A rare case of Wernicke encephalopathy in stage IV gastric cancer.

A 38-year-old male with stage IV gastric adenocarcinoma presented with abdominal pain, nausea, bilious non-bloody vomiting, and lethargy. He was found to have an ileus and was treated appropriately with bowel rest and nasogastric tube decompression. However, the patient was also noted to have confusion and nystagmus. While he was abstinent from alcohol for 20 years, he was found to have Wernicke Encephalopathy (WE) as a result of malnutrition from the underlying malignancy.

Case Report: Three cases of clinically suspected viral myocarditis with recovery of left ventricular dysfunction.

Viral myocarditis is an important cause of non-ischemic cardiomyopathy. Multiple clinical manifestations have been reported, including acute heart failure, cardiogenic shock, and ventricular arrhythmias. We present three patients with clinically suspected viral myocarditis causing acute heart failure. Serum coxsackievirus B antibodies were positive in all three patients. Each case resulted in significant clinical improvement with hemodynamic support and acute recovery of left ventricular ejection fraction. Despite an initial critical presentation concerning for cardiogenic shock, we highlight three cases of clinically suspected coxsackie myocarditis with an excellent short-term prognosis.

Coronary Air Embolism Secondary to Percutaneous Lung Biopsy: A Systematic Review.

To determine mortality and morbidity associated with coronary air embolism (CAE) secondary to complications of percutaneous lung biopsy (PLB) and illicit-specific risk factor associated with this complication and overall mortality, we searched PubMed to identify reported cases of CAE secondary to PLB. After assessing inclusion eligibility, a total of 31 cases from 26 publications were included in our study. Data were analyzed using Fisher's exact test. In 31 reported cases, cardiac arrest was more common after left lower lobe (LLL) biopsies (n=4, 80%, p=0.001). Of these patients who suffered from cardiac arrest, CAE was found more frequently in the right coronary artery (RCA) than other locations but did not reach statistical significance (n=5, 62%, p=0.39). At the same time, intervention in the LLL was significantly associated with patient mortality (n=3, 60%, p=0.010). Of the patients who died, CAE was more likely to have occurred in the RCA, but this association was not statistically significant (n=4, 57%, p=0.33). LLL biopsies have a statistically significant correlation with cardiac arrest and patient death. More research is needed to examine the effect of the air location in the RCA on patient morbidity and mortality.

Accidental Extravasation of Mitomycin C into the Subcutaneous Tissue.

Introduction: Mitomycin C (MMC) is a common chemotherapeutic agent used to treat a variety of solid tumors. Cutaneous adverse events are rare, but MMC is a known vesicant reported to cause tissue necrosis and sloughing, erythema, and ulceration if incorrectly infused into the subcutaneous tissue. Definitive treatment of extravasation injuries due to MMC depends on the severity of the cutaneous manifestation, which includes stopping the infusion, removing the catheter, or possible debridement. Case Presentation: We present the case of a 70-year-old female with extensive soft-tissue injury secondary to extravasation of MMC that required hospital admission and surgical intervention to remove the implantable venous access device. Conclusion: Extravasation injuries caused by vesicant drugs, such as MMC, often present as local skin irritation and inflammation. MMC extravasation may present a wide range of skin and soft tissue manifestations, ranging from erythema to ulcerations to necrosis. This rare but potentially detrimental complication of chemotherapy infusions should be recognized in cancer patients.

Contrast-Induced encephalopathy following diagnostic coronary angiography.

Contrast-induced encephalopathy (CIE) is a rare, reversible complication of coronary angiography that can mimic acute strokes. This case illustrates the diagnostic challenges for a patient presenting with confusion following coronary angiography and raises awareness for CIE as diagnosis of exclusion.

Catching the GIST: Massive Gastrointestinal Stromal Tumor Presenting as Acute Dyspnea.

We present a case of a 55-year-old woman presenting with worsening shortness of breath and constipation over the course of three days. Initial computed tomography scan showed a large, complex abdominal mass with a vascular pedicle and possible pedunculated origin along the inferior aspect of the greater curvature of the stomach. The mass was further evaluated on magnetic resonance imaging showing an active hemorrhage. The patient became hemodynamically unstable and general surgery was consulted for evaluation. Mass resection was performed, and biopsy revealed KIT/CD117+ and DOG1/ANO1+ gastrointestinal stromal tumor staged as T4. Although definitive diagnosis of a gastrointestinal stromal tumor requires biopsy, prompt clinical and radiological recognition is critical for patients to receive definitive treatment of mass resection.

