Atypical Neuroleptic Malignant Syndrome: a Case Presentation

Introduction: Neuroleptic malignant syndrome (NMS) is an emergent, often fatal, medical condition associated with the use of dopamine receptor antagonist medications. Fever, muscle rigidity, autonomic instability and altered mental status are known to be the hallmarks of the disease. In contrast with the typical presentation, Atypical NMS often presents with a different set of symptoms, making diagnosis difficult. It is important to use clinical acumen to make a timely and efficient diagnosis of NMS. We present a case of Atypical NMS in a 21 year old male. Clinical Case Pt is a 21 year old African American male with previous psychiatric history of schizophrenia, bipolar disorder, acute dystonia, and tardive dyskinesia. Pt was transferred from county jail to the emergency room with decreased activity, drooling, howling, and altered mental status. During this time patient was in isolation for previously erratic behavior. Per jail records this was an ongoing process for 2-3 days prior to transfer. Conversations with staff at jail state that pt was tachycardic and hypertensive at times during this episode yet when asked for full records they declined and explained they “don’t keep” charts or records. Jail nurses were also able to tell us his medications include haldol decanoate, oral haldol and artane yet had been refusing medications in recent days to weeks. They were unable to tell us anything about PRN medications given during this period of time. On admission to the hospital he was in pain, moderately stiff, bradykinetic, unable to phonate secondary to oral bradykinesia and minimally encephalopathic. Vital signs including temperature were unremarkable on admission and throughout hospitalization. Lab findings indicated elevated creatinine kinase of 18,963 IU/L. Due to components of the history and physical exam, laboratory and imaging studies, it was determined that this patient was presenting with atypical NMS and bromocriptine therapy was initiated. The patient steadily improved back to baseline over a 22 day admission, much of which was spent waiting for placement. Discussion: It is essential to recognize NMS to prevent associated mortality. Recognition of this disease process can often be difficult as presentations may vary. There is established literature on atypical presentations of NMS; presentations without hallmark signs and symptoms such as fever, muscle rigidity, autonomic instability and altered mental status. It is the goal of this case to discuss NMS pathogenesis, variations in presentation of NMS, the differential diagnosis, and associated treatment

Global Stability of a Class of Difference Equations on Solvable Lie Algebras

Motivated by the ubiquitous sampled-data setup in applied control, we examine the stability of a class of difference equations that arises by sampling a right- or left-invariant flow on a matrix Lie group. The map defining such a difference equation has three key properties that facilitate our analysis: 1) its power series expansion enjoys a type of strong convergence; 2) the origin is an equilibrium; 3) the algebraic ideals enumerated in the lower central series of the Lie algebra are dynamically invariant. We show that certain global stability properties are implied by stability of the Jacobian linearization of dynamics at the origin. In particular global asymptotic stability. If the Lie algebra is nilpotent, then the origin enjoys semiglobal exponential stability

Life cycle assessment in the food supply chain:a case study

This research aims at assessing the environmental impact of the poultry supply chain from cradle to grave using case study research and also life cycle assessment (LCA). While a limited number of generic poultry production LCA studies have been published, fewer yet assess the whole process of a specific organisation, none comparing the increased impact of further processing. Our results show that irrespectively of the impact assessment method utilised, the process of producing portions is considerably higher in total environmental impact due to the extra raw material required to produce the same mass into retail. Our research contributes to the growing number of LCA studies and could be used by practitioners for comparison against national and international averages. From a theoretical point of view, this research provides new insights into the relationship between vertically integrated supply chains and environmental performance which has not been examined in the past

Back to the Future! The Evolving Role of Maintenance Therapy after Hematopoietic Stem Cell Transplantation

AbstractRelapse is a devastating event for patients with hematologic cancers treated with hematopoietic stem cell transplantation. In most situations, relapse treatment options are limited. Maintenance therapy offers the possibility of delaying or avoiding disease recurrence, but its role remains unclear in most conditions that we treat with transplantation. Here, Dr. Hourigan presents an overview of minimal residual disease (MRD) measurement in hematologic malignancies and the applicability of MRD-based post-transplantation interventions. Dr. McCarthy reviews current knowledge of maintenance therapy in the autologous transplantation context, with emphasis on immunologic interventions and immune modulation strategies designed to prevent relapse. Dr. de Lima discusses current lines of investigation in disease recurrence prevention after allogeneic transplantation, focusing on acute myeloid leukemia and myelodysplastic syndrome

Learning By Living: Empathy Learned Through An Extended Medical Education Immersion Project

Introduction: Medical student training and experiences in nursing homes are often viewed as negative; however, long-term care services represent a growing aspect of our medical system that receives little attention in medical education. The University of New England College of Osteopathic Medicine Learning by Living Nursing Home Immersion Project accelerates students learning about older adult care and the importance of empathy. Methods: Learning by Living applies qualitative ethnographic/autobiographic research methods to answer the question: “What is it like for me to live the life of an older adult nursing home resident?” Two first year medical students (female, 25 y/o & male, 27 y/o) were “admitted” into two different nursing homes for 11 days each. The students were wheelchair reliant from their assigned diagnoses of dominant-side paralysis secondary to stroke and aspiration pneumonia; requiring standard procedures of care experienced by older adults residents with similar conditions. Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and resident encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Four themes of significance intersected for the two medical students: 1) control; 2) quality of life; 3) communication; and 4) isolation. Being immersed in nursing home life provided the students with firsthand experiences of loss and challenges faced by nursing home residents. This aided students’ learning about empathy and communication as key components of providing health care. Conclusion: This experience imparted knowledge to the medical students’ about aging, dignity, and the importance of making meaningful connections in order to thrive. These insights provided a gateway to establish a model of patient-centered care that is comprehensive and empathic for the older adult population