RESUMO
Euthyroid sick syndrome (ESS), also referred to as nonthyroidal illness syndrome, is an intriguing condition characterized by dysregulation of thyroid hormones despite normal thyroid gland function. It is diagnosed by low serum triiodothyronine levels, and, in some cases, other thyroid hormones such as thyroxine and thyroid-stimulating hormone may be affected. This condition arises via various physiologic mechanisms and is associated with intensive care unit (ICU) admissions, caloric deprivation, and severe illness. Myxedema coma (MC) is a rare medical emergency with a high mortality rate. It is caused by severe hypothyroidism, resulting in multiorgan failure with features including adrenal insufficiency, thermal dysregulation, and altered mentation. Generally, it is observed in untreated and poorly managed cases of hypothyroidism. However, stress from infections, surgical procedures, and medical comorbidities may precipitate this condition. It is particularly uncommon to see MC arise in the setting of ESS, especially in a patient with no history of thyroid disease, which makes this diagnosis easy to miss. In our case, a 36-year-old female presented with septic shock and was admitted to the ICU, where she subsequently developed ESS and features of MC. This case report aims to explore the risk factors, features, and diagnostic and therapeutic management of these conditions, as well as the diagnostic challenges that arise when these diseases present simultaneously.
RESUMO
Background: Consistent follow up after a bariatric surgery is considered vital to adequate and sustained weight reduction. This study examined the strength to which compliance with postsurgical appointments predicted an increase in total body weight loss percent (TBWL%) and change in body mass index (BMI) in a cohort of Illinois based surgical center patients. Methods: Participants (n = 78) were patients with obesity who underwent bariatric surgery between 2019 and 2021. Patient preoperative weight and BMI, and postoperative weight and BMI at 3-month intervals for one year, and the number of visits were collected from chart review to calculate TBWL%, and change in BMI. Relationship between these factors and postoperative visit compliance were evaluated using linear regression to assess if it was a significant predictor of success. Results: Follow up visit compliance had a weak positive association with increased TBWL% (Model R2 = 0.134, B = 0.011, p = 0.004) and a minimally stronger association with increased change in BMI (Model R2 = 0.229, B = 0.015, p = 0.0001). Conclusions: Adherence with follow up visits was weakly related to improved weight reduction outcomes after bariatric surgery. Future investigations should consider how follow up visits can better influence a patient's success in sustaining achieved weight reduction.
RESUMO
Emphysematous cholecystitis is a rare infection of the gallbladder that stems from acute cholecystitis. It can rapidly progress and perforate the gallbladder, which would require urgent surgical intervention. A perforated gallbladder can be diagnosed using an abdominal computed tomography by confirming the presence of air in the gallbladder lumen with adjacent extraluminal air. The causes of ruptured emphysematous cholecystitis include, but are not limited to, diabetes, atherosclerotic changes in blood vessels, and infection with Clostridium perfringens, Escherichia coli, and Klebsiella spp., and is usually present in diabetic men. We report on a 57-year-old female who developed gall bladder perforation with an overflow of gallstones into the peritoneum without a history of diabetes or atherosclerotic disease. Due to the vast availability of computerized tomography and early surgical intervention, the rate of mortality due to perforated emphysematous cholecystitis has decreased over the last few decades.