A 'Natural' thyroid storm!

What Is Known And Objective: Over the counter supplements are often taken for granted during medication reconciliation in the emergency department. Supplements are not regulated by FDA, and some can be potentially dangerous.

Case Summary: We report a case of thyrotoxicosis secondary to over the counter bovine thyroid supplements.

Tetanus outbreak in a sheep flock due to ear tagging.

Tetanus is an acute, often fatal, infectious neuromuscular disease in all farmed mammals caused by Clostridium tetani. The disease is sporadic but outbreaks of tetanus have been described, as a result of wound contaminated with spores of C. tetani, which sporulates to the vegetative form and produce toxins.

Age-sex specific and sequela-specific disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation: An assessment at the national and subnational levels in Iran, 2016.

We assessed disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation apportioned by sex, age group, sequela, province, and community type in Iran, 2016. The burden of disease due to dental caries was extracted from the Global Burden of Disease Study 2016 (GBD 2016) and the caries preventive effect of water fluoridation was calculated using a database of fluoride levels in drinking water. All the preventable DALYs were caused by years lived with disability (YLDs) because of the non-fatal character of dental caries.

Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department.

Point-of-care ultrasound (POCUS) has the potential to diagnose papilledema, a sign of increased intracranial pressure, through optic disc elevation as well as optic nerve sheath diameter measurements. Idiopathic intracranial hypertension (IIH) is a syndrome resulting in increased intracranial pressure. We present a case of IIH where the emergency physician diagnosed papilledema by POCUS via presence of both optic disc elevation and a widened optic nerve sheath diameter.

Zellweger syndrome and associated brain malformations: report of a novel Peroxin1 (PEX1) mutation in a Native American infant.

Zellweger syndrome (cerebrohepatorenal syndrome) is very rare and is the most severe form of peroxisomal biogenesis disorders. These can be caused by mutations in any of the currently known Peroxin genes and typically present in the neonatal period with multiorgan involvement. Patients usually do not survive beyond 1 year of age.

Ectopic pregnancy in the cervix: a case report.

Cervical pregnancy is an extremely rare condition with potential grave consequences if not diagnosed and treated early enough. We present a case and an ultrasound image of early cervical ectopic pregnancy with a history of two previous cesarean sections who was successfully treated with suction curettage.

Visual outcomes in five different approaches for treatment of central retinal vein occlusion.

Background And Objective: Four treatment methods for central retinal vein occlusion were compared with its natural course.

Patients And Methods: In this partially prospective, comparative, interventional case series on 63 eyes with central retinal vein occlusion, five approaches were compared: intravitreal triamcinolone injection; radial optic neurotomy; combined radial optic neurotomy and intraocular triamcinolone injection; combined internal limiting membrane peeling, radial optic neurotomy, and intraocular triamcinolone; and observation.

Results: Final visual acuity in the intravitreal triamcinolone group was better compared with the observation (P = .

Monitoring of fluoride in groundwater resources of Iran.

Fluoride concentration in groundwater resources that used as the source of drinking water in urban areas of Iran was determined. All of the groundwater wells located in urban areas were monitored in 2008. Fluoride concentration of water samples was measured using SPADNS method.

FIRST: a practical approach to the causes and management of febrile seizures.

During almost 4 decades of clinical practice of pediatrics and pediatric neurology, the senior authors have rarely made a formal presentation on the topic of "febrile seizures." In any large pediatric teaching hospital, questions regarding the diagnosis and management of febrile seizures are raised by medical students, pediatric residents, and adult and pediatric neurology residents. The acronym FIRST was developed as a teaching tool to present a simple and pragmatic clinical approach to children presenting with a single seizure or cluster of seizures in 1 day associated with a febrile illness before, during, or after the seizure event(s).