scholarly journals A Rare Manifestation of Tuberculosis Presenting in the United States

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Osman Bhatty ◽  
David Waters ◽  
Nicholas Wilka ◽  
Shradha Samuel ◽  
John Horne ◽  
...  
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
The United States ◽  
Care Physician ◽  
Western World ◽  
Gram Stain ◽  
Breast Lump ◽  
Rare Presentation ◽  
High Clinical Suspicion ◽  
Rare Manifestation ◽  
Initial Biopsy

A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world.

scholarly journals Tuberculous Gastric Abscess in a Patient with AIDS: A Rare Presentation

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Ekta Nayyar ◽  
Julian A. Torres ◽  
Carlos D. Malvestutto
Keyword(s):  
Opportunistic Infections ◽  
Epigastric Pain ◽  
Extrapulmonary Tuberculosis ◽  
Immunocompromised Host ◽  
Rare Presentation ◽  
Accurate Identification ◽  
Gastric Tuberculosis ◽  
High Clinical Suspicion ◽  
Clinical Syndromes ◽  
Diagnostic Modalities

Tuberculosis is a healthcare concern that affects millions of individuals around the globe. Coinfection with HIV has changed both the clinical presentation and the outcome of the disease dramatically in the last few decades. Extrapulmonary tuberculosis is seen more frequently in the immunocompromised host. An unusual case of gastric tuberculosis in an AIDS patient is reported here. A 49-year-old female with AIDS was admitted for fever and epigastric pain. A gastric submucosal abscess was observed on imaging and confirmed by biopsy showing numerous neutrophils and acid-fast bacilli. Aspirate grewMycobacterium tuberculosis.This report highlights a very unusual presentation of tuberculosis in an immunodeficient patient. High clinical suspicion for opportunistic infections in unusual locations should be maintained in these patients presenting with clinical syndromes that do not respond to standard treatments. New diagnostic modalities facilitate accurate identification of these infections.

scholarly journals When systemic lupus erythematosus affects vision: a rare presentation of this condition

2020 ◽  
Vol 13 (1) ◽  
pp. e229382
Author(s):  
Tiago Gama Ramires ◽  
Luísa Vieira ◽  
Nuno Riso ◽  
Maria Francisca Moraes-Fontes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Blurred Vision ◽  
Rare Presentation ◽  
Complement Components ◽  
Oral Ulcers ◽  
Dsdna Antibody ◽  
Rare Manifestation ◽  
Retinal Vascular Tortuosity

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

scholarly journals Metastatic Prostate Cancer Involving the Sphenoid Sinus and Mandible

2021 ◽  
pp. 014556132110060
Author(s):  
Fadlullah Ba’th ◽  
Tanisha Hutchinson ◽  
Annie Meares ◽  
David Hamlar
Keyword(s):  
Prostate Cancer ◽  
Sphenoid Sinus ◽  
Metastatic Prostate Cancer ◽  
The United States ◽  
Endoscopic Examination ◽  
Atypical Presentation ◽  
Rare Presentation ◽  
The Third ◽  
Pathological Evaluation ◽  
Low Threshold

Prostate cancer is the third most leading cause of cancer in men in the United States. Although expected metastatic spread to bone, liver, and lymph nodes are often monitored, there are other rare presentations that can occur. This case report demonstrates a rare presentation of prostate cancer spreading to the paranasal sinuses and orbit. Not only did this case have an atypical presentation mimicking infection, the diagnosis was also only achieved through pathological evaluation after an endoscopic examination and biopsy. This case demonstrates the importance of a low threshold for endoscopic examinations in uncertain sinonasal presentations, and consistent biopsies when performing endoscopic examinations.

scholarly journals Cutaneous Metastasis of Prostate Adenocarcinoma: A Rare Presentation of a Common Disease

2021 ◽  
Vol 9 ◽  
pp. 232470962199076
Author(s):  
Alexander Dills ◽  
Okechukwu Obi ◽  
Kevin Bustos ◽  
Jesse Jiang ◽  
Shweta Gupta
Keyword(s):  
Prostate Cancer ◽  
Serine Proteases ◽  
Cancer Genetics ◽  
Performance Status ◽  
Distant Metastases ◽  
The United States ◽  
Cutaneous Metastasis ◽  
Common Disease ◽  
Cutaneous Metastases ◽  
Rare Presentation

Prostate cancer is the most common cancer affecting men in the United States and the second greatest cause of cancer-related death. Metastases usually occur to bone followed by distant lymph nodes and then viscera. Cutaneous metastases are extremely rare. Their presence indicates advanced disease and a poor prognosis. As they are highly variable in appearance and may mimic a more benign process, biopsy is essential for identification. Serine proteases, particularly human tissue kallikreins, may play an important role in promoting metastasis and facilitate infiltration of the skin. Individual cancer genetics may predispose to more aggressive cancer and thus earlier and more distant metastases. In this article, we report our case of a 67-year-old man with a 4-year history of castrate-resistant prostate cancer with cutaneous metastases confirmed by histology. Despite multiple lines of systemic therapy, the patient suffered progressive disease with worsening performance status and was enrolled in hospice.

