scholarly journals Legionnaires’ Disease: Clinicoradiological Comparison of Sporadic Versus Outbreak Cases

2017 ◽  
Vol 11 ◽  
pp. 117954841771194 ◽  
Author(s):  
Hafiz Rizwan Talib Hashmi ◽  
Lakshmi Saladi ◽  
Frances Petersen ◽  
Misbahuddin Khaja ◽  
Gilda Diaz-Fuentes
Keyword(s):  
New York ◽  
Early Recognition ◽  
Retrospective Chart Review ◽  
Sporadic Case ◽  
Discharge Disposition ◽  
Appropriate Treatment ◽  
Short Term Mortality ◽  
History Of ◽  
Sporadic Cases ◽  
Legionnaires Disease

Background: In 2015, New York City experienced the worst outbreak of Legionnaires’ disease in the history of the city. We compare patients seen during the 2015 outbreak with sporadic cases of Legionella during the past 5 years. Methods: We conducted a retrospective chart review of 90 patients with Legionnaires’ disease, including sporadic cases of Legionella infection admitted from 2010 to 2015 (n = 55) and cases admitted during the 2015 outbreak (n = 35). Results: We saw no significant differences between the 2 groups regarding demographics, smoking habits, alcohol intake, underlying medical disease, or residence type. Univariate and multivariate analyses showed that patients with sporadic case of Legionella had a longer stay in the hospital and intensive care unit as well as an increased stay in mechanical ventilation. Short-term mortality, discharge disposition, and most clinical parameters did not differ significantly between the 2 groups. Conclusions: We found no specific clinicoradiological characteristics that could differentiate sporadic from epidemic cases of Legionella. Early recognition and high suspicion for Legionnaires’ disease are critical to provide appropriate treatment. Cluster of cases should increase suspicion for an outbreak.

scholarly journals MON-084 Hyperosmolar Hyperglycemic State as Initial Presentation of Type 1 Diabetes in Children

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fabiola D’Ambrosio ◽  
Isabella Marranzini-Rodriguez ◽  
Roxana Aguirre Castaneda ◽  
Claudia Boucher-Berry
Keyword(s):  
African American ◽  
Early Recognition ◽  
Fluid Management ◽  
Low Frequency ◽  
Serum Glucose ◽  
African American Female ◽  
Appropriate Treatment ◽  
Hyperosmolar Hyperglycemic State ◽  
History Of ◽  
Sugary Beverages

Abstract INTRODUCTION: We present 2 pediatric patients with Hyperosmolar Hyperglycemic State (HHS) at diabetes onset. CASE 1: 3 year old African American female presented to the pediatrician office with a 5 day history of polydipsia, polyuria and emesis. POCT glucose read high and patient was transferred to the PICU. Laboratory studies were significant for serum glucose of 1032 mg/dl, Na 128 mMOL/L (corrected 142mMOL/L), VBG showed pH 7.36, HCO3 20 mMOL/L, Serum osm 331 mOsm/Kg. Patient received a 20ml/kg bolus of 0.9%NaCl, followed by 2 times maintenance IV fluids and glargine 2 units. Glucose dropped from 418 to 122 mg/dl in 3 hours. Due to this Dextrose was added and IVF rate was decreased. CASE 2: 8 year old African American obese male was admitted to the PICU for management of new onset diabetes. He presented with 3 days of flu-like symptoms and worsening drowsiness. Patient had increased consumption of large quantities of sugary beverages due to increased thirst. Laboratory workup: serum glucose of 2309 mg/dl, Na 133 mMOL/L (corrected 168 mMOL/L), pH 7.13, HCO3 10 mMOL/L. Patient was given 30 cc/kg NS bolus followed by an insulin drip of 0.1 u/kg/hour. Repeat studies 3 hours later showed a serum glucose of 1,414 mg/dl, Na 152 mMol/L (corrected 184 mMOL/L), pH 7.19, HCO3 17 mMOL/L, and serum osmolality of 408 mOsm/Kg. IVF were adjusted to correct the water deficit and insulin drip was decreased to 0.05u/kg/hour. DISCUSSION: HHS continues to be a challenging diagnosis due to its low frequency compared with Diabetic Ketoacidosis especially when presenting at a very young age. Most practitioners will mistake the presentation for DKA and start an insulin drip. The early use of insulin is not necessary in the setting of HHS due to the risk of complications. A fast drop in glucose decreases the osmotic pressure and compromises the circulatory status with a higher chance of thromboembolism. In mixed HHS and DKA, the management aligns more with the DKA management but the amount of fluids needed is higher and insulin infusion may cause fast drop of glucose with potential decrease of intravascular volume as in our second patient. It is imperative that the diagnosis of HHS is made early so that the appropriate treatment can be instituted. CONCLUSION: Appropriate fluid administration and delay in insulin administration are key in the management of HHS. The awareness of this possible presentation and the early recognition and appropriate fluid management are needed to improve outcomes. REFERENCE: Zeitler, Phil, et al. “Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment.” The Journal of Pediatrics, vol. 158, no. 1, 2011, doi:10.1016/j.jpeds.2010.09.048

