Journal of the Louisiana State Medical Society
tific testing, and potential harmful side effects are not well understood. Here we present two cases of a new syndrome, MICI, encountered in patients immediately after intoxication with the synthetic cannabinoid “Mojo.” Case: Two unacquainted patients, ages 19 (patient A) and 23 (patient B), were brought to their local emergency departments after family witnessed repeated episodes of loss of consciousness followed by thrashing of the arms/ legs. Both patients were disoriented, uncooperative to questioning/commands, and extremely agitated. Bothwere intubated, started on propofol infusions, and transferred to Ochsner Medical Center for presumed status epilepticus. Past medical history was limited to a one-year history of questionable seizures (patient A) and poorly controlled status asthmaticus (patient B). The patients’ mothers each reported their sons’ heavy use of “Mojo” to avoid positive drug tests. Each had negative toxicology panels. CT, MRI, and EEGwere negative for any acute process/seizures. Both developed acute hypoxic respiratory distress, tachycardia, persistent leukocytosis despite broad antibiotic coverage, rhabdomyolysis, and acute renal failure requiring emergent dialysis. After 21 days, patient A was discharged in stable condition. He adamantly refused all substance abuse other than smoking “Mojo” the night prior to presentation. Patient B became progressively hypoxic, hypercapnic, acidotic, with leukocytosis greater than 70,000, and creatine kinase greater than 40,000, despite prompt discontinuation of propofol. He was treated with lung protective ventilation, nitric oxide, broad spectrum antibiotics, but developed hypotension despite three vasopressors. On ICU day 11, he died sur- rounded by family. Discussion: MICI is a clinical syndrome that mimics status epilepticus. In this case report, after being admitted, both individuals developed similar patterns of multi-organ failure that included acute respiratory failure, severe rhab- domyolysis, and acute kidney failure requiring dialysis. Although much remains unknown, we believe MICI is an important clinical syndrome that should be recognized by healthcare providers. Demographic Impact onAsthma andHealth-RelatedQual- ity of Life - A Pilot Study C. Caruthers, H. Shah, A. Agrawal, C. Desai, T. Solanky, S. Kamboj, and P. Kumar LSU-Health Sciences Center, New Orleans Background: Asthma is a chronic inflammatory disorder with significant morbidity and mortality. It is a medically managed disease affected by proper medication reconciliation. Presumably, the higher the compliance, the better control of asthma and improved health-related quality of life (HRQOL). We analyzed the impact of demographic factors on a patient’s ability to access medications and dis- ease comprehension. Methods: IRB approval was obtained. Adults with asthma were studied at allergy-immunology clinics. In- formed consent was obtained from all research subjects.
Asthma control test (ACT) and HRQOL, via SF-36 standard quality-of-life scores, were assessed and demographics col- lected. Compliance was determined by ascertaining proper medication usage. Results: 49 bronchial asthmatic patients were stud- ied – 14 in charity clinics and 35 in private clinics. Insured patients had mean SF-36 of 42.40 compared to uninsured patients who had mean of 35.94 (p=0.04). Analysis of the different income levels with ANOVAmodel showed statis- tical significance (p=0.01) for SF-36. Upon further analysis between income levels of less than $25,000 and more than $50,000, the mean was 38.66 and 47.58 (p=0.01). Analysis of clinic location, age, and education level were not statistically significant, although there was a trend in SF-36 and ACT scores. In private clinics, the mean SF-36 and ACT scores were 42.27 and 16.69, while in charity clinics, 39.02 and 14.64. Older age groups had a lower SF-36 when comparing younger age group. For patients aged 18-25, mean SF-36 was 45.33, 25-50 years oldwas 41.73, and older than 50 was 40.69. Higher education level demonstrated improved SF-36 and ACT scores. Patients who did not complete high school had mean SF-36 and ACT scores of 37.90 and 14.14, high school graduates were 39.94 and 15.43, and college graduates were 44.31 and 17.63. Conclusion: Patients with health insurance and higher income have an improved quality of life and better asthma control. Higher educationwas associatedwith better quality of life and asthma control, although the differences were not statistically significant. Vagus Nerve Palsy Caused By Herpes Zoster: A Case Report Introduction: Vagal Nerve Palsy due to herpes zoster represents a unique presentation of a common clinical en- tity. We report a case of vagus nerve palsy in a patient with hoarseness and dysphagia. Diagnosis was made by find- ings of uvula deviation, classic herpetic lesions, and direct laryngoscopy visualizing unilateral vocal cord paralysis. Case: A 67-year-old female with a past medical history of gastroesophageal reflux disease (GERD), migraine head- aches, hyperlipidemia, and breast cancer status post-bilateral mastectomy. The patient was currently receiving treatment with neoadjuvant chemotherapy, including adriamycin and cyclophosphomide. She presented to the EDwith a two-day history of hoarseness and dysphagia. Physical exam find- ings included uvula deviation to the right. All other cranial nerves were intact. Review of systems elicited paresthesia over the left lateral cervical region without associated skin findings. The remainder of the physical exam, as well as laboratory results, was unremarkable. In the emergency room, the patient developed tachypnea with audible stridor. An Ear, Nose, and Throat specialist (ENT) was consulted, and the patient was given empiric steroids and nebulizer treatments. The ENT performed direct video laryngoscopy, A. Harless, M.A. Khan, and W. Davis Ochsner Medical Center, New Orleans
86 J La State Med Soc VOL 166 March/April 2014
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