scholarly journals 1655. Extrapulmonary Tuberculosis in a Large Healthcare System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S816-S816
Author(s):  
Travis Denmeade ◽  
William Smith ◽  
Banks Kooken ◽  
Michael Leonard
Keyword(s):  
Health System ◽  
Healthcare System ◽  
Extrapulmonary Tuberculosis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Hiv Positive ◽  
Hiv Status ◽  
Southeastern Us ◽  
Race Ethnicity

Abstract Background The US has seen a rise in the proportion of patients with extrapulmonary tuberculosis (TB) even though the yearly incidence of new TB cases has been in decline. The purpose of this study was to analyze incidence of extrapulmonary TB at Atrium Health, a large non-profit health system in the Southeastern US. Methods Retrospective chart review of 94 adult patients with culture confirmed extrapulmonary TB between 2008-2019. Individuals younger than 18 years were excluded from analysis. The primary objective was to examine incidence of extrapulmonary TB and compare it to that reported in the literature. Secondary objectives included determination of sites of extrapulmonary disease and associated patient characteristics including HIV status, race, ethnicity, and birthplace. Results 237 patients were identified as having confirmed TB infection from 2008-2019 in a retrospective analysis within the Atrium Health System. 94 (40%) were found to have extrapulmonary disease; 42 (45%) with concomitant pulmonary disease. The patients were 55% male, 40% African American, 21% Hispanic or Latino, and 51% US-born. Median age was 44 years (range 20-62). The most common sites of extrapulmonary TB were lymphatic (35%), pleural (24%), GI/Peritoneal (12%), CNS (10%), and Bone/Joint (10%). Lymphatic involvement was 40% cervical, 19% intrathoracic, and 16% axillary. 66% of skeletal disease was vertebral. Other sites included GU, pericardial, skin, and disseminated disease (5%). 37% were HIV positive, 18% with unknown HIV status as they were never tested. Information regarding patient’s race, ethnicity, and birthplace were unknown for 2 patients. The percentage of extrapulmonary cases were 29% in 2008, 39% in 2012, 38% in 2016, and 49% in 2019. Conclusion Lymphatic and pleural involvement were the most common extrapulmonary sites. Of those tested, 37% were HIV positive but there was a significant portion never tested showing a need for increased testing. The proportion of extrapulmonary TB cases since 2008 is higher at 40% compared to the 31% reported in the United States. There has been a rise in the proportion of extrapulmonary TB within our healthcare system and deserves further analysis. Disclosures All Authors: No reported disclosures

Considerations Regarding Anthropology in High School Curricula

1961 ◽  
Vol 20 (3) ◽  
pp. 134-140 ◽  
Author(s):  
Anthony Leeds
Keyword(s):  
High School ◽  
Rice Paddy ◽  
The United States ◽  
Cultural Relativism ◽  
School Level ◽  
Western World ◽  
Total System ◽  
High School Level ◽  
Or Economics ◽  
School Curricula

Few courses in anthropology have been taught as such at the high school level in the United States. Nevertheless, both in high schools and in elementary schools, and more particularly in the private schools, information which the anthropologists consider their own special interest has been used. Thus, children may be taught information about the Eskimo, apparently the favorite culture to represent the non-Western world and almost undoubtedly the only primitive one existing in the curriculum-makers' Baedeker, although an occasional bow in made to the American plains or Southwest. Now and then, studies of the major Asian countries are made whose focus is cultural rather than properly geographical. Other cultures, ranging up to the most complex, ordinarily appear to be brought into a curriculum more as functions of the description of the locations inhabited by humans than as descriptions, informed by some conception as to the nature of culture, of the specific cultures themselves. In short, one may safely assert, I believe, that the students get some sense of the variations exhibited by societies but mostly as curiosa and oddities of peculiar peoples. They do not get a sense of the cultural necessities of variation and differences as these derive from the technological articulations with environment. Rather, variation and differences are presented as if they were more or less accidentally associated with particular kinds of geographic features. Children appear rarely to be taught that there is such a class of events as technologies which can systematically be studied like geography or economics. Rather, they become familiar only with technical activities which they see as scattered hither and yon rather planlessly on the earth's far-away surfaces, activities such as camel-herding here, rice-paddy planting there. Certainly they get no sense of the effects of technology as a formal determinant of social structure and as conditioners of ideologies; far less are they presented, or do they achieve, a notion of culture as a total system. Much less are they led to see culture as a system which operates by its own laws, which has its own distinguishing characteristics and process, and whose variants cannot be reduced to any known ultimate value hierarchy. Thus, by learning mere esoterica, they are prevented from learning the fundamental first step required of all anthropologists, the scientific and ethical principle of cultural relativism. Consequently, too, they are prevented from learning the kind of perspective on world, culture, and self which anthropology can afford.

