A Young Female Who Develops Tachycardia and Orthostatic Intolerance Following a Recent Infection

Case Presentation The patient is a 20-year-old female with a history of asthma and anxiety with panic attacks who presented with palpitations and lightheadedness/pre-syncope. The morning of admission, she was attending a seminar and experienced an acute onset of palpitations. The palpitations started while she was seated and worsened upon standing. They were associated with lightheadedness, shortness of breath, and chest tightness. A nurse attending the seminar recommended that she go to the emergency room. On presentation to the emergency department (ED) her vital signs were: Temperature: 99.2°F, Blood pressure (BP): 140/98; Heart rate (HR): 140; Respiratory rate (RR): 16; Oxygen saturation: 100% on room air. She reported that she had experienced prior panic attacks but that this episode was persistent and significantly more intense in comparison. She also reported that a few days prior to presentation she had completed a prolonged course of antibiotics for tonsillitis. Her only medications were oral contraceptive pills (OCPs) and dextroamphetamine/ amphetamine (Adderall®). She reported taking her Adderall® as prescribed, most recently on the day prior to presentation. She denied other stimulant or illicit drug abuse. Her family history was significant for anti-phospholipid antibody syndrome (APS) in her mother

A 47-Year Old Female with Muscular Rigidity, New-Onset Diabetes and Hypothyroidism

Background This case highlights a rare but devastating neurologic condition, Stiff Person Syndrome (SPS). While symptoms of muscular rigidity andspasms areassocia ted with numerous neuromuscular conditions, the association between SPS, autoimmune diabetes, and other autoimmune disorders such as thyroiditis, pernicious anemia, and vitiligo, could aid in the early diagnosis of this debilitating condition. Case Presentation A 47-year-old African American female presented with six months of progressively worsening rigidity and spasticity of her axial muscles and extremities. The patient was in good health until one and a half years prior to admission when she lost consciousness while driving and was subsequently diagnosed with epilepsy. Her daughter was a passenger in the car and suffered a brief coma. Over the next year, the patient started having anxiety with increasingly more frequent and severe panic attacks. Six months prior to admission, she developed muscle stiffness and painful spasms that were so severe, she had difficulty ambulating and eventually became bed-bound. Magnetic Resonance Imaging (MRI) of the brain and spine did not reveal any pathology. Additionally, during the past year she was diagnosed with diabetes, which was unusual given her thin body habitus (Body-Mass Index of 20.9)

From the Editors

We are excited to present you with the 16th annual edition of The Medicine Forum. This work is a culmination of months of effort on the part of medical students, residents, fellows and faculty to share clinical pearls from the last year of their experiences. Amongst the greatest strengths of medical professionals and patients alike is the ability to tell stories. Stories, and how they are told form the basis of medical care. The way in which a particular patient\u27s story unfolds has a lasting impact on physicians, trainees, other medical staff, and perhaps most importantly, on future patients. Stories of patient cases formed the earliest beginnings of evidence-based medicine. There is a Babylonian tablet dating earlier than 6000 B.C.E. which describes a case of dropsy , for the instruction of patients of this condition.1 Stories told amongst practitioners of medicine date back to the first published medical journal, the Acta Medicorum Berolinensium, from Berlin in 1722.

The history and evolution of the clinical effectiveness of haemophilia type a treatment: a systematic review.

First evidence of cases of haemophilia dates from ancient Egypt, but it was when Queen Victoria from England in the 19th century transmitted this illness to her descendants, when it became known as the "royal disease". Last decades of the 20th century account for major discoveries that improved the life expectancy and quality of life of these patients. The history and evolution of haemophilia healthcare counts ups and downs. The introduction of prophylactic schemes during the 1970s have proved to be more effective that the classic on-demand replacement of clotting factors, nevertheless many patients managed with frequent plasma transfusions or derived products became infected with the Human Immunodeficiency Virus (HIV) and Hepatitis C virus during the 1980s and 1990s. Recombinant factor VIII inception has decreased the risk of blood borne infections and restored back longer life expectancies. Main concerns for haemophilia healthcare are shifting from the pure clinical aspects to the economic considerations of long-term replacement therapy. Nowadays researchers' attention has been placed on the future costs and cost-effectiveness of costly long-term treatment. Equity considerations are relevant as well, and alternative options for less affluent countries are under the scope of further research. The aim of this review was to assess the evidence of different treatment options for haemophilia type A over the past four decades, focusing on the most important technological advances that have influenced the natural course of this "royal disease"

Soft-templated synthesis of mesoporous nickel oxide using poly(styrene-block-acrylic acid-block-ethylene glycol) block copolymers

In this work, we report the soft-templated preparation of mesoporous nickel oxide using an asymmetric poly(styrene-block-acrylic acid-block-ethylene glycol) (PS-b-PAA-b-PEG) triblock copolymer. This block copolymer forms a micelle consisting of a PS core, a PAA shell and a PEG corona in aqueous solutions, which can serve as a soft template. Specifically, the PS block forms the core of the micelles on the basis of its lower solubility in water. The anionic PAA block interacts with the cationic Ni ions present in the solution to generate the shell. The PEG block forms the corona of the micelles and stabilizes the micelles by preventing secondary aggregation through steric repulsion between the PEG chains. In terms of textural characteristics, the as-synthesized mesoporous NiO exhibits a large average pore size of 35 nm with large specific surface area and pore volume of 97.0 m g and 0.411 cm g, respectively. It is expected that the proposed soft-templated strategy can be expanded to other metal oxides/sulfides in the future for potential applications in gas sensors, catalysis, energy storage and conversion, optoelectronics, and biomedical applications

Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports

Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-guided transseptal approach might be a promising modality for TCRFA of LSAP

Development of Functional and Molecular Correlates of Vaccine-Induced Protection for a Model Intracellular Pathogen, F. tularensis LVS

In contrast with common human infections for which vaccine efficacy can be evaluated directly in field studies, alternative strategies are needed to evaluate efficacy for slowly developing or sporadic diseases like tularemia. For diseases such as these caused by intracellular bacteria, serological measures of antibodies are generally not predictive. Here, we used vaccines varying in efficacy to explore development of clinically useful correlates of protection for intracellular bacteria, using Francisella tularensis as an experimental model. F. tularensis is an intracellular bacterium classified as Category A bioterrorism agent which causes tularemia. The primary vaccine candidate in the U.S., called Live Vaccine Strain (LVS), has been the subject of ongoing clinical studies; however, safety and efficacy are not well established, and LVS is not licensed by the U.S. FDA. Using a mouse model, we compared the in vivo efficacy of a panel of qualitatively different Francisella vaccine candidates, the in vitro functional activity of immune lymphocytes derived from vaccinated mice, and relative gene expression in immune lymphocytes. Integrated analyses showed that the hierarchy of protection in vivo engendered by qualitatively different vaccines was reflected by the degree of lymphocytes' in vitro activity in controlling the intramacrophage growth of Francisella. Thus, this assay may be a functional correlate. Further, the strength of protection was significantly related to the degree of up-regulation of expression of a panel of genes in cells recovered from the assay. These included IFN-γ, IL-6, IL-12Rβ2, T-bet, SOCS-1, and IL-18bp. Taken together, the results indicate that an in vitro assay that detects control of bacterial growth, and/or a selected panel of mediators, may ultimately be developed to predict the outcome of vaccine efficacy and to complement clinical trials. The overall approach may be applicable to intracellular pathogens in general

Search for pair-produced long-lived neutral particles decaying to jets in the ATLAS hadronic calorimeter in ppcollisions at √s=8TeV

The ATLAS detector at the Large Hadron Collider at CERN is used to search for the decay of a scalar boson to a pair of long-lived particles, neutral under the Standard Model gauge group, in 20.3fb−1of data collected in proton–proton collisions at √s=8TeV. This search is sensitive to long-lived particles that decay to Standard Model particles producing jets at the outer edge of the ATLAS electromagnetic calorimeter or inside the hadronic calorimeter. No significant excess of events is observed. Limits are reported on the product of the scalar boson production cross section times branching ratio into long-lived neutral particles as a function of the proper lifetime of the particles. Limits are reported for boson masses from 100 GeVto 900 GeV, and a long-lived neutral particle mass from 10 GeVto 150 GeV

Measurement of the cross-section of high transverse momentum vector bosons reconstructed as single jets and studies of jet substructure in pp collisions at √s = 7 TeV with the ATLAS detector

This paper presents a measurement of the cross-section for high transverse momentum W and Z bosons produced in pp collisions and decaying to all-hadronic final states. The data used in the analysis were recorded by the ATLAS detector at the CERN Large Hadron Collider at a centre-of-mass energy of √s = 7 TeV;{\rm Te}{\rm V}$and correspond to an integrated luminosity of$4.6\;{\rm f}{{{\rm b}}^{-1}}$. The measurement is performed by reconstructing the boosted W or Z bosons in single jets. The reconstructed jet mass is used to identify the W and Z bosons, and a jet substructure method based on energy cluster information in the jet centre-of-mass frame is used to suppress the large multi-jet background. The cross-section for events with a hadronically decaying W or Z boson, with transverse momentum${{p}_{{\rm T}}}\gt 320\;{\rm Ge}{\rm V}$and pseudorapidity$|\eta |\lt 1.9$, is measured to be${{\sigma }_{W+Z}}=8.5\pm 1.7$ pb and is compared to next-to-leading-order calculations. The selected events are further used to study jet grooming techniques

Search for direct pair production of the top squark in all-hadronic final states in proton-proton collisions at s√=8 TeV with the ATLAS detector

The results of a search for direct pair production of the scalar partner to the top quark using an integrated luminosity of 20.1fb−1 of proton–proton collision data at √s = 8 TeV recorded with the ATLAS detector at the LHC are reported. The top squark is assumed to decay via t˜→tχ˜01 or t˜→ bχ˜±1 →bW(∗)χ˜01 , where χ˜01 (χ˜±1 ) denotes the lightest neutralino (chargino) in supersymmetric models. The search targets a fully-hadronic final state in events with four or more jets and large missing transverse momentum. No significant excess over the Standard Model background prediction is observed, and exclusion limits are reported in terms of the top squark and neutralino masses and as a function of the branching fraction of t˜ → tχ˜01 . For a branching fraction of 100%, top squark masses in the range 270–645 GeV are excluded for χ˜01 masses below 30 GeV. For a branching fraction of 50% to either t˜ → tχ˜01 or t˜ → bχ˜±1 , and assuming the χ˜±1 mass to be twice the χ˜01 mass, top squark masses in the range 250–550 GeV are excluded for χ˜01 masses below 60 GeV