scholarly journals Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwaseun Shogbesan ◽  
Andrew Rettew ◽  
Bilal Shaikh ◽  
Abdullateef Abdulkareem ◽  
Anthony Donato
Keyword(s):  
Laboratory Data ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Shigella Sonnei ◽  
Public Health Issue ◽  
Watery Stool ◽  
Normal Limits ◽  
Significant Public Health ◽  
History Of

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases ofShigellainfection are reported annually in the United States.Shigellabacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of aShigella sonneibacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson’s disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive forShigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

scholarly journals HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents

2021 ◽  
Vol 3 ◽  
Author(s):  
Beth Sundstrom ◽  
Kathleen B. Cartmell ◽  
Ashley A. White ◽  
Nicole Russo ◽  
Henry Well ◽  
...  
Keyword(s):  
Social Media ◽  
Feasibility Study ◽  
Hpv Vaccination ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Public Health Issue ◽  
Significant Difference ◽  
Significant Public Health ◽  
Developed Nations

Human papillomavirus (HPV) vaccination prevents 6 HPV-related cancers in men and women. Yet, rates of HPV vaccination among adolescents in the United States lag behind other developed nations, revealing a significant public health issue. This feasibility study tested a collaborative online learning environment to cultivate HPV vaccination champions. A 3-month training program recruited parents to serve as proponents and social media influencers to identify solutions to overcome barriers to HPV vaccination. A mixed methods study design included a pretest survey, three online asynchronous focus groups, a posttest survey, as well as a longitudinal follow-up survey at 6 months. Participants included 22 parents who self-identified as female (95.4%) and white (90.9%). Overall, there was a statistically significant difference in knowledge of HPV and HPV vaccination between pretest and posttest (p = 0.0042). This technology-mediated intervention increased parents' confidence and motivated them to speak more freely about HPV vaccination in-person and online with others in their social networks. Participants identified prevalent misinformation about HPV vaccination and learned how to effectively craft messages to address concerns related to safety and side effects, gender, understanding of risk, and sexual activity. Objective measures and qualitative open-ended assessment showed high intervention engagement and treatment satisfaction. All participants (100%) indicated that they enjoyed participating in the intervention. The effectiveness of this feasibility study suggests that social media is an appropriate platform to empower parents to counter vaccine hesitancy and misinformation through HPV vaccination information that is simple and shareable in-person and online.

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

scholarly journals Association of Housing Stress With Child Maltreatment: A Systematic Review

2020 ◽  
pp. 152483802093913
Author(s):  
Caroline E. Chandler ◽  
Anna E. Austin ◽  
Meghan E. Shanahan
Keyword(s):  
Child Maltreatment ◽  
Child Protective Services ◽  
The United States ◽  
Public Health Issue ◽  
Material Hardship ◽  
Protective Services ◽  
Stress Indicators ◽  
Effective Prevention ◽  
Established Risk Factor ◽  
Significant Public Health

Child maltreatment is a significant public health issue in the United States. Understanding key risk factors for child maltreatment is critical to informing effective prevention. Poverty is an established risk factor for child maltreatment. However, recent research indicates that material hardship (i.e., difficulties meeting basic needs) may serve as a more direct measure of the way in which poverty affects daily life. One form of material hardship that is common among families is housing stress. Previous reviews have summarized the existing literature regarding the association of economic insecurity with child maltreatment, but no reviews have synthesized and critically evaluated the literature specific to the association of various types of housing stress with child maltreatment. We conducted a systematic search of multiple electronic databases to identify peer-reviewed studies conducted in the U.S. regarding the association of housing stress with child maltreatment. We identified 21 articles that used nine distinct measures of housing stress including homelessness or eviction, homeless or emergency shelter stays, foreclosure filing, housing instability, inadequate housing, physical housing risk, living doubled-up, housing unaffordability, and composite housing stress indicators. Overall, results from this body of literature indicate that housing stress is associated with an increased likelihood of caregiver or child self-reported maltreatment, child protective services (CPS) reports, investigated and substantiated CPS reports, out-of-home placements, and maltreatment death. Additional theory-driven research is needed to further our understanding of the contribution of specific types of housing stress to risk for specific types of maltreatment.

