Unusual Cause of a Cardiac Arrest in a Former African American Collegiate Athlete.

Yamaguchi-variant cardiomyopathy is an underreported but significant cause of cardiac arrest among athletes. We studied the hospital course of one patient who arrived at the emergency department after a sudden cardiac arrest while playing a recreational basketball game. We used the electronic medical record (Epic) to follow the notes, labs, imaging, and procedures that were performed. Although a rare disease, Yamaguchi syndrome should not be overlooked when working up a patient who has suffered a sudden cardiac arrest. Proper knowledge of automatic external defibrillators and basic cardiopulmonary resuscitation principles can have a significant positive impact, and the importance of these interventions should not be overlooked in patients with a sudden cardiac arrest.

Evaluation of the cutaneous expression of IL-17, IL-22, IL-31, and their receptors in canine atopic dermatitis.

Interleukins (IL)-17, IL-22, and IL-31 play roles in human atopic dermatitis (AD), but scant information is available on canine AD. Histopathological assessment for interleukin expression is a challenge due to a lack of canine specific antibodies. To evaluate the mRNA and protein expression of IL-17 and IL-22, and mRNA expression of IL-31 and their receptors in the skin of healthy and atopic dogs, seventeen atopic (10 with and 7 without an active infection) and 13 healthy privately owned dogs were sampled. RNAscope® In situ hybridization (ISH) for IL-17, IL-22, IL-31, and their receptors was performed on archived canine skin samples. Simultaneously, indirect immunofluorescence (IIF) was performed for IL-17 and IL-22. RNAscope® ISH probes were validated by RT-PCR and RNAscope® ISH on cytospin preparations of peripheral blood mononuclear cells from atopic dogs. IL-17, IL-22, IL-31, and their receptors were successfully detected by RNAscope® ISH and by IIF (IL-17 and IL-22) in both atopic and healthy canine skin. There was no significant difference in the expression of interleukins and their receptors between healthy and atopic skin with or without active infection. Data from both methodologies were similar. The role and the relationship among those proteins in atopic skin is unclear from this study results. Data from IIF and ISH were overlapping and support each other. Fresh skin samples taken at different times during the development of atopic dermatitis might better assess the role that interleukins and their receptors play in AD.

Evaluation of the cutaneous inflammatory cells in dogs with leishmaniosis and in dogs without the disease that were naturally infected by Leishmania infantum (syn. L. chagasi).

BACKGROUND: Canine leishmaniosis (CanL) is associated with an aberrant cutaneous immune response. Few studies have compared cutaneous immune cells among dogs with leishmaniosis or infected without leishmaniosis, and noninfected dogs. HYPOTHESIS/OBJECTIVE: Evaluate the number of neutrophils, histiocytes, T lymphocytes, T-bet-positive, GATA3-positive, FoxP3-positive and interleukin (IL)-17-positive cells, in lesional (Group A) and normal-looking (Group B) skin of nine dogs with stage II/III leishmaniosis; in normal-looking PCR-positive (Group C; n = 6) or PCR-negative (Group D; n = 6) skin of infected dogs; and in the normal-looking skin of 12 noninfected dogs (Group E). METHODS AND MATERIALS: Diagnosis of CanL considered clinical signs, clinicopathological abnormalities, detection of Leishmania amastigotes in lymph nodes, and/or bone marrow and positive serological results. Paraffin-embedded skin biopsies were processed for routine immunofluorescence and positive cells were identified using commercially available anti-canine antibodies. RESULTS: In Group A, there was a significantly higher number of neutrophils (P < 0.001), histiocytes (P = 0.012), T lymphocytes (P = 0.011), GATA3-positive (P = 0.02) and IL-17A-positive (P = 0.002) cells compared to Group E. In Group B, there was a significantly higher number of histiocytes (P = 0.02), T lymphocytes (P = 0.004), GATA3-positive (P = 0.006) and FoxP3-positive (P = 0.028) cells compared to Group E. There was no difference in between groups A and B and between groups C or D and E. CONCLUSIONS AND CLINICAL IMPORTANCE: In the lesional and/or normal-looking skin of dogs with moderate/severe CanL there is an infiltration of neutrophils, histiocytes, T lymphocytes, GATA3-, FoxP3- and IL17A-positive cells. By contrast, the number of these cells is not increased in the normal-looking skin of infected dogs without CanL compared to the skin of noninfected dogs.

Patient Safety during Rapid Sequence Intubation When Using Succinylcholine Instead of Nondepolarizing Paralytic Agents: Should We Change a Common Rapid Sequence Intubation Pathway?

BACKGROUND: Succinylcholine is a depolarizing agent used for rapid sequence intubation (RIS). While the agent is the most widely used drug of choice in most emergency departments (EDs), the adverse effect profile is lengthy compared to nondepolarizing paralytic agents included rocuronium and vecuronium. OBJECTIVES: Our objective in this analysis is to detect potential safety signals and differences in safety related outcomes between patients that received succinylcholine compared to those that received rocuronium or vecuronium when undergoing RSI. Specifically, we asked whether there was a difference in all-cause mortality, whether succinylcholine was used in patient later found to have contraindications to the medication, as well as differences in the rates of rescue airway or difficult airway algorithms utilized. METHODS: We utilize two clinical cases as a framework to review adverse events among ED patients undergoing RSI when using succinylcholine compared to nondepolarizing agents over a 7 years' period at our institution as part of a quality review project. The review is retrospective and does not allow us to link adverse events specifically with drug but, instead, considers aggregate level event frequency. RESULTS: From January 31, 2013, to January 31, 2018, there were 36,059 intubations with paralytics in the ED (75.39% with succinylcholine and 24.61% with rocuronium or vecuronium). There was no evidence of death or associated adverse events in 98.49% of patients. Of 36,059 intubations, 14 patients expired, representing 0.039% of all RSI encounters. There were 39/100,000 total deaths during RSI events. There was a higher rate of mortality in the combined vecuronium/rocuronium group (90/100,000) compared to the sample of patients intubated with succinylcholine (22/100,000). CONCLUSIONS: While the succinylcholine adverse effect profile is concerning, data from our institution does not support removal of the agent as an available option for RSI as the mortality rate among patients receiving succinylcholine was lower than that of patients receiving non-depolarizing agents. Patient level data will be needed in future work to further understand why the all-cause mortality rate was higher in the group receiving rocuronium or vecuronium and whether those patients had increased risk of mortality from underlying disease at time of presentation.

From Tucking to Twisting; A Case of Self-induced Testicular Torsion in a Cross Dressing Male.

A self-induced, non-traumatic testicular torsion is a rare entity that to our knowledge has not been reported in the literature. We report the case of a 28-year-old male who caused a self-induced testicular torsion during acts associated with cross dressing. Differential diagnosis of the acute scrotum in an adult should always include testicular torsion, as outcomes in this population are worse than in younger populations. Additional unusual causes of testicular torsion are reviewed.