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Case Report: When Confusion Signals a Crisis: Rethinking the Diagnosis of Meningitis in Geriatric Sepsis
Full text linkWe report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with altered mental status and the need for early sepsis management, including empiric antibiotic therapy
THE ELECTRONIC MUSICIAN PROJECT: THE INTERACTION OF LIVE-LOOPING, SAMPLING AND TURNTABLISM IN THE LIVE JAZZ ENSEMBLE SETTING
No full textThis dissertation will explore an unknown territory of integrating live-looping, sampling and turntablism with live jazz ensembles. By examining the rich history of each art-form, it will expose how their origins are relevant to this concept. Due to intertwining jazz with three technology-based mediums, the timeline of jazz audio recording will also be explored. To rehearse this method, one electronic musician was included with three jazz ensembles of differing orchestrations. He used a music software program called Ableton Live and an external MIDI drum pad controller to sync with the band. This gave him access to their audio, so he was able to record them live. Once recorded, he manipulated their sampled audio with loops and audio effects for improvisation. He also functioned as accompaniment for the band during certain sections of pieces. The electronic musician was given a scored part, just as any other acoustic performer in the band would receive. A notation system was created for this practice by combining Western music notation with graphic symbols. This dissertation will reflect on the creative and technological experiences of rehearsing this new approach of combining jazz with electronics. It concludes with a discussion between the author and the electronic musician, which gives personal insight to its approach, conflicts, resolutions, and potential
Cannabinoid Hyperemesis Syndrome Induced Pneumomediastinum in an Adolescent
Full text linkCannabinoid hyperemesis syndrome (CHS) is a condition characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain in individuals with chronic cannabis use. Despite its increasing recognition, CHS remains underdiagnosed, particularly in adolescents, and can be associated with a range of complications, some of which are potentially life-threatening. One such complication is spontaneous pneumomediastinum (SPM), a rare but serious condition where air accumulates in the mediastinum without any clear traumatic cause. Although SPM is typically benign, it can present with significant respiratory distress and requires prompt identification and management. Here we present the case of an 18-year-old patient with spontaneous pneumomediastinum (SPM) secondary to cannabinoid hyperemesis syndrome (CHS). This case highlights the uncommon but critical association between CHS and SPM, emphasizing the importance of considering CHS in young patients with chronic cannabis use and understanding the potential for serious complications in these cases
Pain Management in Pregnant Women with Opioid Use Disorder: A Systematic Review
Full text linkBackground: The prevalence of opioid use disorder (OUD) among pregnant individuals has risen significantly, posing challenges in managing labor and postpartum pain. Factors such as opioid tolerance, opioid-induced hyperalgesia, and concerns about relapse complicate analgesic strategies. Despite these complexities, evidence-based guidelines for pain management in this population remain limited.
Hypothesis: Pregnant women with OUD experience disparities in pain management during labor and postpartum periods, leading to suboptimal outcomes.
Methods: A systematic review was conducted, analyzing peer-reviewed studies from databases including PubMed and Embase. Inclusion criteria encompassed studies focusing on pain management in pregnant women with OUD. Data extraction focused on pain scores, analgesic use, patient and provider perspectives, and clinical outcomes.
Results:
·Women with OUD reported higher pain scores postpartum compared to those without OUD.
·Patients expressed concerns about inadequate pain control and limited analgesia options.
·Providers acknowledged challenges in balancing effective pain management with the risk of relapse. ·Women maintained on buprenorphine experienced more pain and required more analgesics after C-sections ·A lack of standardized protocols for managing pain in this population was evident.
Conclusion: To enhance pain management strategies for pregnant women with OUD, future research and clinical efforts should focus on development of evidence-based guidelines, provider education and training, and assessment of non-opioid analgesics
The Correlation Between a Methylenetetrahydrofolate Reductase Deficiency in Autism Spectrum Disorder Patients and The Presence of Mental Health Disorders
Full text link• Currently little literature exists on connection between Methylenetetrahydrofolate reductase (MTHFR) deficiency and mental health disorders
• Reduced enzyme activity associated with certain MTHFR variants contributes to altered folate metabolism, elevated homocysteine levels, and disrupted DNA methylation, all of which are implicated in mental health disorders
• Identifying genetic risk factors could facilitate earlier diagnosis and intervention, leading to improved outcomes
• Relevant results could help reduce stigma and promote greater understanding of challenges faced by patients on the spectru
The Physical and Mental Health Implications on Patients of Childbearing Age Following the Dobbs Deicison
Full text linkBackground: In June 2022, the Supreme Court ruled to overturn Roe v. Wade in the Dobbs v. Jackson case which allowed for individual states to determine the legality of abortion. Thirteen states had “trigger” laws in place that immediately restricted abortion access. Since then, many states have enacted laws restricting access to abortion, increasing the total number of states where abortion is outlawed or heavily restricted.
