ResearchPad - Internal Medicine https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[High Serum Neuron-Specific Enolase Level Is Associated with Mild Cognitive Impairment in Patients with Diabetic Retinopathy]]> https://www.researchpad.co/product?articleinfo=N3bedff73-70e0-40e1-9672-8f56c1c90a99

Purpose

Diabetic retinopathy (DR) can increase the risk of mild cognitive impairment (MCI), which has been confirmed by previous researches. With the frequent occurrence of MCI in patients with DR, the early detection of MCI has become a research hot-spot. The aim of this study was to investigate the relationship between neuron-specific enolase (NSE) and MCI in patients with DR.

Patients and Methods

A total of 124 patients with DR, including 56 MCI patients and 68 normal cognition patients, were recruited in this cross-sectional study. The demographic and clinical data of patients were collected through questionnaires. Serum NSE was measured using electrochemiluminescence immunoassay. The Minimum Mental State Examination (MMSE) scale was used to evaluate the cognitive function of the participants.

Results

Compared with the normal cognition group, serum NSE levels and HbA1c levels in the MCI group were higher, while MMSE scores and educational level were lower (P<0.05). Serum NSE levels were significantly negatively correlated with MMSE total score, attention and calculation score, and language score (P<0.05). After adjusting for confounding factors, serum NSE still increased the MCI risk in DR patients (OR:1.606, 95CI%:1.264–2.041, P<0.001). The areas under the receiver operating characteristics (ROC) curves (AUC) of the crude model and the adjusted model were 0.75 and 0.73, respectively.

Conclusion

A high serum NSE level is an independent risk factor for MCI in DR patients. In addition, serum NSE is expected to be a potential biomarker in DR patients with MCI.

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<![CDATA[Association Between Blood Glucose Within 24 Hours After Intensive Care Unit Admission and Prognosis: A Retrospective Cohort Study]]> https://www.researchpad.co/product?articleinfo=Nf0df6fc6-6927-46bb-bccc-b03c0110e224

Purpose

The aim of this study was to evaluate the association between blood glucose within 24 hours after intensive care unit (ICU) admission and prognosis.

Patients and Methods

A retrospective cohort study was conducted using data from a large critical care database. Patients who had a length of ICU stay ≥24 hours and at least two blood glucose records within 24 hours after ICU admission were included and hospital mortality was chosen as the primary outcome. The average, minimum, and maximum blood glucose within 24 hours after ICU admission were a priori selected as exposures and associations between each exposure and outcomes were assessed after adjusted for potential confounders.

Results

A total of 14,237 patients were included finally with an average age of 62.9±17.7 years and a mean SAPS II on admission of 34 (26–44). Among the study population, 20.2% (2872/14,237) had uncomplicated diabetes, and 6.7% (953/14,237) had complicated diabetes. Lowest hospital mortality rate was observed in the stratum with an average blood glucose ranged 110–140 mg/dL, a minimum blood glucose ranged 80–110 mg/dL, and a maximum blood glucose ranged 110–140 mg/dL. After adjusted for confounders including age, sex, disease severity scores and comorbidities, an average blood glucose ranged 110–140 mg/dL, a minimum blood glucose ranged 80–110 mg/dL, and a maximum blood glucose ranged 110–140 mg/dL were associated with the lowest risk of hospital mortality. Consistent results were found among patients without diabetes in the subgroup analyses stratified by diabetes.

Conclusion

A range of 110–140 mg/dL for average and maximum blood glucose and a range of 80–110 mg/dL for minimum blood glucose within 24 hours after ICU admission predicted better prognosis especially among patients without diabetes.

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<![CDATA[Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis]]> https://www.researchpad.co/product?articleinfo=Nc72007ca-839d-4b51-b527-6c6eabbd1838

Background

Acute pancreatitis (AP) and metabolic syndrome (MetS) are common clinical problems with serious complications and high cost of treatment. The relationship between MetS and severity of AP is unknown, and because there are very few published articles, further studies had been recommended. Therefore, we designed this study to estimate the association between MetS and its components with AP severity.

