Exacerbation of demyelinating syndrome after exposure to wireless modem with public hotspot

ABSTRACT

In August 2003, 48-year-old JS of Colorado, USA, a fitness therapist and sports nutritionist, contracted neuroinvasive West Nile virus which left her with disabilities due to spinal axonal damage.In August 2014, she suddenly developed symptoms very much like her acute West Nile infection 11 years ago, including focal seizures, ataxia, vertigo and headaches. Her blood count looked normal so there was no obvious infection. What struck her as odd was that when she left her apartment for any length of time, the symptoms stopped. She found out that a new type of wireless modem, enabled for both personal use and functioning as a public hotspot designed to reach up to 100 m, had been installed in the flat under hers.Her neighbor replaced the modem with a router without the hotspot feature. After that, the seizures stopped immediately, and the other symptoms faded gradually, after which she was fine and again could sleep well. Later, when another activated hotspot was installed in an adjacent flat, JS once again noticed symptoms.A possible association between electrohypersensitivity, myelin integrity and exposure to low-intensity radiofrequency electromagnetic ?elds (RF-EMF) typical in the modern world has recently been proposed. Since the West Nile virus attacks both the nerve cells and the glial ones, one explanation to the above observed case effects is that the initial virus attack and the wireless modem’s RF-EMF affect the nervous system through the very same, or similar, avenues, and maybe both via the oligodendrocytes.     

Identifying and managing adverse environmental health effects: 1. Taking an exposure history

PUBLIC CONCERN AND AWARENESS ARE GROWING about adverse health effects of exposure to environmental contaminants. Frequently patients present to their physicians with questions or concerns about exposures to such substances as lead, air pollutants and pesticides. Most primary care physicians lack training in and knowledge of the clinical recognition, management and avoidance of such exposures. We have found that it can be helpful to use the CH²OPD² mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) as a tool to identify a patient''s history of exposures to potentially toxic environmental contaminants. In this article we discuss why it is important to take a patient''s environmental exposure history, when and how to take the history, and how to interpret the findings. Possible routes of exposure and common sources of potentially toxic biological, physical and chemical substances are identified. A case of sick-building syndrome is used to illustrate the use of the mnemonic.CaseA 40-year-old married bookkeeper presents with a 3-year history of headaches. She describes having “tight,” bitemporal headaches almost daily that resolve after taking three 325-mg tablets of ASA. She also complains of a “spacey” feeling, difficulty concentrating and remembering, fatigue, a stuffy nose and a full feeling in her ears. Her symptoms improve on weekends and over the holidays and seem to be worse in the winter. Over the past 2 years she has noticed that she gets a stuffy nose and headaches when exposed to perfumes, tobacco smoke and automobile exhaust. Her past medical history is remarkable only for infantile eczema. Her family history is unremarkable other than her mother having hypothyroidism. She is taking no medications other than ASA, does not smoke, reports having no allergies and says she is happily married with no major family, financial or social concerns. She enjoys her work and coworkers. On physical examination she has puffy, dark circles under her eyes, there is loss of light reflex on her left ear drum, and her nasal mucosa appears edematous and erythematous. There are multiple excoriated, erythematous papules 5 mm in diameter on her face, anterior chest and anterior lower legs.Questions surrounding this case: What is sick-building syndrome and how do patients commonly present? What causes or contributes to sick-building syndrome? What are the risk factors? How should cases be managed?     

Life span in captive nocturnal prosimians (Perodicticus potto) with reproductive and mortality records

Three pottos survived captivity 4 to 19 years. The female that died recently was probably 21 years old at the time of her death since she was at least primiparous at the time of her capture in December 1959. During her captive lifetime she had given birth to three single individuals and one set of twins. Her mate is still alive and is believed to be at least 20 years old, having survived 19 years of captivity. Regular copulatory behavior was noted within one month of her death. These data suggest a somewhat longer life span for this species than had been previous recorded in the scientific literature.     