scholarly journals Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096251
Author(s):  
Bradley M. Kruckeberg ◽  
Devin P. Leland ◽  
Christopher D. Bernard ◽  
Aaron J. Krych ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
The United States ◽  
Anterior Shoulder Instability ◽  
Geographic Population ◽  
Increased Risk ◽  
Modifiable Factors ◽  
History Of ◽  
Former Smokers

Background: The rate of osteoarthritis (OA) in patients with a history of previous anterior shoulder instability (ASI) varies within the literature, with the majority of studies investigating rates after surgical stabilization. ASI appears to lead to increased rates of OA, although risk factors for developing OA in cohorts treated nonoperatively and operatively are not well-defined. Purpose: To determine the incidence of clinically symptomatic OA and identify potential risk factors for the development of OA in patients younger than 40 years with a known history of ASI. Study Design: Case-control study; Level of evidence, 3. Methods: An established, geographically based database was used to identify patients in the United States who were younger than 40 years and were diagnosed with ASI between 1994 and 2014. Patient information, including demographic, imaging, and surgical details, was collected. Comparative analysis was performed between groups with and without OA at final follow-up as well as between patients who underwent surgical and nonsurgical management. Results: The study population consisted of 154 patients with a mean follow-up of 15.2 years (range, 5.1-29.8 years). The mean age at initial instability event was 20.9 years (95% CI, 19.9-22.0 years). Overall, 22.7% of patients developed clinically symptomatic glenohumeral OA. Multivariate analysis revealed that current or former smokers (odds ratio [OR], 4.3; 95% CI, 1.1-16.5; P = .030), hyperlaxity (OR, 10.1; 95% CI, 1.4-72.4; P = .020), laborer occupation (OR, 6.1; 95% CI, 1.02-36.1; P = .043), body mass index (BMI) (OR, 1.2; 95% CI, 1.03-1.3; P = .012), and age at initial instability (OR, 1.1; 95% CI, 1.02-1.2; P = .013) as potential independent risk factors when accounting for other demographic and clinical variables. Conclusion: In a US geographic population of patients younger than 40 years with ASI, approximately one-fourth of patients developed symptomatic OA at a mean follow-up of 15 years from their first instability event. When accounting for differences in patient demographic and clinical data, we noted a potentially increased risk for the development of OA in patients who are current or former smokers, have hyperlaxity, are laborers, have higher BMI, and have increased age at initial instability event. Smoking status, occupation, and BMI are modifiable factors that could potentially decrease risk for the development of symptomatic OA in these patients.

Psycho-Oncology: Cancer patients with past suicide attempts, or a family history of suicide.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23173-e23173
Author(s):  
Daniela Gercovich ◽  
Ernesto Gil Deza ◽  
Flavio Tognelli ◽  
Carlos Fernando Garcia Gerardi ◽  
Claudia Lorena Acuna ◽  
...  
Keyword(s):  
Family History ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Illicit Drugs ◽  
Suicide Attempts ◽  
The United States ◽  
Population Characteristics ◽  
History Of ◽  
Psychological Risk

