Vaping-associated acute respiratory distress syndrome.

Vaping-associated lung injury via the use of electronic nicotine delivery systems (ENDS) is currently being evaluated as a potential source of pulmonary injury with uncertain etiology as the use of tetrahydrocannabinol (THC) is increasing throughout the USA. ENDS are marketed to be unlike traditional cigarette smoking in that they are purported to contain only propylene glycol, vegetable glycerine, nicotine, and flavorants compared with the > 60 carcinogenic ingredients in cigarettes. The New England Journal of Medicine (NEJM) currently reports four imaging patterns correlated with vaping-attributed pathology including acute eosinophilic pneumonia, diffuse alveolar damage, organizing pneumonia, and lipoid pneumonia. The incidence and extent of lung disease in otherwise young healthy patients with a history of vaping has not however been definitively recognized within the field of radiology. We present a case of vaping-associated acute respiratory distress syndrome (ARDS) in a young patient with no additional past medical history. The immediate radiologic recognition of vaping as a risk factor for ARDS in the emergency setting is pivotal so that appropriate medical management and respiratory support can be initiated without delay.

Factor structure and psychometric properties of the english version of the trier inventory for chronic stress (TICS-E).

BACKGROUND: Demands placed on individuals in occupational and social settings, as well as imbalances in personal traits and resources, can lead to chronic stress. The Trier Inventory for Chronic Stress (TICS) measures chronic stress while incorporating domain-specific aspects, and has been found to be a highly reliable and valid research tool. The aims of the present study were to confirm the German version TICS factorial structure in an English translation of the instrument (TICS-E) and to report its psychometric properties. METHODS: A random route sample of healthy participants (N = 483) aged 18-30 years completed the TICS-E. The robust maximum likelihood estimation with a mean-adjusted chi-square test statistic was applied due to the sample's significant deviation from the multivariate normal distribution. Goodness of fit, absolute model fit, and relative model fit were assessed by means of the root mean square error of approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker Lewis Index (TLI). RESULTS: Reliability estimates (Cronbach's α and adjusted split-half reliability) ranged from .84 to .92. Item-scale correlations ranged from .50 to .85. Measures of fit showed values of .052 for RMSEA (Cl = 0.50-.054) and .067 for SRMR for absolute model fit, and values of .846 (TLI) and .855 (CFI) for relative model-fit. Factor loadings ranged from .55 to .91. CONCLUSION: The psychometric properties and factor structure of the TICS-E are comparable to the German version of the TICS. The instrument therefore meets quality standards for an adequate measurement of chronic stress.

Subjective wellbeing and longevity: a co-twin control study.

Mental health is increasingly defined not only by the absence of illness but by the presence of subjective well-being (SWB). Previous cohort studies have consistently shown that indicators of SWB predict favorable life outcomes, including better mental and somatic health, and longevity. The favorable effects associated with SWB have prompted new research aimed at raising happiness and wellbeing through individual interventions and public health initiatives. Standard observational studies of individual-level associations, however, are subject to potential confounding of exposure and outcome by shared genes and environment. The present study explored the association between SWB and increased longevity, using twin pair analyses to determine whether the association is consistent with causality or is due to genetic or environmental confounding. The study sample of 3,966 twins aged 70 or older, followed for a median time period of 9 years, was drawn from the population-based Longitudinal Study of Aging Danish Twins (LSADT). The association between SWB, operationalized as affect and life satisfaction, and all-cause mortality risk was examined using between-individual and within-pair survival analyses. As expected, at the individual level, SWB predicted increased longevity. Exposure effects were also present in unadjusted and adjusted within-pair analyses of 400 dizygotic (DZ) pairs and 274 monozygotic (MZ) pairs, indicating that SWB is associated with increased longevity independent of familial factors of genes and shared environment.

Acute gastric outlet obstruction secondary to papillary serous adenocarcinoma of the endometrium with peritoneal psammomatous implants: a case report.

Endometrial carcinoma is the most common gynecologic cancer in the United States. Uterine papillary serous carcinoma comprises approximately 5-10% of endometrial carcinomas. This aggressive carcinoma typically occurs in older women, characteristically arising on atrophic endometrium. This frequently is associated with early extrauterine spread and, infrequently, with peritoneal dissemination. We present a case of acute gastric outlet obstruction secondary to papillary serous adenocarcinoma of the endometrium with diffuse peritoneal psammomatous implants.

Characterization of the IS200/IS605 Insertion Sequence Family in Halanaerobium Hydrogeniformans.

Mobile DNA elements play a significant evolutionary role by promoting genome plasticity. Insertion sequences are the smallest prokaryotic transposable elements. They are highly diverse elements, and the ability to accurately identify, annotate, and infer the full genomic impact of insertion sequences is lacking. Halanaerobium hydrogeniformans is a haloalkaliphilic bacterium with an abnormally high number of insertion sequences. One family, IS200/IS605, showed several interesting features distinct from other elements in this genome. Twenty-three loci harbor elements of this family in varying stages of decay, from nearly intact to an ends-only sequence. The loci were characterized with respect to two divergent open reading frames (ORF), tnpA and tnpB, and left and right ends of the elements. The tnpB ORF contains two nearly identical insert sequences that suggest recombination between tnpB ORF is occurring. From these results, insertion sequence activity can be inferred, including transposition capability and element interaction.