A case of dengue hemorrhagic fever in a Japanese child

A 6-year-old Japanese girl contracted a febrile illness with hemorrhagic manifestations when she traveled in Indonesia. A remarkable decrease in the numbers of platelets and white blood cells was observed in her acute-phase blood specimens. Her father, who accompanied her, showed dengue fever-like symptoms at almost the same time as her illness. It was determined by serological tests that they were infected with dengue virus type 1. Moreover, she showed a secondary antibody response to the flavivirus due to the pre-existing antibody to Japanese encephalitis virus. This is the first confirmed case of dengue hemorrhagic fever (DHF) in Japanese people.     

Anna Meyer and the distinction between grades and clades in early models of gastropod evolution

Abstract. Anna Meyer published her first (and apparently last) scientific paper in 1913, in which she reported, in part, on the organization of the renogenital systems in the "Diotocardia" and "Monotocardia," and the evolutionary signal present in this character suite. Meyer's phylogeny broke with conventional wisdom of her time and she reconstructed early gastropod evolution as a sequence of branching events rather than a continuous grade. Her phylogeny was ignored because it did not correspond to the well-ordered grades that came to dominate gastropod systematics for over 75 years, but her schematics of renogenital configurations have been featured in the literature for over 55 years, sometimes without citation and redrawn to show a different set of relationships. We hope that the translation of her paper from German into English ( http://www.ucmp.berkeley.edu/collections/archdat.html ) will make her contribution more accessible to workers.     

Self-directed EMG training for the control of pain and spasticity in paraplegia: a case study

A 25-year-old paraplegic woman was able to gain control of her debilitating leg and bladder spasms and abdominal pain using self-directed EMG biofeedback. The case is significant in that she previously had only cursory exposure to biofeedback as an undergraduate student and received only minimal support and direction from an instructor. She proceeded through daily home practice using a borrowed EMG unit and audiotapes from Lester Fehmi's Open Focus series. Records were kept of the frequency and intensity of her pain and spasms, as well as the frequency and procedures of her home practice. She also maintained a record of specific psychosocial events in her life, which, over time, showed a strong, consistent pattern of influence on the recurrence and severity of her symptoms. The woman's physician declared her medical progress remarkable and encouraged her biofeedback work. At 2-year follow-up, she remains virtually symptom- and medication-free. Her successful biofeedback training program provides support for the value of client-directed biofeedback in selected cases.     

Self-directed EMG training for the control of pain and spasticity in paraplegia: A case study

A 25-year-old paraplegic woman was able to gain control of her debilitating leg and bladder spasms and abdominal pain using self-directed EMG biofeedback. The case is significant in that she previously had only cursory exposure to biofeedback as an undergraduate student and received only minimal support and direction from an instructor. She proceeded through daily home practice using a borrowed EMG unit and audiotapes from Lester Fehmi'sOpen Focus series. Records were kept of the frequency and intensity of her pain and spasms, as well as the frequency and procedures of her home practice. She also maintained a record of specific psychosocial events in her life, which, over time, showed a strong, consistent pattern of influence on the recurrence and severity of her symptoms. The woman's physician declared her medical progress remarkable and encouraged her biofeedback work. At 2-year follow-up, she remains virtually symptom- and medication-free. Her successful biofeedback training program provides support for the value of client-directed biofeedback in selected cases.     

A case of giardiasis expressing severe systemic symptoms and marked hypereosinophilia

An 88-year-old Japanese woman was referred to our hospital due to a one-month history of face edema, aphagia, shortness of breath, and skin rush over almost her entire skin. She had no abdominal symptoms. Her peripheral blood count showed a white blood cell (WBC) count of 27.1 × 10⁹/L with 82.1% eosinophils. Serum non-specific Immunoglobulin E was within a normal range. Soluble interleukin-2 receptor was elevated to 4200 U/mL. At first, her eosinophil count was so high that we suspected she had an eosinophilic leukemia or hypereosinophilic syndrome. After admission, cysts of Giardia duodenalis (G. duodenalis) were detected in the patient's feces by microscopic analysis, then she was diagnosed with giardiasis, and 750 mg per day of metronidazole was administered for seven days. Her WBC count decreased to 6.0 × 10⁹/L with 10% eosinophils, and her systemic symptoms improved. At that time her serum IL-5 was within a normal range. A few months later, the patient again complained of skin rush, and G. duodenalis was once again found in her feces. Her serum IL-5 was elevated to 751 pg/mL. Metronidazole was administered for two weeks, and her eosinophil count decreased. G. duodenalis is a protozoan parasite, and it is one of the most common waterborne transmission gastrointestinal parasites in the world. G. duodenalis rarely causes hypereosinophilia. To our knowledge, this is the first case report of giardiasis with extreme hypereosinophilia and severe systemic symptoms.     

