Chinedu Ivonye

The Impact of Health Literacy on Self-Monitoring of Blood Glucose in Patients With Diabetes Receiving Care in an Inner-City Hospital

BACKGROUND Self-monitoring of blood glucose (SMBG) is considered to be 1 of the cornerstones of diabetes self-management. It is unclear whether inadequate health literacy affects SMBG. OBJECTIVE The objective of this study was to examine the relationship between health literacy and SMBG. METHODS This was a cross-sectional survey of 189 patients with diabetes, aged 18 to 65 years, receiving care in a large urban, public health care setting. We measured health literacy using the shortened version of the Test of Functional Health Literacy in Adults. The diabetes care profile was used to determine the use of self-monitoring of blood glucose. RESULTS Most (60.9%) of the survey participants were assessed as functionally health literate. The majority (90.9%) of the study participants reported testing their blood sugar at least once daily. Although adequate health literacy was associated with recording of blood sugar testing (p = .049), we found no statistically significant relationship between health literacy and the frequency of SMBG. Persons self-reporting having diabetes for more than 10 years were less likely to self-monitor blood glucose (odds ratio, 0.33; 95% CI, 0.11-0.99). CONCLUSIONS SMBG frequency is not independently associated with health literacy, but SMBG result recording is noted among patients with inadequate literacy.

Is telemetry overused? Is it as helpful as thought?

Cardiac telemetry is widely used in hospitals, but it is expensive and labor-intensive. Therefore, it should be used only in those most likely to benefit. The authors review the available evidence and offer their recommendations. Cardiac telemetry is widely used in hospitals, but it is expensive and labor-intensive. Therefore, it should be used only in those most likely to benefit.

Evaluation of Telemetry Utilization, Policy, and Outcomes in an Inner-City Academic Medical Center

OBJECTIVE To evaluate the appropriateness and intermediate outcomes of telemetry admissions. METHODS We abstracted demographic and clinical data from records of all new telemetry admissions during a 2-month period. To determine appropriateness, 2 authors classified patients using the American College of Cardiology (ACC) guidelines and our telemetry policy. Other utilization and outcome measures were assessed. Agreement between both guidelines was computed (kappa coefficient). Categorical group covariates were compared using chi2 test. Variations in telemetry length of stay (LOS) were compared using Mann-Whitney and Kruskal-Wallis tests. LOS predictors were ascertained by multiple regression analysis. RESULTS Of the 120 patients, appropriate admission was 81.6% (ACC criteria) and 83% by our criteria. Guidelines interrater reliability was .89 (kappa). Telemetry events incidence was 33.3%, with 5.8% major and 27.5% minor. LOS was longer among major than minor events group(7.8 vs. 3.4 days, p = .01). Type of telemetry event was a predictor of LOS (p = .0001). The occurrence of a major telemetry event was associated with cardiology consultation (p = .03). CONCLUSIONS Appropriate telemetry admission was observed in more than 80% of cases. Our telemetry policy had very good agreement with standard guideline. However, the low rate of major telemetry events in all patient groups suggests current guidelines might have considerable limitations.

Disseminated sarcoidosis resulting in portal hypertension and gastrointestinal bleeding: A rare presentation

A 41-year-old man was evaluated for an upper gastrointestinal bleed. He was stabilized and an upper esophagogastroduodenoscopy revealed gastritis and esophageal varices. A computed tomography (CT) scan of the abdomen showed hepatosplenomegaly and moderate ascites. Analysis of the ascitic fluid was consistent with portal hypertension. A liver biopsy demonstrated noncaseating granuloma consistent with sarcoidosis, there was no evidence of liver cirrhosis on pathology. Portal hypertension associated with sarcoidosis is rare; after the first reported case in 1949, 35 other cases have been reported in the English literature, with only 16 patients presenting with portal hypertension without evidence of liver cirrhosis. Our patient is among the small group reported to have sarcoidosis-related portal hypertension without evidence of liver cirrhosis. The present case illustrates the importance of recognizing an uncommon manifestation of sarcoidosis

Pancreatic Neuroendocrine Tumor Presenting as a Cushings Syndrome Associated with Hypertension

A young female was evaluated in the emergency department (ED) for persistent headache and fatigue one week after being started on antihypertensive therapy with poor response. Her medications were Amlodipine 10 mg daily, Hydrochlorothiazide 25 mg daily, Atenolol 100 mg daily and Hydralazine 50 mg three times daily. Further evaluation revealed cushingoid appearance, her blood pressure was 171/100 mmHg despite compliance with multiple antihypertensive therapy. Her clinical manisfestation prompted the evaluation for secondary causes of hypertension with laboratory evidence of hypokalemia, hyperglycemia, hypercortisolism with high ACTH that did not respond to low and high dose dexamethasone suppression. A splice mutation in MEN 1gene was found with the eventual diagnosis of metastatic pancreatic neuroendocrine tumor. Her turbulent course unravels how complex medical problems continue to masquerade as general medical ailments.

Uncommon skin lesion in a patient with ataxia-telangiectasia

A 20‐year‐old African‐American man, with a history of ataxia‐telangiectasia diagnosed at the age of one year, presented to the hospital with fever, cough, and headache of 2 days’ duration. The fever was of high grade, associated with chills and rigors. The headache was frontal in location, constant, pounding in nature, and associated with photophobia and phonophobia; there was no neck pain, no neck stiffness, and no blurring of vision. The patient complained of facial pain. There were no relieving or aggravating factors. The family denied any change in mental status.

Candida dubliniensis abscess: A clinical case and a review of the literature

Candida dubliniensis infections are rare in the absence of prolonged immunocompromised status or intravenous drug abuse. We present a case of a C. dubliniensis soft tissue abscess in a patient with uncontrolled diabetes as his only immunocompromising risk factor, treated with surgical drainage and medical management.