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.

Hyperpigmented nodular rash in a 61-year-old African American female

2022 ◽  
pp. 42-44
Author(s):  
Danielle C. Ware
Keyword(s):  
African American ◽  
Family Health ◽  
Aneurysm Rupture ◽  
African American Female ◽  
The Past ◽  
Below The Knee ◽  
Back Face ◽  
History Of ◽  
Skin Nodules

A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before spreading across her upper arms, lower leg, back, face and scalp. She has a history of controlled type 2 diabetes mellitus, cerebral aneurysm rupture, Sjögren’s syndrome, asthma and a left below-the-knee amputation due to osteomyelitis. She smokes cigarettes but does not use alcohol or illicit substances. She has also noticed a dry cough with mild dyspnea on exertion over the past 6 months. On physical exam, hyperpigmented nodules are palpable in both the intradermal and subcutaneous layers of the skin. Nodules are firm, mobile and nontender. Alopecia is noted where scalp nodules are present. Her lungs exhibit diminished air movement throughout, with scattered, end-expiratory wheezing.

Factor VII Deficiency - A Restrospective Case Review.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4011-4011
Author(s):  
Randi J. Katz ◽  
Amir Steinberg ◽  
Robert Klafter
Keyword(s):  
African American ◽  
Tooth Extraction ◽  
Descriptive Study ◽  
Factor Vii ◽  
Bleeding Complications ◽  
African American Female ◽  
Factor Level ◽  
Factor Vii Deficiency ◽  
Factor Deficiency ◽  
History Of

Abstract Factor VII deficiency is a rare autosomal recessive disorder. Its incidence is thought to be 1 in 500,000. Symptoms vary from mild to severe. Factor VII deficient patients usually do not experience bleeding if their level of factor VII is less than 10%. Manifestations are seen with levels less than 5%, and severe bleeding can occur with levels less than 1%. Surgical hemostasis is obtained with levels greater than 25%. Factor VII deficiency is notable for causing a prolonged PT with a normal aPTT, making the diagnosis easy to determine. This is a descriptive study based on a population of patients from our community based teaching hospital with severe Factor VII deficiency. We reviewed lab data and found any patients with less than a 5% factor deficiency from March 2004- June 2006. In our experience we have noted varying manifestations in moderate factor deficiency patients. We describe four patients with varying symptoms, all with factor levels less than 3%. Their charts were reviewed, and three of the patients were available for a telephone interview. Patient A is a 75 yo African American female found to have factor deficiency after an increased Prothrombin time (PT) of 31.2 seconds, INR 5.9, and Partial thromboplastin time (PTT) of 34.9 seconds on routine blood work. This patieny’s factor level was found to be 1.86%. Patient A denied any history of bleeding complications, including an uncomplicated tooth extraction. Patient B is a 46 yo African American female with a long history of bleeding complications. Laboratory data revealed a PT of 26 seconds, INR 4.2, PTT 22 seconds and a Factor level of 1%. She experienced years of heavy menstrual periods and nose bleeds. A hysterectomy was performed secondary to bleeding fibroids. She required multiple doses of novoseven as well as FFP. Patient C was diagnosed at the age of 11. Laboratory results revealed a factor level of 1.87 %, and a PT of 25.1 seconds and an INR of 4.1. She has had minor bleeding events, such as gum bleeding. She did receive FFP prior to a foot surgery, and tooth extraction. Patient D is a 46 year old Hispanic man found to have and INR of 4.3 and, factor VII 1.45. Pt had an uncomplicated cholocystectomy. This is a descriptive study of four different patients with factor VII levels of less than 2%. These four cases demonstrate the wide range of clinical manifestations that factor VII patients may experience. One patient did require novoseven prior to a hysterectomy. Though, as our cases illustrate, some patients do not experience any bleeding manifestations, and therefore, prophylactic plasma may not be required. Furthermore, treatment of factor VII deficient patients needs to be individualized, and guided by personal history. Coagulation Studies of our Patients Patient Prothrombin Time INR Factor VII A 31.2 5.9 1.86% B 26 4.2 1% C 25.1 4.1 1.87% D 46 4.3 1.45%

A Case of HPP with a Novel Combination of α and β Spectrin Mutations.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1736-1736
Author(s):  
Kavita Natarajan ◽  
Ferdane Kutlar ◽  
Tao Li ◽  
Patrick Gallagher ◽  
Abdullah Kutlar
Keyword(s):  
African American ◽  
Sequence Data ◽  
Novel Mutation ◽  
African American Female ◽  
Red Cell ◽  
Red Cell Membrane ◽  
Amino Terminal ◽  
Blood Disorder ◽  
Immune Hemolytic Anemia ◽  
History Of

