Assessing Indications of Riskiness in Adolescents

Adolescents are often likely to engage in perilous behaviors during their transitional years from youth to adulthood. Nearly 75% of the primary causes of death in the adolescent population are of preventable causes. In order to address the harmful issues facing this young population today, researchers at the University of Michigan developed the Rapid Assessment for Adolescent Preventive Services (RAAPS), a 21-question risk screening examination that identifies the behaviors contributing the most to adolescent morbidity, mortality, and social problems. Over the course of this study, beginning in 2015, researchers utilized the RAAPS to gather data from University of Michigan Health System (UMHS) health clinics around Southeast Michigan. Clinic patients between the ages of 11 and 21 were administered the questionnaire as part of their primary care visit. The simple yes/no structure of each question allowed for a straightforward entry of data that could be analyzed to compare different factors affecting adolescents. Data from the assessment was entered into the Statistical Package for the Social Sciences (SPSS) statistical software for an in-depth analysis by researchers through the use of the Chi-squared test for categorical variables. Results regarding the data obtained from the assessment are still pending at the time of abstract submission; however, it is predicted that significant indications of harmful behavior will be linked to factors such as sexual orientation and/or median household income-level. These findings may suggest a new direction in which physicians can address issues for adolescents who identify with certain characteristics

EDTA contamination: a preanalytical cause for interference in iron and unsaturated iron binding capacity assay

Background: The aim of the study is focussed very keenly at performing RCA (root cause analysis) of those particular sample containing the absurd results of the Serum UIBC (Unsaturated Iron Binding Capacity), which was also tallied vigilantly side by side with Serum Iron observed at Clinical Biochemistry laboratory of The New Civil Hospital Surat, Gujarat.Methods: The Absurd value from the samples requested for Serum Iiron and Serum Serum UIBC (Unsaturated Iron Binding Capacity) from month of August 2018 till the month of August 2019 were taken in to account for analysis. RCA (root cause analysis) of absurd value for Serum Iron and Serum UIBC (Unsaturated Iron Binding Capacity) which were prepared was mainly focused on tallying with Serum Calcium and Serum Potassium result.Results: With the continious and strenous monitoring from the side of the researchers, the researchers had throughly analysed and found that in almost all of those analysed test containing absurd results of Serum Iron and Serum UIBC(Unsaturated Iron Binding Capacity) which were some way or the other, associated with absurd results of Serum Calcium along with absurd result of Serum Potassium too from the same samples.Conclusions: The Absurd results of Serum Calcium and Serum Potassium are caused mainly due to pre-analytical errors more likely due to the sample contamination with EDTA (ethylene diamine tetra acetic acid). The contaminated EDTA (ethylene diamine tetra acetic acid) sample cause interference in Serum Iron measurement by producing turbidity in sample and in Serum UIBC (Unsaturated Iron Binding Capacity) by chelating Iron

Does Acute Exercise Improve Driving Performance in Patients with Untreated Obstructive Sleep Apnea?

poster abstractObstructive Sleep Apnea (OSA) is a highly prevalent, yet frequently undiagnosed sleep disorder that often is associated with excessive daytime fatigue, and increased risk for motor vehicle accidents. Although treatment with continuous positive airway pressure (CPAP) is effective, adherence in many patients with OSA is often problematic. The primary objective of this study is to determine if a brief bout of moderate-intensity exercise improves driving performance in those who have recently been diagnosed with, are awaiting treatment for OSA. Each participant will complete two visits to the TASI Driving Simulator Lab where they will perform two 20-minute driving simulation tests, one of which will involve a brief (10-min) bout of moderate-intensity exercise (e.g. walking briskly). Measures of interest during the driving simulation trials include lane deviation, collision events, and braking response time. We hypothesize that driving performance will be improved during simulated driving trials where OSA patients participate in short duration exercise immediately before driving. The research proposed in this application is significant because our focus is on an inexpensive intervention (i.e. exercise) available to virtually all OSA patients that may have short- and long-term potential for improving key OSArelated outcomes considered essential for driving safety

Clinical Usage of Photodynamic Therapy

This chapter will provide a brief overview of the fundamentals of photodynamic therapy with an emphasis on its use in a clinical setting. Beginning with the history and fundamental science underlying photodynamic therapy and delving into clinical uses. There will be a primary focus on understanding the use of photodynamic therapy under currently approved clinical indications along with their limitations. There are a number of approved therapeutic indications for photodynamic therapy, but there are important limitations and contraindications when applying this therapy. Photodynamic therapy, as applied to the clinical treatment of cancer will be the primary focus with further emphasis on endoluminal and specifically endobronchial cancer as the primary case study

One-session bilateral sequential whole lung lavage (OSBSWLL) for the management of pulmonary alveolar proteinosis

