scholarly journals ACUTE VENLAFAXINE OVERDOSE WITH POSITIVE URINE IMMUNOASSAY FOR TRAMADOL – CLINICAL AND DIAGNOSTIC OVERLAP - CASE REPORT AND LITERATURE OVERVIEW

2019 ◽  
Vol 31 (4) ◽  
pp. 1027-1031
Author(s):  
Pereska Zanina ◽  
Danijela Janicevic-Ivanovska ◽  
Niko Bekjarovski ◽  
Natasha Simonovska ◽  
Aleksandra Babulovska
Keyword(s):  
Metabolic Pathways ◽  
Cross Reactivity ◽  
Medical Decisions ◽  
Case Presentation ◽  
Literature Overview ◽  
Clinical Syndromes ◽  
Clinical Presentations ◽  
Acute Medication ◽  
High Concentrations ◽  
Homogeneous Enzyme Immunoassay

Objective. The overlapping of pharmacokinetics and/or the pharmacodynamics of medicines causes the occurrence of overlapping clinical syndromes and diagnostic issues, potentiated in overdoses. We report a case of severe venlafaxine poisoning where the clinical presentation and the results of rapid immunoassay test overlapped with tramadol intoxication. Case presentation. An unconscious women with recurrent seizers, hypertension and supposed acute medication poisoning in suicidal attempt was transported to our clinic. Previously, she had been lavaged, rehydrated and treated with 20 mg diazepam iv, 40 mg furosemide at the local general hospital. Her regular tablet therapy consisted of losartan, levothyroxine, venlafaxine, occasionally tramadol. At admission she was comatose, with isochoric normal pupils, BP 130/80 mm Hg, SaO2 86%, and recurrent episodes of seizures treated with 10mg diazepam iv, ocular clonus, hypertonus, temperature 38.9C, diaphoresis, facial hyperaemia, dark coloured urine, hyponatremia and rhabdomyolisis. The lateral flow immunoassay (AbuGnostR) was positive for tramadol, but the homogeneous enzyme immunoassay did not confirm it. After 36 hours of intensive treatment she became somnolent and reported ingestion of 2250 mg tbl Venlafaxine. The AbuGnost R test detects tramadol at cut off urine values 200ng/ml, but present cross reactivity with O-desmethyl-venlafaxine at cut off values up to 25000ng/ml. The following days she complained of muscular weakness, headaches and cognitive impairment, which lasted for more then one month after release from hospital. Conclusion. High concentrations of venlafaxine metabolites induce false positive tramadol immunoassay (AbuGnostR) test. Overlapping clinical presentations and metabolic pathways of venlafaxine and tramadol should alert physicians when interpret rapid immunoassay test. The mandatory principle when making medical decisions should cover synthesis of critically interpreted toxicology analysis, interview data and clinical features of the poisoning, which may help to avoid misleading conclusions and improve the diagnostic and therapy decisions.

scholarly journals The vagaries of IgM: a case report of EBV infection with concomitantly false-positive IgM for CMV, VZV, and HSV

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Raai Mahmood ◽  
Khalid Mohamed ◽  
Naba Saeed ◽  
Kadhim Al-Banaa ◽  
Jonathan Zimmerman ◽  
...  
Keyword(s):  
Infectious Mononucleosis ◽  
Total Bilirubin ◽  
Viral Infections ◽  
Total Bilirubin Level ◽  
Peripheral Blood Smear ◽  
Cross Reactivity ◽  
Immunoglobulin M ◽  
Case Presentation ◽  
Ebv Infection ◽  
Acute Infectious Mononucleosis

Abstract Background Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk misdiagnosis. Case presentation We report a case of infectious mononucleosis with concomitantly positive IgM for EBV, CMV, VZV, and HSV. A 26-year-old man presented with acute infectious mononucleosis picture. His blood work showed a total bilirubin level of 7.7 mg/dl, ALT 1077 U/L, AST 806 U/L, ALP 325 U/L, and INR 1.0. Monospot was positive; peripheral blood smear showed atypical lymphocytes; however, because EBV infectious mononucleosis does not typically cause elevation of liver enzymes over 1000, other etiologies were explored. Tests for hepatitis A, B, C, HIV, ANA, and ASMA returned negative. IgM for EBV-VCA, CMV, HSV, and VZV all returned positive, and the diagnosis of EBV IM was called into question. Subsequent tests of CMV and HSV PCR for viral load were negative (VZV was not clinically suspected), and later on, EBV-EBNA returned negative and EBV-VCA IgM and IgG returned positive, confirming the diagnosis of acute EBV infection. Conclusion We believe that IgM seropositivity can result from cross-reactivity among several viruses (especially herpes viruses), and although often relied on, a positive IgM should not serve as the sole determinant for diagnosis of acute viral infections.

Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Akiko Kurasaki ◽  
Junichi Hasegawa ◽  
Natsumi Furuya ◽  
Chika Homma ◽  
Satoshi Harada ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Thrombus Formation ◽  
Umbilical Vein ◽  
Second Trimester ◽  
Venous Flow ◽  
Case Presentation ◽  
Neonatal Blood ◽  
High Concentrations ◽  
Venous Varix ◽  
D Dimer

Abstract Objectives Umbilical cord varix is an abnormal dilatation of the umbilical vein. There are two types of umbilical venous varix, of which the free-loop type is extremely rare, and the prognosis and etiology are unclear. In this report, we present a case of a significantly enlarged varix in the free loop of the umbilical cord found in the second trimester. Case presentation Cesarean section was performed at 28 weeks’ gestation due to enlargement of the varix and rapidly increased umbilical venous velocity at the outlet of the varix. Neonatal blood tests revealed anemia and high concentrations of D-dimer, and they were considered to be due to clot formation inside the umbilical cord venous varix. The neonate received blood transfusion but other neonatal course was generally favorable. Thrombus formation in the enlarged varix was due to the constriction of the umbilical cord. Conclusions This case showed that the assessment of umbilical venous flow velocity can be used for estimating the constriction of the umbilical vein and for determining the timing of delivery.

scholarly journals Intra-Abdominal Localisation of a Buschke-Lowenstein Tumour: Case Presentation and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
N. E. Wester ◽  
E. M. Hutten ◽  
C. Krikke ◽  
Robert A. Pol
Keyword(s):  
Interferon Therapy ◽  
Verrucous Carcinoma ◽  
Treatment Options ◽  
Condyloma Acuminata ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Advantages And Disadvantages ◽  
Literature Overview ◽  
Mucosal Surfaces ◽  
Tumour Reduction

Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.

Measurement of Plasma 1,25 Dihydroxyvitamin D Using a Novel Immunoextraction Technique and Immunoassay with Iodine Labelled Vitamin D Tracer

1997 ◽  
Vol 34 (6) ◽  
pp. 632-637 ◽  
Author(s):  
W D Fraser ◽  
B H Durham ◽  
J L Berry ◽  
E B Mawer
Keyword(s):  
Vitamin D ◽  
Solid Phase ◽  
Plasma Concentrations ◽  
Sample Volume ◽  
Cross Reactivity ◽  
Regression Equations ◽  
Vitamin D Metabolites ◽  
Dihydroxyvitamin D ◽  
1,25 Dihydroxyvitamin D ◽  
High Concentrations

We evaluated a novel assay for the measurement of 1,25 dihydroxyvitamin D (1,25 (OH)2D). Immunoextraction of 1,25 (OH)2D is performed using a mini column containing a solid-phase monoclonal antibody followed by radioimmunoassay (RIA) using an 125I-labelled 1,25 (OH)2D derivative tracer and Sac-cell separation. The mean recovery of 1,25(OH)2D3 was 101%, linearity was excellent, inter- and intra-assay coefficients of variation were 9, 8 and 13% and 11, 10 and 14% at low, medium and high concentrations of 1,25(OH)2D3, respectively. The cross-reactivity of vitamin D metabolites was <0·0015% for 25-hydroxyvitamin D3, 24, 25 dihydroxyvitamin D3 and dihydrotachysterol and 0·54% for lα calcidol. 1,25 dihydroxyvitamin D2 cross-reactivity was 79%. The detection limit of the assay was 5pmol/L. Comparison with a commercial radio receptor assay (RRA) and an in-house RIA gave regression equations of y = 0·94x+11·8 ( r = 0·98) and y = 0·91x-1·7 ( r = 0.95), respectively, with no major discrepancies between the methods in all patient groups studied. Plasma concentrations of 1,25 (OH)2D obtained with the assay were as follows: normal, unsupplemented subjects: mean 88, range 48–155 pmol/L, n = 68, patients with chronic renal failure: mean 11, range 3–36 pmol/L, n = 27, primary hyperparathyroidism: mean 198, range 130–299 pmol/L, n = 23, Paget's disease: mean 92, range 42–149 pmol/L, n = 24, osteomalacia: mean 43, range 27–61 pmol/L, n = 9. A minimum sample volume of 300 μL is required, the hands-on time is significantly less than other commercial assays and the measuring procedure is gamma counting rather than scintillation counting. The assay offers several advantages over previous methods and should allow more laboratories to offer measurement of 1,25 (OH)2D as part of their repertoire.