Sister Mary Joseph nodule: an often overlooked or misdiagnosed entity on imaging.

Sister Mary Joseph nodule (SMJN) is an umbilical nodule representing a metastatic deposit from an intra-abdominal primary malignancy. Most radiologists are unaware of this phenomenon, and cases of SMJN have rarely been described in the radiology literature, to our knowledge. We present an example of a patient with known primary pancreatic adenocarcinoma found to have an umbilical nodule as the first manifestation of metastatic disease after an initial misdiagnosis on computed tomography. In addition, we delineate the importance of maintaining a high index of suspicion and pattern recognition for SMJN during imaging when a patient presents with umbilical pain in the setting of known malignancy, since early diagnosis can alter management.

Early Diagnosis of COVID-19 on Non-Chest CT Studies in the Emergency Setting: A Case Series and Review of the Literature.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel strain of coronavirus that has spread throughout the globe causing coronavirus disease 2019 (COVID-19). As the number of cases rises in the United States (US), it has become more imperative to detect COVID-19 at its earliest radiologic stage to decrease community transmission. In this case series, we discuss five patients who presented with non-respiratory-related symptoms and underwent non-chest CT imaging, such as abdominal and neck CT, with a portion of the lungs visualized in each respective study. Imaging findings of COVID-19 include basilar and peripherally predominant pulmonary parenchymal ground-glass opacities. All five of our patients had findings suggestive of COVID-19 that prompted the radiologist to suggest testing for the disease. Subsequently, four of the five patients tested positive for COVID-19, and one of them was presumed to have the diagnosis based on clinical and imaging findings.

Computed tomography imaging characteristics of shone syndrome.

Shone syndrome was first described in 1963 by Dr JD Shone. It is a constellation of congenital abnormalities compromising approximately 0.6% of all cases of congenital cardiac abnormalities. Shone syndrome is also known as Shone complex, involving several characteristic cardiac abnormalities: coarctation of the aorta, subaortic stenosis, supravalvular mitral ring, and a parachute mitral valve. Given the uncommon nature of the disease, we present this case to illustrate potential postsurgical appearances of Shone syndrome, specifically on computed tomography imaging.

Dramatic treatment response of cutaneous plasmablastic lymphoma in an HIV patient: a case report.

Plasmablastic lymphoma is a variant of diffuse large B-cell lymphoma, characterized by rapid progression and is associated with a poor outcome. We report a 35-year-old male with poorly controlled HIV infection and AIDS who presented with skin lesions and swelling throughout the body. Computed tomography (CT) revealed innumerable enhancing soft tissue masses within the subcutaneous soft tissues and lymphadenopathy. Plasmablastic lymphoma was diagnosed, patient was treated with chemotherapy, and post treatment CT demonstrated complete resolution. Imaging plays a key role in the diagnosis and surveillance of this disease.

Differential item functioning in the Cambridge Mental Disorders in the Elderly (CAMDEX) Depression Scale across middle age and late life.

A long-standing and critical problem in the study of aging and depression is the comparability of measurement across age groups. While psychological measures of depression typically show increased incidence of symptoms with increasing age, rates of depression diagnosis do not show the same age trend. This analysis presents tests of differential item functioning on the depression section of the CAMDEX interview schedule, using factor analysis-derived affective and somatic subscales (McGue & Christensen, 1997). Results for the affective subscale show significant differences in item functioning in the majority of the affective items as a function of age (items "Happy Life," "Lonely," "Nervous" "Worthless," and "Future": χ6(2) = [30.193, 255.971] across items, all p < .0001). Analyses for the somatic subscale show differential item functioning is limited to a single item relating to coping (χ6(2) = 180.754, p < .0001). These results indicate that differences in depression symptoms across age groups are not entirely consistent with a unidimensional depression trait, and that the measurement structure of depression varies over the life span.

UK department of health guidance on prescribing for impotence following the introduction of sildenafil: potential to contain costs in the average health authority district.

OBJECTIVES: To evaluate the effectiveness at containing service costs of the UK's Department of Health (DoH) guidance on prescribing for impotence implemented after the introduction of sildenafil and taking effect from 1 July 1999. DESIGN: A pragmatic economic analysis of the impact of the DoH guidance on specialist-care activity and costs and primary-care prescribing costs from the perspective of the UK National Health Service. Primary-care prescribing costs and specialist-care activity and cost data were collected for 12-month periods before and after the introduction of the guidance. SETTING: Portsmouth and South East Hampshire Health Authority. RESULTS: Specialist-care activity and associated costs fell by 70% in the first year following the introduction of the DoH guidance while primary-care prescribing costs doubled. The overall cost for providing impotence services in Portsmouth and South East Hampshire in 1999-2000 was pound 232,619, and is similar to the cost incurred in 1998-1999 of pound 225,108 (uplifted to 1999-2000 values). CONCLUSIONS: The DoH guidance on prescribing for impotence has effectively reduced specialist-care activity and costs in Portsmouth and South East Hampshire. It offers the potential to allow the overall costs of impotence services in the district to be contained even with the use of higher cost drugs, such as sildenafil.

