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A case ofa patient with extremely elevated fer-ritin and septic shock [Meeting Abstract]

Knoll, B; Boodram, P; Odedosu, T
Learning Objective #1: Recgonizing hemophagocytic lymphohistiocytosis (HLH) in septic patients with ferritin levels greater than 20,000 CASE: A 35-year-old woman with a history of recurrent urinary tract infections (UTIs) complicated by nephrolithiasis presented with four days of fever and a sore throat. She was febrile to 103.1, blood pressure 99/62, and heart rate 100. WBC was 12, Hgb 8.6, creatinine 1.8, AST 304, ALT 92, and HIV, streptococcus, mononucleosis and EBV IgM testing were all negative. Urinalysis was consistent with a UTI, she was admitted, and started on antibiotics. A CTscan of the abdomen revealeda right, staghorn calculi with surrounding, ill-defined lesions in the parenchyma. Urology placed a right nephrostomy tube which drained frank pus. Other work-up revealed an LDH of 2,502, triglycerides of 474, ferritin of 31,000. An Interleukin 2 Receptor (CD25) soluble test was sent but bone marrow biopsy was deferred given improvement in clinical symptoms and laboratory data. Twelve days into her admission, the patient clinically deteriorated. Lactate was elevated to 5.7, LFTs and LDH began to rise, and ferritin was 24,000 from a nadir of 8,000. Repeat triglycerides were 1,210. She was transferred to the intensive care unit for septic shock, placed on vasopressors and was subsequently intubated. A bone marrow biopsy revealed histiocytosis in a scattered and cluster pattern and hemophagocytosis and hemophagocytic lymphohistiocytosis (HLH) was diagnosed. Treatment with dexamethasone and etoposide was initiated on day fourteen based on the modified HLH 94 protocol. Her CD25 soluble test later came back elevated. She was weaned of vasopressors, extubated and completed chemotherapy inpatient. She was discharged three months after presentation. IMPACT/DISCUSSION: HLH is a rare, life-threating condition characterized by excessive immune activation that is most common in the pediatric population but can occur at any age. There are pre-disposing genetic defects and/or an immunological trigger such as infection, malignancy or rheumatologic disorder that have been linked to the development of HLH. Most commonly infectious HLH is reported in viral infections-commonly EBV-but it is possible the diagnosis is being overlooked in bacterial infections that lead to sepsis. It is easy in sepsis to attribute cytopenia and rising LFTs to end organ damage from the sepsis itself, making it difficult to distinguish from HLH. Infection itself is also commonly associated with high ferritin levels making it even more difficult to distinguish from HLH. Without treatment, patients often only survive a few months and overall mortality is as high as 75%. Appropriate, early treatment have shown remission rates up to 71%.
Conclusion(s): Thus, this case report exemplifies the importance of investigating HLH as a possible contributor to end-organ damage in septic shock when extremely high ferritins are noted. Mortality is high in patients with HLH which makes timely diagnosis of the utmost importance
ISSN: 1525-1497
CID: 4052952


Guttmann, Allison; Leung, Galen; Gomez-Viso, Alejandro; Odedosu, Taiye
ISSN: 1525-1497
CID: 2481932

Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks

Schoenthaler, Antoinette; Luerassi, Leanne; Silver, Stephanie; Odedosu, Taiye; Kong, Jian; Ravenell, Joseph; Teresi, Jeanne A; Ogedegbe, Gbenga
BACKGROUND: Although the efficacy of therapeutic lifestyle change (TLC) interventions are well proven, their relative effectiveness vs. single-session lifestyle counseling (SSC) on blood pressure (BP) reduction in primary care practices remains largely untested in hypertensive Blacks. The aim of this trial was to evaluate the comparative effectiveness of a comprehensive practice-based TLC intervention (motivational interviewing (MINT)-TLC) vs. SSC on BP reduction among 194 Blacks with uncontrolled hypertension. METHODS: The MINT-TLC arm included 10 weekly group classes on TLC, followed by 3 individual MINT sessions. The SSC group received 1 individual counseling session on lifestyle modification plus print versions of the intervention material. The primary outcome was within-patient change in systolic BP (SBP) and diastolic BP (DBP) from baseline to 6 months. The secondary outcome was BP control at 6 months. RESULTS: Mean age of the total sample was 57 (10.2) years; 50% were women, and the mean baseline BP was 147.4/89.3mm Hg. Eighty-four percent of SSC and 77% of MINT-TLC patients completed the final 6-month assessments. BP declined significantly (P < 0.001) in both groups at 6 months with a net-adjusted systolic BP reduction of 12.9mm Hg for the SSC group vs. 9.5mm Hg for the MINT-TLC group (P = 0.18); and diastolic BP reduction of 7.6 and 7.2mm Hg for the SSC and MINT-TLC group, respectively (P = 0.79). The between-group difference in proportion of patients with adequate BP control at 6 months was nonsignificant (P = 0.82). CONCLUSION: A significant group difference in BP between the intervention groups was not observed among a sample of hypertensive Blacks. Implementation of the pragmatic single-session intervention and its effects on utilization of healthcare services should be further evaluated. CLINICAL TRIAL REGISTRATION: Trial Number NCT01070056 at
PMID: 26135553
ISSN: 1941-7225
CID: 1650022

Race/ethnicity moderates the relationship between chronic life stress and quality of life in type 2 diabetes

Shallcross, Amanda J; Ojie, Mary-Jane; Chaplin, William; Levy, Natalie; Odedosu, Taiye; Ogedegbe, Gbenga; Spruill, Tanya M
AIMS: To determine whether chronic life stress is differentially associated with quality of life (QoL) for Blacks vs. Hispanics with type 2 diabetes. METHODS: We assessed self-reported chronic stress and QoL in 125 patients with type 2 diabetes who self-identified as either non-Hispanic Black or Hispanic. Separate cross-sectional two-way interaction models (stressxrace/ethnicity) with physical and mental health as outcomes were examined. RESULTS: The two-way interaction predicted mental (b=3.12, P=.04) but not physical health. Simple slopes analyses indicated that under conditions of high stress, Blacks (b=-4.4, P<.001), but not Hispanics, experienced significantly lower levels of mental health. In exploratory analyses, we examined a three-way interaction (stressxrace/ethnicityxsocial support) with physical and mental health as outcomes. Results indicated the three-way interaction predicted mental (b=.62, P=.01) but not physical health. Simple slopes analyses indicated that under conditions of high stress, high levels of social support improved mental health for Hispanics (b=1.2, P<.001), but not for Blacks. CONCLUSIONS: Black patients with type 2 diabetes may be particularly vulnerable to the deleterious effects of high chronic stress. Social support buffers effects of stress on mental health in Hispanics but not Blacks, which suggests differences in the use and/or quality of social support between Hispanics and Blacks. Longitudinal investigations that examine race/ethnicity, stress, social support, and QoL should help clarify the processes that underlie these observed relations.
PMID: 25704600
ISSN: 0168-8227
CID: 1473412


Manasson, Julia; Kirsch, Hannah; Charubhumi, Vanessa; Garment, Ann; Odedosu, Taiye
ISSN: 1525-1497
CID: 1730142


Doyle-Burr, Caleb; Yee, Jessica; Odedosu, Taiye
ISSN: 1525-1497
CID: 1730382

Food Insecurity and Effectiveness of Behavioral Interventions to Reduce Blood Pressure, New York City, 2012-2013

