An Unusual Diagnosis Presenting as SOB and Pleural Effusions

​BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave way to more significant pedal edema at the end of the day and progressively worsening exertional dyspnea. He noted a low grade fever and loss of appetite. His initial vitals were a blood pressure of 185/96 mm Hg, a heart rate of 106 bpm, a respiratory rate of 20 bpm, a temperature of 100.1°F, and oxygen saturation of 97% on room air.The patient appeared well, but would not stop sipping water despite obvious myxedema. He also had a history of autoimmune and oncological conditions.The differential for this case included an infectious process such as viral or bacterial infiltrate. Lung mass or atypical presentation of myeloma with the patient's history of MGUS was also on the differential, but cardiorenal disease, nephrotic disease, and congestive heart failure were higher on the list. Other etiologies were considered, including thyroid disease, syndrome of i...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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ConclusionsPatients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short ‐term secondary postoperative outcomes and reduced long‐term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
AbstractThe first successful human heart transplantation was reported on 3 December 1967, by Christiaan Barnard in South Africa. Since then this life ‐saving procedure has been performed in over 120 000 patients. A limitation to the performance of this procedure is the availability of donor hearts with as many as 20% of patients dying before a donor's heart is available for transplant. Today, hearts for transplantation are procured from indiv iduals experiencing donation after brain death (DBD). Interestingly, this, however, was not always the case as the first heart transplants occurred after circulatory dea...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: REVIEW ARTICLE Source Type: research
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Source: LWT Food Science and Technology - Category: Food Science Source Type: research
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Source: Molecular Nutrition and Food Research - Category: Food Science Authors: Tags: Research Article Source Type: research
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Source: Protein Expression and Purification - Category: Biochemistry Source Type: research
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Source: Inorganica Chimica Acta - Category: Chemistry Source Type: research
This article is licensed under aCreative Commons Attribution-NonCommercial 3.0 Unported Licence.Nicola Migliore, Francesco Picchioni, Patrizio Raffa In this work rheological and surface properties of various random copolymers of styrene and sodium (meth)acrylate, prepared using reversible deactivation radical polymerization (RDRP), were studied. It is shown that the... The content of this RSS Feed (c) The Royal Society of Chemistry
Source: RSC - Soft Matter latest articles - Category: Chemistry Authors: Source Type: research
This article is licensed under aCreative Commons Attribution 3.0 Unported Licence.Christian Storm Ahart, Jochen Blumberger, Kevin Rosso Iron oxides such as hematite ($\alpha \ce{-Fe2O3}$) play an important role in diverse fields ranging from biogeochemistry to photocatalysis. Here we perform calculations of both the electron and electron hole... The content of this RSS Feed (c) The Royal Society of Chemistry
Source: RSC - Phys. Chem. Chem. Phys. latest articles - Category: Chemistry Authors: Source Type: research
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Source: RSC - J. Mater. Chem. latest articles - Category: Chemistry Authors: Source Type: research
Chem. Commun., 2020, Accepted Manuscript DOI: 10.1039/C9CC08907A, CommunicationMaurice Beske, Lukas Tapmeyer, Martin U. Schmidt As early as 1837, Liebig synthesised solid C2H5ONa. Today, C2H5ONa is one of the standard bases in organic synthesis. Here, we report the identification of different solid phases and the... The content of this RSS Feed (c) The Royal Society of Chemistry
Source: RSC - Chem. Commun. latest articles - Category: Chemistry Authors: Source Type: research
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