scholarly journals Reactive Arthritis Secondary to Cauda Equina Injury following Spine Fracture: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Xiao Li ◽  
Shaoling Wu ◽  
Chao Ma
Keyword(s):  
Urinary Tract Infection ◽  
Reactive Arthritis ◽  
Early Recognition ◽  
Burst Fracture ◽  
Cauda Equina ◽  
Spine Fracture ◽  
Appropriate Treatment ◽  
Delayed Initiation ◽  
History Of

A 38-year-old man presented with a one-month history of muscle weakness and dysesthesia in the lower extremities, urinary retention, and urinary tract infection after lumbar burst fracture resulted from high fall. During the rehabilitation in our hospital, he had arthritis in both the ankle and knee. However, the patient was treated as gouty arthropathy initially. The arthritis was completely remitted in a few days after the patient was diagnosed as reactive arthritis and started with sulfasalazine therapy and there was no recurrence during 4 months of follow-up. Based on this case, early recognition of reactive arthritis is of major importance to avoid delayed initiation of appropriate treatment in the patients with polyarthritis secondary to neurogenic bladder following cauda equina injury after spine fracture.

TABES DORSALIS IN THE POST ANTIBIOTIC ERA: NEVER SAY NEVER

2015 ◽  
Vol 86 (11) ◽  
pp. e4.123-e4
Author(s):  
Chinar Osman ◽  
Tristan Clark ◽  
Boyd Ghosh ◽  
Christopher Halfpenny
Keyword(s):  
Urinary Incontinence ◽  
Early Recognition ◽  
Undetectable Viral Load ◽  
Dorsal Column ◽  
High Signal ◽  
Appropriate Treatment ◽  
Tabes Dorsalis ◽  
History Of ◽  
Whole Spine

BackgroundTabes dorsalis is a neurological form of tertiary syphilis and is considered to be rare in the post antibiotic era. It results from damage to nerve cells in the dorsal column and roots of the spinal cord. It is characterised by sensory ataxia, lightening pains and urinary incontinence. If left untreated it can progress to paralysis and dementia.Case summaryWe present the case of an HIV positive 47 year old male with a CD4 count of 400 and an undetectable viral load on HAART. He presented with an 8 month history of progressively severe lightening pains, gait disturbance, tinnitus, hearing loss, and urinary incontinence. He had a positive plasma VDRL with a titre of 1:32, and his CSF was VDRL positive. Whole spine MRI scan demonstrated high signal in the dorsal cord with associated atrophy. He was treated with intravenous benzylpenicillin 2.4 grams 4 hourly for 14 days. Follow up at 4 and 8 months demonstrated marked clinical improvement with a falling serum VRDL titre. Repeat LP at 6 month post treatment demonstrated VDRL negativity.DiscussionTabes Dorsalis may still occur in the post antibiotic era. Early recognition and appropriate treatment can lead to good clinical outcomes.

