Ventricular Arrhythmias in a Patient With Propionic Acidemia.

Propionic acidemia (PA) is a metabolic disorder that involves a defective copy of propionyl-CoA carboxylase (PCC). It has previously been shown that there is an association between QT-prolongation in propionic acidemia. The patient seen in this case is a male in his early twenties with known PA who was found unconscious on initial presentation due to cardiac arrest with a downtime of twenty minutes. He was subsequently resuscitated and stabilized. The patient underwent placement of an automatic implantable cardioverter-defibrillator (AICD) nineteen days after the initial presentation.

Immunotherapeutic approach for advanced pancreatic adenocarcinoma.

Pancreatic adenocarcinoma (PDAC) is the third leading cause of cancer-related death in the USA and the seventh leading cause of cancer-related death worldwide. Most of the patients' presentation is in advanced stages and remains resistant to currently available standard therapies. An in-depth understanding of PDAC's pathogenesis has shown that immunotherapy could bring about a revolution in the treatment response. Immunotherapy in PDAC appears promising in preclinical studies but failed to show benefits in clinical studies. These novel agents' therapeutic failure can be attributed to multiple variables including the tumor microenvironment, early metastasis, tumor heterogeneity and resistance to therapy. There is a need to develop biomarkers for the patient's stratification and provide individualized treatment to improve treatment outcomes.

Lay abstract Pancreatic adenocarcinoma (PDAC) is the third leading cause of cancer-related death in the USA and the seventh leading cause of cancer-related death worldwide. PDAC is a lethal cancer; most patients present at advanced stages with minimal clinical response to the current standard therapies. Immunotherapy treatment in PDAC showed promising results in the preclinical studies. However, the majority of clinical studies on immunotherapy in PDAC did not show clinical benefits. There is a need for research to explore the benefits of immunotherapy in PDAC patients. The development of new treatment strategies and a patient-tailored approach might improve future outcomes.

Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine.

Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM. LEARNING POINTS: Hemiplegic migraine (HM) is difficult to diagnose and can mimic stroke, resulting in administration of dangerous medications such as thrombolytics/alteplase.A thorough history, intercommunication between health systems and integrated EMR are essential for early diagnosis and management of HM.