scholarly journals A Rare Case of Rhabdomyolysis in a Patient With Pembrolizumab Induced Hypothyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A916-A917
Author(s):  
Setana Idriss ◽  
Mazin Shaikhoun ◽  
Srivyshnavi Ramineni ◽  
Sheikan Elnigomy ◽  
Margaret Apedo
Keyword(s):  
Rare Case ◽  
Clinical Status ◽  
The United States ◽  
Muscular Weakness ◽  
Muscle Enzymes ◽  
Prompt Treatment ◽  
History Of ◽  
Crush Injuries ◽  
Progressive Weakness ◽  
Precipitating Factor

Abstract Introduction: Although reported in previous literature, Rhabdomyolysis due to hypothyroidism,without an obvious precipitating factor, is rare. We report a case of severe hypothyroidism leading torhabdomyolysis. Case Report: A 70-year-old man with a history of progressive weakness, myalgia x1 month, statinallergy, pancreatic adenocarcinoma, metastatic melanoma, and acquired hypothyroidism afterreceiving Pembrolizumab for 6 months. He was non-adherent to the levothyroxine, prescribed 1month before hospitalization. He presented to the ED after slipping from his bed onto the floor in aseating position and being unable to get up due to his weakness. Initially, he was afebrile, hypoxic,tachypneic, tachycardic, hypotensive, lethargic, oriented x2, and had a global muscular weakness. Labs were significant for CK of 10,180 (n < 166 IU/L), TSH 136.18(n 0.34-5.6 mU/L), FT4 < 0.25 (n0.6-1.10 ng/dl), FT3 1.4 (n 2.5-3.9 Pg/ml), AKI, leukocytosis, abnormal electrolytes and LFTs. IV fluidsand antibiotics failed to improve the patient’s clinical status in 48 hours. He was started on IVthyroxine and stress steroids with improved weakness and overall clinical picture. Discussion: 4.6 % of people have hypothyroidism per the United States National Health andNutrition Examination Survey. Rhabdomyolysis is defined as the rapid breakdown of skeletal muscle,which may also develop due to hypothyroidism. Most patients with hypothyroidism who developrhabdomyolysis are found to have a clear precipitating risk factor, such as the use of statins orstrenuous exercise. Still, none of these risk factors were present in this case. Our patient acquiredhypothyroidism after a few months of receiving Immunotherapy. It is reported that hypothyroidismoccurs in (9% to 18%) of patients receiving Pembrolizumab. Although the patient was prescribedthyroid replacement therapy, he was not adherent to the medication for 1 month prior topresentation. Although mechanical injury is reported to cause elevated CK levels, mostrhabdomyolysis cases are related to crush injuries. We believe that the fall was probably related tohis progressive generalized weakness due to his noncompliance with medical therapy leading tomyxedema coma and rhabdomyolysis. Conclusion: Screening for hypothyroidism in patients with elevated muscle enzymes should behighly considered since an early diagnosis. Prompt treatment of hypothyroidism is essential toprevent rhabdomyolysis and its consequence.

scholarly journals Rare Case of Servelle Martorelle Syndrome

2014 ◽  
Vol 10 (4) ◽  
pp. 91-94
Author(s):  
A Bhatnagar ◽  
M Deshpande
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Rare Case ◽  
Prompt Treatment ◽  
Congenital Vascular Malformation ◽  
History Of ◽  
The Right ◽  
Scapular Region

Servelle Martorelle Syndrome is a congenital vascular malformation associated with soft tissue hypertrophy and bony hypoplasia. This rarely involves whole of an extremity, with involvement of part of limbs reported in literature. We present a case of a twelve year boy who presented to the Department of Plastic Surgery SGPGIMS in April 2011 ,with history of circumferential soft tissue hypertrophy involving whole of left upper limb, scapular region and axilla since birth. The entire left upper limb length was lesser than the right upper limb. Hence this is a very rare case of Servelle Martorelle Syndrome having extensive limb involvement at a very young age. Highlighted is the role of conservative treatment and close follow-up to understand the natural history of the diseases, with prompt treatment of complications. DOI: http://dx.doi.org/10.3126/kumj.v10i4.11011 Kathmandu Univ Med J 2012;10(4):91-94

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.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

Review of A brief history of the United States.

