Airway compromise is an under-recognised side effect of vagus nerve stimulation. We describe the first known case of stridor and contralateral vocal fold palsy in a vagus nerve stimulator user. We highlight the need for better understanding amongst otolaryngologists of the laryngopharyngeal side effects of this technology.
Introduction:India is a land of culture and heritage always known for its rituals. The devotees offer their prayers in the form of fasting, sacrifices and many other difficult ways to please Almighty! While doing so they often endanger their lives. Rhabdomyolysis, in a particular group of devotees of Bihar/Jharkhand known as Dak-Bum, is a life-threatening clinical entity which occurs in these devotees who travel a long distance in a short period in a fasting state. Rhabdomyolysis detected by myoglobinuria can lead to acute kidney injury and mortality.Aim:To study and identify cases of rhabdomyolysis in devotees (Dak-Bum) and the role of early diagnosis and management.Materials and Methods:The study was conducted at Ruban Emergency Hospital Patna from August 2010 to August 2013 over 27 patients - 26 males and 1 female of age group 22–34 years. They presented with major symptoms such as dehydration, tender swollen calf muscles and myoglobinuria. The patients were admitted over a period of 2–3 weeks time in a single year (nine patients in 2010, five patients in 2011 and seven patients in 2012 and six patients in 2013). The study was restricted to the month of August every year, as this ritual occurs in a particular season. Inclusion criteria were all previously healthy devotees. The study period was from admission till discharge with daily follow-up of each patient.Results:Rhabdomyolysis developed in 27 Dak-Bum devotees and all had acute renal failure at the time of admission. RIFLE criteria-Stage F (failure) and acute kidney injury network criteria (3rd stage). However, recovery was good due to early intervention in the form of haemodialysis and forced alkaline diuresis by soda bicarbonate infusion.Conclusion:Rhabdomyolysis developing in Dak-Bum devotees because of travelling a long distance in a short period, could be managed well due of early diagnosis, timely referral, haemodialysis and forced alkaline diuresis.
Background: Health issues are linked to gestational diabetes mellitus (GDM) in both the mother and the foetus. Adipose tissue (AT) health issues and obesity are linked to the emergence of GDM. Recent research has nevertheless demonstrated that decreased AT health can exist even in the absence of fat. In this study, we investigated whether AT health influences the onset of GDM in non-obese women.
Method: GDM-diagnosed expectant mothers were examined. Non-GDM women with matching BMI and age served as the Controls (n=6 per group). Before and during cesarian sections, samples of AT and fasting blood were taken, respectively. Using the Bioplex assay, the serum levels of adiponectin were determined. Western blotting was used to quantify the expression of phosphorylated p38 (p-p38) in AT, and average adipocyte size values were calculated. Two-tailed unequal variance was used to determine the differences in the variables between the groups. P < .0 was regarded as statistically significant for the Student t test.
Results: The pre-pregnancy BMI and age did not differ. The serum level of adiponectin was considerably lower in the GDM group. p-AT p38's expression, however, was noticeably higher. In the GDM group, the adipocyte size was 11% smaller, but the difference did not statistically vary from zero.
Conclusion: Our findings show that among non-obese women, the development of GDM may be significantly influenced by AT health. Future research is necessary to identify the pathways via which AT health, in the absence of obesity, contributes to the development of GDM.
Disclosure
A.K.Sinha: None. B.B.Bharti: None. B.K.Choudhary: None. P.Hans: None.
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