Patients and Methods

In this prospective analytical cross-sectional study, all AP patients who referred to two referral hospitals affiliated with Shiraz University of Medical Sciences between 2016 and 2019 were evaluated. The diagnosis of MetS syndrome as well as follow-up of patients for evaluation of severity and outcome of AP was performed in all enrolled patients. National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) was used for diagnosis of MetS. Bedside Index for Severity in Acute Pancreatitis (BISAP) and revised Atlanta classification (RAC) were used to estimate the severity of AP. Finally, the association between MetS syndrome and its components at different AP severities was compared.

Results

Of the 214 patients referred to our center, a total of 76 patients with AP were included in this study. Of the included patients, 40 (52.6%) were male and 36 (47.4%) were female. Frequency of patients in Mets and non-MetS groups was 34 (44.74%) and 42 (55.26%), respectively. The gender and mean age difference between Mets and non-MetS groups were not statistically significant. According to Mets groups, 25 (73.5%) and 9 (26.5%) AP patients with MetS had BISAP score of 0–2 and 3–5, respectively. BISAP score in MetS group was significantly higher than non-MetS group (P = 0.022). Overall, 20 (58.8%), 11 (32.4%), and 3 (8.8%) of AP patients with MetS had mild, moderately severe, and severe AP based on RAC, respectively. Severe RAC was significantly higher in the MetS group than in the non-MetS group (P = 0.029). The frequency of complications in MetS group was significantly higher than in non-MetS group (P= 0.008). The length of hospital stay was also significantly higher in the MetS group than in the non-MetS group (P = 0.001). Overall, three patients died, two of whom had MetS and all had severe RAC and BISAP 3–5. Waist circumference, fasting blood sugar, and triglyceride were significantly higher in the severe and moderately severe types of AP group than in the mild AP group, according to RAC. Although, mean of all components of MetS except HDL-cholesterol were higher in BISAP of 3–5 group than BISAP of 0–2 group, the difference was only significant in waist circumference.

Conclusion

The present study showed that there was a significant association between the rate of MetS and its components including waist circumference, hyperglycemia and hypertriglyceridemia with increasing AP severity. This study showed that the incidence of more severe AP in patients with MetS is much higher than in patients without MetS. We recommend that the new studies with larger sample sizes are conducted with careful consideration of confounding factors to investigate the relationship between the severity of MetS and AP as well as the effect of MetS treatment on the nature of AP.

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<![CDATA[The Role of JNk Signaling Pathway in Obesity-Driven Insulin Resistance]]> https://www.researchpad.co/product?articleinfo=N30a740e4-87eb-44f7-b49e-b6326a0aaed7

Abstract

Obesity is not only closely related to insulin resistance but is one of the main factors leading to the formation of Type 2 Diabetes (T2D) too. The c-Jun N-terminal kinase (JNK) family is a member of the mitogen-activated protein kinase (MAPK) superfamily. JNK is also one of the most investigated signal transducers in obesity and insulin resistance. JNK-centric JNK signaling pathway can be activated by growth factors, cytokines, stress responses, and other factors. Many researches have identified that the activated phosphorylation JNK negatively regulates insulin signaling pathway in insulin resistance which can be simultaneously regulated by multiple signaling pathways related to the JNK signaling pathway. In this review, we provide an overview of the composition of the JNK signaling pathway, its regulation of insulin signaling pathway, and the relationship between the JNK signaling pathway and other pathways in insulin resistance.

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<![CDATA[Effects of Two Types of Moderate- and High-Intensity Interval Training on Serum Salusin-α and Salusin-β Levels and Lipid Profile in Women with Overweight/Obesity]]> https://www.researchpad.co/product?articleinfo=Nf778aaf6-195d-4f03-b861-c3f1b693934d

Objective

The current study aimed to compare the effects of two modes of moderate- and high-intensity interval training on serum Salusin-α and Salusin-β and lipid profile in women with overweight/obesity.

