Potential Triggers Research Articles

Descriptive Profile of Anaphylactic Reaction Patients Hospitalized at RSUP Prof. DR. I.G.N.G Ngoerah Period 2018-2023

Introduction: Anaphylactic reaction is a severe, potentially life-threatening systemic hypersensitivity reaction caused by a specific allergen. This study aimed to evaluate the clinical profile of anaphylactic patients hospitalized in Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar. Method: This was a cross-sectional descriptive study of anaphylactic patients hospitalized in our center from January 2018 to December 2023. Patients diagnosed with anaphylactic reactions were included in this study. All the data (demographic, clinical manifestations, potential trigger) were attained from medical records for descriptive analysis. Result: 292 patients were enrolled in this study; half were women (54,4%), and the median age was 38,50 years (interquartile range 24). The most common potential triggers were drugs (57%), followed by food (18,5%), blood products (14,1), insect bites, and other triggers (4,8%). Almost all patients experience skin and mucosal manifestations (99%). Anaphylactic shock occurs in only 22% of patients. Discussion: Previous studies have found similar results to our findings, and anaphylactic reaction caused by drugs was associated with a more severe reaction. The effect of estrogen hormones on more severe reactions has been reported in female mice, but human research is still limited. Conclusion: Further studies are needed to investigate the correlation between demographic characteristics or specific clinical manifestations with a severe reaction.

Effect of Vitamin D deficiency and some hematological parameters in Iraqi female patients with Systemic Lupus Erythematosus

Background: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects multiple organs. Vitamin D deficiency is considered potential environmental factor triggering some autoimmune disorders, including SLE. This study was performed for determination of effect of vitamin D deficiency in SLE infection or disease worsening, and the relationship of ESR, HB, and WBCs with level of vitamin D in SLE disease, in addition to determine which of the previous parameter may describe the disease case of patients. Methods: This study included fifty three (53) SLE female patients and twenty six (26) healthy females were included. White blood count (WBC) and Heamoglobin (Hb) were determined in complete blood count (CBC) device, traditional Westergren method was used for Erythrocyte sedimentation rate (ESR) estimation, vitamin D was measured by using enzyme link immune-sorbent assay (ELISA) Kit. Results: The results showed a significant decrease in the hemoglobin levels in the SLE patients; significant increase was noticed in the ESR of SLE patients and significant increase was noticed in the WBC counts compared to the control group’s samples. A significant decrease in serum levels of vitamin D in patients compared to apparently healthy controls. Conclusions: Photosensitivity to sun in SLE patients contributed in decrease of vitamin D blood-levels. According to the ROC results, each of Hb, WBC, ESR and vitamin D may describe the disease case of patients.

Association between Helicobacter pylori and its eradication and the development of cancer

BackgroundHelicobacter pylori (H. pylori) is a gram-negative gastrointestinal pathogen that colonises the human stomach and is considered a major risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma. Furthermore,...

Increased intestinal permeability and lipopolysaccharide contribute to swainsonine-induced systemic inflammation

Long-term consumption of swainsonine could be poisonous to livestock, including facilitating apoptosis by impairing lysosomal function and inhibiting autophagic degradation, leading to liver inflammation and even death in livestock. However, the mechanism by swainsonine induced systemic inflammatory responses remained unclear, especially the effects of swainsonine on intestinal permeability, lipopolysaccharide (LPS) level and oxidative stress response were unknown. In this study, swainsonine increased intestinal permeability as evidenced by the significant down-regulation of colonic goblet cells, Akkermansia muciniphila and intestinal tight junction protein Occludin, Claudin 1 and ZO-1, and the significant up-regulation of mRNA expression level of the intestinal permeability indicator protein tyrosine phosphatase receptor type H (Ptprh) in the ileum of mice. Simultaneously, the elevated LPS biosynthetic genes in intestinal microbiota and increased intestinal permeability facilitated more bacterial endotoxin LPS to enter the blood. High concentration of free-form LPS induced high levels of proinflammatory cytokines and oxidative stress response, thereby causing the systemic inflammation. These findings provided a new perspective on swainsonine-induced systemic inflammation, suggesting that intestinal permeability and free-form LPS level may be the potential trigger factors.

Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers’ experiences

ObjectivesInsufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather...

