BackgroundTricyclic antidepressants (TCA) are becoming one of the most frequently used substances in self poisoning. Significant morbidity and mortality associated with TCA overdose are often related to and refractory hypotension. We report the first case of survival after severe amitriptyline poisoning, leading to prolonged cardiac arrest and ventricular tachycardia (VT), resuscitated with 3 h of uninterrupted cardiac massage and Direct current (DC) shocks.Case presentationA 25 year old girl presented with severe amitriptyline poisoning causing pulseless VT and prolonged cardiac arrest. After 3 h of uninterrupted external cardiac massage, together with nine DC shocks and intra venous bicarbonate injections the rhythm reverted to a nodal tachycardia, initial 2D echocardiogram showed left ventricular dysfunction, which recovered to normal after 2 weeks and the patient had a complete recovery subsequently.ConclusionOur case highlights the importance of continued resuscitation in patients presenting with TCA poisoning and resistant arrhythmia, especially in young and otherwise healthy patients.
Background: Bone is a common metastatic site of primary lung carcinoma. But bone metastasis being the initial presentation of primary lung malignancy is rare and only a few cases are reported in literature. We report a case of a primary lung cancer with extensive bone metastasis to skull and long bones, with no clinically or radiologically evident primary tumor.
Background Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody- (ANCA-) associated small vessel vasculitis with multisystem involvement. It is characterized with asthma, eosinophilia, and renal and peripheral nervous system involvement. However, EGPA presenting with bullous skin eruption is an uncommon dermatological manifestation. We report a rare case of EGPA overlapped with mixed essential cryoglobulinemia presenting with a bullous skin eruption. Case Presentation A 49-year-old female presented with bilateral lower limb erythematous bullous rash with bilateral lower limb numbness. She had bilateral ankle edema with frothyuria and a recent onset wheeze. Blood investigations revealed a marked peripheral eosinophilia with positive P-ANCA. Skin biopsy was suggestive of leukocytoclastic vasculitis. She also had positive cryoglobulins with a high rheumatoid factor titre. The patient was diagnosed of having EGPA with overlapping mixed essential cryoglobulinemia. Her skin eruptions and systemic manifestations improved with prednisolone and cyclophosphamide therapy. Conclusion EGPA can rarely present with a bullous skin eruption and may rarely associate with secondary cryoglobulinemia. Early recognition of these rare manifestations and prompt treatment would prevent further complications and death.
A 39-year-old G3P3 female presented with abrupt onset dyspnoea of one month duration. She was markedly symptomatic when lying supine and resorted to prone sleeping. Chest X-ray reported as cardiomegaly. Transthoracic echocardiography was unremarkable twice. Computed tomography chest showed a dilated pulmonary artery. Transesophageal echocardiography identified a 12-mm ostium secundum atrial septal defect with mild pulmonary hypertension. The defect was closed with a cocoon device and rendered her symptom free. This case highlights the importance of timely organization of transesophageal echocardiography when transthoracic echocardiography is negative. It also illustrates marked dyspnoea could be a presentation of undiagnosed atrial septal defect with mild pulmonary hypertension.
Introduction:There is a dearth of evidence on response to antihypertensive treatment among younger individuals with essential hypertension. The objective of this study was to describe the associated comorbidities and response to treatment in young hypertensive patients without complications at diagnosis who were attending VP/OPD clinic in Badulla Provincial General Hospital.Methods: An observational retrospective longitudinal study was carried out with secondary data from 85 young (20-40 years) hypertensive patients with a follow up of at least 6 months. A pre-tested data extraction sheet was used. Descriptive analysis was followed by hypothesis testing with nonparametric tests at a significance level of 5%.
Results:The median (IQR) age was 35 (33.5 to 38.0) years with male to female ratio being approximately 1:3. Median (IQR) follow up period was 46 (23 to 80) months. At enrolment median (IQR) systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 150 (147.5 to 160.0) mmHg and 100 (100 to 100) mmHg respectively. There was no significant difference of the SBP and DBP between men and women (P>0.05). In the follow up there was a significant reduction of the SBP and DBP of the total sample as well as of all three grades of hypertension (all p<0.05). There was a significant reduction of the total cholesterol and triglyceride (both p<0.05). None in the grade 1 hypertension category, had developed any hypertension related events.
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