Subjects and Methods

A number of forty females were assigned to each of (1) Control (BMI= 30.2 ± 2.8 kg/m2, n=14), (2) Moderate-intensity (BMI= 31.2 ±3.3 kg/m2, n=13) and (3) High-intensity interval training (BMI=30.9±3.4 kg/m2, n=13) groups. The subjects of experimental groups participated in the selected interval trainings for eight weeks. The first blood sampling was performed within 48 hours prior to the first training session and the second samples were obtained 48 hours after the last training session.

Results

The findings revealed that there were significant increases in Salusin-α (36% vs. 3%; p = 0.001) and high-density lipoprotein levels (7% vs. 5%; P = 0.039), while significant reductions in the levels of Triglyceride (−8% vs. −9%; p= 0.012) and total cholesterol (−1% vs. −8%; P =0.01) levels of moderate- and high-intensity interval training groups, respectively. Also, there were insignificant changes in Salusin-β (−7% vs. −5%; P = 0.108), low-density lipoproteins (−3% vs. −11%; P =0.046) and very-low-density lipoprotein (−10% vs. −8%; P = 0.056) compared to control group. There were only significant differences between Salusin-α and high-density lipoprotein levels of training groups (P<0.05).

Conclusion

It is suggested that, although improvements in lipid profile was nearly similar for two training modes, moderate intensity interval training was more effective to prevent and control atherosclerosis.

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<![CDATA[Progressive Loss of Corneal Nerve Fibers and Sensitivity in Rats Modeling Obesity and Type 2 Diabetes Is Reversible with Omega-3 Fatty Acid Intervention: Supporting Cornea Analyses as a Marker for Peripheral Neuropathy and Treatment]]> https://www.researchpad.co/product?articleinfo=N62b92a85-3682-40d4-9a53-128570209595

Purpose

To determine whether cornea nerve fiber density and/or corneal function are valid markers for early detection and treatment of peripheral neuropathy in rats modeling prediabetes and type 2 diabetes.

Methods

High-fat feeding combined without or with low-dose streptozotocin was used to create rat models for prediabetes and type 2 diabetes that were longitudinally studied for loss of structure and function of sensory nerves in the cornea and skin as well as nerve conduction velocity and vascular reactivity of epineurial arterioles. There were three time points examined in each of the three conditions with 12 rats per group. The latest time point (24 weeks of high-fat diet with or without 16 weeks of hyperglycemia) was used to examine reversibility of neuro and vascular pathology following 16 weeks of treatment with menhaden oil, a natural source of long-chain omega-3 polyunsaturated fatty acids. The number of rats in the intervention study ranged from 6 to 17.

Results

Our longitudinal study demonstrated that vascular and neural dysfunction associated with obesity or type 2 diabetes occur early and are progressive. Decrease in cornea nerve fiber length and function were valid markers of disease in both the pre-diabetic and diabetic rat models and were more sensitive than decrease in intraepidermal nerve fiber density of the skin and thermal nociception of the hindpaw. Late intervention with menhaden oil significantly reversed both vascular and peripheral nerve damage induced by chronic obesity or type 2 diabetes.

Conclusion

These studies provide support for examination of corneal structure and function as an early marker of peripheral neuropathy in prediabetes and type 2 diabetes. Furthermore, we demonstrate that omega-3 polyunsaturated fatty acids derived from fish oil are an effective treatment for peripheral neuropathy that occurs with chronic obesity or type 2 diabetes.

