An Incidental Finding of a Glucagon-Like Peptide 1 (GLP-1)-Induced Acute Kidney Injury: A Case Report.

Acute kidney injury (AKI) involves a rapid decline in kidney function, classified into prerenal, intrarenal, and postrenal causes. Drug-induced AKI's complex pathophysiology includes altered hemodynamics, inflammation, crystal deposition, hemolysis, and rhabdomyolysis. This report details a 42-year-old female with hypertension and diabetes who, following a dog bite, exhibited reduced kidney function (GFR: 16 ​​mL/min/1.73m2; BUN/Cr: 23/3.23 mg/dL). A renal ultrasound revealed no stones or masses, and the recent use of tirzepatide was identified. Discontinuation of the drug, IV fluid maintenance, and close monitoring led to swift kidney function improvement. This case underscores the importance of recognizing drug-induced AKI, even in unrelated complaints, and highlights the need for vigilance and research into the adverse effects of medications such as glucagon-like peptide 1 (GLP-1) receptor agonists.

Adenocarcinoma of the Breast Presenting as Occult Breast Cancer With Axillary and Supraclavicular Lymph Node Metastasis: A Case Report.

Breast cancer is a leading cause of cancer-related mortality in women, with over 250,000 new cases diagnosed annually in the United States. Although mortality rates have decreased, breast cancer remains the second most common cause of cancer death in women. Occult breast cancer (OBC), a rare form of breath cancer that typically presents as axillary lymphadenopathy with no evidence of primary disease, accounts for less than 1% of all breath cancer diagnoses. To date, only three cases of OBC treated with radical mastectomy have been documented in the literature. This case presents a 76-year-old female with a benign left breast mass who was subsequently diagnosed with metastatic estrogen receptor/progesterone receptor (ER/PR)-positive ductal cell breast carcinoma after a visible axillary lymph node was detected on follow-up imaging. Due to the rarity of OBC, standardized treatment guidelines have not been established. Our patient underwent a left radical mastectomy with axillary and cervical lymph node dissection. Clinicians should maintain a high index of suspicion for biopsying axillary lymph nodes in females without evidence of breast malignancy, even though OBC has a low incidence rate. This case report aims to present a documented case of OBC and comprehensibly review the existing literature, discussing the available diagnostic and treatment approaches for this condition. We describe the case of a 76-year-old woman referred to surgery consultation due to a mammographic finding of a left superior lateral mass. The mass was biopsied and found to have no malignancy. On follow-up imaging, she was found to have a left axillary lymph node visible. Her only complaints at this time were breast tenderness and swelling. She underwent fine needle aspiration of the mass, which showed atypical cells that led to an excisional biopsy of the detected axillary node. The biopsy pathology report showed ER/PR-positive ductal cell breast carcinoma. The patient underwent left modified radical mastectomy with left axillary and cervical lymph node dissection. It was during this procedure that the pathology report revealed a 2 cm lesion on the left breast that showed ER/PR-positive infiltrating ductal carcinoma with 32 out of the 37 lymph nodes positive for metastatic disease. This case illustrates the importance of having a low imaging threshold in patients with vague breast symptoms. Surgeons should have a high level of suspicion when metastatic breast cancer is found, even if there is no clinical or radiographic evidence of a primary lesion. This includes conducting lymph node biopsies in patients who present with lymphadenopathy without the initial presence of primary breast cancer. Many studies agree that a modified radical mastectomy with lymph node recession is the treatment of choice for metastatic breast cancer without evidence of primary lesion. However, the efficacy of adjuvant treatments like radiation therapy or chemotherapy should be further studied.

Flesh Fly Maggot-Infected Abscess in a Burn Victim Patient in the United States Without a History of International Travel: A Case Report.

This case report describes an uncommon occurrence of myiasis, specifically a maggot-infected abscess, in a patient with reduced skin sensitivity resulting from severe burns. Myiasis is the infestation of live animal tissue by fly larvae, and while it is primarily associated with tropical and subtropical regions, cases acquired within the United States are rare. The presented case involves a 70-year-old male who arrived at the emergency department with an intensely painful, non-healing wound in the left elbow. Upon examination, the wound was found to be infested with numerous live maggots, and subsequent investigations revealed the larvae to be of the flesh fly species (Sarcophagidae). The patient's history of reduced skin sensitivity, previous burn injuries, and exposure to outdoor environments, coupled with poor hygiene and homelessness, likely contributed to the infestation. This report emphasizes the importance of considering myiasis caused by flesh fly larvae even in non-travel-related cases within the United States. Early recognition and prompt treatment are vital to preventing complications and secondary infections. Healthcare providers should remain vigilant in identifying and managing myiasis, and patients with decreased skin sensation should be educated about the need for regular skin surveillance and the utilization of preventive measures to mitigate potential infestations.

Psychoactive Drugs in the Management of Post Traumatic Stress Disorder: A Promising New Horizon.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that often presents after exposure to a traumatic, life-threatening event. Experiencing a traumatic event is not rare, with inciting incidents ranging from being burglarized to politically motivated genocide. While traditional psychopharmacology and psychotherapy are the mainstays of the treatment of PTSD currently, psychoactive drugs (otherwise known as psychedelics) are being explored for their novel role in the treatment of PTSD patients. Psychoactive drugs such as MDMA, ketamine, and psilocybin have been shown to specifically target and decrease fear and anxiety pathways in the brain. These unique properties hold the potential to be utilized in addressing symptoms of trauma in those with refractory or treatment-resistant PTSD. Historically, federal and state laws have restricted research into how psychoactive drugs can be used to treat mental illness due to the widespread belief that these drugs present more harm than benefit. However, the current shift in public opinion on psychedelics has propelled research to look into the benefits of these drugs for patients with mental illness. This article aims to discuss the mechanisms of how MDMA, ketamine, and psilocybin work in the PTSD brain, as well as their beneficial role in treatment.