General Medicine

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21760

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    CONGENITAL IDIOPATHIC HYPOGONADOTROPIC HYPOGONADISM: A CASE REPORT
    (2014-03) Sumko, Dan; Soutt, William; Wong, Long; Weis, Stephen
    Abstract: Congenital idiopathic hypogonadotropic hypogonadism (IHH) is caused by the lack of production or physiological response to gonadotropin releasing hormone (GnRH). A wide variety of genetic mutations have been implicated in the disorder demonstrating autosomal dominant, recessive, and X-linked inheritance patterns. Diagnosis of IHH is complicated by its similarity in presentation to a constitutional delay of puberty and often goes undiagnosed in patients under the age of 18. Once IHH is identified, the effects of the disturbed HPA axis must be addressed. In this report, we offer a brief overview of the diagnosis and management of IHH and present the case of a 27-year old male with undiagnosed IHH. We present the following case: A 27-year old male presented to a family medicine clinic with complaint of a changing skin lesion that was a melanoma in situ. As a result he had a full-skin exam and was found to have a microphallus, undescended testes, and minimal pubic hair distribution. He had a normal sense of smell. Laboratory evaluation showed total testosterone to be 26 ng/dL (250-1100 normal), LH 0.4 mIU/mL (1.5-9.3 normal), and FSH 1.6 mIU/mL (1.6-8.0 normal). Prolactin, PTH, and calcium were within normal limits, as well as his CBC and BMP. MRI of the brain showed no lesions of the hypothalamus or pituitary gland. An abdominal CT confirmed undescended testes. DEXA scan revealed osteopenia. He was diagnosed as IHH. The patient was provided with supplementary vitamin D, calcium, and referrals to endocrinology and urology for orchiopexy. Purpose: (a): Congenital idiopathic hypogonadotropic hypogonadism (IHH) is caused by the lack of production or physiological response to gonadotropin releasing hormone (GnRH). A wide variety of genetic mutations have been implicated in the disorder demonstrating autosomal dominant, recessive, and X-linked inheritance patterns. Diagnosis of IHH is complicated by its similarity in presentation to a constitutional delay of puberty and often goes undiagnosed in patients under the age of 18. Once IHH is identified, the effects of the disturbed HPA axis must be addressed. In this report, we offer a brief overview of the diagnosis and management of IHH and present the case of a 27-year old male with undiagnosed IHH. Methods (b): A 27-year old male presented to a family medicine clinic with complaint of a changing skin lesion that was a melanoma in situ. As a result the patient had a full-skin exam and was found to have a microphallus, undescended testes, and minimal pubic hair distribution. He had a normal sense of smell. Laboratory evaluation showed total testosterone to be 26 ng/dL (250-1100 normal), LH 0.4 mIU/mL (1.5-9.3 normal), and FSH 1.6 mIU/mL (1.6-8.0 normal). Prolactin, PTH, and calcium were within normal limits, as well as his CBC and BMP. MRI of the brain showed no lesions of the hypothalamus or pituitary gland. An abdominal CT confirmed undescended testes. DEXA scan revealed osteopenia. Results (c): The patients was diagnosed as IHH. The patient was provided with supplementary vitamin D, calcium, and referrals to endocrinology and urology for orchiopexy. Conclusions (d): The diagnosis of IHH in this patient was critical for his future health. Osteoporosis, increased risk of testicular cancer secondary to cryptorchidism, and infertility are just a few of the more serious sequelae associated with IHH. When diagnosed early, these comorbidities can be reduced or even eliminated. This case highlights the value of obtaining a detailed history and performing a thorough physical examination as this patient’s risk of cancer, fractures, and infertility could have been dramatically reduced with an earlier diagnosis.
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    META-ANALYSIS OF THE HEALTH EFFECTS FROM CARBON DISULFIDE EXPOSURE TO NATURAL GAS INDUSTRIAL WORKERS
    (2014-03) Al-Angari, Samiah S.; Rich, Alisa L.; Patel, Jay T.
    The textile industry historically has been associated with high levels of air pollution and adverse health effects for workers exposed to the pollution. With the migration of textile industry overseas, much of the pollution has been sent overseas as well. Carbon disulfide (CS2), a chemical commonly seen in the textile industry, has received little attention due to this migration. With the recent expansion of natural gas extraction in the U.S., CS2 has once again surfaced in air emissions produced from this industrial process. This study revealed that natural gas workers may suffer health effects similar to viscose rayon workers from exposure to CS2. Purpose (a): Health effects from occupational exposure to Carbon disulfide (CS2) have been primarily associated with viscose rayon plant workers. The objective of this study was to examine the potential for health impairment from CS2 exposure in natural gas workers. This study is unique in associating exposure to CS2 to natural gas workers and unrecognized adverse health impairments. Methods (b): A meta-analysis study was conducted and published literature on the health effects of CS2 were reviewed. Databases searched included MEDLINE, TOXLINE, and PubMed. Studies related to exposure to CS2 were limited and historically associated with the viscose rayon industry. Analysis of the published literature of CS2 exposure to workers in petrochemical refineries were identified but limited. Selection criteria were inclusive to all studies available despite study design. The inclusivity of all study designs was influenced by the lack of current literature of CS2 exposure to occupational workers in the U.S. Results (c): Results revealed exposure to CS2 was associated with multiple health effects in various body systems. The potential for significant health effects both on a short-term and long-term basis were identified in natural gas extraction and processing workers exposed to CS2. Conclusions (d): Natural gas occupational workers may be exposed to CS2 from extraction and processing leading to adverse health effects comparable to viscose rayon workers. This study is the first to associate CS2 to occupational workers involved in natural gas extraction or processing operations. This study illuminates the need for application of regular medical diagnostic tools to recognize CS2 levels in workers.
