Daisy Hill Hospital is an acute teaching hospital located in Newry, Co Armagh, Northern Ireland.It is situated on the Hospital Road and backs onto the A25 Camlough Road. It is managed by the Southern Health and Social Care Trust.
Bartter syndrome (BS) is a rare autosomal recessive salt-wasting tubulopathy characterized by hypokalemic metabolic alkalosis, hyperreninemia, and hyperaldosteronism without hypertension. It usually presents in childhood; however, adult-onset cases are infrequent and often misdiagnosed. We report a young adult male from Pakistan with congenital deaf-mutism who presented with vomiting, irritability, and altered sensorium. Laboratory findings revealed persistent hypokalemia, metabolic alkalosis, and acute kidney injury secondary to sepsis. Despite adequate potassium replacement, hypokalemia persisted, prompting evaluation for a renal potassium-wasting disorder. Further investigations showed elevated urinary sodium, potassium, and chloride with normal magnesium and a normal-to-high urinary calcium-to-creatinine ratio, consistent with Bartter syndrome. The patient was managed with intravenous fluids, antibiotics, and potassium supplementation, followed by the addition of oral potassium chloride and spironolactone. Clinical and biochemical improvement was noted, with normalization of renal function and serum electrolytes at discharge and on follow-up. This case underscores the diagnostic importance of considering Bartter syndrome in adults with refractory hypokalemia and metabolic alkalosis, particularly after excluding more common causes such as vomiting or diuretic abuse. The coexistence of chronic hypotension and prior myocardial infarction highlights the potential cardiovascular implications of chronic hypokalemia. Bartter syndrome may present in adulthood with atypical features. Early recognition through targeted biochemical evaluation and timely initiation of potassium-sparing therapy are crucial for favorable outcomes and prevention of renal and cardiovascular complications, especially in resource-limited settings lacking genetic diagnostic facilities.
Introduction and importance: In the subcontinent, hair color containing paraphenylenediamine (PPD) is frequently used due to its affordability and easy accessibility. When administered topically or consumed, PPD has harmful effects both locally and systemically. Since there is no known cure, early detection and supportive interventions are the cornerstones of care. Case presentation: We now describe the effective treatment of a young female patient who experienced angioedema, cardiac manifestations, and hepatic dysfunction following PPD ingestion. Clinical signs such as angioedema and dark brown urine may indicate PPD toxicity in the absence of testing facilities. Clinical discussion: When taken orally, it is highly hazardous, and the results are primarily dependent on the dosage. Angioedema resulting in dysphagia and respiratory distress, hepatic necrosis, rhabdomyolysis, intravascular hemolysis, and abrupt renal failure are significant clinical symptoms. In PPD poisoning, myocarditis or deadly arrhythmias are also possible outcomes. Conclusion: Healthcare providers should maintain vigilance in regions where PPD exposure is prevalent, and public awareness and product regulation measures are necessary to mitigate the risks associated with PPD-containing products.
Kidney cachexia is a debilitating and under-recognised complication of advanced chronic kidney disease (CKD), characterised by unintentional weight loss, muscle wasting, inflammation, and reduced functional capacity. Its profound impact on morbidity, quality of life, and healthcare utilisation underscores the need for targeted, implementable interventions. The multicomponent implementation strategy for a multi-modal, integrated, exercise, anti-inflammatory, and dietary advice (MMIEAD) intervention seeks to address this gap. Guided by the practical, robust implementation, and sustainability model (PRISM), which incorporates reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes, this study aims to ensure strong intervention–context alignment to support future scalability. The MMIEAD model will be evaluated by determining patient eligibility and recruitment rates, identifying intervention retention and adherence, assessing key statistical and methodological considerations to inform optimal study design and data collection burden, conducting a qualitative process evaluation to examine intervention acceptability and practicality, and determining the feasibility of undertaking a definitive economic evaluation. This mixed-methods study consists of three phases. Phase 1 will deliver and evaluate a 12-week multimodal intervention using a feasibility cluster randomised controlled trial (cRCT) design. Phase 2 will undertake a qualitative process evaluation with healthcare practitioners (HCPs) and patients. Phase 3 will assess the feasibility of conducting a full economic evaluation. Patients will be eligible if they have haemodialysis-dependent CKD stage 5 for more than 3 months, have experienced unintentional weight loss of at least 5
Plummer-Vinson syndrome (PVS) is a rare condition characterised by the triad of iron deficiency anaemia, dysphagia, and oesophageal webs. While dysphagia is a recognised feature, complications such as aspiration are infrequently reported. We describe a 60-year-old woman with a history of Crohn's disease who presented with aspiration pneumonia in the context of previously undiagnosed PVS. This case demonstrates aspiration pneumonia as a potential and under-recognised complication of proximal oesophageal webs and highlights the importance of early investigation of dysphagia in patients with iron deficiency.
