Sayed Ali

Rule Out Acute Stroke

A 70-year-old retired male with a history of hypertension, hyperlipidemia, and type II diabetes mellitus presented to the emergency department (ED) at the insistence of his wife. His wife had noticed that “he was not talking right.” In addition, he had spilt his coffee that morning, acting clumsier than normal. On further questioning, he endorsed difficulty getting words out and that his right hand seemed weaker than usual. The symptoms started abruptly at breakfast, waxing and waning for the last 2 h. He denied any pain, fever, or chills. His medications included lisinopril, metformin, and simvastatin. He denied current tobacco use (quit about 10 years ago) and drank a few beers socially on the weekends. He had a brother who had a brain tumor. He denied allergies, recent surgical procedures, or using any over-the-counter medications.

Spontaneous regression of a primary squamous cell lung cancer following biopsy: a case report

BackgroundSpontaneous regression has been defined as occurring when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease. Recently, studies have implicated immunological responses as likely being involved. We report a case of a patient with squamous cell carcinoma of the lung who experienced spontaneous regression following biopsy without other intervention.Case presentationA 57-year-old white man was referred to our pulmonary clinic after an incidental finding of a nodule in the lower lobe of his left lung. Thoracic computed tomography revealed a 2.0 × 1.4 × 1.5 cm spiculated nodule in the superior segment of the left lower lobe. Workup identified the mass as a squamous cell carcinoma that was clinically staged as T1M0N0. The patient deferred treatment of this lesion. He undertook no significant lifestyle or medical changes. Three months later, computed tomography revealed that, compared with the initial study, the solitary mass had decreased in size to 1.6 × 0.9 × 0.9 cm. Follow-up computed tomography 1 year after the original workup demonstrated that the nodule had stabilized to its smaller size.ConclusionsStudies have shown that immunological response can be initiated by trauma to an area. Because the tumor regression became evident in our patient only after the tissue biopsy, his immune response to the surgical procedure seems to be a plausible contributor to the spontaneous regression. Further understanding of spontaneous regression can potentially impact the identification of neoplastic drug targets or even the course of a patient’s treatment plan and goals.

Dasatinib-induced chylothorax in chronic myeloid leukemia.

Pulmonary adverse events are common abnormalities associated with the use of dasatinib in chronic myeloid leukemia. We present a case of a 69-year-old man who suddenly developed a rare chylothorax pulmonary adverse event following 10 months of dasatinib treatment.

Non-Islet Cell Tumor Hypoglycemia: A Rare Cause of Hypoglycemia in Pulmonary Sarcomatoid Cancer

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic condition caused most commonly by metastatic mesenchymal tumors. A 74-year-old non-diabetic male with an eight-year history of metastatic sarcomatoid lung cancer presented with altered mental status. His previous treatment included a lobectomy and radiation. Laboratory investigations were significant for blood glucose of 28 mg/dL, confirming hypoglycemia. He was hypokalemic, a condition seen in approximately 50% of patients with NICTH, at 2.8 mEq/L of potassium (normal 3.5-5.2 mEq/dL) and his urine toxicology screen was negative. A computed tomography (CT) of the head was negative for any acute events. His tumor burden had progressed as compared to previous CTs. Administration of dextrose resolved his symptoms. Laboratory studies during subsequent hypoglycemic events measured his insulin-like growth factor-I (IGF-I) at 51 ng/mL, insulin-like growth factor-II (IGF-II) at 290 ng/mL, growth hormone (GH) at 0.6 ng/mL, C-peptide at 0.16 ng/mL (low), and insulin levels at <1 uIU/mL. ‘Big’ IGF-II, the gold standard for the diagnosis of NICTH, was not available at our facility. Based on these results, NITCH was diagnosed clinically. NICTH is a rare condition with episodes of recurrent hypoglycemic episodes in the setting of metastatic cancer. Ideal therapy for NICTH is tumor resection or debulking. In cases of inoperable tumors, glucocorticoids or recombinant human growth hormone (rGH) maintain euglycemia, with glucagon rescue in case of an emergency.

A fatty cough

Lipoid pneumonia is a rare form of pneumonia caused by accumulation of exogenous or endogenous lipids in the pulmonary system. Symptoms can often range from being asymptomatic to presenting with chest pain, fevers and shortness of breath. High resolution CT and bronchoalveolar lavage (BAL) remain important in establishing the diagnosis. The treatment of lipoid pneumonia includes stopping the offending agents and providing supportive therapy. The use of anti-inflammatory agents has shown some benefit in severe cases.

A Diagnostic Conundrum: The Spice Sensation

Synthetic cannabinoids (SCBs) are recreational drugs that are readily available and marketed under various disingenuous brand names. They have gained increasing popularity among young adults, including military soldiers. Initially designed to study effects on pain and brain functioning, these drugs have evolved rapidly and are often used for their lasting euphoric effects. Their relatively cheap cost, easy availability and lack of detection in commercial urine drugs screening tests, has led to an increase in use of SCBs. Due to their unpredictable toxicity and abuse potential, they continue to pose a large public health concern. Treatment, even though not clearly defined, often involves supportive care and symptoms management. Additional studies are required to better understand the various risks and adverse health outcomes that SCBs pose to the general public.

Smart Phones: Friend or Foe?

Smart phones arguably a necessity, An immense cause of joy and felicity. The world, figuratively in your palms, News, games, blogs and various medicine balms. Medical students and residents busy cranking, Improved patient care, evidence lacking. The latest models and many fancy attractions, Too often a cause of distractions. Diabetes, heart disease and hypertension, Alas! Too focused on their device; minimal attention. The buzzing and the ringing, Rounds accompanied by melancholy, singing.