Introduction:Encephalomalacia is the loss of brain tissue caused by an insult to the cerebral matter. Encephalomalacia is not frequently described in literature, with most focusing on infants and children, and rarely on the adult population. When described in the adult population, encephalomalacia is most commonly described following a cerebrovascular event. Reports of trauma-induced encephalomalacia in adults are uncommon, making such cases clinically significant. Despite some identified etiology in infants and children, our understanding of adult risk factors besides a cerebrovascular event remains limited. The following report describes a case of encephalomalacia in a young adult resulting from an atypical predisposing etiology. Case Presentation:Our case is of a twenty-eight-year-old male who presented with non-specific and abrupt symptoms of chest tightness, dyspnea, and aphasia after an apparent episode of alcohol intoxication. Further investigations and pertinent history-taking revealed a chronic history of similar symptoms traced back to a severe head trauma five years prior. The symptoms were ultimately attributed to left temporal lobe encephalomalacia, as evidenced by neuroimaging with CT and MRI. The patient received symptomatic treatment for possible alcohol withdrawal and was hospitalized until his symptoms improved. He was then discharged for continued outpatient follow-up care. Conclusion:This case report aims to identify the unknown cause of neurobehavioral deficits in adults and highlight physical trauma as the probable etiology of encephalomalacia in such patients. It underscores the potential for early identification through neuroimaging and appropriate symptomatic management, offering hope for mitigating the impact on the patient's quality of life.

Background: Internal carotid artery occlusion (ICAO) is uncommon in young adults and may present with mild or transient symptoms, posing challenges in determining the timing and necessity of endovascular intervention. While conservative management is often preferred in patients with minimal deficits, some may experience delayed infarct progression requiring escalation of care. Case Description: We present a 24-year-old male with no prior medical history who developed mild stroke symptoms during physical activity. Imaging revealed complete occlusion of the left internal carotid artery (ICA). Due to rapid symptom resolution and a low National Institutes of Health Stroke Scale (NIHSS) score, he was managed conservatively with antiplatelet therapy and discharged. Twelve days later, he returned with new-onset right-sided weakness and numbness. Imaging showed a new infarct and persistent ICAO with middle cerebral artery (MCA) involvement. Despite medical therapy, he deteriorated neurologically, and a large MCA infarct with midline shift was identified. Emergent mechanical thrombectomy of the first segment of the middle cerebral artery (M1) segment was performed. The patient showed meaningful improvement post-procedure and was discharged to rehabilitation. At follow-up, he remained ambulatory with assistance and functionally independent self-care but continued to have expressive aphasia and right-sided weakness. Conclusions: This case demonstrates that young patients with ICAO and initially mild symptoms may still be at risk for infarct progression and delayed neurological deterioration. Mechanical thrombectomy can lead to favorable outcomes even when performed beyond traditional time windows. Our findings highlight the importance of close monitoring and re-evaluation in this population and support a flexible, individualized approach to intervention timing based on evolving clinical and radiographic evidence.

Gastric perforation is a serious yet rare complication in critically ill patients on mechanical ventilation and GI prophylaxis. This report highlights an unexpected gastric perforation in a patient with a negative barium swallow study while receiving GI prophylaxis during intubation. A 65-year-old male with COPD and tobacco use disorder was treated with Oseltamivir for Influenza A infection, intubated for acute respiratory failure, and received IV pantoprazole for GI prophylaxis. After extubation and an unremarkable barium swallow study, he developed abdominal pain and tachycardia. Imaging showed free air under the diaphragm, and a CT scan indicated gastrointestinal perforation. Emergency surgery confirmed an anterior gastric ulcer perforation with purulent peritonitis. He was successfully treated with a washout and antibiotics and was discharged in stable condition. This case underscores the necessity of vigilance for abdominal symptoms and the potential for gastric perforation in critically ill patients despite GI prophylaxis, highlighting the importance of recognizing early signs of pneumoperitoneum.

