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

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.

Intervention Services for a Child With Multiple Disabilities

This chapter will focus on providing intervention services for an eight-year-old African-American female, Dawn, with multiple disabilities. Dawn has been diagnosed with Down syndrome, a comorbid diagnosis of an intellectual disability, and exhibits behavior problems at home and school. In this scenario, she has been evaluated within the school system to determine eligibility for services, and the speech-language pathologist needs to develop intervention goals and select therapy strategies to provide appropriate services. While both parents are involved in the child's care, the family does not have permanent housing and moves frequently. Information from actual cases has been incorporated into this chapter.

Reunion with Self in Terry McMillan’s I Almost Forgot About You

The novel I Almost Forgot About You by Terry McMillan, which deals with the problem of finding your own identity by studying the components of personality and the context in the formation of identity, is examined. African American feminist literature consists of common themes like sense of being different, managing multiple selves and quest for identity. Terry McMillans works represent African American female characters struggle for self-realization that help them in better understanding of the present and planning for the future by reestablishing their identity. The predicament of Georgia, protagonist of the novel, is that she has lost selfhood after subsequent divorces. In due course of time, her role in the family becomes diminished; also she loses interest in the professional life. Her aimlessness and strong desire to restore self leads her to search for male companion among her old boyfriends. She believes that self-satisfaction is possible with exploration of self for that she decides to go on a train trip and tries to focus on nurturing the hobby of woodwork. It helps her in regaining her internal and external self. Thus, the leitmotif of the novel is the search for your own identity as an attempt of inquiry for the destined future.

Epigenome association study for DNA methylation biomarkers in buccal and monocyte cells for female rheumatoid arthritis

Genetics (i.e., mutations) has been assumed to be the major factor in rheumatoid arthritis (RA) etiology, but accounts for a minority of the variance in disease risk for RA. In contrast to genetics, the environment can have dramatic impacts on epigenetics that associate with disease etiology. The current study used buccal cells and purified blood monocytes from two different clinical cohorts involving Caucasian or African American female populations with or without arthritis. The differential DNA methylation regions (DMRs) between the control and RA populations were identified with an epigenome-wide association study. The DMRs (i.e., epimutations) identified in the buccal cells and monocytes were found to be distinct. The DMR associated genes were identified and many have previously been shown to be associated with arthritis. Observations demonstrate DNA methylation epimutation RA biomarkers are cell type specific and similar findings were observed with the two racial background populations. Rheumatoid arthritis susceptibility epigenetic diagnosis appears feasible and may improve the clinical management of RA and allowpreventative medicine considerations.

Plantar fasciopathy—looking beyond the obvious? A case report

Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

Acute psychosis and serotonin syndrome in the setting of “Triple-C” overdose: a case report

Background Over-the-counter medication overdose is a difficult diagnostic challenge for many physicians as common drug screening assays cannot detect these substances. We present a case of acute psychosis, serotonin syndrome, and anticholinergic overdose-like properties in the setting of Coricidin HBP Cough & Cold tablets, known by their street name Triple-C. This is the first case report we are aware of involving a patient presenting with these symptoms and requiring critical-care-level support. Case presentation A 31-year-old African American female with a past medical history of anxiety, childhood asthma, previous methamphetamine abuse, and coronavirus disease 2019 infection in August 2020 was brought to the emergency department by the local police department with altered mental status. Initial blood work, including extended drug screens, were unremarkable for a definitive diagnosis. This patient required critical-care-level support and high sedation because of her symptoms. Collateral history revealed the patient regularly consumed Triple-C daily for the 6 weeks prior to admission. A trial off sedation was attempted after 24 hours with no complications. The patient admitted to regular Triple-C consumption and auditory hallucinations since adolescence. She was discharged safely after 48 hours back into the community. She was lost to follow-up with psychiatry and internal medicine; however, she was evaluated in the emergency room 1 month later with a similar psychiatric presentation. Conclusion Overdose of Triple-C should be kept in the differential diagnosis of patients presenting with a triad of psychosis, serotonin syndrome, and anticholinergic overdose, in the setting of unknown substance ingestion.

Abstract 1122‐000037: LVO in the Setting of TTP

Introduction : Thrombotic Thrombocytopenic Purpura (TTP) is a disorder of coagulation caused by a deficiency of ADAMTS13 due to either hereditary mutations or acquired autoimmune inhibitors. Low levels of ADAMTS13 metalloprotease leads to Von Willebrand Factor (VWF)‐platelet aggregation and microvascular thrombosis when patients with TTP are exposed to high shear stress in the microcirculation. [1] Hematologic disorder or coagulopathies are the major cause of 1–4% of all ischemic strokes. [2] TTP patients usually present with small vessel strokes or sometimes very distal branches of large arteries. The gold standard treatment for acute stroke in these patients is plasma exchange, however in patients presenting with LVO strokes, recanalization therapies should be considered. [3] Here we present a case of large vessel occlusion stroke in the setting of TTP. Methods : 31‐year‐old African American female with TTP and Strokes admitted to with right sided hemiparesis, and expressive aphasia within 2h of symptom onset. National Institute of Health Stroke Scale (NIHSS) of 16. Laboratory work up significant for Platelets 114k, Hemoglobin 12, PTT 24 seconds, Serum glucose 107, ADAMTS‐13 <1 IU/dL and negative COVID‐19 PCR. CTH showing ASPECTS of 9 (Picture A), CTA head and neck revealing a left MCA occlusion and intracranial vessel irregularities in the left Anterior Cerebral Artery (ACA) and bilateral Posterior Cerebral Arteries (PCA) (Picture B). CTP with 24cc core and 132 cc mismatch (Picture C). Patient was taken to the Angiogram Suite for urgent thrombectomy with a final TICI score of 3 achieved after one pass (Picture D/E). Results : Post procedure NIHSS was 1 for mild expressive aphasia. Brain MRI revealed Left MCA and right parietal territories infarct (Picture F). Transesophageal Echocardiogram was unremarkable. She underwent urgent Plasma Exchange (PLEX) for TTP flair in light of undetectable ADAMTS‐13, significant drop in platelet count and thrombotic event. After 5 PLEX sessions platelets remained stable with counts greater than 150.000. Immunotherapy with Prednisone, Caplacizumab, Atovaquone and Mycophenolate Mofetil was continued and she was discharged home on day 7 from admission. Conclusions : Our patient had severe and refractory disease presenting with LVO and underwent an unusual therapeutic approach considering the etiology of her disease. IV thrombolysis and arterial thrombectomy are well established therapies for acute strokes in the general population, but are rarely performed in patients affected by Thrombotic Microangiopathy (TMA) such as TTP. Safety and efficacy of these procedures have not been studied in this population and it is usually selected by extrapolating data from studies that used individuals without TMA. We aim to illustrate this uncommon case of LVO stroke in the setting of TTP and potentially stimulate the elaboration of studies that include these patients.

A rare case of a patient with systemic lupus erythematosus who presented with Rowell syndrome responding to treatment with hydroxychloroquine and prednisone with 1 year of relapse-free survival on belimumab

ABSTRACT Rowell syndrome, first described in 1963 by Rowell et al., is an infrequently reported and unique syndrome occurring in patients with systemic lupus erythematosus (SLE). This syndrome characteristically presents with erythema-multiforme-like lesions as well as other specific immunologic and histopathological manifestations. Since Rowell’s original description, diagnostic criteria have been proposed and modified to better describe the syndrome. We describe a 32-year-old African American female patient with a previous history of SLE who presented with dermatologic, immunologic, and histopathological manifestations that fit the modified diagnostic criteria for Rowell syndrome.