Background Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition affecting the spine, characterized by ossification of paravertebral ligaments. Our cross-sectional study investigated the frequency, associated morbidity, and healthcare utilization of DISH patients at our university hospital over 1 year. Methods Our university's database of spinal radiographs was searched from 2005 to 2015 for “DISH” or “diffuse idiopathic skeletal hyperostosis.” The diagnosis of DISH was made by 2 board-certified radiologists (B.B. and C.Q.) based on the radiographs of cervical, thoracic, or lumbar spine. Patients from 2015 were further analyzed with regards to demographics, comorbidities, and healthcare interventions. Their spinal radiographs were reread by 2 authors. Patients were divided into those who fulfilled the Resnick criteria for DISH (group A), and those who did not fully meet the criteria but had radiographic features suggestive of DISH (group B). Means and proportions were used to describe variables. For group comparisons, t test and χ2 test were used. Results Between 2005 and 2015, 3439 radiology records mentioned DISH as a diagnosis. Of 195 patients diagnosed with DISH in 2015, 153 were in group A, 41 were in group B, and 2 had erroneous diagnoses. Chronic back pain was common, and more often reported in group B than in group A (81% vs 63%, p = 0.04). Substantial portions of patients required opioid medications for pain control (51%), spinal surgery (31%), and consultations with various specialists for regional pain (57%). Conclusions Diffuse idiopathic skeletal hyperostosis is a diagnosis with significant morbidity, despite being commonly viewed as asymptomatic. A majority of DISH patients had chronic back pain, and a large proportion required spinal surgery, although there may be several confounders. Future research is needed to systematically assess healthcare utilization by DISH patients.

Objective: The main goal of this literature review is to investigate and compare the current screening procedures for the diagnosis of cystic fibrosis in neonates. Cystic Fibrosis or CF is a lethal, genetic disease. The disease is neither too widespread nor too rare. There are more than 30,000 CF patients in the United States, and the number of CF carriers is still unidentified. CF affects more than one organ system in patient's body; due to this, there is no definitive treatment plan for the disease. The cure is dependent on the results of prenatal and postnatal diagnosis. The patients may exhibit all or few symptoms associated with the disease. Sometimes, symptoms are completely absent at the time of birth and become more prevalent with the age. Methods & Materials: We extensively studied the peer-reviewed scientific journals to understand the existing diagnostic and screening methods for cystic fibrosis. During our research, we kept the focus on newborn screening and evaluated the clinical data from previous studies. We retrieved tables and figures from electronic databases to indicate these results more effectively. We also analyzed the available information on sensitivity, specificity, positive predictive value and negative predictive value of these screening programs. Result & Conclusion: The data indicates that sensitivity of neonatal screening programs is less than 90% (or even below 80% in some cases) when only one test is performed. However, sensitivity increases as the multi-stage approach is adopted. Besides, the CF detection rate is also influenced by multiple factors including ethnicity and age of the patient, duration of the study, type of CFTR mutation, nutritional habits, etc. Many studies need to be carried out to determine optimal cutoff values for both IRT and the sweat test. Genomics and computational biology can be used not only in identifying the other important CFTR mutations, but also in evaluating their impact on the patient's body.

