Several male animal studies have demonstrated bone-protective effects of dried plum; however, no human male study has evaluated the effect of dried plum on bone health. We conducted a randomized controlled clinical study to test if daily inclusion of 100 g of dried plum in the diet positively influenced bone mineral density (BMD), bone strength, and bone biomarkers in men. Sixty-six men were randomly assigned to one of two daily treatment groups: (1) control (0 g dried plum) or (2) 100 g dried plum. Blood samples were collected at baseline and after 3, 6, and 12 months to assess bone biomarkers. Bone was measured at baseline and after 6 and 12 months via dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Tartrate-resistant acid phosphatase-5b (TRAP5b) and C-terminal collagen cross-link (CTX) levels decreased significantly in the dried plum group at 3-, 6-, and 12-month intervals compared with baseline. No changes were observed in the control group for TRAP5b and CTX levels. Bone-specific alkaline phosphatase levels decreased significantly after 6 and 12 months in the control and dried plum groups. BMD for total body, spine (L1-L4), hip, and ulna did not change in the control and dried plum groups from baseline to 6 or 12 months. In the proximal tibia, endosteal circumferences increased significantly within the dried plum group during the course of treatment. The results suggest that daily consumption of 100 g dried plum for 12 months has modest bone-protective effects in men. ClinicalTrials.gov identifier: NCT04720833.

Traditionally, osteoporosis has been viewed as a disease mostly affecting women, but cases in men are increasing. Fractures due to osteoporosis can lead to a decreased quality of life in vulnerable populations and lead to increased mortality in men. Although several studies of male and female animals and adult women have demonstrated bone protective effects of dried plum (prunes), no human study has evaluated the effect of dried plum on bone health in men. The objective of the current study was to examine the long-term effects of 100 g dried plum on bone density and strength in men. Sixty-six men (50–79 years old) were randomly assigned into two treatment groups for 12 months: (1) 100 g/day of dried plums; (2) control (0 g/day dried plum). Bone mineral density was measured at baseline, 6- and 12-months at the total body, hip, lumbar spine, and ulna via dual-energy x-ray absorptiometry (DXA). Evaluation of volumetric bone density and strength of the left tibia occurred at baseline, 6- and 12-months using peripheral quantitative computed tomography (pQCT). There were no statistically significant changes in bone mineral density (BMD) from baseline to 6 months and 12 months for total body, spine (L1-L4), right and left hip BMD in the control group (0 g/day dried plum) or 100 g/day dried plum group. Modest beneficial effects of dried plums were observed for changes in bone geometry as detected by pQCT including a tendency for BMD to increase as well as increases in periosteal and endosteal circumferences at the 66% region of the tibia, which may promote greater bone strength. Dried plums have the potential to improve bone morphometry of the proximal tibia in healthy adult men when consumed for 12 months. Future studies should examine the impact on men with low bone density to further evaluate the bone protective effects of dried plum in male populations. This study was funded by the California Dried Plum Board.

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Vibrio parahaemolyticus is a gram-negative bacterium that is classically associated with diarrheal illness in the setting of seafood consumption. However, it also has the ability to cause wound infections and septicemia. CASE PRESENTATION: A 67-year-old male with prostate cancer s/p prostatectomy presented to the emergency department complaining of acute left hand pain. He reported slipping and falling off his boat yesterday, landing with an outstretched left hand on an oyster bed. He sustained a laceration to the hypothenar eminence, which he promptly irrigated with hydrogen peroxide. The following morning he noticed erythema surrounding the laceration and streaking up his arm. As such, he presented to an outside ED where he received a tetanus vaccine and was discharged home. He developed malaise and progressively worsening hand pain, so he presented to our ED later that evening. On arrival he was tachycardic and hypotensive. He endorsed subjective fever and chills, but denied diarrhea. He reported no history of hemochromatosis, liver disease, alcohol abuse or diabetes. Physical was remarkable for a 3cm laceration on the left hypothenar eminence with surrounding edema and linear erythema extending proximally to mid-bicep. Labs were significant for leukocytosis with neutrophilic predominance. He was given fluids per sepsis protocol, as well as ceftazidime and doxycycline on admission. He remained tachycardic with a leukocytosis, so MRI of the left upper extremity was pursued and showed complex fluid collections along the hypothenar eminence and dorsum of the radial carpus extending to the triscaphe joint concerning for abscesses. A small hypointense focus in the subcutaneous tissue concerning for a retained foreign body was also noted. Incision and drainage was performed with frank purulent discharge. Blood cultures remained negative. However, wound culture grew vibrio parahaemolyticus. Once he stabilized he was discharged home on ciprofloxacin and doxycycline. DISCUSSION: Non-foodborne vibrio infections, which account for up to one-quarter of vibrio infections, have high morbidity and mortality. Nearly seventy five percent of cases occur in the Gulf Coast states. Surveillance data has shown cases associated with recreational water exposure have the highest hospitalization (77.6%) and mortality (22.4%) rates. Treatment of vibrio parahaemolyticus wound infections often require debridement in addition to antibiotics. In those with risk factors or septicemia a third-generation cephalosporin and tetracycline are recommended. CONCLUSIONS: One should consider vibrio parahaemolyticus infection in patients who have had exposure of a wound to brackish water, especially in those with underlying liver disease, diabetes or alcoholism. Reference #1: Morris, J Glenn. “Vibrio Parahaemolyticus Infections.” UpToDate, 16 Apr. 2018, www.uptodate.com/contents/vibrio-parahaemolyticus-infections?search=vibrio%20parahaemolyticus§ionRank=3&usage_type=default&anchor=H12051994&source=machineLearning&selectedTitle=1∼9&display_rank=1#H3. Reference #2: AM, Dechet, et al. “Nonfoodborne Vibrio Infections: an Important Cause of Morbidity and Mortality in the United States, 1997-2006.” National Center for Biotechnology Information, U.S. National Library of Medicine, 1 Apr. 2008, www.ncbi.nlm.nih.gov/pubmed. Reference #3: Yoder, J S, et al. “Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water Use and Other Aquatic Facility-Associated Health Events--United States, 2005-2006.” Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002)., U.S. National Library of Medicine, 12 Sept. 2008, www.ncbi.nlm.nih.gov/pubmed?term=18784642. DISCLOSURES: No relevant relationships by Ashley Eisner, source=Web Response