PREMATURE AND NEWBORN INFANTS

PEDIATRICS ◽  
1957 ◽  
Vol 20 (1) ◽  
pp. 143-154
Author(s):  
Richard L. Day ◽  
William A. Silverman
Keyword(s):  
New York ◽  
Early Recognition ◽  
Medical Center ◽  
Newborn Infants ◽  
Breech Presentation ◽  
County Hospital ◽  
Gastrointestinal Complications ◽  
Kings County ◽  
First Feeding ◽  
History Of

Participating in the seminar's first session were Dr. William R. Richardson, Kings County Hospital, Brooklyn, New York, who served as moderator, Dr. Thomas Santulli, Children's Surgeon at Columbia-Presbyterian Hospital, New York City, Dr. Marel H. Harmel, Anesthesiologist at Kings County Hospital, and Dr. Lawrence K. Pickett, Chief of Surgery at the State University of New York Medical Center in Syracuse. All speakers emphasized the importance of closely co-operative effort by pediatricians, surgeons, radiologists, anesthesiologists and nursing personnel to facilitate early recognition, diagnosis and effective treatment of neonatal complications requiring surgery. Diagnosis Early recognition of surgical problems usually depends upon the observations of well-trained nurses. Any history of obstetric complications especially breech presentation, a maternal history of hydramnios, any signs of respiratory distress, difficulty in swallowing at the time of the first feeding, emesis of bile-stained fluid, abdominal distention, or failure of the appearance of the first stool within 24 hours after birth should alert all observers to the possibility of complications which will require surgery. As soon as respiratory or gastrointestinal complications are suspected, Dr. Pickett requests radiologic consultation. A roentgenogram of the chest, taken at this time, will delineate not only the infant's pulmonary status, but also the gas pattern of the intestinal tract. When the clinical picture suggests gastrointestinal obstruction, Dr. Pickett and his colleagues employ a No. 8 to 10 French soft rubber catheter, specially prepared by punching several holes in its terminal 1 cm portion. This tube is inserted under fluoroscopic control and passed cautiously to avoid traumatic puncture of any obstructing tissue which may be encountered When esophageal atresia is recognized the proximal esophageal pouch is carefully aspirated to remove pooled saliva.

scholarly journals 662. Tick Borne-Associated Thrombocytopenia Among United States Veterans in Long Island New York

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S239-S239
Author(s):  
Olga Kaplun ◽  
Beth Lemaitre ◽  
Zeena Lobo ◽  
George Psevdos
Keyword(s):  
New York ◽  
Chart Review ◽  
Medical Center ◽  
Long Island ◽  
Febrile Illness ◽  
Retrospective Chart Review ◽  
Veterans Affairs ◽  
Babesia Microti ◽  
The Past ◽  
History Of

