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Biomedical subjects

Ali A Rizvi

Publications and source records attributed to Ali A Rizvi.

15 recordsLinked to original sources
PubMed2007

Management of diabetes in older adults.

Enhanced life expectancy and the aging of society have conspired with rising rates of obesity and physical inactivity to cause an unprecedented increase in diabetes prevalence worldwide. The disease and its chronic complications have unique presentations and challenges in the elderly. Postprandial hyperglycemia may be the predominant manifestation, comorbid health conditions are often present, and the risk of cardiovascular disease is vastly increased. Periodic screening is essential for early diagnosis and proper treatment. The principles of multidisciplinary management emphasizing nutrition, exercise, education, psychosocial care, attention to concomitant metabolic risk factors, and prudent use of pharmacologic agents are the mainstay of therapy for older adults. Treatment should be tailored to the individual patient, and the assistance of family and caregivers should be combined with rational utilization of community resources. An evidence-based, comprehensive, and proactive approach is needed to reduce the burden of morbidity and mortality from diabetes in the elderly.

Aged↗
PubMed2006

Severe primary hypothyroidism manifesting with torsades de pointes.

Hypothyroidism can manifest with myriad cardiac abnormalities, often consisting of a combination of morphologic and functional changes. Low voltage, sinus bradycardia, and slowed conduction are usually found on electrocardiography. We describe a patient with severe hypothyroidism who presented with presyncope, prolongation of the QT interval, and polymorphic ventricular tachycardia (torsades de pointes). No other cause for the malignant ventricular ectopy was evident. With levothyroxine therapy, the QT interval normalized and the ventricular tachycardia was abolished. In addition to its commonly known cardiac effects, myxedema can predispose to the potentially life-threatening arrhythmia of torsades de pointes. Conversely, in patients presenting with QT interval prolongation and polymorphic ventricular tachycardia, hypothyroidism should be considered in the differential diagnosis.

Diagnosis, Differential↗
PubMed2006

Levofloxacin-induced hypoglycemia in a nondiabetic patient.

The fluoroquinolones can cause severe hypoglycemia in older individuals with diabetes who are taking oral hypoglycemic agents. We describe a patient without diabetes who had new-onset hypoglycemia when given oral levaquin for pneumonia that developed after cardiac bypass surgery. The condition manifested with profound neurologic disturbances and required intravenous dextrose and parenteral glucagon for treatment. No other cause could be identified, and the problem remitted a few days after administration of the antibiotic was stopped. Laboratory evaluation showed relatively inappropriate insulin elevation at the time of the hypoglycemic episodes, consistent with pancreatic beta-cell stimulation. The report highlights glucose-lowering as an adverse effect of the fluoroquinolone class of antibiotics in persons without diabetes or taking hypoglycemic medication. Although levaquin is useful as broad-spectrum therapy in a variety of situations, clinicians should be cognizant of the occurrence of potentially serious or even fatal hypoglycemia with its use.

Aged↗
PubMed2006

Assessment and monitoring of glycemic control in primary diabetes care: monitoring techniques, record keeping, meter downloads, tests of average glycemia, and point-of-care evaluation.

PURPOSE: To present a review of glucose monitoring methods useful in primary care. DATA SOURCES: Pertinent publications in the literature, printed materials and resources, and the clinical experience of the authors as a referral center for care of patients with diabetes. CONCLUSIONS: Regular monitoring of glucose control is an integral and important aspect of diabetes care. It allows the advanced practice nurse (APN) to assess whether diabetes goals are being met or not, involves patients in the care of their disease, and assists in making informed treatment decisions. IMPLICATIONS FOR PRACTICE: A working knowledge of glucose monitoring methods, monitors, testing devices, and laboratory tests is extremely beneficial for the APN in attaining standards of care for patients with diabetes.

Blood Glucose↗
PubMed2004

Type 2 diabetes: epidemiologic trends, evolving pathogenetic [corrected] concepts, and recent changes in therapeutic approach.

