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Intestinal mucosal immunity and COVID-19.
Cancer survivors had a median age of 55 years (interquartile range 48-61 years), were mostly female (n = 146, 66.1%), and of Hispanic ethnicity (n = 94, 52.5%). Cancer survivors were more likely to be current smokers (n = 42, 25.1%) compared to patients without a cancer history (n = 759, 16.1%). Patients with a history of cancer were more likely to be current drinkers (n = 34, 26%) compared to non-cancer patients (n = 942, 22.9%). There was no significant difference in illicit drug use history between the two groups. Conclusions Our study demonstrates that uninsured cancer survivors are more likely to be smokers and alcohol consumers than uninsured patients without a history of cancer. There was no significant difference in illicit drug use in cancer survivors and patients without a history of cancer. Future educational interventions should target substance use among uninsured cancer survivors.Coronary artery embolism (CAE) is a rare clinical entity that can cause acute myocardial infarction (AMI). The exact prevalence of coronary artery embolism is unknown. CAE was found to be associated with conditions that can lead to thrombo-embolism, including infective endocarditis, atrial fibrillation, mitral valve disease, valve surgery. Herein, we report a 78-year-old male with a past medical history of atrial fibrillation on rivaroxaban who presented to the hospital emergency department complaining of chest pain. The patient's anticoagulation therapy was recently held due to a concern for gastrointestinal bleeding. After further evaluation of the patient's symptoms and reviewing his electrocardiogram (ECG) which showed ST-depression in lateral leads and ST-elevation in aVR, urgent cardiac catheterization was done which showed left main coronary artery thrombosis extending into the left anterior descending artery (LAD) and left circumflex artery (LCX). The patient was started on a heparin drip and underwent a successful aspiration thrombectomy with subsequent improvement in his symptoms.Malignant epithelioid tumors have been described in various organ systems, but are rarely seen in the brain. They are aggressive tumors and have high mortality. In certain cases, the immunohistochemistry (IHC) findings may not be sufficient to clarify the diagnosis. In these cases, next-generation genetic sequencing may play a role in clarifying the diagnosis. In addition to lab testing, a thorough history and physical exam are necessary to rule out other sources of the tumor such as melanoma. Patients presenting with neurological symptoms are cared for by a wide variety of physicians, hence it is important to raise awareness of rare tumors in order to provide timely and appropriate management and referral for these patients. We present the case of a middle-aged woman who was diagnosed with a 'malignant epithelioid neoplasm' of the brain, a rare variety of tumors. We also give the clinical course of this illness.We present a case of a male diabetic patient with one of the most well-known major complications of diabetes mellitus (DM), i.e., diabetic ketoacidosis (DKA). The finding of euglycemic DKA, or DKA with blood glucose levels of less than 200 mg/dL, is a rare occurrence especially in patients with type II DM. He presented with hypotension and increased anion gap metabolic acidosis on a background of keto diet for weight loss and recent use of sodium-glucose linked transporter inhibitors. He was successfully managed with dextrose water, insulin infusion, and potassium replacement. A ketogenic diet consists of high fat, low carbohydrate, and adequate protein regimen that sends the body into a state of starvation in which high glucagon and low insulin levels lead to the activation of other counter-regulatory hormones, such as epinephrine and cortisol, that causes a rise in the level of free fatty acids in the blood increasing ketone body production. Rarely, sodium-glucose linked transport inhibitors can also cause DKA, with euglycemia instead of hyperglycemia. check details The finding of plasma glucose levels within normal range prompted patients to maintain and sometimes even lower their insulin dose; even their providers were often misled by the euglycemia that resulted in delayed diagnosis and treatment. Thus, it is imperative to stay aware of the possible clinical presentations in order to intervene in a timely manner and prevent further progression and complications.The mainstay of treatment for type 1 diabetes is insulin. The use of insulin for tight glycemic control is the key to preventing micro- and macrovascular complications, but it can also lead to hypoglycemic episodes. Therefore, there is a need for the introduction of a drug that can maintain glucose levels within a safe range without increasing the risk of hypoglycemia. For this reason, SGLT2 (sodium-glucose co-transporter-2) inhibitors has been a hot topic in the last couple of years. They have been proved very efficient in treating type 2 diabetes. Many trials on the safety and efficacy of SGLT2 inhibitors have been done on type 1 diabetics. Some other studies have also been done that prove their benefits in increasing arterial efficacy and reducing GFR (glomerular filtration rate). This review article discusses the benefits and risks. The literature search was performed using PubMed, and after applying the inclusion and exclusion criteria, 16 published papers were found. All relevant articles on the topic hlity of the patients. However, more studies need to be done to fully understand DKA caused by SGLT2 inhibitors.Background The prevalence and impact of anemia on the outcomes of transcatheter mitral valve repair (TMVr) have not been well-studied. Anemia is a commonly encountered comorbidity among patients with cardiovascular disorders