Atypical Thyroid Stimulating Hormone Levels in Myxedema Coma Complicated by Severe Sepsis.

Most cases of Myxedema Coma are associated with primary hypothyroidism characterized by significantly elevated thyroid stimulating hormone (TSH) levels. However, this case presents an atypical manifestation of myxedema coma with low TSH levels despite severe hypothyroidism. The rarity of this presentation lies in the absence of central lesions typically responsible for such TSH suppression.

Home Treatment for Low-risk Pulmonary Embolism: Is it Happening?

Patients with pulmonary embolus (PE) can be stratified into low, intermediate, and high risk based on such factors as hemodynamics and the status of the right ventricle. Low risk patients who meet appropriate criteria can potentially be discharged home with oral anticoagulation, avoiding unnecessary hospitalization and associated complications and costs. However, limited data suggest early discharge of low-risk patients has not gained widespread traction.

Hidradenitis Suppurativa and Peripheral Ulcerative Keratitis.

The co-occurrence of inflammatory eye disease and hidradenitis suppurativa (HS) is uncommon; ocular involvement typically manifests as anterior uveitis. In this report, we present a unique case of peripheral ulcerative keratitis (PUK) where both infectious and rheumatological workup was negative, leading us to consider the possibility of an association between this condition and severe HS. As far as we are aware, there have only been six documented cases of PUK associated with HS.

Beneath the Surface: Diagnosing Gastric Linitis Plastica.

Gastric Linitis plastica is characterized by extensive infiltration of gastric wall by poorly differentiated tumor cells, creating a "leather-bottle stomach" appearance. We describe a case involving a 71-year-old male presenting with globus sensation, early satiety and weight loss. Recent EGD had revealed chronic gastritis with polypoid mucosa at the GE junction, and subsequent FDG-PET indicated asymmetric FDG localization.

Isolated Alkaline Phosphatase Elevation in Severe Osteoporosis Treatment: Implications of Teriparatide.

In severe osteoporosis, anabolic agents such as teriparatide (Forteo) are more commonly used. As a PTH analog, teripararide has a limited side effect profile with potential for mild hypercalcemia and dyspepsia. In this report we highlight another less common side effect, asymptomatic elevation in alkaline phosphatase.

Lymphocytic Gastritis in a Patient With Microscopic Colitis: A Case Report.

Lymphocytic gastritis (LG) is a rare form of gastritis characterized by lymphocytosis in the gastric mucosa, while microscopic colitis (MC) is the chronic inflammatory disease of the large intestine with lymphocytic or collagenous colitis as two distinct histologic forms. These lymphocytic disorders of the gastrointestinal tract (GIT) have various associations, commonly gluten-sensitive enteropathy, infection and while others are less commonly associated. We report a case of a 24-year-old patient with concomitant lymphocytic gastritis and microscopic colitis diagnosed via histopathologic analysis of tissue specimens from stomach and colon.

Recurrent Hypoglycemia in a Patient with Advanced Hepatocellular Carcinoma.

Background: Nonislet cell tumor hypoglycemia (NICTH) is a rare but serious complication of malignancy. Various causes of this type of hypoglycemia include excessive tumor burden resulting in destruction of the liver or adrenal glands, production of autoantibodies against insulin and tumoral production of incompletely processed IGF-2.

Objectives: Objective of this case report is to explore pathogenic mechanisms for hypoglycemia in hepatocellular carcinoma (HCC), and evidence-based treatment options.

Outcomes of Low Barrier Hepatitis C Treatment in High Risk Populations From Primary Care.

Hepatitis C (HCV) can be treated in the primary care setting; however, most patients are referred to subspecialists. Marginalized populations may be refused treatment due to stigma or substance use. We aimed to treat HCV in these high-risk patients, and prevent a delay in time from diagnosis to the time of treatment and sustained virologic response (SVR), by utilizing a multidisciplinary treatment team in a primary care clinic.

New Era - Same Perspective.

