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The outcomes of acute promyelocytic leukemia (APL) in pregnancy are largely unknown. The MEDLINE database was systematically searched to obtain 43 articles with 71 patients with new-onset APL during pregnancy. Induction therapy included various regimens of all-trans retinoic acid (ATRA), cytarabine, and anthracycline and resulted in a complete remission rate of 93%. Obstetric and fetal complications included pre-term deliveries (46%), spontaneous/therapeutic abortion/intrauterine death (33.3%) and other neonatal complications (25.9%). Mothers diagnosed in the first trimester were more likely to experience obstetric (p < 0.01) and fetal (p < 0.01) complications. To our knowledge, this is the largest systematic review of APL in pregnancy. The vast majority of APL patients in pregnancy may achieve remission with initial induction therapy. APL or its therapy in pregnancy, however, is associated with a high risk of fetal and obstetrical complications. The results of our study may help in patient counseling and informed decision-making. [ABSTRACT FROM AUTHOR]

Prior studies demonstrated that secondary acute promyelocytic leukemia (sAPL) andde novoAPL may but not consistently have similar overall survival (OS). We used the Surveillance, Epidemiology, and End Results (SEER) 13 database to compare their OS. Patients with sAPL (n= 90), compared tode novoAPL (n= 1600), were more likely to be older, White and diagnosed after year 2005. Mortality rate at 1 month (28.9% vs. 23.0%,p= 0.20) and 5-year OS (42% vs. 50%,p= 0.24) was similar between sAPL andde novoAPL. In a multivariate analysis, sAPL was associated with similar OS asde novoAPL (hazard ratio, HR 1.11; 95% confidence interval, CI 0.78–1.58;p= 0.546). This population-based study demonstrated no difference in OS or early mortality rate between sAPL andde novoAPL. sAPL can be managed very similarly tode novoAPL and does not need to be excluded from clinical trials of APL. [ABSTRACT FROM PUBLISHER]

Although the median survival in polycythemia vera (PV) is 14 years, mortality is higher than in an age- and sex-matched population. This study included 3941 PV patients diagnosed between 2000-2012 from Surveillance, Epidemiology and End Results (SEER) 13 registry to determine 5-year survival and the incidence of second primary malignancies (SPM). The actuarial 5 year survival in the overall cohort was 79.5%. The cumulative incidence of SPM was 13.1% at 10 years. SPMs occurred at a standardized incidence ratio (SIR) of 1.29 (95% CI = 1.16-1.43; p < 0.001) with an absolute excess risk (AER) of 42.49 per 10 000 population. A significantly higher risk was noted for acute myeloid leukemia (SIR = 12.24; 95% CI = 8.17-17.8; p-value < 0.001) and chronic myeloid leukemia (SIR = 10.66; 95% CI = 3.75-19.6; p-value < 0.001). Patients with PV are at a high risk of SPM and leukemic transformation, which may compromise long-term survival. [ABSTRACT FROM AUTHOR]

Background: Apixaban, a novel oral anticoagulant, is also used for deep vein thrombosis (DVT) prophylaxis. In this study, we sought to critically evaluate the differences in the rates of symptomatic DVT and bleeding, and analyze the rates of pulmonary embolism (PE) in subgroups of patients from ADVANCE I and II trials given their similar indication and design. Methods: Studies were identified through electronic literature searches of MEDLINE, clinicaltrial.gov, SCOPUS, and EMBASE up to January 2014. Phase III RCTs involving use of apixaban and enoxaparin for thromboprophylaxis in patients undergoing total knee or hip replacement were included. Study-specific odds ratios were calculated and between-study heterogeneity was assessed using the I2 statistics. Results: In three studies involving 11,659 patients, the risk of symptomatic DVT (pooled OR 0.38, 95% CI 0.16-0.90, I2 =0%, p=0.03) and bleeding (pooled OR 0.87, 95% CI 0.77-0.99, I2 =0%, p=0.03) was less in apixaban group compared to the enoxaparin group. However, it was interesting to note that on subgroup analysis, the risk of PE was higher with apixaban when used for thromboprophylaxis in knee replacement surgery (pooled OR 2.58, 95% CI 1.10-6.04, I2 =0%, p=0.03). Conclusion: Apixaban was found to be associated with lower risk of symptomatic DVT and bleeding compared to enoxaparin when used for thromboprophylaxis in patients undergoing knee and hip replacement surgeries. However, it was associated with higher risk of PE in patients undergoing knee replacement. [ABSTRACT FROM AUTHOR]

