Background: Ewing sarcoma (ES), the second most common malignant bone tumor after osteosarcoma in the second decade, occurs in 0.9% of cases as the primary non-sacral form.Case: A 20-years-old male presented with acute paraparesis of bilateral lower limb and numbness following initial back pain for the last 6 months. Magnetic resonance imaging (MRI) of the lumbar spine revealed a 4 cm enhancing soft tissue mass at the L4/L5 vertebra extending into the spinal canal with compression of the thecal sac.The computed tomography (CT) of the chest, abdomen, and pelvis revealed aggressive lytic lesions in the L4 spinous process with soft tissue extension into the spinal canal with no other site of distant metastasis. He was treated with IV steroids (Injection dexamethasone 10 mg IV followed by 4 mg tablet dexamethasone q6h; subsequently tapered off). A core needle biopsy showed a small, round blue cell neoplasm, (suggestive of a primitive neuroectodermal) stained positive for CD99 and vimentin stain. The diagnosis of ES lumbar spine was made which was treated with surgical resection with an appropriate margin measuring 8 Â 4.5 Â 2.5 cm with decompression and L4/5 laminectomies, which had a negative margin in the surgical pathology report. Concomitant local radiotherapy and chemotherapy [cycles of vincristine 2 mg/m 2 , adriamycin/doxorubicin 75 mg/m 2 , cyclophosphamide 1200 mg/m 2 (VDC) with mesna rescue alternating with cycles of ifosfamide 1800 mg/m 2 and etoposide 100 mg/m 2 (IE)] was started. The motor strength was regained gradually with preserved spine biomechanics and oncological control with no recurrence in 2-year follow-ups. Conclusions:The presentation of lumbar ES can vary from local pain and swelling to acute paraparesis. Timely diagnosis and treatment with multimodal therapy, namely, steroids for acute spinal cord compression and surgery with chemoradiotherapy for ES can improve spinal biomechanics and oncological control.

Introduction: According to White et al., health literacy is defined as ‘the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions. Nearly 36 percent of adults in the United State have low health literacy. Low health literacy not only affects the individual and the communities but also puts a lot of burden on healthcare resulting in high healthcare costs. It has adversely influenced diabetes care due to lack of use of preventive services, poor physician-patient communication, poor comprehension of medical instructions, and errors in medication dosing, and timing. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump therapy, and continuous glucose monitors (CGM) are commonly indicated in patients with inadequate glycemic control, high glucose variability, unpredictable hypoglycemia, patients with an erratic schedule or varied work shifts. We present a case of uncontrolled diabetes mellitus in a patient with low health literacy, with significant improvement in glycemic control after starting CSII with CGM. Case: A 59-year-old female with a 13-year history of Latent Autoimmune Diabetes in Adults, on Insulin and Semaglutide, presented for evaluation in the clinic. She was struggling with insulin dosing and blood glucose control with multiple hospital admissions for hypo- and hyperglycemia. Her home blood glucose levels ranged from 92 to 536 mg/dl. Her HbA1C was between 12 and 18% in the past years. She had developed microvascular complications like diabetic nephropathy, neuropathy, and had a cerebrovascular accident in the past. Her current insulin dose was Glargine 50 units daily at nighttime and Lispro 25 units with each meal. Her most recent HbA1c was 14.5. She was not compliant with diet and has difficulty exercising due to residual weakness from CVA. The patient was struggling with insulin injection with errors in the dosing and timing of insulin due to difficulty in understanding medical instructions. Considering all the struggles and uncontrolled diabetes, CSII with CGM was initiated, with a simple protocol for her, one-click, or two clicks depending on the meal size. Within two months there was a significant improvement in her glycemic control. Her recent HbA1C was 9.5%. Conclusion: CSII can be considered as a viable treatment option in patients with low health literacy with uncontrolled diabetes mellitus like in our patient.