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<![CDATA[Detrimental Effect of C-Reactive Protein on the Cardiometabolic Cells and Its Rectifying by Metabolic Surgery in Obese Diabetic Patients]]> https://www.researchpad.co/product?articleinfo=N0efea14f-073f-4215-9b65-daade5f56cdb

Background

High-sensitivity C-reactive protein (hs-CRP) has been regarded as a biomarker of low-degree inflammation in illness; however, whether CRP exerts its pathogenic effect on the cardiometabolic system remains unknown. Aside from the beneficial effects of metabolic surgery on cardiometabolic system, its impact on inflammation still worth examining. Thus, this study aims to investigate the effect of CRP on adipose and vascular cells, and their responses to metabolic surgery in obese diabetic patients.

Patients and Methods

The expression of CRP and RAS- and ERK-related factors in the adipocytes and VSMCs were measured. Obese patients with type 2 diabetes who underwent metabolic surgery were followed up for 2 years thereafter. Laboratory tests, which included serum hs-CRP levels and visceral fat thickness (VFT), were obtained before and after surgery.

Results

CRP administration significantly and dose-dependently increased the intracellular-free calcium concentration ([Ca2+]i) in cultured adipocytes and in the VSMCs. CRP administration significantly increased ACE, Ang II, AT1R and p-ERK expressions, but reduced ACE2 expression in both the adipocytes and VSMCs. Clinical study showed that VFT was closely associated with serum hs-CRP. Furthermore, VFT and serum hs-CRP were found to be highly associated with blood pressure. Finally, metabolic surgery remarkably decreased blood pressure, visceral fat and serum hs-CRP levels.

Conclusion

CRP has a detrimental effect on cardiometabolic cells, aside from functioning merely as a biomarker. Serum hs-CRP levels are highly associated with hypertension and visceral obesity, which can be antagonized by metabolic surgery in obese diabetic patients.

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<![CDATA[A Case of a COVID-19-positive Patient]]> https://www.researchpad.co/product?articleinfo=Nbec05835-91fe-4567-9718-12978631cffc

The coronavirus (COVID-19), discovered in 2019, has been creating havoc since it first emerged in China and is now spreading worldwide. Its presentation is somewhat similar to influenza. We hereby discuss the salient features of the coronavirus and present the case of a 33-year-old male who was tested positive for COVID-19. 

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<![CDATA[An Interesting Case of Congenital Intrahepatic Porto-hepatic Shunt as a Cause of Unexplained Encephalopathy]]> https://www.researchpad.co/product?articleinfo=Nf42d1eb4-bf94-4ab6-9557-939d935370fd

Congenital portosystemic shunts can be divided into two types: intrahepatic shunts in which there is an abnormal connection between the branches of the portal vein and either the inferior vena cava or the hepatic veins and less commonly the extrahepatic type in which the portal system is connected to one of the branches of the mesenteric veins. Here we describe a 73-year-old woman who was admitted to the hospital with clinical evidence of encephalopathy and was found to have hyperammonemia. Abdominal computed tomography angiography was performed and revealed a dilated portal vein measuring up to 1.8 cm at the porta-hepatis along with dilated superior mesenteric and splenic veins. Multiple dilated vascular channels were identified within the right hepatic lobe. An intrahepatic portosystemic shunt between an enlarged middle hepatic vein and two separate branches of the right portal vein was demonstrated. A liver biopsy showed normal architecture with no evidence of inflammation or fibrosis. Portosystemic shunts are rare and often detected in adulthood but should be considered as an important cause of unexplained encephalopathy in the absence of cirrhotic liver disease or hepatic trauma. Given that the size of such shunts increases with age, older persons are more prone to the effect of toxic metabolites.This age-associated increase in shunt size may help explain why some patients remain asymptomatic until later in their life which may account for the late presentation in our patient.

