Carbamazepine poisoning managed with haemodialysis and haemoperfusion in three adolescents

Carbamazepine is a widely used antiepileptic agent. Accidental or suicidal overdose in children is not uncommon. Acute toxicity is associated with seizures, coma, arrhythmias and death in severe cases. Here we report three adolescents with carbamzepine overdose, two managed with standard low-flux haemodialysis and one with charcoal haemoperfusion. Our report emphasizes that haemodialysis might be a cheaper and easier alternative for carbamazepine overdose in milder cases, with fewer side-effects than haemoperfusion.     

Effect of age on the response to short-term partial bladder outlet obstruction in the rabbit

OBJECTIVE: To compare the physiological and structural changes after short-term partial bladder outlet obstruction (PBOO) in young and old rabbits, as PBOO results in marked contractile and histological alterations in the bladder. MATERIALS AND METHODS: In all, 20 young (7-8-week-old) and 20 old (2 years old) male rabbits were divided into four subgroups of five each (four obstructed and one sham control rabbit). The rabbits in the groups were evaluated after 1, 3, 7 and 14 days of PBOO, respectively. At the end of the respective periods, cystometry and contractile responses to field stimulation (FS), ATP, carbachol and potassium chloride were determined. Full-thickness sections of the bladder body and base were used to determine the vascular density, nerve density and smooth muscle/collagen ratios. RESULTS: The bladder weight of young rabbits increased at 1-7 days of PBOO and returned toward control levels at 14 days of PBOO, while in old rabbits it was higher than the control during the entire experiment. For the young rabbits, the responses to field stimulation decreased progressively for 1, 3 and 7 days, and increased significantly at 14 days. For old rabbits there was a progressive decrease to a minimal response by 3 days of PBOO and the response remained at this level over 14 days. The contractile response to ATP, carbachol and KCl were similar to the responses to FS. The vascular density in both groups increased to a maximum at 7 days and then decreased toward control values at 14 days. For the young rabbits, nerve density decreased more than in old rabbits. In the old group, the smooth muscle/collagen ratio was increased throughout PBOO and was higher than in young rabbits. The connective tissue compartment was markedly greater than in the young rabbits and the basal mucosa had vacuoles which were not apparent in the young bladders. CONCLUSIONS: This study shows that the adaptive changes to PBOO are faster in young rabbit bladders than in older rabbits.     

Left ventricle hydatid cyst mimicking acute coronary syndrome

Cardiac echinococcosis rarely mimics acute coronary syndrome. The diagnosis of cardiac hydatid cyst might be difficult on account of varying clinical presentations and nonspesific symptoms.?A 75-year-old female was admitted to our hospital with typical chest pain. The patient had no history of previous cardiac symptoms or any illness leading to heart disease. Her ECG revealed ischemic changes. However, her coronary angiography revealed noncritical plaques in the left anterior descending artery. The diagnosis of cardiac echinococcosis was identified using echocardiography, computed tomography and magnetic resonance imaging. The patient was referred to cardiac surgery for resection of the cyst; however, she refused surgery. Albendezol 800 mg/day was prescribed.     

Economic burden of ventilator-associated pneumonia in a developing country

Ventilator-associated pneumonia (VAP) developed in 96 (60%) of 159 patients with 37.2 cases per 1000 ventilation-days in a medical intensive care unit (MICU). Median time for VAP development was 5.5 days (range: 2-25). The most significant risk factors for VAP were stay in hospital before MICU and length of stay in MICU. The mean length of stay in MICU for VAP patients was 23.8 ± 19.8 days, which was four-fold higher than for non-VAP patients. The daily cost for VAP patients was half that for non-VAP patients. The total costs for VAP patients were about three-fold higher than for non-VAP patients.