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Altered mental status and acute decompensated heart failure with increased abdominal girth as an initial presentation of primary effusion lymphoma in a human immunodeficiency virus-negative (HIV) and non-organ recipient individual: A case report [Meeting Abstract]

Hossain, M; Hurtado, M; Cho, J; Ha, J -E
LEARNING OBJECTIVE #1: Recognize need for early diagnostic fluid study for patients presenting with new ascites or effusion and constitutional symptoms, despite history of CHF LEARNING OBJECTIVE #2: Diagnose and manage HIV-unrelated, HHV-8-associated PEL in patients presenting with unusual clinical presentation CASE: 70-year-old HIV-negative male with advanced heart failure presented with altered mental status and mild hypotension. Physical exam was remarkable for increased abdominal girth concerning for new ascites and lab work was remarkable for mild leukocytosis, hypercalcemia and supratherapeutic INR. With no history of liver cirrhosis, ascites was thought to be secondary to heart failure and congestive hepatopathy and paracentesis was delayed due to elevated INR. Patient remained lethargic despite negative stroke work up, and was treated for aspiration pneumonia. Patient was eventually transferred to ICU for worsening delirium, hypotension, atrial fibrillation with RVR, and new fever of 103 F. Paracentesis with cytology confirmed a new diagnosis of primary effusion lymphoma. Patient tested negative for HIV and Epstein-Barr Encoding region (EBER), but was positive for Human Herpesvirus Type 8 (HHV8). Clinical course was complicated by aspiration pneumonia, C. difficile infection, and persistent hypotension, making him a poor candidate for chemotherapy treatment. IMPACT/DISCUSSION: Primary effusion lymphoma (PEL) is a rare, high-grade non-Hodgkin's lymphoma (NHL) that typically develops in immunocompromised patients, with HIV or following organ transplant, and often associated with HHV8 or Ebstein-Barr virus. Patients often present with constitutional symptoms and effusions in body cavities with no defining mass or overt sign of malignancy. Our patient presented with new ascites but diagnosis was delayed due to elevated INR and attribution to acute decompensated heart failure with congestive hepatopathy. Recognition of unexplained hypercalcemia and constitutional symptoms followed by early diagnostic paracentesis may have expedited the diagnosis and affected patient's clinical course.
CONCLUSION(S): Primary effusion lymphoma is a very rare disease that almost exclusively occurs in HIV positive or immunocompromised patients, representing only 4% of NHL cases associated with HIV and only 0.1% to 1% of all lymphomas in patients with other types of immunodeficiency. This case highlights HIV- negative/EBV-negative/HHV-8-positive PEL in a patient presenting unusually as acute decompensated heart failure and altered mental status treated for aspiration pneumonia. It is imperative that patients presenting with new ascites or pleural effusion get an early diagnostic fluid study with a high suspicion of malignancy especially with other constitutional symptoms and metabolic encephalopathy with unexplained hypercalcemia and negative infectious workup. Early recognition in patients particularly with underlying CHF may lead to timely treatment initiation and further reduce complications
EMBASE:633957462
ISSN: 1525-1497
CID: 4805272

Ouch! Addressing Microaggressions on the Interdisciplinary Team [Meeting Abstract]

Reiff, Stefanie; Moussa, Marwa; Ha, Jung-Eun; Manfield, Laura; Lee-Riley, Lorna; Duran, Deserie; Volpicelli, Frank; Trivedi, Shreya P
ORIGINAL:0014789
ISSN: 1525-1497
CID: 4610372

Can Appreciative Inquiry Improve Interdisciplinary Experiences [Meeting Abstract]

Trivedi, Shreya P; Reiff, Stefanie; Ha, Jung-Eun; Moussa, Marwa; Boardman, Davis; Altshuler, Lisa; Duran, Deserie; Lee-Riley, Lorna; Mansfield, Laura; Volpicelli, Frank
ORIGINAL:0014788
ISSN: 1525-1497
CID: 4610362

Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community-dwelling older adults: A population-based study in rural Ecuador

