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    1 OF 953

    When one disease is not enough: succinyl-CoA: 3-oxoacid coenzyme A transferase (SCOT) deficiency due to a novel mutation in OXCT1 in an infant with known phenylketonuria.
    J Pediatr Endocrinol Metab 2017 Aug 18. Epub 2017 Aug 18.
    .
    A 9-month-old Turkish girl was admitted several times within 3 months to the hospital in reduced general condition and with extreme tachypnea. The patient had been diagnosed with phenylketonuria (PKU) in newborn screening and has been treated with a low phenylalanine diet and amino acid supplements. Each time an unexplained pronounced metabolic acidosis was noted, and the child was treated with sodium-bicarbonate and glucose-electrolyte infusions. Read More

    Long QT syndrome diagnosed in two sisters with propionic acidemia: a case report.
    J Pediatr Endocrinol Metab 2017 Aug 18. Epub 2017 Aug 18.
    .
    Propionic acidemia (PA) is a rare autosomal recessive metabolic disorder caused by deficiency of the mitochondrial enzyme propionyl-CoA carboxylase (PCC). This disorder mostly progresses with episodes of metabolic acidosis. Cardiomyopathy is among the cardiac complications known to occur during metabolic decompensation episodes. Read More

    Black Toenail Sign in MELAS Syndrome.
    Pediatr Neurol 2017 Jul 12. Epub 2017 Jul 12.
    Department of Neurology, Children's National Medical Center, Washington, District of Columbia.
    Background: Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a mitochondrial disorder often causing progressive brain injury that is not confined to large arterial territories. Severe insults ultimately lead to gyral necrosis affecting the cortex and juxtacortical white matter; the neuroimaging correlate is partial gyral signal suppression on T2/FLAIR sequences that resemble black toenails. We aimed to characterize the imaging features and the natural history of MELAS-related gyral necrosis. Read More

    Healthcare outcomes in undocumented immigrants undergoing two emergency dialysis approaches
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    Clin Nephrol 2017 Aug 17. Epub 2017 Aug 17.
    Background: Current estimates suggest 6,500 undocumented end-stage renal disease (ESRD) patients in the United States are ineligible for scheduled hemodialysis and require emergent dialysis. In order to remain in compliance with Emergency Medicaid, an academic health center altered its emergency dialysis criteria from those emphasizing interdialytic interval to a set emphasizing numerical thresholds. We report the impact of this administrative change on the biochemical parameters, utilization, and adverse outcomes in an undocumented patient cohort. Read More

    Microbial community composition along the digestive tract in forage- and grain-fed bison.
    BMC Vet Res 2017 Aug 17;13(1):253. Epub 2017 Aug 17.
    Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, Ramaley N122, Campus Box 334, Boulder, Colorado, 80309-0334, USA.
    Background: Diversity and composition of microbial communities was compared across the 13 major sections of the digestive tract (esophagus, reticulum, rumen, omasum, abomasum, duodenum, jejunum, ileum, cecum, ascending colon, transverse colon, descending colon, and rectum) in two captive populations of American bison (Bison bison), one of which was finished on forage, the other on grain.

    Results: Microbial diversity fell to its lowest levels in the small intestine, with Bacteroidetes reaching their lowest relative abundance in that region, while Firmicutes and Euryarchaeota attained their highest relative abundances there. Gammaproteobacteria were most abundant in the esophagus, small intestine, and colon. Read More

    Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea.
    PLoS One 2017 17;12(8):e0182938. Epub 2017 Aug 17.
    College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, United States of America.
    Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. Read More

    The Liver Circadian Clock Modulates Biochemical and Physiological Responses to Metformin.
    J Biol Rhythms 2017 Aug 15;32(4):345-358. Epub 2017 Jun 15.
    Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA.
    Metformin is widely used in the treatment of type 2 diabetes to lower blood glucose. Although metformin is a relatively safe and effective drug, its clinical efficacy is variable and under certain circumstances it may contribute to life-threatening lactic acidosis. Thus, additional understanding of metformin pharmacokinetics and pharmacodynamics could provide important information regarding therapeutic use of this widely prescribed drug. Read More

    Change of plasmalogen content of red blood cells in myocardial hypoxia and acidosis.
    Acta Cardiol 2017 Aug 17:1-8. Epub 2017 Aug 17.
    a Central Educational and Research Laboratory , Mogilev State A. Kuleshov University , Mogilev , Belarus.
    Background: The contribution of hypoxic conditions to the chemical composition of membranes is not completely established. Plasmalogens, containing an alkenyl group with aldehydogenic ether linkage, are significant components of membrane lipids and their level can change in oxygen deficiency.