Background: Bempedoic Acid (BA) is a novel drug that has a potential to serve as an alternative to statins to decrease lipid levels and improve cardiovascular disease (CVD) outcomes, particularly for statin-intolerant individuals. However, insufficient statistical power has limited our understanding of the efficacy and safety of BA. This meta-analysis utilizes the latest data to improve our knowledge of BA's effects on lipids and CVD with increased statistical power. Methods: MEDLINE, Embase, Cochrane Central, Clinicaltrials.gov, abstracts of national and international conferences, and reference lists of studies were searched for relevant studies. Rayyan was used to screen the search results, and Revman 5.3 was used for the meta-analysis and sensitivity analysis. Results: Our final analysis included seven randomized control trials (RCTs) with 17,782 participants, 53.6 % in the BA group (n = 9535) and 46.4 % in the placebo group (n = 8247). BA significantly decreased major adverse cardiovascular events (MACE) (OR: 0.86; 95 % CI 0.78-0.95; p = 0.03), non-fatal myocardial infarction (OR 0.72; 95 % CI 0.61-0.85; p = 0.0001), and new onset/worsening diabetes (OR:0.55; 95 % CI 0.30-0.98, p = 0.04), while reducing low-density lipoprotein cholesterol (LDL-C) levels by 22.5 % (MD: -22.53 %; 95 % CI -25.54 to -19.52, p < 0.00001). Conclusion: The findings of this meta-analysis suggest that BA is a promising and effective alternative to statin therapy, particularly for statin-intolerant and high CVD-risk patients. However, further studies with diverse populations are needed to quantify the long-term efficacy and safety endpoints.

Pulmonary embolism (PE) is significant cause of morbidity and mortality, with an incidence of 100-200/100,000 population annually in the USA. Understanding mortality trends is crucial in targeted interventions. Analyze PE-mortality trends in USA utilizing Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Study analyzed PE-cases (ICD-10-code i26) using CDC WONDER focusing on age-adjusted mortality rates (AAMR)/100,000 population, utilizing regression analysis for annual percentage change (APC) to identify trends. Total PE-related deaths in the USA were 179,233 (1999-2020). Mortality rates slowly declined until 2003, followed by sharp decline until 2007 (APC: -7.19, p < 0.05), and then an uptrend afterwards. Males showed overall higher AAMR (2.47, 95% CI 2.45-2.48) than females (2.43, 95% CI 2.41-2.44). Both genders showed a downtrend in APC in the first decade [(Males, APC: -4.48, p < 0.05, 1999-2008), (Females, APC: -7.19, p < 0.05, 2003-2007)], followed by a reversal of trends. African-Americans had the highest AAMR (4.48, 95% CI 4.43-4.54), followed by Whites (2.47, 95% CI 2.45-2.48), American-Indians (1.7, 95% CI 1.6-1.8), Hispanics (1.03, 95% CI 1.01-1.06), and Asians (0.51, 95% CI 0.48-0.54). The East-South-Central division of the USA showed the highest AAMR, followed by the West-South-Central division. Mississippi showed the highest AAMR, followed by Arkansas and Alabama. Non-metro areas exhibited the highest AAMR, while large-central-metro areas the lowest. Rise of PE-related mortality trends after 2007, gender and racial disparities underscores ongoing challenges in management and highlight the need for targeted public health interventions.

A 46-year-old diabetic woman with unilateral renal fungus ball was successfully treated with antifungal therapy, endoscopic extraction and ureteral stent placement. The patient was initially treated for a right staghorn calculus, thereafter developed urinary symptoms. Imaging revealed distal left ureter filling defects and a previous stent at the ureteropelvic junction. Urine culture confirmed Candida glabrata sensitive to Micafungin. Bilateral ureteroscopy facilitated the extraction of a left renal pelvis fungus ball. This case underscores the challenges in diagnosing fungal UTIs in patients with predisposing factors, and highlights a combined medical and surgical approach for effective treatment of renal fungus balls.

Kaposi sarcoma (KS) is an angioproliferative neoplasm that affects the skin and lymph nodes. Human herpesvirus-8 (HHV-8) triggers KS by infecting the endothelium and inducing angiogenesis through the production of vascular endothelial growth factors and cytokines. KS is characterized by purplish or hyperpigmented plaques involving the skin and mucous membranes, and visceral involvement is very rare. Pulmonary KS (PKS) is an exceedingly rare visceral manifestation of KS and has a poor prognosis. PKS often presents with cough, hemoptysis, pleuritic chest pain, fever, and weight loss. In this case series, we share our experience in diagnosing and treating two patients with PKS. We also provide a concise review of the epidemiology, signs and symptoms, diagnosis, and management of this rare condition.