and is frequently under-recognized. The study aimed to analyze the prevalence of anemia and its impact on post-TMVr in-hospital outcomes. Methods The National Inpatient Sample (NIS) was queried to identify all patients who underwent TMVr from 2011-2015 in the United States by utilizing suitable International Classification of Diseases, Ninth Revision (ICD-9) codes. The baseline characteristics and in-hospital outcomes were compared among patients with and without anemia. Results A total of 4,382 patients were identified. Out of these, 978 (22.3%) patients had baseline anemia. Anemic patients were noted to have a higher burden of co-morbidities, including chronic kidney disease, hypertension, and diabetes mellitus. The in-hospital mortality was higher but not statistically significant between anemic and non-anemic patients (3.6% vs 2.6%; odds ratio (OR) 1.44; confidence interval (CI) 0.85-2.46, p=0.179). The other adverse outcomes, including the length of stay, the requirement for blood transfusions, the incidence of post-implant acute kidney injury, hemodialysis, and the cost of hospitalization, were higher in anemic patients. Conclusion Anemia was present in one out of five patients undergoing TMVr in this nationally representative cohort. Baseline anemia showed numerically higher but not statistically significant in-hospital mortality and was associated with other in-hospital adverse outcomes. Further larger studies are needed to highlight the importance of anemia in the TMVr procedure.Neurosarcoidosis (NS) is a mimicker of many infectious, neoplastic, and inflammatory diseases. It most commonly involves the cranial nerves followed by meninges, ventricles, hypothalamic-pituitary axis, spinal cord, and brainstem/cerebellum. While NS myelopathy has been increasingly recognized, pathophysiological/prognostic and management principles in NS-mediated cauda equina (CE) and conus medullaris (CM) syndromes, which constitute a small and rare minority of this subset, remain elusive. We present the case of a 49 -year-old Hispanic man who developed a peripheral facial palsy and primary hypogonadism within a span of 12 months and eventually got diagnosed with NS after he presented with CE syndrome. We also performed an extensive literature review, with a discussion on the underlying pathophysiology and current management recommendations for NS-mediated CE/CM syndrome. CE/CM syndromes in a middle-aged man should prompt the consideration of NS as a possible differential diagnosis. While steroid responsive, the majority of NS-CE/CM patients are left with residual neurodeficits with quick relapses when steroids are tapered, making the case for early institution of immunosuppressive therapies.Falsely elevated potassium levels are common in routine laboratory tests and should be differentiated from true hyperkalemia. If the patient is inappropriately treated for hyperkalemia, the resulting hypokalemia can lead to life-threatening cardiac arrhythmias. We present the case of a 67-year-old woman with a past medical history of stable chronic lymphocytic leukemia, who presented for chest pain and had an elevated potassium level of 5.8 mEq/L, which, upon repeat laboratory testing, was then 6.7 mEq/L. She was initially treated for hyperkalemia. Laboratory test results showed creatine kinase levels at 43 U/L, lactate dehydrogenase levels at 177 U/L, phosphorus levels at 4.5 mg/dL, and uric acid levels at 6.4 mg/dL, indicating no evidence of tumor lysis syndrome. The patient was later diagnosed with reverse pseudohyperkalemia, indicated by falsely elevated plasma potassium levels in the presence of serum potassium levels within normal limits and venous blood gas samples.Diabetes is a common disease, and the number of patients is increasing every year. We report a case of a 34-year-old man with a history of diabetes mellitus (diagnosed at eight years old) and was on treatment with tablet glimepride with poor compliance. The patient sought consultation due to vomiting and abdominal pain 12 hours after onset along with burning micturition for four days. His initial blood sugar random (BSR) level was 84 mg/dL. Further lab tests revealed pH 7.14, bicarbonate 6.4 mEq/dL, sodium 141, potasium 3.8, chloride 107, PO2 115, PCO2 19.4, serum amylase 51, base excess (BE) -21.3 mmol/L, and positive ketonemia, i.e. 1.39. He was reanimated with parenteral crystalloids and insulin infusion. Eventually with subsequent arterial blood gases (ABGs) and ketones, the patient got better and was eventually declared to be out of diabetic ketoacidosis (DKA) and later discharged. There are very less studies done on euglycemic DKA (eu-DKA); so many physicians fail to diagnose the patients properly and they fall into the invisible cases chunk.Background Cosmetic problems induced by conventional prostaglandin F2α (PGF2α) analogs are common. We prospectively evaluated the improvement of patients with prostaglandin-associated periorbital syndrome (PAPS) for whom the treatment regimen was switched from conventional PGF2α analogs to a new selective prostaglandin-EP2 agonist (i.e., omidenepag isopropyl). Methods We finally evaluated 12 patients with follow-up for one year who changed the therapy from conventional PGF2α drugs to omidenepag isopropyl. Digital facial images of the patients were captured prior to the initiation of therapy with omidenepag isopropyl and after approximately three, six, and 12 months. Three independent observers judged the recovery according to the five signs of PAPS - deepening of the upper eyelid sulcus (DUES), flattening of the lower eyelid bags, upper eyelid ptosis, ciliary hypertrichosis, and periorbital skin hyperpigmentation - by comparing images at baseline and each month. Results The mean age of patients (eight females; four males) was 61 years.
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