Abstract Hereditary pyropoikilocytosis (HPP) is a red cell membrane disorder classified under the broad umbrella of hereditary elliptocytosis (HE). It is usually the most severe form of HE and is inherited in an autosomal recessive manner. HE results from alterations in RBC membrane cytoskeleton proteins: spectrin, ankyrin, pallidin, band 4.1, and band 3. Quantitative or qualitative deficiencies result in varying clinical syndromes. In general, mutations in the α gene are closer to the amino terminal, and those in the β spectrin gene are nearer the carboxyl terminal and affect the formation of tetramers. We describe a patient associated with a novel mutation in the β and α spectrin genes. A 19 year old black female with a lifelong history of anemia and jaundice that worsened since age 15 presented with history of early satiety of a few months duration. Neither parent had a history of a blood disorder; a maternal uncle had history of splenectomy in his thirties. Her pre-splenectomy labs showed a Hb of 4.8g/dl with a MCV of 62, RDW of 38.8, and chemistries consistent with non-immune hemolytic anemia. Imaging and clinical exam revealed a spleen of 19cms and bizarre red cell morphology including RBC fragmentation and microcytosis. Post splenectomy the patient is entirely asymptomatic with a Hb of 13.2 with pathologic exam of the spleen showing benign, enlarged, red pulp consistent with hypersplenism. Genomic DNA was extracted from peripheral blood. Sequencing of the β-spectrin exon 30 was undertaken at the MCG Sickle Cell Center that revealed a GCT → CCT mutation (Ala → Pro) in codon 2053. This mutation has been previously reported in the homozygous state in a young boy from Mali with HPP (β spectrin Kayes). Since we could not explain the relatively severe phenotype in this patient with heterozygous β spectrin Kayes, further molecular analyses was performed at Yale. This revealed a mutation in the α-spectrin exon 5; L207P, α spectrin St.Louis. This is the 2nd reported case of HPP due to compound heterozygosity for an α and β spectrin mutation and the first combination of α spectrin St. Louis and β spectrin Kayes. African American female, 19 years old Diagnoses: “Pyropoikilocytosis” Sequence data: Spectrin bate-Kayes African American female, 19 years old Diagnoses: “Pyropoikilocytosis” Sequence data: Spectrin bate-Kayes

Multiple Cutaneous Granular Cell Tumors: Case Report of a 19-Year-Old African American Female

2011 ◽  
Vol 15 (6) ◽  
pp. 344-346 ◽  
Author(s):  
Matthew Henry ◽  
Adam Perry
Keyword(s):  
African American ◽  
Clinical Presentation ◽  
Granular Cell ◽  
African American Female ◽  
Older Patient ◽  
Granular Cytoplasm ◽  
Neural Origin ◽  
History Of ◽  
Low Incidence ◽  
Slow Growing

Background and Objective: This is a somewhat rare case of a 19-year-old African American female with multiple cutaneous granular cell tumors. Granular cell tumors are of neural origin, except in rare cases, and are considered benign, with a low incidence of malignancy. The clinical presentation varies greatly, but these tumors are most commonly painful and slow growing, with two-thirds occurring on the head and neck. Patients are most commonly in their second to fourth decades of life, two-thirds are black, and two-thirds are women. Granular cell tumors are diagnosed by the characteristic pathologic findings of polygonal cells with eosinophilic granular cytoplasm. Conclusion: These tumors are most commonly singular but can be multiple in 10 to 15% of patients. Older patient age, rapid growth or enlargement, and a history of local recurrence should raise concern for malignant behavior. The distribution and family history in this case are suggestive of possible mosaicism.

African American Women Chemists in the Modern Era

2018 ◽  
Author(s):  
Jeannette E. Brown
Keyword(s):  
African American ◽  
Civil Rights ◽  
African American Women ◽  
Oral History ◽  
Career Paths ◽  
African American Female ◽  
American Women ◽  
Civil Rights Act ◽  
History Of ◽  
Modern Era

This is the second of two books about African-American female chemists. The first book (African-American Women Chemists, 2011) focused on the early pioneers--women chemists from the Civil War to the Civil Rights Act. African American Women Chemists in the Modern Era focuses on contemporary women who have benefited from the Civil Rights Act and are now working as chemists or chemical engineers. This book was produced by taking the oral history of women who are leaders in their field and who wanted to tell the world how they suceeded. It features eighteen amazing women in this book and each of them has a claim to fame, despite hiding in plain sight. These women reveal the history of their lives from youth to adult. Overall, Jeannette Brown aims to inspire women and minorities to pursue careers in the sciences, as evidenced by the successful career paths of the women that came before them.

scholarly journals Mucous Membrane Pemphigoid with Tracheal Involvement

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Arash Minaie ◽  
Salim R. Surani
Keyword(s):  
African American ◽  
Mucous Membrane ◽  
Main Stem ◽  
Mucous Membrane Pemphigoid ◽  
African American Female ◽  
History Of

34-year-old African American female with history of pemphigoid presented with hemoptysis. Patient was found to have mucous membrane pemphigoid involving the oropharynx and extending to trachea, till just above main stem carina. Four other cases described mucosal pemphigoid involving the trachea. We hereby present a brief review of current consensus on management of mucous membrane pemphigoid with airway involvement.

Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis of a Placenta: Rare co-existence

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S34-S34
Author(s):  
E Ozluk ◽  
J Cotelingam ◽  
M Ong
Keyword(s):  
African American ◽  
Spontaneous Abortion ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
African American Female ◽  
Fibrin Deposition ◽  
Literature Report ◽  
Intrauterine Growth ◽  
History Of ◽  
Histiocytic Infiltration

Abstract Introduction/Objective Massive perivillous fibrin deposition (MPFD) and chronic histiocytic intervillositis (CHI) of the placenta are both very rare entities individually. They both are associated with reccurent loss of the fetus. Methods Here we report a placenta with coexisting MPFD and CHI. Patient is a 24-year-old African American female who has a history of spontaneous abortion at the 10th week when she was 18. Her latest pregnancy is complicated by intrauterine growth retardation and she eventually losses the fetus at 20th week of gestation. Results Histopathology reveals extensive fibrin deposition of the perivillous area and the histiocytic infiltration of the intervillous spaces which is highlighted by CD68 staining. Conclusion This is the second literature report of a co-occurrence of MPFD and CHI to our knowledge. Pathologists must be familiar with these entities and inform the obstetricians because these placental lesions often result with recurrent loss of fetus.

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.

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