Mortality and length of stay among HIV patients hospitalized for heart failure: A multicenter retrospective study.

Study objective: The purpose of our study was to determine if CD4+ T-lymphocyte count (CD4 count) was inversely associated with inpatient mortality and length of stay (LOS) among patients with HIV hospitalized for acute heart failure. Design: Retrospective cohort study. Setting: HCA hospitals throughout the United States. Participants: 1704 patients with human immunodeficiency virus (HIV) hospitalized for acute heart failure with a documented, time-updated CD4 count. Interventions: Patients were categorized by CD4 count ranges consisting of >500, 200-499, <200 cells/µL. Main outcome measures: A multivariable negative binomial regression was performed with CD4 count as a predictor of length of stay. Multivariable logistic regression was performed with CD4 count as a predictor of mortality. Results: A CD4 count <200 cells/µL was associated with an increased length of stay compared to a CD4 > 500 cells/µL (IRR 1.24, 95 % CI: 1.11 to 1.39, P ≤ 0.01). A CD4 of 200-499 cells/µL was associated with a shorter LOS compared to a CD4 < 200 cells/µL (IRR 0.82, 95 % CI: 0.75 to 0.89, P ≤ 0.01). A CD4 < 200 cells/µL was associated with an increased mortality compared to a CD4 > 500 cells/µL (OR 3.62, 95 % CI: 1.63 to 8.05, P ≤ 0.01). CD4 count was not independently associated with in-patient mortality after adjusting for viral load. Conclusion: A time-updated CD4 count <200 cells/µL on hospital admission was independently associated with increased length of stay. CD4 cell count and viral load are important markers when considering the morbidity and mortality among patients with HIV hospitalized for acute heart failure.

A Systematic Review and Meta-Analysis on Possible Role of Vitamin C in Sepsis.

Sepsis is a substantial healthcare burden, and its management continues to be a major challenge. Prior studies demonstrate conflicting evidence regarding the utility of vitamin C in sepsis. This systematic review and meta-analysis aim to collect data among critically ill patients (sepsis/septic shock), comparing the efficacy of parenteral vitamin C with standard care. A literature review was conducted using databases including PubMed, Web of Science, Google Scholar, and the Cochrane Library to identify randomized controlled trials (RCTs) and observational studies comparing intravenous vitamin C alone or in combination with thiamine or glucocorticoids to the standard of care. We identified 11 RCTs and seven retrospective cohort studies. The primary outcome was 28-day mortality. Secondary outcomes included intensive care unit (ICU) length of stay, change in Sequential Organ Failure Assessment (SOFA) score, duration of vasopressor use, and duration of mechanical ventilation. A total of 18 studies with 4078 patients were included in our final analysis. Overall, we found no mortality reduction in patients treated with vitamin C compared to standard of care (odds ratio (OR) 0.92; 95% confidence interval (CI) 0.78 to 1.09; p = 0.34). Studies that reported a change in SOFA scores, ICU length of stay, duration of mechanical ventilation, or duration of vasopressor use did not show any significant difference between groups. Subgroup analysis with RCT versus observational studies and vitamin C dosage regimens did not show any difference. Among patients with sepsis or septic shock, treatment with vitamin C was not associated with a reduction in mortality, ICU length of stay, change in SOFA score, duration of vasopressor use, or duration of mechanical ventilation. Further studies are needed to demonstrate the potential role of vitamin C in the management of sepsis.

Automated forward and reverse ratcheting of DNA in a nanopore at 5-Å precision.

An emerging DNA sequencing technique uses protein or solid-state pores to analyze individual strands as they are driven in single-file order past a nanoscale sensor. However, uncontrolled electrophoresis of DNA through these nanopores is too fast for accurate base reads. Here, we describe forward and reverse ratcheting of DNA templates through the α-hemolysin nanopore controlled by phi29 DNA polymerase without the need for active voltage control. DNA strands were ratcheted through the pore at median rates of 2.5-40 nucleotides per second and were examined at one nucleotide spatial precision in real time. Up to 500 molecules were processed at ∼130 molecules per hour through one pore. The probability of a registry error (an insertion or deletion) at individual positions during one pass along the template strand ranged from 10% to 24.5% without optimization. This strategy facilitates multiple reads of individual strands and is transferable to other nanopore devices for implementation of DNA sequence analysis.