ABSTRACT
Hypertriglyceridemia causing unexplained hypobicarbotinemia and elevated anion gap is rare. We report the case of a 33-year-old woman who presented with an unexplained high anion gap after a subacute gastrointestinal illness. An arterial blood gas showed a normal bicarbonate level, and a lipid panel resulted in a triglyceride level too high to read, establishing the diagnosis. Treatment included using triglyceride-lowering agents with normalization in the patient's serum bicarbonate levels.
Subject(s)
Acid-Base Equilibrium , Acidosis , Female , Humans , Adult , Bicarbonates , Acidosis/diagnosis , Acidosis/etiology , Blood Gas AnalysisABSTRACT
We present the case of a 61-year-old male with hyperlipidemia and lumbar radiculopathy admitted to our hospital with rhabdomyolysis attributed to the recent initiation of statin therapy. Despite aggressive fluid resuscitation and an initial declination in his creatine phosphokinase (CPK) levels, he had persistent myalgias with progressive weakness. Rheumatologic and neurologic evaluation for other causes of myopathy were negative. Muscle biopsy obtained showed signs of necrosis and muscle regeneration. Given his recent statin use, persistent CPK elevation, proximal muscle weakness, and muscle biopsy findings, he was diagnosed as having statin-induced necrotizing autoimmune myopathy. He improved with the initiation of immunosuppressive therapy. Statin-induced necrotizing autoimmune myopathy is an underdiagnosed cause of myalgias, proximal muscle weakness, and significant CPK elevation that fails to respond to statin discontinuation and fluid resuscitation. Given the prevalence of statin use, internists need to have a high index of suspicion for this diagnosis in patients presenting with CPK elevations and muscle weakness who take statin therapy.
Subject(s)
Autoimmune Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Muscular Diseases , Autoimmune Diseases/pathology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Male , Middle Aged , Muscular Diseases/chemically induced , Muscular Diseases/diagnosis , Muscular Diseases/pathology , Myalgia/chemically induced , Physical ExaminationABSTRACT
OBJECTIVES: Based on the conceptual overlap between shift-&-persist (S&P) and culturally based strategies (critical civic engagement [CCE] and spiritually based coping), this study tests whether associations between these three previously disparate strategies are attributable to the existence of a higher-order coping construct: culturally informed S&P. METHODS: Among 364 diverse minoritized youth (Mage = 18.79, 85.2% female), we tested for the existence of this higher-order factor through confirmatory factor analysis. RESULTS: We found theoretical and empirical support for the existence of a higher-order factor structure and for our higher-order factor-culturally informed S&P. Culturally informed S&P promotes fewer depressive symptoms as a main effect in addition to completely protecting against the negative impact of discrimination on depressive symptoms when culturally informed S&P is high. CONCLUSIONS: The current study illustrates relations between three previously distinct coping strategies through their association with culturally informed S&P. Results highlight culturally informed S&P's promotive and protective effects in the face of ethnic-racial discrimination. Implications for subsequent study of culturally based coping are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Subject(s)
Depression , Racism , Adaptation, Psychological , Adolescent , Ethnicity , Female , Humans , Male , Social IdentificationABSTRACT
OBJECTIVE: We evaluated the safety of baricitinib 4 mg at 24 weeks for the treatment of moderate to severe rheumatoid arthritis (RA). METHODS: Multiple databases were searched from inception up to November 26, 2019 for randomized controlled trials comparing baricitinib 4 mg with placebo for the treatment of moderate to severe RA. The safety outcomes of interest were the incidence of serious adverse events, adverse events leading to study discontinuation, all infections, and serious infections. Adjusted risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for safety outcomes. The Cochrane tool was used to assess the risk of bias. RESULTS: This analysis included four randomized controlled trials with 3106 patients. For serious adverse events, the pooled RR (95% CI) was 1.09 (0.76-1.57). For adverse events leading to study discontinuation, the pooled RR (95% CI) was 1.41 (0.94-2.11). For all reported infections, the pooled RR (95% CI) was 1.24 (1.10-1.40), For serious infections, pooled RR (95% CI) was 0.97 (0.51-2.57). CONCLUSIONS: Patients with RA taking 4 mg baricitinib daily did have an increased risk of infections; however, the incidence of serious adverse events, adverse events leading to study discontinuation, or serious infections were not significantly different in patients treated with baricitinib 4 mg compared with placebo.