Patient: Male, 20Final Diagnosis: Anorexia nervosa with gelatinous transformation of bone marrowSymptoms: Bradycardia • generalized weakness • weigh lossMedication: —Clinical Procedure: —Specialty: General and Internal MedicineObjective:Rare diseaseBackground:Anorexia nervosa is a relatively frequently encountered eating disorder. Beyond its psychiatric significance, it is associated with multiple hematological features such as cytopenia. It can be related to gelatinous transformation of the bone marrow.Case Report:We describe the case of a 20-year-old male admitted for rapid involuntarily weight loss. He presented with extreme bradycardia with a heart rate of 30 beats per minute with recent psychomotor impairment. Routine laboratory tests showed pancytopenia, and cytolysis on liver function tests. Cardiac investigations did not reveal abnormalities except for sinus bradycardia. Bone marrow aspirate revealed hypo-cellular marrow with infiltration by gelatinous substance. In addition, bone marrow biopsy showed fat cell atrophy along with loss of hematopoietic elements in areas of gelatinous transformation. During the patient’s hospital stay, he had a restrictive oral diet. Thus, after consulting with a psychiatric specialist, a diagnosis of anorexia nervosa complicated with gelatinous transformation of bone marrow, bradycardia, and acute hepatitis was made. After psychiatric treatment and nutritional care, the patient regained weight, had a normal heart rate and normal liver function tests, and his full blood count and bone marrow examination were within normal range.Conclusions:Gelatinous transformation of bone marrow can be the revealing feature of anorexia nervosa and some potentially reversible associations might prove life threatening if misdiagnosed. Furthermore, lack of suspicion can lead to unwarranted investigations increasing the cost incurred in healthcare delivery. Our patient had 3 systems involved: cardiac, hepatic, and hematological systems. Gelatinous transformation of bone marrow, although a rare condition, must be considered in such patients.
In this paper, we test the existence of financial development threshold effects, firstly, between financial development and long-term growth, and, secondly, between financial development and long-term GDP. We also ask whether such effects may explain the link financial development - convergence/ divergence to the advanced countries’ growth. Our work builds on that of Aghion, Howitt, and Mayer-Foulkes (2004). It differs from previous work about assumptions and methodology. Estimates are performed with GMM dynamic panel data techniques for 112 emerging and developing countries from 1975 to 2007. The results show a positive but vanishing effect of financial development on steady-state GDP, from a critical (an average) level of financial development. They do not validate, however, the assumption that the marginal impact of financial development on the steady-state growth rate is more favorable than the degree of financial development is low. We support only partially the role that the financial development could play in the acceleration of the convergence of emerging and developing economies towards the world frontier growth
Les atteintes cliniques et biologiques communes au syndrome d'activation macrophagique (SAM) et à la leishmaniose viscérale (LV) rendent le diagnostic étiologique du SAM très difficile. Cette association est rare et grave. Nous rapportons trois nouvelles observations de SAM secondaire à une LV, compliquées de coagulation intravasculaire disséminée (CIVD). Il s'agissait de trois hommes, âgés respectivement de 31, 20 et 60 ans. Le tableau était fait de fièvre et de splénomégalie associés à une pancytopénie et une CIVD. Le diagnostic de LV était fait par le myélogramme, les sérologies et la polymerase chain reaction. Chez l'un de nos patients, une deuxième sérologie était nécessaire. Tous nos patients étaient traités par Glucantime® avec une bonne évolution. Un cas de pancréatite aigue était noté. En en zones d'endémie, devant un SAM compliqué de CIVD, une LV doit être recherchée, en répétant si nécessaire certaines explorations initialement négatives. Le pronostic dépend de la rapidité du traitement spécifique.
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