Case Report: A Patient with Gait Dysfunction with Acute Inflammatory Demyelinating Polyneuropathy Masquerading as Diabetic Polyneuropathy

New onset gait dysfunction often prompts admission to the hospital for further evaluation. The typical patient is an elderly person who normally is self-sufficient but had recently experienced a decline in their ability to care for themselves. Sometimes, however, those who present with gait dysfunction do not fit the expected demographic. These individuals raise concern for less common “zebra” presentations of neurological dysfunction. We describe one such rare case of a 39-year-old female with a new onset of type 2 diabetes mellitus and recent COVID-19 infection that presented to the emergency department with a sensation of bilateral lower extremity burning with sensorineural changes, weakness, and an inability to ambulate. Emergency department labs and preliminary imaging were grossly unremarkable. Treatment as an inpatient with IViG led to significant improvement in symptoms. Gait dysfunction is a common presentation in the ED. Recognizing abnormalities to the typical demographic and presentation are important in proper disease workup and remaining vigilant in the face of atypical diagnoses

Diaphragmatic Adjacencies: Pulmonary Embolism Presenting as Abdominal Pain

Pulmonary embolism is a common yet potentially life-threatening diagnosis that should not be missed in the Emergency Department. Common presenting symptoms include dyspnea, pleuritic chest pain, cough, hemoptysis, syncope or pre-syncope. Less often, however, presenting symptoms can include abdominal pain. A clinician should recognize that pain adjacent to the diaphragm (including the lower chest and upper abdomen), can be secondary to underlying pathology either above or below the diaphragm. Here we describe an unusual case of pleuritic, post-prandial, right upper quadrant abdominal pain that was a result of pulmonary embolism

Flexor Tenosynovitis After Bite by Sugar Glider

Flexor tenosynovitis is one of the few orthopedic emergencies, often first identified in the emergency department. Pyogenic flexor tenosynovitis is an infection of the flexor tendon sheath of a finger causing local inflammation and tissue destruction. The pathognomonic symptoms of flexor tenosynovitis are known as Kanavel’s signs, a constellation of symptoms that include: pain with passive extension of the finger, tenderness over the flexor tendon sheath, fusiform swelling of the affected finger, and the finger held in passive flexion. The most common cause of flexor tenosynovitis is penetrating trauma into the flexion tendon sheath. Our case involves a 59-year-old male who presented to the emergency department with left second finger pain and swelling after sustaining an bite by a domesticated sugar glider, Petaurus breviceps, a small marsupial that is one of the most commonly traded exotic pets in the United States

Case Report: Vocal Cord Paralysis in the ED

The incident rate of vocal cord paralysis varies greatly depending on the cause of paralysis as well as if it\u27s unilateral or bilateral, for this poster we will be focusing on unilateral paralysis. From 1985 to 1995 cancer was the primary cause for vocal cord paralysis, however this shifted to primarily iatrogenic surgical injury from 1996 to 2005. In another study it was found that idiopathic paralysis and tumors to both be the primary cause (31.11% respectively), with surgery consisting of 28.89%, and trauma, brain problems, systemic disease and other causes being 2.2%

Incidental Malrotation in Adolescent Diagnosed with Appendicitis

17-year-old male patient with a history of autism presenting with right lower quadrant pain that started in the morning. The appendix was not able to be visualized by ultrasonography. An abdominal and pelvic CT with contrast showed a dilated appendix with surrounding inflammation. Malrotation was not identified on CT Scan. Patient was transferred to a nearby Children’s Hospital for laparoscopic appendectomy. During the procedure, the pediatric surgeon noted that initially, neither the appendix nor cecum was present in the right lower quadrant. This case represents an uncommon finding for a patient in the adolescent age group

Case Report: Proximal Large Bowel Obstruction Due to Constipation Requiring Subtotal Colectomy and Ileostomy

Large bowel obstructions are an abdominal emergency with morbidity and mortality dependent on early diagnosis . This case is of a 58-year-old male who presented with large bowel obstruction due to constipation. Differential diagnosis of large bowel obstruction ranges from benign to emergent should include conditions such as Ogilvie’s syndrome, paralytic ileus, small bowel obstruction to toxic megacolon. This male with only a risk factor of opioid use after spinal surgery. Attempts at medical management were made but the patient ultimately needed definitive management through exploratory laparostomy

