Nerium indicum is a tree belonging to the order: Gentianales, Family Apocynaceae, which grows mainly on Jeju Island in Korea and is predominantly used as an ornamental plant. The tree contains toxic substances such as oleandrin and adynerin, and of these, oleandrin acts as a potent cardiac glycoside, causing symptoms similar to digoxin poisoning. A 38-year-old male was admitted to the emergency department with symptoms of nausea, vomiting, dizziness, and abdominal pain after ingesting about 1 L of water boiled with oleander that he had collected intending to commit suicide. The electrocardiogram (ECG) showed a 2:1 atrioventricular block with ST-segment depression and T-wave inversion. He was treated with atropine and digoxin-specific antibody fragments (DigiFab). The patient was discharged without any specific complaints or findings except for persistent ST-segment and T-wave abnormalities on the ECG. In cases of poisoning due to Nerium indicum, atropine may be helpful in the management of severe bradycardia. The use of a digoxin-specific antibody as an antidote, even in small doses, followed by additional doses based on the clinical course, may be effective in treating the poisoning.

Clinical presentation of Bartter syndrome is similar to surrepitious vomiting or use of diuretics. Therefore, precise differential diagnosis of Bartter syndrome is crucial. We report a case of medullary nephrocalcinosis (MNC) induced by furosemide mimicking Bartter syndrome. A 55-year-old female patient visited our hospital with renal dysfunction on basis of hypokalemia and metabolic alkalosis. She had no history of hypertension or drug use except allopurinol and atorvastatin. She did not complain of nausea or vomiting on presentation and the serum magnesium level was normal. We performed ultrasonography, that showed MNC. For these reasons, we suspected Bartter syndrome and corrected the electrolyte imbalance. During outpatient follow up, we found that the patient had been taking 400 mg of furosemide daily for 30 years. We could diagnose furosemide induced MNC, and recommended to her to reduce the amount of furosemide.
Alkalosis ; Allopurinol ; Bartter Syndrome* ; Diagnosis, Differential ; Diuretics ; Female ; Follow-Up Studies ; Furosemide* ; Humans ; Hypertension ; Hypokalemia ; Magnesium ; Middle Aged ; Nausea ; Nephrocalcinosis* ; Outpatients ; Ultrasonography ; Vomiting ; Atorvastatin Calcium

OBJECTIVE: To preliminarily evaluate technical feasibility of a dual-echo ultrashort echo time (UTE) subtraction MR imaging by using concurrent dephasing and excitation (CODE) sequence for visualization of iron-oxide enhancement in focal inflammatory pulmonary lesions. MATERIALS AND METHODS: A UTE pulmonary MR imaging before and after the injection of clinically usable superparamagnetic iron-oxide nanoparticles, ferumoxytol, was conducted using CODE sequence with dual echo times of 0.14 ms for the first echo and 4.15 ms for the second echo on 3T scanner in two rabbits concurrently having granulomatous lung disease and lung cancer in separate lobes. A mean ratio of standardized signal intensity (SI) was calculated for comparison of granulomatous lesion and cancer at first echo, second echo, and subtracted images. Lesions were pathologically evaluated with Prussian blue and immunohistochemistry staining. RESULTS: Post-contrast subtracted CODE images visualized exclusive enhancement of iron oxide in granulomatous disease, but not in the cancer (mean ratio of SI, 2.15 ± 0.68 for granulomatous lesion versus 1.00 ± 0.07 for cancer; p value = 0.002). Prussian blue and corresponding anti-rabbit macrophage IgG-staining suggested an intracellular uptake of iron-oxide nanoparticles in macrophages of granulomatous lesions. CONCLUSION: Dual-echo UTE subtraction MR imaging using CODE sequence depicts an exclusive positive enhancement of iron-oxide nanoparticle in rabbits in focal granulomatous inflammatory lesions.
Ferrosoferric Oxide ; Granuloma ; Immunohistochemistry ; Iron ; Lung Diseases ; Lung Neoplasms ; Macrophages ; Magnetic Resonance Imaging ; Nanoparticles ; Rabbits

In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.