Psychosis as Initial Presentation of Small Cell Lung Cancer: A Case Report.

Paraneoplastic neurological syndromes (PNS) are a group of symptoms and physical findings that can reflect various neurological conditions, which may uncommonly include acute psychosis. In this report, we present the case of a 62-year-old African American male with a medical history significant for sarcoidosis and adrenal insufficiency who presented with several months of altered mentation and aggressive behavior of unknown etiology. Extensive laboratory workup, including lumbar puncture and cerebrospinal fluid antibodies, did not reveal any significant findings. Imaging studies, including computed tomography of the chest, showed mediastinal adenopathy and densities suggestive of metastatic small cell carcinoma, which was later confirmed following bronchoscopy and lymph node biopsy. A PNS was suspected as the explanation for the patient's psychiatric symptoms. Treatment with steroids and intravenous immunoglobulins was started, but there was no improvement. Surgery and systemic therapy were not recommended, and the family elected to pursue a palliative care option for the remainder of the patient's treatment. Our goal in this report is to provide basic information on PNS and highlight the need for a multidisciplinary approach to the diagnosis and treatment of these rare, albeit interesting, presentations.

Stopping Empagliflozin Unmasks Heart Failure.

SGLT2 inhibitors have been shown to have a role in the management of heart failure in patients with type 2 diabetes mellitus, but there is a risk of exacerbation when discontinued.

Real-World Experience With Automated Insulin Pump Technology in Veterans With Type 1 Diabetes.

BACKGROUND: Advancements in diabetes technology now allow insulin pump and continuous glucose monitor (CGM) technology to be a part of usual US Department Veterans Affairs (VA) clinical care. The automated insulin pump (AIP) delivers insulin automatically based on CGM readings. In randomized clinical trials the closed-loop system has shown to improve glycemic control in children and younger adults with type 1 diabetes mellitus (T1DM) while preventing hypoglycemia. However, its safety and efficacy is less well known in older veterans with T1DM. In this VA pilot study, we aimed to assess AIP technology in the real world of an older population of veterans with T1DM followed in the outpatient setting. METHODS: Thirty-seven patients with T1DM new to AIP seen at the Malcom Randall VA Medical Center in Gainesville, Florida, were evaluated between March and December of 2018 on an Medtronic Minimed 670G Insulin Pump System. We collected demographic as well as clinical data before and after the initiation of AIP, including standard insulin pump/CGM information (sensor wear, time in target glucose range, time in automated mode, other). RESULTS: At the time of the initiation of AIP, the mean (SD) age of patients was 59.1 (14.4) years; 35 identified as male and 2 as female. The mean (SD) duration of T1DM was 25.3 (12.0) years. Patients transitioned from either insulin injections or other non-AIP pump to AIP safely-there was no increase in hypoglycemia, and the mean (SD) hemoglobin A1c decreased from 7.6% (0.8) to 7.3% (0.8) by the second follow-up visit. CONCLUSION: In this real-world study, AIP use was both safe and viable as a tool for T1DM management with older veterans. This technology further engaged veterans in monitoring their blood sugars and achieving more optimal glycemic control. Future long-term, larger studies are much needed in this setting.

Diagnosing Post-Polio Syndrome in the Elderly, a Case Report.

Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome. Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.