Hypothesis: The goal of this review was to examine the potential implications of restricted access to abortion care on the physical and mental health of patients of childbearing age, which was hypothesized to be negatively impacted.
Methods: Online databases were accessed, and nine studies met inclusion criteria for this literature review. Inclusion criteria consisted of cross-sectional, case, regression model, retrospective, and prospective studies related to abortion care or the overturn of Roe v. Wade. Studies specific to the Dobbs decision (2020–2024) were included alongside others from 1999–2024.
Results: In restrictive states and states with trigger laws, the loss of abortion rights was associated with a 10% increase in mental distress, higher reported levels of anxiety and depression, and an increase in internet searches for abortion and contraception related terms. Additionally, there was a significant increase in necessary travel time to the nearest abortion facility, delaying care and increasing self-induced abortions.
Conclusion: Overall, the Dobbs decision has had a negative impact on both physical and mental health among individuals of childbearing age. Further research is needed to fully understand the broader implications of these consequences
From Gut to Heart: TMAO as a Predictive Marker for Cardiovascular Risk
Full text linkBackground: Trimethylamine N-oxide (TMAO), a metabolite produced by gut microbiota from dietary nutrients such as choline and carnitine, has emerged as a potential biomarker linking the gut microbiome to cardiovascular disease (CVD). This review synthesizes findings from 31 studies examining the association between circulating TMAO levels and cardiovascular outcomes.
Objective: To evaluate the prognostic value of plasma or serum TMAO concentrations in predicting major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and cardiovascular mortality.
Methods: Studies were identified through a systematic search and screened based on inclusion criteria that required human populations, quantification of blood-based TMAO, and analysis of cardiovascular outcomes. A total of 31 studies published in the last 5 years were included.
Results: Elevated TMAO levels were consistently associated with increased risk of cardiovascular events across both general and high-risk populations, including individuals with coronary artery disease, heart failure, and diabetes. Hazard ratios for adverse outcomes ranged from 1.5 to 3.5 in most studies, even after adjustment for traditional risk factors such as lipid levels and renal function. Some studies also observed additive risk when TMAO elevation coexisted with metabolic comorbidities.
Conclusion: TMAO demonstrates strong potential as an independent biomarker for cardiovascular risk stratification. Its integration into clinical practice could enhance precision prevention strategies. However, further research is needed to standardize cut-off levels and explore whether interventions that reduce TMAO levels can improve outcomes
Unusual Path: Gallstone Ileus with Pneumobilia and Jejunal Obstruction
Full text linkWe present a case of a 48-year-old female with two-day history of diffuse abdominal pain, nausea and vomiting. She was diagnosed with small bowel obstruction due to gallstone ileus. Diagnosis is usually challenging due to its nonspecific presentation, but computed tomography reveals the classic findings of Rigler’s triad -- pneumobilia, bowel obstruction, and an ectopic gallstone. The patient underwent laparoscopy with enterolithotomy with subsequent resolution of symptoms. Prompt diagnosis through imaging and timely surgical intervention is critical for in preventing complications and improving patient outcomes
Kratom as a Therapeutic Option for Opioid Use Disorder: A Comprehensive Review
Full text linkKratom (Mitragyna speciosa) has gained significant attention for its potential role in managing opioid use disorder (OUD). This review examines kratom’s pharmacology, safety profile, addiction potential, and ethical considerations in research, while exploring its future as a therapeutic option. Kratom’s primary alkaloids, mitragynine and 7-hydroxymitragynine, act as partial mu-opioid receptor agonists, producing analgesic and sedative effects at higher doses and stimulant-like effects at lower doses. Preclinical and observational studies suggest kratom may alleviate opioid withdrawal symptoms and cravings, but concerns remain regarding its dependency potential and adverse effects, including gastrointestinal distress, hepatotoxicity, and withdrawal symptoms upon cessation. While kratom carries a lower risk of fatal overdose compared to traditional opioids, its safety and efficacy in OUD treatment remain inadequately studied due to a lack of standardized clinical trials and regulatory oversight. Ethical concerns in kratom research include ensuring informed consent, minimizing risks to vulnerable populations, and addressing conflicts of interest in industry-funded studies. Future research must prioritize randomized controlled trials, product standardization, and long-term safety assessments to determine kratom’s viability as an alternative or adjunct to FDA-approved OUD treatments. Effective regulation informed by scientific findings is essential to maximize therapeutic benefits while minimizing harm
Drug-induced Hyperpigmentation due to Levofloxacin
No full textDrug-induced hyperpigmentation is responsible for up to 20% of acquired hyperpigmentation cases, especially among the elderly population. The pathogenesis varies depending on the medication involved and may include melanin accumulation, drug deposition, production of special pigments, and iron deposition. We report the case of an elderly, immunocompromised patient with a history significant for leukemia presenting with black-blue hyperpigmentation of the upper and lower extremities, associated with iron deposition following levofloxacin exposure