Haemophagocytic lymphocytic histiocytosis/macrophage activation syndrome with acute inflammatory gastroenteritis.

Haemophagocytic lymphocytic histiocytosis (HLH) is a rare, life-threatening condition caused by abnormal activation of cytotoxic T lymphocytes, natural killer cells and macrophages resulting in hypercytokinaemia and immune-mediated injury of multiple organ systems. Secondary HLH occurs in the setting of a malignant, infectious or autoimmune stimulus. Macrophage activation syndrome (MAS) is the term used to describe HLH that develops secondary to rheumatological diseases such as lupus and juvenile idiopathic arthritis, among others.

A case of superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome, also known as Cast syndrome, Wilkie's syndrome, or duodenal ileus, is a rare condition involving compression of the duodenum between the aorta and the SMA, primarily attributed to loss of the intervening mesenteric fat pad. Clinical symptoms include postprandial epigastric abdominal pain, nausea, emesis, and weight loss. At-risk individuals include those with rapid weight loss, debilitating illness, malignancy, malabsorption syndromes, trauma, neurologic injury, eating disorders, and substance abuse.

Intrathecal Fentanyl With a Paracervical Block Is Safe and Effective for Elective Termination of Pregnancy in a Patient With Primary Pulmonary Hypertension.

Pulmonary hypertension (PH) in pregnancy, irrespective of etiology, is associated with significant maternal morbidity and mortality. This case describes a novel approach to providing anesthesia for a hemodynamically fragile patient. It demonstrates the careful planning and weighted decision-making that is required when approaching a parturient with severe pulmonary hypertension.

An objective metric of individual health and aging for population surveys.

Background: We have previously developed and validated a biomarker-based metric of overall health status using Mahalanobis distance (DM) to measure how far from the norm of a reference population (RP) an individual's biomarker profile is. DM is not particularly sensitive to the choice of biomarkers; however, this makes comparison across studies difficult. Here we aimed to identify and validate a standard, optimized version of DM that would be highly stable across populations, while using fewer and more commonly measured biomarkers.

Proteins in the pathway from high red blood cell width distribution to all-cause mortality.

Background: The pathophysiological mechanisms underlying the association between red blood cell distribution width (RDW) and all-cause mortality are unknown. We conducted a data-driven discovery investigation to identify plasma proteins that mediate the association between RDW and time to death in community-dwelling adults.

Methods: At baseline, 962 adults (women, 54·4%; age range, 21-98 years) participated in the InCHIANTI, "Aging in the Chianti Area" study, and proteomics data were generated from their plasma specimens.

A Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia.

SARS-CoV-2, which originated in China in late 2019, has spread rapidly resulting in a global pandemic. Multiple vaccines have been developed to help prevent COVID-19 infection. Similar to other vaccines, common side effects including fever, fatigue, myalgias have occurred; however, episodes of more serious side effects have been noted.

Murmur on top of the head: bioprosthetic mitral valve insufficiency.

In 1961, K Merendino 'in pure curiosity', while tracking the murmur of mitral regurgitation, placed his stethoscope 'on the vertex of the head', and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the 'Murmur on Top of the Head' building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves.

Recurrent Dysphagia Associated with Esophageal Intramural Pseudodiverticulosis.

Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder of the esophagus characterized by the presence of outpouching flask-shaped lesions. These lesions represent false lumens that may be scattered throughout the esophageal wall. We present a rare case of EIPD complicated with esophageal strictures.

Legionella Coinfection in a Patient With COVID-19 Pneumonia.

Bacterial superinfection is a well-reported complication of viral pneumonia leading to significantly increased morbidity and mortality. Such superinfections have been reported in patients with pathogenic coronaviruses including severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), but there are scant reports pertaining to superinfection in the context of coronavirus disease 2019 (COVID-19). We report a case of a middle-aged man who presented with worsening shortness of breath in the context of COVID-19 complicated by superimposed pneumonia.

A case of Guillain-Barre syndrome following Pfizer COVID-19 vaccine.