Danger of Hypoglycemia Due to Acute Tramadol Poisoning

ObjectiveTo report a case of prolonged hypoglycemia after acute tramadol poisoning.MethodsWe describe a patient’s clinical presentation and outcome with prolonged hypoglycemia attributable to acute tramadol poisoning. In addition, the possible mechanism for the hypoglycemia is discussed, and a brief review of the pertinent literature is presented.ResultsA 54-year-old woman had previously under- gone a partial hepatectomy because of involvement of her liver by a gastrointestinal stromal tumor. After ingestion of 3,000 mg of tramadol with suicidal intent, she developed prolonged hypoglycemia that necessitated treatment with continuous intravenous glucose infusion for 24 hours. Reports in the literature have described central nervous system depression, nausea, vomiting, tachycardia, seizures, and even death from tramadol overdoses.ConclusionThis report alerts clinicians to the potential danger of severe hypoglycemia in tramadol poisoning. (Endocr Pract. 2012;18:e151-e152)     

Methylmercury poisoning in Iraqi children: clinical observations over two years.

The clinical features of 49 children who had eaten bread contaminated with methylmercury in rural Iraq were reviewed. Symptoms and signs relating to the nervous system--varying degrees of ataxia, weakness, and visual and sensory changes--dominated the clinical picture. The severity of poisoning was related to the blood mercury concentration, as was the degree of recovery. Follow-up over two years showed that children who had had mild or moderate poisoning slowly but steadily improved, some of them recovering normal function, though all had a residual generalized hyperreflexia. In some patients ataxia and motor weakness disappeared. Visual changes also improved, though less completely, and of 17 blind children, only five had recovered partial sight by the end of two years. Seven of the 18 children who suffered very severe poisoning were left physically and mentally incapacitated. The degree of clinical progress shown by these children was better than that shown by some other groups of patients, possibly because the poisoning was relatively acute and mercury consumption was stopped immediately after its effects had become obvious.     

Type A-insulin resistance with lipopexia on extremities: a case report.

We present the unusual case of a 17-year-old female with insulin-resistant diabetes, acanthosis nigricans, hirsutism, amenorrhea, dental dysplasia and lipopexia on the extremities. She had been diagnosed as having border line diabetes with hyperinsulinemia at age 12 when she was not obese and diabetes mellitus at age 13. On admission, she was obese and had lipopexia only on the extremities. The presence of hyperinsulinemia and poor response to exogenous insulin suggested severe insulin resistance. Insulin binding to transformed B-lymphoblasts derived from her was extremely low compared to the normal control, showing decreased receptor affinity. Her parents and sister exhibited hypersecretion of insulin in response to a 75 g oral glucose tolerance test. Her mother was diabetic, and her father and sister had border line diabetes, whereas her brother had a normal response. These findings support strongly the diagnosis of a type A syndrome with severe insulin resistance associated with lipopexia on the extremities. A genetic defect in the insulin receptor gene may be responsible.     

Food consumption and growth of a female dusky dolphin (Lagenorhynchus obscurus)

Food consumption, body measurements, weight changes, and body temperatures of a female dusky dolphin are presented for the 13 years that she was at Sea World, Durban. Her annual food consumption increased from 1,870 kg at the age of 3 years to 2,170 kg when she was 5 years old. During her sixth year, her annual food intake increased to approximately 2,900 kg. This increase coincided with the installation of a cooling system that was used in the summer in the years thereafter. After her sixth year, her food consumption fluctuated between 2,400 and 2,800 kg per year. The dolphin's body weight increased gradually from approximately 52 kg at the age of 2 years to approximately 66 kg at the age of 6 years. Thereafter, her weight fluctuated between 61 and 74 kg. As body weight increased, daily food consumption as a percentage of body weight decreased. In general, her food intake was above average during autumn and winter, and below average during spring and summer. The average pool water temperature fluctuated seasonally. Gastrointestinal initial passage time was measured using carmine red dye. The median passage time was 150 minutes. The average rectal temperature was 36.9°C. Zoo Biol 19:131–142, 2000. © 2000 Wiley‐Liss, Inc.     

