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Kounis syndrome following solenopsis (fire ant) bite

Ng BH, Tan HX, Vijayasingham S

Med J Malaysia, 2019 08;74(4):344-346.
PMID: 31424048

Anaphylaxis is rarely associated with the vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. We report here a case of Kounis syndrome in a man with no known cardiovascular risk developed acute ST-elevation myocardial infarction complicated with complete heart block following Solenopsis (fire ant) bite.
Fulltext Addressing Emotional Dysregulation and Potential Pharmacogenetic Implication of 5-HTTLPR Genotype in Attention Deficit Hyperactivity Disorder

Tan HX, Md Kamal A, Thurairajasingam S, Phipps ME

Complex Psychiatry, 2023;9(1-4):70-88.
PMID: 37404870 DOI: 10.1159/000529732

BACKGROUND: This review unpacks the emotional presentation of externalizing behaviors in attention deficit hyperactivity disorder (ADHD), by diving into the psychophysiology, neurophysiology, and neurogenetics in relation to executive function. The correlations among these three variables are identified, showing that standard assessments for ADHD leave out the emotional dysregulation element. This may lead to suboptimal management outcomes during the developmental progression into adolescence and adulthood.
SUMMARY: The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood.
KEY MESSAGES: The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.
Fulltext Post COVID-19 organizing pneumonia treated with mycophenolate mofetil

Tan HX, Wong CK, Yik WF, Lam YF, Lachmanan KR

Respirol Case Rep, 2022 Nov;10(11):e01042.
PMID: 36204457 DOI: 10.1002/rcr2.1042

Organizing pneumonia (OP) promptly responds to corticosteroids. However, a minority of patients demonstrate corticosteroid resistance or relapse on corticosteroid tapering. We describe post COVID-19 OP patients with clinically inadequate response to corticosteroids but that improved after the addition of Mycophenolate Mofetil (MMF). Case 1: A gentleman was diagnosed with post COVID-19 OP but had suboptimal clinico-physiologic-radiologic response and steroid toxicity during outpatient reviews. MMF was initiated resulting in marked clinical response and quick weaning from corticosteroids. Case 2: A gentleman with post COVID-19 OP relapsed during tapering of steroids. Clarithromycin and MMF were added to his regimen, which improved his clinico-physiologic parameters and allowed corticosteroid tapering. Unfortunately, he developed MMF-related colitis needing therapy cessation. Currently, no studies have reported on MMF utilization in difficult post COVID-19 OP patients. Nevertheless, we believe, similar as in non-COVID OPs, MMF or other immunomodulators, potentially have a role in treating difficult or steroid-resistant OPs.

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