Extramedullary hematopoiesis (EMH) in individuals with thalassemia is often the result of undertreated severe anemia. Radiation or surgery is often the chosen approach to handle spinal cord compression due to these paraspinal EMH elements. Our patient is a 28-year-old male with E-beta-thalassemia who presented with both upper thoracic and lower extremity symptoms of spinal cord compression and was successfully managed with the combination of transfusion and hydroxyurea. Given the variation in symptoms as a result of the sporadic location as well as the extent of these EMH elements along the spinal canal, the hematological communities will continue to benefit from case reports that offer treatment therapy.
Pulmonary manifestations of systemic lupus erythematosus (SLE) include, but are not limited to, pneumonia, interstitial pneumonitis, atelectasis and pleural effusion. Cavitary lung lesions are rarely associated with SLE. We present herein the case of a female patient with SLE and lupus nephritis who presented to the hospital with respiratory failure, rash and arthralgias. She was found to have a cavitary lung lesion most concerning for infection. However, despite an extensive inpatient antibiotic course, her symptoms persisted. After a collaborative effort between the primary team, pulmonology, infectious disease and rheumatology, she was placed on systemic glucocorticoid therapy, which resolved not only her respiratory failure, but also her cavitary lung lesion on subsequent follow-up with imaging. The dilemma of management in such cases will be discussed in addition to a review of previously reported cases.
Coronary artery disease is the leading cause of death in both men and women, yet adequate control of risk factors can largely reduce the incidence and recurrence of cardiac events. In this review, we discuss various life style and pharmacological measures for both the primary and secondary prevention of coronary artery disease. With a clear understanding of management options, health care providers have an excellent opportunity to educate patients and ameliorate a significant burden of morbidity and mortality.
Diabetic retinopathy (DR) is a preventable complication of diabetes with early detection and intervention. Prior studies have shown patient engagement and empowerment improve patient knowledge and self-care resulting in better outcomes. Yet, screening and treatment of DR remain a major challenge especially in our underserved, indigent patient populations. Graphic education material is often used to improve detection of DR but its effectiveness is rarely assessed, especially in the underserved. To improve DR screening in our population, we developed a quality improvement project using in-clinic graphic material to empower patients to screen for DR, followed by post clinic surveys to evaluate the impacts on screening rates and patient engagement.
Posters in English and Spanish were placed in primary care clinics directly viewed by patients for 3 months. We surveyed 100 patients and 12 providers to evaluate the effectiveness of the intervention. We reviewed 84 and 200 charts to determine both pre- and post-intervention DR screening rates.
No difference was seen in the DR screening rate between the pre- and post-intervention periods (51.0% vs. 50.0%, p = 0.86). There were improvements in the referral rate and the retinal exam visit rate between pre- and post-intervention periods (76.2% vs. 82.2%, p = 0.142; 63.9% vs. 73.3%, p = 0.046, respectively). Among the 49 patients who saw educational posters, 69.4% reported the posters prompted them to discuss with the providers about retinal screening exams.
Our study demonstrated that posters can improve patients’ awareness of DR leading to positive engagement with their providers, and eventually improve DR screening efforts. However, multiple factors such as patient literacy, limited encounter time, and understanding may limit the effectiveness of education interventions particularly in our underserved patients. As DR particularly impacts this population, more innovative and direct interactions may need to be implemented to improve self knowledge and patient empowerment to improve DR screening.
Disclosure
A.J. Yang: None. V.T. La: None. C.U. Eke: None. A. Firek: None.
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