Brief history of JCHIMP, future direction and acknowledgement of our 2023 reviewers and sources of our authors.

A Rare Case of Anti-Caspr2 Autoimmune Encephalitis Associated with a Testicular Mixed Germ Cell Tumor.

Paraneoplastic limbic encephalitis (PLE) is a poorly understood condition, thought to be caused by the cross-reacting of tumor antibodies with neurons in the brain, resulting in neuropsychiatric sequelae, such as personality and behavioral changes, psychosis, memory loss, and seizures. Anti-contactin-associated protein-like 2 (CASPR2) antibodies can cause PLE in patients with particular tumors, which in most cases can be identified as thymoma, lung cancer, or endometrial cancer. Some case reports show rare instances with other tumors, such as throat or sigmoid carcinoma.

Type B Aortic Dissection Secondary to Non-typhoidal Salmonella Aortitis: A Case Report and Literature Review.

Infectious aortitis is an uncommon but potentially fatal condition that can lead to aortic dissection or rupture. We describe a case of a 69-year-old female who developed a Stanford type B aortic dissection, presumptively caused by Salmonella, which was successfully managed with thoracic endovascular aneurysm repair (TEVAR) and long-term antibiotics. A literature review of 17 reported cases from 2000 to 2024 of aortic dissection secondary to infectious aortitis was conducted.

Review of Attributes and Outcomes of Hospitalized Patients with Alcohol Withdrawal.

Background: Alcohol abuse leads to millions of hospital admissions each year in the United States. Alcohol withdrawal syndrome (AWS) is associated with several serious complications, including seizures, delirium tremens, and death. Benzodiazepines have been the mainstay of treatment for hospitalized patients with alcohol withdrawal.

The Diagnostic and Therapeutic Dilemma of Multiple Left Ventricular Masses.

Intracardiac masses are rare and potentially life-threatening entities with diverse clinical presentations. The prompt identification of cardiac masses is critical. However, even with the advancement we have in imaging modalities, diagnosing cardiac masses remains a formidable challenge.

Dieulafoy's Lesion in the Esophagus Causing Gastrointestinal Bleeding: A Concise Review.

Dieulafoy's lesion (DL) is an uncommon cause of life-threatening gastrointestinal (GI) bleeding. It can occur in any part of the GI tract, including the stomach, duodenum, colon, and esophagus. Dieulafoy's lesion in the esophagus (DLE) is an exceedingly rare entity, with only 23 case reports/series (27 patients) reported to date.

Current practice of using the airway pressure release ventilation mode in acute respiratory distress syndrome patients among respiratory therapists in Saudi Arabia.

Background: There is a limited data examining the practice of using the airway pressure release ventilation mode for patients with acute respiratory distress syndrome among respiratory therapists.

Objectives: To evaluate the current practice and barriers when using airway pressure release ventilation mode in the management of patients with acute respiratory distress syndrome.

Methods: A cross-sectional online survey was disseminated between November 2022 and April 2023 to respiratory therapists in Saudi Arabia.

Area-Specific Assessment of Stratum Corneum Hydration and Transepidermal Water Loss in Pediatric Patients With Atopic Dermatitis.

SCORring atopic dermatitis (SCORAD) is widely used to assess the severity of atopic eczema, but score systems based on the entire body may be limited in effective monitoring and intervention. It is crucial to monitor moisture levels in each affected body part, but empirical research is still lacking. The objective of this study was to analyze the levels of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in atopic dermatitis (AD) patients, focusing on the presence and location of atopic lesions at different body sites.

Age-stratified trends and outcomes of inpatient cholecystectomy for acute cholecystitis in the United States.

Background: The elderly population in the United States is rapidly expanding. Older patients over age 65 with acute cholecystitis may face greater perioperative risk compared to younger patients undergoing urgent laparoscopic cholecystectomy. We aimed to characterize trends in utilization and outcomes of inpatient cholecystectomy across the United States stratified by age.

