Stella Pak

Tacrolimus-associated diabetic ketoacidosis: a case report and literature review

Post-transplant diabetes mellitus is a well-established adverse effect of calcineurin inhibitors, such as tacrolimus and cyclosporine. Failure to identify and manage this side effect in a timely manner could lead to life-threatening complications like diabetic ketoacidosis (DKA). To the best of our knowledge, this is the seventh published case of an uncommon but severe, and potentially fatal, adverse effect from tacrolimus after renal transplantation. The purpose of this case report is to add to the scant body of literature on tacrolimus-induced diabetes following renal transplantation.

Pasteurella multocida pneumonia in an immunocompetent patient: Case report and systematic review of literature

Pasteurella multocida infection is most commonly associated with the immunocompromised, mostly in the form of soft-tissue infection, although other sites of infection are still possible and have been reported in the immunocompetent. We report a case of an immunocompetent male with a history of exposure to carrier organisms without portal of entry who developed P. multocida pneumonia with bacteremia. We undertook a focused review of literature of previously reported cases of P. multocida pneumonia in patients with chronic obstructive pulmonary disease. This literature review supports the use of penicillins as the first line of treatment over macrolides. Considering the high mortality rates with P. multocida bacteremia, it is important for clinicians to maintain a high level of suspicion for this organism in any patient with a history of carrier species exposure.

Ventilator-dependent pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease

Nocardiosis is a rare infectious disease entity that mostly affects the lungs, brain, or skin of immunocompromised individuals. Recent reports of pulmonary nocardiosis (PN) in patients with chronic obstructive pulmonary disease (COPD) as the only risk factor suggest a possible association between nocardiosis and COPD. Herein, we present a case of ventilator-dependent PN in a patient with a moderate degree of COPD. A high level of suspicion for PN should be maintained when encountered with COPD patients complaining of symptoms of pneumonia and excessive thirst.

Recurrent Cellulitis in a Patient with Papillomatosis Cutis Lymphostatica

Author(s): Pak, Stella; Markovic, John-Phillip; Yatsynovich, Yan; Tope, Ethan; Valencia, Damian

Correlation between the severity of chronic inflammatory respiratory disorders and the frequency of venous thromboembolism: meta-analysis

The present study aims to integrate the growing body of evidence on the possible association between the severity of chronic inflammatory respiratory disorders (CIRDs) and the frequency of venous thromboembolism (VTE). Eight studies were analyzed to assess the correlation between the severity of CIRDs and the incidence of VTE. Our results suggest that there is no significant increased risk of VTE in patients with severe CIRD compared to mild or moderate CIRD, OR=0.92 (95% CI 0.59 – 1.43; I = 74%). Further studies are indicated to explore this possible association. Gaining a better understanding of the VTE risk for patients with CIRDs will enable clinicians to provide better individualized risk management and preventive care.

Transformation of hashimoto thyroiditis to Graves’ disease

Hashimoto’s thyroiditis and Graves’ disease are thyroid-specific autoimmune disorders with distinct pathological mechanism. Clinical presentation and histopathological features also vary greatly in these disorders. Sequential conversation from Hashimoto’s thyroiditis (HT) to Graves’ disease (GD) has been rarely reported throughout the world. Herein, we report a woman with history of HT, who then developed GD requiring total thyroidectomy. By reporting this case, we hope to raise awareness about this phenomenon among clinicians and illustrate the potential mechanisms behind such change. Improving recognition and identification of this potential conversation between HT and GD would allow clinicians to expeditiously implement appropriate treatment, increasing the quality of care. Correspondence to: Stella Pak, MD, Department of Medicine, Kettering Medical Center, Kettering, 3535 Southern Blvd, Kettering, OH 45429, USA, Tel. (937) 395-8997; Fax: (937) 395-8399; E-mail: Stella.Pak@ketteringhealth.org

Comparison of transcatheter aortic valve replacement risk score against currently accepted surgical risk models as predictors of 30-day mortality in transcatheter aortic valve replacement

