Gene/Protein Disease Symptom Drug Enzyme Compound
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This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.
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PMID:Medication Management; Hypertensive Crisis During a Home Visit. 3201 42

Ketogenic diets have been proposed as a non-pharmacological strategy for the management of several chronic conditions. Their efficacy and safety have been evaluated in the field of neurology, oncology and endocrinology for disorders including cancer, dementia, drug-resistant epilepsy, migraines, obesity, polycystic ovary syndrome and type 2 diabetes mellitus. The nutritional requirements of these subjects are expected to differ significantly. Indeed, although all ketogenic diets restrict carbohydrates, each intervention is characterized by a specific daily calorie intake, macronutrient composition and duration. However, the adopted nomenclature was often unclear to the general reader; also, the same abbreviations for different protocols were used. This possibly resulted in mistakes in the interpretation of the available evidence and limited the impact of studies on the topic in the clinical practice. Adopting a clear and consistent vocabulary is key in any context. Here, we present a practical and clinically-based proposal for the classification and abbreviation of ketogenic diets.
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PMID:Confusion in the nomenclature of ketogenic diets blurs evidence. 3208 Jul 96

In this report, we present a case of acquired copper deficiency which initially presented as progressive pain and numbness in the patient's lower extremities. The acquired copper deficiency is attributed to a previous bariatric surgery exacerbated by zinc toxicity. A 42-year-old female with a past medical history of type 2 diabetes mellitus, anemia, hypertension, bipolar disorder, attention deficit disorder, pulmonary embolus, fibromyalgia, migraine headaches, and chronic pain as well as a remote past surgical history of gastric bypass procedure presented with progressive pain and numbness in her lower extremities. The patient reported chronic use of zinc supplements. Clinical evaluation revealed abnormal neurologic exam consistent with a myeloneuropathy and anemia. A cervical spine MRI showed increased signal intensity primarily affecting the posterior columns from C2-C6. Laboratory studies confirmed low copper, low ceruloplasmin, and elevated zinc levels. This case is an example of acquired copper deficiency due to previous bariatric surgery exacerbated by zinc ingestion. With an increased prevalence of bariatric surgery, it is important to monitor patients postoperatively for neurologic symptoms potentially due to copper deficiency.
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PMID:A Case of Copper Deficiency Myeloneuropathy Precipitated by Zinc Ingestion and Bariatric Surgery. 3244 6


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