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Butala A.,Woodhull Medical Center
BMJ case reports

We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient. Source

Kalani A.,Woodhull Medical Center
BMJ case reports

Congenital adrenal hyperplasia (CAH) is a well-characterised family of disorders of the adrenal cortices, resulting in varying degrees of cortisol, aldosterone and androgen deficiency or androgen excess, depending on the enzyme(s) affected and the degree of quantitative or functional enzyme deficit. Withania somnifera (WS), commonly known as Ashwagandha, is a medicinal plant that has been employed for centuries in ayurvedic medicine. Preclinical studies have shown that WS increases circulating cortisol levels and improves insulin sensitivity. We report the case of a 57-year-old woman with non-classical adrenal hyperplasia due to both 3-β-ol dehydrogenase deficiency and aldosterone synthase deficiency who was self-treated with WS for 6 months. After 6 months of treatment her serum 18-OH-hydroxycorticoserone, 17-OH-pregnenolone, corticosterone and 11-deoxycortisol decreased by 31%, 66%, 69% and 55%, respectively. The biochemical improvement was accompanied by a noticeable reduction in scalp hair loss. Source

Patel M.,SUNY Downstate Medical Center | Sinha A.A.,Roswell Park Cancer Institute | Gilbert E.,SUNY Downstate Medical Center | Gilbert E.,Woodhull Medical Center
Journal of Drugs in Dermatology

Background: Bullous pemphigoid (BP) is an acquired, autoimmune, sub-epidermal blistering disease. The incidence of both BP and internal malignancy increases with age, yet the relationship between BP and malignancy has been a matter of debate for many years. Numerous cases have been published that link BP with various internal malignancies. While some analyses of large sets of clinical data fail to show a statistically significant correlation between BP and internal malignancy, others imply that there is a measurable correlation. Observation: We report a case of a 71-year-old male with invasive squamous cell carcinoma of the left heel and renal cell carcinoma who presented with urticarial bullous pemphigoid. Conclusions: There are few case reports in the literature associating bullous pemphigoid and renal cell carcinoma or squamous cell carcinoma. To our knowledge, this is the first reported case of coincident renal cell carcinoma, squamous cell carcinoma and urticarial BP. This case further supports investigation for underlying malignancy in patients with BP, particularly in the elderly. Copyright © 2012 Journal of Drugs in Dermatology. Source

Joseph S.J.,St. Georges University | Delcastilo E.,St. Georges University | Osiro S.,St. Georges University | Osiro S.,Woodhull Medical Center | Loukas M.,St. Georges University
Medical Science Monitor

Background: A Centenarian is a person who attains and lives beyond the age of 100. Four percent of centenarians die from cancer. It is therefore important to understand which cancers affect them in order to devise better methods to prevent and treat them. The aim of this study was to investigate the top cancers that affect centenarians. Material/Method: We identified 1385 cases with the Surveillance Epidemiology and End Result (SEER) database. Our study included centenarians age 100-115 years diagnosed with the 5 most common cancers between 1973 and 2007 in the United States. Observed survival (OS) was calculated for each cancer type. The Kaplan-Meier (KM) method was used to calculate OS at 1-month intervals for the first 40 months after diagnosis using SEER*Stat version 7.04. A log rank test was performed on KM survival output and a Cox roportional hazard model was used to calculate hazard ratios. All statistical analyses were performed with 95% confidence intervals with significance determined at P<0.05. Cox proportional hazard analysis was done using GraphPad Prism version 5.04. Results: There were 879 (63.47%) females and 506 (36.53%) males. There were 1118 (80.72%) whites, 159 (11.48%) blacks, and 108 (7.80%) other. The top cancers were 405 (29.24%) breast, 267 (19.28%) colorectal, 254 (18.34%) prostate, 247 (17.83%) lung and bronchus, and 212 (15.31%) urinary and kidney cancer cases. Conclusions: As the prevalence of centenarians increases, it is becoming increasingly important to become aware of the cancers that affect them in order to better manage them. © Med Sci Monit, 2014. Source

Ghody P.,SUNY Downstate Medical Center | Shikha D.,SUNY Downstate Medical Center | Karam J.,Maimonides Medical Center | Bahtiyar G.,Woodhull Medical Center

The rates of long-term diabetes related complications have declined substantially over the past decade. On the contrary, the growth in the incidence of prediabetes is note-worthy - especially in the population 60 years and above. As a result, the focus is now shifting toward early identification and prevention of diabetes. Prediabetes is a high risk state in the continuum of glycemic progression and beta cell dysfunction toward the development of diabetes mellitus. Observational studies have shown association of prediabetes with increased incidence of vascular complications. Long-term prospective randomized clinical trials across the globe have demonstrated a reduction in progression of prediabetes when lifestyle modifications are adopted and these effects can last up to 20 years beyond the period of intervention. While there has been recent interest in using pharmacotherapy for diabetes prevention, they have not been shown to be superior to lifestyle changes. This review hopes to provide a concise summary for the interested reader. © 2015 Elsevier Ireland Ltd. Source

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