Role of Prophylactic Steroids in Differentiation Syndrome.

Acute promyelocytic leukemia (APML) is defined as a balanced chromosomal translocation between chromosomes 15 and 17 t(15;17)(q24;q21), which results in the formation of promyelocytic leukemia-retinoic acid receptor-alpha (PML-RARA) fusion protein. A widespread recommendation for APML treatment is combined all-trans retinoic acid (ATRA)/arsenic trioxide (ATO) therapy. Differentiation syndrome (DS), or retinoic acid syndrome, is one of the well-known complications of APML treated with ATRA or ATO. The presenting symptoms of APML-induced DS are diverse, and rare symptoms are easily misdiagnosed. However, unexplained fever, dyspnea, weight gain > 5 kg, leukocytosis, acute renal failure, and a chest radiograph demonstrating pleural or pericardial effusion are the most common manifestations of DS. Early recognition and prompt initiation of corticosteroids are key factors in the management of DS. As soon as ATRA/ATO therapy is started, prophylactic treatment with steroids has been recommended to minimize the severity of DS. It is proposed that ATRA/ATO should be stopped or held once the signs and symptoms of DS develop. This case report describes a 45-year-old male who was diagnosed with APML after he developed episodes of hematuria and nose bleeding at home. The patient was also given an empiric steroid along with ATRA/ATO to lessen the intensity of DS. Our study suggests that early initiation of prophylactic steroid treatment can improve the prognosis and mortality of patients with APML-induced DS.

Acute Complications of COVID-19 With Lasting Damages: A Case of Severe Long-Term Sequelae in a Middle-Aged Female Post COVID-19.

Following coronavirus disease-2019 (COVID-19), many patients experience acute complications and long-term sequelae. Acute complications include respiratory failure, myocardial injury, and neurological complications. Respiratory and thromboembolic complications prove to be acute changes that cause detrimental long-term outcomes. A continued exploration of the COVID-19 hospital course will allow for effective management and treatment of the virus. We report the case of a 48-year-old Hispanic woman who experienced a pulmonary embolism, deep vein thrombosis in all four extremities, and a brain embolus following a COVID-19 infection in 2021. Despite hospital care and prompt treatment, she developed long-term sequelae, specifically post-intubation tracheal stenosis. The critical factor promoting this inflammatory state is the overproduction of cytokines in what is coined a "cytokine storm." The lasting complications have multiple facets that need to be explored beyond the virus itself. Treatment modalities have their own risks and side effects. Comparing effective and ineffective treatment outcomes for this patient may lead to improvements in COVID-19 management. For this reason, exploring the treatment and complications in the acute setting is necessary for the prevention of the long-term sequelae accompanying cases of COVID-19. While literature exists detailing the unique thrombotic and respiratory complications that can present as a result of COVID-19 coagulopathies, this field is continuously evolving and warrants further research.

A Case Report of Baclofen- and Clozapine-Induced Dyskinesia: A Movement Disorder.

Movement disorder is a broad term comprising multiple disorders which result in either an excess or a paucity of voluntary and involuntary movements. There are numerous pieces of literature on drug-induced dyskinesia, although the exact mechanism underlying this phenomenon is yet to be understood. Drug-induced movement disorder is a complex and often neglected clinical presentation. There are various interactions of drugs with the dopaminergic, GABAergic, and serotonergic pathways in the body that seem to be the foundation, leading to these movement disorders. Further research and clinical trials are required to understand this clinical entity. Here we present a case report of GABAergic baclofen and an anti-dopaminergic clozapine-induced atypical case of dyskinesia, a severe form of movement disorder in a 69-year-old-male with a past medical history of physiologic tremor and neuropathic pain.

Anti-hyperglycemic Medication Compliance: A Quality Assurance Project.

In order to determine the prevalence of adherence among diabetes patients treated at Queens Hospital Center's Diabetes Clinic and to determine barriers preventing adherence, 50 patients were asked a series of questions regarding their medication intake. The majority of patients reported that they understood the self-management steps that were necessary in order to control their diabetes. However, 30% of the interviewed patients with type 1 or type 2 diabetes reported that they missed a dose of their diabetes medication on at least one day in the last month. Forgetting and lifestyle inconveniences were the two most frequently reported reasons for non-adherence. Side effects and problems with the pharmacy or insurance were also significant reasons for non-adherence. Adherence can potentially be increased by combining new forms of treatment and increasing educational reinforcement.