Diplopia after Sleeve Gastrectomy: The Canary in the Coal Mine.

Wernicke's encephalopathy (WE) is a neurologic emergency requiring timely intravenous thiamine supplementation to prevent permanent neurologic deficits. Historically, the WE diagnosis was limited to individuals with alcohol use disorder. However, it is now widely recognized to occur in patients who are chronically malnourished, post-bariatric surgery, pregnant with hyperemesis gravidarum, and with severe anorexia nervosa. Here we present a young woman who developed WE after undergoing a recent sleeve gastrectomy followed by protracted emesis for several days. This case underscores the importance of performing a thorough neurological review of systems and physical exam in high-risk patients and having a low clinical threshold to initiate appropriate thiamine treatment.

Does Parental Report of Having a Medical Home Attenuate the Negative Association Between Unmet Basic Needs and Health for Low-Income Children?

Background. It is unknown whether the medical home reduces the impact of adverse social determinants on low-income child health. Objective. To examine whether the medical home attenuates the association between unmet basic needs and health for low-income children. Design/Methods. Secondary data analysis of the 2011-12 NSCH restricted to <200% FPL children (n = 26 974). Multivariable logistic regression modeled child health with unmet basic needs to examine the effect modification of the medical home. Results. Low-income children with unmet needs had lower odds of "excellent/very good" health compared to children without unmet needs, regardless of the medical home [aOR = 0.78 (0.61-0.99) vs aOR = 0.77 (0.63-0.94), P = .01), respectively]. The medical home did not modify the negative association between unmet basic needs and "excellent/very good" child health (P = .97). Conclusion. Having a medical home per parental report did not attenuate the negative relationship between unmet basic needs and lowincome child health.