Hiccups: An Atypical Manifestation of Miliary Tuberculosis and Myocardial Ischemia.

Hiccups are a benign, self-limiting condition caused by intermittent spasmodic contractions of the diaphragm. However, its persistence may be indicative of a more ominous underlying condition, and its manifestation is seen in myocardial ischemia/infarction and tuberculosis (TB). We present two unique cases where persistent hiccups lead to the diagnosis of miliary tuberculosis in one patient and myocardial infarction in the other. It stresses the importance that such a benign presentation may be a warning for a more sinister pathology and thus requires extensive work-up in high-risk and senior individuals.

Saved by Menorrhagia: Spontaneous Coronary Artery Dissection Complicated With a Left Ventricular Thrombus.

Spontaneous Coronary Artery Dissection (SCAD) is a non-atherosclerotic, non-iatrogenic cause of Acute Coronary Syndrome (ACS) resulting in a tear in the coronary artery wall with subsequent myocardial infarction. Though rare, it has been increasingly recognized, especially in young women. This is a case report on SCAD where, fortuitously, the patient did not receive standard tissue plasminogen activator (TPA) on presentation of suspected ST-elevation Myocardial Infarction (STEMI). Subsequent investigations revealed a left ventricular thrombus on echocardiogram and SCAD on coronary angiogram.

Understanding the Burden of Kidney Failure in Trinidad and Tobago: A Review of the Epidemiological Data From a Regional Center.

Objective The aim of this study was to determine the incidence of new patients requiring renal replacement therapy and to gather data on sex, age, ethnicity, mortality, and causes of kidney failure in Trinidad and Tobago in comparison with the rest of the world. Method Electronic data were gathered for new patients initiating dialysis between January 1, 2016, and December 31, 2017, including the date of dialysis initiation, age, gender, ethnicity, diagnosis, dialysis access and modality, and outcome at three months and the end of the year. The data were analyzed using simple descriptive statistics via Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Over a two-year period, 265 new patients underwent renal replacement therapy, of which 51.7% were 50-69 years of age, 53.9% were male, 46% were female, 67.9% were Afro-Trinidadian, and 38.1% had a combination of diabetes mellitus and hypertension as the cause of kidney failure. The incidence rates of treated end-stage renal disease (ESRD) globally in 2016 and 2017 were 306 and 224 per million population, respectively, and mortality for both years was 32% and 32.1%, respectively. Conclusion Our study showed that Trinidad and Tobago has one of the highest incidences of patients initiating renal replacement therapy and mortality rates.

Calciphylaxis Case Series: A Late Presentation of Chronic Kidney Disease From the Eastern Caribbean.

Calcific uremic arteriolopathy (CUA) or calciphylaxis is a rare condition that predominantly affects the dialysis population and is characterized by calcification of cutaneous arterioles accompanied by painful necrotic skin ulcers. At the hemodialysis unit of the Port-of-Spain General Hospital, there have been eight cases between the years 2015-2019 with an incidence of 121 cases per 10,000 patients undergoing renal replacement therapy, quite possibly one of the highest in the world along with an 87.5% mortality when diagnosed with this condition. Risk factors identified in this case series include female gender, obesity, and late presentation of end-stage renal disease. This case series highlights limitations in the diagnosis and management of the disease in a resource-limited setting and intends to raise awareness of this condition in the Caribbean.

Refeeding Syndrome With Hyperemesis Gravidarum: A Case Report.

Refeeding syndrome refers to a clinical condition whereby biochemical abnormalities such as hypokalemia, hypomagnesemia, and mainly hypophosphatemia occur upon recommencement of feeding, typically in malnourished catabolic patients. A 36-year-old female presented at 30 weeks gestation with hyperemesis gravidarum. During this admission, the patient developed transaminitis with low platelets prompting suspicion of hemolysis, elevated liver enzymes low platelets (HELLP) syndrome, but the concurrent findings of severe hypophosphatemia and rhabdomyolysis were not in favor of HELLP syndrome but that of refeeding syndrome. These clinical entities proved to be a diagnostic dilemma but, ultimately, the patient was managed under refeeding syndrome. The multidisciplinary approach amongst gastroenterology, internal medicine, obstetrics, hematology, and dietetics departments led to the slowing up of the titration of caloric feeds, which ultimately led to full recovery.

A Myasthenic Crisis Complicated by a Takotsubo Cardiomyopathy.

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that affects skeletal muscles causing weakness, typically the ocular, facial, oropharyngeal, respiratory, and limb muscles. Patients can present as either an MG exacerbation with weakness of any muscle group or an MG crisis which is a life-threatening weakness of the respiratory muscles that usually requires intubation and mechanical ventilation; however, though rare, cardiac manifestations must be considered in the management of such patients.