Significance of the Hepatic Falciform Artery.

The authors present a case that highlights the anatomy of the hepatic falciform artery and describes its importance. The hepatic falciform artery is an anatomic variant that arises from the hepatic vasculature and provides arterial communication between the abdominal wall and the liver. It is essential to identify its presence, especially when surgery or embolization is planned for that area.

Aortic Thrombus Extending to Left Subclavian in a Patient With Diffuse Venous Thromboembolism on Aromatase Inhibitor Therapy.

Concomitant arterial and venous thrombosis is an infrequent event often associated with malignancy, hyperhomocysteinemia, and thrombophilic conditions. Some overlapping pathophysiology mechanisms suggest an association between arterial and venous thrombosis. It is reported that thrombosis in the arterial and venous systems develops through distinct mechanisms affecting inflammatory and oxidative pathways.

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.

Perspectives on Heyde's Syndrome and Calcific Aortic Valve Disease.

Heyde's syndrome is a multisystem disorder describing the association between calcified aortic stenosis, gastrointestinal tract bleeding from arteriovenous malformations, and acquired von Willebrand syndrome. Several studies have reported an increase in prevalence of gastrointestinal arteriovenous malformation in patients with aortic stenosis and vice versa; however, the incidence of Heyde's syndrome remains controversial. In general, the syndrome is prevalent in the elderly population.

Operative Confidence Among U.S General Surgery Residents.

Background: General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors.

Methods: A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs.

An Uncommon Rash in the Emergency Department: Sporothrix schenckii.

The authors present a case of diagnosed in the emergency department, based on a thorough history. The patient presented with skin nodules that had spread proximally up the arm in various stages of healing. He reported minimal pain for the unhealed ulcer and no pain for the healing ulcers, and no other concerning symptoms.

Update on the Cardiovascular Benefits of Sodium-Glucose Co-Transporter-2 Inhibitors: Mechanism of Action, Available Agents and Comprehensive Review of Literature.

Despite the currently established treatment for heart failure (HF), HF remains a growing public healthcare problem with an increasing burden. Therefore, novel therapeutic innovations are needed to overcome this issue and improve HF prognosis. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are state-of-the-art in type 2 diabetes mellitus management.

Bilateral Pulmonary Emboli on Dabigatran.

We present the case of a 44-year-old female who presented to the emergency department (ED) via emergency medical services with a chief concern of shortness of breath and was found to have bilateral pulmonary emboli (PE) while taking the direct oral anticoagulant dabigatran. The authors highlight the importance of considering PE even in patients who are on anticoagulation.

Emphysematous Cholecystitis Secondary to Fusobacterium nucleatum.

may be implicated in cases of emphysematous cholecystitis (EC) and carries a high mortality risk, especially in individuals with heart disease, renal insufficiency, and underlying malignancy.  infections are rarely detected in the setting of cholecystitis possibly due to the difficulty with properly culturing the bacteria. We describe a case of a patient with EC in whom blood cultures were positive for growth of in one of two samples.

Adult Anomalous Left Coronary Artery Arising From the Pulmonary Artery (ALCAPA) Syndrome as First Presentation With Atrial Fibrillation in a Marathon Runner.

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) syndrome is a very rare congenital heart disease with an incidence of one in 300,000 and a high rate of mortality early in life if left untreated. Adult-type ALCAPA presents when significant collaterals develop from the right coronary artery (RCA) to the left coronary artery (LCA). Even with the collaterals, chronic sub-endocardial ischemia occurs in most cases, and patients die from sudden cardiac death.

Characteristics and outcomes of diabetic patients with acute exacerbation of COPD.

Rationale Aims And Objectives: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and diabetes mellitus form a special population due to an increased risk of hyperglycemia from the use of corticosteroids. There is limited data regarding specific outcomes in diabetic patients with AECOPD.

Methods: A retrospective data analysis of adult patients admitted to North Florida Division of the Hospital Corporation of America (HCA Healthcare) with a primary or secondary diagnosis of AECOPD from January 1, 2018, to December 31, 2018.

Impact of COVID-19 on the mental health of US college students.

Background/aim: In the beginning of 2020, the novel Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus, became a public health emergency in the U.S. and rapidly escalated into a global pandemic.

Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study.

Background And Objectives: Maternity care training is a standard requirement for all family medicine residents, and family physicians play a critical role in the US maternity care workforce. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) updated the required obstetrical experience during family medicine residency training from a volume-based to a competency-based requirement of 200 hours (2 months rotation). This study aimed to determine if family medicine resident maternity care training experience differed after this change in requirements.

Cardio-oncology: Capecitabine Can Sometimes be Heatbreaking Capecitabine-Induced Takotsubo Cardiomyopathy Case Report and Literature Review.

