Comparison of pooled cohort equation and PREVENT™ risk calculator for statin treatment allocation.

Background And Aims: Effective hypercholesterolemia management is linked to lower all-cause and cardiovascular mortality. The 2018 AHA/ACC guidelines recommended using the Pooled Cohort Equations (PCE) for lipid management, but these may overestimate risk and be less accurate for certain racial groups. The AHA's new PREVENT equation, which omits race and includes cardiometabolic factors, aims to provide a more accurate risk assessment for a diverse population.

Management of Myocardial Infarction: Emerging Paradigms for the Future.

Despite significant advancements in managing acute ST-segment elevation myocardial infarctions, the prevalence of heart failure has not decreased. Emerging paradigms with a focus on reducing infarct size show promising evidence in the improvement of the incidence of heart failure after experiencing acute coronary syndromes. Limiting infarct size has been the focus of multiple clinical trials over the past decades and has led to left ventricular (LV) unloading as a potential mechanism.

An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome.

Intracranial bleeds, such as subarachnoid hemorrhage, carry high morbidity and mortality rates. Often intracranial hemorrhages result in debilitating residual neurological symptoms but can be so extensive that cardiac complications can also be seen. We present a rare case of a patient who was found to have a subarachnoid hemorrhage that incited the development of Takotsubo cardiomyopathy, which subsequently progressed to an acute myocardial infarction.

Type 5 Cardiorenal Syndrome: An Underdiagnosed and Underrecognized Disease Process of the American Mother.

Cardiorenal syndrome (CRS) continues to be an area of concern due to the changing understanding of identification, pathophysiology and optimal management. Originally thought that diuretics were always the answer, recent literature has shed lights on the five major CRS subphenotypes, and while conceptual in their classifications, different strategies may be utilized to manage each type. The effect of CRS in pregnant women is largely under discussed and underappreciated as its own entity.

Preoperative Coronary Intervention Before Orthotopic Liver Transplantation (from a Review of Literature).

There is significant morbidity and mortality associated with the presence of coronary artery disease (CAD) in the setting of orthotopic liver transplantation in patients with end-stage liver disease. The prevalence of CAD in this cohort is similar to, if not higher, than the general population. Several studies show improved survival rates for patients with obstructive CAD who undergo percutaneous coronary intervention (PCI) and support a low threshold for PCI in these patients.

Does the ISCHEMIA Trial Apply to My Patients?

Purpose Of Review: The ISCHEMIA trial demonstrated no difference in myocardial infarction or death in patients with stable coronary disease and moderate or large ischemia territory treated either with invasive revascularization or optimal medical therapy. Whether the findings of the randomized control trial relates to real-world outcomes is uncertain.

Recent Findings: Contemporary guideline-directed medical therapy has had a significant impact on the prognosis of coronary artery disease.

Eculizumab as a Treatment for Hyper-Haemolytic and Aplastic Crisis in Sickle Cell Disease.

Background: Patients with sickle cell disease can experience various crises including sequestration crisis, haemolytic crisis and aplastic crisis. Due to alloantibody formation, transfusion alloantibodies can cause a haemolytic crisis. Treatment involves avoiding packed red blood cell transfusions, as well as intravenous immunoglobulin, steroids and eculizumab to decrease the chances of haemolysis.

Empyema Induced by Dental Abscess: A Case Report.

is a gram-positive catalase-negative cocci and commensal flora of the oropharynx and gastrointestinal tract. is known to be highly virulent and known to cause invasive pyogenic infection which may necessitate emergent surgical treatment. We present a case of a 53-year-old female with dental caries and uncontrolled diabetes mellitus who presented with progressive shortness of breath for 1 week.

Inpatient glycemic control and outcome of COVID-19 patients: A retrospective cohort.

Objectives: Although there have been associations between diabetes and mortality in COVID-19 patients, it is unclear whether this is driven by the disease itself or whether it can be attributed to an inability to exhibit effective glucose control.

Methods: We conducted a retrospective cohort study of 292 patients admitted to a tertiary referral center to assess the association of mortality and glycemic control among COVID-19-positive patients. We used a logistic regression model to determine whether average fasting glycemic levels were associated with in-hospital mortality.

Outcomes of Renal Function in Cardiogenic Shock Patients With or Without Mechanical Circulatory Support.

Background: The objective of the study was to compare the renal outcomes in patients presenting with all-cause cardiogenic shock who were supported by either Impella devices (Abiomed, Danvers, MA), intra-aortic balloon pump (IABP), or vasopressors alone. Outcomes of cardiogenic shock remain poor even with the advancement of early revascularization and circulatory supportive care. Percutaneous mechanical circulatory support (MCS) device has emerged as an effective strategy in protecting end organ function especially renal function during high risk percutaneous coronary intervention (PCI) and in patients with cardiogenic shock.

Use of Impella CP Device in Off-Pump Coronary Artery Bypass Graft Surgery.

Off-pump coronary artery bypass grafting (OPCABG) may be performed on patients with high surgical risk who are poor candidates for traditional mechanical circulatory support. Hemodynamic support with micro-axial mechanical circulatory devices has been performed with limited but promising results.We report a case of a 66-year-old male with multiple comorbidities and low cardiac output undergoing OPCABG.

