St. Vincent's Medical Center

Acute esophageal necrosis, also known as "black esophagus," is an uncommon but potentially life-threatening condition marked by diffuse circumferential necrosis of the esophageal mucosa. It typically presents with upper gastrointestinal bleeding, such as hematemesis or melena, in 85-90% of reported cases. Acute esophageal necrosis is often multifactorial in etiology and associated with underlying comorbidities including cardiovascular disease and esophageal mucosal injury. Owing to its rarity, atypical presentations of acute esophageal necrosis can delay diagnosis and appropriate management. This case is noteworthy for its nonclassical presentation and its support of the "two-hit" hypothesis for acute esophageal necrosis pathogenesis. A 71-year-old African American male with a medical history of coronary artery disease and untreated gastroesophageal reflux disease presented with odynophagia, epigastric discomfort, and nonradiating chest pain. He notably denied hematemesis or melena. Esophagogastroduodenoscopy revealed extensive circumferential black discoloration of the distal esophageal mucosa consistent with necrosis, along with duodenal ulcers. Biopsy findings confirmed the diagnosis of acute esophageal necrosis along with evidence of Candida infection. The patient was treated conservatively with intravenous proton pump inhibitors (esomeprazole), oral fluconazole, and sucralfate. A repeat esophagogastroduodenoscopy performed after several weeks demonstrated complete mucosal healing and resolution of necrosis. This case highlights an atypical, nonbleeding presentation of acute esophageal necrosis and reinforces the importance of maintaining clinical suspicion even in the absence of classic symptoms. It underscores the relevance of the "two-hit" hypothesis, where ischemic insult and impaired mucosal defense act synergistically to cause esophageal necrosis. Timely endoscopic evaluation and early initiation of appropriate therapy led to favorable outcomes in this high-risk patient. Increased awareness of such presentations can aid in earlier diagnosis and reduce the high morbidity and mortality associated with acute esophageal necrosis.

Fungating breast tumors represent advanced breast cancer and are frequently complicated by secondary infection. While bacterial colonization is common, infection with carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) in breast wounds is rare and poses significant therapeutic challenges. We report the case of a 60-year-old woman who presented with a six-month history of a progressively enlarging fungating right breast mass, with delayed evaluation due to severe blood-injection-injury (BII) phobia. On admission, she was septic and profoundly anemic. Imaging demonstrated a large exophytic breast mass with bilateral axillary lymphadenopathy, and biopsy confirmed grade 3 invasive mammary carcinoma. Wound cultures grew CR-PSA, necessitating intravenous antibiotics, surgical debridement, and targeted antimicrobial therapy. Her clinical course required blood transfusions and multiple specialities consulted prior to stabilization and discharge for outpatient oncologic care. This case highlights the potential for fungating breast tumors to harbor multidrug-resistant organisms and illustrates how psychological barriers to care can contribute to advanced disease and complex clinical presentations.

Trung Quốc là một trong những quốc gia đối mặt với thách thức nghiêm trọng nhất về tài nguyên nước trên thế giới, bao gồm tình trạng khan hiếm nước, ô nhiễm gia tăng và áp lực mạnh mẽ từ quá trình đô thị hóa – công nghiệp hóa quy mô lớn. Trong gần năm thập kỷ qua, quốc gia này đã từng bước hình thành mô hình quản lý tài nguyên nước bền vững dựa trên cách tiếp cận tổng hợp, kết hợp cải cách thể chế, nâng cao tiêu chuẩn môi trường, đổi mới công nghệ xử lý nước – bùn thải và thúc đẩy kinh tế tuần hoàn. Bài báo phân tích có hệ thống quá trình chuyển đổi tư duy và thực tiễn quản lý tài nguyên nước ở Trung Quốc, làm rõ các trụ cột thể chế – công nghệ – kinh tế tuần hoàn, đồng thời rút ra những bài học kinh nghiệm có giá trị tham chiếu cho Việt Nam và các quốc gia đang phát triển.

ABSTRACTWolfram syndrome is a rare autosomal recessive disorder characterized by diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD). We present the case of a 19‐year‐old male with a history of juvenile‐onset non‐autoimmune diabetes mellitus who presented with fever, chills, seizures, altered sensorium, vomiting, and abdominal pain. The patient was treated for a hyperosmolar hyperglycemic state precipitated by gastrointestinal infection with intravenous fluids, antibiotics, and insulin therapy. Physical examination revealed short stature, delayed secondary sexual characteristics, neck rigidity, and bilateral upward plantar reflexes. Further neuroimaging revealed pontine atrophy, partial central diabetes insipidus, and bilateral optic atrophy. Fundoscopy confirmed optic disc pallor and generalized visual field loss. Pure tone audiometry indicated profound bilateral high‐frequency sensorineural hearing loss, and magnetic resonance (MR) urography findings were consistent with a neurogenic bladder. His sensorium and neurological deficits improved within 3 days, and he was later discharged with close follow‐up by a multidisciplinary team. This case highlights the classic presentation of Wolfram syndrome in a young male with diabetes and neurological complications, emphasizing the need for early recognition and multidisciplinary management. Wolfram syndrome poses significant diagnostic challenges due to its varied and progressive symptoms, and this report aims to contribute to the existing knowledge base and create awareness about the condition, its clinical presentation, and the need for a multidisciplinary management approach.

