Intermittent Sinus Pause/Asystole in the Setting of Anticholinergic Overdose.

Anticholinergic toxicity typically presents with symptoms of cutaneous vasodilation, delirium, mydriasis, urinary retention, hyperthermia, anhidrosis, and tachycardia. This case report presents a 68-year-old female patient who exhibited some of these signs and symptoms after ingesting an unknown quantity of dicyclomine. However, she displayed one notable exception to the classic toxidrome.

Developing a patient toolkit for opioid use and management through co-creation.

Canada has been experiencing an opioid use crisis, and urgent efforts are being made to stem the tide. With funding support from Health Canada, the Association of Faculties of Medicine of Canada (AFMC) recently developed a series of asynchronous online bilingual modules to educate key players across the medical education spectrum on chronic pain and opioid use. The curriculum for the modules which informed the development of the Patient-Physician Partnership Toolkit was co-created through an authentic collaboration between healthcare professionals (HCPs), and patient subject matter experts who were patients with lived experience.

Perceptions of Machine Learning among Therapists Practicing Applied Behavior Analysis: A National Survey.

Unlabelled: Collecting data and logging behaviors of clients who have autism spectrum disorder (ASD) during applied behavior analysis (ABA) therapy sessions can be challenging in real time, especially when the behaviors require a rapid response, like self-injury or aggression. Little information is available about the automation of data collection in ABA therapy, such as through machine learning (ML). Our survey of ABA therapists nationally revealed mixed levels of familiarity with ML and generally neutral responses to statements endorsing the benefits of ML.

Stuck in the Sump: A Rare Complication of Biliary Surgery.

Sump syndrome is a rare complication of biliary surgery that is now rarely seen in the era of Endoscopic Retrograde Cholangiopancreatography (ERCP). It occurs when the distal common bile duct becomes obstructed between an anastomosis from a choledochoduodenostomy (CDD) and the ampulla of Vater, forming a sump that accumulates debris. Sump syndrome should be considered as a diagnosis in patients who present with cholangitis or pancreatitis and any history of biliary diversion, regardless of the time of presentation.

Capnocytophaga Meningitis: A Rare Case of Bacterial Infection With Neurological Manifestation.

We discuss a case of meningitis caused by infection in a previously healthy elderly male who presented with altered mental status and new-onset seizures requiring intensive care. An open wound had served as an entry point for the infectious organism. After 25 days of treatment with meropenem, he recovered with persistent functional limitations and was discharged.

Seizing the Teachable Moment: A Pilot Study of Preventive Lifestyle Education in the Emergency Department.

Background Preventive measures are critical in avoiding and limiting the severity of diseases. Key lifestyle behaviors include sleep hygiene, habitual exercise, a healthy diet, and avoidance of risky substances, particularly the use of tobacco. The transtheoretical model (TTM) of change suggests that patients can move towards healthful changes through education.

Inclisiran as a siRNA Inhibitor of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9); Past, Present, and Future.

Reducing low-density lipoprotein cholesterol (LDL-C) levels has been shown to reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Statins are the foundation of LDL-C lowering therapy with other non-statin agents used in circumstances where goal LDL-C levels are not reached or owing to intolerance to adverse effects of statins. In 2003, the discovery of the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) system in promoting elevated LDL-C levels led to new avenues of drug development to achieve target LDL-C.

Case report: HSV lymphadenitis in immunocompromised patient with CLL.

Background: Richter's transformation (RT) in chronic lymphocytic leukemia (CLL) is associated with poor prognosis and requires prompt modifications in patient care. CLL patients are susceptible to severe infections due to immune dysregulation induced by their malignancy and immunosuppressive therapies.

Case Presentation: We present a case of a 63-year-old man with CLL who previously achieved remission and presented with a right inguinal mass.

Iatrogenic Cardiac Arrest During Thyroid Storm.

Introduction: Thyroid storm is a life-threatening condition with often severe cardiac implications. Correct treatment choices can vary depending on underlying cardiac systolic function.

Case Description: We present a case of a 47-year-old male with untreated Grave's disease who presented with a thyroid storm.

A Systematic Review of the Attitudes, Beliefs, and Acceptance of the COVID-19 Vaccine in the Western and Eastern Hemispheres.

The availability of an effective vaccine does not equate to its use; its effectiveness primarily depends on vaccine acceptance by the targeted population. Despite the rapid development and widespread access to the COVID-19 vaccine, herd immunity is yet to be achieved, with vaccine hesitancy as a major barrier. This study sought to systematically assess the beliefs, attitudes, and acceptance towards COVID-19 vaccines, including factors contributing to vaccination hesitancy in the Eastern and Western Hemispheres.

Impact of an Inpatient Family Medicine Exposure: Changing Student Perception.

Introduction: Currently there is a primary care physician shortage in the United States, and this shortage is expected to worsen into the foreseeable future. In 2023, only 7.5 % of US allopathic graduates entered family medicine (FM) residencies.

Hypoxia-induced PD-L1 expression and modulation of muscle stem cell allograft rejection.