The prevalence of type 2 diabetes has assumed epidemic dimensions. Children are now vulnerable to a disease that was once the exclusive domain of adulthood. Increased body weight and sedentary behavior accelerate insulin resistance and beta-cell dysfunction, leading to the clinical manifestation of hyperglycemia. Other cardiovascular risk factors tend to cluster in this milieu, setting the stage for vastly increased macrovascular morbidity. Many more people have impaired glucose tolerance ('prediabetes'). They are not only at risk for frank diabetes but also for the recently recognized entity of 'metabolic syndrome,' which is further characterized by hypertension, dyslipidemia, and central adiposity. A multifactorial approach addressing these aspects in addition to intensive glycemic control is the most efficacious therapy, optimally achieved through a team effort comprising the clinician, diabetes nurse, dietitian, and other professionals. Early use of oral-agent combinations is gaining favor. Insulin is best utilized in a basal-bolus fashion to manage both fasting and postprandial glycemia, delivered with multiple-dose injections or continuously via the pump. In hospitalized patients, good diabetic control reduces mortality. Finally, recent trials show that optimal weight maintenance and regular exercise can prevent or delay type 2 diabetes. Such information can serve as the foundation for large-scale preventive endeavors at the community level.

Adolescent↗
PubMedDate not supplied

Some clues and pitfalls in the diagnosis of acromegaly.

OBJECTIVE: To describe a case of acromegaly in a young woman using oral contraceptives who had nonspecific symptoms and persistent hyperphosphatemia and to analyze the reasons for delay in diagnosis. METHODS: A 31-year-old woman underwent evaluation for failure of menstrual flow to resume after discontinued use of oral contraceptives. Clinical and laboratory findings are summarized, and atypical manifestations of acromegaly are discussed. RESULTS: The patient complained of weight gain, acne, and increased facial hair growth, and laboratory tests showed a low estradiol level and hyperinsulinemia. "Post-pill amenorrhea" and polycystic ovary syndrome were considered possible diagnoses. During subsequent endocrinology consultation, hyperphosphatemia was present on three occasions during a 7-month period. Hormonal studies for evaluation of pituitary function revealed increased insulin-like growth factor-I and growth hormone (GH) levels. Acromegaly was suspected, and the increased GH level failed to suppress after a glucose load. Magnetic resonance imaging revealed a pituitary macro-adenoma with suprasellar extension. Visual field testing showed bitemporal abnormalities. Transsphenoidal resection successfully removed the GH-producing tumor, and hormone replacement therapy was initiated postoperatively. CONCLUSION: The textbook presentation of GH excess is a late feature of acromegaly. The diagnosis in a young woman can be easily missed when clinicopathologic findings are not classic and the picture is further clouded by factors such as oral contraceptive use. Features may also resemble polycystic ovary syndrome, a more common condition in women of childbearing age. This case also illustrates that hyperphosphatemia, overlooked in this patient, can precede the full-blown clinical manifestations of acromegaly and serve as a subtle clue to the underlying disease. Awareness of these situations and screening for high GH levels in patients with unexplained, persistent hyperphosphatemia are advisable for making an early correct diagnosis and providing appropriate therapy.

Acromegaly↗
PubMedDate not supplied

Hypocalcemia and parathyroid function in metastatic prostate cancer.

