Cardiac Arrest as First Presentation of Thyroid Storm

Thyroid storm is a life-threatening condition characterized by a high level of circulating thyroid hormones and harbors high mortality and morbidity, even if diagnosed and treated early. The condition is frequently overlooked and under-recognized in emergency departments owing to its rarity. Here, we present a case of a 24-year-old male patient, previously healthy, who presented with cardiac arrest and was found to have heart failure and high thyroid hormone levels after investigations. Consequently, the presentation was attributed to thyroid storm. His clinical status and cardiac function improved after treatment of the hyperthyroidism.

Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review

BACKGROUND

Over the past few years, there has been a worldwide significant increase in the incidence of type II diabetes mellitus with both increase in morbidity and mortality. Controlling diabetes through life style modifications, including diet and exercise has always been the cornerstone in diabetes management. Increasing evidence suggests that the Mediterranean diet could be of benefit in diseases associated with chronic inflammation, including metabolic syndrome, diabetes, obesity as well as atherosclerosis, cancer, pulmonary diseases, and cognition disorders As a matter of fact, a number of studies addressed the relationship between Mediterranean diet and diabetes control. The result of these studies was conflicting. Some were able to elicit a protective role, while others showed no added benefit. As a result; we decided to conduct a systematic review to have a better understanding of the relationship between adherence to Mediterranean diet and diabetes control.

METHODS

A systematic review was conducted on the effect of Mediterranean diet in diabetes control and cardiovascular risk modification as well as the possible mechanism through which this diet might exhibit its beneficial role. We did a comprehensive search of multiple electronic databases such as Medline, Google Scholars, PubMed, and the Cochrane central register data until May 2014. We included cross-sectional, prospective, and controlled clinical trials that looked at the associations between Mediterranean diet and indices of diabetes control such HbA1c, fasting glucose, and homeostasis model assessment, in addition to cardiovascular and peripheral vascular outcomes.

OUTCOME/CONCLUSION

Most of the studies showed favorable effects of Mediterranean diet on glycemic control and CVD, although a certain degree of controversy remains regarding some issues, such as obesity. Important methodological differences and limitations in the studies make it difficult to compare results, thus further longer term studies are needed to evaluate the long-term efficacy of the Mediterranean diet along with the possibility of explaining its mechanism.

Epidural tramadol for postoperative pain after Cesarean section

PURPOSE

To compare the post-operative analgesic effect of 100 mg vs 200 mg epidural tramadol and saline in patients undergoing elective Cesarean section.

METHODS

Sixty healthy women undergoing Cesarean delivery with epidural anesthesia were randomly allocated into three groups (n = 20 in each). Patients received, at skin closure via the epidural catheter, 100 mg tramadol (Group I), 200 mg tramadol (Group II) or 10 ml saline (Control group). Pain scores and side effects were evaluated at 1, 2, 4, 8, 12 and 24 hr after surgery. Mean times to the first analgesic administration, as well as the cumulative doses of analgesic requirements over 24 hr postoperatively were compared.

RESULTS

The mean time to first analgesic administration was longer in patients who received 100 mg tramadol (4.5 +/- 3.1 hr) and the 200 mg tramadol (6.6 +/- 3.4 hr) than in those who received placebo (2.8 +/- 2 hr). The mean cumulative doses of meperidine over 24 hr were less in the 100 mg tramadol group (0.3 +/- 0.3 mg x kg(-1)) and the 200 mg tramadol group (0.3 +/- 0.3 mg x kg(-1)) than in the control group (0.7 +/- 0.4 mg x kg(-1)). Also, the mean doses of diclofenac over 24 hr were less in the 100 mg tramadol group (156 +/- 59 mg) and the 200 mg tramadol group (142 +/- 62 mg) than in the control group (214 +/- 70 mg). However, no difference was obtained between patients receiving 100 mg and 200 mg tramadol concerning all parameters studied.

CONCLUSION

Epidural tramadol 100 mg can provide adequate postoperative analgesia without respiratory depression in patients after Cesarean delivery.