Associations between attention and threat in dental settings

Dental fear still causes health risks and high costs for health insurances due to the common avoidance of dental visits by dentally fearful patients. Selective attention may be a potential trigger of dental fear. The aim of the present studies was to investigate the influence of threatening dental stimuli in image combinations on the performance in a visual search task. In three studies, we compared the influence of dental stimuli with pictures of weapons or accidents and different distractors, i.e., cutlery, animals, landscapes. In the first two studies, participants had to decide if a target is available in a 3 × 3 matrix or not. In the third experiment, participants had to decide if a threatening or a neutral stimulus was the target. In all three studies we could replicate the finding that there is a threat-superiority-effect as well as a disengagement-effect for dental stimuli in visual search tasks. Dental stimuli were not only detected faster than deciding that no dental stimulus is available with different distractors, but dental stimuli also decreased search performance within the 3 × 3 matrices when presented as distractors. This is the first paper that demonstrates that dental stimuli that are associated with a negative threatening valence attract attention very quickly in the context of non-threatening stimuli. Future studies should investigate if a distraction from these threatening stimuli or a habituation to these threatening stimuli could reduce dental fear.

Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology.

Fluctuations in progesterone (P4) and estradiol (E2) across the menstrual cycle can exert direct effects on biological systems implicated in neuropsychiatric disorders and represent a key biological source of variability in affective, cognitive, and behavioral disorders. Although these cyclical symptoms may be most readily identified when they occur exclusively in relation to the menstrual cycle, as in DSM-5 premenstrual dysphoric disorder, symptom changes of similar magnitude occur in a larger proportion of people with ongoing psychiatric disorders. Studies investigating cyclical regulation of brain and behavior often produce inconsistent results, which may be attributed to a lack of focus on specific hormonal events and individual differences in related sensitivities. We propose a transdiagnostic Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC) framework, postulating that atypical neural responses to several key hormonal events provoke specific temporal patterns of affective and behavioral change across the menstrual cycle. We review prospective and experimental evidence providing initial support for these dimensions, which include (1) luteal-onset negative affect caused by a sensitivity to E2 or P4 surges (mediated by neuroactive metabolites such as allopregnanolone), typified by irritability and hyperarousal; (2) perimenstrual-onset negative affect caused by a sensitivity to low or falling E2, typified by low mood and cognitive dysfunction; and (3) preovulatory-onset positive affect dysregulation caused by a sensitivity to E2 surges, typified by harmful substance use and other risky reward-seeking. This multidimensional, transdiagnostic framework for hormone sensitivity can inform more precise research on ovarian steroid regulation of psychopathology, including further mechanistic research, diagnostic refinement, and precision psychiatry treatment development. Additionally, given the high rates of hormone sensitivity across affective disorders, the DASH-MC may guide broader insights into the complex neurobiological vulnerabilities driving female-biased affective risk, as well as potential triggers and mechanisms of affective state change in psychiatric disorders.

Comprehensive Clinical Characterization of Patients Diagnosed With Dilated Cardiomyopathy: A Cross-Sectional Study.

Background The term "cardiomyopathy" encompasses a wide range of diseases with various underlying causes. Dilated cardiomyopathy (DCM) is characterized by ventricular dilation and impaired cardiac function in the absence of congenital, valvular, hypertensive, or ischemic heart disease (IHD). This study was motivated by the high prevalence of underlying DCM and chronic heart failure, coupled with a lack of comprehensive information on DCM. The primary objective of this study was to identify the clinical characteristics and contributing factors associated with individuals diagnosed with DCM. Methods A total of 120 patients with DCM were enrolled in a two-year, hospital-based observational cross-sectional study conducted within the Medicine Department of a tertiary care center. The study assessed risk factors, including IHD, diabetes mellitus, alcohol consumption, and smoking. Results DCM was observed across all age groups, though it was notably more prevalent among middle-aged individuals (n = 50, or 41.7%) and the elderly (n = 35, or 37.5%). The condition was more commonly seen in men. IHD emerged as the predominant risk factor, affecting 75% of patients (n = 90), followed by diabetes mellitus (n = 85, or 70.8%), alcohol use (n = 75, or 62.5%), and smoking (n = 50, or 41.7%). Common symptoms included pedal edema, palpitations, easy fatigability, and exertional dyspnea. Conclusion In conclusion, DCM is a critical condition that necessitates vigilant monitoring. Consistent observation of symptoms, recognition of potential triggers, and prompt identification of adverse drug reactions, electrolyte disturbances, and echocardiographic changes are essential. This awareness and early detection were responsible for the lower mortality and early symptom improvement observed in the present study group.