Outcomes and predictors of unplanned intensive care unit admission for pediatric trauma patients.

Background: Unplanned intensive care unit (ICU) admission (UIA) is associated with increased morbidity in adult trauma patients, however, is not well studied in pediatric trauma patients (PTPs). We sought to identify predictors of UIA, hypothesizing PTPs with UIA have increased odds of mortality.

Methods: The 2017-2019 Trauma Quality Improvement Program (TQIP) database was queried for PTPs ≤16-years-old admitted to non-ICU level of care.

Microphysiological system to address the opioid crisis: A novel multi-organ model of acute opioid overdose and recovery.

Opioids have been the primary method used to manage pain for hundreds of years, however the increasing prescription rate of these drugs in the modern world has led to a public health crisis of overdose related deaths. Naloxone is the current standard treatment for opioid overdose rescue, but it has not been fully investigated for potential off-target toxicity effects. The current methods for pharmaceutical development do not correlate well with pre-clinical animal studies compared to clinical results, creating a need for improved methods for therapeutic evaluation.

A Design Review for Biomedical Wireless Power Transfer Systems with a Three-Coil Inductive Link through a Case Study for NICU Applications.

This paper outlines a design approach for biomedical wireless power transfer systems with a focus on three-coil inductive links for neonatal intensive care unit applications. The relevant literature has been explored to support the design approach, equations, simulation results, and the process of experimental analysis. The paper begins with a brief overview of various power amplifier classes, followed by an in-depth examination of the most common power amplifiers used in biomedical wireless power transfer systems.

Venom immunization: IgG/IgE titers, safety, risk, and methods of the VIPRBITEM cohort.

Background: This is the first study to examine a cohort that engages in the practice of immunization with snake venoms. In this practice, either fresh wet venom or venom reconstituted from freeze-dried form is used in vaccination protocols to produce hyper-immunity to venom.

Methods: This is a retrospective community-initiated collaborative research (CICR) project that collated the records of venom immunization.

Data-driven discovery of associations between prescribed drugs and dementia risk: A systematic review.

Abstract: Recent clinical trials on slowing dementia progression have led to renewed focus on finding safer, more effective treatments. One approach to identify plausible candidates is to assess whether existing medications for other conditions may affect dementia risk. We conducted a systematic review to identify studies adopting a data-driven approach to investigate the association between a wide range of prescribed medications and dementia risk.

Perspective: Minimally clinically important "symptomatic" benefit associated with disease modification resulting from anti-amyloid immunotherapy.

Unlabelled: Despite some skepticism regarding the amyloid hypothesis, there is growing evidence that clearing amyloid by targeting specific species of amyloid (plaque, oligomers, fibrils, and protofibrils) for removal has therapeutic benefits. Specifically, there is growing evidence that, in mild cognitive impairment and mild dementia due to Alzheimer's disease (AD), robust and aggressive removal of amyloid can slow cognitive decline as measured by global instruments, composite measures, and cognitive testing. Furthermore, clinical efficacy signals coupled with clear biomarker changes provide the first evidence of disease modification.

Dynamic neurocognitive adaptation in aging: Development and validation of a new scale.

Introduction: Forty-five percent of Alzheimer's disease (AD) cases may have been preventable through protective factors. Reserve, resilience, and resistance share common neurocognitive adaptive processes, acting through protective mechanisms. In this article we propose the development and validation of a new scale, called dynamic Neurocognitive Adaptation, developed in this direction.

Artificial intelligence models assisting physicians in quantifying pancreatic necrosis in acute pancreatitis.

Background: Acute pancreatitis (AP) is a potentially life-threatening condition characterized by inflammation of the pancreas, which can lead to complications such as pancreatic necrosis. The modified computed tomography severity index (MCTSI) is a widely used tool for assessing the severity of AP, particularly the extent of pancreatic necrosis. The accurate and timely assessment of the necrosis volume is crucial in guiding treatment decisions and improving patient outcomes.