My Achy-Breaky Heart: A Case of Diffuse Large B-Cell Lymphoma Presenting as Impending Cardiac Tamponade in a Hispanic Woman

Background: Mediastinal masses can arise from typical structures within the mediastinal or they can develop secondary to metastasis from other organ systems [1] Primary mediastinal diffuse large B-Cell lymphomas (PMBCL) are uncommon, accounting for 7% of the cases of diffuse large b cell lymphoma. We describe a case of a 35-year-old woman who presented with atypical chest pain and shortness of breath and was diagnosed with PMBCL in the setting of impending cardiac tamponade. Case Report: A 35-year-old woman with history of cutaneous lupus presented with an 8-month history of chest pain with associated worsening shortness of breath. Upon further questioning, the patient reported having night sweats intermittently with an associated 10-lb weight loss. On examination, patient was tachycardic to 140 BPM, dyspneic with SPO2 99% on room air, with a BP of 137/87 mm/Hg. Results: CXR was performed which showed a widened mediastinum and cardiomegaly. LDH 514 IU/L. Echocardiogram was performed which revealed a large mediastinal tumor, pericardial effusion with suspicion of possible diastolic compromise. Patient was taken to OR for an emergent pericardial window and biopsy of the mass. Pathology along with immunostaining positive for CD45, CD20, Bcl1, Bcl6 correlated with a diagnosis of PMBCL. Conclusions: PMBCL can be aggressive but tend to have similar response rates compared to other types of b cell lymphomas when combination chemotherapy and mediastinum irradiation is initiated [3]. Our patient opted to be transferred to MD Anderson for higher level of care. Patient is scheduled to follow-up with the oncology team soon

Methotrexate-Induced Pancytopenia: A Call For Mindful Medication Practices

Introduction: Methotrexate(MTX) is a widely used disease-modifying antirheumatic drug for various conditions including autoimmune diseases or malignancies. Pancytopenia as an adverse effect of methotrexate is rarely reported but sometimes fatal, and requires more attention. This case report shows a 76-year-old woman with a history of rheumatoid arthritis(RA) on MTX therapy, presenting with severe pancytopenia and oral lesions, and highlights the importance of safe medication practices especially in elderly patients with poor health literacy and compliance. Case Presentation: A 76-year-old female with rheumatoid arthritis presented to the emergency department with a worsening oral lesion. She had been on an unspecified maintenance dose of MTX for the management of RA for more than 2 years without adequate follow-ups. On initial evaluation, the patient had multiple ulcerative lesions in her oral cavity involving buccal mucosa and soft palate, and severe gingivitis in the upper and lower gumline, associated odynophagia. She also had similar ulcerative lesions in the genitalia with vaginal bleeding. On initial labs, she had severe pancytopenia with hemoglobin(Hb) 8.6 g/dL, white blood cell(WBC) count 670/uL with absolute neutrophil count(ANC) 300/uL, and platelet(PLT) 12,000/uL. It was a dramatic change compared to the lab 3 months ago showing Hb 10.7g/dL, WBC 4,710/uL, and PLT 142,000/uL. As an initial investigation of pancytopenia and newly developed mouth ulcers, broad differentials are discussed including primary bone marrow(BM) disorder, medication-induced pancytopenia, nutritional deficiencies, infectious disease, and autoimmune disease. Autoimmune panels including ANA and ANCA came out negative. Vitamin B12 and Folic acid levels were above normal limits, and infectious workup with HIV antibody and RPR tests came out negative. Peripheral blood smear revealed pancytopenia but didn’t reveal myeloid or blast cells. BM biopsy revealed markedly hypocellular BM with 2~3% cellularity. Flow cytometry did not reveal any abnormalities. The methotrexate level that was drawn on day 2 of admission was unremarkable. With the ambiguous diagnosis of methotrexate-induced pancytopenia versus aplastic anemia, the patient was started on eltrombopag, which was discontinued on day 5 with dramatic improvement in all cell lineages. Upon discharge, the patient was put off the methotrexate and was closely monitored in the outpatient setting without treatment for pancytopenia. The patient continued to maintain the recovered state of all cell lineages, which is more suggestive of drug-induced pancytopenia Discussion: MTX-induced pancytopenia is a rare but severe complication observed in patients undergoing high-dose infusion therapy or long-term maintenance therapy with a possible pathophysiology being interference of DNA synthesis by inhibition of dihydrofolate reductase, leading to BM suppression. Although MTX is a widely used medication, safety education for physicians and patients has fallen short. For patients with rheumatologic diseases, the initial and the maintenance dose and duration of this medication differ greatly and toxicities should be closely monitored with proper education. Especially in elderly patients with a poor understanding of the disease, adverse effects can be seen more frequently and safety education is warranted

Role of plants in anticancer drug discovery

Cancer is one of the major causes of death and the number of new cases, as well as the number of individuals living with cancer, is expanding continuously. Worldwide the alarming rise in mortality rate due to cancer has fuelled the pursuit for effective anticancer agents to combat this disease. Finding novel and efficient compounds of natural origin has been a major point of concern for research in the pharmaceutical sciences. Plants have been seen to possess the potential to be excellent lead structures and to serve as a basis of promising therapeutic agents for cancer treatment. Many successful anti-cancer drugs currently in use or their analogues are plant derived and many more are under clinical trials. This review aims to highlight the invaluable role that plants have played, and continue to play, in the discovery of anticancer agents.We acknowledge the University of Pretoria for Postdoctoral fellowship to J.K. and B.A.M.http://www.elsevier.com/locate/phytolhb2017ChemistryGenetic

Estudio Comparativo entre los Métodos Tradicionales y el Uso de Técnicas Avanzadas de Diagnóstico por Imagen para el Aprendizaje de Anatomía: Resultados Preliminares

La anatomía puede resultar un desafío tanto para enseñar como para aprender dentro del plan de estudios de medicina veterinaria. Durante muchos años se han utilizado técnicas tradicionales para su enseñanza, pero en la actualidad se está avanzando hacia modelos digitales alternativos e interactivos para involucrar al estudiante y mejorar el aprendizaje anatómico. Sin embargo, las innovaciones digitales en el plan de estudios generalmente han estado más orientadas hacia el plan de estudios médico. De esta manera, el objetivo de este trabajo consistió en la aplicación y comparación de herramientas tradicionales frente a modelos digitales interactivos creados mediante técnicas avanzadas de diagnóstico por imagen para el aprendizaje de anatomía veterinaria. Nuestra experiencia mostró que la combinación de ambas herramientas favoreció una mayor comprensión y evaluación de la materia por parte de los estudiantes, convirtiendo dichas actividades, en innovadoras e interesantes para nuestros alumnos4537