e23173 Background: “The suicide rate in cancer patients is twice that observed in the general population in the United States” (JNCI vol 100, 24, page 1750, 2008). This paper focuses ona population with great psychological risk: cancer patients (Pt) with previous suicide attempts (SA) or a family history of suicide (FS); both grouped under SAFS for the purpose of this study. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions. The database was locked and anonymized. Those with a history of SAFS before cancer diagnosis were selected. Results: Out of 15,617 Pt, 184 Pt (1.2%) were SAFS(141 Pt were SA, 39 Pt were FS and 4 Pt were both). The relative risk ofSA was ten times larger for those with FS. Psychiatric Medication: Antipsychotics: 15Pt (8%), Antidepressants: 23 Pt (12%) and Benzodiazepines 45 Pt(24%), No treatment 101 Pt (55%). Population Characteristics: Sex: F:144 Pt . M: 40 Pt. Age: 56y (r = 26-88). Tumor Dx: Breast (65 Pt ) - Gastrointestinal (24 Pt) - Urological (21 Pt ) - Lung (21 Pt ) -Gynecological (19 Pt) - Hematological (11 Pt) -Head &Neck (8 Pt) - Endocrine (7 Pt) - Other (8 Pt). Stages: Early (0-I-II-III): 130 Pt, Advanced: 54 Pt. Ob-Gyn history:25 Pt (17%) nulliparous, 18 Pt (12%) with one child, 77 Pt (53%) with 2 or 3 children and 24 Pt (17%) with more than 3 children; 62 Pt (43%) had previous abortions. Average severe comorbidities (respiratory and psychiatric) was 3 per Pt (r = 0-18). Toxic habits: Smoking: 120 Pt (65%), Alcohol: 37 Pt (20%) and Illicit Drugs: 4 Pt (2%). Follow-up: 19 months (r = 0-70). No Pt had any SA, or commited suicide, during the follow-up.Living patients:177 (96%). Conclusions: 1) In our vast cohort, 184 Pt (1.2%) were identified as highly vulnerable psychiatric Pt due to SAFS. 2) Given the high psychological risk and stressful cancer diagnosis, 83 Pt (45%) were prescribed psychiatric drugs. 3) Follow-up of SAFS Pt by a multidisciplinary team is requiredfor adequate Pt and family support.

Five years of experience with hydroxyurea in children and young adults with sickle cell disease

Blood ◽  
2001 ◽  
Vol 97 (11) ◽  
pp. 3628-3632 ◽  
Author(s):  
Alina Ferster ◽  
Parvine Tahriri ◽  
Christiane Vermylen ◽  
Geneviève Sturbois ◽  
Francis Corazza ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Laboratory Data ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Significant Difference ◽  
History Of ◽  
Ischemic Attack

The short-term beneficial effect of hydroxyurea (HU) in sickle cell disease (SCD) has been proven by randomized studies in children and adults. The Belgian registry of HU-treated SCD patients was created to evaluate its long-term efficacy and toxicity. The median follow-up of the 93 patients registered is 3.5 years; clinical and laboratory data have been obtained for 82 patients at 1 year, 61 at 2 years, 44 at 3 years, 33 at 4 years, and 22 after 5 years. On HU, the number of hospitalizations and days hospitalized dropped significantly. Analysis of the 22 patients with a minimum of 5 years of follow-up confirm a significant difference in the number of hospitalizations (P = .0002) and days in the hospital (P < .01), throughout the treatment when compared to prior to HU therapy. The probabilities of not experiencing any event or any vaso-occlusive crisis requiring hospitalization during the 5 years of treatment were, respectively, 47% and 55%. On HU, the rate per 100 patient-years of severe events was estimated to be 3.5% for acute chest syndrome, 1.2% for aplastic crisis, 0.4% for splenic sequestration; it was 0% for the 9 patients with a history of stroke or transient ischemic attack followed for an average of 4 years. No important adverse effect occurred. Long-term chronic treatment with HU for patients with SCD appears feasible, effective, and devoid of any major toxicity; in patients with a history of stroke, HU may be a valid alternative to chronic transfusion support.

scholarly journals Uterus unicornis and pregnancy in two feline littermates

2017 ◽  
Vol 3 (2) ◽  
pp. 205511691774361
Author(s):  
Wilson C Brookshire ◽  
Jacob Shivley ◽  
Kimberly Woodruff ◽  
Jim Cooley
Keyword(s):  
Renal Agenesis ◽  
Case Series ◽  
Abdominal Ultrasound ◽  
Female Offspring ◽  
Uterine Horn ◽  
Normal Limits ◽  
Histopathologic Diagnosis ◽  
Underlying Causes ◽  
The Right