Reversible cerebral vasoconstriction syndrome post-cardiac transplantation: a therapeutic dilemma: case report

BackgroundReversible cerebral vasoconstriction syndrome (RCVS) is characterized by diffuse, multifocal segmental narrowing of cerebral arteries and can result in ischaemic stroke. Causal factors, identified in 60% of cases, include immunosuppressant pharmacotherapy. The few reports following heart transplantation are almost all in Asian recipients. We report on a Caucasian Australian patient with immunotherapy induced RCVS post heart transplantation to highlight the state of knowledge of the condition and the treatment dilemma it poses.Case presentationA 51-year-old female underwent orthotopic heart transplantation at our institution. Induction immunotherapy comprised basiliximab, mycophenolate mofetil and methylprednisolone. On day 6 post-transplantation the patient was transitioned to oral prednisolone and tacrolimus. On day 7 the patient began to experience bilateral, severe, transient occipital and temporal headaches. On day 9 tacrolimus dose was up-titrated. A non-contrast computed tomography brain (CTB) was normal. Endomyocardial biopsy on day 12 demonstrated moderate Acute Cellular Rejection (ACR), which was treated with intravenous methylprednisolone. That evening the patient experienced a 15-minute episode of expressive dysphasia. The following morning she became confused, aphasic, and demonstrated right sided neglect and right hemianopia. A CT cerebral perfusion scan demonstrated hypoperfusion in the left middle cerebral artery (MCA) territory and cerebral angiography revealed widespread, focal multi-segmental narrowing of the anterior and posterior circulations. A diagnosis of RCVS was made, and nimodipine was commenced. As both steroids and tacrolimus are potential triggers of RCVS, cyclosporin replaced tacrolimus and methylprednisolone dose was reduced. A further CTB demonstrated a large left MCA territory infarct with left M2 MCA occlusion. The patient made steady neurological improvement. She was discharged 34 days post-transplantation with mild residual right lower limb weakness and persistent visual field defect on verapamil, cyclosporine, everolimus, mycophenolate mofetil and prednisolone.ConclusionReversible cerebral vasoconstriction syndrome is rare after orthotopic heart transplantation. Until now, RCVS has been almost exclusively described in Asian recipients, and is typically caused by immunotherapy. The condition may lead to permanent neurological deficits, and in the absence of definitive treatments, early recognition and imaging based diagnosis is essential to provide the opportunity to remove the causal agent(s). Co-existent ACR, can pose unique treatment difficulties.

Potential anatomical triggers for plan adaptation of cervical cancer external beam radiotherapy.

This study aimed to identify potential anatomical variation triggers using magnetic resonance imaging for plan adaption of cervical cancer patients to ensure dose requirements were met over an external beam radiotherapy course. Magnetic resonance images (MRIs) acquired before and during treatment were rigidly registered to a pre-treatment computerised tomography (CT) image for 11 retrospective cervix cancer datasets. Target volumes (TVs) and organs at risk (OARs) were delineated on both MRIs and propagated onto the CT. Treatment plans were generated based on the pre-treatment contours and applied to the mid-treatment contours. Anatomical and dosimetric changes between each timepoint were assessed. The anatomical changes included the change in centroid position and volume size. Dosimetric changes included the V30Gy and V40Gy for the OARs, and V95%, V100%, D95% and D98% for the TVs. Correlation with dosimetric and anatomical changes were assessed to determine potential replan triggers. Changes in the bowel volume and position in the superior-inferior direction, and the high-risk CTV anterior posterior position were highly correlated with a change in dose to the bowel and target, respectively. Hence changes in bowel and high-risk CTV could be used as a potential replan triggers.