北京怀柔“4.23”急性可乐定中毒事件临床救治体会

本研究旨在观察群体性急性可乐定中毒的流行病学特点、临床表现及救治方法,尤其是评价血液灌流（hemoperfusion,HP）治疗急性可乐定中毒的有效性和安全性.通过对北京怀柔4.23急性可乐定中毒事件行流行病学调查,分析所有80例患者的所有流行病学资料,研究病情较重的34例患者的临床表现、治疗方案、预后情况.采用HA230树脂血液灌流器数次HP治疗前后血可乐定、尿可乐定浓度的变化,计算血可乐定浓度下降率,及与常规内科治疗相比HP的排毒效率.观察治疗前患者血压、心率及其他实验室指标如血小板、心肌酶谱、肝酶谱的变化并评价疗效及副作用.研究发现急性可乐定中毒具有隐蔽性强,发病潜伏期短,症状重等特点,HP治疗可显著降低血可乐定水平,短暂升高尿可乐定水平.患者临床症状亦显著改善,血可乐定的下降率为（81±12）%,所有患者经间断HP治疗1～3次后血、尿可乐定水平接近正常.随着患者血可乐定浓度渐趋正常,其临床症状及实验室指标亦能明显改善,短期HP治疗无明显副作用,随访观察半月余,未观察到后遗症.群体性可乐定中毒常常具有危害人群广,症状重风险大,诊治难度大的特点,重者致人死亡,或者造成社会极大恐慌.研究群体性可乐定中毒有浓厚的军事医学意义,HP是治疗可乐定中毒安全有效的治疗手段.     

Effects of hGRF treatment of a patient with hGRF deficiency

A 12-year old girl was admitted to our hospital for evaluation of her short stature. Her height was below -3.5 SD of the mean height for her age. She was diagnosed as having craniopharyngioma and treated surgically. Thereafter she was treated with thyroxine and hydrocortisone. One and a half years later, she revisited our hospital for treatment of short stature. Her plasma GH did not respond to insulin-induced hypoglycemia but increased after hGRF-44 administration, indicating hGRF deficiency. hGRF was therefore administered at a dosage of 100 micrograms twice a day subcutaneously for three months. Her height increased 1.6 cm during treatment, which corresponded to a height increase of 6.4 cm/year. These findings indicate that hGRF treatment stimulates height increase in patients with GRF deficiency. For complete evaluation of hGRF therapy, further studies will be required.     

Severe self-mutilation of hands in a nonpsychotic, nonretarded patient

A case report of a young female teenager with a long history of self-destruction of her hands by chewing, scratching, and gnawing is presented. This habit was related to her successfully repaired cervical meningomyelocele in infancy. Not only did she first present with ulcerations and osteomyelitis, but also with distal autoamputation and severe iron deficiency anemia. A team approach with a pediatrician, neurologist, psychiatrist, and plastic surgeon was employed for her treatment. Behavior modification was moderately successful. Her hands and forearms were reconstructed with arthrodesis, local and distant flaps, and skin grafting without incident. She has been followed now for 4 years.     

The transformative power of story for healing

One of our goals in this session was, not just to talk about the healing power of narrative, but to experience it as well. Louise Profeit-LeBlanc is one of the presenters we invited specifically because of her skills as a storyteller. She has been heavily involved for several years as both an organizer and a participant in the Yukon Storytelling Festival, held every year in late May in Whitehorse. Woven into her presentation is a useful framework for differentiating various kinds of stories. As she tells us a series of stories, she takes us through a wide range of emotions from grief and loss to laughter and awe. For each of her stories, she gives us some personal contextual information that adds to the story’s meaning and helps us appreciate its significance. Her final story, in particular, is the kind of traditional story that has probably existed for a very long time. Such stories may be told with slightly different emphases, depending on the occasion, but they carry wisdom and value for every generation that hears them.     

