Atypical Pulmonary Metastasis of Prostate Adenocarcinoma: A Rare Phenomenon.

Prostate cancer can metastasise to the lung. Most common presentations described in the literature are solitary pulmonary nodules, lymphangitic spread and, rarely, pleural effusion. We describe a case of prostate adenocarcinoma with diffuse bilateral reticulonodular and lymphangitic pulmonary metastasis, and malignant pleural effusion while being on androgen deprivation therapy. LEARNING POINTS: Lymphangitic metastasis of prostate cancer to the lung with diffuse reticulonodular infiltrate is a rare presentation.In chemical castration-sensitive prostate cancer, prostate-specific antigen (PSA) levels can be improving but the patient can still develop new distant metastases.

A Post-Neurosurgical Infection due to KPC-Producing Klebsiella pneumoniae Treated with Meropenem-Vaborbactam: A Case Report.

This case report describes a patient with post-neurosurgical infection and bacteremia caused by Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae. There is limited evidence to guide antibiotic treatment decisions for such infections. The patient was treated with meropenem-vaborbactam (MEV). MEV monotherapy was associated with bacteremia clearance.

Novel coronavirus-related acute respiratory distress syndrome in a patient with twin pregnancy: A case report.

We present the case of a 39-year-old woman, G1P0, who had conceived twins via in-vitro fertilization, who presented at 27 weeks of gestation with nasal congestion and dry cough for 7 days. On presentation, her physical examination was benign, except for sinus tachycardia, and she was oxygenating adequately on room air. Laboratory studies were unremarkable, except a PCR test positive for SARS-COV2, and a CT scan of her chest showed bilateral multi-focal ground-glass opacities. A fetal non-stress test was reassuring. She was treated with intravenous fluids, ceftriaxone, azithromycin, and hydroxychloroquine. During her hospital stay, she developed progressively worsening respiratory failure, initially requiring non-invasive ventilation, and subsequently progressed to acute respiratory distress syndrome requiring mechanical ventilation. She then suffered from sudden hypoxemia and hemodynamic collapse, on maximal ventilatory support, prompting an emergency cesarean section at bedside. This led to rapid stabilization of hemodynamic parameters, and of her overall respiratory status. Both the twins were born prematurely, and one of them tested positive for SARS-COV2.

Abrupt versus gradual cessation of steroids in patients with septic shock.

PURPOSE: To determine if a difference in hemodynamic stability would be identified in patients with abrupt withdrawal of steroids compared to patients who underwent a taper. MATERIAL AND METHODS: This retrospective cohort study identified patients who received vasopressors followed by IV hydrocortisone for treatment of septic shock from January 1, 2013 until January 1, 2015.The primary endpoint evaluated the percent of patients requiring vasopressor re-initiation during taper and 72 h following taper, or 72 h directly following abrupt withdrawal. Secondary endpoints evaluated include glycemic control, and ICU length of stay. RESULTS: A total of 87 patients were included for final analysis. Of the 87 patients, 7 out of 41 patients (17.1%) in the steroid taper group developed hemodynamic instability and required re-initiation of vasopressors compared to 1 out of 46 patients (2.2%) in the abrupt withdrawal group (p = 0.024). Patients in the taper group also had worse glycemic control (125.1 mg/dL abrupt vs. 150.8 taper; p < 0.001). There was no statistical difference found in the ICU length of stay (8.28 days abrupt vs.10.73 taper; p = 0.14). CONCLUSION: The abrupt withdrawal of steroids in patients with resolving septic shock did not impact hemodynamic stability and offers an opportunity to reduce medication burden and reduce adverse drug reactions.

Doxorubicin mediated cardiotoxicity in rats: protective role of felodipine on cardiac indices.

Anthracyclines find vital uses in the treatment of solid tumors and other kind of malignancies. A typical side effect observed with few agents of this class is dose-dependent cardiotoxicity. Doxorubicin is one such agent which backs the generation of free radicals through metabolism of its quinone structure. This effect combined with induction of apoptotic and necrotic pathways leads to the development of irreversible cardiotoxicity. Reports showing the cardioprotective effects of felodipine have been published in the past. We chose to evaluate protective effect of felodipine in acute cardiotoxicity in rats induced by single dose of doxorubicin. Felodipine was assessed against doxorubicin-induced cardiotoxicity and we found that felodipine not only improves cardiac marker enzymes (P<0.001 for LDH; P<0.01 for CK-MB) but also prevents damage to myocardial tissue (20.61% necrosed area in doxorubicin intoxication; 11.52% necrosed area in felodipine treated group). Activation of apoptotic pathways is decelerated which is indicated by a significant reduction in myocardial caspase-3 activity (P<0.05) following felodipine pretreatment. Felodipine pretreatment was able to maintain normal cardiac morphology and histoarchitecture. Gravimetric analysis revealed beneficial effects following felodipine pretreatment. Abnormalities seen in the ECG after doxorubicin treatment were normalized to a significant extent (ST interval normalization was significant at P<0.01) in felodipine treated rats. In itself, felodipine was not found to have any detrimental effects on the myocardium or hemodynamic parameters of rats. Findings of the study suggest that pretreatment with felodipine prevents doxorubicin induced cardiotoxicity.