15 research outputs found
Association Between Serum Total Bilirubin and Serum Creatinine and the Effect of Hypertension
No full textSevere Insulin Resistance in the Setting of Therapeutic Hypothermia
Get PDFBackground: Hyperglycemia is common in critically ill patients and has been associated with poor outcomes. The effect of hypothermia, whether induced or spontaneous, on insulin resistance and hyperglycemia is not well understood and sometimes overlooked.
Objectives: To review the literature on glucose metabolism and insulin resistance in patients treated with therapeutic Hypothermia (TH) after sudden cardiac arrest (SCA). And also to present knowledge about the possible effects of hypothermia on glycemic control and insulin sensitivity.
Methods: we present an example of extreme insulin resistance during the period of therapeutic hypothermia in a patient who was admitted after a sudden cardiac Arrest. Literature review was conducted as a Medline/PubMed search. Studies were assessed regarding designs, primary and secondary efficacy parameters on TH after sudden cardiac arrest and effects on glucose metabolism.
Results: A 68-year-old male who was admitted after SCA was noted to have extreme insulin resistance during TH which completely resolved during the rewarming phase of TH. No randomized, controlled trials were found in the Medline search. Two studies found that there was an increase in insulin resistance during TH especially during the cooling phase, whereas three studies found no direct association between TH and blood glucose levels.
Conclusion: There is a possible association between TH and a reversible form of insulin resistance. More studies are needed. Patients who are treated with TH after SCA may present a challenge in glucose management
The Relationship of BrafV600E Mutation Status to FDG PET/CT Avidity in Thyroid Cancer: A Review and Meta-Analysis
No full textAggressive Differentiated Thyroid Cancer due to EML4e13-ALKe20 Fusion: A Case Presentation and Review of the Literature
No full textBackground. Differentiated thyroid cancer (DTC) is an indolent malignancy. It rarely presents with aggressive local invasion and/or distant metastatic disease. Patient findings. We describe a case of a 30-year-old man with a locally aggressive form of papillary thyroid cancer with EML4e13-ALKe20 fusion (EML4: echinoderm microtubule-associated protein-like 4; ALK: anaplastic lymphoma kinase). He presented with right-side cervical lymphadenopathy with a highly suspicious right-side thyroid nodule. Total thyroidectomy and level IV lymph node resection showed extensive bilateral disease, with extrathyroidal and extranodal extension. FDG-PET CT scan following surgery confirmed the presence of significant residual disease in the neck area. He underwent bilateral lateral lymph node dissection followed by radioactive iodine treatment. Somatic mutation testing showed EML4e13-ALKe20 fusion. Summary. This case represents an aggressive form of DTC with EML4e13-ALKe20 fusion. The rapid progression of clinical signs and symptoms and the local extension beyond the thyroid and lymph nodes with the persistence of high-volume local disease after thyroidectomy highlight the aggressive nature of this mutation and the importance of performing genetic analysis to guide future treatments and determine prognosis. Conclusion. This case highlights the importance of using molecular diagnostics in patient care, especially if the presentation is unusual for DTC. A thorough evaluation of the tumor pathology and the somatic mutational profile analysis are important for obtaining vital therapeutic and prognostic guidance
Apolipoprotein B and Insulin Resistance in Hypertensive Compared With Normotensive Patients: An Epidemiological Study
No full textSheehan’s Syndrome: It Is Time to Become More Proactive in Identifying This Disease
Get PDFSheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing resulted in an ACTH stimulation test with inadequate response, secondary hypothyroidism, and low prolactin. Her menstrual period could not be assessed due to daily progesterone therapy for contraception. MRI of the brain showed an empty sella, after which she was diagnosed with Sheehan’s syndrome, and started on hydrocortisone and levothyroxine
How safe is Healthcare? Perceptions within the Healthcare Community and the general public
Get PDFObjectives: Complexity of health care is progressively increasing and with that the number of medical errors and adverse events are increasing to an alarming level. The purpose of this study is to assess the perception of healthcare safety within the healthcare community and the general public and examine the association between the perception regarding healthcare safety and the prior exposure to medical errors.
Methods: The study is a cross-sectional online survey. The online survey included basic demographics and a series of questions related to the knowledge and perception about healthcare safety and personal healthcare experience.
Results: 504 respondent completed the survey. 78.6% were healthcare workers. 84% reported one or more exposure to medical errors or adverse events. Most respondents (81.5%) estimated the rate of medical errors to be 1:100 or less. only 29.3% of the respondents thought that medical errors are occurring more frequently than 10 years ago. 89.6% of the respondents thought that healthcare is a safe industry. Looking at Factors Predicting the Perception that Healthcare is Safe, there was no clear correlation with the exposure to medical errors except for surgical complications exposure (p-value=0.01, OR 21.4)
Conclusions: There is a strong indication in our data that healthcare workers and public perception is far from the reality of the dangers of the healthcare system There is a need to educate the public regarding the medical error rate and the healthcare safety to help make patients and their families become partners in their care and to help healthcare workers better understand the limitations of healthcare processes that may affect patient safety and outcomes
Cushing Syndrome Due to Ectopic Adrenocorticotropic Hormone Secretion by a Pulmonary Carcinoid Tumor in a Patient with Pneumoconiosis
No full textObjective: Sites with a high prevalence of pneumoconiosis are especially challenging to physicians. The presence of pneumoconiotic nodules on chest computed tomography (CT) scans makes it difficult to localize the source of ectopic adrenocorticotropic hormone (ACTH). Because of false-positive results that may occur with the use of fluorine 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) scans, alternative imaging modalities are needed.
Methods: Gallium 68-dodecanetetraacetic acid tyrosine-3-octreotate (68Ga-DOTATATE) is a positron emitter-labeled somatostatin analog used with PET/CT. 68Ga-DOTATATE may improve the diagnostic accuracy of localizing ectopic ACTH-secreting carcinoid tumors in patients with pneumoconiosis by reducing false-positive results.
Results: We describe a patient with pneumoconiosis and Cushing syndrome due to ectopic ACTH from a pulmonary carcinoid tumor, highlighting challenges in diagnosis and management.
Conclusion: Prospective studies comparing fluorine 18-fluorodeoxyglucose PET/CT with 68Ga-DOTATATE PET/CT for diagnosis of bronchial carcinoid tumors in patients with ectopic ACTH and pneumoconiosis are highly needed. We also review the scarce available literature and provide recommendations based on our experience
How safe is Healthcare? Perceptions within the Healthcare Community and the general public
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