Renal tubular acidosis (RTA) is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I) is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI) represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI.
Radioiodine ablation does not cause vitamin B12 deficiency. However, a prospective study with a larger number of patients is required to confirm this finding.
INTRODUCTION: Gastrointestinal (GI) bleeding is one of the major medical problems causing about 300000 hospitalizations in the United States. We report the trend of the number of patients who were admitted & readmitted for GI bleeding in a tertiary care setting of Northern Pennsylvania. METHODS: Patients admitted with Gastrointestinal bleeding were extracted using ICD 10 codes K92.0, K92.1 and K92.2. Essential baseline characteristics including age, race, Primary Diagnosis, Readmission Diagnosis, Patients on bleeding medications, atrial fibrillation, Deep Vein Thrombosis, Pulmonary embolism, Metallic Heart Valve, History of CVA, 30-day mortality, causes of readmissions were identified by reviewing the electronic medical record of individual patients. Statistical analysis was performed using SPSS version 25. RESULTS: Total of 1296 patients was admitted in the last decade from 2009-2018 with the diagnosis of Gastrointestinal bleeding. Mean age of patients was 70.31 ± 15.38(Mean ± SD), the majority were Males (50.2%) and Caucasians (97.1%). Patients had following associated co-morbidities such as Deep venous thrombosis (9.0%), Pulmonary Embolism (5.8%), Atrial Fibrillation (33.4%), Metallic Heart Valve(5.8%) and History of Stroke/TIA (16.4%). Patients' mean hemoglobin at the time of admission was 10.1 ± 1.72(Mean ± SD) mg/dl. Median Length of stay was 4 days (IQ Range 2-6), 30 days Readmission rate was 19.4% and overall 30-day mortality was 6%. Among readmitted patients, 38.1% of patients were readmitted due to GI causes and 61.9% were readmitted due to Non-GI causes. The rate of readmission was observed to be increasing from 2009-2018 but was not statistically significant from (13.3% vs. 17.9% linear by linear P-value 0.717). CONCLUSION: This study showed that the number of admissions with a diagnosis of Gastrointestinal bleeding in the tertiary care setting of Northern Pennsylvania increased from 2009 to 2018 but the rate of readmission was not significantly affected.
INTRODUCTION: Non alcoholic Fatty liver disease (NAFLD) is one of the leading cause of chronic liver disease in United States. Combined with diabetes and metabolic syndrome, NAFLD is expected to be the most common cause of liver transplantation. We sought to determine the trend of NAFLD induced cirrhosis in National Population. We also studied the risk of decompensation and in hospital mortality in patients with NAFLD cirrhosis. METHODS: We obtained data from Nationwide Inpatient sample database using International classification of Diseases, the 9th revision, clinical modification codes to identify patients who had diagnosis of Cirrhosis and NAFLD from 2006-2014. We also obtained data on decompensation and patient's mortality in patients who had cirrhosis with history of NAFLD. Decompensated cirrhosis was defined as patients with cirrhosis and having one or more of these conditions: hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, ascites or variceal bleeding. Data was extrapolated using SPSS statistics software. RESULTS: Total of 4,226,236 patients had diagnosis of cirrhosis, 114,972 had NAFLD diagnosis. Trend of NAFLD is significantly increasing from 2007 (1.2%) to 2014 (3%). 2,313,524 (54.7%) of patients had decompensated cirrhosis. NAFLD was present in 3.2% (74,557) of patients in decompensated cirrhosis as compared to 2.1% (40,415) of patients who had compensated cirrhosis (P < 0.001). In hospital mortality of patients in decompensated cirrhosis with history of NAFLD was 4.3% and without history of NAFLD was 7.9% (P < 0.001). On Univariate analysis, patients with NAFLD were at low risk of in hospital death as compared to patients without NAFLD OR 0.53 (CI: 0.513–0.550). CONCLUSION: There has been significant increasing trend of NAFLD induced cirrhosis in last decade. NAFLD is associated with increased risk of cirrhosis decompensation as compared to other causes of cirrhosis. Interestingly, NAFLD cirrhotic patients have lower in hospital mortality as compared to patients with other causes of cirrhosis.
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