Stem cell therapy has shown immense promise in treating genetic disorders, particularly muscular diseases like Duchenne muscular dystrophy (DMD). This study investigates a novel method to enhance the viability of stem cell transplants in DMD by upregulating Programmed Death Ligand 1 (PD-L1) in muscle stem cells (MuSCs) through preconditioning with hypoxia and/or interferon-γ (IFN-γ) to mitigate T cell immune rejection. MuSCs were treated with 5% hypoxia for 72 h and further treated with IFN-γ to enhance PD-L1 expression.

Re-operation following urgent and emergent colectomies: An investigation of indications and utility as a quality indicator.

Background: For urgent and emergent colectomies, return to the operating room is interpreted as a negative quality indicator. We sought to describe indications, procedures performed, and outcomes of patients undergoing reoperation after colectomy.

Methods: Retrospective study of patients undergoing urgent and emergent colectomy with re-operation at a single institution from 2013 to 2023.

The Effects of Carbonate on Candida albicans Filamentation, Biofilm Formation, and Antifungal Resistance.

Candida albicans, a member of the normal microbial population of healthy humans, is an opportunistic pathogen that can cause serious disease in immunocompromised patients. An important virulence factor of C. albicans is the formation of biofilms.

The future of hypertension pharmacotherapy: Ongoing and future clinical trials for hypertension.

Hypertension is among the most prevalent diagnoses across the world and increases the risk of many serious health problems, such as stroke, heart disease, and kidney disease. Pharmacological approaches to treat hypertension are often required and reduce blood pressure through mechanisms such as vasodilation, inhibition of the renin-angiotensin-aldosterone pathway, and increased urine output to reduce blood volume, among other mechanisms. Further research is ongoing to find novel pathways and mechanisms to treat hypertension, which we summarize in this review.

Explaining key stakeholders' preferences for potential policies governing psychiatric electroceutical intervention use.

In recent years, legislators in many states have proposed laws governing the use of psychiatric electroceutical interventions (PEIs), which use electrical or magnetic stimulation to treat mental disorders. To examine how the PEI views of relevant stakeholder groups (e.g.

Gender variations in 30-day outcomes following cholecystectomy in patients with biliary acute pancreatitis.

Background: Biliary acute pancreatitis (BAP) can be associated with severe morbidity and mortality. This study aims to evaluate whether gender is associated with worse 30-day postoperative outcomes following cholecystectomy for BAP.

Methods: Patients in the ACS-NSQIP database (2014-2017) with a diagnosis of BAP who underwent cholecystectomy were stratified into two groups: male and female.

Primary anaplastic T-cell lymphoma of the omentum presenting as small bowel obstruction and complicated with Massilia timonae infection: a case report.

Background: Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology.

Cephalomedullary Nail Lag Screw Migration Following Open Reduction and Internal Fixation of an Intertrochanteric Femur Fracture in a Patient With Body Mass Index of 63.

Hip fractures are prevalent among the elderly population and are correlated with notable morbidity and mortality. Treatment with intramedullary nails has risen in popularity with good results, however complications can occur. We report on a 62-year-old female with a body mass index of 63 kg/m who presents with cephalomedullary nail lag screw migration following an open reduction and internal fixation of an intertrochanteric fracture, which was subsequently converted to a hip hemiarthroplasty after hardware failure of her cephalomedullary nail.

Persistent Fever in Bilateral Septic Cavernous Sinus Thrombosis: A Case Report.

Septic cavernous sinus thrombosis (SCST) is a rare and life-threatening condition characterized by thrombus formation within the cavernous sinus, typically resulting from the spread of infection from facial, paranasal sinus, or dental origins. We report the case of a middle-aged man with a history of methicillin-resistant Staphylococcus aureus (MRSA) skin infections who presented with severe neck pain, fever, and bilateral eye swelling. The patient was bacteremic with MRSA and found on imaging to have thickening of extraocular muscles and air-fluid levels present within the sphenoid sinuses.

Translation, cultural adaptation, and validation of the PHQ-9 and GAD-7 in Kinyarwanda for primary care in the United States.

Background: Depression and anxiety are significant health burdens that greatly impact the quality of life of refugees and migrants. In this study, we have translated and culturally adapted the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7) into Kinyarwanda and performed a validation study in a United States (US) primary care setting.

Methods: A committee of seven experts including psychiatric and family medicine providers, health researchers, and trained medical interpreters translated and culturally adapted the PHQ-9 and GAD-7, and incorporated feedback from cognitive interviews with bilingual participants.

The genetics of severe depression.

Genome-wide association studies (GWASs) of major depressive disorder (MDD) have recently achieved extremely large sample sizes and yielded substantial numbers of genome-wide significant loci. Because of the approach to ascertainment and assessment in many of these studies, some of these loci appear to be associated with dysphoria rather than with MDD, potentially decreasing the clinical relevance of the findings. An alternative approach to MDD GWAS is to focus on the most severe forms of MDD, with the hope that this will enrich for loci of larger effect, rendering their identification plausible, and providing potentially more clinically actionable findings.