A Delayed Presentation of a Sinus Venosus Atrial Septal Defect.

Sinus venosus atrial septal defects (ASDs) are rare congenital anomalies that result from an abnormality of the junction between the right atrium, superior vena cava (SVC), and pulmonary veins. This defect causes right-to-left shunting, which can lead to progressive right heart enlargement. We present a case of a 59-year-old man with a history of hypertension and hyperlipidemia who presented with dyspnea and newly diagnosed atrial flutter.

Severe allergic reaction to contrast dye during emergent coronary angiogram.

We present a case of a middle-aged woman with an extensive history of adverse reactions to iodinated contrast media (ICM) despite premedication. The patient presented from an outside hospital with an ST elevation myocardial infarction in the inferior and anterior leads. She received thrombolytics and was transferred to our hospital.

Direct oral anticoagulants versus Vitamin K antagonists for left ventricular thrombus management.

Background: This study compared the rates of intracranial hemorrhage (ICH), ischemic stroke, transient ischemic attack (TIA), and major bleeding events between patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) management.

Methods: In this retrospective analysis of claims data, 3152 patients receiving treatment for LVT were identified. Two cohorts were exactly matched on age, sex, and pertinent comorbidities.

Racial and ethnic inequities to noise pollution from transportation- and work-related sources in the United States.

Background: Racial and ethnic inequities in environmental noise exist in the US, partially attributable to historical structural racism. However, previous studies have not considered the totality of people's exposures. Since people spend most of their waking time at work, there is a need to consider cumulative exposure to noise both in and out of the workplace to understand who is most at risk of noise pollution-related adverse health outcomes.

Modeling platelet P2Y pathway to integrin activation.

Through experimental studies, many details of the pathway of integrin αβ activation by ADP during the platelet aggregation process have been mapped out. ADP binds to two separate G protein-coupled receptors on platelet surfaces, leading to alterations in the regulation of the small GTPase RAP1. We seek to 1) gain insights into the relative contributions of both pathways to RAP1-mediated integrin activation and to 2) predict wild-type and mutated cell behavior in response to a continuous range of external agonist concentrations.

Acute Fulminant Myocarditis Secondary to Coxsackie B Virus.

Fulminant myocarditis is a severe form of acute myocarditis, characterized by complications such as hemodynamic compromise, often requiring advanced mechanical support. It can occur as a result of infection, toxin exposure, or autoimmune processes. This is a case of a 53-year-old male with no past medical history who presented with one week of fever, shortness of breath, and upper respiratory symptoms and subsequently developed fulminant myocarditis, characterized by severe left ventricular dysfunction and cardiogenic shock requiring both inotropic and advanced mechanical support.

Modeling Platelet P2Y$_1$/$_{12}$ Pathway to Integrin Activation.

Through experimental studies, many details of the pathway of integrin $\alpha_{\rm IIb}\beta_3$ activation by ADP during the platelet aggregation process have been mapped out. ADP binds to two separate G protein coupled receptors on platelet surfaces, leading to alterations in the regulation of the small GTPase RAP1. We seek to (1) gain insights into the relative contributions of both pathways to RAP1-mediated integrin activation and to (2) predict wildtype and mutated cell behavior in response to a continuous range of external agonist concentrations.

Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization.

Introduction: Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.

Definition of Polypharmacy in Heart Failure: A Scoping Review of the Literature.

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients.

Dopamine projections to the basolateral amygdala drive the encoding of identity-specific reward memories.

To make adaptive decisions, we build an internal model of the associative relationships in an environment and use it to make predictions and inferences about specific available outcomes. Detailed, identity-specific cue-reward memories are a core feature of such cognitive maps. Here we used fiber photometry, cell-type and pathway-specific optogenetic manipulation, Pavlovian cue-reward conditioning and decision-making tests in male and female rats, to reveal that ventral tegmental area dopamine (VTA) projections to the basolateral amygdala (BLA) drive the encoding of identity-specific cue-reward memories.

A rare case of type 2 Kounis syndrome secondary to iodinated contrast.

Unlabelled: Immune-mediated acute coronary syndrome, also known as Kounis syndrome (KS), is an underrecognized and challenging diagnosis. In this case report, we present a case of cardiac arrest secondary to iodinated contrast allergy requiring emergent cardiac catheterization and hemodynamic support secondary to type 2 KS. KS necessitates a high index of clinical suspicion by the treating physician in order to address both the hypersensitivity reaction and its cardiac implications.

Role of Psychologists in Pediatric Congenital Heart Disease.

Congenital heart disease (CHD) is stressful to both pediatric patients and their caregivers. Maternal anxiety during pregnancy is associated with adverse perinatal outcomes. After birth, a prolonged hospital stay can be taxing on the infant and caregiver leading to long-term adverse effects.

A Rare Complication of Herpes Zoster: Segmental Zoster Paresis.

Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement.We present a case of an 80-year-old female with a resolving HZ rash on her left leg and buttocks that presented with left leg weakness for two weeks. The patient's rash preceded the left leg weakness by two weeks.

Utilizing Percutaneous Cholecystostomy Tube as a Temporary Minimally Invasive Approach for Acute Cholecystitis during Third Trimester of a High-Risk Pregnancy.

