Disseminated Varicella-Zoster Virus Infection Complicated by Encephalitis and Ramsay Hunt Syndrome in an HIV Patient

Varicella-zoster virus (VZV) is a human α-herpesvirus which cause primary varicella infection (chicken pox) or herpes zoster infection (shingles) after reactivation of the dormant virus. VZV infection is usually self-limited but disseminated infection can be seen in immunocompromised individuals. It can also get complicated by central nervous system (CNS) involvement. We describe a case of a 51-year-old male with human immunodeficiency virus (HIV) who presented with altered mental status and deficits in his right-sided cranial nerves of VI, VII, and VIII. The patient also had disseminated vesicular-pustular rash all over his body at different stages of healing. A diagnosis of disseminated VZV infection complicated by encephalitis and Ramsay Hunt syndrome was made and the patient was treated with intravenous acyclovir and oral prednisone with a rapid improvement. The coexistence of these conditions is rare. The purpose of this report is to increase awareness of the coexistence of these two conditions in HIV infected patients

Cholangiocarcinoma Presenting as Humoral Hypercalcemia of Malignancy: A Case Report and Literature Review

Humoral hypercalcemia of malignancy (HHM) is most commonly encountered in squamous cell carcinoma (SCC) of different organs, and It is characterized by elevated parathyroid hormone-related peptide (PTHrP) levels. It may be seen as a manifestation of cholangiocarcinoma (CCC) at presentation and later in the course of the disease. However, HHM due to intrahepatic cholangiocarcinoma is a rare association and is associated with a poor prognosis. We herein report a case of hypercalcemia presenting as the first manifestation of an underlying rare variant of intrahepatic cholangiocarcinoma. Our patient is a 57-year-old male who presented to the emergency room with severe symptoms of constipation and polyuria and was admitted to the hospital for symptomatic hypercalcemia. He was found to have a hypermetabolic 15 cm liver mass, abdominal lymph nodes on imaging, which was subsequently diagnosed as adenosquamous cholangiocarcinoma by liver biopsy. This necessitated an urgent inpatient treatment with gemcitabine/cisplatin combination chemotherapy to control the aggressive nature of the malignancy. However, he deteriorated and expired after three months of his diagnosis. Adenosquamous cholangiocarcinoma is a very rare variant of a liver tumor. It develops due to squamous metaplasia of an underlying cholangiocarcinoma and usually has aggressive clinicopathological features. HMM is a life-threatening, yet unrecognized, phenomenon of cholangiocarcinoma, which represents a poor prognostic marker. Prompt recognition of this complication is important for preventing serious complications associated with hypercalcemia and to improve the quality of life of these patients

Acute Kidney Injury Caused by Levetiracetam in a Patient With Status Epilepticus

Levetiracetam is a widely used, effective and usually well-tolerated anti-epileptic medicine. It is mostly excreted by kidneys and requires dose adjustment according to the glomerular filtration rate. Very few case reports have been published in the literature about levetiracetam causing acute kidney injury (AKI). We present a case of a 26-year-old male with a seizure disorder on levetiracetam, presented with status epilepticus requiring intubation for airway protection. He received 4 g of intravenous levetiracetam as a loading dose and continued with a maintenance dose of 750 mg intravenous every 12 hours. He had signs of AKI on day two and creatinine eventually reached a maximum level of 12.2 mg/dL. His kidney function improved to his new baseline in a period of 30 days without requiring renal replacement therapy. He did not have significant rhabdomyolysis and his kidney function started improving right after his anti-epileptic therapy was switched to valproic acid pointing towards levetiracetam as the primary cause of kidney injury. Clinicians should be aware that levetiracetam can cause AKI on patients with a seizure disorder, especially when administered in high doses. Kidney function should be monitored closely and patients should be treated aggressively with intravenous fluids when they have any signs of rhabdomyolysis to prevent further kidney damage

The Association Between Anemia of Chronic Inflammation and Alzheimer\u27s Disease and Related Dementias

Background: Dementia is a spectrum of neurological diseases characterized by memory impairment and cognitive decline with the pathogenesis and effective management remaining elusive. Several studies have identified a correlation between anemia and Alzheimer\u27s disease and related dementias (ADRD); however, anemia subtypes and association with ADRD have yet to be studied conclusively. Objective: To study an association between ADRD and anemia of chronic inflammation. Methods: We conducted a retrospective case-control study of the patients, diagnosed with ADRD at Brookdale Hospital. Pair-wise comparisons between means of controls and cases in terms of iron studies and laboratory results were performed using a Mann-Whitney U test. Pair-wise comparisons between anemia subgroups (moderate and severe) were performed using a Two Sample proportion Z-Test, where for each couple of normally distributed population. Results: There was a total of 4,517 (1,274 ADRD group; 3,243 Control group) patients. There was significant difference in hemoglobin 10.15 versus 11.04 [ Conclusion: We demonstrated an association between ADRD and anemia of chronic inflammation independent of age, renal function, and HgbA1C levels

A Method for Determination of Moment Contribution Ratio under Foundation Rotation in Shear Wall-Frame Systems