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<![CDATA[Metastatic Melanoma Presenting as a Ventricular Arrhythmia]]> https://www.researchpad.co/product?articleinfo=N9c7269c7-6e67-47e4-9b33-7eec90d90ff7

Melanoma is a highly aggressive disease with the risk of developing metastasis to virtually all organs including the heart, which can manifest as arrhythmia, right ventricular obstruction, heart failure, or pericardial effusion. Only a few reports are found in the literature of metastatic melanoma, causing ventricular arrhythmia. Prior to the advent of contemporary therapies, cardiac metastases implied a very poor prognosis. The use of immune checkpoint inhibitors and targeted therapy has greatly improved survival outcomes of metastatic melanoma. Aggressive therapy of cardiac metastasis including cardiac surgery can yield good outcomes. We present a case of a 57-year old gentleman with metastatic melanoma and cardiac involvement who initially presented as a ventricular arrhythmia and was successfully treated with immune checkpoint inhibitors and targeted therapy.

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<![CDATA[A Rare ST-Elevation Myocardial Infarction Mimic or a True Event?]]> https://www.researchpad.co/product?articleinfo=N46c3e4c8-4729-4ea7-aee9-281547783666

The etiology of ST-elevation myocardial infarction (STEMI) is either rupture or erosion of unstable plaque with subsequent thrombosis. With the widespread use of plaque-stabilizing lipid-lowering therapies (statins), plaque erosion, rather than rupture, now accounts for most cases of acute coronary syndromes (ACS). In the spectrum of ACS, STEMI usually results from the total occlusion of the culprit epicardial coronary artery, leading to the occlusion of blood flow to the affected myocardium. The differential diagnosis of ST-elevations on electrocardiograms are broad. However, an elevated cardiac marker, evidence of wall motion abnormality on echocardiogram or positive stress testing makes an alternate diagnosis less likely. This prompts emergent coronary angiography with an intent to fix the underlying cause. In some cases like ours, when the clinical suspicion of STEMI is high, the coronary angiography may be unrevealing of the diagnosis.

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<![CDATA[Acute ST-Elevation Myocardial Infarction Caused by Simultaneous Occlusion of Two Culprit Arteries]]> https://www.researchpad.co/product?articleinfo=N68f27915-4624-43c4-a572-fd5cbbd5812b

ST-elevation myocardial infarction (STEMI) is usually caused by acute thrombosis of a single culprit vessel, whereas STEMI caused by the simultaneous thrombosis of multiple coronary arteries is rare. A review of 711 STEMI cases undergoing percutaneous coronary intervention (PCI) revealed that only 2.5% of patients had acute coronary thrombosis of multiple arteries. We present a case of an 80-year-old female with a history of hypertension who presented with acute onset chest pain and underwent emergent angiography. Her angiography showed acute coronary thrombosis of both the distal left anterior descending artery (dLAD) and the distal obtuse marginal branch 3. She underwent PCI and had restoration of flow. Given the unique presentation of simultaneous multiple coronary thrombi, she underwent additional diagnostic workup before being discharged with guideline-directed medical therapy. While the American College of Cardiology and the European Society of Cardiology guidelines address culprit lesion only PCI versus complete revascularization of non-infarct related lesions, there are no guidelines or randomized controlled trials that have attempted to characterize the best management of STEMI caused by multiple culprit lesions. As a result, the best management of these cases is not standardized. Further case reports leading to prospective studies are needed to better predict outcomes and guide future management.

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<![CDATA[Human T-cell Lymphotropic Virus Type I Associated with Amyotrophic Lateral Sclerosis Syndrome: Immunopathological Aspects and Treatment Options]]> https://www.researchpad.co/product?articleinfo=Nfc197654-122a-4fc5-b9ac-75f1e2de608e

Human T-cell lymphotropic virus type I (HTLV-I) is a retrovirus related to infectious myelopathies, neoplasms, lymphomas, leukemias, and amyotrophic lateral sclerosis (ALS). It is acquired through sexual transmission, transfusion of blood products, and breastfeeding. The increased expression of human endogenous retrovirus K (HERV-K) in the brain tissue of patients with ALS has been demonstrated, a finding that supports the relationship between the virus and this disease. Therapeutic options include supportive measures and symptomatic treatment with anti-inflammatory medications including steroids, cyclosporines, pentoxifylline, danazol, interferons, and vitamin C. New management proposals are being implemented with valproic acid that acts to facilitate the recognition of the virus by the immune system and with zidovudine antivirals focused on reducing viral load. The purpose of this paper is to describe a clinical case that exhibits clinical signs and evidence of motor neuron compromise as described in electrophysiology studies along with positive laboratory tests for the HTLV-I virus.

