A Peculiar Peritoneum: A Case of Tuberculosis in a Male Without Known Risk Factors.

Peritoneal tuberculosis is an uncommon diagnosis in developed countries and most commonly presents in patients with known risk factors for tuberculosis. We report a case of a patient without tuberculosis risk factors who presented with 4 years of intermittent fevers, several weeks of increasing abdominal distention, and newly discovered elevated liver tests. The diagnosis of peritoneal tuberculosis was confirmed following an extensive workup with a positive ascitic fluid culture for Mycobacterium tuberculosis. The patient's fevers resolved with antibiotic therapy, and antibiotic therapy was subsequently de-escalated based on the susceptibility profile.

Determination of Sensitivity and Specificity of Electrocardiography for Left Ventricular Hypertrophy in a Large, Diverse Patient Population.

BACKGROUND: Electrocardiography (ECG) is poorly sensitive, but highly specific for the diagnosis of left ventricular hypertrophy. However, previous studies documenting this were small and lacked patient diversity. Furthermore, little is known about the impact of patient characteristics on the sensitivity and specificity of ECG for left ventricular hypertrophy. To address this issue, the present study was conducted to ascertain the sensitivity and specificity of ECG for left ventricular hypertrophy in a large, diverse patient population. METHODS: We performed a retrospective cohort study using ECG and echocardiography (ECHO) data from a large metropolitan health system. All patients had one ECG and ECHO on file, obtained within 1 week of each other. Sensitivity and specificity of ECG for left ventricular hypertrophy were determined by comparing results from the MUSE® 12-SL (GE Healthcare, Chicago, IL) computer-generated algorithm for ECG to ECHO left ventricular mass index. Subgroup analyses of individual patient characteristics were performed with corresponding chi-squared analyses to determine significance. RESULTS: A total of 13,960 subjects were included in the study. The typical subject was 60 years of age or older, female, overweight, and hypertensive, and demonstrated low socioeconomic status. The sensitivity and specificity of ECG for left ventricular hypertrophy in the overall cohort were 30.7% and 84.4%, respectively, with multiple patient characteristics influencing these results. CONCLUSIONS: This is the first study to confirm the sensitivity and specificity of ECG for left ventricular hypertrophy in a large, diverse patient population with significant minority representation. Furthermore, although these statistical measures are influenced by patient characteristics, such differences are likely not clinically significant.

Electrophysiologic similarities of overdose between digoxin and bufadienolides found in a Chinese aphrodisiac.

Classically derived from toad venom, bufadienolides are a group of cardioactive steroids with properties similar to digoxin. Some traditional Chinese medications, including several aphrodisiacs, contain bufadienolides. Owing to their physiologic similarities to digoxin, bufadienolides have been shown to produce a toxic profile similar to that of digoxin and there have been multiple case reports of the use of these aphrodisiacs resulting in death. This report will describe a case that illustrates the electrophysiologic similarities between bufadienolide toxicity and digoxin toxicity as well as the treatment of bufadienolide toxicity.