{"title":"Resident Experiences with Journaling","authors":"T. Sunder, G. Diemer, V. Sunder","doi":"10.29046/TMF.020.1.016","DOIUrl":"https://doi.org/10.29046/TMF.020.1.016","url":null,"abstract":"","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121749448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac amyloidosis is an increasingly recognized entity that causes significant morbidity and mortality. Transthyretin amyloidosis (ATTR) is present in about 16% of patients with severe aortic stenosis and up to 17% of patients with heart failure with preserved ejection fraction 9,10 . Though the screening test of choice, echocardiography is not highly sensitive or specific, and it should not be relied upon to rule out cardiac amyloidosis, especially if clinical suspicion is high. We present a case of a 58-year-old woman with a history of bilateral carpal tunnel syndrome who presented with paresthesia and syncope. Extensive workup for neurologic, infectious, and malignant etiologies was negative. EKG was remarkable for low voltage. Transthoracic echocardiogram (TTE) was not suggestive of infiltrative disease. Subsequent cardiac MRI demonstrated diffuse biventricular late gadolinium enhancement and technetium 99M pyrophosphate scan revealed diffuse (3+) uptake, which was in stark contrast to the TTE. The diagnosis of ATTR amyloidosis allowed for prompt initiation of treatment in this patient. Syncope is an uncommon presentation of cardiac amyloidosis. Such significant cardiac burden of disease without appreciable changes on TTE or clinical heart failure, demonstrates the importance of clinical vigilance and thorough workup when suspicion for amyloidosis is high, particularly if characteristic signs and symptoms consistent with systemic disease are present, as timely treatment can significantly reduce the morbidity and mortality of this disease.
{"title":"Cardiac Amyloidosis: A Known Disease with an Unknown Presentation","authors":"Svenja Schneider, MD, Tudor Sturzoiu, MD, Tanuka Datta, MD, Yevgeniy Brailovsky, DO, FACC, Sung-Hae Cho, MD, FACC, Paulina Gorodin-Kiliddar, MD","doi":"10.29046/tmf.023.1.007","DOIUrl":"https://doi.org/10.29046/tmf.023.1.007","url":null,"abstract":"Cardiac amyloidosis is an increasingly recognized entity that causes significant morbidity and mortality. Transthyretin amyloidosis (ATTR) is present in about 16% of patients with severe aortic stenosis and up to 17% of patients with heart failure with preserved ejection fraction 9,10 . Though the screening test of choice, echocardiography is not highly sensitive or specific, and it should not be relied upon to rule out cardiac amyloidosis, especially if clinical suspicion is high. We present a case of a 58-year-old woman with a history of bilateral carpal tunnel syndrome who presented with paresthesia and syncope. Extensive workup for neurologic, infectious, and malignant etiologies was negative. EKG was remarkable for low voltage. Transthoracic echocardiogram (TTE) was not suggestive of infiltrative disease. Subsequent cardiac MRI demonstrated diffuse biventricular late gadolinium enhancement and technetium 99M pyrophosphate scan revealed diffuse (3+) uptake, which was in stark contrast to the TTE. The diagnosis of ATTR amyloidosis allowed for prompt initiation of treatment in this patient. Syncope is an uncommon presentation of cardiac amyloidosis. Such significant cardiac burden of disease without appreciable changes on TTE or clinical heart failure, demonstrates the importance of clinical vigilance and thorough workup when suspicion for amyloidosis is high, particularly if characteristic signs and symptoms consistent with systemic disease are present, as timely treatment can significantly reduce the morbidity and mortality of this disease.","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124780904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case of Patent Foramen Ovale as a Cause of Persistent Hypoxia","authors":"Jaya Janadhyala, MD, Jonathan Foster, MD","doi":"10.29046/tmf.023.1.008","DOIUrl":"https://doi.org/10.29046/tmf.023.1.008","url":null,"abstract":"","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121433947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Achenbach Syndrome: A Classic Presentation of a Not-So-Common Condition","authors":"Brandon Pecchia, MD, MS","doi":"10.29046/tmf.024.1.005","DOIUrl":"https://doi.org/10.29046/tmf.024.1.005","url":null,"abstract":"","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122656903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are being prescribed increasingly more often for type 2 diabetes mellitus as well as heart failure. They have not typically been associated with acute pancreatitis, but there has been a steady flow of case reports implicating them in acute pancreatitis over the years since they were initially approved. Here, we present the case of an 82-year-old woman with a past medical history of T2DM, COPD, hyperlipidemia, a remote stroke, peripheral arterial disease, and remote breast cancer now with recurrent localized breast cancer on treatment with ademaciclib and letrozole who presented to the emergency department with abdominal pain, weakness, decreased oral intake, and nausea and vomiting. These symptoms started two weeks after the initiation of the SGLT-2 inhibitor empagliflozin for her T2DM. Initial labs were notable for sodium of 129, glucose of 409, a normal anion gap, beta hydroxybutyrate of 4.6, serum creatinine of 0.92, calcium of 9.8, total bilirubin of 3.0 with direct bilirubin 2.6, alkaline phosphatase of 773, AST of 330, ALT of 446, lipase of 1,159, triglycerides of 237, and leukocyte count of 4.9. Following admission, CT and MRCP demonstrated pancreatitis with no intrahepatic or extrahepatic ductal dilation, gallstones choledocholithiasis, or other obvious etiology of her presentation. Her symptoms improved with supportive care following the discontinuation of her SGLT-2 inhibitor and she was discharged to inpatient rehab shortly after presentation. This case highlights the importance of keeping the uncommon diagnosis of SGLT-2 inhibitor associated pancreatitis in mind in patients who present with acute pancreatitis.
钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂越来越多地被用于治疗2型糖尿病和心力衰竭。它们通常与急性胰腺炎无关，但自从它们最初被批准以来，多年来一直有稳定的病例报告表明它们与急性胰腺炎有关。在此，我们报告一位82岁的女性，既往有T2DM、COPD、高脂血症、远端中风、外周动脉疾病和远端乳腺癌病史，目前在阿德马昔利布和来曲唑治疗下复发性局限性乳腺癌，她以腹痛、虚弱、口服摄入量减少、恶心和呕吐就诊于急诊科。这些症状是在她开始使用SGLT-2抑制剂恩格列净治疗T2DM两周后出现的。初步检测结果:钠129，葡萄糖409，阴离子间隙正常，-羟基丁酸4.6，血清肌酐0.92，钙9.8，总胆红素3.0，直接胆红素2.6，碱性磷酸酶773,AST 330, ALT 446，脂肪酶1159，甘油三酯237，白细胞计数4.9。入院后，CT和MRCP显示胰腺炎，无肝内或肝外导管扩张、胆结石、胆总管结石或其他明显病因。在停用SGLT-2抑制剂后，她的症状在支持性护理下得到改善，并在出现后不久出院至住院康复中心。本病例强调了在急性胰腺炎患者中保持SGLT-2抑制剂相关性胰腺炎罕见诊断的重要性。
{"title":"A Case of Acute Pancreatitis Associated with Empagliflozin","authors":"Tudor Sturzoiu, MD, Sameep Thapa, MD, E. Solomon, Suchit Bhutani, MD","doi":"10.29046/tmf.023.1.011","DOIUrl":"https://doi.org/10.29046/tmf.023.1.011","url":null,"abstract":"Sodium-glucose cotransporter 2 (SGLT2) inhibitors are being prescribed increasingly more often for type 2 diabetes mellitus as well as heart failure. They have not typically been associated with acute pancreatitis, but there has been a steady flow of case reports implicating them in acute pancreatitis over the years since they were initially approved. Here, we present the case of an 82-year-old woman with a past medical history of T2DM, COPD, hyperlipidemia, a remote stroke, peripheral arterial disease, and remote breast cancer now with recurrent localized breast cancer on treatment with ademaciclib and letrozole who presented to the emergency department with abdominal pain, weakness, decreased oral intake, and nausea and vomiting. These symptoms started two weeks after the initiation of the SGLT-2 inhibitor empagliflozin for her T2DM. Initial labs were notable for sodium of 129, glucose of 409, a normal anion gap, beta hydroxybutyrate of 4.6, serum creatinine of 0.92, calcium of 9.8, total bilirubin of 3.0 with direct bilirubin 2.6, alkaline phosphatase of 773, AST of 330, ALT of 446, lipase of 1,159, triglycerides of 237, and leukocyte count of 4.9. Following admission, CT and MRCP demonstrated pancreatitis with no intrahepatic or extrahepatic ductal dilation, gallstones choledocholithiasis, or other obvious etiology of her presentation. Her symptoms improved with supportive care following the discontinuation of her SGLT-2 inhibitor and she was discharged to inpatient rehab shortly after presentation. This case highlights the importance of keeping the uncommon diagnosis of SGLT-2 inhibitor associated pancreatitis in mind in patients who present with acute pancreatitis.","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123313496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Manual for Ultrasound Guided Intravenous Access: Allay your Fears, Alleviate with Humor, Approach with Confidence","authors":"Michael Dong, MD","doi":"10.29046/tmf.024.1.016","DOIUrl":"https://doi.org/10.29046/tmf.024.1.016","url":null,"abstract":"","PeriodicalId":246494,"journal":{"name":"The Medicine Forum","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130756117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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