonin for septic shock was 63 and 65% respectively. Sites typically infected by gram negative bacteria have higher procalcitonin values than sites infected by gram positive bacteria (p = 0.03). Higher procalcitonin in bacteremia than non-bacteremic infections (p = 0.004). Higher procalcitonin in dialysis-dependent CKD patients (p = 0.020). CONCLUSIONS: Procalcitonin has a higher specificity for bacterial infections than other acute phase reactants. Although initial procalcitonin value may be helpful in the determination of illness severity, it is not always a reliable prognostic indicator and carries little significance as a standalone value. Procalcitonin values may be influenced by preexisting comorbid conditions such as chronic kidney disease, which are associated with higher procalcitonin values at baseline. Procalcitonin can provide invaluable information when viewed as one piece of a clinical puzzle, and is most powerful when the interpreting physician is aware of how values are influenced by the different clinical scenarios presented in this article.

Misconceptions concerning maternal and child health in low socioeconomic status societies.

This cross-sectional questionnaire-based study was conducted in order to assess the frequency of misconceptions present in societies of low socioeconomic status so that healthcare providers can pay due attention to whichever misconceptions are most prevalent and work towards eradicating them. The study was conducted in Sultanabad and Rehri Goth areas of Karachi, both being of low socioeconomic status. A sample size of 75 interviewees from each settlement was taken and data collected over the time period of one month. The results indicated that a high frequency of misconceptions is prevalent in societies of low socioeconomic status, where the literacy rates were low.