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Kratom is a plant extract readily available for purchase in the USA. It is known to produce both stimulant and opioid-related effects, predisposing it to abuse. The long-term effects of kratom are poorly understood. In rare cases, serious side effects have been reported. Here, we report a case of a patient with a history of bipolar type schizoaffective disorder presenting with acute onset paranoia and delusions. The patient had been hospitalized seven times previously with psychotic symptoms, with no reported history of paranoid delusional thought content in previous admissions. It was discovered that the patient had been ingesting increasingly large quantities of kratom in the weeks leading up to the admission. It is believed that kratom may be responsible for the novel symptoms contributing to the patient's acute psychiatric decompensation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Awad et al.)

The pathophysiology of Patau's syndrome involves the triplication of chromosomes, leading to multiple comorbidities. An omphalocele is characterized by a protrusion of abdominal contents from the base of the umbilical cord through the peritoneum. An omphalomesenteric duct remnant occurs when there is a failure of duct closure that results in a diverticulum extending from the fetal midgut to the yolk sac. While congenital defects rarely occur simultaneously in patients with Patau's syndrome, this case report describes a newborn with Patau syndrome who presented with both an omphalocele and an omphalomesenteric duct remnant. The newborn exhibited various congenital abnormalities such as coloboma, microphthalmia, broad nasal bridge, cleft lip, cleft palate, low-set ears, systolic murmur, omphalocele, intestinal umbilical fistula (omphalomesenteric continuous vitelointestinal duct remnant), polydactyly, rocker-bottom feet, left-sided clubbed foot, and ruptured myelomeningocele. Imaging revealed additional complications such as a large patent ductus arteriosus, hypoplastic distal arch, markedly dilated right atrium and left ventricle, and cerebellar hypoplasia. Chromosomal analysis confirmed the diagnosis of Patau's syndrome. Given the untreatable medical condition, the patient was placed under "Do Not Resuscitate," and palliative care was initiated. The simultaneous appearance of an omphalocele and an omphalomesenteric continuous vitelointestinal duct is rare, and surgical intervention is the standard of care if the patient is deemed suitable for surgery. However, in cases where surgery is not feasible, palliative care is initiated. Regardless of the outcome, genetic counseling is essential and should include a discussion on paternal autonomy, understanding the disorder, suggesting alternative management methods, and making crucial decisions concerning future family care and planning., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Beyari et al.)

An 80-year-old male with a history of atrial fibrillation and a single-chamber ventricular pacemaker presented to the hospital for an elective colonoscopy. He experienced a transient episode of unresponsiveness with seizure-like activity before the procedure. This prompted him to get an EKG showing deep T-wave inversions (TWIs) in the precordial leads on a background of paced beats. Such findings were concerning for an acute and potentially life-threatening process such as myocardial infarction (MI) or intracranial insult. After ruling out any severe conditions, the EKG findings were attributed to cardiac memory, an underdiagnosed cause of deep TWIs in patients with a pacemaker., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Naik et al.)

Takotsubo cardiomyopathy (TCM) is a well-recognized non-ischemic complication of physical and emotional stressors leading to heart dysfunction. Both thyroid storm and cocaine have been implicated with TCM to varying degrees. We present the case of a 26-year-old male with Graves' disease and cocaine abuse who was hospitalized with thyroid storm resulting in takotsubo cardiomyopathy and cardiogenic shock. The patient had a long and complicated hospital course, requiring advanced therapies including extracorporeal membrane oxygenation and other medical and mechanical circulatory support therapies. With treatment for thyroid storm using antithyroid medications and steroids, the patient eventually had complete recovery of his left ventricular function and was ultimately weaned from pressors, inotropes and mechanical support., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Oredegbe et al.)