RWJBarnabas Health is a network of independent healthcare providers in New Jersey, based out of West Orange. Members include academic centers, acute care facilities, and research hospitals. The goals of the network include collaboration on educational and research programs.RWJBarnabas Health was created through the 2015 merger of the Robert Wood Johnson Health System and the Saint Barnabas Health Care System.
Background: Despite continuous glucose monitoring (CGM) being the standard of treatment for type 1 and type 2 diabetes, patient uptake has been reported to under 50%. Clinician awareness and identification of barriers can help reduce diabetes-related complications; however, less than half of pharmacy schools provide CGM education. The objective is to explore pharmacy students' perceptions of a CGM wear experience and their self-reported awareness of patient challenges, device usability, and empathyrelated considerations. Methods: A CGM student-wear experience was incorporated into two sessions of an elective advanced pharmacotherapy course for third-year pharmacy students. The experience was divided into three parts over two class sessions, including a one-week CGM student-wear experience. Reflections were collected through an anonymous questionnaire and a recorded focus group. A thematic approach guided analysis, and reviewers reached consensus on themes. Results: Seventeen students participated; 70.6% had prior experience with traditional finger-stick blood glucose monitoring, while only one had CGM experience. Students described four areas of awareness: empathy for patient experiences, recognition of CGM as a self-management tool, perceived value of hands-on learning, and anticipated barriers. Conclusion: Students perceived greater awareness of CGM-related challenges and patient experiences, suggesting that application-based activities can support patient-centred learning in pharmacy curricula.
Abstract Introduction Hemophagocytic lymphohistiocytosis (HLH) is a severe, difficult-to-diagnose syndrome of excessive immune activation. Primary HLH is the result of a genetic mutation, while secondary HLH is acquired, triggered by malignancy, infection, or autoimmune disease. Sustained immune activation leads to a proinflammatory cytokine cascade, causing multiorgan dysfunction. We present a notable finding of foamy histiocytes in the cerebrospinal fluid (CSF), coupled with the absence of hemophagocytes on bone marrow biopsy, highlighting a rare diagnostic discordance. Case Report A 31-year-old female with recurrent nephrolithiasis, autoimmune hepatitis, and primary biliary cholangitis presented with flank pain. She was diagnosed with obstructive nephrolithiasis and underwent nephrostomy tube placement. Subsequently developing encephalopathy, fever, and tachycardia prompting ICU admission. She developed pancytopenia which prompted bone marrow biopsy. Her clinical deterioration raised concern for HLH, prompting transfer to a tertiary center for chemotherapy.Upon arrival, she was intubated for encephalopathy and respiratory distress. She was started on dexamethasone 10mg, vancomycin, and piperacillin-tazobactam. Hematology initiated etoposide; she met five HLH-2004 diagnostic criteria: fever, splenomegaly, bi-cytopenia, hypertriglyceridemia, and hyperferritinemia. Bone marrow biopsy was normal. A lumbar puncture performed to evaluate her encephalopathy revealed foamy histiocytes, suggestive of HLH.Her multiorgan failure progressed despite appropriate management. She developed bilateral mydriasis, imaging revealed cerebral edema with herniation, suspected secondary to hyperammonemia. Given her poor prognosis, the family elected for hospice care. Discussion This case highlights secondary HLH presenting with the rare finding of foamy histiocytes in CSF despite the absent hemophagocytes on bone marrow biopsy. HLH is a rare and underrecognized, often mimicking sepsis in critically ill patients. Secondary HLH is triggered by infection, malignancy, or autoimmune disease; in this patient, bacterial infection related to nephrolithiasis was most likely.Pathogenesis involves dysregulated cytotoxic T-cell and natural killer cell activity, resulting in uncontrolled cytokine release and multiorgan dysfunction. Neurologic involvement is less common in adults when compared to primary HLH. In our patient, CSF cytology revealed foamy histiocytes, consistent with macrophage activation, even when bone marrow findings were unrevealing. Treatment remains challenging and requires prompt initiation of immunosuppressive therapy tailored to the underlying trigger. Despite evolving treatment algorithms, mortality remains high. This case underscores the importance of further research that is necessary to target inflammatory biomarkers to manage HLH. Maintaining a high index of suspicion for HLH and that CSF cytology can provide diagnostic clues, even when bone marrow biopsy is negative. This abstract is funded by: None