In shear wall-frame systems, the foundation rotation that may occur under the shear walls changes the displacements and interstory drift ratios and changes the internal force distribution. This study investigates the effect of foundation rotations under shear walls on internal force distribution in shear-frame systems. The originality of the study lies in considering parabolic loads and dynamic analysis (first mode), in addition to static uniform or triangular distributed loads, when determining the shear wall moment contribution ratio under the influence of foundation rotation. The shear wall contribution ratio, a key parameter in many earthquake codes, is defined as the ratio of the sum of bending moments taken by the shear walls at the base to the overturning moment. It plays a crucial role in determining the building’s behavior. Depending on this ratio, the load-reduction coefficient is changed. This study investigates the effect of foundation rotation on the moment distribution at the base for three different static load cases and the first mode in the dynamic analysis. The multi-story building is modeled as an equivalent sandwich beam. The moment contribution ratio (MCR) was calculated with the help of analytical solutions of the differential equations written for three different load cases in static conditions, and graphs were created for practical use directly calculating the MCR. In the methodology of the study, the initial step involves the calculation of the equivalent sandwich beam stiffness parameters and the foundational rotational spring. Subsequent to these calculations, the MCR values can be directly obtained with the help of graphs. This approach facilitates the rapid and practical determination of the MCR and can be used in the preliminary sizing phase to eliminate possible errors in the data entry of software that performs detailed analysis. In addition, in the presented study, it has been shown that taking a single mode into account is sufficient when calculating MCR values in dynamic analysis

Unexplained chronic cytopenia: is it idiopathic cytopenia of undetermined significance or myelodysplastic syndrome

Idiopathic cytopenia is a condition where there is a decrease in peripheral blood counts causing either anaemia, leucopoenia and thrombocytopaenia. Most cases of cytopenia reveal a cause on further workup. But very rarely, in some cases, a definitive cause could not be identified. Unexplained cytopenia becomes challenging and poses difficulty in diagnosis and management. Discriminating these groups of bone marrow failure disorders from myelodysplastic syndrome (MDS) becomes an important clinical question. We describe a case of a middle-aged Hispanic woman who presented with pancytopenia and on extensive workup did not reveal any specific cause. Her bone marrow examination revealed severely reduced megakaryocytes but with normal haemopoiesis of other lineages. Cytogenetics, flow cytometry, comprehensive next-generation whole genomic analysis did not reveal any abnormalities. She fit the criteria for idiopathic cytopenia of undetermined significance rather than MDS. She remained asymptomatic and her counts never improved with immunosuppressives or thrombopoietin mimetics

The role of hyponatremia in preeclampsia

Preeclampsia associated hyponatraemia is a quite rare condition that cannot be separated from preeclampsia with severe features completely. This condition may be life-threatening for mothers and fetuses and is needed a multidisciplinary management. A 31-year-old primigravida was referred to our perinatology clinic at 28 weeks 4 days due to preeclampsia. She had nephrotic proteinuria and developed hypervolemic, hypoosmolar, chronic, severe hyponatremia. The pregnant was delivered at 29 weeks of gestation because of severe preeclampsia. The baby died in 48 hours postpartum and maternal hyponatremia improved spontaneously within 72 hours. Studies major on vasopressin about hyponatremia-complicated preeclampsia that its pathogenesis and management is still unclear. Studies that note the importance of vasopressin in the pathogenesis of preeclampsia support the theories and highlight the association of vasopressin and hyponatremia. It is known that the definite treatment is delivery. Maternal outcomes are good but neonatal outcomes are variable. [Med-Science 2017; 6(3.000): 592-7

Electronic cigarette (e-cigarette)

Electronic cigarette (e-cigarette) is a device developed with an intent to enable smokers to quit smoking and avoid the unhealthful effects of cigarettes. The popularity of e-cigarette has increased rapidly in recent years. The increase in its use during the adolescence period is attention-grabbing. Despite the fact that e-cigarette has become popular in a dramatic way, there are certain differences of opinion regarding its long-term effects on health, in particular. While some people assert that it is less harmful than conventional cigarettes, some others assert the contrary. Although e-cigarette contains less toxic substances compared to conventional cigarette, it contains certain carcinogens existing in conventional cigarette such as formaldehyde and acetaldehyde. It also contains heavy metals (nickel, chrome) that conventional cigarette does not contain; and therefore, raises concerns about health. E-cigarette leads to upper and lower respiratory tract irritation as well as an increased airway resistance and an increased bacterial colonization in the respiratory tract. It may also cause tahcycardia and increase diastolic blood pressure. Although e-cigarette has been found to have certain benefits in terms of smoking cessation, most of the studies have shown unfavorable results. In this collected work, the effects of e-cigarette on health and its role in smoking cessation are discussed in detail

An Unusual Presentation of Merkel Cell Carcinoma in a HIV Patient: A Case Report and Literature Review

Merkel cell carcinoma (MCC) is a rare, rapidly growing, aggressive neuroendocrine skin cancer that generally arises on sun-exposed areas of body such as head, neck, upper limbs, and shoulders of people with light complexity. Typically, MCC presents as shiny, flesh-colored or bluish-red, intracutaneous nodule, possibly with ulceration or crusting. In most of the cases, there is an association with Merkel cell polyomavirus. Even though these are very aggressive tumors, early detection and treatment has always given favorable outcome. There seems to be no consensus in definite prognostic markers, and advanced stages have the worst outcome even with treatment. There has been a recent trend in using PD-I/PD-L1 target therapy rather than chemotherapy in these cancers and have shown to improve survival by many months. In this article, we report a very unusual presentation of MCC first found on left frontoparietal skull as an 8-cm diameter fixed, subcutaneous mass without any typical features of MCC and was found to have metastatic spread to lung and liver. The patient was treated with palliative radiotherapy to brain and chemotherapy with cisplatin/etoposide with addition of immunotherapy later