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McPherson Garrison posted an update 4 days, 11 hours ago
Dementia with Lewy bodies (DLB) is one of the most common forms of dementia. It can present as neurocognitive decline, visual hallucinations, and concomitant symptoms of rapid eye movement (REM) sleep behavior disorder. Early diagnosis remains one of the cornerstones of managing this form of neurocognitive disorder but, often, making an early and accurate diagnosis can prove to be challenging. For this article, our goal was to review the utility of various neuroimaging modalities in making a swift and accurate diagnosis of DLB. We used PubMed to look for helpful, informative, and peer-reviewed articles. We discussed the role of a plethora of different imaging techniques, ranging from structural imaging like computed tomography (CT) and magnetic resonance imaging (MRI) to molecular imaging (single-photon emission computed tomography, positron emission to- tomography) as a diagnostic tool for DLB. We arrived at the conclusion that these novel neuroimaging modalities have already proven to be very helpful in ruling out differentials and making an early diagnosis of DLB. However, ongoing research is required to increase the diagnostic accuracy, leading to the early identification and treatment of DLB.Urachal anomalies are infrequent in the adult population and may represent a diagnostic challenge. Few cases of urachal sinuses are reported and are usually asymptomatic unless a complication occurs, most likely infectious. Infected urachal sinus’ clinical manifestations are a purulent umbilical discharge, abdominal pain, and a periumbilical mass. We report the case of a late presentation of an infected urachal sinus in a male adult. Clinical and imaging features allowed accurate diagnosis. Antibiotic therapy was followed by the urachal remnant’s surgical excision. The postoperative course was uneventful. Histological examination revealed no signs of malignancy.Objectives In this study, we aimed to examine and analyze liver abnormalities among patients with systemic lupus erythematosus (SLE), including both newly diagnosed patients and those being followed up, as well as the prevalence of lupus hepatitis. Methods This was a prospective observational study. Clinical data, liver function tests (LFTs), and the findings from the ultrasonography of the abdomen among the patients were prospectively recorded and evaluated. Results Overall, 28 of the total 135 (20.7%) patients had liver abnormalities, including biochemical and those detected via ultrasonography. Ten patients had transaminitis, defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels >2 times the upper limit of normal (ULN). Nine patients had elevated alkaline phosphatase (ALP) or gamma-glutamyl transferase (GGT) of >2 times ULN. In three patients, transaminitis was due to anti-tubercular therapy (ATT)-induced hepatitis; in seven (5.2%), no specific cause for transaminitis could be identified, and hence they were classified as cases of lupus hepatitis. On comparing clinical features between patients with (n=7) and without lupus hepatitis (n=128), the condition was more prevalent in newly diagnosed SLE patients compared to those who had been on follow-up [six (85.7%) vs. 30 (23.6%), p=0.002]. All seven patients with lupus hepatitis had complete resolution of the transaminitis on follow-ups. However, one patient who had received ATT (isoniazid, rifampicin, ethambutol, and pyrazinamide) died. Ultrasonography showed fatty liver in seven patients and chronic liver disease in one patient. Conclusion In this study, transaminitis due to lupus hepatitis was seen in newly diagnosed lupus patients and was not associated with disease activity. selleck compound Before diagnosing lupus hepatitis, drug-induced liver disease has to be ruled out, and if persistent LFT abnormalities are present, further workup is suggested to rule out overlap with primary biliary cirrhosis and/or autoimmune hepatitis.Mesenchymal tumors of the genitourinary tract account for 5% percent of bladder malignancies and there are currently 35 documented cases of osteosarcoma type. Concomitant involvement of the prostate in mesenchymal genitourinary malignancies is even rarer. Herein we describe a case of a 72-year-old male with a history of radiation for prostate cancer who develops hematuria. A hematuria evaluation revealed osteosarcoma of the bladder and prostate. He underwent radical cystoprostatectomy with ileal conduit and adjuvant chemotherapy. His disease progressed despite treatment and he elected palliative care 10 months after initial resection. This case reviews a rare histological variant of genitourinary malignancy.Dual training in Internal Medicine-Pediatrics (MedPeds) was recognized by the American Board of Medical Specialties in 1967. Residents complete 24 months each in Internal Medicine and Pediatrics and are board-eligible for both at the conclusion of training. Graduates are eligible for fellowships in either or both fields. Many graduates pursue fellowship training. A small absolute number of graduates apply for dual training in adult and pediatric subspecialties, but those that do bring direct, in-depth clinical experience across the lifespan, and familiarity with care in both pediatric and adult settings. As such, they contribute unique perspectives and capabilities to their fellowship and future practice. This includes the ability to provide subspecialty care in settings with limited resources, where they are able to address needs without age restrictions, and in the transition of subspecialty care for emerging adults with childhood-onset conditions. Due to the small number of applicants pursuing joint adult and pediatric fellowships, many fellowship directors may have limited experience with dual fellowships but may want to create opportunities for these unique trainees. This summary was developed jointly by residents, fellows, MedPeds program directors, and fellowship directors in Pediatrics and Internal Medicine subspecialties, and approved by their respective leadership councils to offer some key points on common questions, suggest additional resources, and share best practices, with a goal of facilitating this process for fellowship programs and residents alike.