Diabetes mellitus can lead to a diverse array of systemic complications. Poorly managed hyperglycemia can result in serious neurological consequences ranging from peripheral neuropathy to seizures and coma. A rare neurologic disorder seen in acute decompensated type 2 diabetes mellitus (T2DM) is hemichorea-hemiballismus (HCHB). HCHB is a movement disorder primarily associated with cerebrovascular accidents of infarct or hemorrhagic origin. It is a condition that can occur in a diabetic patient, especially when no other signs or symptoms of hyperglycemia are present. It is urgent to recognize HCHB movement disorder quickly as it may be the only presenting sign of hyperglycemia and can alert medical personnel to a possible hyperosmolar hyperglycemic state (HHS). We report an unusual case of HCHB in a patient with HHS, whose only presenting sign was unilateral hyperkinesis, which completely resolved after adequate blood glucose control. Prompt treatment and management of hyperglycemia yields an excellent prognosis in HCHB.
We conducted near-surface geophysical surveys in and around the Majes I agricultural development (60 km west of Arequipa, Peru), where the nexus of geology and agriculture has increased landslide activity along the Majes–Siguas River Valley. Through DC resistivity, transient electromagnetics (TEM), and seismic surveys, we refined the understanding of local geology, characterized the agricultural impact on the local water table, and updated landslide modeling to help inform discussions on landslide mitigation strategies at Majes I and landslide prevention at the planned Majes II site. At the Majes I development, we identified an increase in water table and water saturation due to irrigation. At the planned Majes II site, which shares similar geology to Majes I, we interpret the regional water table that has yet to be affected by significant human development. We integrated these results into updated landslide modeling. Our modeling for Majes I suggests stable conditions prior to irrigation; as the water table rose from irrigation, landsliding began and evolved as a retrogressive failure that is now focused along the headscarp near critical infrastructure including the Carretera Panamericana (Pan-American Highway). Majes II is currently stable and irrigation management, such as drip versus flood techniques, must be supported. Soil ameliorants such as polymers and/or biochar should be encouraged to hold water near the roots to reduce the risk of landslide initiation. Combined this work shows the value of integrated hydrological and geophysical research for landslide management and optimized irrigation.
Neutropenia is a serious complication found in immunocompromised patients, particularly those with cancer and human immunodeficiency virus (HIV). The etiology of neutropenia is multifactorial and can be caused by the direct effects of HIV infection, cytotoxic antineoplastic therapy, and malignancy. The main complication of neutropenia is a bloodstream infection caused by gram-positive bacteria (GPB) and gram-negative bacteria (GNB). GPB, specifically S. epidermidis, tend to affect cancer patients more often than GNB. However, GNB such as Pseudomonas aeruginosa have been associated with more serious infections. We report a case of neutropenic fever caused by a GNB, Pantoea agglomerans, in a 47-year-old Afro-Caribbean man with HIV and metastatic salivary adenocarcinoma. Pantoea agglomerans is a non-spore forming rod typically isolated from plants, fruits, and fecal matter, and is rarely pathogenic in humans. In the current literature, cases of P. agglomerans have been documented primarily in the pediatric population secondary to penetrating wound trauma. To our knowledge, this is the first case of spontaneous neutropenic fever secondary to P. agglomerans bacteremia in an Afro-Caribbean adult male.
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