The American journal of medicine
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Reports of nonrheumatic streptococcal pharyngitis associated myocarditis (SPAM) are rare, and its incidence, pathophysiology, and clinical features remain unclear. We evaluated the clinical course and outcome of patients diagnosed with nonrheumatic SPAM, with a particular focus on differentiating it from other etiologies of myocarditis. ⋯ Nonrheumatic SPAM may not be as infrequent as thought and should be considered in the differential diagnosis of acute ST-segment elevation myocardial infarction, especially in male patients with sore throat and fever.
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A 35-year-old male with a history of hypertension presented with a thunderclap headache. Laboratory tests revealed isolated mild thrombocytopenia and plain brain imaging was normal. Subsequently he developed chest pain and breathlessness, accompanied with an acute kidney injury, elevated troponins and worsening thrombocytopenia. The constellation of features prompted consideration of thrombotic thrombocytopenic purpura.
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Social determinants of health are key factors driving disease progression. In type 2 diabetes there is limited literature on how distal or intermediate factors (e.g., those at the neighborhood level) influence cause-specific mortality or liver disease outcomes. ⋯ Intermediate neighborhood-level socioeconomic status was associated with overall and cause-specific mortality in type 2 diabetes, with larger effects on liver-related mortality than other causes.