A Rare Case of Asystole During a Laparoscopic Appendectomy In a Young Patient

Laparoscopic surgery has become the mainstay of treatment for uncomplicated appendicitis cases. We describe a case of a 29 year old male with a pertinent past medical history of poorly controlled hypertension who was undergoing a routine laparoscopic appendectomy for confirmed appendicitis and developed bradycardia and subsequent asystolic cardiac arrest approximately one hour into the operation. Urgent cardiopulmonary resuscitation and intravenous (IV) atropine were required to reinitiate sinus cardiac rhythm. While the patient was admitted to the intensive care unit for close monitoring following his operation, he ultimately had an uncomplicated postoperative period and an unremarkable cardiac work up and was consequently discharged the day after his procedure. Numerous causes of cardiovascular collapse during laparoscopic procedures have been discussed in the literature including mechanical obstruction of the vagal nerve, high intraabdominal pressures and gas embolism

Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary

Inferior STEMI Complicated by Retroperitoneal Hemorrhage due to Ruptured AAA

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal aortic aneurysm

Homozygous in-frame deletion in CATSPERE in a man producing spermatozoa with loss of CatSper function and compromised fertilizing capacity

STUDY QUESTIONDoes a man (patient 1) with a previously described deficiency in principle cation channel of sperm (CatSper) function have a mutation in the CatSper-epsilon (CATSPERE) and/or CatSper-zeta (CATSPERZ) gene?SUMMARY ANSWERPatient 1 has a homozygous in-frame 6-bp deletion in exon 18 (c.2393_2398delCTATGG, rs761237686) of CATSPERE.WHAT IS KNOWN ALREADYCatSper is the principal calcium channel of mammalian spermatozoa. Spermatozoa from patient 1 had a specific loss of CatSper function and were unable to fertilize at IVF. Loss of CatSper function could not be attributed to genetic abnormalities in coding regions of seven CatSper subunits. Two additional subunits (CatSper-epsilon (CATPSERE) and CatSper-zeta (CATSPERZ)) were recently identified, and are now proposed to contribute to the formation of the mature channel complex.STUDY DESIGN, SIZE, DURATIONThis was a basic medical research study analysing genomic data from a single patient (patient 1) for defects in CATSPERE and CATSPERZ.PARTICIPANTS/MATERIALS, SETTING, METHODSThe original exome sequencing data for patient 1 were analysed for mutations in CATSPERE and CATSPERZ. Sanger sequencing was conducted to confirm the presence of a rare variant.MAIN RESULTS AND THE ROLE OF CHANCEPatient 1 is homozygous for an in-frame 6-bp deletion in exon 18 (c.2393_2398delCTATGG, rs761237686) of CATSPERE that is predicted to be highly deleterious.LIMITATIONS, REASONS FOR CAUTIONThe nature of the molecular deficit caused by the rs761237686 variant and whether it is exclusively responsible for the loss of CatSper function remain to be elucidated.WIDER IMPLICATIONS OF THE FINDINGSPopulation genetics are available for a significant number of predicted deleterious variants of CatSper subunits. The consequence of homozygous and compound heterozygous forms on sperm fertilization potential could be significant. Selective targeting of CatSper subunit expression maybe a feasible strategy for the development of novel contraceptives.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by project grants from the MRC (MR/K013343/1 and MR/012492/1), Chief Scientist Office/NHS research Scotland. This work was also supported by NIH R01GM111802, Pew Biomedical Scholars Award 00028642 and Packer Wentz Endowment Will to P.V.L. C.L.R.B is the editor-in-chief of Molecular Human Reproduction, has received lecturing fees from Merck and Ferring, and is on the Scientific Advisory Panel for Ohana BioSciences. C.L.R.B was chair of the World Health Organization Expert Synthesis Group on Diagnosis of Male infertility (2012–2016)

