Cary N. Mariash

The major obstacles to the successful use of individual nutritional compounds as preventive or therapeutic agents are their efficacy and bioavailability. One approach to overcoming this problem is to use combinations of nutrients to induce synergistic effects. The objective of this research was to investigate the synergistic effects of two dietary components: docosahexaenoic acid (DHA), an omega-3 fatty acid present in cold-water fish, and curcumin (CCM), an herbal nutrient present in turmeric, in an in vivo model of DMBA-induced mammary tumorigenesis in mice.

Myxedema coma (MC) is rare entity that often presents as a diagnostic challenge. If unrecognized and untreated, it is often fatal with mortality reported as high as 30-50% due, in part, to various recommendations for treatment. To date there have been no reported objective criteria to aid with making the diagnosis. Therefore, we performed a retrospective chart review of patients admitted with the diagnosis of MC and developed an objective screening tool to help correctly classify such patients. All patients aged 18 years or older admitted to Methodist Hospital between January 1, 2005 to June 13, 2010 with a diagnosis of MC were identified. Heart rate, temperature and Glasgow Coma Scale (GCS) were measured at the time of admission. TSH and free T4 (FT4) when measured during the hospitalization were recorded. A secondary insult such as a precipitating illness was identified (for example: cold exposure, infection, drugs). We used these 6 criteria to develop an objective score to classify patients as definite, likely, or unlikely to have MC. We assigned points to each patient based on these 6 criteria: 1) GCS of 0-10 = 4, 11 - 13 = 3, 14 =2, 15 = 0; 2) TSH > 30 = 2, 15-30 = 1; 3) FT4 below normal = 1; 4) hypothermic (temp < 95 F) = 1; 5) bradycardic (HR < 60) =1; 6) precipitating illness present = 1. We then considered MC present if the score was >7, likely = 5 -7, unlikely < 5. Ten patients aged 68+/− 25 years old were admitted with a diagnosis of MC. All had a GCS of less than 15. Eight (80%) had a TSH of more than 30 μU/ml. Six (60%) were found to be bradycardic. Five (50%) had an identifiable precipitating factor. Four (40%) were hypothermic. Based on our scoring system two (20%) patients had definite MC, 6 (60%) had likely MC and 2 (20%) were unlikely to have MC. The two patients unlikely to have MC had secondary hypothyroidism. We would recommend patients that have a score >7 be treated for MC; patients with scores from 5 to 7 also be treated if there are no other plausible causes for the findings. In summary, we developed an objective-screening tool to aid in the rapid diagnosis of MC. As the features of MC are non-specific, this screening tool enables physicians to rapidly make the diagnosis of MC to expedite immediate treatment. We propose this screening tool be used prospectively to create a more refined diagnostic tool for the rapid diagnosis of this rare but lethal syndrome and to study the optimal treatment of MC. Nothing to Disclose: YVC, CNM