COVID-19-Induced Complete Heart Block: Case Series and Literature Review.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to the emergence of a wide range of complications, including those affecting the cardiovascular system. In this case series, we present four patients who developed complete atrioventricular block, a serious and potentially life-threatening heart rhythm disorder, during the course of their coronavirus disease 2019 (COVID-19) illness. The mechanisms by which SARS-CoV-2 may lead to arrhythmias are not fully understood but may involve direct infection and damage to heart tissue, as well as inflammation and cytokine storms. The extent and duration of complete heart block varied among these cases, highlighting the need for further research to understand the spectrum of disease and to improve mortality and morbidity in future waves of SARS-CoV-2 infections. We hope that this case series will draw attention to this serious complication of COVID-19 and inspire further research to improve management and outcomes for affected patients.

A Rare Case of Splenic Artery Thrombosis Provoked By Medroxyprogesterone Acetate Requiring Splenectomy.

Splenic artery thrombosis is estimated to occur in only 0.016% of hospital admissions. Hormonal contraception is known to have hypercoagulable side effects, but splenic artery thrombosis (SAT) followed by functional autosplenectomy is a very rare side effect. We report a case of a 48-year-old female with persistent SAT provoked by depot medroxyprogesterone acetate (DMPA). She initially presented with severe left lower quadrant abdominal pain, and imaging revealed an extensive thrombus in the splenic artery. She was immediately started on intravenous heparin, and her symptoms improved after a few days, at which point she was discharged on oral apixaban. Three months after discharge, the patient presented with symptoms similar to the initial presentation. Further history revealed that she received an injectable DMPA shot prior to her initial admission. Other possible causes of SAT were ruled out. On imaging, her previous thrombus had increased in size and now filled the entire splenic artery. Therefore, the patient underwent robotic splenectomy with remarkable improvement in her symptoms. This case represents a rare clinical manifestation of a hypercoagulable state induced by DMPA. We review the existing literature to explain the epidemiology, presentation, diagnosis, and treatment of SAT, and incorporate our patient's presentation into the existing literature regarding the effect of contraception in inducing thrombotic events.

A Rare Presentation of Undiagnosed Systemic Syphilis: A Case Report and Review of Literature.

Within the specialties of infectious diseases and dermatology, few rashes involve the palms and soles. The syphilitic rash has a pathognomonic association with these body surfaces and signals physicians to investigate this disease. However, the distinct presentations and symptoms associated with syphilis and the various stages of the disease make it diagnostically challenging. We herein report a rather intricate and unusual case of a patient who presented with a new-onset headache and blurred vision and a two-month history of diffuse pruritic maculopapular rash sparing the palms and soles. Several physicians had not established a diagnosis in the outpatient setting. Inpatient workup eventually revealed that the patient was suffering from secondary syphilis with neurological and ocular involvement. Management included a prolonged course of intravenous penicillin G leading to a complete recovery. We share images of the skin findings and the details of the intricate workup and hospital course, as well as a review of the literature.

Oculogyric Crisis in the Setting of Low Dose Risperidone and Benztropine Mesylate Use in a Patient With Schizophrenia: A Case Report and Review of Literature.

In this case report, we describe a rather unique case of a 37-year-old male patient suffering from schizophrenia who presented with a fixed upwards gaze diagnosed as oculogyric crisis (OGC). This presentation was attributed to the effects of risperidone, a second-generation antipsychotic, while concomitantly taking benztropine mesylate. The latter is a medication commonly used to prevent dystonia in this type of patient population. Interestingly, the dose of risperidone was minimal, and side effects were not expected, making this presentation rare and not often cited or represented in the medical literature, given that second-generation antipsychotics are known to have a safer side effect profile when compared to their counterparts. We also aim to provide a review of the literature on this topic and describe the approach to diagnosis and treatment of such.

Metastasis of Melanoma to the Adrenal Glands: A Case Report and Literature Review.

Immune checkpoint inhibitors have significantly improved the prognosis of metastatic melanoma, but metastases to the adrenal glands remain highly resistant to these new treatments. Adrenal gland metastases from melanoma can present in an unusual manner, such as in this report, making it diagnostically and therapeutically challenging. In this case report, we present a patient with histologically confirmed metastatic melanoma to the adrenal glands, a large intracardiac mass suspicious for metastatic disease, and an inferior vena cava thrombus. We review the existing literature to explain the unique characteristics, clinical relevance, pathogenesis, diagnosis, and treatment of adrenal gland metastases from melanoma.

Zieve Syndrome in a Patient With Hepatitis C.

Zieve syndrome is a very rare syndrome that presents as a triad of hemolytic anemia, jaundice, and transient hyperlipidemia in patients with alcoholic liver disease. Herein, we present a case of a 30-year-old female with alcoholic liver disease and chronic hepatitis C. She presented with altered mental status and profound jaundice and was subsequently found to have acute hemolytic anemia due to Zieve syndrome. All other causes of hemolytic anemia were ruled out. She abstained from alcohol and received blood transfusions as needed, leading to the improvement of her anemia. This case highlights the need for more medical education about Zieve syndrome as the under-recognition of the disease can lead to unnecessary treatments. We review the existing literature to explain the epidemiology, pathogenesis, diagnosis, and treatment of Zieve syndrome. This case represents a rare presentation of Zieve syndrome in a patient with hepatitis C, and we have hypothesized a possible role of chronic hepatitis C infection in its pathophysiology.

The Potential of High-Throughput DNA Sequencing of the Paranasal Sinus Microbiome in Diagnosing Odontogenic Sinusitis.

OBJECTIVE: High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin. STUDY DESIGN: Case series with chart review. SETTING: Single tertiary care academic medical center. SUBJECTS AND METHODS: A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane. RESULTS: Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%). CONCLUSION: This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis.

Unique heating curves generated by radiofrequency electric-field interactions with semi-aqueous solutions.

Aqueous and nanoparticle-based solutions have been reported to heat when exposed to an alternating radiofrequency (RF) electric-field. Although the theoretical models have been developed to accurately model such a behavior given the solution composition as well as the geometrical constraints of the sample holder, these models have not been investigated across a wide-range of solutions where the dielectric properties differ, especially with regard to the real permittivity. In this work, we investigate the RF heating properties of non-aqueous solutions composed of ethanol, propylene glycol, and glycine betaine with and without varying amounts of NaCl and LiCl. This allowed us to modulate the real permittivity across the range 25-132, as well as the imaginary permittivity across the range 37-177. Our results are in excellent agreement with the previously developed theoretical models. We have shown that different materials generate unique RF heating curves that differ from the standard aqueous heating curves. The theoretical model previously described is robust and accounts for the RF heating behavior of materials with a variety of dielectric properties, which may provide applications in non-invasive RF cancer hyperthermia.

Water-structuring molecules and nanomaterials enhance radiofrequency heating in biologically relevant solutions.

For potential applications in nano-mediated radiofrequency cancer hyperthermia, the nanomaterial under investigation must increase the heating of any aqueous solution in which it is suspended when exposed to radiofrequency electric fields. This should also be true for a broad range of solution conductivities, especially those that artificially mimic the ionic environment of biological systems. Herein we demonstrate enhanced heating of biologically relevant aqueous solutions using kosmotropes and a hexamalonoserinolamide fullerene.