Abstract Background Long Island, New York, is highly endemic for tick borne illnesses (TBI) with rising numbers of cases in the past years. Thrombocytopenia is a known complication of babesiosis caused by Babesia microti, anaplasmosis caused by Anaplasma phagocytophilum, and ehrlichiosis caused by Ehrlichia chaffeensis. We identified cases of thrombocytopenia attributed to TBI in our institution. Methods Retrospective chart review of patients diagnosed with babesiosis, anaplasmosis, and ehrlichiosis from 2000 to 2017 at Northport Veterans Affairs Medical Center. Demographics, method of diagnosis (PCR/serologies), CBC/chemistries, treatment choices, and outcomes were analyzed. Results Thirty-two veterans (VETS) were identified with the following TBI: Babesiosis 22, Ehrlichiosis 6, Anaplasmosis 4. The majority of cases (19) were from Suffolk County, Long Island. The median (MED) age of this group was 62 years (range 31–89). Ninety-one percent were Caucasian, 9% Black. 37.5% had history of tick bite. The MED temperature on presentation was 101.9°F (range 97.6–105.2°F). 56% had HTN, 6% DM, 37% HLD, 9% hepatitis C, 3% HIV. Laboratory studies: MED platelet count 88,000/µL (36,000–161,000); MED hemoglobin 12 gm/dL (5.6–15.6); MED ALT 41 IU/L (6–330); MED LDH 335 IU/L (193–1,322). Twelve VETS had positive C6 peptide. The peak MED B. microti parasitemia was 1.4% (0.1–3%). PCR tests were available in the later years of the study period: three were positive for E. chaffeensis, two for A. phagocytophilum, and 14 for B. microti. The majority of the cases (19) were observed after year 2010. Morulae were seen in only one case. Haptoglobin in eight VETS was undetectable. One veteran with history of splenectomy and babesiosis with 3% parasitemia required exchange transfusion with 12 units of PRBCs. Two other babesiosis cases required regular transfusion of PRBCs. 20 babesiosis cases were treated with azithromycin-atovaquone and two with clindamycin-primaquine. Doxycycline was used in the other cases. One patient developed NSTEMI and required coronary stent placement. Platelet counts returned to baseline levels with treatment. No deaths occurred. Conclusion The incidence of TBI in Long Island, New York is rising. PCR testing for TBI can be utilized in our VETS presenting with febrile illness and thrombocytopenia to help identify the possible tick borne pathogen during the months of high tick activity. Disclosures All authors: No reported disclosures.

scholarly journals Presentation of spinal cord and column tumors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. i18-i24
Author(s):  
Jared S Fridley ◽  
Sohail Syed ◽  
Tianyi Niu ◽  
Owen P Leary ◽  
Ziya L Gokaslan
Keyword(s):  
Back Pain ◽  
Systemic Treatment ◽  
Early Recognition ◽  
Spinal Metastases ◽  
Appropriate Treatment ◽  
Initial Work ◽  
History Of ◽  
Patient Prognosis ◽  
Work Up ◽  
Spine Disease

Abstract Metastatic spine disease occurs in more than 10% of all cancer patients. Advances in systemic treatment for cancer has led to improved overall survival for many types of cancer, which has increased the overall incidence of spinal metastases. The most common presenting complaint of patients with spinal metastases is pain. Pain originating from spinal metastases can be oncological, mechanical, and/or neurological in nature. Early recognition of these symptoms is helpful to guide treatment and accurately gauge patient prognosis. Unfortunately, the prevalence of degenerative back pain in the general population can complicate early clinical recognition of patients with metastatic spine disease. Therefore, back pain in any patient with a history of malignancy should prompt clinicians to perform an expedited workup for metastatic disease of the spine. Diagnostic imaging and laboratory studies are part of the initial work up. Obtaining pathology via biopsy to establish tumor histology is essential to determine the appropriate treatment.

Special Considerations for Evaluation and Treatment of Spanish-Speaking Patients with Cleft Palate

2016 ◽  
Vol 1 (5) ◽  
pp. 41-49
Author(s):  
Ellen Moore
Keyword(s):  
Cleft Palate ◽  
The United States ◽  
Culturally Competent ◽  
Speech Language Pathology ◽  
Spanish Speaking ◽  
Appropriate Treatment ◽  
Oral Pressure ◽  
Language Pathology ◽  
History Of ◽  
Spanish Speaking Population

As the Spanish-speaking population in the United States continues to grow, there is increasing need for culturally competent and linguistically appropriate treatment across the field of speech-language pathology. This paper reviews information relevant to the evaluation and treatment of Spanish-speaking and Spanish-English bilingual children with a history of cleft palate. The phonetics and phonology of Spanish are reviewed and contrasted with English, with a focus on oral pressure consonants. Cultural factors and bilingualism are discussed briefly. Finally, practical strategies for evaluation and treatment are presented. Information is presented for monolingual and bilingual speech-language pathologists, both in the community and on cleft palate teams.

