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Abstract

was treated with ceftriaxone, vancomycin, azithromycin, and bicarbonate. Potassium and magnesium were replaced. She expired despite all resuscitative measures which included mechanical ventilation and vasopressor support. The majority of tenofovir associated nephrotoxicity has been reported in the HIV population. To our knowledge, this is one of the rare cases reported in a non-HIV patient. The patient's non-anion gap metabolic acidosis, hypokalemia, glucosuria, proteinuria, ketonuria, multiple spontaneous rib fractures and osteopenia were consistent with Fanconi's syndrome. The severity of the acidosis and renal failure likely contributed to this patient's inability to withstand the stress of severe sepsis. Recently the WHO has issued guidelines regarding the management of renal diseases in patients being treated with tenofovir for chronic hepatitis B that include obtaining baseline and biannual renal indices. Tenofovir induced renal failure and Fanconi's syndrome can significantly worsen the prognosis of patient with severe sepsis.Case Report: Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is a newly defined autoimmune encephalitis predominantly affecting young, previously healthy women. It is considered paraneoplastic as 60% of cases are associated with tumors, usually ovarian teratomas. It typically presents in separate phases. A prodromal phase that mimics a viral infection. A psychotic phase often characterized by sudden onset delusions, hallucinations or other bizarre behavior. Lastly a deterioration phase associated with seizures, inability to maintain an airway and catatonia. Diagnosis is confirmed by serum and CSF anti-NMDAR antibodies. Treatment centers on early immune suppression, antibody removal and tumor resection if present. Titers guide treatment response. Prognosis is correlated with timely treatment. 75% of patients make a near/full recovery. There is a 5% mortality rate. Recovery may take up to 2.5 yr and prolonged hospital stay is common. This case series describes the classic presentation of anti-NMDAR encephalitis in three patients at a tertiary care center over five yr. All three are young, previously healthy women that presented with status epilepticus and were admitted to MICU. Despite treatment for bacterial/viral encephalitis the patients failed to improve. Anti-NMDAR antibody serology testing was sent with diagnostic elevated titers. Adnexal evaluation was remarkable showing ovarian lesions unilaterally. Laparoscopic salpingoophorectomy was completed. Final pathology showed mature cystic teratoma. All three patients received IVIG and plasmapheresis following resection with significant improvement and eventual discharge to rehab after 2-3 mo. Anti-NMDAR encephalitis is a rare, often under/misdiagnosed autoimmune encephalitis with distinctive clinical features, a diagnostic antibody, and effective treatment; the prognosis of which is greatly affected by early intervention. This case series seeks to provide clinical knowledge so that anti-NMDAR encephalitis is considered in...

Incidence and factor analysis for the heat-related illness on the Tokyo 2020 Olympic and Paralympic Games

“…Also included in the definition of ‘severe’ heat-related illnesses are those with exercise-induced hyperthermia12–15 who have a high body temperature of 39.5°C or higher during exercise and are deemed to require cold water immersion (CWI) treatment with an ice bath in a heat deck.…”