Case series summary A queen, tom and four 1-year-old female offspring presented for routine neuter. Two of the littermates (cats 1 and 2) were diagnosed with a uterine abnormality during surgery. The left uterine horn of both cats appeared as a thin, solid, cord-like structure, whereas the right uterine horn of both cats appeared to have intermittent bulges consistent with pregnancy. The two other littermates, queen and tom were reproductively normal. The uteruses of the affected cats were nearly identical with a gross and histopathologic diagnosis of uterus unicornis with concurrent pregnancy. Ovaries were present, bilaterally. An oviduct was present only on the single normally developed and pregnant uterine horn in both cats. At a postoperative follow-up evaluation, abdominal ultrasound was performed on the two cats with uterine abnormalities. Cat 1 was ultrasonographically within normal limits. Cat 2 was diagnosed with ipsilateral renal agenesis on the same side as the absent uterine horn. Relevance and novel information The complexity of uterus unicornis and renal aplasia is demonstrated by this unique presentation of five related cats for ovariohysterectomy. This report raises questions regarding the genetic, environmental, hormonal or other underlying causes of this anatomic abnormality in cats that may spur additional research. This is the first publication describing uterus unicornis in gravid feline littermates, with one of the cats having ipsilateral renal agenesis. This is also the first publication to describe oviduct agenesis on the affected uterine horn in feline uterus unicornis.

scholarly journals SAT-472 An Atypical Presentation of Severe Hypothyroidism, a Case of Large Posterior Pericardial Effusion Without Hemodynamic Compromise

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Paola Andrea Sanchez Garay ◽  
Daniele Restifo ◽  
Swathi Rao ◽  
Diana Espinoza ◽  
Madalina Liliana Ionescu ◽  
...  
Keyword(s):  
United States ◽  
Pericardial Effusion ◽  
Medical Care ◽  
Chronic Diseases ◽  
Social Services ◽  
Laboratory Data ◽  
The United States ◽  
Healthcare Outcomes ◽  
Large Pericardial Effusion

Abstract BACKGROUND We are reporting a case of a Hispanic female who presented with a pericardial effusion as a complication of hypothyroidism, untreated due to lack of medical care, which demonstrates health disparities in chronic diseases. CLINICAL CASE The patient is a 48 year-old Hispanic female with PMHx of hypothyroidism, non-compliant with medical therapy, who presented to the ED with fatigue and dyspnea. Despite progressively worsening symptoms for the past 4 months, she had refused to be seen by a physician because she was uninsured. Her physical exam was notable for generalized pallor and bradycardia, with otherwise normal cardiopulmonary exam. Her initial laboratory data showed hemoglobin of 5.5 g/dl. CXR demonstrated an enlarged cardiac silhouette, which on CT was found to represent a large pericardial effusion. On admission her laboratory data demonstrated low ferritin, TSH of 94 mIU/L and T4 of 1.4 mcg/dl. m. Cortisol was 9 mcg/dl at 11 am. Repeat hemoglobin post-transfusion was 9 g/dl The patient was started on IV levothyroxine and hydrocortisone. Echocardiogram showed a large posterior wall pericardial effusion without evidence of RV strain. Pericardiocentesis was attempted but was unsuccessful because of difficult access to the fluid location. She was discharged on levothyroxine 88mcg QD and recommended to follow up with endocrinology and cardiology as an outpatient. It is well known that the United States spends a disproportionate amount of money in healthcare in comparison to developing countries (1). Underinvestment in social services and high prices set by pharmaceutical companies are likely contributing factors (1). Unfortunately, the resulting outcomes do not necessarily reflect the spending. Minorities are well known to have a higher morbidity and mortality as well as to present more frequently with dramatic manifestations of chronic diseases. This can often be attributed to a lack of access to medical care and poor follow up. Our patient was diagnosed with pericardial effusion as a complication of untreated hypothyroidism, a condition that is underdiagnosed despite a high incidence (3-37%). This pericardial effusion was initially concerning due to its large volume. The fact that she was hemodynamically stable reflects its chronicity, but it could have led to a fatal complication if she continued without appropriate therapy for a longer period of time. CONCLUSION A case such as this should make us question what more we can do to improve healthcare outcomes for minorities in the USA. REFERENCES (1). Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. “Health care spending in the United States and other high-income countries.” Jama 319.10 (2018): 1024-1039.