    Methods: Analysis of plasmalogens in red blood cells was performed in patients (n = 17) with coronary heart disease, stable angina (functional class II-III) and coronary atherosclerosis. Read More

    Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers.
    Clin Toxicol (Phila) 2017 Aug 16:1-5. Epub 2017 Aug 16.
    f Louisiana Poison Center , Shreveport , LA , USA.
    Background: SGLT2 inhibitors are a new class of oral antidiabetics prescribed in the United States since 2013. They act by inhibiting reabsorption of glucose in the proximal convoluted tubule of the kidney, allowing excess glucose to be excreted. Little has been reported regarding effects of non-therapeutic exposure to this class of medication. Read More

    Successful Resuscitation of a Patient with Life-Threatening Metabolic Acidosis by Hemodialysis: A Case of Ethylene Glycol Intoxication.
    Case Rep Nephrol 2017 25;2017:9529028. Epub 2017 Jul 25.
    Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
    Background: Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Read More

    Importance of Distinguishing Between Mitochondrial Encephalomyopathy With Elderly Onset of Stroke-Like Episodes and Cerebral Infarction.
    J Clin Med Res 2017 Sep 27;9(9):812-819. Epub 2017 Jul 27.
    Department of Neurology, Hospital of International University of Health and Welfare, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
    The most common disease-causing mitochondrial DNA (mtDNA) mutation in mitochondrial encephalomyopathy (ME) with lactic acidosis and stroke-like episodes (MELAS) is m.3243A>G. In the future, the incidence of patients with cerebral infarction and diabetes mellitus is expected to increase tremendously. Read More

    Combined Respiratory Chain Deficiency and UQCC2 Mutations in Neonatal Encephalomyopathy: Defective Supercomplex Assembly in Complex III Deficiencies.
    Oxid Med Cell Longev 2017 19;2017:7202589. Epub 2017 Jul 19.
    Department of Pediatrics, Salzburger Landeskliniken (SALK) and Paracelsus Medical University (PMU), 5020 Salzburg, Austria.
    Vertebrate respiratory chain complex III consists of eleven subunits. Mutations in five subunits either mitochondrial (MT-CYB) or nuclear (CYC1, UQCRC2, UQCRB, and UQCRQ) encoded have been reported. Defects in five further factors for assembly (TTC19, UQCC2, and UQCC3) or iron-sulphur cluster loading (BCS1L and LYRM7) cause complex III deficiency. Read More

    Acute regulated expression of pendrin in human urinary exosomes.
    Pflugers Arch 2017 Aug 12. Epub 2017 Aug 12.
    Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.
    It is well known that pendrin, an apical Cl(-)/HCO3(-)exchanger in type B intercalated cells, is modulated by chronic acid-base disturbances and electrolyte intake. To study this adaptation further at the acute level, we analyzed urinary exosomes from individuals subjected to oral acute acid, alkali, and NaCl loading. Acute oral NH4Cl loading (n = 8) elicited systemic acidemia with a drop in urinary pH and an increase in urinary NH4 excretion. Read More

    Intraoperative ventilation during thoracoscopic repair of neonatal congenital diaphragmatic hernia.
    Pediatr Surg Int 2017 Aug 12. Epub 2017 Aug 12.
    Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
    Purpose: To evaluate the optimal ventilation mode during thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH), we compared high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV).

    Methods: Twenty-three neonatal CDH cases who underwent TR without intraoperative inhalation of nitric oxide at our institution between 2007 and 2016 were reviewed. Patients were initially ventilated with HFOV, which was converted to CMV if the HFOV settings were decreased to FiO2 <0. Read More

    Uses and misuses of sodium bicarbonate in the neonatal intensive care unit.
    Semin Fetal Neonatal Med 2017 Aug 8. Epub 2017 Aug 8.
    Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address:
    Over the past several decades, bicarbonate therapy continues to be used routinely in the treatment of acute metabolic acidosis in critically ill neonates despite the lack of evidence for its effectiveness in the treatment of acid-base imbalance, and evidence indicating that it may be detrimental. Clinicians often feel compelled to use bicarbonate since acidosis implies a need for such therapy and thus the justification for its use is based on hearsay rather than science. This review summarizes the evidence and refutes the clinical practice of administering sodium bicarbonate to treat metabolic acidosis associated with several specific clinical syndromes in neonates. Read More

