Menfil Orellana-Barrios

Electronic Cigarettes—A Narrative Review for Clinicians

Electronic cigarettes (e-cigarettes) were introduced into the US market in 2007 and have quickly become a popular source of nicotine for many patients. They are designed to simulate smoking by heating a nicotine-containing solution producing an aerosol that the user inhales. The short- and long-term effects of e-cigarette use are still unclear, but their use is increasing. Some acute effects of e-cigarettes on heart rate, blood pressure, and airway resistance are reported. Although there are some reports of improved cessation in a subset of users, there are also studies reporting decreased cessation in dual users of regular and e-cigarettes. Additionally, there is no current regulation of these devices, and this allows virtually anyone with a form of online payment to obtain them.

High Flow Nasal Cannulas for Oxygenation: An Audit of Its Use in a Tertiary Care Hospital.

Background:High flow nasal cannulas (HFNCs) provide humidified oxygen at higher flow rates and higher FiO2s than conventional delivery devices and are typically used in special care units. There is limited information on their use in general hospital settings. Methods:The medical records of all patients who were treated with HFNC during the calendar year 2014 were retrospectively reviewed to collect information on age, sex, indications, arterial blood gases when available, O2 saturations and outcomes. Results:One hundred six patients received oxygen supplementation by HFNC in their hospital in 2014. The average age was 61.6 ± 16.2 years; 62 patients were men. The indications for HFNC included dyspnea (1 patient), hypoxemic respiratory failure (101 patients) and hypercapneic respiratory failure (4 patients). The PaO2 increased from 68.2 ± 16.3 mm Hg to 83.1 ± 32.2 mm Hg (N = 32, P = 0.02) with the change to HFNC. The O2 saturation increased from 93.1 ± 4.5% to 95.1 ± 3.0% (N = 106, P = 0.00015). The mean duration of use was 4.3 ± 3.7 days. Sixty-five patients did not require intubation or noninvasive ventilation (NIV). Sixteen required NIV, 16 required intubation and 9 required both. The overall mortality was 15%. Conclusions:HFNC oxygen therapy is used relatively frequently in their hospital on surgical and medical services. PaO2s and O2 saturations improved when patients were switched to this mode of oxygenation, but some patients subsequently required NIV and/or intubation. Patients on HFNC need careful monitoring for deterioration in their respiratory status.

Prevalence of Hypertension and Associated Anthropometric Risk Factors in Indigenous Adults of Guatemala

Background: Hypertension (HT) epidemiological studies in developing regions of the world like rural Guatemala are lacking. Methods: A sample size of 1104 subjects (552 females, all 18 years or older) was obtained through quota and geographical clustering in the entire Department of Sololá, Guatemala. Descriptive statistics and logistic regression were used. Results: Average systolic, diastolic, and mean arterial pressures were significantly higher in men compared with women (116.24 vs 113.80 mm Hg, 75.24 vs 72.69 mm Hg, and 88.91 vs 86.39 mm Hg, respectively; all with P < .05). The crude prevalence of HT was 12.5% with no gender differences. Women had a significantly higher mean body mass index (BMI) than men (26.25 vs 24.71 kg/m2, P < .001). An abnormally high waist circumference (WC) was found in 12.7% of men and in 50.7% of women. Significant associations were found between the presence of HT, age ≥55 years, and an elevated WC. The single most important isolated risk factor for HT was age in women (OR 6.76, 95% CI 3.59-12.72) and WC in men (OR 3.23, 95% CI 1.52-6.87). Increased BMIs (≥25-30 or ≥30 kg/m2) were not associated with HT in this study. Residing in Sololá’s capital was a protective factor in women (OR 0.33, 95% CI 0.13-0.83). Conclusion: Hypertension and associated anthropometric risk factors are present in rural regions of Guatemala. Significant associations are found between gender, age ≥55 years, and increased WC but not with an increased BMI in this population.

