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A 56-year-old lady presented to the hospital with 2-day history of flu like symptoms. These had begun within a few hours after starting Nitrofurantoin for urinary tract infection that was prescribed by her primary care doctor. Blood tests upon admission revealed elevated aminotransferase levels with normal bilirubin levels. The medication was stopped, and other causes of hepatitis were investigated. Nitrofurantoin induced idiosyncratic drug-induced liver injury (IDILI) was confirmed by excluding all other causes. Patient’s symptoms and liver enzymes improved the next day and she was discharged. A follow-up on the laboratory’s nine-days later revealed liver enzymes almost back to normal.
Nitrofurantoin; Urinary tract infection; Idiosyncratic drug induced liver injury; Acute reversible hepatotoxicity; Flu-like illness; Elevated transaminases.
The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) designated as novel coronavirus is a cause of highly infectious disease referred to as coronavirus disease-2019 (COVID-19). The global pandemic that affected millions of people worldwide has claimed many lives and brought about catastrophe in low-income countries. The high mortality and rapid spread of the infection have brought about an urgent need for a safe and effective vaccine to control the pandemic. In this perspective, it becomes essential to understand the structure, mode of transmission, and virulence of SARS-Cov-2. In this article, an emphasis is made on understanding the infection pathogenesis and the host defense mechanisms against the infection to break the chain of transmission. Furthermore, we have tried to summarize the development and characteristics of different types of COVID-19 vaccines. In addition to this, we have highlighted the challenges of the public health system in the procurement and delivery of
the vaccine to the community and especially to the most vulnerable society. It becomes the main priority to find support financially and make the public health system ready to imbibe the importance of vaccination through meticulous strategies so that vaccine reaches out to the community.
SARS-CoV-2; COVID-19; Vaccine; COVID-19 treatment.
Low serum bicarbonate, with or without an elevated anion gap, can indicate metabolic acidosis. High anion gap metabolic acidosis is due to the unmeasured anions. Hypertriglyceridemia can also be associated with spuriously low serum bicarbonate levels due to lab interference. We present a 44-year-old woman who presented with anion gap metabolic acidosis in the presence of severe hypertriglyceridemia.
Hypertriglyceridemia; Acid-base disorders; Low serum bicarbonate; Metabolic acidosis.
Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria. Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria.
Proteinuria; Glomerular; Tubular; Nephritic; Nephrotic.
Diabetes mellitus (DM), an epidemic non-communicable disease, is associated with macro- and micro-vascular complications which may result in sudden cardiac death at a young age. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) emerged as a new therapeutic option for managing DM with cardiovascular complications as well as diabetic patients with multiple risk factors. Three drugs in this class significantly reduced cardiovascular mortality and heart failure events, in both type 2 diabetes mellitus and non-diabetic patients with a reduced ejection fraction, to prevent heart failure related hospitalisation. Evidence of kidney protection was another major advantage provided in more than one study. We reviewed recent SGLT2-I related literature and discuss the benefits beyond the cardiac system.
Diabetes mellitus (DM); Cardiovascular disease; Sodium-glucose cotransporter-2 inhibitors (SGLT2-I); Renal protection.
Leg ulcers are a painful side-effect commonly seen in patients with long-term use of hydroxyurea. We describe an ulcer in a patient with sickle cell disease (SCD) with an 8-year history of hydroxyurea use. Wound care team used cadexomer-iodine topical
and collagenase to aid in healing. There are limited options for the treatment of these ulcers beside the cessation of hydroxyurea, a very effective drug in reducing painful sickle cell episodes. It is imperative to be aware of this complication to prevent expensive tests and further work up. Future study into alternative treatment of hydroxyurea-induced leg ulcers for sickle cell patients is necessary.
Leg Ulcer; Sickle cell disease (SCD); Hydroxyurea.
Interventional Cardiologist Trained OverseasResearch Fellow at the University Hospitals Cleveland Medical Center10900 Euclid Avenue Cleveland, Ohio 44106, USA
Director of Medicine Professor Department of MedicineBaruch Padeh Poria Medical Center affiliated to the Faculty of Medicine Bar-Ilan University Ramat Gan, 5290002, Israel
Specialist in General SurgeryAggregate Professor of SurgeryTor Vergata UniversityRome, Italy