The American journal of the medical sciences
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Case Reports
A possible hypophosphatemia-induced, life-threatening encephalopathy in diabetic ketoacidosis: a case report.
Hypophosphatemia, a common metabolic disorder, is usually silent and diagnosed by blood tests. However, misdiagnosis may result in delayed phosphate repletion, responsible for significant morbidity and potential mortality. We report an exceptional case of hypophosphatemia-related, life-threatening encephalopathy. ⋯ Prompt phosphate repletion resulted in progressive and complete recovery. This observation allowed us to study the relations between the coma depth, the electroencephalographic findings, and the serum phosphate concentrations. Our data strongly suggest that phosphate depletion-induced encephalopathy probably originates from direct impairment of cerebral electrophysiological activity rather than from cardiac flow alteration.
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Stroke is the third leading cause of death in the United States. We investigated racial differences in death after hospital discharge for ischemic stroke in a large cohort of Veterans Health Affairs (VHA) stroke patients. We hypothesized that having access to VA care would ameliorate the excess stroke mortality rates in African-Americans (AA) reported in non-VA studies. ⋯ Despite having similar severity of illness and adjusting for other clinical differences, mortality rate was marginally lower in AA after being discharged from VA hospitals after ischemic strokes. This is contrary to prior reports from non-VA hospitals and suggests the possibility of access to care playing a role in stroke deaths.
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We report a case of thrombocytopenia caused by Kasabach-Merritt syndrome (KMS) in a 69-year-old man with a metastatic angiosarcoma of the scalp. A review of the literature revealed that only 4 cases of KMS associated with angiosarcoma have been previously reported. All these cases occurred with a solitary large lesion. This is the first case of thrombocytopenia caused by KMS associated with small metastatic lesions of angiosarcoma that developed after the primary lesion has been completely removed.
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Review
Vitamin D deficiency and secondary hyperparathyroidism among patients with chronic kidney disease.
Chronic kidney disease (CKD) is associated with morbid complications that lead to high mortality and costs. Vitamin D deficiency and secondary hyperparathyroidism (SHPT) are frequent complications of CKD. ⋯ In conclusion, current management of vitamin D deficiency and SHPT is suboptimal. Early diagnosis of vitamin D deficiency and SHPT are integral to optimal management of CKD, and additional research is needed in this area.
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More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients. ⋯ Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training.