Takotsubo Cardiomyopathy Associated With Influenza A and a Ground-Level Fall.

Our case involves a 92-year-old female who presented to the emergency department due to a ground-level fall and difficulty breathing. She was found to have influenza A, elevated troponin, and decreased left ventricular ejection fraction. However, cardiac catheterization did not reveal any coronary artery stenosis, supporting a diagnosis of takotsubo cardiomyopathy (TC). The patient's ejection fraction was normal after nine months. This case highlights the importance of considering TC in elderly female patients who have reduced ejection fraction and elevated troponin in the setting of infection and a recent fall.

Non-metastatic Nephrogenic Hepatic Dysfunction (Stauffer Syndrome) and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in a Patient With Renal Cell Carcinoma Coinciding With Liposarcoma.

Stauffer syndrome is a non-metastatic, nephrogenic, hepatic dysfunction syndrome that is linked to extrahepatic paraneoplastic tumors. It manifests with varying clinical signs that include jaundice, anicteric transaminitis, elevated alkaline phosphatase, thrombocytosis, elevated erythrocyte sedimentation rate, prolonged prothrombin time, and, in some cases, hepatosplenomegaly in the absence of hepatobiliary obstruction. Stauffer syndrome is mostly associated with renal cell carcinoma, but research shows other solid malignancies are implicated with this syndrome. Stauffer syndrome is characterized by elevated liver function tests, specifically those that indicate the presence of cholestasis with or without hepatosplenomegaly. The abnormality is not due to tumor infiltration but rather indirect paraneoplastic effects that are poorly understood. Additionally, emerging literature also supports the association of syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to malignancy in the setting of elevated interleukin-6. In this article, we present the case of a 76-year-old patient with SIADH and abnormalities in liver function tests in the context of Stauffer syndrome tied to renal cell carcinoma coinciding with liposarcoma.

Disseminated Histoplasmosis Mimicking Macrophage Activation Syndrome in a Patient With Rheumatoid Arthritis.

Infections caused by Histoplasma capsulatum typically do not produce symptoms. However, in individuals who are immunocompromised, progressive disseminated histoplasmosis may occur. A 67-year-old female, with lengthy history of immunosuppression due to management of rheumatoid arthritis, reported a two-month history of fatigue, headaches, and intermittent fevers following hip surgery. Due to the concern for macrophage activation syndrome and hemophagocytic lymphohistiocytosis, a bone marrow biopsy was performed. However, the results indicated the presence of Histoplasma, which was supported by the presence of Histoplasma antigens in the serum and urine, Histoplasma antibodies in the serum, positive (1,3)-beta-D-glucan results, and fungal blood cultures. The patient initially received amphotericin B, but it was switched to itraconazole due to adverse effects. The patient remains on itraconazole therapy and follows as an outpatient with an infectious diseases specialist.

StepWatch accuracy during walking, running, and intermittent activities.

INTRODUCTION: The purpose of this study was two-fold: 1) to investigate effects of cadence and sensitivity settings for the StepWatch (SW3) on step count accuracy over a wide range of ambulatory speeds, and 2) to compare the preprogrammed "quick start" settings to modified settings during intermittent lifestyle activities. METHODS: Part 1: Fifteen participants (18-57 years of age) performed two trials of treadmill walking and running at ten speeds ranging from 26.8 to 268mmin-1 while wearing four SW3 devices. During the first trial, the cadence setting was maintained while sensitivity was varied; in the second trial sensitivity was maintained while the cadence setting was varied. Part 2: Fifteen participants performed four intermittent activities and drove an automobile while wearing two SW3 devices, one with preprogrammed settings and the other with the modified settings determined in Part 1. RESULTS: Part 1: The modified settings (cadence setting of 70% of default and sensitivity of 16) provided the greatest step counting accuracy across a wide range of speeds reporting 96.0-104% of actual steps between 53.6 and 268mmin-1. Part 2: The preprogrammed settings tended to have higher accuracy for light household tasks (recording 88% to 94% of actual steps) than the modified settings (recording 82% to 86% of actual steps) which showed a trend towards higher accuracy for tennis (recording 93% vs. 89% of actual steps) (p<0.05). CONCLUSION: The preprogrammed "quick start" StepWatch settings should be used with individuals who do not engage in running and vigorous sports. However, for individuals who engage in running and tennis, use of modified settings may result in improved step counting accuracy.