scholarly journals Rare presentation of Limb Body Wall Complex in a Neonate: Case report and review of literature

2022 ◽  
Author(s):  
Omoloro Adeleke ◽  
Farrukh Gill ◽  
Ramesh Krishnan
Keyword(s):  
Body Wall ◽  
Anorectal Malformations ◽  
Epidemiologic Studies ◽  
Normal Male ◽  
Rare Occurrence ◽  
Pathological Findings ◽  
Review Of Literature ◽  
Rare Presentation ◽  
Case Presentation ◽  
Clinical Presentations

The Limb Body Wall Complex (LBWC) aka. Body Stalk Syndrome is an uncommon congenital disorder characterized by severe malformations of limb, thorax, and abdomen, characterized by the presence of thoracoschisis, abdominoschisis, limb defects, and exencephaly. This condition is extremely rare with an incidence of 1 per 14,000 and 1 per 31,000 pregnancies in large epidemiologic studies. Majority of these malformed fetuses end up with spontaneous abortions. We present this rare case with occurrence in a preterm infant of 35 weeks gestation. Our report highlights majority of the clinical presentations as reported in previous literature, but the significant pathological findings of absent genitalia and malformed genitourinary, anorectal malformations make this case presentation an even more rare occurrence. Infant karyotyping was normal male and there is no specific underlying genetic correlation in this condition which has fatal prognosis.

scholarly journals The clinical cross-reactivity and immunological cross-antigenicity of wheat and barley

2021 ◽  
Author(s):  
Shohei Kubota ◽  
Yuji Aoki ◽  
Tomomi Sskai ◽  
Katsumasa Kitamura ◽  
Teruaki Matsui ◽  
...  
Keyword(s):  
Oral Immunotherapy ◽  
Cross Reactivity ◽  
The Other ◽  
Enzyme Linked Immunosorbent Assay ◽  
Wheat Allergy ◽  
Extract Concentration ◽  
Low Concentrations ◽  
High Concentrations ◽  
Food Challenges ◽  
Elisa Inhibition

Background: Some patients with a wheat allergy have been reported to show clinical cross-reactivity to barley. However, it is not clear whether the development of barley allergy in patients with a wheat allergy is due to cross-antigenicity between wheat and barley. In our study, we aimed to determine the clinical cross-reactivity and immunological cross-antigenicity of wheat and barley. Methods: We compared the results of barley oral food challenges (OFCs) before oral immunotherapy (OIT) for wheat with those after OIT in nine patients with a wheat allergy to estimate the clinical cross-reactivity of wheat and barley. Moreover, we performed enzyme-linked immunosorbent assay (ELISA) inhibition and immunoblotting inhibition using serum from seven patients allergic to wheat and barley. Results: Nine patients who had positive barley-OFC results performed before OIT for wheat were all negative on barley-OFC performed after OIT. In ELISA inhibition, preincubation of serum from patients allergic to wheat and barley with a high barley extract concentration inhibited binding of IgE to wheat extract by less than 10%. On the other hand, wheat and barley extracts equally inhibited binding to barley sIgE at high concentrations. In the immunoblotting inhibition test, the spots of wheat were inhibited but weakly by barley extracts, and most of the spots of barley were inhibited even by low concentrations of the wheat and barley extract. Conclusion: We showed that barley allergy associated with wheat allergy is caused by cross-reactivity from wheat. The OIT for wheat was one of the promising options for barley allergy.

Neuropsychiatry of consciousness

2020 ◽  
pp. 161-168
Author(s):  
David Linden
Keyword(s):  
Vegetative State ◽  
Persistent Vegetative State ◽  
Mental States ◽  
Unresponsive Wakefulness Syndrome ◽  
Clinical Syndromes ◽  
Clinical Presentations ◽  
Clinical Scenarios ◽  
Ascending Reticular Activating System ◽  
Reticular Activating System ◽  
Neurophysiological Mechanisms

Consciousness requires wakefulness and awareness. Many neuropsychiatric syndromes involve the disturbance of these functions. This chapter provides an overview of the various clinical presentations involving quantitative or qualitative disturbances of consciousness in order to explore the associated pathologies and underlying neurophysiological mechanisms. It lays out a number of clinical syndromes associated with impaired consciousness, such as persistent vegetative state (PVS) or unresponsive wakefulness syndrome (UWS), where the patient’s bodily functions can continue independently and show activity in higher motor areas when prompted under functional magnetic resonance imaging, yet are unable to communicate or follow commands. Focus is then given to altered mental states where conditions, such as neuroleptic malignant syndrome (NMS), may cause patients to experience depersonalization, fugue states, and hallucinations. After exploring the neuroanatomy and neurophysiology of such disorders, with a description of the function and significance of the ascending reticular activating system (ARAS), a number of clinical scenarios are presented.