BACKGROUND: Whole Lung Lavage (WLL) has been an important part in the management of Pulmonary Alveolar Proteinosis (PAP) since it improves radiologic and clinical parameters. Bilateral WLL is usually performed in two sessions on different days. Few case reports have described one-session bilateral sequential lung lavage (OSBSWLL), and none have described ambulatory management (same-day discharge). METHODS: Demographic characteristics, physiologic parameters, procedure details and outcomes were retrospectively collected on consecutive patients who underwent OSBSWLL for PAP following an ambulatory protocol stablished in our institution. RESULTS: A total of 13 patients underwent 30 OSBSWLL (61.5% male; mean age 40). The mean SpO2 was 90% (IQR 9) and 94% (IQR 6), before and after OSBSWLL respectively. In 63.3% of cases, patients were discharged home the same day of procedure. Only in two cases (6.6%), patients required post-procedure prolonged mechanical ventilation (\u3e 4 h) due to persistent hypoxia. CONCLUSIONS: OSBSWLL can be performed with same-day discharge

Severe Hypercalcemia: Unusual Life-threatening Presentation of Addison’s Disease

Background: Addison’s Disease, also known as primary adrenal insufficiency, is a rare disorder of the adrenal gland typically characterized by the combination of cortisol and mineralocorticoid deficiencies in addition to electrolyte abnormalities including hyponatremia and hyperkalemia. Addison\u27s disease is an uncommon cause of hypercalcemia. We present a rare case of hypercalcemia in the setting of primary adrenal insufficiency. Case Presentation: Our patient is 43-year-old Hispanic lady with no reported medical history who presented to the Emergency Room for evaluation of intractable nausea and vomiting of about a month duration. Clinical examination revealed a lethargic, dehydrated, and hypotensive lady. Initial laboratory findings revealed severe hypercalcemia of 15.4 mg/dl (N: 8.6-10.4). Serum AM Cortisol level was low \u3c 0.5ug/dl ( N: 7-25ug/dl) and Adrenocorticotropic Hormone (ACTH) level was elevated 612 pg/ml ( N: 7.2-63.3pg/ml) confirming the diagnosis of Addison’s disease. However, laboratory investigations and imaging studies into other causes of hypercalcemia were unremarkable. She was admitted, rehydrated, placed on pressors, Calcitonin, Hydrocortisone and Fludrocortisone . Her symptoms improved with resolution of hypercalcemia. Conclusion: Though rare, Addison’s disease should always be considered by physicians in the work up for hypercalcemia. This high index of suspicion improved the outcome in the management of this patient

Combination GLP-1 and Insulin Treatment Fails to Alter Myocardial Fuel Selection Versus Insulin Alone in Type 2 Diabetes

Context Glucagon-like peptide-1 (GLP-1) and the clinically available GLP-1 agonists have been shown to exert effects on the heart. It is unclear whether these effects occur at clinically used doses in vivo in humans, possibly contributing to CVD risk reduction. Objective To determine whether liraglutide at clinical dosing augments myocardial glucose uptake alone or in combination with insulin compared to insulin alone in metformin-treated Type 2 diabetes mellitus. Design Comparison of myocardial fuel utilization after 3 months of treatment with insulin detemir, liraglutide, or combination detemir+liraglutide. Setting Academic hospital Participants Type 2 diabetes treated with metformin plus oral agents or basal insulin. Interventions Insulin detemir, liraglutide, or combination added to background metformin Main Outcome Measures Myocardial blood flow, fuel selection and rates of fuel utilization evaluated using positron emission tomography, powered to demonstrate large effects. Results We observed greater myocardial blood flow in the insulin-treated groups (median[25th, 75th percentile]: detemir 0.64[0.50, 0.69], liraglutide 0.52[0.46, 0.58] and detemir+liraglutide 0.75[0.55, 0.77] mL/g/min, p=0.035 comparing 3 groups and p=0.01 comparing detemir groups to liraglutide alone). There were no evident differences between groups in myocardial glucose uptake (detemir 0.040[0.013, 0.049], liraglutide 0.055[0.019, 0.105], detemir+liraglutide 0.037[0.009, 0.046] µmol/g/min, p=0.68 comparing 3 groups). Similarly there were no treatment group differences in measures of myocardial fatty acid uptake or handling, and no differences in total oxidation rate. Conclusions These observations argue against large effects of GLP-1 agonists on myocardial fuel metabolism as mediators of beneficial treatment effects on myocardial function and ischemia protection

IVIG for refractory dysphagia in Antisynthetase syndrome: A truth hard to swallow

Refractory dysphasia could be the main symptom of Antisynthetase syndrome (ASS). IVIG may have a major impact in the successful treatment of dysphasia in patients with ASS. In our patient with ASS, IVIG treatment was an unreplaceable treatment option, and the patient regains her ability to swallow within 2 days