    Practical approach to the patient with acute neuromuscular weakness.
    World J Clin Cases 2017 Jul;5(7):270-279
    Rajeev Nayak, Department of Neurology, Jabalpur Hospital and Research Centre, Jabalpur 482002, Madhyapradesh, India.
    Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Read More

    The proton-sensing G protein-coupled receptor T-cell death-associated gene 8 (TDAG8) shows cardioprotective effects against myocardial infarction.
    Sci Rep 2017 Aug 10;7(1):7812. Epub 2017 Aug 10.
    Department of Pharmacology and Toxicology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
    Myocardial infarction (MI) is an ischaemic heart condition caused by the occlusion of coronary arteries. Following MI, lactic acid from anaerobic glycolysis increases and infiltrating immune cells produce severe inflammation, which leads to acidosis in the ischaemic heart. However, the physiological implication of this pH reduction remains largely unknown. Read More

    Quantification of paracetamol and 5-oxoproline in serum by capillary electrophoresis: Implication for clinical toxicology.
    J Pharm Biomed Anal 2017 Jul 26;145:616-620. Epub 2017 Jul 26.
    Charles University and General University Hospital, First Faculty of Medicine, Institute of Forensic Medicine and Toxicology, Ke Karlovu 2, 121 08, Prague 2, Czech Republic; Charles University, Faculty of Science, Department of Analytical Chemistry, Albertov 6, 128 43, Prague 2, Czech Republic. Electronic address:
    High anion gap metabolic acidosis frequently complicates acute paracetamol overdose and is generally attributed to lactic acidosis or compromised hepatic function. However, metabolic acidosis can also be caused by organic acid 5-oxoproline (pyroglutamic acid). Paracetamol's toxic intermediate, N-acetyl-p-benzoquinoneimine irreversibly binds to glutathione and its depletion leads to subsequent disruption of the gamma glutamyl cycle and an excessive 5-oxoproline generation. Read More

    Hyperosmolar metabolic acidosis in burn patients exposed to glycol based topical antimicrobials-A systematic review.
    Burns 2017 Aug 7. Epub 2017 Aug 7.
    The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
    Background: The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Read More

    Effect of sodium bicarbonate on prolonged running performance: A randomized, double-blind, cross-over study.
    PLoS One 2017 10;12(8):e0182158. Epub 2017 Aug 10.
    Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany.
    Background: The ability to sustain intense exercise seems to be partially limited by the body's capability to counteract decreases in both intra- and extracellular pH. While the influence of an enhanced buffering capacity via sodium bicarbonate (BICA) on short-term, high-intensity exercise performance has been repeatedly investigated, studies on prolonged endurance performances are comparatively rare, especially for running. The aim of the following study was to assess the ergogenic effects of an oral BICA substitution upon exhaustive intensive endurance running performance. Read More

    Synthetic cannabinoid induced acute respiratory depression: Case series and literature review.
    Respir Med Case Rep 2017 29;22:137-141. Epub 2017 Jul 29.
    Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, New York City Health+Hospitals Harlem, Columbia University College of Physicians and Surgeons, New York, NY, USA.
    Synthetic Cannabinoids are a street drug that is widely attainable and cheap compared to natural cannabis, and has variable potency and unpredictable effects with no commercially available diagnostic test to confirm its presence. Similar to natural cannabis, Synthetic Cannabinoid intoxication can present in several ways with the most common emergency room presentations to be of neurologic and psychiatric manifestation. The respiratory depressive effect of Synthetic Cannabinoids has not been well documented in medical literature. Read More

    A case series on simultaneous liver and kidney transplantation: do we need intraoperative renal replacement therapy?
    Korean J Anesthesiol 2017 Aug 21;70(4):467-476. Epub 2017 Apr 21.
    Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea.
    Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Read More

    Tubulointerstitial Nephritis with IgM-Positive Plasma Cells.
    J Am Soc Nephrol 2017 Aug 9. Epub 2017 Aug 9.
    Departments of Nephrology.
    Infiltration by IgG-positive plasma cells is a common finding in tubulointerstitial nephritis. Indeed, it has been thought that CD138-positive mature plasma cells secrete mainly IgG, and the occurrence of tubulointerstitial nephritis with CD138-positive plasma cells secreting IgM has rarely been reported. Routine immunofluorescence of fresh frozen sections is considered the gold standard for detection of immune deposits. Read More

