High doses of dextromethorphan induced shock and convulsions in a 19-year-old female:A case report

BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there are numerous instances of mild symptoms,with only a limited number of reports of severe cases necessitating intensive care.We presented the case of a female who ingested 111 tablets of dextromethorphan,leading to shock and convulsions and requiring intensive care that ultimately saved her life.CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance,having overdosed on 111 tablets of dextromethorphan(15 mg)obtained through an online importer in a suicide attempt.The patient had a history of drug abuse and multiple self-inflicted injuries.At the time of admission,she exhibited symptoms of shock and altered consciousness.However,upon arrival at the hospital,the patient experienced recurrent generalized clonic convulsions and status epilepticus,necessitating tracheal intubation.The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock,and noradrenaline was administered as a vasopressor.Gastric lavage and activated charcoal were also administered after intubation.Through systemic management in the intensive care unit,the patient’s condition stabilized,and the need for vasopressors ceased.The patient regained consciousness and was extubated.The patient was subsequently transferred to a psychiatric facility,as suicidal ideation persisted.CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.

Angiotensin receptor blocker neprilysin inhibitors

Heart failure(HF)is a clinical syndrome that results from a structural or functional cardiac disorder that reduces the ability of the ventricle of the heart to fill with,or eject,blood.It is a multifaceted clinical condition that affects up to 2%of the population in the developed world,and is linked to significant morbidity and mortality;it is therefore considered a major concern for public health.Regarding the mechanism of HF,three neurohumoral factors-the reninangiotensin-aldosterone system,the sympathetic nervous system,and natriuretic peptides—are related to the pathology of chronic HF(CHF),and the targets of treatment.Angiotensin receptor blocker and neprilysin inhibitor(angiotensinreceptor neprilysin inhibitor),namely sacubitril/valsartan(SAC/VAL),has been introduced as a treatment for CHF.SAC/VAL is an efficacious,safe,and costeffective therapy that improves quality of life and longevity in patients with HF with reduced ejection fraction(HFrEF),and reduces hospital admissions.An inhospital initiation strategy offers a potential new avenue to improve the clinical uptake of SAC/VAL.In the last five years,SAC/VAL has been established as a cornerstone component of comprehensive disease-modifying medical therapy in the management of chronic HFrEF.On the other hand,further work,with carefully designed and controlled preclinical studies,is necessary for understanding the molecular mechanisms,effects,and confirmation of issues such as long-term safety in both human and animal models.

Exophiala dermatitidis

Exophiala is a genus comprising several species of opportunistic black yeasts,which belongs to Ascomycotina.It is a rare cause of fungal infections.However,infections are often chronic and recalcitrant,and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people,detailed knowledge remains scarce regarding infection mechanisms,virulence factors,specific predisposing factors,risk factors,and host response.The most common manifestations of Exophiala infection are skin infections,and the most frequent type of deep infection is pulmonary infection due to inhalation.The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs.The final identification of the causative organism should be achieved through a combination of several methods,including the newly introduced diagnostic analysis,matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry,together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi,and histological and culture findings.Regarding treatment,because anti-infective agents and natural compounds exhibited poor antibiofilm activity,few treatments have ultimately been found to be effective for specific antifungal therapy,so the optimal antifungal therapy and duration of therapy for these infections remain unknown.Therefore,most forms of disease caused by Exophiala dermatitidis require aggressive combination therapies:Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.

Diffuse large B cell lymphoma originating from the maxillary sinus with skin metastases:A case report and review of literature

BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is the most common type of malignant lymphoma(ML),accounting for 30%-40%of cases of non-Hodgkin’s lymphoma(NHL)in adults.Primary paranasal sinus lymphoma is a rare presentation of extranodal NHL that accounts for only 0.17%of all lymphomas.ML from the maxillary sinus(MS)is a particularly rare presentation,and is thus often difficult to diagnose.We have reported the first known case of DLBCL originating from the MS with rapidly occurrent multiple skin metastasis.CASE SUMMARY An 81-year-old Japanese man visited our hospital due to continuous pain for 12 d in the left maxillary nerve area.His medical history included splenectomy due to a traffic injury,an old right cerebral infarction from when he was 74-years-old,hypertension,and type 2 diabetes mellitus.A plain head computed tomography(CT)scan revealed a 3 cm×3.1 cm×3 cm sized left MS.On day 25,left diplopia and ptosis occurred,and a follow-up CT on day 31 revealed the growth of the left MS mass.Based on an MS biopsy on day 50,we established a definitive diagnosis of DLBCL,non-germinal center B-cell-like originating from the left MS.The patient was admitted on day 62 due to rapid deterioration of his condition,and a plain CT scan revealed the further growth of the left MS mass,as well as multiple systemic metastasis,including of the skin.A skin biopsy on day 70 was found to be the same as that of the left MS mass.We notified the patient and his family of the disease,and they opted for palliative care,considering on his condition and age.The patient died on day 80.CONCLUSION This case suggests the need for careful,detailed examination,and for careful follow-up,when encountering patients presenting with a mass.