Search

Abstract Background Thyroid storm is a state of circulating thyroid hormone excess leading to multiorgan dysfunction and systemic decompensation. It typically occurs in the setting of poorly controlled hyperthyroidism and a precipitating illness or event. Management of thyroid storm in pregnancy poses unique diagnostic and therapeutic challenges. Main body Thyroid storm is a clinical diagnosis characterized by hyperpyrexia, tachyarrhythmias, congestive heart failure, gastrointestinal and neuropsychiatric disturbances. However, diagnostic scoring systems have not been validated in pregnancy. Treatment involves specialist consultation, supportive care, and pharmacological options such as anti-thyroid medications, beta blockers, iodine solutions, glucocorticoids, and cholestyramine. These must be adapted and modified in pregnancy to prevent fetal and maternal complications. Conclusion There is a critical need to recognize thyroid storm during pregnancy and initiate proper medical interventions promptly.

The early introduction of effective nutritional educational programs is pivotal for instilling sustainable healthy behaviors. The present work aims to present a best practice example of a nutrition and overall lifestyle school-based training program, the Nutritional Adventures (“Diatrofoperipeteies”). Conducted during 2020–2022 in Greek primary schools, this synchronous, online educational initiative included two 1-school-hour activities with a nutrition instructor. Additionally, schools were randomly assigned to supplementary “at-home” supported-by-parents or “in-class” supported-by-educators educational activities. In total, n = 12,451 students of 84 primary schools participated. Parent-completed questionnaires were selected in the recruitment and post-intervention phase (40% participation rate); overall, the working sample was n = 1487 students. In the post-intervention phase, a significant increase in Mediterranean diet adherence was observed (KIDMED score: mean increment = 0.25 units; p < 0.001), particularly fruit and vegetable consumption. Time spent on physical activity increased, while screen time decreased. Students’ total quality of life significantly improved (PedsQL; mean increment = 1.35 units; p < 0.001), including on all of its subscales (physical, emotional, social, and school function). Supplementary educational activities that were supported by educators rather than parents yielded a more favorable impact on students’ lifestyle and quality of life. The Nutritional Adventures program can be regarded as a successful initiative in primary schools, yielding immediate advantages that extend beyond promoting healthy dietary habits.

Background: The United Nations deployed about 8,000 soldiers in a peacekeeping mission in Angola. Malaria is the most common disease there and consequently it was the major risk to the UN troops. Most of them are from malaria free areas. As a result of improper prophylactic measures there were many cases of malaria, including some deaths in 1995. In February-March 1996, an Israeli team was sent to Angola to evaluate the malaria situation among UN soldiers. This paper deals specifically with some aspects of chemoprophylaxis and diagnosis. The efforts were concentrated in one particular area where malaria incidence had been reported as the highest.Methods: Blood samples were collected from nonimmune soldiers who were using mefloquine as a prophylactic drug and were exposed to malaria. The mefloquine and the antimalarial antibody plasma levels were monitored.Results: While the local laboratory indicated that about 80% had a malaria episode, the serological results revealed that only 5 soldiers of the 56 (9%) examined had antimalarial antibodies, of which 3 were Angolans. Despite a controlled prophylactic regimen there was considerable variability in mefloquine plasma levels: 46% of the samples were below the required prophylactic level and 26% above it. All patients who were proven positive with malaria by both microscopic and serologic observation had a low level of mefloquine.Conclusions: In field conditions, a kit which identifies plasmodial antigens, is preferable, to a microscopic diagnostic method. Controlled mefloquine prophylaxis may not prevent malaria, especially when blood levels are low. The reason for the low mefloquine blood levels is not clear and needs further evaluation. [ABSTRACT FROM AUTHOR]

A 25 year old woman suffering from recurrent attacks of hypoglycaemia underwent a laparotomy for suspected insulinoma. No tumour was found, but histology showed islet cell hyperplasia and nesidioblastosis. Although these changes have been reported as a cause of hypoglycaemia in infants, they are only rarely the cause of hypoglycaemia in adults; in the present case they were found to be the result of covert sulphonylurea administration. The fact that sulphonylureas can cause nesidioblastosis is not well recognised by either physicians or pathologists and it should be considered before "cryptogenic nesidioblastosis" is deemed the cause of hypoglycaemia in adults. [ABSTRACT FROM PUBLISHER]

Background: High dose busulfan (BU) is used in preparative chemotherapy regimens for patients undergoing stem cell transplantation (SCT). Myelo- and submyeloablative protocols for IV BU, have been developed to achieve stable PK while minimizing toxicity and relapse. We sought to examine the PK of BU in different protocols with vs. without fludarabine and to measure oxidative stress in these protocols.Patients & methods: 46 SCT patients were studied. Blood samples for PK curves were drawn at the first and mid dosing period. For each protocol PK parameters were estimated using a 1-compartment open model.Results: BU PK parameters, were: t 1/2= 2.83±0.75 hr, Cl=0.17±0.04 (1/hr)/Kg and Vd=0.69±0.19 1/Kg. AUC and Cmax increased lineary with increasing cumulative dose up to 12.8 mg/Kg (r2=0.997 and 0.994, respectively). BU PK were not changed by fludarabine. Initial plasma oxidative stress (OS) was high[glutathione oxidative potential (Eh) = (-285) ± (-20) mV] compared to normal values[(-315) - (-320) mV]. BU aggravated OS: increased Eh by +40 mv and reduced uric acid levels (5.1 ± 2.0 to 2.6 ± 1.1 mg%).Conclusions: IV BU PK are stable, linear, predictable and not affected by fludarabine. The optimization of the therapeutic range of BU AUC and plasma OS for the individual patient requires further research.Clinical Pharmacology & Therapeutics (2005) 79, P10–P10; doi: 10.1016/j.clpt.2005.12.035 [ABSTRACT FROM AUTHOR]