    Oral pyridoxine can substitute for intravenous pyridoxine in managing patients with severe poisoning with isoniazid and rifampicin fixed dose combination tablets: a case report.
    BMC Res Notes 2017 Aug 8;10(1):370. Epub 2017 Aug 8.
    University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
    Background: Fixed drug combination of isoniazid and rifampicin is a rare cause of poisoning even in endemic countries for tuberculosis infection. Severe poisoning can cause severe morbidity and mortality if not treated promptly. Though intravenous pyridoxine is the preferred antidote for severe standard isoniazid poisoning it is not freely available even in best of care centers. Read More

    Uremic encephalopathy with isolated brainstem involvement revealed by magnetic resonance image: a case report.
    BMC Neurol 2017 Aug 8;17(1):154. Epub 2017 Aug 8.
    Department of Neurology, The Second Hospital of Hebei Medical University, Hebei, Shijiazhuang, 050000, People's Republic of China.
    Background: Uremic Encephalopathy (UE) is a neurological complication associated with acute or chronic renal failure. Imaging findings of UE may present involvement of the basal ganglia, cortical or subcortical regions, and white matter. We report a rare case of UE caused by neurogenic bladder with isolated brainstem involvement revealed by magnetic resonance imaging (MRI). Read More

    [Approaches to pre-hospital bleeding management : Current overview on civilian emergency medicine].
    Anaesthesist 2017 Aug 7. Epub 2017 Aug 7.
    Klinik für Anästhesiologie & Intensivmedizin, Bundeswehrkrankenhaus, Ulm, Deutschland.
    Severe bleeding is a typical result of traumatic injuries. Hemorrhage is responsible for almost 50% of deaths within the first 6 h after trauma. Appropriate bleeding control and coagulation therapy depends on an integrated concept of local hemostasis by primary pressure with the hands, compression, and tourniquets accompanied by prevention of hypothermia, acidosis and hypocalcemia. Read More

    Status Epilepticus due to Intraperitoneal Injection of Vehicle Containing Propylene Glycol in Sprague Dawley Rats.
    Vet Med Int 2017 12;2017:1757059. Epub 2017 Jul 12.
    Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, 151 W/APT, Cleveland, OH 44106, USA.
    Published reports of status epilepticus due to intraperitoneal injection containing propylene glycol in rats are sparse. In fact, there are no reports specifying a maximum safe dose of propylene glycol through intraperitoneal administration. We report here a case of unexpected seizures in Sprague Dawley rats after receiving an intraperitoneal injection containing propylene glycol. Read More

    Experimental Models to Study the Neuroprotection of Acidic Postconditioning Against Cerebral Ischemia.
    J Vis Exp 2017 Jul 31(125). Epub 2017 Jul 31.
    Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Department of Pharmacology, Key Laboratory of Medical Neurobiology of The Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, Zhejiang University;
    Stroke is one of the leading causes of mortality and disability worldwide, with limited therapeutic approaches. As an endogenous strategy for neuroprotection, postconditioning treatments have proven to be promising therapies against cerebral ischemia. However, complicated procedures and potential safety issues limit their clinical application. Read More

    Enhanced maximal exercise capacity, vasodilation to electrical muscle contraction, and hind limb vascular density in ASIC1a null mice.
    Physiol Rep 2017 Aug;5(15)
    Department of Physiology and Biophysics and the Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, Mississippi.
    Acid-sensing ion channel (ASIC) proteins form extracellular proton-gated, cation-selective channels in neurons and vascular smooth muscle cells and are proposed to act as extracellular proton sensors. However, their importance to vascular responses under conditions associated with extracellular acidosis, such as strenuous exercise, is unclear. Therefore, the purpose of this study was to determine if one ASIC protein, ASIC1a, contributes to extracellular proton-gated vascular responses and exercise tolerance. Read More

    Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome.
    J Matern Fetal Neonatal Med 2017 Aug 17:1-6. Epub 2017 Aug 17.
    b Department of Obstetrics and Gynecology , Clinicum Aschaffenburg, Teaching Hospital of University of Würzburg , Germany.
    Objective: The objective of this study is to assess retrospectively the predictive value of fetal scalp pH and base excess (BE) for fetal acidosis and poor neonatal outcome in term, low-risk, spontaneous deliveries with suspicious or pathological intrapartum cardiotocography (CTG) tracings.