Messy, Energetic, Intense: A Roundtable Conversation among New York's Asian American Experimental Filmmakers of the Eighties with Roddy Bogawa, Daryl Chin, Shu Lea Cheang, and Rea Tajiri

2020 ◽  
Vol 73 (3) ◽  
pp. 66-78
Author(s):  
Vince Schleitwiler ◽  
Abby Sun ◽  
Rea Tajiri
Keyword(s):  
New York ◽  
New York City ◽  
Asian American ◽  
York City ◽  
American Film ◽  
The Sixties ◽  
History Of

This roundtable grew out of conversations between filmmaker Rea Tajiri, programmer Abby Sun, and scholar Vince Schleitwiler about a misunderstood chapter in the history of Asian American film and media: New York City in the eighties, a vibrant capital of Asian American filmmaking with a distinctively experimental edge. To tell this story, Rea Tajiri contacted her artist contemporaries Shu Lea Cheang and Roddy Bogawa as well as writer and critic Daryl Chin. Daryl had been a fixture in New York City art circles since the sixties, his presence central to Asian American film from the beginning. The scope of this discussion extends loosely from the mid-seventies through the late nineties, with Tajiri, Abby Sun, and Vince Schleitwiler initiating topics, compiling responses, and finalizing its form as a collage-style conversation.

The Modernities of H. Lawrence Freeman

2019 ◽  
Vol 72 (3) ◽  
pp. 719-779
Author(s):  
David Gutkin
Keyword(s):  
Nineteenth Century ◽  
New York ◽  
Reception History ◽  
Black Press ◽  
Late Nineteenth Century ◽  
Starting Point ◽  
History Of ◽  
Late Nineteenth ◽  
White Press ◽  
Grand Opera

H. Lawrence Freeman's “Negro Jazz Grand Opera,” Voodoo, was premiered in 1928 in Manhattan's Broadway district. Its reception bespoke competing, racially charged values that underpinned the idea of the “modern” in the 1920s. The white press critiqued the opera for its allegedly anxiety-ridden indebtedness to nineteenth-century European conventions, while the black press hailed it as the pathbreaking work of a “pioneer composer.” Taking the reception history of Voodoo as a starting point, this article shows how Freeman's lifelong project, the creation of what he would call “Negro Grand Opera,” mediated between disparate and sometimes apparently irreconcilable figurations of the modern that spanned the late nineteenth century through the interwar years: Wagnerism, uplift ideology, primitivism, and popular music (including, but not limited to, jazz). I focus on Freeman's inheritance of a worldview that could be called progressivist, evolutionist, or, to borrow a term from Wilson Moses, civilizationist. I then trace the complex relationship between this mode of imagining modernity and subsequent versions of modernism that Freeman engaged with during the first decades of the twentieth century. Through readings of Freeman's aesthetic manifestos and his stylistically syncretic musical corpus I show how ideas about race inflected the process by which the qualitatively modern slips out of joint with temporal modernity. The most substantial musical analysis examines leitmotivic transformations that play out across Freeman's jazz opera American Romance (1924–29): lions become subways; Mississippi becomes New York; and jazz, like modernity itself, keeps metamorphosing. A concluding section considers a broader set of questions concerning the historiography of modernism and modernity.

Beérkezett könyvek

2008 ◽  
Vol 63 (4) ◽  
pp. 769-770
Author(s):  
Csaba Pléh
Keyword(s):  
New York ◽  
Point Of View ◽  
Cambridge University ◽  
New Science ◽  
Oxford University ◽  
History Of ◽  
The Mind ◽  
Oxford University Press

Danziger, Kurt: Marking the mind. A history of memory . Cambridge University Press, Cambridge, 2008Farkas, Katalin: The subject’s point of view. Oxford University Press, Oxford, 2008MosoninéFriedJudités TolnaiMárton(szerk.): Tudomány és politika. Typotex, Budapest, 2008Iacobini, Marco: Mirroring people. The new science of how we connect with others. Farrar, Straus and Giroux, New York, 2008Changeux, Jean-Pierre. Du vrai, du beau, du bien.Une nouvelle approche neuronale. Odile Jacob, PárizsGazzaniga_n

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