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    SUSTAINED CHANGES IN GLP-1 AND INSULIN 12 MONTHS AFTER LAPAROSCOPIC GASTRIC BANDING SURGERY
    (2014-03) Ake, Stephen; Franks, Susan; Smith, Adam B.
    Bariatric surgery has been effective in promoting sustained weight loss and improving diabetes control in many patients with morbid obesity. Increases in GLP-1 after bariatric surgery have been implicated in improved glucose homeostasis in studies examining Roux-en-Y gastric bypass. However similar studies in laparoscopic gastric banding surgery (LGBS) have been conflicting. The co-authors of the present study previously reported an increase in GLP-1 and a decrease in insulin 6 months after LGBS. The aim of this study was to further evaluate sustained changes in GLP-1 and insulin after LGBS. Purpose (a): The following hypotheses were examined: (1) Fasting and post-prandial (pp) GLP-1 will be increased 12 months after LGBS, and (2) Fasting and pp-insulin will be decreased after LGBS. Relationships between GLP-1 and weight loss were explored. Methods (b): Thirteen LGBS patients (9 women and 4 men) who underwent pre-surgical and 6-month post-surgical testing were retested at 12-months post-surgically. Average baseline BMI was 40.5 (32.4-48.4). Average age was 47.5 (24-66). Fasting and pp-blood samples were taken to evaluate GLP-1 and insulin. Data were analyzed using repeated measures ANOVA. Results (c): In comparison to baseline, fasting GLP-1 increased (F=6.46, p=0.006), fasting insulin decreased (F=6.11, p=0.022) and pp-insulin decreased (F=9.46, p=0.008). The ppGLP-1 increase approached significance (F=3.70, p=0.065), with a significant post-hoc pairwise finding at 12-months in comparison to baseline (p=0.004). Conclusions (d): Results suggest that LGBS improves GLP-1 and insulin as early as 6 months and that these improvements persist up to 1 year. Overall, these improvements appear independent of weight loss, although exploration of data suggests a possible connection with post-prandial GLP-1 at 12-months. These results provide further evidence of the efficacy of LGBS for the treatment of diabetes.
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    MEDICAL SCHOOL EMPLOYEE HEALTH COMPARED TO STATE AND NATIONAL AVERAGES
    (2014-03) Lovell, Andrew J.; Nejtek, Vicki A.; Talari, Deepika; Ake, Steven; Filipetto, Frank
    Purpose (a): The 2012 Center for Disease Control (CDC) survey found 65.1% of Texans and 63.9% of U.S. citizens’ body mass index (BMI) is >25 indicating that most Americans are overweight or obese.1 Health data for medical school employees in comparison to state and national averages is scarce. Here, we examined the health status and behaviors of medical school employees to determine the influence of the health promotion environment. We hypothesized that medical school employees are healthier than the state and national averages. Methods (b): A prospective study was conducted to examine medical school employee health status and behaviors. Vital signs, weight, fat percentage, random serum glucose, exercise, and sleep were primary outcomes measured. Subjects completing the study received $1 compensation. Frequencies and chi-square analyses were performed using SPSS (version 19). A 95% confidence interval and an alpha of 0.05 were used to determine significance. Results (c): Sixty-nine employees volunteered to participate. We found that BMI (25.8 + 5.5) was slightly higher than the recommended range (18.5-24.9). Almost 45% of participants were slightly overweight edging towards obesity (BMI >25). Mean systolic/diastolic blood pressure was 125/79 mmHg (normal=120/80). Mean body fat % for men (17.2) was within the recommended range (15-20%), but was slightly higher for women (31.8 vs. 24-30%). However, these values are substantially lower than the national average (28.1 = men, 39.8 = women). Significant race/ethnicity differences in BMI were evident. Conclusions (d): Based on the recommended values and the state and national averages, these data suggest that medical school employees seem to have healthier physiology than the general population. Although prevalence of overweight and obesity in our sample is better than the state and national averages, these values are still higher than the recommended range. Working in a medical school environment may offer some protective factors, but more work is needed to reduce body weight. These preliminary data interpretations are limited due to a small sample size.