Non-ketotic hemichorea-hemiballismus presenting as generalised tonic-clonic convulsive state in uncontrolled diabetes

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient’s history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.

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Serum Sodium Levels Predict the Recurrence of Febrile Seizure within 24 Hours

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201961 ◽

2019 ◽

Author(s):

Jatuporn Duangpetsang

Keyword(s):

Family History ◽

Serum Sodium ◽

Medical Records ◽

Febrile Seizure ◽

Serum Sodium Level ◽

Febrile Seizures ◽

P Value ◽

Seizure Recurrence ◽

History Of

Objective: Febrile seizure is a common disorder in children that occurs in 2.5% of children 6-60 months of age. The study was conducted to ascertain the role of serum sodium as a predictor of seizure recurrence within the same febrile illness.Material and Methods: A retrospective study was conducted in children with febrile seizures who were admitted to Kaengkhro Hospital between 1 January 2014 and 31 December 2017. The data collected from medical records included age, gender, serum sodium level, body temperature, duration of fever, and family history of febrile seizures.Results: Two hundred ten children were diagnosed with febrile seizures; 190 had a single febrile seizure and 20 had recurrent febrile seizures. Mean±standard deviation ages of children with a single febrile seizure and recurrent febrile seizures were 22.95 ± 0.95 and 22.34 ± 0.89 months, respectively. Serum sodium levels in children with recurrent seizures within 24 hours (130.80 mmol/L) were significantly lower than in children with a single febrile seizure (132.37 mmol/L, p-value=0.02). A family history of febrile seizures was significant for predicting recurrent seizures within 24 hours (p−value= 0.006).Conclusion: Serum sodium levels predict the recurrence of febrile seizure within 24 hours.

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Characteristics of suspected COVID-19 patients admitted with non-COVID illness in department of Endocrinology, BIRDEM General Hospital, Dhaka

BIRDEM Medical Journal ◽

10.3329/birdem.v10i0.50977 ◽

2020 ◽

pp. 29-32

Author(s):

Faria Afsana ◽

Abdullah Al Parvez ◽

Jubaida Nahar ◽

Mohammad Aminul Islam ◽

Kazi Nazmul Hossain ◽

...

Keyword(s):

General Hospital ◽

Electronic Medical Records ◽

Medical Records ◽

Rt Pcr ◽

Uncontrolled Diabetes ◽

General Weakness ◽

History Of ◽

Variable Presentation ◽

Prior Permission ◽

Neurological System

Background: Since March 2019 the outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Bangladesh. There is variable presentation of COVID-19. Though SARS-CoV-2 primarily involves respiratory system, as time passing on it is evident that it can affect any other system including gastrointestinal, cardiovascular and neurological system. This study described the characteristics of the patients admitted in Department of Endocrinology, BIRDEM General Hospital with non-COVID illness and later revealed positive for SARS-CoV-2. Methods: This observational study was conducted during the period of 13th April to 14thOctober, 2020.Data of all patients admitted in Department of Endocrinology, BIRDEM General Hospital during this period was retractedretrospectively from hospital electronic medical records with prior permission from institutional head. Though admitted for non-COVID illness, patientshavingsymptoms or supportive lab investigations of COVID- 19 were advised RT-PCR for SARS-CoV-2. All hospital records of these suspected COVID-19 cases wererecoded and analyzed by SPSS version 20. Results:Total patients were 63. Among them 21(33.3%) patients were admitted with uncontrolled diabetes (DM),19(30.2%) had other endocrinopathies(later query revealed history of fever),8(9.5%) had newly detected DM,11(7.5%)had hypoglycemia,6(9.6%) had general weakness. Though all study subjects were advised to do RT-PCR for COVID, 22(34.9%) refused the test either due to symptom denial or due to cost of the test and 24(38.1%) become positive. Conclusion: Non-critically ill COVID-19 patients had variable clinical characteristics. This study shows that uncontrolled diabetes mellitus, newly detected diabetes and hypoglycemia are found in patients with COVID- 19 and may not have typical clinical features. Birdem Med J 2020; 10, COVID Supplement: 29-32