Systematic Review of Individual Patient Data COVID-19 Infection and Vaccination–Associated Thrombotic Microangiopathy

Sporadic cases of atypical hemolytic uremic syndrome (aHUS) have been described in the literature in association with COVID-19 infection and vaccination in adults and pediatric patients. The exact mechanisms underlying COVID-19-associated thrombotic microangiopathies (TMAs) remain incompletely understood. Herein, we present a detailed meta-analysis of the clinical characteristics, outcomes, and management strategies of COVID-19-associated aHUS and thrombotic thrombocytopenic purpura (TTP). This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses updated guidelines. PubMed was utilized for searching for case reports and series. Adverse outcome at last follow-up was defined as estimated glomerular filtration rate< 30 ml/min per 1.73 m2 (patients with aHUS), no remission with therapy, or patient death. Data were analyzed using Wilcoxon rank and Chi-square tests. Our analysis cohort included 118 studies reporting on 170 patients. These included 84 cases of aHUS and 86 cases of TTP resulting from COVID-19 infection (n= 92) or vaccination (n= 78). Significantly more cases of aHUS were reported after infection (n= 65) than immunization (n= 19), compared to TTP, where the reverse was true (n= 27 and n= 59, respectively; P< 0.001). In patients with aHUS with stage 3 acute kidney injury (AKI), requirement of kidney replacement therapy (KRT) was seen in three-fourths of the cohort for a median of 15. In patients with TTP, severe COVID-19 infection (P= 0.04) predicted nonremission or death at last follow-up. Administration of i.v., rituximab and caplacizumab were protective (P= 0.03 and P= 0.06, respectively). Immune TTP (iTTP) was reported more often than HUS following mRNA vaccines (81% vs. 58%; P= 0.06). COVID-19 infection and vaccination are a potential trigger for onset or relapse of aHUS and TTP, especially in patients who are not on maintenance complement inhibitors or immunosuppression.

Numerical Investigation of Bedding Rock Slope Potential Failure Modes and Triggering Factors: A Case Study of a Bridge Anchorage Excavated Foundation Pit Slope

The analysis of slope failure modes is essential for understanding slope stability. This study investigated the failure modes and triggering factors of a rock slope using the limit equilibrium method, finite differences method, and exploratory factor analysis. First, the limit equilibrium method was used to identify potential sliding surfaces. Then, the finite differences method was employed to study deformation and failure features in a slope. Stability factors were calculated considering specific conditions such as rainfall, prestressing loss, and earthquakes using the strength reduction method. Finally, exploratory factor analysis was utilized to identify the triggering factors of each failure mode. The results revealed that failure modes were categorized into two types based on the positions of the sliding surface. The main triggering factors for Failure Mode 1 were rainfall and prestress loss, while for Failure Mode 2 they were earthquake loading and prestress loss. This study offers a comprehensive exploration of potential failure modes and their triggering factors from mechanical and statistical perspectives, enriching our understanding of potential failure modes in rock slopes.

Urinary opioid peptides in children with autism spectrum disorders. A Pilot Study

BACKGROUND: Circulating β-casomorphins (BCM) and gluten exorphins (GE), which are exogenous opioid peptides originating from bovine milk protein casein and cereal protein gluten, respectively, have been proposed as potential trigger factor to symptoms observed in children with autism. OBJECTIVE: Given the debate surrounding the detectability of these opioid peptides in body fluids, particularly using highly sensitive and specific mass spectrometry (HPLC-MS) techniques, we aimed to investigate their presence in urine samples of autistic subjects. METHODS: We employed an HPLC-MS method for peptide detection. RESULTS: The presence of several BCMs and GEs in the urine of both autistic children (ASD) and healthy controls (HC) was documented. The detection of dietary opioid peptides even at very low concentrations underscores the sensitivity of this novel HPLC-MS method. BCM-8 was more often detected in the ASD group compared to the HC group. A higher prevalence of gastrointestinal (GI) symptoms were also observed in the ASD group. CONCLUSIONS: This pilot study supports the presence of BCMs and GEs in urine samples in subjects with autism as well as healthy controls which was the main goal of this pilot study. Prolonged exposure to bovine BCMs and GEs may play a role in the manifestation of core and GI symptoms in subgroups of autism. Further research is warranted to investigate this phenomenon thoroughly.

The risk of anaphylaxis on holidays.

The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations. A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis. This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i.e., travels, outdoor activities and eating out). Moreover, it underlines the need for a further allergological education in these cases, in order to prepare allergic patients to avoid and manage undesired situations.

