Fool Me Once: An Uncommon Presentation of PE

​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it showed significant elevation at 4,360. PA and lateral chest x-rays were notable for mild cardiomegaly without any focal consolidation or pulmonary edema. A 12-lead ECG showed a left axis deviation, incomplete right bundle branch block, prolonged QT interval, and poor R wave progression with T wave inversions in inferolateral leads (aVF, V2-V5).She was admitted for an acute inferolateral NSTEMI, and empirically managed with aspirin 81 mg daily, metoprolol 12.5 mg twice daily, and atorvastatin 40 mg daily. Her troponin I showed a downward trend, and cardiology performed a coronary angiogram, which was unremarkable for clinically emergent coronary artery pathologies. The patient also had a bilateral lower extremity venous Doppler study evident for left lower extremity chronic DVT and right lower extremity subacute DVT.Further study was recommended to rule out ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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We describe a contiguous gene deletion of the ATM locus in a multi-generation family of Italian descent with a strong family history of pancreatic cancer. A deletion of one copy of the entire ATM gene was identified by routine panel testing and further characterized by chromosomal microarray analysis. An 11q22.3 microdeletion of approximately 960kb was identified that is predicted to result in loss of 10 genes including ATM. The deletion was identified in two additional family members including a presymptomatic daughter and an affected sibling. A normal disomic complement of the 11q22.3 region was detected in a third famil...
Source: Cancer Genetics - Category: Cancer & Oncology Source Type: research
Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (rem...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
ConclusionsThis case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.ResumoJustificativa e objetivosA ressonância magnética (RM) cardíaca é uma técnica utilizada na avaliação de crianças com cardiopatias congênitas. A anestesia geral garante imobilidade, especialmente em pacientes não cooperador...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)Author(s): Q. Xu, M. Lv, Y. Xia, Y. Zhao, W. Zhang, Y. ChenAbstractA 42-year-old woman presented with a ten-day history of dysphagia, slight chest pain and occasional vomiting. With the performance of thoracic and abdominal enhanced computed tomography (CT) and upper gastrointestinal contrast, once esophageal cancer was suspected. Significant activity mass in esophagus and mediastinal lymph nodes could be found on the imaging of 18F-FDG PET/CT, which also supported malignancy. However, T...
Source: Revista Espanola de Medicina Nuclear e Imagen Molecular - Category: Nuclear Medicine Source Type: research
CONCLUSIONS IQGAP3 may be a potential target gene for Kaempferol in the treatment of BC, and upregulation of IQGAP3 inhibits Kaempferol-induced apoptosis in BC cells by ERK1/2 signaling activation. Targeting IQGAP3 may contribute to the study of natural phytochemicals as anti-tumor drugs in BC. PMID: 31605603 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
CONCLUSIONS PVT1 exerts an oncogenic role through activating Wnt/ß-catenin signaling in pituitary adenoma cells. The present results may provide a potential therapeutic target or approach for treating pituitary adenomas. PMID: 31604907 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
CONCLUSIONS lncRNA TSLNC8 remarkably inhibited the proliferation and migration and accelerated apoptosis of lung cancer cells by targeting the IL-6/STAT3/HIF-1alpha signaling pathway. TSLNC8 may be a potential therapeutic target for the diagnosis and treatment of NSCLC. PMID: 31601776 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
John SamplesElizabeth Warren ’s presidential campaign has a new Facebook ad claiming Mark Zuckerberg, the CEO of Facebook, has endorsed Donald Trump for re-election. That claim is false, and Warren admits as much in the ad. Warren is not trying to mislead people about Zuckerberg. She is trying to control what can be said on Facebook. That is much more dangerous than any lie appearing in a campaign ad.Recently the Trump campaign ran an ad on Facebook saying former vice president Joe Biden had sought to fire a Ukrainian prosecutor investigating a company whose board included Biden ’s son. Many on the left like Wa...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
Publication date: Available online 12 October 2019Source: Materials Today: ProceedingsAuthor(s): A. Saikiran, M. Vivekanand, M. Prahalad, S. Yuvan, N. RameshbabuAbstractMicrowave synthesis of nanocrystalline Zn/Mg substituted and Zn/Mg-F co-substituted hydroxyapatites is reported in this study. Substitution of Zn/Mg is expected to increase the bioactivity, whereas the fluorine substitution is aimed for the attainment of chemical and thermal stability of the hydroxyapatite. The thermal stability of the nanopowders was studied by annealing the samples at 900 °C for 2 h. The phase composition and crystallite size of t...
Source: Materials Today: Proceedings - Category: Materials Science Source Type: research
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