A Case of Histoplasmosis Mimicking Primary Lung Cancer With Liver Metastasis.

Histoplasmosis is usually self-limiting in healthy individuals but often fatal in immunocompromised patients. It can mimic primary lung malignancy and liver metastasis, causing a delay in appropriate therapy. We report a case of a 58-year-old male, with a 20 pack-year smoking habit, who presented with a three-week history of persistent fevers and productive cough with night sweats. Computed tomography (CT) scan of chest, abdomen and pelvis showed findings suggestive for primary lung malignancy associated with liver metastasis. Liver biopsy showed budding yeast. Bronchoalveolar lavage (BAL) fluid grew fungal organisms. Urine and serology were positive for histoplasmosis. Patient was pancytopenic, hence, we decided to evaluate further with a bone marrow biopsy which revealed underlying hairy cell leukemia. In the case of disseminated histoplasmosis, a high degree of suspicion towards any immunosuppressive condition should be entertained and any signs should be promptly investigated.

Lemmel's Syndrome Secondary to Common Bile Duct Compression by an Inflamed Duodenal Diverticulum.

A 50-year-old female presented with acute epigastric abdominal pain, diarrhea, nausea, and vomiting for two days. Laboratory data showed hyperbilirubinemia and leukocytosis. Abdominal imagining was concerning for a pancreatic head/uncinate process lesion concerning a pancreatic neoplasm. Subsequent esophagogastroduodenoscopy with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography found the major papilla adjacent to an inflamed and infected duodenal diverticulum, which was extrinsically compressing the distal common bile duct, causing biliary obstruction and common bile duct dilation. These findings are consistent with a diagnosis of Lemmel's syndrome. A biliary sphincterotomy was performed to relieve the obstruction and one temporary plastic biliary stent was placed into the common bile duct. The duodenal diverticulitis was treated with antibiotics for 10 days and the patient made a good recovery.

Observation Services Linked With an Urgent Care Center in the Absence of an Emergency Department: An Innovative Mechanism to Initiate Efficient Health Care Delivery in the Aftermath of a Natural Disaster.

OBJECTIVE: The emergency department (ED) of NYU Langone Medical Center was destroyed by Hurricane Sandy, contributing to a public health disaster in New York City. We evaluated hospital-based acute care provided through the establishment of an urgent care center with an associated ED-run observation service (EDOS) that operated in the absence of an ED during this disaster. METHODS: We conducted a retrospective cohort study of all patients placed in an EDOS following a visit to an urgent care center during the 18 months of ED closure. We reviewed diagnoses, clinical protocols, selection criteria, and performance metrics. RESULTS: Of 55,723 urgent care center visits, 15,498 patients were hospitalized, and 3167 of all hospitalized patients (20.4%) were placed in the EDOS. A total of 2660 EDOS patients (84%) were discharged from the EDOS. The 8 most frequently utilized clinical protocols accounted for 76% of the EDOS volume. CONCLUSIONS: A diverse group of patients presenting to an urgent care center following the destruction of an ED by natural disaster can be cared for in an EDOS, regardless of association with a physical ED. An urgent care center with an associated EDOS can be implemented to provide patient care in a disaster situation. This may be useful when existing ED or hospital resources are compromised. (Disaster Med Public Health Preparedness. 2016;10:405-410).

Transmembrane inhibitors of P-glycoprotein, an ABC transporter.

Drug resistance mediated by ABC transporters such as P-glycoprotein (P-gp) continues to be a major impediment to effective cancer chemotherapy. We have developed a panel of highly specific peptide inhibitors of P-gp based on the structure of the transmembrane domains of the transporter. These peptides are thought to exert their inhibitory action by disrupting the proper assembly of P-gp. A novel 96-well-plate assay based on the efflux of fluorescent P-gp substrate DiOC2 (3-ethyl-2-[3-(3-ethyl-2(3H)-benzoxazolylidene)-1-propenyl]benzoxazolium iodide) was developed and used for structure-functional characterization of transporter inhibitors. The studies strongly suggest that potent and selective inhibitors of ABC transporters can now be developed solely on the basis of the primary structures of the target proteins. The inhibition of P-gp with transmembrane peptides was shown to be chirality-independent. A 25-residue long retroinverso D-analogue of transmembrane domain 5 inhibited the efflux of the fluorescent P-gp substrate with an IC50 of 500 nM. Transmembrane peptides effectively sensitized resistant cancer cells to doxorubicin in vitro without demonstrating any cell toxicity of their own. The newly synthesized P-gp antagonists appear to be promising nontoxic drug resistance inhibitors that merit further development.

Oxidative stress and heart disease: cardiac dysfunction, nutrition, and gene therapy.

Oxidative stress is defined as the imbalance between the generation of reactive oxygen species and antioxidant defense mechanisms. The cardiovascular system is a major target for reactive oxygen species. Cardiomyocytes and the vasculature of the heart can be severely damaged as a result of oxidative stress. In this paper, we discuss recent findings with respect to the role of oxidative stress in heart disease. The efficacies of treatments with vitamins and wine-derived compounds, as well as innovative gene therapeutic experiments that may potentially alleviate oxidative stress-induced disease, are also discussed.