Shitij Arora

ST-segment elevation myocardial infarction in a 37-year-old man with normal coronaries—it is not always cocaine!

Heart disease is one of the leading causes of death in the United States. With the increase in substance abuse, the incidence of acute myocardial infarction (MI) in younger population has been on the rise. Traditionally, cocaine has been blamed for acute MI; however, recently, there have been more incidences of marijuana as an inciting factor. We present a case of marijuana-induced acute MI and discuss the proposed mechanism.

A bilateral primary yolk sac tumor of the lung associated with chromosome 3 polysomy: understanding the Oct 3/4 and Sox 2 interaction.

Extragonadal germ cell tumors (EGCTs) in the lung are extremely rare and their pathogenesis is poorly understood. We report a case in a 48-year-old female which was very aggressive and stained positive for primoridial germ cell markers. Interestingly, there was chromosome 3 polysomy noted. To our knowledge this is the first chromosomal aberration noted in a primary germ cell tumor of the lung.

Molecular genetics of head and neck cancer (Review)

Understanding of molecular regulatory pathways presents a novel therapeutic approach for the treatment of head and neck cancer. These specific check points are becoming the targeted therapeutic approach. In this review, we highlight certain major signaling mechanisms, which are involved in the pathophysiology of head and neck cancer. Also, we discuss the current ongoing trials based on the in vitro success of targeted therapies.

Incretins and thiazolidinediones in glucose homeostasis and cancer: Role of common polymorphisms

With growing epidemiologic and molecular evidence linking the pathogenesis of diabetes mellitus and oncogenesis, the role of anti-diabetic drugs as antineoplastic agents becomes a subject of intense investigation. Several trials are underway assessing the effect of adding metformin to the existing chemotherapy regimen in the treatment of cancers. This review has a focus on other commonly used drugs classified into two broad groups, incretins and thiazolidinediones. The aim of this review is to discuss the common genetic polymorphisms implicated in the pathogenesis of type 2 diabetes mellitus (type 2 DM) and how they are linked to molecular pathways involved in carcinogenesis.

Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

Not Just Another Cause of Dyspnea: Common Complaint Leads to a Rare Diagnosis

A 62-year-old man with past medical history of type 2 diabetes mellitus (DM-2) and hypertension presented with progressive shortness of breath since three months. He was diagnosed with diabetic polyradiculopathy with diaphragmatic involvement and was started on intravenous immunoglobulin (IVIg) therapy. Rapid improvement was seen as evidenced by increased vital capacity and other pulmonary function parameters. Considering the patients positive response to intravenous immunoglobulins (IVIg), this case strengthens the fact that diaphragmatic involvement in Type 2 Diabetes Mellitus can be a part of focal or polyneuropathy and that the pathogenesis is immune mediated.

Pituitary Hormones and the Pathophysiology of Osteoporosis

Pituitary hormones orchestrate the structure and function of various organ systems in the body. A specific, limited function is ascribed to each pituitary hormone. We have come to appreciate that pituitary hormones have profound effects on bone, so much so that the “pituitary-bone axis” is now understood to be integral to skeletal biology. All pituitary hormones play a part in bone regulation, including growth hormone (GH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), prolactin and oxytocin. In mice, reduction in hormone levels due to haploinsufficiency for any one of several pituitary hormones or their receptors alters bone dynamics, while the “primary” target organ remains unaffected. This finding indicates that bone is the more sensitive organ. An in-depth insight into the mechanism of action of each hormone gives us a better understanding of bone pathophysiology and opens up new avenues for treatment of osteoporosis. In this chapter, we discuss the interaction of each pituitary hormone with bone and the potential that targeting these interactions holds in management of osteoporosis.

A vanishing act: the incredible erlotinib.

Sir, A 57-year-old male with 100-pack-year smoking history came to our hospital with shortness of breath. Imaging revealed multiple bilateral nodules (Panel a) which on biopsy showed a focally mucin producing, broncho-alveoloar carcinoma [Figure 1]. He was started on cisplatinum and gemcitabine. After 2 cycles, there was no evident reduction in the bulk of the disease. Mutational analysis studies suggested EGFR mutation (deletion of exon 19) and the patient was then started on erlotinib monotherapy. The follow up chest X-ray done at 3 months post erlotinib therapy is shown in Panel b [Figure 1].

Intraabdominal focal fat infarction in a 75-year-old woman presenting as acute abdomen ☆ ☆☆ ☆☆☆

Epiploic appendagitis is a rare, self-limiting inflammation of the epiploic appendices or omental appendices. It presents as abdominal pain often misdiagnosed as appendicitis, cholecystitis, or diverticulitis. Epiploic appendagitis can be treated conservatively with anti-inflammatory and pain medications. It is important to diagnose this etiology of abdominal pain in order to avoid long-term hospital stay and other medical expenses including surgery. In this case report we present a rare case of epiploic appendagitis that presents in a 75 year old female patient.