Biomarkers in Acute Heart Failure Syndromes: An Update.

Heart failure is one of the leading healthcare problems in the world. Clinical data lacks sensitivity and specificity in the diagnosis of heart failure. Laboratory biomarkers are a non-invasive method of assessing suspected decompensated heart failure. Biomarkers such as natriuretic peptides have shown promising results in the management of heart failure. The literature does not provide comprehensive guidance in the utilization of biomarkers in the setting of acute heart failure syndrome. Many conditions that manifest with similar pathophysiology as acute heart failure syndrome may demonstrate positive biomarkers. The following is a review of biomarkers in heart failure, enlightening their role in diagnosis, prognosis and management of heart failure.

Galactin-3 and soluble ST2 as complementary tools to cardiac MRI for sudden cardiac death risk stratification in heart failure: A review.

Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.

Recurrent Metastatic Eccrine Porocarcinoma: A Case Report and Review of the Literature.

BACKGROUND Eccrine porocarcinoma, or malignant eccrine poroma, is a rare primary skin tumor that develops in the sixth and seventh decades of life, and can present as a painless and solitary nodule. Histopathology is required to confirm the diagnosis. A rare case is presented of metastatic eccrine porocarcinoma, occurring four years after surgical excision of the primary scalp tumor, and includes a review of the literature. CASE REPORT A 67-year-old man initially presented with a scalp lesion that was non-painful, exophytic, and pigmented. Following complete excision, histopathology confirmed the diagnosis of eccrine porocarcinoma with clear resection margins. Four years later, he presented with discrete erythematous patches and plaques, in a zosteriform distribution, in the skin of the right neck, shoulder, and chest. A biopsy and histopathology of the skin rash confirmed metastatic eccrine porocarcinoma. A positron-emission tomography-computed tomography (PET-CT) scan identified areas of hypermetabolic activity, with a standardized uptake value (SUV) of 12, and an infiltrating soft tissue tumor in the right suboccipital region. Surgical resection of the suboccipital mass, followed by histopathology, confirmed metastatic eccrine porocarcinoma. During a postoperative ear, nose, and throat (ENT) examination, he was found to have metastases in the right ear canal. The patient received five cycles of chemotherapy, but later developed renal failure and eventually chose palliative care. CONCLUSIONS A rash-like presentation of skin metastasis to the trunk and metastasis to the ear from a primary eccrine porocarcinoma is rare. Early diagnosis and adequate surgical resection are recommended to reduce patient mortality.

An update on the CardioMEMS pulmonary artery pressure sensor.

Heart failure (HF) is one of the most important healthcare issues due to its prevalence, high morbidity and mortality, as well as its economic burden. A shift in the healthcare model towards reducing inpatient hospitalizations might have a significant impact on HF-related costs and quality of life. Recently, wireless monitoring has begun to be an essential part of the management in the patient with HF. The CardioMEMS HF system is one of the best examples pertaining to the success in this field. This article will discuss the CardioMEMS HF system and the rationale behind its development.

Myocardial Infarction following Organophosphorus Compound Poisoning.

We report a 22 year old male who was admitted to our hospital with alleged history of consumption of monocrotophos poison and had presented with chest pain. His electrocardiogram (ECG) had showed ST segment elevation myocardial infarction and troponins were elevated. He also had low cholinesterase levels and was treated with pralidoxime and atropine and his condition improved. Cardiac catheterization showed patent coronaries. Acute coronary syndrome is a rare manifestation of organophosphorus compound (OPC) poisoning. The current case and subsequent review of literature tells us the need for close cardiac monitoring of all patients with OPC poisoning.

Uncommon cause of fungemia in a patient with renal cell cancer: A case report of Candida lusitaniae Fungemia.

INTRODUCTION: We present an interesting case of Candida lusitaniae infection in a patient diagnosed with renal clear cell carcinoma.An 82-year-old male presented with worsening back pain for 1 week. Physical examination including neurologic examination was normal. A computed tomography scan of the abdomen revealed a mass in the right upper pole of the kidney suggestive of a renal neoplasm. Pathology from a percutaneous biopsy of the kidney revealed clear cell carcinoma. During his hospitalization the patient developed fungemia due to C lusitaniae. He was started on fluconazole, which was later switched to caspofungin due to worsening transaminitis. The patient's clinical status improved and repeat blood cultures were negative for fungal growth. CONCLUSION: To our knowledge, this is the first case of C lusitaniae reported in a patient diagnosed with clear cell carcinoma of the kidney.

Triple synchronous primary lung cancer: a case report and review of the literature.

BACKGROUND: Multiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous multiple primary lung cancer describes multiple lung lesions that develop at different times, typically following treatment of the primary lung cancer. Patients with previously treated lung cancer are at risk for developing metachronous lung cancer, but with the success of computed tomography and positron emission tomography, the ability to detect both synchronous and metachronous lung cancer has increased. CASE PRESENTATION: We present a case of a 63-year-old Hispanic man who came to our hospital for evaluation of chest pain, dry cough, and weight loss. He had recently been diagnosed with adenocarcinoma in the right upper lobe, with a poorly differentiated carcinoma favoring squamous cell cancer based on bronchoalveolar lavage of the right lower lobe for which treatment was started. Later, bronchoscopy incidentally revealed the patient to have an endobronchial lesion that turned out to be mixed small and large cell neuroendocrine lung cancer. Our patient had triple synchronous primary lung cancers that histologically were variant primary cancers. CONCLUSIONS: Triple synchronous primary lung cancer management continues to be a challenge. Our patient's case suggests that multiple primary lung cancers may still occur at a greater rate than can be detected by high-resolution computed tomography.

Cystic Lymphangioma of the Colon: Endoscopic Removal beyond the Frontiers of Size.

Cystic lymphangiomas are benign colonic neoplasms arising from the submucosa. Traditionally, endoscopic resection has been described for smaller lesions, while surgery is reserved for larger symptomatic lesions. We present a case of a 69-year-old asymptomatic individual noted to have a cystic lymphangioma of the colon measuring 5 cm, which was successfully removed with endoloop endoscopic resection without any complications.

Cervical Spinal Cord Compression: A Rare Presentation of Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver. Distant metastasis to various organs is well known. Skeletal metastasis is also reported to various locations. Vertebral metastasis has been reported mostly to thoracic spine. However, cervical spinal cord involvement leading to cord compression has been reported very rarely in literature. We present a case of 58-year-old male with liver cirrhosis presenting as neck pain. Further work-up revealed metastatic HCC to cervical spinal cord resulting in acute cord compression. Patient has been treated with neurosurgical intervention.