Isolated multidrug-resistant tubercular tenosynovitis of the flexor tendon of the little finger

2021 ◽  
Vol 14 (2) ◽  
pp. e238339
Author(s):  
Sunny Chaudhary ◽  
Subhajit Maji ◽  
Varun Garg ◽  
Vivek Singh
Keyword(s):  
Flexor Tendon ◽  
Extrapulmonary Tuberculosis ◽  
Functional Limitation ◽  
Clinical Signs ◽  
Multidrug Resistant ◽  
Interesting Case ◽  
Antitubercular Therapy ◽  
Histopathological Diagnosis ◽  
Rare Presentation ◽  
Little Finger

Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.

Populating Israel's Mountains while Preserving Their Environmental Quality

1981 ◽  
Vol 8 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Arnon Soffer
Keyword(s):  
Land Use ◽  
The United States ◽  
Swiss Alps ◽  
Western World ◽  
Rural Settlements ◽  
Agricultural Terraces ◽  
Unusual Phenomenon ◽  
And Migration ◽  
State Of Israel ◽  
Mountain Population

At the beginning of the twentieth century, the Galilee Mountains were still practically a ‘closed system’, as a result of which the balance of land-use was more or less preserved. Rural settlements had then hardly developed, and stagnation of the few remaining mountain towns was observed. In general, the roads were unpaved routes, the economy served for subsistence only (based mainly on agricultural terraces), while most of the area was of forest or rocky ground serving as pasture.During the British Mandatory period, the Galilee Mountains area opened up slowly, and this process has increased ever since the establishment of the State of Israel. The Mountains are facing a tremendous increase in population as a result of natural local increase (mostly Arabs) and migration (mostly Jews). This excessive mountain population in Israel is an unusual phenomenon in comparison with other mountain regions in the western world, which have generally decreased in population though there, too, the equilibrium of land-use has been shaken—for instance in the Swiss Alps (Bugmann, 1980; Gallusser, 1980; Messerli et al., 1980), and in the Rocky Mountains of the United States (Kelly, 1980).

Abstract P636: Social Determinants of Stroke Hospitalization and Mortality in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Randhir Sagar Yadav ◽  
Durgesh Chaudhary ◽  
Shima Shahjouei ◽  
Jiang Li ◽  
Vida Abedi ◽  
...  
Keyword(s):  
United States ◽  
Income Inequality ◽  
Social Determinants ◽  
Hemorrhagic Stroke ◽  
The United States ◽  
Care Physician ◽  
County Level ◽  
Medicare Beneficiaries ◽  
Level Data ◽  
Control And Prevention

Introduction: Stroke hospitalization and mortality are influenced by various social determinants. This ecological study aimed to determine the associations between social determinants and stroke hospitalization and outcome at county-level in the United States. Methods: County-level data were recorded from the Centers for Disease Control and Prevention as of January 7, 2020. We considered four outcomes: all-age (1) Ischemic and (2) Hemorrhagic stroke Death rates per 100,000 individuals (ID and HD respectively), and (3) Ischemic and (4) Hemorrhagic stroke Hospitalization rate per 1,000 Medicare beneficiaries (IH and HH respectively). Results: Data of 3,225 counties showed IH (12.5 ± 3.4) and ID (22.2 ± 5.1) were more frequent than HH (2.0 ± 0.4) and HD (9.8 ± 2.1). Income inequality as expressed by Gini Index was found to be 44.6% ± 3.6% and unemployment rate was 4.3% ± 1.5%. Only 29.8% of the counties had at least one hospital with neurological services. The uninsured rate was 11.0% ± 4.7% and people living within half a mile of a park was only 18.7% ± 17.6%. Age-adjusted obesity rate was 32.0% ± 4.5%. In regression models, age-adjusted obesity (OR for IH: 1.11; HH: 1.04) and number of hospitals with neurological services (IH: 1.40; HH: 1.50) showed an association with IH and HH. Age-adjusted obesity (ID: 1.16; HD: 1.11), unemployment (ID: 1.21; HD: 1.18) and income inequality (ID: 1.09; HD: 1.11) showed an association with ID and HD. Park access showed inverse associations with all four outcomes. Additionally, population per primary-care physician was associated with HH while number of pharmacy and uninsured rate were associated with ID. All associations and OR had p ≤0.04. Conclusion: Unemployment and income inequality are significantly associated with increased stroke mortality rates.

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