Del Brutto, Oscar H; Mera, Robertino M; Gillman, Jennifer; Ha, Jung-Eun; Zambrano, Mauricio
AIM/OBJECTIVE:Using a population-based, cross-sectional design, we aimed to assess whether the presence of calcifications in the carotid siphon (as seen on computed tomography) is associated with silent markers of cerebral small vessel disease (on magnetic resonance imaging) in apparently healthy older adults living in Atahualpa, a rural Ecuadorian village. METHODS:Stroke-free Atahualpa residents aged ≥60 years identified during a door-to-door survey underwent head computed tomography for assessment of carotid siphon calcifications, and brain magnetic resonance imaging for identification of white matter hyperintensities and silent lacunar infarcts. We evaluated the association between calcifications and markers of small vessel disease using logistic regression models adjusted for demographics and cardiovascular risk factors. RESULTS:The mean age of the 236 participants was 71 ± 8 years, and 139 (59%) were women. Computed tomography readings showed high calcium content in the carotid siphon in 64 individuals (27%), and magnetic resonance imaging showed moderate-to-severe white matter hyperintensities in 51 (30%) and lacunar infarcts in 28 (12%). In the univariate analysis, individuals with high calcium content were older and were more likely to have high fasting glucose levels than those with low calcium content. After adjusting for confounding variables, we found an independent association between high calcium content in the carotid siphon and moderate-to-severe white matter hyperintensities (OR 2.3, 95% CI 1.1-4.9, P = 0.035) as well as lacunar infarcts (OR 3.1, 95% CI 1.3-7.6, P = 0.013). CONCLUSIONS:The present study shows a direct relationship between calcium content in the carotid siphon and silent small vessel disease in an indigenous Latin American population. Geriatr Gerontol Int 2016; 16: 1063-1067.
PMID: 26337141
ISSN: 1447-0594
CID: 3215302

Oily fish consumption is inversely correlated with cerebral microbleeds in community-dwelling older adults: results from the Atahualpa Project

Del Brutto, Oscar H; Mera, Robertino M; Ha, Jung-Eun; Del Brutto, Victor J; Castillo, Pablo R; Zambrano, Mauricio; Gillman, Jennifer
BACKGROUND:Oily fish is a major dietary source of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). These nutrients improve endothelial dysfunction, reduce β-amyloid induced damage of neurovascular units, and might prevent the occurrence of cerebral microbleeds. However, this relationship has not been investigated so far. AIM/OBJECTIVE:To evaluate the association between oily fish intake and cerebral microbleeds in a population of frequent fish consumers living in coastal Ecuador. METHODS:Cerebral microbleeds were identified by gradient-echo MRI and oily fish consumption was calculated in community-dwellers aged ≥60 years enrolled in the Atahualpa Project. The association between cerebral microbleeds and fish servings was examined in regression models adjusted for relevant confounders. A predictive model was constructed using quintiles of fish servings to take into account the non-linearity in the relationship. RESULTS:Out of 311 eligible individuals, 293 (94 %) were enrolled. Cerebral microbleeds were recognized in 37 (13 %) individuals. Mean fish consumption was 8.8 ± 5.4 servings per week (ω-3 PUFAs estimates: 10.2 ± 7.1 g). Multivariate analysis showed an inverse relationship between cerebral microbleeds and fish consumption (p < 0.001). Predictive margins of CMB were higher for individuals in the lowest (≤4.3) than for those in the highest (≥13.1) quintile of fish servings (17.4 vs 2.3 %, p < 0.001). CONCLUSIONS:This study shows a lower cerebral microbleed presence among older adults eating large amounts of oily fish (13 servings per week, equivalent to about 15 g of ω-3 PUFAs). These high requirements can be more readily accomplished in other populations by taking fish oil preparations. Longitudinal studies are warranted to assess whether these interventions reduce incident cerebral microbleeds in high-risk individuals.
PMID: 26497828
ISSN: 1720-8319
CID: 3215322