Mechanism and Effect of Beta-Blockers on Pancreatic Adenocarcinoma: A Literature Review.

Pancreatic adenocarcinoma has a poor 5-year survival rate despite many advancements in pharmacotherapies. Studies have suggested the involvement of β-adrenergic pathway in the progression of pancreatic adenocarcinoma. Animal experiments and retrospective trials have reported the use of beta-blockers as potential chemo-preventative agents.

Mixed Cryoglobulinemia Syndrome (MCS) due to untreated hepatitis B with uncommon presentation: case report and literature review.

Background: The mixed cryoglobulinemia (MC) syndrome is a systemic inflammatory syndrome that causes small-to-medium vessel vasculitis due to cryoglobulin-containing immune complexes most commonly caused by chronic hepatitis C virus (HCV), and rarely by chronic hepatitis B virus (HBV). Its clinical presentation is significantly varied, with manifestations ranging from purpura, arthralgia, and myalgia to more severe neurologic and renal involvement. Pulmonary involvement as organizing pneumonia, alveolar hemorrhage, and pulmonary vasculitis have been reported, but appear to be quite rare.

Focal Neurological Seizure due to Hyperglycemic Hyperosmolar Non-Ketotic Syndrome in Undiagnosed Diabetes Mellitus.

Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) is a life-threatening complication of type 2 diabetes mellitus with a wide range of presenting symptoms. Neurological symptoms, such as coma, can also be part of the manifestation of HHNS; however, focal seizures remain a rare but notable association.  A 85-year-old male patient with no history of diabetes presented to our emergency department complaining of a two-day history of twitching movements of his left wrist.

Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction.

According to the World Health Organization, cardiovascular disease is the number one cause of death globally, claiming millions of lives each year with an increasing prevalence. Myocardial infarction (MI) makes up a large sum of these deaths each year. While MI in itself is lethal, there are several complications that can increase the morbidity and mortality of an MI, such as left ventricular wall rupture and aneurysms.

Meningitis from invasive in a healthy young adult.

is well known to be a potential etiology of bacterial meningitis in neonates. Invasive has been also reported in nonpregnant adults. Among adults, the incidence of invasive group B Streptococcus (GBS) has been increasing 2-4 times in the past 2 decades.

"Do Not Ignore Musculoskeletal Pain"-Initial Presentation of a Rare Malignant Disease: Case Report and Literature Review.

Gray zone lymphoma, also known as B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma, is a rare malignancy with overlapping features of both diffuse large B-cell lymphoma and classical Hodgkin lymphoma. Most commonly mediastinal involvement is seen. Extranodal involvement is rare.

Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report.

Respiratory failure is presumptively caused by microvascular thrombosis in some patients with coronavirus disease 2019 (COVID-19) requiring therapeutic anticoagulation. Anticoagulation treatment may cause life-threatening bleeding complications such as retroperitoneal hemorrhage. To the best of our knowledge, we report first case of a COVID-19 patient treated with therapeutic anticoagulation resulting in psoas hematoma due to lumbar artery bleeding.

Aggressive Endocarditis in a Young Healthy Patient: A Case Report.

() is a β-hemolytic coagulase-negative staphylococcus causing skin and soft tissue infections with an increasing incidence. Commonly found as normal flora in the perineal region, has been found in rare cases of infective endocarditis causing increased morbidity and mortality. We present a case of a previously healthy young male diagnosed with -caused infective endocarditis.

Cocaine-Induced Giant Bullous Emphysema.

Background: Emphysematous bullae, defined as airspaces of greater than or equal to one centimeter in diameter, have a variety of etiologies such as tobacco use and alpha-1 antitrypsin being the most common. Emphysematous bullae have also been reported in patients using cocaine usually involving the lung periphery and sparing the central lung parenchyma. We present a case of a male with a history of cocaine abuse found to have a singular giant emphysematous bulla occupying >95% of the right hemithorax requiring video-assisted thoracic surgery (VATS) with a favorable outcome.

Amiodarone-Induced Thyroid Storm Causing Sustained Monomorphic Ventricular Tachycardia Treated With Plasmapheresis: A Challenging Clinical Case.

Thyroid storm is a rare endocrine emergency with a high mortality rate approaching 20%. It manifests with the exaggerated symptoms of hyperthyroidism including hyperpyrexia, hypotension, cardiac arrhythmias, and death. The mainstay of treatment includes supportive intensive care and initiation of thionamides, beta blockers, corticosteroids, and if necessary anti-arrhythmics in the presence of refractory ventricular arrhythmias.

Management of Acute Kidney Injury in the Setting of Acute Respiratory Distress Syndrome: Review Focusing on Ventilation and Fluid Management Strategies.

Acute respiratory distress syndrome (ARDS) is a major cause of mortality in adults with acute hypoxic respiratory failure and can predispose those afflicted to develop acute kidney injury (AKI). In the setting where AKI and ARDS overlap, incidence of mortality, length of intensive care unit stay, and complexity of management increases drastically. Lung protective ventilation strategy and conservative fluid management are the main focus of therapy in patients with ARDS, but have major implications on renal function.