Background: Ischemic heart disease (IHD) affects over 120 million people and is the leading cause of death globally. Our study aims to assess the trends in IHD-related mortality in the regions of the Americas. Research Questions/Hypothesis: Has IHD-related mortality decreased from 2000 to 2019 in all regions of the Americas? Aims: Analyze differences in IHD-related mortality in different regions of the Americas. Methods: We analyzed the Pan American Health Organization (PAHO) database for IHD-related mortality rates in 2000, 2010, and 2019. The age-standardized mortality rates per 100,000 population were extracted, and trends were analyzed by gender and region. Results: The IHD-related mortality was consistently higher in males as compared to females in the last 2 decades. The mortality rate decreased in males in all regions from 2000 to 2019 apart from the Mexico, Central America and Latin Caribbean region where it increased from 115.12 in 2000 to 119.50 in 2019.The greatest decrease in IHD-related mortality in males was seen in the North America region from 164.49 in 2000 to 93.73 in 2019. This opposite trend was seen in females where mortality decreased in all regions from 2000 to 2019. Conclusion: The sociodemographic and temporal trends highlighted by this study need to be further investigated, and targeted policy measures are required to reduce the disparities in IHD-related mortality.

Mounier-Kuhn syndrome, characterized by tracheal dilatation due to the loss of elastic fibers and smooth muscle cells, is a rare condition, often leading to recurrent respiratory infections from impaired mucociliary clearance.

Coronavirus disease 2019 (COVID-19) infection has been associated with a multitude of complications, one established complication being thromboembolism, a result of the proinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This prothrombotic state is a cumulation of many inflammatory pathways at work. Here, we present an interesting case of a 43-year-old female who did not present with the typical COVID-19 clinical picture. Instead, she presented with periumbilical pain, nausea, and vomiting. Upon further investigation, she was found to have a splenic infarct on a computed tomography (CT) scan. An extensive workup was performed to explore possible etiologies; however, it was concluded that her splenic infarct was secondary to her COVID-19 infection. With this case, we aim to add to the literature regarding the manifestations of the prothrombotic state of SARS-CoV-2.

We present a fascinating case of a patient who suffered from persistent headaches for three months due to an epidermoid cyst located in the prepontine cistern. Epidermoid cysts are a very uncommon type of intracranial tumor, known for their slow growth and gradual onset of neurological symptoms. In this particular case, our patient, a 35-year-old, experienced a headache that was accompanied by dizziness, photophobia, and pain when moving their eyes. Further imaging revealed a cystic lesion in the prepontine cistern, which had a mass effect on the pons. After confirming the lesion was likely an epidermoid cyst through an MRI, the patient underwent surgery to have it removed. We hope to highlight the rarity of this type of tumor and its unique features when viewed through imaging.

Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.

Wernicke encephalopathy (WE) is an acute neurological syndrome caused by thiamine (vitamin B1) deficiency. This disorder manifests as a triad of gait ataxia, confusion, and vision abnormalities. The absence of a full triad does not rule out WE. Because of its vague presentation, WE is commonly missed in patients with no history of alcohol abuse. Other risk factors for WE include bariatric surgery, hemodialysis, hyperemesis gravidarum, and malabsorption syndromes. WE is a clinical diagnosis that can be confirmed with an MRI of the brain as hyperintensities in the mammillary bodies, periaqueductal area, thalami, and hippocampus. If suspected in a patient, WE must be immediately treated with intravenous thiamine to prevent evolution into Korsakoff syndrome, coma, or death. Currently, there is no consensus in the medical community as to how much thiamine must be given and for how long. Therefore, there is a need for more research in the diagnosis and management of WE after bariatric surgery. Herein, we report a rare case of a 23-year-old female with a history of morbid obesity who developed WE two weeks after a laparoscopic sleeve gastrectomy.