Hyperkalemia can present with a spectrum of clinical manifestations with progressive EKG changes and life-threatening arrhythmias. Although no formal guidelines exist as to when to initiate treatment for hyperkalemia, it is generally recommended in clinically symptomatic patients with or without EKG changes. Timely diagnosis and reversal can relieve symptoms and prevent life-threatening arrhythmias. We review the EKG changes associated with hyperkalemia and management principles along with an example of a case of severe hyperkalemia resulting in arrhythmia and flaccid paralysis. [ABSTRACT FROM AUTHOR]

Late onset seroma is a rare post-operative complication occurring after various surgeries including thymectomy. Most cases are asymptomatic; however, seromas occurring in the mediastinal cavity may cause compression symptoms including airway compression or cardiac tamponade. We present a 62-year-old male with a history of thymectomy for myasthenia gravis who presented with cardiac tamponade several years ago. Further evaluation revealed a late onset seroma anteriorly compressing the cardiac chambers resulting in tamponade physiology. [ABSTRACT FROM AUTHOR]

Fulminant hepatic failure (FHF) is a relatively rare manifestation of Hodgkin's lymphoma. Clinical features, laboratory findings, and imaging of the liver are usually inconclusive, and liver biopsy may be required for confirmation. We present a case of an FHF in a woman 1 week after the diagnosis of Hodgkin's lymphoma. Chemotherapy could not be instituted due to hepatic encephalopathy and other complications. Autopsy revealed diffuse infiltration of the liver parenchyma. This case illustrates the importance of early diagnosis and institution of chemotherapy, which may reverse the liver failure. [ABSTRACT FROM AUTHOR]

Background: Acute mountain sickness (AMS) can occur in anyone going to a high altitude. Non-steroidal anti-inflammatory drugs (NSAIDs) have been studied for the prevention of AMS with mixed results. In this systematic review, we analyze all existing data on the use of NSAIDs to prevent AMS using the Lake Louise Scoring System (LLSS) in different randomized clinical trials (RCTs). Methods: Electronic literature searches for relevant studies were identified through MEDLINE, EMBASE, SCOPUS, and Cochrane library up to June 2013. RCTs involving NSAIDs compared to placebo in patients undergoing ascent to a height of at least 3,800mwere included. Odds ratios (OR) were calculated and combined using fixed-effect model meta-analysis if I2=0%. Differences between groups were calculated using the inverse variance of the standard mean differences. Between-study heterogeneity was assessed using the I2 statistics. Results: In three clinical trials involving 349 patients, AMS using LLSS occurred in 26.92% of patients on NSAIDs and 43.71% on placebo (OR 0.43; CI [confidence interval] 0.27-0.69, I2=0%, p=0.0005), NNT=6. Minor outcome of end point Spo2 was not significant in the two groups (IV=0.74; 95% CI -0.20-1.69, I2=81%, p=0.12). Similarly, a change in Spo2 from baseline was also not significant in the two groups (IV=0.05; 95% CI -0.28-0.37, I2=44%, p=0.78). Conclusion: NSAIDs might be a safe and effective alternative for the prevention of AMS. However, further larger population studies and studies comparing NSAIDs to acetazolamide and dexamethasone in the future may provide further data to its relative efficacy. [ABSTRACT FROM AUTHOR]

Primary cardiac sarcomas are rare malignant tumors of the heart. Clinical features depend on the site of tumor and vary from symptoms of congestive heart failure to thromboembolism and arrhythmias. Echocardiography is helpful but definitive diagnosis is established by histopathology. Surgical resection is the mainstay of treatment, and the role of chemotherapy and radiotherapy is unclear. We report a case of primary cardiac sarcoma which presented with signs and symptoms of acute left-sided heart failure. [ABSTRACT FROM AUTHOR]