Urgent Coronary Artery Bypass Grafting Due to Multi- Vessel Coronary Aneurysm

Coronary Artery Aneurysm (CAA) is defined as a dilation of more than 1.5 times normal in a segment of the coronary artery. While the incidence of CAA is highest in the Right Coronary Artery (RCA), it is agreed that left main coronary artery or three-vessel involvement is extremely rare. Wide ranges of factors have been implicated in the cause of CAA with atherosclerosis being the most common at 50%. Congenital CAA occurs in 20-30% of cases followed by connective tissue disease at 10%. Blood stagnation and exposure of the underlying collagen make aneurysms prone to thrombosis, dissection, and vasospasm. Depending on the size, symptoms, and etiology of the aneurysms; a surgical, percutaneous, or medical approach may be used. In this paper, we are presenting a patient who presented to the emergency department (ED) with chest pain due to Acute Coronary Syndrome (ACS) that was found to be due to multi-vessels CAAs involving the left main as well as RCA, Left Anterior Descending (LAD) artery and Left Circumflex Artery (LCA) requiring urgent Coronary Artery Bypass Grafting (CABG)

A Rare Case of Asystole During a Laparoscopic Appendectomy In a Young Patient

Laparoscopic surgery has become the mainstay of treatment for uncomplicated appendicitis cases. We describe a case of a 29 year old male with a pertinent past medical history of poorly controlled hypertension who was undergoing a routine laparoscopic appendectomy for confirmed appendicitis and developed bradycardia and subsequent asystolic cardiac arrest approximately one hour into the operation. Urgent cardiopulmonary resuscitation and intravenous (IV) atropine were required to reinitiate sinus cardiac rhythm. While the patient was admitted to the intensive care unit for close monitoring following his operation, he ultimately had an uncomplicated postoperative period and an unremarkable cardiac work up and was consequently discharged the day after his procedure. Numerous causes of cardiovascular collapse during laparoscopic procedures have been discussed in the literature including mechanical obstruction of the vagal nerve, high intraabdominal pressures and gas embolism

Cooperative Extension’s Capacity to Address Food Insecurity by Supporting Food Recovery Organizations

Virginia Cooperative Extension (VCE) educators are uniquely positioned to support the food recovery organizations (FROs) which address hunger-related needs resulting from food insecurity. Based on an online survey to measure how VCE educators have engaged with FROs and their experiences, respondents who previously supported FROs did so across multiple programming areas, and those who had not indicated an interest while also experiencing barriers. Respondents also reported the need for context- and audience-specific resources particular to the spectrum of food recovery. Addressing barriers and resource needs through a transdisciplinary eXtension Food Recovery Community of Practice may support educators in doing this work

The human CHRNA7 and CHRFAM7A genes: A review of the genetics, regulation, and function

The human α7 neuronal nicotinic acetylcholine receptor gene (CHRNA7) is ubiquitously expressed in both the central nervous system and in the periphery. CHRNA7 is genetically linked to multiple disorders with cognitive deficits, including schizophrenia, bipolar disorder, ADHD, epilepsy, Alzheimer's disease, and Rett syndrome. The regulation of CHRNA7 is complex; more than a dozen mechanisms are known, one of which is a partial duplication of the parent gene. Exons 5–10 of CHRNA7 on chromosome 15 were duplicated and inserted 1.6 Mb upstream of CHRNA7, interrupting an earlier partial duplication of two other genes. The chimeric CHRFAM7A gene product, dupα7, assembles with α7 subunits, resulting in a dominant negative regulation of function. The duplication is human specific, occurring neither in primates nor in rodents. The duplicated α7 sequence in exons 5–10 of CHRFAM7A is almost identical to CHRNA7, and thus is not completely queried in high throughput genetic studies (GWAS). Further, pre-clinical animal models of the α7nAChR utilized in drug development research do not have CHRFAM7A (dupα7) and cannot fully model human drug responses. The wide expression of CHRNA7, its multiple functions and modes of regulation present challenges for study of this gene in disease

An Unusual Migration of A Stent: A Case Report

Stent dislodgment and embolization is a rare complication of coronary stenting. There are reports of intra-coronary stent entrapment, stripping, and dislodgement during percutaneous coronary interventions causing potentially life threatening complications, including intra-coronary or systemic embolization. Reports of dislodgment and migration of previously placed drug eluting intra-coronary stent several months after deployment are very limited in the literature. We describe a drug eluting stent dislodgment and migration in an 88 year-old male 10 months after its deployment

Inferior STEMI Complicated by Retroperitoneal Hemorrhage due to Ruptured AAA

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal aortic aneurysm