RESUMO
Brugada syndrome is a genetic condition that predisposes to an increased risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. The Brugada type 1 electrocardiogram (ECG) pattern may occur independently of the actual syndrome, and this clinical phenomenon is often referred to as Brugada phenocopy. There are several other factors which have been known to induce this electrocardiographic pattern, and currently, there is a paucity of literature with respect to the pattern that is observed in patients with electrolyte disturbances, specifically hyponatremia. This case report highlights a suspected hyponatremia-induced Brugada type 1 ECG pattern, which subsequently normalized following resolution of the electrolyte derangement.
RESUMO
Spondylodiscitis of the lumbar spine is described in a 67-year-old-man receiving chronic haemodialysis via a central venous catheter for diabetic nephropathy. He also had a forearm arteriovenous fistula created 1 month earlier. Clinical, MRI and surgical findings are described. The patient died despite spinal surgery and 1 month of antibiotic therapy from suspected pulmonary embolism. Early recognition by MRI or other imaging technique, prompt antibiotic therapy and often surgery are necessary for a successful outcome in this increasingly recognised complication in patients on chronic haemodialysis. Diabetes mellitus may be an added risk factor.
Assuntos
Nefropatias Diabéticas/terapia , Discite/diagnóstico , Empiema/diagnóstico , Falência Renal Crônica/terapia , Edema Pulmonar/diagnóstico , Diálise Renal/métodos , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/diagnóstico , Discite/cirurgia , Empiema/terapia , Evolução Fatal , Humanos , Falência Renal Crônica/diagnóstico , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Vértebras Lombares , Imageamento por Ressonância Magnética/métodos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Edema Pulmonar/terapia , Diálise Renal/efeitos adversos , Índice de Gravidade de Doença , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodosRESUMO
OBJECTIVE The aim of this study is to compare albuminuria measured by conventional 24-hour urine collection and by spot urine albumin and by determining ACR, in a spot sample of urine. METHODS: A first morning spot sample and 24 hour urine samples were collected from 64 subjects, irrespective of the prevailing pathology. The urinary albumin and creatinine in both the spot and 24 hour urine samples was analyzed using the fully automated chemistry analyzer. RESULTS: Of the 64 participants studied the 24 hour albumin varied from 30-3000 gm, the interquartile range 450-2814 mg. The sensitivity and specificity of the spot urine sample was 81.3% (95% CI 70.9-91.7) and 83.3% (95% CI 76.6-92). CONCLUSION: ACR did not provide any advantage over microalbumin measurement alone and in fact there was satisfactory agreement between the two measurements. ACR in addition requires a higher laboratory effort therefore in a low resource setting microalbumin measurement alone is the more convenient screening method in routine clininical practice especially in the developing world.