A Young Female Who Develops Tachycardia and Orthostatic Intolerance Following a Recent Infection

Case Presentation The patient is a 20-year-old female with a history of asthma and anxiety with panic attacks who presented with palpitations and lightheadedness/pre-syncope. The morning of admission, she was attending a seminar and experienced an acute onset of palpitations. The palpitations started while she was seated and worsened upon standing. They were associated with lightheadedness, shortness of breath, and chest tightness. A nurse attending the seminar recommended that she go to the emergency room. On presentation to the emergency department (ED) her vital signs were: Temperature: 99.2°F, Blood pressure (BP): 140/98; Heart rate (HR): 140; Respiratory rate (RR): 16; Oxygen saturation: 100% on room air. She reported that she had experienced prior panic attacks but that this episode was persistent and significantly more intense in comparison. She also reported that a few days prior to presentation she had completed a prolonged course of antibiotics for tonsillitis. Her only medications were oral contraceptive pills (OCPs) and dextroamphetamine/ amphetamine (Adderall®). She reported taking her Adderall® as prescribed, most recently on the day prior to presentation. She denied other stimulant or illicit drug abuse. Her family history was significant for anti-phospholipid antibody syndrome (APS) in her mother

A 47-Year Old Female with Muscular Rigidity, New-Onset Diabetes and Hypothyroidism

Background This case highlights a rare but devastating neurologic condition, Stiff Person Syndrome (SPS). While symptoms of muscular rigidity andspasms areassocia ted with numerous neuromuscular conditions, the association between SPS, autoimmune diabetes, and other autoimmune disorders such as thyroiditis, pernicious anemia, and vitiligo, could aid in the early diagnosis of this debilitating condition. Case Presentation A 47-year-old African American female presented with six months of progressively worsening rigidity and spasticity of her axial muscles and extremities. The patient was in good health until one and a half years prior to admission when she lost consciousness while driving and was subsequently diagnosed with epilepsy. Her daughter was a passenger in the car and suffered a brief coma. Over the next year, the patient started having anxiety with increasingly more frequent and severe panic attacks. Six months prior to admission, she developed muscle stiffness and painful spasms that were so severe, she had difficulty ambulating and eventually became bed-bound. Magnetic Resonance Imaging (MRI) of the brain and spine did not reveal any pathology. Additionally, during the past year she was diagnosed with diabetes, which was unusual given her thin body habitus (Body-Mass Index of 20.9)

Sizing up pharmacotherapy for obesity.

Obesity has increased over the last 20 years, from a condition affecting only a small portion of populations in developed countries, into a global pandemic. The impact of obesity can be appreciated in the context of the populations at risk, and it is estimated that \u3e1 billion adults worldwide are overweight (BMI \u3e25 kg/m2), 300 million of whom are clinically obese (BMI \u3e30 kg/m2). In the United States, 65% of adults are overweight, and 32.2% of them are obese, a prevalence that has doubled over 20 years. In industrialized countries, obesity rates have tripled, coinciding with adoption of a Western lifestyle. Further, the growing worldwide rates of childhood obesity have reached epidemic values in developed countries. This global obesity pandemic reflects genetic susceptibility, availability of high-energy foods, and decreased physical activity. Accelerating rates of obesity have profound health and economic consequences. Obesity is associated with a myriad of co-morbidities, including type II diabetes, coronary artery disease, obstructive sleep apnea, stroke, cancer, hypertension, osteoarthritis, and liver and biliary disease which collectively increase mortality. Indeed, the health care impact of chronic obesity exceeds that of smoking or alcohol abuse. National health care costs of obesity are $70-100 billion, and if this trend continues, in 15 years 20% of health care costs in the United States will be attributed to the chronic diseases associated with obesity

From the Editors

We are excited to present you with the 16th annual edition of The Medicine Forum. This work is a culmination of months of effort on the part of medical students, residents, fellows and faculty to share clinical pearls from the last year of their experiences. Amongst the greatest strengths of medical professionals and patients alike is the ability to tell stories. Stories, and how they are told form the basis of medical care. The way in which a particular patient\u27s story unfolds has a lasting impact on physicians, trainees, other medical staff, and perhaps most importantly, on future patients. Stories of patient cases formed the earliest beginnings of evidence-based medicine. There is a Babylonian tablet dating earlier than 6000 B.C.E. which describes a case of dropsy , for the instruction of patients of this condition.1 Stories told amongst practitioners of medicine date back to the first published medical journal, the Acta Medicorum Berolinensium, from Berlin in 1722.

Fastener starter tool

A fastener starter tool includes a number of spring retention fingers for retaining a small part, or combination of parts. The tool has an inner housing, which holds the spring retention fingers, a hand grip, and an outer housing configured to slide over the inner housing and the spring retention fingers toward and away from the hand grip, exposing and opening, or respectively, covering and closing, the spring retention fingers. By sliding the outer housing toward (away from) the hand grip, a part can be released from (retained by) the tool. The tool may include replaceable inserts, for retaining parts, such as screws, and configured to limit the torque applied to the part, to prevent cross threading. The inner housing has means to transfer torque from the hand grip to the insert. The tool may include replaceable bits, the inner housing having means for transferring torque to the replaceable bit