Acquired methemoglobinemia is a medical emergency, and its prompt recognition and treatment can avoid catastrophic complications including death. However, in mild asymptomatic cases without any comorbid conditions, itwould be reasonable to simply observe and treat symptomatically to avoid severe treatment-related complications, especially in patients with suspected glucose-6-phosphate dehydrogenase (G6PD) deficiency. We present a case of mild methemoglobinemia in occult G6PD deficiency in which the patient developed hemolysis after treatment with intravenous methylene blue, requiring transfusion. [ABSTRACT FROM AUTHOR]

Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a disorder characterized by post-prandial hypoglycemia and islet cell hypertrophy. It is an uncommon complication of weight-loss surgery. However, with the rising incidence of gastric bypass surgeries, it is important to be able to recognize the clinical picture of NIPHS and not to incorrectly ascribe the symptoms to late dumping syndrome. [ABSTRACT FROM AUTHOR]

Central Poststroke Pain syndrome (CPSP) can occur due to disruption of the somatosensory pathways of the brain at any level such as the thalamus, medulla, or cerebral cortex. It is characterized by sensory abnormalities and hyperesthesia in the part of the body correlating to the central lesion. The treatment of this pain syndrome is often difficult, and it does not usually respond to traditional analgesics. The first line of treatment is drugs aimed at lowering neuronal hyperexcitability, for example, amitriptyline or lamotrigine, with gabapentin considered a second line. [ABSTRACT FROM AUTHOR]

Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and a cardiac chamber or major vessel, seen in about 0.8% of the cases undergoing coronary angiography. Most patients are asymptomatic and diagnosis is made incidentally during coronary angiography. We present an image case of CCF which was found incidentally during pre-liver transplantation work up. [ABSTRACT FROM AUTHOR]

A 69-year-old female with history of immobilization presented with shortness of breath and generalized weakness and was found to have large saddle pulmonary embolus on CT scan. Further evaluation with a transthoracic echocardiography revealed a moderately enlarged and hypokinetic right ventricle with a pulmonary artery clot of about 1.5 cm seen at the bifurcation while the ultrasound of the legs was negative for deep vein thrombosis. [ABSTRACT FROM AUTHOR]

We present a case of 56-year-old male with small cell carcinoma of the lung with metastatic tumor nodule of the umbilicus. To our knowledge, this is only the second reported case of small cell lung cancer associated with Sister Mary Joseph's nodule. [ABSTRACT FROM AUTHOR]

The article focuses on the aspects of diagonal ear lobe crease also known as Frank's sign as a potential marker for the prediction of carotid and coronary artery atherosclerosis. Topics discussed include several hypotheses proposed for the association of sign to various diseases, the study regarding the controversies of its association, and its genetic commonality with myocardium.

The article presents a case study of a 46 year old female presented after two episodes of generalized tonic-clonic seizures to the emergency department. She complains of headache and mildly confused. She was maintained with levetiracetam, an anti convulsant drug. The article discusses colloid cysts and its other presentations including vertigo, diplopia and memory deficit. It mentioned the surgical approaches to avoid long anti-seizure medications and prevent the recurrence.

A response from the author of the article "A review of hyperkalemic manifestations" published in 2015 issue is presented.

The article focuses on the study conducted by researcher Shoaib Bilal Fareedy on pigmented dermatosis erythema ab igne due to repeated heating pad use and published in the journal "Clinical Imaging".

The article presents a case study of a 67 year old male presented in the hospital with deep vein thrombosis. He was recently diagnosed iwth amyloidosis and treated with cyclophosphanimide-bortezomib-dexamethasone. His physical examination revealed enlarged tongue with lateral scalloping without speech or eating difficulties. The article discusses macroglossia which considers a sign for amyloidosis.

Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here,we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 47-year-old woman who reported an 18-month-old pretibial rash her left shin during a routine office visit. She was diagnosed with necrobiosis lipoidica, an inflammatory skin disorder of unknown cause, occurring three times more often in females than in males. The disease typically involves the shins, ankles, and feet and it occurs in less than 1% of all diabetic patients.