Consumption of fruits reduces the risk of chronic diseases such as cardiovascular disease; however, very few studies have investigated the effect of fruit consumption in overweight and obese children. We examined whether consuming dried apple as a snack is a practical solution for weight loss and improves body composition and metabolic markers. Thirty-eight overweight or obese children aged 10 to 16 years were randomly assigned to one of two groups consuming twice daily 120 kcal serving per day of either dried apple or a control snack (muffin) for 8 weeks. Body weight, height, waist circumference, and body composition were determined during an initial visit and after 8 weeks of intervention. Blood samples were collected to measure serum concentrations of blood lipids, glucose, insulin, proinsulin, total adiponectin, and C-reactive protein, as well as total antioxidant capacity and activity of glutathione peroxidase. Body weight increased in the muffin group (P = .01). BodPod and dual-energy X-ray absorptiometry showed that fat-free mass increased (P < .05) only in the muffin group. High-density lipoprotein cholesterol concentration increased (P = .04) after the 8-week treatment within the apple group. Overall, minor differences were detected in growing children who consumed snacks of either dried apples or muffins with similar macronutrient profiles for 8 weeks. Future research should evaluate the effects of consuming fresh apples that include the peel.

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Stroke mimics have been estimated to account for 30% of stroke like presentations. Some potential imitators include seizures, brain tumors, hypoglycemia, demyelinating disease, migraine and syncope. While often overlooked, electrolyte disturbance is an important consideration and should remain on the differential. We present a case of a focal neurologic deficit found to be attributable to polydipsia induced hyponatremia. CASE PRESENTATION: A 41 year old male with a history of anxiety presented to the ED complaining of atypical chest pain, similar to recent episodes that were attributed to panic attacks. He endorsed worsening of his anxiety, new onset polydipsia and urinary urgency. Vitals and physical exam were unremarkable. He was given lorazepam for presumed panic attack. Minutes later he became acutely somnolent. Neurological exam was unremarkable with the exception of repetitive, non-purposeful movements of the bilateral upper extremities and expressive aphasia. CT head, blood glucose, urine drug screen, EKG and troponin were obtained and unremarkable. Labs were significant for hyponatremia of 123 with a serum osmolality of 260 and urine osmolality of 147. He received tPA (tissue plasminogen activator) as stroke could not be ruled out. Subsequent MRI brain and CTA head and neck were negative. EEG was without evidence of seizure. Sodium was slowly corrected over the following two days with 3% saline and desmopressin. This gradual sodium correction led to complete resolution of the patient’s expressive aphasia. He was discharged home with a fluid restricted diet. DISCUSSION: Common precipitants of hypotonic hyponatremia include SIADH, heart failure, cirrhosis and primary polydipsia, as in this patient. While hyponatremia is a common electrolyte disturbance, a focal neurologic deficit is an unusual manifestation. Typically, acute hyponatremia presents with initially with headache, confusion and lethargy. This can lead to seizures and even respiratory arrest. CONCLUSIONS: Acute hyponatremia can present with a focal neurologic deficit, mimicking stroke. In addition to the more common culprits discussed above, electrolyte disturbance is an important consideration in the differential of stroke like symptoms. Reference #1: Hosseininezhad, Mozafar, and Reza Sohrabnejad. “Stroke Mimics in Patients with Clinical Signs of Stroke.” Caspian Journal of Internal Medicine, vol. 8, no. 3, 2017, pp. 213–216., https://doi.org/10.22088/cjim.8.3.213. Reference #2: Wareing, W., et al. “Hyponatraemic Encephalopathy: an Unusual Stroke Mimic.” Case Reports, vol. 2015, no. jan23 2, 2015, https://doi.org/10.1136/bcr-2014-207397. Reference #3: Sterns, Richard H. “Disorders of Plasma Sodium — Causes, Consequences, and Correction.” New England Journal of Medicine, vol. 372, no. 1, 2015, pp. 55–65., https://doi.org/10.1056/nejmra1404489. DISCLOSURES: No relevant relationships by Stephen Clum, source=Web Response No relevant relationships by Ashley Eisner, source=Web Response