Tipped Over the Edge: A Case of Diabetes Ketoacidosis Precipitated by High-Dose Steroids in the Setting of a Large Peritonsillar Abscess.

Peritonsillar abscess is an infection of tonsillar soft tissue which can spread into additional neck structures leading to symptoms of fever, sore throat, dysphagia, and airway compromise. We describe a case of diabetic ketoacidosis in a patient with a history of uncontrolled type II diabetes mellitus admitted for a peritonsillar abscess who received intravenous steroids for management of the abscess swelling. The patient was treated with an insulin drip, hydration, and electrolyte replacement with a resolution to his anion gap and metabolic acidosis. Diabetic ketoacidosis occurs during increased gluconeogenesis leading to ketosis and metabolic acidosis which can be a life-threatening condition if not quickly recognized and treated. This case highlights the importance of monitoring and treating elevated blood glucose in acutely ill patients receiving steroid therapy.

The current status of orthodontic education in U.S. pediatric dental residencies.

PURPOSE/OBJECTIVES: The purpose of this study was to survey the current status of orthodontic education at pediatric dental residencies in the United States. A similar survey was conducted >10 years ago. With changing healthcare politics, social demands, and technology, it is important to have current information about dental education. METHODS: A 23-item anonymous survey was sent to individual pediatric dental residency program directors via Qualtrics email software. The survey was sent a total of 4 times over an 8-week period. If the surveys were not completed in a predetermined amount of time, they were resent to those who had not yet completed them. RESULTS: There were 34 responders for a 24% response rate. Of the respondents, 73% reported teaching biomechanics of tooth movement, and 45% reported teaching 2 × 4 mechanics to "marginally acceptable" level. Early (91%) to late mixed dentition (77%) is the most commonly treated orthodontic case. While most programs do not require a minimum number of orthodontic cases for graduation (85%), residents' understanding of growth and development is mostly (71%) evaluated through the results of the American Board of Pediatric Dentistry Qualifying Examination. CONCLUSION: This study summarizes the current climate of the orthodontic education component in U.S. pediatric dental residencies.

Blepharoptosis and Cholesterol-Lowering Medications: A Retrospective Study.

PURPOSE: To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center series to evaluate this association. METHODS: A retrospective chart review of adult patients presenting with ptosis on concomitant anticholesterol medications. RESULTS: Two hundred ninety-three adult patients with ptosis taking anticholesterol therapy were identified from October 2011 to October 2016. Forty-seven patients (16.0%) reported muscle weakness. Laboratory markers including creatine kinase (CK) and myoglobin levels were obtained. Of the 47 patients, 13 patients (4.4%) were identified to have ptosis and laboratory confirmed anticholesterol therapy-induced myopathy. Two additional patients with statin-induced myositis and rhabdomyolysis were identified from the period 2008-2011. All patients had measurably elevated CK and/or myoglobin levels. All patients experienced improvement in ptosis or systemic symptoms after discontinuation or changing medications. Nine patients (60%) demonstrated statistically significant improvement in the ptosis. CONCLUSIONS: Many patients with involutional ptosis also have both cardiovascular disease and hyperlipidemia and thus take cholesterol-lowering medication. Our study demonstrates a World Health Organization-defined probable association between ptosis and anticholesterol-induced myopathy. The frequency of anticholesterol-induced myopathy in adult ptosis was 4.4%, which is substantially higher than previously predicted. Anticholesterol-induced myositis can cause a reversible ptosis, and thus, a thorough evaluation of adult patients presenting with involutional ptosis includes inquiry into the use of anticholesterol drugs and associated muscle weakness.Anticholesterol medication may induce or exacerbate myogenic ptosis in some individuals.

Ocular Injuries Associated With Air-Powered Salt Guns.

This report discusses the potential ocular injuries associated with an air-powered salt gun, a new product that may appeal to children. The authors hope to inform both providers and patients of the potential risks and treatment considerations if an injury of this type is sustained. [J Pediatr Ophthalmol Strabismus. 2019;56:e65-e67.].