Deep Vein Thrombosis in a Patient with Negative Age-Adjusted D-Dimer Level.

D-dimer level, along with a clinical probability tool that uses the Wells score, is commonly used to exclude deep vein thrombosis (DVT). Age-adjusted D-dimer values are routinely used in clinical practice to increase the negative predictive value and avoid unnecessary Doppler ultrasound imaging. We describe a patient with a low pre-test probability of DVT upon admission and a negative D-dimer level based on age-adjusted values who was later diagnosed with DVT. Our experiences with this case highlight that the geriatric population is unique and, at times, frail.

A Case of Prolonged Fever in a Patient Infected With COVID-19 on Ofatumumab.

We discuss a case of a 53-year-old woman with multiple sclerosis on monthly ofatumumab injections, who was infected with SARS-CoV-2 with persistent fevers for seven weeks. She was hospitalized for fever with diagnostic workup being unremarkable with negative SARS-CoV-2 IgM and undetectable nucleocapsid IgG antibodies four weeks out from the initial infection, indicating she may not have mounted an appropriate immune response to the infection. Patients on immunosuppression therapy may have a prolonged course of disease given that medications such as ofatumumab can take up to 24 weeks of B-cell recovery post-treatment discontinuation and a longer road to recovery.

Fifth-Generation Cephalosporins Is Not Spared From Drug-Induced Liver Injury.

Ceftaroline fosamil is a fairly new parenteral cephalosporin antibacterial approved by the US Food and Drug Administration (FDA) for use in the treatment of acute bacterial skin and skin structure infections (ABSSSI). Drug-induced liver injury (DILI) is an important side effect profile to consider with antibiotic use. This case reports DILI in a previously healthy individual associated with a widely used antibiotic, ceftaroline, after only two doses. Discontinuation of the ceftaroline resulted in a resolution of DILI in a three-week period. Ceftaroline-induced liver injury is highlighted in this case report, along with a discussion of how we excluded other potential factors that can cause liver injury with the use of the Roussel Uclaf Causality Assessment Method (RUCAM) score. We also explained why other causes like hemochromatosis, Wilson's disease, celiac disease, and thyroid disease were unlikely.

Ketamine as an Analgesic Adjunct for Opioid-Induced Hyperalgesia in a Patient With a Sickle Cell Pain Episode.

Background: Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been proposed as a safe and effective nonopioid analgesic when given in lower doses than those historically used for general anesthesia. Case reports have demonstrated efficacy using low-dose ketamine for pain management and opioid weaning in patients with chronic noncancer pain, but reports of successful use in patients with sickle cell pain are limited. Case Report: A 35-year-old African American male with sickle cell disease presented to the emergency department with severe generalized body aches and left flank pain. Several days later, his pain became localized to the bilateral lower extremities. Escalating opioid doses provided no improvement. Workup was negative for infection, deep venous thrombosis, ischemia, and infarct. On hospital day 29, the Acute Pain Management Service was consulted and initiated a low-dose ketamine infusion for analgesia and to facilitate opioid weaning. Five days later, the patient was discharged pain-free. Conclusion: Ketamine is a potent nonopioid analgesic, and this report adds to the body of literature supporting the use of low-dose ketamine in patients with sickle cell disease to treat poorly controlled pain and opioid-induced hyperalgesia.

Pathobiology and evolving therapies of coronary artery vasospasm.

Coronary artery vasospasm is a known cause of chest pain and requires a high level of clinical suspicion for diagnosis. It also remains in the differential diagnosis for patients presenting with type 2 myocardial infarction. There are few randomized controlled trials for guideline-based prevention and treatment for coronary artery vasospasm. In this article, we review updated concepts in coronary artery vasospasm. Specifically, our aim is to provide current evidence of pathophysiology, identify the risk factors, propose a diagnostic algorithm, review available evidence of evolving therapies, and identify patients who would benefit from automatic implantable cardioverter defibrillators.

Visible-Light-Mediated Synthesis of 1,2,4-Dithiazolidines from ß-Ketothioamides through a Hydrogen-Atom-Transfer Photocatalytic Approach of Eosin Y.

An efficient protocol for visible-light-mediated synthesis of a specific class of 1,2,4-dithiazolidines from ß-ketothioamides is devised employing eosin Y as a photoinitiator at ambient temperature in an open pot. The reaction proceeds via an in situ-generated thiyl radical followed by dimerization/deaminative cyclization cascade, enabling the creation of a dithiazolidine ring through successive formation of S-S and N-C bonds under metal- and additive-free conditions. Remarkably, the benign conditions, sustainability, and quantifying forbearance of wide horizons of functional groups are added characteristics to the strategy. The developed hydrogen-atom-transfer methodology will be helpful in postsynthetic modification via added synthetic handles.

Infected congenital urethral diverticulum in an adult male.

Congenital anterior urethral diverticulum is a rare anomaly. The majority present in infancy with urinary obstruction. Those who present beyond infancy do so on account of recurrent urinary tract infection or dribbling. We present a case of congenital anterior urethral diverticulum manifesting in adulthood with suppuration in the diverticulum.