Spontaneous Papillary Muscle Rupture: An Uncommon Presentation in the Absence of Myocardial Infarction.

BACKGROUND Papillary muscle rupture (PMR) is a rare complication of myocardial infarction (MI); experiencing PMR without MI makes it even more uncommon, thereby complicating its diagnosis. Therefore, we report a case of spontaneous PMR to raise awareness of this entity. CASE REPORT A 48-year-old man with type 2 diabetes presented to the Emergency Department (ED) after experiencing sudden shortness of breath that began the day before. He had no history of chest trauma, fever, chills, or ischemic chest pain. His vital signs showed stable blood pressure and mild tachycardia. The patient had hypoxemia that did not respond to use of a non-rebreather mask (oxygen saturation 70%). Upon examination, he had increased respiratory rate, altered sensorium, no lower-limb edema, and his chest auscultation revealed bilateral crackles. Chest radiography showed pulmonary edema. Two electrocardiograms (ECG) showed no signs of ST elevation myocardial infarction (STEMI) or RV strain. The patient was intubated but remained hypoxic despite maximum ventilation settings. Transthoracic echocardiography (TTE) performed immediately thereafter revealed acute severe mitral regurgitation with evidence of PMR. A multidisciplinary team approach was adopted early in this case, which resulted in a positive outcome. Eventually, mitral valve replacement was performed, and the patient was discharged home after 17 days, with a favorable neurological outcome. CONCLUSIONS We report a very rare case of spontaneous PMR in a middle-aged man with no evidence of MI, infective endocarditis, or preceding chest trauma. It shows the importance of adopting an early multidisciplinary team approach and showcases the abilities of emergency medicine physicians in early recognition.

The Utilization of Computed Tomography in the Pediatric Emergency Department for Patients With Ventriculoperitoneal Shunts.

Introduction Despite all the advantages of computed tomography (CT) scanning, there is a significant concern due to the rising use of CT scans in children with ventriculoperitoneal (VP) shunts. High doses of radiation are absorbed by patients, raising their chance of acquiring cancer. Evaluating a potential VP shunt malfunction is a frequent encounter in the pediatric emergency room, often necessitating the utilization of a CT scan. This study aims to recognize and quantify the utilization of CT scans in an emergency setting for pediatric patients with a clinical suspicion of VP shunt malfunction. Methods This retrospective chart review was conducted on patients who visited the emergency department with suspected VP shunt malfunction in a pediatric tertiary care hospital (King Abdullah Specialist Children Hospital), Riyadh, Saudi Arabia. The study included the files of children between the years 2018 and 2019. Results A total of 119 children were included; the main indication for VP shunt insertion was congenital hydrocephalus at 46.8% (n=52). The median number of CT scans done per patient was seven (IQR=3-9). CT findings were abnormal among 55.6% (n=60). The univariate analysis examining the impact of different factors on CT findings showed an association between an abnormal CT finding and female gender (P=0.017), younger age (P=0.03), and the presence of a cerebral cyst (P=0.001); however, subsequent multivariate analysis was not significant for any of these factors. Twenty-two point three percent (n=25) of the patients required neurosurgical intervention, and the associated factors with neurosurgical intervention included changes in activity level (P=0.04), weakness (P=0.004), and altered mental status (P=0.001). Conclusion Children with VP shunts are susceptible to significant radiation exposure through the utilization of CT scans whenever they present to the ER with suspected shunt malfunction during their lifespan, which puts them at risk of radiation-related complications, such as cancers. CT imaging remains a helpful tool aiding physicians in making accurate decisions. However, in this study, almost half of the children had unremarkable CT findings. Thus, it is imperative to rationalize its use by establishing tailored guidelines that delineate the appropriate circumstances warranting its application.

Appraising the degree of physical activities among male students at a Saudi medical school.

OBJECTIVES: This study aimed to assess the degree of physical activity among male medical students. We also investigated the association between their physical activity and academic performance. METHODS: In this cross-sectional study, we distributed the International Physical Activity Questionnaire among male medical students of the first year through the fourth year by using a convenient sampling technique. Physical activity was measured by using the Metabolic Equivalent Task (MET) score. The demographic variables included academic year and age of the participants. RESULTS: The study included 317 students; of those, 219 were pre-clinical (first and second year), and 98 were clinical (third and fourth year) students. According to the MET score, the degree of physical activity was categorized into three groups. As many as 140 (44%) students were classified as highly active (MET>3000) and 98 (34%) moderately active (MET 600-3000), while 69 (22%) students were inactive (MET<600). The second-year students had a higher degree of inactivity than others (p = 0.004). Additionally, there was a significant difference in the amount of siting time during the week, with a higher median sitting time by second-year students than by third- and fourth-year students (p = 0.001). CONCLUSION: In our study, most male medical students showed moderate or high physical activity. However, second-year students were physically inactive. Hence, the reason for such inactivity among second-year students should be explored. This study calls for the implementation of university-level programs that can motivate students to participate in physical activities.