Since the first-reported case of Severe Acute Respiratory Distress Syndrome-Coronavirus 2 in December 2019, COVID-19 has caused a global pandemic associated with significant morbidity and mortality. After a year of advances in vaccine research and development, three vaccines for the prevention of COVID-19 (manufactured by Pfizer, Moderna and Johnson & Johnson's Janssen Biotech) are approved for use in the USA. We report the first case of Guillain-Barre Syndrome after receiving the second dose of the Pfizer COVID-19 vaccine, in a 42-year-old woman presenting with progressive ascending weakness and paresthesias.

The 100 Most Mentioned Glaucoma Articles Online With Highest Altmetric Attention Scores.

Prcis: Characteristics of the most mentioned glaucoma articles on the internet were analyzed, allowing a better understanding of the dissemination of glaucoma research to the general public.

Purpose: The aim was to determine the 100 most mentioned articles on the internet in the field of glaucoma and analyze their characteristics.

Materials And Methods: We identified the top 100 glaucoma articles with the highest Altmetric Attention Score (AAS), an automatically calculated metric for monitoring social media.

Missing PEG tube found at the ileocecal valve.

Percutaneous endoscopic gastrostomy (PEG) tubes are indicated in cases of oropharyngeal or esophageal dysphagia to allow alimentation. Complications are superficial and minor, however obstruction in the setting of PEG migration has been noted. Most obstructions remain proximal, localized to the pyloric or pre-pyloric region, though distal migration to the large intestine, including the cecum, have been noted.

Erratum to "Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage".

[This corrects the article DOI: 10.1155/2021/5555961.].

Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics.

A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest.

A large unruptured ectopic pregnancy.

Ectopic pregnancy carries a significant mortality risk in the first trimester given the increased likelihood of rupture of large embryos. In this report, an otherwise asymptomatic woman presented with amenorrhea and a positive urine pregnancy test. Results included an elevated beta-human chorionic gonadotropin (B-hCG) of 39,947 IU/L and Transvaginal ultrasound suggestive of a 3.

Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage.

Pemphigus vulgaris (PV) is an autoimmune blistering disorder of the skin and mucosal surfaces characterized by acantholysis (loss of adhesion between epidermal cells). Esophageal involvement of PV is an underdiagnosed entity as routine diagnostic endoscopy is not recommended in asymptomatic patients. Dysphagia and odynophagia are common presenting symptoms; however, upper gastrointestinal bleeding (UGIB) associated with esophageal involvement of PV without a history of mucosal blistering is extremely uncommon.

Situs Inversus Totalis in the Neonatal Setting.

Situs inversus totalis (SIT) is a rare condition of complete inversion and mirroring of normal human anatomy. The incidence is approximately 1 in 8,000 to 1 in 25,000 live births. SIT is inherited in an autosomal recessive pattern and is associated with multiple gene mutations.

Role of Radiofrequency Ablation in the Management of Unresectable Pancreatic Cancer.

Pancreatic cancer is one of the most aggressive malignancies of the digestive tract and carries a poor prognosis. The majority of patients have advanced disease at the time of diagnosis. Surgical resection offers the only curative treatment, but only a small proportion of patients can undergo surgical resection.

The Pathophysiology of Gastrointestinal and Hepatic Manifestations of COVID-19.

Coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the sixth international public health emergency. While COVID-19 classically manifests as a respiratory illness, SARS-CoV-2 may infect multiple organ systems and cause a wide array of presentations. The gastrointestinal tract has become increasingly recognized as a site of SARS-CoV-2 infection with reports of diarrhea, nausea, and liver failure, with or without concomitant respiratory involvement.

Severe functional mitral stenosis due to a left atrial myxoma masquerading as asthma.

While cardiac myxomas are the most common primary cardiac tumours, their overall incidence remains rare. Most cases (90%) are sporadic and occur in the third-sixth decades of life with a female predominance and have a specific predilection for the left atrium (75%). While often asymptomatic, clinical presentations depend on the tumour size, architecture and location.

Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients.

Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma.

Preliminary Assessment of a Telehealth Approach to Evaluating, Treating, and Discharging Low-Acuity Patients With Suspected COVID-19.

Background: Telemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the Coronavirus Disease 2019 (COVID-19) pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE).

Objectives: To describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection.

Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.

The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium-with diverse expertise and representation-representing more than half of all hospitals in the state.