Galantamine-Induced Third-Degree Heart Block.

Galantamine is commonly used to manage symptoms of Alzheimer's disease and other cognitive disorders. While it is generally well-tolerated, cardiovascular side effects are rare but can be serious. We report the case of a patient who developed a third-degree heart block after initiating galantamine therapy. This case highlights the importance of monitoring patients for cardiac adverse effects when using galantamine and the need for prompt intervention when such effects occur.

Chest Pain: A Relatively Benign Symptom of Type IV Hiatal Hernia.

Hiatal hernia results from the translocation of intra-abdominal contents from their usual position into the thorax. They can be categorized into type I-IV which implies varying gradations of herniation. The symptomatology can range from just chest pain in the less severe types to respiratory and hemodynamic compromise resulting from strangulation in the advanced hernias. Our patient was an 81-year-old female with a past medical history of gastroesophageal reflux disease (GERD), deep venous thrombosis (DVT), hypertension, hyperlipidemia, coronary artery disease (CAD), and cerebrovascular accident (CVA), who presented to the emergency department (ED) with the chief complaint of chest pain. Assessment of the vitals in the ED revealed a temperature of 37.2 °C, respiratory rate of 18 breaths/minute with an oxygen saturation of 100% on room air, heart rate of 95 beats/min, and blood pressure reading of 132/110 mmHg. Due to significant concern of a possible coronary pathology leading to chest pain, the patient was given 325 mg of aspirin and one tablet of sublingual nitroglycerin. Her electrocardiogram (EKG) was unremarkable but the chest X-ray revealed a large retrocardiac hernia. The finding was corroborated after a review of the computerized tomography (CT) scan performed at the outlying facility. She was treated with omeprazole, a gastroenterologist was consulted, and an esophagogastroduodenoscopy (EGD) performed which revealed significant erosions in the distal esophagus and gastric antrum. She was deemed a high-risk surgical candidate for any intervention and thus managed conservatively with proton pump inhibitor (PPI) therapy. The case highlights the pertinent facts about hiatal hernia. Although the diagnosis of chest pain with the aforementioned comorbidities could be skewed towards coronary pathology, keeping a wide differential is important so that the right diagnosis can be made in a timely fashion and complications avoided.

Acute Pancreatitis Associated With Hypothermia: An Uncommon Presentation.

Hypothermia is not known as a common cause of acute pancreatitis, although there have been previously reported cases. Herein, we describe a 55-year-old man who presented with acute pancreatitis preceded by hypothermia in the absence of the more traditional causative factors, such as gallstones or alcohol consumption. On arrival to the emergency department, he was found to have a temperature of 84.3°F, consistent with moderate hypothermia, a blood pressure of 84/50 mmHg, and a heart rate of 60 bpm. Serum lipase and amylase levels were 2,225 and 980 U/L, respectively. A CT scan of the abdomen with intravenous (IV) contrast revealed peripancreatic fat stranding, consistent with the diagnosis. No evidence of gallstones or common bile duct dilatation was found. He had also developed acute kidney injury and lactic acidosis consistent with end-organ damage. After appropriate triage, he was admitted to the intensive care unit and supportively managed. An external rewarming strategy with IV fluids and antibiotics resulted in improvement in clinical status. Hypothermia can cause subtle changes in the microvasculature and production of free radicals, which can result in acute pancreatitis. It is important to determine the etiology so that appropriate treatment can be instituted with better outcomes.

Review Analysis on Thymectomy vs Conservative Medical Management in Myasthenia Gravis.

Myasthenia gravis (MG) is an acquired, rare autoimmune disease that occurs due to autoantibodies blocking neuromuscular transmission. Its pathophysiology involves production of antibodies against the nicotinic acetylcholine receptors. Patients with negative anti-acetylcholine receptors (AChR) antibodies results are recognized as seronegative myasthenia gravis. In this review we tried to compare surgical and medical management of MG with each other to find out which is more effective. Different clinical trials and retrospective cohorts comparing these two parameters statistically were searched and studied. Remission rates in both medical and surgical management were compared. We found out that rates of remission were better in post thymectomy patients than patients on various medical treatment options including corticosteroids, immunosuppressants, intravenous immunoglobulins and acetylcholinesterase inhibitors alone. Hence thymectomy is studied to be the superior treatment option than other conservative medical management options alone.