Hoffmann syndrome is a rare form of hypothyroid myopathy in adults characterized by presence of muscle weakness, stiffness and pseudohypertrophy. We report a 39 year old male with primary hypothyroidism diagnosed at childhood and not on regular thyroxine therapy who presented with fatigue, cold intolerance, constipation, exertional breathlessness, progressive proximal muscle weakness and swelling of the legs for one year. Examination revealed pseudohypertrophy of calf muscles with marked symmetrical proximal upper and lower limb weakness. His TSH and Creatine phosphokinase (CPK) levels were significantly elevated and electromyography (EMG) was compatible with myopathic disorder. After institution of thyroxine therapy his weakness improved markedly and pseudohypertrophy regressed in two months. We report this case because of its rarity.
Background. Intentional ingestion of organophosphate (OP) and carbamate is a significant health issue worldwide. It causes adverse health effects on the liver. This study aimed to determine liver transaminases (AST and ALT) and bilirubin levels to assess the severity of poisoning in patients with acute OP and carbamate poisoning. Methods. A descriptive cross-sectional study was conducted on patients admitted to a selected hospital in Sri Lanka with acute OP and carbamate poisoning. The severity of poisoning was measured by RBC cholinesterase and Peradeniya Organophosphorus Poisoning scale (POP), where six clinical features were assessed based on a 3-point scale. A score of 0–3 was considered mild, 4–7 to be moderate, and 8–11 to be severe poisoning. Liver parameters such as AST, ALT, and total and direct bilirubin were measured. Results. Among the 188 screened patients, 166 were recruited. Majority were males (112, 67.5%). Kruskal–Wallis test showed significant differences in AST and ALT on admission and AST on discharge, across POP groups ((χ2 (2, n = 166) = 26.48, p ≤ 0.001 ), (χ2 (2, n = 166) = 14.31, p = 0.001 ), and (χ2 (2, n = 157) = 11.34, p = 0.003 ), respectively)). Mann–Whitney U test showed significantly higher AST and ALT in the moderate POP group compared to the mild POP group (AST: U = 1709, z = −4.50, p ≤ 0.001 , r = 0.36; ALT: U = 2114, z = −3.04, p = 0.002 , r = 0.26) on admission. In addition, the treatment outcomes (duration of hospital stay and duration of ventilator assistance) were significantly correlated ( p ≤ 0.001 ) with the severity of poisoning and serum AST and ALT at the time of admission. Conclusion. AST and ALT levels on admission and AST level at discharge showed significant correlations with the severity of poisoning. Treatment outcomes significantly correlated with the severity of poisoning and serum AST and ALT levels.
BackgroundHump-nosed pit vipers (Genus: Hypnale) are medically important snakes in Sri Lanka and South India. Merrem’s Hump-nosed pit viper (Hypnale hypnale) frequently leads to potentially fatal envenomings in Sri Lanka and India. Venom-induced consumption coagulopathay (VICC), local envenoming and acute kidney injury (AKI) are the commonest effects of the envenoming by this snake.Case presentationWe report a previously unreported presentation of H. hypnale envenoming, with an isolated urinary salt loss leading to moderate hyponatraemia resulting seizures. The patient was treated with careful fluid and electrolyte management. No antivenom is currently available for H. hypnale envenoming.ConclusionIn the absence of any evidence of venom induced consumptive coagulopathy, acute kidney injury and cerebral haemorrhage, we hypothesize that this effect is likely due to the presence of a natriuretic peptide in H. hypnale venom, similar to the natriuretic peptides identified in few other snake venoms.
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