Unusual source of tachycardia in an adolescent

Mahaim fiber tachycardia is an uncommon cause of palpitations among the pediatric population. This case report describes an adolescent female who presented with recurrent episodes of tachycardia with chest pain and dizziness. Her ECG showed tachycardia with wide QRS complexes and left bundle branch block pattern. Repeat ECG after adenosine treatment revealed sinus rhythm with persistence of the left bundle branch block pattern. Metoprolol was started however she continued to have episodes of sustained tachycardia

Allele-Specific HLA Loss and Immune Escape in Lung Cancer Evolution

Immune evasion is a hallmark of cancer. Losing the ability to present neoantigens through human leukocyte antigen (HLA) loss may facilitate immune evasion. However, the polymorphic nature of the locus has precluded accurate HLA copy-number analysis. Here, we present loss of heterozygosity in human leukocyte antigen (LOHHLA), a computational tool to determine HLA allele-specific copy number from sequencing data. Using LOHHLA, we find that HLA LOH occurs in 40% of non-small-cell lung cancers (NSCLCs) and is associated with a high subclonal neoantigen burden, APOBEC-mediated mutagenesis, upregulation of cytolytic activity, and PD-L1 positivity. The focal nature of HLA LOH alterations, their subclonal frequencies, enrichment in metastatic sites, and occurrence as parallel events suggests that HLA LOH is an immune escape mechanism that is subject to strong microenvironmental selection pressures later in tumor evolution. Characterizing HLA LOH with LOHHLA refines neoantigen prediction and may have implications for our understanding of resistance mechanisms and immunotherapeutic approaches targeting neoantigens. Video Abstract [Figure presented] Development of the bioinformatics tool LOHHLA allows precise measurement of allele-specific HLA copy number, improves the accuracy in neoantigen prediction, and uncovers insights into how immune escape contributes to tumor evolution in non-small-cell lung cancer

Suspected Brown Recluse Envenomation: A Case Report And Review Of Different Treatment Modalities

Background: The Loxosceles reclusa, commonly known as the brown recluse spider, is responsible for virtually all cases of spider bites leading to a significant necrosis. Case Report: We report the case of a 72-year-old man who presented to the Emergency Department complaining of back pain, weakness, and diarrhea. The patient stated that he sustained a bug bite 1 week before presenting to the hospital. His wound was necrotizing in nature and after an exhaustive work-up, the most likely etiology was found to be envenomation by a brown recluse spider, Loxosceles reclusa. Conclusion: This is an endemic cause of a necrotizing wound bite in areas of the Midwestern and Southern United States, but it is rarely reported in the Northeast