Abstract We describe 2 new genera and 6 new species of unusual armored scale insects (Hemiptera: Coccomorpha: Diaspididae) from Chile: Austraspis Normark, Normark and Amouroux, gen. n.; Aysenaspis Normark, Normark and Amouroux, gen. n.; Austraspis foye Normark, Normark and Amouroux, sp. n.; Austraspis llanquihue Normark, Normark and Amouroux, sp. n.; Austraspis pehuen Normark, Normark and Amouroux, sp. n.; Austraspis relicta Normark, Normark and Amouroux, sp. n.; Aysenaspis michay Normark, Normark and Amouroux, sp. n.; and Anotaspis paradisi Normark, Normark and Amouroux, sp. n. Austraspis is remarkable for having abdominal segments V and VI free (not fused), with only segments VII and VIII fused to form the pygidium, and in having a proliferation of multilobulate lobes (each with 3 to 6 lobules) on the abdomen. Aysenaspis is remarkable for having all 8 abdominal segments free and in having ducts that are 8-shaped at the internal end. Phylogenetic analysis of part of 28S rRNA places the 2 new genera (Austraspis and Aysenaspis) outside of currently recognized subfamilies of Diaspididae and corroborates the placement of Anotaspis in Ancepaspidinae. We place the new genera in the heretofore monotypic taxon Xanthophthalminae Ferris, revived subfamily. We provide a revised key to the subfamilies of Diaspididae and global keys to all the species of Xanthophthalminae and Ancepaspidinae. The host plants of Austraspis are Araucaria araucana (Araucariaceae) and Drimys winteri (Winteraceae), which both have undergone little morphological change since the Mesozoic. Austraspis may also retain a relatively ancient morphology; its pygidial appendages are relatively undifferentiated compared to those of other diaspidids.

On January 8, 2020, Al Asad Air Base was attacked with more than 12 Theatre Ballistic Missiles launched by Iran, marking the largest ballistic missile strike on U.S. service members (SMs). Following the attack, many SMs reported experiencing post-concussive symptoms and changes in sleep patterns. This study aimed to assess the long-term health impacts, specifically focusing on neurobehavioral symptoms, sleep disturbances, and the relationship between blast exposure, location during the attack, and symptom severity. A survey was conducted 4-6 weeks after the missile attack, gathering data from 583 SMs. The survey evaluated self-reported blast exposure, neurobehavioral symptoms (such as difficulty sleeping, anxiety, and headaches), and sleep habits. Latent class analysis was used to identify neurobehavioral phenotypes among respondents based on their symptoms. Additionally, repeated-measures analysis of variance was employed to assess the relationship between neurobehavioral phenotypes and sleep duration, controlling for factors like blast exposure, location at the time of the attack, and age. This study received a "not research" designation by the Department of Defense institutional review board. Three distinct neurobehavioral phenotypes were identified: "Minimally Affected" (60.5%), "Moderately Affected" (28.8%), and "Profoundly Affected" (10.7%). Service members in the Moderately and Profoundly Affected phenotypes reported higher probabilities of persistent symptoms and shorter sleep durations, especially those who were closer to the missile strikes. Over 80% of participants reported blast exposure. The Profoundly Affected group had a significantly higher likelihood of being within 100 m of a missile strike compared to those who were more than 100 m away or off the base at the time of the attack, who reported milder symptoms. Sleep duration post-attack was significantly shorter for the Moderately and Profoundly Affected groups compared to the Minimally Affected group (P < .001). Furthermore, the Profoundly Affected group reported significantly shorter sleep durations than the Moderately Affected group. This study highlights the significant impact of missile proximity on both neurobehavioral symptoms and sleep disturbances. The findings suggest that those exposed to the missile strike at closer proximity had more persistent and severe symptoms, including disrupted sleep patterns. The identification of three neurobehavioral phenotypes emphasizes the need for targeted screening and follow-up care to ensure the best long-term response for these SMs, especially for those in the more severely affected groups. Future studies should investigate the long-term effects of such exposure and explore potential interventions to mitigate health impacts for those at risk. The strengths of this study lie in its large sample size and detailed analysis, while limitations include the lack of longitudinal data.

e13519 Background: Breast cancer poses a significant threat to women's health, as evidenced by the alarming statistics that it is the second most common form of cancer among females. It is responsible for a staggering 30% of all female cancers, according to data from the American Cancer Society. Furthermore, the incidence of breast cancer is projected to rise by 1% annually by 2025. This can be attributed to various factors, including low literacy levels and lack of health care awareness. In this project, we explore how Chat Generated Pre-Trained Transform (ChatGPT), an emerging artificial intelligence, can be leveraged to simplify the abundant data about breast cancer available on the National Breast Cancer Foundation website, making it more accessible to low-literacy populations. Methods: We aimed to examine the readability of the 17 breast cancer-related questions and answers provided by the National Breast Cancer Foundation on their website. Additionally, we investigated the effectiveness of using ChatGPT in simplifying the content to ensure it is easily understood by individuals with a sixth-grade reading level. To compare the original text and the readability of ChatGPT-generated text, we used the Flesch-Kincaid scoring criteria to understand the education and reading levels needed to interpret this text. We then employed STATA BE 18.5 software using a paired t-test to statistically analyze the Flesch-Kincaid grade level and readability ease score of the original text and ChatGPT-generated text. Results: The results of the paired t-test analysis revealed a significant difference between the mean values of original and ChatGPT-modified text, with a standard error of 0.54 and a standard deviation of 2.23. The 95% confidence interval for the mean difference ranged from 1.38 to 3.67, with the mean difference being 2.523 and a corresponding p-value of 0.0003, which is statistically significant (p &lt; 0.05). Conclusions: Breast cancer continues to be a major public health concern, particularly among women, and there is a pressing need to develop innovative approaches to enhance awareness and encourage early detection. Emerging research suggests that artificial intelligence technologies, such as chatbots, may provide a promising solution to address the barriers faced by individuals with low literacy rates in accessing and comprehending crucial health information.