OBJECTIVES Aim of the study was to assess the predictive capability of Transcatheter Aortic Valve Replacement Risk Score (TAVR-RS) in comparison with Society of Thoracic Surgeon-Predicted Risk of Mortality (STS PROM) and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) on 30-day mortality following TAVR. BACKGROUND With exponentially increasing use of TAVR, a risk stratification model to accurately predict mortality risks in patients undergoing TAVR is urgently warranted. METHODS Retrospective analysis of 182 TAVRs between 2014 and 2017, 179 by transfemoral, 3 by subclavian approach. Clinical, laboratory and echocardiography variables were collected. The performance of risk models was evaluated using equivalence tests, receiver operating characteristic (ROC) and area under the ROC curve (AUC). Outcome was 30-day mortality prediction. RESULTS Observed 30-day mortality was 5.49%. TAVR-RS underestimated (4.0%) while surgical models (STS PROM and EuroSCORE II) overestimated mortality, 7.24% and 8.14%, respectively. The TAVR-RS was found to have statistically significant correlation with both individual and group mortalities. AUC was highest for TAVR-RS 0.66 (95%CI: 0.31-0.96), but no difference in 30-day mortality prediction was found in comparison with STS PROM (P = 0.06) or EuroSCORE II (P = 0.2161). CONCLUSIONS The TAVR-RS was a better predictor of both group and individual mortality at 30 days. The outcomes were comparable on pairwise testing against surgical risk models, although TAVR-RS was on verge of significance when compared to STS PROM. This study supports the current dogma that a risk model specifically tailored for TAVR population should be implemented to obtain a better patient selection.

Cerebral amyloidosis angiopathy related inflammation as a cause of erratic driving in elderly

Received: October 20, 2017; Accepted: October 31, 2017; Published: November 03, 2017 Figure 1. Computerized tomography of brain demonstrating a shift of midline structures by 6.4 mm to the left, leading to mass effect upon the right lateral ventricles. Cerebral amyloid angiopathy is a well-known clinicopathology prevalent in the elderly population. This disease is characterized by β-amyloid deposits in the vessels supplying blood to the cerebral cortex and the leptomeninges [1]. A rare complication of this disease is cerebral amyloid angiopathy-related inflammation (CAA-ri), which is a reversible encephalopathy caused by inflammation and edema [2]. Common clinical presentations of this complication are headaches, focal neurological deficit, and seizure [1]. Herein, we present a case of a patient who presented with an abrupt onset of driving impairment due to CAA-ri.

Long Esophageal Stricture in a Brittle Diabetic

Aim: We report a case of atypical esophageal stricture in a young diabetic woman. Background: Diabetes mellitus and gastroesophageal reflux disease (GERD) are two common disorders in modern society. Case report: A young diabetic woman developed a 6-cm-long esophageal stricture. This stricture was refractory to multiple esophageal dilation procedures. She underwent subtotal esophagectomy and had excellent treatment outcome. Conclusion: Gastroesophageal reflux disease can cause severe long esophageal stricture in a brittle diabetic. Clinical significance: Improving the awareness of their association between diabetes and GERD would greatly benefit the day-to-day practice of medicine. How to cite this article: Pak SC, Darr U, Alastal Y, Yoon Y. Long Esophageal Stricture in a Brittle Diabetic. Euroasian J Hepato-Gastroenterol 2017;7(2):191-192.

Chronic Salmonella Osteomyelitis in a Diabetic Patient

Salmonella osteomyelitis in patients without hemoglobulinopathy is quite uncommon. Osteal involvement is seen in only 0.8% of all Salmonella infection cases. We describe the case of a 67-year-old diabetic woman who developed Salmonella osteomyelitis and subsequently underwent a surgical excision of a tibial lesion followed by two months of intravenous (IV) antibiotic therapy. The patient responded very well to the treatment. This case is exemplary for the successful treatment of chronic Salmonella osteomyelitis in a diabetic patient with a vascular complication.