scholarly journals ANTIDEPRESSANT USE AND MORTALITY RISK IN OLDER ADULTS WITH HISTORY OF STROKE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S269-S269
Author(s):  
Madison B Lenox ◽  
Victor Tran ◽  
Grace Tworek ◽  
Andrew Solow ◽  
Diana Hincapie
Keyword(s):  
Older Adults ◽  
Mortality Risk ◽  
The United States ◽  
Mortality Rates ◽  
Lower Mortality ◽  
Public Health Issue ◽  
Post Stroke ◽  
Cognitive Limitations ◽  
History Of ◽  
Antidepressant Use

Abstract The American Stroke Association reports stroke as the fourth leading cause of death in the United States, with 66% of hospitalized cases being older adults. Recovery from stroke is a public health issue, as post-stroke depression (PSD) is a significant concern. Approximately 20-23% of stroke survivors identified co-occurring diagnoses, which are associated with physical, functional, and cognitive limitations and increased mortality risk. Antidepressant use has exhibited its efficacy in treating PSD. This study explores the association between antidepressant use and mortality risk in older adults with history of stroke. Older adults aged 65 and older (N=3631, 55.4% female, 72.6% Caucasian, Mage=79.64 years, SDage=7.29 years, MEd=14.55 years, SDEd=8.269 years) with history of stroke were selected from the National Alzheimer’s Coordinating Center database to explore the association between antidepressant use and mortality. A chi-squared test of independence was calculated comparing antidepressant use and mortality rates. A significant association was found (χ2 (1) = 15.933, p < .001) between current antidepressant use and mortality. Findings suggest antidepressant use is associated with lower mortality rates in subjects with a history of stroke. Implications include highlighting the role psychologists play in the early identification of PSD and early antidepressant intervention post-stroke to increase life longevity. Although findings only infer association, they demonstrate evidence for the link between PSD, antidepressant use, and lower mortality rates. Future directions include exploring other forms of depression treatment and mechanisms of antidepressant use. Limitations include examining potential moderators (e.g., gender, SES, type of stroke), and substance use within this population.

Incidence of cholelithiasis after laparoscopic sleeve gastrectomy

2020 ◽  
Vol 2 (2) ◽  
pp. 63-69
Author(s):  
Iea Alabbasi ◽  
Issam Merdan ◽  
Falih Al-Gazgooz
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Weight Reduction ◽  
Gallstone Formation ◽  
Abdominal Ultrasound ◽  
Gallbladder Polyps ◽  
Concomitant Cholecystectomy ◽  
History Of ◽  
Age Range

Background: Laparoscopic sleeve gastrectomy is a well-known method for weight reduction. Post-operative weight loss is a major risk factor for gallstone formation. Objective: To determine whether prophylactic concomitant laparoscopic cholecystectomy should be performed on all patients at the time of laparoscopic sleeve gastrostomy or not. Patients and Methods: A retrospective and prospective study on 540 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy; their BMI range was between 38 and 53, their age range was 18 to 63 years, and 335 of them were females. The exclusion criteria were patients with a history of cholecystectomy, gallstone patients or gallbladder polyps more than 1 cm in preoperative abdominal ultrasound, and those who failed to follow-up. All patients were followed up with every 6–12 months, including those who had cholecystectomy by other surgeons. Results: During the study period, from the total 540 patients who had laparoscopic sleeve gastrectomy, 167 patients (30.92%) had cholecystectomy, out of which 20 patients (3.7%) had achieved 45% weight reduction during the first six months; while in another 6 months, 147 patients (27.22%) had cholecystectomy, achieving additional 30% weight reduction. Conclusions: The incidence of gallstones after laparoscopic sleeve gastrostomy is about 30.92%, indicating that 69.08% will not have gallstones in the postoperative follow-up period, so it would be unwise to do prophylactic concomitant cholecystectomy for all patients. Keywords: Bariatric procedures, cholecystectomy, incidence

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