OBJECTIVE: To report the occurrence of hypocalcemia in a patient with metastatic prostate cancer, discuss its pathogenesis, and review the related medical literature. METHODS: An 82-year-old man with a known history of prostate cancer was found to have a serum calcium level of 5.4 mg/dL during an admission to the hospital for small bowel obstruction. A thorough review of his medical history revealed a temporal relationship between the diagnosis of malignant disease and progressive hypocalcemia. A complete evaluation was performed, including laboratory and imaging studies, to ascertain the cause of the hypocalcemia. RESULTS: The patient had no history of hypocalcemia before the diagnosis of, and initiation of antiandrogen therapy for, advanced prostate cancer. Serum magnesium and phosphorus levels were within normal limits. The serum calcium level responded to therapy in the hospital but remained between 5.8 and 7.1 mg/dL. The parathyroid hormone level was normal, and the 25-hydroxyvitamin D value was low. A 24-hour urine collection showed substantially reduced calcium excretion, and a whole-body bone scan revealed widespread metastatic deposits. These findings were compatible with hypocalcemia related to prostate cancer and bone metastatic lesions. CONCLUSION: This case serves as a reminder that hypocalcemia can be a manifestation of prostate cancer metastatic to bone. In contrast to the occurrence of secondary hyperparathyroidism in this setting, however, this patient had normal levels of parathyroid hormone. Review of similar previous reports and the causes and implications of a possible functional hypoparathyroid state are discussed.

Aged, 80 and over↗
PubMedDate not supplied

Thiazolidinedione therapy in a patient with diabetes after cardiac transplantation.

OBJECTIVE: To describe the successful use of a thiazolidinedione agent for the treatment of diabetes diagnosed after heart transplantation. METHODS: We present a case report of a 51-year-old woman who underwent cardiac transplantation because of cardiomyopathy; diabetes developed 6 months later. Her clinical course and serial laboratory findings are documented as insulin therapy was initiated and subsequently transitioned to rosiglitazone during maintenance of the immunosuppressive regimen. RESULTS: After rosiglitazone therapy was instituted, the patient's insulin dose was gradually tapered and eventually stopped. Target glycemic control was maintained without apparent aggravation of cardiac function or volume overload. No deleterious effects on other organ systems or interactions with the antirejection medications were noted during close follow-up. CONCLUSION: Rosiglitazone may be safe and effective therapy for patients with posttransplantation diabetes. Rosiglitazone also helps to counteract the insulin-resistant state and reduces or eliminates the need for exogenous insulin. Further studies should attempt to confirm the usefulness of treatment with thiazolidinediones for patients with diabetes after organ transplantation.

Blood Glucose↗
PubMedDate not supplied

Primary ovarian lymphoma manifesting with severe hypercalcemia.

OBJECTIVE: To describe a case of primary ovarian lymphoma manifesting with severe hypercalcemia. METHODS: We report the occurrence of a substantially increased serum calcium level in a 74-year-old female patient who presented with progressive weakness, volume depletion, confusion, slurred speech, cardiac abnormalities, and renal insufficiency. The patient's clinical course is reviewed, and the results of laboratory and imaging studies leading to the underlying diagnosis are presented. RESULTS: Initial evaluation revealed hemodynamic instability, disorientation, cardiac rhythm abnormalities, high levels of blood urea nitrogen and creatinine, and a serum calcium level of 18 mg/dL. A cranial computed tomographic scan showed no evidence of pronounced atrophy or stroke. Aggressive rehydration was initiated, and a permanent pacemaker was inserted. A suppressed level of parathyroid hormone and a high serum 1,25-dihy-droxyvitamin D concentration were found, but no evidence of granulomatous disease, infection, or overt malignant lesion was detected. The patient showed clinical improvement and was dismissed from the hospital, but the hypercalcemic state recurred soon thereafter. A computed tomographic scan of the abdomen and pelvis revealed a pelvic mass, which was diagnosed as ovarian lymphoma after surgical removal. The serum calcium and 1,25-dihy-droxyvitamin D levels normalized postoperatively. CONCLUSIONS: Primary ovarian lymphoma can be a cause of, and can manifest solely as, a severe and symptomatic increase in the serum calcium level, which is mediated by an increased serum concentration of 1,25-dihy-droxyvitamin D. It should be considered in the differential diagnosis of unexplained nonparathyroid hypercalcemia.

Aged↗