Mount Sinai Queens

We present the case of a 26-year-old female patient with a history of asthma who initially presented with symptoms suggestive of a common infection. Her constellation of facial swelling, productive cough, and fatigue, coupled with imaging findings, first led to a diagnosis of right upper lobe pneumonia and suspected cellulitis. Despite appropriate antibiotic therapy, her symptoms persisted, and her clinical picture became more complex with the identification ofActinomycesin her sputum, shifting the differential diagnosis toward a more indolent cervicofacial infection. However, a progressively worsening and profound leukocytosis, along with a lack of clinical improvement, prompted further investigation. This ultimately revealed a large mediastinal mass, and subsequent tissue analysis confirmed a diagnosis of primary mediastinal large B-cell lymphoma. This case highlights a critical diagnostic challenge, illustrating how a rare and aggressive malignancy can masquerade as a common infectious process in a young, otherwise healthy individual, leading to a significant delay in diagnosis and treatment.

Gastrointestinal subepithelial tumors (SETs), including neoplastic and non-neoplastic lesions, often require resection when symptomatic or when they possess malignant potential. Endoscopic full-thickness resection (EFTR) and submucosal tunnel endoscopic resection (STER) are minimally invasive techniques used for resecting these lesions. This meta-analysis aims to compare the efficacy and safety of EFTR and STER in the treatment of upper gastrointestinal (GI) lesions. A systematic search was conducted in Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases up to August 2024. Studies comparing EFTR and STER for upper GI lesions were included. Outcomes assessed were en bloc resection rate, complete resection rate, procedure time, recurrence rate, hospital stay, perforation rate, bleeding, and follow-up duration. Data were pooled using a random-effects model, and statistical significance was set at P <0.05. Eight studies, including 725 patients, were included. EFTR showed a significantly higher en-bloc resection rate (OR=4.81, 95% CI=1.56-14.90, P =0.006) and complete resection rate (OR=3.58, 95% CI=1.19-10.76, P =0.02). Recurrence rates were lower with EFTR (OR=0.17, 95% CI=0.03-0.87, P =0.03). No significant differences were found between EFTR and STER in procedure time (MD=-6.50min, P =0.06), perforation rate (OR=9.38, P =0.41), or bleeding rates (OR=0.72, P =0.20). EFTR was associated with a shorter hospital stay (MD=0.66d, 95% CI=0.27-1.05). EFTR offers superior en-bloc and complete resection rates, and a lower recurrence rate compared with STER for upper GI lesions. Both techniques are comparable in terms of procedure time and adverse events, with EFTR offering shorter hospital stays. However, the choice between EFTR and STER should be guided by tumor characteristics (size and location), endoscopist experience, and institutional resources. Further multicenter randomized studies are needed to confirm these findings and address variability in perforation risk.

Thrombotic microangiopathy (TMA) is a medical emergency characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury (AKI). Its subtypes, including thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), and secondary TMA, require rapid differentiation due to divergent treatments. Acute pancreatitis, in some cases, can trigger TMA through systemic inflammation and complement activation. A middle-aged male with chronic kidney disease and diabetes was admitted for acute pancreatitis, likely in the setting of glucagon-like peptide-1 (GLP-1) use. On day 3, he developed progressive thrombocytopenia, anemia, and worsening renal function. Peripheral smear showed schistocytes; laboratory valueswere remarkable for hemolysis. Given the high suspicion for TMA and a PLASMIC score of 5, empiric plasma exchange and corticosteroids were initiated, which showed clinical improvement. ADAMTS13 activity returned at 99%, effectively excluding TTP. Complement studies for aHUS were inconclusive and were obtained post-plasma exchange, which can alter results. The patient completed five sessions of plasma exchange and was discharged in stable condition. A follow-up was arranged for hematology.This case highlights the diagnostic complexity of TMA triggered by acute pancreatitis and the necessity of early empiric treatment. It also calls attention to the limitations of delayed ADAMTS13 and complement testing and advocates for broader implementation of rapid in-house assays to guide timely, precise therapy.

Salmonella urinary tract infections (UTIs) are rare and typically affect immunocompromised or anatomically predisposed individuals. While usually foodborne, transmission can also occur from pets or person to person. Symptoms mimic common UTIs and may present with or without prior gastrointestinal illness. We report the case of a 56-year-old HIV-positive male with poor medication compliance who presented with altered mental status and burning micturition. Urine and blood cultures revealed non-typhoidal Salmonella, prompting targeted antibiotic therapy. Treatment involves at least 14 days of antibiotics, with repeat urine cultures to ensure eradication. Rising antibiotic resistance necessitates awareness of local sensitivity patterns.

defibrillator pads.Following the training, 100% felt confident about the BLS protocol, the code documentation tool, and the LUCAS device, and reported no challenges. Conclusion:This hands-on training program effectively improved the confidence of healthcare providers in performing critical resuscitation tasks.We found that the stepwise approach to the LUCAS device application was an easy skill for the nurses to grasp and minimized CPR interruptions.In the future we plan to conduct longitudinal assessments of confidence and knowledge, expand training in different departments, conduct chart audits, and add mock codes to the institution's annual skills fair.

Loeffler's syndrome is a rare, benign respiratory disease usually associated with peripheral eosinophilia, first described by Wilhelm Loeffler in 1932. It is caused by the larvae of helminths such as hookworms, Ascaris, and Strongyloides that transmigrate through the lungs during the active phase of infection. We present a case of a 53-year-old man who complained of a productive cough with intermittent hemoptysis and left-sided posterior chest pain. Initial evaluation revealed ground-glass opacity in the left upper lobe on chest X-ray and computed tomography (CT) scan, with laboratory results suggestive of leukocytosis, eosinophilia, and elevated IgE levels. After ruling out other potential diagnoses, strongyloidiasis was suspected. Serology for Strongyloides stercoralis was positive, and stool studies confirmed the presence of Strongyloides larvae. The patient was started on ivermectin and followed up in the outpatient clinic. Repeat chest CT after one month showed resolution of the previously noted left upper lobe infiltrate. This case report aims to describe this rare instance of Loeffler's syndrome and provide an update on the epidemiology, risk factors, and association of strongyloidiasis with other diseases and medications.