Laparoscopic cholecystectomy (LC) is the treatment modality of choice for symptomatic cholelithiasis and cholecystitis during pregnancy and is associated with shorter length of stay, shorter operative times, and fewer complications compared to open cholecystectomy. However, in high-risk pregnant patients, LC can be challenging. Percutaneous cholecystostomy tube (PCT) offers a temporary management option during the peripartum period until interval LC is performed.

Opioid-Associated Amnestic Syndrome.

Opioid-associated amnestic syndrome (OAS) is a relatively new condition that is associated with opioid abuse and has increased in prevalence since the notable rise in opioid-related deaths and opioid-related hospitalizations of the opioid crisis. Patients often present with acute anterograde amnesia and current opioid abuse, most commonly fentanyl. OAS is frequently diagnosed when other potentially infectious or metabolic conditions such as encephalitis and seizures are ruled out, as these conditions can also present similarly to OAS.

Suspected Post-ictal Psychosis in Temporal Lobe Epilepsy Secondary to Human Herpesvirus 6 Encephalitis.

Human herpesvirus 6 (HHV-6) may lead to temporal lobe epilepsy (TLE). Psychotic syndrome frequency in the setting of TLE is 7% to 11%. We report a case of post-ictal psychosis (PIP) secondary to TLE in the setting of HHV-6 encephalitis.

Left Ventricular Thrombus Formation in a Young Female With a Severely Reduced Left Ventricular Ejection Fraction and a Recent Non-ST Segment Elevation-Acute Coronary Syndrome.

A 30-year-old female with a past medical history of heart failure with reduced ejection fraction (HFrEF of 20%), non-ST segment elevation-acute coronary syndrome (NSTE-ACS), and polysubstance abuse (heavy alcohol and methamphetamine use) was admitted for a heart failure exacerbation. Electrocardiogram and troponin levels were negative. Pro brain natriuretic peptide was elevated at 4,152 pg/mL.

Plummer-Vinson Syndrome in an African-American Woman.

Plummer-Vinson syndrome (PVS) presents with the classic triad of iron-deficiency anemia, dysphagia, and esophageal webs. The mainstay treatment of PVS is iron supplementation and the dysphagia usually responds to iron supplementation before the hematologic abnormalities are corrected. This syndrome classically affects middle-aged Caucasian women and very few cases have been reported in African Americans.

The Role of Psychiatric, Analgesic, and Antiepileptic Medications in Chronic Pruritus.

Chronic pruritus is a complex yet prevalent concern without a gold standard treatment. The mainstay therapy for chronic pruritus includes topical ointments such as corticosteroids, capsaicin, local anesthetics, antihistamines, and immunomodulators. There are many different subtypes of chronic pruritus, and each unique subtype may benefit from specialized treatments.

Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma.

Bile leaks are a rare occurrence most often seen as a complication of cholecystectomy. Other less common etiologies include endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), liver surgery, percutaneous drainage of liver abscesses, living donor hepatectomy, and non-iatrogenic abdominal trauma. In this case study, we present a 67-year-old female with morbid obesity who presented with abdominal pain and was diagnosed with a spontaneous bile leak.

Leptomeningeal Carcinomatosis Secondary to a Gastrointestinal Stromal Tumor.

A 66-year-old male presented to the emergency department (ED) with altered mental status and concern for stroke. Seven months prior to presentation, the patient was diagnosed with a benign gastrointestinal stromal tumor (GIST), for which he did not receive further workup. Initially, there was a concern for a stroke, however, CT of the brain, CT angiography of the head and neck, and MRI of the brain were negative for any acute abnormalities.

The other side of atopic dermatitis: An evaluation of psychosocial comorbidities.

Atopic dermatitis is a chronic skin disease that commonly affects patients. In addition to its effects on the skin, it has also been associated with other physical, psychosocial, and economic burdens along with numerous debilitating comorbidities. More recently, research has focused on the psychosocial and mental health aspect of atopic dermatitis, which has remained controversial.

Initial Presentation of Renal Cell Carcinoma as Heart Failure Secondary to Tumor-Thrombus Extension to the Right Atrium.

Renal cell carcinoma (RCC) can invade locally through the renal vein and into the inferior vena cava (IVC) with tumor-thrombus formation reported in 5%-15% of patients. From the IVC, RCC can grow intravascularly and extend into the right atrium. We present a rare case with two uncommon findings: tumor-thrombus extension leading to a right atrial mass and initial presentation of RCC as heart failure.

Acne Vulgaris: The Majority of Patients Do Not Achieve Success According to FDA Guidance.

Background: The Food and Drug Administration (FDA) recommends grading Acne vulgaris via an Investigator’s Global Assessment (IGA) scale and assessing treatment as either success or failure, with success defined as clear (grade 0) or almost clear (grade 1) with at least a two-grade improvement in acne severity from baseline.

Objective: To determine the likelihood of achieving real world treatment success in patients with acne according to FDA guidance.

Methods: We calculated estimated appropriates to obtain the IGA 0/1 (clear or almost clear rate) for many of the oral and topical medications.