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The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

10.2196/preprints.25427 ◽

2020 ◽

Author(s):

Emma Chavez ◽

Vanessa Perez ◽

Angélica Urrutia

Keyword(s):

Decision Making ◽

Essential Hypertension ◽

Medical History ◽

Medical Records ◽

Medical Training ◽

Relevant Information ◽

Domain Ontology ◽

Free Text ◽

Snomed Ct ◽

History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Tuberculosis presenting as dacryoadenitis in the USA

BMJ Case Reports ◽

10.1136/bcr-2019-231694 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231694 ◽

Cited By ~ 1

Author(s):

Harry Ross Powers ◽

Mark Anthony Diaz ◽

Julio C Mendez

Keyword(s):

Correct Diagnosis ◽

Developed Countries ◽

Histopathological Analysis ◽

Orbital Mass ◽

Antituberculosis Therapy ◽

The Usa ◽

History Of ◽

Patient’S History ◽

High Degree ◽

Filipino Woman

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

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Additive value of positron emission tomography/computed tomography scan for detection of aortic tube graft infection: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa512 ◽

2020 ◽

Author(s):

Farnoosh Larti ◽

Mohammad Amin Khadembashiri ◽

Mehrshad Abbasi ◽

Alborz Sherafati

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Diagnostic Accuracy ◽

Ct Scan ◽

Graft Infection ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

History Of ◽

Pet Ct Scan

Abstract Background Diagnosis of aortic graft infection is challenging, and delayed diagnosis is associated with poor prognosis. Positron emission tomography/computed tomography (PET/CT) has improved diagnostic accuracy. Case summary A patient with a history of congenital heart disease was admitted due to fever. He had a history of four cardiac surgeries, including the Bentall procedure for endocarditis. Blood cultures were negative. A semi-mobile mass was detected in the distal portion of the aortic tube graft in echocardiography. PET/CT scan was used to confirm tube graft infection and to support proceeding to cardiac surgery. Discussion Using multimodality imaging, including PET/CT scan in combination with echocardiography, can improve diagnostic accuracy for the detection of aortic tube graft infection, infection of prosthetic valves, or intra-cardiac devices, especially in high-risk surgical cases.

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Pancreatic enzymatic mediastinitis followed by total gastrectomy with splenectomy: report of two cases

Surgical Case Reports ◽

10.1186/s40792-021-01240-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yoko Zaitsu ◽

Takashi Nishizaki ◽

Takuma Izumi ◽

Daisuke Taniguchi ◽

Yuichiro Kajiwara ◽

...

Keyword(s):

Gastric Cancer ◽

Abdominal Surgery ◽

Ct Scan ◽

Pancreatic Fistula ◽

Medical History ◽

Advanced Gastric Cancer ◽

Total Gastrectomy ◽

Upper Body ◽

History Of ◽

Acute Mediastinitis

Abstract Background Acute mediastinitis is a rare disease that rapidly progresses with a high mortality rate. Its most common cause is direct injury of the mediastinum, including iatrogenic causes such as cardiac surgery or upper endoscopy. Enzymatic mediastinitis is a rare complication of a pancreatic fistula caused by the inflammatory digestion of the parietal peritoneum spreading to the mediastinum. Here, we present two cases of enzymatic mediastinitis caused by total gastrectomy with splenectomy. One of them was successfully treated and cured after early diagnosis and transabdominal drainage. Case presentation Case 1 was that of a 60-year-old man (body mass index [BMI] 27) with a medical history of diabetes and hypertension who was diagnosed with advanced gastric cancer in the upper body of the stomach. A total gastrectomy with splenectomy was performed. The patient experienced acute respiratory failure 24 h after surgery. Pulmonary embolism was suspected, so a computed tomography (CT) scan was performed; however, no relevant causes were found. Although he was immediately intubated and treated with catecholamine, he died in the intensive care unit (ICU) 40 h after surgery. Post-mortem findings revealed retroperitonitis caused by a pancreatic fistula spreading towards the mediastinum, causing severe mediastinitis; a review of the CT scan revealed pneumomediastinum. We concluded that the cause of death was enzymatic mediastinitis due to post-gastrectomy pancreatic fistula. Case 2 involved a 61-year-old man (BMI 25) with a medical history of appendicitis who was diagnosed with advanced gastric cancer at the gastric angle between the lesser curvature and the pylorus, spreading to the upper body of the stomach. A total gastrectomy with splenectomy was also performed. The patient had a high fever 3 days after the surgery, and a CT scan revealed pneumomediastinum, indicating mediastinitis. As the inflammation was below the bronchial bifurcation, we chose a transabdominal approach for drainage. The patient was successfully treated and discharged. Conclusion Acute mediastinitis caused by gastrectomy is rare. The acknowledgment of abdominal surgery as a cause of mediastinitis is important. In treating mediastinitis caused by abdominal surgery, transabdominal drainage may be a minimally invasive yet effective method if the inflammation is mainly located below the bifurcation of the trachea.

