2 research outputs found

    Iatrogenic Cushing’s Syndrome Caused by Adulteration of a Health Product with Dexamethasone

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    Background: Intake of glucocorticoids (GCs) may result in iatrogenic Cushing’s syndrome.Objective: To describe a case of severe iatrogenic Cushing’s syndrome caused by administration of a non-prescription drug adulterated with dexamethasone, and to alert physicians and public about harm associated with this product.Methods: PubMed and internet search up to July 24, 2022. Search terms are Cushing’s, glucocorticoids, adulteration, iatrogenic. Case reports, case series and review articles are included.Case report: A 54-year-old man presented with severe Cushinoid features. Laboratory work-up was consistent with exogenous source of GCs. Patient denied previous or current intake of GCs but reported taking a health product called “Artri-King” for knee pain. Inspection of this drug did not reveal any GCs among its ingredients. Yet, laboratory analysis performed by the Food and Drug Administration (FDA) confirmed that this drug contains dexamethasone, which was not listed on the product label. Review of literature reveals that GC adulteration in Chinese health products is common. Among 61 patients who consumed GC-adulterated Chinese medicines, dexamethasone was implicated in 47.5%. Most subjects (62.3%) taking products with undeclared GCs had one or more complications attributed to GCs, 11.5% required admission to intensive care, and 3.3% died. In another series, iatrogenic Cushing’s syndrome was the second clinical presentation of use of adulterated Chinese medicines occurring in 10.6% of cases, whereas psychosis was the first most frequent presentation (12.9% of cases).  Conclusion: In any case of iatrogenic Cushing’s syndrome, discontinuation of supplemental health products is essential because many of these products may include undeclared GCs

    Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members

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    BackgroundThe rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. ObjectiveThis study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. MethodsFunded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the “Summary of Diabetes Self-Care Activities.” Evaluations were made at baseline and at 3, 6, and 12 months. ResultsThis study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. ConclusionsThe results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. Trial RegistrationClinicalTrials.gov NCT03092063; https://clinicaltrials.gov/ct2/show/NCT03092063 International Registered Report Identifier (IRRID)DERR1-10.2196/4479
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