Military nursing at the forefront: the Army Forward Surgical Team.

From World War II to current conflicts, history has validated the need for early surgical intervention to save lives and established the need for FSTs. Historically 10% to 15% of soldiers wounded in action require surgery to control hemorrhage and to provide stabilization sufficient for evacuation to a medical treatment facility where definitive care can be provided. Undoubtedly, many lives were saved in past conflicts because resuscitative surgery and care were available a short time after being wounded. The need for surgical stabilization for patients to survive a long evacuation was well-established during military operations such as Operation Desert Storm. Resuscitative surgery capability must be present on the battlefield, and this capability must be able to move with the units the FST is supporting. These two imperatives were the driving force of the creation of the US Army's FSTs: they are light, easily transportable, and able to keep pace with the supported units. FSTs are an integral and essential element in providing surgical care to save soldiers' lives on the modem battlefield. The US military has been involved in more operations and deployments since the end of the Cold War than in the preceding years. FSTs participated in many of these operations and have performed superbly. FSTs will continue to have a critical role in providing combat health service support to soldiers on the battlefield of the twenty-first century, and FST nurses will continue to be an indispensable asset.

Kikuchi-Fujimoto disease with spontaneous subdural hematoma in a middle-aged Hispanic male.

Kikuchi-Fujimoto disease (KFD) is an uncommon disorder that usually presents in young adults of Asian descent with fever and cervical lymphadenopathy. Clinically, this disease is often misdiagnosed as lymphoma or tuberculosis, and biopsy is needed for confirmation. The authors report an unusual case of KFD in a Hispanic male presenting with a subacute subdural hematoma, whose care was complicated by extranodal features not typically associated with KFD. The clinical, histopathologic, and radiographic manifestations of KFD are discussed.

US, CT, and MR imaging of hepatic masses in Alström syndrome: a case report.

Alström syndrome is among the rarest genetic disorders described in the medical literature. It is characterized by retinal pigment degeneration, obesity, sensorineural deafness, non-insulin-dependent diabetes mellitus, progressive chronic nephropathy, cardiomyopathy, and hepatic dysfunction. Hepatic inflammation and fibrosis, which leads to cirrhosis, portal hypertension, and liver failure, is the final pathway of the hepatopathy in Alström syndrome. We report a case of Alström syndrome with particular emphasis on hepatic findings.

CT imaging of acute E. Coli-related colitis.

Patients with abdominal pain and bloody diarrhea often present in the acute setting to the emergency department for evaluation. After the appropriate clinical assessment, cross-sectional imaging is often utilized to evaluate for the severity of the disease. Although a wide spectrum of findings may be seen, diffuse colonic mural thickening, consistent with pancolitis, is most common. We report an Escherichia coli 0157:H7-related pancolitis in a patient with spinach intake linked to the recent outbreak.

Spontaneous pneumomediastinum in a patient with recent air travel.

Spontaneous pneumomediastinum (SPM) is a fairly uncommon condition in which free air is present in the mediastinum, often in young patients without injury or serious underlying pulmonary disease. We present a case of SPM in a 36-year-old man with no pertinent medical history who presented with chest pain after a 3-h flight. To the best of our knowledge, this is the first known case in radiology literature of SPM caused by increased intra-alveolar pressure secondary to increased altitude.

Pyogenic liver abscess: Klebsiella as an emerging pathogen.

Patients with pyogenic liver abscesses often present to the emergency department with fever of unknown origin. After the appropriate clinical evaluation, cross-sectional imaging may be performed in the emergent setting to aid in localization of fever source. On computed tomography imaging, pyogenic liver abscesses may present as inflammatory masses in the liver, with Escherichia coli as the most common pathogen. We report an emerging hepatic pathogen as the cause, Klebsiella pneumoniae.

Hepatic leiomyomas in two adult patients with AIDS: intravenous contrast-enhanced CT and MR imaging.

Multiple opportunistic infections and neoplasms have been described in the AIDS population over the past 20 years. Four cases of AIDS-related hepatic smooth muscle tumors (leiomyomas) have been described, and of these, three were in children. The fourth case was in a single patient with two hepatic lesions. We describe the imaging features of two adult cases with biopsy-proven hepatic leiomyomas. In one of the cases, the gadolinium-enhanced MRI findings are described, which have not previously been reported.

Bystander trauma in the World Trade Center disaster.

We present the CT and clinical findings in a 21-year old male who presented to the emergency department following bystander trauma during the rescue effort of the World Trade Center disaster.