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Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽

10.1542/peds.98.6.1119 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1119-1121

Author(s):

Joseph Maytal ◽

Gerald Novak ◽

Catherine Ascher ◽

Robert Bienkowski

Keyword(s):

Status Epilepticus ◽

Antiepileptic Drug ◽

Medical Records ◽

Clinic Visit ◽

Drug Levels ◽

Progressive Encephalopathy ◽

History Of ◽

The Mean ◽

Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

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The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up

PEDIATRICS ◽

10.1542/peds.98.2.216 ◽

1996 ◽

Vol 98 (2) ◽

pp. 216-225 ◽

Cited By ~ 2

Author(s):

Shlomo Shinnar ◽

Anne T. Berg ◽

Solomon L. Moshe ◽

Christine O'Dell ◽

Marta Alemany ◽

...

Keyword(s):

Risk Factors ◽

Age Of Onset ◽

Multivariable Analysis ◽

Cumulative Risk ◽

Febrile Seizures ◽

Recurrence Risk ◽

Early Recurrence ◽

Seizure Recurrence ◽

Unprovoked Seizure ◽

History Of

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

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Obtaining a Family Psychiatric History: Is it Worth the Effort?

The Canadian Journal of Psychiatry ◽

10.1177/070674379303800904 ◽

1993 ◽

Vol 38 (9) ◽

pp. 590-594 ◽

Cited By ~ 2

Author(s):

Ronald A. Remick ◽

Adele D. Sadovnick ◽

Boris Gimbarzevsky ◽

Raymond W. Lam ◽

Athanasios P. Zis ◽

...

Keyword(s):

Family History ◽

Psychiatric Disorder ◽

Mood Disorder ◽

Mood Disorders ◽

Medical Records ◽

Psychiatric History ◽

First Degree Relatives ◽

History Of ◽

Generated Family ◽

Index Cases

The purpose of this study was to determine whether, for first-degree relatives of patients presenting to a mood disorders clinic, family history information on psychiatric conditions collected by a psychiatrist and incorporated into the patient's medical records is as informative as that gathered during an interview specifically designed to collect family history data. The study group consisted of 472 first-degree relatives of 78 randomly selected index cases from a large mood disorders genetic database. Family history of psychiatric disorders recorded in regular psychiatric medical records (“clinician history”), and data obtained by a genetic counsellor administering specific family psychiatric history questionnaires to patients and multiple family informants (“family history”) were compared using a kappa statistic. Good agreement between the two methods on the presence or absence of a psychiatric disorder was found among first-degree relatives of index cases, but poor agreement was found with respect to the presence or absence of a specific mood disorder diagnosis(es) in a relative. The results suggest that a clinician-generated family psychiatric history is sensitive to the presence or absence of a psychiatric disorder when compared to a more structured detailed genetic interview. However, for research purposes, a clinician-generated family psychiatric history of a specific mood disorder diagnosis, without supporting collateral information, may not be reliable for use in supporting a mood disorder diagnosis in a patient and/or his relatives.

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