The Effect of Elevated Triglycerides on the Onset and Progression of Coronary Artery Disease: A Retrospective Chart Review.

Background. The American College of Cardiology and American Heart Association did not indicate a correlation between treating hypertriglyceridemia and reducing cardiovascular events. Objective. This study investigated whether patients with hypertriglyceridemia were more prone to worse outcomes during cardiac catheterization. Methods. Data collected over a one-year period analyzed lipid panels obtained at the time of cardiac catheterization. Triglyceride levels were categorized into three groups: <150 mg/dL, 150 mg/dL-300 mg/dL, and >300 mg/dL. Controlled variables included age, gender, the presence of hypertension, diabetes, hyperlipidemia, and history of coronary artery disease. Results. Subjects with a triglyceride level <150 mg/dL have a 54% likelihood of being treated medically compared to 38% and 41% in the 150 mg/dL-300 mg/dL and >300 mg/dL groups, respectively (p < 0.01). Subjects with a triglyceride level >300 mg/dL have a 20% percent chance of being treated with a coronary artery bypass graft compared to 12% and 15% in the <150 mg/dL and 150 mg/dL-300 mg/dL groups, respectively (p < 0.01). Subjects with a triglyceride level between 150 and 300 mg/dL have a 44% percent of being treated with a percutaneous coronary intervention compared to 34% and 43% in the <150 mg/dL and >300 mg/dL groups, respectively (p < 0.01). Conclusion. Hypertriglyceridemia was associated with worse outcomes in percutaneous coronary intervention or surgery.

Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter.

In rare instances, patients may be diagnosed with two different primary malignancies. Though such synchronous malignancies have been documented in sporadic case reports, the overwhelming majority of malignancies involving multiple organs can be attributed to a primary source. Papillary thyroid carcinoma and lung adenocarcinoma are rarely diagnosed within the same year. Our case report presents a patient who was diagnosed with these two malignancies during her same hospital visit. Biopsies results proved that the two malignancies were in fact separate entities and not a consequence of metastasis from a primary source.

Rare Strain of Vibrio cholerae Septicemia in a Patient with Multiple Myeloma.

Introduction. Non-O1/non-O139 is a rare strain of Vibrio cholera that has been documented to cause significant morbidity and mortality in the immunosuppressed population. Case Presentation. A patient with multiple myeloma develops non-O1/non-O139 Vibrio cholera septicemia, leading to multiorgan failure and ultimately death. Discussion. An exceedingly rare strain of Vibrio cholera, non-O1/non-O139, may be an important factor of morbidity and mortality in certain immunosuppressed populations, such as patients with multiple myeloma and malignancies. Conclusion. Bacteremia involving generally noninvasive microbes, such as non-O1/non-O139 Vibrio cholerae, can have significant deleterious effects in the immunosuppressed patients as shown by this case report. Physicians need to be more diligent when treating these patients.

The incidence of vitamin D deficiency in the obese: a retrospective chart review.

OBJECTIVE: To determine whether the obese population is more likely to be vitamin D deficient compared to healthy and overweight individuals. PATIENTS AND METHODS: A retrospective chart review was performed for patients seen in two ambulatory clinics in South Florida over a 1-year period (n=402). Patients' vitamin D levels drawn during annual wellness visits were analyzed. Subjects were categorized based on body mass index (BMI) as normal (BMI <24.9), overweight (BMI 25.0-29.9), and obese (BMI >30.0). Their 25-OH vitamin D status was defined as normal (>30 ng/mL), insufficient (20.0-29.9 ng/mL), and deficient (<20 ng/mL). The study included both men and women of black, white, Hispanic, and Asian races. Other variables in the study included age, history of hypertension, and diabetes. Patients with conditions leading to vitamin D malabsorption (chronic pancreatitis, celiac disease, Crohn's disease, cystic fibrosis, ileocecal resection) were excluded. Patients with prior vitamin D supplementation were also excluded. RESULTS: The results of the study indicated a significant association of vitamin D deficiency and obesity (p<0.05). Patients who were obese had a relative risk of 3.36 (95% CI: 1.50-7.54) for vitamin D deficiency compared to subjects with normal BMI. The study also showed a significant association between vitamin D levels and obesity when controlling for age, race, and presence of hypertension (p <0.05), with Asians and blacks more likely to be vitamin D deficient. CONCLUSION: These results demonstrated that obesity was a risk factor for vitamin D deficiency in all races, especially the Asian and black populations. This suggests that physicians should screen for vitamin D deficiency in the obese populations, especially among Asian and black races.

Localized advanced hürthle cell carcinoma with symptomatic intrathoracic goiter.

INTRATHORACIC GOITERS ARE DIVIDED INTO TWO CATEGORIES: primary and secondary. Intrathoracic goiters (IG) can cause upper airway obstruction. The presence of obstructive symptoms secondary to increased thyroid growth and tracheal compression is major indication for surgery; however, goiters do not always require immediate surgical attention. In addition, although some diagnostic tests indicate upper airway obstruction, many patients remain asymptomatic. Surgeries to remove IG are performed routinely however, they are not without risk. In some cases, intrathoracic goiters present as thyroid cancers. Very rare cancers such as Hürthle cell carcinoma (HCC) can create a challenge for the surgeon when surgical intervention is vital.