    Methods: Umbilical artery pH and BE values obtained immediately after delivery and Apgar score were the outcomes under consideration. Statistics included receiver-operating characteristic curve (ROC) and multiple logistic regression analysis. Read More

    Metabolic acidosis caused by concomitant use of paracetamol (acetaminophen) and flucloxacillin? A case report and a retrospective study.
    Eur J Clin Pharmacol 2017 Aug 7. Epub 2017 Aug 7.
    Department of Hospital Pharmacy, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
    Purpose: A patient was identified with severe metabolic acidosis, a high anion gap and 5-oxoproline accumulation, probably caused by the simultaneous use of paracetamol (acetaminophen) and flucloxacillin. We wanted to investigate the necessity to control the interaction between both drugs with an automatic alert system.

    Methods: To investigate the relevance of the interaction of paracetamol and flucloxacillin, a retrospective study was conducted. Read More

    Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study.
    Pediatr Neonatol 2017 Jul 20. Epub 2017 Jul 20.
    Department of Pediatrics, MacKay Children's Hospital, Taipei 10449, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan. Electronic address:
    Background: Patent ductus arteriosus (PDA) is one of the most common cardiac conditions in preterm infants. Closure of the PDA in symptomatic patients can be achieved medically or surgically. Atropine is commonly administered in general anesthesia as a premedication in this age group but with limited evidence addressing the effect of its use. Read More

    Severe pulmonary edema following hyperbaric oxygen therapy for acute carbon monoxide poisoning: a case report and clinical experience.
    Undersea Hyperb Med 2017 May-Jun;44(3):287-291
    Department of Hyperbaric Oxygen, Navy General Hospital, PR China.
    Purpose: Pulmonary edema following hyperbaric oxygen (HBO₂) therapy is a rare clinical phenomenon. This case report describes such a patient - a 56-year-old woman who suffered from severe pulmonary edema after HBO₂ therapy for carbon monoxide (CO) poisoning.

    Case: Patient experienced ecphysesis and dyspnea suddenly after HBO₂ therapy (100% oxygen at 0. Read More

    Novel mutations in SERAC1 gene in two Indian patients presenting with dystonia and intellectual disability.
    Eur J Med Genet 2017 Aug 1. Epub 2017 Aug 1.
    Paediatric Neurologist, Rainbow Children Hospital, Hyderabad, 500082, India.
    In this study we present the first two cases from India of a rare inborn error of metabolism manifesting as dystonia and 3-methylglutaconic aciduria and a Leigh like lesions in the brain MRI associated with SERAC1 gene mutation, a phenotype characteristic of MEGDEL syndrome. A four base pair duplication in exon 15 i.e. Read More

    [ABCC8 gene analysis, treatment and follow-up of an infant with neonatal diabetes mellitus].
    Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2017 Aug;34(4):571-575
    Department of Endocrionology, Fuzhou Children's Hospital of Fujian, Fujian Medical University Teaching Hospital, Fuzhou 350005, Fujian, China.
    Objective: To analyze the clinical characteristics of an infant with neonatal diabetes mellitus (NDM) and to sequence the ABCC8 gene of this family in order to provide a theoretical basis for the diagnosis and treatment.

    Methods: The clinical data of the patient was collected, and the proband and his direct relatives within three generations were sequenced.

    Results: The patient was 1-month-old, random blood glucose was more than 27. Read More

    Metformin: historical overview.
    Diabetologia 2017 Aug 3. Epub 2017 Aug 3.
    School of Life and Health Sciences, Aston University, Gosta Green, Birmingham, B4 7ET, UK.
    Metformin (dimethylbiguanide) has become the preferred first-line oral blood glucose-lowering agent to manage type 2 diabetes. Its history is linked to Galega officinalis (also known as goat's rue), a traditional herbal medicine in Europe, found to be rich in guanidine, which, in 1918, was shown to lower blood glucose. Guanidine derivatives, including metformin, were synthesised and some (not metformin) were used to treat diabetes in the 1920s and 1930s but were discontinued due to toxicity and the increased availability of insulin. Read More

