Delayed hepatic necrosis in a cystic fibrosis patient taking Elexacaftor/Tezacaftor/Ivacaftor (Kaftrio).

The introduction of Cystic Fibrosis Trans Regulatory modulator (CFTRm) drugs has seen a transformation in Cystic Fibrosis (CF) treatment. This has led to a significant improvement in lung function and quality of life with the potential for a real impact on life expectancy. Transient mild to moderate hepatic transaminitis is a well-known side effect of CFTRm drugs, which often improves on cessation and may not recur following the re-institution of the drug. We describe a case of transaminitis developing nine months after the initiation of Kaftrio, which progressed to liver necrosis despite stopping Kaftrio and took many months to resolve. The patient had experienced significant improvement in lung function and overall health while on Kaftrio and deteriorated when it was stopped. He was keen to restart; however, Kaftrio was not reinstated due to the potential risk of acute liver failure.

Pneumomediastinum in a cannabis smoker precipitated by vigorous sexual intercourse.

Primary pneumomediastinum is the presence of air in the interstitium of the mediastinum. The exact aetiology is unclear; nevertheless, it has been reported more frequently in patients with asthma and in individuals who use recreational drugs. It is commonly preceded by a sharp rise in intrathoracic pressure as in a Valsalva-like manoeuvre. We describe a rare case of severe pneumomediastinum with a small pneumothorax related to cannabis smoking and aggravated by vigorous sexual intercourse. The patient was successfully treated conservatively due to clinical and radiological stability and the absence of secondary cause.

Pleural Effusion: A Rare Presentation of Mature Teratoma in a Young Patient.

Mediastinal masses always present a diagnostic challenge to clinicians and radiologists. There are wide varieties of pathologies ranging from benign to malignant conditions. Teratomas are one of the rare causes of mediastinal tumors. In this case, we report a young male who presented to the emergency room with acute pleuritic chest pain. The chest X-ray showed massive right-sided pleural effusion. Subsequently, bedside chest ultrasound ruled out septations and helped drain the fluid. The pleural fluid analysis demonstrated transudate chemistry. A computerized tomography (CT) of the chest was performed, revealing a complex anterior mediastinal mass suspected of Mature Teratoma. The tumor was surgically removed in its entirety, and pathology confirmed it a mature teratoma. The patient remained asymptomatic on postoperative follow-up.

Bewildering ST-Elevation With Wellens' Electrocardiogram Pattern - Is Myocarditis in Your Differentials?

Myocarditis is the inflammation of the myocardium and is a challenging diagnosis owing to the heterogeneity in its etiology, pathogenesis and clinical presentations. It often presents as an acute coronary syndrome (ACS) mimic and hence may pose both diagnostic and therapeutic challenges to treating physicians to reliably differentiate between these two entities. In this case, we discuss a young male whose initial presentation of chest pain was dubious of the acute coronary syndrome but detailed history, physical examination and by careful selection of non-invasive investigations including echo and cardiac magnetic resonance imaging (MRI), led to a diagnosis of acute myocarditis. This approach not only avoided undue radiation exposure to a young individual but also eluded the unnecessary treatment with potent antiplatelet and anticoagulation therapy.

Baffled with fever and lymphadenopathy: neither infection nor malignancy, think Kikuchi disease.

Kikuchi disease is a rare, benign condition of unknown aetiology, which usually involves young women and is characterised by cervical lymphadenopathy and fever. Herein, we are reporting a case of a young Asian woman, who presented with fever and lymphadenopathy raising possibility of either infection or malignancy but after appropriate clinical investigations including lymph node biopsy, it turned out to be Kikuchi disease. She made an uneventful complete recovery with only symptomatic treatment.

Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO): An Interesting Clinical Syndrome.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disorder that classically involves the musculoskeletal system, i.e. bone, joint and skin. The exact pathogenesis of this syndrome is unknown. However, autoimmunity, infections, immune malfunction and genetic factors are attributed to its pathophysiology. Bone and joint involvements are the hallmark of SAPHO syndrome and not necessarily require cutaneous involvement at the time of diagnosis. X-ray of the affected joints could show osteitis with sclerosis. Anterior chest wall involvement particularly ''bullhead appearance'' seen on bone scan is a striking feature of the syndrome. Erythrocyte sedimentation rate (ESR) is usually elevated amongst the majority of patients. Diagnosis of SAPHO is always challenging and often delayed because of a multitude of symptoms. The mainstay of treatment is control of pain and inflammation with both non-steroidal anti-inflammatory drugs (NSAIDs) and rescue courses of systemic steroids. If failed to control symptoms with first-line agents and in those with severe disease, disease-modifying anti-inflammatory drugs (DMARDs) may be needed eventually. Despite a chronic inflammatory condition, it remains stable in the majority of cases. Here in this case report, we reiterate the importance of early recognition, timely diagnosis and prompt treatment initiation.

Prediction of human breast and colon cancers from imbalanced data using nearest neighbor and support vector machines.

This study proposes a novel prediction approach for human breast and colon cancers using different feature spaces. The proposed scheme consists of two stages: the preprocessor and the predictor. In the preprocessor stage, the mega-trend diffusion (MTD) technique is employed to increase the samples of the minority class, thereby balancing the dataset. In the predictor stage, machine-learning approaches of K-nearest neighbor (KNN) and support vector machines (SVM) are used to develop hybrid MTD-SVM and MTD-KNN prediction models. MTD-SVM model has provided the best values of accuracy, G-mean and Matthew's correlation coefficient of 96.71%, 96.70% and 71.98% for cancer/non-cancer dataset, breast/non-breast cancer dataset and colon/non-colon cancer dataset, respectively. We found that hybrid MTD-SVM is the best with respect to prediction performance and computational cost. MTD-KNN model has achieved moderately better prediction as compared to hybrid MTD-NB (Naïve Bayes) but at the expense of higher computing cost. MTD-KNN model is faster than MTD-RF (random forest) but its prediction is not better than MTD-RF. To the best of our knowledge, the reported results are the best results, so far, for these datasets. The proposed scheme indicates that the developed models can be used as a tool for the prediction of cancer. This scheme may be useful for study of any sequential information such as protein sequence or any nucleic acid sequence.