BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by nati...BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by natives of Southeast Asia for centuries.The substance has been used for its stimulant activity at low doses,and as an opium substitute at higher doses due to a morphine like effect.CASE SUMMARY A 37-year-old female with a history of depression and obesity(body mass index:32)presented to emergency room with a week-long history of nausea,decreased appetite,fatigue,and two days of jaundice.On admission bilirubin was markedly elevated.Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms.Liver biopsy showed changes mimicking primary biliary cholangitis.Patient’s symptoms and jaundice improved quickly.CONCLUSION The use of Kratom has been on the rise in recent years across the United States and Europe.Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness.Only a few case reports have highlighted the hepatotoxic effects of Kratom.Even fewer reports exist describing the detailed histopathological changes.展开更多
Chronic infammation and nutritional imbalance are impor-tant comorbid conditions that correlate with poor clinical outcomes in children with chronic kidney disease （CKD）. Nutritional disorders such as cachexia/prote...Chronic infammation and nutritional imbalance are impor-tant comorbid conditions that correlate with poor clinical outcomes in children with chronic kidney disease （CKD）. Nutritional disorders such as cachexia/protein energy wasting, obesity and growth retardation negatively impact the quality of life and disease progression in children with CKD. Inadequate nutrition has been asso-ciated with growth disturbances in children with CKD. On the other hand, over-nutrition and obesity are associated with poor outcomes in children with CKD. The exact mechanisms leading to these unfavorable conditions are not fully elucidated and are most likely multifactorial. In this review, we focus on the pathophysiology of nutrition disorders and infammation and their impact on clinical outcomes in children with CKD.展开更多
Antibiotic-impregnated ventricular shunt catheters(AIVSCs)with 0.15%clindamycin and 0.054%rifampin are commonly used to prevent ventriculo-peritoneal(VP)shunt infections.Initially approved by the United States Food an...Antibiotic-impregnated ventricular shunt catheters(AIVSCs)with 0.15%clindamycin and 0.054%rifampin are commonly used to prevent ventriculo-peritoneal(VP)shunt infections.Initially approved by the United States Food and Drug Administration in 2003(https://www.integralife.com/file/general/1561404015.pdf),they have antimicrobial activity documented for minimum 31 days(https://www.accessdata.fda.gov/cdrh_docs/pdf11/K110560.pdf).These antibiotics were chosen as they cover the majority of Staphylococcus aureus and may provide some activity against coagulase negative staphylococci.1 These normal skin flora account for the majority of VP shunt infections.In the largest randomized controlled trial(RCT)to date,AIVSCs significantly reduced the risk of infection compared with standard shunts(cause-specific hazard ratio(HR)0.38).2 This effect was mainly due to a reduction in staphylococcal infections;the number of gram-negative infections was similar in both groups.Observational studies3–5 and a meta-analysis6 in children support the findings of this RCT.The objective of this study was to examine the spectrum of pathogens,time to infection,and outcomes with AIVSCs vs standard shunts.展开更多
文摘BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by natives of Southeast Asia for centuries.The substance has been used for its stimulant activity at low doses,and as an opium substitute at higher doses due to a morphine like effect.CASE SUMMARY A 37-year-old female with a history of depression and obesity(body mass index:32)presented to emergency room with a week-long history of nausea,decreased appetite,fatigue,and two days of jaundice.On admission bilirubin was markedly elevated.Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms.Liver biopsy showed changes mimicking primary biliary cholangitis.Patient’s symptoms and jaundice improved quickly.CONCLUSION The use of Kratom has been on the rise in recent years across the United States and Europe.Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness.Only a few case reports have highlighted the hepatotoxic effects of Kratom.Even fewer reports exist describing the detailed histopathological changes.
基金Supported by The Capital Health Research and Development of Special Research Fund 2014-4-2102(to Juan Tu)
文摘Chronic infammation and nutritional imbalance are impor-tant comorbid conditions that correlate with poor clinical outcomes in children with chronic kidney disease （CKD）. Nutritional disorders such as cachexia/protein energy wasting, obesity and growth retardation negatively impact the quality of life and disease progression in children with CKD. Inadequate nutrition has been asso-ciated with growth disturbances in children with CKD. On the other hand, over-nutrition and obesity are associated with poor outcomes in children with CKD. The exact mechanisms leading to these unfavorable conditions are not fully elucidated and are most likely multifactorial. In this review, we focus on the pathophysiology of nutrition disorders and infammation and their impact on clinical outcomes in children with CKD.
文摘Antibiotic-impregnated ventricular shunt catheters(AIVSCs)with 0.15%clindamycin and 0.054%rifampin are commonly used to prevent ventriculo-peritoneal(VP)shunt infections.Initially approved by the United States Food and Drug Administration in 2003(https://www.integralife.com/file/general/1561404015.pdf),they have antimicrobial activity documented for minimum 31 days(https://www.accessdata.fda.gov/cdrh_docs/pdf11/K110560.pdf).These antibiotics were chosen as they cover the majority of Staphylococcus aureus and may provide some activity against coagulase negative staphylococci.1 These normal skin flora account for the majority of VP shunt infections.In the largest randomized controlled trial(RCT)to date,AIVSCs significantly reduced the risk of infection compared with standard shunts(cause-specific hazard ratio(HR)0.38).2 This effect was mainly due to a reduction in staphylococcal infections;the number of gram-negative infections was similar in both groups.Observational studies3–5 and a meta-analysis6 in children support the findings of this RCT.The objective of this study was to examine the spectrum of pathogens,time to infection,and outcomes with AIVSCs vs standard shunts.