Grilo, Stephanie A; Shallcross, Amanda J; Ogedegbe, Gbenga; Odedosu, Taiye; Levy, Natalie; Lehrer, Susan; Chaplin, William; Spruill, Tanya M
INTRODUCTION: Food insecurity is associated with diet-sensitive diseases and may be a barrier to successful chronic disease self-management. To evaluate the impact of food insecurity on blood pressure reduction in a pilot clinical trial, we tested the effectiveness of 2 behavioral interventions for hypertension in people with and without food security. METHODS: A group of 28 men and women with type 2 diabetes and uncontrolled hypertension were randomized to either 1) home blood pressure telemonitoring alone or 2) home blood pressure telemonitoring plus telephone-based nurse case management. The primary outcome was 6-month change in systolic blood pressure. RESULTS: The 2 interventions resulted in modest, nonsignificant blood pressure reductions. Food-secure patients experienced clinically and statistically significant reductions in blood pressure, whereas no significant change was seen among food-insecure patients. CONCLUSION: Screening for food insecurity may help identify patients in need of tailored disease management interventions.
PMID: 25674675
ISSN: 1545-1151
CID: 1461982


Schoenthaler, Antoinette; Teresi, Jeanne; Luerassi, Leanne; Silver, Stephanie; Kong, Jian; Odedosu, Taiye; Ogedegbe, Gbenga
ISSN: 1525-1497
CID: 1268042

Overcoming barriers to hypertension control in African Americans

Odedosu, Taiye; Schoenthaler, Antoinette; Vieira, Dorice L; Agyemang, Charles; Ogedegbe, Gbenga
Barriers to blood pressure control exist at the patient, physician, and system levels. We review the current evidence for interventions that target patient- and physician-related barriers, such as patient education, home blood pressure monitoring, and computerized decision-support systems for physicians, and we emphasize the need for more studies that address the effectiveness of these interventions in African American patients
PMID: 22219234
ISSN: 1939-2869
CID: 148740

A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial

Schoenthaler, Antoinette; Luerassi, Leanne; Teresi, Jeanne A; Silver, Stephanie; Kong, Jian; Odedosu, Taiye; Trilling, Samantha; Errico, Anna; Uvwo, Oshevire; Sebek, Kimberly; Adekoya, Adetutu; Ogedegbe, Gbenga
ABSTRACT: BACKGROUND: Poorly controlled hypertension (HTN) remains one of the most significant public health problems in the United States, in terms of morbidity, mortality, and economic burden. Despite compelling evidence supporting the beneficial effects of therapeutic lifestyle changes (TLC) for blood pressure (BP) reduction, the effectiveness of these approaches in primary care practices remains untested, especially among African Americans, who share a disproportionately greater burden of HTN-related outcomes. METHODS/DESIGN: This randomized controlled trial tests the effectiveness of a practice-based comprehensive therapeutic lifestyle intervention, delivered through group-based counseling and motivational interviewing (MINT-TLC) versus Usual Care (UC) in 200 low-income, African Americans with uncontrolled hypertension. MINT-TLC is designed to help patients make appropriate lifestyle changes and develop skills to maintain these changes long-term. Patients in the MINT-TLC group attend 10 weekly group classes focused on healthy lifestyle changes (intensive phase); followed by 3 monthly individual motivational interviewing (MINT) sessions (maintenance phase). The intervention is delivered by trained research personnel with appropriate treatment fidelity procedures. Patients in the UC condition receive a single individual counseling session on healthy lifestyle changes and print versions of the intervention materials. The primary outcome is within-patient change in both systolic and diastolic BP from baseline to 6 months. In addition to BP control at 6 months, other secondary outcomes include changes in the following lifestyle behaviors from baseline to 6 months: a) physical activity, b) weight loss, c) number of daily servings of fruits and vegetables and d) 24-hour urinary sodium excretion. DISCUSSION: This vanguard trial will provide information on how to refine MINT-TLC and integrate it into a standard treatment protocol for hypertensive African Americans as a result of the data obtained; thus maximizing the likelihood of its translation into clinical practice. TRIAL REGISTRATION: NCT01070056
PMID: 22192273
ISSN: 1745-6215
CID: 150563