Capecitabine-induced posterior reversible encephalopathy syndrome (PRES) in a patient with gastric adenocarcinoma.

Posterior reversible encephalopathy syndrome (PRES) is characterised by encephalopathy, visual disturbances and seizures, accompanied by radiological parieto-occipital oedema. Immunosuppressive and immunomodulatory drugs are risk factors. While capecitabine-induced PRES cases are rare, this report details a young woman with advanced gastric adenocarcinoma on capecitabine. She exhibited symptoms of nausea, vomiting and abdominal pain before developing hypertension, drowsiness and a seizure. Brain MRI revealed parieto-occipital hyperintense areas indicative of PRES. Suspending capecitabine led to a gradually improved mental state. Prompt recognition and treatment of PRES offer reversibility, often achievable through dose reduction or discontinuation of the causative drug.

Ogilvie Syndrome and COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) is an airborne infection transmitted via respiratory droplets and aerosolized material; however, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the same angiotensin-converting enzyme type 2 receptor present in the respiratory epithelial cells to bind surface epithelial cells in the gastrointestinal tract. Here we report a case of Ogilvie syndrome in a patient who tested positive for SARS-CoV-2 a month prior to hospital admission. Quick recognition of Ogilvie syndrome as a potential complication of COVID-19 infection, prompt treatment with conservative measures, and prevention of possible fecal-oral transmission of the virus are crucial steps.

Utilizing Chamber Music to Teach Non-Verbal Communication to Medical Students: A Pilot Initiative.

Introduction The importance of non-verbal cues in communication between physicians and patients is well published in the medical literature. However, few medical school curricula teach non-verbal communication. Chamber musicians employ non-verbal communication to coordinate musician intention. Observation of chamber musicians' use of non-verbal communication may improve the understanding of non-verbal communication among medical students. Methods A total of 72 medical students attended rehearsals of two world-renowned string quartets on a single date. Following a brief discussion and demonstration on non-verbal communication by musicians, students observed the non-verbal cues employed by the quartets during musical rehearsals. Authors provided pre- and post-surveys, which included closed and open-ended questions to assess understanding of non-verbal communication and confidence in identifying non-verbal cues with patients and healthcare providers. Close-ended questions used numerical scales. The authors used paired t-tests to compare mean numerical scores pre- and post-intervention and analyzed qualitative, open-ended responses thematically. Results Of the 72 students who attended the workshop, 63 (88%) completed both pre- and post-surveys. Comparison demonstrated significant improvement in students' ability to appreciate non-verbal interactions among healthcare teams (p<0.05) and patients (p<0.05). Following the workshop, students commented that they appreciated the similarities in non-verbal cues between musicians and medical professionals. Discussion Chamber musicians and physicians share similarities, e.g., working in teams and performing specialized tasks; good communication is crucial to both. Observation of chamber musicians may serve as a vehicle to instruct medical students on non-verbal communication. Next steps include determining the longer-term impact of the workshop on confidence in communication by resurveying participants and comparing responses with those students who did not attend the workshop. Future studies are needed to assess the clinical impact of chamber music observation on medical students' non-verbal communication skills.

Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study.

BACKGROUND: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. METHODS: This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. RESULTS: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8-10.8) for 1 point, 12.0 (95% CI 4.9-29.4) for 2 points, and 41.7 (95% CI 15.8-110.1) for 3 points (c-statistic = 0.77). CONCLUSION: An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

A Unique Case of Severe Hematochezia: Ruptured Pseudoaneurysm of the Superior Rectal Artery.

Visceral artery aneurysms are rare, with an incidence of 0.01%-2% based on autopsy results. Among the visceral arteries, inferior mesenteric artery aneurysms are the rarest. To our knowledge, we report the first case of acute lower gastrointestinal bleeding in a 45-year-old man, arising from a nontraumatic pseudoaneurysm of the superior rectal artery, a branch of the inferior mesenteric artery. Urgent angiography provided the diagnosis and allowed successful hemostatic intervention via endovascular coil embolization. A subsequent routine colonoscopy revealed an ulcer with central yellow-bluish bulge in the distal rectum correlating with the site of the treated pseudoaneurysm.