Electronic Cigarette Toxicity

Electronic cigarettes (e-cigarettes) are often advertised as a healthier product when compared with traditional cigarettes. Currently, there are limited data to support this and only a threat of federal regulation from the US Food and Drug Administration. Calls to poison control centers about e-cigarette toxicity, especially in children, and case reports of toxic exposures have increased over the past 3 years. This research letter reports the frequency of hazardous exposures to e-cigarettes and characterizes the reported adverse health effects associated with e-cigarette toxicity.

Fixed drug eruption associated with aspirin

A previously healthy 27-year-old woman presented to the outpatient urgent care clinic complaining of dark spots that appeared suddenly on both her feet and face. She had been prescribed aspirin (650 mg orally every 6 hours as needed) the day prior to presentation as therapy for migraine-type headache. She also then recalled that these spots had appeared suddenly, in exactly the same areas approximately 1 year before the current episode, …

Venous Stent Migration into Right Ventricle

Venous stents (VS) are used to treat central and peripheral stenoses. Stent embolization into a cardiac chamber is a rare, yet serious complication. We present a case of a 61-year-old man with a recently stented arteriovenous graft venous stenosis who developed VS migration into the right ventricle, associated with S. aureus bacteremia.

Implantable cardiac defibrillator infections: the emerging importance of Mycobacterium fortuitum

Infection is a clinically relevant complication associated with intracardiac devices. Atypical mycobacteria, particularly Mycobacterium fortuitum, have been increasingly implicated in cardiovascular implantable electronic device (CIED) infections. We present a case of M. fortuitum CIED infection in a patient with ischaemic cardiomyopathy occurring approximately 3 weeks after insertion. The recognition and adequate treatment, including device removal, tissue sampling and the determination of antimicrobial sensitivities, are essential in the proper management of these patients.

Sodium-glucose Cotransporter 2 Inhibitor–induced Diabetic Ketoacidosis in a Type 2 Diabetic Patient

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel drug class for the treatment of type 2 diabetes mellitus (DMII), which work by decreasing renal glucose reabsorption. Almost 2 years after approval in the United States, the U.S. Food and Drug Administration issued a Drug Safety communication about the potential risk of developing diabetic ketoacidosis (DKA) while taking these SGLT2 inhibitors. We recently encountered a 36-year-old Hispanic man with 16-year history of DMII, hyperlipidemia and hypertension, who presented to the emergency department with a 2-week history of nausea, vomiting, fatigue and headache. His symptom onset coincided with changing his regular DMII medications (metformin, 1 g b.i.d.; glyburide, 5 mg q.d.) to canagliflozin (Invokana) 300 mg daily plus metformin 1 g b.i.d. for uncontrolled hemoglobin A1c (HgbA1c) levels (10.9%). Owing to the increasing vomiting, he stopped canagliflozin within 3 days but continued metformin. At his 3-week follow-up, canagliflozin was restarted at a decreased dose of 100 mg daily. Again, his symptoms returned so he was admitted to the emergency department. On admission, physical examination was remarkable for obesity (body mass index 1⁄4 36 kg/m), tachycardia (102 bpm), dry oral mucosa and acanthosis nigricans. Laboratory evaluation revealed glucose 219 mg/dL, bicarbonate 8 mmol/L, anion gap 38, high serum acetone (41.0 mmol/L), sodium 130 mmol/L, potassium 4.9 mmol/L, creatinine 0.5 mg/dL, blood urea nitrogen 19 mg/dL, lactic acid 1.1 mmol/L and white blood cell 10.4 k/mL. Arterial pH was 7.25 and PCO2 was 21 mm Hg. He was started on insulin drip and intravenous fluids. After treatment, the anion gap closed, his symptoms improved and he was started on insulin detemir 30 U daily. The patients blood glucose remained within a range of 167-248 mg/dL. Glutamic acid decarboxylaxe 65 autoantibody was negative. He was discharged on metformin 1 g b.i.d. and insulin detemir 30 U daily. At 4-month follow-up, he had not had any other ketoacidosis episodes, although he still presented high HgbA1c levels (11%). His insulin level was increased to 45 U daily and lifestyle changes were enforced.