1919 ◽  
Vol 10 (8) ◽  
pp. 414-414
Author(s):  
No authorship indicated
Keyword(s):  
United States ◽  
The United States ◽  
History Of

The Role of the Mongolian People’s Republic in the Korean War

2018 ◽  
pp. 97-130
Author(s):  
Denzenlkham Ulambayar
Keyword(s):  
Soviet Union ◽  
Korean War ◽  
World Order ◽  
The United States ◽  
Central Intelligence Agency ◽  
Intelligence Agency ◽  
The Soviet Union ◽  
Archival Documents ◽  
The Korean War ◽  
History Of

Since the 1990s, when previously classified and top secret Russian archival documents on the Korean War became open and accessible, it has become clear for post-communist countries that Kim Il Sung, Stalin and Mao Zedong were the primary organizers of the war. It is now equally certain that tensions arising from Soviet and American struggle generated the origins of the Korean War, namely the Soviet Union’s occupation of the northern half of the Korean peninsula and the United States’ occupation of the southern half to the 38th parallel after 1945 as well as the emerging bipolar world order of international relations and Cold War. Newly available Russian archival documents produced much in the way of new energies and opportunities for international study and research into the Korean War.2 However, within this research few documents connected to Mongolia have so far been found, and little specific research has yet been done regarding why and how Mongolia participated in the Korean War. At the same time, it is becoming today more evident that both Soviet guidance and U.S. information reports (evaluated and unevaluated) regarding Mongolia were far different from the situation and developments of that period. New examples of this tendency are documents declassified in the early 2000s and released publicly from the American Central Intelligence Agency (CIA) in December 2016 which contain inaccurate information. The original, uncorrupted sources about why, how and to what degree the Mongolian People’s Republic (MPR) became a participant in the Korean War are in fact in documents held within the Mongolian Central Archives of Foreign Affairs. These archives contain multiple documents in relation to North Korea. Prior to the 1990s Mongolian scholars Dr. B. Lkhamsuren,3 Dr. B. Ligden,4 Dr. Sh. Sandag,5 junior scholar J. Sukhee,6 and A. A. Osipov7 mention briefly in their writings the history of relations between the MPR and the DPRK during the Korean War. Since the 1990s the Korean War has also briefly been touched upon in the writings of B. Lkhamsuren,8 D. Ulambayar (the author of this paper),9 Ts. Batbayar,10 J. Battur,11 K. Demberel,12 Balảzs Szalontai,13 Sergey Radchenko14 and Li Narangoa.15 There have also been significant collections of documents about the two countries and a collection of memoirs published in 200716 and 2008.17 The author intends within this paper to discuss particularly about why, how and to what degree Mongolia participated in the Korean War, the rumors and realities of the war and its consequences for the MPR’s membership in the United Nations. The MPR was the second socialist country following the Soviet Union (the Union of the Soviet Socialist Republics) to recognize the DPRK (Democratic People’s Republic of Korea) and establish diplomatic ties. That was part of the initial stage of socialist system formation comprising the Soviet Union, nations in Eastern Europe, the MPR, the PRC (People’s Republic of China) and the DPRK. Accordingly between the MPR and the DPRK fraternal friendship and a framework of cooperation based on the principles of proletarian and socialist internationalism had been developed.18 In light of and as part of this framework, The Korean War has left its deep traces in the history of the MPR’s external diplomatic environment and state sovereignty

An American Language

2018 ◽  
Author(s):  
Rosina Lozano
Keyword(s):  
United States ◽  
National Policy ◽  
The United States ◽  
Spanish Language ◽  
Spanish Speakers ◽  
Language Recognition ◽  
Political Language ◽  
Political Issue ◽  
History Of ◽  
The U.S

An American Language is a political history of the Spanish language in the United States. The nation has always been multilingual and the Spanish language in particular has remained as an important political issue into the present. After the U.S.-Mexican War, the Spanish language became a language of politics as Spanish speakers in the U.S. Southwest used it to build territorial and state governments. In the twentieth century, Spanish became a political language where speakers and those opposed to its use clashed over what Spanish's presence in the United States meant. This book recovers this story by using evidence that includes Spanish language newspapers, letters, state and territorial session laws, and federal archives to profile the struggle and resilience of Spanish speakers who advocated for their language rights as U.S. citizens. Comparing Spanish as a language of politics and as a political language across the Southwest and noncontiguous territories provides an opportunity to measure shifts in allegiance to the nation and exposes differing forms of nationalism. Language concessions and continued use of Spanish is a measure of power. Official language recognition by federal or state officials validates Spanish speakers' claims to US citizenship. The long history of policies relating to language in the United States provides a way to measure how U.S. visions of itself have shifted due to continuous migration from Latin America. Spanish-speaking U.S. citizens are crucial arbiters of Spanish language politics and their successes have broader implications on national policy and our understanding of Americans.

Sign in / Sign up

Export Citation Format

Share Document