Dietary Oily Fish Intake and Blood Pressure Levels: A Population-Based Study

Del Brutto, Oscar H; Mera, Robertino M; Gillman, Jennifer; Castillo, Pablo R; Zambrano, Mauricio; Ha, Jung-Eun
The effect of fish consumption on blood pressure is controversial. The authors measured blood pressure and calculated oily fish servings per week in 677 community-dwellers aged 40 years and older living in rural coastal Ecuador. Using regression models with linear splines, the authors evaluated whether dietary fish intake was related to blood pressure levels, after adjusting for relevant confounders. Mean oily fish consumption was 9.1±5.6 servings per week. There was a nonlinear relationship between systolic pressure and fish servings. In the group of individuals consuming up to five servings per week, each serving significantly reduced systolic pressure by 2.3 mm Hg (P=.020). Any extra serving provided no further effects. The study shows an inverse relationship between oily fish consumption and systolic pressure. Currently recommended amounts of dietary oily fish intake per week (1-2 servings) might be insufficient to exert beneficial effects of fish in the control of blood pressure.
PMID: 26395549
ISSN: 1751-7176
CID: 3215312

Oily Fish Intake and Cognitive Performance in Community-Dwelling Older Adults: The Atahualpa Project

Del Brutto, Oscar H; Mera, Robertino M; Gillman, Jennifer; Zambrano, Mauricio; Ha, Jung-eun
Due to their high content of omega-3 polyunsaturated fatty acids, oily fish consumption is likely associated with a better cognitive performance. However, information on this association is controversial, with some studies showing a positive effect while others showing no association. We aimed to assess the effects of oily fish consumption on cognitive performance in a population of frequent fish consumers living in rural coastal Ecuador. Atahualpa residents aged ≥60 years were identified during a door-to-door survey and evaluated by the use of the Montreal Cognitive Assessment (MoCA). Oily fish servings per week were calculated in all participants. We estimated whether fish intake correlated with MoCA scores in generalized multivariate linear models adjusted for demographics, cardiovascular risk factors, edentulism and symptoms of depression. Out of 330 eligible persons, 307 (93%) were enrolled. Mean MoCA scores were 19 ± 4.8 points, and mean oily fish consumption was 8.6 ± 5.3 servings per week. In multivariate analyses, MoCA scores were related to fish servings (β 0.097, 95% CI 0.005-0.188, p = 0.038). Locally weighted scatterplot smoothing showed an inflection point in the total MoCA score curve at four fish servings per week. However, predictive margins of the MoCA score were similar across groups below and above this point, suggesting a direct linear relationship between oily fish intake and cognitive performance. Simple preventive measures, such as modifying dietary habits might be of value to reduce the rate of cognitive decline in community-dwelling older adults living in underserved populations.
PMID: 26187093
ISSN: 1573-3610
CID: 3215292

Dietary fish intake and sleep quality: a population-based study

Del Brutto, Oscar H; Mera, Robertino M; Ha, Jung-Eun; Gillman, Jennifer; Zambrano, Mauricio; Castillo, Pablo R
BACKGROUND/OBJECTIVES/OBJECTIVE:Due to the content of omega-3 and vitamin D, fish consumption is likely to be associated with better sleep. However, current data are limited to a single study that is not representative of the population at large. The present study aimed to assess the effects of oily fish consumption on sleep quality in community dwelling adults living in rural coastal Ecuador. METHODS:Atahualpa residents aged ≥40 years and who were identified during a door-to-door survey were interviewed with field instruments directed at assessing cardiovascular risk factors, sleep quality, and fish consumption. Using parametric regression and generalized linear models adjusted for demographics and cardiovascular risk factors, the study evaluated whether oily fish consumption is associated with a lower Pittsburgh sleep quality index (PSQI). RESULTS:Out of 721 eligible people, 677 (94%) were enrolled. Mean oily fish consumption was 9 ± 6 servings per week (one serving = 140 grams). Poor sleep quality was noticed in 187 (28%) individuals. Oily fish intake was higher in individuals with good sleep quality (p = 0.013). There was an inverse association between the PSQI score and oily fish servings per week in both parametric regression (β = -0.040; 95% CI -0.690 to -0.011, p = 0.007) and the adjusted generalized linear model (β = -0.032; 95% CI -0.605 to -0.004, p = 0.025). CONCLUSIONS:Oily fish consumption is associated with better sleep quality. Even in people who ingest more than the recommended amount of fish, an increase in fish intake is associated with further improvement in the quality of sleep.
PMID: 26847986
ISSN: 1878-5506
CID: 3215332