    Diabetic ketoacidosis in a postoperative gastric bypass patient.
    J Surg Case Rep 2017 Jul 28;2017(7):rjx148. Epub 2017 Jul 28.
    Northwest Nephrology Clinic, 5255 Snapfinger Park Drive #110, Decatur, GA, Georgia.
    We report a case of postoperative life threatening metabolic acidosis in a young Type-2 diabetic woman who had no history of diabetic ketoacidosis. The patient underwent a non-complicated laparoscopic Roux-en-Y gastric bypass 6 days earlier. We discuss her clinical features, pathogenesis, management and outcome. Read More

    Furosemide/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers.
    Clin J Am Soc Nephrol 2017 Aug 3. Epub 2017 Aug 3.
    Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;
    Background And Objectives: Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. Read More

    Thrombotic microangiopathy associated with Valproic acid toxicity.
    BMC Nephrol 2017 Aug 3;18(1):262. Epub 2017 Aug 3.
    Department of Pediatrics, Division of Nephrology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Children's Memorial Hermann Hospital, 6431 Fannin Street, MSB 3. 121, Houston, TX, USA.
    Background: Thrombotic microangiopathy (TMA) is a serious, sometimes life-threatening disorder marked by the presence of endothelial injury and microvascular thrombi. Drug-induced thrombotic microangiopathy (DI-TMA) is one specific TMA syndrome that occurs following drug exposure via drug-dependent antibodies or direct tissue toxicity. Common examples include calcineurin inhibitors Tacrolimus and Cyclosporine and antineoplastics Gemcitabine and Mitomycin. Read More

    Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis.
    Intensive Care Med Exp 2017 Dec 1;5(1):34. Epub 2017 Aug 1.
    Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, D-51109, Cologne, Germany.
    Background: Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1. Read More

    Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit.
    Korean Circ J 2017 Jul 27;47(4):490-500. Epub 2017 Jul 27.
    Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
    Background And Objectives: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality.

    Subjects And Methods: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Read More

    Expanding the differential: toluene-induced toxicity.
    BMJ Case Rep 2017 Aug 1;2017. Epub 2017 Aug 1.
    Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
    A 31-year-old woman presented to the hospital with generalised weakness and lower back and abdominal pain. The only significant finding on physical examination was the weakness of the legs. Laboratory analysis in the emergency department revealed that she was hypokalaemic with metabolic acidosis. Read More

    Minding the Gap: Utility of the Anion Gap in the Differential Diagnosis of Metabolic Acidosis.
    Neonatal Netw 2017 Jul;36(4):229-232
    The anion gap, in conjunction with other laboratory results, can be a useful clue in the differential diagnosis of metabolic acidosis. There are three primary causes of metabolic acidosis: loss of base, decreased renal excretion of acid, and increased acid production. Depending on the cause of metabolic acidosis, the anion gap may be elevated or normal. Read More

    Migraine in mitochondrial disorders: Prevalence and characteristics.
    Cephalalgia 2017 Jan 1:333102417723568. Epub 2017 Jan 1.
    1 Unità di Neurofisiopatologia, Area Neuroscienze, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
    Background Migraine is a well-known feature of mitochondrial disorders (MDs). However, no systematic epidemiological data are available in large populations of patients. Aims The aim of this cross-sectional cohort study was to describe the prevalence and migraine characteristics in a large cohort of patients with mitochondrial encephalomyopathies. Read More

    [The Retroperitoneal space].
    G Ital Nefrol 2017 Aug 1;34(4):72-82. Epub 2017 Aug 1.
    Struttura Complessa di Nefrologia e Dialisi, Ospedale DiVenere, Bari.
    We describe the case of a 45-year-old woman with a clinical history of breast cancer presenting with anuric renal failure, metabolic acidosis and bilateral grade 2-3 hydronephrosis. Following insertion of bilateral ureteral stents, urinary output was 5000 ml in the subsequent 24 hours with frankly bloody urine, after which anuria recurred. A new ultrasound examination showed hydronephrotic kidneys with properly positioned stents, a distended bladder free of clots and a hypo-anechoic, well-demarcated mass enveloping the aorta. Read More

    Comparison of warm fluid and cold fluid resuscitation during uncontrolled hemorrhagic shock model in rats.
    Ulus Travma Acil Cerrahi Derg 2017 Jul;23(4):287-293
    Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
    Background: This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats.

    Methods: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14. Read More

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