If left untreated P. falciparum malaria can rapidly develop into severe malaria with consequent renal failure (kidney failure), pulmonary oedema (fluid in the lungs), convulsions (fitting), coma, and eventually death (WHO 2010; Sinclair 2012).
When these are severely curtailed by an amnesic state, the links connecting present and past are severed, with a consequent failure of reproduction.
This event causes farnesylpyrophosphate (FPP) and geranylgeranyl pyrophosphate (GGPP) deprivation with a consequent failure of farnesylation and geranylation of small GTPases of the RAS superfamily, thereby disrupting the subcellular localisation and normal function of these essential signalling proteins and eventually stopping osteoclast-mediated bone resorption.
Limitations in tumour localisation may lead to a greater incidence of positive resection margins and the need for repeated excision or mastectomy in patients with a consequent failure to attain the desired goals of aesthetic breast conservation and optimum tumour control.
Alternatively, brain tissue abnormalities may be related to a deficiency in ATP7A mitochondrial copper-containing enzyme [9] with consequent energy failure.
However, there are other reports describing icteric hepatitis cases which are also reversible, due to NVP [ 8] and although rare, reports on cases who developed fulminant hepatitis with consequent liver failure either requiring transplantation or being fatal [ 4].
In summary, this patient's unusual clinical presentation highlights that in the kidney, pendrin does play a part in maintaining acid base homeostasis in humans, with its absence and consequent failure of renal bicarbonate excretion leading to potentially life-threatening metabolic alkalosis in the context of inter-current illness.
In Past Imperfect (1992), Tony Judt studied the infatuation of twentieth-century French intellectuals with Communism and denounced their consequent failure to be politically, morally, or intellectually responsible.
Typically, symptoms begin after weaning with refusal of feeding, vomiting and consequent failure to thrive.
The consequent failure of regeneration with persistence of scar tissue leads to high rates of both re-injury (up to 50%) and retirement (up to 70%) [ 4- 7].