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Introduction Hyperparathyroid crisis is a rare endocrine emergency with a high mortality. Primary hyperparathyroidism (PHP) can present as severe hypercalcemia. There are very few cases documented in literature of patients with concomitant SLE and PHP. We present a case of hypercalcemic crisis in a patient with untreated primary hyperparathyroidism with a history of SLE. Case description A 46 year old woman was found to have hypercalcemia of 12.9 mg/dl on routine lab work. Her medical history is significant for SLE (diagnosed 9 years prior) and osteoarthritis. She had no physical complaints. Further workup confirmed primary hyperparathyroidism with PTH of 322.8 pg/ml and findings consistent with parathyroid adenoma on Sestamibi scintigraphy. Parathyroidectomy was strongly recommended however the patient refused. She was then offered medical management but did not show up for any follow up appointments. Two years later, she presented to the emergency department with altered mentation, lethargy, poor oral intake and abdominal pain for 2 days. She was found to have severe hypercalcemia with a serum calcium of > 24.8 mg/dl and was in acute renal failure. On admission, EKG changes suggestive of pseudoinfarct pattern from severe hypercalcemia were present. She was managed in the intensive care unit with intravenous hydration, calcitonin, zoledronic acid and hemodialysis. Shortly after initiation of hemodialysis, the patient succumbed to a cardiac arrest. Conclusion Hyperparathyroid crisis when untreated has a 100% mortality rate. Early management with surgical intervention is the only confirmed cure for PHP. There are only 18 cases reported in literature of hypercalcemia in SLE. Mechanisms involved are believed to be stimulatory PTH antibodies, PTHrP and osteoclastic activity due to inflammatory cytokines. To our best knowledge this is the 6th case report of a patient with concomitant SLE and PHP. A prospective study by Norman et. al 1 done in 10000 PHP patients demonstrated a Gaussian distribution with the average calcium concentration being 10.9 ± 0.6 mg/dL and the average parathyroid hormone concentration being 105.8 ± 48 pg/ml . Her baseline calcium at diagnosis was 13mg/dl and intact PTH was 322.8 pg/ml which is higher than seen in the normograms as per the study. In our patient, we believe SLE could have exacerbated the hypercalcemia caused by PHP. It is important to perform further studies to identify if any association exists between the two conditions. Physicians must recognize their concomitant occurrence as prompt management of hypercalcemia becomes even more crucial in these cases. References: 1) Norman J, Goodman A, Politz D. Calcium, parathyroid hormone, and vitamin D in patients with primary hyperparathyroidism: normograms developed from 10,000 cases. Endocr Pract. 2011 May-Jun;17(3): 384-94. doi: 10.4158/EP09346. OR. PMID: 21134884. Presentation: No date and time listed

Background: Hypertension, defined as a systolic blood pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg, is one of the most common chronic diseases (prevalence is 29.0% among adults) and is part of the Ambulatory Care Sensitive Conditions (ACSC). In most cases, hypertension is considered a secondary diagnosis because complications that could result from the disease are the reasons why patients with hypertension are admitted to the hospital and Emergency Department (ED). Thereby, preventive approaches are integral in the management of these complications and access to primary care along with continuity are considered to be crucial components of preventive medicine. Hypothesis: We assess the hypothesis that increased access to primary care and continuity of care can reduce ED visits along with hospitalization rates in patients with hypertension. Methods: We reviewed articles from years 2005 to 2019 from peer reviewed journals. All publications were written in English and were mostly from the United States. However, we also included studies from other countries for comparison. We identified 2115 articles in total: 784 from Science Direct, 687 from Pubmed and 644 from Google Scholar, using these keywords: Hypertension, Hospitalization, Emergency Department, Primary care, Ambulatory Care Sensitive Conditions. Based on the titles, we investigated abstracts of 198 potentially relevant articles. Abstracts were rated independently by each member of the pair of reviewers and scored for relevance (relevant/ non-relevant). The second step was to have the full text of the remaining studies (n = 146) reviewed by the same team to check whether papers met inclusion criteria. Through this process, 96 studies were excluded. A total of 50 studies remained and were included in our systematic review. Results: From 50 research articles that were included; 38 studies showed statistically significant (p < 0.05) finding that increased access to primary care and its continuity decreases hospitalizations and/or ED admissions in patients with hypertension, 8 studies did not find statistically significant association between these factors. 4 studies showed statistically significant conclusion that general or family physicians as PCPs decrease hospitalization and ED admission rate in comparison with specialist physicians as PCP. Conclusion: We concluded that increased primary care access and its continuity are associated with a statistically significant decrease in the incidence of hospitalizations and/or ED visits for patients with hypertension.