Conclusion This issue should be explored in prospective studies in larger groups.Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients. We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. selleck screening library The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms. Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.Introduction Intensive Care Unit (ICU) is a resource intense area consuming a vast majority of the hospital’s budget. This study aimed to determine the costs of providing critical care to non-survivors in an adult ICU at a tertiary care teaching hospital in the Caribbean. Methods A chart review of non-survivors over a period of nine months was done in an adult ICU. Admission diagnoses, Simplified Acute Physiology Score (SAPS II) score, daily laboratory investigations, drugs, and all therapeutic interventions including mechanical ventilation were recorded. Activity-based costs were prospectively estimated by data obtained from ICU flowsheets, nursing-activity scores, and various hospital departments. Results A total of 316 days of ICU intervention data were collected from the 39 non-survivors enrolled. The median patient age was 56 years. The median ICU length of stay (LOS) and the median duration of mechanical ventilation were five days. The median SAPS II score was 62. One-third of patients had cardiovascular problems and 28% were surgical patients. The total cost of providing ICU care for the non-survivors was US$ 765,233 with an average cost of US$ 19,621 per patient. Human resources (39%) and consumables (29%) were the highest components of costs. Patients who had a cardiac arrest before admission consumed more resources. A higher SAPS II score predicted a shorter LOS (p=0.01) and lower costs (p=0.03). Conclusions ICU care for non-survivors consume significantly high resources. Stringent admission protocols and consideration of medical futility at an earlier stage, using prognostic models and clinical criteria may prevent unnecessary interventions and costs.Pneumatosis intestinalis (PI) is a rare condition characterized by multiple air-filled cystic lesions in the submucosa or subserosa of the intestine. Despite a limited understanding of its pathogenesis, the causes of PI can be categorized into life-threatening or benign, which helps guide patient management. For benign etiologies, interventions should be minimized and endoscopic maneuvers should be avoided as most of these cases can be managed conservatively. We present a patient with asymptomatic, benign PI who subsequently developed symptoms following cyst biopsy during a screening colonoscopy.The Cartesian model of mind-body dualism concurs with religious traditions. However, science has supplanted this idea with an energy-matter theory of consciousness, where matter is equivalent to the body and energy replaces the mind or soul. This equivalency is analogous to the concept of the interchange of mass and energy as expressed by Einstein’s famous equation [Formula see text]. Immanuel Kant, in his Critique of Pure Reason, provided the intellectual and theoretical framework for a theory of mind or consciousness. Any theory of consciousness must include the fact that a conscious entity, as far as is known, is a wet biological medium (the brain), of stupendously high entropy. This organ or entity generates a field that must account for the “binding problem”, which we will define. This proposed field, the conscious electro-magnetic information (CEMI) field, also has physical properties, which we will outline. We will also demonstrate the seamless transition of the Kantian philosophy of the a priori conceon a Riemmanian manifold, where the gradient of ascent on this manifold across contour lines determines the magnitude of perception or the degree of update of the belief-system in a Bayesian inference model. Finally, the science of consciousness has transcended metaphysics and its study is now rooted in the latest advances of neurophysiology, neuro-radiology under the aegis of mathematics.Gallstone ileus is a rare but significant cause of bowel obstruction. An 82-year-old female was admitted to the hospital with abdominal pain and was initially treated for a possible urinary tract infection. Following a surgical review and based on history, clinical examination as well as radiological findings, a diagnosis of gallstone ileus was made. The patient was prepared for surgery; however, whilst awaiting theatre, she spontaneously passed the obstructing gallstone with full resolution of bowel obstruction symptoms. The usual treatment for gallstone ileus is surgical management with an enterolithotomy; nevertheless, this case highlights the importance of close monitoring and adapting a management plan to fit an evolving clinical scenario.Urinary tract infection (UTI) is the most commonly occurring serious bacterial infection in young infants. Uncircumcised male infants have a higher rate of UTI when compared with circumcised male infants and girls. A prostatic abscess is a very rare clinical variety of UTI, especially in neonates. We present the case of a 15-day-old male neonate who developed a rare variety of urosepsis. The baby was evaluated and found to have a prostatic abscess. Ultrasound of the abdomen showed an enlarged prostate gland with diffuse heterogeneous hypoechogenicity. Magnetic resonance imaging (MRI) of the pelvis showed an enlarged, lobulated prostate with T2 hyperintense signal and T1 hypointense signal and diffusion restriction. The post-contrast images in the pelvis-MRI also showed peripheral rim enhancement suggestive of a prostatic abscess. Urine culture showed growth of methicillin-resistant Staphylococcus aureus (MRSA). The baby was treated with intravenous vancomycin, and pus was drained through a transurethral approach.