A Rare Case of Inadvertent Iatrogenic Osmotic Demyelination Syndrome.

A 73-year-old African American male presented with altered mental status, severe hyperglycemia, and acute kidney injury. His metabolic derangements including hyperglycemia and hyponatremia were initially thought to be the cause of his encephalopathy. While managing his hyperglycemic hyperosmolar non-ketotic state, he received intravenous rehydration with almost three times his physiologic requirement for normalization of his electrolyte abnormalities. After the correction of the metabolic derangements, he remained confused with dysarthria and labile mood. Magnetic resonance imaging of the brain revealed osmotic demyelination syndrome.

A Case of Chronic Right Hip Pain Revealing an Insidious, Incidental Eight-Centimeter Internal Aneurysm Among Multiple Diffuse Aneurysms.

The prevalence of internal iliac artery aneurysms (IIAA) is very low. Existing data on IIAA are scarce and mainly based on case reports and small retrospective series. We present the case of a 55-year-old African American man with a past medical history of HIV, hypertension, pulmonary embolism (PE), chronic obstructive pulmonary disease (COPD), coronary artery disease, polysubstance abuse, schizophrenia, depression, and bipolar disorder who presented to the emergency department with dyspnea on exertion. He was admitted for COPD exacerbation. He reported concerns of ambulatory chronic right hip pain, for which he underwent a CT, which revealed the presence of a partially visible right IIAA. A CT of his abdomen/pelvis revealed multiple aneurysms, including a partially thrombosed 8-cm fusiform right IIAA. Due to the presence of multiple aneurysms, the vascular surgery team was consulted, and elective repair was recommended. IIAA should be considered in the differential diagnosis of patients with significant smoking history and hip pain and acted upon immediately.

Nodules that Wax and Wane: Unusual Presentation of Amiodarone Lung Toxicity.

Amiodarone is associated with a wide variety of side effects, but unusual presentations can make it difficult to diagnose and treat. This case report describes amiodarone causing nodular changes in the lung, as opposed to diffuse interstitial disease. After cessation of the medication, there was marked radiographic improvement in the nodules.

Fermentation of Ammonia Fiber Expansion Treated and Untreated Barley Straw in a Rumen Simulation Technique Using Rumen Inoculum from Cattle with Slow versus Fast Rate of Fiber Disappearance.

The purpose of this study was to determine the effect of rumen inoculum from heifers with fast vs. slow rate of in situ fiber digestion on the fermentation of complex versus easily digested fiber sources in the forms of untreated and Ammonia Fiber Expansion (AFEX) treated barley straw, respectively, using an artificial rumen simulation technique (Rusitec). In situ fiber digestion was measured in a previous study by incubating untreated barley straw in the rumen of 16 heifers fed a diet consisting of 700 g/kg barley straw and 300 g/kg concentrate. The two heifers with fastest rate of digestion (Fast ≥ 4.18% h-1) and the two heifers with the slowest rate of digestion (Slow ≤ 3.17% h-1) were chosen as inoculum donors for this study. Two Rusitec apparatuses each equipped with eight fermenters were used in a completely randomized block design with two blocks (apparatus) and four treatments in a 2 × 2 factorial arrangement of treatments (Fast or Slow rumen inoculum and untreated or AFEX treated straw). Fast rumen inoculum and AFEX straw both increased (P < 0.05) disappearance of dry matter (DMD), organic matter, true DMD, neutral detergent fiber, acid detergent fiber, and nitrogen (N) with an interactive effect between the two (P < 0.05). Fast rumen inoculum increased (P > 0.05) methane production per gram of digested material for both untreated and AFEX straw, and reduced (interaction, P < 0.05) acetate: propionate ratio for untreated straw. Greater relative populations of Ruminococcus albus (P < 0.05) and increased microbial N production (P = 0.045) were observed in Fast rumen inoculum. AFEX straw in Fast inoculum had greater total bacterial populations than Slow, but for untreated straw this result was reversed (interaction, P = 0.013). These findings indicate that differences in microbial populations in rumen fluid contribute to differences in the capacity of rumen inoculum to digest fiber.

Triple therapy: boon or bane for high-risk CV patients?

The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of patients, but its use remains controversial. Here's why.