BRASH syndrome with a complete heart block- a case report

INTRODUCTION

BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia.

CASE PRESENTATION

We present a case of a 68 years old female patient with past history of hypertension taking atenolol and Enalapril presented to emergency department with the complaint of loss of consciousness of 02 hours duration. She had 03 days history of fatigue, poor oral intake, decreased urine output, appetite loss, vertigo and global headache. Her vital signs were blood pressure of 60/40 mmHg, absent radial pulse and temperature of 36.4 °C. Her systemic examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13/15. Her laboratory tests showed creatinine of 1.83 mg/dL, blood urea nitrogen of 89 mg/dL and potassium elevated to the level of 6.39 mEq/dL. ECG revealed complete heart block with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous medications were discontinued and the patient was resuscitated with intravenous (IV) fluids. She was given 03 doses of 1 mg atropine every 5 minutes but there was no increment in heart rate. She was given 50% dextrose with 10 international units of regular insulin, 1 g of calcium gluconate and Intravenous perfusion of norepinephrine and dopamine. Subsequently, after 14 hours of ICU admission the patient had a cardiac arrest with asystole and resuscitation was attempted but she couldn't survive.

CONCLUSION

BRASH syndrome is largely an under-recognized life threatening clinical diagnosis. Physicians should have high index of suspicion for BRASH when they encounter patients with bradycardia, hyperkalemia, and renal failure, as timely diagnosis is crucial in the management.

Women's desire to limit child-bearing and its associated factors in rural Ethiopia: A multilevel analysis

Introduction

Ethiopia ranks twelfth globally and second in Africa by population size. High fertility rates, especially in rural areas, contribute to rapid population growth, impacting the country's economy. The decision of women to control the number of children they have is a crucial factor influencing population growth and contributing to elevated health risks for both women and children.Objective: the purpose of this study was to assess women desire to limit childbearing and its associated factor among rural women in Ethiopia.

Methods

A cross-sectional survey dataset of Ethiopian demographic and health survey 2016 was used for this study. A total of 12,019 rural women were included in the study. A multilevel binary logistic regression was used to identify the predictors of women's desire to limit childbearing. The adjusted odds ratio with respective 95 % confidence interval was used to declare statistically significant variables.

Result

In rural Ethiopia, 33.04 % of women had a desired to limit their childbearing. Women in the age group of 25-34 years (AOR = 1.61, 95 % CI = 1.28,2.13), 35-49 years (AOR = 4.96, 95 % CI = 3.64, 6.65), had no children (AOR = 0.06, 95 % CI = 0.04, 0.09), having children 1-3 (AOR = 0.29, 95 % CI = 0.23, 0.36), married (AOR = 0.45, 95 % CI = 0.27, 0.75), living in small peripherals region (AOR = 0.33,95 % CI = 0.24, 0.45) and community level poverty (AOR = 0.72, 95 % CI = 0.57, 0.89) were significant predictors of women's desire to limit the number of children they bear.

Conclusion

In rural Ethiopia, there is a limited inclination to control childbearing. Older women and those with higher number of children express a stronger desire to limit childbearing. Conversely, married women, from smaller peripheral regions and those residing in areas with a higher community poverty rate are less likely to have a desire to limit childbearing. Thus, promoting education on the advantages of smaller family sizes and offering family planning services could be crucial in fostering women's willingness to limit their childbearing.

Histopathological Evaluation of Ethanolic Leaf Extract of Lippia adoensis on Liver, Kidney, and Biochemical Parameters in Swiss Albino Mice

Background

Eighty percent of Ethiopians use traditional medicine, one of which is the leaf of Lippea adoensis.

Objective

To investigate subacute toxicity of aqueous extracts of L. adoensis leaves on the liver and kidney and biochemical parameters in Swiss albino mice.

Methods

LD₅₀ was assessed with nine experimental groups and one control group of adult female Swiss albino mice (five in each group). In the subacute study, 40 mice of both sexes were randomly divided into four groups of ten mice (both sexes) per group. Group I served as controls and received distilled water and feed only. Groups II-IV were used as treatment groups. They received calculated doses of aqueous leaf extracts orally at doses of 500 mg/kg, 1000 mg/kg, and 2000 mg/kg body weight, respectively.

Results

Since 80% of deaths occurred at the 10,000 mg/kg body-weight dose in this experiment, LD₅₀ was considered to be <10,000 mg/kg. In the subacute test, general signs of toxicity like hypoactivity, piloerection, lethargy, and a single episode of convulsion were observed at the 2000 mg/kg dose. Beginning from the third week of administration, both male and female mice receiving 500 mg/kg and 2000 mg/kg and all treatment groups in the fourth week showed significant (P<0.05) weight loss compared to controls. Biochemical parameters were found to increase in all groups treated with ethanolic leaf extracts. Several histopathological changes like congestion, hemorrhage, severe necrosis, and infiltration of inflammatory cells in both liver and kidney in the L. adoensis-treated rats were observed at all doses.

Conclusion

In the present study, the ethanolic leaf extracts of L. adoensis produced dose-dependent weight loss and histopathological and biochemical changes in Swiss albino mice.