Distinguishing Acute Rheumatic Fever From Post-streptococcal Reactive Arthritis.

We report an initial episode of post-streptococcal reactive arthritis (PRSA) in a 61-year-old male with group A streptococcal (GAS) bacteremia. The disease is commonly reported in young children and young adults. Additionally, this patient exemplifies the nonlinear boundaries of acute rheumatic fever (ARF) and PRSA, bringing into question whether they are truly distinct disease entities. These two conditions oftentimes present in similar fashions, making it difficult for clinicians to determine a specific diagnosis. We highlight the importance of recognizing ARF versus PRSA as an incorrect diagnosis can lead to the development of harmful complications including rheumatic heart disease (RHD).

Coxsackie B Virus-Induced Cardiac Tamponade and Adrenal Insufficiency.

We report a case involving a young male patient without a significant medical history who exhibited symptoms of fatigue, shortness of breath, chest and back pain, and syncope with vomiting. He was found to have adrenal insufficiency and cardiac tamponade requiring pericardiocentesis. Further inpatient workup revealed the patient had positive IgM and IgG antibody titers for the coxsackie B virus, which we believe caused his presentation. The coxsackie B virus strain can cause mild gastrointestinal to more severe cardiac and neurological complications, including meningitis and myocarditis. On rare occasions, the virus can appear in an unexpected fashion, such as in cardiac tamponade or hormonal disruption. This case raises attention to the broad manifestations of the virus and recognizing its more uncommon presentations.

A Case of Euglycemic Diabetic Ketoacidosis (DKA), Influenza, and a Dipeptidyl Peptidase-4 (DPP-4) Inhibitor.

A subclass of diabetic ketoacidosis (DKA) is euglycemic DKA, characterized by the same traits of ketoacidosis and low bicarbonate levels. However, the condition differs from classic DKA because of its normoglycemic levels. Euglycemic DKA was once thought to be incredibly rare, but its incidence has been on the rise with the widespread use of sodium-glucose-cotransporter-2 (SGLT2) inhibitors and other newer anti-diabetic medications. The disorder is not fully understood and is often missed when presenting because of the non-elevated blood sugars. Common triggers for euglycemic DKA include infection, fasting, pregnancy, and medications such as SGLT2 inhibitors. This case report involves a patient with type 2 diabetes mellitus on sitagliptin that presented to the emergency department with shortness of breath, cough, nausea, vomiting, and abdominal pain and tested influenza positive with blood glucose levels of 209 mg/dl. He was started on IV fluids and subcutaneous insulin but developed worsening acidosis. The following day, he was transferred to the ICU for DKA protocol and diagnosed with euglycemic DKA.

Yeast-based assays for characterization of the functional effects of single nucleotide polymorphisms in human DNA repair genes.

DNA repair mechanisms maintain genomic integrity upon exposure to various types of DNA damage, which cause either single- or double-strand breaks in the DNA. Here, we propose a strategy for the functional study of single nucleotide polymorphisms (SNPs) in the human DNA repair genes XPD/ERCC2, RAD18, and KU70/XRCC6 and the checkpoint activation gene ATR that are essentially involved in the cell cycle and DNA damage repair. We analyzed the mutational effects of the DNA repair genes under DNA-damaging conditions, including ultraviolet irradiation and treatment with genotoxic reagents, using a Saccharomyces cerevisiae system to overcome the limitations of the human cell-based assay. We identified causal variants from selected SNPs in the present analyses. (i) R594C SNP in RAD3 (human XPD/ERCC2) caused severe reductions in the growth rate of mutant cells upon short-wavelength UV irradiation or chemical reagent treatment. (ii) The growth rates of the selected variants in RAD18, YKU70, and MEC1 were similar to those of wild-type cells on methyl methanesulfonate and hydroxyurea treated media. (iii) We also assessed the structural impact of the SNPs by analyzing differences in the structural conformation and calculating the root mean square deviation, which is a measure of the discordance of the Cα atoms between protein structures. Based on the above results, we propose that these analytical approaches serve as efficient methods for the identification of causal variants of human disease-causing genes and elucidation of yeast-cell based molecular mechanisms.

Functional heterogeneity of the supplementary motor area.

BACKGROUND AND PURPOSE: The purpose of this study was to assess supplementary motor area (SMA) activation during motor, sensory, word generation, listening comprehension, and working memory tasks by using functional MR imaging (fMRI). Human supplementary motor area (SMA) has been shown to play roles in motor control and other various functions such as sensory, speech expression, and memory. However, topographical localizations of these functions in the SMA remain unclear. The purpose of this study was to assess SMA activation during motor, sensory, word generation, listening comprehension, and working memory tasks by using functional MR imaging (fMRI). METHODS: Sixteen healthy right-handed subjects (nine men and seven women) were imaged on a Siemens 1.5T system. Whole-brain functional maps were acquired by using blood oxygenation level-dependent echo-planar imaging sequences in the axial plane. Each paradigm consisted of five epochs of activation versus the control condition. The activation tasks consisted of left-finger complex movement, heat sensory stimulation of the left hand, word generation, listening comprehension, and working memory. The reference function was a boxcar waveform. Activation maps were thresholded at an uncorrected P = .0001. The thresholded activation maps were placed into MNI (Montreal Neurologic Institute) stereotactic coordinates, and the anatomic localization of activation within the SMA was compared across tasks. RESULTS: SMA activation was observed in 16 volunteers for the motor task, 11 for the sensory task, 15 for the word generation task, five for the listening comprehension task, and 15 for the working memory task. Although not statistically significant, qualitative differences in the location of activation within the SMA were present by task. The rostral aspects of the SMA tended to activate during word generation and working memory tasks, and the caudal aspect of the SMA tended to activate during the motor and sensory tasks. Right (contralateral) SMA activation was observed during the motor and sensory tasks, and left SMA activation during the word generation and memory tasks. CONCLUSION: Our results suggest that SMA is involved in a variety of functional tasks, including motor, sensory, word generation, and working memory. Some are tasks that are traditionally associated with this area (such as motor and sensory), and others are not (such as word generation and working memory). Qualitatively, the anterior and posterior portions of the SMA appeared to be engaged by different types of tasks.