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<![CDATA[Prevalence of sub-clinical mastitis and its association with milking practices in an intensive dairy production region of Uganda]]> https://www.researchpad.co/product?articleinfo=N7a38fb9c-cb3e-4ba8-9f17-1c2838dec5c5

A cross-sectional study was conducted to investigate the risk factors for sub-clinical mastitis (SCM) in Mbarara District, an intensive dairy production region of Uganda where hand-milking is dominant. In 30 farms, herd-level milking practices and SCM prevalence were studied. The SCM prevalences were 68.6% (417/608, 95% confidence interval (CI): 64.9–72.2%) and 39.2% (946/2,411, 37.3–41.2%) at the cow- and quarter-levels, respectively. A preventive factor for SCM was cow calmness at the end of milking (OR: 0.20, 95%CI: 0.05–0.79, P=0.021); a risk factor was rough teat-end (OR: 1.75, 95%CI: 1.14–2.68, P=0.011). Good cow hygiene was negatively associated with environmental mastitis (P=0.002). Appropriate hand-milking practices that avoid teat damage are expected to reduce SCM in Uganda.

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<![CDATA[Tumid Lupus Erythematosus and Systemic Lupus Erythematosus: A Report on Their Rare Coexistence]]> https://www.researchpad.co/product?articleinfo=Nd4eda7bd-9eaa-460e-a826-5fd6fe3e6c97

Tumid lupus erythematosus (TLE) is a rare variant of cutaneous lupus erythematosus. Clinically, it lacks typical changes found in discoid lupus and antinuclear antibodies (ANA) levels are elevated in only 10% of the patients. Coexistent systemic lupus erythematosus (SLE) has been reported to be rare, and literature shows only a few case reports. We present a case of coexistent tumid lupus and SLE. We present a case of a 48-year-old Caucasian female who presented with chronic facial rash, photosensitivity, intermittent oral ulcers, joint pain with morning stiffness, and unintentional weight loss. Laboratory studies showed positive ANA at 1:640, elevated erythrocyte sedimentation rate, positive anticardiolipin immunoglobulin (Ig) G, anticardiolipin IgM, and anti-beta-2 glycoprotein IgM. Skin biopsy of the rash showed a superficial and deep dense lymphocytic infiltrate with mucin deposition, histopathology favoring tumid lupus. The patient was diagnosed with TLE with SLE and was started on hydroxychloroquine with improvement in her rash. Ultraviolet light and certain medications have been proven to play a role in the pathogenesis of tumid lupus. It usually responds to photoprotection, topical treatment, or oral antimalarial therapy.

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<![CDATA[A Rare Cause of Intestinal Pseudo-obstruction: Gastrointestinal Amyloid]]> https://www.researchpad.co/product?articleinfo=N02f46774-587f-4285-a260-12e476d7c1e8

Amyloidosis is characterized by extracellular deposition of the amyloid protein. It can affect multiple organ systems but it most commonly affects the heart, kidney and gastrointestinal (GI) tract. It can occur sporadically or in association with other conditions like multiple myeloma, chronic inflammatory diseases, infections etc. Its involvement of the gastrointestinal tract is rare and diffuse. It has variable manifestations in GI tract from involving the stomach to the large bowel including liver. We present a case of 55 year old Caucasian male with recent diagnosis of multiple myeloma who presented with recurrent episodes of small bowel obstruction which was later found to be caused by amyloid deposition.

