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QUESTIONS TO CONSIDER

What are the main causes of microcytic anemia?

What are the diagnostic tests for acute intermittent porphyria?

Which secondary porphyria can mimic acute porphyria?

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Microcytic anemia is most commonly caused by thalassemia, anemia of chronic disease, iron deficiency, lead poisoning, or congenital sideroblastic anemia (acronym, TAILS). Microcytic anemia can also be caused by vitamin B (pyridoxine) deficiency. AIP, a rare metabolic disorder characterized by a deficiency in the enzyme PBG deaminase, is not normally associated with microcytic anemia but it was considered in these patients because of the complaint of acute abdominal pain. AIP is associated with increased urine PBG and ALA concentrations. Lead poisoning and hereditary tyrosinemia type I can mimic AIP.

The second patient, during hospital stay, demanded prescription of opioids for pain management; finally, he admitted to having an opium addiction. Soon it was revealed that the patients were friends (they accompanied each other to the outpatient clinic) and had been ingesting opium orally from the same Iranian supplier.

A previous case series has reported oral opium as a cause of lead poisoning and described patients who presented with similar clinical and biochemical symptoms ( woven Gancio sneakers Nude amp; Neutrals Salvatore Ferragamo Cheap Authentic Outlet 2koYL45NkN
). Hence, the possibility of lead poisoning was investigated in our patients, revealing the following lead concentrations: case 1: 124.2 μg/dL (reference interval <10 μg/dL); case 2: 223.6 μg/dL; and case 3: 190.5 μg/dL. A sample of the opium they were ingesting was requested for analysis. Lead was detected in the sample (225 μg/g), thus confirming the diagnosis of lead poisoning.

Lead poisoning is preventable, and it is caused primarily by either inhalation or ingestion. The incidence of occupational lead poisoning has declined worldwide because of improved industrial safety measures and the limited use of lead in various applications, such as paint, water pipes, and canned goods ( Womens Gatsby Vintage Shoes TBar Heels Joe Browns Websites Online Visit Discount Sale Cheap Footlocker qA6GgZEo
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). The 3 patients self-reported daily opium intake of 10 g for several years exceeded the WHO-recommended daily lead intake limit of 3.6 μg/kg body weight by almost 10 times. In 2010, WHO withdrew this set limitation because the lead dose is not directly related to the key adverse effects and did not establish new recommendation ( 6 ).

R has three basic indexing operators, with syntax displayed by the following examples

For vectors and matrices the [[ forms are rarely used, although they have some slight semantic differences from the [ form (e.g. it drops any names or dimnames attribute, and that partial matching is used for character indices). When indexing multi-dimensional structures with a single index, x[[i]] or x[i] will return the i th sequential element of x .

For lists, one generally uses [[ to select any single element, whereas [ returns a list of the selected elements.

The [[ form allows only a single element to be selected using integer or character indices, whereas [ allows indexing by vectors. Note though that for a list or other recursive object, the index can be a vector and each element of the vector is applied in turn to the list, the selected component, the selected component of that component, and so on. The result is still a single element.

The form using $ applies to recursive objects such as lists and pairlists. It allows only a literal character string or a symbol as the index. That is, the index is not computable: for cases where you need to evaluate an expression to find the index, use x[[expr]] . Applying $ to a non-recursive object is an error.

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][ Index ]

R allows some powerful constructions using vectors as indices. We shall discuss indexing of simple vectors first. For simplicity, assume that the expression is x[i] . Then the following possibilities exist according to the type of i .

Integer

If i is positive and exceeds length(x) then the corresponding selection is NA . Negative out of bounds values for i are silently disregarded since R version 2.6.0, S compatibly, as they mean to drop non-existing elements and that is an empty operation (“no-op”).

A special case is the zero index, which has null effects: x[0] is an empty vector and otherwise including zeros among positive or negative indices has the same effect as if they were omitted.

Other numeric Logical Character Factor

Indexing with a missing (i.e. NA ) value gives an NA result. This rule applies also to the case of logical indexing, i.e. the elements of x that have an NA selector in i get included in the result, but their value will be NA .

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