Diabetic ketoacidosis in a patient with type 2 diabetes induced by multiple triggers: a case report and implications for clinical practice

AbstractDiabetic ketoacidosis is a recognized side effect of SGLT‐2 inhibitors precipitated by several factors. A 58‐year‐old man with long‐standing, well‐controlled type 2 diabetes on dapagliflozin, metformin and gliclazide and subacute De Quervain thyroiditis treated with high dose prednisolone was evaluated in the emergency department for abdominal pain and tachypnea. Severe diabetic ketoacidosis related to dapagliflozin was diagnosed. De Quervain thyroiditis and treatment with high dose prednisolone were identified as potential triggering factors. Combined use of dapagliflozin and high dose prednisolone may increase the risk for SGLT‐2 inhibitors related diabetic ketoacidosis, especially in the course of acute illness.

Acute Cardiovascular Effects of Simultaneous Energy Drink and Alcohol Consumption in Young Adults: A Review of Case Reports.

(1) Background: The aim of this review was to identify and summarize adverse cardiovascular health events associated with the simultaneous consumption of energy drinks (ED) and alcohol. Potential prevention strategies and the implementation of research toward the underlying mechanisms for these pathologies were highlighted to emphasize the need for further investigation and to encourage more attention to this field. (2) Methods: The PubMed database was searched for case reports linked with adverse cardiovascular events after simultaneous ED and alcohol consumption. Inclusion criteria were: the reported age of the patient is between 16 and 35 years and confirmed co-consumption of EDs and alcohol. All relevant articles that met the inclusion criteria were fully read and all relevant data was extracted. The extracted data was summarized and presented in this review of cases. (3) Results: In total, 10 cases were identified. The analysis showed that mainly young adults (median age = 24.5 years), in particular men (80%) were affected. The three parts of the cardiovascular system affected were heart rhythm (42%), myocardial function (33%), and coronary arteries (25%). In 3 cases the outcome was fatal. Moreover, preexisting health conditions and/or potential trigger factors were present in 60% of selected cases. (4) Conclusions: This review of case reports suggests that the simultaneous consumption of EDs and alcohol can lead to adverse cardiovascular health events and even incidents with fatal outcomes were reported. Potential trigger factors and preexisting health conditions seem to increase the probability of adverse cardiovascular health events. Consumers should be informed about the potential risks and follow responsible consumption behavior to prevent future health events. More systematic studies are needed to determine the acute effects on the cardiovascular system in young adults.

Retrospect on the Ground Deformation Process and Potential Triggering Mechanism of the Traditional Steel Production Base in Laiwu with ALOS PALSAR and Sentinel-1 SAR Sensors.

The realization of a harmonious relationship between the natural environment and economic development has always been the unremitting pursuit of traditional mineral resource-based cities. With rich reserves of iron and coal ore resources, Laiwu has become an important steel production base in Shandong Province in China, after several decades of industrial development. However, some serious environmental problems have occurred with the quick development of local steel industries, with ground subsidence and consequent secondary disasters as the most representative ones. To better evaluate possible ground collapse risk, comprehensive approaches incorporating the common deformation monitoring with small-baseline subset (SBAS)-synthetic aperture radar interferometry (InSAR) technique, environmental factors analysis, and risk evaluation are designed here with ALOS PALSAR and Sentinel-1 SAR observations. A retrospect on the ground deformation process indicates that ground deformation has largely decreased by around 51.57% in area but increased on average by around -5.4 mm/year in magnitude over the observation period of Sentinel-1 (30 July 2015 to 22 August 2022), compared to that of ALOS PALSAR (17 January 2007 to 28 October 2010). To better reveal the potential triggering mechanism, environmental factors are also utilized and conjointly analyzed with the ground deformation time series. These analysis results indicate that the ground deformation signals are highly correlated with human industrial activities, such underground mining, and the operation of manual infrastructures (landfill, tailing pond, and so on). In addition, the evaluation demonstrates that the area with potential collapse risk (levels of medium, high, and extremely high) occupies around 8.19 km2, approximately 0.86% of the whole study region. This study sheds a bright light on the safety guarantee for the industrial operation and the ecologically friendly urban development of traditional steel production industrial cities in China.

Sudden Cardiac Death-Etiology, Risk Factors and Demographic Characteristics: An Extensive Study of 1618 Forensic Autopsies.