scholarly journals Postoperative Hardware-Related Infection from Kytococcus schroeteri: Its Association with Prosthetic Material and Hematological Malignancies—A Report of a Case and Review of Existing Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Aditya S. Shah ◽  
Prakhar Vijayvargiya ◽  
Sarah Jung ◽  
John W. Wilson
Keyword(s):  
Hematological Malignancies ◽  
Prosthetic Valve Endocarditis ◽  
Human Infection ◽  
Prosthetic Material ◽  
Commensal Bacterium ◽  
Case Presentation ◽  
Osteoarticular Infections ◽  
Clinical Presentations ◽  
Kytococcus Schroeteri ◽  
Susceptibility Profiles

Introduction. Kytococcus schroeteri is an infrequently isolated Gram-positive coccus often encountered as a commensal bacterium. Only eighteen cases of human infection associated with this organism have been previously reported. Most of these cases involved patients with implanted prosthetic materials or patients with immunosuppressive conditions. It has been described in prosthetic valve endocarditis and in select patients with hematologic diseases but only one prior report as being involved in osteoarticular infections. Case Presentation. We describe a case of postsurgical osteoarticular hardware-related infection by K. schroeteri and discuss a possible association with implanted prosthetic material. Conclusion. Other clinical presentations of K. schroeteri, including reported infection syndromes, antimicrobial susceptibility profiles, and treatment outcomes, are also reviewed.

scholarly journals Translational Research in Intensive Care Unit: Novel Approaches for Drug Development and Personalized Medicine

2019 ◽  
Vol 40 (05) ◽  
pp. 687-698
Author(s):  
Romit J. Samanta ◽  
Charlotte Summers
Keyword(s):  
Distress Syndrome ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Clinical Syndromes ◽  
Clinical Presentations ◽  
Novel Approaches ◽  
And Personalized Medicine ◽  
Insight Into ◽  
Made In

AbstractThe major clinical presentations seen by critical care physicians are sepsis and acute respiratory distress syndrome (ARDS), both of which are heterogeneous clinical syndromes rather than specific diagnoses. The current diagnostic criteria provide little insight into the mechanisms underlying these heterogeneous syndromes and minimal progress has been made with regard to the development of therapies, despite many large randomized controlled trials being undertaken. This review outlines the advances made in improved characterization of critically-ill patients, using ARDS as an exemplar, and highlights the need for this improved patient characterization to be coupled with mechanistic science to develop therapies that target specific pathomechanisms.

Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase.

1989 ◽  
Vol 35 (9) ◽  
pp. 1949-1954 ◽  
Author(s):  
K Beever ◽  
J Bradbury ◽  
D Phillips ◽  
S M McLachlan ◽  
C Pegg ◽  
...  
Keyword(s):  
Solid Phase ◽  
Protein A ◽  
Cross Reactivity ◽  
Thyroid Peroxidase ◽  
Scatchard Analysis ◽  
Thyroid Autoantibodies ◽  
Serum Samples ◽  
Highly Sensitive ◽  
Phase Protein ◽  
High Concentrations

Abstract These highly sensitive assays are based on the interaction between thyroid autoantibodies and 125I-labeled autoantigens. Serum samples are incubated with labeled thyroid peroxidase (TPO) or thyroglobulin (Tg) to allow the formation of antibody-labeled antigen complexes. The complexes are then precipitated by addition of solid-phase Protein A. In the presence of high concentrations of TPO antibody or Tg antibody, more than 50% of the respective labeled antigen was precipitated, whereas only 1-2% was precipitated in the absence of autoantibody. Interassay CVs were 3.2% and 5.7%, respectively, for the anti-TPO and anti-Tg assays. There was no cross-reactivity between Tg antibody and TPO antibody. Results correlated highly significantly with results from other assay systems based on antigen-coated cells or plastic supports, but the assays described here were considerably more sensitive. Scatchard analysis of the assay data provided information on the affinity and serum concentration of TPO autoantibodies (ka approximately 10(9) L/mol and concentrations up to 1 g/L) and Tg autoantibodies (ka approximately 4 x 10(10) L/mol and concentrations up to 1 g/L). Overall, these assays provide a sensitive, precise, and convenient system for measuring and investigating the properties of thyroid autoantibodies.

Sign in / Sign up

Export Citation Format

Share Document