An Unusual ED Case: Aortic Aneurysm Presenting as CHF Exacerbation

There has been a significant increase in the incidence of thoracic aortic aneurysms, currently making aneurysmal disease the 18th most common cause of death within the United States. This disease is typically an insidious one, with the aorta growing an average of only 0.1 cm per year. Consequently, most patients remain asymptomatic until late stages of the disease when dissection or worse, rupture has occurred. Under extremely rare circumstances, thoracic aortic aneurysms can present clinically due to mass effect. Airway, esophageal and vascular compression, secondary to aortic arch dilation has been previously documented. The condition can be acquired or congenital, and can also manifest as double aortic arch, aberrant subclavian artery, and pulmonary artery sling. Additionally, Kommerell’s diverticulum, a bulbous configuration at the proximal descending aorta of left or right arch configuration, is a rare cause of tracheobronchial compression. Regardless of its form, mass effect due to thoracic vascular abnormality such as aneurysm can lead to tracheomalacia, and ultimately airway collapse, under chronic conditions. Clinical presentation can vary from cough, to hoarseness of voice, chest pain, and in the case of our patient, progressive dyspnea which was initially mistaken for acute exacerbation of chronic heart failure

Spontaneous Iliac Arteriovenous Fistula, High-Output Heart Failure, and Cardiac Arrest

High-output heart failure is a potentially life-threatening condition that can lead to cardiac arrest. The most common causes of this condition are obesity, liver disease, arteriovenous shunts, lung disease, and myeloproliferative disorders, however the exact prevalence remains uncertain [1]. Here we describe an unusual case of cardiac arrest as a consequence of high-output heart failure, secondary to rupture of an iliac artery aneurysm into the common iliac vein, with arteriovenous (AV) fistula formation

Quantifying the effects of temperature on mosquito and parasite traits that determine the transmission potential of human malaria

Malaria transmission is known to be strongly impacted by temperature. The current understanding of how temperature affects mosquito and parasite life history traits derives from a limited number of empirical studies. These studies, some dating back to the early part of last century, are often poorly controlled, have limited replication, explore a narrow range of temperatures, and use a mixture of parasite and mosquito species. Here, we use a single pairing of the Asian mosquito vector, An. stephensi and the human malaria parasite, P. falciparum to conduct a comprehensive evaluation of the thermal performance curves of a range of mosquito and parasite traits relevant to transmission. We show that biting rate, adult mortality rate, parasite development rate, and vector competence are temperature sensitive. Importantly, we find qualitative and quantitative differences to the assumed temperature-dependent relationships. To explore the overall implications of temperature for transmission, we first use a standard model of relative vectorial capacity. This approach suggests a temperature optimum for transmission of 29°C, with minimum and maximum temperatures of 12°C and 38°C, respectively. However, the robustness of the vectorial capacity approach is challenged by the fact that the empirical data violate several of the model's simplifying assumptions. Accordingly, we present an alternative model of relative force of infection that better captures the observed biology of the vector-parasite interaction. This model suggests a temperature optimum for transmission of 26°C, with a minimum and maximum of 17°C and 35°C, respectively. The differences between the models lead to potentially divergent predictions for the potential impacts of current and future climate change on malaria transmission. The study provides a framework for more detailed, system-specific studies that are essential to develop an improved understanding on the effects of temperature on malaria transmission

Burden of Climate Change on Malaria Mortality

In 2015, an estimated 429,000 deaths and 212 million cases of malaria occurred worldwide, while 70% of the deaths occurred in children under five years old. Changes in climatic exposure such as temperature and precipitation makes malaria one of the most climate sensitive outcomes. Using a global malaria mortality dataset for 105 countries between 1980 and 2010, we estimate that the global optimal temperature maximizing all-age malaria mortality is 20.6, lower than previously predicted in the literature. While in the case of child mortality, a significantly lower optimum temperature of 19.3° is estimated. Our results also suggest that in Africa and Asia, the continents where malaria is most prevalent malaria, mortality is maximized at 28.4 and 26.3, respectively. Furthermore, we estimate that child mortality (ages 0-4) is likely to increase by up to 20 percent in some areas due to climate change by the end of the 21st century