A Rare Case of Non-small Cell Lung Cancer With Skeletal Metastasis to the Sartorius Muscle.

We report an interesting case of skeletal muscle metastasis from lung cancer. Skeletal muscle metastasis is an unusual clinical occurrence and therefore lacks a standardized treatment approach. A 60-year-old female patient initially presented with abdominal pain and was found to have right lung consolidation, two hepatic lesions, and a lesion to the sartorius muscle. Initially treated as pneumonia, questions arose as to the lesion to the liver as well as the sartorius muscle. The primary site of malignancy was initially questioned due to the large size of the two hepatic lesions, with differential diagnoses including lung or hepatic origin. The sartorius muscle biopsy confirmed the presence of an adenocarcinoma lesion, consistent with non-small cell lung cancer (NSCLC).

Exophytic primary gastric squamous cell carcinoma and H. pylori gastritis.

Primary gastric squamous cell carcinoma (SCC) is rare, and the simultaneous Helicobacter pylori infection has not been reported in the literature. Here, we presented a patient with concurrent H. pylori gastritis and primary gastric SCC. A 54-year-old Hispanic man presented with diarrhoea, chills, night sweats and weight loss of 16 lbs for the previous 6 weeks. Abdominal CT revealed large exophytic mass from the stomach infiltrating multiple organs. Biopsy was performed and histology showed squamoid features. Immunohistochemistry stain was positive for p40, CK5/6, CK7 and Helicobacter type organisms. Patient was diagnosed with primary gastric SCC and has been receiving chemotherapy. We also reviewed the diagnosis, prognosis and treatment of primary gastric SCC.

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD).

Left ventricular assist devices (LVADs) are an exceedingly important form of mechanical support for patients with end-stage heart failure. LVADs can be utilized both as a bridge to cardiac transplant and also as a definitive treatment. However, a few complications are associated with LVAD placement, the most common and cumbersome of which is gastrointestinal (GI) bleeding with an incidence of about 30%. These bleeding events often require transfusion therapy, but they are rarely fatal. The etiologies of GI bleeding following LVAD are multifactorial and include unstable hemodynamics, an acquired von Willebrand factor (vWf) deficiency, impaired platelet aggregation, and activation of fibrinolytic systems. The treatment of choice in LVAD implantation-associated GI bleeding is endoscopy, which plays a vital role in both its diagnosis and management. Even so, its effectiveness in controlling post-LVAD implantation GI bleeding is still poorly ascertained. In this article, we will review the use of medication and alterations in the LVAD setting to prevent the occurrence of GI bleeding, as well as the findings of previously reported literature on LVAD implantation-associated GI bleeding.

A Case of Munchausen Syndrome Presenting with Hematemesis: A Case Report.

Munchausen syndrome (MS) was first reported in 1951 by Richard Alan John Asher as a factitious disorder. It is a condition in which the patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i.e. unnecessary medical tests and evaluations. This makes it one of the most challenging diagnosis in any medical set up. We present this rare case of a patient with chronic factitious disorder who presented to the emergency with hematemesis. The patient was successfully treated with psychotherapy with no recurrence. It is the need of the hour to create awareness amongst the medical and nonmedical population about factitious disorders so that they can easily be diagnosed and treated with efficiency. Further research is needed to find the risks leading to this syndrome and discover the cultural and social aspects of this disease, which may help us explore treatment strategies and avoid unnecessary tests and treatment.​.

Psychiatric Symptoms as the First Clinical Presentation of Multiple Sclerosis: A Case Report.

Multiple sclerosis (MS) is an autoimmune condition which affects the axon myelination in the brain. There can be multiple ways it can present initially, but physical signs and symptoms are the most common ones. We are reporting a case of MS from Pakistan which presented with neuropsychiatric features and was offered psychiatric care, but the patient declined treatment because of stigma related to psychiatric care. Four months later when her condition worsened, further investigation showed it to be a case of MS. The purpose of this case report is that psychiatric features should be considered for differentials of MS.

Transradial vs. Transfemoral Approach in Cardiac Catheterization: A Literature Review.

The main objective of this review paper is to study the comparison between transradial and transfemoral approach in catheterization. Transradial and transfemoral are two main approaches which are used as a diagnostic and therapeutic purpose in catheterization. The transradial approach in interventional cardiology is safe, effective, and feasible as compared to the transfemoral approach. The aim of this study is to compare pros and cons of transradial vs. transfemoral approach in catheterization. We conducted this systematic review on the role of transradial vs. transfemoral catheterization. The articles included real human data on interventional approaches. Reviews on these strategies were conducted in PubMed, medical literature analysis and retrieval system online (MEDLINE), Cochrane, Medscape and National Institute of Health. To maintain a high standard of review, studies published in all non-famous journals were excluded. Data collected from the studies have suggested that transradial approach has less bleeding complications, cost effective, decreased hospital mortality rate, and less access site complications as compared to transfemoral approach. However, longer procedural duration and radiation exposure are still concerns regarding transradial approach. The findings of the present study show that transradial approach in catheterization is safe, effective, and feasible as compared to the transfemoral approach. However, duration and radiation exposure are higher in the transradial access. Several studies suggest that the modern approach overweight in benefits with the comparison to the classical approach.

Fighting the Dengue Virus.

The incidence of dengue has been on the upsurge in the last decade. It has affected around one-third of the world's population living in endemic areas. It can be asymptomatic or may present with some specific symptoms. No control measures have proven beneficial to decrease the prevalence of this disease. The emergence of dengue vaccine has been a revolutionary hope in the future of patients affected with this disease. No doubt, this vaccine has its limitations and may do more harm than good, but with correct use, it can prove to be the most beneficial step taken in managing dengue so far.