An Unusual Diagnosis Presenting as SOB and Pleural Effusions

​BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave way to more significant pedal edema at the end of the day and progressively worsening exertional dyspnea. He noted a low grade fever and loss of appetite. His initial vitals were a blood pressure of 185/96 mm Hg, a heart rate of 106 bpm, a respiratory rate of 20 bpm, a temperature of 100.1°F, and oxygen saturation of 97% on room air.The patient appeared well, but would not stop sipping water despite obvious myxedema. He also had a history of autoimmune and oncological conditions.The differential for this case included an infectious process such as viral or bacterial infiltrate. Lung mass or atypical presentation of myeloma with the patient's history of MGUS was also on the differential, but cardiorenal disease, nephrotic disease, and congestive heart failure were higher on the list. Other etiologies were considered, including thyroid disease, syndrome of i...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Publication date: Available online 23 April 2019Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Dae-Hee Lee, Darryl D. D’Lima, Sang Hak LeeAbstractPurposeSome reports have noted favorable long-term clinical results with milder postoperative arthritic changes after total meniscectomy in symptomatic patients with torn discoid lateral meniscus (DLM). This meta-analysis was conducted to compare the clinical and radiographic results between partial and total meniscectomy in patients with symptomatic DLM.MethodsStudies were included in the meta-analysis if (1) they analysed patients who underwent ar...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
Conclusion: Tacrolimus may be associated with optic neuropathy and PRES at the initial presentation to an ophthalmologist.Case Rep Ophthalmol 2019;10:140 –144
Source: Case Reports in Ophthalmology - Category: Opthalmology Source Type: research
This study aimed to evaluate the therapeutic effect of folic acid (FA) on diabetic retinopathy (DR) in a genetic mouse model of obese type 2 diabetes mellitus (T2D). C57BL/KsJ-db/db(db/db) T2D mice were divided into control, FA, metformin (MET), and FA plus MET groups (n = 10/group). Serum levels of glucose, glycated hemoglobin, and insulin were determined weekly. The retinal thickness was measured using optical coherence tomography (OCT) at 4 weeks after treatments. The retinal expression and serum levels of vascular formation, inflammation, and oxidative stress-associated molecules were examined. Our results demonstrated...
Source: Ophthalmic Research - Category: Opthalmology Source Type: research
Conclusions: Eyes from diabetic patients in the initial stages of DR with different Early Treatment Diabetic Retinopathy Study gradings show similar prevalence of SCME and CIME, independent of the severity of the retinopathy. Retinal edema is located mainly in the INL and appears to be mostly extracellular except in the earliest stages of diabetic retinal disease where intracellular edema predominates.Ophthalmic Res
Source: Ophthalmic Research - Category: Opthalmology Source Type: research
This study aimed to investigate the effect of stevioside on fatty liver. Rats with hyperlipidemic fatty liver were treated with 75–150 mg/kg stevioside for 6 weeks. After oral administration of stevioside, the levels of serum and hepatic lipids and degree of hepatic steatosis were decreased. Stevioside treatment increased the expressions of hepatic peroxisome proliferator-activated receptor (PPAR)α and carnitine palmitoyltransferase-1A proteins and decreased the expressions of hepatic sterol regulatory element-binding protein-1c, fatty acid synthase and diacylglycerol acyltransferase proteins. Following tre...
Source: Journal of Functional Foods - Category: Nutrition Source Type: research
Publication date: June 2019Source: Journal of Functional Foods, Volume 57Author(s): Kamesh Venkatakrishnan, Hui-Fang Chiu, Chin-Kun WangAbstractDiabetes mellitus (DM) and its related complications are the serious public health concern globally. This is the first review highlight on major functional foods and herbs with anti-diabetic activity particularly focus on type 2 diabetes mellitus (T2DM) with special reference to clinical trials and their proposed anti-diabetic mechanisms. This contribution summarizes the current prevalence of DM, etiology and pathophysiology, complications related to DM, current conventional treatm...
Source: Journal of Functional Foods - Category: Nutrition Source Type: research
In “Is Nutrient Content and Other Label Information for Prescription Prenatal Supplements Different from Nonprescription Products?” from the September 2017 issue of the Journal (117(9):1429-1436), an error appears in Table 1, which affects the text in the results and conclusions sections on the pr oportion of products that exceed the UL levels for folate. The Tolerable Upper Intake Levels (ULs) for folate established by the Food and Nutrition Board (FNB) of the National Academies of Sciences, Engineering, and Medicine, applies to the synthetic form of folate obtained from supplements, fortifi ed foods, or ...
Source: Journal of the American Dietetic Association - Category: Nutrition Tags: From the Academy Source Type: research
Assessing nutritional intake in all-you-care-to-eat dining facilities poses unique challenges. New methods that streamline accurate data collection would facilitate better nutrition intervention research in this dining hall environment, which is common on university campuses.
Source: Journal of the American Dietetic Association - Category: Nutrition Authors: Tags: Research Source Type: research
Background: The circadian timing system or circadian clock plays a crucial role in many biological processes, such as the sleep-wake cycle, hormone secretion, cardiovascular health, glucose homeostasis, and body temperature regulation. Energy balance is also one of the most important cornerstones of metabolic processes, whereas energy imbalance is associated with many diseases (i.e., obesity, diabetes, cardiovascular disease). Circadian clock is the main regulator of metabolism, and this analysis provides an overview of the bidirectional effect of circadian rhythm on metabolic processes and energy balance.Summary: The circ...
Source: Annals of Nutrition and Metabolism - Category: Nutrition Source Type: research
This study briefly reviews the physiological mechanisms of exercise therapy in diabetes and the potential role of these cytokines in exercise.Key Messages: More high-quality, targeted, randomized controlled studies are needed urgently, from mechanism study to treatment direction, to provide a more theoretical basis for exercise therapy and to explore new therapeutic targets for diabetes.Ann Nutr Metab 2019;74:313 –321
Source: Annals of Nutrition and Metabolism - Category: Nutrition Source Type: research
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