Case report of acute necrotizing pancreatitis associated with combination treatment of sitagliptin and exenatide

ObjectiveTo report the first postmarketing case of necrotizing pancreatitis in a patient on combination therapy of sitagliptin and exenatide.MethodsWe describe the patient’s clinical presentation, laboratory test results, imaging, and autopsy findings.ResultsA 76-year-old woman with a history of type 2 diabetes mellitus presented with severe abdominal pain, vomiting, and fever requiring hospital admission. She had been treated with exenatide for 3 years to manage her diabetes mellitus. A few weeks before presentation, sitagliptin was added, presumably to further optimize her glycemic control. Acute pancreatitis was diagnosed during hospital admission. At initial presentation, her serum amylase concentration was 1136 U/L (reference range, 10-130 U/L) and her lipase concentration was greater than 3500 U/L (reference range, 0-75 U/L). In addition, computed tomography of the abdomen and pelvis demonstrated extensive pancreatic parenchymal necrosis. She had undergone previous cholecystectomy, reported no alcohol consumption, and had a normal lipid profile. Although she had a long-standing history of diabetes mellitus, she had no history of pancreatitis or other risk factors that would have caused her to develop the underlying condition. After initial brief improvement, her symptoms worsened, and despite aggressive care, her clinical state deteriorated and she died. Autopsy findings demonstrated acute necrotizing pancreatitis with complete digestion of the pancreas.ConclusionsConsidering the temporal relationship of her symptoms to the addition of sitagliptin to her existing exenatide regimen, this case strongly suggests a possible causal link between exenatide or sitagliptin (or the combination of the 2 drugs) and the etiology of pancreatitis in this patient. (Endocr Pract. 2012;18:e10-e13)     

Life, death, and humor: approaches to storytelling in Native America

Edith Turner has been studying healing as a sensitive, spiritually attuned participant-observer for a long time. Despite her academic background, experiential learning and knowing are important parts of Turner’s approach to research. Her efforts to understand healing have taken her on journeys to Africa, Mexico, Ireland, and more recently, Alaska’s North Slope. In these contexts, she has experienced healing offered by others, and learned to heal in various traditional ways herself. In her book, The Hands Feel It (1996), Turner focuses on the role that touch and spirit presence have in healing in a North Slope I?upiat community. However, her book makes clear that narrative and storytelling are important parts of the healing process, as well. In this paper, Turner elaborates on some aspects of the connection between narrative and healing based on her North Slope experience.     

Stress-induced cardiomyopathy

A 58-year-old female presented with typical chest pain, which had started a week ago. She presented late because she first suspected that her symptoms were due to severe stress related to the terminal illness of her father.     

Type B Insulin Resistance Syndrome Associated with Systemic Lupus Erythematosus

ObjectiveTo document a case of type B insulin resistance syndrome associated with systemic lupus erythematosus.MethodsWe present the clinical course of a female patient with type B insulin resistance syndrome, from the onset, diagnosis, and empiric treatment until remission of her disease.ResultsA 40-year-old African American woman with systemic lupus erythematosus presented with a relatively acute onset of severe hyperglycemia in January 2004. Her hyperglycemia was resistant to treatment with high doses of insulin (up to an equivalent dose of regular insulin of 4,500 units daily). The diagnosis of type B insulin resistance syndrome was confirmed after her insulin receptor antibody was found to be strongly positive. The patient’s hemoglobin A1c level improved substantially after she had been treated with azathioprine for 3 months. By November 2004, she was able to discontinue insulin therapy. Repeated insulin receptor antibody testing in February 2005 revealed that her insulin receptor antibody had become negative. The patient’s fasting glucose level became normal, and only occasional mild postprandial hyperglycemic episodes have been noted.ConclusionImmunosuppressive therapy with azathioprine seems to be responsible for our patient’s remission of type B insulin resistance, although the possibility of the occurrence of a spontaneous remission cannot be completely excluded. (Endocr Pract. 2007;13:51-55)