Capecitabine has been more recognized for its cardiotoxicity with an incidence that varies widely. It demonstrates its toxicity in the forms of acute coronary syndrome, arrhythmias and, to a lesser extent, cardiomyopathy. There are several proposed theories including coronary vasospasm, endothelial injury, and oxidative stress.

Cardiovascular Outcomes With Anti-Inflammatory Therapies: Review of Literature.

Inflammation is a major contributing factor in the development of cardiovascular disease (CVD) and has been a popular topic of discussion as it provides a potential therapeutic target to reduce disease progression. Multiple inflammatory markers have been linked with progressive atherosclerosis which includes interleukin-6, tumor necrosis factor-α, C-reactive protein amongst others, this article aims to review current literature to evaluate the effectiveness of anti-inflammatory therapies in cardiovascular disease.

Mechanical Circulatory Assist Devices: Available Modalities and Review of Literature.

Despite advancements in the field interventional cardiology, the prognosis in patients who suffer from cardiogenic shock is poor. Over the years, the use of percutaneous mechanical circulatory support (MCS) devices has increased with the aim to improve short- and long-term outcomes. In this article, we aim to review the different modalities available for MCS devices and current literature comparing their uses.

Erythema ab igne: Toasted Skin Syndrome.

Introduction: Erythema ab igne is a benign skin condition caused by long-term exposure to infrared radiation and/or heat. Erythema ab igne begins as a mild erythema over the previously exposed areas and develops into an erythematous reticulated hyperpigmentation with scaling and telangiectasias.

Clinical Findings: A 55-year-old female presented to the primary care clinic with concerns due to the development of a rash on her lower back in the previous 1 to 2 weeks.

Hematemesis Secondary to Complex Incarcerated Pantaloon Hernia.

Hematemesis with concomitant small bowel obstruction is an uncommon emergency department presentation. We report the case of a patient who presented with hematemesis and an incarcerated pantaloon hernia. While the patient initially had intact bowel movements and flatus, he eventually developed complete obstruction that required open surgical repair.

Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians in the United States.

Background: Emergency medicine (EM) physicians have been on the front line of the COVID-19 pandemic. This study aims to determine the impact of COVID-19 pandemic and other related factors such as resource availability and institutional support on well-being, burnout and job-satisfaction of EM physicians in the United States.

Methods: A cross-sectional survey study of EM physicians was conducted through the Emergency Medicine Practice Research Network of the ACEP.

Outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) utilization in trauma patients with and without traumatic brain injuries: A national analysis of the American College of Surgeons Trauma Quality Improvement Program data set.

Background: Hemorrhage remains a leading cause of death among trauma patients. Resuscitative endovascular balloon occlusion of the aorta has grown in popularity as an efficient, less invasive alternative to managing patients with noncompressible hemorrhage. The aim of this study to investigate the clinical outcomes of resuscitative endovascular balloon occlusion of the aorta use in adult civilian trauma patients with and without concomitant traumatic brain injury.

A Rapid Diagnosis and Treatment of a Traumatic Aortic Transection: A Case of Survival to the ICU.

We present the case of a young man with traumatic aortic dissection secondary to a motor vehicle collision. While the differential diagnosis for traumatic injury after a motor vehicle collision can include commonly studied and trained for cases, such as pneumo/hemothorax, pulmonary contusion, splenic laceration, and pelvic fractures, for example, one of the more deadly and hence rare presentations of motor vehicle trauma is aortic transection. The fact that the diagnostic studies included as part of the initial Advanced Trauma Life Support (ATLS) trauma survey are not well equipped to diagnose such an injury is also a deadly factor.

Acute Management of Trimalleolar Fracture.

Extremity trauma is a common emergency department presentation. The authors report a case of an elderly woman who sustained a trimalleolar ankle fracture. Emergency department care includes stabilization of the fracture with a splint, with careful assessment of neurovascular status.

An Unusual Presentation of Catatonia in Non-alcoholic Wernicke Encephalopathy.

Wernicke encephalopathy (WE) is an acute reaction to thiamine deficiency, which presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. However, thiamine deficiency can also present with several neuropsychiatric signs and symptoms other than the classical triad. We report a patient who presented with catatonia as a presenting feature of WE.

Nine SARS-CoV-2 Positive Pregnant Women and Their Infant Delivery Outcomes.

There are scientific reports from around the world describing the cases of COVID-19. This is a case series reporting outcomes of deliveries from nine mothers with positive SARS-CoV-2 testing at Healthcare Corporation of America hospitals in the United States from January to April 2020. Thirty-three percent of the women had cesarean sections.