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<![CDATA[Superior Mesenteric Artery Dissection After Lumbar Puncture]]> https://www.researchpad.co/product?articleinfo=N186d9125-0c1e-470d-bfc5-9fec941039f6

We hereby present a case of iatrogenic dissection of the superior mesenteric artery dissection in a 63-year-old female undergoing a lumbar puncture (LP). She presented with severe diffused abdominal pain accompanied by lower back pain, nausea and vomiting a few hours after undergoing an LP due to ongoing headaches. Abdominal CT showed evidence of hemoperitoneum. She was then transferred to another facility and while in route received one unit of packed red blood cellsdue to drop in hemoglobin levels from 15 to 11 gm/dl. Physicians should consider the possibility of arterial variations and the level at which spinal tap is performed during interventions. Acute abdominal pain is a significant, common complaint that should be appropriately investigated.

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<![CDATA[A Rare Case of Statin-induced Immune-mediated Necrotizing Myopathy]]> https://www.researchpad.co/product?articleinfo=N5532b632-8114-483b-8009-c26d7df82dd4

Statin-associated myopathy comprises of a spectrum of conditions ranging from benign myalgias to statin-induced immune-mediated necrotizing myopathy. Statin-induced immune-mediated necrotizing myopathy is an autoimmune condition wherein there is a destruction of normal skeletal muscular architecture that can be severely debilitating if not recognized promptly. Given its rarity, management is a challenge. We present one such case that was managed with aggressive immunosuppression.

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<![CDATA[Conned by Conn’s: The Manifestation of Conn’s Syndrome Post-renal Transplant in a Patient with Polycystic Kidney Disease]]> https://www.researchpad.co/product?articleinfo=N7cf5652e-d78b-427e-ac95-c868bc6b14f5

We present the case of a 66-year-old African-American male with end-stage renal disease (ESRD) secondary to polycystic kidney disease (PCKD), with well-controlled hypertension. He was placed on peritoneal dialysis for two years before successfully undergoing a cadaveric renal transplant. There was an immediate graft function with no relevant postoperative complications. On regular follow-ups two months later, the patient now presents with worsening control of hypertension despite an increase in anti-hypertensive medications. Common causes of new-onset hypertension, such as renal artery stenosis, anti-calcineurin therapy, and allograft injury, were excluded. The patient’s biochemistry revealed the presence of hypokalemia, which was absent in previous reports. In light of this, plasma aldosterone and renin levels were sent and were found to be elevated: aldosterone: 50.4 ng/dL, renin: 0.4 ng/dL, aldosterone-renin Ratio (ARR): 126. In retrospect, a routine CT (computed tomography) scan performed in 2017 revealed an adrenal adenoma of 17 x 13 mm, which was diagnosed as an incidental finding at that time. A repeat CT scan was performed and showed no change in the size of the adenoma. In view of the new symptoms, the patient was started on spironolactone with little to no improvement in blood pressure and potassium levels. We present a case of Conn's syndrome in a patient with PCKD manifesting only after a renal transplant.

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<![CDATA[Pneumococcal Epidural Abscess in an Asplenic Patient Presenting After Mild Hip Trauma]]> https://www.researchpad.co/product?articleinfo=Nb30a7a69-ddff-4883-9a42-550a87cdc995

We report a unique presentation of an epidural abscess following mild trauma in a patient with asplenia. The patient reported subjective fever and marked pain along the right hip and flank, which are atypical locations for epidural abscess pain. A subsequent urinalysis showed leukocytes, and the diagnosis of an epidural abscess was missed until the patient presented over two weeks later with fever, spinal pain, leg weakness, and urinary incontinence. This report highlights the importance of heightened clinical suspicion of pneumococcal infections in asplenic patients with unexplained subjective fever. Cost-effective yet sensitive tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can help guide further investigation of epidural abscesses in such patients. Blood and urine cultures may also be warranted. Early diagnosis of epidural abscesses is essential to ensure improved outcomes.

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