Sudden cardiac death (SCD) is a major public health concern worldwide, affecting all age and social groups. In this retrospective study, of the 8265 autopsies performed in the Institute of Legal Medicine, 1618 cases of SCD were included. The aim of this study is to identify demographic characteristics, etiological factors, epidemiological characteristics and risk factors that lead to SCD. The highest incidence of SCD was in age group 40-69 years (65.0%), 71.6% of this age group being men. Of the total number, 32.1% (520) occurred in the emergency room. The most common cause of sudden death is represented by coronary atherosclerotic disease, reported in 89.8% (1453) of cases, tricoronary lesions being found in 60% (870) of cases. Etiological factors of SCD encountered during autopsies were acute myocardial infarction in 13.9% (225), dilated cardiomyopathy 43.9% (710), cardiac hypertrophy 579 (36.07%), pericarditis 1.9% (30), myocarditis 1.73% (28) and adipositas cordis 5% (81). Along with epicardial fat and BMI, alcohol consumption was recorded in 17.9% (290), this being a potential trigger. Based on forensic autopsy and histological findings, a wide variety of factors are involved in the etiopathogenesis of SCD, some of which can be eliminated through preventive measures implemented early.

How Membrane Phospholipids Containing Long-Chain Polyunsaturated Fatty Acids and Their Oxidation Products Orchestrate Lipid Raft Dynamics to Control Inflammation

BackgroundLong-chain PUFA (LC-PUFA) influence varying aspects of inflammation. One mechanism by which they regulate inflammation is by controlling the size and molecular composition of lipid rafts. Lipid rafts are sphingolipid/cholesterol-enriched plasma membrane microdomains that compartmentalize signaling proteins and thereby control downstream inflammatory gene expression and cytokine production. ObjectivesThis review summarizes developments in our understanding of how LC-PUFA acyl chains of phospholipids, in addition to oxidized derivatives of LC-PUFAs such as oxidized 1-palmitoyl-2-arachidonyl-phosphatidylcholine (oxPAPC), manipulate formation of lipid rafts and thereby inflammation. MethodsWe reviewed the literature, largely from the past 2 decades, on the impact of LC-PUFA acyl chains and oxidized products of LC-PUFAs on lipid raft biophysical organization of myeloid and lymphoid cells. The majority of the studies are based on rodent or cellular experiments with supporting mechanistic studies using biomimetic membranes and molecular dynamic simulations. These studies have focused largely on the LC-PUFA docosahexaenoic acid, with some studies addressing eicosapentaenoic acid. A few studies have investigated the role of oxidized phospholipids on rafts. ResultsThe biophysical literature suggests a model in which n-3 LC-PUFAs, in addition to oxPAPC, localize predominately to nonraft regions and impart a disordering effect in this environment. Rafts become larger because of the ensuing increase in the difference in order between raft and nonrafts. Biochemical studies suggest that some n-3 LC-PUFAs can be found within rafts. This deviation from homeostasis is a potential trigger for controlling aspects of innate and adaptive immunity. ConclusionOverall, select LC-PUFA acyl chains and oxidized acyl chains of phospholipids control lipid raft dynamics and downstream inflammation. Gaps in knowledge remain, particularly on underlying molecular mechanisms by which plasma membrane receptor organization is controlled in response to oxidized LC-PUFA acyl chains of membrane phospholipids. Validation in humans is also an area for future study.

Familial Mediterranean Fever Triggered by Menstruation – A Case Report from Zambia

Familial Mediterranean Fever (FMF) is an autoinflammatory autosomal-recessive disorder that is characterized by recurrent attacks of abdominal pains, fevers and serositis. It is highly prevalent among people from the Mediterranean basin including Arabs and Turks. However, due to the increase in migration worldwide, we start to recognize cases of FMF outside the Mediterranean region. We present the case of a 27-year-old Lebanese female residing in Zambia whose recurrent attacks constantly coincided with her menstruation. Due to the rarity of occurrence of FMF in regions such as Zambia, the coming up with the diagnosis was delayed and unnecessary interventions such as exploratory laparotomy were done. This case aims to highlight the importance of considering FMF and its potential triggers especially menstruation by the healthcare providers in non-Mediterranean areas to ensure timely recognition and management to avoid serious future complications such as amyloidosis.